CAM 2 E Metropolitan Borongh of Cambermell REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1925 HOWELL W. BARNES, B.A., M.B., B.Ch., D.P.H. Printed by HENDERSON & SPALDING Ltd. Sylvan Grove, Old Kent Road, S.E. 15 CAM 25 Report or the medical Officer of health. Public Health Department, 35, Brunswick Square, Camberwell, S.E. 5. 1st June, 1926, To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Mr. Mayor, Ladies and Gentlemen, —I have the honour to submit my Annual Report for the year 1925 on the health and sanitary condition of the Borough of Camberwell. This report is intended to be a Survey Report, and is prepared in accordance with the instructions of the Ministry of Health as conveyed in their Circular No. 648, dated the 10th December, 1925. Survey Reports are expected to deal comprehensively with (a) The measure of progress made in the area during the preceding five years in the improvement of the public health. (b) The extent and the character of the changes made during that period in the public health services of the area. (c) Any further action of importance in the organisation or development of public health services contemplated by Local Authorities or considered desirable by the Medical Officer of Health. Progress in public health depends on many factors—social, industrial and economic, associated with an ever-increasing knowledge and practice of the established precepts of healthy living. Prevention of disease is by far the greatest field of modern medicine, and has been proved to be not only the most economical but also the most satisfactory plan of procedure in respect to disease. To be effective it is essential to have an educated public. One of the most striking factors in reviewing the state of the public health for the last five years is the increasing interest taken by the inhabitants of this Borough in matters affecting their health. The Public Health Department has endeavoured to assist the public by issuing pamphlets giving information on subjects relating to the early signs of cancer, the danger of measles and whooping cough being regarded as minor diseases, and the rearing of infants. A But there is still much to be done to further the education of the average citizen in these matters. Unfortunately, this work has been hampered owing to the limitation of the present statutory powers, but there is every prospect, with the passing of the General Powers Bill to be introduced by the London County Council shortly, that this limitation will disappear, and the provision in the Bill for publication of information relating to health and disease will go far to enlighten the individual what is required of him to maintain good health. A very important memorandum, issued in 1925 by the Minister of Health, on the provisional proposals for Poor Law Reform, makes it clear that the Central Authority are anxious to deal with matters of public health administration and provide legislation for further public health progress. The future of preventive medicine seems to be more assured than ever, and there only remains to be established a closer relationship between the fields of cure and preventive medicine. The general death rate for the Borough in 1925 was 11.1, as compared with 11.4 for the previous year. The infantile mortality rate also shows improvement, a decline from 70 per thousand births in 1924 to 64.7 last year. A further fall in the birth rate has also to be recorded, the rate for last year being 17.7. In conclusion, I desire to take this opportunity to express my thanks to the Chairmen and Members of the Public Health, Maternity and Child Welfare and Housing Committees for their consideration and support during the year, and to the staff of the Department for their loyalty and assistance, which has been invaluable to me in the performance of my duties as Medical Officer of Health. I am, Ladies and Gentlemen, Your obedient Servant, HOWELL W. BARNES, Medical Officer of Health. Staff of the Public Health Department at the end of 1925. *Medical Officer of Health and Medical Officer, Maternity and Child Welfare. H. W. Barnes, B.A., M.B., B.Ch., D.P.H. Hon. Consulting Medical Officer of Health Francis J. Stevens, D.M. *Tuberculosis Medical Officer 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 (Dr. Barnes), (Mrs.) Margaret Dunstan, M.8., B.Ch., D.P.H., J. H. Clatworthy, M.D., and Mrs. F. Cowling, M.R.C.S., L.R.C.P. Public Analyst E. A. Pinchin, B.Sc., F.I.C., F.R.M.S., certified bacteriologist. *Inspector under the Food and Drugs Acts. George T. Dewey, b *Sanitary Inspectors—Male. Dist. Dist. 1. Maurice Malins, a, c 7. George W. Scudamore. b 8. Richard F. Nash, a, c 2. William T. Worsfold. c 9. George G. Morley. b 3. 0. R. Smart, c 4. A. L. Dobson. a, c 10. William Eagle. 11. Edwin R. Collins. 6 5. Henry C. Green, a, c 6. Donald Glenday. a, c * Women Sanitary Inspectors. Miss F. O'Riordan. Miss M. Butcher. a, c, d, g, h, i, j. c, d, g, h, i. *Health Visitors. Miss A. M. Stoddart, d Miss A. Duffield d and Miss K. Jerrard. c, d. Clerks. H. K. Wright. H. N. Jones, a, c *F. T. Harman. H. J. Hurst. H. J. S. Murray. A. J. Hardiman. *C. T. Wilson (Temporary). A. J. Baker (Temporary). E. S. Rushton (Temporary) *Miss M. L. Thompson (Temporary), part-time Milk Inquiries and part-time at Infant Welfare Centres. *R. Hodgson (Temporary). *Miss E. Watkins (Temporary), Maternity Ward Bookings. Tuberculosis Dispensary. *Tuberculosis Nurses. Miss H. Chambers, g Miss M. Thistleton f and Miss F. M. Whitney, k, l, m. *Clerks. Miss J. M. Fry, H. W. Leonard and F. W. Grimwood. *Dispenser. Miss M. F. Smith (part-time). Disinfecting and Cleansing Station. Foreman Disinfector. A. Franklin. Assistants. E. Corby, A. Peppier (motor driver), F. Hickey, J. Smith, J. Conner and F. G. Mersh. 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. a Meat and other Foods Certificate. b Royal Sanitary Institute Certificate. c Certificate Sanitary Inspectors' Examination Board. d Central Midwives Board Certificate and Health Visitors' Diploma. e General Training Certificate and Central Midwives Board Certificate. f General Training Certificate and Certificate Special Course in Tuberculosis. 0 Three Years Hospital General Training Certificate. h Certificate of State Registration for Nurses. i Royal Sanitary Institute Certificate Maternity and Child Welfare. j Royal Institute of Public Health Certificate in Hygiene. k Health Visitors' Diploma. I Certificate Medical and Surgical Nursing. m Tuberculosis Nurses Certificate. A 2 NATURAL AND SOCIAL CONDITIONS OF THE AREA. The Borough of Camberwell comprises the Parliamentary Divisions of North-West Camberwell, North Camberwell, Peckham and Dulwich, and has a total area of 4,480 acres. Its greatest length is 4¾ miles, the greatest breadth 2½ miles, and the highest point is 365 feet above the Ordnance datum—Crystal Palace Parade. The total length of the roads in the Borough, comprising public, private and boundary roads, is 139 miles. The physical characteristics of the Borough may be marked out by a line drawn from. Kennington Gate to New Cross Gate. On the north side of this line the area is low-lying, whilst on the south side the ground rises gradually until the hilly ground at the Crystal Palace, the southernmost point in the Borough, is reached. London clay forms for the most part the sub-soil of the Borough. It is of an uniform mineral structure, bluish grey in colour, except near the surface, where it is brown. In the lowlying parts of the Borough, however, it is hidden by gravel, and can only be seen by excavation. A bed of pure white sand is to be found in various parts of Peckham and Camberwell. Occupations of the Inhabitants. The following particulars as to the chief occupations of the residents of Camberwell are taken from the Census Returns for 1921:— Males. Females. Metalworkers 7,183 - Electrical Apparatus Makers and Fitters 1 252 — Workers in Skins and Leather 963 - Textile Goods and Articles of Dress 1,611 5,703 Foods, Drinks, Tobacco 1,745 1,108 Workers in Wood and Furniture 3,869 — Makers of and Workers in Paper, Printers, Bookbinders, etc 4,296 2,383 Builders and Bricklayers, Stone and Slate Workers 3,321 — Painters and Decorators 2,482 — Persons employed in Transport and Communications 14,442 — Commercial ami Finance and Insurance (excluding Clerks 9,946 5,515 Public Administration and Defence (excluding Professional Men and Typists) 3,561 1,039 Professional Occupations (excluding Clerical Staff) 2,112 2,334 Persons in Personal Service (including Clubs and Institutions) 3,159 11,467 Clerks and Draughtsmen (not Civil Service or Local Authority Typists) 7,853 6,457 "Warehousemen, Storekeepers and Packers 3,318 1,680 Other and Undefined Workers 6,540 — Retired, not gainfully occupied 12,748 71,434 The largest industry in Camberwell is to be found in the northern part of the Borough, that of the manufacture of gas and its by-products, at the works of the South Metropolitan Gas Co., Old Kent Road. Apart from this there are no particular businesses or trades beyond those usually associated with a working class neighbourhood. GENERAL STATISTICS, 1925. Area (acres) 4,480 Population (Census 1921) 267,198 Do. (estimated 1925) 275,400 Number of inhabited houses (Census, 1921) 41,419 Do. do. do. (approximately, 1925) 45,115 Number of families or separate occupiers, 1921 66,104 Rateable value £1,421,153 Sum represented by a penny rate, about £5,810 Poor Law Relief. The total expenditure of the Camberwell Board of Guardians for the financial year ended 31st March, 1925, was £483,377 9s. 4d. The admissions to the Board's institutions during the period under review numbered 14,904. The number of persons relieved was: — In-door. Out-door. Medical relief only. 11,352. 36,762. 689. Population. —The Registrar-General has estimated the population of the Borough at the middle of 1925 to be 275,400, and it is upon this figure that the death and birth rates are calculated. The estimated population of the different wards is as follows: — Population. Census Estimated Estimated Estimated Estimated Ward. 1921. 1922. 1923. 1924. 1925. 15,442 15,736 1 15,621 15,818 15,918 14,771 2 14,420 14,587 14,695 14,863 14,546 14,638 3 14,201 14,366 14,472 16,878 17071 4 16,562 16,754 16,966 16,096 16,286 16,488 16,592 5 16,406 13,495 13,655 6 13,243 13,396 13,565 16,702 7 16,230 16,418 16,540 16,624 15,844 15,927 16,026 8 15,548 15,728 16,548 16,633 16,738 9 16,238 16,426 9,079 9,146 9,252 10 8,975 9,193 11,571 11,654 11,716 11,790 11 11,438 14,025 14,188 14,366 14,457 12 14,293 10,866 10,662 10,786 10,922 10,990 13 14 10,712 10,836 10,973 11,042 10,916 15 12,126 12,361 12,421 12,500 12,267 14,735 16 14,566 14,844 14,920 15,014 14,998 15,092 17 14,642 14,812 14,922 16,215 16,523 18 16,029 16,335 16,420 12,278 12,369 12,432 12,510 19 12,137 3,980 4,027 20 3,906 3,951 4,001 267,198 270,300 275,400 272,300 273,700 Most of the inhabitants of Camberwell, and this applies especially to those living on the northern side of the Borough, are of the working class, of whom a fairly large proportion live in model dwellings and tenement houses. There are a small number of the very poor living in common lodging houses. In this area most of the factories and workshops are situated. On the south side of Peekham Road the houses are of a more modern type. In Dulwich and Sydenham most of the property is large, standing in considerable areas of ground and occupied by business and professional men. Of late years, however, there has been a tendency to convert some of these houses into flats. Extracts from Vital Statistics for the Year 1925. Total. M. F. (Legitimate 4,751 2,401 2,350) Births {Illegitimate 126 60 66} Birth Rate, 17·7 Deaths 3,065 Death Rate, 1·11 Number of women dying in, or in consequence of, Childbirth:— From Sepsis 6 From other causes 7 Deaths of infants under one year of age per 1,000 births 64.7 Legitimate, 303; Illegitimate, 13. Total 316 Deaths from Measles, all ages 15 Deaths from Whooping Cough, all ages 39 Deaths from Diarrhoea, under 2 years of age 31 Births. —The total number of births registered in the Borough was 4,266. The corrected number of births arrived at by adding 682 births which occurred outside the Borough of persons belonging to the Borough and deducting 71 births which occurred in the Borough of persons not belonging to Camberwell, amounted to 4,877 —2,416 females and 2,461 males. The birth rate for 1925 was 17.7 births per thousand population. The following table gives the births and birth rates since 1921:— Year. Population. Births. Birth Rates. 1921 267,198 6,301 23.5 1922 270,300 5,802 21.4 1923 272,300 5,657 20.7 1924 273,700 5,146 18.8 1925 275,400 4,877 17.7 Illegitimate Births.—The number of Camberwell births reported as illegitimate was 126, equal to a rate of 25.8 per 1,000 registered births. Notification of Births Act.—During the year 4,653 births were notified as follows:— Notified by Mid wives 2,464 Notified by Medical Practitioners 1,290 Notified by Parents 299 Other Persons 600 Still-Births.—Of the 4,653 births notified, 127 were returned as born dead. Deaths. The deaths registered during 1925 as having taken place in the Borough were 3,448. The corrected number of deaths found by deducting 909 deaths of non-residents who died in the Borough and adding 526 deaths of inhabitants of Camberwell who died elsewhere, was 3,065. The corrected death rate for Camberwell for 1925 was 11.1, as compared with 11.4 for 1924. The subjoined tables show the total deaths registered, redistributed, and the death rate for each sub-district and for the whole Borough since 1921:— Deaths registered in the Sub-Districts of Camberwell. Year. East Dulwich. North-West Camberwell North Camberwell. Unattached. Borough. Dulwich. Peckham. 1921 3,245 160 493 819 940 801 32 183 515 893 27 1922 3,635 989 1,028 1923 3,000 189 419 799 881 696 16 1924 3,146 183 498 798 715 26 926 1925 164 470 802 712 23 3.065 894 Deaths redistributed in Sub Districts. Borough. Dulwich. East Dulwich. North-West Camberwell. North Camberwell. Year, Peckham. 1921 3,245 809 498 949 162 827 1922 3,635 184 519 996 1,036 900 1923 190 421 803 886 700 3,000 3,146 184 1924 502 805 934 721 1925 3,065 165 474 808 901 717 Death Rate for each Sub-District in Camberwell. Year. Borough. Dulwich. East Dulwich. North-West Camberwell. Peckham. North Camberwell. 12.0 10.07 11.08 12.3 1921 12.3 12.02 11.4 1922 13.4 11.3 14.8 13.3 14.3 11.6 1923 11.0 9.1 11.7 11.3 11.0 10.8 11.8 11.9 1924 11.4 11.2 11.3 10.4 11.9 1925 11.1 10.0 11.8 11.2 The following comparative death rates are of interest: — Death Rates, 1925. England and Wales 12.2 London 11.7 Camber well 11.1 105 great Towns 12.2 157 smaller Towns 11.2 Seasonal Mortality. —The mortality in the four quarters of the year was: — Deaths. Death Rate. First Quarter 906 13.1 Second Quarter 58 9.5 Third Quarter 484 7.0 Fourth Quarter 1,017 14.0 TABLE No. I.—CAUSES OF, AND AGES AT, DEATHS DURING THE YEAR 1925. 45 to 65. 65 and up. Deaths of Camberwell residents in Institutions in the Borough. 20 to 35. 35 to 45. 2 to 3 3 to 4. 4 to 5. 10 to 15. 15 to 20. Under 1. All ages. 1 to 2. 5 to 10. Cause of Deaths. Enteric Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - Small-Pox 5 - - 3 4 1 1 - - - Measles 15 1 5 - - 2 2 1 - 1 - - Scarlet Fever 13 1 3 3 - - 13 - - - 39 20 4 2 - - - - Whooping Cough 13 - 2 1 - 5 4 8 11 4 - 22 - Diphtheria and Croup 40 4 1 1 12 4 - - 3 1 22 41 2 - - - 3 Influenza - 3 - - 2 Erysipelas 5 - - - - - 93 - - - 28 103 44 64 12 - - 4 5 260 - 7 Phthisis (Pulmonary Tuberculosis) - - 5 - - 1 1 2 1 - Tuberculous Meningitis 19 6 2 1 - 13 1 2 3 7 4 1 2 1 Other Tuberculous Diseases 26 4 1 - - 2 35 179 127 137 1 1 - 4 Cancer 350 1 - - - 5 10 5 3 1 1 Rheumatic Fever 20 - - - - - - - 5 - 1 2 2 2 1 2 2 - - Meningitis 18 5 1 101 16 205 - 2 2 5 12 90 333 1 Organic Heart Disease - - - 76 210 102 4 8 20 4 1 1 - - Bronchitis 324 - - 19 115 2 8 8 77 77 11 8 2 8 Pneumonia (All forms) 297 56 21 15 17 6 13 1 1 1 2 1 1 Other Diseases of Respiratory Organs 41 - - - - 14 - 31 28 - - - Diarrhoea and Enteritis 3 - - - - - 11 2 3 4 3 5 1 20 2 Appendicitis and Typhilitis - - - 1 - - 11 2 3 Cirrhosis of the Liver 14 - - - - - - - - - - - - - - - - Alcoholism - - - - - - 46 - 1 6 8 42 38 1 Nephritis, Bright's Disease 96 - - - - - - 1 3 4 1 - Puerperal Fever 6 - - - - - - - - 6 1 5 - - - Other Accidents and Diseases of Pregnancy and Parturition 7 - - - - - - - - - - Congenital Debility and Malformation, including Premature Birth - - - - 27 - - - 130 129 1 20 20 7 3 5 9 7 19 1 1 2 2 Violent Deaths 82 6 5 6 4 2 3 Suicides 16 - - - - - - - - 30 172 302 2 9 4 11 37 495 813 39 7 4 3 Other Defined Diseases 1 - 1 1 2 - - Diseases ill-defined or unknown 5 - - - - - - 3 - 1 - - - Encephalitis Lethargica 4 - - - - - - - 1,232 1,055 Total 19 59 31 71 214 197 792 3,065 67 36 31 316 10 11 TABLE No. II.—BIRTH, DEATH AND INFANTILE MORTALITY RATES AND DEATHS FROM PRINCIPAL DISEASES. Infantile Mortality Rate. Deaths from All forms Tuberculosis. Bronchitis. All forms Pneumonia. Birth Rate. Death Rate. Scarlet Fever. Population. Cancer. Measles. Whooping Cough. Diphtheria. Whole Borough Ward. 350 324 275,400 17.7 11.1 64.7 13 40 15 39 305 297 No. 1 15,918 23.9 13.1 83.8 20 29 14 26 1 1 1 7 22.6 12.3 3 21 20 2 14,863 77.0 2 4 1 18 19 3 14,638 16.4 10.4 58.0 3 10 18 13 17 2 1 - 4 17,071 21.8 27 18 19 11.4 79.7 1 3 7 3 17 16,592 21 16 5 20.4 10.8 86.7 1 3 2 22 22 - 13,655 6 18.9 10.1 53.0 12 13 24 15 1 2 - - 7 23 22 16 16,702 24.1 11.8 74.2 1 5 3 20 - 8 17 16,026 20.1 11.7 71.2 1 2 25 21 23 - - 9 16,738 19.3 11.4 69.6 2 30 13 23 20 2 2 - 10 9,252 17.1 12.1 9 12 15 47.7 3 8 - - - 8 12 11 11,790 16.8 10.1 60.5 2 14 13 - 2 - 12 14,457 17.9 11.8 78.4 1 4 13 19 13 25 1 - 13 10,990 12.3 16 11 10.3 59.2 1 7 7 - - - 11,042 14 18.5 12.5 53.9 1 2 1 17 16 18 15 - 6 15 12,500 13.6 11.3 47.0 10 14 13 1 2 - - 16 15,014 10 18 20 14.4 9.6 44.6 1 2 1 1 15 16.9 15 17 15,092 9.7 56.8 1 1 16 9 16 4 51.0 - 1 18 16,523 13.4 10.6 16 16 28 18 5 1 - 19 12,510 11.9 9.3 37.5 6 17 12 1 11 - - - 2 20 4,027 12.9 11.9 96.1 3 4 6 - - - - 1 2 Unknown Locality - - - - - - - - - - TABLE No. III.—INFANTILE MORTALITY DURING THE YEAR 1925. Deaths from Stated Causes at Various Ages under One Year of Age. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 1 month, 1 to 3 months 3 to 6 months. 6 to 9 months. 9 to 12 months. Cause of Death. - - - - - Small-pox - - - - - - Chicken-pox - - - - - - - 1 - - - - - - Measles - - 1 - - - Scarlet Fever - - - - - 5 3 9 3 Whooping Cough - - - - - 1 2 1 - Diphtheria and Croup - - - - - - - - - - - Erysipelas - - - 2 3 1 Tuberculous Meningitis - - - - - - - 1 - Abdominal Tuberculosis - - - - - - 1 2 Other Tuberculous Diseases - - - - - - - 1 2 2 - - Meningitis - - - - 2 1 1 1 3 - - - Convulsions - - - Laryngitis - - - - - - - 2 6 5 3 4 2 Bronchitis - - - 6 12 8 15 15 2 2 2 Pneumonia (All forms) - 2 3 1 - Diarrhoea - - - - - 9 2 2 2 5 3 Enteritis - - - 1 1 1 - - - Gastritis - - - - - Syphilis - - - - - - - - - - - - - Rickets - - - - - - - - Suffocation - - - - 3 1 4 - - - Injury at Birth - - - 3 Atelectasis 3 - - - - - - - 2 22 6 4 1 3 Congenital Malformation 15 2 3 2 41 5 6 2 54 3 - - Premature Birth 6 2 2 10 4 4 18 8 Atrophy, Debility and Marasmus - 10 3 1 1 7 2 5 Other Causes 8 - 62 41 48 40 81 18 17 9 125 Totals Cancer. Although there was a decrease in the number of deaths from cancer during 1925 as compared with 1924, yet this disease was again the cause of the greatest number of deaths in Camberwell during 1925. The following table sets out the deaths, the sex distribution and the death rate per 1,000 of the population since 1921:— Year. Males. Females. Total. Deaths per 1,000 Population. 1921 175 168 343 1.0 148 1922 178 326 0.9 1923 332 135 197 1.1 1924 171 377 206 1.3 1925 166 184 1.2 350 Respiratory Diseases.—324 deaths were due to bronchitis, 297 to pneumonia (all forms) and 41 to other diseases of the respiratory organs, as compared with 313 bronchitis, 291 pneumonia, and a similar number of deaths from other respiratory diseases during 1924. Violent Deaths. —82 deaths occurred under this heading as compared with 78 for the previous year. Suicides. —l6 persons committed suicide in the Borough as compared with 20 during 1924. Infantile Mortality. The infantile mortality rate for the year 1925 was 64.7 as compared with 70 for 1924. The number of deaths shows a decrease of 45 on the recorded figure for 1924. The principal causes of death in 1925, in their order of severity, were as follows:—Premature birth, pneumonia, congenital genital malformation, atrophy and debility, bronchitis and whooping cough. During the years covered by this Survey Report the number of deaths and the death rate of children under 1 year of age are set out in the following table:— Year. No. of Deaths. Infantile Mortality Rate. 1921 462 74 1922 454 78 1923 321 56 1924 361 70 1925 316 64 The decrease in the infantile mortality rate in recent years is due to a variety of causes, but the outstanding factor which has been the cause of this reduction is the improvement in the knowledge of mothers on questions concerning the rearing of healthy children. Special Causes of Sickness, 1921 to 1925. Reliable information as to the amount of sickness amongst the population is not available, with the result that it has been found necessary to have recourse to the death returns and conversations with local general practitioners. Apart from the prevalence of infectious disease and the increase of cancer, which have been commented upon in other parts of this Report, there were no causes of sickness or invalidity which call for special mention during the period under review. Naturally, as can be expected during the winter months, there was an increase of respiratory diseases, but not to an extent as to require any special comment. Warmth, in the way of clothes and good food, are not available to all of the population, and consequently respiratory diseases are far more prevalent among the poor and especially the younger generation. Hospitals Available for the District. King's College, Denmark Hill, S.E. 5. Camberwell Board of Guardians' Institutions. All General Hospitals in and around London. Municipal Maternity Ward, St. Giles' Hospital, Brunswick Square, Camberwell. A private Ward containing six beds, subsidised by the Borough Council. Institutional Provision for Unmarried Mothers, etc. National British Women's Temperance Association "House of Help," 201, Camberwell Grove, S.E. 5, subsidised by the Camberwell Borough Council. Southwark Diocesan Association for Preventive and Rescue Work, subsidised by the Borough Council for cases boarded out in approved homes. Ambulance Facilities. (a) For Infectious Cases —The Metropolitan Asylums Board. (b) For Non-Infectious and Accident Cases —Camberwell Board of Guardians and General Hospitals for non-infectious and the London County Council for accident cases. Professional Nursing in the Home. See under Maternity and Child Welfare Section. Midwives. During 1925 there were 46 practising midwives in the Borough of Camberwell. Public Mortuary. The Public Mortuary is situated in St. George's Road, Peckham. During 1925, 343 bodies were deposited there. In 236 cases post-mortem examinations were made, and 335 inquests were held. Public Swimming Baths. In 1924 I was requested by the Public Service Committee to submit a report as to the purity of the water in the Public Swimming Baths in the Borough. Various samples were taken and submitted to the Borough Bacteriologist, and, resulting from the analyses, I suggested certain methods which, if adopted, would ensure that each person obtained pure water to bathe in. Arising out of the report in question the Council are installing a sterilisation plant at the Old Kent Road Baths. Nature of Accommodation. By whom provided. Sessions. Situation. Bird-in-Bush, 616, Old Kent Road Maternity and Child Welfare Cenltres. Central Hall; waiting and lecture room; service room; Medical Officer's and weighing rooms Voluntary Mondays & Thursdays; antenatal natal, 2nd & 4th Fridays. do. Tuesdays & Thursdays. Cambridge House, 6, Addington Square Cobourg, Kempshead Hall, Kempshead Road. Help and advice daily (except Saturday); ante-natal, 1st Monday; dental clinic 1st and 3rd Fridays. Private rooms Waiting room; consultation and dental work room; disrobing room. do. do. Waiting room; weighing room; consultation room. Thursdays & Fridays. Nunhead, 31, Nunhead Grove do. St. Luke's, 2, Commercial Road Wednesdays & Fridays; antenatal, 1st & 3rd Mondays. 3 rooms do. Waiting room; weighing room; consultation room. Tuesdays & Fridays. Union of Girls' Schools Infant Welfare Centres, 17, Peckham Road Wednesdays & Thursdays. do. And Amott Road, East Dulwich Oamberwell Municipal, 140, Camberwell Road. do. do. Mondays & Fridays; antenatal, 2nd & 4th Thursdays. Rented by Camberwell Boro' Council do. do. do. do. do. do. Wednesdays & Thursdays. Dulwich Municipal, 114, Lordship Lane Peckham Municipal, St. Jude's Church Hall, Meeting House Lane, Peckham, S.E. Every Tuesday. do. do. do. do. Camberwell Borough Council. Accommodation for cleansing of verminous children; one receving room; one bath room and a discharge room. Daily except Saturday. Disinfecting Station, Peckham Park Road do. do. Daily. Waiting room; investigation room; two dressing rooms; two Medical Officer's rooms, and a dispensary. Tuberculosis Dispensary, 19, Brunswick Square. Daily except Saturday. Voluntary Peckham, Nunhead and District: Private rooms Day Nursery, 109, Gibbon Road Venereal Diseases—Nil SANITARY CIRCUMSTANCES OF THE AREA. Closet Accommodation. With the exception of a small number of earth closets used by Sports Clubs, the water conservancy system is in general use in this Borough. There are 5 cess-pools which are periodically emptied by the Borough Council. Scavenging. The removal of house and trade refuse is carried out under the direction of the Borough Engineer and Surveyor of this Council. A weekly collection of refuse is the rule, but where necessary a more frequent collection is made from blocks of tenements, boarding houses, etc. The refuse is then transported by rail and barges from East Dulwich, Bricklayer's Arms and Nunhead Stations, and from Glengall Wharf on the Grand Surrey Canal. In the majority of the houses in this Borough the substitution of movable for fixed dustbins has been completed. Special bins, which are not perhaps strictly in accordance with the by-laws as regards size, have been sanctioned in places where portable bins have in the past disappeared owing to the large number of persons having access to them. Smoke Abatement. Much of the nuisance from industrial smoke is due to careless or inefficient stoking and the use of coal of an indifferent type. It has been calculated that roughly one-fourth of the pollution of the air is due to industrial smoke. It is evident that the elimination of industrial smoke will not entirely solve the problem of atmospheric pollution, with its effect on the health of the people, as there still remains the nuisance from domestic chimneys. Of late years the increased use of gas and electricity for domestic purposes has resulted in some improvement, but the solution of this problem to some extent depends upon the more extensive use of smokeless fuel. The difficulty seems to be, however, to produce this type of fuel on a commercial scale at a cost at least equal to that of ordinary coal. During 1925, 114 observations were made and 13 nuisances occurred for which Notices were served. There were no legal proceedings instituted. B 17 18 19 SUMMARY OF INSPECTIONS, ETC., JANUARY 1st TO DECEMBER 31st, 1925. Inspectors. Description of Work. Totals. G. G. Morley. G. W. Seudamore. E. R. Collins. W. T. Worsfold. W. R. Farmer. A. L. Dobson. Miss O'Riordan. Miss Butcher. W. Eagle. H. C. Green. R. F. Nash. D. Glenday. 0. W. Smart. M. Malins. 249 304 310 269 151 168 379 Visits to complaints 263 477 470 245 218 15 3,523 5 88 269 260 264 House inspections following on complaints 117 120 229 80 307 333 165 161 6 2,399 225 205 161 207 - 9 117 176 24 76 House-to-house inspections 78 121 123 2 7 - 1,524 - 1 61 27 134 Tenement inspections - - 15 27 27 - - 299 - Houses let in lodgings inspections - - - - 186 42 - - - - 228 - - - - Housing and Town Planning inspections - - - 172 - - - 172 308 829 416 - - - - - - - 77 27 Visits to new buildings 38 18 222 13 70 1 2,019 1 16 - - - Visits re overcrowding - - - 1 5 7 - - 22 2 19 73 16 22 - 19 - 2 6 15 59 Slaughterhouses 7 133 1 280 82 - - - 24 66 51 8 33 Bakehouses 42 6 16 49 30 14 421 1 - - Cowhouses - - - - - - 4 5 203 80 116 105 - - - - - - 140 86 155 83 Milkshops and dairies 136 129 148 81 1,462 - - 11 39 4 17 1 20 31 Eating houses 18 8 28 24 24 225 23 17 48 87 - - Ice cream shops and stalls 35 40 37 48 276 28 - 42 681 7 93 - - 1 69 Railway stations - - 1 171 59 - - - - - - 46 88 33 116 83 - Workshops 22 78 34 98 100 64 196 197 1,214 14 60 20 27 Factories 6 60 57 33 85 78 53 30 180 79 8 782 Offensive Trade Premises —Visits - - 8 - - 10 3 37 - - - - - 29 77 28 8 67 - Urinals, public 53 63 49 12 19 124 176 - 28 66 631 223 168 388 205 166 113 142 476 Do. private 207 313 155 3,209 3,974 3,847 - - 2,732 3,205 1,199 2,648 3,385 2,158 2,647 Re-inspections 3,474 2,477 2,145 139 15 270 206 34,522 248 74 Miscellaneous 15 457 198 311 132 234 100 1,052 99 178 3,574 103 146 154 Infectious cases visited and houses inspected 133 41 163 251 144 178 269 155 162 23 27 22 18 23 1,949 19 22 42 Infectious cases, inquiries 30 25 105 26 43 24 943 440 1,782 42 12 121 34 Infectious disease contacts visited 1 4 19 13 31 58 24 42 61 176 37 48 - - 401 Inspection of foodstuffs 38 169 250 3,320 229 761 365 125 5,579 3 - - 17 18 - 3 Smoke observations - 3 1 6 53 2 8 114 3 22 2 - - Schools, private - 3 2 - - - 37 111 180 - - - - - - - Outworkers visited - - - - 599 1,959 - - - - 1,360 Measles - - - - - - 1,079 - - - - - - 478 1,557 Scabies - - - - - - - - - 10 7 17 - - - - - 26 Ophth. Neonm. - - - - - - - - - - 68 94 Verms. Cplts., visits - - - - - 35 - - - - - - 21 56 14 4 15 - Fish curers' premises - - 16 7 6 - - 22 14 98 2 1 - - Rag and bone dealers' premises 9 - - - 3 10 8 1 2 - - 36 5,179 5,149 6,694 6,407 4,994 - Total number of visits 1,965 5,605 7,039 4,826 4,611 3,691 7,062 4,550 3,010 70,788 Seizures of foodstuffs - - - - - - 2 - - - - - - Smoke nuisances 4 - - - - - 1 1 - - - - - 3 11 Drains, total reconstruction 6 1 10 - - - 7 - - - - 9 12 4 12 44 1 - 49 20 20 2 - Do. partial reconstruction - 7 22 22 1 1 - 152 425 363 413 479 119 - Intimations 514 451 289 388 623 449 453 102 8 5,076 134 217 Statutory notices, Public Health 136 182 36 183 145 46 180 144 51 96 5 1,555 - Notices, Section 3, Housing Act, 1925 - - - - - - - - - - - - - 1 5 - - Do. Section 5 do. do. - - 14 6 - - - - - 2 28 - - Intimations, houses let in lodgings - - - 187 21 - - - - - - - - 208 - 32 - Notices, houses let in lodgings - - - - 36 - - - - - 68 - - B 2 20 21 SUMMARY OF SANITARY ORDERS, JANUARY 1st TO DECEMBER 31st, 1925. Description of Work. Inspector. Totals. W. Eagle. G. W. Scudamore. E. R. Collins. W. R. Farmer. H. C. Green. W. T. Worsfold. A. L. Dobson. Miss O'Riordan. Miss Butcher. G. G. Morley. O. W. Smart. R. F. Nash. D. Glenday. M. Malins. Cleanse and repair walls and ceilings 309 171 173 296 70 438 339 230 267 387 271 359 31 3,341 Repair roof, guttering, etc. 160 117 92 - 54 106 111 230 135 156 1 1,729 Provide damp-proof course, etc. 146 79 178 51 208 184 - 73 1,127 Abate overcrowding 118 46 78 86 92 120 124 110 1 4 2 - - 2 13 5 6 10 6 4 1 53 Abate smoke nuisance 7 1 - - - - 3 1 1 13 Repair stoves, coppers, etc. 43 25 15 - - - - - - - - 106 735 Repair windows, sashlines, doors, etc. 40 50 16 159 46 47 64 98 66 41 35 - - 65 26 230 72 47 130 131 80 129 1,026 Repair flooring, stairs, etc. 45 25 37 - - 14 167 76 92 125 58 110 823 Light and ventilate staircase, etc. 4 1 34 39 1 - 3 5 2 Provide dustbin 14 1 30 50 33 39 - - - - - - - 46 11 106 88 39 46 77 117 75 1 728 Remove accumulation 19 10 - 40 8 10 12 18 19 1 148 Pave, level and drain yard 22 11 1 15 10 72 69 - Provide or repair manure pit 44 17 108 63 25 71 72 55 94 712 6 3 - - - 1 2 3 2 1 3 6 2 1 30 Provide sufficient water supply 3 5 6 - - 12 1 5 5 10 5 4 63 Provide receptacle or render accessible 1 3 4 - - - - 1 Repair cover or cleanse receptacles, etc. 12 2 2 1 1 1 2 11 2 4 - - - - 10 7 37 9 8 6 25 17 21 158 Clear premises of rats, etc. 1 13 1 - - 7 6 3 13 9 81 Provide, cleanse, repair or remove closets, pans, etc. 55 10 4 10 4 89 76 - - 1,393 49 32 248 135 83 133 159 100 193 32 9 Provide water supply to closet, repair flushing apparatus 62 34 28 39 12 61 31 27 86 55 50 12 2 526 Ventilate and remove outside soil pipes, cleanse, repair and trap drains, etc. 27 67 36 35 Provide, cleanse, repair or trap sinks, waste pipes, etc 46 28 85 42 44 68 50 55 68 5 629 30 30 30 - Animals to be kept clean or removed 15 43 36 21 47 30 28 32 1 361 2 6 2 18 - 3 2 24 Public conveniences, cleanse, supply with water, etc. 3 1 1 1 2 1 - - - - - - Private conveniences, cleanse, supply with water, etc. 4 1 3 - - - - - - - - - - - - 2 6 8 3 11 12 53 Miscellaneous 9 10 3 - - 19 - - 23 12 15 226 7 5 37 8 24 12 45 - Rats and Mice (Destruction) Act, 1919. 173 complaints of premises being infested with rats were received during the year. Visits were made in all cases by the Sanitary Inspectors and advice given. Defective drains or sewers, where found, were relaid or repaired. In suitable cases poison was supplied or laid by the Inspectors. Poison baits were also laid in the Council's sewers from time to time by the Borough Engineer's Department. During National Eat Week additional baits were laid in the sewers, and the occupiers of premises known or suspected to be infested with rats were visited by the Sanitary Inspectors and impressed with the necessity for special efforts. By the courtesy of several managers of cinemas in the Borough, a lantern slide designed by the Department was exhibited in various parts of the Borough drawing the attention of the public to the damage caused by rats, and urging the necessity for combined efforts during Bat Week. Premises and Occupations which can be controlled by By-laws or Regulations. —The following list sets out the majority of the premises or occupations under this head:— On Register at end of 1925 Number of Inspections 1925 Number of Notices 1925 Number of Prosecutions 1925 A. Business Premises. 421 147 22 - Bakehouses 70 Cowsheds 70 1 - Fried Fish Shops 70 - - 70 Fish Curers 47 98 8 - 12 Ice Cream Premises 338 681 - 450 1,462 37 - Milk Premises Offensive Trade Premises 9 - 5 - - 2 280 Slaughterhouses - Butter and Margarine Manufacturers and Dealers 31 - - - B. Habitations. Houses Let in Lodgings 297 228 276 - Common Lodging Houses 5 - - Underground Sleeping Rooms not registered - 6 - - - HOUSING. General Housing Conditions in the Area. Some idea of the housing conditions can be drawn from the following table, obtained from the Census Returns, 1921: — Area. Population in Private Families. Structurally Separate Dwellings Occupied. Rooms Occupied. Private Families. Rooms per Person. 1,120,897 London 701,035 4,057,271 0.96 4,243,838 Camberwell. Totals 66,104 259,591 0.96 41,419 248,529 15,265 No. Wards. 3,898 2,354 12,086 0.79 1. The West 2. Addington 3,232 14,377 2,392 9,903 0.69 2,220 0.84 3. Town Hall 3,330 12,828 10,800 2,221 0.77 4. St. George's 4,056 16,548 12,669 3,733 1,846 11,748 0.73 5. Cobourg 16,052 13,205 1,789 11,372 6. Marlborough 3,424 0.86 7. North Peckham 16,197 2,173 0.71 3,753 11,485 2,223 0.78 8. Goldsmith 3,731 15,543 12,055 4,124 15,988 2,358 14,051 0.88 9. Clifton 2,332 8,646 1,458 8,189 0.95 10. Rye Lane 3,016 10,997 1,788 11,200 1.02 11. St. Mary s 3,436 0.85 12. Nunhead 13,999 2,113 11,894 2,732 10,341 13. The Rye 2,001 12,492 1.21 2,908 10,236 1,550 10,637 1.04 14. St. Giles' 3,162 11,081 1,979 13,784 15. Lyndhurst 1.24 3,981 14,378 2,531 16,540 1.15 16. St. John's 17. Alleyn 3,418 12,870 2,183 1.10 14,193 18. Ruskin 4,070 15,823 3,086 20,950 1.32 16,454 1.40 19. The Hamlet 2,985 11,739 2,493 3,478 20. The College 783 6,027 1.73 661 Definitions of Terms used in the above Table. Private Family.—Any person or group of persons included in a separate return as being in separate occupation of any premises or part of premises is treated as a separate family for Census purposes, lodgers being so treated only when returned as boarding separately, and not otherwise. Private families comprise all such families with the exception ception of those enumerated in (i) Institutions or (ii) business establishments or boarding houses in which the number of resident trade assistant or resident boarders exceeds the number of members of the employer's or householder's family (including private domestic servants). Structurally Separate Duellings.—A structurally separate dwelling has been defined for the Census as any room or set of rooms, intended or used for habitation, having separate access either to the street or to a common landing or staircase. Thus each flat in a block of flats is a separate unit; a private house which has not been structurally subdivided is similarly a single unit whether occupied by one family or by several families. But where a private house has been sub-divided into maisonettes or portions, each having its front door opening on to the street or on to a common landing or staircase to which visitors have access, then each such portion is treated as a separate unit. When an undivided house is used partly for business or professional purposes it is treated as occupied by a private family unless the portion used for non-domestic purposes consists of at least three rooms and is more than one quarter of the whole. The dwellings shown in this table are those occupied by private families only. Rooms.—For the purpose of the Census the rooms enumerated are the usual living rooms, including bedrooms and kitchens, but excluding sculleries, landings, lobbies, closets, bathrooms or any warehouse, office, or shop rooms. In 1920 a return submitted to the Ministry of Health gave the figure 2,183 as the number of houses to be built if the housing needs of the Borough were to be met. The Council in the same year decided to build houses on land at the Newlands and Casino House grounds, and a scheme for 448 houses was passed. At the end of that year 30 were ready for occupation. At the end of 1921 this number had increased to 296, and a further 140 were completed by the end of 1922 and the remainder in 1923. In 1922 private enterprise, which had not been able since the War to build economically, began to erect houses, and at the end of 1925 120 were erected. These houses were built for sale. Overcrowding Since the War overcrowding of rooms has been very prevalent, especially in the northern part of the Borough, and the Census Returns of 1921 give definite proof of this. Information of housing accommodation obtained in the investigation of infectious diseases shows that overcrowding does not diminish to any extent from year to year. Obviously, it exists more amongst the unemployed and very poor, and this can readily be understood owing to their inability to pay for a requisite number of rooms. A certain amount of overcrowding is also caused by the desire on the part of many of the inhabitants, for economic reasons, to live near their work. Camberwell is situated within reasonable distance from the City and the Docks, and serves as a dormitory. Further, the natural increase in the population, i.e., the excess of births over deaths, is another factor to be considered sidered, and, of course, the tendency for the inhabitants of the central Boroughs to be pushed further out by the absorption of houses into factories and workshops, and consequently causing a continual stream of fresh inhabitants, also aggravates this question. This problem will, it would seem, remain insoluble until the overcrowding of London has been dealt with as a whole. During 1925, 53 complaints relating to overcrowding were received. ceived. No legal proceedings were taken, however, owing to the housing difficulties. Nevertheless, in cases where it was found that it could be eased by re-arranging the sleeping accommodation of the families who were overcrowded, every effort was made by this Department for this to be done; and the owners and tenants have been warned that steps must be taken to prevent overcroding in the future. Should no notice be taken of this warning, the question arises as to whether such houses should be registered as houses-let-in-lodgings. At the present time there are 297 such houses in the Borough on the Register. No additions have been made to the number of houses listed for registration during the past five years. Of late years they have received much attention on the part of the Council's Sanitary Inspectors to maintain them in a satisfactory condition. Owing to the housing shortage there are numbers of houses in the Borough let out in floors and rooms at various rents, but when the new By-laws which have been framed by the London County Council, under the Public Health (London) Act, 1891, and Section 6 of the Housing Act, 1925, become operative, many of the working class properties which are occupied by more than one family, commencing with the worst houses, should be added to the Houses-let-in-lodgings Register. (These By-laws have now been approved by the Ministry of Health.) The new By-laws are to a large extent a codification of those in operation in the Borough, with such modifications as are necessary to bring them up to date. They are based largely on the model By-laws issued by the Ministry of Health, and represent sent a standard to be worked up to rather than one immediately attainable. From every point of view they can be regarded as an improvement, and any suggestion of harshness is met by the postponement ponement of the operation of certain of them. The inspections of registered houses-let-in-lodgings in the Borough during 1925 numbered 228. Fitness of Houses. Efforts have been directed during the last four years to try to ameliorate the deterioration of houses which occurred during the years of the War, and it can be said now that with more labour and material available the general standard of fitness has much improved. Especially is this the case in the direction of ensuring that houses have watertight roofs, removing the causes of ground dampness and improving the decorative condition of the houses. Unfortunately, in some parts of Camberwell there are a considerable number of streets containing houses which are old arid worn out, having come to the end of their useful life. These old houses have deteriorated rapidly since the War owing to abnormal wear and tear, and are now in such a state, due to the lack of proper damp proof courses, bulging masonry, settlements and grave sanitary defects, as to be insanitary. They have arrived at such a condition that no repairs can render them fit for human habitation. Overcrowding is prevalent in these houses, and they are peopled by types of tenants who are not desirous of leaving the neighbourhood. There is no doubt in my mind that houses of this kind will have to be replaced by tenement buildings of the most modern type. It is true that small houses with gardens are much to be preferred, but it is not possible to provide these amenities in some of the Metropolitan Boroughs. It is difficult to say how far defects are due to the lack of proper management and supervision by owners, or to the acts of waste and neglect by the tenant. In the same way as there are bad landlords who neglect their property and who are the cause of much worry to the Health Department so are there bad tenants who pay no regard to preserving the property. Each type is known, and on the whole it may be said that both get their deserts. Action was generally taken under the Public Health Acts, and no notices were served under the Housing Acts. In cases where owners found it difficult to carry out the repairs specified, either from personal reasons or as the result of receiving several notices at one time in respect of more than one property, extension of time was given for the decorative repairs required after the more serious nuisances had been abated. Unhealthy Areas. In 1922 five areas were inspected and represented to the Council. The areas were as follows:— Name of Area. Acreage. Number of Working Class Houses on Area. Woodland Cottages .285 10 Tiger Yard .173 17 Joiners' Arms Yard .045 6 Mayhews Buildings .188 14 Levant Street, Island site . 124 18 The number of persons to be displaced in these areas was approximately 341. In 1923 these areas were the subject of a local inquiry by the Ministry of Health, with the result that all were condemned as unfit for habitation. Unfortunately, no further action could be taken owing to the lack of other accommodation for the people it was proposed to dehouse. The Wyndham Road Area Improvement Scheme. In May, 1924, the Housing Committee of this Council had before them an offer of freehold property in the Wyndham Road Area, and surveyed the same with a view of effecting an improvement scheme. As a result of their report, particulars of the offer were submitted by this Council to the London County Council, and the latter were asked to consider the advisability of effecting an improvement scheme in the Wyndham Road Area upon the site offered in conjunction with adjoining property. The London County Council considered the matter, and a recommendation mendation was made to make an improvement under Part I of the Housing of the Working Classes Act, 1890. The scheme for this Borough has been linked up with two other schemes for slum clearances in South London, viz., The China Walk area in North Lambeth and the Hatfield area in Southwark, the whole being known as The London County Council (China Walk, etc) Improvement Scheme, 1925. In pursuance of this scheme, and in accordance with the Housing Acts, 1890 to 1924, I represented to the London County Council on the 12th January, 1925, that certain properties in the Wyndham Road area, about three acres in extent, were, owing to various reasons, dangerous and injurious to the health of the inhabitants of the said area, or of neighbouring buildings, and that the most satisfactory factory way of dealing with the evils mentioned was an improvement ment scheme for the re-arrangement and re-construction of the streets and houses within such area. The difficulty in the past of dealing with insanitary areas has been the impossibility of providing other accommodation for the persons displaced. To overcome this difficulty the London County Council, in their tentative improvement scheme for the Wyndham Road area, provided for the acquisition of an additional four acres of adjacent lands and premises, thus making seven acres in all, as a site to be cleared for re-housing purposes. The number of houses, families, and persons living in the area covered by the Improvement Scheme is shown in the following table: — No. of Houses. No. of Families. No. of Persons. Bowyer Street 14 14 92 "A" Insanitary Area. 3 Acres. Crown Street 6 7 28 Mayhews Buildings 12 12 45 Wyndham Road 28 38 168 Pinto Place 9 12 42 17 68 Pallador Place 11 Comber Grove 4 15 4 Totals 84 104 458 254 Comber Grove 39 80 "B" Area to be acquired 4 Acres. Blucher Road 3 5 23 Aliens Cottages 3 5 19 45 90 296 Totals for the whole area 129 194 754 27 It will be seen from the above table that 194 families, comprising 754 people, would be dehoused by the clearance of the whole site of seven acres. The London County Council suggest in their scheme the provision of accommodation for 2,020 persons in six compact blocks of buildings. The local inquiry with reference to the scheme was held at the Lambeth Town Hall, by a representative of the Ministry of Health, on 20th November, 1925, when I gave evidence in support of my representation. The grounds on which I based the official representation relating to this area were as follows: —In many cases the floors of the ground floor rooms are below ground level; the main walls dilapidated or bulging; the staircases are not lighted or ventilated to the external air. Many of the rooms in the area are unfit for human habitation owing to the dampness arising from the ground or the dilapidated condition of the main roofs. Most of the dwellings represented in Bowyer Street are so overcrowded that the washhouses are in use as living rooms, and many of the bedrooms are verminous. Some of the houses have back bedrooms of a capacity not exceeding 400 cubic feet. In all the houses dealt with in this street there are no water fittings within the buildings and no washing-up sinks provided. Mayhews Buildings in Wyndham Road consist of a block of back-to-back houses built almost entirely of wood. The ground floors of these houses are much below ground level, and entered from a common yard by doors, in some cases only 4 feet 6 inches high. The staircases are narrow', winding, insufficiently lighted and ill-ventilated. The floors of the rooms are worm eaten and the plastering of the ceilings and internal walls generally dilapidated. These houses are without coppers and washing-up sinks, have no water fittings within the buildings, and are provided with only one water closet and one water stand pipe for the use of two houses. Closeness of buildings, interfering with the circulation of air, and the lighting of the front rooms is the worst feature of the houses in Pinto Place, the fronts of which are divided by a yard only 11 to 13 feet across from the much higher buildings of the wreck of a brewery (which was shattered by an explosion during the War). Bising dampness is very apparent in the walls of the ground floor rooms of these houses. The closeness and bad arrangement of the back additions are the main features in the unsuitability for human habitation of the houses in Pallador Place (off Wyndham Road). The distances between the back additions average less than six feet. The back windows of the houses are very small and the yard spaces cramped. The first floor back bedrooms have an average capacity of less than 500 cubic feet. The back addition bedrooms are without fire-places and contain less than 400 cubic feet of air space. The result of the local enquiry will be known in due course. Increase of Rent and Mortgage Interest (Restrictions) Act. 12 certificates under this Act were issued in 1925. STATISTICS.—HOUSING CONDITIONS. Number of New Houses erected during the Year 1925. (a) Total 120 (6) With State assistance under the Housing Acts— (1) By the Local Authority None (2) By other bodies or persons Information not available I. Unfit Dwelling Houses. Inspection— 1925. (1) Total number of dwelling houses inspected for housing defects (under Public Health and Housing Acts) 6,571 (2) Number of dwelling-houses inspected and recorded under the Housing (Inspection of District) Regulations 1910 172. (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 5,041 11. Remedy of defects without service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or its officers 3,446 111. Action under Statutory Powers. (a) Proceedings under Section 3 of the Housing Act, 1925 — (6) Proceedings under the Public Health Act— (1) Number of dwelling-houses in respect of which Statutory Notices were served requiring defects to be remedied 1,595 (2) Number of dwelling houses in which defects were remedied after service of formal Notices— (a) By owners All (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909 — 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Inspections made by Sanitary Inspectors in 1925. Number of Prosecutions. (4) Written Notices. (3) Premises, (i) Inspections. (2) 782 Factories (including Factory Laundries) Workshops (including Workshop Laundris) 41 - - 1,214 99 Workplaces (other than Outworkers' premises) 140 Total 1,996 - 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES Number of Defects. Remedied. (3) Referred to H.M. Inspector. (4) Number of Prosecutions. (5) Particulars. (1) Found. (2) Nuisances under the Public Health Acts :— * - 43 43 Want of cleanliness - Want of ventilation 7 7 - - Overcrowding - - - - - Want of drainage floors - - - 107 Other nuisances 105 - - Sanitary accommodation — Insufficient 2 2 - 1 - - Unsuitable or defective 1 - Not separate for sexes 3 1 - - Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) - - - - Other offences [excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Fac-tories and Workshops Transfer of Powers) Order, 1921 - - - - 163 159 - - Total *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. Factories, Workshops and Workplaces on the Register at the end of 1925. Wearing apparel 249 Engineering trades 169 Building trades 97 Preparation, etc., of foodstuffs 72 Sawmills, joinery works, etc. 95 Printing and lithography 42 Laundries 35 Chemical works, manufacturing chemists 7 Brush Trade 9 Toy makers 9 Varnish and colour works 4 Offensive trades 9 Glass blowing 2 Gas works 1 Bakehouses 147 Eating houses 159 Miscellaneous 534 Total 1,640 Outworkers. In accordance with S. 107 of the Factories and Workshops Act, lists of outworkers were received from 79 persons carrying on business in Camberwell, in addition to those received from other Boroughs (i.e., outworkers living in Camberwell but employed by persons in other Boroughs). The women sanitary inspectors made 1,959 visits to outworkers' homes. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. The bulk of the milk supply for the inhabitants of Camberwell well comes from farms outside London. There is in the Borough only one licensed cowshed. This cowshed was regularly inspected and steps were taken to prevent any contamination of the milk. A sample of this milk was taken for bacteriological analysis and was reported to be free from tubercle bacilli. Milk supervision has two purposes. The first is to protect the consumer against adulteration or a low-grade product. The second is to secure a milk as clean as possible. The modern practice of collecting milk from many farmers and taking it to large creameries and milk depots, where it is mixed, prevents the possibility of tracing either dirty or infected milk to the source of production. Pure milk may be defined as milk which contains at least 3 per cent, of fat and 8.5 per cent, of non-fatty solids, has no added preservatives, and which is clean. The definition of clean milk is based on the bacterial count, and is related especially to the presence and number of the coliform bacilli and the absence of tubercle bacillus. The necessity for a fixed bacterial standard for milk.—It is sad to relate that we are still battling against dirty milk, and although progress has been made in the fight yet the question of transit in properly cooled vehicles, whether by rail or road, and a bacteriological standard for milk of any description still remain to prevent our victory. Unclean milk is a menace to the health of the community, and especially to that of its youngest members. The indifference displayed by the ordinary householder as to the purity of his milk supply is beyond all comprehension. A bacteriological standard of purity for all milk is required, and when the public realise the value of milk with a small bacteriological count then we may hope to see an Order enforcing this admirable state of affairs. The distribution of a large quantity of the milk used in Camberwell is carried out by large firms, but there are still a considerable able number of small dealers on the register. It is estimated that about 60 per cent, of the milk is supplied and distributed by one of the large wholesale firms. During the last five years there has been a great improvement in the purity and wholesome character of the supply, partly due to the large firms that handle the milk. Although there may be objections as to the large combines having the control of the supply of milk owing to the limitation of competition, nevertheless these firms have done and are still doing much to ensure the purity of the milk supply to the vendor. These companies have excellent premises fitted with modern machinery, and make every effort to supply clean milk. A further improvement could be brought about if it were compulsory for milk to be sold in bottles with sealed caps. This would overcome the possibilities of contamination not only in shops and in the distribution, but also in the homes of the consumers. During the year there has been a very large increase in the use of bottles for retailing milk, other than graded, to the consumer, one large company delivering entirely by this method, while other firms, both large and small, are gradually dispensing with hand cans for bottles with tight-fitting discs. Pasteurisation of milk is coming into more general use by the larger distributors. It is claimed that by this process all pathogenic organisms are destroyed, and provided the pasteurisation is followed immediately by bottling the milk before it reaches the household it can be regarded as safe. It is to be hoped that pasteurisation will not obscure the higher ideal of a clean milk supply, which the ability of the farmer and the dairyman is quite capable of producing for consumption. During the past year a fairly considerable amount of sterilised milk was supplied by firms having factories both outside and inside this Borough. After the milk is sterilised it is placed in air-tight, screw-stoppered bottles, and delivered in crates to the various retailers. It is claimed that this milk will keep sweet for several days, according to the temperature. At certain periods after delivery any stock that remains unsold is collected and replaced by fresh. The condition of shops in which milk is sold has improved considerably of late years. Milk and Dairies Consolidation Act, 1915. This Act, which came into force on Ist September, 1925, gives power to the Ministry of Health to make Orders for the regulation and inspection of all branches of the milk industry, with the concurrence of the Ministry of Agriculture and Fisheries. The first schedule of the Act provides legal machinery for stopping the supply of milk that is likely to cause tuberculosis. The sale for human consumption of tuberculous milk or milk from a cow suffering from certain specified diseases, or the products of such milk, is definitely prohibited. All vehicles and the receptacles used for the sale of milk in public places must be conspicuously inscribed with the name and address of the person selling the milk. The Act also requires that C 33 tins containing condensed, separated or skimmed milk must be visibly labelled with the appropriate descriptive words in large type. The warranty defence may not be pleaded by a purveyor when the sample is taken from mixed milks of more than one seller or consignor. In the case of receiving milk from one seller or consignor the purveyor is entitled within sixty hours to declare the name and address of his supplier and the time and place of delivery to him by the consignor, and require the Authority taking the original sample to procure a further sample, in the course of transit or delivery, from a corresponding milking (unless this has been done previously), and if the owner of the cows so requests, an additional sample must be taken at the place where the cows are kept. Power to appoint a veterinary inspector for the purpose of the Act is given, and power is also given for the Sanitary Authority of any district, with the approval of the Ministry of Health, to establish milk depots for the sale of milk prepared for consumption by infants under two years of age at not less than cost price. In connection with the sale of tuberculous milk the Ministry of Agriculture and Fisheries issued an Order known as the Tuberculous Order of 1925. This Order came into operation Ist September, 1925, and compels the slaughter of all such cows and any other bovine animal which may be suffering from tuberculous emaciation or from chronic cough and showing definite clinical signs of the disease. The owner is required to report such animal to the Police, and veterinary surgeons are required to report such animals to the Local Authority. Several dairymen in the Borough, from whom samples had been taken, availed themselves of the provisions of Section 9, and the provisions contained in the Third Schedule to this Act, by giving notice in writing (within sixty hours of the time the retail sample was obtained) requesting that formal samples be taken in the course of delivery from the wholesale firms supplying them. 12 samples so obtained were all reported to be genuine. These samples, with one exception, were taken between 2 o'clock and 7 o'clock in the morning. The Milk and Dairies (Amendment) Act, 1922, Section 2, empowers the Council to refuse to enter any person's name on the register or to remove his name from that register if they are satisfied that the public health is, or is likely to be, endangered by an act or default of his in relation to the quality, storage or distribution of milk. It was not found to be necessary to remove any names from the register. The following table is self-explanatory:— Period. Milkshops. General Shops. Restaurants. Total. On Register December 31st, 1921 280 12 111 403 ,, ,, ,, ,, 1922 121 315 13 449 „ „ „ „ 1923 128 289 14 431 „ „ „ „ 1924 128 284 16 428 450 ,, ,, ,, ,, 1925 129 305 16 The Dairies, Cowsheds and Milkshops Order of 1885 requires the Council to keep a register of persons from time to time carrying on the trade of dairymen or purveyors of milk, and provides that a person may not carry on the trade unless registered. In 1923 the Council passed a resolution that persons registered as purveyors of milk and those applying for registration be informed of the following conditions which must be observed:— 1. The milk container must be kept covered (to exclude flies and dust) when not serving. 2. The milk container and its cover, and also the measures used, must be scalded daily before use. 3. The floors and the fittings of the shop to be kept clean and free from dust at all times. 4. If jams, syrups and/or pickles are sold from open jars a closely fitting cover must be kept in position when not serving. 5. No paraffin or similar oil, vegetables, fish, raw meat or offal to be sold from the premises. In the event of non-compliance with the foregoing conditions steps were to be taken to cancel the registration, or in the case of a new application that the same be refused unless the conditions were agreed to. During the year 1925, 141 applications for registration were received from persons who proposed to sell milk, 29 of which were for the sale of milk in sealed bottles only. Of these 140 were granted, one being refused on the grounds that the premises were not suitable for the storage of milk and for cleansing the receptacles. Milk (Special Designations) Order, 1923. Under the provisions of the Milk and Dairies (Amendment) Act, 1922, the Minister of Health has issued an Order which prescribes the conditions subject to which licenses may be granted for the sale of milk, described as Certified, Grade "A" (Tuberculin Tested), Grade "A," Grade "A" (Pasteurised) and Pasteurised. Under this Order the Council are authorised to grant licenses to persons c 2 other than a producer to sell milk under any of the special designations above mentioned. This Order, apart from affording an opportunity to the public of buying a clean milk supply, has also served as an object lesson to milk producers in showing them that clean milk can be produced on a farm. The production of clean milk depends entirely on the steps taken at the farm to keep the cowshed clean and sanitary: the washing of the cows and drying before milking begins; the milker requires a clean overall and his hands must be washed and dried before commencing to milk, and the use of clean pails for the reception of the milk. Certified Milk must be produced from cows which have passed a prescribed test and a veterinary examination every six months. The milk must be bottled on the farm and the name and address of the farm or producer, the day of production and the words " certified milk " must appear on the bottle cap, and the milk must not contain at any time more than 30,000 bacteria per c.c. or any coliform bacillus in 0.1 c.c. on delivery of the milk. Grade "A " (Tuberculin Tested) Milk is subject to the same conditions as certified milk with regard to the testing and examination ation of cattle. The milk must be bottled before distribution, and must not at any time contain more than 200,000 bacteria per c.c. or any coliform bacillus in 0.01 c.c. If this grade of milk is bottled on the farm or the dairy where it is produced the bottles must be sealed with a cap, the name and address of the producer, the day of production and the words "Grade 'A' (Tuberculin Tested) Milk "being stamped thereon. If the milk is not bottled as above stated it shall be consigned in an unventilated, sealed container, which shall be labelled or marked in a suitable manner, with the address of the dairy, the day of production (with the words "morning" or " vening according to the time of milking) and the words" Grade 'A' (Tuberculin Tested) Milk." Where this milk is consigned to a " dealer " (wholesale or retailer distributor) under these conditions, the milk, before distribution tribution, shall be bottled by him and the bottles shall be sealed with a cap bearing the name of the dealer, the address of the bottling establishment, the words "Grade 'A' (Tuberculin Tested) Milk," and the day of production. Grade "A" Milk must satisfy the same conditions as Grade "A" (Tuberculin Tested) with the exception that the tuberculin test is not required and that veterinary examination of the cows in the herd are made at intervals of three months instead of six. Grade "A" (Pasteurised) is a Grade "A" Milk which has been pasteurised by holding it at a temperature of 145 to 150 degrees F. (63 to 66 degrees C.) for at least half an hour, and then cooled to 55 degrees P. (13 degrees C.), and it must not be heated more than once. It must not at any time contain more than 30,000 bacteria per c.c. or any coliform bacillus in 0.1 c.c. Pasteurised Milk is any milk pasteurised in the same way as is required for Grade "A" (Pasteurised). It must not contain more than 100,000 bacteria per c.c. There is no test for coliform bacillus. Every vessel containing the milk shall bear a suitable label with the words "Pasteurised Milk." During the year 1925 licences granted for the sale of designated milk in the Borough were as follows: — Dealers licences to use the designation " Certified Milk " 25 „ „ „ „ Certified (Supplementary) 1 „ „ „ „ Grade "A" (Tuberculin Tested Milk) 22 „ „ „ „ „ (Supplementary) 1 Grade "A" 21 „ „ „ „Grade "A" Pasteurised — „ „ „ „ Pasteurised 20 Total 90 An additional bottling establishment (one already being in existence) has been installed in this Borough where Grade "A" (Tuberculin Tested) milk consigned in sealed churns from the farmer to the dairyman is bottled and sealed by him at the dairy for distribution to his retail customers. No licence has been issued for the pasteurisation of milk in the Borough. Under this Order no retailers of milk were refused registration and no registrations were revoked. In February the Ministry of Health requested that samples of certified milk, bottled at the farm by a licensed producer and supplied to certain licensed dealers in this Borough should be obtained for bacteriological examination. The samples were to be taken, one or two each month, from April to December inclusive, in accordance with a schedule supplied by the Minister. The Minister further requested that he be furnished with a report of each examination. In this connection the attention of the Minister was directed to the unsatisfactory results of the bacteriological examination of nearly all these samples. (See Bacteriological Reports of Certified Milk.) The communication was acknowledged, and this Department was informed that the matter would receive attention. The Order in question provides that the Local Authority shall from time to time submit samples of Grade "A" (Tuberculin Tested) Milk for bacteriological examination. Six samples were examined, the results of which are set out in the report on the bacteriological examination of milk. As certain of the samples did not, in all respects, comply with the conditions laid down by the Minister, the attention of the distributors in question was called to the matter. Further samples will be taken for examination, and if it is found that they are not in accordance with the required standard the matter will be dealt with as provided by the Order. Bacteriological Examination of Milk. The following table gives the results of the bacteriological examinations of samples of graded and other milks: — CERTIFIED MILK. Result of Bacteriological Examination. Conditions prescribed for the Sale of Certified Milk. No. Date obtained. Bacteria Count. Presence of Coliform Bacillus. Per c.c. 3 27/4/25 10,000 Absent in 48 hours. Not more than 30,000 bacteria per c.c. and no coliform bacillus in one-tenth of a c.c. 6 21/5/25 3,599 Lactose fermenting organisms in 1 c.c. in 48 hours. 7 4/6/25 5,066 Bacillus Coli present in 24 hours in all three tubes. This implies a lactose fermenting organism. 12 9/7/25 1,668,000 Acid and gas in lactose in one-tenth c.c. in 24 hours. 13 30/7/25 25,900 Acid and gas in lactose medium in one-tenth c.c. in 24 hours. 16 20/8/25 31,000 Acid and gas in lactose in one-tenth c.c. in 24 hours. 1 cc. of milk acid and gas. 17 27/8/25 694,000 Acid and gas in lactose in 24 hours. 18 3/9/25 608,000 Acid and gas in one-tenth c.c. in 48 hours. Coli, i.e., acid and gas in 1 cc. in 24 hours. 19 17/9/25 9,400 Acid and gas in lactose in one-tenth c.c. in 24 hours 1 c.c. acid and gas in 24 hours Acid and gas in lactose in one-tenth c.c. in 48 hours. 22 5/10/25 25,000 B. coli in 1 c.c. 24 hours (acid and gas). 24 12/11/25 2,200 Acid in one-tenth c.c. in 48 hours 1 c.c. acid and gas in 48 hours. 25 21/12/25 9,700 Bacillus Coli absent in onetenth c.c. in 48 hours. Acid and gas in 1 c.c. in 48 hours. Result of Bacteriological Examination. Conditions prescribed for the Sale of Grade "A" (T.T.) Milk. Bacteria Count. Presence of Coliform Bacillus. No. Date obtained. GRADE Per c.c. "A" (T.T.) MILK. Not more than 200,000 bacteria per c.c. and no coliform bacillus in 1/100 c.c. 4 7/5/25 17,880 Absent. 5 7/5/25 7,380 Absent. 17,100 Acid and gas in lactose in 1/100 c.c. in 24 hours. do. do. do. 14 13/8/25 15 13/8/25 24/9/25 24/9/25 81,000 7,100 do. in 48 hours. Acid and gas in lactose (slight) in 1/100 c.c. in 48 hours. 20 1,650 21 ORDINARY MILK. 10,000 B. Coli present in 1 c.c. 10 2/7/25 2/7/25 9,000 B. Coli found in 1 c.c. 11 7/10/25 This milk was examined for Tubercle with a negative result. 23 26 29/12/25 70,000 Bacillus Coli Communis (i.e., an organism producing acid and gas in lactose broth) is present in 0.0l c.c. in 24 hours. Public Health (Meat) Regulations, 1924. The above Regulations came into force on April Ist, 1925. They were designed to secure more effective inspection of animals slaughtered for human consumption, and improvements in the handling, transport and distribution of meat. Part I of the Regulations contains definitions and directions, and also forbids any person suffering from a notifiable infectious disease to take part in the slaughtering of animals intended for human consumption or the handling of meat. Part II deals with the rules and regulations to be observed in slaughterhouses and slaughtering. Part 111 gives power to Local Authorities to adopt a stamp with which to mark meat that has been inspected by the authorised officers. It is stated that the stamp must receive the approval of the Ministry of Health. Part IV deals with meat sold from stalls, and provides for the protection of such meat from flies, dust, splashing, etc. Part V sets out the various sanitary requirements in shops, stores, etc., and provides for the due cleanliness of such places; the protection of the meat from flies, filth and such like contamination, and the storage of trimmings, refuse and rubbish, which must be placed in properly covered receptacles, kept apart from any meat intended for sale. Part VI provides for the observance of cleanliness in the transport of meat by hand or in a vehicle, except when it is packed in hampers or in impervious cases. In June, 1925, a Circular was issued by the Ministry of Health for the purpose of informing Local Authorities the intention of the Department and the construction which might properly be given to the provisions in question. In this Circular the definition of meat is given as the raw and untreated edible parts of the carcase of slaughtered cattle, swine, sheep and goats. The Regulations do not apply to rabbits, poultry, fish, butter, margarine and cheese, cooked meats, lard and sausages and other preparations of or containing meat, and might be regarded as outside the scope of the Regulations. For the purpose of administering these Regulations, the Medical Officer of Health and the District Sanitary Inspectors were authorised by this Council to enter and inspect any slaughterhouse or other place and any stall or vehicle to which these Regulations apply. The enforcement of these Regulations has thrown a considerable amount of extra work on the Inspectors in bringing all the premises concerned up to the required standard, and the Inspectors in whose area the two private slaughterhouses are situated have had to be on duty frequently in the evenings for the purpose of inspection of the meat at the time of slaughter. The work of meat inspection naturally falls into two sections —the inspection of animals slaughtered at the private slaughterhouses and the inspection of meat as presented for sale in the butchers' shops and from stalls. The main difficulty in connection with the Regulations has been in connection with the butchers' shops and stores. Meat traders are at present complying with the spirit of the Regulations. Each case has been dealt with on its merits, and although it is not possible to enforce the provision of glass fronts for all butchers' shops, yet an ever increasing number have seen the value of such fronts and have had them installed. There are only two stalls in the Borough which come under the above Regulations, and there has been no necessity to take any action against them for not carrying out the Regulations. The methods of transport and handling by carriers have lately shown marked improvement owing to the action taken in pointing out to the persons responsible how infringements of the Regulations had occurred. As time goes on a further improvement will be registered by the present carts for conveying meat being replaced by those designed to avoid contamination, and those persons engaged in transport will instinctively take the necessary action to prevent fouling. The following table gives the number of slaughterhouses in use in the Borough of Camberwell at the dates mentioned: — January, 1925. December, 1925. 1920. 4 2 Licensed 6 From the commencement of the operation of the Meat Regulations to the 31st December, 1925, the number of animals slaughtered at the two licensed slaughterhouses in the Borough was as follows:- Cattle, 93. Sheep, 613. Pigs, 183. Calves, 12. The animals were of a generally high standard of quality, and the amount of disease found was therefore not so great as would be expected in animals of a lower standard. The following table gives particulars of the organs seized, the total weight of the diseased meat destroyed amounted to 9cwts. 0 qrs. 2lbs.: — SLAUGHTERHOUSES. ORGANS SEIZED. Lungs. Heart. Stomach. Mesenteries. Head. Intestines. Kidneys. Tongue. Spleen, Cause of destruction. Liver. Cattle. I I 1 i "I "I - 3 8 6 - - - Tuberculosis 4 - - - - 3 - Cirrhosis - 2 - - - - - - - - - - - Actinomycosis - - - - - Fluke - 6 - - - - - - 1 Abscess - - - - - - - - - Sheep. - - - - - 1 Pericarditis - - - - - 61 - - Parasitic disease - - - - Fluke - 9 - - - - - - - - - Pleurisy One entire carcase destroyed One entire carcase destroyed. Dropsy and Emaciation - Pigs. . - - - 1 - Tuberculosis 1 1 - - 6 - - - Pneumonia - - - - - - 41 The above Regulations are a most welcome addition to existing Public Health legislation in relation to food, but there still remains the absence of statutory orders to enable the Public Health Authority to deal with the sale of foodstuffs, other than meat, from stalls in street markets,or by hawkers. The absence of any power to control the conduct of the sale of articles of food which have been rendered liable to contamination by animals, dust, surface drainage from the roadways, and mud, etc., owing to the careless manner in which such foods are stored and deposited for sale, has been forced on my attention for some considerable time. It used to be a common practice in the street markets to find various articles of food, such as fruit, fish, vegetables, sweets, etc.,stored on the roadway or under stalls without any regard to protection from pollution, but at the present time it is satisfactory to record that as a result of constant attention to this matter by your Inspectors the majority of stall-holders now place their goods on baskets or boxes sufficiently high above the footway, thus reducing to a minimum the risk of contamination. It would seem, therefore, that the time has arrived to go even further than this, with a view of securing a general prohibition of exposure on the street of meat, fruit, sweets and the more important and readily contaminated articles of food, unless adequate protective precautions are taken. Bakehouses There were 147 bakehouses on the register at the end of 1925. Of these two use power, and are therefore factories within the meaning of the Factories and Workshops Act, 1901. 99 of the bakehouses are above ground and 48 underground. 421 inspections were made by the Sanitary Inspectors and 21 notices were served for the cleansing of walls and ceilings. Ice Cream Premises. The number of such premises in the Borough on the register at the end of 1925 was 338. The trade is mainly regulated under the London County Council (General Powers) Act, 1902, which makes it an offence to store ice cream in a sleeping room, or in a shed or room in which there is an inlet or a drain. The Act also provides that every itinerant vendor should exhibit on his barrow the name and address of the person from whom the ice cream has been obtained. Two samples of ice cream were submitted by the Food and Drugs Inspector for bacteriological examination. The reports showed that bacillus coli was present in 0.01 c.c. in both samples, and that the number of organisms per c.c. was 100,000 and 1,300,000 respectively. The Sanitary Inspectors made 681 visits, and 12 notices were served. Butter, Margarine, etc., Premises. At the end of the year there were 31 dealers in margarine on the register. The registration of wholesale margarine dealers is required by Section 9 of the Margarine Act, 1887, as extended by Section 7 of the Sale of Food and Drugs Act, 1899. Fried Fish Shops. There are 70 fried fish shops on the register. These premises were inspected to see that they were kept in conformity with the By-laws made by the London County Council. Fish Curers. The number of premises in the Borough used by fish curers is 47. The Inspectors made 98 visits, and 8 notices were served. Restaurants, Eating Houses, etc. 225 inspections were made of 90 restaurant eating houses in the Borough, particular attention being directed to the kitchens and places where the food was prepared. 33 notices were served. Other Foods. Unsound food is dealt with under Section 47 of the Public Health (London) Act, 1891. Throughout the year a regular inspection of Street markets and shops has been carried out by the District Inspectors, as well as the special Saturday night inspections. The following table gives the number of inspections of food made during the years 1921-1925, with the number of seizures of unsound food: — Number of Seizures. Number of Food Inspections. Year. 1921 595 38 1922 10 656 1,301 1 1923 1924 1,453 2 - 1925 5,579 On a great many occasions the Inspectors were asked by vendors to examine articles of food and to accept surrender of such as were unsound or unwholesome and unfit for food. In my opinion the routine duties of the Inspectors render it impossible for them to devote as much time to the very important work of food inspection as is necessary. In a Borough of the size and importance of Camberwell it is highly desirable, in my opinion, that there should be at least one whole-time food inspector. The following table represents the description and the amount of unsound and diseased food destroyed during the years 1921-1925 at the Disinfecting Station at Peckham Park Road Depot: — Year. Fish. Meat. Fruit. Tinned Food. Poultry. lbs. qrs. lbs. Tons. cwt. qrs. lbs. cwt. qrs. lbs. lbs. Tons. cwt. qrs. Tons. cwt. Tons. cwt. qrs. Tons. 10 5 0 0 0 0 0 0 1 10 7 0 11 1 4 0 1921 0 15 2 0 16 1 10 1 9 8 1 0 0 1 8 20 0 6 1 1 1922 0 14 2 2 0 0 0 1 0 0 7 3 14 2 27 0 13 0 9 1 18 1923 0 9 0 19 0 0 0 0 27 1 3 2 1 3 3 1924 0 22 0 1 0 13 0 0 9 2 6 0 0 0 20 24 0 3 12 1 6 15 0 0 13 0 16 1925 0 Year. Vegetables. Eggs. Tons. cwt. qrs. lbs. 1921 Tons. cwt. qrs. lbs. 0 0 0 0 0 0 0 0 1 4 0 0 0 1922 0 1 0 1923 0 0 0 0 0 7 1 18 0 0 0 1924 0 0 0 0 0 0 0 0 0 0 1925 0 0 0 44 SALE OF FOOD AND DRUGS ACTS. One Inspector is appointed under the above Acts for obtaining samples, and this system works admirably. The samples obtained are of two kinds, namely, formal and informal, and in procuring these samples the Inspector is usually assisted by an agent. It cannot be emphasised too strongly the necessity of taking informal samples. The experience gained in this method of sampling shows that well-known and well-tried customers are often victimised, where the casual customer obtains goods genuine in quality. Reference to the table on informal samples will show the nature and extent of the adulteration of these samples. Public Health Department, 35, Brunswick Square, S.E.5. May 1st, 1926. To Dr. H. W. Barnes, Medical Officer of Health, Camberwell. Sir,—l beg to report herewith on the work carried out under (1) The Sale of Food and Drugs Acts; (2) The Margarine Acts; (3) The Public Health (Condensed Milk) Regulations; (4) The Public Health (Dried Milk) Regulations; (5) The Public Health (Milk and Cream) Regulations; and (6) The Sale of Food Order, for the year ending December 31st, 1925. The formal samples taken under the above Acts and Regulations total 1,085, and the informal samples 129. The formal samples, the percentage of adulteration, and the action taken in connection with the adulterated samples, are set out under Table "A." Table " B " shows the percentage of adulteration for the past five years (all formal samples). The extent and nature of the adulteration and the result of proceedings or other action taken are given under Tables" C " and" D," the latter table dealing with milk only. Table" E " shows the percentage of milk adulteration for the past five years. The practice of sending notifications to the vendors of genuine samples has been again carried out this year, 758 cards being sent to the tradesmen concerned. Their appreciation has many times been expressed. I am, Sir, your obedient Servant, GEORGE T. DEWEY, Food and Drugs Inspector. TABLE "A." SAMPLES TAKEN UNDER THE SALE OF FOOD AND DRUGS ACTS. Number of Samples taken. Genuine. Percentage Not Genuine. Summonses. Not Genuine. Cautions. Article. Milk 678 671 7 103 7‡ 1 1 2‡ Butter* 101 0.99 - 100 43 41 2 4.65 2 Mustard - 0 Lard 32 32 - - - 2 2 Vinegar 25 23 8.00 - 1 23 22 1 4.34 Malt Vinegar 20 0 Cocoa 20 - - - 11 11 0 Self Raising Flour - - - 10.00 1 10 9 1 Camphorated Oil - 9 9 0 Custard Powder - - - 8 0 Arrowroot 8 - - - 0 Preserved Cream 8 8 - - - 7 7 0 Condensed Milk - - - 6 6 0 Baking Powder - - - Strawberry Jam 6 6 0 - - - 2 6 4 2 33.3 Separated Milk - 5 5 0 Pepper - - - 5 0 Blackcurrant Jam 5 - - - 4 Margarine 5 5 0 - - 1 5 3 2 40.00 1 Cream 4 0 Sponge Cakes 4 - - - 0 Raspberry Jam 4 4 - - - 4 0 Coffee 4 - - - 4 0 Crushed Linseed 4 - - 0 4 4 - - Ground Ginger - Zinc Ointment 4 4 0 - - - 1 2 2 50.00 1 Golden Syrup 4 3 0 Beef Sausages 3 - - - Whisky 3 3 0 - - - 3 3 0 Olive Oil - - - 2 0 Fish Paste 2 - - - 2 0 - - Cornflour 2 - Dried Milk 2 0 2 - - - 2 0 Pork Brawn 2 - - - 2 0 Lemonade Powder 2 - - - 0 Corned Beef 2 2 - - - 2 2 0 Lemon Cheese - - - 2 0 Ground Almonds 2 - - - 50.00 1 Boric Ointment 2 1 1 - 1 Gin 2 1 1 50.00 - Jam Sandwich and Cream 1 0 1 - - - Chocolate Cream 1 1 0 - - - 1 1 Dripping 0 - - - 1 0 Ale 1 - - - 1 1 0 - Stout - - 1 1 0 Pound Cake - - - 1 0 Cream Cheese 1 - - - 0 Lemonade 1 1 - - - Cream of Tartar 1 1 0 - - - Number of Samples taken. Genuine. Not Genuine. Percengate Not Genuine. Summonses. Article. Cautions. Breakfast Sausage - - 1 0 - 1 Sponge Fingers 1 1 - - 0 1 1 0 Pure Honey - 1 - - Tincture of lodine 1 0 - - - - 1 - 1 0 - Rice - - 1 1 Rum 0 - - 1,063 1,085 22 202 12 16 Total Sixteen samples of Butter and one sample of Margarine were analysed to ascertain the amount of moisture. In no case did the amount exceed the statutory limit of 16 per cent. † Four Margarines did not comply with the requirements, being sold in wrappers that were not stamped with the word " Margarine." ‡ Two summonses in respect of one sample of milk were issued against one of the vendors, and two summonses against one of the retailers of a sample of butter. Included in the milk samples were 12 samples that were taken in the course of delivery under Section 9 and the Schedule thereto of The Milk and Dairies (Consolidation) Act, 1915. The following table shows the percentage of adulteration of samples for the past five years:— TABLE "B." Year. 1921. 1922. 1923. 1925. 1924. 2.02 Percentage of adulteration 3.03 2.9 2.32 2.58 Milk. 678 formal samples of milk and six samples of separated milk, making a total of 684, were submitted to the Public Analyst. Nine samples were reported against (7 milks and 2 separated milks), the adulteration being 1.31 per cent. These are set out under Table " C." Included in the samples of milk (Table "A") are two samples of sterilised milk, sold in sealed bottles. Both were found to comply with the required standard. Refusal to serve. In December proceedings were instituted against a dairyman registered in this Borough for refusing to serve. The milkman in question was retailing milk in a public thoroughfare from a six-quart hand can, containing three quarts. Sufficient money to pay for the milk required was tendered, and three demands made. He, however, persisted in filling the hand can from the churn. A sample eventually obtained from this can after it had been filled only just reached the standard, while a sample from another can was of good quality. At the hearing of the summons the defendant was convicted and fined £1 and £2 2s. costs. 47 TABLE "C." Particulars of Adulterated Samples (other than Milk), including Samples taken under the Margarine Act, and Result of Proceedings or other Action taken. Number of Sample. Article. Result of Analysis. Result of Proceedings or other action taken. Camphorated Oil 938 19 per cent, deficient in Camphor Caution, Public Health Committee. 979 Vinegar 12 per cent, deficient in Acetic Acid Do. 1039 Mustard 25 per cent, wheat flour, coloured with Tumeric Do. 1041 11 per cent, of wheat flour, coloured with Tumeric Mustard Do. 1052 Margarine Genuine; article sold in an unstamped wrapper Do. 25 Vinegar 12 per cent, deficient in Acetio Acid Do. 36 Butter Vendor fined £5 and £225. costs. Two Summonses, one withdrawn. 20 per cent, foreign fat Margarine Genuine ; article sold in an unstamped wrapper 106 Caution, Public Health Committee. 214 Margarine Genuine ; article sold in an unstamped wrapper Do. Golden Syrup 75 per cent. Glucose Syrup Vendor fined £1 and £1 1s. costs. 224 Golden Syrup 244 85 per cent. Glucose Syrup Caution, Public Health Committee. 335 Malt Vinegar 100 per cent. Vinegar other than malt Vendor fined £1 and £1 1s. costs. 407 Margarine Genuine: article sold in an unstamped wrapper Caution, Public Health Committee. Cream 425 Containing 003 per cent. Boric Acid, carton unlabelled Do. 634 Vendor fined £2 and £2 2s. costs. Cream Containing 0·22 per cent. Boric Acid, carton unlabelled 762 Gin 36.5 degrees under proof Caution, Public Health Committee. Boric Acid Ointment Do. 816 Deficient in Boric Acid to the extent of 20 per cent. TABLE "D." Milk and Separated Milk. Number of Sample. Deficiency of Fat. per cent. Added Water, per cent. Presence of a Preservative. Result of proceedings, or other action taken. No. 916 - 18 - Summons dismissed on payment of £1 1s. costs. 8 - - No. 937 Summons dismissed on payment of £2 2s. costs. - 22 - No. 964 Vendor fined £2 and £2 2s. costs. No. 62 18 - Vendor fined £1 and £1 1s. costs. - No. 161 4 - Caution, Public Health Committee. - - - 13 No. 189 Vendor fined £2 and £2 2s. costs. No.264 8 - - Two summonses, one against the employee withdrawn. Summons against owner dismissed on payment of £1 1s. costs. - - Separated Milk, containing 0.006 per cent Boric Acid. Caution, Public Health Committee. No. 424 - No. 462 Separated Milk containing 0.008 per cent Boric Acid. Do. - Table "E" shows the percentage of Milk adulteration for the last five years : — TABLE "E." Year. 1921. 1922. 1923. 1924. 1925. Percentage of Adulteration 1.95 20 1.95 1.59 1.31 Informal Sampling. 129 informal samples were submitted to the Public Analyst, exceeding by 13 the number that were submitted last year. Many other articles of food were purchased as test samples only. Although the adulteration works out at 17 per cent., it must not be overlooked that these adulterated samples were divided between five shops. The necessity and importance of informal sampling is borne out by the fact that at the shops in question the articles sold were, on occasions, genuine. Even the position D from which they were served had to be noted, and had some bearing on future operations. Below is a return of the informal samples submitted and the nature and extent of the adulteration: Percentage of Adulteration. Number Submitted. Not Genuine. Genuine. Article. 77 8 9-41 Butter 85 13 34.21 Milk 38 26 Golden Syrup 3 2 1 33.3 1 1 Margarine - - 1 Cream 1 - - Mustard 1 1 - - Totals 129 107 22 17.05 The nature and extent of the adulteration is shown below:— Number of Sample Nature and extent of adulteration. Article. Remarks. Milk 7 per cent, of added water All purchased from same purveyor. 80 87 Do. 8 Do. do. For formal sample see Table " C," No. 964. Do 27 Do. do. 90 Do. 93 Do. 20 do. do. 96 Do. 24 Do. Do 11 Do. do. 97 do. All purchased from same purveyor. For formal sample see Table " C," No. 189. 15 Do. 10 Do. Do. 5 Do. do. 21 Do. 7 per cent, abstraction of Fat 23 20 per cent, of added Water 26 Do. All purchased from same purveyor. Formal sample not yet taken. Do. 3 Do. do. 49 79 Do. 4 Do. do. 83 Do. 4 Do. do. Golden Syrup. 90 per cent. Glucose Syrup For formal sample see Table "B," No. 224. 92 30 per cent. Margarine All purchased from the same Vendor. For formal sample see Table "B," No. 36. 99 Butter Do. 40 Do. do. 104 Do. 40 Do. do. 106 Do. do. 114 Do. 35 115 Do. 40 Do. do. Do. 40 Do. do. 1 35 Do. do. 3 Do. do. Do. 20 Do. 5 Margarine. 34 informal samples of margarine were purchased to ascertain whether the requirements as to stamping the wrappers were being complied with. Of this number one purchase was served in an unstamped wrapper, one bore part of the word margarine, and two were indistinctly stamped. Public Health (Condensed Milk) Regulations, 1923. These Regulations prescribe the labelling and composition of condensed milk. Every tin or other receptacle containing condensed milk must have a label upon which is printed a declaration in prescribed form, including a statement (in pints or fractions of a pint) of the equivalent amount of liquid milk of the required standard that the contents of the tin will make. All condensed milk must contain not less than the appropriate percentages of milk fat and milk solids as specified in the following table: — Percentage of Milk Fat. Percentage of all Milk solids, including Fat. Description of Condensed Milk. 9.0 31.0 Full cream unsweetened 9.0 31.0 Full cream sweetened - 20.0 Skimmed unsweetened Skimmed sweetened 26.0 - For the purposes of the equivalent standard, the milk must contain not less than 12.4 per cent, of milk solids (including not less than 3.6 per cent, of milk fat), and skimmed milk means milk which contains not less than 9 per cent, of milk solids other than milk fat. During the year 1925 seven samples of full cream condensed milk were taken. Each sample was found to comply with the requirements of the Regulations as to labelling. The samples were examined for the standard of composition, and all were found to comply with the standard required. Public Health (Dried Milk) Regulations, 1923. These Regulations apply to dried milk to which no other substance has been added and to dried milk contained in any powder or solid of which not less than 70 per cent, consists of dried milk. In accordance with these Regulations dried milk must contain not less than the appropriate percentages of milk fat as specified in the following table: — Description of Milk. Percentage of Fat. Pull cream 26 Partly skimmed Not less than 8 per cent., but less than 26 per cent. Three-quarter cream 20 Half cream 14 Quarter cream 8 Skimmed, containing less than 8 The declaration on the label must include a description of the milk, and must also contain a statement as to the number of D2 51 pints of ordinary liquid milk of each class of a required standard to which the contents of the container are equivalent. For this purpose the milk shall contain not less than the following percentages of milk fat and milk solids:- Milk Fat. Milk Solids (including fat). 3.6 12.4 Milk 2.7 11.6 Three-quarter cream milk 1.8 10.8 Half cream milk .9 9.9 Quarter cream milk At one shop in this Borough tins of dried milk were found bearing labels not in accordance with the Regulations. Upon the attention of the shopkeeper being called to this fact the tins of milk were forthwith withdrawn from sale. Nearly all the dried milk sold in this Borough is of the well-known proprietary brands. Two samples were submitted for analysis, and both were found to comply with the required composition. Skimmed Milk is defined as milk which contains not less than 9.0 per cent, of milk solids other than milk fat. The labels on the containers of partly skimmed dried milk must contain the words "Should not be used for babies except under medical advice," and the label on the container of the skimmed variety the words "Unfit for babies." Two samples of dried milk were taken during the year, and both were found to comply with the Regulations in all respects. Milk and Cream Regulations, 1912-1917. The Public Health (Milk- and Cream) Regulations, 1912, prohibit the presence of any kind of preservative in milk or in cream containing less than 35 per cent, of milk fat and the addition of any thickening substance of any kind. In the ease of cream containing 35 per cent, of fat or more the effect of the Regulations is to permit the addition of boric acid, borax or hydrogen peroxide provided the cream so preserved is sold in vessels having a label with a printed declaration of the percentage of borax or peroxide which lias been used. The addition of any other kind of preservative is prohibited. The Public Health (Milk and Cream) Regulations, 1917, amended the former Regulations of 1912 by placing a limit on the boric acid and borax which may be added to cream containing 35 per cent. or more of fat to an amount not exceeding 0.4 per cent by weight of the cream. The declaratory labels must state that the cream is not suitable for infants or invalids. During the year 678 formal samples and 38 informal samples of "full cream milk," together with six formal samples of separated milk, were submitted for analysis. Only two separated milks were reported as containing a preservative, both being purchased from the same vendor. Of five formal samples and one informal sample of cream, two of the former were found to contain a preservative. Eight samples of cream sold as preserved cream did not exceed the statutory amount of 0.4 per cent, of boric acid. The details herewith are set out in the form prescribed by the Ministry of Health Memorandum of January, 1921: — (1) Milk and Cream not sold as Preserved Cream. ( a Number of samples examined for the presence of a preservative Number in which preservative was reported to be present and percentage of preservative found in each sample. Action taken under the Regulations. Milk- Formal Samples 678 Informal Samples 38 Nil. - 716 Separated Milk 6 2 - No. 424, 0.006 per cent. Caution, Public Boric Acid Health Committee No. 462, 0.008 do. do. do. Cream — Formal Samples 2 - 5 No. 425, 0.03 do. Caution, Public Informal Sample 1 No. 634, 0.22 do. Health Committee Proceedings taken against Vendor for failing to attach declaratory label to receptacle in which Cream was sold. Fined 40s. and 42s. costs. This Vendor had been previously cautioned. 6 (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. (I) Correct statement made 8 (II) Statements incorrect 0 8 (III) Percentage of preservative found in each sample. Percentage stated on the Statutory Label. Sample No. 158 0.36 Boric Acid per cent. Not exceeding 0.4 per cent. Boric Acid do. Do. 206 0.26 Do. Do. do. Do. 223 0.37 Do. do. Do. do. Do. 283 0.28 Do. do. Do. do. 0.34 do. Do. 365 Do. Do. do. Do. 599 0.28 Do. do. Do. do. Do. 641 0.19 Do. do. Do. do. Do. 811 0.31 do. Do. Do. do. (b) Determinations made of Milk Fat in Cream sold as preserved cream:— (i) Above 35 per cent 8 (II) Below 35 per cent 0 8 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V (1) and the proviso in Article V (2) of the Regulations have not been observed. (d) Particulars of each case in which the Regulations have not been compiled with and action taken:— (C) Number of instances where Regulations have not been complied with. (d) In what respect the Regulations not complied with Action taken. Sample No. 223. Declaratory label on 3-pint jug containing the bulk of insufficient size. Do. 283. Declaratory label on 2-quart hand can containing the bulk of insufficient size. Do. 365. Declaratory label on quart hand can, do. do. 7 Do. 425. Receptacle containing the bulk unlabeled do. purchasers' receptacle. Do. 599. Receptacle containing the bulk unlabelled. Do. 634. Receptacle containing bulk unlabelled. Purchaser's receptacle unlabelled Do. 811. Receptacle containing the bulk unlabelled. Caution. Caution. Caution. Caution. Caution. Caution. Proceedings taken fined 40s. and 425. Costs, see Table 1. Caution. (3) Thickening substances. —Thickeners were absent in all Samples. (4) Other observations.—From a survey of the year's work it would appear that the prosecutions instituted by the Borough Council under these Regulations during 1924 have had the effect of making vendors of cream more careful in carrying out the requirements. Sale of Food Order. At nine shops imported eggs, marked either "new laid" or "fresh," were exposed for sale without the word "Imported" or the country of origin forming part of the description. At six butchers' shops imported meat was exposed for sale without the necessary notice being exhibited denoting that the meat was imported. In each case the requirements of the Order were explained to the tradesmen and a caution given. The Order is generally being complied with, although in the case of imported eggs the fact must be again emphasised that there is still a practice on the part of many shopkeepers to partly obscure either the word "Imported" or the words denoting the country of origin on the tickets, or to have them written in very small letters, while the words " new laid " or " fresh " are boldly shown. Summary of Legal Proceedings for the year ending December 31st, 1925. Costs. Number of Summonses. Fines. s. d. Summonses under the Sale of Food and Drugs Acts. £ £ s. d. 12 13 0 0 15 15 0 Summonses under the Public Health (Milk and Cream) Regulations 1 2 0 0 2 2 0 15 0 13 0 17 17 0 PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. The following notifiable infectious diseases are compulsorily notifiable in Camberwell: — Small-pox, Diphtheria, Membranous Croup, Scarlatina or Scarlet Fever, Typhoid or Enteric Fever, Typhus Fever, Plague Relapsing Fever, Continued Fever, Puerperal Fever, Cerebro-Spinal Fever, Cholera, Erysipelas, Anthrax, Acute Polioencephalitis, Anterior Poliomyelitis, Ophthalmia Neonatorum, Glanders, Hydrophobia, Tuberculosis, Acute Primary and Influenzal Pneumonia, Encephalitis Lethargica, Malaria, Dysentery, Trench Fever. The outstanding features in the history of infectious disease in Camberwell since 1921 have been the prevalence of scarlet fever and diphtheria and the serious increase in the diseases of the central nervous system—poliomyelitis, polio-encephalitis and encephalitis lethargica. Scarlet fever may now be taken as a disease which is unlikely to end fatally. Within 30 years the case mortality has fallen considerably. Its interference with education and its cost in money and labour still make it desirable for efforts to be made to render the population immune to this disease. During the last five years diphtheria has been very prevalent in Camberwell. In 1919 there were 453 notifications of this disease, and in the following year this number was almost doubled. In 1921 there was a small decrease in the number of notifications, and during the following three years the figures have been more or less stationary, but in 1925 there was a marked increase. Nevertheless, one cannot be satisfied with the position in relation to diphtheria as it stands to-day. Diphtheria is still the most destructive of the infectious diseases. The introduction of anti-toxin treatment in 1894 resulted in a large reduction in case mortality, but the death rate of patients still remains high. The probable explanation of the increased number of notifications received last year was due to the facilities offered for the bacteriological examination of swabs, resulting in a number of cases being notified although the clinical signs of the disease were not present. Small Pox. Although there has been a relatively high prevalence of this disease in the Midlands and the North of England of recent years, Camberwell has been extremely fortunate in having only one case, which occurred in 1923. The patient in question was employed at an hotel in London, and contracted the disease whilst looking after a case of undiagnosed small-pox. Fortunately, no contacts in the Borough contracted the disease. A number of patients with a rash or symptoms suggestive of the possibility of small-pox have been seen in past years, in consultation with medical practitioners, but in every case they were found to be suffering from maladies other than small-pox. Information has also been received from time to time of the arrival in this Borough of contacts of cases that have occurred on hoard ships and also of passengers who had arrived from infected ports. These were kept under observation daily until the incubation period had passed. The danger of a serious epidemic of this disease occurring in England is always possible, due to the absence of systematic vaccination, and until the people of this country realise the value of vaccination there will always remain a large section of the community susceptible. It is only by the vigilance of the medical profession that an epidemic on a large scale has not occurred. Diphtheria. The number of cases of this disease notified during 1925 was 934. Of these 907 were admitted to hospitals. This is an increase of 103 in the number notified during 1924. 27 cases were returned from hospitals of the Metropolitan Asylums Board certified as not suffering from diphtheria. The deaths numbered 40. There were 87 secondary cases. The ages groups which claimed the greatest number of cases were Ito 5 and 5 to 15. Of the 189 children notified between the ages of 3 and 5, 67 were attending schools. The following table records the number of notifications and the deaths from diphtheria during the past five years:— Number of Notifications. Number of Deaths. Year. 1921 875 64 1922 821 63 1923 875 72 1924 831 42 1925 934 40 There were two "return" cases during 1925 as follows: — Date Discharged. Total days in Hospital. Onset of Secondary case. Date admitted to Hospital. Remarks on Primary case. 10/1/25 17/3/25 67 20/3/25 - 57 11/2/25 8/4/25 23/4/25 Sores on face and round mouth. A "return" case may be defined as one which occurs within 28 days after the release of the original case from isolation. The persistence or recurrence of mucous discharges from the nose or ears of the original case is the cause of the spread of the infection. To avoid the probability of return cases occurring, the women Inspectors visit the homes of the patients discharged from hospital and strongly advise, where possible, that he should have a bedroom to himself for a few weeks. Warning is also given that should any discharge of the nose or ears occur a doctor's advice and treatment should be obtained. An outbreak of diphtheria occurred in an Institution under the care of the Camberwell Board of Guardians at the end of 1925, 13 cases being notified. The cause of the outbreak was traced to a carrier of virulent germs of diphtheria. Although bacteriology is a valuable aid in diagnosing this disease, there are many factors which may cause the result of the swab not to be satisfactory. It cannot be emphasised too strongly that a negative bacteriological report does not contraindicate a clinical diagnosis of diphtheria. Conversely, the presence of morphological diphtheria bacilli does not necessarily imply clinical diphtheria, as the bacilli, although morphologically K.L.B., may not be of a virulent strain, and contribute no menace to the public health. Far more important from the patient's point of view than the swabbing of the throat is the giving of antitoxin in every suspicious and clinical case. The routine swabbing of contacts for the discovery of "carrier" cases is carried out in Camberwell only amongst such families where the spread of the disease is suspected to be due to a "carrier." It is necessary to discriminate between the dangerous carrier of virulent bacilli and the harmless bearer of non-virulent organisms, which can only be done in the laboratory by tests on guineapigs. The segregation of the virulent carrier is, in my opinion, necessary. On the other hand, care should be taken for the prevention of persons harbouring non-virulent organisms being sent to hospital. It is possible that many such cases are notified as diphtheria and are sent to hospital, thus occupying valuable beds needed for more serious cases, and incidentally, of course, falsifying the statistics of the disease. Fortunately, in London, notification and removal to hospital follow immediately in the majority of cases in which diphtheria is suspected. Prophylaxis of Diphtheria. The usual administrative measures in dealing with epidemics of this disease have not in the past given satisfactory results. Consequently, the work of Schick and others in determining the susceptibility of individuals to diphtheria and immunisation of positive reactors with toxin, antitoxin or with toxoid antitoxin solutions is being watched very carefully. No attempt has yet been made to inaugurate this method of protection in the Borough, although favourable results have been received in places where artificial immunisation has been practised. The medical profession as a whole are becoming more convinced that the Schick test does distinguish between the susceptible and the immune, that the process of immunisation does render the susceptible immune, and that this immunity is of sufficient duration to be of real value, and that the whole process is free from risk. Next comes the greater difficulty of persuading the public to accept the introduction of this new principle. Objections are sure to be raised, especially in a community where there is already an extreme feeling against vaccination. Nevertheless, many mothers who know of the danger of their children contracting diphtheria, and who live in dread of such an event happening, would welcome an opportunity of making their offspring immune by inoculation. lam convinced of the necessity for the provision of facilities for immunisation against diphtheria, and as children under five years of age are very susceptible to this disease a commencement might be made with those in this age group. At the same time an intensive propaganda campaign should be started as to the value of diphtheria prevention by this means. Diphtheria Antitoxin. Phials, containing 500 units for prophylactic and 8,000 units for treatment purposes, are available free of charge on application by Medical Practitioners during the day, between the hours of 9 a.m. and 5 p.m., at the Public Health Department, 35, Brunswick Square, S.E. 5, and at the Dulwich Baths, East Dulwich Road, S.E. 22, and at all hours, day and night, at the Camberwell Town Hall, Peckham Eoad, S.E. 5. In 1922 a circular was sent to all medical practitioners of the Borough emphasising the value of antitoxin, and pointing out that the earlier antitoxin is given in a case of diphtheria the better the chance of recovery. In 1925, 36 phials for prophylactic and 87 phials for treatment purposes were issued. Typhoid and Paratyphoid Fevers. It speaks well of the hygiene of this country, and of London in particular, that so few cases of this disease occur. The action taken in tracing the source of infection and the careful guarding against contaminated water and food supplies has helped to bring about this satisfactory state of affairs. There still remains, however, the less easily controlled factor, viz., the carrier of the disease, particularly where the individual who, unknowingly, has suffered from a mild attack of the disease is engaged in the preparation or handling of food. The number of notifications received during 1925 was 15. Of these, 13 were removed to hospitals. There were no deaths. There were no instances of more than one case occurring in the same house. The following table shows the number of notifications received, the number removed to hospitals and the total deaths from this cause since 1921:— Number of deaths. Number of Notifications. Removed to hospital. Year. 1921 19 15 5 1922 11 8 4 1923 10 9 3 1924 10 8 2 1925 15 13 Nil Scarlet Fever. General Prevalence, 1921-25. In the autumn of 1920 a large increase in the number of scarlet fever cases occurred in Camberwell. This prevalence was not confined to any one part of the Borough. During 1921 an even greater number of cases was brought to this Department's notice, and this number has only been exceeded once since scarlet fever became compulsorily notifiable in Camberwell. Various reasons were attributed as to the causes of this epidemic, the exceptionally dry summers of 1920 and 1921, and the increased prevalence of fleas on school children. The probable explanation was the presence of a large number of susceptible children who had accumulated since the last outbreak in 1913. To what extent undiagnosed eases played a part in transmitting this disease is not known, but there is reason to believe that in this outbreak the total amount of infection existing was not brought into control. 1,083 cases were notified in 1922, a fall of 876 cases as compared with the previous year. There were, however, more deaths in that year than in 1921, the numbers being 22 as against 19. In 1923 a marked decline in the number of cases occurred, less than half the number being notified than in the previous year. This decline was not continued, however, during 1924, there being an increase of 78 notifications on the recorded figure of 520 for 1923. In 1925 the number of notifications increased to 927, but 32 of these cases were returned from hospital certified as not suffering from scarlet fever. Scarlet Fever. Preventive Aspect. Research work in connection with scarlet fever prosecuted during the last five years has been of great importance and promises profitable rewards to the Public Health Administrator and the Clinician. Doctors George and Gladys Dick have advanced the view that a particular variety of streptococcus causes scarlet fever, that the symptoms of this disease are produced by the toxin of this germ, and that the tissue cells of the recovering patient provide a protective antitoxin, also that scarlet fever may be produced by experimental inoculation with haemolytic streptococci and cured with an antitoxin serum. But far more important, from the preventive medicine aspect, is the claim regarding the test for detecting susceptibility to the disease and the possibility of immunisation with scarlet fever toxin. If with wider experience these claims are substantiated, the measures taken for the control of this disease will have to be materially changed. For some time doubts have been raised as to whether isolation in hospital and disinfection have failed in appreciably diminishing the incidence and periodic virulence of scarlet fever, although there can be no argument as to the value of isolation hospitals for the treatment of serious cases and those with complications in comparison with treatment at home. As yet no steps have been taken in Camberwell to make use of the Dick test or to provide facilities for conferring immunisation to those found to be susceptible to this disease. It must be remembered that this work can still be regarded as being in the experimental stage, so that we must wait until the value of the test has been proved conclusively before urging any definite line of action with regard to the measures to be adopted to ensure a more effective control of the occurrence of this disease. Anthrax. Two cases of human anthrax occurred in Camberwell during the past five years. A case was notified in each of the years 1924 and 1925. Investigation of the probable cause of infection revealed that in both cases the patients were employed at a skin dressers. Erysipelas. 119 cases of erysipelas were notified during 1925. Of these 46 were removed to hospitals. The deaths numbered 5. Malaria, Dysentery and Trench Fever. The Public Health (Pneumonia, Malaria, Dysentery, etc.) were doubtless framed, in so far as they relate to malaria, dysentery and trench fever, to provide a greater measure of control of these diseases in order to prevent the spread of the infection amongst the civil population of this country as the result of the demobilisation of troops from the various war areas where serious epidemics had occurred. Reviewing the number of notifications received in Camberwell during the past five years supports the view of those who are responsible for keeping a watchful eye on the health of the people of Great Britain that it was necessary to take these steps to limit the possibility of the spread of infection. The number of notifications shows a steady fall, in the case of malaria from 40 in 1921 to 9 in 1925, and in regard to dysentery from 11 in 1921 to nil last year. There were no cases of trench fever notified during the past five years. Ophthalmia Neonatorum. See under Maternity and Child Welfare Section. Pneumonia. 47 cases of acute influenzal and 85 of acute primary forms of pneumonia were notified during the year. Of these 69 were numbered 305, as compared with 311 during 1924. The deaths by the Council where assistance was sought. Puerperal Fever. There were 11 cases of this disease notified during 1925, and all of them were removed to institutions. The deaths numbered 6. (See also under Maternity and Child Welfare Section.) Tuberculosis. The number of new cases notified during 1925 was 493, excluding duplicates, as compared with 559 for 1924. The deaths numbered 306, as compared with 311 during 1924. The number of deaths of non-notified cases was 69. In each of these cases the medical attendant was asked for an explanation as to the circumstances under which formal notification was not made, but in no case was it found to be due to wilful neglect or refusal to carry out the Public Health (Tuberculosis) Regulations, 1912 and 1921. (See also pages 74-100.) Acute Infections of the Nervous System. Under this heading are described the diseases known as cerebro-spinal meningitis, poliomyelitis and polioencephalitis and encephalitis lethargica. These diseases are notifiable, as they are considered to be infectious. Cerebro-Spinal Meningitis. There was one case of this disease notified in 1925, as compared with 4 in the previous year. The following table gives the number of cases reported and the deaths from this cause during the past five years:- Deaths. Year. Cases. 3 1921 4 2 1 1922 1923 Nil - 4 3 1924 1925 1 Nil Anterior Poliomyelitis and Polioencephalitis. The number of cases of this disease that have been notified during the past five years is as follows: — 1922 1923 1924 1925 1921 4 3 3 4 3 The treatment of this disease demands many months of careful and painstaking work. It has been felt for some time that whereas arrangements can be made without difficulty for the admission of acute cases, better facilities were needed for cases requiring prolonged residential treatment in order to limit the possibility of permanent crippling and physical deformity. At the end of 1924 the Ministry of Health issued a circular on the subject of the early diagnosis and treatment of cases of poliomyelitis among children, and in the early part of last year arrangements were made by the London County Council with the Metropolitan Asylums Board for beds to be set aside at the Queen Mary's Hospital, Carshalton, for the treatment of cases entering upon the second stage of the disease and for cases discharged from hospital after undergoing correctional treatment. During 1925 five Camberwell cases received treatment under this scheme. Encephalitis Lethargica. This disease was made compulsorily notifiable in 1919. The following table gives the notifications received and the deaths recorded for the period 1921-1925: — Year. Notified Cases. Cases Removed. Deaths. 12 9 1921 - 1 - 1922 1 2 1923 3 2 16 3 1924 31 1925 4 4 16 The figures in the above table may not reflect the real incidence of the disease, nor can they be taken as a true estimate 65 64 TABLE OP NOTIFIABLE INFECTIOUS DISEASES, 1925. Notifications and Deaths. Age Distributions.— Total Cases Notified. Admitted to Hospital. 45 to 65. 65 and upwards Total Deaths. 5 to 10. 15 to 20. 35 to 45. Disease, 1 to 2. 3 to 4. 4 to 5. 10 to 15. 120 to 35. Under 1. 2 to 3. Deaths. Deaths. Deaths. Notifications. Deaths. Deaths. Notifications. Notifications. Deaths. Notifications. Deaths. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Deaths. Deaths. Deaths. Deaths. Deaths. - - - - - - - - - - - - - - - - - - - Small Pox - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera, Plague - - - - - - - - - 84 105 8 322 11 143 4 57 2 64 1 11 2 4 - - - - 934 907 40 26 4 43 1 78 5 Diphtheria and Croup 45 33 9 1 89 3 133 2 383 1 152 1 841 24 - - - - - - 9271 13 10 1 2 48 3 3 Scarlet Fever 3 1 3 3 2 - - - - - - - - - 13 - - - 1 Enteric Fever 15 - - - - - - - 9 4 1 1 1 - - 11 6 - - - - - - - - - - Puerperal Fever 11 - - - - 1 2 1 - - 1 1 2 6 3 6 2 7 6 13 7 30 - - - - Acute Influenzal 47 12 1 Pneumonia - - - - - 6 4 14 4 3 5 10 6 4 - - - - - - - - - 85 39 5 14 10 Acute Primary - - - - - 7 15 19 40 2 18 3 5 8 - - 1 2 3 2 - - - - - - 119 46 - Erysipelas - - 1 - - - - - - - - - - - - - - - - - 1 1 - 1 Cerebro spinal Meningitis - - - - - - 1 1 1 - - - - - - - - - - - - 4 - 1 - - Poliomyelitis - - - - - - 7 1 1 - - 9 1 - - - - - - - - - - - - - Malaria TV - - - - - - - - - - - - - - - - - - - - - - - - - 1 Dysentery - - - - - - - - - 3 1 1 1 4 3 3 1 - - - - - 16 12 4 1 - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - - - - - - Typhus Fever - - - - - - - - - - - - - - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - 6 24 - - - - - - - - - - - - - - Ophthalmia Neonatorum 24 - - - - - - - 1 - - - - - - - - - - - - - - - - 1 1 Anthrax - - - - - - - -- - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - 56 8 Tuberculosis:— 1 2 2 7 4 27 12 75 56 53 29 47 5 - - - M. 220 365 158 17 Pulmonary - - - - - - 2 4 1 24 16 72 47 28 15 16 4 4 F. 149 180 102 1 - - - - - - - - - - 5 51 72 64 12 1 2 4 11 28 147 103 81 44 9 - - - Total 375 545 260 - 1 - - - - 5 - 4 1 8 3 6 2 1 3 - 1 17 8 2 10 5 Non-Pulmonary 65 2l\ 3 2 - M. 67 4 4 - - 3 1 1 14 3 8 X 3 1 8 2 4 3 2 2 - - I F. 51 55 23 3 6 2 3 3 1 2 - 2 11 7 1 6 - 1 31 16 3 18 5 10 8 4 6 6 5 - Total 118 120 45 10 3 1 of the number of deaths that occurred among persons attacked by encephalitis. Owing to the difficulty of diagnosing this disease it is probable that notification is often delayed for some time after the actual attack, and that many mild and abortive cases escape notification altogether. Although encephalitis lethargica is regarded as infectious, the degree of infectivity seems to be very slight. As yet, in no house in this Borough has more than one case occurred, and it has not been possible to trace any contact between any two cases. The conveyance of infection from one person to another is attributed to carriers. At the same time it is desirable to impress that association with an infected person should be limited, and that the patient should be removed to hospital or isolated until recovery is made. As the disease frequently runs a long and slow course and the after effects are of such a serious nature, involving crippling and mental impairment, it has been the custom for all cases to be followed up and kept under observation. Information was received in 1925 from the London County Council that suitable cases of post encephalitis lethargica could be sent to the Metropolitan Asylums Board Hospital, Winchmore Hill. Cases will only be admitted up to 15 years of age. This is a step in the right direction, and an early extension of the arrangements to take suitable cases at all ages is highly desirable. Measles. This disease is not notifiable in Camberwell, consequently this Department has to depend on the Schools' returns of absentees, information from Health Visitors and other agencies for information as to cases. In view of the dangerous complications which are liable to follow neglected cases of measles, all known cases are visited by the Women Inspectors, and the parents advised as to the necessity of seeking the assistance of a doctor. Isolation, as far as possible, is insisted on, and, when necessary, the services of a district nurse are provided. Many cases, whose living conditions do not allow of satisfactory treatment at home, are removed to the Metropolitan Asylums Board hospitals on the certificate of the Medical Officer of Health. A conference was held in 1921 between the London County Council and the representatives of the Metropolian Borough Councils for the purpose of considering the' better control of measles in London. Resolutions were passed for the purpose of making more effective the existing powers with regard to the control of this disease, the chief of which was the compulsory notification and the provision of nursing services. In 1924 this Council considered the question of making measles notifiable, but decided that it was not desirable to follow this course. It was resolved, however, to leave a card containing information on what to do in the event of measles occurring in the home at every house from which a notification of birth was received. On the reverse side of this card similar hints are given concerning whooping cough. In 1925, 1,557 cases of measles were visited by the women Sanitary Inspectors. The deaths numbered 15, as compared with 72 recorded for the previous year. Influenza. A severe epidemic of influenza occurred at the end of 1921, and was responsible for 158 deaths during the following year. The highest mortality occurred in the ages groups 45-65 and 65 and upwards, although 38 deaths were recorded between the ages of 20 to 45. In the following year the number of deaths fell to 25, and in 1924 the deaths attributed to this cause was 46, and last year they numbered 41. All known cases were visited by the Sanitary Inspectors, who advised as to isolation, disinfection, etc. Nursing assistance was provided in all cases where the necessity arose. Pneumonia continues to be one of the most fatal illnesses. No age group is immune to the disease. Public Health measures seem to have had little effect in preventing the dissemination of infection, and it would appear that the only hope of reducing the mortality from this cause is by the prompt removal of those cases to hospital where the home surroundings are unfavourable for proper nursing attention. Diarrhoea and Enteritis. Much has been done in recent years by the issue of pamphlets, posters and other means to direct public attention to the dangers of neglect of the elementary rules of hygiene in relation to the general health of the people. In particular, the prevention of summer diarrhoea in children has specially received attention. In 1921 the Ministry of Health issued a Circular to Local Authorities on the prevention of epidemic diarrhoea, in which was urged the importance of attention to domestic cleanliness, frequent removal of refuse and excreta, the careful storage of food, the destruction of flies and the clearance of their haunts. It is true that the most favourable material for the hatching of flies' eggs has been greatly lessened by the gradual passing away of horse traffic in E 2 the London streets, but, generally speaking, it may be said that, the improvement to be noticed in the mortality rates from summer diarrhoea has been due to individual instruction by the Health Visitors and Sanitary Inspectors, and the issue of pamphlets drawing attention to the importance of safeguarding young children from the likely sources of infection. The following table is of interest, as it provides the best evidence of the result of the work of the various health agencies who have been, and continue to be, ceaseless in their efforts to prevent the mortality in young children from this cause:— Deaths From Diarrhoea. Mortality per 1,000 Births. Year. Deaths under 1 year. 1921 85 13.4 1922 31 5.3 1923 41 7.2 8.5 1924 44 5.7 1925 28 Public Health (Small-Pox Prevention) Regulations, 1917. In accordance with the request of the Ministry of Health the following particulars in regard to the number of vaccinations performed by the Medical Officer of Health during the past five years are included:- Primary. Secondary. Nil Nil. 14 BACTERIOLOGY. The bacteriological work of the Borough had been carried out by Dr.E.C. Bousfield from 1898 up to the time of his death in 1921, when the work was transferred under the terms of an Agreement to the Pathological Department at King's College Hospital, Denmark Hill. In 1924 the agreement was terminated, and fresh arrangements were made for the work to be done at the Camberwell Board of Guardians, St. Giles' Hospital, Brunswick Square, S.E,, where it continues to be carried out. The nature and extent of the bacteriological examination work performed on behalf of the medical practitioners of Camberwell may be understood on reference to the subjoined report of the Pathologist at the Hospital, Dr. G. Bousfield, which sets out in detail the number of specimens submitted during the year 1925. St. Giles' Hospital, S.E.5. Annual Report on Bacteriological Examinations. January 1st, 1925, to December 31st, 1925, inclusive. The number of examinations undertaken during the past year was 5,674, as compared with 4,179 during the previous twelve months. This represents an increase of 1,495 specimens, or 35.6 per cent. This has naturally thrown a considerable strain on the laboratory at times, and will necessitate the consideration of the question of increasing our staff if the same amount of work comes in. The analysis of specimens gives the following results: — Diphtheria examinations 3,002 Percentage positive 15.6 Sputum examinations 2,621 Percentage positive 14.7 Widal blood tests 10 Percentage positive 20.0 Other special tests 41 Total examinations 5,674 The section entitled "other" specimens includes the bacteriological examination of a number of samples of Grade "A" and Certified Milk, under the Milk (Special Designations) Order, 1922. G. BOUSFIELD, Borough Bacteriologist. There has been in past years an ever-increasing demand for bacteriological examinations, and the more that general practitioners can depend on the results furnished, so will the demand continue to increase. The number of diphtheria specimens examined last year is convincing of the importance of bacteriological reports for the detection of cases. More than 1,000 specimens in excess of the number dealt with last year were sent for examination by medical practitioners. The increase is probably due in some measure to the tendency at the present day to swab all sore throats and even those which are clinically diphtheritic. In the course of tracing a carrier who is transmitting the disease nasal and throat swabs may have to be taken on more than one occasion. It is known that virulent diphtheria bacilli may be present in large numbers in the throat and nose of an individual without there being any clinical symptoms of the disease present. It can be understood that cases of this type are a distinct menace to the health of the community as a whole, and it requires no further comment to demonstrate the importance of the adoption of such means as swabbing to prevent the spread of this disease until the population appreciate the value of securing immunisation from diphtheria. The London County Council doctors also do a considerable amount of swabbing at the elementary schools, and any child harbouring suspicious organisms is reported, and the home address is visited by the Sanitary Inspector for the purpose of advising medical treatment and segregation. During 1925 the number of swabs taken in the Public Health Department was 134. Of these 13 were positive. DISINFECTION. The disinfecting and cleansing stations are situated at the Peckham Park Road Depot. Two steam disinfectors are installed in the disinfecting station. Bedding, clothing, etc., are disinfected by exposure to steam, under a pressure varying between 10 and 12 lbs., for twenty minutes. Vapour is used for the disinfection of leather, furs and other articles which cannot be exposed to high temperatures. Rooms which have been exposed to infection are disinfected by a spraying apparatus with formalir at 3 per cent. Verminous rooms are disinfected by spraying with eucryl at a strength of one in 50. Disinfection of Library Boohs. —Books which are found in a house where there has been a case of infectious disease are collected, disinfected by formalin vapour and returned to their respective owners. The work done by the Disinfecting and Cleansing Station Staffs during the past year is set out in the tables which appear on pages 72 and 73. The Cleansing Station consists of a reception room, bath room, with two baths, and a treatment room, and is used for dealing with verminous conditions in children and adults. The London County Council has an arrangement with this Authority for the cleansing of school children affected with vermin and scabies. The homes of the children cleansed are visited and the bedding and rooms are disinfected where necessary. DISINFECTING DEPARTMENT. RETURN OF WORK, 1925. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Articles Disinfected. 133 96 Beds 129 107 118 87 96 114 128 491 613 515 440 544 477 777 625 Blankets 505 Bolsters 99 67 89 80 67 92 107 64 94 25 Books, Public Library 50 39 37 62 40 22 13 - 32 46 18 23 34 36 23 7 Cushions 40 2 Carpets 9 9 5 1 - - - - 71 73 Mattresses 66 73 69 67 73 146 66 4 1 2 2 4 Palliasses - - - - 292 313 259 240 324 195 235 Pillows 306 258 Quilts 154 146 112 139 116 141 141 86 117 181 187 149 145 135 175 224 135 184 Sheets Wearing apparel (suits, dresses, etc.) 2,255 2,550 2,105 2,735 1,027 2,821 2,179 835 2,759 7 21 Curtains (pairs) - - - - 1 - - 3,535 4,275 2,419 3,466 4,300 2,400 Total 4,066 3,744 4,229 66 67 71 69 67 71 73 50 62 Mattresses re-tabbed 1 2 Palliasses re-tabbed - - - - - - - Cushions re-tabbed 21 25 3 6 24 15 6 - - 71 87 92 72 74 97 56 Total 88 62 124 Mattresses and Palliasses destroyed 84 244 109 105 203 218 165 148 Miscellaneous articles destroyed 22 533 2 8 6 113 4 - - 109 132 617 107 Total 266 209 331 165 152 375 395 Houses visited 435 323 402 499 439 377 368 270 244 244 Rooms disinfected 300 281 256 275 376 283 735 593 631 677 875 660 Total 676 612 686 May. Sept. Nov. Dec. Total. Feb. Mar. Apr. July. Aug. Oct. Jan. June. Persons cleansed, Verminous:— 13 4 3 2 62 5 2 5 6 5 2 7 8 Adults—Males - 1 1 - - - Females - - - - - - - 3 11 9 13 99 Children —Males 8 5 3 6 13 11 6 11 194 220 182 67 292 274 271 2,798 Females 188 285 244 297 284 Personscleansed, scabies:— 3 4 1 1 10 Adults —Males 1 - - - - - - - Females - - - - - - - - 58 - - - - - 15 307 38 7 25 26 10 Children —Males ... 44 33 14 37 - 29 11 219 39 26 21 14 15 3 28 28 Females 15 - Verminous rooms disinfected 3 115 3 2 - 22 27 15 13 19 10 1 - 2 1 54 Verminous bedding disinfected 10 6 3 1 4 9 5 3 10 - 73 TUBERCULOSIS. The Camberwell Tuberculosis Dispensary, situated at 19, Brunswick Square, came under the control of the Borough Council in April, 1921. Prior to that date it was directed by a voluntary organisation. The advantages which have resulted from the change-over cannot be emphasised too strongly. Indeed, the efficiency of the present organisation, the increased co-operation with the general practitioners and hospitals serving the Borough, the linking up with the various bodies responsible for residential schemes and the after-care work for dealing with tuberculosis, constitute broadly the aims for securing the diagnosis and treatment of every case of tuberculosis in the Borough and the prevention of the spread of the disease. A review of the work of the Tuberculosis Dispensary for the year 1925, by the Tuberculosis Medical Officer, Dr. W. Brand, to whom I am indebted for this section of the report on the health of the Borough, follows in the succeeding pages. The report covers the requirements of the Ministry of Health as laid down in their Circular No.648. It should be recorded, however, that no action was taken during the year under the Public Health (Prevention of Tuberculosis) Regulations, 1925, relating to tuberculous employes in the milk trade. REPORT OF THE TUBERCULOSIS MEDICAL OFFICER FOR THE YEAR 1925. The Current List of Notifications of Tuberculosis in Camberwell as at December 31st,1925. On December 31st, 1925, there were 2,891 cases of tuberculosis on the current list in Camberwell. There were 2,071 cases of pulmonary tuberculosis-1,180 males and 891 females —and 820 cases of non-pulmonary tuberculosis—439 males and 381 females. Table I supplies an analysis under age periods, sex, and the broad grouping of pulmonary and non-pulmonary forms. Table II indicates the number of cases in each Ward of the Borough. To record the number of cases according to streets, although of interest, would occupy too much space in the Report. TABLE I. Individual Notified Patients on Current List, December 31st, 1925. 1 to 5 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total. Age Periods. 0 to 1 5 to 10 - 75 1,180 14 106 307 2 46 132 273 193 32 Pulmonary Males 891 Pulmonary Females 11 39 224 195 101 60 18 - 1 118 124 439 Non-Pulmonary Males 63 112 46 26 14 23 123 24 5 - 3 87 88 47 23 13 4 1 381 „ Females 1 17 48 52 TABLE II. Individual Notified Patients on Current List at 31st December, 1925, ALLOCATED TO THE WARDS OF THE BOROUGH. Pulmonary Non-Pulmonary Grand Total. Wards. Males. Females. Total. Males. Females. Total. 73 129 35 38 286 1 84 213 155 54 103 24 28 52 2 49 29 76 60 29 58 194 3 136 217 4 66 35 27 62 89 155 5 55 142 40 30 70 212 87 23 100 38 138 6 56 44 15 7 40 37 77 284 107 100 207 28 67 8 72 160 39 227 88 40 72 84 46 130 32 202 9 27 35 32 15 12 94 10 67 18 31 11 37 29 66 13 97 27 12 44 86 13 14 113 42 11 17 13 37 31 68 6 85 14 11 25 90 14 41 24 65 29 8 4 12 66 15 25 54 40 96 12 27 123 16 56 15 26 38 64 21 40 104 17 19 18 63 41 104 15 18 33 137 10 55 19 27 18 45 5 5 1 20 5 5 10 1 2 12 The Notification of Tuberculosis in Camberwell in 1925. The number of Primary Notifications of Tuberculosis in Camberwell in 1925 was 491. 373 were cases of pulmonary tuberculosis and 118 were cases of non-pulmonary tuberculosis. On Table III the number of Primary Notifications for each of the last five years are compared. A steady fall in the numbers can be noted. TABLE III (CAMBERWELL). Other Forms. Year. All Forms. Pulmonary Tuberculosis. 155 1921 750 595 506 147 1922 653 657 505 152 1923 559 416 143 1924 1925 491 373 118 On Table IV the number of primary notifications for the years 1916 and 1925 are compared. The reduction during the decade is noteworthy. TABLE IV (CAMBERWELL). Year. All Forms. Pulmonary Tuberculosis. Other Forms. 321 1916 929 608 491 373 118 1925 On Table V is given the primary notification rate (per 1,000 population of Camberwell) for the last five years. TABLE V. Other Forms. Pulmonary Tuberculosis. All Forms. Year. Population. 1921 267,198* 2.80 2.22 0.58 270,300a 2.41 1.87 0.54 1922 0.55 1923 2.40 1.85 272,300a 1924 273,700a 2.04 1.52 0.52 0.42 1925 275,400a 1.78 1.35 a Estimated. * Census, 1921. On Table VI the summary of notifications for the year 1925 is treated in more detail. TABLE VI. Summary or Notifications during the Period from January 4th, 1925, to January 2nd, 1926. Notifications on Form C. Notifications on Form A. Notifications on Form B. Poor Law Institutions. Sanatoria. Total Notifications on Form B. Total Notifications on Form A. Number of Primary Notifications. Number of Primary Notifications. Under 5 6-10 10-15 Total Primary Notifications. Total Primary Notifications. 65 and upwards. 15-20 20-25 1-5 5-10 10-15 25-35 35-45 45-55 55-65 0-1 142 223 27 28 47 52 32 24 4 224 324 - 1 2 7 - - - - - 28 12 4 4 149 210 99 81 1 4 24 36 36 - - - - - - - 51 4 6 6 3 2 67 84 14 3 10 17 8 8 - - - - - - 1 1 15 40 3 2 6 4 1 1 51 69 1 3 9 14 8 - - - On Table VII the primary notifications of 1925 are allocated to the Wards of the Borough. TABLE VII. Primary Notifications of 1925 Allocated to the Wards of the Borough. Pulmonary. Non-Pulmonary. Grand Total. Wards. Males. Females. Males. Females. Total. Total. 1 21 30 4 6 40 9 10 14 13 4 9 36 2 27 5 8 18 3 2 5 23 3 10 4 16 29 3 7 4 13 36 5 8 27 9 4 13 40 19 3 6 19 2 18 3 6 24 12 7 16 11 27 3 9 39 11 25 14 9 4 13 38 8 26 30 9 21 5 1 3 4 13 - - 13 10 10 3 - 22 7 31 11 13 9 2 9 11 23 1 1 24 12 12 - 9 - 2 11 13 4 5 2 6 6 4 10 3 3 16 14 15 5 10 2 6 16 5 4 21 16 8 15 5 1 6 7 6 17 9 4 13 2 4 19 1 18 18 11 6 17 1 - 3 1 11 19 5 8 2 3 5 6 - - 20 1 - 6 Table VIII. Supplemental Return. New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during 1925 otherwise than by notification on Form A. or on Form B. under the Public Health (Tuberculosis) Regulations, 1912. The information is obtained from the certificates of death and from irregular notifications made after death. TABLE VIII. Supplemental Return fob the Year 1925. 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Totals. Age Periods. 0 to 1 1 to 5 5 to 10 10 to 15 Pulmonary Males - - 2 4 4 7 5 4 30 3 - 1 - 1 3 1 4 1 1 2 19 Pulmonary Females 2 4 - - Non-Pulmonary Males 1 - - 1 2 1 8 - - - 3 1 „ Females 6 3 1 - 1 - - - 12 - - On Table IX the supplemental returns for 1925 are allocated to the Wards of the Borough. TABLE IX. Wards. Pulmonary Non- Pulmonary Grand Total. Males. Females. Total. Males. Total. Females. 6 1 1 7 1 4 2 - 2 2 1 2 4 1 - 2 1 2 3 2 3 1 - - 1 1 3 3 4 4 - - 5 2 2 - 2 - - - 6 1 2 3 - - 3 - 1 1 2 7 - 2 4 2 1 3 4 7 8 2 3 1 1 9 3 1 4 3 - - 1 1 1 10 - - - - 11 1 1 - - - 1 - 1 2 1 1 12 1 - 3 - - - 13 - - - - 7 14 3 6 1 1 3 - 1 2 3 3 15 - - - 1 4 16 1 2 3 1 - 1 5 17 3 1 4 - 1 18 3 3 2 2 5 - - 1 19 1 1 - - - - 20 1 1 - 1 - - - There is one Pulmonary Female whose address is given as Camberwell. Is the number of cases of tuberculosis brought for the first time to the notice of the Medical Officer of Health on the certificate of death or by irregular notification after death diminishing? The answer is given on Table X. TABLE X. Number of cases of Tuberculosis discovered by the Public Health Department after death. Year. 1921 88 1922 83 1923 73 1924 69 1925 69 In 1925, as compared with 1921, there is an absolute reduction of 19 in the number of cases of tuberculosis made known for the first time after death. The reduction has gradually been made year by year during the hemi-decade. Compared with the total number of deaths from tuberculosis, however, the percentage 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and upwards Totals. Age Periods. Under 1 1-2 2-3 3-4 29 158 - - - 2 12 56 47 8 - - 4 Pulmonary—Males 15 4 - - 2 1 - 16 17 47 102 - - „ Females 1 - - 1 2 22 4 - - 4 2 3 5 Non-Pulmonary—Males 2 1 3 1 1 - 1 - 2 3 23 6 „ Females 3 80 reduction is only 2. In 1921, 25 per cent, of the deaths from tuberculosis in Camberwell were not notified before death. In 1925, 23 per cent, were not notified before death. Deaths from Tuberculosis (Camberwell) in 1925. The number of deaths from tuberculosis in Camberwell during 1925 was 305. Of these 260 were from pulmonary tuberculosis and 45 from other forms of the disease. 69 cases were not notified during life as suffering from the tuberculosis of which they died. On Table XI the deaths from tuberculosis (Camberwell) during 1925 are detailed under sex, age periods, and broad sub-divisions of the disease. On Table XII the deaths from tuberculosis (Camberwell) during 1925 are allocated to the Wards in the Borough. TABLE XII. Deaths from Tuberculosis, 1925, allocated to the Wards of the Borough. Wards. Pulmonary. Non-Pulmonary. Grand Total. Males. Females. Total. Males. Females. Total. 1 4 10 4 20 6 - 16 18 2 7 7 14 2 4 2 3 6 4 10 - - 10 - 4 6 7 13 3 4 17 1 2 5 2 18 2 4 22 16 6 7 5 12 - - 12 - 7 8 17 9 1 3 20 2 8 19 10 9 5 1 6 25 9 21 1 30 5 4 26 3 4 1 - 8 10 3 7 1 14 11 4 8 1 2 2 12 6 12 6 12 1 1 13 - 4 1 13 5 - 2 2 7 14 5 1 1 2 17 11 4 1 10 15 5 3 8 1 2 16 7 6 2 2 15 13 - 17 9 - 2 2 16 5 14 18 7 7 14 2 2 16 - 19 9 2 11 11 - - - 3 20 1 2 3 - - - One homeless Pulmonary Female not included in above table. Table XIII. Showing the number of deaths from tuberculosis during the last five years allocated to the Wards of the Borough. F 81 TABLE XIII. Deaths. Number of Wards. Total of 5 years. Population of Wards (*). 1921. 1922. 1923. 1924. 1925. 1 22 31 18 13 20 104 15,918 2 17 24 27 25 18 111 14,863 3 21 27 19 12 10 89 14,638 4 35 22 13 25 17 112 17,071 5 21 25 22 26 22 116 16,592 6 15 20 12 79 13,655 18 14 7 25 29 28 17 20 119 16,702 8 22 26 16 20 25 109 16,026 9 24 13 29 24 30 120 16,738 10 18 7 7 8 8 48 9,252 11 21 11 16 15 14 77 11,790 12 17 19 7 13 13 69 14,457 13 19 11 11 9 7 57 10,990 14 12 8 19 15 17 71 11,042 15 13 12 7 21 10 63 12,500 16 21 15 16 17 17 86 15,014 17 10 12 6 14 16 58 15,092 18 12 15 13 12 16 68 16,523 19 5 8 5 11 34 12,510 5 15 20 1 3 4 4 3 4,027 Homeless eases not included. *Estimated population, 1925. Deaths from Tuberculous Meningitis in Camberwell. It will be noted from Table XIV that the deaths from tuberculous meningitis in Camberwell have been decreasing in number since 1921. The decrease has been steady each year. In 1921 there were 34 deaths from tuberculous meningitis in the Borough, or 1.3 per ten thousand of the population (Census 1921). In 1925 there were 18 deaths from tuberculous meningitis in the Borough, or 0.65 per ten thousand of the estimated population of that year. It is a point of interest that of 18 deaths from tuberculous meningitis in 1925 in only one case did our investigations or the Notification Register show any contact infection of human source, either in the family or in a house shared by more than one family. It is generally accepted that most cases of tuberculous meningitis are caused by the human type of tubercle bacillus, and that a minority, perhaps round about 18 per cent., are caused by the bovine bacillus. The figures of 1925 are small in number, and no one would base any definite conclusions on them. The figures of the last five years, however, give support to the hope that the sources of infection by tubercle bacilli, which are so destructive to very young children in the form of generalised tuberculosis, are less numerous or less virulent in our midst. 82*** TABLE XIV. Deaths feom Tuberculous Meningitis (Cambekwell), 1921-1925. Age Periods. Sex. Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 65 and over. 35-45 45-65 Totals. M. and F. 1 1 21 M. 4 1 1 4 5 - - - 4 - 1 13 1 1 1 2 F. 5 2 - - - - - 3 1 1 1 18 M. 5 1 2 - - - 4 - 1 10 F. 1 1 2 1 - - - 3 1 - - 11 1 2 1 1 F. 4 2 - - - - - - 1 3 2 11 F. 2 1 1 1 - - - - - 1 2 2 1 12 1 1 1 - M. 3 - - - 1 8 F. 1 1 3 1 1 - - - - - - 2 1 1 2 1 8 1 - - M. - - - - 10 F. 5 2 1 2 - - - - - - - - 3 M 70 23 13 6 7 3 1 Totals 29 20 4 7 6 F. 52 TABLE XV. Non-notified Fatal Cases. All forms of tuberculosis. Proportion of non-notified fatal cases to total number of deaths Pulmonary tuberculosis. Proportion of non-notified fatal cases to total pulmonary deaths Non-pulmonary tuberculosis. Proportion of non-notified fatal cases to total non-pulmonary deaths Proportion of non-notified cases who died in Institutions to total of non-notified fatal cases Proportion of non-notified cases who died at home to total of non-notified fatal cases 1923 Per cent. 24 16 64 74 26 1925 1924 Per cent. 22 Per cent. 23 19 14 44 73 58 75 42 25 Table XVI. Camberwell. The years 1923, 1924 and 1925. Deaths from tuberculosis and the relation of their date to that of notification. TABLE XVI. Year 1923. The total number of deaths from tuberculosis was 305. Not notified or notified after death 73 Notified within one month of death 37 Notified within three months of death 33 Notified within six months of death 44 114 Notified more than six months 118 305 Year 1924. The total number of deaths from tuberculosis was 311. Not notified or notified after death 69 69 Notified within one month of death 33 Notified within three months of death 29 Notified within six months of death 29 91 Notified more than six months 151 311 Year 1925. The total number of deaths from tuberculosis was 305. Not notified or notified after death 6 69 Notified within one month of death 36 Notified within three months of death 27 Notified within six months of death 31 94 Notified more than six months 142 305 - - - 84 TABLE XVII. Showing the Occupation of Males who died from Tuberculosis in 1925. Accountant 2 Baker 3 Barman 1 Billiard marker 1 Bioscope operator 1 Bookbinder 1 Boot repairer 2 Brass finisher 2 Bricklayer 1 Bricklayer's labourer 1 Bus conductor 1 Carman 6 Carpenter 4 Carpet planner 1 Cat's meat man 1 Chauffeur 1 Chef 2 Clerk Civil Service 3 do. Commercial 19 do. Printer's 1 Coach painter 2 Company Director 1 Commercial Traveller 2 Compositor 1 Confectioner 1 Decorator 5 Dock labourer 3 Electrician 1 Engineer 4 Engineer's storekeeper 1 Footman 1 Funeral furnisher 1 Gardener 1 Gas fitter 1 General dealer 1 Glazier 1 Grainer 1 Green grocer 1 Hawker 1 Hotel manager 1 Hotel waiter 2 Ironmonger's assistant 1 Iron moulder 1 Labourer (general) 14 Meat salesman 1 Motor mechanic 2 Musician 1 Newspaper (job hand) 2 No occupation 10 Optician's improver 1 Packer 2 Painter's labourer 1 Plasterer 1 Porter (fish market) 2 Porter (general) - 4 Portmanteau maker 1 Postman 2 Post Office sorter 1 Printer's assistant 8 Railway (shunter) 1 Railway carriage cleaner 2 Railway porter 1 Saddler 1 School children 11 School master 2 Stableman 1 Steeplejack 1 Sto er 1 Stonemason's apprentice 1 Tailor 1 Taxi driver 2 Tin washer 1 Tobacconist 1 Under school age 4 Upholsterer 1 Warehouseman 2 Waste paper merchant 1 Wine cooper 1 Wire frame maker 1 Wood sawyer 1 180 TABLE XVIII. Showing the Occupation of Females who died from Tuberculosis in 1925, Barmaid 1 No occupation 13 Book folder 1 Nurse 3 1 Bottle washer 1 Packer 1 Box maker 2 Perfumery dresser 1 Canvasser 1 School girl 7 Shop assistant 4 Commercial clerk 3 Domestic servant 4 Telephone operator 1 Under school age 11 Embroiderer 1 Not classified 7 Errand girl 1 Housewife 58 125 Librarian 1 Machinist 2 Multigraph operator 1 Institutional (Residential) Treatment of Camberwell Patients in 1925. A. Through the London County Council. 1. Adult Males: — Number of applicants for residential treatment 235 Number who received residential treatment 195 Number who did not receive residential treatment:— Not accepted 10 Failed to enter 14 Awaiting residential treatment at December 31st, 1925 16 Classification of Adult Males who Received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 31 Pulmonary cases in which tubercle bacilli had been found in the sputum 108 Early pulmonary tuberculosis 5 Moderately advanced pulmonary tuberculosis 88 Advanced pulmonary tuberculosis 15 Surgical tuberculosis 13 Diagnosis of tuberculosis 4 Not classified 39 2. Adult Females:— Number of applicants for residential treatment 119 Number who received residential treatment 96 Number who did not receive residential treatment: — Not accepted 10 Failed to enter 10 Awaiting residential treatment at December 31st, 1925 2 Classification of Adult Females who Received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 19 Pulmonary cases in which tubercle bacilli had been found in the sputum 47 Early pulmonary tuberculosis 11 Moderately advanced pulmonary tuberculosis 30 Advanced pulmonary tuberculosis 6 Surgical tuberculosis 9 Diagnosis of tuberculosis 6 Not classified 15 3. Boys:— Number of applicants for residential treatment 22 Number who received residential treatment 21 Number who did not receive residential treatment: — Not accepted - Failed to enter — Awaiting residential treatment at December 31st, 1920 1 Classification of Boys who Received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 3 Pulmonary cases in which tubercle bacilli had been found in the sputum - Early pulmonary tuberculosis - Moderately advanced pulmonary tuberculosis - Advanced pulmonary tuberculosis - Surgical tuberculosis 18 Diagnosis of tuberculosis - Not classified - 4. Girls:— Number of applicants for residential treatment 18 Number who received residential treatment 18 Number who did not receive residential treatment: — Not accepted - Failed to enter - Awaiting residential treatment at December 31st, 1925 - Classification of Girls who Received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 1 Pulmonary cases in which tubercle bacilli had been found in the s p utum 4 Early pulmonary tuberculosis 1 Moderately advanced pulmonary tuberculosis 1 Advanced pulmonary tuberculosis 2 Surgical tuberculosis 12 Diagnosis of tuberculosis1 Not classified - B. Through the Guardians of Camberwell. 221 cases of pulmonary tuberculosis were admitted to St. Giles' Hospital during 1925 for varying periods of treatment. 24 cases of acute miliary tuberculosis were treated in the same hospital during the year. The London County Council used beds in the following institutions for Camberwell patients:- Adults. Hospitals. Sanatoria. Burrow Hill. Brompton. King George V., Godalming. Northern. Frimley, Surrey. Eversfield. Fairlight. St. Luke's, Lowestoft. Holy Cross, Surrey. St. Anthony's, Cheam. Northamptonshire, Creaton. City of London. Liverpool Road. Hermitage, 1.0. W. Grosvenor, Ashford. King George, Bramshott. Hawthorndene, 1.0. W. Colindale. Kelling, Norfolk. Maltings Farm, Suffolk. Pinewood, Berks. National, Benenden, Kent. Adults. Sanatoria (contd.) Homes. Chilton House. Tait. Manchester. Seaview, St. Leonards. Standish House. St. Michael's, Axbridge. Rushden House. St. Barnabas, Torquay. Victoria, Davos, Switzerland. Bishopsbourne, Broadstairs. St. George's, Chelsea. Colonies. Burrow Hill. Papworth, Cambridgeshire. Preston Hall, Kent. Children. Hospitals. Sanatoria and Homes. Highwood, Brentwood. Nay land. Alexandra Hip. Alton, Lord Mayor Treloar. Cheyne. Millfield, Rusting ton. Heatherwood, Ascot. North Devon Children's Princess Mary's, Margate. Brockley Hill. Queen Mary's, Carshalton. Dorset Red Cross, Swanage. The average duration of residential treatment given by the London County Council in 1925 to 291 adults was 15.1 weeks. The average duration of residential treatment given to 40 children by the London County Council in 1925 was 18.6 weeks. This refers only to those who began treatment in that year. Many of these patients will remain in institutions during varying periods of 1926—some will probably remain the whole year. The ultimate averages are therefore to be reckoned as considerably higher. It should also be remembered that a good many patients took their discharge before the completion of treatment, thereby reducing the possible averages. The Work of the Tuberculosis Dispensary for the Year 1925. 1,555 persons were examined for the first time during the year. Of these 1,295 were examined at the Dispensary and 260 at home. 1,532 old patients re-attended, making the total number of persons who attended the Dispensary 3,087—exclusive of those seen at home. Medical practitioners sent 614 new patients for diagnosis or consultation, as compared with 603 in 1924, 698 in 1923, 607 in 1922 and 662 in 1921. 729 patients who had attended in previous years were sent for renewed consultation. The total attendances at the Dispensary numbered 9,326. 33 persons were under observation at the Dispensary on January 1st, 1925, pending diagnosis. Adding those examined for the first time during 1925, the total coming for diagnosis in 1925 was 1,588. Of these 346 were found to have active tuberculosis, 1,126 were discharged as not suffering from tuberculosis and 54 remained under observation on December 31st, 1925, pending diagnosis. An analysis of persons dealt with by the Dispensary for diagnosis in 1925 is given in Table XIX. Summary of the Work of the Tuberculosis Dispensary in 1925 Number of new persons examined 1,555 Number of old patients examined 1,532 Number of new patients sent by medical men for diagnosis or consultation 614 Number of old patients sent by medical men for consultation 729 Total attendances of persons at the Dispensary 9,326 Number of new contacts examined 745 Number of patients referred to hospital for consultation 278 Total number of attendances of insured patients at the Dispensary 3,849 Total number of attendances of uninsured patients at the Dispensary 5,477 Total number of specimens of sputum examined in connection with the work of the Dispensary 1,475 Number of home visits paid by tuberculosis officers 1,317 Number of home visits paid by the tuberculosis nurses 9,296 During the year 745 "home contacts" of tuberculous cases were examined. 36 were found to be suffering from pulmonary tuberculosis and 15 from non-pulmonary tuberculosis. There was considerable co-operation between the practitioners of the Borough and the Tuberculosis Dispensary in 1925. As mentioned on another page, the number of new patients sent by practitioners in 1925 for purposes of diagnosis and consultation was 614, and the number of old patients sent for consultation was 729. During the year 846 reports were received from practitioners on Form G.P. 36 in respect of 317 Insured patients who were at some time of the year on domiciliary treatment. It is doubtful if forms tend to foster the spirit of co-operation. Co-operation between the School Medical Service and the Tuberculosis Dispensary continues. The School Medical Officers observe the child "contacts" of infectious cases of tuberculosis and refer back to the Dispensary any cases requiring special consideration. Co-operation between the Dispensary and King's College Hospital has been very satisfactory, and the indebtedness of the Dispensary to the physicians and surgeons of the hospital is gratefully acknowledged. Co-operation between the Tuberculosis Dispensary and St. Giles' Hospital has been fully and pleasantly maintained. Co-operation with the Ministry of Pensions continued, and included every ex-service pensioner in the Borough pensioned for tuberculosis. Co-operation with numerous voluntary bodies was close. The Arrangements for following up Patients in Cases in which the Diagnosis is Doubtful. The patient is asked to return. A mutually convenient date is fixed. If the appointment is not kept an appropriate letter is sent—one that is not unmindful of possibilities—the patient may be confined to bed or may have returned to work, and so on. A patient who feels that a real interest is being taken in his case will —provided his illness is not a mere passing affair—seldom fail to respond to a reasonable request to return for further examination. There are exceptions. In every case the value of full co-operation with the medical man who sent the patient for diagnosis is obvious. The Arrangements for Securing the Examination and Systematic Supervision of "Home Contacts." The Dispensary Medical Officers usually urge the importance of the examination of the "home contacts" on the appropriate members of the patient's family. They may be able to arrange dates. The Tuberculosis Nurses follow this up when visiting the homes of the notified patients. An offer may be made to examine the "home contacts" at home. Of 727 new "contacts" examined by the Dispensary in 1925, 260 were examined at their homes. Nearly all of these were children of or below school age and their mothers. Adults, as a rule, are examined at the Dispensary. An evening hour is arranged for those who are at work. The systematic supervision of "home contacts" of tubercle positive lung cases who are of school age is carried out by the School Medical Service in co-operation with the Dispensary. The systematic supervision of "home contacts" who are over school age is not an easy matter. Young people busy at work and feeling well would naturally resent periodical re-examinations. We may and do advise any who get symptoms of ill-health to return for re-examination. Here, again, the value of full co-operation with the panel or family doctors is obvious. 390 "home contacts" examined prior to 1925 were re-examined during that year. These are exclusive of the 745 new "contacts" of 1925. The examination of "home contacts" of or below school age at home is usually a more convenient arrangement for the parent than bringing them to the Dispensary. It also aids the Tuberculosis Officers in their study of home conditions. Information as to Special Methods of Diagnosis and Treatment in use and the Number of Persons to whom these Special Methods have been Applied. We have placed chief reliance on accurate history taking, careful reading of symptoms, temperature charting and pulse study, thorough physical examination and repeated sputum testing in tubercle negative cases. When the above methods are not neglected in the diagnosis of a case the use of the X-rays is of the highest value. Arrangements exist with King's College Hospital for the X-ray examination of Dispensary patients. During 1925 118 patients were sent to King's College Hospital for X-ray examination. We think facilities for X-ray examination of Dispensary cases should be extended. To limit the use of X-rays as an aid to diagnosis is to handicap any Tuberculosis Officer seriously. Further, the X-rays are of great use in forming any conclusion as to the extent, etc., of the local lesion. The limitation of the service to sputum negative cases is without justification. Pneumothorax treatment, as an accessory to general treatment, is available for suitable Dispensary cases. This may be carried out while the patient is in the sanatorium, or later while on home treatment. By arrangement, the A.P. treatment is given at the Brompton Hospital to patients who are on home treatment. Sanocrysin treatment was given by two London Hospitals to three Camberwell Dispensary patients during 1925. The individual results were unsatisfactory. No opinion can be expressed on the actual case for or against the gold treatment from three cases. The Nature and Extent of any Dental Treatment Provided by the Council for Tuberculous Patients. The cost of dentures supplied under the Borough dental scheme to 14 patients in 1925 was (after deduction of Approved Societies' grants) £43 18s. 6d. The net cost was, however, much reduced, as the Dispensary Voluntary Dental Fund contributed £15 Is. and patients contributed £2 16s. Housing and Home Conditions of 454 Cases of Tuberculosis who were Notified for the first time in 1925. In 53 cases the patient's family occupied a whole house an important point in connection with the spread of tuberculosis. In the case of 401 patients their families shared a house with others. In 9 cases the patient's family occupied a basement. In 66 cases the patient's family occupied the ground floor. Invalids occupying a ground floor are saved the trouble of climbing stairs, but are not as likely to keep their' windows open at night. In 121 cases the patient's family occupied the first floor. Apart from the stairs, this is a good floor for an invalid. Windows can be kept open at night with less fear of feline and other intruders, and the street dust nuisance is not as bad as on the ground floor. In 35 cases the patient's family occupied the second floor. Here there are longer stairs to climb but more sunshine and less street dust is caught than in the case of a lower floor. In 4 cases the patient's family lived on the third floor. Here the staircase problem is intensified and the air, especially in summer, TABLE XIX.—ANALYSIS OP PATIENTS DEALT WITH BY THE DISPENSARY FOR DIAGNOSIS IN 1925. Examined for the first time during the year. Under observation at the Dispensary on Jan. Ist pending diagnosis. Number of Total. Found to be Under observation at the Dispensary on Dec. 31st pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Non Pulmonary. Pulmonary. (a) All persona (including "Contacts.") M. 17 402 163 419 18 189 22 27 Adults F. 12 424 136 100 13 265 29 29 Children under 15 M. 4 364 308 8 20 2 333 5 F. 365 365 - 5 19 339 1 1 276 Total 33 1,555 1,588 70 1,126 54 62 M. 75 (b) "Contacts" (included in (a)). 6 81 14 - 55 5 7 Adults F. 10 148 158 16 6 121 15 - Children under 15 M. 2 234 236 3 226 4 1 2 F. 270 270 3 5 261 1 - - (c) Insured persons (included in (a) ). I M. 14 303 317 115 14 149 17 22 F. 10 167 177 41 7 80 18 21 is warmer. There is an advantage as far as sunshine and street, dust are to be considered. In 166 cases the family of the patient lived on more than one floor, though not occupying the whole house. TABLE XX. Housing accommodation of 454 families in which there was a Primary Notification of Tuberculosis in 1925. Number of families occupying 1 Room. 2 Rooms. 3 Rooms. 4 Rooms. 5 Rooms. 6 Rooms or more. - Patient living alone 18 1 - - - „ „ with 1 other 13 24 25 10 2 1 1 „ „ „ 2 „ 11 13 43 10 13 32 14 2 17 23 7 „ „ „ 3 „ „ „ „ 4 „ 1 16 15 16 10 8 5 9 7 „ „ „ 5 „ 6 5 - 8 „ „ „ 6 „ 2 3 7 1 3 2 2 „ „ „ 7 „ 2 7 6 - 1 4 1 2 - 4 „ „ „ 8 „ - 1 2 5 „ „ „ 9 „ 1 - 3 1 1 „ „ „ 10 „ - - - - 1 „ „ „ 11 „ - - - - 141 89 Total 47 82 47 48 Table XXI. Sleeping accommodation of 454 tuberculous cases notified for the first time in 1925. The figures refer to the Tuberculosis Nurses first home visit. The patient slept— In a separate room In 134 cases. Alone in bed with 1 other in room „ 25 „ „ „ 2 others „ „ 32 „ „ „ 3 „ „ „ „ 12 „ „ „ 4 „ „ „ „ 3 „ Slept in bed with 1 person and no others in room „ 141 „ „ „ 1 „ 1 Other „ „ 42 „ „ „ 1 „ 2 other „ „ 29 „ „ „ 1 „ 3 „ „ 8 „ „ „ 1 „ 4 „ „ „ 4 „ Slept in bed with 2 persons and no others in room „ 8 „ „ „ 2 „ 1 „ „ „ 4 „ „ „ 2 „ 2 „ „ „ 6 „ „ „ 2 „3 „ „ „ 1 „ „ „ 2 „ 4 „ „ „ 2 „ Slept in bed with 3 persons and no others in room „ 2 „ „ „ 3 „ 1 other „ „ 1 „ „ 3 „ 2 others „ „ 1 „ „ „ 3 „ 3 „ „ „ 1 „ Slept in bed with 5 others „ 1 „ 454 The Financial Circumstances of 454 Patients Notified as Suffering from Tuberculosis in Camberwell ( Primary Notifications, 1925). If poverty is a contributory cause to the breakdown in health known as tuberculosis it seems clearly evident that while the patient is on domiciliary treatment the relief of the poverty should be regarded as an integral factor in restoring the lost health. Further, a Tuberculosis Officer should not consider he is capable of laying down a sound or proper line of treatment unless he has a knowledge of the financial circumstances of the patient. In 135 cases the financial circumstances could not be blamed for the breakdown. In 184 cases the financial circumstances were on the border line or just above it. In the majority of cases they were probably not contributory factors in any special degree in the breakdown. However, an open mind had to be kept and circumstances frequently reviewed. In 135 cases the financial circumstances were frankly bad. These are first enquiries, and were made within a week or two of the primary notifications, and cannot be assumed to be parallel with the financial position of patients—say one year after the notification. The Day Sanatorium, 6, Grove Hill Road. Managing Committee (appointed by the London County Council): Mrs. Hugh Dal ton, L.C.C. T. Gautrey, Esq., J.P. The Hon. Mrs. Gilbert Johnstone. The Countess de Lormet. Mrs. Morrogh. Mrs. Townsend. Mrs. P. Worsthorne, L.C.C. Teacher in Charge Mrs. K. L. Glover. Medical Officer William Brand, 8.A., M.8., C.M. Visiting Nurses Miss H. Chambers, Miss M. Thistleton, and Miss F. M. Whitney. This open-air school for non-infectious tuberculous children is now in the tenth year of its existence. It is of interest to note that two members of the present Managing Committee were chiefly instrumental in founding the school. Mrs. Morrogh, at that time Hon. Secretary of Camberwell Tuberculosis Dispensary, after searching all over Camberwell, discovered No. 6, Grove Hill Koad, with its ideal garden, for the purposes of an open-air school. Mrs. Townsend and Mrs. Morrogh collected the greater part of the money required during the first four years of the school's existence. Nearly all the former pupils have got on well since they passed from school to business. The following statistics of 1925 may be given:— Number on roll on December 31st, 1925 ... ... ... 30 Number admitted during 1925 13 Number discharged during 1925 - Reasons for Discharge. Number fit for elementary school 2 Number fit for work 8 Number transferred to hospital or sanatorium - Number removed from district - Number transferred to special school - Number discharged for other reasons 2 Gain or Loss of Weight of Children who have been in the School for more than twelve months. Number of children who have shown a gain in weight 19 Average gain in kilos 3·6 Number of children who lost weight or whose weight was stationary - Average loss in kilos - The Care Work of the Tuberculosis Dispensary in 1925. Some figures which follow are given with the view of showing important points in connection with the care work of the Tuberculosis Dispensary in 1925. 1. The opportunity the staff had of ascertaining if needs of any kind were interfering with the proper treatment of the tuberculous patients of the Borough or were tending to the spread of the disease. During 1925, 10,613 home visits were paid by the Dispensary staff—9,296 visits by the Tuberculosis Nurses and 1,317 by the Tuberculosis Officers. The attendances at the Dispensary of tuberculous patients, i.e., patients on the current Notification Register, numbered 5,032. (We have omitted from this consideration the attendances of non-tuberculous contacts at the Dispensary for examination. It should, however, be mentioned that on very many of their visits we had the opportunity of ascertaining if things were going well or badly at home.) There were 931 attendances (not included in any other figures in the Report) at the office of the Care Work Secretary. During the year 1,504 letters were sent to patients or to their relatives, letters which gave an opportunity, in the answer, of stating if anything was going wrong. The Dispensary staff, therefore, had 18,080 opportunities (indirect only in the case of the letters) of face and ascerting if all was well—apart from the purely medical sense with the tuberculous patients of the Borough and their families. Opportunities doubtless were missed, but we do feel that the spirit of care work pervades every member of the Dispensary staff. From Voluntary and other Societies and from private individual —from, in fact, many well-wishers and helpers of the tuberculous, we received much assistance by our attention being drawn to needy cases, also in dealing with the needs. We have not included these in the above figures, which relate to the official staff only. In applying these figures to the number of tuberculous patients on the current Notification Register of the Borough the reader should be told that many cases on the Register are in no wise incapacitated by their tuberculosis, and might, indeed, be removed from that register did they conform with the instructions of the Ministry of Health on one point. A case of pulmonary tuberculosis cannot be removed from the Register unless the disease has been arrested for five years. A case of non-pulmonary tuberculosis cannot be removed unless the disease has been arrested for three years. Again, in a large number of cases the breadwinners of the family are not the patients, and in such cases the normal financial position of the family may not be affected by reason of the tuberculosis. Another point of importance in connection with the question under consideration is the fact that there may be two or more cases of tuberculosis in one family or in one house, thus lessening the time required to ascertain family needs. Lastly, the Dispensary has a street index, and this is an immense saving of time. 2. How much care work did the Tuberculosis Dispensary staff accomplish in 1925? No one, I feel sure, will refute the suggestion that many of the finer parts of care work cannot be recorded. The acts of courtesy, sympathy, and the other little and. big things so cheering to the mind of the sick that patients so often tell me about concerning other members of the staff cannot be recorded individually or in figures. The financial and environmental circumstances of nearly every primary notification of 1925 were enquired into and considered—not in the spirit of officials prying into the home secrets of others but because we cannot know who are in need unless we ask all. In 69 cases, from the failure of notification, the first home visit was paid after the death of the patient. Enquiries were made as to the health of the contacts of the deceased and advice was given to any of the families in need as to whom and where to apply for assistance. A surprisingly large number of the families in which a case of tuberculosis was notified in 1925 were not in any need of assistance throughout the year. Many others were receiving assistance from the Guardians and elsewhere when we first got to know them—for assisting such we cannot lay claim to any credit. In other cases we advised and helped them to get assistance in various ways. In some cases our efforts came to nought, but some of these families found the assistance they required otherwise, e.g., by finding work, etc. With regard to the cases notified in previous years we endeavoured to keep in touch with them as often as was necessary. Many of these were army pensioners, many others were self supporting by their own efforts—indeed, many tuberculous people, notified in former years, were supporting large families. Many were not self-supporting, but were maintained adequately by their families. Unfortunately, many would remain in want were it not for the relief given by the Guardians. This relief may be supplemented by an extra diet allowance by the Guardians on a medical certificate. Illustrative Cases of Dispensary Care Work. A. Was a young woman, an ex-sanatorium case, working in a healthy environment. Her firm moved her to a basement room. At her request we informed the firm that such a working room might be prejudicial to her health. The firm responded by giving her a month's holiday in the south-west of England, paying her board and travelling expenses and allowing her ample pocket money. On her return she was put in a good work room. B. Was a middle aged woman, notified as suffering from pulmonary tuberculosis some years ago. We had never found any tubercle germs in her sputum and regarded her disease as arrested. Still she remained tired and unfit for her work. Through the kindness of a friend of the Dispensary she was sent to a suitable home at Weston-super-Mare, all her expenses being paid, for a month. This tonic treatment restored her energy greatly. C. A young woman, an orthopaedic case of former years, temporarily took a job as a dressmaker (her trade) in the country. After being away a few months she wrote that she was afraid the old trouble was returning. We advised her to return to her hospital in London for examination. She replied that she could not pay the fare. The fare was found; she came to the Orthopædic department: X-ray and clinical examinations proved there was no return of the disease, and she returned to her work in the country rejoicing. She is now a sewing maid in a big mansion in the country with a mistress who treats her with the utmost consideration. D. Was a young woman who declined to go to a sanatorium. She would not give any reason, but later her mother came to say that her daughter's garments were so worn out that she was ashamed to go away in them, and could not find new ones. Two voluntary Dispensary workers soon prepared an ample supply of new garments and the sanatorium difficulties vanished. E. Was a middle aged man who returned from sanatorium in good condition for suitable occupation. This was found for him through the kind services of several people connected with a great Corporation, who co-operated with the Dispensary in the matter. F. Was a young woman who had non-pulmonary tuberculosis some years ago. The Dispensary helped her to get a G 97 maid's job in a seaside Convalescent home. After some months there she was offered an even better job at the seaside. G. Was a widow. Two children were kept in a home by the U.S.F. The Guardians helped the mother, but when she had to go to sanatorium they could not continue the relief while she was away. The C.O.S. kindly found the money to pay the rent of her home while she was away. H. Was a man at Lowestoft hospital suffering from non-pulmonary tuberculosis. Between a grant from the U.S.F and her husband's panel money his wife could just manage at home. She could not pay the fare to Lowestoft to visit her husband. It was considered very advisable that she should visit him, and the C.0.5., on being asked, kindly paid the railway fare. I. Was a young man in advanced consumption. In order to make an alteration in the sleeping arrangements a bed and bedding was required. On putting the matter forward the bed and bedding was supplied by the U.S.F. and a Church fund. J. Was a pensioner who had been in a sanatorium for over a year. We strongly advised that he should not return to his home, as it was faulty in many respects. We pressed his case before the L.C.C., and he entered a new home at Becontree with his wife and family on the day he was discharged from sanatorium. The British Red Cross (Emergency Fund) paid the costs of the removal. K. Was a young man unable to pay his railway fare to sanatorium. The L.C.C. had previously agreed to give him free treatment at the sanatorium. On ringing up the appropriate department of that Council on the phone a voucher was sent for his fare by the next post. L. Was a middle-aged woman who had tuberculosis. She required a full set of dentures. These were provided. 50 per cent, of the cost came from the Borough Tuberculosis dental scheme, the patient paid a small amount, and our voluntary dental fund paid the remainder. M. Was a child suffering from debility and glandular enlargement. Prolonged convalescence to the seaside was needed. The Invalid Children's Aid Association kindly agreed to arrange the convalescence, and they kept the child away until such treatment was completed. N. and 0. Were two children living in one room with parents, one of whom had advanced pulmonary tuberculosis. At our request the L.C.C. agreed to board the children out in the country for some months in order to remove them from the infectious environment and at the same time to improve their health. The plan worked well until the parents insisted on having their children home again. P. Was a child aged one year. The mother had to go to sanatorium. Arrangements made with relatives to care for the child during the absence of the mother broke down the day before the mother was due at the sanatorium. We had impressed on the parents the necessity of keeping in close touch with the Dispensary, and accordingly were informed of the breakdown in the plans almost at once. Through the energy of Miss Fisher the child was placed in a home approved by both parents on personally visiting it, and the mother went to sanatorium at the appointed time. Miss Fry, Dispensary Clerk and Care Secretary, has compiled the following figures and items of information in relation to some of the Care work of the Dispensary in 1925: — 1. 65 Dispensary patients received extra diet. 2. 14 patients received dentures. The voluntary dental fund paid part of the cost, patients paid a little. The Borough dental scheme contributed the remainder. 3. 135 patients were advised to apply to the Guardians for assistance. In this way patients obtained money, food, extra diet, clothing, convalescence, etc. 4. 36 cases were advised to apply to the British Bed Cross (Emergency Fund). In this way pensioners obtained such assistance as money, clothing, beds, bedding, etc. 5. 38 cases were advised to apply to the United Services Fund. In this way ex-service men or their families obtained money, clothing, beds, bedding, and convalescence. 6. We assisted the London County Council in many ways in the arrangements for the Institutional treatment of 330 patients. 7. We ensured that all patients going to sanatorium who could not afford the travelling expenses received vouchers from the London County Council. 8. We did our best to settle all home difficulties that threatened to bring a parent home from sanatorium too soon. 9. We co-operated with the Charity Organisation Society (Camberwell and Dulwich) in over 50 cases, and our tuberculous patients received much benefit thereby. 10. We co-operated with the Invalid Children's Aid Association in over 100 cases with the happiest results. 11. We co-operated with many families in whom there was a tuberculous member in endeavouring to obtain homes for them on the new housing estates of the London County Council. G 2 12. We communicated with employers when patients specially requested us to do so, with good results in some cases and no results in other cases. In conclusion, we failed to do what we wished to do in many cases, and our failures are not recorded. WILLIAM BRAND, Tuberculosis Medical Officer _ MATERNITY AND CHILD WELFARE In order to appreciate to what extent development has taken place during the past five years in the arrangements made for the care of expectant and nursing mothers and children under five years of age, it is only necessary to set out the Maternity and Child Welfare activities at the beginning of 1921 and to compare them with the position as it was at the end of 1925. The scheme at January 1st, 1921, was represented by the following: — 1. Six Voluntary Infant Welfare Centres. 2. Two Homes for Unmarried Mothers, 3. Nursing services for maternity and infectious disease cases arising out of maternity, and illnesses in children under 5 years of age. 4. The supply of milk to necessitous mothers (expectant and nursing) and young children. S. Convalescent treatment in special cases for mothers after confinement, and for some conditions in children under 5 years of age. 6. The payment of midwives' fees for services rendered to indigent mothers. 7. A dental clinic (Cobourg Infant Welfare Centre). The year 1921 may be said to have marked the commencement of the changes noted in the progress of the Maternity and Child Welfare scheme in the Borough. In May of that year the first Municipal Centre was opened at 140, Camberwell Road, and in the following November another at 114, Lordship Lane. In the following year it was necessary to add another session at the Dulwich Municipal Centre in order to relieve the congestion at the Thursday afternoon clinic, and further, the Council also decided to take off some of the work of the St. Luke's and Bird-in-Bush Centres by establishing a Municipal Centre to cover half No. 8 Ward and the whole of Ward No. 9. In the same year, too, the Council increased the annual grant to the Peckham, Nunhead and District Day Nursery with a view of extending the work of the creche, and further gave consideration to the question of providing institutional accommodation for 1. Patients showing some abnormality either during pregnancy or at the time of labour which calls for special medical treatment and skill, and 2. Patients whose domestic conditions are unfavourable for confinement in their own homes, even where a normal labour may be expected. November, 1923, saw the opening of the Municipal Maternity Ward containing six beds and a labour room equipped with all modern appliances. A good deal of attention was also given to the question of the areas of the nursing associations operating in the Borough, and in the early part of 1924 arrangements were completed with the Rotherhithe District Nursing Association whereby the Council agreed to pay the sum of 1s. per visit for services rendered to notified cases of ophthalmia neonatorum, puerperal septicaemia, pneumonia, malaria and dysentery in that part of the Borough not covered by the other nursing associations, viz., part of Wards Nos. 6 and 7. In the early part of 1925 information was received from the authorities controlling the Southwark Diocesan Home for Unmarried Mothers that their institution at 24, De Crespigny Park, would close down at the 31st March. It was stated that they proposed to board out their cases in other approved Homes, and the Council were asked to consider the question of paying grant for Camberwell cases as they occurred, which was adopted. At the end of 1925 another Voluntary Infant Welfare Centre was opened at Amott Road, East Dulwich (a branch Centre of the Union of Girls' School Centre), for the purpose of meeting the needs of those who live a considerable distance from the Centre in Peckham Road. The extension of the scheme during the past five years includes, therefore, three Municipal Centres, a Municipal Maternity Ward and another Voluntary Infant Welfare Centre. Work of the Infant Welfare Centres. The infant welfare work in Camberwell is undertaken by 7 Voluntary Centres (6 being subsidised by the Council) and 3 Municipal ones. A return of the work carried out appears on page 103. It is worthy of notice that the number of attendances is well maintained, and the number of visits shows an increase over the previous year. Maternity Ward. This Council entered into an agreement with the Camberwell Board of Guardians in July, 1923, to provide maternity accommodation, for cases approved by the Borough Council, for a period of three years. The agreement in question provided for a ward containing six beds and a labour room to be set aside in the St. Giles' Hospital, Brunswick Square, Camberwell. The ward was ready for the reception of cases in November, 1923. In the following tables will be found a medical review of MUNICIPAL AND SUBSIDISED INFANT WELFARE CENTRES. RETURN OF WORK, 1925. Infant Welfare Centre. I Consultations. Children—Attendances at Consultations. Mothercraft Classes. Analysis of Visits. Expectant Mothers. Children Attending Centre. Miscellaneous and other Visits not defined. Visits by Voluntary Helpers. Visits to Mothers & Children not attending the Centre. Expectant Mothers. First Attendances. Subsequent Attendances. Doctor's Consultations. Superintendent's Consultations. Doctor's Consultations and Weighings. Sewing Class. Sewing Class and Health Talk. After Notification of Birth. Before attending Centre. Total Visits. Attendances— Dental Clinic. Total. Health Talk. Post-Natal Mothers. Miscell. Attendances. Weighing only. Under 1 year. First Visits. Under 1 year. Over 1 year. Over 1 year. Subsequent Visits. Subsequent Visits. First Visits. 161 2447 - 352 118 41 408 1146 3028 Camberwell Municipal, 140, Camberwell Road. 41 178 39 1359 759: 112 349 - 1825; 73 1004 240 — - - - 400 - 100 877 126 2059 - 380 576 332 Duhvich Municipal, 114, Lordship Lane 261 551 2130 1103(1 301 277 2563 38301 14 210 - - - - - 705 83 1530 - 4891 795 - 178 16 1384 402 71 65 - 385 2051 66 14 594 286 2543 Peckham Municipal, St. Jude's Hall, Meeting House Lane. - - - - 274 - 196 435 - 1948 195: 2154 568 6019 3131 577 16808 12274 Bird-in-Bush Voluntary, 610, Old Kent Road 340; 102 3418 2718: 12733 - 317 810 - - - 96 102 - 340 2494 116 977 - 306 4158 Cambridge House, 6, Addington Square. 36 177 33 1508 941 1680 - - 26571 1116 54 1106 - - - 7 11053 100 438 867- 66 - - 3638 Cobourg, Kempshead Hall, Kempshead Road. 120, 1074 53 239 102 - 1260 133 1740' 360 - - - - - - 266 44 645 5039 39 1954 1256 - - 3173 286 537' 103 168 1606 Nunhead, 31, Nunhead Grove 47 212 963 - 1917 51 1889 577 - - 227 41 1800 722 1148 11613 2790 62 182 206 83 7 1208 4GS 155,: ,3068 5077; St. Luke's, 2, Commercial Road - - - - 29 88 - - 205 3628 153 191 81 2132 701 6417 10356 Union of Girls' School, 17, Peckham Road 356 61 2094 2442 13149 548 6139 571 1172 247 584 - - - - - 33 137 5 4 531 8 13 163 19 211 - - 271 4 1 28 73 Amott Road Centre, E.Dulwich - - 4 - - - - - 385 2077 130637 1079 1598 9411 13390 14837 652 2104 23584 48335 159 Totals 634 2079 406 18286 9379 487 10972 10883 6218 1597 2432. 5334 * Not subsidised by the Council. the work and a record of the number of applications received: — Medical Review. 1924. 1925. Number of ante-natal examinations 666 745 „ „ abnormalities and diseases requiring treatment found 36 35 „ „ patients confined — (a) Normal labour 99 167 (b) Abnormal labour 15 21 „ „ after results of confinement requiring treatment 3 14 „ „ births 116 189 „ „ children born with any abnormality 3 9 „ „ deaths— (a) Premature 5 1 (6) Still-births 4 8 Bookings Opening Date to December 31st, 1925. Medical reasons for Admission. First Confinement only. First Confinement & Housing. Housing Difficulties. Total Confinements. 3 2 - 1 1923 - 3 49 59 114 1924 3 6 93 188 1925 22 67 9 153 27 116 305 Totals Additional Applications Received. Number of Applications. Admission fee not accepted by patient. Accommodation not available. Unsuitable cases. First Confinement cases. Housing circumstances cases. 4 1 4 1923 5 1 - 13 13 91 1924 104 43 48 13 20 99 1925 119 25 81 72 Totals 228 129 27 34 194 It will be noticed that the number of applications was greatly in excess of the number that could be accepted and I anticipate that the demand for institutional accommodation will increase as time goes on. The housing shortage has a distinct bearing on the increasing desire to be confined away from home, and if, as the result of this shortage, women are becoming alive to the value of medical supervision during pregnancy and the advantages of constant medical and nursing attention at the time of confinement and during the puerperium, then a good deal more has been accomplished in the direction of creating an intelligent interest in these matters than could be hoped for along the ordinary lines of educational development. A very important part of the Municipal scheme is the antenatal supervision of the mother, so that any abnormal conditions of pregnancy may be detected and the necessary treatment given. During the past two years 1,411 ante-natal examinations have been carried out, and 71 patients were found to be in need of treatment during pregnancy. Many of these cases would doubtless have presented difficulties and possible risk of injury to the mother and child at the time of confinement but for the correctional treatment beforehand. The value of institutional treatment can therefore be appreciated if considered in the light of the possible cost to the community as a whole in having to assume the financial responsibility of maintaining cripples and chronic invalids, which may result from inattention before and at the time of confinement. In November of the year under review a report was submitted to the Maternity and Child Welfare Committee in which I reviewed the work of the Ward from the opening date. Therein I suggested that the education given to the mother before and during the confinement should be supplemented by instruction in the care of the health of her infant during the first years of its life. This instruction can, of course, be obtained at the Infant Welfare Centres, but for the benefit of those mothers who, for domestic or other reasons, are unable to attend, I obtained authority to invite every Municipal patient to purchase at the Public Health Department a small booklet entitled "To Wives and Mothers," issued by the National League for Health, Maternity and Child Welfare, 117, Piccadilly, W., in order that she might have at hand a simple guide on questions relating to the care and management of infants. Maternal Mortality. The question of the high mortality associated with childbirth has received much attention at the hands of the medical profession during the past five years. Valuable information has been made available on this subject in the report of Dr. Janet Campbell on Maternal Mortality, which was published in 1924, and the report on Maternal Morbidity and Mortality issued by the Scottish Board of Health in the same year. As the result of Dr. Campbell's report the Ministry of Health issued a Circular drawing attention to the number of maternal deaths which takes place annually in this country, and the means whereby Local Authorities could assist to bring about an improvement in the death rate from this cause. The Circular in question sets out the importance of educational measures, ante-natal supervision and the provision of maternity beds as definite agencies towards this end. In Camberwell steps have been taken to bring to the attention of the medical profession and midwives the facilities available for obstetric advice and treatment. In addition to the prenatal clinics at St. Giles' Hospital and the various Infant Welfare Centres, the professional supervision of the expectant mother is an integral part of the arrangements of the General Lying-in Hospitals in and around London, where many Camberwell mothers are confined annually, so that it may be said that there is a considerably larger proportion of women, receiving individual instruction and attention nowadays than took place a few years ago. The success of any measures to reduce the maternal mortality rate depends to a large extent on the creation of an enlightened public opinion. Without it the work of the medical profession is greatly hampered. We know that as the result of ante-natal examinations such conditions as eclampsia can be prevented; obstructed labour, with its unfortunate sequelae, can also be prevented. Therefore it is important for women to realise that the earlier they receive medical supervision during pregnancy the less likelihood is there of difficulty and danger at the time of confinement. It is pleasing to record that there was a further decline in the number of deaths connected with childbirth during last year. Indeed, as far as is known, the present mortality rate is the lowest that has ever been recorded in Camberwell. In the following table is shown the number of deaths and the rate per 1,000 births during the past 5 years:— Maternal Mortality. Other Causes. Deaths per 1,000 Births. Total No. Deaths. Total Child birth. Year. From Sepsis. Sepsis. Other Causes. 7 1921 16 9 1·42 1·11 2·53 15 7 8 1·47 2·76 1922 1·29 9 11 1·94 3·53 1923 20 1·59 3·30 1924 17 10 7 1·94 1·36 6 7 1·23 1925 13 1·43 2·66 It will be observed on examination of the above table that puerperal sepsis is the principal cause of death amongst parturient women. The causation of puerperal fever and morbidity is at the present time receiving the careful consideration of a Committee set up by the British Medical Association. It is agreed, however, that by proper ante-natal supervision and the timely transference to hospital of eases in which in all probability there will not be a normal confinement would go a long way to diminishing the number of such cases. Homes for Unmarried Mothers The work of the care of the unmarried mother and her infant was continued to be carried out by the National British Women's Temperance Association Home, 201, Camberwell Grove, and by the Southwark Diocesan Association, who, until the end of March, 1925, carried on their activities at 24, De Crespigny Park, when the Home was closed. Since that date patients, with the consent of the Council, have been boarded out in Homes outside the Borough, approved by the Ministry of Health, so that although there is now only one institution in Camberwell for this purpose the work has not suffered in consequence. During 1925 the Diocesan Association investigated 61 cases; of these 15 were placed in suitable homes, 5 marriages were arranged, 1 was sent to hospital for confinement, 1 had a foster mother found for the child, 2 received legal help and 10 were referred to other agencies. 19 mothers and their babies were admitted to the House of Help, 201, Camberwell Grove, during 1925. Two of the mothers obtained situations and were allowed to take their babies with them, 4 obtained daily situations and returned to their babies at night, 2 returned to their parents and one to friends. At the 31st December the number of mothers in the Home was 14. A good deal of after-care work is done by both Homes. Convalescent Treatment. The practice of sending approved cases for convalescent treatment was continued, and, during the year 1925, 26 children received treatment for one month and 1 child for 6 weeks. Milk. There was an appreciable drop in the number of applications during the year for the issue of milk in accordance with the Ministry of Health Circular No. 185. The approximate number of pints distributed was 244,500, together with 850 lbs. of dried milk. The estimated cost of this service amounted to £3,250. Every application was considered by the appropriate Committee, and in cases where there was a doubt with regard to the information given by the applicants enquiries were made before a grant was authorised. In two instances it was necessary to request the attendance of the applicants before the Committee to explain the conflicting evidence of circumstances. It was decided, however, that the nature of the offences did not warrant any action other than administering a caution in each case. Hospital Treatment for Infants. During the year under review an account was received from a special dietetic hostel for in-patient treatment of a Camberwell child suffering from a mal-formed jaw and a short tongue. The matter was referred to the Ministry of Health, who gave the necessary authority for payment. Nursing Services. The nursing arrangements provided by the Council for the treatment of maternity cases and infectious disease cases arising out of maternity, and for illnesses 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, were undertaken as in previous years by the Ranyard Nurses and the Camberwell District Nursing Association, the East Dulwich and Dulwich Village Nursing Society, and the Rotherhithe District Nursing Association. The record of cases dealt with and the number of visits made by the two Associations who received payment from the Borough Council for their services is set out in the following table:— The Ranyard and Camberwell District Nursing Associations. Quarter ended No. of Cases. No. of Visits. Cost. 116 1,240 Kir 1. £ s. d. March 62 0 0 June 120 1,267 63 7 0 1,051 September 108 52 11 0 129 1,805 December 90 5 0 Total 473 5,363 268 3 0 Ophthalmia Neonatorum. The particulars relating to this disease are set out in the form required by the Ministry of Health as laid down in their Circular No. 648. Notified. Cases Treated. Vision Impaired. Total Blindness. Vision Unimpaired. At Home. In Hospital. Deaths. 24* 9 14 20 1 Nil 2 *One case notified from a Boarding Establishment —no information as to the result of treatment. Unfortunately, in one case, the child lost the sight of one eye. The patient was, however, under constant medical supervision from the time of birth, before being removed to hospital for further treatment. Peckham, Nunhead and District Day Nursery. The number of attendances at the above Institution during the year 1925 was 3,729, a daily average of 15, as compared with 2,791 attendances and a daily average of 12 for the previous year. Midwives' Fees. In one instance authority was given for the payment of a midwife's account for services rendered to an indigent mother in confinement. INDEX. PAGE. Ambulance Facilities 14 Ante-natal 104 - 106 Anterior Polio-MyelitlS 63 Anthrax 61 Anti-toxin 59 Area of Borough 4 Bacteriology 69,70 Bakehouses 42 Baths, Public Swimming 15 Births — Birth Rate 2,6 Illegitimate, No. of 6 Notified, No. of 6 Regsitered 6 Still-Births 7 Business Premises 22 Butter, Margarine, etc., Premises 42,43 Cancer 13 Cerebro-Spinal Meningitis 63 Cleansing Station 71,73 Clinics and Treatment Centres 16 Closet Accommodation 17 Convalescent Treatment 107 Cowshed 32 Day Nursery: Peckham, Nunhead and District 109 Day Sanatorium: Tuberculosis 94 Deaths: — Death Rate 2,6,7 No. Registered 7 Seasonal Mortality 7 Table, Causes of and Ages at 8,9 Table, Mortality Rates of Principle Diseases 10,11 Dental Clinic 101 Dental Treatment 91 Diarrhœa and Enteritis 67,68 Diarrhœa, Deaths from 6, 68 Diphtheria 57 - 59 Disinfection and Disinfestation 71 - 73 Dysentery 62 Eating Houses 43 Encephalitis Lethargica 63 - 66 Erysipelas 61 Factories, Workshops and Workplaces, Inspection of, Tables 30 Factories and Workshops and Workplaces on Register 31 Fish Curers ... 43 Food: — Destroyed 44 Meat 39 - 42 Milk 32 - 39, 45-55, 107, 108 Other Food 43 Unsound 43, 44 INDEX—Continued. PAGE Food and Drugs Acts—Administration of 45 - 55 Adulterated Samples (other than Milk), Table 48 Condensed Milk Regulations 51 Dried Milk Regulations 51, 52 Informal Sampling 49, 50 Margarine 51 Milk and Cream Regulations 52 - 54 Milk and Separated Milk, Table 49 Sale of Food Order 54, 55 Samples Taken, Table 46, 47 Skimmed Milk 52 Summary of Legal Proceedings 55 Pried Fish Shops 43 Hospitals Available for District 14 Housing .23-29 General Conditions in the Area, Table 23 Houses Let in Lodgings 25 Improvement Scheme 26 - 29 Inhabited Houses, No. of 5 Overcrowding 24, 25 Statistics 29 Summary of Inspections 18, 19 Unhealthy Areas 26-29 Ice Cream Premises 42 Increase of Rent and Mortgage Interest (Restrictions) Act 29 Infants, Hospital Treatment for 108 Infantile Mortality 2, 6, 13 Rates of Principal Diseases, Table 10, 11 Stated Causes, Table of 12 Infant Welfare Centres 102 Return of Work 103 Influenza67 Informal Sampling 49, 50 Insanitary Areas 26 - 29 Malaria . 62 Margarine 42, 43, 51 Maternal Mortality 6, 105 - 107 Maternity and Child Welfare 101 - 109 Maternity Ward 102, 104, 105 Measles . 6, 66, 67 Meat Regulations 39 - 42 Midwives 14, 109 Milk:- Bacteriological Examinations 38, 39 Certified Milk 36 Circular No. 185 107, 108 Dairies, Cowsheds and Milkshops Order 35 Grade "A" 36 Grade "A" Pasteurised36, 37 Grade "A" Tuberculin Tested 36 Milk and Dairies Amendment Act 34 Milk and Dairies Consolidation Act 33,34 Pasteurised 37 Special Designations Order 35, 36 Supply 32, 33 See also under Food and Drugs Inspector's Report 45-55 INDEX—Continued. page Mortuary, Public 15 Natural and Social Conditions of Area 4 Non-Notifiable Diseases 66 - 68 Notifiable Infectious Diseases 56 - 66 Table of 64,65 Nursing Services 108 Occupations of Inhabitants 4 Ophthalmia Neonatorum 109 Outworkers 31 Overcrowding 24 Pneumonia 62 Polio-Encephalitis 63 Population 5 Poor Law Relief 5 Puerperal Fever 62 Rateable Value 5 Rats and Mice Destruction Act 22 Respiratory Diseases 13 Restaurants, Eating Houses, etc. 43 Sanitary Circumstances of Area 17 - 21 Closet Accommodation 17 Houses Let in Lodgings 25 Housing Conditions, Statistics 29 Insanitary Areas 26 - 29 Scavenging 17 Smoke Abatement 17 Summary of Inspections, Table 18, 19 Summary of Sanitary Orders, Table 20, 21 Scarlet Fever 61 Scavenging 17 Slaughterhouses 41 Small-Pox 56, 57 Prevention and Regulations 68 Smoke Abatement 17 Special Causes of Sickness 14 Staff 3 Statistics, General 5 Suicides13 Trench Fever 62 Tuberculosis 62, 74-100 Analysis of Patiens, Table 92 Day Sanatorium 94 Deaths from, Tables 80 - 82 Deaths, Occupational Table 85 Dental Treatment 91 Dispensary Care Work 95 - 100 Dispensary, Work of 88 - 94 Institutional Treatment 86 - 88 Summary of Notifications, Tables 75 - 79 Tuberculous Meningitis, Deaths from, Table 83 Typhoid Fever 59, 60 Unhealthy Areas 26 - 29 Unmarried Mothers 14, 107 Unsound Food 43 Table 44 Vaccination 68 Violent Deaths 13 Vital Statistics 6 Whooping Cough 6