Metropolitan Borough of Camberwell MEDICAL OFFICER OF HEALTH HOWELL W. BARNES, B.A, M.B., B.Ch., D.P.H. Printed by HENDERSON & SCALDING Ltd Sylvan Gkovjc, Old Kent Koad, S.E. 15 73 75 CAM Report of tbe Medical Officer of Health. Public Health Department, 35, Brunswick Square, S.E. 5. May 31st, 1930. The Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Mr. Mayor, Ladies and Gentlemen, The following report on the state of the Public Health of Camberwell which 1 have the honour to present to you has been prepared in accordance with the requirements of the Sanitary Officers Order, 1926, and follows the directions of the Ministry of Health as to the contents and arrangement of the matters referred to therein. The death rate for the year was 13.6 per thousand of the estimated population, as compared with 11.9 in the previous year. This increase is due to the number of deaths from influenza as well as respiratory diseases which occurred during the spell of abnormally cold weather in February and early March of last year. The mortality of infants under one year of age also shows an increase, from 61 per thousand registered live births in 1928 to 68 for the year under review. The birth rate for 1929 was 15.3, which is the lowest rate recorded since the last year of the war. An outbreak of mild smallpox occurred in Camberwell, as in most other districts in the Metropolis, during the year. Every administrative measure of control was adopted to limit the spread of the disease and to prevent it assuming epidemic proportions. The sanitary circumstances of the area, the sanitary administration and the vital statistics of the district are dealt with in their respective sections of the report. Important changes in the future health administration of London were indicated with the passing into law during the year of the Local Government Act, 1929. This Act, which came into operation on April 1st last, has secured, by the abolition of the functions of the Boards of Guardians and the Metropolitan Asylums Board and their transfer to the London County Council, a partial adjustment of the more or less haphazard distribution of health activities amongst the public authorities in London. This unification of control will enable the Central Authority to rearrange the functions of the various a 2 dential institutions to the best possible advantage. It is doubtful, however, whether these changes will bring any relief to the confusion and uneconomical expenditure of labour which now exist as a result of the duplicated responsibilities of the London County Council and the Metropolitan Borough Councils in relation to the various public health activities other than those in connection with residential institutions, unless the Minister of Health is requested to make an Order transferring or delegating to the Metropolitan Borough Councils some of the services now carried out by the London County Council. I am of opinion that the London County Council should be given relief under Section 64 of the Act from the detailed administration of the following health services, for example, which could quite well be performed by Borough Councils, viz.:— (a) Midwives Act, 1902 and 1918. Midwives and Maternity Homes Act, 1926. (b) Children's Act, 1908, Part I. (c) Adoption of Children Act, 1926, Section 8. (d) Nursing Homes (Registration) Act, 1927. It is only by a distribution of such functions and the removal of the difficulties which arise from duplication and dual responsibility that health administration in the Metropolis can become efficient, elastic and capable of the fullest development. In conclusion, I again desire to express thanks to every one of my staff for their loyalty to me and for the assistance so readily given at all times. To the Chairmen of the various Committees of the Council I am also indebted for the consideration and support which has been extended to me during the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. W. BARNES, Medical Officer of Health. 3 Staff of the Public Health Department at the end of 1929. *Medical Officer of Health H. W. Barnes, B.A., M.B., B.Ch., D.P.H. Hon. Consulting Medical Officer of Francis J. Stevens, M.A., D.M. Health. *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 Wei- TheMedical Officer of Health (Dr. H. W., fare Centres. Barnes), (Mrs.) Margaret Dunstan, M.B., B.Ch., D.P.H., J. H. Clatworthy, M.D., and Mrs. F. Cowlin, M.R.C.S., L.R.C.P. *Assistant (Temporary) Tuberculosis Margaret Baird Darroch, M.B., Ch.B., Medical Officer. D.P.H. Medical Officer at Diphtheria Immuni- G. Bousfield, M.D., B.S. (Lond.). sation Clinic. Public Analyst Vacant. *Inspector under the Sale of Food and George T. Dewey, c Drugs Acts. *Food Inspector Richard F. Nash, a *Sanitary Inspectors—Male. Dist. Dist. 1. Maurice Malins. a 6. Donald Glenday. a 2. William T. Worsfold. b 7. George W. Scudamore. c 3. Donald H. Pickard, M.C. a 8. George C. Morley. c 4. Arnold L. Dobson. a 9. Henry C. Green, a 5. Leslie W. Burrell. a 10. Edwin R. Collins, c * Women Sanitary Inspectors. Miss F. O'Riordan, Maxwell Lefroy Gold Medallist. Mrs. M. Scudamore. a, d b, d. * Health Visitors. Miss A. M. Stoddart. f Miss N. G. Cooke, e. Miss A. H. Mitchell, e. Clerks. H. K. Wright. R. A. Davies. *F. T. Harman. *C. T. Wilson (Temporary). H. J. Hurst. A. J. Baker (Temporary'). A. J. Carly. E. S. Rushton (Temporary). *Miss M. L. Thompson. *Miss E. Watkin (Temporary), S. A. Cranfield. Tuberculosis Dispensary. *Tuberculosis Nurses Miss M. Thistleton g, Miss F. M. Whitney h, and Miss E. Johns (Temporary) i. *Clerks Mrs. J. M. Leonard, Miss E. Hand (Temporary). *Dispenser Miss F. L. Davis (Part-time). *Porter William J. Cripps. Disinfecting and Cleansing Station. Foreman Disinfector A. Franklin. Assistants J. Conner, J. Smith, F. G. Mersh, R. J. Hodgson, and J. Sawyer, A. Peppier (motor driver). a 2 4 Women Assistants. For Cleansing of Children, etc. Mrs. E. Payton (Temporary). Mrs. D. Farmer (Part-time, temporary). Mortuary Keeper. A. E. A. Dennison. *Officers to whose salary contribution is made under the Public Health Acts or by Exchequer Grants. a Certificate Sanitary Inspectors' Examination Board and Meat and Other Foods Certificate b Certificate Sanitary Inspectors' Examination Board. c Royal Sanitary Institute Certificate. d General Training Certificate; C.M.B. Health Visitors' Certificate, Royal Sanitary Institute; Maternity and Child Welfare Certificate, Royal Sanitary Institute. e General Training Certificate; C.M.B.; Royal Sanitary Institute (New) Health Visitor's Certificate. f Health Visitor's Certificate, Royal Sanitary Institute; C.M.B. g General Training Certificate and Certificate Special Course in Tuberculosis. h Health Visitor's Certificate, Royal Sanitary Institute; Certificate Medical and Surgical Nursing; Tuberculosis Nurses Certificate. i C.M.B.; Certificate Medical, Surgical, Fever, Mental, Massage, etc. 5 SUMMARY OF STATISTICS for the Year 1929. Population (Estimated) 256,900 Area of Borough in Acres 4,480 Number of Births 3,934 Birth Rate 15.3 Number of Deaths 3,491 Death Rate 13.6 Infantile Mortality:— Deaths under 1 year 268 Infantile Deaths per 1,000 Births 68 Maternal Mortality:— Deaths of Women from Diseases or Accidents associated with Childbirth 11 Maternal Death Rate 2.79 Deaths from Phthisis 236 Phthisis Death Rate 0.92 Deaths from all forms of Tuberculosis 280 Tuberculosis Death Rate 109 Product of a 1d. Rate (Estimated) £6,400 Rateable Value £1,551,457 Natural and Social Conditions of the Area. With the exception of a small residential area in the southern part of the Borough, Camberwell may be described as a suburban working-class district. The Borough covers an area of 4,480 acres and is divided into 20 Wards. 6 Population. In my last Annual Report I referred to the disparity between the enumerated population at the last Census and to the estimated population of Camberwell for 1928, as provided by the RegistrarGeneral. The Census population of Camberwell in 1921 was returned at 267,198, and in the years that followed to 1926 an annual progressive increase was reported, when the population was stated to be 275,400. In the following year it was computed that the population of Camberwell had decreased by 4,300, and that during the next 12 months there had been a further fall of 10,700. In my comments of these figures I mentioned certain factors which undoubtedly influenced the population figure, and stated it was difficult to believe that the effect of those factors could possibly result in a difference in population of over 10,000 in one year and 15,000 less than two years previously. The Registrar-General's estimate for 1929 furnishes information that the population of Camberwell has fallen still further and is 3,500 less than the previous year's figure, viz., 256,900, as compared with 260,400 in 1928, and 10,298 fewer than the Census enumerated in 1921. As I stated last year, fortunately the time is approaching when an accurate representation of the position will become known, but in the meanwhile, and as in former years the population as estimated by the Registrar-General for 1929 has been used at the request of the Ministry of Health throughout this report in calculating the birth and death rates. The estimated population of the different Wards is as follows: Ward. Census 1921. Estimated 1929. West 15,442 14,847 Addington 14,420 13,864 Town Hall 14,201 13,653 St. George's 16,562 15,927 Cobourg 16,096 15,476 Marlborough 13,243 12,732 North Peckham 16,230 15,578 Goldsmith 15,548 14,941 Clifton 16,238 15,612 Rye Lane 8,975 8,632 St. Mary's 11,438 11,000 Nunhead 14,025 13,484 The Rye 10,662 10,251 St. Giles 10,712 10,298 Lyndhurst 12,126 11,659 St. John's 14,566 14,005 Alleyn 14,642 14,078 Ruskin 16,029 15,401 The Hamlet 12,137 11,707 The College 3,906 3,756 267,198 266,900 7 Extracts from Vital Statistics, for the Year 1929. Total. M. F. Births{ Legitimate 3,815 1,937 1,878} Illegitimate 119 61 58 Birth rate, 15.3 Deaths 3,491 1,739 1,752 Death rate, 13.6 Number of women dying in, or in consequence of, Childbirth:— From Sepsis 7 From other causes 4 Deaths of infants under one year of age per 1,000 births 68 Legitimate, 251; Illegitimate, 17. Total 268 Death from Measles, all ages 4 Deaths from Whooping Cough, all ages 66 Deaths from Diarrhoea, under 2 years of age 38 Registered Births. The Registrar-General provided particulars that the number of Camberwell births for the year after correction for inward and outward transfers was 3,934. These comprised 1,937 legitimate males, 61 illegitimate males, 1,878 legitimate females, and 58 illegitimate females. The following table sets out Particulars showing the census population at the last enumeration, the estimated population in each successive year, the number of births registered, and the birth rate in each year since 1921. Year. Population. Births. Birth Rate. Census 1921 267,198 6,301 23.5 1922 270,300 5,802 21.4 1923 272,300 5,657 20.7 1924 273,700 5,146 18.8 1925 275,400 4,877 17.7 1926 275,400 4,584 16.6 1927 271,100 4,232 15.6 1928 260,400 4,135 15.8 1929 256,900 3,934 15.3 Notification of Births Act, 1907. The information provided by the provisions of this Act is supplementary to the responsibility which devolves upon the individual under the Births Registration Act, and requires all live and still births occurring after the 28th week of pregnancy to be reported within 36 hours to the Medical Officer of Health of the district in which the birth takes place. The information thus provided by notification is extremely valuable, as it enables the Health Visitor to exercise health supervision of the mother and child in the early days following confinement. During the year 3,739 births were notified, and of this number 120 were born dead. A cautionary letter was sent to the person in default whenever it was discovered through the agency of the district Registrars' returns that the birth of a child had not been 8 notified in accordance with the requirements of the Act. The following table indicates the source of notifications. Live Births. Still-Births. Notified by Midwives 1,571 42 Notified by Medical Practitioners 1,298 60 Notified by Parents 217 2 Notified by Nurses and other Persons 533 16 It is interesting to record that of the total births notified 1,189 patients were confined in municipal and general hospitals and private nursing homes. Deaths. The deaths belonging to the Borough of Camberwell after correction for inward and outward transfers numbered 3,491. The death rate for 1929 is therefore 13.6 per thousand of the population, as compared with 11.9 in 1928. The causes of death classified in accordance with the particulars provided by the Registrar-General are shown in the following table:— DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1929. Cause of Death. Sex. All Ages. 0- 1- 2- 5- 15- 25- 45- 65- 75- All causes M. 1,739 143 44 38 46 66 186 529 358 329 F. 1,752 125 41 30 39 75 142 391 374 535 Enteric fever M. — — — — — — — — - - F. - - - - - - - - - - Small-pox M. — — — — — — - — - — F. - - - - - - - - - - Measles M. 1 1 - - - - - - - - F. 3 - 2 1 - - - - - - Scarlet fever M. 3 - - 1 1 - 1 - - - F. 1 - - - 1 - - - - - Whooping cough M. 36 10 12 13 1 - - - - - F. 30 9 15 6 - - - - - - Diphtheria M. 8 — 2 4 2 - - - - - F. 8 1 2 2 3 - — - - - Influenza M. 79 1 3 2 1 5 9 27 18 13 F. 83 1 1 — 2 — 8 29 24 18 Encephalitis lethargica M. 4 — — — — 1 1 1 1 — F. 1 - - - - 1 - - - - Meningococcal meningitis M. 2 — 1 - 1 — — — — — F. 2 — 1 1 - - — — - - Tuberculosis of respiratory system M. 143 — — — 2 23 60 53 5 — F. 96 — — — 6 33 33 22 — 2 Other tuberculous diseases M. 20 1 — 1 7 3 5 3 — — F. 21 1 1 5 6 6 1 1 — - Cancer, malignant disease M. 189 — — — — 1 12 88 66 22 F. 195 — — — 1 2 20 75 50 47 Rheumatic fever M. 1 - - - - - 1 — — — F. 4 - - - 2 1 — 1 — - Diabetes M. 11 - - - - - 1 5 4 1 F. 18 - - - - - 1 7 4 6 Cerebral haemorrhage, etc. M. 62 — — — — 1 — 18 17 26 F. 76 — — - 1 — 1 17 28 29 9 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1929.—continued. Cause of Death. Sex. All Ages. 0- 1- 2- 5- 15- 25- 45- 65- 75- Heart disease M. 318 - - 1 2 3 24 98 98 92 F. 367 - - — 1 7 19 77 115 148 Arterio-sclerosis M. 41 - - - - - - 10 16 15 F. 50 - - - - - - 8 20 22 Bronchitis M. 101 17 1 1 1 — 5 22 27 27 F. 126 6 — — 1 — 3 17 38 61 Pneumonia (all forms) M. 190 28 20 8 4 5 21 63 24 17 F. 145 26 12 11 3 2 9 27 29 26 Other respiratory diseases M. 15 2 - - - - - 5 5 3 F. 21 1 1 — — — 1 7 1 10 Ulcer of stomach or duodenum M. 16 - - - - - 4 10 2 — F. 9 — — — — 1 1 3 4 — Diarrhoea, etc. M. 23 22 1 - - - - - - - F. 17 14 1 — — 1 — 1 — — Appendicitis and typhlitis M. 16 — — 1 2 3 3 7 — — F. 2 — — — — — — 2 — — Cirrhosis of liver M. 5 - - - - - 1 1 2 1 F. 9 - - - - - 1 3 2 3 Acute and chronic nephritis M. 78 — — — 1 7 7 25 19 19 F. 72 — — — — 4 9 27 17 15 Puerperal sepsis M. - - - - - - - - - - F. 7 — — — — 1 6 — — — Other accidents and diseases of pregnancy and parturition. M. - - - - - - - - - - F. 4 — — — — 2 2 — — — Congenital debility and malformation, premature birth M. 47 45 — — — — 2 — — — F. 47 44 — — 1 2 — — — — Suicide M. 23 - - - - - 4 16 — 3 F. 12 - - - - - 7 4 1 — Other deaths from violence M. 61 — — 3 9 7 9 14 11 8 F. 29 1 — 1 4 1 1 6 5 10 Other defined diseases M. 246 16 4 3 12 7 16 63 43 82 F. 297 21 5 3 7 11 19 57 36 138 Causes ill-defined or unknown M. - - - - - - - - - - F. - - - - - - - - - - Zymotic Dentin Rate. The principal zymotic diseases are smallpox, measles, scarlet fever, dipththeria, whooping cough, enteric fever (including fever not otherwise defined) and diarrhoea. The deaths from these diseases during the year numbered 90, representing a mortality rate of 0.35 per thousand of the population. Cancer. Cancer was responsible for 384 deaths in Camberwell in 1929. Towards the close of the year I was requested by the Public Health Committee to report on the subject of the formation of Cancer Clinics in this Borough. In this report I stated that Camberwell was very favourably situated in regard to its accessibility to London General and Cancer Hospitals, where expert 10 advice and treatment could be obtained by everyone in the Borough, and that in my opinion a Cancer Diagnostic Clinic was perhaps not so much required in Camberwell as in less fortunately situated districts. The Council agreed with this view, and also shared my opinion that it was doubtful whether the public would make use of a Cancer Diagnostic Clinic to an extent which would justify its establishment, but that far better results would possibly be obtained in the fight against cancer by an extension of the present activities for disseminating knowledge of the disease. For some years past a pamphlet containing information relating to (1) the sites of the body attacked; (2) suspicious signs and symptoms to be looked for; (3) the importance of early diagnosis and treatment of this disease; aricl (4) the danger of delay in obtaining medical advice, has been distributed by the the Health Visitors when visiting the homes of the people of Camberwell. During recent years the London County Council have performed a most useful service by teaching in their schools the elementary facts of physiology and hygiene, and in my opinion it would seem desirable to carry this instruction a step further to include elementary teaching of the origin and spread of various diseases. In this regard the imparting of knowledge concerning the nature and formation of cancers could not fail to have an impressionable effect on the minds of the older children. The medical practitioner in daily intercourse with his patients is also in a most favourable position to give simple and concise information on the subject. Further, the lay press has in the past, and will also no doubt in the future, continue to give publicity to the ravages of cancer. It has been argued that the benefit which would accrue from giving information to the public of the signs and symptoms of cancer would be counterbalanced by the terror that is likely to arise in the minds of the timorous, and that even harm might result by frightening the community. But the simple truth about this disease and the information as to the preventive methods such as that any source of chronic irritation and inflammation is liable to form a focus for the development of cancer is not, I venture to suggest, likely to cause uneasiness in the healthv-minded section of the community. The greatest hope of cure of this disease lies in the early diagnosis and treatment, and consequently there can be no doubt as to the value of personal instruction and the distributive means of propaganda to assist in securing a reduction in the incidence and mortality of this disease. With this end in view the Council have authorised me to arrange for the distribution of leaflets at factories in the Borough where women are employed, and also to display posters at the 11 several Infant Welfare Centres in the Borough. The chief object of public education is to encourage the acceptance of skilled examination and treatment without delay. There is consequently a need for the provision of cancer treatment centres staffed by highly trained surgeons, fully competent and well equipped radiologists working together, but there are obvious disadvantages of establishing such clinics elsewhere than in general hospitals. A radium centre for the treatment of carcinoma of the uterus has recently been established at the North-Western Hospital, and although no indication can be given as yet of the results, I understand that 54 patients were admitted for treatment during the first 6 months. Infantile Mortality. The infant death rate for Camberwell, which was 61 per 1,000 births in 1928, rose to 68 last year. The principal factor responsible for this increase was the large number of deaths that occurred during the extreme cold weather of last February and March, when 89 deaths of children under 1 year of age were reported. The severe weather in the early part of the year was expected to influence the mortality rate, particularly in the poorer districts of the Borough. Environment plays an important part in the determination of the infantile mortality rate. It is an elementary truth that a child born in a family where suitable nutrition, warmth and comfort is assured stands a far better chance of surviving the first year of its life than an infant born in less fortunate circumstances. But as important as environment is in this matter, there can be little doubt that education of the mother in proper feeding and attention to personal hygiene yields good results, even in cases where the economic circumstances of the family are such that every shilling counts. Such is the work of the Health Visitor. "During the year, of a total of 268 infant deaths, no less than 94 occurred of infants under one month old. Gastro-intestinal disorders were responsible for 85 deaths, respiratory diseases for 40, injuries at birth 10, and certain illdefined conditions, such as prematurity, malformation, atrophy and debility, for 71 deaths. Causes of Sickness or Invalidity. With the exception of the prevalence of smallpox, which is fullv dealt with in the appropriate Section of this Report, there was no cause of sickness or invalidity during the year which calls for any special comment. 12 Table showing the Birth Rates, Death Rates and Infantile Mortality Rates in the 29 Metropolitan Cities and Boroughs in 1929. Births per 1,000 Population. Deaths per 1,000 Population. Infantile Deaths per 1,000 Births. City of London 7.4 Lewisham 11.5 Lewisham 44 Holborn 10.2 Woolwich 12.6 Stoke Newington 47 City of Westminster 10.4 Wandsworth 12.8 Hampstead 54 Hampstead 11.4 St. Marylebone 13.2 Hackney 56 Chelsea 11.7 Bethnal Green 13.3 Wandsworth 61 St. Marylebone 11.9 Deptford 13.3 Battersea 62 Wandsworth 13.0 Greenwich 13.3 City of London 62 Kinsington 14.4 Fulham 13.4 Hammersmith 62 Paddington 14.9 Stoke Newington 13.4 Woolwich 62 Fulham 15.2 Hampstead 13.5 Bethnal Green 64 Camberwell 15.3 Camberwell 13.6 Lambeth 67 St. Pancras 15.5 Stepney 13.6 Camberwell 68 Lambeth 15.6 Hammersmith 13.7 Chelsea 70 Lewisham 15.7 Hackney 13.9 Greenwich 70 Greenwich 15.8 City of London 14.0 Bermondsey 71 Hammersmith 15.8 Battersea 14.2 Fulham 72 Hackney 15.9 Poplar 14.2 Islington 73 Stoke Newington 16.1 Bermondsey 14.5 Holborn 74 Battersea 16.2 Islington 14.8 Finsbury 75 Woolwich 16.3 City of Westminster 14.8 Poplar 75 Deptford 16.8 Lambeth 14.9 Deptford 76 Islington 17.2 St. Pancras 15.3 City of Westminster 77 Stepney 17.2 Kensington 15.4 St. Marylebone 77 South wark 18.1 Paddington 15.4 Southwark 81 Bethnal Green 18.4 Holborn 15.6 St. Pancras 83 Poplar 19.1 South wark 15.6 Kensington 84 Bermondsey 19.8 Chelsea 15.7 Shoreditch 88 Shoreditch 20.6 Finsbury 16.0 Stepney 89 Finsbury 21.2 Shoreditch 16.0 Paddington 101 13 INFANTILE MORTALITY TABLE. Deaths from Stated Causes at Various Aoes under One Year of Age, 1929. Cause of Death. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 1 month. 1 to 3 months. 3 to 6 months. 6 to 9 months. 9 to 12 months. Total under. 1 year. Measles — — - - — —. — 1 — 1 Scarlet Fever — — - — — — — - — Whooping Cough — — - - — 1 4 8 5 18 Diphtheria and Croup — — — - — - 1 — - 1 Erysipelas - — — - — - - 1 - 1 Tuberculous Meningitis — — — - — — - — - — Abdominal Tuberculosis — — — - — - - — - - Other Tuberculous Diseases — — — - — — 1 — - 1 Meningitis - — — - — — 2 1 - 3 Convulsions 1 — — 1 2 — 2 — 1 5 Laryngitis — — — - — 1 — — - 1 Bronchitis 1 1 4 - 6 9 6 7 3 31 Pneumonia — — — - — 1 1 4 2 8 Diarrhoea — — 1 - 1 6 4 2 3 16 Enteritis - — — - — 10 9 1 2 22 Gastritis — — — - — — — — — — Syphilis — 1 1 - 2 — — — — 2 Rickets — — — - — — — — — — Suffocation — — — — — —- - — — - Injury at Birth 8 — 1 - 9 — 1 — — 10 Atelectasis 6 — — — 6 1 — — - 7 Congenital Malformation 5 — 2 - 7 2 1 — - 10 Premature Birth 29 5 2 3 39 6 — - - 45 Atrophy, Debility and Marasmus 6 — — — 6 7 2 - 1 16 Other Causes 6 3 2 1 12 1 2 2 6 23 Broncho-pneumonia 4 — — — 4 5 11 13 13 46 Influenza — — — — — — — — 1 1 Totals 66 10 13 5 94 50 47 40 37 268 14 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Hospitals Provided or Subsidised by the Local Authority During the Year 1929. Fever and Smallpox. There is no fever hospital situated in the Borough. The Metropolitan Asylums Board was 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. St. Giles' Hospital and Constance Road Institution, and a large number" of London General Hospitals within easy access. Institutional Provision for Unmamed 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 home§. Ambulance Services. Infectious Cases.—The authority responsible for the provision of institutional treatment of notifiable infectious disease cases in the Metropolitan area was the Metropolitan Asylums Board, and the Board's ambulance service was available for the removal of such cases at any hour of the day or night. Non-Infectious Cases and Accident Cases.—The ambulance service of the M.A.B. was also available for the conveyance of patients not suffering from infectious diseases, but a charge is made for their removal. Further, the London County Council has provided a free ambulance service to deal with street accident cases and persons taken suddenly ill in the street or any public place. 15 Midlives and Maternity Homes Acts, 1902-26. The London County Council provided information that 31 midwives residing in the Borough of Camberwell gave notice of their intention to practise during the year 1929. Public Mortuary. As the result of a communication from H.M. Coroner for South London inviting the attention of this Council to the existing facilities at the mortuary and post-mortem room attached to the Coroner's Court in St. George's Road, Peckham, the matters referred to were fully considered by the Council, who authorised specified alterations and the provision of modern equipment to meet the requirements of the work carried out at the mortuary. The work, which included internal structural alterations, new fittings, and the provision of additional instruments, was carried out at a cost of £510. H.M. Coroner, in a letter subsequently addressed to the Council, paid tribute to the admirable manner in which the suggestions made for remodelling the post-mortem room attached to the Court had been carried out, and stated that the room with its fittings as it now exists is a credit to the Borough and might well serve as a model elsewhere in the County of London. A monthly summary of the number of bodies received at the Public Mortuary during the year is set out in the following table: — PUBLIC MORTUARY. Return of Bodies Received. Month. Males. Females. Total. For Burial only. For Inquests. Number of P.M.'s held. Number of Courts. Residents. Non-Residents— Bodies brought from outside the Borough for the convenience of the Coroner. January — — — — — — — — — February 4 5 9 — 9 4 1 8 1 March 19 15 34 — 34 18 12 20 14 April 27 9 36 — 36 21 12 21 15 May 20 7 27 — 27 15 11 20 7 June 12 7 19 — 19 12 12 11 8 July 19 19 38 — 38 18 16 18 20 August 2 3 5 4 1 1 1 5 Nil. September 4 4 8 4 4 3 1 5 3 October 17 9 26 2 24 12 10 13 13 November 24 10 34 — 34 22 15 20 14 December 20 20 40 — 40 25 14 27 13 Totals 168 108 276 10 266 151 105 168 108 16 Purification of Swimming Bath Water. Considerable public interest has been shown in recent years concerning the standard of purity of the water in public swimming baths, and the liability of the spread of disease from contamination unless effective steps are taken to ensure that the water in the ponds is maintained in a wholesome condition. It is satisfactory to record that this Council has recognised the importance of this matter, and in 1927 a plant was installed at the Old Kent Road Baths for the filtration, aeration and chemical treatment of the water. In the following year a similar plant was installed at the Church Street Baths, and during last year the Council approved the erection of a further plant at the Dulwich Baths, the work of which is now proceeding. Samples of the water have been taken from the Old Kent Road and Church Street Baths from time to time and submitted for chemical analysis and bacteriological examination. The reports have always been satisfactory. The inhabitants of Camberwell can therefore be assured that as the result of the establishment of filtration plants at the Public Baths in the Borough all practicable steps have been taken to secure for the bather, as far as possible, protection from the risk of disease transmission. On economic grounds a considerable saving of water has also been effected by the substitution of chemical treatment for the practice of periodically emptying the ponds. Suspected Food Poisoning. In December of the year under review a local medical practitioner telephoned this Department and reported that he had been called in to treat several persons at a Day and Boarding School in this Borough who were suffering from symptoms suggestive of food poisoning. In the course of investigations at the School I was informed that 22 persons on the previous day had had salmon, vinegar, stewed apples and custard, made from a proprietary brand of custard powder, for lunch, which was eaten at 12.15 p.m. At 3 o'clock the same afternoon a female student, aged 15 years, had an attack of vomiting, diarrhoea and gastric pains. An hour later another female scholar, aged 15 years, had a similar attack, and about the same time a female boarder aged 15 and a maid aged 17 were taken ill with slight vomiting. A kitchen maid, aged 27 years, was also ill at the same time with pains in the stomach, diarrhoea, vomiting and extreme prostration. This patient was removed to St. Giles' hospital the same day, where she made a rapid recovery. None of these patients had had the same food for breakfast. The article of food which was suspected to be responsible for the illness of the patients was the contents of 4 tins of salmon, 17 3 of which had been boiled in water for half an hour, and immediately opened and emptied. It appeared that the 5 persons attacked asked for another helping, and were served from a tin of salmon which was opened as received at the time of purchase. A statement was made that the contents of this tin was eaten only by the persons who were attacked with diarrhoea and vomiting, but the evidence is not conclusive. The 4 tins, which were recovered from the refuse bin, together with 2 unopened tins of salmon purchased at the same time as those which were consumed, were subsequently sent to the Ministry of Health for examination. Xo specimen of vomit or faeces could be obtained, as the patients had made a rapid recovery. This attack of suspected food poisoning was characterised by the rapid onset of illness and the speedy recovery of the affected persons. The kitchen and cooking utensils were examined the same day and found to be in a clean condition. The school has an establishment of 50 day and resident students and a staff of 10, including domestics. The Ministry of Health bacteriologist, in his report on the 4 tins which contained salmon, stated that the tins were all too thoroughly cleaned out for any appreciable amount of salmon to be obtained. They were, however, again rinsed out, and the rinsings were incubated in peptone water, but none of the specific food poisoning bacteria were isolated. As far as could be determined on inspection none of the tins had had a leak. 18 CLINICS AND TREATMENT CENTRES. Situation. Nature of Accommodation. By whom provided. Medical Sessions. Maternity and Child Welfare Centres. Bird-in-Bush, 616, Old Kent Road Central Hall; waiting and lecture room; service room; Medical Officer's and weighing rooms Voluntary Association Mondays, Tuesdays. Thursdays and Fridays; ante-natal, Fridays. Cambridge House, 6, Addington Square Private rooms do. Every Thursday and antenatal when necessary. Cobourg, Kempshead Hall, Kempshead Road. Large Hall; weighing room; consultation room; dental work room. do.1 Thursdays; ante-natal, 1st Monday in month; dental clinic, 1st and 3rd Fridays in month. Nun head, 96, Nunhead Grove St. Antholin's Mission Hall do. Thursdays and Fridays. St. Luke's, 2, Commercial Road 2 rooms and hut in garden do. Wednesdays & Fridays and special clinic alternate Tuesdays. Union of Girls' Schools Infant Welfare Centres, 15, Peckham Road. Ground floor of premises'. do. Tuesdays and Fridays. Do. Amott Road, Peckham Waiting room; weighing room; consultation room. do. Mondays, Wednesdays and Thursdays. Camberwell Municipal, 140, Camberwell Road. do. do. Rented by Camberwell Boro' Council Mondays; ante-natal, 2nd and 4th Thursdays. Dulwich Municipal, 114, Lordship Lane do. do. do. do. Wednesdays and Thursdays. Peckham Municipal, St. Jude's Church Hall, Meeting House Lane, Peckham, S.E. do. do. do. do. Every Tuesday. 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. Waiting room; investigation room; two dressing rooms; two Medical Officer's rooms, and a dispensary. do. do. Daily. 19 SANITARY CIRCUMSTANCES OF THE AREA. Closet Accommodation. The water carriage system is general throughout the Borough with the exception of one or two outlying places where no sewers are available and cesspools have to be used. Drainage. During the year new drains were constructed to 119 new buildings, and the drains of 414 existing buildings were partially or entirely reconstructed under the supervision of the Sanitary Inspectors. Smoke Abatement. Delegates appointed by this Authority attended the Greater London Joint Smoke Abatement Conference held at the Guildhall in October last. The resolutions adopted by the Conference subsequently received the approval of the Council, who also directed that the London County Council be requested to make a bye-law under Section 2 of the Public Health (Smoke Abatement) Act, 1926, in the following terms suggested by the Greater London Joint Smoke Abatement Committee for the guidance of municipal Authorities:— Draft Form of Bye-law. Byelaw made in pursuance of Section 2 of the Public Health (Smoke Abatement) Act, 1926, by the Whereas Section 2 of the Public Health (Smoke Abatement) Act, 1926, provides that any Local Authority may make Byelaws regulating the emission of s moke of such colour, density or content as may be prescribed by the Byelaws and tha t where such Byelaws are in force the emission of smoke of the character so prescribed for such period as may be prescribed in the Byelaws either from buildings generally to which the enactments relating to smoke nuisances apply or from such classes of those buildings as may be so prescribed shall until the contrary is proved be presumed to be a nuisance:— The do by this Bye -law prescribe that the emission of black smoke for a period of two minutes in the aggregate within any continuous period of thirty minutes from any one chimney of a building other than a private dwelling house shall until the contrary is proved be presumed to be a nuisance. There can be no doubt that the question of smoke pollution is one which demands the application of every available means to secure its abatement or regulation. The domestic chimney, although excepted from the provisions of any enactment governing the subject of smoke abatement, is, in many districts, possibly a worse offender than the industrial shaft in causing atmospheric pollution. Notwithstanding the public interest in this question on aesthetic and health grounds, it does not seem to be generally known that a smokeless fuel is now available practically for all purposes of heating. It is, however, satisfactory to note that b 2 20 every year increased use is made of smokeless fuel, gas and electricity, and Government Departments and many other authorities have set an example in the campaign of smoke abatement in this way. Rats and Mice (Destruction) Act, 1919. Efforts to secure the abatement of nuisances caused by the presence of rats were continued, as in previous years, during 1929. The number of complaints received of the presence of rats was 176, as compared with 135 in 1928. Every complaint was duly investigated and, where the nuisance was found to exist as the result of the defective condition of the house drains, notices were served on the owners of the property. In other cases advice was offered as to the steps to be taken to get rid of them, and in many instances this advice was supplemented by the issue of poison baits. The Borough Engineer and Surveyor also followed the practice of systematically laying baits in the sewers. During official Rat Week a special publicity campaign was conducted, and the thanks of the Council are due to the various cinema proprietors in the Borough, who readily co-operated with this Department by displaying a lantern slide drawing the attention of the public to the menace of the rat. Removal of Aged or Incapacitated Persons. Section 28 of the London County Council (General Powers) Act, 1928, enables a Local Authority to make application to a petty sessional court for an order to secure the compulsory removal to hospital, institution or similar place of an aged, infirm, or physically incapacitated person living under insanitary conditions, or is suffering from any grave chronic disease, should a Medical Officer of Health certify accordingly. During the year the attention of this Department was drawn to a woman 81 years of age residing in the northern part of the Borough who was living in one room1 under insanitary conditions, without friends or relations to assist her. The matter was duly reported to the Council, who were of opinion that the case was one which came within the provisions of Section 28, and the Medical Officer of Health was authorised, in the event of no relative being found to look after her within 14 days from the date of the Council's resolution, to take all necessary steps to comply with the provisions of the Act. The threat of proceedings appeared to have a salutary effect, as the person concerned suddenly disappeared and could not be traced. Two further cases of aged persons living under similar conditions were also reported, but in these instances the relatives 21 were traced and appealed to to come to their assistance, with satisfactory results. The powers of compulsory removal of infirm persons to a hospital or other institution who are incapable of looking after themselves is a most desirable addition to existing Public Health legislation, and provides a solution of the difficulties which have been experienced for so long of effectively dealing with such persons in the interest of their own health and for preventing injury to the health of or serious nuisance to others. Sewer Emanations and Public Health. A large number of complaints were received during the summer of offensive odours arising from open ventilators of the London County Council sewers. It will be remembered that the summer of 1929 was a very dry one, and the absence of rain for long periods caused the nuisance to be almost unbearable in certain parts of the Borough. It is true that no serious outbreak of disease has ever been attributed to emanations of sewer gas, and that men working in the sewers have an exceptionally good record of health, but nevertheless considerable inconvenience and annoyance is caused to the general public as the result of ventilating sewers by manholes at ground level. The complaints were represented to the London County Council, and the matter also received consideration by the Metropolitan Boroughs' Standing Joint Committee. The County Council subsequently issued a report of their Main Drainage Committee on the subject, from which it appears that as the result of the inquiry into the Holborn explosions, the number of open surface ventilators was increased from about 2,000 to 4,000, but as the result of complaints of offensive smell 250 were afterwards closed, and it was stated that whilst the County Council adhered generally to the present system of surface ventilation of sewers, they had authorised the Main Drainage Committee to decide as to the ventilation required in any particular case, having regard to the circumstances involved. This Council were, however, of opinion that remedial action should be taken by the L.C C. in this matter of sewer ventilation, and the Metropolitan Boroughs' Standing Joint Committee were informed to this effect. 22 23 RETURN OF WORK FOR THE FIFTY- TWO WEEKS ENDED DECEMBER 31st, 1929. Description of Work. Inspections. Totals. G. W. Scudamore. E. R. Collins. G. G. Morley. M. Malins. H. C. Green. W. T. Worsfold. D. Glenday. A. L. Dobson. D. H. Pickard. L. W. Burrell. Miss O'Riordan. Mrs. Scudamore. Complaints received 323 224 418 318 506 440 271 433 508 654 21 6 4,122 Complaints found to be justified 314 174 300 288 362 381 209 356 450 545 18 3 3,400 Following complaints (general) 318 228 411 291 493 384 190 366 548 654 — — 3,883 Following complaints (overcrowding) — — 14 27 — 15 38 44 27 — — — 165 Re-inspections 2,163 2,917 2,017 863 2,322 1,423 1,730 1,553 1,412 1,477 — — 17,877 Systematic house-to-house 100 145 138 85 91 96 65 136 64 50 — — 970 Re-inspections 113 298 441 498 200 347 520 675 424 145 — — 3,661 Houses let in lodgings — — — 207 — — 120 1 — — — — 220 Re-inspections — — — 602 — — 4 — — — — — 606 Tenements — 6 — 62 — 63 — 50 9 — 17 — 207 Re-inspections — — — 98 — 123 — 141 33 — — — 395 Underground living and sleeping rooms — — — 2 — 1 — — — — — — 3 Re-inspections — 8 — — — — — — — — — — 8 Rent (Restrictions) Act — 1 1 — — — 4 1 — — 7 Re-inspections — 10 — — — — — 1 13 — — — 24 Dwelling houses (New) 8 3 2 74 1 — 1 — 2 2 — — 93 Business premises (New) 39 32 4 6 13 2 — 7 4 36 — — 143 Re-inspections 99 224 167 127 221 45 378 206 63 10 — — 1,540 Following infectious disease 125 117 129 159 251 192 188 326 356 329 — — 2,172 Re-inspections 22 6 421 259 249 397 184 519 443 106 — — 2,606 Factories 27 10 29 35 33 75 82 126 5 59 263 81 796 Workshops 50 29 64 39 52 65 75 57 10 19 175 161 796 Workplaces 4 — 1 34 — 27 15 48 1 77 92 — 299 Offensive trades — — — 1 — — — 16 5 — — — 22 Outworkers — — — — — — — — — — 1,025 1,232 2,257 Smoke complaints received — — 11 4 1 — 2 3 5 3 — — 29 Smoke observations 9 — 94 16 3 13 5 22 8 14 — — 184 Smoke nuisances found 1 — 21 — — — 3 1 3 — — — 29 Re-inspections — — 1 164 — 41 4 45 39 64 — — 358 Milk shops and dairies 137 92 165 132 241 185 184 1 — 77 — — 1,561 Slaughter houses — — — 20 15 — — 1 — — — — 36 Other food premises — — — 14 — 2 — 2 — 2 — — 20 Street Markets — — — 4 — 18 13 18 11 — — — 64 Re-inspections — — — 37 — 20 3 12 22 — — — 94 Rag and bone dealers 3 — — 9 3 — 7 11 2 — — — 35 Railway stations 1 63 45 — — — — — — — — — 109 24 25 RETURN OF WORK FOR THE FIFTY- TWO WEEKS ENDED DECEMBER 31st, 1929—continued. Description of Work. Inspections. Totals. G. W. Scudamore. E. R. Collins. G. G. Morley. M. Malins. H. C. Green. W. T. Worsfold. D. Glenday. A. L. Dobson. D. H. Pickard. L. W. Burrell. Miss O'Riordan. Mrs. Scudamore. Schools, private 3 5 — 3 — — — — — — 34 89 134 Public Conveniences 13 37 — 52 17 67 7 12 26 32 122 66 451 Urinals, private 152 160 295 104 234 138 90 368 262 298 10 6 2,117 Vermin — — 1 2 — — — 2 — — 13 5 23 Scabies — — — — — — — — — — 53 13 66 Re-inspections — — 1 167 — 467 2 75 137 — — — 849 Infectious disease inquiries 5 38 21 22 54 136 51 45 130 42 438 202 1,184 Infectious disease contacts—visits to 557 654 1,005 936 1,332 1,710 808 1,130 2,278 3,584 — — 13,994 Inspections not defined 2 128 87 14 207 88 183 166 173 163 491 189 1,891 Measles Infectious Disease Cases visited by Women Inspectors. — — — — — — — — — — 191 173 364 Ophthalmia Neonatorum — — — — — — — — — — 12 6 18 Puerperal Fever — — — — — — — — — — 5 3 8 Puerperal pyrexia — — — — — — — — — — 8 5 13 Whooping Cough — — — — — — — — — — 395 251 646 Other Diseases — — — — — — — — — — 414 1 415 Re-inspections—Women Inspectors — — — — — — — — — — 325 19 344 Cowhouses — — — — 11 — — — — — — — 11 Housing and Town Planning inspections — — — 41 — — — — — — — — 41 Total number of visits 4,588 5,608 6,301 5,827 6,916 6,960 5,314 7,188 7,610 8,440 4,121 2,516 71,389 Total number of houses repaired 316 272 374 558 374 596 377 600 546 415 — — 4,428 Number of house drains tested 139 280 135 259 230 335 442 350 319 271 5 — 2,765 Number of house drains tested and found defective — 77 12 32 21 31 4 19 12 — — — 208 Number of house drains partially reconstructed 6 67 7 50 80 50 12 15 18 — — — 305 Number of house drains totally reconstructed 2 9 4 3 24 2 20 11 34 — — — 109 Number of house drains constructed (new houses) — 4 — 17 37 — — — — — — — 58 Number of house drains constructed (business premises) 4 18 — 5 4 3 6 5 4 12 — — 61 House repairs—Sec. 3 (a) By owners — — — — — — — — — — — — — (b) By Local Authority in default — — — — — — — — — — — — — House demolished 6 1 — 7 — 2 5 — 10 — — — 31 Number of houses converted into business premises — 1 — — — — — — — — — — 1 Number of dwelling houses converted into flats — 6 2 — — — — — — — — — 8 Jobs completed without service of notice 18 73 54 19 23 44 30 13 57 — 8 10 349 Number of intimations 398 237 468 650 609 600 445 796 856 545 53 8 5,665 Number of Statutory Notices 85 89 149 240 226 238 144 278 322 143 9 — 1,923 26 27 SUMMARY OF SANITARY ORDERS FOR THE FIFTY-TWO WEEKS ENDED DECEMBER 31st, 1929. Description of Work. Inspector. Totals. G. W. Scudamore. E. R. Collins. G. G. Morley. M. Malins. H. C. Green. W. T. Worsfold. D. Glenday. A. L. Dobson. D. H. Pickard. L. W. Burrell. Miss O'Riordan. Mrs. Scudamore. Cleanse and repair 181 133 242 393 309 416 266 462 495 356 29 2 3,284 Repair roof, guttering, etc. 115 80 161 186 205 169 178 262 236 208 3 — 1,803 Provide damp-proof course, etc. 65 60 91 54 99 141 128 226 119 250 — 2 1,235 Abate overcrowding 1 — 7 22 13 26 27 39 18 3 — — 156 Abate smoke nuisance 3 — 5 — — — 1 1 2 — — — 12 Repair stoves, coppers, hearths, etc. 24 16 42 161 59 112 59 112 118 70 — — 773 Repair windows, sashlines, etc. 26 20 32 181 54 239 90 228 99 93 — — 1,062 Repair flooring, stairs, doors, etc. 21 14 27 127 79 150 88 136 104 68 2 1 817 Light and ventilate staircase, etc. 1 1 — 14 — 1 — 1 2 3 1 — 24 Provide dustbin 97 30 42 118 77 71 49 129 124 57 1 — 795 Remove accumulation 8 1 7 13 8 1 1 2 14 7 1 — 63 Pave, level and drain yard 8 38 19 70 47 99 95 44 78 69 — — 567 Provide or repair manure pit 1 1 — 2 1 — — 2 — 1 — — 8 Provide sufficient water supply 3 5 5 4 7 10 3 10 8 14 — — 69 Provide water receptacle or render accessible 1 — 2 2 2 4 — — 4 5 — — 20 Repair cover or cleanse receptacles, etc. 12 8 18 20 29 5 13 38 46 25 — 2 216 Clear premises of rats, etc. 10 4 15 — 15 4 4 15 23 — — — 90 Provide, cleanse, repair or remove closets, pans, etc. 53 38 44 128 75 94 95 128 119 82 14 8 878 Provide water supply to closet, repair flushing apparatus 38 18 45 69 40 47 43 102 112 49 6 3 572 Ventilate and remove outside soil pipes, cleanse, repair and trap drains or sinks 23 24 51 67 73 63 21 62 73 34 — — 491 Cleanse, repair, trap, etc., sinks and wastepipes 30 16 18 62 35 59 34 80 68 37 — — 439 Animals to be kept clean or removed 2 — 1 3 2 — — 4 5 — — — 17 Public conveniences, cleanse, supply with water, etc. — — — — — — — — — — — — — Private conveniences, cleanse, supply with water, etc. 2 1 — 3 1 — 5 7 1 — — — 20 Miscellaneous 17 13 24 74 30 34 37 124 68 27 22 5 475 28 SUMMARY OF NOTICES SERVED. The following table shows the number of notices served in rcspect of nuisances found in the various districts during the year:— Public Health (London) Act, 1891. Intimations 5,665 Statutory Notices 1,923 Summonses applied for 60 Housing Act, 1925. Notices, Sect. 3 Nil Sect. 5 33 Summonses Nil By-Laws. Houses let in Lodgings 155 London County Council (General Powers) Act. Intimations 7 Notices 7 Summonses Nil Rats and Mice (Destruction) Act, 1908. Complaints received 176 Intimations 14 Notices 1 SUMMARY OF LEGAL PROCEEDINGS. Summonses. Complaint. Result. Fine. Costs. 30 Insanitary Premises Withdrawn—work done — Paid in each case, varying from 13s. 6d. to £1 1s. 1 ditto Adjourned "sine die" — — 23 ditto Magistrate's Order made varying from 14 to 28 days — Costs in each, £1 1s. 4 Non-compliance with Magistrate's Order. Fines totalling £16 1 Costs to Council amounting to £9 9s. 2 ditto Withdrawn — — 29 HOUSING. Erection of New Houses. The number of water certificates for new houses issued during the year in respect of properties built by private enterprise was 41 and by the London County Council 17. Inspection of Houses. The Housing (Consolidated) Regulations, 1925, provide for the periodical inspection of houses. During the year 970 houses were inspected and the inspections recorded, so that the conditions found at the time of the initial and subsequent inspection of a particular house in a street can easily be ascertained. The re-inspections of these premises numbered 3,661. Insanitary Areas. The question is often asked, why do persons desire to continue to live in slum areas, and the answer usually given is that the vast majority of slum dwellers have no ambition to live anywhere else. Such has not been my experience, and I am satisfied that in the majority of cases it is due either to poverty or a desire to live within easy reach of their place of work. The people generally found to be living in these areas are those of the unskilled labour class, street hawkers, and the odd job man, whose economic circumstances prevent their seeking improved housing conditions elsewhere. One of the most distressing features of slum life is the evil effect of such environment on the children living in these areas, not only from the public health point of view, but also from the mental and moral aspects. There is little doubt that children born in slums and brought up in slums tend to develop a slum mind. If it were possible to imagine a slum with an eliminated or restricted child population the problem would not be of so great importance. But unfortunately children usually abound in the slums, with the result that the associated evils of bad housing and overcrowded conditions cannot fail to seriously interfere with the healthy development of these children. In recent years schemes involving the demolition of insanitary and worn out properties in the Wvndham Road and Blue Anchor Lane areas have been put in operation, and the erection of working-class dwellings on the sites is proceeding. At the end of 1928, 42 flats had been erected and occupied in the Wyndham Road area, an additional 17 flats were completed and occupied during 1929, and a further 56 dwellings are now in the course of erection. 30 Building operations were commenced during the year at Blue Anchor Lane, and at the end of 1929, 91 flats were in the process of erection. There are four small insanitary areas in the Borough which urgently require to be dealt with, and are described in the following table:— Name of Area. Acreage. Number of Working Class Houses in Area. Woodland Cottages .285 10 Tiger Yard .173 17 Joiners' Arms Yard .045 6 Levant Street, Island site .124 18 These properties were officially represented in 1922, and the Council prepared a scheme which embraced the four areas and submitted the same to the Ministry of Health. The Ministry, however, would not pass the scheme as drafted, and stipulated that alternative accommodation should be provided in new buildings to give accommodation for the persons to be displaced. The areas in question are quite unsuitable for use for the erection of new dwelling-houses. It has not been found possible to provide new accommodation in the vicinity of the areas, but the Council has, through a Sub-Committee of the Housing Committee, been considering the possibility of entering into an arrangement with the London County Council to provide accommodation in the blocks of buildings now being erected in the Borough. Negotiations are still proceeding in this direction, but up to the time of the preparation of this report it has not been found possible to arrive at a satisfactory understanding. Overcrowding. The difficulty which tends to defeat all efforts to solve the problem of overcrowding is perhaps not so much the shortage of houses as the inability of poor people with large families to pay an economic rent. What is required is a type of dwelling to span the gap between the slum and the tenement occupied by the more prosperous class of worker which can be rented by the poorer classes of the community. It would seem that the most suitable provision to meet the requirements of this class is the storey-dwellings type of accommodation. There are, of course, arguments against the advocacy of the erection of dwellings of this description, but there is a 81 pressing need for accommodation at low rents, and in my opinion blocks of dwellings of an improved standard, with as many as possible of the domestic amenities of the small dwelling-house preserved, probably offers the best solution of the problem, particularly in districts where there is an absence of suitable building sites. The number of cases of overcrowding which came to the notice of this department during the year was 165, and in one instance legal proceedings were taken against the person responsible for the nuisance. 82 families were recommended to the London County Council for consideration for accommodation on their housing estates as extreme hardship cases, either for overcrowded conditions or medical reasons, and of these 52 were offered houses by that Authority. Rent and Mortgage Interest (Restrictions) Act, 1920 and 1923. During the year 15 applications were made by occupiers of houses for certificates that the premises in question were not in a reasonable state of repair. In every case a certificate was granted and action was taken under the Public Health (London) Act, 1891, to compel the owners to make the premises reasonably fit for habitation. Underground Sleeping Rooms. During the year 4 underground rooms which were illegally occupied for sleeping purposes were closed or their occupation discontinued. 32 HOUSING, 1929. STATISTICS. Number of New Dwelling Houses erected during the Year 1929. (а) Total (including numbers given separately under (b) 41 and 17 Flats (b) With State assistance under the Housing Acts— (1) By the Local Authority Nil (2) By other bodies or persons 58 1. Unfit Dwelling Houses:— Inspection— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 7,411 (2) Number of dwelling houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 970 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (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 5,733 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 304 3. Action under Statutory Powers:— (а) Proceedings under Section 3 of the Housing Act, 1925 Nil (1) Number of dwelling houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling houses which were rendered fit after service of formal notices— (a) By owners Nil (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 statutory notices were served requiring defects to be remedied 1,923 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) By owners 1,923 (b) By Local Authority in default of owners Nil (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 33 FACTORY AND WORKSHOP ACT, 1901. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Inspections made by Sanitary Inspectors in 1929. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including Factory Laundries) 825 45 — Workshops (including Workshop Laundries) 1,095 45 — Workplaces (other than Outworkers' premises) Total 1,920 90 — DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Found. Remedied. Referred to H.M. Inspector. Number of Prosecution. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 26 25 — — Want of ventilation 5 — — — Overcrowding — — — — Want of drainage floors — — — — Other nuisances 35 30 1 — Sanitary accommodation— Insufficient — — — — Unsuitable or defective 77 74 — — Not separate for sexes 3 2 — — 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] 11 11 11 — Total 157 142 12 — *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. C 34 FACTORIES, WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1929. Factories, Workshops and Workplaces where Men are Employed. Trade. Factories. Workshops and Workplaces. Total. Brush Trade 2 7 9 Building Trades 6 48 54 Chemical Trades 2 1 3 Engineering Trades 45 9 54 Gas Works 1 — 1 Glass Blowing 2 — 2 Laundries 27 9 36 Miscellaneous 206 505 711 Offensive Trades 4 6 10 Preparation of Foodstuffs 16 28 44 Printing and Lithography 30 19 49 Sawmills and Joinery Works 31 31 62 Toymakers 2 7 9 Varnish and Colour Works 4 2 6 Wearing Apparel 15 50 65 Bakehouses 69 67 136 Eating Houses — 163 163 462 952 1,414 Factories and Workshops where Women are Employed. Trade. Factories. Workshops. Total. Brush Trade 3 1 4 Engineering Trades 2 — 2 Glass Blowing 1 — 1 Laundries 35 2 37 Miscellaneous 92 82 174 Offensive Trades 3 — 3 Preparation of Foodstuffs 19 8 27 Printing and Lithography 11 1 12 Sawmills and Joinery Works 5 1 6 Varnish and Colour Works 2 — 2 Wearing Apparel 51 147 198 224 242 466 Outworkers. During the year lists of outworkers were received from 70 contractors carrying on business in this Borough. These lists contained the names of 285 persons employed as outworkers resident in Camberwell. Notices were also received from other Sanitary Authorities giving the names of 589 persons 35 living in this Borough who received home work from employers outside Camberwell. The women sanitary inspectors made 2,257 visits of inspection of outworkers' premises during the year, and 14 sanitary notices were served in respect of unwholesome conditions. The number of cases of infectious diseases reported from outworkers' premises during the year was 6. In 5 instances it was necessary to send cautionary letters to contractors for neglecting to send a list of the names and addresses of persons employed as outworkers, as required by Section 107 of the Factory and Workshop Act, 1901. The following table gives information of the nature of the work carried on where unsatisfactory conditions prevailed at outworkers' premises during the year. Defects found at Outworkers' Premises. Nature of Work. Instances. Verbal Intimations. Notices Served. Prosecutions. Mantle Making 12 2 10 — Shirt Making 1 — 1 — Dress Making 1 — 1 — Tailoring ] — 1 — Dyeing and Cleaning 1 — 1 — INSPECTION AND SUPEBVISION OF FOOD. Milk Supply. Dairies and Milkshops.—The Milk and Dairies Order, 1926, requires the Council to keep a register of premises where milk is sold or deposited for sale, and also the names of persons registered as dairymen or purveyors of milk. Premises from which only bottled milk is sold are not required to be registered, but this exemption from registration does not apply to the proprietor of such premises. During 1929 there were 44 transfers, 64 purveyors and premises removed, and 66 purveyors and premises added to the register by resolution of the Public Health Committee. As a result of these alterations on December 31st, 1920, 471 dairymen and premises were registered for the sale of milk, of which 54 were registered for the sale of milk in sealed bottles only. The Sanitary Inspectors made 1,555 inspections of dairies and milkshops during the year, and in 22 instances notices were served for sanitary defects. Cowkeepers.—There is one registered cowshed in this Borough with accommodation for 47 cows. The average number of cows kept at the premises during the year was 38. C 2 36 The premises were frequently inspected, and it is satisfactory to record that at each visit of inspection there were no contraventions of the provisions of the Milk and Dairies Order, 1926, observed in connection with the conduct of the business. The milk obtained from this source is not supplied to the wholesale trade, but is retailed to families living in the immediate neighbourhood. One sample of milk obtained from cows kept at this establishment was examined for the presence of tubercle, and the report is set out below:— Serial No. Date sample obtained. Copy of certificate. 1 Dec. 17th No T.B. found. Milk (Special Designations) Order, 1926. During the year 80 licences under the above Order were issued by this Authority. The licences automatically expire on December 31st of each year. Applications to sell milk under the following designations were granted: — Certified Milk (including one supplementary license) 13 Grade "A" (Tuberculin Tested) Milk (including four supplementary licenses) 27 Grade "A" 7 Pasteurised (including one supplementary license) 33 Total 80 There are two establishments licensed for bottling Grade "A" (Tuberculin Tested) Milk which are included in the above particulars of the number of retailers licensed to sell Grade A (T. T.) Milk. No application has been made for a licence to set up a pasteurising establishment in the Borough. Examination of Designated Milk. Samples of Certified Milk are obtained for examination at the request of the Minister of Health. For some years past the Ministry has requested that samples of certified milk supplied to dealers in this area by a certain licensed producer be obtained for bacteriological examination. During the year under review the producer in question was not licensed for the production of Certified Milk, but only for the production and sale of Oracle "A" (Tuberculin Tested) Milk. At the direction of the Ministry samples of this grade of milk bottled at the farm by this producer for licensed dealers in this Borough were obtained to ascertain whether the milk complied with the standards laid down in the Order. The results of these samples are shown in the following table. 37 Samples of Grade A (Tuberculin Tested) Milk were also obtained for examination from the two bottling establishments, and the bacteriological reports relating thereto are also set out below: — Standard for Grade "A" (Tuberculin Tested) Milk. Maximum No. of Bacteria permitted per cc. Presence of Bacillus Coli. 200,000 Must not be present in 1/100 cc. Reports on the Examination of Grade "A" (T.T.) Milk bottled on Farm. Serial No. Date sample taken. Bacteria per cc. Presence of Bacillus Coli Sample complied with or did not comply with requirements. 1 March 18 th 1,580 Absent Complied. 2 April 22nd 940 Do. Do. 3 May 13th 3,100 Present Did not comply. 4 June 13th 11,500 Absent Complied. 5 July 4th 3,107,000 Present Did not comply. 6 July 22nd 2,456,000 Do. Do. 7 August 6th 2,600,000 Do. Do. 8 August 8th 2,260 Absent Complied. 9 August 13th 2,500 Do. Do. 10 August 15th 83,000 Do. Do. 11 August 19th 2,300 Do. Do. 12 August 22nd 2,000 Do. Do. 13 August 26th 10,600 Do. Do. 14 August 29th 1,090 Do. Do. 15 September 2nd 9,400 Present Did not comply. 16 September 5th 48,000 Do. Do. 17 October 14th 5,600 Absent Complied 18 November 14th 5,500 Do. Do. Reports on the Examination of Samples of Grade "A" (T.T.) Milk obtained from Bottling Establishments. Serial No. Date sample obtained. Bacteria per cc. Presence of Bacillus Coli inl/100 cc. Sample complied with or did not comply with requirements. 3A May 27th 2,800 Present Did not comply. 3B May 30th 270,000 Do. Do. 4A December 5th 1,400 Absent Complied. 4B December 9th 70,000 Do. Do. The attention of the vendors was drawn to the samples referred to in the above table which did not comply with the requirements of the Milk Designations Order. 38 Report of Food Inspector R. F. Nash relating] to the Inspection of Premises where food is prepared, or offered for sale, for the year ended December 31st, 1929. Bakehouses. Total No. of Bakehouses on Register, 1929 136 Total No. of underground Bakehouses actually in use included in above 44 Visits made to Bakehouses during the year 270 Notices served 57 Notices complied with 57 No. of Factory Bakehouses above ground 52 69 136 No. of Factory Bakehouses underground 17 No. of Workshop Bakehouses above ground 40 67 No. of Workshop Bakehouses underground 27 Food Preparations for Export. During the year 27 certificates were granted to manufacturers of food products in this Borough in respect of potted meats, fish pastes, etc., intended for shipment overseas. In every case the process of preparation was supervised by the Food Inspector of this Council before the certificates were issued, particular attention being directed to the quality and description of the products to be exported. It is worthy of record that considerable care appears to be exercised by the manufacturers concerned in the preparation and handling of these products and to the maintenance of a satisfactory standard of cleanliness generally throughout the factories. Fish Curers. There are at present 49 premises in the Borough used for the purpose of fish curing; of this number 44 are retail fishmongers who cure fish for sale on the premises. The remaining 5 cure for the wholesale market at Billingsgate. Large quantities of fish are handled and prepared in a very satisfactory manner. During the year 209 visits were paid to these premises while curing was in progress. All the premises complied with the requirements of the L.C.C. By-laws. It was only necessary in 3 instances to serve cleansing notices. Fish Shops and Stalls. At the end of the year there were 65 fishmongers' shops (excluding fried fish shops) and 10 fish stalls in the Borough. The majority of the fishmongers are also engaged in the business of fish curing, to which reference is made above. The premises were systematically visited and special attention v. as directed to fish 39 stalls, which were visited in many cases more than once a day during the summer months. Fried Fish Shops. The number of these premises on the register at the end of 1929 was 93, and during the year 391 inspections were made and 7 notices served. Particular attention was given to the quality and condition of the fish and materials used in frying. In every case the requirements of the L.C.C. By-laws were complied with. Ice Cream. Section 29 of the London County Council (General Powers) Act, 1928, secures for Local Authorities increased powers relating to any premises used or proposed to be used for the sale or manufacture for the purpose of sale of ice cream or other similar commodity or the storage of ice cream or other similar commodity intended for sale. Such premises must be registered by the owner or occupier thereof with the Sanitary Authority, and no premises shall be used for the purposes aforesaid or any of them unless the same are registered. Any person offending against the provisions of this section shall be liable to a penalty not exceeding 40s. and to a daily penalty not exceeding 20s. Section 29 of the Act does not, however, apply to any premises occupied as a factory or workshop and any premises used as an hotel, restaurant or club. The increased consumption of ice cream in this country in recent years and the easy manner by which this commodity can be contaminated compels attention to the need for maintaining a high standard of purity of this article. Compulsory registration of these premises marks a very definite advance on existing legislation relating to the conduct of this industry, but public health authorities should not feel satisfied that the measures of control of this commodity have been met until certain specifications and standards have been fixed which will ensure the same safeguards to the public which are at least comparable with those regulating the sale of milk. It should be noted that Local Authorities have no power to refuse registration to any person desirous of engaging in the business of manufacture or sale of ice cream nor to remove a name from the register. The number of premises registered in accordance with the provisions of Section 29 of the L.C.C. (General Powers) Act, 1928, at December 31st, 1929, was 198. The inspections numbered 294. The number of sanitary notices served for unwholesome conditions was 7. 40 Two samples of ice cream were submitted to the Borough Bacteriologist for examination, and the reports are herewith appended:— Serial No. Date sample obtained. From where obtained. Bacteria per cc. Presence of Bacillus Coli. 1 August 26th Shop 140,000 Present in 1 /1000 cc. 2 Sep. 24th Purchased from a barrrow in a public thoroughfare. Manufactured at premises outside this Borough. 6,500,000 Do. Sale of Food Order, 1921. Shops and stalls at which imported meat were on sale were visited by the Food Inspector to ascertain whether the terms of the Order were being carried out. In the main, it was found that the requirements were being complied with. Public Health (Meat) Regulations, 1924. The effect of these Regulations, which have now been in force for a period of five years, has undoubtedly produced a noticeable improvement in the conduct of the business of slaughtering of cattle, the handling and transport of meat, and in the measures to secure freedom from contamination of meat by flies, mud and filth. The majority of the meat traders in this Borough have met the spirit of the Regulations by the provision of glass fronts to their shops, but unfortunately there are still several instances where the open front is retained. In these cases the requirements of the Regulations have been complied with, in so far as the traders concerned have taken such steps as may be reasonably necessary to guard against contamination. A shop blind and side-screening offers a certain measure of protection, but in my judgment the only practicable means to effectively guard against contamination from mud and filth, etc., is by structural alterations to the premises which will permit of a glass front being fitted. The butchers' shops and stalls in the Borough were frequently inspected during the year with satisfactory results. In fact, the meat traders and other vendors of perishable foodstuffs in Camberwell deserve a word of praise for the excellent manner in which they conducted their business, particularly for the maintenance of a wholesome food supply under very difficult conditions during the very hot weather of last summer. Only on one occasion was a complaint made to this Department questioning the quality of a purchase which took place on a Sunday morning. The matter was investigated and the complaint was found not to be justified. 41 Restaurants and Eating Houses. There were 163 restaurants and eating houses on the Register at the end of the year under review. The number of visits made to these premises was 242, and 11 notices were served and complied with to remedy insanitarv conditions. Street Markets. During the year the Food Inspector made 872 visits of inspection to the various street markets in the Borough. The total visits and inspections to these and other food premises, excluding those specifically referred to, numbered 3,653. Maggots in Oranges In May my attention was drawn to the maggoty condition of some oranges purchased by a person in this Borough for her sick child. It was stated that as the result of squeezing one of the oranges a number of maggots were found in the juice. The juice and the pulp of the orange from which it was extracted, together with another orange of the same purchase, were brought by the purchaser to this Department for inspection. The last mentioned orange, which appeared to be perfectly sound, was also found on examination to contain a number of live maggots. The matter was brought to the notice of the Ministry of Agriculture and Fisheries, who requested that the oranges and maggots be forwarded to them for examination by the officers of their Department. This request was complied with, and the following is a copy of the report which was subsequently received:— I am directed to refer to your letter of the 15th instant and to say that the maggots found in the oranges forwarded therewith have been identified as the larvae of the Mediterranean Fruit Fly (Ceratitis capitata), an insect which has frequently been found in imported fruit. It is not included in any Order made by the Minister under the Destructive Insects and Pests Acts, 1877 to 1927." Swine Fever. An outbreak of swine fever occurred in December at Constance Road Institution. In accordance with the provisions of the Diseases of Animals Act, the L.C.C. Veterinary Inspector was notified and the outbreak confirmed. A number of pigs were found to be contagious and were destroyed on the premises. The remaining stock was sent to the Corporation Abattoirs at Islington for slaughter. Slaughter-houses. There are two slaughter-houses in the Borough, and slaughtering took place at these premises on 146 occasions during the year; the visits of inspection numbered 158. The number 42 of animals slaughtered and inspected are set out in the following table: — Animals Slaughtered 1929. Month. Cattle. Sheep, Lambs. Pigs. Calves. Totals. January 10 78 35 2 115 February 8 49 16 2 75 March 6 74 18 10 108 April 8 64 15 7 94 May 10 69 1 5 85 June 8 65 - 5 78 July 10 63 - 8 81 August 8 61 1 3 73 September 8 42 15 4 69 October 11 69 29 5 114 November 8 55 44 1 108 December 12 63 32 2 109 Totals 107 752 196 54 1,109 Diseased Meat Condemned and Destroyed. The following table gives particulars of the diseased meat and organs condemned at the licensed slaughter-houses in the Borough during 1929. The weight of meat condemned and destroyed at the Council s Depot, Peckham Park Road, was 8 cwts. 1 qr. 21 lbs. Cause of destruction. Carcase, including organs. Fore-quarters. Hind-quarters. Head. Tongue. Lungs. Heart. Liver. Stomach. Spleen. Mesenteries. Intestines. Kidney. Udder. Cattle. Cirrhosis - - - - - - - 1 - - - - - - Tuberculosis - - - 3 3 8 8 2 1 - 3 - - - Abscess - - - - - - - 2 - - - - - - Flake - - - - - - - 1 - - - - - - Sheep. Cirrhosis - - - - - - - 3 - - - - - - Abscess - - - - - - - - - - - - - - Parasitic Disease - - - - - 203 - - - - - - - - Pigs. Abscess - - - 2 - - - - - - - - - - Tuberculosis 1 1 - 5 - 8 8 8 - 4 8 - - - Broken fore-leg and bruising - 1 - - - - - - - - - - - - Cirrhosis - - - - - - - - - - - - - - Calves. Tuberculosis - - - - - 1 1 - - 1 - - - Totals 1 2 - 10 3 220 17 18 1 4 12 - - - 43 Particulars of foodstuffs inspected, surrendered and destroyed as unfit for human food. Nature of Food. Weight. Surrendered or seized. Result of Action taken. T. c. q. 1. Fish— Rock Salmon - 1 l 24 Surrendered Destroyed at Council's Depot. Winkles - 2 2 14 do. do. Herrings - 1 0 0 do. do. Cod - - 1 7 do. do. Skate - 1 1 7 do. do. Haddocks (Smoked) - - 3 0 do. do. Haddocks (Fresh) - 1 3 4 do. do. Plaice - 1 1 12 do. do. - 10 2 12 Fruit— Apples - - 1 22 do. do. Peaches - - - 7 do. do. Tomatoes - 6 2 10 do. do. - 7 0 11 Meat— Bacon - - 1 2 do. do. Butchers' Meat - 10 0 6 do. do. Rabbits (18) - - 1 9 do. do. Turkeys(2) - - - 20 do. do. - 10 3 9 Tinned Foods— Condensed and Evaporated Milk, 6,916 tins 2 16 0 13 do. do. Fish, 5,872 tins 2 6 2 9 do. do. Fruit, 561 tins - 6 3 7 do. do. Meat, 53 tins - - 2 17 do. do. Fish and Meat Pastes, 23,652 tins 2 12 3 0 do. do. Syrup, 12 tins - - - 25 do. do. Pickles, 4 jars - - - 4 do. do. 8 3 0 19 Packet Foods— Soups, Gravy Salts, Savouries, Jellies, Egg Powders and Pudding Mixtures 2 8 1 0 do. do. Confectionery— Toffee and Chocolates - 4 2 22 do. do. Total amount of food destroyed 12 4 2 17 44 Return of Work of Food Inspector for 52 weeks ended Dec. 31st, 1929 Inspections Complaints received 52 Complaints found to be justified 8 Street market inspections 872 Bakehouses 270 Fish curers' premises 209 Fried fish Shops 391 Ice cream premises 294 Restaurants and eating houses 242 Merchandise Marks Order— Imported goods 35 Slaughterhouses 158 Carcases inspected 1,109 do. condemned 1 Organs inspected 2,239 Organs condemned 288 Other food premises 2,781 Food surrendered (parcels of varying weight) 40 Foodstuffs certified for export 27 Number of food premises defects found and remedied 136 Number of intimations served 107 Number of Statutory Notices served 16 Inspections not defined 360 Re-inspections 84 Report of the Food and Drugs Inspector, G. T. Dewey, on the Administration of the Food and Drugs (Adulteration) Act, 1928, and other Acts, Regidations and Orders, for the year ended December 31st, 1929. On the 1st day of January, 1929, an Act, which repealed and consolidated the provisions of the Sale of Food and Drugs Acts, 1875 to 1927, together with a number of amending provisions contained in other statutes, and cited as the Food and Drugs (Adulteration) Act, 1928, came into operation. In addition, the following Acts and Orders also became wholly or partly operative at various periods of the year, viz.:— The Merchandise Marks (Imported Goods) No. 3 Order, 1928 (Part I); the Merchandise Marks (Imported Goods) No. 5 Order, 1928, Parts I, II, III and IV; and the Artificial Cream Act, 1929. During the year under review 1,031 formal samples and 88 informal samples were submitted for analysis. Of the formal, 51 were returned as either adulterated or not conforming in other respects to requirements, the percentage being 4.94; and with regard to the informal samples 9 were not up to standard, giving a percentage of adulteration of 10.22. The total percentage of samples submitted for analysis during the year, both formal and informal, which were found to be adulterated was 5.36. Six hundred and thirty-seven post-cards were 45 sent to the vendors of genuine samples intimating that the portions left with them need no longer be retained. A brief résumé of a few matters and cases of special interest is herewith appended. Butter.—It is worthy of note that of the 133 samples of butter examined all were returned as genuine. Thirteen samples examined for moisture did not exceed the statutory limit of 16 per cent. Margarine.—Under the Margarine Acts, recently repealed, it was provided that the wrapper immediately enclosing this article should have the word "Margarine" appearing thereon in halfinch block letters, even though the whole was eventually placed into another wrapper or bag. A slight modification of this provision appears in the Consolidated Act, which states that if the article is enclosed in more than one wrapper, then the word "Margarine" shall appear on the outside of the outer wrapper. It is a common practice for vendors to cut a properly stamped half-pound parcel of margarine into two portions, when a quarter of a pound is requested, the customer thus having only a part of the word "Margarine" on the wrapper, the irregularity being further aggravated by the article then being placed into a plain outside paper or bag. The attention of the retail vendors and the wholesale firms was drawn to this contravention, were cautioned, and also advised as to the requirements of the new Act. In certain instances proceedings have been instituted, where it has been considered that the circumstances have warranted this course of action. In one of these cases the circumstances were somewhat unusual. The margarine in question had been manufactured for export, but apparently did not leave this country. The wrapper enclosing the article bore the name of the port to which the margarine was intended to be sent, the word "Margarine" being in letters of insufficient size, and other printed matter also appeared thereon, contrary to the provisions of the Act. This sample is also dealt with in that part of this report dealing with the Preservative Regulations. One sample of margarine examined for moisture was returned as being within the limit of 16 per cent., which is the maximum amount of moisture allowed for margarine, as well as butter. Of the 64 informal samples (not submitted for analysis) which were purchased to ascertain whether the regulations as to stamping the wrappers were being carried out, 26 had only part of the word "Margarine" thereon and 4 were sold in plain wrappers. Cautions were given to the vendors in each case. 46 Butter Factories and Wholesale Dealers in Margarine. Under Section 8 of the Food and Drugs (Adulteration) Act, 1928, butter factories and wholesale dealers in margarine have to be registered by the Local Authority. At the end of the year the register contained the names of 22 wholesale dealers registered for the sale of this article. Milk. During the year 538 formal samples of milk (including 2 formal samples of separated milk) were submitted for analysis. Of this number 13 were adulterated, the percentage of adulteration being 2.42. As will be seen by reference to Table D this figure is higher than that of last year. In 11 instances the adulteration was due to the abstraction of fat, and 2 in consequence of added water. In 5 of the cases of "abstraction" (where the article was served from a quart bottle) the deficiency was undoubtedly due to the failure on the part of the vendors to thoroughly mix the contents of the bottles at the time of serving. Unless this is done the first customer to be served will of necessity receive the bulk of the fat content. This is what occurred in the cases referred to, and consequently the official sample was deficient in the amount of fat content that should have been present. These cases continue to occur, despite the fact that shopkeepers have been repeatedly advised as to the best methods to adopt, when retailing milk under these conditions, to ensure the article being thoroughly mixed before supplying their customers. The vendor of Sample No. 227 (milk adulterated by the addition of 25 per cent. of added water) was an itinerant purveyor. He was not registered for the sale of milk, nor was his name and address inscribed upon the vehicle or receptacle. Further, the name and address he gave were found to be fictitious. Instructions were given for proceedings to be taken against this vendor in respect of the above offences. The summonses, however, could not be served, and a warrant was therefore granted. After some difficulty he was traced and arrested. A conviction was obtained, the Court imposing fines amounting to £5 10s., with an alternative of five weeks' imprisonment. Milk and Dairies (Consolidation) Act, 1915. Section 6 of this Act provides that every person who sells milk in any place of public resort shall have his name and address conspicuously inscribed on his vehicle or receptacle. For failing to comply with this requirement a purveyor of milk against whom proceedings were taken was convicted and fined ten shillings. 47 Public Health (Condensed Milk) Regulations, 1923-1927. During the year 7 formal samples of condensed full cream milk sweetened and 1 formal sample of condensed machineskimmed milk sweetened were submitted for examination. All were certified to comply with the required composition. The tin of machine-skimmed condensed milk was one purchased from amongst many unlabellcd tins of this article which were exposed for sale and sold by auction at a cheap rate from a stall in one of the principal market thoroughfares in this Borough. It is an offence to expose, sell or deposit for the purpose of sale condensed milk unless labelled in the manner prescribed in the first Schedule to these Regulations. In the case of machine skimmed condensed milk an additional statement is required on the labels to the effect that the milk is "Unfit for Babies." This contravention of the Regulations was accordingly reported to the appropriate Committee, who authorised proceedings to be instituted. The defendant was convicted and ordered to pay £3 and £ 1 1s. costs. Milk and Dairies Order, 1926. Section 31, sub-section 2, provides that where a person delivers milk in bottles he shall cause every such bottle to be filled and closed on registered premises. Cautions were given to 7 roundsmen who were observed contravening this Section by filling bottles with milk in public thoroughfares. In consequence of a complaint, proceedings were taken against a roundsman who was seen filling dirty bottles with milk in a place of public resort. A conviction was obtained, the Court inflicting a penalty of £2 and £1 1s. costs. Public Health (Dried Milk) Regulations, 1923-1927. No dried milk was found to be on sale in this Borough other than the well-known proprietary brands, many of which have from time to time been examined. All declaratory notices examined were in accordance with requirements of the Regulations. The Artificial Cream Act, 1929. This Act came into operation on June 1st, 1929, and provides that where any substance purporting to be cream or artificial cream is artificial cream it shall not be sold and described as "cream" unless that word is immediately preceded by the word "artificial." All receptacles used for conveying or containing "artificial cream" must be labelled with the words "artificial cream in large and legible type. 48 With certain specified exceptions, premises where artificial cream is manufactured or sold must be registered with the Local Authority. Such premises may be inspected by their officers at all reasonable times. No application for registration for the purposes of the manufacture or sale of artificial cream has been made, nor has it been found that artificial cream has been exposed or deposited for sale, or sold, as cream in this Borough contrary to the Act. The Public Health (Preservative, etc., in Food) Regulations 1923-1927. All articles of food set out under Table A were examined for the presence of a preservative and were found to conform to the requirements, with the exception of the samples mentioned below, viz.:— One sample of margarine, ten samples of beef sausages, and one of pork sausages. The margarine contained a prohibited preservative, viz., boric acid, to the extent of 0.31 per cent. This sample was part of a consignment that had been manufactured by a well-known firm of manufacturers for export to Gibraltar. This consignment of margarine formed part of a cargo which was salvaged from a ship before it reached its intended destination, and eventually found its way to this Borough and exposed for sale in a shop which mainly dealt with the sale of hardware goods. Proceedings were taken against the vendors, who were convicted and ordered to pay £20 and £3 3s. costs. The samples of beef and pork sausages were sold, containing a preservative, and without notice thereof being given to the purchaser in the manner prescribed in these Regulations. Only in one case did the amount of preservative exceed the limit allowed. Each case was carefully considered by the appropriate Committee and in eight instances proceedings were instituted, and in three, cautions in writing were sent to the vendors (see- Table B). Eight samples of cream submitted for analysis were all certified as being free from preservative. Raisin Wine. A bottle of wine, with the words "Raisin Wine (nonalcoholic)" inscribed thereon, was submitted for analysis and certified to consist of a solution of sugar and water coloured with an aniline dye. Proceedings were instituted against the vendor, who set up a warranty defence, which the Court upheld. A summons was also issued against the wholesale firm for having given a false warranty. 49 After a lengthy hearing, during which expert evidence was heard, the Court dismissed the summons on the ground that all the ingredients usually found in British wines were found in this particular article, and was, from the commercial point of view, what the consumer expected to get. The Merchandise Marks Act, 1926, and Orders made thereunder. The Merchandise Marks (Imported Goods) No. 3 Order. Part II of this Order, which deals with imported fresh apples, came into operation in November, 1928. Part I, relating to the sale of imported honey, became operative as from the 14th day of January, 1929. The Act provides that the indication of origin shall be printed, stencilled, stamped or branded on the container, or on a label securely attached thereto, in letters l-12th of an inch in height if the greatest dimension of the package does not exceed 6 inches, and not less than 1/8th of an inch in height if the greatest dimension exceeds 6 inches. The form of indication of origin in the case of blends or mixtures containing imported honey shall be either— (a) Honey derived entirely from countries within the Empire, the word "Empire"; if derived entirely from foreign countries, the word "Foreign"; or (b) A definite indication of all the countries of origin of the honeys forming the blend or mixture; or (c) The words "blended imported." A sample of honey forming part of a quantity exposed for sale, without any indication of origin, was purchased for analysis under this Order. From enquiries made after the sample was procured it transpired that the article was the produce of the United States of America. Sub-Section 5 of Section 5 of the Act provides:— "A person shall not be treated as being guilty by virtue of this Section of an offence against the principal Act if he proves— (a) That having taken all reasonable precautions against committing such an offence, he had at the time of commission of the alleged offence no reason to suspect that the goods were goods to which this Act or an Order in Council made thereunder applied, and that on a demand made by or on behalf of the prosecutor he gave all the information in his power with respect to the persons from whom he obtained the goods; or (b) That otherwise he had acted innocently. The vendor having furnished the Council's officers with the name and address of the wholesale firm, in view of the terms of d 50 the above Sub-Section the Committee directed that a caution in writing be sent to the vendor and that the particulars of the offence be brought to the notice of the Local Authority in whose area the wholesale firm's premises were situated. A further Order, cited as the Merchandise Marks (Imported Goods) No. 5 Order, provides for the marking with the indication of origin of— (a) Currants, sultanas and raisins. (b) Eggs in shell and dried eggs. (c) Oat products. Part I (Currants, sultanas and raisins) came into operation on June 21st, 1929. Part II (Eggs in shell) became operative on April 21st, 1929. Part III (Dried eggs) as from March 21st, 1929. Part IV (Oat products) as from June 21st, 1929. The expression "oat products" shall mean oatmeal, rolled oats (but not crushed or bruised natural oats), oat flour, and groats. Directions are given for marking the goods coming under Parts I and IV when they are exposed for sale retail and prepacked. For prepacked goods the requirements are somewhat similar to those laid down in connection with the sale of honey. On exposure for sale of these articles not prepacked by means of a show ticket bearing the indication of origin in letters not less than ½ of an inch in height forming the words "Empire" or "Foreign," as the case may be, with the addition in the case of oat products, the alternative indication " Blended Imported." When oat products (prepacked after importation) are exposed for sale by retail, either by means of a show ticket or marking on each package as prescribed. It is, however, provided that The articles mentioned under Part I are not required to bear an indication of origin on exposure for sale by retail in packages made up for sale on the premises of a retailer, or on sale, when sold in quantities not exceeding 14 pounds in weight, the last proviso also applying to articles under Part IV. Part II provides that imported eggs in shell shall have the indication of origin conspicuously and durably marked in ink on the shell, in letters not less than two millimetres in height. Part III provides for the marketing of dried eggs on importation in letters ½ inch in height on each outer container, and when prepacked, on exposure for sale wholesale or retail and on sale, in l-12th inch or l-8th inch letters, according to the dimensions of the package. In connection with the above Orders, where it was found that tradesmen had failed to comply with the provisions therein contained, they were advised as to their responsibilities under the 51 Act and Orders made thereunder, and as to the necessity of complying with the requirements thereof. The Agricultural Produce (Grading and Marking) Act, 1928. The above Act, dated August 3rd, 1928, provides for the grading and marking of agricultural produce. The Minister of Agriculture and Fisheries may, by regulations made under this Act, prescribe such designations (in this Act referred to as "grade designations") as he may consider appropriate to indicate the quality of any articles of agricultural produce. Where any person sells any article of agricultural produce to which a grade designation is applied it shall be deemed to be a term of the contract of sale that the quality of the article accords with the statutory definition indicated by the grade designation. A grade designation shall be deemed to be applied to an article if it is used when the article is sold or delivered or exposed or offered for sale in any manner calculated to lead to the belief that the quality of the article accords with the statutory definition indicated by the grade designation. Penalties are provided where it is proved that any person has forged any grade designation mark or has used in connection with any article any mark nearly resembling a grade designation mark as to be calculated to deceive. Under this Act Regulations cited as the Agricultural Produce (Grading and Marking) (Eggs) Regulations, dated December 15th, 1928', were made by the Minister of Agriculture and Fisheries as to Grade Designations and Grade Designation Marks for Eggs produced in England and Wales, and as to the marking of eggs which have been subjected to any process of preservation. Grade designations to indicate the quality of hen and duck eggs produced in England and Wales are respectively as follows: "Special," "Standard" and "Pullet Standard," "Special (Duck)," "Standard (Duck)," "Ducklet Standard," and to be of a specified weight and condition as set out in the Schedule to the Regulations. Under Section 4 of these Regulations methods are prescribed for marking any preserved eggs to which Section 3 of the Agricultural Produce (Grading and Marking) Act, 1928, applies. It is provided that any preserved eggs as above described shall be marked conspicuously and legibly on the shell with the word "Preserved" in letters not less than 1/16-inch in height, enclosed in a circle of not less than ½-inch diameter. Section 5 provides under certain conditions that any British egg which has been kept in cold storage or chemical storage shall in the former case be marked conspicuously and legibly on the D 2 52 53 TABLE "A." Formal and Informal Samples Submitted for Analysis for the Year ended December 31st, 1929. Article. Number Examined. Number Adulterated, etc. Percentage of Adulteration. Formal. Informal. Private. Total. Formal. Informal. Private. Total. Formal. Informal. Milk 536 3 - 539 13 - - 13 2.42 - Butter 96 37 - 133 - - - - - - Vinegar 37 - - 37 1 - - 1 2.70 - Malt Vinegar 35 - - 35 2 - - 2 5.71 - Beef Sausages 18 - - 18 10 - - 10 55.55 - Self-Raising Flour 17 - - 17 - - - - - - Lard 17 - - 17 - - - - - - Margarine* 16 - - 16 15 - - 15 93.75 - Brawn 15 - - 15 - - - - - - White Pepper 15 - - 15 - - - - - - Cocoa 12 - - 12 - - - - - - Dripping 12 - - 12 - - - - - - Whisky 10 39 - 49 6 9 - 15 60.00 23.07 Mustard 9 - - 9 - - - - - - Sauces (Various) 9 - - 9 - - - - - - Corn Flour 8 - - 8 - - - - - - Black Currant Jam 8 - - 8 - - - - - - Cream- 8 - - 8 - - - - - - Salmon and Shrimp Paste 7 - - 7 - - - - - - Condensed Full Cream Milk, Sweetened 7 - - 7 - - - - - - Raspberry Jam 6 - - 6 - - - - - - Baking Powder 6 - - 6 - - - - - - Breakfast Sausage 6 - - 6 - - - - - - Camphorated Oil 5 - - 5 - - - - - - Prescriptions 5 - - 5 - - - - - - Custard Powder 5 - - 5 5 - - - - - - Lemonade Powder 5 - - 5 - - - - - - Arrowroot 4 - - 4 - - - - - - Strawberry Jam 4 - - 4 4 - - - - - - Lemon Curd and Cheese 4 - - 4 - - - - - - Cream Cheese 4 - - 4 - - - - - - Corned Beef 4 - - 4 - - - - - - Preserved Beef Sausages 4 - - 4 - - - - - - Gin - 3 - 3 - - - - - - Flour 3 - - 3 - - - - - - Pork Sausages 3 - - 3 - - - - - - Pearl Barley 3 - - 3 1 - - 1 33.33 - Sponge Cakes and Fingers 3 - - 3 - - - - - - Mincemeat 3 - - 3 - - - - - - Crushed Linseed 3 - - 3 — - - - - - Boric Acid Ointment 3 - - 3 — - - - - - Alcoholic Wines - 2 - 3 2 — - - - - - Coffee 2 — - 2 — - - - - - Separated Milk 2 — - 2 — - - - - - Chicken and Ham Galantine 2 — - 2 — - - - - - Plum Jam 2 — - 2 — - - - - - Marmalade 2 — - 2 — - - - - - Sultana Cake 2 — - 2 — - - - - - Citrate of Magnesia 2 — - 2 — - - - - - Zinc Ointment 2 — - 2 — - - - - - Tincture of Iodine 2 — - 2 - - - - - - Non-Alcoholic Wine — 1 - 1 — - - - - - Mixed Candied Peel 1 — - 1 - - - - - - Boiled Bacon 1 — - 1 - - - - - - Bacon 1 - - 1 - - - - - - Potted Ham 1 - - 1 - - - - - - Rice 1 - - 1 - - - - - - Raisin Wine 1 — - 1 1 - - 1 100.0 - Castor Oil 1 — - 1 - - - - - - Lemon Curd Powder 1 — - 1 - - - - - - Tinned Peas 1 — - 1 - - - - - - Tinned Red Cherries 1 — - 1 - - - - - - Egg Substitute Powder 1 — - 1 - - - - - - Jelly Crystals 1 — - 1 - - - - - - Veal and Ham Loaf 1 - - 1 - - - - - - Raspberry and Gooseberry Jam 1 — - 1 - - - - - - Sherbet 1 - - 1 - - - - - - Raspberry and Apple Jam 1 - - 1 - - - - - - Orange Curd 1 - - 1 - - - - - - Ham 1 - - 1 - - - - - - Egg Self-Raising Flour 1 - - 1 - - - - - - Anchovy Paste 1 - - 1 - - - - - - Salmon and Anchovy Paste 1 - - 1 - - - - - - Mixed Fruit Jam 1 - - 1 - - - - - - Lobster Paste 1 - - 1 - - - - - - Beef and Tongue 1 - - 1 - - - - - - Preserved Pork Sausages 1 - - 1 - - - - - - Ginger Beer Powder 1 - - 1 - - - - - - Gooseberry Jam 1 - - 1 - - - - - - Pineapple Butter 1 - - 1 - - - - - - Ground Ginger 1 - - 1 - - - - - - Red Currant Jelly 1 - - 1 - - - - - - Black Treacle 1 - - 1 - - - - - - Chocolate Powder 1 - - 1 - - - - - - Machine Skimmed Condensed Milk, Sweetened† 1 - - 1 1 - - 1 100.0 - Full Cream Dutch Cheese 1 - - 1 - - - - - - Rum 1 3 - 4 - - - - - - Honey‡ 1 - - 1 1 - - 1 100.0 - Ground Almonds 1 - - 1 - - - - - Purified Borax 1 - - 1 - - - - - - 1,031 88 - 1,119 51 9 — 60 4.94 10.22 * Article sold in unstamped wrappers. † Article sold in an unlabelled tin. ‡ Article sold without notice of indication of country of origin. 54 55 TABLE "B." SAMPLES ADULTERATED, ETC. Serial No. Article. Whether Formal, Informal or Private. Nature of Adulteration or Irregularity. Observations. Result of Proceedings or other Action taken. 1004 Milk Formal 26 per cent. of the original fat abstracted - Summons dismissed. Vendor to pay £1 14s. costs. 15 Do Do. 33 Do. Do. - Vendor cautioned. Resolution of the Public Health committee 147 Do Do. 27 Do. Do. - Summons dismissed. Vendor to pay 15s. costs. 148 Do. Do. 6 Do. Do. - Vendor cautioned. Resolution, Public Health Committee. 166 Do. Do. 38 Do. Do. - Summons dismissed. Vendor to pay 10s. 6d. costs. 199 Do. Do. 11 per cent. of added water - Do. Do. 227 Do. Do. 25 Do. Vendor's name and address not on vehicle or receptacle. 'Food and Drugs (Adulteration) Act. Milk and Dairies (Consolidation) Act, 1915. Fined £5, or one month's imprisonment. Fined 10s., or seven days imprisonment. Two Summonses. 289 Do. Do. 17 per cent. of the original fat abstracted - Vendor fined 5s. and 7s. 6d. costs. 318 Do. Do. 45 Do. Do. - Do. 357 Do. Do. 13 Do. Do. Previous convictions. Vendor lined £5 and £1 1s. costs. 456 Do. Do. 10 Do. Do. - Vendor cautioned. Resolution, Public Health Committee. 489 Do. Do. 10 Do. Do. - Vendor fined 5s. and £1 1s. costs. 678 Do. Do. 19 Do. Do. - Vendor cautioned. Resolution, Public Health Committee. 791 Margarine Do. Contained 0.31 per cent. Boric Acid. Wrapper enclosing article not stamped in accordance with requirements. Public Health (Preservative, etc., in Food) Regulations, 1925-7 Food and Drugs (Adulteration) Act, 1918. Vendor fined £20 and £3 3s. costs Vendor fined 10s. Two Summonses. 797 Do. Do. Wrapper enclosing article improperly stamped - Vendor cautioned. Resolution, Public Health Committee. 804 Do. Do. Article enclosed in an unstamped wrapper - Do. Do. 824 Do. Do. Do. Do. - Do. Do. 1011 Do. Do. Do. Do. - Summons dismissed. Vendor to pay 5s. costs. 32 Do. Do. Do. Do. - Vendor cautioned. Resolution, Public Health Committee. 68 Do. Do. Do. Do. - Do. Do. 377 Do. Do. Do. Do. - Do. Do. 420 Do. Do. Do. Do. - Do. Do. 473 Do. Do. Do. Do. - Vendor fined 10s. and 10s. 6d. costs. 483 Do. Do. Do. Do. - Summons dismissed. Vendor to pay 10s. 6d. costs. 485 Do. Do. Do. Do. - Do. Do. 585 Do. Do. Do. Do. - Vendor cautioned. Resolution, Public Health Com¬mittee. 657 Do. Do. Do. Do. - Do. Do. 733 Do. Do. Do. Do. - Do. Do. 818 Beef Sausages. Do. Contained Sulphur Dioxide 150 parts per million. - Do. Do. 850 Do. Do. Do. 300 Do. - Summons dismissed. Vendor to pay £5 5s. costs. 1012 Do. Do. Do. 227 Do. - Do. Do. 1034 Do. Do. Do. 247 Do. - Vendor cautioned. Resolution, Public Health Committee. 1035 Do. Do. Do. 110 Do. - Summons dismissed. Vendor to pav £1 Is. costs 11 Do. Do. Do. 261 Do. - Do. Do. 34 Do. Do. Do. 220 Do. - Do. Do. 207 Do. Do. Do. 233 Do. - Vendor cautioned. Resolution, Public Health . 56 57 TABLE "B."—continued. SAMPLES ADULTERATED, Etc.—continued. Serial No. Article. Whether Formal, Informal or Private. Nature of Adulteration or Irregularity. Observations. Result of Proceedings or other Action taken. 401 Beef Sausages Formal. Contained Sulphur Dioxide 452 parts per million. — Summons dismissed. Vendor to pay £3 3s. costs. 414 Do Do. Do. 178 Do. — Do. Do. Do. 933 Pork Sausages Do. Do. 220 Do. — Do. Do. 5s. costs. 876 Whisky Do. 37.6 degrees under proof — Do. Do. £2 2s. costs. 245 Do. Do. 36.9 Do. — Vendor fined 15s. and 10s. costs. 638 Do. Do. 36.2 Do. — Vendor cautioned. Resolution, Public Health Committee. 714 Do. Do. 43.7 Do. — Summons dismissed. Vendor to pay £4 4s. costs. 715 Do. Do. 36.4 Do. — Vendor cautioned. Resolution, Public Health Committee. 742 Do. Do. 35.9 Do. — Do. Do. 131 Do. Informal 37.2 Do. See formal sample No. 876. 5 Do. Do. 47.3 Do. Formal sample No. 43 genuine. 6 Do. Do. 38.4 Do. Do. 44 Do. 9 Do. Do. 37.1 Do. Do. 144 Do. 14 Do. Do. 37.1 Do. See formal sample No. 245 39 Do. Do. 36.0 Do. Do. 638 45 Do. Do. 35.9 Do. Do. 742. 46 Do. Do. 44.0 Do. Do. 714. 49 Do. Do. 36.1 Do. Do. 715. 844 Malt Vinegar Formal 63 per cent. deficient in Acetic Acid — Vendor fined 10s. 6d. and £1 1s. costs. 729 Do Do. 52 Do. Do. — Summons dismissed. Vendor to pay 7s. 6d. costs. 57 Vinegar Do. 15 Do. Do. - Vendor cautioned. Resolution, Public Health Committee. 846 Raisin Wine Do. Article consisted of a solution of sugar in water, coloured with an aniline dye. - Vendor's summons dismissed on Warranty. Two Summonses. Summons against wholesale firm dismissed. 619 Machine Skimmed Condensed Milk, Sweetened. Do. Article sold in unlabelled tin Contravention of the Public Health (Condensed Milk) Regulations. Vendor fined £3 and £1 1s. costs. 676 Pale Honey Do. Article sold without indication of Country of Origin. Contravention of Merchandise Marks Act, 1926, and No. 3 Order, 1928. Vendor cautioned. Resolution, Public Health Committee. Milk & Dairies Order, 1926. Causing dirty bottles to be filled with milk in public thoroughfare. Summons against employer dismissed. Two Summonses. Employee fined £2 and £1 1s. costs. TABLE "C." Percentage of adulteration, etc., of Formal samples for the past five years. Year. 1925. 1926. 1927. 1928. 1929. Percentage of Adulteration 2.02 3.31 3.13 2.13 4.94 TABLE "D." Percentage of adulteration of Formal samples of Milk for the past five years. Year. 1925. 1926. 1927. 1928. 1929. Percentage of adulteration 1.31 2.25 1.88 .99 2.41 58 shell with the word "Chilled" or the words "Cold Stored," and in the latter case with the word "Sterilized," the letters being in each case not less than 1/16-inch in height and the word or words enclosed in a circle of not less than ½-inch diameter. This part of the Regulations came into operation after the 28th day of February, 1929. Premises used for the purposes of cold or chemical storage of eggs are registered by the Local Authority. SUMMARY, 1929. Total formal and informal samples submitted for analysis 1,119 Formal samples adulterated, etc. 51 Informal samples adulterated, etc. 9 Cautions administered 22 Summonses (including summonses issued under the Public Health (Condensed Milk) Regulations and the Milk & Dairies Order) 34 Act, Regulation or Order under which proceedings were taken. Number of Summonses. Fines. Costs. £ s. d. £ s. d. The Food and Drugs (Adulteration) Act, 1928 21 13 0 0 16 3 0 The Public Heath (Preservatives, etc., in Food) Regulations, 1923-1927 9 20 0 0 18 12 0 The Public Health (Condensed Milk) Regulations, 1923-1927 1 3 0 0 1 1 0 The Milk and Dairies (Consolidation) Act, 1915 1 0 10 0 - The Milk and Dairies Order, 1926 2 2 0 0 1 1 0 34 38 10 0 36 17 0 PREVALENCE OF AND CONTROL OYER INFECTIOUS DISEASES. The total number of infectious diseases, excluding tuberculosis, notified during the year was 2,307, as compared with 2,103 in 1928. This increase was due to the prevalence of smallpox and an unusually large number of cases of scarlet fever. A table showing the notifications received for each disease and the age distributions will be found on pages 72—73. Smallpox. During the year 119 cases of smallpox occurred at 51 premises in the Borough, and the number of families affected was 62. The disease was extremely mild in nature, with almost a total absence of complications and sequelæ. 59 The cases comprised 64 females and 55 males, in age groups as shown in the following table:— Under 1 year 2 1 to 2 years 1 2 to 3 2 3 to 4 ,, 2 4 to 5 ,, 5 5 to 10 „ 21 10 to 15 29 15 to 20 22 20 to 35 17 35 to 45 4 45 to 65 ,, 12 65 and upwards 2 In spite of the most energetic measures to stamp out the occurrence of smallpox in Camberwell last year, cases continued to be reported weekly up to the time of the preparation of this report. The possible reason why smallpox has not been exterminated in London is because it is not the virulent type of the disease; the attack in many cases has been so very slight that the sufferers have neglected to obtain medical assistance until the disease was well advanced, and there have been instances also where it has never been sought. Further, in a community with so many opposed to vaccination, some have stated quite openly that they would prefer to have the disease in its present form rather than be vaccinated. The prominence given of late to the possibility of a form of encephalitis occurring after vaccination in late childhood and adult life has, no doubt, considerably influenced this opposition to vaccination. Unfortunately, too, it is an exceedingly difficult matter to instil a sense of understanding into the minds of a certain section of the public that the control of the disease depends largely on giving accurate information to the officers of this Department in the course of investigation of cases. The factors responsible for spreading the disease may therefore be summarised as follows:— 1. The unvaccinated state of the population resulting in a large number of unvaccinated contacts. Experience has also shown that there has been a marked disinclination to be vaccinated until more than one case has been removed from the house, and in one instance absolute objection to vaccination was encountered. In this family 9 of 11 persons were removed to hospital suffering from the disease. 2. Unrecognised cases due to the absence of severe physical symptoms and neglect in some cases to seek medical advice until the characteristic eruptive features of the disease threaten facial disfigurement. 60 3. Unreliable information as to the movements of the patient with the disease and the names of contacts. Administrative Measures Adopted.—Every possible measure was taken as each case occurred to prevent the spread of infection. House disinfection, including beds, bedding and clothing, was carried out. Immediate contacts of the patients attended the Council's Disinfecting and Cleaning Station for the purpose of having a bath and for the disinfection of personal clothing while their homes were being disinfected. The vaccination of contacts was strongly recommended in every case. The closest co-operation between the Public Vaccinators and the Vaccination Officer in the information of cases has also been maintained. Arrangements were made with the London County Council for the medical inspection of school children at various schools in infected areas. A house-to-house enquiry as to the health of residents has been conducted in some of the infected streets; circular letters drawing attention to the steps to be taken to prevent the spread of infection were also sent to householders in certain areas of the Borough. Posters advising vaccination and re-vaccination containing full information as to the facilities available have been displayed all over the Borough on more than one occasion during the year. Source of Infection.—In the majority of the cases notified the source of infection was traced, but in a few instances the primary case in a household was only discovered when subsequent cases in the family with a more profuse rash were reported, or discovered as the result of examining and following up contacts. An analysis of the cases reported during the year showing the source of infection is shown in the following table:— "Missed" Cases in House. (Noninfectious when discovered). 119 Notified Cases. Primary Case in House. Additional Cases reported arising from infection in Infection not traced. Cases resulting from infection in immediate neighbourhood. Infection imported from other districts. (a) same house. (b) Elsewhere in Borough. 7 21 77 14 61 19 Vaccinal Condition.—The vaccinal condition of the patients appears in the subjoined table. 61 It will be observed that 97 of the 119 cases reported were unvaccinated and 12 patients over 45 years had not been vaccinated since infancy. Age Group. Vaccinated in infancy. Unvaccinated. Vaccination doubtful. Totals. Under 1 year 2 - 2 1 to 2 years — 1 — 1 2 to 3 — 2 — 2 3 to 4 „ — 2 — 2 4 to 5 ,, — 5 — 5 5 to 10 ,, — 20 1 21 10 to 15 „ — 27 2 29 15 to 20 „ 1 21 — 22 20 to 35 „ 2 14 1 17 35 to 45 2 2 — 4 45 to 65 „ 10 1 1 12 65 and upwards 2 — — 2 Totals 17 97 5 119 Contacts.—In addition to the contacts arising from the cases reported in this Borough, a large number of contacts was also received from other districts, including the Port Medical Authorities of London, Southampton and Liverpool. All these persons were kept under observation for a period of 18 days, and the number of visits made by the Sanitary Inspectors to these persons during the year totalled 13,994. General Review.—The incubation period of this type of smallpox is usually 14 days, but several cases have come to my notice where the incubation period has extended to 16—18 days, and in one or two instances as long as 20 days. The disease is usually ushered in by a sharp sudden illness characterised by headache, pain in the back and limbs, and a provisional diagnosis of influenza is common. The similarity in the early symptoms of the disease with those of influenza was brought to the attention of every general practitioner in the Borough in the early months of the year, and at the same time I took the opportunity of stating that I should be pleased to offer my services in consultation in any doubtful case. Owing to the anomalous character of the disease the diagnosis of cases of this type of smallpox is frequently extremely difficult and is often a source of considerable anxiety. Any test, therefore, which could be used to assist in the diagnosis would be of inestimable value. In this connection the results of the experimental use of an anti-vaccinia serum for the purpose of the differentiation of smallpox crusts from the crusts of severe cases of chickenpox gives promise that such a test may be available in the near future for the diagnosis of smallpox. Smallpox, whether it be severe or mild in character is disturbing to the community and is extremely costly in money. 62 Many people are disposed to regard the present type of illness as too trivial in nature to be worth serious attention, and in some cases are beginning to display irritation with the administrative measures of control of the disease. It must be remembered that Local Authorities are charged with a definite responsibility to control infectious diseases, and the public should not be expected to incur any risks which may result from any relaxation of the existing measures adopted to check the spread of specific diseases, unless there are strong grounds to believe that any modification of the present practice, if effected, would be consistent with safety to the community as a whole. The matter is, however, of sufficient importance in my opinion, to merit early and careful consideration from every standpoint. Vaccination. The Vaccination Order, 1929, dated August 15th, 1929, embodies changes based on the recommendations of the Rolleston Committee of Inquiry into matters relating to vaccination. The Minister has accordingly amended the Vaccination Orders so far as is necessary to give effect to certain recommendations of the Committee referred to as follows which came into operation on October 1st last:— (1) In place of the officially advocated four insertions, trial shall be made of vaccination or re-vaccination in one insertion. (2) Primary vaccination to be performed in infancy between the ages of 2 and 6 months, as at present, and re-vaccination be offered at the time when a child enters school (5 to 7 years) and again on leaving (14 to 16 years). (3) Vaccination in multiple insertions to be available for such persons as desire to obtain the maximum protection against smallpox obtainable at one operation. (4) In public vaccinations parents to be informed that if in consequence of vaccination a child requires medical attention, it is the duty of the public vaccinator concerned to provide such attention without cost to the parents. (5) The Minister draws attention to the remarks in the report of the Committee of Inquiry in which reference is made to the occurrence of Post-Vaccinal Nervous Disease. It is pointed out that however seldom such cases may occur, they are of serious import and cannot fail to have an effect on vaccination, both in its administrative and its purely medical aspects. The Committee also refer to the extreme rarity of such manifestations, particularly after re-vaccination and after primary vaccination in early infancy. The Minister recognises that both in this country and abroad post-vaccinal nervous diseases have occurred mainly in children of school age or adolescents who had never previously 63 been vaccinated, and this fact emphasises the desirability of securing the successful vaccination of infants. The Minister is of opinion that, in the present state of knowledge, and so long as the smallpox prevalent in this country retains its present mild character it is not generally expedient to press for the vaccination of persons of these ages who have not previously been vaccinated, unless they have been in personal contact with a case of smallpox or directly exposed to smallpox infection. Diphtheria. It is satisfactory to record that a further decrease occurred in the number of notifications received and also in the number of deaths from this cause during 1929. The cases reported numbered 669, as compared with 744 in the previous year. Of these, 652 were removed to hospital for treatment. In 17 instances the diagnosis was not confirmed, and the patients were discharged from hospital as not suffering from diphtheria or any other notifiable disease. The deaths from this disease numbered 16. The return cases numbered 12 (a return case is defined as one which occurs within 28 days after the release of the original case from isolation). The following table shows the number of notifications and deaths from this disease during the last 9 years:— Year. Number of Notifications. Number of Deaths. 1921 875 64 1922 821 63 1923 875 72 1924 831 42 1925 934 40 1926 1,063 54 1927 768 23 1928 744 22 1929 669 16 Diphtheria anti-toxin is available free of charge for the use of medical practitioners on application during the day between the hours of 9 a.m. and 5 p.m. at the Town Hall, the Public Health Department, 35, Brunswick Square, and at the Dulwich Baths, East Dulwich Eoad, and at all hours, day and night, at the Town Hall, Peckham Eoad. During the year 64 phials of anti-toxin of 8,000 units each were supplied to medical practitioners for treatment purposes and 58 phials of 500 units of anti-toxin for prophylactic purposes. Diphtheria Immunisation Clinic. The Diphtheria Immunisation Clinic at 140, Camberwell Eoad was established in December, 1926. The work at this clinic has proceeded very smoothly during the year. The figures of attendance show steady progress, although there has been some falling off in the numbers as compared with the first complete year's work of the clinic. A return of work for the year is set out in the following tables:— 64 65 DIPHTHERIA IMMUNISATION CLINIC. RETURN OF WORK, 1929. TABLE I.—AGES OF PERSONS SCHICKTESTED WITH RESULT OF TEST. 6 to 12 mths. 1 to 2 yrs. 2 to 3 yrs. 3 to 4 yrs. 4 to 5 yrs 5 to 6 yrs. 6 to 7 yrs. 7 to 8 yrs. 8 to 9 yrs. 9to 10 yrs. 10to 11 yrs. 11 to 12 yrs. 12 to l3 yrs. 13 to l4 yrs. 14 to l5 yrs. 15 yrs. and above. Total 1929 4 6 9 7 14 18 9 7 12 18 7 6 3 3 — 45 168 Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. P08. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Positive 110 Negative 53 Not read 5 2 1 1 6 - - 8 1 - 6 1 - 11 3 - 12 4 2 4 5 - 6 1 - 9 1 2 13 5 - 6 1 - 5 1 - 1 2 - 1 2 - - - - 20 25 - TABLE II.—IMMUNISATION TREATMENT TABLE. 6 to 12 mths. 1 to 2 yrs. 2 to 3 yrs. 3 to 4 yrs. 4 to 5 yrs. 5 to 6 yrs. 6 to 7 yrs. 7 to 8 yrs. 8 to 9 yrs. 9 to 10 yrs. 10 to 11 yrs. 11 to 12 yrs. 12 to 13 yrs. 13 to 14 yrs. 14 to 15 yrs. 15 yrs. and above. Totals 1929 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 Injections, 106 1st Injection 2nd 3rd 1st Injection. 2nd 3rd 1st Injection 2nd 3rd 1st Injection. 2nd 3rd 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd 1st Injection. 2nd 3rd 1st Injection. 2nd 3rd „ 1st Injection. 2nd 3rd 1st Injection. 2nd 3rd 1st Injection. 2nd „ 3rd „ 4th 1st Injection. 2nd „ 3rd 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd 3rd „ 1st Injection. 2nd „ 3rd „ 4th 2nd „ 87 3rd „ 78 4th „ 15 5th „ 2 6th ,, 1 2 1 1 6 5 5 8 6 7 6 5 4 1211 11 10 9 8 3 1 6 5 9 8 7 13 11 9 7 4 4 5 3 3 1 1 1 1 i 1 1 - 1 1 17 14 11 10 4th 1 4th 1 5th 1 4th 1 4th 1 5th 1 6th 1 TABLE 111.—AGES OF PERSONS RE-SCHICKED AFTER TREATMENT AND FOUND TO BE NEGATIVE. 6 to 12 mthn. 1 to 2 yrs. 2 to 3 yrs. 3 to 4 yrs. 4 to 5 yrs. 5 to 6 yrs. 6 to 7 yrs. 7 to 8 yrs. 8 to 9 yrs. 9 to 10 yrs. 10 to 11 yrs. 11 to 12 yrs. 12 to 13 yrs. 13 to 14 yrs. 14 to 15 yrs. 15 yrs. and above. Total 1 9 5 10 10 7 2 9 5 2 1 — — — 9 70 e 66 Scarlet Fever. Scarlet fever to-day is a disease of slight clinical importance, and the mildness of the infection results in many cases escaping detection. In 1929, 1,043 notifications were received and the of these 957 patients were removed to hospital for treatment. The deaths numbered 4. In 28 instances patients who had been removed to hospital were found after admission not to be suffering from scarlet fever or any other infectious disease and were returned home. Removal to hospital, unless adequate facilities were available at home for the satisfactory nursing of the patient, steam disinfection of bedding and fumigation of rooms and exclusion from school of contacts were carried out in each case. The return cases numbered 38. (A return case is defined as one which occurs within 28 days after the release of the original case from isolation.) As far as T am aware, no use was made in the Rorough of the Dick Test for the detection of susceptible contacts, or of the employment of the means to ensure active immunisation against this disease. Enteric Fever, including Paratyphoid. Twelve notifications of enteric fever were received during the year, and with the exception of two cases which were nursed at home the patients were removed to hospital for treatment. Of the 10 cases sent to hospital, 2 were returned home as not suffering from enteric fever or any other notifiable disease. There were no deaths. Careful enquiries were made as each case was reported to discover whether any of the usually looked for contaminating agencies were responsible for the disease, viz., water, milk, shellfish, watercress, etc., or a carrier engaged in the manufacture, preparation or handling of food, could be attributed to the possible cause of the illness, but the source of infection was not traced in any of the cases. Cerehro-Spinal Meningitis,. 4 cases of cerebro-spinal meningitis were notified during 1929 to the Public Health Department. The particulars and subsequent history of the cases appear in the following table:— Sex. Age. Date of notification. Where treated. Subsequent history. M. 10 mths. Feb. 7th, 1929 M.A.B. Hospital Died. "Broncho-Pneumonia and Enteritis." P. 11 Aug. 15th, 1929 St. Giles' Hospital Recovered. M. 6 Nov. 6th, 1929 St. Giles' Hospital Died. F. 4 Nov. 21st, 1929. St. Giles' Hospital. Recovered. 67 Dysentery. One case of dysentery was reported, and it was found on enquiry that the patient contracted the disease in Egypt during Encephalitis Lethargica. In 1929, five cases of encephalitis lethargica were notified. The number of deaths from this cause during the year was 5. In respect of 4 of these cases, the particulars provided by the death certificate was the only knowledge this Department had of the existence of these cases. In the remaining case the patient was notified as suffering from the disease in March of the previous year. The particulars of the notified cases and the deaths reported during the year are shown in the following tables:— Notified Cases, Encephalitis Lethargica, Year ended 1929. Sex. Age. Date of Notification. Subsequent History. F. 30 March 21st, 1929 Apparently recovered, no paralysis. F. 20 May 20th, 1929 Died. "T.B. Meningitis." M. 65 August 9th, 1929 Apparently recovered, no paralysis. F. 17 October 8th, 1929 Do. Do. M. 6 October 15th, 1929 Died. "T.B. Meningitis." Deaths from Encephalitis Lethargica, Year ended 1929. Sex. Age. Date of Notification. Date of Death. M. 21 Not notified January 4th, 1929. F. 19 March 5th, 1928 January 29th, 1929. M. 59 Not notified February 18th, 1929. M. 28 Not notified April 4th, 1929. M. 65 Not notified July 18th, 1929. Erysipelas. 125 cases of this disease were reported during the year, and 53 of the patients were removed to hospital for treatment. Malaria. Three cases of malaria were notified, and investigations revealed that in two cases the patients contracted the disease in India, and in the other in Mesopotamia during the war. Ophthalmia Neonatorum. Eighteen notifications of ophthalmia neonatorum were received during the year. Eight of these were from private practitioners E 2 68 and ten from medical officers of institutions. The particulars of the notified cases are set out in the following table:— Notified. Cases Treated. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. At Home. In Hospital. 18 12 6 18 - — — In addition to the notified cases, 67 cases of inflammation of the eyes in infants came to the notice of this Department. The Women Sanitary Inspectors or Health Visitors visited every case to ensure that continuous treatment was being carried out, and where necessary district nursing services were obtained. Pneumonia. The diseases acute primary pneumonia and acute influenzal pneumonia are compulsorily notifiable under the Public Health Infectious Diseases (London) Regulations, 1927, and during the year under review 127 notifications of the first-named type of pneumonia and 147 of the influenzal form of the disease were received. The number of notified cases removed to hospital for treatment was 134. Polio-Myelitis and Polio-Encephalitis. There were 2 cases of this disease notified during the year. The following table gives particulars of the cases and subsequent history to end of 1929:— Sex. Age. Date of notification. Where treated. Subsequent history. F. 4 Aug. 19th, 1929 St. Giles' Hospital Diagnosis not confirmed. Recovered. F. 7 Sept. 21st, 1929 Belgrave Hospital Died. Puerperal Fever and Puerperal Pyrexia. There; were 8 cases of puerperal fever notified during 1929, and 7 of them received institutional treatment: 4 in St. Giles' Hospital, 2 in M.A.B. hospitals, and 1 in The General Lying in Hospital. The number of puerperal pyrexia cases reported was 24, and of these 20 received institutional treatment. Thirteen notifications were received from private medical practitioners and 11 from institutions and nursing homes. Public Health (Smallpox Prevention) Regulations, 1917. In accordance with the requirements of Ministry of Health Circular 939 the following is a statement of the number of 69 vaccinations performed by the Medical Officer of Health during 1929:— (a) Primary Vaccinations Nil (b) Revaccinations Nil Tuberculosis. The Borough Tuberculosis Dispensary is situated at 19, Brunswick Square. Staff.—The staff of the Dispensary consists of a Tuberculosis Officer, an Assistant Tuberculosis Officer, 3 Tuberculosis Health Visitors, L part-time Dispenser, 1 Clerk (who also occupies the position of Secretary to the Tuberculosis Care Committee), 1 Assistant Clerk, and 1 Porter. The statistics relating to tuberculosis and the work of the Dispensary for the year is contained in a separate section of this report on pages 89—104. Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was taken during the year under the above-named Regulations relating to tuberculous employees in the milk trade. NON-NOTIFIABLE DISEASES. Measles. Epidemics of measles happen about every two years in London. The last epidemic occurred in 1928. Measles, with its associated complications, is responsible for a high mortality rate among young children, and also results in a large number of damaged recoveries. The apathy and ignorance of the public with regard to the serious complications which are so likely to occur with this disease is, in these enlightened days, deplorable, notwithstanding the endeavours of this Department to educate the public by the systematic distribution of health leaflets. At the end of the year under review a scheme of control was adopted and a plan of campaign established for the epidemic expected to occur in 1930. This scheme of control aims at securing through the local public health and the school organisation services the earliest possible notification of cases to the Medical Officer of Health; impressing on parents the fact that measles is a dangerous disease; improving the care and nursing of children suffering and convalescent from measles, and by removing to hospital infected children unsuitably housed and those suffering from complications. The number of cases of measles which came to the knowledge of the Public Health Department during the year through reports from schools, parents and Health Visitors was 548. The Department was able to secure the removal of 60 patients to the hospitals of the Metropolitan Asylums Board for treatment. 70 The home visiting of patients suffering from measles is conducted by the women sanitary inspectors, who also arrange for the attendance of the district nurses where necessary. In recent years serum from human convalescents who have suffered from an attack of measles has been used with great success in the prevention of this disease. Most of the supplies of this serum, which are extremely small, are obtained from adult volunteers tested for freedom from diseases conveyable to the recipients through the serum. During the year under review the Metropolitan Branch of the Society of Medical Officers of Health considered and approved of a scheme for making measles serum available to Local Authorities in London, but until adequate supplies become available it will be necessary to restrict its use to very young children, particularly those who are delicate. Whooping Cough. Whooping cough is not a notifiable disease in this Borough, and consequently the Department is dependent on information of cases obtained through the agency of the head teachers of elementary schools in Camberwell. v During the year 730 cases were reported in this way. Every patient was visited by the women sanitary inspectors, and in those cases where professional nursing assistance was required the Council provided the services of a district nurse. The health visitors also continued the practice which has been in operation for many years of leaving a card, containing valuable information about this disease, at every home visited by them after notification of birth. The deaths from this cause during 1929 numbered 66, which are shown, distributed in age groups, in the subjoined table:— Whooping Cough—Age Distribution Table. Under 1 year. 1-2 years. 2-5 years. 5-15 years. Males 10 12 13 1 Females 9 15 6 Influenza. Influenza was extremely prevalent during the first three .months of 1929. The type of the illness was mild, but the extreme cold weather in February and March last year was very unfavourable for those in the decline of life who were attacked by the disease. There were 145 notifications of influenzal pneumonia received during 1929, and of these 114 were reported in the first three months of the year. The number of deaths ascribed to influenza during 1929 was 102. Of these deaths 92 persons died from influenza pneumonia. 71 In January, 1929, the Minister of Health drew the attention of Sanitary Authorities to the Memorandum on Influenza issued in January, 1927, in which general sanction was given to Local Authorities for medical assistance (including nursing) for the poorer inhabitants of their districts suffering from this disease. Although the etiology of influenza remains obscure and consequently there is no specific prophylactic available yet, the ravages of this disease can be lessened by the public carrying out certain elementary precautions. The individual can reduce his chance of contracting the disease by keeping up his general bodily resistance, avoiding as far as possible badly ventilated rooms and other places of resort where large numbers of people congregate, and by spraying the nose and throat with a mild antiseptic solution. Most important of all is the necessity of immediate isolation as soon as symptoms of the disease appear. Bacteriological Examinations. The bacteriological examination of specimens was continued to be conducted by Dr. Bousfield, pathologist, St. Giles' Hospital, in the laboratory at the hospital. The following summary furnishes in detail the number and the result of the specimens submitted during the year. The total number of specimens examined during the year was 4,446. The numbers respectively received and examined were:— Swabs for Diphtheria 2,420 Positive 410 Percent, positive 16.9 Sputa for tubercle 1,968 „ 319 ,, ,, 16.2 Widal reactions 10 ,, 1 ,, „ 10 0 Faeces for typhoid 1 „ 0 „ ,, 0.0 Milks (Grade "A," etc.) 21 Ice Creams 2 Bath waters 13 Miscellaneous 11 Total specimens 4,446 The arrangements made for the examination of urgent specimens at night or at holiday times at Dr. Bousfield's laboratory, 6 De Crespigny Park, were continued, and practitioners availed themselves of these voluntary emergency facilities to a greater extent than ever before. Over 200 specimens were dealt with in this way when the hospital laboratory was closed. The immunisation against diphtheria of the children in the scattered homes under the control of the Board of Guardians has maintained the number of swabs from that quarter at a minimum. The children have remained free from diptheria. Disinfection. Returns of the work carried out at the Disinfecting Depot and Cleansing Station appear on pages 74 and 75. 72 73 TABLE OF NOTIFIABLE INFECTIOUS DISEASES, 1929. Disease. Total Cases Notified. Admitted to Hospital. Notifications and Age Distributions. 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. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Small Pox *120 120 2 1 2 2 5 22 29 19 18 6 12 2 Cholera, Plague — — — — — — — — — — — — — — Diphtheria and Croup 669 652 17 37 44 63 72 292 64 25 38 11 5 1 Scarlet Fever 1,043 957 5 25 47 60 87 488 144 78 84 20 5 — Enteric Fever 12 10 — 1 — — — 1 1 3 6 — — — Acute Influenzal Pneumonia 145 82 7 6 6 8 1 10 5 12 30 12 33 15 Acute Primary 127 52 8 16 13 11 4 15 3 4 19 13 16 5 Erysipelas 125 53 2 2 1 1 — 5 2 10 20 10 47 25 Cerebro-spinal Meningitis 4 4 1 — — — 1 1 1 - — — — — Poliomyelitis 2 2 — — — — 1 1 — - — — - — Malaria 3 — — — — — — — — - 2 — 1 — Dysentery 1 — — — — — — — — - — 1 — — Encephalitis Lethargica 5 5 — — — — — 1 — 1 2 — — 1 Typhus Fever — — — — — — — — — - — — — — Relapsing Fever — — — — — — — — — - — — — — Continued Fever — — — — — — — — — - — — — — Ophthalmia Neonatorum 18 6 18 — — — — — — - — — — — Anthrax 1 1 — — — — — — — - — 1 — — Glanders — — — — — — — — — - — — — Puerperal Fever 8 7 — — — — — — — - 8 - — — Puerperal Pyrexia 24 20 — - — — - - - - 17 7 — — Totals 2,307 1,971 60 88 113 145 171 836 249 152 244 81 119 49 *Includes one notification of a patient subsequently returned from hospital as not suffering from the disease. 74 DISINFECTING DEPARTMENT. RETURN OF WORK, 1929. Articles Disinfected. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. Beds 109 95 115 131 121 109 110 82 113 269 234 204 1,692 Blankets 544 464 565 724 518 546 509 661 612 957 966 736 7,802 Bolsters 85 67 94 99 123 96 91 70 93 278 289 261 1,646 Books, Public Library 71 58 366 73 119 59 88 15 99 102 92 65 1,207 Cushions 34 50 48 69 35 27 35 13 22 148 150 127 758 Curtains 6 — 15 35 20 32 8 — — 75 91 98 380 Carpets 8 12 18 88 65 18 25 4 22 136 187 128 711 Mattresses 67 62 81 92 117 73 78 59 75 184 183 139 1,210 Palliasses — — — 6 — 4 2 — 4 4 4 2 26 Pillows 269 243 283 352 317 251 279 238 276 716 697 548 4,469 Quilts 187 158 199 221 213 171 169 114 137 421 442 394 2,826 Sheets 149 145 182 247 218 202 209 140 191 526 483 449 3,141 Wearing apparel (suits, dresses, etc.) 3,300 2,670 3,099 4,026 1,490 2,689 2,958 647 3,294 10,328 7,997 5,426 47,924 Totals 4,829 4,024 5,065 6,163 3,356 4,277 4,561 2,043 4,938 14,144 11,815 8,577 73,792 Mattresses re-tabbed 67 62 80 90 110 70 76 52 70 180 178 135 1,170 Palliasses re-tabbed — — — 6 — 4 2 - 4 4 4 2 26 Cushions re-tabbed 4 6 8 9 5 6 5 3 2 18 14 20 100 Totals 71 68 88 105 115 80 83 55 76 202 196 157 1,296 Mattresses and Palliasses destroyed 48 51 42 90 53 81 61 119 104 74 13 21 757 Miscellaneous articles destroyed 31 57 109 94 33 56 97 5 19 14 27 25 567 Totals 79 108 151 184 86 137 158 124 123 88 40 46 1,324 Houses visited 419 336 429 474 511 396 391 390 410 728 646 534 5,664 Rooms disinfected 257 220 296 365 358 302 301 219 334 608 535 480 4,275 Totals 676 556 725 839 869 698 692 609 744 1,336 1,181 1,014 9,939 75 DISINFESTATION. RETURN OF WORK, 1929. Jan. Feb. Mar. Apr. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals. Persons cleansed, Vermin:— Adults— Males 4 1 1 1 3 4 2 1 2 - 1 - 20 Females — — — — - — — — - - — - — Children- Males 18 17 32 31 — 26 35 2 24 36 37 14 272 Females 170 154 170 100 131 285 26 186 306 191 141 1,860 Persons cleansed, scabies:— Adults— Males 1 - - - - - - - - 1 2 — 4 Females 1 2 2 — — 1 1 - — — — — 7 Children- Males 97 91 102 30 — 11 31 5 46 39 86 55 593 Females 66 91 69 65 — 1 7 2 23 31 118 87 560 Persons cleansed, Smallpox contacts:— Adults— Males 5 — — 21 14 9 2 - 9 43 48 26 177 Females 7 — 2 16 22 11 4 — 16 51 61 31 221 Children- Males — — — 16 12 5 1 — 3 24 34 13 108 Females — — — 14 9 2 1 — 2 16 31 15 90 Verminous rooms disinfected 5 1 12 23 46 51 27 48 71 23 13 10 330 Verminousbedding disinfected 1 1 2 1 4 10 4 8 19 10 2 2 64 76 MATERNITY AND CHILD WELFARE. The Borough Council's Scheme of Maternity and Child Welfare includes the following activities:— 1. The provision of two maternity wards, each containing six beds. 2. The establishment of three Municipal Infant Welfare Centres and a Municipal Ante-natal Clinic. 3. Financial assistance to 6 of the 7 Voluntary Centres undertaking infant and maternity work in the Borough. 4. The home visiting of expectant and nursing mothers and children. 5. Convalescent Home treatment for mothers and infants. 6. The provision of home nursing for sick mothers and infants. 7. The supply of milk free or at half price to necessitous mothers and children. 8. Arrangements for the care of unmarried mothers in approved Homes. 9. Hospital treatment for mothers and infants. 10. Payment for professional services rendered by midwives to necessitous patients. 11. The distribution of pamphlets giving advice on various matters affecting the health and welfare of mothers and infants. Municipal Maternity Ward. The number of confinements which took place in the Council's Maternity Wards during the year was 313, and the number of births 316. The number of patients who had difficult confinements was 25, which included one cæsarean section, 24 forceps deliveries, 9 for maternal distress, and 15 for foetal distress. In 4 instances labour had to be induced, and in 5 cases the manual removal of adherent placenta under a general anæsthetic was necessary. There were 19 premature births; of these. 3 were still-born, one infant died at 2 hours, and another 6 hours after birth. These infants weighed 3½ lbs. and 3 lbs. respectively. 8 infants were discharged with their mothers on the 14th day, having gained in weight, but in 6 instances it was necessary for the infants to remain in the hospital for a period of 6 to 7 weeks. 6 children were born with abnormalities, one with a deformity of the right hand—digits missing, 3 with hæmatoma of scalp, one with spina bifida and one monstrosity. 4 slides were taken of eye discharges, and in one case gonococci were found on examination, which resulted in the mother 77 and baby being transferred for treatment to the M.A.B. St. Margaret's Hospital. The number of still-births was 9, which included 5 cases of macerated foetus, one monstrosity, one spina bifida, one short cord tightly round child's neck, and in one case no foetal heart was heard on admission. The births comprised 167 boys and 149 girls. There were no> maternal deaths. Ante-natal Supervision. An important feature of the Municipal Maternity Scheme is. the compulsory attendance of every patient at the ante-natal clinic at St. Giles' Hospital. The attendances during 1929 numbered 1,497, and the number and nature of the unsatisfactory conditions found as the result of the pre-natal examination of patients appear in the following summary: — 37 patients were found to be suffering from albuminuria, 8 of whom had a raised blood pressure; 4 of these cases were admitted to the General Ward for treatment and the remainder responded satisfactorily to diet advised. 5 cases of vomiting responded to dietary and rest. There were 21 cases of external version. 6 patients were X-rayed for the purpose of ascertaining lie of foetus. 5 patients suffered from heart trouble, 2 of whom wereadmitted to hospital for complete rest. (i patients had a flat pelvis—2 needed induction at the 38th week of pregnancy. 2 patients were treated for ante-partum haemorrhage. 2 cases of sleeplessness were given advice with satisfactory results. 1 patient with a nasal abscess was warded for incision. 1 patient suffering from pleurisy was admitted and treated in General Ward. Dental attention was advised for 6 patients and the necessary treatment was obtained in each case before confinement. f> patients had varicose veins; bandaging and rest was advised with good effect. One patient was warded for complete rest. 1 case of cystocele received correctional treatment. 6 Wassermann tests and 3 specimens of vaginal discharge were taken with negative results. 2 patients were found to be suffering from hvdramnos. 2 patients with a rash yielded to treatment. Pi>st-)iatal Stipervision. Every patient was examined before leaving the Ward for the purpose of the discovery and treatment of any after-effects of confinement. 78 2 patients suffered from post-partum haemorrhage, in one case due to a severe bilateral tear of cervix. There were 8 cases of retroversion, which were all adjusted. in 2 cases the mothers returned to hospital at a later date for removal of pessaries. Medical Review. 1924 1925 1926 1927 1928 1929 Number of ante-natal examinations 666 745 651 1,665 1976 1,497 „ ,, abnormalities and diseases requiring treatment found 36 35 78 182 214 109 ,, ,, patients confined— (a) Normal labour 99 167 138 255 290 288 (b) Abnormal labour 15 21 15 45 24 25 ,, ,, after results of confinement requiring treatment 3 14 9 24 31 10 „ „ births 116 189 155 305 317 316 ,, ,, children born with any abnormality 3 9 4 3 13 6 ,, ,, deaths— (a) Premature births 5 1 1 2 1 2 (6) Still-births 4 8 4 10 7 9 (r) Children before discharge of patient - - 1 - - - (d) Maternal Deaths — — 3 1 1 — Bookings, Opening Date to December 31st, 1929. Medical reasons for Admission. First Confinement only. First Confinement & Housing. Housing Difficulties. Total Confinements. 1923 - 2 - 1 3 1924 3 3 49 59 114 1925 6 22 67 93 188 1926 7 20 65 61 153 1927 16 47 124 113 300 1928 17 145 31 121 314 1929 26 16 5 26 96 313 Totals 75 404 362 544 1,385 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 1926 148 77 53 18 66 82 1927 145 72 52 21 59 86 1928 137 44 67 26 59 78 1929 153 22 94 37 85 68 Totals 811 287 391 129 303 508 79 Infant Welfare Centres. The infant welfare work in Camberwell is undertaken by three Municipal Centres and seven voluntary institutions. It is satisfactory to record that increased use was made of the Centres during last year, the attendances being considerably over 4,000 in excess of the 1928 figures. The number of home visits also show an increase. During the year three voluntary centres followed the example of the Bird-in-Bush Centre by establishing special "toddlers'" clinics, and a return of these activities, together with tables of work carried out at all the centres in the Borough, appear in the following pages. MUNICIPAL AND SUBSIDISED INFANT WELFARE CENTRES. RETURN OF WORK, 1929. CLINIC ATTENDANCES. Infant Welfare Centre. Consultations. Children—Attendances at Consultations. Expectant Mothers. Post-Natal Mothers. First Attendances. Subsequent Attendances. Miscell. Attendances. Doctor's Consultations. Superintendent's Consultations. Doctor's Consultations and Weighings. Weighing only. Total. Attendances— Dental Clinic. Under 1 year. Over 1 year. Under 1 year. Over 1 year. Camberwell Municipal, 140, Camberwell Road. 92 - 175 36 1594 714 319 60 - 1781 678 2838 - Dulwich Municipal, 114, Lordship Lane. — - 210 41 2102 1323 373 138 - 2995 543 4049 - Peckham Municipal, St. Jude's Hall, Meeting House Lane. - - 162 13 1686 513 389 71 - 1644 659 2763 - Bird-in-Bush, 616, Old Kent Road. 481 121 305 59 3623 1238 2973 2252 — — 5225 — Cambridge House, 6, Addington Square. 25 84 191 16 1687 1069 — 1167 1796 — — 2963 — *Cobourg, Kempshead Hall, Kempshead Road. 61 2259 136 112 1299 845 - 2392 — — — 2392 160 Nunhead, 96, Nunhead Grove. - - 245 26 3621 1173 - 2403 - — 2662 5065 — St. Luke's, 2, Commercial Road. - - 230 32 2540 1675 268 1988 2489 — — 4745 — Union of Girls' School, 17, Peckham Road. - 95 281 50 3641 2463 — 2742 3693 - — 6435 — Do. Amott Rd., E. Dulwich - 50 270 48 4009 2943 231 2496 4774 — — 7501 — Totals 659 2609 2205 433 25802 13956 1580 16430 15004 6420 4542 43976 160 * Not subsidised by the Council. 80 RETURN OF VISITS. Infant Welfare Centre. Analysis of Visits. Expectant Mothers. Children Attending Centre. After Notification of Birth. Before attending Centre. Miscellaneous and other Visits not defined. Visits by Voluntary Helpers. Visits to Mothers & Children not attending the Centre. Total Visits. First Visits. Subsequent Visits. First Visits. Subsequent Visits. Camberwell Municipal, 140, Camberwell Road. 120 108 10 408 330 4 80 - 1941. 3474 Dulwich Municipal, 114, Lordship Lane. 100 12 101 373 453 198 - 1004 2307 Peokham Municipal, St. Jude's Hall, Meeting House Lane. 88 41 12 908 392 303 - 934 2738 Bird-in-Bush, (31(1, Old Kent Rd. 135 321 96 2580 438 - - 4706 8276 Cambridge House, 6, Addington Square. 96 98 51 1427 259 - - 2574 4505 Cobourg, Kompshead Hall, Kempshead Road. 150 399 130 1820 433 — 501 430 3809 Nunhead, 90, Nunhead Grove 138 337 273 2128 472 — — 3390 6738 St. Luke's, 2, Commercial Road 68 52 11 1119 324 - 453 2284 4306 Union of Girls' School, la, Peckham Road. 177 124 60 607 330 1233 3527 6064 Do., Amott Rd., E. Dulwich 115 193 22 2408 379 191 5207 8575 Totals 1194 1685 832 13958 3822 2405 954 26002 50852 * Not subsidised by the Council. MOTHERCRAFT CLASSES. ATTENDANCES. Infant Welfare Centre. Sewing Class. Health Talk. Sewing Class and Health Talk. Massage Clinic. Camberwell Municipal, 140, Camberwell Road - - 322 Dulwich Municipal, 114, Lordship Lane; — — 401 Peckham Municipal, St. .hide's Hall, Meeting House Lane - - 351 Bird-in-Bush, 010, Old Kent Road - - 3525 Cambridge House, 6, Addington Square 481 453 — *Cobourg, Kempsliead Hall, Kempshead Road - - 1041 Nunhead, 90, Nunhead Grove - - — St. Luke's, 2, Commercial Road - - 714 Union of Girls' School, 15, Peckham Road 29 188 - Do. Amott Road 432 708 — Totals 942 1,409 6,414 * Not subsidised by Council. 81 TODDLERS' CLINICS. Infant Welfare Centre. Opening Date of Session. Number of Sessions held 1929. Number of Individual Children on Register. Number of Individual Children who Attended Clinic between Ages Total Attendances. 18 months and 2 Years. 2-3 Years. 3-5 Years. Bird-in-Bush, 616, Old Kent Road December 6th, 1927. 48 176 33 74 95 626 St. Luke's, 2, Commercial Road, Peckham May 28th, 1919. 23 166 36 54 76 565 Union of Girls' School, Amott Road, Peckham July 11th, i929. 23 293 82 91 120 975 Union of Girls' School, Peckham Road July 18th, 1929. 24 129 21 50 58 473 82 Maternal Mortality. The ill-health of expectant mothers and the difficulties and risks attending child-birth and their relationship to the subject of Maternal Mortality in Child-birth continued to engage the attention of the Ministry of Health and Public Health Authorities during the year. In 1928 the Ministry of Health set up two important Committees—one to consider the working of the Midwives Acts and the other to advise upon the application to Maternal Mortality and Morbidity of the medical and surgical knowledge at present available, and to enquire into the need and direction of further research work. This latter Committee, to assist their investigations into the subject of reference, sought the co-operation of Medical Officers of Health in the completion of an Inquiry Form, which had been specially drawn up by the Committee, in every case of a maternal death associated with pregnancy or child-birth occurring in the district. In Circular (No. 934) issued by the Ministry dated October, 1928, it was stated that if the Local Authority finds that the proper investigation of these cases involves additional expense, reasonable expenditure for this purpose would be approved. The Council accordingly authorised the employment of the services of an Obstetric Consultant to collaborate with me in such cases which appeared to require special obstetric knowledge. During the year 5 cases were referred to the Obstetric Specialist to conduct the inquiry into the circumstances of the death. There were 11 maternal deaths registered as belonging to Camberwell according to the information provided by the Registrar General, representing a mortality rate of 2.79 per thousand births. Of these, 7 were ascribed to puerperal sepsis. The prevention of serious morbidity and mortality from puerperal sepsis is largely dependent on the early recognition of the infection, and to secure this end all cases of puerperal pyrexia occurring in a woman within 21 days after child-birth or miscarriage are now required to be notified. There are nevertheless still a number of cases every year where institutional treatment is delayed until the disease is so advanced that the prospect of recovery is remote. In my opinion every case of puerperal sepsis should as soon as it is diagnosed be admitted to a M.A.B. hospital where special facilities are available for the treatment of such patients suffering from this disease. Post-Natal Maternal Care. The importance of post-natal supervision is beginning to be recognised by women, and it is to be regretted that it has not reached the stage of general adoption. 83 Experience has shown that frequently a woman suffering from chronic ill-health dates her suffering from the birth of a child. The establishment of post-natal clinics where the diagnosis and treatment in the earliest stages of such sequelae of parturition as might manifest themselves after the conclusion of the lying-in period calls for early consideration. It is by means of post-natal maternal care conducted at special clinics that a mother's return to health can be rendered as complete as possible, and in my opinion this field of preventive medicine rivals in importance the routine supervision and examination before delivery. Maternal Mortality in Child-birth. Ante-natal Clinics. Ante-natal Supervision. In August of last year the Ministry of Health issued as an official document for the guidance of Local Authorities and their officers a Memorandum which had been prepared by the Maternal Mortality Committee on Maternal Mortality in Child-birth— Antenatal Clinics, their conduct and scope. The suggestions set forth in the Memorandum were, in my opinion, of such importance that I reported fully on the subject of the Ministry's proposals and the present position relating to ante-natal supervision in Camberwell to the appropriate Committee of the Council, of which the following is an extract of the principal points of interest: — The Memorandum lays down the principles on which antenatal care should be based, and these are (1) the prevention of difficult labours as far as this can be done by efficient examination; (2) the early detection and treatment of toxaemia; (3) measures against infection and for increasing resistance to infection; (4) the diagnosis and treatment of venereal disease; (5) co-operation between the clinic and those responsible for the care of childbearing women; (6) the educational effect of a well-organised clinic. The Memorandum further deals with the application of these principles and the sub-division of the Ante-Natal Clinic as follows : (a) the Consulting Clinic; and (b) the Clinic for routine examination or the Examination Clinic. The Consulting Clinic staffed by obstetricians of standing to •leal with diseases requiring specialist's advice and treatment is in my opinion an essential part of any scheme and should be held on hospital premises and staffed by hospital obstetricians. The suggestion relating to the establishment- of Consulting Clinics is an estimable one, and possibly offers the best inducement to the professional attendants to make use of such clinics f 2 84 in cases where consultation with a specialist in obstetric knowledge is necessary. The organisation of the Examination Clinic or clinic for routine examination is very clearly set out. There only remains to draw attention to the most important point referred to, viz., that it is not advisable to hold such clinics on hospitals' premises and that such clinics should be easily accessible. The selection of the personnel is of the greatest importance. The Medical Officer, it is stated, whether whole or part time, should be trained and experienced both in obstetrics and antenatal work, and should preferably have held a resident appointment in a Maternity Hospital with experience at its ante-natal clinic. Failing this, at least three months' post-graduate instruction at a recognised school should be required if the Medical Officer has had no recent obstetrical experience. Obstetrical experience in general practice is extremely valuable, but should be supplemented by post-graduate training or experience in ante-natal work. The nurse to assist the Medical Officer should be a midwife with post-certificate experience in obstetrics and ante-natal work. The importance of careful record keeping and for the proper interchange of information is stressed as well as the necessity for co-operation with hospitals. Subsidiary activities of the clinics are also referred to and mention is made of the supply of sterilised maternity outfits for labour, at cheap rates, also the supply at wholesale prices of suitable antiseptics to midwives. In necessitous cases the provision of food and milk is stated may be desirable. The scope of ante-natal examinations, including their extent and frequency , is set out, and here 1 should like to emphasise the statement in the Memorandum that, generally speaking, treatment of abnormal conditions is not the work of an ante-natal clinic. Any cases requiring treatment beyond simple measures should be referred wherever possible to the family doctor or to a consulting clinic or a hospital. Tt is evident that the clinic is to be a clearing house and an educational establishment. Reference is also made to the need for the distribution to patients attending the clinic of an "Advice Leaflet." I have accordingly prepared some practical notes relating to personal hygiene, clothing and feeding, etc., which I purpose bringing into use at once at the existing Municipal Ante-Natal Clinic. The final words of the Memorandum which draw attention to the importance of co-operation between the clinic and the professional attendant as well as the accurate keeping of records are of considerable interest. Existing Ante-Natal Care Facilities in Camberwell. There are at present three Ante-Natal Clinics in the Borough in association with Tnfant Welfare Centres, namely, Camberwell 85 Municipal Centre, the Bird-in-Bush and Cobourg Centres. Ante-natal examinations are also conducted at the Cambridge House Centre when required. The Municipal Centre is, however, less circumscribed in its activities as compared with the other clinics, inasmuch as patients may be sent there for examination and advice from any address in the Borough. The Municipal Scheme of Maternity accommodation also provides for the ante-natal supervision of the mother, and in addition to the pre-natal clinic at St. Giles' Hospital for Municipal and General Ward patients, professional supervision of the expectant mother is also undertaken at General Hospitals, Maternity Hospitals and other institutions. Institutional confinements represent approximately 30 per cent, of the total births occurring annually in the Borough, private medical practitioners attend approximately 33 per cent, and midwives the remainder. A certain amount of professional supervision is given by private medical practitioners and midwives to patients booked for confinement in their own homes, but the only reliable information available as to the measure of pre-natal supervision is that provided by the institutional confinements. The importance of ante-natal supervision for every pregnant woman cannot be overstated, and with the active co-operation of doctors, midwives, hospitals and the officers of the Local Authority there is every reason to expect that much of the ill-health of •expectant mothers and the difficulties and risks attending childbirth will be prevented. Co-operative action is the keynote of the terms of the Memorandum, but I feel that in the present state of uncertainty concerning the duties and responsibilities of local authorities in matters relating to the health services any action designed to comply with the requirements of the Minister of Health should be deferred pending the receipt of the administrative scheme of the arrangements proposed to be made by the London County Council for discharging the functions transferred under Part I of the Local Government Act, 1929. I am of this opinion for the reason that the position of the midwife is such as to influence very considerably the whole question of the application of the principles of ante-natal care. A comprehensive scheme of ante-natal supervision should embody as a first principle the direct supervision by the Officers of the Local Authority of all practising midwives in the area. At present such supervision is undertaken by the L.C.C., and until these duties are delegated any attempt to secure co-ordination of effort is, in my opinion, not likely to meet with much success. In conclusion, I append tables relating to the situation, sessions and personnel of the Ante-Natal Clinics in the Borough and particulars showing the number of births and the Maternal Mortality rate in each year since 1920. 86 Ante-Natal Clinics. Situation. Sessions. By whom conducted. Nurse in attendance. Camberwell Munioipal Centre, 140, Camberwell Road. Every second and fourth Thursday in month, at 11 a.m. Medical Officer of Health Health Visitor for district. Bird-in-Bush Centre, 616, Old Kent Road. Every Friday, 2 p.m. Doctor specially appointed for purpose. Do. Cobourg Centre, Kempshead Road. First Monday in month, 2.30 p.m. ' Infant Welfare Centre Clinic Medical Officer. Do. Number of Registered Births and Maternal Mortality Rates. Year 1920. 1921. 1922. 1923. 1925. 1925. 1926. 1927. 1928. No. of Births 7,505 6,301 5,802 5,657 5,146 4,877 4,584 4,232 4,135 Maternal Mortality Rates 1.86 2.53 2.58 3.53 3.30 2.66 3.27 4.01 4.35 87 Nursery Schools. With a view to securing systematic health visiting of children up to the age at which they enter school, and to the early detection and treatment of all defects or diseases, the Minister of Health and the President of the Board of Education, in an Official Circular dated Dec. 5th last, requested local Education Authorities and Maternity and Child Welfare Authorities to consider the provision of Nursery Schools for children between 2 and 5 years old and the extension of the present arrangements of health visiting and medical examination and treatment of children. It was also suggested that in some areas Maternity and Child Welfare Authorities may decide to supplement these arrangements by the provision of Day Nurseries. The systematic health supervision of the pre-school child from the date when it is first able to "toddle" is a matter of first importance. Many of the defects of children found on medical examination as school entrants are acquired between the years of 2 and 5. These defective physical conditions could, in the majority of cases, be corrected if mothers would cease to regard the period of an Infant Welfare Centre's usefulness to be at an end as soon as the child began to "toddle." The Circular suggests that the proposals outlined by the respective Ministers are not to be regarded as the only method of attacking the problem. There are no Nursery Schools in Camberwell, but it is perhaps appropriate to state that the slow development of the Nursery School movement by the Authority concerned has been met by this Council by an alternative method to secure systematic medical inspection of children under 5 years by encouraging the establishment of special " Toddlers " Clinics at. Infant Welfare Centres in the Borough. The first of these clinics was started in December, 1927, and during last year three other Centres have followed this example. A return of the work of the special clinics is set out in the table which appears on page 81. Any further consideration of these special clinics will depend on the success, after extended trial, of this effort to secure the systematic medical inspection of "toddlers" and to the action which may be taken by the Education Authority in London with regard to the provision of Nursery Schools. This Council has consequently adjourned for the time being further consideration of the Official Circular. Supply of Milk for Expectant and Nursing Mothers and for Infants. The Milk Applications Committee met regularly every week throughout the vear to consider applications from necessitous 88 persons for milk under this Council's Milk Distribution Scheme, and authorised the distribution of upwards of 195,500 pints of milk, together with 2,220 lbs. of dried milk, during the period January to December, 1929. The issues were made in accordance with the provisions of Ministry of Health Circular Xo. 185 as follows: — 1. (a) Nursing mothers; (b) Expectant mothers in the last three months of pregnancy, and (c) Children up to 3 years of age, and exceptionally to children between 3 and 5 years of age. 2. The quantity of milk supplied at less than cost price must not ordinarily exceed one pint per day per person, but in the case of infants between 3 months and 18 months in exceptional cases 1£ pints a day may be supplied. In cases where the Committee were not satisfied as to the correctness of the information supplied in the application, inquiries were instituted before a grant was made. There were no instances where it was necessary to take any action beyond administering a caution to certain applicants who had neglected to comply with the instructions contained in the form of application, or who had failed to notify this department of a change in the domestic circumstances of the family whilst the order was in progress. The Committee's grant to applicants was, generally speaking, for a period of 28 days. Hospital Treatment for Mothers and Infants. During the year the Council made a contribution, with the appipval of the Ministry of Health, towards the cost of the inpatient treatment of a mother and her infant in a special dietetic hospital, for the purpose of re-establishment of breast feeding, and in another instance authorised payment of the full cost of an infant's accommodation in a residential nursery for the treatment of cleft palate and hare lip. Convalescent Home Treatment. Five mothers and infants were sent for convalescent treatment following confinement for a period of 14 days and also 6 children for a term of 28 days. The patients were sent to Ministry of Health approved Homes, viz., All Saints' Hospital, Eastbourne, and the Hertfordshire County Council Home, St. Leonard's-on-Sea. 89 Home Nursing Services. The nursing of maternity and infectious disease cases arising out of maternity, of specified cases of illness in children under 5 years, and also of the diseases set out in the Infectious Diseases (London) Regulations, 1927, continued to be carried out by the following nursing associations operating in the Borough: — The Ranyard Nurses; Camberwell District Nursing Association; Rotherhithe District Nurses; The East Dulwich and Dulwich Village Nursing Association, and Nurse Thomas, who is responsible for the nursing duties in the St. George's Parish of Camberwell. With the exception of the East Dulwich and Dulwich Village Nursing Association, who undertake the work of district nursing without financial assistance from this Authority, the Council pays each Association one shilling per visit to cases nursed and approved by the Medical Officer of Health. REPORT OF THE TUBERCULOSIS MEDICAL OFFICER FOR THE YEAR 1929. The Current List of Notifications of Tuberculosis in Camberwell as at December 31st, 1929. At December 31st, 1929, there were 2,591 cases of tuberculosis on the current list in Camberwell. There were 1,812 cases of pulmonary tuberculosis—1,000 males and 812 females, and 779 cases of non-pulmonary tuberculosis—425 males and 354 females. TABLE I. Number of Individual Cases on the Tuberculosis Register (Camberwell, at the end of the years 1926, 1927, 1928 and 1929 respectively. Year. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Male. Female. Total. Male. Female. Total. 1926 1,092 834 1,926 414 373 787 1927 983 738 1,721 386 350 736 ] 928 965 769 1,734 395 342 737 1929 1,000 812 1,812 425 354 779 On Table I the number of notifications on the Tuberculosis Register in Camberwell at the end of the years 1926, 1927, 1928 and 1929 respectively are compared. Table II supplies an analysis under age periods, sex and the broad grouping of pulmonary and non-pulmonary forms. 90 TABLE II.— INDIVIDUAL NOTIFIED CASES ON CURRENT LIST, DECEMBER 31st, 1929. Age Periods. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and upwards Totals. Pulmonary—Males — 1 19 36 101 134 222 228 172 64 23 1,000 ,, Females — 1 15 35 139 143 187 159 74 42 17 812 Non-Pulmonary— Males 4 36 86 112 81 37 23 26 10 9 1 425 ,, Females 2 18 63 73 68 45 45 17 13 5 5 354 91 TABLE III. Individual Notified Patients on Current List at December 31st, 1929' allocated to the wards of the borough. Wards. Pulmonary Non-Pulmonary Grand Total. Males. Females. Total. Males. Females. Total. 1 100 67 167 42 32 74 241 2 49 29 78 16 19 35 113 3 64 55 119 26 16 42 161 4 82 77 159 29 27 56 215 5 42 23 65 40 32 72 137 6 47 23 70 24 26 50 120 7 96 93 189 40 37 77 266 8 60 50 110 29 26 55 165 9 61 41 102 26 18 44 146 10 38 28 66 21 14 35 101 11 45 35 80 25 20 45 125 12 32 55 87 25 14 39 126 13 40 36 76 9 9 18 94 14 35 39 74 15 11 26 100 15 29 34 63 12 10 22 85 16 47 38 85 12 7 19 104 17 40 20 60 16 17 33 93 18 58 38 96 10 11 21 117 19 30 24 54 7 6 13 67 20 5 7 12 1 2 3 15 The Notification of Tuberculosis in Camberwell in 1929. The number of primary notifications of tuberculosis in Camberwell in 1929 was 495; 393 were cases of pulmonary tuberculosis and 102 were cases of non-pulmonary tuberculosis. On Table IV the number of primary notifications yearly since 1921 are compared. 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 1927 451 353 98 1928 465 363 102 1929 495 393 102 On table V is given the primary notification rate (per 1,000 population of Camberwell) for the last nine years. 92 TABLE V. Year. Population. All Forms. Pulmonary Tuberculosis. Other Forms. 1921 267,198* 2.80 2.22 0.58 1922 270,300a 2.41 1.87 0.54 1923 272,300a 2.40 1.85 0.55 1924 273,700a 2.04 1.52 0.52 1925 275,400a 1.78 1.35 0.42 1926 276,400a 1.80 1.43 0.40 1927 271,100a 1.66 1.30 0.36 1928 260.400a 1.78 1.39 0.39 1929 256,900a 1.92 1.52 0.39 * Census, 1921. a Estimated. On Table VI the summary of notifications for the year 1929 is treated in more detail. 93 TABLE VI. Summary of Notifications during the Period from December 28th, 1928, to December 28th, 1929. Notifications on Form A. Notifications on Form B. Notifications on Form C. Number of Primary Notifications. Total Notifications on Form A. Number of Primary Notifications. Total Notifications on Form B. Poor Law Institu tions. Sanatoria. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and upwards. Total Primary Notifications. Under 5 5-10 10-15 Total Primary Notifications. Pulmonary— Males — — 4 3 24 30 49 38 39 29 6 222 301 - - - - - 119 202 „ Females — — 1 7 36 44 42 19 13 5 4 171 227 - - - - - 111 130 Non-Pulmonary— Males 5 8 19 5 7 4 2 5 2 — 2 59 80 - - - - - 10 38 „ Females 1 7 9 6 8 6 4 — — — 2 43 58 - - - - - 13 26 94 On Table VII the primary notifications of 1929 are allocated to the Wards of the Borough. TABLE VII. Primary Notifications of 1929 Allocated to the Wards of the Borough. Wards. Pulmonary. Non-Pulmonary. Grand Total. Males. Females. Total. Males. Females. Total. 1 10 8 18 8 2 10 28 2 17 13 30 3 1 4 34 3 15 9 24 2 — 2 26 4 12 13 25 2 2 4 29 5 10 5 15 7 6 13 28 6 9 4 13 4 5 9 22 7 12 12 24 2 4 6 30 8 18 8 26 3 5 8 34 9 12 11 23 2 3 5 28 10 6 4 10 1 1 2 12 11 7 7 14 2 1 3 17 12 11 12 23 6 1 7 30 13 12 4 16 3 2 5 21 14 11 10 21 3 2 5 26 15 17 6 23 4 3 7 30 16 12 10 22 1 — 1 23 17 13 11 24 4 1 5 29 18 11 10 21 — 1 1 22 19 5 7 12 1 2 3 15 20 2 7 9 1 1 2 11 Table VIII. Supplemental Return. New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during 1929 otherwise than by notification on Form A or on Form Ji under the Public Health (Tuberculosis) Regulations, 1912. The information is obtained from the certificates of death and from irregular notifications made after death. 95 Table VIII—supplemental return, 1929. Age Periods. 0-1 1-5 5-10 10-15 I 15-20 20-25 25-35 35-45 45-55 55-65 65 and upwards. Totals. Pulmonary—Males - - - - - 2 - 2 - - 2 6 „ Females - - 1 - - - - - 1 3 9 7 Non-Pulmonary—Males - 1 1 — 1 - 1 1 — - — 5 „ Females — 3 — 1 1 — 1 1 — — - 7 90 On Table IX the supplemental returns for 1929 are allocated to the Wards of the Borough. TABLE IX. Wards. Pulmonary, Non-Pulmonary. Grand Total. Males. Females. Total. Males. Females. Total. 1 1 1 2 — 2 2 4 2 - - — 1 — 1 1 3 - 1 1 — 1 1 2 4 - 1 1 — — — 1 5 - — — — 1 1 1 6 - — — — — — — 7 - 1 1 — — — 1 8 - — - — — — — 9 1 — 1 1 1 2 3 10 - — — — — — — 11 - — — 1 — 1 1 12 1 — 1 — — — 1 13 - — — — 1 1 1 14 — 2 2 - — — 2 15 1 — 1 1 — 1 2 16 1 — 1 1 — 1 2 17 - — — — — — — 18 1 1 2 - — — 2 19 - — - - 1 1 1 20 - - - - - - - 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. TABLE X. Year. Number of cases of Tuberculosis discovered by the Public Health Department after death. 1921 88 1922 83 1923 73 1924 69 1925 69 1926 34 1927 33 1928 26 1929 25 Death from Tuberculosis (Camberwell), 1929. The number of deaths from tuberculosis in Camberwell during 1929, as stated by the Registrar-General, was 280. Of these, 239 were from pulmonary tuberculosis and 41 from other forms of the disease. On Table XI the deaths from tuberculosis (Camberwell) during 1929 are detailed under sex, age periods and broad sub-division of the disease. TABLE XI.—DEATHS FROM TUBERCULOSIS, 1929. Age Periods. Under 1 1-2 2-5 5-15 15-25 25-45 45-65 65-75 75 and upwards Totals. Pulmonary—Males — — — 2 23 60 53 5 - 143 „ Females — — — 6 33 33 22 — 2 96 Non-Pulmonary—Males 1 — 1 7 3 5 3 — — 20 Females 1 1 5 6 6 1 1 — — 21 97 98 TABLE XII. Showing the Occupation of 159 Males who died from Tuberculosis in 1929. Acetylene Gas Generator 1 Motor Engineer 2 Art Engraver 1 No Occupation 1 Baker (Journeyman) 1 Omnibus Conductor 2 Builder (Master) 1 „ Inspector 1 Baby Carriage Painter 1 Porter (Coal) 2 Book binder 1 „ (Tailor's) 1 Blacksmith 1 (Railway) 2 Boot Shop Assistant 1 Painter (House) 2 „Repairer 2 Postman 2 Basket Maker 1 Presser (Tailor's) 1 Brush Dealer 1 Pensioner (Army) 1 Brass Finisher 2 Plumber 2 Barman 2 Provision Maker (Preserved) 1 Carman 2 Printer's Assistant 2 Carpenter 6 „ Warehouseman 2 Clerk (Solicitor's) 1 Photographic Printer's Developer 1 „ (Bank) 1 „ (Railway) 1 Postal Sorter 2 „ (Dispatch) 1 Packer 2 „ (Commercial) 2 Police Constable 1 „ (Insurance) 1 Petty Officer (R.N.) 1 „ (Shipping) 2 Process Engraver 1 „ (Wharf) 1 Plasterer 1 „ (Accountant's) 1 Plater 1 Carpenter's Journeyman 1 Railway Engine Driver 1 Cook 1 „ Stoker 1 Cartage Contractor 1 „ Lampman 1 Chemist's Assistant 1 „ Station Foreman 1 Compositor 2 Radio Mechanic 1 Dock Labourer 5 School 9 Draper's Warehouseman 1 Ship's Broker 1 Dairyman 1 Shop Assistant 4 Electrician 3 Stationer's Messenger 1 „ Mate 1 Steel Bender 1 Engineer (Laundry) 1 Saleman (Sports) 1 Fitter (Engineer's) 3 School Teacher 1 2 (Steampipe) 1 Storekeeper 1 Fish Curer 2 Soldier 1 Grocer's Assistant 1 Surgical Instrument Journeyman 1 General Dealer 2 Hatter 1 Stoker (Factory) 1 Hawker 1 Seaman (R.N.) 1 Joiner (House) 1 Taxicab Driver 2 Journalist 1 Tar Pavior 1 Kitchen Porter 9 Traveller 1 Labourer 2 Trunk Maker 1 „ (Builder's) 1 Typewriter Repairer 1 ,, (General) 5 Under School Age 2 „ (L.C.C.) 1 Warehouseman (Dresses) 2 Licensed Victualler 2 Watchman (Laundry) 1 Mantle Maker 1 Warehouseman (Tea) 1 Motorman (L.C.C.) 1 (Textile) 1 Motor Mechanic 1 159 Motor Driver 2 99 TABLE XIV. Return showing the Work of the Dispensary during the Year 192!). Diagnosis. Pulmonary. Nonpulmonary. 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):— (a) Definitely tuberculous 105 69 1 — 10 6 11 7 115 75 ] 2 7 (6) Doubtfully tuberculous - — — — — — — — 34 39 5 6 (c) Non-tuberculous — — - - - - - - |141 158 79 77 B.—Contacts examined during the year (a) Definitely tuberculous 35 29 4 6 5 3 5 1 40 32 9 7 (b) Doubtfully tuberculous — — - - - - - - 11 26 3 3 (c) Non-tuberculous - - - - - - - - 80 168 193 193 C.—Cases written off the Dispensary Register as (a) Cured 2 2 — — — — 1 2 2 2 1 2 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 254 381 279 274 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 720 599 59 54 148 219 199 142 868 818 258 196 (b) Diagnosis not completed - - - - - - - - 11 7 - 4 TABLE XIII. Showing the Occupation of 115 Females who died from Tuberculosis in 1928. Book Folder 1 No occupation 2 Bedding Cutter 1 Photographic Finisher 1 Button-hole Maker 1 Printer's Assistant 1 Clerk 6 Pattern Hand 1 Cook 1 Paper Bag Maker 1 Dressmaker's Assistant 2 School Child 13 Dressmaker 2 Showroom Assistant 1 French Polisher 1 Shorthand Typist 1 Finisher (Mantle) 1 Stockroom (Underclothes) 1 Gown Examiner 1 Shop Assistant . 5 Gramophone Tester 1 Transfer Worker 1 Housewife 52 Under School Ago 8 Housekeeper 1 Waitress 2 Laundry Worker 2 115 Milliner 3 Music Teacher 1 100 1. Number of persons on Dispensary Register on January 1st 2,060 9. Number of patients to whom Dental Treatment was given at or in connection with the Dispensary 11 2. Number of patients transferred from other areas and of "lost sight of" cases returned 25 10. Number of consultations with medical practitioners :— (a) At Homes of Applicants 43 3. Number of patients transferred to other areas and cases " lost sight of " 86 (b) Otherwise 712 11. Number of other visits by Tuberculosis Officers to homes 499 4. Died during the year 155 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 5,934 5. Number of observation cases under A (6) and B (b) above in which period of observation exceeded 2 months 30 13. Number of (a) Specimens of sputum, &c., examined 948 (b) X-ray examinations made in connection with Dispensary work 152 6. Number of attendances at the Dispensary (including Contacts) 4,678 14. Number of Insured Persons on Dispensary Register on December 31st 1,224 7. Number of attendances of non-pulmonary cases at Orthopaedic Outstations for treatment or supervision - 15. Number of Insured Persons under Domiciliary Treatment on December 31st 571 8. Number of attendances at General Hospitals or other Institutions approved for the purpose of patients for:— 16. Number of reports received during the year in respect of Insured Persons :— (a) " Light " treatment 47 (6) Other special forms of treatment 103 (a) Form G.P. 17 25 (b) Form G.P. 36 775 101 Institutional (Residential) Treatment of Camberwell Patients in 1929 through the London County Council. 420 applications for residential treatment were received during 1929, and 386 patients were admitted to various institutions. The London County Council used beds in the following institutions for Camberwell patients: — Adults. Hospitals. Sanatoria. Brompton. King Edward VII. Northern. Burrow Hill. Eversfield. King George V, Godalming. St. Luke's, Lowestoft. Frimley. Grove Park. Holy Cross. St. Anthony's Northamptonshire. City of London. Hermitage. Liverpool Road. Grosvenor. King George's. Hawthorndene. Colindale. Maltings Farm. Royal National. Pinewood. Royal Sea Bathing. National, Benenden. King's College. Rushdene House. Old Manor House. Fairlight. Children. Hospitals. Sanatoria and Homes. Highwood, Brentwood. Nayland. Alexandra, Hip. Alton, Lord Mayor Treloar's. Heatherwood, Ascot. Millfield. Princess Mary's. Metropolitan Convalescent. Queen Mary's. East Anglian. East London. Victoria Convalescent. City of London. Royal Orthopaedic. Royal Waterloo. 102 TABLE XV. Housing accommodation of 495 families in which there was a Primary Notification of Tuberculosis in 1929. Number of families occupying 1 Room. 2 Rooms. 3 Rooms. 4 Rooms. 5 Rooms. 6 Rooms or more. Patient living alone 37 18 2 5 - - „ „ with 1 other 6 24 24 5 2 - „ 2 „ 15 22 38 18 6 6 „ 3 „ 2 7 35 21 11 14 „ 4 „ 1 10 19 23 9 11 „ 5 „ 1 5 10 13 6 5 „ 6 „ 3 2 7 9 8 5 „ 7 „ — 2 6 4 2 3 „ 8 „ — — 3 2 3 - „ 9 „ — — 2 — 1 2 „ 10 „ — — — — - — Total 65 90 146 100 48 46 TABLE XVI. Sleeping accommodation for 495 tuberculous cases notified for the first time in 1929. The figures refer to the Tuberculosis Nurse's first home visit. The patient slept— In separate room In 160 cases. Alone in bed with 1 other in room „ 51 „ „ 2 others „ „ 30 „ „ 3 2 „ 12 „ „4„ „ - „ In bed with 1 person and no others in room „ 146 ,, „ 1 „ 1 other in room „ 33 „ „ 1„ 2 others „ „ 18 „ „ 1 „ 3 „ „ 11 „ „ 1 „ 4 „ „ 10 „ In bed with 2 persons and no others in room „ 14 „ „2 „ 1 other „ - „ „ 2 „ 2 others „ „ 1 „ „ 2 „ 3 „ 2 „ In bed with 3 persons and no others in room „ 3 „ „ 4 „ „ 4 „ 495 103 The Care Work of the Tuberculosis Dispensary, 1929. The 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 1929: — 1. 92 Dispensary patients received extra diet. 2. 11 patients received dentures. Those who could afford it paid a little. Approved Societies contributed in the case of insured patients and the remainder was contributed from the Borough Dental Scheme. 3. 115 cases were specially helped in their application to the Guardians for assistance. Thus patients received relief in money, food, extra diet, convalescence, clothes, etc. 4. 15 cases were assisted in their application to the British Red Cross Emergency Fund. Thus pensioners received such assistance as money, clothing, beds, bedding, etc. 5. 19 cases were assisted in their application to the United Services Fund. In this way ex-Service men or their families obtained money, clothing, beds, bedding, convalescence. 6. We assisted the London County Council in many ways in making arrangements for the institutional treatment of 386 patients. 7. We ensured that all patients going to sanatorium who could not afford the travelling expenses received vouchers from the L.C.C. covering their fare to sanatorium. 8. We did our best to settle all home difficulties that threatened to bring patients home from sanatorium too soon. 9. We co-operated with the Charity Organisation Society in over 28 cases, and our tuberculosis patients received much benefit thereby. 10. We co-operated with the Invalid Children's Aid Association in 56 cases. 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 L.C.C. and elsewhere. 104 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 were able to obtain beds and bedside comforts for several advanced cases. 14. Other patients were helped, for example, in the way of clothing, boots, convalescence in the country by kind donors. 15. To a very large number of patients personal help in discussing difficulties was freely given WILLIAM BRAND, Tuberculosis Officer. 105 INDEX. h page Agriculture Produce (Grading and Marking) 51, 58 Ambulance Services 14 Ante-Natal Supervision 83 Area 5 Bacteriological Examinations 71 Bakehouses 38 Baths,Swimming 16 Births— Notifications of Births Act 7 Registered number of 7 Cancer 9-11 Cerebro-Spinal Meningitis 66 Clinics and Treatment Centres 18 Closet Accommodation 19 Convalescent Home Treatment 89 Cowkeepers 35 Dairies and Milkshops 35 Deaths— Registered number of 8 Table of 8, 9 Diphtheria— Anti-toxin 63 Immunisation 63—65 Disinfection and Disinfestation 71, 74—75 Drainage 19 Dysentery 67 Eating Houses 41 Encephalitis Lethargica 67 Enteric Fever 66 Erysipelas 67 Factory and Workshop Act 33-35 Fish Premises 38,39 Food— Dairies and Milkshops 35 Diseased meat, etc. 42, 43 Fish premises 38, 39 For Export 38 Inspectors' Reports 38-58 Meat Regulations 40 Milk (see under Food and Drugs Acts) 35—37,& 46, 47 Poisoning, suspected 16 Restaurants and Eating Houses 41 Food and Drugs Acts— 44—58 Agriculture Produce Act 51, 58 Artificial Cream Act 47 Butter 45 Formal and Informal Samples 44, 52 Inspector's Summary 58 106 INDEX—Continued. Food and Drugs Acts—continued pace Legal Proceedings 58 Margarine 45 Merchandise Marks Act 44, 49-51 Milk— 46, 47 Condensed Milk Regulations 47 Milk and Dairies Consolidation Act 46 Milk and Dairies Order 47 Dried Milk Regulations 47 Preservatives in Food 48 Raisin Wine 48 Samples Adulterated, Tables 54—57 Health Services for the Area 14 Hospital Treatment 88 Hospitals 14 Housing— Insanitary Areas 29 Inspection of Houses 29 New Houses 29 Overcrowding 30 Rent and Mortgage Interest (Restrictions) Act 31 Statistics 32 Underground Sleeping Rooms 31 Ice Cream 39 Infantile Mortality 11 Table, Metropolitan Boroughs 12 Table, Stated Causes 13 Infant Welfare Centres 79-81 Infectious Diseases 58—69 Infirm Persons 20 Influenza 70 Insanitary Areas 29 Malaria 67 Maternal Mortality 82 Maternity and Child Welfare 76-89 Maternity Ward 76—78 Measles 69 Meat Regulations 40 Midwives 15 Milk- Circular No. 185 88 Dairies and Milkshops 35 Designated Milks 36 Distribution Scheme 88 (See also under Food and Drugs Acts) Mortuary, Public 15 Nursery Schools 87 Nursing Services 89 Ophthalmia Neonatorum 67 Oranges, Maggots in, 41 Outworkers . 34 Overcrowding 30 Paratyphoid Fever 66 Persons, Aged or Incapacitated 20 Pneumonia 68 Polio-Encephalitis 68 Polio-Myelitis 68 107 INDEX— Continued. page Population 6 Raisin Wine 48 Rats and Mice Destruction Act 20 Rent and Mortgage Interest (Restrictions) Act 31 Restaurants and Eating Houses 41 Sale of Food Order 40 Sanitary Circumstances of Area 19 Inspection Tables 22-25 Summary of Legal Proceedings 28 Summary of Notices Served 28 Summary of Sanitary Orders Tables 26 Scarlet Fever 68 Sewer Emanations 21 Sickness or Invalidity, Causes of 11 Slaughterhouses 41 Smallpox 58-62 Smallpox Prevention Regulations 69 Smoke Abatement 19 Staff 3 Statistics, Summary of 5 Street Markets 41 Swine Fever 41 Swimming Baths 16 Toddlers Clinics 81 Tuberculosis 69, 89-104 Deaths from and Table 96 Dispensary Care Work 103 Dispensary, Return of Work 99 Housing Accommodation of Patients—Table 102 Individual Notified Cases—Tables 90 Institutional Treatment Summary 101 Notifications—Tables 89, 91 Occupational Tables, Deaths 98 Primary Notifications—Tables 94 Supplemental Returns—Tables 95 Underground Sleeping Rooms 31 Vaccination 62, 68 Vital Statistics 5 Whooping Cough 70 Zymotic Death Rate 9