ackjubgk CAM 26 P.5510 Metropolitan Borough of camberwell REPORT OF THE MEDICAL OFFICER OF HEALTH 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 26 Report of medical Officer of health. Public Health Department, 35, Brunswick Square, Camberwell, S.E. 5. May 31st, 1927. 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 1926. The report deals with the vital statistics and sanitary condition of the Borough, in addition to the particulars of the work carried out during the year by the staff of the Department. It is with pleasure that I have to record that the health of the Borough during the last year was satisfactory. No serious epidemic of infectious disease occurred, although diphtheria was prevalent. The birth rate showed a further fall from 17.7 in 1925 to 16.6, the death rate was 11.0 as compared with 11.1 for the preceding year, and the infantile mortality rate remained at the figure recorded for the previous year, viz., 64 per 1,000 births. The problem of the housing shortage shows an improvement with the passing of every year. There still remains the difficulty, however, of dealing with those persons who, from economic causes, cannot afford to pay for better accommodation, and are compelled to live under conditions which cannot be described as being satisfactory from the public health standpoint. Two insanitary areas, known as the Basing Place and Blue Anchor Lane areas, were represented during 1926 to be dealt with under Section 35 of the Housing Act, 1925, and the year covered by this report was also noteworthy for the following additions to the Public Health Service:— (1) Extension of the Municipal Maternity Ward Scheme. (2) Prevention of infectious diseases.—Establishment of a Diphtheria Immunisation Clinic. A In conclusion, I have to express my indebtedness for the support and consideration which has been extended to me by the Chairmen and Members of the Public Health, Maternity and Child Welfare and Housing Committees of the Council, and to make public my appreciation of the work of the Public Health and Tuberculosis Dispensary Staffs, who have at all times loyally assisted me in the discharge of my, duties as Medical Officer of Health for the Borough of Camberwell. Yours obediently, H. W. BARNES. Staff of the Public Health Department at the end of 1926. *Medical Officer of Health H. W. Barnes, B.A., M.B, B.Ch D.P.H. Hon. Consulting Medical Officer of Health Francis J. Stevens, M.A., D.M. *Tuberculosis Medical Officer W. Brand, B.A., M.B., 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.B., B.Ch., D.P.H., J. H. Clatworthy, M.D., and Mrs. F. Cowling, M.R.C.S., L.R.C.P. Medical Officer at Diphtheria Immunisation Clinic Public Analyst G. Bousfield, M.B., B.S.,(Lond.) E. A. Pinchin, B.Sc., F.I.C., F.R.M.S., certified bacteriologist. *Inspector under the Food and Drugs George T. Dewey, b Acts. * Sanitary Inspectors—Male. Dist. Dist. 1. Maurice Malins, a, c 7. George W. Scudamore. b 2. William T. Worsfold. c 8. Richard F. Nash, a, c 3. D. H. Pickard, M.C., a, c 9. George G. Morley. b 4. A. L. Dobson. a, c 10. William Eagle. 5. Henry C. Green, a, c 11. Edwin R. Collins. b 6. Donald Glenday. a, c * Women Sanitary Inspectors. Miss F. O'Riordan. Miss M. Butcher. c, d, g, h, i. a, c, d, g, h, i, j. * Health Visitors. Miss A. M. Stoddart, d Miss A. Duffield d and Miss K. Jerrard. c, d. Clerks. H. K. Wright. H. J. Hurst. *F. T. Harman. A. J. Hardiman. H. J. S. Murray, n. A. J. Baker (Temporary). *C. T. Wilson (Temporary). *Miss M. L. Thompson part-time Milk E. S. Rushton (Temporary) Inquiries and part-time at Infant *R. Hodgson (Temporary). Welfare Centres. *Miss E. Watkins (Temporary), Maternity Ward Bookings. Tuberculosis Dispensary. *Tuberculosis Nurses. Miss H. Chambers, g Miss M. Thistleton ∫ and Miss F. M. Whitney, k, l, m. *Clerks. Miss J. M. Fry, H. W. Leonard, a, c, and F. W. Grimwood. *Dispenser. Miss F. L. Davis (part-time). Disinfecting and Cleansing Station. Foreman Disinfector. A. Franklin. Assistants. E. Corby, A. Peppler (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. g 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. l Certificate Medical and Surgical Nursing. m Tuberculosis Nurses Certificate. n Certificate Royal Sanitary institute and Sanitary Inspectors' Examination Joint Board. A 2 SUMMARY OF STATISTICS FOR THE YEAR 1926. Population (Estimated) 275,400 Area of Borough in Acres 4,480 Separate Houses or Self-contained Flats Inhabited:— *No. of Structurally Separate Dwellings (Census 1921) 41,419 No. of Hereditaments wholly or partially used as Dwellings, 1926 45,307 Number of Births 4,584 Birth Rate 16.6 Number of Deaths 3,038 Death Rate 11.0 Infantile Mortality :— Deaths under 1 year 294 Infantile Deaths per 1,000 Births 64 Maternal Mortality:— Deaths of Women from Diseases or Accidents associated with Childbirth 15 Maternal Death Rate 3.27 Deaths from Phthisis 251 Phthisis Death Rate 0.91 Deaths from all forms of Tuberculosis 286 Tuberculosis Death Rate 1.04 Product of a Id. Rate £6,230 Rateable Value £1,529,580 * Structurally Separate Dwellings.—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. SOCIAL CONDITIONS OF THE AREA. The Metropolitan Borough of Camberwell covers an area of 4,480 acres, and is divided into 20 Wards. The northern portion of the Borough principally houses a working-class population, and is congested in places. In the southern part of Camberwell the houses are of a better type, many of them possessing extensive gardens. There are several Open Spaces in this part of the Borough. Population. The Registrar-General has estimated the population of the Borough at the middle of 1926 to be 275,400, and it is on this figure that the birth and death rates for the Borough are calculated. It should be noted that the population figure for 1926 is stated to be the same as that recorded for the previous year. The estimated population of the different Wards is as follows: Population. Ward. Census 1921. Estimated 1926. West 15,442 15,918 Addington 14,420 14,863 Town Hall 14,201 14,638 St. George's 16,562 17,071 Cobourg 16,096 16,592 Marlborough 13,243 13,655 North Peckham 16,230 16,702 Goldsmith 15,548 16,026 Clifton 16,238 16,738 Rye Lane 8,975 9,252 St. Mary's 11,438 11,790 Nunhead 14,025 14,457 The Rye 10,662 10,990 St. Giles 10,712 11,042 Lyndhurst 12,126 12,500 St. John's 14,566 15,014 Alleyn 14,642 15,092 Ruskin 16,029 16,523 The Hamlet 12,137 12,510 The College 3,906 4,027 267,198 275,400 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. Metal Workers 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 Males. Females. 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 4,442 — Commercial and Finance and Insurance (excluding Clerks) 9,946 3,515 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 1,434 There are no occupations which may be regarded as having any particular influence on the public health. Extracts from Vital Statistics for the Year 1926. Total. M. F. Births Legitimate Illegitimate 4,444 140 2,258 68 2,186 72 Birth rate, 16.6 Deaths V — O - - - Death rate, 11.0 Number of women dying in, or in consequence of, Childbirth : — From Sepsis 7 From other causes 8 Deaths of infants under one year of age per 1,000 births 64 Legitimate, 276; Illegitimate, 18. Total 294 Deaths from Measles, all ages 48 Deaths from Whooping Cough, all ages 7 Deaths from Diarrhoea, under 2 years of age 48 Causes of Sickness and Invalidity. On the whole, 1926 may be described as a healthy year, and no cause of sickness or invalidity requires any special comment. The incidence of infectious disease is dealt with under another section of this report. Births. The number of Camberwell births for the year, after correction for inward and outward transfers, was 4,584. The decline in the birth rate in the last few years is shown in the following table. This decline is not peculiar to Camberwell, but is taking place throughout England and Wales. Birth Rate. Year. Population. Births. 21.4 1922 270,300 5,802 272,300 5,657 20.7 1923 1924 273,700 5,146 18.8 1925 275,400 4,877 17.7 1926 275,400 4,584 16.6 The following table is of interest in showing the birth rate of England and Wales, London, the Borough of Camberwell and the several Wards in the Borough, for the year 1926:— District. No. of Births. Birth Rate. England and Wales 694,897 17.8 London 78,825 17.1 The Borough 4,584 16.6 West Ward 352 22.2 Addington Ward 337 22.7 Town Hall Ward 216 14.8 St. George's Ward 351 20.6 Cobourg Ward 332 20.0 Marlborough Ward 230 16.9 North Peckham Ward 338 20.3 Goldsmith Ward. 344 21.5 Clifton Ward 283 16.9 Rye Lane Ward 127 13.8 St. Mary's Ward 186 15.8 Nunhead Ward 252 17.5 The Rye Ward 133 12.1 St. Giles' Ward 171 15.5 Lyndhurst Ward 148 11.9 St. John's Ward 198 13.2 Alleyn Ward 207 13.8 Ruskin Ward 202 12.3 The Hamlet Ward 133 10.7 The College Ward 44 10.9 Notification of Births Act.—This Act requires all live births and every still-birth occurring after the twenty-eighth week of pregnancy to be notified within thirty-six hours to the Medical Officer of Health of the district in which they occur. This information is of extreme value, as it constitutes the starting point of the work of Health Visitors. During the year 4,126 live births were notified, or ninety percent, of the total number of registered births. The number of still-births notified was 97. A cautionary letter was sent to the person in default whenever it was discovered through the agency of the Registrar's returns that the birth of a child had not been notified. The following table indicates the source of notifications: — Live Births. Still-Births. Notified by Midwives 2,111 33 Notified by Medical Practitioners 1,185 45 Notified by Parents 210 2 Other persons and outlying Institutions 523 17 Deaths. The deaths registered during 1926 as having taken place in the Borough were 3,395. The corrected number of deaths found by deducting 897 deaths of non-residents who died in the Borough and adding 540 deaths of inhabitants of Camberwell who died elsewhere, was 3,038. The corrected death rate for Camberwell for 1926 was 11.0 as compared with 11.1 for 1925. Cancer. There were 397 deaths from cancer in 1926 as compared with 350 in 1925. This is the largest number of deaths from this disease ever recorded. Many and varied are the theories propounded as to the cause of cancer, and of recent years it has been the subject of great public interest. The cause of this disease, however, still remains obscure. We know it to be the most formidable calamity afflicting mankind, and during the last 20 years the death rate has increased 20 per cent. Cancer is at first a local, not a general disease, and therefore our main object should be to secure early diagnosis and operative treatment. It has been the custom in Cmberwell for some years to leave a pamphlet, which contains information as to the early signs and symptoms of this disease in various organs, at every house where a birth takes place, in order to impress on the minds of the people the importance of early medical advice for suspicious cases. The opposition raised to the distribution of the pamphlet on the ground of instilling fear can be discounted. It is more likely that the knowledge it contains has exactly the opposite effect. Respiratory Diseases. 333 deaths were due to bronchitis, 226 to pneumonia (all forms), and 34 to other diseases of the respiratory organs, as compared with 324 bronchitis, 297 pneumonia (all forms), and 41 other diseases of the respiratory organs in 1925. Violent Deaths. 71 deaths occurred under this heading as compared with 82 for the previous year. Suicides. 34 persons committed suicide in the Borough during 1926 as compared with 16 in 1925. Infantile Mortality. The infantile mortality rate for the year was 64. The number of deaths of infants under 1 year was 294, a decrease of 22 on the recorded figure for 1925. The principal causes of deaths in their order of severity were premature birth, pneumonia, enteritis, atrophy, debility and marasmus, and congenital malformation. The following tables show the deaths from all causes, the infantile deaths and deaths from the principal diseases, together with information relating to the birth, death and infantile rates in the 29 Metropolitan Cities and Boroughs in 1926:— 10 11 TABLE I.—CAUSES OF, AND AGES AT, DEATHS DURING THE YEAR 1926. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and up. Deaths of Camberwell residents in Institutions in the Borough. All ages. Under 1. 1 to 2. Cause of Deaths. - - - - - - - - - - Enteric Fever - - - - Small-Pox - - - - - - - - - - - - - - Measles 48 13 19 9 3 4 - - - - - - - 22 Scarlet Fever 5 - - 1 1 1 2 - - - - - - - Whooping Cough 7 2 3 2 - - - - - - - - - - 1 Diphtheria and Croup 6 8 5 7 18 4 54 5 - — — - - Influenza - - - 1 - 1 22 15 39 - - - - - Erysipelas - - 1 - 1 - 2 1 3 6 8 - - - 1 - - 2 3 28 74 65 65 7 119 Phthisis (Pulmonary Tuberculosis) 251 4 2 2 Tuberculous Meningitis 21 1 2 2 2 3 6 1 3 12 - 2 - 5 Other Tuberculous Diseases 2 1 - - 1 1 2 3 1 2 1 14 - Cancer 397 - - - 1 1 1 2 10 20 183 179 157 - Rheumatic Fever 9 - - - - 1 3 1 1 - - 3 3 - - - 3 - 1 2 2 1 - 8 Meningitis 12 2 1 - 223 115 Organic Heart Disease - - - - 1 3 4 12 17 91 351 - 199 Bronchitis 333 14 4 1 - - 2 - - - 14 99 101 Pneumonia (All forms) 226 45 19 5 6 2 3 - - 12 18 58 58 105 Other Diseases of Respiratory Organs 34 1 - 1 - 3 - - 3 4 13 9 11 - 21 Diarrhoea and Enteritis 48 46 2 - - - - - - - - - - 8 Appendicitis and Typhilitis 13 - - - 1 - 1 2 2 2 1 6 1 8 Cirrhosis of the Liver - - - - - - - 2 11 7 20 - - Alcoholism 2 - - - 1 - - - - - 2 - - - 2 63 11 4 37 50 Nephritis, Bright's Disease 108 - - - 1 3 - - - - 6 - 1 - 7 Puerperal Fever 7 - - - - - - 6 Other Accidents and Diseases of Pregnancy and Parturition - - - - - - 5 3 - - 8 - - Congenital Debility and Malformation, including Premature Birth 37 110 110 - - - - - - - - - - - 3 10 9 6 15 21 19 Violent Deaths 3 1 2 1 - 71 - 9 14 5 34 Suicides 34 - - - - - - - 3 3 Other Defined Diseases 807 1 1 2 8 12 10 36 41 175 473 325 46 2 - - - - - - - - - - - Diseases ill-defined or unknown - - - 1 - - - - - - - 1 - - - - Encephalitis Lethargica - 3,038 294 30 22 22 56 35 68 191 210 796 1,254 1,192 60 Total 13 12 TABLE II—BIRTH, DEATH AND INFANTILE MORTALITY RATES AND DEATHS FROM PRINCIPAL DISEASES, 1926. Deaths from Population. Birth Rate. Death Rate. Infantile Mortality Rate. Scarlet Fever. Measles. Whooping Cough. All forms Tuberculosis. All forms Pneumonia. Cancer. Bronchitis. Diphtheria. Whole Borough Ward 275,400 16.6 11.0 64 54 5 48 7 286 226 397 333 No. 1 15,918 22.2 13.3 2 1 6 28 19 24 17 77 - 2 14,863 22.7 10.8 74 7 - 5 - 18 22 15 19 20 24 3 14,638 74 - 4 8 16 14.8 9.2 - 3 2 2 20 24 25 31 4 17,071 20.6 12.7 1 63 16,592 20.0 4 - 18 11 16 24 5 1 7 11.6 90 6 13,655 16.9 6 2 12 18 23 78 1 1 14 10.5 7 12 12 21 18 7 16,702 20.3 7 11.4 95 - - 8 16,026 21.5 5 - 2 - 21 9 23 18 10.7 9 16,738 16.9 41 3 1 2 18 13 33 22 13.5 57 - 10 9,252 13.8 3 1 - 9 5 11 12 10.8 63 - 11,790 15.8 1 11 1 1 1 12 12 14 12 11.1 75 4 12 14,457 17.5 11.3 - 5 27 10 23 13 52 4 - 13 10,990 12.1 11.5 6 18 12 11 68 - - - - 14 11,042 15.5 13.3 11 58 - - - 6 20 19 1 15 12,500 11.9 34 - - 11 6 27 8 9.1 - - 16 15,014 13.2 10 20 17 8.3 1 2 - 16 50 - 17 15,092 13.8 8 9 21 10 8.6 34 - - 2 1 18 16,523 7 22 19 19 12.3 9.0 1 54 3 - - 7 9 20 9 19 12,510 10.7 9.2 38 - - - - 2 1 5 20 4,027 13.1 6 10.9 45 - - - - 1 TABLE III.—INFANTILE MORTALITY DURING THE YEAR 1926. Deaths from Stated Causes at Various Ages under One Year of Age. Under 1week. 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. 1 to 2 weeks. Cause of Death. Small-pox - - - - - - - - - Chicken-pox - - - - - - - - - Measles - - 1 - 4 8 - - - - - - - Scarlet Fever - - - - - Whooping Cough - 1 - - - 1 - - - Diphtheria and Croup - - - - 2 1 2 - - Erysipelas - - - - - - - - - Tuberculous Meningitis - - - - - 1 - - - Abdominal Tuberculosis - - - - - - - - - Other Tuberculous Diseases - - - - - 4 1 - 1 - Meningitis - - - - - 1 1 1 6 Convulsions - - 6 1 - - 1 1 Laryngitis - - - - - - - - - - Bronchitis - - - - 3 5 4 2 Pneumonia (All forms) 1 8 2 3 2 9 8 12 8 Diarrhoea - - - - 1 - 1 - - Enteritis 1 2 - 3 19 6 - 6 7 - 2 1 Gastritis - - - - - - - Syphilis - - 1 1 1 1 - - Rickets - - - - - - - - - Suffocation 4 - - 4 1 1 - - - - - Injury at Birth 6 - - - 6 - - Atelectasis 3 1 - 1 5 - - - - Congenital Malformation 9 3 4 1 17 4 4 1 - 4 3 43 Premature Birth 32 4 4 4 1 - 1 Atrophy, Debility and Marasmus 3 2 3 13 6 4 1 9 10 1 17 1 - - Other Causes 4 2 2 Totals 75 Table showing the Birth Rates, Death Rates and Infantile Mortality Rates in the 29 Metropolitan Cities and Boroughs in 1926. Deaths per 1,000 Population. Infantile Deaths per 1,000 Births. Births per 1,000 Population. City of London 7.9 City of Westminster 11.3 Hampstead 12.2 Holborn 12.4 St. Marylebone 12.8 Chelsea 13.3 Wandsworth 14.3 Kensington 15.1 Paddington 15.4 Lewisham 15.5 Stoke Newington 15.6 Fulham 16.3 Hammersmith 16.3 Camberwell 16.6 St. Pancras 16.8 Woolwich 16.9 Lambeth 17.2 Battersea 17.3 Hackney 17.3 Greenwich 17.8 Deptford 18.2 Islington 18.5 Stepney 19.7 Southwark 20.2 Finsbury 20.6 Bermondsey 20.8 Bethnal Green 20.9 Poplar 21.7 Shoreditch 23.3 Lewisham 10.0 Woolwich 10.1 Hampstead 10.1 Wandsworth 10.4 Hackney 10.6 Fulham 10.7 Greenwich 10.9 City of London 10.9 Camberwell 11.0 Stoke Newington 11.0 Deptford 11.1 Battersea 11.2 City of Westminster 11.2 Poplar 11.3 Hammersmith 11.3 Lambeth 11.5 Bethnal Green 11.6 Stepney 11.7 Holborn 11.7 Bermondsey 11.7 Shoreditch 11.9 Islington 12.0 St. Pancras 12.2 Paddington 12.3 Chelsea 12.4 Kensington 12.4 St. Marylebone 12.6 Southwark 12.7 Finsbury 12.8 Lewisham 40 Woolwich 42 Stoke Newington 49 Lambeth 54 Deptford 56 Bermondsey 56 Hampstead 58 Hackney 60 Kensington 61 Battersea 61 City of Westminster 62 Greenwich 63 Camberwell 64 Wandsworth 64 Fulham 65 Chelsea 65 Stepney 65 City of London 66 Shoreditch 66 Finsbury 67 Islington 67 Hammersmith 67 Southwark 70 Poplar 70 Bethnal Green 72 St. Pancras 76 St. Marylebone 82 Paddington 84 Holborn 90 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Hospitals Provided or Subsidised by the Local Authority. Fever and Small-Pox. There is no fever hospital situated in the Borough. The Metropolitan Asylums Board is responsible for the provision of fever hospitals in London. Tuberculosis. The London County Council is responsible for the institutional treatment of tuberculosis in London. They maintain no institution in Camberwell. Maternity. The Borough Council subsidise two wards in St. Giles' Hospital, Brunswick Square. Children. There are no children's hospitals in the area. The nearest institution, viz., The Belgrave Hospital for Children, is situated about one mile from the Borough boundary in the neighbouring Borough of Lambeth. Other Hospitals. The residents of Camberwell are particularly fortunate in having St. Giles' Hospital (Camberwell Board of Guardians Hospital) and a large number of General Hospitals within easy access. Institutional Provision for Unmarried Mothers. 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. Union of Girls' Schools Infant Welfare Centres, 17, Peckham Road Waiting room; weighing room; consultation room. do. Tuesdays & Fridays. And Amott Road, East Dulwich do. do. do. Wednesdays & Thursdays. Camberwell Municipal, 140, Camberwell Road. do. do. Rented by Camberwell Boro' Council Mondays; ante-natal, 2nd & 4th Thursdays. Dulwich Municipal, 114, Lordship Lane do. do. do. do. Wednesdays & Thursdays. Every Tuesday. Peckham Municipal, St. Jude's Church Hall, Meeting House Lane, Peckham, S.E. do. do. do. do. Disinfecting Station, Peckham Park Road Accommodation for cleansing of verminous children; one receiving room; one bath room and a discharge room. Camberwell Borough Council. Daily except Saturday. Tuberculosis Dispensary, 19, Brunswick Square. do. do. Daily. Waiting room; investigation room; two dressing rooms; two Medical Officer's rooms, and a dispensary. Nursing Arrangements. The Ranyard Nursing Association operates in Peckham and also in parts of Camberwell and the Dulwich areas of the Borough; the Camberwell District Nursing Association in North-West Camberwell, and the East Dulwich and Dulwich Village Nursing Association in that part of Dulwich not covered by the Ranyard nurses; the Rotherhithe District Nursing Association in the area which lies to the north of Old Kent Road, viz., parts of Wards Nos. 6 and 7. The Borough Council pays at the rate of 1s. per visit for visits made to maternity and infectious disease cases arising out of maternity, including puerperal septicaemia, and to cases of illness in children under 5 years of age, and also for patients suffering from diseases specified in the Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1919, and other approved cases made by the Ranyard Nursing Association and the Camberwell District Nursing Association. The Council also has an arrangement with the Rotherhithe District Nursing Association to pay at the rate of 1s. per visit made by their nurses to notified cases under the Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1919, and to cases of puerperal septicaemia and ophthalmia neonatorum. The following table shows the number of cases attended, the visits paid and the cost of this service to the Council by the Associations which rendered accounts during the year ended 31st December, 1926, viz., the Ranyard and Camberwell District Nursing Associations: — Quarter ended Cases. Visits. Cost. £ s. d. March 155 1,935 96 15 0 June 129 1,479 73 19 0 September 104 1,016 50 16 0 December 132 1,421 70 18 6 Total 520 5,851 292 8 6 Midwifery. During 1926 there were 45 practising midwives in the Borough of Camberwell. There is also in the Borough a Post Certificate School for Midwives situated at Southampton Street, Camberwell. The school is a branch of the General Lying-in Hospital, York Road, Lambeth, whose purpose is the training of pupil midwives and the provision of " refresher courses " for practising midwives especially those working in rural areas. Much useful work is being done, and the extent of the popularity of the school and the value of the training that is given may be appreciated by recording that among the counties which send midwives for " refreshers " are Cornwall, Somerset, Sussex, Essex, Leicester, Northampton and Norfolk, in order that they may be equipped with the most up-to-date knowledge and methods of present day midwifery. The school also receives scholarship students each year and midwives home on furlough from other countries. The midwives and pupils are resident at the school, and courses are arranged for one or two months' duration. The training includes home visiting, instruction at the ante-natal clinic which is held at the school three times a week, also attendance at clinics and lectures at the General Lying-in Hospital, St. Giles' Hospital, Camberwell, and other institutions. Courses of lectures are given from time to time to which other public health workers are invited. The Ministry of Health pay a grant of £ 1 per week for each student. Public Baths. Three public swimming baths are provided for the inhabitants of Camberwell. They are as follows: — Camberwell Baths, situated at Church Street. Men's First Class Swimming Bath, capacity of 120,000 gallons. Men's Second Class Swimming Bath, capacity of 120,000 gallons. Dulwich Baths, situated at East Dulwich Road Men's First Class Swimming Bath, capacity of 120,000 gallons. Men's Second Class Swimming Bath, capacity of 90,000 gallons. Old Kent Road Baths, situated at Old Kent Road. Men's First Class Swimming Bath, capacity of 85,000 gallons. Men's Second Class Swimming Bath, capacity of 75,000 gallons. During the year the Council installed a modern apparatus for the constant filtration and aeration of the water at the Old Kent Road Baths. The type of plant selected was that made by Messrs. Bell Bros. (Manchester) Ltd. An analysis of the water following the installation of the plant showed a very satisfactory water condition both from the chemical and the bacteriological points of view. B2 Public Mortuary. The following is a return of the year's work of the Public Mortuary, which is situated at St. George's Road, Peckham: — Bodies Received. Non-Residents. Bodies brought from outside the Borough for the convenience of the Coroner. 18 182 17 16 12 17 16 12 12 11 13 22 16 Camberwell Residents. 19 12 215 22 15 19 24 21 15 12 23 13 20 139 11 11 Number of Courts. 14 11 13 11 13 8 6 15 13 13 Number of P.M.s Held. 19 258 26 28 29 21 27 18 19 13 13 18 27 Return of Work for 1926. For Inquests. 36 30 PUBLIC MORTUARY. 362 38 27 35 28 27 21 18 31 35 36 - - For Burial only. Total. - 35 - 1 12 6 6 5 5 - - 36 30 397 38 27 36 40 33 27 23 36 35 36 Females. 15 15 14 13 151 9 11 10 8 14 13 18 11 Males. 23 22 17 22 22 18 246 21 17 29 15 13 27 Month. January February March June July December Totals August September October November April May SANITARY CIRCUMSTANCES OF THE AREA. Closet Accommodation. The water carriage system is general throughout the Borough with the exception of five outlying places where no sewers are available, and cess pools have to be used. A small number of sports grounds are provided with earth closets. Sewerage and Drainage. The number of sewers relaid or partially relaid during the year was 8. 115 drains were totally reconstructed and 177 drainage systems partially reconstructed or repaired during the year. Scavenging. The collection of house refuse is carried out by the Works Department of the Council. A weekly collection is the rule, but where necessary a more frequent collection is made in the case of blocks of tenements, boarding houses, etc. During the year attention was given to the question of ensuring that every house had an efficient dust bin. 1,311 notices were served for improper dust bins. Smoke Abatement 67 observations were made for smoke nuisances. In 5 instances it was necessary to serve a statutory notice. Owing to the shortage of British coal in the last quarter of the year, inferior coal had to be used in the various factories in the Borough, which in many instances was responsible for causing a nuisance of the emission of black smoke. Steps were taken by the Inspectors, however, to reduce to a minimum the occurrence of nuisances by offering advice on the methods of careful and efficient stoking. The Public Health Smoke Abatement Act, 1926, comes into operation on July Ist, 1927. It amends the provision of the Public Health Act, 1875, and the Public Health (London) Act, 1891, relating to smoke nuisances. The principal provisions of the Act deal with the following matters:—Power to take proceedings in respect of a nuisance from smoke which is not black. The expression " smoke " to include soot, ash, grit and gritty particles. Power to make By-laws prescribing standards as to the emission of smoke, and respecting cooking and heating arrangements in new buildings, other than private dwelling houses. Power to the Minister of Health to authorise the County Council to carry out duties with regard to smoke abatement in default of the Sanitary Authority, and authority to the Minister of Health to extend the operation of the Alkali Act. Rats and Mice (Destruction) Act, 1919. The same procedure was adopted as in previous years for dealing with this nuisance. 22 23 SUMMARY OF INSPECTIONS, ETC., JANUARY 1st TO DECEMBER 31ST, 1926. Description op Work. Inspectors. Totals. Mrs. Scudamore. Miss O'Riordan. M. Malins. H. C. Green. R. F. Nash. W. T. Worsfold. D. Glenday. A. L. Dobson. D. H. Pickard. W. Eagle. G. W. Scudamore. G. G. Morley. E. R. Collins. 4 679 707 300 12 5,600 Visits to complaints 518 293 725 481 565 425 370 521 39 9 - 2,982 378 333 138 527 62 308 177 421 House inspections following on complaints 140 450 4 2,152 336 225 222 251 129 186 130 - 165 211 247 46 House-to-house inspections 247 - 90 39 - 56 - Tenement inspections 3 13 41 4 1 - - 271 - - Houses let in lodgings inspections - 271 - - - - - - - - - 297 - - - Housing and Town Planning inspections - - 51 102 - 144 - - - - 324 43 - - 2,068 Visits to new buildings 502 175 274 33 78 - 638 - 1 5 41 - 4 155 Visits re overcrowding 19 5 8 21 2 4 1 10 35 - - 195 Slaughterhouses 112 73 5 2 - - 3 - 50 - - 28 27 17 - 388 23 77 36 16 47 34 33 - Bakehouses 50 - 16 16 - - Cowhouses - - - - - - - - - 192 118 132 188 98 - 1,435 Milkshops and dairies 85 169 75 113 120 - 145 - 17 26 28 23 224 Eating houses 13 8 14 5 21 - 64 5 90 33 486 Ice cream shops and stalls 37 32 50 49 45 - 14 20 43 73 - - 154 - Railway stations 7 75 69 - - - - 3 - - - 311 24 97 85 253 1,269 Workshops 46 115 98 24 54 48 59 55 52 296 90 745 37 48 18 50 23 75 Factories 3 15 17 21 3 - 3 16 - 27 Offensive Trade Premises—Visits - 5 - - - - - - 13 27 118 68 645 83 33 46 61 75 61 28 Urinals, public 32 - 136 414 2,542 Do. private 147 285 144 428 137 - 165 157 159 370 - 37,163 1,581 2,873 3,782 4,609 2,044 354 2 Re-inspections 3,825 3,994 2,982 4,143 3,029 3,945 4,763 242 56 1,115 141 Miscellaneous 325 372 386 288 429 445 296 313 355 211 10 10 1,913 Infectious cases visited and houses inspected 155 227 151 249 319 112 126 109 87 147 1,202 31 17 517 278 28 12 37 35 27 19 120 61 Infectious cases, inquiries 20 - - 131 Infectious disease contacts visited - 4 10 1 15 1 - - 5 84 11 5,582 279 3,626 200 692 304 92 - - Inspection of foodstuffs 1 48 38 46 256 11 26 5 - - 67 6 15 4 - Smoke observations - - - - 96 157 39 - 11 2 - - - - Schools, private 9 - - - 921 1,869 2,790 - - Outworkers visited - - - - - - - - - 1,083 - 774 309 Measles - - - - - - - - - - 6 24 Scabies - - 18 - - - - - - - - - 203 - - 200 3 Ophth. Neonm. - - - - - - - - - 52 - - 43 9 - - - Verms. Cplts., visits - - - - - - 4 - 62 2 4 12 9 4 3 10 5 - 5 4 Fish curers premises 5 1 8 - - - 24 Rag and bone dealers' premises 3 - 3 4 - - - 4,797 3,142 77,114 7,240 5,821 3,282 6,103 6,843 7,389 6,961 7,929 Total number of visits 5,201 6,892 5,424 - 2 Seizures of foodstuffs - - 2 - - - - - - - - - - - 1 - 1 3 - 7 Smoke nuisances 2 - - - - - 10 26 2 - 115 9 9 7 9 13 Drains, total reconstruction 14 16 - - 177 47 9 20 6 - - - Do. partial reconstruction 16 - 54 2 12 11 7,007 965 684 8 506 645 678 512 666 439 632 533 169 Intimations 510 243 - - 2,048 225 153 180 92 273 220 149 Statutory notices, Public Health 187 111 215 - 4 - - - - Notices, Section 3, Housing Act, 1925 - - - - - - 4 - 4 10 2 - 58 - 1 4 14 23 - Do. Section 5 do. do. - - - 276 Intimations, houses let in lodgings 276 - - - - - - - - - - - - 99 - 99 - - - - - - Notices, houses let in lodgings - - - - - - 20 - 227 18 22 39 9 5 - Jobs done without notices 88 26 - - 24 25 SUMMARY OF SANITARY ORDERS JANUARY 1st TO DECEMBER 31ST, 19 2 6. Inspector. Description of Work. W. T. Worsfold. D. Glenday. A. L. Dobson. D. H. Pickard. G. G. Morley. M. Malins. H. C. Green. R. F. Nash. W. Eagle. E. R. Collins. G.W. Scudamore. Cleanse and repair walls and ceilings 331 299 461 390 229 569 341 149 358 129 460 216 237 132 241 366 Repair roof, guttering, etc. 188 269 229 180 105 78 137 229 66 Provide damp-proof course, etc. 158 88 112 126 238 135 61 63 12 8 8 15 4 8 11 Abate overcrowding 1 26 4 - 1 1 1 1 2 Abate smoke nuisance 2 1 - - - - 90 87 63 55 151 64 40 100 Repair stoves, coppers, etc. 52 25 16 175 96 211 70 31 232 127 Repair windows, sashlines, doors, etc. 39 32 10 47 139 29 192 158 104 57 33 175 80 Repair flooring, stairs, etc. 13 20 1 - 4 1 9 - - Light and ventilate staircase, etc. - - - 320 - 168 127 140 125 Provide dustbin 200 225 256 183 230 238 21 11 2 14 Remove accumulation 6 10 11 5 13 12 3 144 93 34 96 87 30 106 105 Pave, level and drain yard 12 33 78 2 2 1 1 2 3 1 2 1 Provide or repair manure pit ... 3 1 6 2 4 3 16 4 2 5 6 Provide sufficient water supply 5 8 - 1 Provide receptacle or render accessible 2 7 1 - - 1 - 23 - - 13 5 7 12 35 Repair cover or cleanse receptacles, etc. 13 10 13 11 9 16 17 Clear premises of rats, etc. 4 15 9 3 5 2 4 1 6 60 118 Provide, cleanse, repair or remove closets, pans, etc. 34 71 74 50 11 39 84 71 37 46 28 15 27 114 78 Provide water supply to closet, repair flushing apparatus 30 59 35 67 17 Ventilate and remove outside soil pipes, cleanse, repair and trap drains, etc. 26 99 27 52 65 58 49 18 55 21 54 36 63 22 43 41 62 74 Provide, cleanse, repair or trap sinks, waste pipes, etc. 41 20 17 38 - 10 Animals to be kept clean or removed 3 5 3 3 4 2 4 1 4 - - - - - 1 Public conveniences, cleanse, supply with water, etc. - - - - - 3 1 5 8 Private conveniences, cleanse, supply with water, etc. 4 8 3 3 - - - 44 48 122 65 41 145 complaints were received of premises being infested with rats, and the necessary action was taken to get rid of them. Where it was found that the nuisance was caused by the defective condition of the drains, notices were served on the owners. In other instances assistance was given to the occupiers by the distribution of poison baits. Sanitary Inspections. The following table shows the number of notices which have been served in respect of nuisances found in the various districts during the year: — Public Health (London) Act, 1891. Intimations 7,007 Statutory Notices 2,048 Summonses applied for Housing Act, 1925. 63 Notices, Sect. 3 4 Sect. 5 58 Summonses Nil. By-Laws. Houses let in Lodgings 99 London County Council (General Powers) Act. Intimations 21 Notices 6 Summonses — Rats and Mice (Destruction) Act, 1908. Complaints received 145 Intimations 58 Notices - SUMMARY OF LEGAL PROCEEDINGS. Summonses. Complaint. Result. Fine. Costs. 46 Insanitary Premises Withdrawn —work done Nil Paid in each case, varying from 13s. 6d. to £1 1s. 4 ditto Paid in one case. Adjourned "sine die" - - 11 ditto Magistrate's Order made varying from 14 to 28 days Costs in each, £1 1s. - 1 Neglecting to provide sanitary dustbin. Withdrawn —bin supplied Costs to Council. - - 1 Non-compliance with Magistrate's Order. Withdrawn Causing offensive matter to be carried through the streets of the Borough during prohibited hours. 3 cases fined 1 case withdrawn 1 case dismissed £2 £1 1s. costs in two cases. 5 HOUSING. Overcrowding. Overcrowding is still prevalent, especially in the northern part of the Borough. 155 cases of overcrowding came to the notice of the Health Department during the year. In 80 instances a letter was given to assist the family to obtain accommodation on one of the London County Council Housing Estates. Information received from the London County Council that 50 families, living in unhealthy or overcrowded conditions, had been invited to view accommodation on one of the Council's estates. The owner or tenant of each house in which these families were living were warned of the steps that would be taken if the vacated accommodation again became overcrowded. Rent and Mortgage, Interest Restrictions Acts, 1920-1923. During the year 11 applications were received from tenants for certificates under these Acts, and in every case a certificate was granted. Notices were served on the owners of the premises to abate such nuisances as could be dealt with under the Public Health (London) Act, 1891. Houses Let in Lodgings. By-laws framed by the London County Council under the Public Health (London) Act, 1891, and Section 6 of the Housing Act, 1925, with respect to houses intended or used for occupation by the working classes and let in lodgings or occupied by members of more than one family, were confirmed by the Minister of Health in 1925. The Clauses of these By-laws under which the Council can require considerable structural alterations so as to provide more satisfactory water closet, washing and food accommodation, and the lighting of every common staircase, do not come into operation until six months after the Pent and Mortgage Interest (Restrictions) Acts, or any re-enactments thereof, shall have ceased to be in force. At the present time there are 297 houses let in lodgings on the Register. No additions to this list were made during the year. Unhealthy Areas. It has not yet been found possible to find alternative accommodation for the people living in the following areas represented in 1922 as unfit for habitation:— 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 Wyndham Road Area Improvement Scheme, 1925. The intention of this scheme is the clearance of an insanitary area in the neighbourhood of Wyndham Road, an insanitary area known as the China Walk area, North Lambeth, and an insanitary area known as the Hatfield area in Southwark, and the acquisition of four acres of lands and premises adjacent to Wyndham Road for the erection of six blocks of buildings by the London County Council for the accommodation of 2,020 persons. The number of houses, families and persons living in Camberwell in the area covered by the Improvement Scheme are 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 Pallador Place 11 17 68 Comber Grove 4 4 15 Totals 84 104 458 Comber Grove 39 80 254 "B" Area to be acquired. 4 Acres. Blucher Road 3 5 23 Allens Cottages 3 5 19 45 90 296 Totals for the whole area 129 194 754 The result of the inquiry held by the Minister of Health is not yet known. During the year under review a representation was made to the London County Council, pursuant to the provisions of Section 35 of the Housing Act, 1925, for an Improvement Scheme embodying the Basing Place and Blue Anchor Lane areas. The number of houses, families and persons involved in the Scheme are shown in the following table: — Basing Place and Blue Anchor Lane Areas. No. of Houses. No. of Families. No. of Persons. Basing Place area 48 61 248 Blue Anchor Lane area 77 121 510 The Ministry of Health local enquiry in connection with the Scheme had not taken place at the close of the year. HOUSING, 1926. STATISTICS. Number of New Houses erected during the Year 1926. (a) Total (including numbers given separately under (6) 92 (b) With State assistance under the Housing Acts— (1) By the Local Authority Nil (2) By other bodies or persons Information not available 1. Unfit Dwelling Houses:— Inspection— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 7,862 (2) Number of dwelling houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 2,152 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 125 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 7,283 2. 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 their officers 227 29 3. Action under Statutory Powers: — (a) Proceedings under Section 3of the Housing Act, 1925 Nil (1) Number of dwelling houses in respect of which notices were served requiring repairs 4 (2) Number of dwelling houses which were rendered fit after service of formal notices — (a) By owners (b) By Local Authority in default of owners ... ... Nil (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil (b) Proceedings under Public Health Acts— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 2,147 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 2,146 (b) By Local Authority in default of owners 1 (c) Proceedings under Sections 11, 14, and 15 of the Housing Act, 1925— (1) Number of representations made with a view to the making of Closing Orders Nil (2) Number of dwelling houses in respect of which Closing Orders were made Nil (3) Number of dwelling houses in respect of which Closing Orders were determined Nil (4) Number of dwelling houses in respect of which Demolition Orders were made Nil (5) Number of dwelling houses demolished in pursuance of Demolition Orders Nil INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Inspections made by Sanitary Inspectors in 1926. Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Premises. (1) Factories (including Factory Laundries) Workshops (including Workshop Laundries) 745 64 - Workplaces (other than Outworkers' premises) 1,269 94 - 2,014 158 - Total 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES, Particulars. (1) Number of Defects. Remedied. (3) Referred to H.M. Inspector. (4) Number of Prosecutions. (5) Found. (2) Nuisances under the Public Health Acts :—* Want of cleanliness 55 55 - - Want of ventilation 2 2 - Overcrowding - - - - - Want of drainage floors - - - - Other nuisances 180 174 - - Sanitary Insufficient 6 6 - - Unsuitable or defective 3 3 - - Not separate for sexes 3 3 - - 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 (Factories and Workshops Transfer of Powers) Order, 1921] ... - - - - 249 243 — — Total * Including those specified in sections 2,3, 7 and Bof the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. Factories, Workshops and Workplaces on the Register at the end of 1926. Wearing apparel Engineering trades Building trades Preparation, etc., of foodstuffs Sawmills, joinery works, etc. Printing and lithography Laundries Chemical works, manufacturing chemists Brush Trade Toy makers Varnish and colour works Offensive trades Glass blowing Gas works Bakehouses Eating Houses Miscellaneous 272 117 64 59 57 52 34 19 10 8 5 9 2 1 127 161 785 Total 1,782 Outworkers. In accordance with Section 107 of the Factories and Workshops Act, lists of outworkers were received from 77 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 2,790 visits to outworkers' homes. INSPECTION AND SUPERVISION OF FOOD. Milk and Dairies Order, 1926. The above Order, made by the Minister of Health in pursuance of his powers under the Milk and Dairies (Consolidation) Act, 1915, Section 1, came into operation on October 1st, 1926. The Order revokes the Dairies, Cowsheds and Milkshops Orders of 1885, 1886 and 1899, and all Regulations made thereunder under by Local Authorities. The main provisions of those Orders and Regulations are replaced in the present Order by provisions similar in general purposes but modified in accordance with the development of modern hygienic knowledge so as to lay greater stress on cleanliness in all operations connected with the production and handling of milk. Important new provisions of the Order (Part IV) relate to the health and inspection of cattle, and these are enforced and executed by Councils of Counties and County Boroughs, the remainder of the Order Being enforced by the Sanitary Authorities. Provisions are made for the registration by Sanitary Authorities of all persons carrying on, in their district, the trade of cowkeeper or dairyman, and of all farms and other premises which are used as dairies (Part III). Under Part V general provisions are made for securing the cleanliness of dairies, etc., and protecting milk against infection and contamination; and Part VIII deals with the conveyance and distribution of milk and the cleansing of churns, etc. Under this part of the Order it is provided that all receptacles containing skimmed or separated milk shall have the words " skimmed milk " or " separated milk " marked on such receptacles in large and legible type. The Register which the Council is required to keep in accordance with the above Order contained, at the end of December, the names and addresses of one cowkeeper and 400 dairymen, and the addresses of 368 premises used as dairies. The inspections of dairies and milkshops during the year numbered 1,435, and such sanitary defects as were found were remedied. Milk Supply. Most of the milk supply for the inhabitants of Camberwell comes from firms outside London. The distribution of milk in bottles has considerably increased of late owing to the knowledge on the part of the public of the advantages of the distribution in this manner. Bacteriological Examination of Milk.—It is generally recognised that the number of bacteria in milk is the only safe indication of its cleanliness and keeping quality. The following table gives the results of the bacteriological examinations of milk, other than that specially designated: — Serial No. Date obtained. Bacteria Count. Presence of Coliform Bacillus. 1926. Feb. 10th Per cc. 165,,000 1 Acid and gas in 1/100 cc. in 24 hours. 4 20 May 20th Nov. 4th 1,430,000 - Do. do. — Tubercle Bacilli not found. Sample of Tinned Cream. 8 July 6th under 100 per cc. Bacillus Coli absent Dirt in Milk.—One sample of milk was submitted for chemical analysis for the presence of dirt, sediment, etc., and was reported on as follows:— Date obtained. Serial No. 2 Feb. 10th No visible or weighable dirt could be detected. Milk (Special Designations) Order, 1923. This Order prescribes the conditions subject to which licenses may be granted for the sale of milk as " Certified," Grade "A" c (Tuberculin Tested), Grade "A," Grade "A" (Pasteurised), and Pasteurised. Every license granted is valid for a period ending on the 31st day of December in the year in respect of which it is granted. During the year 1926 the following licenses were granted: — Dealers licenses to use the designation " Certified Milk " 25 Dealers licenses to use the designation Grade " A." (Tuberculin Tested) including two bottling establishments and two supplementary licenses 27 Dealers licenses to use the designation Grade "A " 9 „ „ „ „ Grade "A" (Pasteurised) 2 „ „ „ „ Pasteurised 20 Total 93 During the year 7 samples of " Certified " milk and 4 samples of Grade "A" (Tuberculin Tested) milk were taken for the purpose of ascertaining whether they complied with the bacteriological standard. The results of the examinations are shown in the following tables : — CERTIFIED MILK. Result of Bacteriological Examination. Conditions prescribed for the Sale of Certified Milk. Serial No. Date obtained. Presence of Coliform Bacillus. Bacteria Count. 1926. Per c.c 1 3 Apr. 22nd 7,300 Acid, no gas in 1 c.c. in 48 hours 5 May 26th 106,000 Acid and gas in one-tenth c.c. in 48 hours. 9 2,500,000 July 8th Acid and gas in 1 c.c in 24 hours. Aug. 11th 27,000 13 No acid and gas in 1 c.c. in 48 hours. Sept. 23rd 4,400 Not more than 30,000 bacteria per c.c. and no coliform bacillus in one - tenth of a c.c. 16 Acid and gas in one-tenth c.c. in 48 hours. Dec. 9th 4,300 21 Acid, no gas in one-tenth c.c. in 48 hours. Grade "A" (Tuberculin Tested) Milk. Result of Bacteriological Examination. Conditions prescribed for the Sale of Grade "A" (T.T.) Milk. Serial No. Date obtained. Presence of Coliform Bacillus. Bacteria Count. 1926. Per c.c. 264,000 Absent in 48 hours. Not more than 200,000 bacteria per c.c. and no coliform bacillus in 1/100 c.c. June 10th 6 Do. 4,100 Absent in 48 hours. 7 4,700 Absent. 17 Oct. 14th 760 Absent in 48 hours. 18 Do. Meat The Public Health Meat Regulations, 1924, were designed to secure more effective inspection of animals slaughtered for human consumption, and for the protection of meat from contamination by dust, flies in shops, on stalls and during transit. Slaughterhouses. At the end of 1926 there were 2 slaughterhouses licensed in the Borough. In accordance with the Meat Regulations, notice must be given to the Public Health Department before slaughtering takes place. Upon the receipt of such notice the Inspector of the district in which the slaughterhouse is situated attended during the process of slaughtering, with the result that the carcase and internal organs of every animal slaughtered in the Borough was examined before being passed out for human consumption. No instances of slaughtering without notice were detected during the year. During the year 195 slaughterhouse inspections were made. The following table shows the number of animals slaughtered in the Borough in 1926: — Animals Slaughtered. Month. Cattle. Calves. Sheep and Lambs. Swine. Totals. January 8 61 13 84 2 12 81 61 February 8 - 11 4 54 21 90 March 2 46 April 8 2 34 2 63 74 May 9 - 4 106 121 11 - June 3 97 106 July 6 - - 2 108 August 6 100 105 3 78 14 September 10 72 4 41 18 October 9 66 3 November 10 40 13 93 December 11 2 50 30 c 2 The practice in connection with these inspections is to observe the recommendations of the Ministry of Health set out in a memorandum issued in 1922. The following table gives particulars of the organs condemned:— Slaughterhouses. Organs Condemned. Cause of destruction. Carcase including Organs. Fore-quarters. Hind-quarters. Head. Tongue. Lungs. Heart. Liver. Stomach. Spleen. Mesenteries. Intestines. Kidneys. Udder. 1 f 1 I n r~r 1 I "I II 1 I rn I I I I I i Cattle. Nil 1½ 1 9 2 16 1 3 - - 5 - - Tuberculosis - Abscess 5 - - - - - - - - - - 1 Actinomycosis - - - - - - - - - - - - - 1 5 - Fluke - - - - - - - - - - - Parasitic Disease Sheep. I I I I I I I I I I - - - - 1 - - - - - - - - Cirrhosis - - 1 - - - - - - - - - - Parasitic Disease „ - - 91 - - - 1 - - - - - - - - 6 - - - - - Fluke - - - - - Inflammation - - - 1 - - - - - - - - - Pigs. I I Tuberculosis - - - 5 - 1 1 1 - - 1 - - Inflammation „ - - - 4 1 - - - - - - - - 1 Cirrhosis - - - - - - - - - - - - 2 Parasitic Disease Calves. - - - - 1 3 - - - - - - Tuberculosis „ - - - - 3 - - - - 1 - - - The total amount of the diseased meat condemned amounted to 10 cwt. 3 qrs. 2½ 1bs. All meat condemned is taken as soon as practicable to the Council's Depot, Peckham Park Road. The amount of time devoted by the Inspectors to this section of the work is amply justified by the results. By-laws prescribing humane slaughtering came into operation in London during 1924. The Council's Inspectors at their visits satisfy themselves that these methods of slaughtering are applied. No application to authorise the use of a distinctive mark of approvod design in connection with meat inspected was made to the Local Authority during the year. Butchers' Shops, Stalls, etc. The Regulations prescribed for the protection of meat from contamination were carried out without the necessity of having to resort to drastic action to enforce compliance with the Regulations. The Meat Traders have realised the value of the Regulations and have been willing to comply with any reasonable suggestion made for the protection of the meat. At the end of the year there were 157 butcher shops in the Borough, and of these 132 are fitted with glass fronts. In those shops which do not possess glass fronts other precautions have been taken. In addition to the above butchers' shops there were 561 provision dealers' premises, 5 provision dealers' stalls, 6 offal shops, which came under the Meat Regulations. These places were visited systematically by the Inspectors. Meat Transport. The methods of transport and handling required constant supervision to prevent fouling of the meat. It will possibly take some years before those engaged in the transport of meat will realise the importance of the prevention of contamination and the necessity to take steps for the observance of cleanliness. Two warning letters were sent during the year to persons engaged in the transport of meat, pointing out that they were not carrying out the Regulations, and that further steps would be taken if an improvement was not made forthwith. Suspected Food Poisoning. In April, 1926, the attention of the Department was directed to several cases of illness in a family in East Dulwich, resulting in the death of one child, which the doctor in attendance thought was due to food poisoning. After careful investigation and submitting specimens of blood to the Ministry of Health, the conclusion was arrived at that the illness was probably due to gastric influenza and not to food poisoning. Two further suspected outbreaks of food poisoning in the Borough were also investigated last summer, in which two members of one family and five persons of another family were involved. In the former case the patients were removed to St. Giles' Hospital for observation, and subsequently notified as suffering from typhoid fever. The latter family all suffered from diarrhoea, pain, vomiting and giddiness. The investigation showed that the cause of the illness was probably due to the consumption of a meat pie which was made at home. All the patients made a good recovery. OTHER FOOD PREMISES. Bakehouses. At the end of the year there were 127 bakehouses in the Borough. Of these, 43 are underground and 84 above ground. 30 are classified as factory bakehouses owing to the installation of machinery. The Sanitary Inspectors made 388 inspections. In 29 instances it was found necessary to serve notices. Ice Cream. The increased consumption of ice cream in this country in recent years has attracted to the industry, as one would expect, a large number of manufacturers and vendors, with the result that the time has arrived when more effective means of controlling the preparation, storage and sale of this commodity are required. The Public Health Authorities are charged with the duty of ensuring that all articles of food are fit for human consumption, and the easy manner in which ice cream can be contaminated, with the resulting danger to health, compels attention to the need for maintaining a high standard of purity of this article. Moreover, the public are beginning to realise the possibility of their health, and that of their children, being prejudicially affected by the consumption of ice cream made under insanitary conditions, and are becoming anxious on this matter. The experience in Camberwell in connection with vendors of ice cream seems to justify these fears, and gives proof to the well-known fact that ice cream may be a fertile source of acute intestinal illness. In 1921 several cases of enteritis in this Borough were traced to the consumption of ice cream sold by an itinerant vendor. Many similar outbreaks of illness in England in the past have been suspected to be due to this cause. The high bacteriological count shown in the following report on samples of ice cream which were submitted for analysis during the past two years is evidence of the possibility of ice cream of this standard causing ill-health: — No. 1. 2,000,000 organisms per c.c. 10,000 bacillus coli per c.c. No. 2. 3,900,000 organisms per c.c. Bacillus coli present in 1/100th c.c. No. 3. In a dilution of 1-100,000 the organisms are too numerous to count. Bacillus coli appears in 24 hours in 1/50 c.c. This high bacterial count may arise from several causes, such as the ingredients not being pure; improper conditions of manufacture; dirty utensils; the indifference to the importance of personal cleanliness, and the mixing of stale unsold ice cream with a fresh manufacture. Although a large quantity of this article is made in properly equipped factories and retailed by reputable vendors, yet there is an appreciable amount manufactured and handled by confectioners and other small traders. In addition to these two types of traders there are a number of persons who do not regularly engage in the business, but only manufacture and sell ice cream on warm days, Bank Holidays and at the week-end. It is with these casual makers and vendors where the danger lies, inasmuch as the ice cream sold by them may be manufactured under unsatisfactory conditions and by people whose lack of personal cleanliness may give rise to dangerous contamination of this commodity. Many of these people are, of course, known to the Sanitary Inspectors, and can be dealt with under the existing powers for infringements, but there remains a small percentage who escape the notice of the Public Health officer and consequently are not subject to routine inspection. The existing powers in London for controlling this business, viz., the Public Health (London) Act, 1891, and the London County Council (General Powers) Acts, 1902 and 1908, would appear, for the reasons stated above, to be insufficient for the purpose of adequately safeguarding the public, and in my opinion the compulsory registration of manufacturers and vendors of ice cream and the premises where this commodity is manufactured, stored or sold, is urgently required. During the year there were 346 premises known in the Borough where ice cream was manufactured or sold. The inspections numbered 486. 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 71 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 48. The Inspectors made 62 visits, and 5 notices were served. Restaurants, Eating Houses, etc. 224 inspections were made of 85 restaurant eating houses in the Borough, particular attention being directed to the kitchens and places where the food was prepared. 25 notices were served. Clean Food. In 1924 a Committee consisting of 6 representatives of the Royal Sanitary Institute and 5 members of the Society of Medical Officers of Health submitted a report in 1925 on the cleanliness in the handling of food. The subjects investigated by the Committee were meat and meat products, fish, fruit and vegetables, bread and confectionery, milk and ice cream, groceries, restaurants and cafes, premises where prepared food is made, imported foods, food regulations, licensing and registration of premises. The following extracts from the report presented in 1925 are of public importance, and I accordingly venture to bring them to your notice. The Committee were greatly impressed by the fact that apparently Great Britain was practically alone amongst the more advanced of the nations in having failed to take cognisance of the existence of risk to health and of production of disease as a result of defective and careless exposure and handling of food, and to provide legislation for the protection of the people from such risks. The Committee is convinced that the case for suggesting that the time has arrived for providing legislation more definitely aimed at protecting the food of the people than any now in existence is greatly strengthened by the special investigations made by individual members. In the opinion of the Committee procedure in administration would be greatly simplified if one set of regulations were issued containing provisions affecting the several matters that are common to all foods, such as transport, and, if possible, registration, and a general prohibition of exposure on the street of meat, fruit, sweets, and the more important and readily contaminated articles, reserving separate regulations for any trade or article, e.g., bread will call for specific regulation. It is noted that in the United States of America the making of regulations is in the hands of the Local Authorities; this method, the Committee would suggest, has many advantages, and in connection therewith desire to recommend to the Ministry of Health the adoption of this practice, which in fact already exists in relation to sanitation, powers to make By-laws being in the hands of the Local Authorities, the Central Body securing control by forbidding the operation of the provisions until approved by them, and by issuing model by-laws for the guidance of the local bodies. It is to be hoped that this valuable report may be the means of educating the public in the need for greater care in the handling of food, and as a result of this education the Authorities may be stimulated to provide legislation on the lines stated. SALE OF FOOD AND DRUGS ACTS. One Inspector is appointed for the purpose of obtaining samples under the above-named Acts. The samples obtained are of two kinds, viz., formal and informal, and in procuring these samples the Inspector is usually assisted by an agent. In connection with the administration of the Sale of Food and Drugs Acts I would again refer to the necessity, in my opinion, for a standard to be fixed prescribing the fat content of cream. In support of this contention I would state the following example as emphasising the need for such a standard:— A sample of cream (No. 410) was purchased for analysis at a grocer's shop in this Borough, the article being delivered to the purchaser in a cardboard carton, the bulk being contained in a quart jug which was deposited in the ice safe. The Inspector's assistant was informed by the vendor that the cream was fit for infants and invalids. The price charged for three ounces was at the rate of 4s. (Four shillings) per pound. The Public Analyst certified that the cream was free from preservative, but that the fat content only amounted to 20 per cent. Owing to this low fat content the vendor was interviewed, and information was obtained from him to the effect that the cream was tinned cream, and that his custom was to open several tins as required, pour the contents into a receptacle and sell in cartons to his customers. A medium size tin of this particular cream, containing about 5½ ounces, was purchased at this period for 7½d. Prior to adopting this method of sale, this vendor had sold cream obtained direct from Cornwall, and had established a fair trade in this article. In other creams purchased during the year 1926 the fat content varied from 50.4 to 64.8 per cent. Public Health Department, 35, Brunswick Square, S.E.5. May 1st, 1927. To Dr. H. W. Barnes, Medical Officer of Health, Camberwell. Sir, —I beg to report herewith on the work carried out under the Sale of Food and Drugs Acts, the Margarine Acts, the Milk and Cream Regulations, the Condensed and Dried Milk Regulations, the Milk and Dairies (Consolidation) Act, the Milk and Dairies (Amendment Act) and the Sale of Food Order, for the year ending December 31st, 1926. The tables "A" (Samples Analysed) and "D" (Samples Adulterated) are set out in the form suggested by the Minister of Health in the Memo. No. 36, dated January, 1927, on procedure under the Sale of Food and Drugs Acts, etc. I am, Sir, your obedient Servant, GEORGE T. DEWEY, Inspector under the Sale of Food and Drugs Acts. Below is a summary of formal and informal articles submitted to the Public Analyst under the Sale of Food and Drugs Acts and the Public Health Regulations. The formal samples total 1,057, of which 35 were reported against, giving a percentage of adulteration of 3.31. Milk. —621 formal samples of milk, and one separated milk, making a total of 622, were submitted for analysis. Of the former 14 were reported against, the adulteration being 2.25 per cent. Table C set out below shows the percentage of adulteration of milk extending over the past five years. Refusal to Serve. —Proceedings were instituted against a dairyman in this Borough for refusing to serve. The facts shortly are as follows : — A sample of milk had been purchased in a public thoroughfare by an assistant and dealt with as required by the Act. A request was made by the Inspector for a sample of milk from another can, sufficient money for the purchase being tendered. The request was twice repeated and ignored by the dairyman until after he had mixed the contents of the two hand cans. The matter was reported to the Public Health Committee, who ordered proceedings to be taken. Owing to the defendant being deaf the summons was dismissed on the ground that the Court was not satisfied that the defendant realised at the time as to what was demanded. Moisture in Butter. —14 samples of butter were analysed to ascertain the amount of moisture, and only in one case did the amount exceed the statutory limit of 16 per cent. (See table D.) 674 post cards were sent during the year to various tradesmen intimating that the articles purchased from them complied with the requirements. Informal Sampling. 133 informal samples were submitted to the Public Analyst (see table A), of which 12 were reported against, the percentage of adulterated articles being 9.02. 60 other informal purchases were also made of various articles of food as test samples only. Included in this number were 19 creams, purchased to ascertain whether the requirements as to labelling the receptacles, etc., were being carried out. 58 informal samples of margarine were obtained. Of these two were sold in wrappers without the word "Margarine" in half inch block letters appearing thereon, six wrappers had only a part of the word, and in six other instances the word was not distinctly legible as required by the Act. Cautions were given to the vendors. TABLE "A." FORMAL AND INFORMAL SAMPLES SUBMITTED FOR ANALYSIS. Article. Number Examined. Number Adulterated,&c. Percentage of Adulteration. Formal. Informal. Private. Total. Formal. Informal. Private. Total. Formal. Informal. Milk 14 - 16 2.25 11.76 621 17 - 638 2 124 97 221 Butter 4 - 6 1.61 4.12 - 2 Malt Vinegar 44 44 - - 6 - 6 - 13.63 38 2 - Vinegar 40 2 2 - - 5.26 1 - - Lard 30 1 - 31 1 2 3.33 100 - Mustard - 20 20 - - - - - - - - Self Raising Flour 18 18 - - - - - - - Cocoa 14 - - - 14 - - - - - Arrowroot 11 - - 11 - _ - - - 10 - - *Margarine 10 10 - 10 - - - - Pepper - 9 - 9 - - - - - - Cream 9 10 1 - 5 - 5 55.55 - 8 - Custard Powder 8 - - - - - - Raspberry Jam - - 7 7 - - - - - - - - Black Currant Jam 5 5 - - - - - - - Boric Acid Ointment 5 1 - 1 - 6 1 20.00 - - - Camphorated Oil 5 - - - - 5 - - 2 - - Whisky 4 10 14 - 3 - 5 50.00 30.00 Full Cream Condensed Milk, Sweetened 4 4 - - - - - - 4 - - Baking Powder - - - 4 - - - - - 3 - Cream of Tartar - 3 - - - - - - 3 4 Gin - 7 1 2 3 3.33 50.00 - Sherbert 3 - 3 - - - - - - - Lemonade Powder 3 3 - - - - - - - - Prescriptions 3 - - 3 - - - - - - Strawberry Jam - - 2 - 2 - - - - - 2 Castor Oil - - 2 - - - - - - 2 Golden Syrup - - 2 - - - - - 2 1 - 2 - - 1 Full Cream Dried Milk 50.00 - - - Preserved Cream 2 2 - - - - - - - - Dripping 2 - 2 - - - - - - - Olive Oil 2 2 - - - - - - - - Pork Sausages 2 2 - - - - - - - - Coffee 2 2 - - - - - - - - Rice 2 - - 2 - - - - - - Ground Almonds 2 2 - - - - - - - - 2 2 Mincemeat - - - - - - - - Purified Epsom Salts - 2 - - 2 - - - - - Sponge Cakes 2 - - 2 - - - - - - Sponge Fingers 2 2 - - - - - - - - 1 Lemon Curd 1 - - - - - - - - Salmon and Shrimp Paste 1 1 - - - - - - - - Full Cream Condensed Milk, Unsweetened - 1 - 1 - 45 TABLE "A"—continued. Number Examined. Number Adulterated, &c. Percentage of Adulteration. Article. Formal. Informal. Private. Total. Formal. Informal. Private. Total. Formal. Informal. Green Bacon 1 - - - - 1 - - - - Tincture of lodine 1 - - 1 - - - - - - Thirst-Quenching Tablets - 1 1 - - - - - - - Condensed Machine Skim Milk, Sweetened 1 - - 1 - - - - - - Lemonade 1 - - 1 - - - - - - Ground Rice 1 - 1 - - - - - - - Potted Meat - 1 - 1 - - - - - - Breakfast Sausage - 1 - 1 - - - - - - - Cream Cheese 1 1 - - - - - - - - - Crushed Linseed 1 1 - - - - - - Cheddar Cheese - 1 1 - - - - Flour - - - - 1 1 - - - - - - - 1 - Glaubers Salts - 1 - - - - - - Pure Glycerine 1 - - 1 - - - - - - - Lemon Cheese 1 1 - - - - - - - Ground Ginger - - 1 1 - - - - - - 1 - - 1 Separated Milk - - - - - - Beef Sausages 1 - - 1 - - - - - - - - 1 - Sausages 1 - - - - - 1,057 133 0 190 45 12 0 57 3.31 9.02 The ten Margarines were genuine, but were sold in wrappers without the word " Margarine " appearing thereon. These are not, therefore, included in the percentage table above as adulterated samples. TABLE "B." Year. 1922. 1923. 1924. 1925. 1926. Percentage of adulteration 2.9 2.32 2.58 2.02 3.31 The following table shows the percentage of Milk adulteration for the past five years:— TABLE "C." 1924. 1925. 1926. Year. 1922. 1923. Percentage of adulteration 1.95 1.59 2.0 2.25 1.31 47 46 TABLE "D." ADULTERATED SAMPLES. Article Whether Formal, Informal or Private. Nature of Adulteration or irregularity. Result of Proceedings or other action taken. Observations. Serial No. Milk. 921 Formal Milk Coloured with annato Summons dismissed on payment of £1 1s. costs. - 935 Do. Do. 13 per cent, of added water Do. £5 5s. costs. - 1015 Do. Do. 93 per cent, fat abstracted Vendor fined £6. - 1017 Do. Do. 20 Do. Do. £2. - 3 Do Do. These milks were taken in the course of delivery. Same vendor 16 Do. Do. Summonses dismissed on payment of £6 6s. costs. 4 Do. 17 Do. 5 Do. Do. 20 Do. Do. 226 Vendor fined £3 and £2 2s. costs. Do. 10 Do. - Caution. Public Health Committee. 318 Do. Do. 5 Do. - 420 Summons dismissed on payment of 10s. 6d. costs. Do. Do. 16 Do. - 593 Do . Do. 4 per cent, of added water Same Vendor Summons withdrawn. Vendor fined £3 and £1 1s. costs. 594 Do Do. 10 Do. 731 Vendor ordered one month's hard labour, and name removed from Register of Purveyors of Milk, by order of the Magistrate. (Previous Convictions.) Do. Do. 16 Do. - Do. Summons dismissed on payment of £1 1s. costs. 760 Do. 15 per cent. fat abstracted - Do. Both from same vendor. formal sample No. 935. 95 Informal 8 per cent, of added water 105 Do. Do. 8 Do. Margarine. Tv "ii" TT-.ui. Nt Margarine Article sold in an unstamped wrapper 830 Formal Caution. Public Health Committee. - 866 Do. Do. Do. Do. - Do. Do. 954 Do. Do. - Do. 1063 Do. Do. Do. - Do. Do. Do. Do. 33 - Do. Do. Do. 122 Do. - 224 Do. Do. Do. Do. - 290 Do. Do. Do. Do. - 346 Do. Do. Do. Do. - 546 Do. Do. Do. Do. - Vinegar and Malt Vinegar. 8 per cent, deficient in Acetic Acid Do. 928 Vinegar Do. - Do. 1009 Malt Vinegar Do. 100 per cent, Vinegar other than Malt - Do. Do. 70 Do. 12 per cent, deficient in Acetic Acid - Do. 196 Do. Do. 15 Do. - Summons dismissed on payment of £2 2s. costs. 350 Do. Do. Vinegar other than Malt - 519 Do. Do. Caution. Public Health Committee. Do. - Do. Summons dismissed on payment of £1 1s. costs. 567 Do. Do. - Caution. Public Health Committee. 722 Vinegar Do. 10 per cent, deficient in Acetic Acid - Spirits. Summons dismissed on payment of £1 1s. costs. 973 Whisky Do. 36.78 degrees under proof - 256 Do. £4 4s. costs. Do. Do. 58.7 Do. - Summons withdrawn. Costs paid by defendant, £2 2s. 616 Gin Do. 36.9 Do. - 103 Whisky 36.4 Do. See formal sample No. 973. Informal 8 Do. Formal sample not taken, dilution notice exhibited. Do. 36.1 Do. 36.4 Do. 33 Do. Do. Formal sample No. 617. Genuine. 39 Gin Do. Formal sample No. 449. Genuine. 38.4 Do. Do. 43 Gin 36.9 Do. See Formal sample No. 616. 49 48 ADULTERATED SAMPLES—continued. Whether Formal, Informal or Private. Article. Result of Proceedings or other action taken. Observations. Nature of Adulteration or irregularity. Cream. I Summons dismissed on payment of £3 3s. costs. Formal 0.29 per cent. Basic Acid Unlabelled receptacle Cream Do. £2 2s. costs. Do. Do. Do. 0.25 Do. Do. Caution. Public Health Committee. Do. 0.37 Do. Do. Do. Summons dismissed on payment of £4 4s. costs. Do. 0.30 Do. Do. Caution. Public Health Committee. Do. Do. 0.18 Do. Do. Butter. 5 per cent, excess water Caution. Public Health Committee. Butter Do. - Summons dismissed on payment of £3 3s. costs. Do. 35 per cent. foreign fat - Do. Informal All purchased from the same vendor. See formal sample No. 703 Do 30 Do. Do. 20 Do. Do. Do. 25 Do. Do. Do. Do. 25 Do. Lard. 100 per cent. fat, other than lard Summons dismissed on payment of £2 2s. costs. Formal Same vendor Lard Informal 100 Do. Lard Other Articles. Caution. Public Health Committee. 18 per cent, excess of Boric Acid Boric Acid Ointment Formal - Vendor fined £1 and £2 2s. costs. Full Cream Dried Milk Do. 24 per cent, deficient in milk fat - Public Health (Milk and Cream) Regulations, 1912 and 1917. Report for the year ending 31 st December, 1926. During the year 621 formal and 17 informal samples of milk and one formal sample of separated milk, making a total of 639, were submitted for analysis; all samples were certified to be free from a preservative. Of 9 formal samples and one informal sample of cream, 5 of the former were found to contain a preservative. Two samples of 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. Number of samples examined for the presence of a preservative Action taken under the Regulations. Number in which preservatives was reported to be present and percentage of preservative found in each sample. Milk— I I I I Formal Samples 621 Informal Samples 17 Nil. 638 1 Separated Milk - Total 639 I Cream— I Formal Samples 9 I - Informal Samples 1 - 5 - Sample:— No. 220, 0.29 per cent. Boric Acid Proceedings taken against the vendor for failing to attach to carton a declaratory label. Summons dismissed, defendant ordered to pay £3 3s. costs. No. 232, 0 25 do. Proceedings taken as above. Summons dismissed. Defendant ordered to pay £2 2s. costs. No. 309, 0.37 do. Caution given vendor by order of the Public Health Committee. No. 383, 0.30 do. This sample was taken in the course of delivery from the wholesale firm who supplied the vendor of Sample No. 309. Proceedings instituted for dispatching and delivering cream containing a preservative in an unlabeled vessel. Summons dismissed. Defendants ordered to pay £4 4s. costs. No. 450, 0.18 do. Caution given vendor by order of the Public Health Committee. D2 (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 statements made 2 (ii) Statements incorrect 0 Total 2 Percentage stated on Statutory label. (iii) Percentage of preservative found in each Sample. 0.23 per cent. Boric Acid Not exceeding 0.4 per cent. Boric Acid Sample No. 93 Do. 101 0.23 Do. do. Do. do. (b) Determinations made of milk fat in cream sold as preserved cream:- (i) Above 35 per cent 2 (ii) Below 35 per cent 0 Total 2 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V (1), and the proviso in Article V (2) of the Regulations have not been observed. (d) Particulars of each case in which the Regulations have not been complied with, and action taken. (c) Number of instances where Regulations have not been complied with. Action taken. (d) In what respect the Regulations have not been complied with. Receptacle containing the bulk unlabelled. Vendor cautioned. Sample No. 93. Do. 101. Label on quart jug containing the bulk of insufficient size. Vendor cautioned. Do. 232. Quart jug containing the bulk, bearing only half of a declaratory label 6 Vendor cautioned. (See also Table 1 (b)). Receptacle containing the bulk, unlabelled. Vendor cautioned. Do. 309. Receptacle delivered by wholesale firm to retailer, unlabelled. Proceedings instituted. See table 1(b). Do. 383. Do. 450. Receptacle containing the bulk, unlabelled. Vendor cautioned. (3) Thickening substances. —Thickeners were absent in all samples. (4) Other observations. — The Public Health (Condensed Milk) Regulations, 1923. Four formal samples of full cream condensed milk sweetened, one sample of full cream condensed milk unsweetened, and one sample of condensed skimmed milk sweetened were submitted for analysis. All were returned as conforming to the required composition. The labels in each instance complied with the requirements. The Public Health (Dried Milk) Regulations, 1923. Two samples of full cream dried milk were submitted for analysis, one being certified to be deficient in milk fat to the extent of 24 per cent. of the amount that should have been present, and the other was returned as conforming to the required composition. The samples were purchased on different occasions from the same vendor, and were sold loose from a receptacle containing the bulk, the article in each instance being placed in a paper bag without any declaration being printed thereon or on a separate label. Proceedings were ordered to be instituted in respect of the former sample (No. 57), with the result as shown in Table D. The vendor pleaded as a defence that some full cream dried milk had been inadvertently placed on top of some separated dried milk. The Milk and Dairies (Consolidation) Act, 1915. A complaint was made to this Department in the early part of the year by a dairyman registered in this Borough that the milk consigned to him by a certain firm of farmers was unsatisfactory. As the place of delivery was outside this Borough, a notice in writing was sent to the Medical Officer of Health of the Borough concerned requesting that the authorised officer should take samples of this milk in the course of transit at the delivery railway station, in accordance with Section 8 sub-section 3 of the above Act. Samples were accordingly taken, one from each of six churns, dealt with as required by the Sale of Food and Drugs Acts, and a portion of each sample was submitted to the Public Analyst for this Borough. Three samples were returned as genuine and three (Nos. 3, 4 and 5) were certified to have had fat abstracted to the extent of 16, 17 and 20 per cent, respectively. Proceedings were ordered to be instituted, with the results as shown in Table D. The Milk and Dairies (Amendment) Act, 1922. A summons in respect of a sample of milk (No. 921) containing colouring matter was issued under the above Act, the vendor being ordered to pay £1 1s. costs. (See Table D.),. Sale of Food Order, 1921. The requirements of the above Order are generally being complied with, although it was found necessary to caution 19 traders where imported eggs were exposed for sale improperly described as new laid or fresh, and at two butchers' shops cautions were given for failing to exhibit a label stating that the meat exposed for sale was imported. From further observations at these premises it was found that the Order in this respect was being carried out. Summary or Legal Proceedings for the year ending December 31st, 1926. Number of Summonses. Fines. Costs. Summonses under the Sale of Food and Drugs Acts. One Summons withdrawn, and one Summons resulted in defendant being sent to prison £ s. d. £ s. d. 16 14 0 0 25 14 6 1 1 0 Milk and Dairies (Amendment) Act 1 - 3 - 6 6 0 Milk and Dairies (Consolidation) Act 1 1 0 0 2 2 0 Public Health (Dried Milk) Regulations Public Health (Milk and Cream) Regulations 3 - 9 9 0 24 15 0 0 44 12 6 PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. Notifications. The total number of cases of infectious disease, excluding tuberculosis, notified during the year was 2,263, as compared with 2,193 for the year 1925. A table showing the total number of notifications, the age distribution and deaths will be found on pages 66 and 67. Small-pox. No case of small-pox occurred in the Borough during the year, although this disease was prevalent in the North of England and the Midlands. A number of contacts of cases of this disease were kept under observation during the incubation period and were also urged to be vaccinated if this precautionary measure had not been recently carried out. Your Medical Officer of Health, in consultation with Medical Practitioners, saw a number of patients with a rash or symptoms suggesting the possibility of this disease, but, fortunately, these patients were found to be suffering from maladies other than small-pox. Vaccination. No necessity arose for the Medical Officer of Health to carry out any vaccination under the Public Health (Small-pox Prevention) Regulations. Diphtheria. 1,063 notifications of diphtheria were received during the year. An outbreak of diphtheria, which occurred in an Institution under the care of the Camberwell Board of Guardians at the end of 1925, to which I referred in my last Annual Report, was responsible for the increase in the number of notifications received during that year, and by the continuance of the outbreak into the early weeks of 1926, together with a small crop of cases in an area in the northern part of the Borough, the number of cases reported during the year under review was 129 in excess of the 1925 figure and 232 more than the 1924 total. Of the 215 children notified between the ages of 3 and 5, 97 were attending school. 1,045 were admitted to hospitals of the Metropolitan Asylums Board. 58 cases were returned as not suffering from this disease. The deaths numbered 54. There were 98 secondary cases notified; these do not include hospital cases. A secondary case is one occurring in the same household as the primary case. Return cases numbered 11. A return case is defined as one which occurs within 28 days after the release of the original case from isolation. The following table records the number of notifications and the deaths from diphtheria during the past six years:— Number of Notifications. Number of Deaths. Year. 1921 875 64 821 1922 63 1923 875 72 831 1924 42 1925 40 934 1,063 54 1926 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 the patient should have a separate bedroom for a few days. Warning is also given that should any discharge of the nose or ears occur, a doctor's advice and treatment should immediately be obtained. Carriers. —The routine swabbing of contacts for the discovery of "carrier" cases is carried out only amongst such families where the spread of the disease is suspected to be due to a "carrier." The parents of children found to be harbouring diphtheria bacilli were advised that such children should be segregated and treated by their medical practitioners until the organisms had disappeared. It is not advisable for "carriers" to be sent to hospital. On the other hand, convalescents from an attack of clinical diphtheria when found require hospital treatment, as they harbour virulent organisms, and in the majority of such cases some pathological condition is present in the child's nose or throat. Diphtheria Prevention. The research work of Dr. Schick has now resulted in establishing a very definite claim that by a process of artificial immunisation susceptible persons can be made immune to diphtheria, and that the protection thus afforded is of long duration and that the process is free from risk. In my previous annual reports I have drawn attention to the severity of diphtheria and the importance of the need for active measures to combat this disease. During the year under review I submitted the following report to the Public Health Committee on the claims of artificial immunisation, and it is gratifying to report that the neccssary sanction was obtained, with the approval of the Ministry of Health, to establish an immunisation clinic at the Municipal Infant Welfare Centre, 140, Camberwell Road. DIPHTHERIA IMMUNISATION. With the discovery of the anti-toxin treatment of diphtheria it was hoped that the worst phase of the struggle with this disease was at an end. The timely use of anti-toxin has gone far in reducing the mortality of this disease, but has not led to a diminution in the number of cases. Prophylactic inoculation of contacts of cases of diphtheria with anti-toxin is a highly important measure for conferring temporary immunity, but can obviously only be used on a small scale and under favourable conditions. Further, the duration of immunity resulting is short—about three weeks—and it does not render the carrier non-infectious. In recent years much research work has been carried out for the purpose of discovering a method of determining whether a given person is susceptible or immune, and also for procuring immunisation of the populace against diphtheria infection. By a simple and harmless cutaneous test devised by Schick we are now enabled to determine whether or not a given person's blood contains sufficient anti-toxin to protect him from an attack of diphtheria. As the result of testing a large number of persons of different ages it would appear from published figures that 80 per cent, of infants at birth have a passive immunity and that this fades during the first month or two after birth, the immunity gradually decreasing until at 3 years of age only 28 per cent, of children are immune. It has now been established that a much more enduring protection can be achieved by active immunisation with mixtures of toxoid anti-toxin. The protection thus conferred lasts at least for seven years, and there is every reason to believe that it remains for a lifetime. But even if the protection does not last for ever it must be remembered that the child is rendered immune during a period of years when it is most susceptible to diphtheria. The measures that have been employed in past years to control the disease, viz., hospital isolation and disinfection, cannot be said to have reduced to any great extent the incidence of diphtheria. The following table, which shows the number of cases of diphtheria and the mortality rate from this cause for the past five years, is of interest, as it demonstrates that the time has arrived when we should invite parents to consider the question of securing active immunity for their children, which can be obtained without risk or severe discomfort. DIPHTHERIA—NOTIFICATIONS AND DEATHS. Number of Notifications. Number of Deaths. Year. 1921 875 64 1922 821 63 1923 875 72 1924 831 42 1925 934 40 Active immunisation against diphtheria has been practised in America, Edinburgh, Birmingham, Bristol and one or two Boroughs in London, with results which go to show that this method, with the active co-operation of the general public, will considerably reduce the number of cases of diphtheria. It is essential that such a procedure should be carried out in early childhood, and in recommending that children over six months should be treated I am influenced by the susceptibility of those up to 5 years of age and the relatively high mortality rate. The Schick method of testing whether a person is protected by nature against diphtheria is by injecting a minute quantity of testing fluid under the skin. The test is quickly made, with no pain, beyond a needle prick, either at the time or afterwards. By looking at the skin at the point of injection one week later the doctor can tell whether the person is protected or not. The mark on the skin soon fades away and no scar is left. If it is found that the person is not protected,and thus could catch the disease, then immunisation can be secured by the inoculation with toxoid anti-toxin. As most children between the ages of 6 months and 5 years give a positive reaction to the Schick test there is no necessity for such test to be carried out before inoculation, unless the parents specially wish it. I have no hesitation therefore in suggesting for consideration the opening of a clinic at the Council's Maternity and Infant Welfare Centre, 140, Camberwell Road, for the Schick testing and inoculation of children free of charge, and in support of this suggestion I would stress both the health and economic factors. From information that has been supplied to me it is computed that the approximate cost of every diphtheria patient treated in the Metropolitan Asylums Board Hospitals is £30, excluding administrative charge, whereas the cost of immunisation would be only a few shillings per person. The prejudice which exists against any form of protective measures necessitating the use of the hypodermic syringe is widespread, so that it would be necessary, if the suggestions contained in this report are adopted, to pave the way by the issue of a propaganda leaflet to every mother attending the Infant Welfare Centres explaining the purpose of the clinic and the value of toxoid anti-toxin inoculation and also, by the display of a poster, containing the following information, on the notice boards of the public buildings and conveniences in the Borough. METROPOLITAN BOROUGH OF CAMBERWELL. DIPHTHERIA PREVENTION. To Parents and Guardians. DIPHTHERIA is a DANGEROUS disease causing great loss of life, particularly amongst young children. Some children, and grown up people, do not catch diphtheria because they are protected by Nature against it. Other children who are not immune may contract the disease. Do you know that your children need not have diphtheria, they can be made immune. HOW CAN THIS IMMUNITY BE SECURED? By a simple and painless test it is possible to find out whether your child is susceptible to diphtheria infection. If the test shows that your child is not protected owing to the absence of protective substances in the blood, it can be inoculated and rendered immune. The process is quite harmless and the protection lasts for many years, if not for life. WILL THE PROTECTING INJECTIONS UPSET THE CHILD? Not one in a hundred children is unwell after the injections. There is no sore at the point of injection, and no scar is left. GIVE YOUR CHILDREN ALL THE ADVANTAGES YOU CAN. Do you realise the severity of diphtheria ? In England and Wales eighty of every hundred deaths from this disease occur in young children under ten years of age, most are under five years. It is your duty therefore to consider whether your child should be rendered immune to this disease. WHEN AND WHERE TREATMENT CAN BE OBTAINED. The Camberwell Borough Council has opened a Clinic at the Maternity and Infant Welfare Centre, 140, Camberwell Road, where children from six months old can be brought on Wednesday afternoons from 2.30 to 4 for the purpose of inoculation free of charge. Treatment is not compulsory, but in the interest of your child it is strongly recommended. H. W. Barnes, M.8., B.Ch., D.P.H., Medical Officer of Health. The clinic was opened on December 1st, 1926, and although it is too early to speak of the results at this stage, nevertheless I am hopeful, and the attendances for the first month justify the belief, that the people of Camberwell are beginning to realise the danger of diphtheria. It is advisable that immunisation should be carried cut as soon as possible after the child reaches the age of six months, but it may be many years before the acceptance of this new principle for dealing with diphtheria prevention is sufficiently established in the minds of the people. In the meanwhile there will remain a large number of children attending the elementary schools who are liable to contract this disease at any time, and the question naturally arises as to the desirability of the London County Council considering the question of instituting similar prophylactic clinics. It is an accepted fact that people now-a-days look for a lead from those whose duty it is to look after the public health, and are well aware of the advantages to be derived from taking an intelligent interest in matters affecting their well-being. I am convinced, therefore, that if the London County Council were to adopt a similar scheme of treatment it would secure the immunisation of a large number of susceptible children attending school, and further, would act as a stimulus to parents to have their children treated before they reach school age. The procedure at the clinic is as follows: — Children are admitted separately with parents, or in families, and on receiving authority from the parents to have the work undertaken, the arms are bared and cleansed thoroughly. 0.2 c.c. of Burroughs Wellcome diluted diphtheria toxin is then given intradermically into the skin of the left forearm, and 0.2 c.c. of heated toxin as a control into the skin of the right forearm. People Schick-tested are requested to come back the following week, when readings are taken. Positive readings are then told to bare the shoulder to expose the deltoid region fully. The skin in this area is thoroughly swabbed with iodine solution, in the case of a child, 1 c.c. of toxoid anti-toxin mixture is then injected intramuscularly into the deltoid and the site of injection afterwards touched with iodine. Patients are requested to come up weekly until they have had three full doses, and are then asked to come up again at the end of three months for re-testing. 60 61 The following tables set out the work of the clinic since the opening date, viz., December Ist, 1926. TABLE I.—AGES OF PERSONS SCHICK. TESTED WITH RESULT OF TEST. 13 to 14 yrs. 14 to 15 yrs. 15 and above. 8 to 9 yrs. 9 to 10 yrs. 10 to 11 yrs. 11 to 12 yrs. 12 to 13 yrs. 6 to 7 yrs. 7 to 8 yrs. 6 to 12 mths. 2 to 3 yrs. 3 to 4 yrs. 4 to 5 yrs. 5 to 6 yrs. Ages. 1 to 2 yrs. Total for one month, December, 1926 3 2 3 8 3 4 8 3 2 2 4 4 1 4 7 8 Result of Schick Test Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Not read. Pos. Neg. Not read. Pos. Pos. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Not read. Neg. Neg. Not read. Neg. Pos. Neg. Not read. Positive. Negative. Not Read. 36 14 16 1 1 1 2 - 3 - 6 - 2 2 - 1 3 1 - - 4 5 2 1 1 - 1 1 - 2 - 1 3 - 1 2 - - - 3 1 3 1 3 1 1 - - 4 2 - TABLE II.—IMMUNISATION TREATMENT. 11 to 12 y rs 12 to 13 yrs. 13 to 14 yrs. 14 to 15 yrs. 15 yrs. and above. Ages. 6 to 12 mths. 1 to 2 yrs. 2 to 3 yrs. 3 to 4 yrs. 4 to 5 yrs. 5 to 6 yrs. 8 to 9 yrs. 9 to 10 yrs. 10 to 11 yrs. 6 to 7 yrs. 7 to 8 yrs. T.A.T. T.A.T. T.A.T. T.A.T. T.A.T. T.A.T. T.A.T. T.A.T. T.A.T T.A.T. T.A.T. T.A.T. T.A.T. T.A.T. T.A.T. T.A.T. 1st Inoculation 2nd „ 3 rd „ 1t Inoculation. 2nd „ 3rd „ 1st Inoculation 2nd „ 3rd „ 1st Inoculation. 2nd „ 3rd „ 1st Inoculation. 2nd „ 3rd „ 1st Inoculation. 2nd „ 3rd „ 1st Inoculation. 2nd „ 3rd. „ 1st Inoculation. 2nd „ 3rd „ 1st Inoculation. 3rd „ 1st Inoculation. 2nd „ 3rd „ 1st Inoculation. 2nd „ 3rd „ 1st Inoculation. 2nd „ 3rd „ 1st Inoculation. 2nd „ 3rd „ 1st Inoculation. 2nd „ 3rd „ 2nd „ 1st Inoculation. 2nd „ 3rd „ 1st Inoculation. Total for one month, December, 1926 1st Inoculation 11 2nd Inoculation 12 3rd Inoculation 11 2nd „ 3rd „ *34 1 - - 1 1 - - 1 2 2 1 2 - - 2 1 1 1 1 1 1 1 - 4 1 1 - 1 - - 1 1 1 1 - 1 1 - - - - - - - 1 1 1 - - * 2 Positive Schick Test cases did no t attend for Inoculation. Scarlet Fever. During the year 840 cases of scarlet fever were notified as compared with 927 in 1925. 785 cases were removed to the Metropolitan Asylums Board Hospitals. Of these cases 29 were returned from hospital certified as not suffering from scarlet fever. As in recent years the cases were mild in nature. 37 secondary cases were notified. A secondary case is one occurring in the same household as the primary case. There were 5 deaths from this disease during the year. The "return" cases numbered 16. A "return" case may be defined as one which occurs within 28 days after the release of the original case from isolation. The same procedure is carried out as in diphtheria to avoid the possibility of such cases occurring. Scarlet fever in England at the present day is a trivial disease and the mortality is slight, but unfortunately the incidence is as high as it has ever been. Experience has proved that institutional treatment is unnecessary for a large percentage of scarlet fever patients so far as the illness is concerned. On the other hand, measles has a far heavier fatality. The relative importance of institutional treatment for scarlet fever and measles cases has been the subject of consideration, and in October last year the Metropolitan Asylums Board decided to allocate beds in their institutions to the two diseases, in relation to the required accommodation for each, so that in times of measles prevalence more beds will be available for the treatment of this disease. In the event of the allocated provision not being sufficient to cope with the number of cases desiring to be admitted, the selection of cases will then be made by the Medical Officer of Health in accordance with the necessities and home conditions of the individual case. Dick Test.—As yet no steps have been taken in Camberwell to make use of the Dick test or to provide facilities for conferring immunity to those found to be susceptible to this disease. Typhoid and Paratyphoid Fevers. 14 cases were notified during the year, and of these 12 were removed to hospitals. There were no deaths. 5 of the notified cases were afterwards certified not to be suffering from enteric fever. The source of infection was not traced in any case. Pneumonia. During the year 166 notifications were received, of which 62 were influenzal and 104 acute primary pneumonia. It is generally accepted by the majority of the medical profession that the pneumonias are infectious diseases, and are disseminated by spitting, sneezing and coughing. At present all acute primary and acute influenzal pneumonias are notifiable, but it would seem advisable to make notifiable all forms of pneumonia, both primary and secondary, so that the administrative machinery, such as visiting, arrangements for nursing, removal to hospital where necessary, might be put into force in order to check the ravages of the disease. The number of deaths from pneumonia (all forms) during the year was 226. Erysipelas 120 cases were notified during the year, 57 of which were removed to hospital. The deaths numbered 8. Cerebro-spinal Fever. The notifications of this disease received during the year numbered 3. The cases were removed to hospital, but the subsequent diagnosis in each instance proved the patient to be suffering from a disease other than cerebro-spinal meningitis. Polio-myelitis and Polio-encephalitis. 3 cases of this disease were notified during the year. The following table gives particulars of these cases with the condition of the patient at the end of 1926: — Date of Notification. Where treated. Ultimate Diagnosis. Sex. Age. Subsequent History. Patient moved away M. 3 3/3/26 Hospital Confirmed Still receiving treatment, left arm and leg paralysed F. 1 6/1 2 4/9/26 Hospital Confirmed Confirmed Recovered F. 24 3/12/26 At home This disease is undoubtedly infectious, and it is essential for all patients in the acute stage to be isolated whether the manifestation of illness is slight or severe. The clinical stages of this disease have been divided into three, the acute, which usually has subsided within 6 weeks, the recovery stage, which extends to the end of the second year, and the chronic stage, from the third year onwards. The treatment of the first stage is rest and the prevention of deformities. Early diagnosis of this disease in this stage is most important so that treatment can be started to prevent, crippling. The Metropolitan Asylums Board has set aside beds 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 1926 three cases received treatment at this hospital. Encephalitis Lethargica. This disease was made compulsorily notifiable in 1919. 12 cases were notified during the year. 5 of the notified cases were afterwards certified not to be suffering from encephalitis lethargica. Details of each case are given in the following table: — Ultimate Diagnosis. Date of Notification. Where treated. Subsequent History. Sex. Age. Confirmed Female 22 10/6/26 Hospital Died 3/11/26 Confirmed Male 5¾ 14/6/26 Hospital - Male 50 17/6/26 At home Confirmed - 9½ Male 24/6/26 Hospital Confirmed - Not confirmed Male 44 17/8/26 Hospital - 13/8/26 Hospital Female 16 Not confirmed Died 16/8/26 Not confirmed Died 16/9/26 Female 3 7/9/26 Hospital Female 17/9/26 Hospital Not confirmed 16 - Male 27 16/10/26 At home Confirmed - Male 46 26/11/26 Hospital Not confirmed - Male 37 27/11/26 At home Confirmed - Male 26 17/12/26 Hospital patient moved away—cannot be traced. The Metropolitan Asylums Board has provided facilities at the Northern Hospital, Winchmore Hill, for the treatment of children afflicted with the after-effects of this disease, and it is hoped that in the near future this arrangement may be extended so as to provide similar treatment for adult patients. Ophthalmia Neonatorum. Regulations relating to the notification of ophthalmia neonatorum came into force on the Ist October, 1926, under which the duty of notifying ophthalmia neonatorum is placed solely upon the medical practitioners in attendance on the case. These Regulations revoke the Public Health (Ophthalmia Neonatorum) Regulations, 1914, which placed an obligation on a certified midwife to notify a case in which there was reasonable grounds for supposing that a child upon whom she was in attendance was suffering from this disease, unless the case had already been notified by a medical practitioner. 14 cases of this disease were notified during the year. In addition 133 cases of slight inflammation of the eyes were brought to the Public Health Department's notice. 4 cases were removed to hospital. The particulars relating to this disease are set out in the following table, as required by the Ministry of Health:— Cases Treated. Vision Impaired. Total Blindness. Vision Unimpaired. At Home. In Hospital Deaths. Notified. 10 14 - - - 14 4 Puerperal Fever and Puerperal Pyrexia. In October, 1926, Regulations as to the notification of puerperal fever and puerperal pyrexia came into force. Puerperal fever has been a notifiable disease in this country for many years. The new Regulations, however, also require the notification of all cases of pyrexia during the puerperium, irrespective of the cause to which the fever may be attributed. The expression puerperal pyrexia is defined as: — "Any febrile condition (other than a condition which is required to be notified as puerperal fever) occurring in a woman within 21 days after childbirth or miscarriage in which a temperature of 100.4 degrees F. (38 Centigrade) or more has been sustained during a period of 24 hours or has recurred during that period." It is interesting to record that in the circular accompanying the Regulations a statement is made that the Minister is advised that it will ultimately be desirable to replace the term ''puerperal fever "by the term" puerperal pyrexia," the latter being defined in terms which involve no theory as to causation, but without legislation amending the Infectious Disease (Notification) Acts it is not practicable to substitute "puerperal pyrexia" for puerperal fever as a disease notifiable under these Acts. The attention of all medical practitioners resident or practising in the Borough of Camberwell was drawn to the duties imposed upon them by the Regulations, and the opportunity was taken of reminding the doctors of the arrangements provided by the Metropolitan Asylums Board for the institutional treatment of puerperal fever. The notification of these diseases must be made on forms which are prescribed in the Schedules to the Regulations, and afford facilities at the same time for a request to be made for a E 66 67 TABLE OF NOTIFIABLE INFECTIOUS DISEASES, 1926. Disease. Total Cases Notified. Admitted to Hospital. Total Deaths. Age Distributions.— Notifications and Deaths. Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and upwards Notifications. Deaths. Notifications. Deaths. Notifications. Deaths. Deaths. Deaths. Notifications. Notifications. Deaths. Notifications. Deaths. Deaths. Notifications. Deaths. Notifications. Notifications. Deaths. Deaths. Notifications. Deaths. Notifications. Notifications. - - - Small Pox - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Cholera, Plague - - - - - - - - - - - - - - - - - - - - - - 32 68 7 1 Diphtheria and Croup 1063 1045 54 5 6 89 8 98 5 130 380 18 145 4 39 - 65 11 - 5 1 - - 11 22 1 98 840 785 5 - 50 1 2 142 29 42 - 4 - 4 - Soarlet Fever - 71 1 307 - - - - - - 2 - Enteric Fever 14 12 - - - - - 1 4 2 5 - - - - - - - - - - - - - 12 1 1 17 Acute Influenzal Pneumonia 62 18 7 2 4 2 - 2 - 1 3 6 - 7 3 6 2 - - - - - 3 - 8 5 104 35 4 5 12 9 9 6 - 16 5 13 - 13 1 3 Acute Primary - - - - - - - 57 1 2 - 4 1 9 2 1 18 3 Erysipelas 8 - 2 - - 2 6 1 16 17 43 120 - - - - Cerebrospinal Meningitis - - 3 3 - - 1 1 - - 1 - - - - - - - - - - - - - - - 3 - Poliomyelitis 1 1 - - 1 - - - - 1 - - - - - - - - - - - - - - - - Malaria 5 - 2 - - - - - - - - - - 3 - - - - - - - - - - - - - - - Dysentery - - - - - - - - - - - - - - - - - - - - - - - - - Encephalitis Lethargica 12 9 1 - 2 - - 2 3 2 1 2 - - 1 - - - - - - - - - - - - - - - - - - - Typhus Fever - - - - - - - - - - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - - - - - - - - - - - 14 4 - - Ophthalmia Neonatorum 14 - - - - - - - - - - - - - - - - - - - - - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Glanders - - - - - - - - - - - - - - - - - - - 16 - 5 1 1 - 1 Puerperal Fever 17 7 - - - - 16 - - - - - - - - - - - - - - - Puerperal Pyrexia 6 2 - - - - - - - - - - - - - - - 5 - 1 - - - - - 2263 1987 86 62 5 107 6 154 184 6 239 8 771 21 308 4 87 1 180 6 55 5 30 8 Totals 9 86 7 E 2 second opinion; bacteriological investigation, the provision of trained nurses, or the admission of the patient to hospital. The notification of puerperal pyrexia should go a long way in doing away with the idea that fever during the puerperium is a relatively unimportant incident, and should ensure the provision of adequate nursing and treatment in hospital in the majority of cases as soon as symptoms suggestive of septic infection become manifest. Arising out of the Regulations, the Council appointed your Medical Officer of Health as consultant for a period of three months should a second opinion be asked for under these Regulations. Previous to October, 1926, there were 15 cases of puerperal fever notified. Since the above Regulations came into force two further cases were reported and 6 cases of puerperal pyrexia. 7 cases of puerperal fever were treated in the Metropolitan Asylums Board hospitals, 8 in St. Giles' Hospital, 1 in a General Hospital, and 1 in a Private Nursing Home. The puerperal pyrexia cases were treated as follows :—2 in St. Giles' Hospital and 4 in the patients' own homes. NON-NOTIFIABLE DISEASES. Measles. This disease is not notifiable in Camberwell, but the London County Council, through their school medical service, report to the Medical Officers of Health all children stated to be suffering from measles or are kept away from school by reason of this disease existing in their homes. Further information of cases is also obtained through the Health Visitors and other agencies. By these methods we obtained knowledge during the year of 1,836 cases. Measles was responsible for 48 deaths during the year. All known cases were visited by the Women Inspectors and the parents advised as to the necessity of seeking medical advice. Isolation as far as possible was recommended, and when necessary the services of a district nurse were provided. The policy of the Metropolitan Asylums Board to allocate, in times of measles prevalence, a larger proportion of accommodation than has been done in the past, should help to reduce the high fatality of this disease arising from complications. A card containing information as to what steps should be taken in the event of measles or whooping cough occurring in the home is left by the Health Visitors at every house from which a notification of birth is received. Whooping Cough During the year 147 cases came to the knowledge of this Department. There were 7 deaths Bacteriological Examinations The examination of bacteriological specimens for Camberwell is carried out in the laboratory at St. Giles' Hospital. The following report of Dr. Bousfield, the Pathologist at the Hospital, sets out in detail the number and the result of the specimens submitted during the year 1926: — The number of specimens received and dealt with amounted to 6,147. This number is greater by about 470 than last year. The specimens were composed as follows: — Percentage positive 14.4 Diphtheria swabs 3,485 Percentage positive 16.8 Sputum examinations 2,606 Percentage positive 0.0 Widal reactions 15 Pus, etc. 11 Milks and Ice Creams 19 Waters 5 Other specimens 6 Total 6,147 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 formalin at 3 per cent. Verminous rooms are disinfected by spraying with eucryl at a strength of one in 50. Disinfection of Library Books. —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 70 and 71. Cleansing of Verminous Persons. Under an agreement with the London County Council the station is reserved for the use of school children every day until 4 p.m., except Saturday, while the schools are open. Vermin cases are dealt with on Tuesdays, Wednesdays and Thursdays, and scabies cases on Mondays and Fridays. Adults are dealt with on any day after 4 p.m. The women Sanitary Inspectors visit the homes of the children cleansed and make the necessary arrangements for the cleaning and disinfection of the bedding and rooms, including articles of wearing apparel. DISINFECTING DEPARTMENT. RETURN OF WORK, 1926. Articles Disinfected. Jan. Feb. Mar. Apr. May. June. July. Au g. Sept. Beds 167 191 170 137 122 101 94 105 144 686 551 487 486 381 Blankets 650 765 614 566 Bolsters 87 82 81 112 113 125 81 75 84 20 42 72 53 7 6 25 Books, Public Library 137 — 49 14 32 18 22 29 Cushions 43 36 68 8 1 2 Carpets 4 1 4 3 6 - 64 139 Mattresses 73 77 98 97 64 87 70 2 2 8 4 14 6 8 Palliasses 2 - 232 362 314 175 242 215 243 Pillows 380 221 122 102 Quilts 215 173 177 174 114 100 120 244 216 230 139 141 212 131 160 Sheets 263 2,186 Wearing apparel (suits, dresses, etc.) 3,242 2,331 1,855 3,232 906 2,498 3,069 2,178 3,806 5,027 5,083 3,940 3,455 2,152 3,822 3,947 Total 4,454 Mattresses re-tabbed 73 61 64 97 87 58 70 98 64 2 2 2 4 2 14 Palliasses re-tabbed 2 6 8 15 6 21 12 Cushions re-tabbed 6 13 53 8 8 81 76 153 116 72 87 109 72 90 Total Mattresses and Palliasses destroyed 61 122 160 101 171 127 103 100 93 Miscellaneous articles destroyed 23 370 4 52 14 41 9 19 4 Total 75 145 530 105 119 223 136 97 144 Houses visited 532 557 552 172 342 325 408 454 495 345 418 402 353 271 222 254 316 Rooms disinfected 299 Total 877 975 954 825 613 547 662 770 794 DISINFESTATION. RETURN OF WORK, 1926. Aug. Sept. Oct. Nov. Dec. Total. Jan. Feb. Mar. Apr. May. June. July. Persons cleansed, Vermin:— 2 2 5 2 4 4 2 2 37 Adults —Males 4 3 4 3 - 1 Females - - 1 - - - - - - - - 131 Children — Males 5 14 18 3 7 18 7 9 9 18 10 13 208 2,589 Females 142 229 293 157 173 338 240 86 281 238 204 Persons cleansed, scabies: — i I I I - - Adults—Males - - - - - - - - - - - - 4 Females - - 4 - - - - - - - - 46 41 22 260 Children—Males 18 9 51 29 4 14 16 8 - 11 14 6 9 267 Females 28 42 55 35 53 16 - - Verminous rooms disinfected 3 5 15 19 6 17 16 22 17 39 19 187 9 6 Verminous bedding disinfected - 7 26 8 4 2 9 9 12 145 6 56 71 Maternity and Child Welfare. The most noteworthy feature associated with the Maternity and Child Welfare activities of the Borough during the past year was the development of the Municipal Maternity Ward Scheme, which provides institutional treatment 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. The agreement which the Council entered into with the Camberwell Board of Guardians in 1923, to set aside a Maternity Ward containing 6 beds in St. Giles' Hospital for a period of 3 years, was renewed in November last for a further term of 3 years and the accommodation increased to two 6-bedded wards, as the number of applications received was considerably in excess of the accommodation available. This is evidence of a growing desire on the part of women to be confined away from home, and of an increasing sense of appreciation of the importance of medical supervision during pregnancy and the advantages of constant medical and nursing attention at the time of confinement and during the puerperium. It is pleasing to record that work in connection with the arrangements for attending to the health of expectant and nursing mothers and of children who have not attained the age of five years has continued to be satisfactorily carried out during 1926. The new Infant Welfare Centre which was opened at the end of 1925 at Amott Road (a branch of the Union of Girls' School Centre, Peckham Road), has fully justified its establishment, as a reference to the table of work of the Infant Welfare Centres which follows will show. The Nunhead Centre Authorities at the beginning of the year gave up the unsatisfactory premises at 31, Nunhead Grove, and established themselves in the Cheltenham College Mission Hall at 96, Nunhead Grove. This arrangement, I understand, is only temporary, and it is hoped that shortly more suitable premises will be found or a new centre built. Infant Welfare Centres. The Infant Welfare work in Camberwell is undertaken by seven Voluntary Centres (six being subsidised by the Council) and three Municipal Centres. A return of the work carried out in 1926 appears on the following page. MUNICIPAL AND SUBSIDISED INFANT WELFARE CENTRES. RETURN OF WORK, 1920. Infant Welfare Centre. Consultations. Children —Attendances at Consultations. Mothercraft Classes. Analysis of Visits. Expectant Mothers. Post-Natal Mothers. First Attendances. Subsequent Attendances. Doctor's Consultations. Superinte nde nt 's Consultations. Total. Sewing Class. Health Talk. Sewing Class and Health Talk. Expectant Mothers Children Attending Centre. Miscellaneous and other Visits not defined. Visits by Voluntary Helpers. Visits to Mothers & Children not attending the Centre. Miscell. Attendances. Doctor's Consultations and Weighings. 'Weighing only. After Notification of Birth. Before attending Centre. Total Visits. Under 1 year. Over 1 year. Under 1 year. Over 1 year. First Visits. Subsequent Visits. First Visits. Subsequent Visits. Camberwell Municipal, 140, Camberwell Road. 61 - 152 19 1385 756 119 306 - 1723 283 2431 - - 234 110 67 843 232 371 - 882 2514 9 - 57 813 2352 1865 962 214 268 — 3320 - - 349 75 6 161 556 702 - - 222 2606 232 Dulwich Municipal, 114, Lordship Lane 39 445 - 649 82 — 354 75 3 26 1401 191 1561 592 2426 - - 34 504 — 2219 Peckham Municipal, St. Jude's Hall, Meeting House Lane. - 159 978 120 26 449 312 3278 241 991 10 249 274 3518 1757 — 2297 - 5575 - - 3434 167 232 1867 3969 Bird-in-Bush Voluntary, 616, Old Kent Road - 12 375 41 5327 17 127 206 865 — 1855 979 - - 135 304 2834 376 125 50 1464 2874 Cambridge House, 6, Addington Square. 1722 - 787 - 131 7 2208 - 3960 120 - 880 212 1996 - 1027 126 500 147 1897 890 1190 - - *Cobourg, Kempshead Hall, Kempshead Road. - - 400 - 27 - 10 1354 252 722 1873 341 3568 220 93 198 1437 516 3851 2584 - 154 - 147 1460 Nunhead, 31, Nunhead Grove - - - 58 - 167 - 1167 469 4881 St. Luke's, 2, Commercial Road - - 227 39 1969 1047 - 1151 2131 - 3282 1229 65 7 2 293 2820 - 230 Union of Girls' School, 17, Peckham Road 191 43 3140 - 2073 3424 5497 — 151 38 1801 457 158 5243 8078 - 268 2046 - 442 753 - 28 211 392 81 320 - - 2197 - 2127 2905 5132 4233 6366 Amott Road Centre, E.Dulwich 111 - 100 172 - 87 2613 55 1566 24 Totals 537 595 2102 379 21387 11881 524 13225 14073 5890 2561 36273 1788 2904 5398 1067 1557 849 12286 4294 568 836 22060 43517 * Not subsidised by the Council. Maternity Ward. During the year the Municipal patients made 651 attendances at the ante-natal clinic, St. Giles' Hospital, in connection with the Council's Maternity Ward Scheme. The importance and the value of ante-natal supervision may be judged by the following summary, which shows the number and nature of the conditions found as a result of these examinations: — Contracted Pelvis 43 Varicose Veins 6 Excessive Vomiting 7 Albuminuria 6 Vaginal Discharge 4 Ante-partum Haemorrhage 1 Skin Diseases 3 Carious Teeth 3 Pendulous Abdomen 1 Other Defects 4 Of the 153 patients confined, 138 had normal deliveries and 15 were abnormal, 8 requiring forceps delivery, 2 twins, 2 Caesarean sections, and 1 retained placenta. Induction had to be practised in 5 instances, 3 for small pelvis at the 39th week, 1 for post-maturity, and 1 for pendulous abdomen. No abnormalities occurred in these deliveries. All patients were examined before leaving hospital for the purpose of discovering any after effects requiring treatment. In connection with these examinations it was found necessary for treatment to be carried out for the following abnormalities: — Retroversion 6 Retroflexion 2 Kidney Diseases 1 Old Perineal tear 1 Ovarian Cyst 1 Of the 155 children born there were 6 deaths. One premature died the second day after birth; 4 still-births; and one child died 8 days after birth. Three other children were born with abnormal conditions: one child with hypertrophic stenosis, one with two thumbs, and one with temporary facial paralysis. Medical Review. 1924. 1925 1926. Number of ante-natal examinations 666 745 651 ,, ,, abnormalities and diseases requiring treatment found 36 35 78 ,, ,, patients confined — (a) Normal labour 99 167 138 (b) Abnormal labour 15 21 15 ,, ,, after results of confinement requiring treatment 3 14 9 ,, ,, births 116 189 155 „ „ children born with any abnormality 3 9 4 ,, ,, deaths— (a) Premature 5 1 1 (b) Still-births 4 8 4 (c) Before discharge of patient - - 1 74 Bookings Opening Date to December 31st 1926. First Confinement & Housing. Housing Difficulties. Total Confinements. Medical reasons for Admission. First Confinement only. 1 - - 3 1923 2 3 59 114 1924 3 49 6 93 188 1925 22 67 7 65 61 153 1926 20 47 181 214 458 Totals 16 Additional Applications Received. Number of Applications. Admission fee not accepted by patient. Accommodation not available. Unsuitable cases. First Confinement cases. Housing circumstances cases. 1923 5 4 - 1 1 4 1924 104 43 48 13 13 91 1925 119 25 81 13 20 99 148 82 1926 77 53 18 66 Totals 376 140 182 45 100 276 Convalescent Treatment. During the year there were 11 children under 5 years of age sent to convalescent homes for a period of one month; two for a term of 5 weeks, and one for 7 weeks' treatment; also a mother and her two children for 4 weeks, and another mother and her infant for a period of 3 weeks. Milk. The Council continued to issue milk in accordance with the Ministry of Health Circular No. 185, and during the year the number of pints distributed was approximately 240,000, together with 1,600 lbs. of dried milk. The estimated cost of this service amounted to £3,150. Every application was duly considered by the appropriate Committee, which met every week, and a grant made where the income after the deduction of rent did not exceed the amount laid down in the following approved scale : — INCOME SCALE. Free Issues. No. in family. Income per head. s. 13 10 8 7 7 6 d. 0 6 6 6 0 6 1 2 3 4 5 6 and over Half-price Issues. No. in family. Income per head. s. d. 1 2 3 15 12 10 8 8 7 0 6 0 6 0 0 4 5 6 and over Investigation was made in every case where a doubt existed with regard to the information stated in the application, and in two instances it was found necessary, after enquiries had been made, to request the attendance of the applicants before the Maternity and Child Welfare Committee to offer an explanation of the conflicting information relating to domestic circumstances. In both cases the Committee decided that the nature of the irregularity did not warrant any steps being taken other than the administration of a severe reprimand and the refund to the Council of the cost of the milk supplied. Nursing Arrangements. (See page 18.) Peckham, Nunhead and District Day Nursery, 109, Gibbon Road. The above-named Institution was temporarily closed at the end of the year at the request of the Ministry of Health, and the question of its re-opening remains in abeyance. Homes for Unmarried Mothers. The work in connection with the care of the unmarried mother and her infant was continued to be carried out during the year by the National British Women's Temperance Association in their "House of Help," 201, Camberwell Grove, and by Miss Tucker, of 47, King's Road, Peckham, the Rescue worker of the Southwark Diocesan Association. REPORT OF THE TUBERCULOSIS MEDICAL OFFICER FOR THE YEAR 1926. The Current List of Notifications of Tuberculosis in Camberwell as at December 31st, 1926. At December 31st, 1926, there were 2,713 cases of tuberculosis on the current list in Camberwell. There were 1,926 cases of pulmonary tuberculosis—l,o92 males and 834 females —and 787 cases of non-pulmonary tuberculosis—4l4 males and 373 females. TABLE I, Number of Notifications on the Tuberculosis Register (Camberwell) AT THE END OF THE YEARS 1925 AND 1926 RESPECTIVELY. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Year. Male. Female. Total. Male. Female. Total. 1925 2,071 820 439 1,180 381 891 1,092 834 1,926 787 414 373 1926 On Table I the number of notifications on the Tuberculosis Register in Camberwell at the end of the years 1925 and 1926 respectively are compared. It should be remembered that new primary notifications and transfers of patients from other areas add to the Register, while recoveries—as defined by the Ministry of Health —deaths of enrolled patients from tuberculosis or other causes of death, removals from the area and cases in which the original diagnosis of tuberculosis has been altered, substract from it. The importance of having a true and live register cannot be over-emphasised. All who contribute names of patients to the Register —whether the contributors be hospital consultants, general practitioners, school medical officers or tuberculosis officers —should feel that they share in the responsibility of keeping the Register true. A name on the Register that should not be there is a personal injustice. An altered address may be known to the medical attendant and not to the Medical Officer of Health. In such a case there is in essence a de-notification that may interfere with public health measures. An omission to notify a case of tuberculosis lessens the value of the Register as an index of the magnitude of the local tuberculosis problem, handicaps the appropriate authority in considering questions of staff. beds, etc., loosens the preventive scheme and deprives the patient of any opportunity of participating in the benefits of the public scheme of treatment. Table II supplies an analysis under age periods, sex, and the broad grouping of pulmonary and non-pulmonary forms. Pulmonary—Males - 2 15 39 100 119 261 273 181 72 30 „ Females - 1 13 34 119 117 214 182 88 48 18 Non-Pulmonary—Males 2 64 114 101 44 17 27 26 13 4 2 ,, Females 1 18 52 86 75 52 49 22 12 5 1 TABLE III. Individual Notified Patients on Current List at 31st December, 1926, ALLOCATED TO THE WARDS OF THE BOROUGH. Wards. Pulmonary Non-Pulmonary Grand Total. Males. Females. Total. Males. Females. Total. 86 37 74 293 1 133 219 37 35 44 79 18 22 40 119 2 73 62 135 29 30 59 194 3 87 65 152 35 28 63 215 4 147 52 62 5 33 85 33 29 6 53 29 82 24 21 45 127 7 108 105 213 43 39 82 295 8 72 50 122 24 21 45 167 9 57 40 97 25 19 44 141 10 40 29 69 18 14 32 101 11 42 25 67 21 15 36 103 40 43 83 14 14 28 111 12 37 29 66 7 3 10 76 13 39 29 68 13 12 25 93 14 26 26 52 9 10 19 71 15 57 44 101 19 11 30 131 16 41 30 71 21 24 45 116 17 65 41 106 16 17 33 139 18 30 19 49 7 6 13 62 19 20 5 5 10 1 1 2 12 The Notification of Tuberculosis in Camberwell in 1926. The number of primary notifications of tuberculosis in Camberwell in 1926 was 506. 394 were cases of pulmonary tuberculosis and 112 were cases of non-pulmonary tuberculosis. On Table IV the number of primary notifications yearly since 1921 are compared. A steady fall in the number of primary notifications of non-pulmonary tuberculosis will be noted. A slight rise occurred in the number of primary notifications of pulmonary tuberculosis in 1926 over that of 1925. The reason for the rise may be explained by the fact that the number of un-notified cases at death in 1926 was the lowest we have on record. Whereas, in 1925, 69 patients died before notification, in 1926 the number who died before notification was reduced to 34. TABLE IV. Year. All Forms. Pulmonary Tuberculosis. Other Forms. 1921 750 595 155 1922 653 506 147 1923 657 505 152 1924 559 416 143 1925 491 373 118 1926 506 394 112 On Table V is given the primary notification rate (per 1,000 population of Camberwell) for the last five years. TABLE V. Year. Population. All Forms. Pulmonary Tuberculosis. Other Forms. 0.58 1921 267,198* 2.80 2.22 1922 270,300a 2.41 1.87 0.54 1.85 0.55 1923 272,300a 2.40 0.52 1924 273,700a 2.04 1.52 0.42 1925 275,400a 1.78 1.35 0.40 1926 275,400a 1.80 1.43 * Census, 1921. a Estimated. On Table VI the summary of notifications for the year 1926 is treated in more detail. TABLE VI. Summary of Notifications during the Period from January 3rd, 1926, to January 1st, 1927. Notifications on Form A. Notifications on Form B. Notifications on Form C. Number of Primary Notifications. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institutions. Sanatoria. Total Notifications on Form A. 0-1 l-5 5-10 10-15 15-20 20-25 25-35 35-45 45-65 55-65 65 and upwards. Total Primary Notifications. Under 5 Total Primary Notifications. 5-10 10-15 2 - 6 6 22 24 59 42 33 21 7 222 314 - - - - - 158 235 172 - - 92 - 4 6 26 54 25 8 252 - 106 - 30 5 - 14 - 7 4 - 11 4 52 - 7 10 5 1 - 71 - 2 16 45 - - 9 60 - On Table VII the primary notifications of 1926 are allocated to the Wards of the Borough. TABLE VII. Primary Notifications of 1926 Allocated to the Wards of the Borough. Non-Pulmonary. Pulmonary. Grand Total. Wards. Females. Total. Males. Females. Total. Males. 3 22 18 40 2 5 45 1 6 17 23 3 3 26 2 - 12 9 21 4 4 8 29 3 4 7 14 21 2 2 4 25 5 5 9 8 17 4 9 26 4 6 15 10 25 6 10 35 2 6 32 7 14 12 26 4 2 25 8 16 4 20 3 5 3 5 8 30 9 12 10 22 8 2 5 7 15 10 6 2 4 16 4 3 7 23 11 12 17 11 28 3 2 5 33 12 10 4 14 - - 14 13 - 12 8 20 1 1 2 22 14 15 7 6 13 4 8 12 25 16 6 14 20 6 2 7 27 3 17 10 6 16 2 5 21 3 27 18 16 5 21 3 6 2 23 19 12 8 20 1 3 2 20 1 1 2 - - - One Pulmonary Female of Camberwell address given as Wandsworth Union. Table VIII. Supplemental Return. New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during 1926 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. It will be noted from Table X that the number of such cases has fallen from 69 in 1925 to 34 in 1926, and, as already mentioned, may account for the slight increase in the number of primary notifications in 1926 over those of 1925. 82 1 - - - - - 2 1 3 - 14 Pulmonary—Males 2 „ Females 1 3 - 10 - 1 1 - 1 1 - - - Non-Pulmonary—Males - 2 - - - - 1 - 3 - 3 - - - - 1 „ Females - 2 7 1 - - F 2 83 On Table IX the supplemental returns for 1926 are allocated to the Wards of the Borough. TABLE IX. Wards. Pulmonary Non-Pulmonary Total. Males. Females Total. Grand Total Males. Females. 1 - 2 2 - - - 2 2 1 2 3 1 - 1 4 3 1 - 1 1 1 2 - 4 - - 1 1 1 - - 5 1 - 1 - - 1 - 6 1 1 - - 1 - - 1 1 1 7 - - - - 8 - 1 1 1 - - - 9 2 - 2 2 - - - 10 1 1 2 - - 2 - 11 2 3 1 4 1 - 1 12 1 - 1 1 1 2 3 13 - - - - - - - 14 - - - - - - - 15 2 2 - - 2 - - 16 1 1 - - - 1 - 17 1 1 - 2 2 3 - 18 - 1 1 1 1 2 - - - - - - 19 - - 20 - 1 1 - - - 1 There is one Pulmonary Male of no fixed abode. 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 is diminishing, as will be seen by Table X. The number, however, is still far too large. Apart from cases where the cause of death is ascertained by autopsy to be tuberculosis unsuspected during life, there seems no legitimate reason why the Public Health (Tuberculosis) Regulation, 1912, should not be strictly carried out. The difficulties that have been suggested are not insurmountable. TABLE X. Year. Number of cases of Tuberculosis discovered by the Public Health Department after death. 1921 88 83 1922 73 1923 1924 69 69 1925 34 1926 In 1921, 25 per cent. of the deaths from tuberculosis in Camberwell were not notified before death. In 1926, 12 per cent. were not notified before death. Deaths from Tuberculosis (Camberwell) in 1926. The number of deaths from tuberculosis in Camberwell during 1926 was 286. Of these 251 were from pulmonary tuberculosis and 35 from other forms of the disease. On Table XI the deaths from tuberculosis (Camberwell) during 1926 are detailed under sex, age periods and broad sub-division of the disease. Pulmonary—Males - 3 1 - - - 2 38 43 47 150 12 4 2 - 2 16 2 101 „ Females 1 1 - - 40 17 20 1 1 - 2 - - Non-Pulmonary—Males 1 1 1 2 14 3 2 2 - 1 2 1 4 3 1 1 1 21 ,, Females 1 4 86 On Table XII the deaths from tuberculosis (Camberwell) during 1926 are allocated to the Wards of the Borough. TABLE XII. Deaths from Tuberculosis, 1926, allocated to the Wards of the Borough. Pulmonary. Non-Pulmonary. Wards. Males. Females. Total. Grand Total. Females. Total. Males. 1 11 16 27 - 1 1 28 2 9 7 16 2 18 1 1 3 4 1 5 1 2 3 8 4 8 9 17 3 3 20 - 5 12 6 18 - - 18 - 6 6 6 12 1 1 2 14 7 7 5 12 - - 12 - 8 7 9 16 2 3 5 21 9 15 1 16 2 2 18 - 10 5 2 7 - 2 2 9 11 5 6 11 1 - 1 12 12 14 9 23 3 1 4 27 13 5 1 6 - - 6 - 14 8 1 9 2 2 11 - 15 7 2 9 1 1 5 11 16 7 14 7 2 - 2 16 17 4 2 6 2 2 8 - 11 17 1 2 19 18 6 1 4 3 7 19 - - 7 - - 2 2 20 2 - - - One Pulmonary Male of no fixed abode. Males - - 1a - - 2c 2 1 1 1 1 - 9 - Females 1b - 1 2 1 4 - 2 - - - 11 a. The father has pulmonary tuberculosis. b. The father died of pulmonary tuberculosis. c. In the case of a boy aged 4 years, a woman suffering from tuberculosis of the skin lived in the same house. In no other case was there any known case of human tuberculous infection in the same house or home. 88 TABLE XIV. Non-notified Fatal Cases. Per cent. TABLE XV. Year 1926. The total number of deaths from tuberculosis was 286 Not notified or notified after death 34 Notified within one month of death 58 Notified within three months of death 29 Notified within six months of death 26 113 Notified more than six months after death 139 286 47 Proportion of non-notified cases who died at home to total of non-notified fatal cases 53 Proportion of non-notified cases who died in institutions to total of non-notified fatal cases 28.57 Non-pulmonary tuberculosis. Proportion of non-notified fatal cases to total non-pulmonary deaths 9.56 Pulmonary tuberculosis. Proportion of non-notified fatal cases total pulmonary deaths 11.88 All forms of tuberculosis. Proportion of non-notified cases to total number of deaths TABLE XVI. Showing the Occupation of Males who died from Tuberculosis in 1926. Apprentice (Bookbinding) 1 Artist and designer 1 Barman 1 Basket Maker 1 Bath Attendant 1 Boot repairer 1 Brewer's drayman 1 Bus Conductor 1 Bricklayer 1 Butcher (Master) 1 Carman 1 Carpenter 2 Chiropodist 1 Clerk (Commercial) 16 do. (Solicitor's) 2 Collar Cutter 1 Compositor 3 Cook 2 Cooper 1 Costermonger 1 Cutter (Tailor's) 1 Decorator 3 Engineer (Electrical) 1 do. (Mechanical) 1 Engineer's Fitter 5 do. Turner 3 Flour Factor 1 Flower Maker (Artificial) 1 Gardener 1 General Dealer 5 Greengrocer 1 Hairdresser's Assistant 1 Hawker (Fruit) 1 Importer (Dress Trimmings) 1 Labourer (Builder's) 2 do. (Boot Tree Manfr.'s) 1 do. (General) 9 Law Writer 1 Leather Dresser 2 Messenger 2 Mineral Water Foreman 1 Modeller 1 Monumental Mason 1 Motor Driver 3 do. Mechanic 1 Newsagent 1 No occupation 4 Operator (Cinematograph) 1 Packer 1 Painter 5 do. Assistant 1 Pattern maker (Engineer's) 1 Pensioner (Army) 3 do. (Navy) 1 Plasterer 1 Porter (general) 5 Printer's manager 2 Publisher's Agent (Music) 1 Railway Checker 1 do. Goods Checker 2 Road maker (foreman) 1 Salesman (Book) 1 do. (Boot) 1 Schoolkeeper 1 School children 6 Seaman 1 Ship's Steward 1 Shop Assistant (Grocer) 1 do. (Ironmonger) 1 do. (Colourman) 1 Shop Keeper 1 Skin Sorter 1 Stoker 2 Storekeeper 1 Tar Pavior 1 Taxi driver 1 Teacher (Music) 1 Ticket Writer 1 Tinman 1 Tin Plate Worker 1 Traveller 2 Verger 1 Victualler, Licensed 1 do. do. (Manager) 1 Warehouseman 2 Window Cleaner 1 Wheelwright 1 Wire Worker 1 Under school age 8 Total 164 91 TABLE XVII. Showing the Occupation op Females who died pkom Tuberculosis in 1926. Art Pottery Assistant 1 Ironer (Laundry) 1 Biscuit Maker 1 Leather Stitcher 1 Book Binder 1 Milliner 1 Book Folder 2 Milliner's Assistant 1 Bottle Washer 2 Newspaper Publisher's Asst. 1 Calender Hand (Laundry) 1 No occupation 16 Nurse Carpet Maker 1 2 JU 1 Cashier 1 Nurse (Children's) Clerk (Commercial) 2 Packer 2 Cook 1 Printer's Layer-on 2 Domestic Servant 5 Printer's Ruler's Assistant 1 Dressmaker's Finisher 1 School Children 7 Envelope Maker 1 Telephonist 1 Flannel Presser (Laundry) 1 Under School Age 10 Glove Machinist 1 Gramophone Record Tester 1 122 Helmet Maker 1 Housewife 51 TABLE XVIII. Showing the Work of the Tuberculosis Dispensary for the Year 1926. Diagnosis. Non-pulmonary. Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts): — T T (a) Definitely tuberculous 155 3 5 21 27 16 17 176 128 19 22 101 (b) Doubtfully tuberculous 15 - - - - 87 89 13 - - - - 258 (c) Non-tuberculous - - - - - - 190 - 283 202 - B.—Contacts examined during the year:- "1 n In _ 1 n (a) Definitely tuberculous 1 2 2 2 1 4 - - 1 4 1 (b) Doubtfully tuberculous - - - - - - - - 7 4 1 2 (c) Non-tuberculous - - - - 58 128 - - - - 245 222 C.—Cases written off the Dispensary Register as H (a) Cured 27 30 2 7 8 6 15 6 35 36 17 13 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 309 488 512 435 D.—Number of Persons on Dispensary Register on December 31st: — (a) Diagnosis completed 699 546 59 49 134 217 166 133 833 763 225 182 23 (b) Diagnosis not completed - - - - - 13 4 5 - - - 1. Number of persons on Dispensary Register on January 1st 2,057 2. Number of patients transferred from other areas and of "lost sight of" cases returned 11 3. Number of patients transferred to other areas and cases "lost sight of" 158 4. Died during the year 174 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 90 6. Number of attendances at the Dispensary (including Contacts) 8,574 7. Number of attendances of nonpulmonary cases at Orthpadeic Outstations for treatment or supervision - 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (a) "Light" treatment 130 (b) Other special forms of treatment 78 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 13 10. Number of consultations with medical practitioners: (a) At Homes of Applicants 84 (b) Otherwise 987 11. Number of other visits by Tuberculosis Officers to Homes 1,203 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 6,310 13. Number of (a) Specimens of sputum, &c., examined 1,930 (6) X ray examinations made in connection with Dispensary work 209 14. Number of Insured Persons on Dispensary Register on the 31st December 1,053 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 400 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P.17 46 (b) Form G.P.36 932 Institutional (Residential) Treatment of Camberwell Patients in 1926. A. Through the London County Council. 1. Adult Males:— Number of applicants for residential treatment 255 Number who received residential treatment 212 Number who did not receive residential treatment:— Not accepted 20 Failed to enter 19 Awaiting residential treatment at December 31st, 1926 4 Classification of Adult Males who Received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 26 Pulmonary cases in which tubercle bacilli had been found in the sputum 137 Early pulmonary tuberculosis 17 Moderately advanced pulmonary tuberculosis 95 Advanced pulmonary tuberculosis 25 Surgical tuberculosis 12 Diagnosis of tuberculosis 16 Not classified 21 2. Adult Females:— Number of applicants for residential treatment 138 Number who received residential treatment 114 Number who did not receive residential treatment:— Not accepted 10 Failed to enter 10 Awaiting residential treatment at December 31st, 1926 4 Classification of Adult Females who Received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 12 Pulmonary cases in which tubercle bacilli had been found in the sputum 66 Early pulmonary tuberculosis 14 Moderately advanced pulmonary tuberculosis 43 Advanced pulmonary tuberculosis 9 Surgical tuberculosis 11 Diagnosis of tuberculosis 12 Not classified 13 3. Boys:— Number of applicants for residential treatment 29 Number who received residential treatment 28 Number who did not receive residential treatment:— Not accepted - Failed to enter — Awaiting residential treatment at December 31st,1926 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 22 Diagnosis of tuberculosis 3 Not classified — 4. Girls. 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, 1926 1 Classification of Girls who Received Residential Treatments Pulmonary cases in which tubercle bacilli had not been found in the sputum 5 Pulmonary cases in which tubercle bacilli had been found in the sputum 2 Early pulmonary tuberculosis 1 Moderately advanced pulmonary tuberculosis 1 Advanced pulmonary tuberculosis — Surgical tuberculosis 14 Diagnosis of tuberculosis — Not classified — The London County Council used beds in the following institutions for Camberwell patients:— Adults. Hospitals. All Saints. Brompton. Northern. Eversfield. St. Luke's, Lowestoft. St. Luke's, Bayswater. Grove Park. Golden Square. Royal Chest. St. Anthony's, Cheam. City of London Liverpool Road. King George, Bramshott. Colindale. Homes. Tait. Seaview, St. Leonards. St. Michaels, Axbridge. St. Barnabas, Torquay. Bishopsbourne, Broadstairs. St. George's, Chelsea. Sanatoria. Burrow Hill. King George V., Godalming. Frimley, Surrey. Holy Cross, Surrey. Northamptonshire, Creaton. Hermitage, I.0.W. Grosvenor, Ashford. Hawthorndene, 1.0.W. Kelling, Norfolk. Maltings Farm, Suffolk. Pinewood, Berks. National, Benenden, Kent. Chilton House. Standish House. Rushden House. Old Manor House. Colonies. Burrow Hill. Papworth, Cambridgeshire. Preston Hall, Kent. Children. Hospitals. Sanatoria and Homes. Highwood, Brentwood. Nayland. Alexandra Hip. Alton, Lord Mayor Treloar's. Heatherwood, Ascot. Millfield, Rustington. Princess Mary's, Margate. Brockley Hill. Queen Mary's, Carshalton. Church Army, Fleet. Dorset Red Cross, Swanage. Metropolitan Convalescent. The average duration of residential treatment given by the London County Council in 1926 to 326 adults was 12 weeks. The average residential treatment given to 49 children by the London County Council in 1926 was 18.4 weeks. This refers only to those who began treatment in that year. Many of these patients will remain in institutions during varying periods of 1927—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. TABLE XIX. Number of families occupying Housing accommodation of 506 families in which there was a Primary Notification of Tuberculosis in 1926. 1 Room. 2 Rooms. 3 Rooms. 4 Rooms. 5 Rooms. 6 Rooms or more. Patient living alone 6 - - - - 41 „ „ with 1 other 18 15 8 3 4 4 ,, ,, ,, 2 ,, 10 21 28 15 5 5 ,, ,, ,, 3 ,, 3 23 33 23 14 8 ,, ,, ,, 4 ,, 3 12 12 29 19 12 ,, ,, ,, 5 ,, 2 6 22 15 6 11 ,, ,, ,, 6 ,, 2 5 9 2 5 - ,, ,, ,, 7 ,, 1 7 9 2 6 - ,, ,, ,, 8 ,, 1 2 2 - 7 - ,, ,, ,, 9 ,, - 1 1 1 - - ,, ,, ,, 10 ,, - 1 3 1 - - ,, ,, ,, 11 ,, - - - - - 2 90 125 I 112 55 61 Total 63 TABLE XX. Sleeping accommodation for 506 tuberculous cases notified for the first time in 1926. The figures refer to the Tuberculosis nurse's first home visit. The patient slept— In separate room In 187 cases. Alone in bed with 1 other in room „ 29 „ „ „ 2 others „ „ 25 „ „ „ 3 „ „ „ 5 „ „ „ 4 „ „ „ 1 „ Slept in bed with 1 person and no others in room „ 136 „ „ „ 1 „ 1 other „ „ 51 „ „ „ 1 „ 2 others „ „ 21 „ „ „ 1 „ 3 „ „ „ 12 „ ,, ,, 1 ,, 4 ,, ,, „ 4 „ Slept in bed with 2 persons and no others in room „ 17 „ „ „ 2 „ 1 other „ „ 8 „ „ „ 2 „ 2 others „ „ 3 „ „ „ 2 „ 3 „ „ „ 3 „ „ „ 2 „ 4 „ „ „ - „ Slept in bed with 3 persons and no others in room „ 2 „ „ „ 3 „ 1 other „ „ - „ „ „ 3 „ 2 „ „ „ - „ „ „ 3 „ 3 „ „ „ 1 „ Slept in bed with 4 persons and no other in room „ 1 „ 506 „ The Care Work of the Tuberculosis Dispensary, 1926, 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 1926:— 1. 64 Dispensary patients received extra diet. 2. 13 patients received dentures. The voluntary dental fund paid part of the cost, patients paid a little, and the remainder was contributed from the Borough Dental Scheme. 3. 153 patients were specialiy helped in their applications to the Guardians for assistance. Thus patients obtained relief in money, food, extra diet, convalescence, clothes, etc. 4. 33 cases were assisted in their applications to the British Red Cross Emergency Fund. Thus pensioners obtained such assistance as money, clothing, beds, bedding, etc. 5. 31 cases were assisted in their applications 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 making the arrangements for the institutional treatment of 375 patients. 7. We insured that all patients going to sanatorium who could not afford the travelling expenses received vouchers covering their fare from the London County Council. 8. We did our best to settle all home difficulties that threatened to bring parents home from sanatorium too soon. 9. We co-operated with the Charity Organisation Society in over 30 cases and our tuberculosis 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 and elsewhere. 12. We advised many patients on questions concerning their employment, and endeavoured to put them on the right track with regard to employment. 13. We communicated with employers when specially requested to do so with good results in some cases and no results in others. 14. Through the assistance of anonymous donors we obtained in several cases money to meet the travelling expenses of parents who wished to visit their children in hospitals out of London, but who otherwise could not have gone. 15. We were able to obtain bed and bedside comforts for several advanced cases. 16. Other patients were helped, for example, in the way of clothing, boots, convalescence in the country, and prolonged stay at sanatorium (private arrangement) through the help of generous donors. 17. To a very large number of patients personal help in discussing difficulties of all sorts was freely given. In conclusion I would like to acknowledge my indebtedness to Dr. Gorrie and all the other members of the Staff of the Dispensary for their loyalty and helpfulness at all times in carrying out the work. WILLIAM BBAND, Tuberculosis Medical Officer. INDEX. Page Ambulance Facilities 16 Ante-natal 74 Area of Borough 5 Bakehouses 38 Baths, Public Swimming 19 Births :— Birth Rate 4 Notified, No. of 7, 8 Registered, No. of 6 Butchers Shops 36, 37 Butter, Margarine etc., Premises 39 Cancer 8 Cerebro-Spinal Fever 63 Clinics and Treatment Centres 17 Closet accommodation 21 Convalescent treatment 75 Cowhouse 33 Day Nursery 76 Deaths :— Death Rate 4 Registered, No. of 8 Table Causes of and Ages at 10, 11 Table Mortality Rates of Principal Diseases 12, 13 Diphtheria 55 - 61 Diphtheria Prevention 56 - 61 Disinfection and Disinfestation 69 - 71 Drainage 21 Eating Houses 40 Encephalitis Lethargica 64 Erysipelas 63 Factory and Workshop Act 30 - 32 Fish Curers 40 Food :— Clean Pood 40 Destroyed 36 Meat 35 - 37 Milk and Dairies Order 32, 33 Other Food Premises 38 - 40 Poisoning 37 Sale of Food Order 54 Food and Drugs Act 41 - 54 Adulterated Samples, Table 46 - 49 Condensed Milk Regulations 53 Cream 41 Dried Milk Regulations 53 Informal Sampling 43 Legal Proceedings, Summary of 54 Milk and Cream Regulations 50 - 52 Milk and Dairies Amendment Act 54 Milk and Dairies Consolidation Act 53 Samples Taken, Table 44, 45 Pried Fish Shops 39 INDEX—Continued. Page Hospitals, Provided or Subsidised 15, 16 Houses Let in Lodgings 27 Housing:— 27 - 30 Houses Let in Lodgings 27 Overcrowding 27 Statistics 29, 30 Summary of Inspections, Table 22, 23 Unhealthy Areas 28, 29 Ice Cream 38, 39 Infantile Mortality:— 9 Rate 4 Stated Causes, Table of 14 Infant Welfare Centres, Return of Work 73 Infectious Diseases 54 - 68 Infections Diseases, Table 66, 67 Insanitary Areas 28, 29 Maternal Death Rate 4 Maternal and Child Welfare 72 - 76 Maternity Ward 74 Measles 68 Meat:— Regulations 35 - 37 Stalls 37 Transport 37 Midwifery 18 Midwives Practising 18 Milk:- Bacteriological Examination of 33 - 35 Certified Milk 34 Circular No. 185 75 Dried Milk Regulations 53 Grade "A" 33 - 35 Milk and Cream Regulations 50 - 52 Milk and Dairies Amendment Act 54 Milk and Dairies Consolidation Act 53 Milk and Dairies Order 32, 33 Special Designations Order 33, 34 Mortuary, Public —Table of Work 20 Non-Notifiable Diseases 68 Notifiable Infectious Diseases 54 - 68 Notifiable Infectious Diseases Table 66, 67 Nursing Services 18 Occupations of Inhabitants 5, 6 Ophthalmia Neonatorum 64 Outworkers 2 Overcrowding 27 Pneumonia 62 Polio-myelitis' 63 Population 4 Public Baths 19 Puerperal Fever and Pyrexia 65 - 68 Rats and Mice Destruction Act 21, 26 Rent and Mortgage Interest Restrictions Act 27 Respiratory Diseases 8 Restaurants and Eating Houses 40 Sanitary Circumstances of Area 21 - 26 Closet Accommodation 21 Housing 27 - 30 INDEX —Continued. Sanitary Circumstances of Area—Continued. Page Legal Proceedings, Summary of 26 Sanitary Notices, No. of 26 Scavenging 21 Sewerage and Drainage 21 Smoke Abatement 21 Summary of Inspections, Table 22, 23 Summary of Sanitary Orders, Table 24, 25 Scarlet Fever 62 Schick Test and Immunisation 56 - 61 Sickness and Invalidity 6 Slaughterhouses 35, 36 Small-pox 54 Staff 3 Statistics, Summary of 4 Statistics Table, other Metropolitan Boroughs 15 Suicides 9 Tuberculosis: — 77 - 96 Deaths from 85 - 87 Death Rates 4 Dispensary Care Work 95, 96 Dispensary Work of, Table 91 Individual Notified Patients, Table 78, 79 Institutional Treatment 92 - 94 Notifications, No. of 77 - 79 Notifications, Summary of, Table 81 Occupational Table, Deaths 90, 91 Tuberculous Meningitis, Deaths from. Table 88 Typhoid Fever 62 Unhealthy Areas 28 Unmarried Mothers 16, 76 Unsound Food 36 Vaccination 55 Violent Deaths 8 Vital Statistics 4 Whooping Cough 68