65888 CAM 40 Report of the Medical Officer of Health. Public Health Department, 35, Brunswick Square, Camberwell, S.E.5. 25th June, 1934. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Mr. Mayor, Aldermen and Councillors, I have the honour to present to you my Annual Report for the year 1933 which has been prepared in accordance with the requirements of the Ministry of Health. The Minister requests that this report should be in the nature of an Ordinary Report and not a Survey Report. During the year the good health of the inhabitants of the Borough continued to be maintained, in fact 1933 was one of the healthiest years in the history of Camberwell. The Infantile Mortality Rate was 49 per 1,000 births, the lowest rate ever recorded for the Borough. The general death rate was 12 33 per 1,000 of the estimated resident population as compared with 12-02 in the previous year. The Tuberculosis Death Rate was the same as in 1932, viz., 1.00 per thousand. We owe this favourable health record to a large extent to the improvements in our sanitary environment; a pure water supply; effective sewerage; the prevention and control of infectious disease, and last but not least, the education of the public in matters appertaining to their own health and that of their children. It is interesting to note that the birth rate further declined from 14-57 in 1932 to 13-32 last year. I desire in presenting this Report of taking the opportunity of thanking the members of the Council and in particular the members of the Public Health and the Maternity and Child Welfare Committees for their assistance and kind consideration throughout the year, and to place on record my appreciation of the help which the stall of the Public Health Department has at all times readily furnished me. I am, your obedient Servant, H. W. BARNES, Medical Officer of Health. Staff of the Public Health Department at the end of 1933. Medical Officer of Health and Administrative Tuberculosis Officer. H. W. Barnes, B.A., M.B., B.Ch., D.P.H. Hon. Consulting Medical Officer of Health. F.J.Stevens, M.A., D.M. Tuberculosis Medical Officer. W.Brand, B.A., M.B., C.M. Assistant Tuberculosis Medical Officer. E.A.Gorrie, M.B., Ch.B. Bacteriologist. G.W.J.Bousfield, M.D., B.S.(Lond.). Consultant Gynaecologists and Obstetricians. A.L.Walker, M.A., M.B., B.Ch., F.R.C.S. F. Cook, B.Sc. (Lond.), M.B., B.S., F.R.C.S. Diphtheria Prevention Clinic Medical Officer. G.W.J.Bousfield,M.D.,B.S.(Lond.). Public Analyst. Martin Priest, F.I.C. Medical Officers —Municipal Infant Welfare Centres. The Medical Officer of Health. Margaret N.Dunstan, M.8., Ch.B., D.P.H. J.H.Clatworthy, M.U. Florence E.Cowlin, M.R.C.S., L.R.C.P. C. E. Donaldson, B.A., L.M.S.S.A. Public Vaccinators. St. George's District H. J.Gater, L.M.S.S.A., L.S.A Camberwell „ E. W. G.Masterman, M.D.,F.R.C.S. Peckham „ A. B. Blomfield, M.R.C.S., L.R.C.P. Nunhead „ G. H. Fisher, L.A.H. East Dulwich „ A. F. McMillan, M.B., Ch.B. Dulwich „ G.W.FitzHenry, M.R.C.S., L.S.A. Vaccination Officer. H. Cooper. Sanitary Inspectors—Male. Dist. Dist. 1. M. Leonard Malins. a 6. Donald Glenday. a 7. Donald H.Pickard, M.C. a 2. Fred. Maughan. a 8. William T.Worsfold. b 3. Harry W. Leonard. a 4. Arnold L.Dobson. a 9. Henry C.Green, a 10. Maurice Malins. a 5. Leslie W.Burrell. a Sanitary Inspectors—Female. Miss F. o'Riordan, Maxwell Lefroy, Gold Medallist. a, d *Mrs. M. Scudmore. b, d * Also Infant Life Protection Visitor. 3 SUMMARY OF STATISTICS FOR THE YEAR 1933. Area of Borough in Acres 4,480 Population (Estimated resident population mid-1933) 243,700 Population (Census 1931) 251,294 No. of inhabited houses (end of 1933) according to Rate Books 42,765 Rateable Value £1,631,814 Sum represented by a penny rate £6,507.73 Number of live Births 3,247 Birth Rate 13.32 Number of Deaths 3,005 Death Bate 12.33 Infantile Mortality:— Deaths under 1 year 160 Infantile Deaths per 1,000 Births 49 Maternal Mortality:- Deaths of Women from Diseases or Accidents associated with Childbirth 16 Per 1,000 live births 4.92 Maternal Death Rate Per 1,000 total births 4.77 Deaths from Phthisis 223 Phthisis Death Rate 0.91 Deaths from all forms of Tuberculosis 245 Tuberculosis Death Rate 1.00 Social Conditions of Camberwell, including the Chief Industries carried on in the Area. Camberwell is a district in South-east London; 4¾ miles from west to east, about 2½ miles from north to south, and 4,480 acres in area. The manufacture of gas, and its associated products, is the outstanding industry in the district. Other industries are miscellaneous in character, viz., motor and general engineering, laundries, timber yards, etc. Extracts from Vital Statistics. Total. M. F. Live Births Legitimate Illegitimate 3,148 99 1,589 52 1,559 47 Birth rate per 1,000 of the estimated resident population ... ... 13.32 Still Births ... ... 106 Rate per 1,000 total (live and still) births ... ... 13.75 Deaths ... ... 3,005 Death rate per 1,000 of the estimated resident population ... ... 12.33 Deaths from puerperal causes: — Deaths. Rate per 1,000 total (live and still-births) births. Puerperal Sepsis 6 1.79 Other puerperal causes 10 2.98 Total 16 4.77 Death Rates of Infants under 1 year of age. All infants per 1,000 live births 49 Legitimate infants per 1,000 legitimate live births 48 Illegitimate infants per 1,000 illegitimate live births 101.01 Deaths from Measles (all ages) 4 Deaths from Whooping Cough (all ages) 20 Deaths from Diarrhoea (under 2 years of age) 33 Causes of Sickness or Invalidity. There was no unusual or excessive mortality during the year, nor was the amount of sickness and invalidity, as far as could be ascertained, such as to call for any special comment in this report. During the year considerable public anxiety existed as to whether the present state of economic depression had or had not exerted a harmful effect upon the nutritional condition of the unemployed and the poorer paid workers. No satisfactory or generally accepted method of assessing the nutritional state of individuals is available, and this explains the difficulty in attempting to offer any trustworthy evidence as to the state of nutrition of the population as a whole or of any section of it. An analysis of the mortality statistics shows that death rates have not risen in Camberwell during the years of depression. Population. The Registrar-General's estimate of the population for the mid-year 1933 was 243,700, and this figure has been used for the completion of the statistical information appearing in this Report. The population of the different wards calculated upon this estimated figure is compared in the following table with that of the Ward Census enumeration which took place in 1931. Wards. Population at the Census, 1931. Estimated Population, 1933. (Middle of the Year). 1 14,489 14,051 2 13,016 12,623 3 13,189 12,791 4 14,922 14,471 5 14,421 13,985 6 12,024 11,661 7 14,672 14,229 8 14,274 13,843 9 14,888 14,438 10 7,700 7,467 11 10,833 10,506 12 12,496 12,118 13 11,022 10,689 10,485 14 10,168 15 12,234 11,864 16 13,719 13,304 17 13,861 13,442 18 16,797 16,289 19 12,123 11,757 20 4,129 4,004 Total 251,294 243,700 Vital Statistics. The vital and mortal statistics of every ward in the Borough for the year 1933 are given in the following table:- Estimated Population. Births. Deaths under 1 year Deaths all ages. No. Rate per 1000. Rate per 1000. Rate per 1000. Wards. No. No. 14,051 1 233 16.6 16 69 162 11.5 2 12,623 212 16.8 10 47 12.2 154 3 12,791 193 15.1 11 57 148 11.6 4 14,471 193 13.3 12 62 186 12.8 5 13,985 171 12.2 8 47 159 11.4 6 11,661 161 13.8 11 68 137 11.7 7 14,229 207 14.5 15 72 186 13.1 8 13,843 193 13.9 12 62 189 13.6 9 14,438 196 13.6 5 25 200 13.8 10 7,467 100 13.4 5 50 96 12.8 11 10,506 149 14.2 9 60 145 13.8 12 12,118 149 12.3 5 33 161 13.3 13 10,689 127 11.9 3 24 98 9.2 14 10,168 161 15.8 6 37 165 16.2 15 11,864 161 13.6 6 37 126 10.6 16 13,304 173 13.0 5 29 181 13.6 17 13,442 157 11.7 5 32 162 12.0 18 16,289 157 9.6 6 38 164 10.1 19 11,757 120 10.2 8 67 142 12.1 20 4,004 34 8.5 2 59 44 11.0 The Borough 3,247 3,005 243,700 13.32 160 49 12.33 Births and Birth Rates. During the year the live births after correction for inward and outward transfers, numbered 3,247, of which 1,641 were males and 1,606 females. The birth rate was 13.3 as compared with 14.6 last year, once more a decrease, and constitutes a new low record. This decline in the birth rate has been progressive for many years past, and it will be seen from the information appearing in the following table that since the Census year 1921 the annual number of births has been approximately halved. Year. Population. Births. Birth Rate. Census 1921 23.6 267,198 6,301 1922 Estimated 270,300 5,802 21.5 1923 272,300 5,657 20.8 1924 „ 273,700 5,146 „ 18.8 1925 275,400 4,877 17.7 „ 1926 16.6 275,400 4,584 1927 „ „ 271,100 4,232 15.6 1928 260,400 4,135 „ 15.9 1929 256,900 „ 3,934 15.3 1930 256,900 „ 3,809 14.8 1931 ... Census 251,294 3,704 14.7 1932 Estimated 248,000 3,614 14.6 1933 243,700 3,247 13.3 „ For comparative purposes, the birth rates for England and Wales, London and Camberwell are given in the subjoined table:- Birth rates, 1933. England and Wales 14.4 London 13.2 The Borough 13.3 Notification of Births Act. During the year 2,977 notifications were received under this Act, representing 91.7 per cent, of the number of births registered in the Borough. The following table indicates the source of notification:— No. of Births notified. Source of notification. Live Births. Still Births. 57 By Medical Practitioners 1,333 981 19 By Midwives 98 - By Parents 476 13 By Nurses and other persons 1,615 of these births or 54.2 per cent. took place in Hospitals and Private Nursing Homes. Still Births. The number of still births registered during 1933 was 106, the same number as in the previous year. Of these 3 were illegitimate births. Still births are notifiable after the twenty-eighth week of pregnancy. Information is not available as to the number of pregnancies terminated before that date, but there is reason to believe that the number of such cases is far from negligible. Deaths. The deaths registered during 1933 numbered 3,005, and equalled a rate of 12.33 per 1,000 of the population. The number of deaths was slightly in excess of the 1932 figure, when 2,983 deaths of Camberwell residents were registered. The number of deaths of children under one year of age was 160, and was 74 fewer than in 1932. Thus the Infantile Mortality Rate for the year under review was the extremely low one of 49 per 1,000 births, an unprecedented figure. The number of illegitimate deaths of children under one year was 10, as compared with 12 in the previous year. The deaths from tuberculosis, all forms, totalled 245, as compared with 248 in 1932 and 268 in 1931. The deaths from diseases of the heart and circulatory system show an increase from 808 in the preceding year to 881 in 1933. This group was responsible for the largest number of deaths, representing 29 per cent, of the total. 9 There is also to be recorded an increase in the number of deaths from malignant disease, viz., 451 as compared with 396 in 1932. The deaths from the principal diseases of the respiratory system, pneumonia and bronchitis, accounted for 300, a decrease of 48. Included in the deaths from infectious diseases were: — Diphtheria 20, scarlet fever 6, cerebro-spinal fever 4, encephalitis lethargica 5, measles 4, and whooping-cough 20. There were no deaths registered from typhoid and paratyphoid fevers. A table providing details of all deaths registered, after correction for inward and outward transfers, appears in the following table:— DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1933. All Ages. 0- 1- 25- 35- 45- 55- Sex. 75- Causes of Death. 2- 5- 15- 65- All causes M. 1,486 90 26 22 36 63 80 100 165 249 384 27l 14 13 64 78 127 495 F. 1,519 70 26 61 208 363 Typhoid and Paratyphoid Fevers M. - - - - - - - - - - - - F. - - - - - - - - - - - - Measles M. 1 - - 1 - - - - - - - - F. 3 1 2 - - - - - - - - - Scarlet Fever M. 5 - 3 1 1 - - - - - - - 1 - - - F. 1 - - - - - - - Whooping Cough M. 13 7 5 1 - - - - - - - - F. 7 3 1 - 3 - - - - - - - Diphtheria 11 2 4 - 1 - M. 4 - - - - - - F. 9 2 - 3 4 - - - - - - Influenza M. 44 - 1 1 2 4 8 9 9 5 5 - 54 1 1 3 1 F. 1 - 8 5 14 20 - Encephalitis lethargica M. - - - 1 - - - 2 - 3 - - F. 2 - - - 1 1 - - - - - - Cerebro-spinal Fever M. 2 - - 1 - - - 3 - - - - F. 1 1 - - - - - - - - - - Tuberculosis of respiratory system M. 132 1 1 2 20 36 26 26 12 8 - - F. 91 - 1 35 23 13 12 - 3 3 1 - Other tuberculous diseases M. 13 - 2 1 2 4 1 1 - 2 - - 1 1 4 1 1 1 F. 9 - - - - - Syphilis M. 9 - 1 - - - 1 4 1 2 - - F. 4 1 1 - - 1 1 - - - - - General paralysis of the insane, tabes dorsalis M. 13 - - - - - 5 4 3 - - - F. - - - - - - - - - - - - Cancer, malignant disease M. 211 - - - - - 11 34 57 74 35 - F. 240 1 1 2 6 13 62 72 50 - 33 - Diabetes M. 10 - - - - - - - 5 2 - - F. 19 - - - 2 5 10 2 - - - - Cerebral haemorrhage, etc. M. 50 - - - 1 11 24 14 - - - - F. 72 - - 1 2 1 20 25 23 - - - Heart disease M. - - - - 6 14 22 120 332 5 61 104 F. 457 - 3 6 6 18 23 58 137 - - 206 Aneurysm M. 16 1 1 2 3 - 1 7 1 - - - F. - - - - - - - - - - - - Other circulatory diseases M. 35 - - - - 1 1 6 16 11 - - F 3 41 - - - - 2 15 21 - - - Bronchitis M. 65 4 1 - - 1 3 4 4 7 18 23 F. 67 1 1 - 2 1 6 15 41 - - - 10 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1933—contd. Sex. All Ages. 1- 2- 5- 15- 25- 35- 45- 55- 65- 0- 75- Causes of Death. Pneumonia (all forms) M. 90 6 6 6 5 6 3 7 12 16 15 8 5 1 F. 78 8 2 3 8 9 9 14 19 - Other respiratory diseases M. 21 - - 1 - 1 2 2 1 5 5 4 F. 16 - - - 2 3 - - 2 9 - - 29 - - 6 9 5 1 Peptic Ulcer M. - 2 6 - - 2 F. 5 - - 1 1 1 - - - - - Diarrhoea, etc. M. 23 18 2 1 - 1 1 - - - - - F. 13 17 - - - - 1 - - 3 - - Appendicitis M. 9 - - - 1 1 4 2 1 - - - F. 4 1 - 1 - - - 2 - - - - Cirrhosis of liver - - - - - - M. 4 4 - - - - F. - - - - - - - - - - - - Other diseases of liver, etc. M. 5 - 1 - 1 - - 1 2 - - 1 - 2 1 F. 6 - - 1 1 - - - - Other digestive diseases M. 25 2 1 - 1 - 2 2 5 3 6 3 F. 21 3 - 1 - 2 - 3 2 6 4 - Acute and chronic nephritis M. 56 - - 1 2 - - 10 11 19 14 - 2 7 F. 52 - - - - 2 10 16 15 - Puerperal sepsis - - F. 6 - - 4 2 - - - - - Other Puerperal causes F. 10 - - - - 2 5 2 1 - - - Congenital debility, premature birth, malformations, etc. M. 45 43 - - 1 - 1 - - - - - F. 29 26 2 1 - - - - - - - - Senility M. - - - - - - 3 20 17 - - - - 4 F. 59 - - - - - 55 - - - Suicide M. 22 - - - 1 2 5 6 7 1 - - F. 10 1 1 2 1 - - 5 - - - - Other Violence 6 14 6 5 8 M. 60 2 2 2 4 5 6 4 F. 35 1 2 1 2 2 3 3 8 9 - Other defined diseases M. 111 5 2 10 7 11 7 11 13 25 20 - 1 4 9 7 17 F. 94 9 10 6 16 15 - Causes ill-defined or unknown M. - - - - - - - - - - - - F. - - - - - - - - - - - - Maternal Mortality. In 1933 there were 16 deaths due to child-bearing, of which puerperal sepsis was the cause of 6 and other puerperal causes 10. The maternal mortality rate per 1,000 total births was accordingly 4-77, representing a rate of 1-79 from puerperal sepsis and 2-98 from other puerperal causes. For comparative purposes the mortality rates for the years 1932, 1931 and 1930 were 2.15, 3.39 and 5.25 respectively. The factors affecting the mother's life and health during pregnancy, delivery, and the post-partum period depend upon the provision of efficient maternity services. Our efforts must, therefore, be continued to educate all concerned to make use of these services, which include the provision of ante-natal clinics; pre-natal supervision; the services of a consultant for the mother during the period of pregnancy, at the time of confinement, and during the lying-in period. Maternal Mortality Investigation. The practice of investigating all maternal deaths was continued throughout the year, and a confidential report on Form 97/MCW was forwarded in every case to the Ministry of Health. Infantile Mortality. Of the 3,005 deaths of persons of all ages which occurred among Camberwell residents in 1933, 160, or 5.32 per cent., were in respect of infants under one year of age. It is gratifying to record that there were 74 fewer infantile deaths than in 1932. The Infantile Mortality rate, which is based upon the number of deaths in this age group per 1,000 live brths registered, is therefore 49, as compared with 65 in 1932. The principal causes of death in order of severity were: — Premature birth, enteritis, and congenital malformation. Diarrhoea and enteritis were responsible for 32 deaths, as compared with 35 in 1932. The number of deaths during the year of infants under one month old was 67, representing a neo-natal mortality rate of 20-63 per thousand births. These deaths are to a large extent due to the state of the mother's health before the child is born, and a diminution in the causes responsible for them might be effected by increased maternal supervision during pregnancy and at the confinement, as well as by the education of women in the dangers resulting from interference with intra-natal life in an endeavour to avoid the ties of motherhood. The classification of the total deaths appears in the table on page 12. INFANTILE MORTALITY TABLE. Deaths from Stated Causes at Various Ages under One Year of Age, 1933. 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. Smallpox - - - - - - - - - - Chicken Pox - 1 - - - - - - - - Measles - - - 1 1 - - - - - - - - Scarlet Fever - - - - - 4 - Whooping Cough - 1 4 4 9 - - - - - Diphtheria and Croup - - - - - - - 1 - 1 Erysipelas - - - - - 1 - 1 - - Tuberculous Meningitis - - - - - 1 1 - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - 1 - - - 1 1 - Meningitis - - - - - 1 1 1 1 4 1 Convulsions - - - - - - - - 1 Laryngitis - - - - - - - - - - Bronchitis - - - - - 2 2 - 2 6 1 2 Pneumonia - 1 - - - - 1 - Diarrhoea - 1 - - 1 3 2 1 7 - Enteritis - - 6 8 9 2 25 - - - Gastritis - - - - - - - - - - Syphilis - 1 - 1 - - 1 - - - Rickets - - - - - - - - - - Suffocation 4 - 1 1 6 - 1 - - 7 Injury at Birth 2 - - 2 - - - 2 - - Atelectasis 4 - - 4 1 - - - 5 - Congenital Malformation 1 8 2 2 - 17 5 2 5 1 Premature Birth 25 1 2 1 29 - - 29 - - Atrophy, Debility, &c. 6 2 1 1 10 3 - 1 - 14 Other Diseases 3 3 6 4 3 2 2 17 - - - - - - 4 3 Broncho-pneumonia 3 10 - - Acute Lobar Pneumonia - - - - - - - - - - Influenza - - - - - - - - - - 49 9 6 3 67 31 27 17 18 Totals 160 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Laboratory Facilities. The bacteriological work of the Council is carried out by Dr. Guy Bousfield at his laboratory at 134, Denmark Hill, S.E.5. Particulars of the bacteriological examinations carried out during 1933 will be found on page 89. The chemical analysis of food, etc., is carried out by Mr. Martin Priest at his laboratory, 4, Obelisk Parade, Lewisham. Details of these examinations appear in Table "A" on pages 68 and 69. Ambulance Facilities. The London County Council provide ambulances for infectious, non-infectious, and maternity and accident cases. Nursing in the Home. No change has taken place in the arrangements in respect of home nursing of approved cases which have been in existence for some years between this Local Authority and the Ranyard Nurses, Camberwell District Nursing Association, Rotherhithe District Nursing Association, the Brixton Nursing Association, and the East Dulwich and Dulwich Village Nursing Association. Clinics and Treatment Centres. Name and Situation. Ante-natal Clinics. Camberwell Municipal Centre, 140, Camberwell Road. Bird-in-Bush, 616, Old Kent Road. St.Giles' Hospital, Camberwell. Dulwich Hospital, East Dulwich Grove. Do. Post-Certificate Midwifery School, 77, Southampton Street, Camberwell. Minor Ailments Clinic for children under 5 years. Camberwell Municipal Infant Welfare Centre, 140, Camberwell Road. Cambridge House Infant Welfare Centre, 6, Addington Square, S.E.5. By whom provided. Camberwell Borough Council. Voluntary Infant Welfare Association. London County Council. General Lying-in Hosp., Lambeth. Camberwell Borough Council. Cambridge House— Voluntary Association. Sessions. Second and fourth Thursdays in every month at 11 a.m. Every Friday at 2 p.m. Monday, Tuesday and Thursday at 10 a.m., and alternate Fridays at 2 p.m. Every Thursday at 2.30 p.m. Monday, Tuesday and Friday at 2 p.m. Daily 9-10 a.m. Daily 9.30-10.30 a.m. Diphtheria Prevention Clinic. Camberwell Municipal Centre, 140, Camberwell Road. Camberwell Council. Borough Every Wednesday at 2 p.m. Tuberculosis Dispensary. Monday, Tuesday and Wednesday 10-12 noon and 2-5 p.m. Thursday 10-12 noon, 2-5 p.m. and 6-8 p.m. Saturday 10-11 a.m. 19, Brunswick Square, S.E.5. Camberwell Council. Borough Cleansing Station for Verminous Persons. Borough Daily—Tuesday, Wednesday and Thursday (Vermin). Monday and Friday (Scabies). Adults, Saturday 9-12 noon. Peckham Park Road Depot. Camberwell Council. School Treatment Centres. Camberwell Treatment Centre, 7, Addington Square, S.E.5. Aural—Tuesday (once a month), 2 p.m. (Operationsalternate Wednesdays, 2 p.m., at Hanover Park.) Minor Ailments.—Monday, Wednesday and Friday, 3.30 p.m. Dental. —Monday, Tuesday, Wednesday, Thursday and Friday (once a month), 9.30 a.m. Monday, Tuesday (once a month), Wednesday and Friday, 1.30 p.m. Gas- Tuesday and Friday (3 times a month), 9.30 a.m. East Dulwich Treatment Centre, 29, Amott Road, S.E.22. Minor Ailments. —Wednesday, 3 p.m. Dental. —Monday, Wednesday, Thursday (3 times a month) and Friday, 9.30 a.m. Friday, 1.30 p.m. Gas—Tuesday (3 times a month), 1.30 p.m. Peckham Treatment Centre, 412, Old Kent Road, S.E.I. Vision. —Monday, Friday, 9.30 a.m. Alternate Fridays, 1.30 p.m. An Optician attends this centre on Monday and Friday, 11 a.m. to 12.30 p.m., and alternate Fridays, 4 to 4.30 p.m., or longer if necessary. Aural. —Alternate Wednesdays, 2 p.m. (Operations-Tuesday, 2 p.m., at Hanover Park.) Minor Ailments.—Monday and Thursday, 3.30 p.m. Dental.—Monday, Tuesday, Wednesday, 9.30 a.m. Monday, alternate Thursdays, and Friday, 1.30 p.m. Gas — Tuesday (except 4th in month), 1.30 p.m., Thursday, 9.30 a.m. Rye Lane and Hanover Park Treatment Centre, 7, Hanover Park, S.E.15. Vision. —Tuesday, Thursday, 9.30 a.m. (Optician attends Thursday, 10 a.m.) Aural. —Alternate Tuesdays, 2 p.m. (Operations—Thursday, 2 p.m.) Minor Ailments.—Monday, alternate Thursdays, 3 p.m. Dental. —Monday, Tuesday, Wednesday, Thursday and Friday, 9.30 a.m. Monday, alternate Tuesdays, Thursday, alternate Fridays, 1.30 p.m. Gas —Alternate Tuesdays, Wednesday, alternate Fridays, 1.30 p.m. Minor ailments nursing treatment at the School Treatment Centres after morning and afternoon school, and on Saturday mornings. Day and time of doctor's attendance shown above. Hospitals. The following London County Council Hospitals are situated within the Borough of Camberwell: — St. Giles' Hospital: containing 810 beds. The Council lease two Maternity Wards in this Hospital—12 beds. Dulwich Hospital: containing 733 beds. Maudsley Hospital (Neurological): containing 242 beds. Transfer of Powers (London) Order, 1933. Section 64 of the Local Government Act, 1929, confers upon the Minister of Health power to make an Order on the application being made by the London County Council transferring or delegating to Metropolitan Borough Councils any functions at present exercisable by the County Council, other than Poor Law functions. In the exercise of this power the Minister of Health made the above Order which came into operation on April Ist, 1933, transferring the following public health functions and powers at present exercised by the London County Council to the Metropolitan Borough Councils, viz.:— Common Lodging Houses. —The registration, licensing, inspection and regulation of common lodging houses, and the enforcement of by-laws relating to such common lodging houses, but exclusive of the power of making by-laws, which power will remain vested in the London County Council. Cowhouses and Places for the Keeping of Cows. —The functions under the Public Health (London) Act, 1891, of licensing dairymen to use premises as a cowhouse or place for the keeping of cows. Slaughterhouses and Knackers' Yards. —The functions under Section 20 of the Public Health (London) Act, 1891, and Section 15 Municipal and Subsidised Infant Welfare Centres. Nature of Accommodation. By whom provided. Medical Sessions. Health Talk and Mothercraft Session. Situation. Maternity and Child Welfare Centres. Central Hall; waiting and lecture room; service room; Medical Officer's and weighing rooms. Private rooms Afternoons. Monday and Thursday, "Toddlers" Tuesday, and ante-natal Friday. Bird-in-Bush, 616, Old Kent Road I Voluntary Association Monday Thursday Friday. do. Cambridge House, 6, Addington Square Kempshead Hall, Kempshead Road Every Thursday. Thursday. Wednesday. Large hall; weighing room; consultation room; dental work room. do. Every Wednesday. Tuesday, Thursday and Friday. do. St. Antholin's, 22, Linden Grove Church Hall, Barforth Road and rooms in Institute, 22, Linden Grove. During Med. Sessions. Thursday. Wednesday. do. Wednesdays and Fridays. St. Luke's, 2, Commercial Road 2 rooms and hut in garden Union of Girls' Schools Infant Welfare Centres, May ward House, Brunswick Square. Ground floor of premises do. 53 of the London County Council (General Powers) Act, 1903, of (a) Licensing of slaughterers of cattle or horses or of knackers to use premises as a slaughterhouse or knacker's yard ; (b) Licensing of persons to use premises for receiving or keeping horses for slaughter or the carcases of dead horses. Offensive Trades. —The consideration of and decision upon applications for sanction to the establishment anew or enlargement of certain offensive businesses or imposition, modification or removal of conditions thereon. Infant Life Protection.—The following powers conferred by Part 1 of the Children Act, 1908, as amended by Part V of the Children and Young Persons Act, 1932:— (a) Reception of notices given by persons who undertake for reward the nursing and maintenance in a dwelling of infants, and the inspection of premises by infant protection visitors or other persons appointed by the Council for that purpose. (b) The fixing of the number of infants to be kept in a dwelling in which any infant is kept for reward. (c) Application to a Court or Justice for an order directing the removal of an infant to a place of safety. Disinfection. Disinfection of bedding and clothing is carried out at the disinfecting station in Peckham Park Road, by means of a Manlove Alliott super-heated steam disinfecting machine and an Equifex saturated steam disinfecting machine. Books, furs, leather goods, etc., are disinfected in a formalin chamber. Infectious rooms are sprayed with formalin solution, and verminous rooms are similarly treated with an insecticide fluid after the walls have been stripped. The following is a summary of work carried out by the disinfecting staff during 1933. DISINFECTING DEPARTMENT. Return OF WORK, 1933. Number of houses visited following Infectious Disease 2,556 Number of visits to these premises 5,245 Number of houses visited following other diseases 188 Number of visits to these premises 403 Number of houses visited for miscellaneous purposes 633 Number of visits to these premises 714 Number of rooms disinfected. Infectious Disease 3,687 Number of houses visited. Verminous 443 Number of rooms disinfected. Verminous 576 Number of articles disinfected (steam disinfected) 68,422 Number of articles disinfected (formalin) 3,964 Number of books disinfected 1,545 Number of articles destroyed 3,375 B 17 Cleansing of Verminous Persons. The cleansing of verminous persons is carried out at the cleansing station adjoining the disinfecting station in Peckham Park Road. Children attending the elementary schools in Camberwell found to be in a verminous condition are disinfested by this authority, by arrangement with the London County Council. The record of work carried out during 1933 is as follows:— Disinfestation. Persons cleansed, verminous— Males 17 Females - Males 500 Females 2,145 Total 2,662 Persons cleansed, scabies — Males 12 Females 5 Males 1,157 Females 1,538 Total 2,712 Public Swimming Baths. There are three Municipal swimming baths in Camberwell which are situated at Church Street, Camberwell, Goose Green, East Dulwich, and at Old Kent Road. At the Church Street Second Class Baths, swimming facilities are provided throughout the year. The water in all the swimming pools is purified by means of a filtration and aeration plant and is also chlorinated to ensure the provision of a satisfactory water for bathers. Bacteriological and chemical tests of the water at each Baths were carried out at intervals during the year and the results of these tests show that the filtration plants were at all times functioning efficiently. Public Mortuary and Coroner's Court. Monthly summary of the bodies received at the Coroner's Court, St. George's Road, Camberwell, in 1933. Males. Females. Total. Deposited to await Burial Only. Inquests. P.M.'s Month. Court Sittings January 21 16 37 Nil. 37 26 14 February 24 5 29 Nil 29 18 9 March 1 5 10 25 Nil 25 8 14 April 9 15 24 Nil 24 11 8 31 May 20 11 2 29 11 15 17 8 25 Nil 25 16 June 9 July 19 11 30 Nil 30 17 11 August 27 16 43 Nil 43 16 12 Nil September 18 9 27 27 11 6 11 29 Nil 14 October 18 29 10 November 20 16 36 Nil 36 16 15 December 21 17 38 Nil 38 21 11 Totals 374 191 229 145 2 372 128 Survey of Health Services. Reference was made in the Report for 1932 to the survey of the Public Health Services of this Council which was conducted by a Medical Officer of the Ministry of Health. In June of the year under review the following letter was received from the Ministry in which consideration was requested to be given by the Council to certain matters connected with particular services relating to public health. The Minister's observations were duly considered by the Council and are referred to in the appropriate sections of this Report. 19 attached to these centres to receive the general advice and direction which can scarcely be given by part-time medical officers working independently. Whilst it is for the Council to consider whether such an appointment is immediately practicable, the Minister feels that this development is one which should be kept in mind for execution as and when circumstances permit. It is suggested that advantage should be taken of any favourable opportunity for securing better premises for the work at present carried on at 140, Camberwell Road. It is suggested that in the case of many of the Centres the value of the service rendered would be enhanced if arrangements were made for collective instruction, in the form of short educational talks on matters connected with the care of infants, to be given to mothers by the medical officers in charge of the Centres. Protection of Food Supplies. It is understood that samples of ordinary milk are not examined for the presence of tubercle bacilli, and it is suggested that arrangements should be made for this purpose. Public Cleansing. It is understood that this service is at present receiving special consideration by a Committee of the Council. The Minister will be glad to be informed of the conclusions reached by the Council and of any measure taken or proposed to be taken for the improvement of the service. I am to request that the Minister may also be informed in due course of the result of the Council's consideration of the other suggestions made above. In conclusion, the Minister desires me to express his appreciation of the assistance which was rendered to the Inspecting Officer during the course of the survey. I am, Sir, your obedient Servant, (Signed) T. LINDSAY. The Town Clerk, Town Hall, CAMBERWELL, S.E.5. MATERNITY AND CHILD WELFARE. The Borough for the purpose of Maternity and Child Welfare services is divided into ten districts and in each district there is an Infant Welfare Centre and staff appointed to supervise the physical well-being of mothers and children under school age. The work in seven of these areas is undertaken by voluntary associations, the Controlling Committees of these Associations having the power of appointment of Health Visitors and Clinic Medical Officers for duty in their respective areas. The remaining three areas are municipally directed, the Council being responsible for the provision of the Centre premises, the appointment of Health Visitors, and Clinic Medical Officers. The Maternity and Child Welfare Scheme of this Borough also includes ante-natal services, the provision of two Maternity Wards in St. Giles' Hospital, Camberwel l; the distribution of milk to mothers and infants in necessitous cases in accordance with the terms of Ministry of Health Circular No. 185; convalescent home treatment; home nursing; consultant services for private medical practitioners who require assistance in cases of difficulty either before, during, and after confinement; institutional provision for unmarried mothers; as well as the incidental Infant Welfare service of Infant Life Protection (Children and Young Persons Acts, 1908- 1932), which became an administrative duty of the Metropolitan Local Authorities under the Transfer of Powers (London) Order, 1933. Ante-Natal Services. The following table provides particulars of the ante-natal Clinics and their situation in the Borough. Address. 140, Camberwell Road 616, Old Kent Road 77, Southampton St. St. Giles' Hospital, Brunswick Square. Dulwich Hospital, East Dulwich Grove. By whom provided. Local Authority Bird-in-Bush Infant Welfare Centre. The General Lying-in Hospital Post-Certificate School. London County Council do. Sessions and for whom. Second and fourth Thursday 10.30-12.30. (Any patient residing in the Borough.) Patients residing in the Centres district. For women to be confined in their own homes by midwives of this School. Patients to be confined in this Hospital. do. Expectant mothers seeking advice with regard to their own health are also seen by the Medical Officers at the Cambridge House and the Kempshead Hall Centres at the weekly Infant Clinic Sessions. The number of Camberwell women who were confined in hospitals and nursing homes within and outside Camberwell during 1933 was 1,615. All of these patients received ante-natal supervision at the hospital where the confinement took place. Municipal Maternity Wards. In 1923 this Council entered into an agreement with the Camberwell Board of Guardians for a period of three years for the reservation of a ward containing six beds in St. Giles' Hospital, Camberwell, for women who desired to be confined under this Authority's Maternity Scheme. In view of the demand for beds the agreement was renewed in November, 1926, for a further period of three years and the accommodation increased to two six-bed wards. Under Part I of the Local Government Act, 1929, this Institution was transferred to the London County Council as from April Ist, 1930, and a new agreement for retaining these wards was subsequently entered into with that Authority. During the year under review the L.C.C. notified this Council that the maternity work at St. Giles' Hospital was increasing to such an extent that the accommodation was becoming inadequate and that certain structural alterations were being made at the hospital which would have the effect of increasing the maternity accommodation, and that it would not be possible to make proper provision for the number of maternity cases which the Council will be required to accommodate if the wards reserved for Borough Council cases were set apart exclusively for this purpose. The London County Council therefore sought amendment of the existing agreement, so as to provide for the reception of Borough Council maternity patients on the understanding that beds would not be specifically reserved for such purpose, and that they should have the right as to the disposal of such patients within the hospital, or of admitting them to another hospital conveniently situated, if such action became necessary owing to pressure of accommodation. This Council in their consideration of this matter decided that to insist upon the exclusive reservation of the wards for municipal patients would seriously hamper the London County Council in making the best use of the hospital, and it was accordingly resolved to terminate the agreement by arrangement on March 31st, 1934. Since the transfer of the Boards of Guardians hospitals to the London County Council, the prejudice which hitherto existed of entering a Poor Law institution no longer prevails, and it has been the custom of the appropriate committee, when all the municipal maternity beds were booked, to recommend women desirous of having their confinement in a hospital to make application for a bed either at St. Giles' or Dulwich hospitals. The necessity therefore for this Authority to continue to make provision for maternity patients does not claim the same consideration to-day as in the past, as in addition to the number of beds available at the L.C.C. hospitals in this Borough and King's College Hospital, there are also other maternity and general hospitals within easy distance of Camberwell. During the year 1933 the number of forms of application received for a bed in this Authority's Maternity Wards was 403. The number of patients confined in the wards was 286. Of this number 158 were first confinements, 28 gave medical reasons for admission, and in 100 instances the housing conditions were unsatisfactory for the confinement to take place at home. Under the terms of the agreement this Authority is required to pay the sum of nine shillings per day for each occupied bed. I am indebted to the Medical Superintendent of St. Giles' Hospital for the following review of the Municipal Maternity Ward Scheme for the year:— MUNICIPAL MATERNITY WARDS, 1933. Number of patients delivered 286 Number of infants born, including 3 sets of twins 289 Number of infants born, before admission (in ambulance) 1 Number of maternal deaths 4 Number of infantile deaths 2 Number of stillbirths 9 Number of ante-natal attendances 1,864 Abnormalities requiring treatment— Albuminuria and high blood pressure — (a) Admitted to medical wards 3 (b) Treated at ante-natal clinic 7 10 Carbuncle—warded 1 Severe varicose veins—warded 1 Marked oedema of leg—warded 1 Infected cystocele—warded 1 Thrombophlebitis —warded 1 Antepartum haemorrhage—warded 4 Antepartum haemorrhage and cystocele—warded 1 Pulmonary tuberculosis —sent to sanatorium 1 Fibroid—seen by specialist 1 Hydramnios —warded 1 Influenza 1 Mitral stenosis—warded 2 Pyelitis—warded 3 All patients attending the ante-natal clinic have their blood examined by the Wassermann and Kahn tests. Positive in mother } { 1 Positive in baby }Sent to King's College Hospital for treatment { 1 External versions under general anaesthetic 3 Admitted for induction of premature labour 6 Labour— Normal labour 256 All patients offered light anaesthesia, and practically all accepted. Abnormal labour— Forceps delivery 11 Cæsarean section 2 Severe post-partum haemorrhage 4 Manual removal of placenta 2 30 Breech deliveries 5 Placenta prævia 2 Twins (sets) 3 Face presentations 1 Babies born with abnormalities 0 One baby developed ophthalmia neonatorum on the third day. Mother and baby were transferred to St. Margaret's Hospital. Maternal Deaths — Pulmonary thrombosis in first stage of labour. Pulmonary embolism on 18th day of puerperium. Post-partum haemorrhage in elderly primipara with toxaemia. Septicaemia. Had a macerated foetus, was transferred to fever hospital on third day of puerperium and died on 28th day. Infantile deaths — Atelectasis —lived 7 hours. Prematurity—lived 5 days. Still-births — (a) Forceps delivery for disproportion. (b) Lateral placenta prævia. (c) First twin of mother who died of P.P.H. (d) True knot in very long cord. Died before admission. (e) Prolapsed cord—forceps delivery. (f) Spina bifida —macerated. (g) Anencephalic monster. (h) Macerated foetus —33 weeks' development. (i) Macerated foetus. Abnormal puerperium- (a) Breast abscess 4 (6) Phlebitis 4 (c) Puerperal pyrexia 4 Post-natal abnormalities — Retroverted uterus—rectified and pessary inserted 15 Ante-natal and Post-natal facilities for patients admitted under Municipal Scheme — Eight ante-natal clinics are held weekly. In addition an obstetric specialist attends once a fortnight, and a visiting physician once a week to see patients with heart disease, or other conditions requiring special medical treatment. Dental treatment and ultra-violet rays are given when required, and X-ray photographs taken when necessary. Post-natal care is also given and patients are examined before discharge, and after an interval of a month. Midwives. Through the courtesy of the London County Council information was received that 48 midwives gave notice during 1933 of their intention to practise in the Borough. Of this number 38 are in private practice, the remainder being attached either to the St. Giles' or Dulwich Hospitals. The popularity of hospital confinements, which is no doubt due to the desire for greater comfort as well as to appreciation of the fact that in hospital there are better facilities at hand for treatment in an emergency than are available at home, is influencing the number of patients attended by midwives in private practice. Consequently there is a growing feeling that it would be better from every point of view for midwives engaged in district work to be attached to institutions or to work in group associations instead of practising independently. Midwives' Payment Applications. An application received during the year for payment of the balance of the fee due to a midwife for professional services rendered to a mother in necessitous circumstances was favourably considered and the payment of £1 was authorised by the Maternity and Child Welfare Committee. Sterilised Maternity Outfits. These outfits, for use by patients to be confined at home, can be obtained at cost price on application to the Public Health Department. The demand was very disappointing, only two outfits being sold throughout the year. There was no request for the sterilisation of bed linen, a service which is carried out free of cost. Institutional Provision for Unmarried Mothers. This Local Authority makes an annual contribution towards the cost of the maintenance of unmarried Camberwell girls boarded out by the Southwark Diocesan Association for Prevention and Rescue Work. During the year 14 Camberwell girls were placed in approved Homes and Hostels. The National British Women's Total Abstinence Union, who received an annual grant of £100 in aid of their work from this Authority, gave notice that they had decided to close their Hostel "The House of Help," 201, Camberwell Grove, as from March 25th, 1933. This Hostel provided for the reception of unmarried mothers and their babies, and the reason assigned for the discontinuance of their activities was the lack of applications for admission. SURVEY OF HEALTH SERVICES. Municipal Infant Welfare Centre Premises. The three buildings used as Infant Welfare Centres by the Council are Church premises which are not ideally planned or constructed for the purpose. The deficiencies of these premises have been realised for many years and efforts have been made to obtain the use of more suitable premises in the case of two of these Centres, but without success. The Ministry of Health in their observations to this Council, after consideration of the report made by one of the Medical Officers of the Ministry following the recent survey of the Public Health Services of the Council, referred to the Municipal Infant Welfare Centre premises at 140, Camberwell Road, as follows:- "It is suggested that advantage should be taken of any favourable opportunity for securing better premises for the work at present carried on at 140, Camberwell Road." During the year under review the Dulwich College Mission Authorities were approached with a view of ascertaining whether in the event of their undertaking the building of club premises on a site belonging to the College Authorities in Comber Grove, they would be prepared to let part of such premises to this Council for Maternity and Infant Welfare purposes. Unfortunately there appears to be no prospect at present of rebuilding operations on this site, but negotiations are still proceeding. Should these break down, however, it would seem that as there are no available alternative premises in this district which could be adapted for use as an Infant Welfare Centre, the only remaining way of meeting the suggestion of the Ministry of for the transfer of the work to more suitable premises would be for the Council to consider the question of purchasing a suitable site, the demolition if necessary of any building thereon, and the erection of an up-to-date Infant Welfare Centre. Assistant Medical Officer for Maternity and Child Welfare. The Ministry of Health also referred for consideration by the Council the question of the detailed supervision of the Maternity and Child Welfare work of the Borough, and stated that the more direct responsibility of the Council in regard to the work of the voluntary associations since the Local Government Act 1929, came into operation emphasises the need for the appointment of an Assistant Medical Officer to undertake such supervision under the direction of the Medical Officer of Health. This matter was referred by the Council to the Maternity an Child Welfare Committee who instructed me to furnish a report for their consideration. In this report I stated that in my opinion the efficiency of the Council's scheme could be promoted by the appointment of an Assistant Medical Officer for Maternity and Child Welfare to serve as a liaison officer between the voluntary centres and the Council. I accordingly outlined two schemes, the first providing for the systematic supervision by the officer appointed of the work carried out at all the centres in the Borough and the conduct of the medical sessions at the respective municipal and voluntary Infant Welfare Centres on a rota system. The alternative scheme provided for the discharge of similar duties except for an alteration in the Clinic Medical Session rota duty arrangements. The adoption of either scheme would, in my opinion, have linked up more closely the work of the voluntary associations with that of the local authority. I am also of opinion that this chain could be further strengthened by relieving the Voluntary Associations of the power of appointment of Health Visitors, and for the Council to accept the responsibility of appointing these officers for duty in the areas covered by these Associations. The Maternity and Child Welfare Committee in their report to the Council on the observations of the Ministry of Health stated that they had formed the opinion that although in view of the extent of the Maternity and Child Welfare services, the appointment of an Assistant Medical Officer was not practicable at present, it was, as indicated by the Minister, a development which should be kept in mind for execution as and when circumstances permit. Health Visitors. At the end of the year there were 14 health visitors engaged in health visiting in connection with maternity and child welfare work, eleven being employed by Voluntary Associations and three by this Authority. Part time service of two women sanitary inspectors was also occupied in visiting cases of ophthalmia neonatorum, measles, whooping-cough, puerperal pyrexia and anterior polio-myelitis. The equivalent of whole time service devoted by the whole staff to health visiting, including attendance at infant welfare centres was (a) in the case of health visitors employed by the Council, 3 1/3 and (b) by Voluntary Associations, 10½. The number of visits paid to the homes of children under school age during 1933 was 38,996 as compared with 37,801 in the previous year. The comparative number of visits to children between the ages of 1 and 5 years was 21,471 and 21,349 respectively. Tables showing attendances at all the Centres in Camberwell and details of the visits carried out by the Health Visitors appear on pages 28 and 29. INFANT WELFARE CENTRES—INFANT CLINIC ATTENDANCES, ETC., 1933. Infant Welfare Centres. Under 1 Year. Between 1 & 5 Years. Total Attendances. Analysis of Attendances, Children. Weighings only. Ante-Natal Attendances. Treatment Centre for Minor Ailments Attendances. Post-Natal Mothers for Advice Own Health. First Attendances. Subsequent Attendances. Miscellaneous. Doctors' Consultations. Seen by Health Visitor. First Attendances. Subsequent Attendances. Camberwell Municipal, 140, Camberwell Road, S.E.5 190 2,250 37 298 4,649 2,695 - 96 118 15 1,656 1,874 3,049 24 1,682 5,362 3,019 1,996 - - 204 Dulwich Municipal, 114, Lordship Lane, S.E.22 347 260 - Peckham Municipal, Clifton Congregational Church Hall, Asylum Road, S.E.15 225 3,305 34 1,394 313 5,271 2,492, 2,466 - - - 56 Bird-in-Bush, 616, Old Kent Road. S.E.15 287 3,766 48 2,344 - 6,445 3,306 3,139 - 582 - 304 Cambridge House, 6, Addington Square, S.E.5 181 2,260 58 1,485 - 3,984 1,711 2,273 - 33 260 175 Mothers' and Babies Welcome, Kempshead Road, S.E.5 St. Antholin's 22, Linden Grove, 127 1,629 45 1,084 - 2,885 1,267 1,618 - 5 90 148 St. Antholin's, 22, Linden Grove, S.E.15 290 4,851 61 2,502 - 7,704 4,448 - - 3,250 - - St. Luke's, 2, Commercial Road, S.E.15 163 2,150 37 3,756 1,527 - - - - 1,406, 2,229 - Union of Girls' Schools, 60A, Amott Road, S.E.15 206 4,364 36 3,237 7,933 5,243 - - 74 2,690 - - Mayward House, Brunswick Square, S.E.5 349 5,234 62 - 9,324 3,166 6,158 - - 315 3,679 - 2,368 32,858 442 20,687 958 57,313 26,076 4,448 716 468 1,291 25,831 * Discontinued during year. HEALTH VISITORS—RECORD OF VISITS, 1933, TO EXPECTANT AND POST-NATAL MOTHERS AND CHILDREN. Infant Welfare Centres. To Expectant Mothers. To Post-Natal Mothers. No. Births reported in the Area. To Children. Analysis of Visits to Children. Miscellaneous Visits. Visits by Voluntary Helpers. Under 1 Year. Between 1 and 5 Years. Total Visits. Between 1 and 5 Years. Under 1 Year. Attending Centre Not Attending Centre Attending Centre Not Attending Centre First Visits. Subsequent Visits. Camberwell Municipal, 140, Camberwell Road, S.E.5 229 233 282 707 1,838 2,827 132 807 169 1,719 408 - 250 Dulwich Municipal, 114, Lordship Lane, S.E.22 412 468 470 228 1,055 1,753 226 283 816 175 134 428 - Peckham Municipal, Clifton Congregational Church Hall, Asylum Road, S.E.15 224 354 328 365 892 1,211 2,468 259 918 314 977 243 - Bird-in-Bush, 616, Old Kent Road, S.E.15 148 56 368 327 2,309 3,395 6,031 1,148 1,488 1,051 2,344 - 45 Cambridge House, 6. Addington Square, S.E.5 86 264 212 297 1,269 1,983 3,549 814 752 935 1,048 80 281 Mothers' and Babies' Welcome, Kempshead Road, S.E.5 93 257 171 256 1,458 2,070 3,784 786 928 882 1,188 5 224 St. Antholin's, 22, Linden Grove, S.E.15 177 414 425 407 1,561 3,349 5,317 742 1,261 1,055 2,259 - - St. Luke's, 2, Commercial Road, 5.E.15 96 243 254 265 2,384 2,151 4,800 972 1,673 810 1,345 - 73 Union of Girls' Schools, 60A, Amott Road, S.E.15 206 326 349 326 1,802 1,880 4008* 883 919 916 964 5 326 May ward House, Brunswick Square, S.E.5 229 439 439 469 1,451 2,539 4,459 590 1,330 532 2,007 25 160 1,643 2,994 3,247 3,464 14061 21471 38996 6,552 10,504 6,947 14,667 941 1,109 * Includes voluntary helpers' visits. Home Visiting. The information provided by the notification of the Births Act marks the starting point of a system of supervision both at the Infant Welfare Centre and in the home until the child reaches school age, except in cases where the home conditions are considered to be above visiting standard. The first visit by the Health Visitor is paid as soon as possible after ten days from the birth has elapsed, and periodical visits are made for the purpose of guiding mothers in the care and management of their infants. The number of visits paid and the degree of instruction necessary varies in individual cases, but in the main the number depends upon the age of the child, the home conditions, and whether the child is brought regularly to the Infant Welfare Centre. Children under 1 year, those not attending an Infant Welfare Centre, and others where indifferent home conditions prevail are naturally visited more frequently than infants whose environmental circumstances do not call for the same measure of supervision. Post-Natal Supervision. Careful inquiry as to the state of a mother's health after her confinement is made by the Health Visitor at her first visit following the notification of birth. Mothers found to be suffering from continual backache, prolapse, phlebitis, debility, urinary or intestinal troubles, are referred to their own doctor, a general hospital, or to the Medical Officer at the Infant Welfare Centre for the district. During the year 609 mothers were thus advised by health visitors to seek medical attention. Medical examination of patients before discharge is adopted as a routine measure at most hospitals, a practice which, in my opinion, should be followed by the professional attendant in every case of confinement, so that early treatment could be given in cases of impairment of health resulting from childbirth. Pre-School Child. A large number of mothers find it difficult or do not appreciate the necessity of bringing their children over 1 year of age to the Infant Welfare Centres. It is no easy task to persuade mothers to accept advice as to the importance of periodical medical supervision during the period of growth and development of the child in order to ensure the early detection of signs of departure from the normal. Special medical sessions for " toddlers " are held at three Infant Welfare Centres in the Borough and at other Centres mothers are encouraged to bring the older children to the ordinary Infant Medical Sessions. The number of home visits paid by Health Visitors to children between the ages of one and five during 1933 was 21,471. The attendances of children in this age group at the medical sessions including the special Toddlers' Clinics in 1933 was 21,129 as compared with 18,026 in 1932. TODDLERS' CLINICS. Number of Individual Children attending these Sessions. Number of Sessions held 1933. Total Attendances. Infant Welfare Centre. Amott Road 48 701 1,805 Bird-in-Bush 48 260 1,148 508 1,408 Mayward House, Brunswick Square 47 Mothercraft and Health Talk Sessions. These Sessions are held at eight of the Infant Welfare Centres in Camberwell, and the following is a summary of the sessions and attendances recorded during the year:— Infant Welfare Centre. No. of Sessions. No. of Attendances. Average Attendance. *Dulwich Municipal 48 572 12 116 Bird-in-Bush 2,554 22 Cambridge House 12 192 16 Kempshead Hall, Kempshead Road 13 223 17 *St. Antholin's 30 484 13 St. Luke's 15 41 622 U.G.S., Amott Road 19 219 11 U.G.S., Mayward House 10 169 16 * Clinic Medical Officer also gives short talks during progress of medical session. The Maternity and Child Welfare Committee gave consideration to the suggestion made by the Ministry of Health, arising from the report of the Inspecting Officer following the survey of the Public Health Services of this Council, that the value of this service would be enhanced if arrangements were made for collective instruction, in the form of short educational talks on matters connected with the care of infants, to be given to mothers by the Medical Officers in charge of the Centres. The Committee were of opinion, however, as the result of a number of years' experience at the Infant Welfare Centres that talks of an informal character to small groups of mothers who attend from time to time at the Centres were of considerably more value than formal lectures delivered perhaps to a relatively large number of persons. Infant Life Protection. The functions relating to Infant Life Protection under Part I. of the Children Act, 1908, as amended by Part V. of the Children and Young Persons Act, 1932, were transferred by the Transfer of Powers (London) Order, 1933, from the London County Council to Metropolitan Borough Councils as from April Ist, 1933. The Council decided that these duties should be referred to the Maternity and Child Welfare Committee by virtue of Section 2 (a) of the Local Government Act, 1929, and that the three Municipal health Visitors should undertake this work within their respective districts, and that with regard to those cases outside these districts, the work be carried out by one of the women Sanitary Inspectors. The number of persons who were receiving children for reward at the end of December last was 98, and the number of boarded-out children on the register at the same date was 112. During the period from the transfer of these powers to the end of the year, 1,101 visits were paid to the homes of these children. Except in three cases in which appropriate action was taken, the home conditions were found to be satisfactory. The number of instances reported of non-compliance by foster-mothers with the provisions of the Acts was three, and in each case the Maternity and Child Welfare Committee directed that a warning notice be sent to the person concerned. Three children died whilst in the care of foster-mothers, and the facts were duly reported in each case to the Coroner for the district as required by Section 6 (1) of the 1908 Act. In no case was an inquest deemed to be necessary. No action was necessary under Section 67 of the Act of 1932 requiring the removal to a place of safety of children who were found to be improperly kept. Convalescent Treatment. Convalescent treatment is available for expectant or nursing mothers and for children under 5 years of age recommended by the Medical Officers at the Infant Welfare Centres. A proportion of the actual cost of the treatment provided is recovered from parents whose financial circumstances are such that they can make a contribution. The average period of convalescence authorised by the appropriate committee was 28 days. Eleven mothers with their infants were sent to the All Saints' Hospital, Eastbourne, and three children to the Hertfordshire County Council Home, St. Leonards-on-Sea, during the year. (c) That the supply of liquid milk be discontinued and replaced by dried milk in quantities which, when properly reconstituted, would approximate to the quantities of liquid milk. (d) That milk be only supplied at the Public Health Offices after the production of a certificate from the Medical Officer of an Infant Welfare Centre in the Borough recommending its issue, and upon personal application except in cases where, owing to medical circumstances, a visit to an Infant Welfare Centre would be inadvisable. One of the conditions of the new scheme, which will be noted, is the obligation placed upon the mother to take her children to an Infant Welfare Centre to be seen by the Medical Officer before a recommendation for milk can be entertained. The observance of this condition of issue has the merit of providing for a periodical medical overhaul and the prescription by the Clinic Medical Officer of a particular brand of dried milk best suited to the child. Issues of dried milk containing iron are also available for delicate babies and pregnant women suffering from anaemia. Experience has also shown that children fed upon dried milk can be reared successfully, and that this form of milk has this advantage that it is more suitable in homes where facilities do not exist for keeping cow's milk, particularly in the warm weather. The new scheme is working satisfactorily, and for those who have a real desire to safeguard their children's health it offers distinct medical advantages over the old scheme. In addition to a recommendation for milk, cod liver oil and virol are supplied free at the various centres for those who cannot afford to pay for these preparations, so that by this free distribution it may be stated that an adequate dietary for infants is ensured for all who pass through the Infant Welfare Centres. Measure of Co-operation between the Public Assistance Authority and this Council. Applicants in receipt of public assistance relief are ineligible for consideration under this Council's Milk Distribution Scheme, and are referred to the local Public Assistance Committee. At the request of the London County Council arrangements were made during the year for the issue of extra nourishment through the agency of the Public Health Department to maternity cases where domiciliary relief was being granted by the Public Assistance Authority, the cost of such issues being borne by the London County Council. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The Metropolitan Water Board is responsible for providing the Borough with a safe and sufficient water supply and no complaints were received with regard to this service. Drainage and Sewerage. The total reconstruction of the drains of 94 premises and the partial reconstruction of drains of 428 premises were carried out under the supervision of the sanitary inspectors. Owing to the building development which has taken place in recent years in the Peckham Rye area of the Borough, the Council decided at the end of 1932 to construct a relief sewer on the east side of Peckham Rye Common to take the considerable amount of new drainage discharging into the existing sewer. This work was put in hand without delay in order to relieve unemployment in the district, and was executed by direct labour under the supervision of the Borough Engineer and Surveyor. A similar relief sewer was also authorised to be laid on the west side of Peckham Rye Common, the work in connection with both schemes being completed in September of the year under review. Closet Accommodation. The water carriage system is general throughout the Borough except in certain outlying parts of Camberwell, where the distant situation of the public sewer renders it difficult to arrange for this method of disposal. Public Cleansing. This service is under the control of the Borough Engineer and Surveyor of this Council, and this Officer has provided the following information relating to refuse collection and refuse disposal:— (a) The method of collecting house refuse by horse-drawn vehicles was changed during the year, and collection now takes place by a fleet of end-loading, mechanical tipping refuse vehicles. (b) The method of disposal of house refuse is (i) by loading into barges on the Grand Surrey Canal; and (ii) by loading into railway trucks at Bricklayers' Arms Siding. Sanitary Inspection of the Area. A summary of the inspections carried out by the sanitary inspectors will be found on pages 36-39 of this Report. c 2 35 36 37 SUMMARY OF SANITARY WORK CARRIED OUT DURING THE YEAR 1933. INSPECTORS. Leonard. Dobson. Burrell. Glenday. Pickard. Worsfold. Green. Malins, M. Miss O'Riordan. Mrs. Scudamore. TOTALS. Malins, L. Maughan. Description of Sanitary Improvements ejected during the year— I 334 369 343 298 161 159 293 307 112 42 - 438 2,856 Number of rooms cleansed Defective roofs repaired, gutters or rain water pipes 143 89 176 173 131 87 96 141 54 - 1,175 85 provided or repaired 99 105 85 143 102 34 - 54 205 137 49 - 1,013 Dampness abated 83 57 - 42 66 38 19 33 97 46 26 - - 507 Yards and forecourts paved or paving repaired 27 31 21 27 22 9 27 7 9 18 - - 198 Water fittings repaired - 2 2 30 10 11 8 15 10 6 - 94 Drains entirely reconstructed - 19 18 72 30 52 14 41 76 7 99 - - 428 Drains partially reconstructed 64 44 84 43 42 17 51 92 64 67 3 - Soil and vent pipes renewed or repaired 571 236 213 208 239 169 62 119 168 86 89 59 1 1,649 Premises in which repairs were effected to w.c.' s 105 102 134 167 44 29 101 88 72 121 - - 963 Dustbins provided 247 100 138 159 180 39 51 77 131 51 2 - 1,175 82 Repairs effected to windows 151 143 102 66 32 45 89 63 40 - 813 - Stoves and coppers repaired 73 103 110 102 48 18 69 215 45 53 - - 836 Sinks and wastepipes repaired or renewed .. Flooring repaired or renewed, repair, to woodwork (stairs, etc.) 164 140 102 99 81 37 29 80 87 30 3 - 852 2 2 4 3 1 2 1 2 2 3 - - Ventilation and lighting improved 22 5 6 15 8 2 29 5 2 12 4 1 - 89 Offensive accumulation removed 94 108 76 Miscellaneous repairs and improvements effected 113 27 13 52 38 60 30 18 - 629 Total repairs and improvements effected 1,920 1,596 1,807 1,869 1,235 611 942 1,715 1,241 802 131 1 13,870 ... I I I "I — !' "I ! Inspections — 414 433 559 140 463 13 3 464 421 413 469 336 4,128 Following complaint 64 111 88 143 122 85 94 57 70 114 - 948 House-to-house —(1) Where defects found 20 - 29 2 26 - 1 27 25 11 23 - - (2) Where no defects found 164 208 307 326 310 304 184 185 254 242 120 - 2,440 - On occurrence of infection 245 5 - - - 22 - - - - - 272 - Houses let in lodgings 26 55 80 176 45 60 25 38 24 31 258 21 839 Factories 31 34 35 57 19 49 35 59 10 153 67 588 39 Workshops 26 55 30 87 41 8 10 6 13 80 - - 356 Workplaces 27 3 20 53 - - 9 3 - 45 13 - 173 Tenements 1 1 - - - - - 1 - - - - 3 Underground living and sleeping rooms 1 - 2 - 2 2 13 - - - - 6 Rent (Restrictions) Act 3 - 7 - 12 121 11 13 - - 42 - - 88 New buildings 171 263 166 281 121 183 99 127 220 150 - - 1,781 Milk premises - 5 24 - - - - 3 1 - - 33 - Offensive trades - - - - - - - - - - 963 398 1,361 Outworker's premises 10 2 31 12 - 11 4 - 4 1 - - 75 Rag and bone dealers 158 54 129 340 291 214 724 63 249 112 40 2,554 180 Conveniences (public and private) 2 - - - - 7 - Schools 25 38 2 - 1 5 70 23 108 8 - 48 29 - - - - 150 Common Lodging Houses - 222 291 381 118 447 201 260 107 558 177 449 125 3,336 Miscellaneous 2,159 1,219 1,977 1,082 1,938 1,210 2,179 677 19,403 1,954 1,525 1,714 1,769 Total Inspections 38 39 SUMMARY OF SANITARY WORK CARRIED OUT DURING THE YEAR 1933-continued. INSPECTORS Leonard. Malins, L. Maughan. Dobson. Burrell. Glenday. Pickard. Worsfold. Green. Malins, M. Miss O'Riordan. Mrs. Scudamore. TOTALS. 2,225 2,792 3,447 3,742 2,949 Re-inspections, Calls, &c. 2,652 3,973 1,468 1,540 34,781 3,621 2,965 3,407 1 3 15 6 6 20 Smoke observations - 5 37 5 - 98 - ; ~ Notices served — 551 301 85 853 858 788 566 347 742 479 647 Intimations 1 268 198 104 6,218 145 64 Statutory 173 147 188 208 99 3 - 1,597 1 - 1 - - - - 6 3 - Under Metropolis Management Act 1855 - - 8 1 Under Sec. 17 Housing Act 1930 - - - - - - - - - - - - Under Sec. 19 Housing Act 1930 1 - - 1 - - - - - - - - 2 432 555 723 702 714 222 396 448 527 294 77 1 Premises in respect of which notices were complied with 5,091 Premises in respect of which works in compliance with notices served during the year 1932, were outstanding at the end of the year 187 156 119 83 120 - 74 130 79 118 53 8 1,127 REFERENCE TO DISTRICTS. Inspector. Wards. Inspector. Worsflod Alleyn and parts of Lyndhurst, St. John's and Ruskin. Malins, L. The West and part of St. Giles's. Maughan Addington, Town Hall and St. Giles's (parts of). Green Nunhead, The Rye and part of St. Mary's. Malins The Hamlet, The College and parts of Ruskin and St. John's. Leonard Cobourg and parts of Marlborough and Addington. Dobson North Peckham, Clifton, Marlborough and St. Marys (parts of). Miss O'Riordan North side of Borough from a line drawn from Camberwell Green to New Cross Gate. Burre ll St. George's and parts of Town Hall and Goldsmith. Mrs. Scudamore South side of Borough from a line drawn from Camberwell Green to New Cross Gate. Glenday Goldsmith, North Peckham and Clifton (parts of). Pickard Rye Lane and parts of Lyndhurst, St. Giles's and St. Mary's. SUMMARY OF LEGAL PROCEEDINGS DURING 1933. Dist. No. Address. Complaint. Magistrate's Decision. Fine. Costs. — : £ s. d. £ s. d. 5 267, Sumner Road Dirty walls and ceilings and nuisance from smoke. Adjourned sine die. - - 2 23, Camberwell Grove Defective roof and dirty walls and ceilings Withdrawn. Work done. 0 13 6 - 7 30, Choumert Square Scullery skylight defective Do. - 0 13 6 7 28, Choumert Square Defective guttering Do. 0 13 6 - 5 21, Sedgmoor Place Dirty walls and ceilings. Defective sash and paving of washhouse. Do. - 0 13 6 5 72, Stanton Street Defective window frame, sashes and yard paving. 14 days order. - 0 15 0 3 9, Canal Place Ceiling plaster defective, ceiling dilapidated, wall plaster defective, walls dirty. Do. 1 1 0 - 3 12, Canal Place Ceilings dilapidated and defective. Positive result from drains. Manhole cover needs re-setting. Do. 1 40 1 0 - 3 9, Trafalgar Road Main roof defective Withdrawn. Work done - 0 13 6 5 15, Alder Street Damp walls and ceiling of first floor slip room. Do. 0 13 6 - 5 13, Alder Street Damp wall of ground floor kitchen Do. - 0 13 6 5 53, Jocelyn Street Smells from drain Do. - 0 13 6 5 92, Cator Street Smells from drain. Defective ceiling, dirty walls and broken sashcords. Do. 0 13 6 - 10 9, Cornflower Terrace Defective rain water pipe, dirty walls and ceilings and defective window—requires easing. Do. 0 13 6 - 5 72, Stanton Street Non-compliance Magistrate's Order - 0 0 1 1 0 5 48, Loder Street 4 Withdrawn. Work done. 0 13 6 Defective roofs and brickwork causing dampness, dilapidated walls of scullery and defective door. - 72, Stanton Street Issuing Distress Warrant 5 0 8 0 - - SUMMARY OF LEGAL PROCEEDINGS DURING 1933—continued. Address. Complaint. Magistrate's Decision. Costs. Fine. r d. £ s. d. £ s. 45, Choumert Square Dirty walls and ceilings. First floor front and staircase. Withdrawn. Work done. 0 13 6 - 42, Oglander Road Dirty walls and ceilings, defective sashcords, sink waste pipes, and dampness. Do. 0 13 6 - 11, Woods Road Dirty and dilapidated walls and ceilings, and dampness. Do. 0 13 6 - 80, St. George's Road Unlawfully constructing certain drainage work without giving notice to S.A. Dismissed. - - 1 11, Devonshire Grove Defective roofs, gutters and rain water pipes, dirty and dilapidated walls and ceilings, and dampness. 14 days order. 1 0 - 7, Canal Place Scullery not weather-proof, gutters defective, fireplace freize defective, ceiling and wall plaster defective, walls and ceiling dirty. Withdrawn. Work done. 13 41 0 6 - 8, Canal Place Defective W.C. joint. Ground floor front and back rooms walla and ceiling dirty. Do. 0 13 6 - 57, St. George's Road Defective and worn out sink in basement wash-house. Do. 0 13 6 - 55, St. George's Road Defective main roof, damp and dilapidated ceiling. Do. 0 13 6 - 32, Choumert Square Dirty walls and ceiling of first floor front room and defective guttering. 7 days order. 1 1 0 - 7, Nutbrook Street Dirty walls and ceilings, broken sashcords and sink waste untrapped. Withdrawn. Work done. 0 13 6 - 24, Crown Street Defective roof and gutter of wash-house Do. 0 13 6 Do. - 0 13 31, Nunhead Crescent Defective roof, flooring, sink and sashcords. Walls and ceiling dirty and wall plaster defective. 6 - SUMMARY OF LEGAL PROCEEDINGS DURING 1933—continued. Address. Complaint. Costs. Magistrate's Decision. Fine. £ £ d. d. s. s. 0 13 44a, Choumert Road Defective roof and gutter Withdrawn. Work done. 6 - 4, Choumert Square Roof defective, ceiling of ground floor front room defective, and dirty walls and ceilings. Do. 0 13 6 - - 27, Hollington Street Defective W.C., defective roof to wash-house and rain water pipe to main roof. Do. 0 13 6 - 22, Rye Hill Park Walls and ceilings dirty and defective and flooring defective. Do. 0 13 6 - 13, Trafalgar Road Walls and ceilings dirty and defective, dampness and foul and insanitary surround to sink. 14 days order. 3 3 0 - Kitchen wall damp, scullery and W.C. walls and ceilings dirty. Kitchen ceiling dirty. Work done. 42 15, Linden Groven Withdrawn. 0 13 6 - 0 13 6 6, Nungate Cottages Roof and gutter defective Do. 57, St. George's Road Dilapidated walls, basement front room and passage, dilapidated walls and ceiling of ground floor sliproom. 14 days order. 2 2 0 - 178, Crystal Palace Road First floor landing flooring defective, ground floor front room walls damp, passage staircase and landing walls and ceiling dirty and walls dilapidated. Withdrawn. Work done. 0 13 6 - Common Lodging Houses. The following table gives details of the accommodation available at the common lodging houses in this Borough. Ward. No. Situation of house. Number of lodgers for which licensed. Males. 1 124, Camberwell Road 245 9 168, Meeting House Lane 26 9 184, Meeting House Lane 10 10 20/22, High Street 107 14 80, Church Street 40 These houses were regularly inspected and 6 notices were served for contraventions of the by-laws. Increase of Rent and Mortĝaĝe Interest (Restrictions) Acts. Under these Acts the Sanitary Authority may issue certificates enabling tenants to withhold the permitted increase in rent allowed until such time as the landlord has completed the work necessary to put the dwelling-house into a reasonable state of repair. During 1933, 14 applications for the required certificates were made by tenants, and these were issued. Raĝ and Bone Dealers. During the year 75 visits of inspection were made to the 26 places in the Borough where the business of a dealer in rag and bones is conducted. In only one instance was it necessary to serve an intimation for the abatement of a nuisance. Raĝ Flock Acts, 1911-28. One sample of rag flock was submitted for examination and reported to conform in all respects to the requirements of the above Acts. Rats and Mice (Destruction) Act, 1919. During the year 166 complaints as to premises being infested with rats were received. In every instance an attempt was made to trace the cause of the nuisance, and this was frequently found to be due to a defective drain. In these cases the repair of the drain resulted in the abatement of the nuisance. The free distribution of poison baits in certain cases was continued during the year. In 6 instances it was necessary to serve notices in accordance with the provisions of the Rats and Mice (Destruction) Act, 1919, upon the occupiers of land or premises to abate nuisances. Following past practice an intensive campaign was waged for the destruction of these pests during official "Rat Week" in November, at the request of the Ministry of Agriculture and Fisheries. Removal of Aged and Infirm Persons. Thirteen instances of aged and infirm persons living under conditions which rendered these cases liable to be dealt with under the provisions of the London County Council (General Powers) Act, 1928, with a view of remedying the unsatisfactory nature of the tenancy, came to the notice of the department during the year. Satisfactory arrangements were made to secure better care and attention for these old people who were incapable of looking after themselves, except in two instances where it was necessary to secure the removal of the person to an Institution on the Order of a Stipendiary Magistrate. Schools. The Sanitary Inspectors made 108 inspections of the private schools in the Borough. The water supply of all these schools is drawn from the main. Three intimations were served for defects of the sanitary arrangements, which were promptly remedied. Offensive Trades. The description of the offensive trades and the number of such businesses carried on in the Borough are as follows: — Skin Dressers 6 Skin Merchants 1 Sheep Skin Rugmaker 1 Soap Boilers 1 Fellmongers 1 These premises were frequently inspected during the year, and no occasion arose which necessitated the service of notices requiring the abatement of public health nuisances. Smoke Abatement. During 1933, 98 observations were made by the sanitary inspectors of 20 factory chimneys in the Borough which were the subject of complaint concerning the emission of smoke and it was necessary to serve 8 intimations and one statutory notice in respect of these nuisances. This form of nuisance is usually due to faulty stoking or the use of unsuitable fuel, and can generally be remedied by the acceptance of advice, which the Inspectors are always ready to offer to those responsible, with regard to the measures necessary to prevent the irregular emission of smoke. HOUSING. Insanitary Areas. The subject of Slum Clearance and Improvement received continuous attention by this Council throughout the year, and at the time of the preparation of this report the question of declaring the areas known as Tiger Yard, Joiner's Arms Yard, and Woodland Cottages, as Clearance Areas under the provisions of the Housing Acts, 1925 and 1930, was receiving consideration. The number of dwelling houses in these areas is 33, and the number of families at present in occupation is 29. Action has also been taken under Section 19 of the Housing Act, 1930, in individual cases, where the tenant has vacated the premises, to secure from the owners an undertaking that such premises would not be relet for human habitation. In this way 5 houses at Tiger Yard and 3 at Woodland Cottages have been closed. Appropriate action was also taken under Section 17 of the Housing Act, 1930, during the year in respect of one house in the northern part of Borough. It is satisfactory to record that the London County Council in February, 1934, approved a scheme for the clearance of a site known as the Levant Street Area, comprising about 148 unfit houses, which is situate to the East of Peckham Park Road at its junction with Lower Park Road, and includes Levant Street, Grainger Street, Downes Place, Green Hundred Road, Edwin's Row, and Shard's Square. It will also be necessary in connection with this scheme to acquire a number of additional properties in order to provide a satisfactory site for re-development. The scheme provides for the erection on the whole site of dwellings containing 1,215 rooms providing accommodation for about 2,025 persons on the basis of an average of one and two-thirds persons per room. The displacement of about 968 persons of the working class is included, of whom 765 are in occupation of the buildings on the Clearance Area, and 203 of the buildings on the additional lands. Fitness of Houses. The sanitary condition and the fitness, or otherwise, of dwellings for human habitation is a responsibility shared by the Local Authority, through their Medical Officer of Health and Sanitary Inspectors. In Camberwell there are a number of houses in the North and North West divisions of the Borough so old that unless drastic steps are taken to improve them, it will be necessary, sooner or later, to decide whether they are premises which can be rendered fit for habitation at a reasonable cost. The principal causes of the deterioration of property are: — neglect of necessary repairs ; overcrowding of part and/or whole of houses, and the presence of dirt and vermin. Local Authorities have considerable powers under the Public Health and Housing Acts to enforce repairs and thus prevent additional insanitary areas arising. During the year, 8,109 premises were inspected for dwelling-house defects and other nuisances under the Public Health (London) Act, 1891, including 1,112 house-to-house inspections. It was found necessary during the year to serve 4,200 Intimations requiring the remedying of insanitary conditions, and 2,018 Intimations for other nuisances. The problem of dealing with the overcrowding of rooms and the occupation of houses suitable for one family but occupied by several families will continue to remain unsolved until suitable accommodation becomes available at rentals not beyond the means of the poorest classes of the community. The remedies for the prevention of dirt and vermin lie in the hands of the occupiers, and it is regrettable to state that it is necessary at times to take steps to compel tenants to abate these domestic nuisances. The Council is always willing to assist landlords and tenants in the disinfestation of premises for vermin, especially bugs, and during 1933, 576 rooms were cleansed by the Disinfesting Staff. Houses Let in Lodĝinĝs. The inspections recorded of these premises during the year numbered 272, and 211 notices to remedy defects found were served. In dealing with houses divided into separate tenements, the practice in Camberwell has been to proceed under the provisions of the Public Health (London) Act, 1891, rather than the Tenement By-laws in view of the restrictive period for inspection, if proceedings are to follow. This procedure has proved to be more satisfactory in securing the carrying out of effective cleansing work as well as the abatement of nuisances. Overcrowding. Reference has been made in previous Annual Reports to this subject and to the causes responsible for overcrowding. Large families accompanied by extreme poverty is unquestionably the principal factor, although occasionally cases come to the notice of the Public Health Department where failure to obtain improved housing accommodation was not governed by inability to pay for such accommodation. In determining the existence of overcrowding in any dwelling it is customary to apply the standard of free air space per person similar to the requirements of the London County Council by-laws relating to houses divided into Separate Tenements, viz., in the case of decontrolled houses 400 cubic feet per person of ten years or over, 300 cubic feet per person under ten years, in any room wholly or partly used as a sleeping apartment, and in the case of dwelling houses to which the Rent and Mortgage Interest (Restriction) Act, 1920, applies, any room exclusively used as a sleeping apartment not less than 300 cubic feet of free air space for each person of ten years of age or over, and 150 cubic feet for each child under ten years. The by-laws require that in respect of a child under ten years of age occupying a room not exclusively used as a sleeping apartment not less than 200 cubic feet shall be available. There were 103 cases of overcrowding brought to the notice of the Public Health Department in 1933, and an intimation notice to abate the nuisance was served in every case, in two instances a statutory notice was served, and in one case the issue of a summons was authorised. During the year under review the London County Council provided accommodation for 27 families living in overcrowded conditions, and in 16 cases the nuisance was abated by the families themselves. Underground Rooms. The Public Health (London) Act, 1891, Section 96, requires that underground rooms shall not be occupied as separate dwellings unless they comply with certain structural standards. If, however, the occupier has a room on an upper floor no action can be taken under this Act. Under the powers granted by Section 18 of the Housing Act, surface of the floor of which is more than 3 feet below the surface of the part of the street adjoining or nearest to the room, or more than 3 feet below the surface of any ground within 9 feet of the floor to ceiling, or does not comply with such regulations as the Local Authority with the consent of the Minister of Health may provide for securing proper ventilation and lighting of such rooms, and protection against dampness, etc., shall be deemed to be a house so dangerous or injurious to health as to be unfit for human habitation. During the year action was taken in respect of underground rooms which did not comply with the provisions of the Acts, and in four instances the illegal occupation was discontinued. Action was pending at December 31st 1933, in respect of a front basement room in the northern part of the Borough which by virtue of Section 18 of the Housing Act, 1925, was deemed to be unfit for human habitation. At the time of the preparation of this Report the Sanitary Inspectors were engaged in a survey of the area for the purpose of providing information as to the number of underground rooms used as sleeping places existing in Camberwell, distinguishing those contravening the provisions of (a) the Public Health (London) Act, 1891, (b) the Housing Act, 1925. Housing Statistics, 1933. 1. Inspection of Dwelling Houses during the Year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 8,109 (b) Number of inspections made for the purpose 23,272 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,560 (b) Number of inspections made for the purpose 2,044 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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, and Intimation Notices served 4,200 2. Remedy of Defects during the Year without Service of Formal Notices:— Number of dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 442 3. Action under Statutory Powers during the Year:— (a) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners (b) By Local Authority in default of owners 1 (b) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which statutory notices were served requiring defects to be remedied 1,355 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 3,073 (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 19 and 21 of the Housing Act, 1930 :— * (1) Number of dwelling houses in respect of which Demolition Orders were made Nil (2) Number of dwelling houses demolished in pursuance of Demolition Orders Nil *Notices served under Sec. 19 in respect of two houses, undertakings received that these properties will not be re-let for human habitation. (d) Proceedings under Section 20 of the Housing Act, 1930:- (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil (e) Proceedings under Section 3 of the Housing Act, 1925:- (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 (6) By Local Authority in default of owners Nil (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil (f) Proceedings under Sections 11, 14 and 15 of the Housing Act 1925:— (1) Number of dwelling houses in respect of which Closing Orders were made Nil (2) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil (3) Number of dwelling houses in respect of which Demolition Orders were made Nil (4) Number of dwelling houses demolished in pursuance of Demolition Orders Nil Factory and Workshop Act, 1901. INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Inspections made by Sanitary Inspectors in 1933. Inspections. (2) Number of Written Notices. (3) Prosecutions. (4) Premises. (1) Factories (including Factory Laundries) Workshops (including Workshop Laundries) 839 78 - 53 944 - Workplaces (other than Outworkers' premises 1,783 - TOTAL 131 D DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Number of Defects. Found. (2) Remedied. (3) Number of Prosecutions. (5) Particulars, (i) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts : —* 34 - - 40 Want of cleanliness - Want of ventilation - - - Overcrowding - - - - Want of drainage floors Other nuisances 1 - - - 34 38 - - Sanitary accommodation— Insufficient 1 1 - - Unsuitable or defective 84 79 - - 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]... 19 19 - 19 169 - TOTAL 186 19 * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. FACTORIES, WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1933. Factories, Workshops and workplaces inspected by the Council's Male Sanitary Inspectors. Trade. Workshops and Workplaces. Factories. Total. Brush Trades 3 4 7 Building Trades 46 7 39 Chemical Trades 5 5 10 Engineering Trades 47 37 84 Gas Works 1 1 - Glass Blowing 1 1 - Laundries 33 3 36 Miscellaneous 249 451 700 Offensive Trades 4 6 10 Preparation of Foodstuffs 16 14 30 Printing and Lithography 41 12 53 Timberyards and Woodworkers 37 - 33 70 Toymakers 6 6 Varnish and Colour Works 5 1 6 Wearing Apparel 20 32 52 TOTAL 469 643 1,112 FACTORIES, WORKSHOPS AND WORKSHOPS INSPECTED BY THE COUNCIL'S WOMEN SANITARY INSPECTORS. Trade. Factories. Workshops and Workplaces. Total. - 2 Brush Trades 2 Engineering Trades 3 - 3 Laundries 33 2 35 Miscellaneous 93 100 193 Offensive Trades 3 - 3 Preparation of Foodstuffs 22 5 27 Printing and Lithography 13 - 13 65 93 158 Wearing Apparel TOTAL 234 200 434 Outworkers. Inspections during the year of 765 outworkers' premises where home-work was reported to be carried out numbered 1,361, and as the result of these inspections it was ascertained that in 218 instances home-work had been discontinued. In five instances it was necessary to send a cautionary letter to employers for neglecting to comply with the provisions of Section D 2 107 of the Factory and Workshop Act, 1901, which requires all contractors employing outworkers to send on February 1st and August 1st in each year a list of the names and addresses of such outworkers to the Medical Officer of Health of the district. Thirty-five sanitary notices were served during the year in respect of unwholesome conditions found to exist at outworkers premises. Five cases of infectious disease were reported during the period under review from premises where home-work was carried on. The following table shows the nature of the work conducted by outworkers in this Borough: — Table showing Trades of Outworkers in Employment at end or 1933. Art publishing 1 Baby linen 6 Blinds 1 Blouses 16 Boots and shoes 9 Braces 1 Brushes 2 Button holes 1 Cardboard boxes 12 Card lacing 1 Chemist 1 Chemists' sundries 1 Clothing 1 Coathangers 7 Corsets 1 Crocheting 3 Down quilts 3 Drapery 4 Dressing gowns 8 Embroidery 4 Engraving jewellery 2 Fancy goods 12 Furs 2 Gloves 2 Glove cleaning 1 Gold lace 1 Gowns 45 Handkerchief sachets 2 Hats 8 Hosiers 2 Household linen 2 Ivory and bone goods 1 Jumpers 1 Leatherwork 1 Mantles 174 M/C belting 1 Millinery 3 Ladies' neckwear 9 Gent's neckwear 7 Needlework 8 Novelties 1 Overalls 4 Paper bags 5 Polishing and fitting 1 Pyjamas 3 Quill and featherwork work 1 Rag dolls 1 Shirts 18 Silks 1 Stationery 1 Tailoring 43 Ties 33 Toys 1 Umbrellas 4 Underclothing 33 Wearing apparel 28 Woollen goods 2 547 INSPECTION AND SUPERVISION OF FOOD. Administration of the Milk and Dairies Order, 1926. The Borough Council is required by the provisions of the Milk and Dairies Order, 1926, to keep registers of all persons carrying on in the Borough the trade of cowkeeper or dairyman, and of all premies which are used as dairies. The following summary shows the state of the registers at the end of 1933:— Cowkeepers and cowhouses 1 Dairymen with premises in the Borough 415 Dairymen with premises outside the Borough 20 Purveyors of milk in sealed bottles 113 Dairies and milkshops 368 No applications for registration were refused during the year, nor were there any instances reported of premises being used as a dairy or for the purpose of conducting the business of a dairyman without being registered. During the year 14 inspections were made of the cowhouses in the Borough and 1,781 visits were paid to the dairies and milkshops. In several instances it was necessary to serve notices regarding the use of dirty utensils and 26 notices requiring the cleansing of premises used as dairies. Milk Bottling. Under sub-section 2 of section 31 a person who delivers milk in bottles shall cause every such receptacle to be filled and closed on registered premises. Cautions were administered to four roundsmen, owing to their contravening the provisions of the above section, by filling bottles with milk and sealing same in a public thoroughfare. Milk (Special Designations) Order, 1923. The licences granted to "dealers" for the sale of designated milk, during the year ended December 31st, 1933, were as follows: Certified Milk 9 Certified Milk (supplementary) 1 Grade "A " (Tuberculin Tested) Milk (including two bottling establishments) 25 Grade "A" (Tuberculin Tested) Milk (supplementary) 5 Grade "A" Milk 1 Grade " A " Milk (supplementary) 1 Grade " A " Milk (pasteurised) 6 Pasteurised Milk 35 Pasteurised Milk (supplementary) 3 Total 86 No application was received for a licence to set up a pasteurisation establishment within the area of this Borough. Bacteriological Examination of Designated Milk. No sample of Certified Milk was examined during the year under review. The designations and numbers of other samples examined are shown in the following summary:— Grade "A" (Tuberculin Tested) Milk (bottled by producer) 16 Grade "A" (Tuberculin Tested) Milk (bottled at licensed bottling establishments within this Borough) 4 Pasteurised Milk (consigned in sealed churns) 46 Pasteurised Milk (consigned in sealed bottles) 3 Total 69 RESULTS OF THE EXAMINATION OF DESIGNATED MILK. Grade "A" (Tuberculin Tested) Milk. STANDARD. Maximum number of bacteria permitted per 1 cc. Presence of Coliform Bacillus. 200,000 Must not be present in 1/100 cc. At the request of the Ministry of Health, 16 samples of this grade of milk, bottled and sealed by the producer on the farm and consigned to a licensed dealer in this Borough, were submitted for examination by this Council's Bacteriologist, and reports upon the examinations were sent to the Ministry. When such samples are taken and are found not to comply with the prescribed conditions, any action that may be considered necessary is taken by the Ministry direct. Of the number submitted, four failed to comply with the standard, and were specially brought to the notice of the Ministry. The reports upon these four samples are appended:— Sample marked. Date obtained. Bacteria per 1 cc. Presence of Coliform Bacillus. No. 3 May 11th 62,000 Present in 1/100 cc. No. 9 July 24th 1,800,000 Present in 1/100 cc. No. 12 August 10th 53,000 Present in 1/100 cc. No. 14 September 28th 96,000 Present in 1/100 cc. Four samples of Grade "A" (Tuberculin Tested) Milk, two from each of the bottling establishments in this Borough, were bacteriologically examined and all were found to be satisfactory. "Pasteurised Milk." STANDARD. Maximum number of bacteria permitted per 1 cc. Coliform bacillus. Not to exceed 100,000 No standard. Pasteurised Milk (Consigned in Sealed Churns). Forty-six samples of pasteurised milk consigned in sealed churns to Institutions within this Borough were submitted for examination. All conformed to the required standard. In two samples bacillus coli was present in 1/10 cc. The method of obtaining samples from sealed churns for bacteriological examination is still carried out by the process of vigorously shaking the contents of the churns for a period of two minutes prior to the sample being taken. Pasteurised Milk (Contained in Sealed Bottles). Three samples of pasteurised milk, supplied in sealed bottles, were examined and found to comply with the bacteriological standard. Milk (Not Designated). Seven samples of milk, not designated, were submitted for bacteriological examination. Five were supplied in sealed bottles and two were taken from 10-quart hand cans. In every instance the bacterial count was much below the maximum bacterial standard required for pasteurised milk. Bacillus coli was present in 1/10 cc. (but not in 1/100 cc.), in one of the samples obtained from a hand can, and was present in 1/100 cc. in one of the samples taken from a sealed bottle. Milk (Designated and Ordinary) (Examination for Tubercle Bacilli). Four designated milks were examined by means of the "Animal Test" for the presence of tubercle. Two "Raw" milk samples were similarly examined. Sample "B" was taken from a large counter pan containing mixed milk from cows, stalled at the premises where the sample was obtained, and sample "D" was also taken from a counter pan containing milk supplied to the dairyman by a farmer direct. In no instance was tubercle found. The designations of the milks submitted are appended:— Sample marked. Date submitted. Designation. Result of Examination Grade "A" (T.T.) (bottled on farm). "A" 1933. July 27th Tubercle not found. "B" November 16th "Raw" milk Tubercle not found. "Pasteurised" "C" November 16th Tubercle not found. "D" November 17th "Raw" milk Tubercle not found. "E" December 19th Grade "A" (T.T.) (from bottling establishment). Tubercle not found. "F" December 19th "Certified" Tubercle not found. Milk (Examination for Stomatitis). Owing to a complaint, a sample of milk contained in a sealed quart bottle was examined for the purpose of ascertaining whether it was responsible for an attack of Stomatitis. The Bacteriologist's report stated that "No streptococci ferule or spirochaetes were found. B. coli was absent in 1 /10 cc." Milk Examined for the Presence of Dirt. Public Analyst's Report. Sample marked "A." This sample contains 4 parts per million of dirt, which is of a comparatively innocuous nature. It consists of fine sand, root tissues, and woody fibres, and contains no dung. It is country (or cow-byre) dirt or dust. Sample masked "B". This sample contained less than 4 parts per million of dirt. The sedimentary matter contained no dung, or anything of an objectionable nature. It was mainly woody fibre and sand. Meat and Other Foods. Registration of Food Premises. The London County Council (General Powers) Act, 1932, requires the registration of premises used for the following purposes:— 1. The sale, manufacture or storage of ice cream. 2. The preparation or manufacture of sausages or potted, pressed, pickled or preserved meat, fish or other food intended for sale. In the case of meat or fish the word "preserved" includes preparation by any process of cooking. Ice Cream Premises. Number of premises where ice cream was manufactured and sold 127 Number of premises where ice cream was sold, but not manufactured on the premises 104 Number of premises on register where the sale of ice cream was discontinued during the season 74 Premises on Register December 1933 305 Number of premises removed from the register during the year 6 During the year 328 inspections were made of the premises where ice cream was sold or manufactured, special attention being paid to the cleanliness of the utensils used. It was necessary to serve 11 cleansing notices, all of which were complied with. At present there is no legal standard for ice cream, consequently the quality of this commodity varies, nor is there a bacteriological standard. Ice Cream: Bacteriological Examinations. Nine samples of ice cream were submitted for bacteriological examination, and the reports thereon appear in the appended table:— Sample marked. Date obtained. Where purchased. Bacteria per cc. Presence of Bacillus Coli. No. 1 July 27th Shop 700,000 Present in 1/100 cc. No. 2 July 27th Barrow in a public thoroughfare. 880,000 Absent in 1/10 cc. 85,500,000 No. 3 July 27th Shop Present in 1/100 cc. No. 4 Aug. 17th Barrow in a public thoroughfare. 350,000 Present in 1/100 cc. 120,000 No. 5 Aug. 17th Shop Present in 1/10 cc. No. 6 Aug. 17th Barrow in a public thoroughfare. 500,000 Present in 1/10 cc. 3,100,000 No. 7 Sept. 19th Barrow in a public thoroughfare. Present in 1/100 cc. No. 8 1,110,000 Sept. 19th At a stall outside vendor's shop. Present in 1/1000cc. No. 9 320,000 Sept. 19th Barrow in a public thoroughfare. Absent in 1/100 cc. Endeavours were made to obtain further samples from the vendors of samples Nos. 1, 3 and 4. In the second visit to the vendors of Nos. 1 and 3 it was ascertained that the manufacture of ice cream had been suspended for the season. A further sample was, however, obtained from the vendor of No. 4, and is marked No. 7 in the above summary. It was ascertained that the hulk from which Sample No. 8 was obtained was manufactured outside the area of this Borough. The result of the examination was therefore communicated to the Medical Officer of Health of the Borough within whose area the article was made. As a result of enquiries made in this quarter, information was received to the effect that in all probability the bacteriological content of this ice cream was due to the butter used in the manufacture. Samples Nos. 4 and 5 were also examined for the presence of organisms of the Enteric Group, but were not found. Food Premises. Number of premises used for the preparation of sausages and preservation of meat 176 Number of premises used for the purpose of the preparation or cooking of food 272 Premises on Register December 1933 448 Bakehouses. The following table provides information of the number and description of the bakehouses in the Borough. Total number of Bakehouses on Register, 1933 Above Ground 91 Underground 42 133 Total number of Underground Bakehouses in use included in above 38 Visits made to Bakehouses during year 278 Notices served 87 Notices compiled with 87 Number of Factory Bakehouses above ground 58 Number of Factory Bakehouses underground 23 Number of Workshop Bakehouses above ground 33 Number of Workshop Bakehouses underground 19 Butcher Shops and Meat Stalls. The 176 butcher shops and 3 meat stalls in the Borough were regularly inspected with a view to the enforcement of the Public Health (Meat) Regulations, 1924, which deal with marking, protection from contamination, and transport and handling of meat. During the year it was necessary to serve 38 notices for contraventions of these Regulations. Fish Curers. At the end of 1933 there were 51 premises at which the curing offish was carried on. 246 visits were made by the Food Inspector to these premises and 12 notices were served for insanitary conditions. Fish Shops and Stalls. During the year 232 inspections were made of the 58 fishmongers' shops and the 21 fish stalls in the Borough. 2 parcels of fish were surrendered and certified as being unfit for food. Fried Fish Shops. There are 96 fried fish shops in the Borough which were visited periodically to ensure that they were kept in conformity with the London County Council by-laws and to investigate the soundness of the fish and the wholesomeness of the materials used for frying. During the period under review 387 inspections of these shops were made and 17 notices were served requiring cleansing work to be carried out. Restaurants and Eating Houses. The inspection of the kitchens of restaurants and eating houses is periodically carried out to ensure that the food is prepared in wholesome surroundings. 219 visits were made to the 195 restaurants and eating houses in the Borough during 1933 and it was necessary to serve 17 notices for the abatement of unsatisfactory conditions. Slaughterhouses. There are two registered slaughterhouses in Camberwell. Humane slaughtering by approved methods is adopted at each slaughterhouse. The Food Inspector on receiving notice in accordance with the Public Health (Meat) Regulations, 1924, of the intention to slaughter an animal attends during the slaughtering and examines the carcase. The description of the animals slaughtered at the two slaughterhouses during the year is shown in the following table:— Month. Cattle. Sheep, Pigs. Calves. Totals. January 4 50 11 2 67 February 3 37 16 — 56 March 4 43 14 2 63 April 3 29 7 3 42 May 5 38 2 4 49 June 3 41 1 2 47 July 3 40 - 4 47 August 3 41 1 4 49 September 3 38 18 3 62 October 4 35 20 5 64 November 4 47 25 4 80 December 4 31 21 2 58 Totals 43 470 136 35 684 The following table provides information of the diseased meat condemned at the slaughterhouses and subsequently destroyed at the Council's Depot at Peckham Park Road during 1933:- Liver. Stomach. Spleen. Mesenteries. Intestines. Kidneys. Udders. Carcases, including organs. Fore-quarters. Hind-quarters. Head. Tongue. Lungs. Heart. Cause of destruction. Cattle. I I I I I I I I I Cirrhosis - - - - - - 3 - - - - - - - 1 1 - 2 - Tuberculosis 1 1 - - - - - - - 13 - - - Fluke - - - - - - - - - - - - - 2 2 - Abscess - - - - - - - - - - Actinomycosis - - 1 - - - - 1 - - 1 - Sheep. - - 1 - - - - - - - - - Abscess - 1 - - Parasitic diseases - - - 121 - - - - - - - - - - - 1 - - Fluke Pigs. - - — - - - - - - - - - - 2 - - - - Tuberculosis Abscess - - - - - 1 1 - - - - - - - - - - - 3 - - - - Pneumonia CALVES Tuberculosis - - - - - - - - - - - . 1 i , 1 - I I - I I - - - - - - - TOTALS - - - 4 2 131 2 21 - - 2 - - - Street Markets. The London County Council (General Powers) Act, 1927, requires any person who sells or offers for sale any article or thing from or upon any barrow, cart, stall, or other receptacle occupying a stationary position in any street, to be licensed by the Local Authority. During 1933, 141 licenses to sell various articles of food were granted by this Authority. The storage and the sanitary supervision of the articles intended to be sold or exposed or offered for sale under the authority of the licence is undertaken by the Public Health Department. The number of inspections of street markets made by the Council's Food Inspectors during 1933 was 1,948. The places used by the vendors for the storage of articles of food elsewhere than at the licensed street stand were also regularly inspected. - 61 Unsound Food. No proceedings were instituted during the year under the provisions of Section 47 of the Public Health (London) Act, 1891, against any person in possession of unsound food. The following foodstuffs were, however, voluntarily surrendered to the Council for destruction during the twelve months ended December 1933. Name of Food. Weight. Surrendered or Seized. Result of Action taken. T. 1. c. q. FISH— Haddocks (fresh) 2 11 Surrendered Destroyed at Council's Depot. - - - - 2 11 "l FRUIT— Tomatoes - 2 0 7 do. do. do. Apples 1 0 22½ do. - Peaches do. do. - 1 14 - 2 15½ - 3 t - 14½ Butcher's meat 4 1 do. do. Chickens (374) - 10 0 4½ do. do. - Ducks (2) 9 do. do. - - Rabbits - 1 do. do. - 3 Offal 16 - 7 1 do. do. 1 2 0 19 — TINNED F OODS— - Condensed and Evaporated milk 1,480 tins do. 7½ 11 0 do. Fruit 1,115 tins 15 0 20 do. do. - Fish 470 tins 4 0 4 do. do. - - 13½ do. Meat 17 tins 2 do. - - Vegetables 36 tins 1 10½ do. do. - 27½ 1 11 0 2 2 17 TOTAL WEIGHT 17 SUMMARY OF WORK OF FOOD INSPECTOR FOR 52 WEEKS ENDED DEC. 31ST, 1933. Complaints received Complaints found to be justified Inspections : — Street markets Bakehouses Fish curers' premises Fried fish shops Ice cream premises Restaurants and eating houses Slaughterhouses Other food premises Carcases inspected Organs inspected Inspections not defined Re-inspections Organs condemned Food surrendered (parcels of varying weights) Certificates granted for Foodstuffs for export Number of food premises defects found and remedied Number of intimations served Number of Statutory Notices served 21 6 1,948 278 246 387 328 219 114 3,289 684 1,203 123 484 162 21 18 201 209 6 Adulteration. Food and Drugs (Adulteration) Act, 1928. Samples of food and drugs, for chemical analysis, are collected by Mr. Dewey, the Inspector appointed to act as Sampling Officer, under this Act. During the year under review, 1,032 samples of food and drugs were submitted for analysis to this Council's Public Analyst, Mr. Martin Priest, F.1.C., at his laboratory, 4, Obelisk Parade, Lewisham. Of these samples, 91 were purchased without disclosing to the vendors the fact that they were taken for the purpose of analysis, and are known as informal samples. The formal and informal samples so submitted, together with the number found to be adulterated, are set out in Table "A." The articles reported against; the nature of the adulteration, or irregularity, and proceedings, or other action taken (by direction of the Public Health Committee) are set out in Table "B." These tables are in the form suggested by the Ministry of Health Memorandum No. 36, dated January, 1929, on procedure under the Pood and Drugs Act. Following the practice adopted in past years, cards were sent to the vendors of all samples that were reported as genuine. The cards so sent numbered 619. A few of the samples reported against are perhaps of sufficient interest to call for special comment. Dried Mint. A sample of pre-packed dried mint (sold in sealed packets) was submitted for analysis, and certified to contain 40 per cent, of dried leaves foreign to genuine mint. Proceedings were directed to be taken against the retailer, and also against the wholesale firm, for aiding and abetting. Both summonses were dismissed, the retail defendant being ordered to pay the cost of the summons. A press report of this case stated that the learned magistrate, in dismissing the summons against the wholesale firm, when giving a reserved judgment, said: "It was quite clear on the decided cases that the defendants could not be said to have aided and abetted the shopkeeper, nor could they be held to have counselled and procured. The defendants did not know who was going to sell the article, they did not know to whom it was going to be sold, and they did not know on what terms it was going to be sold." Mint Sauce. Two samples of mint sauce, sold in sealed bottles, were certified to contain not less than 20 and 10 per cent, respectively of leaves foreign to those of genuine mint. A summons was issued in respect of the former sample, and was dismissed under the Probation of Offenders Act, the magistrate ordering the defendants to pay 40s. costs. At the hearing it was stated, on behalf of the defendants, that the adulteration did not take place in this country. Milk Powder. During the course of the year certain premises in the Borough used for the purpose of making "manufactured milk" were visited. At the time of the visit work was in progress, and it was found that a liquid preparation was being made from dried milk powder, cream, and tap water. In answer to questions, the proprietor stated that the preparation was sold to bakers and confectioners as "liquid milk powder." Informal samples of the dried milk, cream, and the liquid made therefrom were taken for analysis. The liquid milk powder was certified to contain 17-17 per cent, total solids (in normal milk the total solids vary from 12 to 13 per cent.), and the fat content was 3.7 per cent. The mineral matter was 1-14 per cent., whereas in ordinary milk it is about 0.75 per cent. The dried milk powder contained only traces of fat, and the cream had a fat content of 53.5 per cent. When submitting these samples for analysis the Public Analyst was asked to give consideration to the question of whether it would be possible to detect by analysis any difference between milk reconstituted from dried milk powder, cream and tap water, and fresh cow's milk. The Public Analyst in his report drew attention to the great difficulty in detecting, by chemical analysis, such admixture, when skilfully carried out, from genuine milk. Activities of this character obviously need to be supervised as a safeguard against the possibility of reconstituted milk being unlawfully sold as fresh milk, and it is suggested that this might be effected if Local Authorities possessed powers to regulate the manufacture and sale of products of this description, by requiring the registration of premises used for this purpose and of all persons carrying on the business of a "milk" manufacturer, with the right of inspection of the firm's records and trading accounts. Milk. During the year under review, 573 formal samples of milk were submitted for examination. Of this number, 9 were reported as being adulterated, giving a percentage of adulteration of 1.57. The adulteration of six of these samples was due to the abstraction of fat. In no instance during the year under review was the deficiency of fat found to be due to the failure of the vendor to thoroughly mix the milk before serving a customer when the sale took place from a pint or a quart bottle from which a previous customer had been served. In the other three cases, the adulteration was due to the presence of added water, one of these being adulterated to the extent of 58 per cent. Of 32 informal samples of milk, 6 were adulterated, all by the addition of extraneous water. These six samples were divided between two vendors, two of which, adulterated to the extent of 15 and 19 per cent, respectively, being obtained from one vendor, and four other samples to the extent of 2, 2, 2 and 4 per cent, respectively were obtained from another vendor. In connection with the former instance, a formal sample, No. 217, was taken, found to be adulterated with 16 per cent, of added water, and a conviction obtained (see Table "B"). In the other instance, the adulteration though slight occurred at irregular intervals, the intervening samples examined being reported as genuine. By the small percentage of added water, and the irregular intervals of such addition, it would appear to indicate that this vendor was applying some skilful method of adulteration with a minimum risk of detection. These premises are still under observation. Milk Sampling in transit or delivery from Wholesalers. Sections Nos. 21 and 29, and the second schedule thereto. Sections Nos. 21 and 29, and the second schedule thereto. Under the above Act and Schedule a purveyor of milk, from whom a retail sample of milk has been taken for analysis, may, within sixty hours of such sample being taken, require the Local Authority to take immediate steps to procure as soon as practicable a sample of milk in the course of transit or delivery, from the wholesale firm from whom he receives the milk. If the purveyor fails to avail himself of this provision, though he purchased his milk with a warranty, he would be unable to plead a warranty defence, in any proceedings taken, in the event of the retail sample being reported against. During the year three purveyors requested that samples be taken m the course of delivery from their wholesale firms, but as it had been ascertained that the retail samples were genuine, they were forthwith informed that under the circumstances the necessity to take samples in the course of delivery did not arise. The Artificial Cream Act, 1929. The provisions of this Act are framed to regulate the manufacture and sale of Artificial Cream. It also provides for the registration (with certain reservations) of all premises where artificial cream is manufactured, sold, or exposed for sale for human consumption. During the year two applications for registration under this Act for the manufacture and sale of this article were made to this Authority and granted. The Public Health (Condensed Milk) Regulations, 1923-27. During the year five samples of condensed full cream milk sweetened were examined and found to conform to the required composition. The Public Health (Dried Milk) Regulations, 1923-27. Two informal samples of dried full cream milk and one informal dried separated milk were examined and found to conform to the required composition. An informal sample submitted and marked "Liquid Milk Powder" was found to be excessively high in total solids. Reference to this sample is made in another part of this Report. The Public Health (Preservatives, etc. in Food) Regulations, 1925-27. All articles of food taken for analysis are examined for the presence of a preservative. Two samples of beef sausages (Nos. 437 and 839, see Table "B") obtained during the year were found to contain a permitted preservative viz., sulphur dioxide, but in quantities that did not exceed the maximum amount allowed by the Regulations, viz. 450 parts per million. They were sold without notice to the purchaser of the presence of a preservative, thus contravening one of the provisions of the Regulations. The appropriate committee directed in each instance that a letter of caution be sent to the vendors. Eight samples of cream were reported to be free from preservative. E Merchandise Marks Act, 1926, and Imported Goods Orders made thereunder. Administration. Inspections are periodically made of shops and stalls in the Borough to ascertain whether the provisions of the various Marking Orders were being carried out. It was found that the Orders with a few exceptions were being observed. Cautions were administered in cases of non-observance. Particular attention was directed to the observance of the Merchandise Marks (Imported Goods) No. 1 Order, 1932. This Order deals with the marking of the indication of origin of all imported butters, or blends, or mixtures of butter which contain imported butter. Six cases where the requirements of the Order were not observed were referred to the appropriate committee. In four instances the committee directed that cautions in writing be sent to the vendors, and in two instances instructions were given that summonses be issued. The proceedings resulted in one vendor being ordered to pay a fine of 10s. and 17s. 6d. costs, and the summons against the other was dismissed under the Probation of Offenders Act, the defendant being ordered to pay 7s. 6d. costs. Agricultural Produce (Grading and Marking) Act, 1928. This Act provides for the grading and marking of agricultural produce, and the Minister of Agriculture and Fisheries may, by Regulations, prescribe grade designations as he may consider appropriate to indicate the quality of any articles of agricultural produce. Where 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. The following regulations were published during 1933: — Regulation. Dated. Cabbage and Lettuce February 20th Cauliflower and Broccoli February 20th May 11th Plums (Amended) Regulations Asparagus May 17th May 23rd Canned vegetables Canned fruits May 23rd Malt Extract and Malt Flour May 24th Black currants May 29th Gooseberries May 29th Loganberries May 29th Raspberries May 29th May 29th Red currants Wheat Flour June 12th Jam July 1st Cheshire Cheese July 4th Bunched Carrots July 7th Bottled fruits August 8th Regulation. Dated. Honey (Amended) August 16th Brussels Sprouts August 25th Dressed Poultry August 31st Celery September 6th Apples September 18th Pears September 18 th Butter Factories and Wholesale Dealers in Margarine. All butter factories, and wholesale dealers in margarine, are required to be registered by the Local Authority, in accordance with the provisions contained in section 8 of the Food and Drugs (Adulteration) Act, 1928. At the end of the year there were 23 wholesale dealers in margarine entered upon the register of this Authority. Chemical and Bacteriological Examination of Food. Details of the chemical analysis of samples of food, etc., carried out by Mr. Martin Priest, Public Analyst, appear in the tables on pages 68 and 69. Particulars of the bacteriological examinations of milk and ice cream conducted by Dr. G. Bousfield, the Council's Bacteriologist, also appear in the references to these articles of food in the Inspection and Supervision of Food section of this Report. Food Poisoning. Nineteen notifications of food poisoning were received during 1933. Every case was carefully investigated. In the majority of these cases the illness was only mild in character and the patients quickly recovered. TABLE "A" FORMAL AND INFORMAL SAMPLES SUBMITTED FOR ANALYSIS FOR THE YEAR ENDED DECEMBER 31ST, 1933. Article. Number Examined. Number Adulterated, etc. Percentage of Adulteration. Formal. Informal. Private. Total. Formal. Informal. Private Total. Formal. In formal. Milk 573 32 - 605 9 6 - 15 1.57 18.75 76 Butter 48 28 - - - - - - - 25 - - 25 5 Malt Vinegar - - 5 20.00 - Self Raising Flour 18 - - 18 - - - - - - Lard - - 17 17 - - - - - - 15 - - 15 - - - - Cheese - - Whisky 9 6 - - 15 - - - - 9 - Vinegar - - 9 - - 22.22 - - - Vinegar 9 2 9 - - - - 2 22.22 - Sultanas 9 - - 9 - - - - - - 8 8 Sauces (Various) - - 2 - - 2 25.00 - Cocoa 8 - - 8 - - - - - - 8 1 9 Cream - - - - - - - Pork Sausages 7 - - 7 - - - - - - 7 7 Lemonade Powder - - - - - - - - Mixed and Sweet Herbs (includingone Dried Mint) 7 - - 7 1 - 1 14.28 - - - - - Prescriptions 6 6 - - - - - Margarine 6 - - 6 - - - - - - 6 - - White Pepper - 6 - - - - - Custard Powder 6 - - 6 2 - - - - - 6 Beef Sausages i - - 6 2 - - 2 33.33 - Camphorated Oil 5 - - 5 - - - - - - Lemon Cheese and Curd - - 5 - 5 - - - - - Fish Paste 5 - 5 - - - - - - - - - Mustard 5 - - 5 — - - - Olive Oil 5 - 5 - - - - - - - Condensed Full Cream Milk, Sweetened 5 - - 5 - - - - - - Chicken and Ham 5 - - - - 5 - - - - 5 Brawn - - 5 - - - - - - Dripping 5 - - 5 - - - - - - 5 - - Shredded Suet - 5 - - - - - Baking Powder 4 - 4 - - - - - - - - 4 Ground Ginger 4 - - - - - - - 4 - - - - Sherbert - - - - - - - Tea 4 4 - - - - - - Strawberry Jam 3 - - - 3 - - - - - 3 Coffee 3 - — - - - - - - Lemon Squash 3 3 - - - - - - - - Veal and Ham Roll 3 3 - - - - - - - Ground Cinnamon - 3 - - 3 - - - Ground Almonds - - - 3 3 - - - - - - - Table Jelly 3 3 - - - - - Desiccated Coconut - - - - 3 3 - - - - - - - Preserved Beef Sausages 2 - 2 - - - - Gin - - - - 2 - 2 - - - - - Crushed Linseed 2 - - - - 2 - - - Blackcurrant Jam - - - 2 2 - - - - - - - - Liver Sausage 2 - - 2 - - - - - - Corn Flour 2 2 - - - - - - - Luncheon Sausage 2 - - 2 - - Citrate of Magnesia - - - - - 2 - 2 - - - - - - Butter (on Bread) - 2 13 - 15 2 4 6 100.00 Marmalade - 30.76 2 - - - 2 - - - - Boric Acid Ointment - 1 - - 1 - Breakfast Sausage - - - - - 1 - 1 - - - - - - Beef Loaf 1 - - - 1 - - - - - - Preserved Pork Sausages 1 1 - - - - - - - 1 - Fresh Crab - - 1 - - - Bloater Paste - - - 1 - 1 - - - - - - Meat Paste 1 - - - 1 - - Egg (Substitute) Powder - - - 1 - - 1 - - - - Lobster and Tomato 1 - - - - - 1 Pearl Barley - - - - - 1 - - - 1 - - - Rice 1 - - - - 1 - - - - Blancmange Powder - - 1 1 - - - - - Corned Beef - - - - 1 - 1 - - - Tomato Soup Powder - - - 1 - 1 - - - - - - Pea Flour 1 - - - 1 - - Jellied Veal - - - - 1 - - 1 - - - - - Gravy Powder - 1 - - 1 Ginger Beer Powder - - - - - - 1 Aspirin Tablets - - 1 - - - - - 1 - - - 1 - Ketchup - - - - - 1 1 - - - - - - - Gra-Vita (Gravy) Cubes 1 - - 1 - Epsom Salts - - - - - - 1 1 - - - - - Glace Cherries 1 - - - - - 1 - - - Ginger Wine - - - 1 - - 1 - - - Dried Milk - - - - 4 - 4 - - - - - - Rum - 4 4 - - - - 1 - - - Brilliantine - — 1 - - - - - - Iodine (phenolated) - 1 - 1 - - - Junket Powder - - - - 1 — 1 - - - - - - Totals 941 70 71 TABLE " B " SAMPLES ADULTERATED, Etc. Nature of Adulteration or Irregularity. Article. Whether Formal, Informal or Private. Observations. Result of Proceedings, or other Action taken. Serial No. 8 Milk Informal 15 per cent. added water See Formal Sample No. 217. — Do. 19 Do. 10 Do. Do. 2 Do. 24 Do. - 2 Do. Do. 28 Do. - 4 Do. Do. I 36 Do. - Do. 2 Do. 60 Do. - 16 Do. Formal Informal Samples Nos. 8 and 10. Adulterated. 217 Do. Fined £2. Costs £1 1s. 9 per cent. of the original fat abstracted Do. 324 Do. - Summons dismissed under the Probation Act, defendant to pay £3 3s. costs. 13 Do. do. Do. Fined £2. Costs £1 1s. 340 Do. - 3 Do. Do. Resolution, Public Health Committee. 358 Do. - Do. 6 Do. do. 359 Do. - Fined £2. Costs £1 1s. 7 per cent. of added water Do. Fined £2. Costs £1 1s. 361 Do. Same Vendor. 58 Do. Do. 362 Do. Fined £5. 23 per cent. of the original fat abstracted Do. 735 Do. Fined £2. Costs £1 1s. - Do. 11 Do. do. 931 Do. - Fined £2. Costs £1 1s. 16 per cent. deficient in Acetic Acid Malt Vinegar Do. 155 - Caution. Resolution, Public Health Committee. A sample of Vinegar, other than Malt Vinegar Do. 160 Do. Summons dismissed. - Do. Do. Do. 618 Do. Do. - Caution. Resolution, Public Health Committee. Do. 10 per cent. deficient in Acetic Acid 629 - Do. Do. Do. A sample of Vinegar, other than Malt Vinegar Do. 719 Do. Filled £3. Costs £1 1s. - Sample deficient in Raspberries to the extent of 32 per cent. Raspberry Jam Do. - 169 Caution. Resolution, Public Health Committee. Do. do. 13 per cent. 237 Do. Do. - Do. Sample contained Sulphur Dioxide, to the extent of 217 parts per million Do. 437 Beef Sausages Article sold without notice of the presence of a preservative. Do. Do. do. do. Do. Do. Do. 839 Do. Sample contained 40 per cent. of dried leaves foreign to genuine mint Do. Mint Two Summonses. Summons against wholesaler dismissed; summons against retailer dismissed on payment of 2s. costs. 286 - Mint Sauce Sample contained not less than 20 per cent. of leaves foreign to those of genuine mint. Do. 696 - Summons dismissed under Probation Act, defendant to pay £2 costs. Do. do. not less than 10 per cent. - Do. Do. Caution. Resolution, Public Health Committee. 717 Informal The Butter consisted of 83 per cent. of Margarine Same Vendor. See formal sample No. 849. 55 Butter (on bread) 64 Do. Do. Do. Do. Formal sample not yet obtained. Do. 47 per cent. of Margarine 65 Do. Do. Do. 100 Do. 80 Do. Do. See formal sample No. 933. Do. 85 Do. 849 Do. Formal Informal samples Nos. 55 and 64 Adulterated. Fined £3. Costs £1 1s. Do. 100 Do. Informal sample No. 80. Adul- terated. Do. Do. Fined £5. Costs £1 1s. 933 TABLE "C." Percentages of Adulteration of Formal Samples during the past Five Years. Year. 1929. 1930. 1931. 1932. 1933. Percentage of Adulteration 4.94 3.03 4.50 2.30 2.44 TABLE "D." Percentages of Adulteration of Formal Samples of Milk during the past Five Years. 1929. 1930. 1931. 1932. 1933. Year. Percentage of Adulteration 2.41 1.58 2.04 1.57 0.98 Summary. Formal samples submitted for analysis 941 Informal samples submitted for analysis 91 Formal samples adulterated 23 Informal samples adulterated 10 Written cautions administered (Food and Drugs (Adulteration) Act, 1928) 9 Written cautions administered (Merchandise Marks Act, 1926) 4 Summonses issued (Food and Drugs (Adulteration) Act, 1928) 15 Summonses issued (Merchandise Marks Act, 1926) 2 RESULT OF PROCEEDINGS. Act, Regulation or Order under which proceedings were taken. Number of Summonses. Fines. Costs. Food & Drugs (Adulteration) Act, 1928 15 £ s. d. £ s. d. 0 0 14 14 0 28 Merchandise Marks Act, 1926 2 0 0 1 5 0 10 Nutrition. A diet sufficient in quantity, quality and variety is essential for physical development and the maintenance of health. The dissemination of knowledge of this subject forms part of the activities of the Public Health Service, and in recent years a good deal of attention has been given to this question in Camberwell. Dietary suggestions for the expectant mother, and the child are included in the Maternity and Child Welfare booklet which is distributed from the Public Health Department. During 1933 the Council also authorised the circulation of a leaflet entitled " A Housewife and her Food Problems—What should she buy ? " The nutritive value of particular kinds of food, and the possible effect upon the health of the individual arising from dietetic errors, is a subject of considerable importance, both from the educational and physical standpoints. In my opinion, nutrition is essentially a subject which should find a place in the present-day curriculum of the schools. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notifiable Diseases. The following diseases are compulsorily notifiable in Camberwell:- Acute Polio-encephalitis. Membranous Croup. Acute Poliomyelitis. Ophthalmia Neonatorum. Plague. Anthrax. Pneumonia —Acute Primary. Cerebro-Spinal Fever. Pneumonia—Acute Influenzal. Cholera. Continued Fever. Puerperal Fever. Diphtheria. Puerperal Pyrexia. Dysentery. Relapsing Fever. Scarlatina or Scarlet Fever. Encephalitis Lethargica. Erysipelas. Smallpox. Food Poisoning. Tuberculosis. Glanders. Typhoid or Enteric Fever. Typhus Fever. Hydrophobia. Malaria. Smallpox (Variola minor). In 1933 there was a further decline in the incidence of the mild type of smallpox which has been prevalent in the Borough since 1927. During the interval between the first week in August and the middle of November no case was notified. In the month of November a fresh outbreak of this disease occurred as the result of a missed case treated as chicken-pox, with the result that fourteen cases were subsequently notified. Throughout the year 55 cases were notified and the number of households affected was 30. There were no deaths. The supervision of contacts was continued on the lines adopted in the previous year. The following tables give the age groups and the vaccinal condition of these patients: — Age groups. No. of cases. Under 1 year — 1 to 2 years 1 2to 3 — 3 to 4 „ - 4 to 5 „ 1 5 to 10 „ 8 10 to 15 „ 10 15 to 20 „ 13 20 to 35 „ 12 35 to 45 „ 3 45 to 65 „ 7 65 and upwards Total 55 - Age Groups. Vaccinated in Infancy. Unvaccinated. Vaccination doubtful. Totals. Under 1 year - - - - 1 to 2 years — 1 — 1 2 to 3 „ — — — — 3to 4 „ - - - - 1 to 5 „ - 1 - 1 5 to 10 „ — 8 — 8 10 to 15 „ - 10 - 10 15 to 20 „ - 13 - 13 20 to 35 „ 3 9 - 12 35 to 45 „ 2 1 - 3 45 to 65 „ 6 1 — 7 65 and upwards - - - - Totals 11 44 - 55 Public Health (Smallpox Prevention) Regulations, 1917. During the year under review, no vaccinations were performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. Diphtheria. During the year 507 cases of diphtheria were notified, as compared with 483 in 1932. 492 cases, equal to 97.04 per cent, were removed to an Isolation Hospital and 24 (4.73 per cent.) were found after admission to Hospital not to be suffering from diphtheria or any other infectious disease and were discharged. "Return" cases numbered 4. Inquiries at the homes of these patients revealed that in one instance the original patient developed a nasal discharge within one month of returning home. Twenty deaths from this disease occurred during the year, equivalent to a mortality rate of 3.9 per cent., as compared with 2.9 per cent, in 1932. The attention of medical practitioners is periodically drawn to the necessity of giving anti-toxin forthwith, or sending the patient into Hospital whenever a diagnosis of diphtheria could not be ruled out. The capability of diphtheria anti-toxin to prevent death varies indirectly with the interval which elapses between the onset of the disease and the giving of anti-toxin serum. The delay of waiting for the result of the examination of a swab in suspected cases may mean the difference between a mild or severe attack and even death of the patient. Anti-toxin in phials containing 500 units for prophylactic and 8,000 units for treatment purposes is available free of charge to medical practitioners during the day between the hours of 9 a.m. and 5 p.m. at the Public Health Department, 35, Brunswick Square, as well as at the Dulwich Baths and at all hours of the day and night at the Town Clerk's Department, 17, Camberwell Green. In 1933 the Borough Council supplied 90 phials of anti-toxin of 8,000 units and 31 phials of 500 units to medical practitioners in the Borough. Immunisation against Diphtheria. Among modern methods of preventive medicine diphtheria immunisation stands pre-eminent. Facilities are available for this treatment at the Municipal Infant Welfare Centre, 140, Camberwell Road, every Wednesday afternoon. An intensive campaign is conducted from the Health Department to bring this process before the public, but unfortunately the response is not very satisfactory. No matter how small the number of persons immunised yearly, this valuable means of preventing this dread disease should, nevertheless, always be available as a Public Health service. The number of injections necessary to complete the treatment no doubt serves as a deterrent in some cases, and if this could be overcome by the use of a prophylactic which would in one injection immunise almost any child and remove the necessity of Schick tests before and after immunisation, there is no doubt that the public would more readily avail itself of this method of securing protection for their children against this disease. There is a certain proportion of children, roughly 10 per cent., in whom the ordinary course of 3 injections of 1 c.c. is not successful in producing permanent immunity. These children are most prone to develop the disease and are those among whom death would normally result in a number of instances. Immunisation can be effected in these children by extending the process. In approximately 1 per cent., protection for any length of time is impossible, as the immunity produced artificially disappears rapidly unless periodically activated. More recently a modified procedure of immunisation by giving a larger final dose of Toxoid-antitoxin,i.e., 1-5 c.c. instead of 1 c.c., has been adopted. The results have been most encouraging, as it is now quite rare to find a child Schick-positive 3 months after the modified course of three injections. It appears that nearly every child can be protected by this means. As regards durability of the immunity so produced, this can only be demonstrated in the course of time, but it seems reasonable to suppose that it will be correspondingly satisfactory. It occasionally happens that a person is notified as suffering from diphtheria, although stated to have been previously immunised. An investigation of these cases is always conducted, and in three such instances reported in 1933 the following facts were elicited:— No. of injections. Period between immunisation and onset of disease. Schick tested previous to immunisation. Schick tested after immunisation. Case. Remarks. 1 Yes. 3 Yes. 3½ months. Report from Hospital that case was not regarded as Diphtheria. Very mild attack. Notified as suffering from diphtheria before sufficient time had elapsed for re-Schick test. 2 Yes. 3 16 days. 3 Yes. 3 Do. 9 days. Moderately severe attack. In regard to these cases, it should be noted that Case 1 was expected to be immune. In neither of the other two cases had sufficient time elapsed for full protection to have developed, three months often being necessary for this to occur. Consequently, the three cases come into line with expectations, and do not represent any breakdown at all in the efficacy of the procedure. A return of the work performed at the Preventive Clinic during 1933 appears on pages 78 and 79. Scarlet Fever. Scarlet Fever continued during the year to be mild in form. There was an increase in the number of notifications received, 1,564 as compared with 919 in 1932; 1,464, equivalent to 93.6 per cent, of cases notified were removed to an Isolation Hospital, 36 of these patients were subsequently discharged from Hospital as not suffering from the disease. The "Return" cases numbered 72. The deaths numbered 6. The adoption of artificial immunisation facilities similar to those provided by this Council in connection with diphtheria has not yet been considered, in view of the present mild character of scarlet fever. 78 79 DIPHTHERIA IMMUNISATION CLINIC. RETURN OF WORK, 1933. TABLE I.—AGES OF PERSONS SCHICK- TESTED WITH RESULT OF TEST 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. 6 to 121 mths. 1 to 2 yrs. 10 to 11 yrs. 11 tol2 yrs. 12 to 13 yrs. 13 to 14 yrs. 14 to 15 yrs. 15 yrs. and above. Total 3 9 20 23 18 17 18 13 12 15 12 9 4 — 22 9 204 Pos. Neg. Notread. Pos. Neg. Notread. Pos. Ne g. Notread. Pos. Pos. Neg. Notread. pos. Neg. Notread. Pos. Neg. Notread. Pos. Neg. Notread. Pos. Neg. Notread. Notread. Pos. Neg. Notread. Pos. Neg. Pos. Neg. Notread. Pos. Neg. Notread. Neg. Notread. Neg. Notread. Pos. Notread. Pos. Pos. Neg. Notread. Positive 132 Negative 68 Not read 5 Neg. 7 - 1 2 - 2 2 7 - - 8 1 - 19 1 - 20 3 - 15 2 1 13 3 1 15 3 - 9 1 9 - 8 7 - 6 5 1 3 - - - 3 3 1 1 18 3 TABLE II.—IMMUNISATION TREATMENT TABLE. 9 to 10 yrs. 10 to 11 yrs. 11 to 12 yrs. 12 to 13 yrs. 13 to 14 yrs. 6 to 12 mths. 1 to 2 yrs. 2 to 3 yrs. 3 to 4 yrs. 4 to 5 yrs. 5 to 6 yra. 6 to 7 yrs. 7 to 8 yrs. 14 to 15 yrs. 15 yrs. and above. Totals 8 to 9 yrs. T. T. A. T. T. .A.' I' T. T. A. T. T. T. T. T. A. T. T. A. T. T. A. T. T. A. T. T. A. T. U T. |T. "i r 3 A. .T. T T. A. b .A.' i—i .T. A. T. T. A. 3 A. '.A. r 'i r T. A. 1st Injections, 147 2nd „ 132 3rd „ 122 4th „ 3 5th „ 1 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 „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 4th „ 1St Injection 2nd „ 3rd „ 2nd „ 8 8 6 21 18 17 20 19 18 17 16 16 16 14 14 16 15 13 10 9 6 10 8 9 8 7 7 3 1 1 1 1 1 2 1 1 1 1 9 9 10 3 1 1 1 3 3 1 1 l'ii 4th 1 5th 1 i □ L J. □ 4th 1 II U I I I TABLE III.—ACES OF PERSONS RK-SCHICKED AFTER TREATMENT AND FOUND TO BE NEGATIVE. 8 to 9 yra. 9 to 10 yrs. 10 to 11 yrs. 11 to 12 yrs. 12 to 13 yrs. 13 to 14 yrs. 14 to 15 yrs. 6 to 12 mths. 1 to 2 yra. 2 to 3 Yrs. 4 to 6 yrs. 5 to 6 yrs. 6 to 7 yrs. 15 yrs. and above. Total 7 to 8 yrs. 3 to 4 yrs. 6 10 11 8 3 1 1 3 1 - 6 9 6 92 Typhoid and Paratyphoid Fever Enteric Fever (typhoid and paratyphoid fever) in Camberwell is mainly sporadic. These sporadic cases are probably due to "carriers" of the B. typhous or Paratyphous. During 1933, 4 cases of typhoid and 7 of paratyphoid were notified. Ten of these patients were treated in hospital. An endeavour is made in every reported case to trace the source of infection, and in respect of 4 cases of paratyphoid which occurred in November of the year under review, investigations were made with a view of discovering a possible common source of infection, but without success. One notified case of typhoid died. The certified cause of death was given as:— 1.(a) Streptococcal septicaemia. (b) Septic Tonsil. (c) Typhoid superimposed. The particulars of each notified case appears in the following table:— Age. Date of notification. Result of bacteriological examination after admission to Hospital or treated at home. Organisms found. Source of infection. Notified as. Sex. 14/3/33 M. 15 Enteric Positive Not traced *M. 21 31/3/33 Paratyphoid Negative Not traced M. 25 13/5/33 Paratyphoid Pos.(Para. B.) Not traced †M. 37 15/7/33 Enteric Diagnosis not confirmed Not traced ††F. 7 12/8/33 Enteric No bacteriological examation Not traced M. 20 18/10/33 Paratyphoid Pos.(Para. B.) Not traced F. 18 23/11/33 Enteric Pos.(Para. B.) Not traced F. 21 25/11/33 Paratyphoid Pos.(Para. B.) Not traced 25/11/33 M. 15 Paratyphoid Pos.(Para. B.) Not traced M. 17 28/11/33 Paratyphoid Pos.(Para. B.) Not traced F. 21 1/12/33 Paratyphoid Not traced Pos.(Para. B.) * Not regarded as Paratyphoid. † Died. †† Patient treated at home. Cerebro-Spinal Meningitis. Ten cases of cerebro-spinal meningitis were notified during the year, and 4 deaths were certified to be due to this disease. Whenever this disease is suspected in children a diagnostic lumbar puncture to obtain a small quantity of the cerebro-spinal fluid for examination is advised. Every case so diagnosed, with few exceptions, should be removed to hospital to ensure continuous medical and nursing attention. A summary of the notified cases appears in the subjoined table. Eight of these cases were notified from hospitals. Particulars of the ten cases are as follows:— Date of notification. Bacteriologically confirmed. Sex. Age. Result. M. 4 16/1/33 Yes. Recovered. Yes. F. 8/12 18/2/33 Died. M. 8/12 3/3/33 Yes. Moved away. Yes. Recovered. F. 6 12/3/33 25 14/3/33 Yes. Died. M. 9/12 21/4/33 Yes. Recovered. F. F. 16 12/6/33 Yes. Recovered. M. 10 23/7/33 No. Subsequent diagnosis, "Orbital abscess." 3/12 Yes. M. 16/11/33 Died. M. 6/12 27/12/33 Yes. Died. Erysipelas. The number of cases of this disease notified increased from 98 in 1932 to 174 in the year under review. The deaths numbered 4, as compared with 5 in 1932. Malaria. One case of malaria was notified during the year. It was ascertained that the patient contracted the disease in Salonica during the war. Ophthalmia Neonatorum. In the following table particulars are given relating to cases of this disease notified in 1933: — No. of Cases Notified. Cases Treated. Vision Unimpaired. Total. Blindness. Vision Impaired. Deaths. At Home. In Hospital. *14 10 4 12 - - - * Two cases still under observation. The patients treated at home were visited daily by the Health Visitors to ensure that they received treatment until pronounced F cured. In four instances treatment was given at the London County Council St. Margaret's Hospital, and in the five remaining cases the infants were nursed, under the direction of a doctor, or by the District Nursing Associations. Pneumonia. Cases of acute primary and acute influenzal pneumonia require to be notified. The number of notifications received during the year was 348 as follows: —Acute primary, 184 ; and the acute influenzal form of pneumonia, 164. These latter notifications show a marked increase as compared with the preceding year, when 73 cases were reported. The deaths from pneumonia (all forms) numbered 168. Puerperal Pyrexia and Puerperal Fever. The number of cases of puerperal pyrexia notified during 1933 was 47 Four of these cases were reported in respect of patients confined at home and 43 following confinement in hospital Two of the notified cases proved fatal, and the certified causes of death were: — (1) (i) (a) General peritonitis. (b) Septic endometritis following full term labour. Laparotomy (2) (i) (a) Lobar pneumonia. (ii) Labour. During the year 12 cases of puerperal fever were notified, 6 after confinement at home and 6 following confinement in hospital. " From the middle of September to the end of the year, 13 cases of puerperal pyrexia and 5 cases of puerperal fever were notified from the London County Council St. Giles' Hospital. These cases occurred during the following time periods:- September 15th to 22nd 4 October 9th to 25th 4 November 17th to 27th 5 December 16th to 28th 5 Every administrative measure was adopted by the hospital authorities to prevent the further occurrence of cases and it is satisfactory to report that at the end of the year this outbreak was effectively under control. Obstetric Specialist Services. The services of the Council's consulting gynaecologist, Mr. Arnold Walker, were requested by general practitioners on six occasions during 1933. Acute Poliomyelitis and Polioencephalitis. Two cases of this disease were notified during the year 1933. Both patients were removed to Hospital. A supply of serum obtained from patients convalescent from acute poliomyelitis may be obtained at the Western Fever Hospital, Seagrave Road, S.W.6, for the treatment of patients in the preparalytic stage of the illness, or exceptionally in a pyrexial phase where the symptoms indicate a rapidly progressive invasion of the spinal cord. Encephalitis Lethargica. Four cases of encephalitis lethargica were notified during the year. Particulars of these cases are as follows:— Date of Notification. Date of Onset. Subsequent history. Sex. Age. *M. 24 Mar. 3rd, 1933 Mar. 3rd, 1933 Died Mar. 31st, 1933. 30 F. April 6th, 1933 Feb. 25th, 1933 (About) Died June 28th, 1933. M. 11 July 29th, 1933 July 19th, 1933 Physical condition stated to be normal. No paralysis. Sept. 20th, 1933 F 25 22nd Aug. 1933 Still in hospital. * This diagnosis was subsequently amended to Cerebro Spinal Meningitis. After Care of Cases of Encephalitis Lethargica. The sequelae of the initial illness may not appear for some considerable time. Every case notified in previous years was visited periodically for the purpose of rendering assistance to the patient and family and the furnishing of progress reports. The following table gives information up to the end of 1933 respecting the cases notified in previous years which are still under observation by this Department:— Number recovered 2 Died 2 No. in L.C.C. Institutions 5 No. in asylums - No. attending Hospital or otherwise and undergoing treatment 17 No. suffering from after effects and not receiving treatment No. left district - 2 F2 83 84 85 TABLE OF NOTIFIABLEVECTIOUS DISEASES, 1933. Notifications andge Distributions. Disease. Total Cases Notified. Admitted to Hospital. Discharged from Hospital as not suffering from the Disease. Total Deaths. 3 to 4. 4 to 6. Under 1. 1 to 2. 2to 3. 10 to 15. 15 to 20. 20 to 35. 5 to 10. 35 to 45. 45 to 65. 65 and upwards Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. 1 8 - 1 - 10 13 12 - 3 7 - 55 4 - Small Pox 55 190 46 49 21 41 76 15 11 - 507 492 15 142 39 4 Diphtheria and Croup 91 643 24 56 136 309 20 1,564 1,464 8 66 83 25 5 - — 36 Scarlet Fever - - - 1 1 6 3 5 Entric Fever & Para-typhoid 11 10 - 2 1 - - 4 1 1* 91 3 5 - 4 3 8 164 29 30 63 13 ( Acute Influenzal 6 20 7 16 14 9 26 - 19 Pneumonia 1 184 115 10 11 27 {Acute Primary 1 6 19 19 1 9 - 15 105 4 2 13 24 28 - 62 24 Erysipelas 174 - 1 - 10 - 1 1 1 1 4 10 5 - - - Cerebro-spinal Meningitis - - - 1 1 - - 1 4 2 2 - - - - - - Poliomyelitis - - - - - - - - - 1 - - - - 1 Malaria - - - - - - 1 4 - - 3 - - 4 - - - - Encephalitis Lethargica - - - 1+ 14 4 14 - - - - - - - Ophthalmia Neonatorum - - - - 12 - - - - 12 2 12 - - - Puerperal Fever - - - - - - 2 2 47 - - - 39 6 - Puerperal Pyrexia 47 - - 2 98 154 197 202 132 873 410 2,411 52 2,749 274 123 169 66 56 74 Totals * Certified cause of death:—(a) Streptococcal Septicaem Septic Tonsil. ( c ) ? Typhoid Superimposed, One other notified case died. Certified can* a. Cerebro-Spinal Meningitis. Name of the Medical Officer or Public Vaccinator. Numbers of successful Primary Vaccinations of persons: — Number of successful Re-vaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. Name of Institution or Vaccination District. Under one year of age. One year and upwards. Peckham Dr. A.B.Blomfield 49 189 13 18 Dr. G.H.Fisher 108 - Nunhead 18 Dulwich Dr. G.W.FitzHenry 3 1 178 55 Dr. H.J.Gater St. George's 8 42 147 East Dulwich Dr. A.F.McMillan 63 277 Camberwell Dr. E. W. G. Masterman 41 1 2 11 St. Giles' Hospital Dr. H. O. West 3 - Dr. O. W. Roberts Dulwich Hospital - - - Constance Road Institution Dr. O. W. Roberts - - 219 919 89 Total INFECTIOUS DISEASES NOT NOTIFIABLE IN CAMBERWELL. Whooping Cough. During the year 1933 351 visits were paid by the women Sanitary Inspectors to 440 cases of whooping-cough which came to the knowledge of the Health Department through the agency of the School Authorities and Health Visitors. Eighty-four of the cases were removed to hospitals of the London County Council and in four instances home nursing assistance was provided by the Council. Whooping-cough still remains a very important cause of child mortality. The deaths from this disease numbered as many as 20. The Health Department is handicapped in its efforts to control the sickness and mortality arising from this disease by the apathy of the lay public, who still persist in not regarding it as a serious illness likely to result in subsequent impairment of health and loss of resistance to other maladies, if not in death. For many years a pamphlet has been distributed by the Health Visitors for the purpose of instructing the public as to the extreme infectivity of whooping-cough, and the necessity for early medical attention before complications have developed. Measles. The Public Health Department is mainly dependent on the School Authorities for information as to the existence of measles. The number of cases brought to the notice of the department during 1933 was 548. All reported cases were visited either by a Health Visitor or the women Sanitary Inspectors. 147 patients were removed to hospitals of the London County Council and in 10 cases nursing assistance was provided by the Council. Four deaths occurred from this disease during 1933. Measles-warning leaflets were distributed throughout the year by the Health Visitors and in November, when this disease began to assume epidemic proportions, the Head Teachers were asked to arrange for a similar distribution to the parents of children attending London County Council Schools. Measles Scheme of Control. Epidemics of this disease occur about every two years in London. With the object of reducing the mortality and mitigating the complications associated with measles epidemics, the close cooperation of the authorities concerned in providing early information of cases and the application of measures to secure prompt and effective treatment is imperative. A scheme drawn up by the London County Council after consultation with borough medical officers of health comprehensively outlines the administrative steps to be taken by the respective authorities during epidemic periods, including the arrangements made for hospital and home nursing treatment of cases according to circumstances. This "scheme of control" was put into operation at the commencement of the epidemic, and continued in force until May of the present year. Measles Serum. Protection from an attack of measles can be conferred by the injection of serum obtained from convalescent patients up to the fourth day of exposure. Unfortunately the immunity thus conferred is only temporary. Serum given between the fourth and eighth days of exposure secures an attenuated attack free from complications. The few medical practitioners who have made application for convalescent measles serum were referred to Dr. Nabarro, Hospital for Sick Children, Great Ormond Street, from whom a supply could be obtained. Adult serum is also claimed to provide a protection, and this protection is stated to be only slightly inferior to that produced by the injection of convalescent serum. Diarrhoea and Enteritis. Although outbreaks of severe diarrhoea in the warmer months of the year among young infants are not so prevalent as they used to be, nevertheless cases of acute intestinal diarrhoea frequently ending in death occur throughout the year. The number of deaths from this cause in children under 2 years of age in 1933 was 33. Early medical and nursing care is essential in the treatment of this disease, and every endeavour is made in all cases coming to the knowledge of this department to secure for the patient the necessary professional attention. Nursing assistance is available for cases treated at home and hospital treatment is also available in special hospitals provided by the London County Council. Influenza. The outbreak of influenza which began in December 1932 and continued throughout the first quarter of 1933 was fortunately of a milder type than was first expected. From the week ended January 7th to March 25th, 140 cases of influenzal pneumonia were notified. The deaths directly attributed to influenza throughout this period numbered 82 and for the whole year 98. Rheumatism. It is generally agreed that there is not one predominating cause of an attack of rheumatism, but that a combination of many factors, such as a damp atmosphere, poverty, lack of ventilation in dwelling houses, produce the clinical condition known as rheumatism. Cases of this disease that come to the notice of this department are visited by the Sanitary Inspectors, and where any sanitary nuisances are discovered in the patient's home these promptly receive attention. Other Diseases. No cases of anthrax, epidemic jaundice, undulant fever, glandular fever, or psittacosis, came to the notice of the Health Department during 1933. Cancer. The deaths from cancer in 1933 unfortunately show an increase, viz., 451, as compared with 396 in 1932. The sites of the body affected and the age at which death occurred is given in the following table. Every endeavour is made to instruct the general public by leaflet distribution as to the symptoms of this disease in sites of the body commonly affected, and to stress the importance of early examination by a doctor for the purpose of receiving treatment in the most favourable stage of the disease for a cure. Bacteriological Examinations. The Council's bacteriological work is conducted by Dr. G. Bousfield, at his laboratory, 134, Denmark Hill. The total number of specimens dealt with during the year (excluding milk and ice cream) was 4,833, as follows: — Diphtheria examinations 2,652 Sputum examinations 2,097 Widal's Test for Typhoid and Paratyphoid 31 Miscellaneous specimens 29 Bath waters 12 Experimental bath water 1 Ice Creams 9 Ice Creams (for Typhoid) 2 Per cent, positive 10.4 20.3 9.6 Total 4,833 Dr. Bousfield states that the number of Diphtheria examinations required during the year was somewhat greater than the previous year, and the number of sputum examinations demanded was approaching 400 less. The total number of examinations done was less by 218 than was the case in the year ended December 31st, 1932. This diminution is entirely confined to the reduction in the number of sputa. All the positive blood tests for the Typhoidparatyphoid group were found to be due to B. Paratyphosus "B." CANCER DEATHS. CLASSIFICATION. 55 to 65 65 to 75 Site of Disease. Under 15 15 to 25 25 to 35 35 to 45 45 to 55 75 and over M. M. F. M. F. M. F. M. F M. F. M. F. M. F. M. F. - 2 - Buccal Cavity - - - - - - - - - - 5 3 - - - - 1 - 6 1 1 3 - 10 Pharynx - - - - - - - 3 - 1 3 13 - - - - - 2 - 5 - Oesophagus - - - 9 7 10 37 Stomach - - 1 3 3 3 6 12 13 - - - - Liver 1 7 1 6 5 3 5 - - - - - - 17 - - - - 1 - Peritoneum - - - — - - 2 - 1 - - - - - 2 8 11 61 Intestines and Rectum 1 2 2 1 7 13 12 28 16 16 - - - 8 Male Genital Organs - - 3 - 5 - - - - - - - - - - - 14 Female Genital Organs - - - - - - 5 - 9 - 19 - - 5 - - - 8 6 Breast - - - 1 - 3 - 1 0 - 11 - - - - - - - - - - - - - - Skin - - - - - - - Other or Unspecified Organs - 1 - - 14 3 - 6 16 7 15 8 8 59 1 15 4 TUBERCULOSIS. The Borough Tuberculosis Dispensary. The Council's Tuberculosis Dispensary is situated at 19, Brunswick Square, S.E.5. The following table gives information as to the sessions held:— Monday, 10 to 12 noon, 2 to 5 p.m. Tuesday, 10 to 12 noon, 2 to 5 p.m. (Afternoon session—children only.) Wednesday, 10 to 12 noon, 2 to 5 p.m. Thursday, 10 to 12 noon, 2 to 5 p.m., 6 to 8 p.m. (Evening session for those employed during the day.) Saturday, 10 to 11 a.m. (Children only.) Notification of Tuberculosis. During the year 290 new cases of pulmonary and 73 new cases of non-pulmonary tuberculosis were notified. No instances occurred of wilful neglect or refusal to notify during the year. In addition to the cases formally notified, 66 cases of tuberculosis came to the knowledge of the Health Department in 1933 in the following manner:— Thirty-two cases were transferred from areas outside the Borough; 21 cases through the agency of the death returns, and the receipt of 13 posthumous notifications. Mortality from Tuberculosis Pulmonary tuberculosis was responsible for 221 deaths, and other tuberculous disease for 22 deaths in 1933. In recent years the number of deaths from all forms of tuberculosis was as follows:— 1928 279 1931 268 1929 280 1932 248 1930 265 1933 243 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths was 1 to 11.57, as compared with 1 to 8.55 in 1932, 1 to 11.65 in 1931, and 1 to 10.6 in 1930. The following table shows the period between the receipt of the primary notification and the death of the patient:— Pulmonary. Non-pulmonary. Not notified and notified after death 24 10 Notified within one month of death 26 11 Notified within three months of death 16 4 - Notified within six months of death 14 Notified more than six months 135 3 The following table gives particulars of new cases of tuberculosis and of deaths from the disease as given by the Registrar- Generalin Camberwell during 1933:— Age Periods. New cases. Age Periods. Deaths. Respiratory. Nonrespiratory. Respiratory. Nonrespiratory. 0- 1 M. 1 F. F. M. F. M. M. F. - 2 0 - 1 - - - 1 - 3 1 - 2 1 - 5 - 1 4 1 - 2 - 5 - 10 1 4 8 2 - 5 1 1 1 2 - 10 - 15 3 6 4 5 - 15 2 1 2 4 - 5 15 - 20 12 17 4 15 - 25 20 35 4 - 4 20 - 25 31 25 4 25 - 35 36 23 1 1 25 - 35 47 36 6 8 35 - 45 26 13 1 - 35 - 45 40 14 3 45 - 55 26 12 1 - - 1 45 - 55 24 12 3 55 - 65 12 3 2 - 3 55 - 65 11 4 3 - 65 - 75 8 - 1 6 3 1 75 & up 1 65 & up - - - - Care is exercised that the Tuberculosis notification register is as far as possible an actual record of the persons in Camberwell who are suffering from this disease. The number of cases of tuberculosis on the Register at the end of 1933 and the changes which have taken place during the year are shown in the following table: — Pulmonary. Non-pulmonary. Totals. Males. Females. Males. Females. 893 654 307 252 2,106 No. of cases on the Register of notifications on January 1st, 1933 174 No. of new cases notified during the year 37 363 116 36 No. of cases brought to notice other than by formal notification 7 26 26 7 66 5 No. of cases replaced on register during the year 4 13 18 40 No. of cases removed from register during the year:— 1. Cured 2 3 3 12 4 2. Removed from district and lost sight of 65 23 53 20 161 138 92 18 15 3. Dead 263 4. Incorrectly diagnosed 3 1 - 4 - No. of cases on the register on January 1st, 1934 312 664 261 898 2,135 Public Health (Prevention of Tuberculosis) Regulations, 1925. No person suffering from pulmonary tuberculosis employed in the milk trade came to the knowledge of this Department. Bovine Tuberculosis. Tuberculosis in man may be due either to the human or the bovine type of bacillus. It is possible to-day for bacteriologists to differentiate with a small margin of error between the human and bovine type of bacillus, with the result that the old-established idea that pulmonary tuberculosis in man is almost invariably due to the human type of tubercle bacillus has had to be modified. Roughly 1 per cent, of the respiratory and 23 per cent, of the non-respiratory deaths from tuberculosis in each year are now held to be bovine in origin. This does not take into account the large amount of ill-health resulting from tuberculous infections, bovine in origin, which do not end in death. It is a well-known fact that the agent of transmission of the tubercle bacillus from cow to man is most frequently the raw milk from a cow suffering from tuberculosis of the udder, or cream made from such milk. These deaths and needless human suffering arising from the consumption of such milk could and should be prevented. It is surely not too much to ask that all milk sold to-day should either be efficiently pasteurised before sale or obtained from cows free from tuberculosis. REPORT OF THE TUBERCULOSIS MEDICAL OFFICER FOR THE YEAR 1933. The Current List of Notifications of Tuberculosis in Camberwell as at December 31st, 1933. On December 31st, 1933, there were 2,135 cases of tuberculosis on the current list in Camberwell. There were 1,562 cases of pulmonary tuberculosis—B9B males and 664 females; 573 cases of non-pulmonary tuberculosis—3l2 males and 261 females. Table I. supplies an analysis under age periods, sex, and the broad grouping of pulmonary and non-pulmonary forms. 116 143 138 53 898 183 Pulmonary—Males 1 18 20 203 23 - 120 129 40 664 „ Females 3 14 38 163 112 33 12 - 17 312 51 26 11 Non-Pulmonary—Males 3 28 70 71 20 14 1 43 29 2 261 „ Females 2 23 42 51 34 16 13 6 94 TABLE II. Individual Notified Patients on Current List at December 31st, 1933, allocated to the Wards of the Borough. Pulmonary. Non-Pulmonary. Grand Total. Wards. Females. Total. Males. Males. Females. Total. 1 55 136 30 67 203 81 37 34 55 11 10 21 76 2 21 39 97 24 14 38 135 3 58 174 4 74 60 134 18 22 40 30 98 5 50 18 68 16 14 71 15 16 31 6 31 12 43 62 141 34 26 60 201 7 79 18 100 8 42 27 69 13 31 110 9 47 36 83 16 11 27 10 25 84 10 28 31 59 15 79 15 10 25 104 11 50 29 12 39 80 20 11 31 111 41 102 13 38 44 82 12 8 20 35 110 14 43 32 75 18 17 9 16 67 15 19 32 51 7 38 85 13 9 22 107 16 47 17 35 19 54 17 11 28 82 13 122 18 70 35 105 4 17 9 66 19 29 28 57 2 7 9 9 - 20 2 7 - - The Notification of Tuberculosis in Camberwell in 1933. The number of primary notifications of tuberculosis in Camberwell in 1933 was 363. ' 290 were cases of pulmonary tuberculosis and 73 were cases of non-pulmonary tuberculosis. On Table III. the number of primary notifications for each of the last thirteen years are compared. TABLE III. Comparative Table of Primary Notifications for past Thirteen Years. Year. All Forms. Pulmonary Tuberculosis. Other Forms. 155 1921 750 595 147 1922 653 506 505 152 1923 657 1924 559 416 143 1925 491 373 118 112 1926 506 394 353 98 1927 451 1928 363 102 465 1929 495 393 102 1930 483 393 90 81 1931 414 333 314 72 1932 386 1933 363 290 73 95 On Table IV. is given the primary notification rate (per 1,000 population of Camberwell) for the last thirteen years. TABLE IV. Showing Annual Primaey Notification Rate of Tuberculosis (All Forms) 1921-1933. Pulmonary Tuberculosis. Other Forms. Year. Population. All Forms. 0.58 267,198 2.80 2.22 1921 2.41 1.87 0.54 1922 270,300a 0.55 2.40 1.85 1923 272,300a 1.52 0.52 1924 273,700a 2.04 1.35 0.42 1925 275,400a 1.78 275,400a 1.80 1.43 0.40 1926 0.36 271,100a 1.66 1.30 1927 0.39 260,400a 1.78 1.39 1928 1.52 0.39 1929 256,900a 1.92 1.88 1.53 0.35 1930 256,900a 0.32 1.64 1.32 1931 252,100* 0.29 248,000a 1.56 1.27 1932 1.19 0.30 1933 243,700a 1.49 *Census, 1931. a Estimated. On Table V. the primary notifications of 1933 are allocated to the Wards of the Borough. TABLE V. Showing No. of Primary Notifications Received during 1933 and Ward Allocation. Pulmonary. Non-Pulmonary. Grand Total. Wards. Males. Females. Total. Males. Females. Total. 4 6 27 1 11 10 21 2 16 5 21 9 7 2 3 2 15 4 7 22 3 7 8 3 4 2 2 19 13 4 17 - 20 5 14 3 3 6 5 9 1 2 17 11 4 15 1 6 15 2 17 7 7 8 2 - 8 3 2 5 23 8 10 18 22 10 16 5 1 6 9 6 1 6 10 3 5 1 - 2 1 3 19 11 11 5 16 2 21 1 4 5 26 12 15 6 15 13 4 11 1 3 4 7 19 6 4 13 2 4 14 9 2 12 15 5 5 10 2 - 4 2 6 24 16 8 10 18 11 10 1 1 17 5 5 - 21 2 23 7 2 18 14 - 2 2 17 19 12 3 15 - 1 - 20 1 - 1 - - Two Pulmonary Males unattached. 97 On Table VI. the summary of notifications for the year 1933 is treated in more detail. Sanatoria. 217 149 18 Poor Law Institutions. 146 84 19 Notifcations under Articles. 239 156 43 Summary of Notifications during the Period from January Ist, 1933 to December 31st, 1933. Formal Notifications under Article 5. Number of Primary Notifications. Total Primary Notifications. 174 116 37 65 and upwards. 6 3 - 4 55 - 65 11 3 45 - 55 24 3 12 35 - 45 40 14 - TABLE VI. 25 - 35 47 36 6 20 - 25 31 25 4 15 - 20 12 17 5 10 - 15 - 3 6 5 - 10 4 2 1 1 - 5 - 1 4 0 - 1 - 1 2 Age Periods. Pulmonary— Males „ Females Non-Pulmonary— Males „ Females - - 5 4 6 6 2 1 2 26 - - Non-Pulmonary—Males - 1 1 1 1 1 - - 2 - 7 - „ „ Females 1 1 1 - 1 2 1 7 - - - - The source or sources from which information as to the above-mentioned cases was obtained stated below: — No. of Cases. Source of Information. Pulmonary. Non- Pulmonary. Death Returns From Local Registrars Transferable deaths from Registrar-General 10 3 6 2 Posthumous notifications 8 5 "Transfers" from other areas (other than transferable deaths) 28 4 Other Sources if any (specify) - - Table VII. Supplemental Return. New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during 1933 otherwise than by notification under Public Health (Tuberculosis) Regulations, 1912. The information is obtained from the certificates of death, from irregular notifications made after death, and cases coming into the Borough previously notified. Deaths from Tuberculosis (Camberwell), 1933. The number of deaths from tuberculosis in Camberwell during 1933 as stated by the Registrar-General was 245. Of these 223 were from pulmonary tuberculosis and 22 from other forms of the disease. 34 were not notified during life as suffering from the tuberculosis of which they died. TABLE VIII. Deaths from Tuberculosis (All Forms) 1933 Allocated to the Wards of the Borough. Pulmonary. Non-Pulmonary. Grand Total. Wards. Females. Total. Males. Females. Total. Males. 22 1 1 23 1 11 11 - 7 7 14 1 1 15 2 - 14 3 9 5 14 - - - 16 4 11 5 16 - - - 14 5 9 5 14 - - - 6 4 10 1 1 2 12 6 7 4 5 9 3 1 4 13 19 8 12 4 16 2 1 3 1 19 9 9 9 18 1 - - 2 10 - 2 2 - - 5 3 8 1 1 2 10 11 1 12 7 4 11 1 12 - 1 1 9 13 4 4 8 - 3 3 14 14 7 4 11 - 15 4 2 6 - - - 6 16 9 4 13 1 1 14 - 11 17 6 3 9 1 1 2 11 11 18 7 4 - - - 7 - 7 19 3 4 - - 20 - 2 2 - 2 - - G 2 Age Periods. Under 1 1 - 2 2 - 5 5 - 15 15 - 25 25 - 35 35 - 45 45 - 55 55 - 65 65 - 75 75 and upwards Totals. 36 Pulmonary—Males - 1 20 26 132 2 26 12 8 - 1 35 23 „ Females - - - 1 13 12 3 3 1 91 1 2 1 2 4 1 - 2 - - 13 Non-Pulmonary—Males - 1 - „ Females 1 1 4 1 _ 9 - - _ - 100 TABLE X. Showing the Occupation of 143 Males who died from Tuberculosis in 1933. Army Pensioner 2 Maintenance Hand 1 Artificial Flower Maker 1 Messenger 1 Ammunition Machinist 1 Advertisement Canvasser 1 Newsvendor 1 Night Watchman 1 Butcher 1 No Occupation 2 Omnibus Driver 1 Baker 2 Baker's Foreman 1 „ Conductor 3 Barman 1 Printer's Assistant 1 Carman 1 „ Works Manager 1 Currier 1 Porter, Fish Market 1 Collar Cutter 1 Porter 8 Club Steward 1 Printer's Apprentice 1 Cinema Attendant 1 Painter and Decorator 8 Chauffeur 1 Porter, Railway 2 Pianoforte Finisher 1 Compositor 3 Clerks 9 P.L.A. Foreman 1 Draper's Assistant 1 „ Secretary 1 Dental Mechanic 1 Pedlar 1 Dyer and Cleaner 1 Plasterer 1 Dry Cooper 1 Plate Engraver 1 Decorator 1 Political Agent 1 Engineer's Turner 1 Postman 1 „ Fitter 1 Packer 2 Fishmonger 1 Railway Carriage Cleaner 1 „ Assistant 1 Stereotyper 1 Farrier 1 School Child 4 Goods Checker 1 Soldier 1 Gas Fitter 1 Sewing Machine Mechanic 1 General Dealer 1 Street Singer 1 Hammer Man 1 Stores Assistant 1 Hardware Salesman ] Ship's Steward 1 Hotel Cook 1 Tailor 1 Insurance Agent 1 Tailor's Cutter 1 Ice Cream Salesman 1 Telephone Tester 1 Ice Salesman 1 Typewriter Mechanic 1 Labourer, General 2 Toilet Goods Merchant 1 „ Builder's 2 Tram Driver 1 Labourer 3 Telephone Operator 1 Licensed Victualler 2 Under School Age 4 Manager, Blouse Manufacturer's 1 Van Traveller 1 Motor Driver 3 Vanguard 1 „ Mechanic 1 Umbrella Maker 1 Milk Carrier 1 Veterinary Assistant 1 Master Builder 1 Waiter 1 Metal Polisher 2 Wood Machinist 1 Master Tailor 3 Wood Case Maker 1 Milk Salesman 1 Warehouseman 1 Machine Minder 1 Washhouseman 1 TABLE XI. Showing the Occupation of 100 Females who died from Tuberculosis in 1933. Artificial Flower Maker 1 Messenger, Gas Co. 1 Book Folder 2 No Occupation 13 Bird Cage Maker 1 Nurse 1 Packer, Confectionery 2 Bedding Manufacturer 1 Counter Hand 1 Printer's Assistant 1 Clerk 4 Rag Sorter 1 „ Insurance 1 School Child 5 Shorthand Typist 5 Domestic Servant 2 Forewoman, Blouse Factory 1 Sweet Boiler 1 Florist's Assistant 1 Shuttlecock Maker 2 Stock Keeper 1 Housewife. 38 Ironer 1 Shop Assistant 2 Laundry Hand 1 Student 1 Machinist 3 Under School Age 3 Music Hall Artist 1 Waitress 1 Milliner 1 TABLE XII. Return showing the Work of the Dispensary during the year 1933. Nonpulmonary. Total. Pulmonary. Adults. Children. Adults. Children Adults. Children. Diagnosis. M F. M. F. M. F. M. F. M. F. M. F. A.—New Casks examined during the year (excluding contacts): — 91 48 3 3 4 9 8 5 11 8 57 95 (a) Definitely tuberculous - 6 - (b) Diagnosis not completed - 10 3 - - - - - - - 111 67 56 (c) Non-tuberculous - - - - - - 150 - B.—Contacts examined during the year:— II II 25 1 3 2 27 21 2 1 18 3 (a) Definitely tuberculous 2 5 - - 3 6 1 1 (b) Diagnosis not completed - - - - - - - — - - 133 222 151 143 (c) Non-tuberculous - — - — C. —Casks written off the Dispensary Register as:— I I 2 3 - - 1 1 - 1 3 - 1 4 (a) Recovered (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - 293 220 199 - - - - - 341 - 573 143 156 D. —Number of Cases on Dispensary Register on December 3lst: — I I I I 794 50 107 115 93 466 41 115 679 (a) Definitely tuberculous - 13 - - - 12 4 1 (b) Diagnosis not completed - - - - 1. Number of cases on Dis- pensary Register on January 1st 7. Number of consultations with medical practitioners:— 1,670 (a) Personal 47 (b) Other 506 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 51 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 614 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 105 8,669 1,220 10. Number of: — (a) Specimens of sputum, &c., examined 4. Cases written off during the year as Dead (all causes) 148 (6) X-ray examinations made in connexion with Dispensary work 432 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 5 5. Number of attendances at the Dispensary (including Contacts) 5,288 6. Number of Insured Persons under Domiciliary Treatment on December 31st 324 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 822 TABLE XIII. Number of Families occupying 1 Room. 5 Rooms. 6 Rooms or more. 2 Rooms. 3 Rooms. 4 Rooms. Housing accommodation of 363 families in which there was a Primary Notification of Tuberculosis in 1933. Patient living alone 25 15 7 - - - 22 18 9 9 1 „ „ with 1 other 15 4 23 23 15 7 5 „ „ 2 „ „ „ 3 „ 9 20 26 10 6 - 8 „ „ 4 „... - 4 13 15 4 - 13 3 6 „ „ 5 „ - 3 4 7 - „ „ 6 „ - 3 - 1 3 1 2 „ „ 7 „ - - „ „ 8 „ - 2 - - - - - „ „ 9 „ - 1 - - — - 1 „ „ 8 „ - - - - 44 89 89 36 29 76 Total TABLE XIV. Sleeping accommodation for 363 tuberculous cases notified for the first time in 1933. The figures refer to the Tuberculosis Nurse's first home visit. The patient slept— In separate room In 109 cases. Alone in bed with 1 other in room „ 29 „ 2 others „ „ 21 „ „ 3 „ „ „ 3 „ „4 „ „ „ 2 „ In bed with 1 person and no others in room „ 109 „ „ „ 1 „ 1 other in room „ 35 „ „ „ 1 „ 2 others „ 29 „ „1 „ 3 „ „ „ 9 „ „ 1 „ 4 „ „ 6 „ In bed with 2 persons and no others in room „ 6 „ „ „ 2 „ 1 other „ 4 „ „ „ 2 „ 2 others „ - „ „ „ 2 „ 3 „ „ - 1 „ In bed with 3 persons and no others in room „ 1 „ „ 4 „ „ „ „ - „ 363 The Nature and Extent of Co-operation with General and Special Hospitals, School Clinics and other Institutions. 1. With General and Special Hospitals, (a) King's College Hospital. Including cases sent to the X-ray Department, 550 Dispensary patients were sent to hospital in 1933 for an opinion as to diagnosis, etc. (b) Other Hospitals. Many of our patients when requested to go to a hospital for further examination and opinion, asked to be sent to the hospital they knew best, and we sent patients to the following hospitals: — St. Thomas's. Sick Children's Hospital, Great Ormond Street. Guy's. Throat Hospital, Golden Square. Charing Cross. Westminster. Brompton. Miller. Evelina. South London Hospital for Women. Belgrave. All Saints'. Several patients were diagnosed in St. Giles' Hospital after a period of observation. Apart from the above we had the opportunity under the London County Council Tuberculosis Scheme of getting patients admitted to special hospitals, for example, Brompton and Highwood Hospitals, for observation as to diagnosis, and to St. George's Home, Chelsea, among other Institutions for disposal as to treatment. 2. With School Clinics. All contacts of school age are referred by the Dispensary to the Divisional School Medical Officer for the area for special and periodical observation by the School Medical Officers' and any doubtful case may be referred back to the Dispensary for special examination. Co-operation with Medical Practitioners. Of 553 new patients sent by practitioners to the dispensary for diagnosis or seen in consultation at their homes, 73.7 per cent, were seen by the Tuberculosis Officer before notification. These figures are very satisfactory in a city like London where patients have such a large choice of hospitals to which practitioners may send them before notification. Classification of New Patients. (a) Pulmonary Tuberculosis. During 1933, 192 patients who attended the Dispensary for the first time and were found to be suffering from tuberculosis were reported by the Tuberculosis Officer to be in the undermentioned stages of the disease at the time of diagnosis:— T.B. minus (sputum negative or absent) 58, or 30.20 per cent. T.B. plus 1 (early cases, sputum positive) 13, or 6.78 per cent. T.B. plus 2 (intermediate cases, sputum positive) 91, or 47.39 per cent. T.B. plus 3 (advanced cases, sputum positive) 30, or 15.63 per cent. (b) Non-Pulmonary Tuberculosis. There were 34 new cases of non-pulmonary tuberculosis in the following forms: — Bones, joints and spine. Abdomen. Other organs. Peripheral glands. Skin. The Necessity for Early Treatment to Ensure the Prospects of Recovery. Under the L.C.C. Residential Institutional Scheme patients suffering from pulmonary tuberculosis are sent away as a rule within two weeks of application. Children suffering from tuberculosis of joints are if possible sent away the day the diagnosis is made. Information as to Special Methods of Diagnosis and Treatment in Use and the Number of Persons to whom these Special Methods have been Applied. We have placed chief reliance on accurate history taking, careful reading of symptoms, temperature charting and pulse study, physical examination and repeated sputum testing in tubercle negative cases. When the above methods are not neglected in the diagnosis of a case the use of X-rays is of the highest value. Special arrangements exist with King's College Hospital for X-ray examination of dispensary patients. During 1933, 432 patients were sent to King's College Hospital for X-ray examination. Artificial pneumothorax treatment is available for suitable dispensary cases and may be carried out while the patient is in a residential institution or later while on home treatment. -By arrangement, artificial pneumothorax treatment can be given at the following hospitals to patients who are on general treatment at home: Brompton, St. Thomas's, Guy's, King's College, Charing Cross, The Miller, Grove Park and Colindale. During 1933, 43 dispensary patients had artificial pneumothorax treatment at one or other of these hospitals. This does not include dispensary patients who were on artificial pneumothorax treatment in sanatorium at December 31st, 1933. Such surgical methods as phrenic evulsion and thoracoplasty are available under the scheme for dispensary patients, and the former operation is coming more and more into use. Finsen Light is available for dispensary patients who have Lupus vulgaris. Two dispensary patients had this treatment at the London Hospital during the year. Artificial sunlight treatment was given by arrangement at King's College Hospital to two dispensary patients during the year. Work of Tuberculosis Nurses. The tuberculosis nurses paid 8,669 visits to the homes of tuberculous patients during the year. Nursing of Patients. We have always been able to obtain a District Nurse whenever one is required. In the majority of cases, however, it is better to urge the removal of a patient who is confined to bed, to hospital. Nature and Extent of any Dental Treatment. Seventeen patients received dentures through the Tuberculosis Dispensary scheme of the Borough. Approved Societies contributed part in the case of the insured, and patients who could afford it contributed. Supply of Extra Nourishment during 1933. Seventy-five dispensary patients received extra diet (Borough scheme). Supply of Sputum Pocket Flasks and Outfits for Sputum Examination. About 132 pocket sputum flasks were supplied to patients during the year. Patients, of course, obtain pocket flasks from other sources, for example, residential institutions and private sources. 1,220 outfits were supplied in connection with sputum examinations. Institutional (Residential) Treatment of Camberwell Patients in 1933 through the London County Council. 1. Adult Males:— Number of applicants for residential treatment 206 Number who received residential treatment 197 Number who did not receive residential treatment:— Not accepted - Failed to enter - 9 Awaiting residential treatment December 31st, 1933 — Classification of Adult Males who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 18 Pulmonary cases in which tubercle bacilli had been found in the sputum 155 Early pulmonary tuberculosis 17 Moderately advanced pulmonary tuberculosi 122 Advanced pulmonary tuberculosis 16 Surgical tuberculosis 5 Diagnosis of tuberculosis 9 Not classified - 2. Adult Females:— Number of applicants for residential treatment 145 Number who received residential treatment 133 Number who did not receive residential treatment:— Not accepted 4 Failed to ente 4 Awaiting residential treatment, December 31st, 1933 4 Classification of Adult Females who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 27 Pulmonary cases in which tubercle bacilli had been found in the sputum 83 Early pulmonary tuberculosi 14 Moderately advanced pulmonary tuberculosis 60 Advanced pulmonary tuberculosis 9 Surgical tuberculosis 15 Diagnosis of tuberculosis 8 Not classified - 3. Boys:— Number of applicants for residential treatment 17 Number who received residential treatment 16 Number who did not receive residential treatment:— Not accepted — Failed to enter — Awaiting residential treatment, December 31st, 1933 1 - Classification of Boys who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 3 Pulmonary cases in which tubercle bacilli had been found in the sputum - Early pulmonary tuberculosis — Moderately advanced pulmonary tuberculosis — Advanced pulmonary tuberculosis Surgical tuberculosis 13 Diagnosis of - Not - 4. Girls:— Number of applicants for residential treatment 13 Number who received residential treatment1 3 Number who did not receive residential treatment: — Not accepted Failed to enter Awaiting residential treatment, December 31st, 1933 Classification of Girls who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 1 Pulmonary cases in which tubercle bacilli had been found in the sputum 2 Early pulmonary tuberculosis1 1 Moderately advanced pulmonary tuberculosis 1 Advanced pulmonary tuberculosis Surgical tuberculosi 10 Diagnosis of tuberculosis Not classified The London County Council used beds in the following institutions:— Adults. Sanatoria. Hospitals. King George V. Brompton. Northern. Frimley, Surrey. St. Luke's, Lowestoft. Holy Cross, Surrey. Grove Park. Northamptonshire, Creaton. Grosvenor. Colindale. Royal Sea Bathing. Hawthorndene, I.O.W. Kelling, Norfolk. Harnwood. Maltings Farm, Suffolk. All Saints'. Pinewood. Royal National Whitstable. National, Benenden. The Old Manor House, Broadstairs. City of London. Fairlight, Hastings. Archway. Dulwich. Fairholme. St. Benedict's. St. Giles'. St. James's. St. Olave's. Homes. Colonies. St. Michael's, Axbridge. Burrow Hill. Papworth, Cambridgeshire. St. Barnabas, Torquay. Bishopsbourne. Preston Hall, Kent. St. George's, Chelsea. Marillac. Hampshire. - - - - - - - - Children. Hospitals. Sanatoria and Homes. Highwood, Brentwood. Naylands. Alexandra Hip. Millfields. Heatherwood, Ascot. Metropolitan Convalescent. Princess Mary's. East Anglian. Queen Mary's. Belgrave. The average duration of residential treatment given by the London County Council in 1933 to 330 adults was 17.4 weeks. The average duration of residential treatment given to 29 children by the London County Council in 1933 was 19.4 weeks. This refers only to those who began treatment in that year. Many of these patients will remain in institutions during varying periods of 1934 —some will probably remain the whole year. The ultimate averages are therefore to be reckoned as considerably higher. It should also be remembered that a good many patients took their discharge before completion of treatment, thereby reducing the possible averages. The Work of the Care Committee. The Secretary for Care Work has compiled the following figures and items of information in relation to some of the work in 1933:— 75 Dispensary patients received extra diet (Borough Scheme). 17 patients received dentures from the Tuberculosis Dispensary Dental Scheme of the Borough. Approved Societies contributed part in the case of the insured, and patients who could afford it paid a little. 138 cases were specially helped in their application to the Public Assistance Committee for assistance. Thus patients received relief in money, food, extra diet, convalescence, clothes, etc. 5 cases were assisted in their application to the British Red Cross Emergency Fund. Thus pensioners received such assistance as money, clothing, sick-room necessities, etc. 18 cases were assisted in their application to the United Services Fund. In this way ex-service men or their families obtained money, clothing, convalescence, etc. We assisted the London County Council in many ways in making arrangements for the institutional treatment of 359 patients. We did our best to settle all difficulties that threatened to bring patients home from sanatoria too soon. We co-operated with the Charity Organisation Society in 14 cases, and with the Invalid Children's Aid Association in 78 cases. We co-operated with many families in which there was a tuberculous member in endeavouring to obtain homes for them on the new housing estates of the L.C.C. and elsewhere. Patients were advised on questions concerning their employment and endeavours made to put them on the right track with regard to that difficult matter. We obtained bed-side comforts for many advanced cases. Other patients were helped from private sources, for example, in the way of clothing, boots, etc. To a large number of patients personal help in discussing difficulties was given. The Tuberculosis Dispensary Handicraft Class is proving a great success, and the average of attendances is excellent. WILLIAM BRAND, Tuberculosis Officer. INDEX. PAGE Aged and Infirm Persons 44 Agriculture (Grading, etc.) Act 66 Ambulance Facilities 13 Ante-natal Services 21 Assistant Medical Officer Bacteriological 89 Bakehouses 58 Births and Birth Rates 7 Notification of Births 8 Still Births 8 Butchers' Shops and Stalls 58 Cancer 89 Table of Deaths 90 Cerebro-spinal Meningitis Clinics and Treatment Centres 13-14 Closet Accommodation 35 Common Lodging Houses 15,43 Convalescent Treatment 32 Cowhouses 15 Deaths 8,9,10 General Table of 9 Infantile 11-12 Maternal 11 Diarrhoea and Enteritis 88 Diphtheria 75 Immunisation.76, 78 Disinfection 17 Drainage and Sewerage 35 Eating Houses 59 Encephalitis Lethargica 83 Enteric Fever 80 Erysipelas 81 Factory and Workshop Act 49 -52 Fish— Curers 58 Fried Fish Shops 59 Shops and Stalls 59 INDEX—continued. PAGE Food Chemical and Bacteriological Examination of 67 Poisoning 67 Premises Registration 56 Preservatives, etc., Regulations Unsound Food Table 61 Food and Drugs Acts— Adulteration Act 62 Artificial Cream Act 65 Butter Factories, etc. 67 Condensed Milk Regulations 65 Dried Milk Regulations 65 Proceedings Table 72 Samples, Tables 68-69 Samples, Adulteration Table 70 HEALHT Home Nursing 33 Home Visiting 30 Hospitals 15 Housing 45-49 Fitness of Houses 45 Houses let in Lodgings 46 Overcrowding 46 Statistics 48 Underground Rooms 47 Ice Cream 57 Infant Life Protection 32 Infant Welfare Centres 16 ,25 Mothercraft and Health Talk Sessions 31 Returns 28,29 "Toddlers" Clinics 31 Infectious Diseases Table of 84 Infirm Persons 44 Influenza 88 Inspection and Supervision of Food 53- 73 Insanitary Areas 45 Laboratory Facilities 13 Malaria 81 Maternity and Child Welfare 21-34 Maternity Outfits 25 INDEX —continued. PAGE Maternity Wards 22 Measles 87 Merchandise Marks Act 66 Midwives 25 Payment of Milk- Bacteriological Examinations Bottling 53 Designations Order 53, 54 Examination for— Dirt 56 Stomatitis 56 Tubercle 55 Pasteurised Milk 55 Milk for Necessitous Persons 33 Mortuary and Coroner's Court 18 Mothercraft Sessions 31 Nursing 13, 33 Nutrition 72 Obstetric Specialist 83 Offensive Trades 17,44 Ophthalmia Neonatorum 81 Outworkers51 Pneumonia 82 Poliomyelitis 83 Population 6 Post-Natal Supervision 30 Pre-School Child 30 Public Cleansing Puerperal Fever 82 Rag and Bone Dealers 43 Rag Flock Acts 43 Rats and Mice Destruction Act 43 Rent Restriction Acts 43 Restaurants 59 Rheumatism 89 Sanitary Circumstances of Area 35 - 44 Inspection Tables 36 - 39 Summary of Legal Proceedings 40 - 42 Scarlet Fever 77 School Treatment Centres 14 INDEX —continued. PAGE Schools, Inspection of 44 Sickness, causes of 5 Slaughterhouses 15, 59 Smallpox 74 Smoke Abatement 44 Social Conditions of Area 5 Staff 2 Statistics, Summary of 4 Statistics, Extracts from 5 Statistics, Vital 7 Street Markets 60 Survey of Health Services 19,26 Swimming Baths 18 Transfer of Powers Order 15 Tuberculosis 91-110 Bovine 93 Care Work 109 Dispensary Table of Work 102 Mortality 91 Notification 91 Report of T.B. Officer 93 Typhoid Fever 80 Unmarried Mothers 25 Vaccinators, Public — Return of Work 86 Verminous Persons 18 Water Supply 35 Whooping Cough 87