CAM 41 Report of the Medical Officer of Health. Public Health Department, Town Hall, Camberwell, S.E.5. 1st July, 1935. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Mr. Mayor, Aldermen and Councillors, I have the honour to submit my Annual Report on the health and sanitary circumstances of the Borough. This report has been prepared in accordance with Ministry of Health Circular 1,417, which indicates the lines to be followed with regard to the contents and arrangement of the Annual Report of Medical Officers of Health for 1934. The Public Health Department which was accommodated at 35, Brunswick Square, Camberwell, for the past twelve years is now established in the new Town Hall, an arrangement which is satisfactory from every point of view. The year 1934 will be remembered as the year during which the Council, in collaboration with the London County Council, started a campaign of slum clearance in Camberwell, and this campaign is still being vigorously pursued. The birth rate still further declined during 1934, the rate per 1,000 of the estimated resident population being 13.22, which is the lowest ever recorded in Camberwell. The comparative figure for 1933 was 13.32. The death rate remained practically unchanged, viz., 12.31 as compared with 12.33 in the previous year. There was also a slight fall in the tuberculosis death rate from 1.OO to 0.97 per thousand estimated resident population. It is particularly gratifying to record, that the maternal death rate fell to the extremely low figure of 2.46 per thousand total live and still-births. On the other hand the infantile mortality rate rose from 49 to 67 per thousand births, and to some extent is accounted for by the increase in the number of deaths from pneumonia (all forms). Except for the biennial measles epidemic which started towards the end of 1933 and continued during the early months of 1934, there was no excessive occurrence of infectious disease during any period of the year. A considerable amount of health propaganda was carried out during the year, especially in connection with measles and diphtheria. I have again to express my appreciation of the loyal help of the staff of the Public Health Department, and to thank the members of the Council for their sustained interest in measures for the improvement of the health of the inhabitants of Camberwell, and for the support and kind consideration which they have extended to me during the year under review. I am, your obedient Servant, H. W. BARNES, Medical Officer of Health. Staff of the Public Health Department at the end of 1934. 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., D.P.H. 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.B., Ch.B., D.P.H. J. H. Clatworthy, M.D. 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. Dist. Dist. 6. Donald Glenday. a 1. M. Leonard Malins. a 7. Donald H. Pickard, M.C. a 2. Fred. Maughan. a 8. William T. Worsfold. b 3. Harry W. Leonard. a 9. Henry C. Green. a 4. Arnold L. Dobson. a 10. Maurice Malins. a 5. Leslie W. Burrell. a Miss F. O'Riordan, Maxwell Lefroy, Gold Medallist. a, d A2 3 4 Sampling Officer—Food and Drugs, etc. Acts. George T. Dewey. c Food Inspector. Richard F. Nash. a Health Visitors. Miss A. M. Stoddart. Miss A. H. Mitchell. e Miss W. Higgins. e Infant Life Protection Visitor. Miss N. G. Cooke. e Chief Clerk. H. K. Wright. Maternity and Child Welfare Clerk. F. T. Harman. Clerks. H. J. Hurst. R. A. Davies. A. J. Carly. Miss E. M. Watkin. Miss M. L. Thompson. H. R. Weaver. a S. A. Cranfield. S. F. Hislam. A. J. Baker (Temporary). Tuberculosis Health Visitors. Miss M. Thistleton. g Miss F. M. Whitney, h Miss H. E. L. Turner. i Clerks Mrs. J. M. Leonard (Secretary Tuberculosis Care Committee), Miss J. M. Grimwood (Temporary). Dispenser Miss L. Gentry. Porter William J. Cripps. Disinfecting and Cleansing Station. Foreman Disinfector A. Franklin. Assistants J. Conner, J. Smith, A. Thomas, R. J. Hodgson, and J. Sawyer, A. Pepler (motor driver). Women Assistants. Mrs. D. Farmer (Temporary). Mrs. E. Payton (Temporary). Mortuary Keeper. W. R. Mottram (Temporary). a Certificate Sanitary Inspectors' Examination Board and Meat and Other Foods Certificate. b Certificate Sanitary Inspectors' Examination Board. c Royal Sanitary Institute. d General Training Certificate; C.M.B. Health Visitors' Certificate, Royal Sanitary Institute; Maternity and Child Welfare Certificate, Royal Sanitary Institute. e General Training Certificate: C.M.B.; Royal Sanitary Institute (New) Health Visitors' Certificate. f Health Visitors' Certificate, Royal Sanitary Institute; C.M.B. g General Training Certificate and Certificate Special Course in Tuberculosis. h Health Visitors' Certificate, Royal Sanitary Institute; Certificate Medical and Surgical Nursing; Tuberculosis Nurses' Certificate. i General Training Certificate; C.M.B., Health Visitors' and Tuberculosis Certificate, Royal Sanitary Institute. SUMMARY OF STATISTICS. for the Year 1934. Area of the Borough in Acres 4,480 Population (Estimated resident population mid-1934) 238,360 Population (Census 1931) 251,294 No. of inhabited houses (end of 1934) according to Rate Books 43,014 Rateable Value £1,634,074 Sum represented by a penny rate £6,525 Number of live Births 3,152 Birth Rate 13.22 Number of Deaths 2,934 Death Rate 12.31 Infantile Mortality:— Deaths under 1 year 214 Infantile Deaths per 1,000 Births 67 Maternal Mortality:— Deaths of Women from Diseases or Accidents associated with Childbirth 8 Maternal Death Rate {Per 1,000 live births 2.54 {Per 1,000 total births 2.46 Deaths from Phthisis 202 Phthisis Death Rate 0.85 Deaths from all forms of Tuberculosis 231 Tuberculosis Death Rate 0.97 Social Conditions and Vital Statistics. Camberwell is largely a dormitory borough situated in Southeast London. Roughly pear-shaped, its greatest length is approximately 4¾ miles and its width about 2½ miles. The area of the Borough is given as 4,480 acres. The northern portion is densely populated, averaging 114 persons to the acre. In this area overcrowding exists and cases of extreme poverty are frequently found. Most of the factories and workshops are situated in the north and north-east parts of the Borough, and include the following industries: Motor and general engineering, printers, laundries, timber yards, etc. The manufacture of gas and its associated products is the most important and largest industrial process carried on in the Borough. Extracts from Vital Statistics of the Year. Total. M. F. Live Births {Legitimate 3,019 1,568 1,451} Birth Rate per 1,000 of the estimated {Illegitimate 133 62 71} resident population, 13.2. Still births 94 58 36 Rate per 1,000 total (live and still) births, 28.9. Deaths 2,934 1,512 1,422 Death Rate per 1,000 of the estimated resident population, 12.3. Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 5 1.54 Other puerperal causes 3 0.92 Total 8 2.46 Death Rate of Infants under one year of age:— All infants per 1,000 live births 67 Legitimate infants per 1,000 legitimate live births 66 Illegitimate infants per 1,000 illegitimate live births 90 Deaths from Measles (all ages) 30 Deaths from Whooping Cough (all ages) 10 Deaths from Diarrhoea (under 2 years of age) 35 Sickness and Invalidity. There was no unusual or excessive sickness or invalidity during the year which calls for any special comment in this report. Unemployment. Unemployment still exists and shows no evidence of diminishing appreciably in the near future. In this connection I have to thank the Manager of the local Ministry of Labour Exchange for the following figures relating to the number of registered unemployed persons in the Borough during the last quarter of 1934: — 6 Men. Boys. Women. Girls. Total. October 5,130 260 1,707 112 7,209 November 5,238 74 1,895 64 7,271 December 5,641 248 2,258 216 8,363 Average for quarter 5,336 194 1,953 131 7,614 The number of unemployed persons stated as a percentage of the insured population of the area equalled 9.3. The number of persons in receipt of domiciliary relief in the Borough averaged 6,183 weekly throughout the year, as compared with 6,416 in 1933, and for this information I am indebted to the Local Public Assistance Officer. Population. The Registrar-General's estimate of the population for the mid-year 1934 was 238,360, 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. Population at the Census, 1931. Estimated Population, 1934. (Middle of the Year). Wards. 1 14,489 13,742 2 13,016 12,344 3 13,189 12,509 4 14,922 14,159 14,421 5 13,677 6 12,024 11,403 7 14,672 13,915 14,274 8 13,543 9 14,888 14,120 10 7,700 7,303 11 10,833 10,282 12 12,496 11,854 13 11,022 10,454 14 10,485 9,946 15 12,234 11,603 13,719 16 13,011 17 13,861 13,146 18 16,797 15,934 19 12,123 11,499 20 4,129 3,916 Total 251,294 238,360 Vital Statistics. The vital and mortal statistics of every ward in the Borough for the year 1934 are given in the following table: — Wards. Estimated Population. Births. Deaths under 1 year Deaths all ages. No. Rate per 1,000. Rate per 1,000. No. Rate per 1,000. No. 1 13,742 239 17.4 16 68 186 13.5 12,344 217 17.6 14 65 142 11.5 2 3 12,509 142 11.4 17 120 154 12.3 108 12.0 14,159 195 13.8 21 170 4 216 5 13,677 15.8 20 93 165 12.0 6 11,403 154 13.5 9 59 136 11.9 186 7 13,915 13·4 14 76 164 11.7 12 152 11.2 8 13,543 206 15.2 59 191 9 14,120 214 15.2 13 61 13.5 76 109 10 7,303 106 14.5 8 14.9 12.6 8 62 133 12.9 11 10,282 130 12.1 70 157 13.2 12 11,854 143 10 10,454 104 8 77 128 12.2 13 9.9 9,946 168 16.9 12 72 134 13·4 12.7 14 68 15 11,603 162 13.9 11 148 12.0 10.4 16 13,011 164 12.6 6 37 157 17 13,146 146 11·1 5 35 138 18 11·9 15,934 142 8·9 5 36 191 11·3 19 11,499 93 8·1 3 33 130 20 6·3 49 3,916 25 2 81 12·5 238,360 3,152 13·2 214 67 2,934 12·3 The Borough Births and Birth Rates. After adjustment, i.e., by the addition of 574 children born of Camberwell mothers confined outside the Borough and the deduction of 466 children of non-residents confined in the Borough, the number of live births registered as belonging to the Borough was 3,152 (1,630 males and 1,522 females). The birth rate for 1934 was therefore 13.22 per 1,000 of the population as compared with 13.32 last year. This is the lowest birth rate ever recorded for the Borough. The fall in the birth rate is not, however, confined to Camberwell, but is general. The following table illustrates the steady fall that has taken place since the last census: — The Borough. County of London. England and Wales. 14.7 15.8 1931 Census 15.0 15.3 1932 14.6 14.3 14.4 1933 13.3 13.2 13.2 14.8 1934 13.2 Illegitimate Births. After correction for inward and outward transfers the number of illegitimate live births registered as belonging to the Borough was 133, 4.21 per cent. of the total live births. Still Births. Still births registrations during the year numbered 94. This number included 10 illegitimate births. Notification of Births Act. Every birth occurring in the Borough should be notified to the Medical Officer of Health within 36 hours of its occurrence. During the year 3,042 births were notified, representing 93.42 per cent. of the number of total births registered in the Borough. The following table indicates the sources of notification: — Source of notification. No. of Births notified. Live Births. Still Births. 1,924 56 By Medical Practitioners and Parents 1,041 15 „ Midwives „ Other Persons 6 - Deaths. The number of deaths registered during the year was 3,499, but of these 1,227 occurred in Camberwell of persons who were not residents of this Borough, while the deaths of 662 Camberwell residents occurred in other districts; thus by subtracting the deaths of nonresidents and adding the deaths of residents who died elsewhere, the number of deaths properly belonging to Camberwell was 2,934. The general death rate for Camberwell in 1934 was 12.3 per 1,000 of the population. The distribution of the deaths and the death rates in the different wards is to be found in the table on the opposite page, and the Registrar-General's diseases classification of the deaths appears on pages 10 and 11. The chief causes and percentage rates of deaths at all ages were:— Diseases of the heart and circulatory system 29.6, malignant disease 13.7, bronchitis, pneumonia, and other respiratory diseases (including pulmonary tuberculosis) 19.2, all forms of tuberculosis 0.97. Deaths of Illegitimate Infants. These numbered 12 during 1934, representing a mortality rate of 90 per 1,000 illegitimate births. The infantile mortality rate for legitimate and illegitimate births was 67. 10 A table showing the age distribution of these deaths in each quarter of the year is appended : — Under 4 weeks. 4 weeks and Under 3 months. 3 months and Under 12 months. Legit. Illegit. Legit. Illegit. Legit. Illegit. Period. 14 24 2 1st Quarter 2 3 38 2nd „ 20 12 1 15 - - 13 1 8 1 13 1 3rd „ 4th „ 15 9 - 23 1 - DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1934. Causes of Death. Sex. All Ages. 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- 25 All causes M. 1,512 21 27 60 77 170 300 320 119 76 317 F. 1,422 36 57 66 186 95 18 23 41 119 324 457 Typhoid and Paratyphoid Fevers M. - - - - - - - - - - - - F. - - - - - - - - - 5 - - - Measles M. - 4 15 5 1 - - - - - - F. 2 - 15 5 5 3 - - - - - - Scarlet Fever M. 3 - 1 1 1 - - - - - - - F. 1 1 - - - - - - - - - - 4 1 Whooping Cough M. 1 2 - - - - - - - - F. 6 2 2 2 - - - - - - - - 3 Diphtheria M. 6 - - 3 - - - - - - - F. 10 14 - 4 - - - - - - - - - Influenza M. 11 - - 1 2 2 2 4 - - - F. 17 - 1 1 3 3 2 6 1 - - - Encephalitis lethargica M. 1 - - 1 - - - - - - - - F. - - - - - - - - - - - - 1 - - Cerebro-spinal Fever M. 1 - - - - 2 - - - F. 2 1 1 - - - - - - - - - Tuberculosis of respiratory system 24 34 M. 142 - - - - 28, 20 28 8 - 1 F. 60 24 19 3 7 4 1 1 - - - 2 1 Other tuberculous diseases M. 13 1 1 3 4 1 - - - - 4 F. 16 1 4 - - 1 2 2 1 2 - M. 1 2 1 Syphilis 5 - - - 1 - - - - F. - - - - - - - - - - - - General paralysis of the insane, tabes dorsalis M. 12 1 5 3 3 - - - - - - - - F. - - - - - - - - - - - M. 9 27 68 Cancer, malignant disease 197 - - 1 2 64 26 - - F. 204 - 2 2 19 28 50 49 54 - - - Diabetes M. 14 - 6 - - 2 5 1 - - - - 7 F. 16 - - 3 3 3 - - - - - 1 19 Cerebral haemorrhage, etc. M. 47 - 2 13 12 - - - - - F. 78 - - 1 10 19 28 20 - - Heart disease - - 351 8 92 M. - 1 6 6 26 74 138 - - F. 402 1 - 4 10 7 13 22 44 110 191 - Aneurysm M. 8 - 1 1 3 3 - - - - - - F. - - - - 1 1 1 1 4 - - - Other circulatory diseases - 2 3 17 M. 51 - - - 6 23 - - F. 51 - - - - 3 7 17 24 - - - 11 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1934—contd. Causes of Death. Sex. All Ages. 0- 1- 5- 15- 35- 45- 55- 2- 25- 65- 75- 4 - 4 9 M. 51 1 1 16 16 Bronchitis - - - 1 2 5 17 39 F. 68 3 1 - - - - 13 Pneumonia (all forms) M. 112 26 9 7 2 3 1 3 22 14 12 96 F. 29 6 6 2 2 1 2 8 7 20 13 M. 19 - 2 2 1 2 2 5 Other respiratory diseases 1 - 4 - 1 F. 16 - 1 - 1 - 3 8 2 - - M. Peptic Ulcer 34 - 1 3 13 9 7 1 - - - - F. 14 - 1 2 4 3 3 1 - - - - 21 1 Diarrhoea, etc M. 27 1 - 2 - 2 - - - - - F. 17 14 - 1 1 - - - - - - 14 2 M. 1 3 1 3 2 Appendicitis - 2 - - - 2 2 - 2 F. 8 - - 1 1 - - - 2 Cirrhosis of liver M. 8 - - - 4 - - - - 2 - F. 7 - - - 3 2 1 1 - - - - M. - Other diseases of liver, etc. 6 - - - 1 1 2 2 - - - - 3 F. 8 - 1 1 2 1 - - - - Other digestive diseases 23 3 2 1 1 3 3 9 1 M. - - - 32 2 4 10 F. 1 1 1 2 2 9 - - 47 - Acute & chronic nephritis M. - - 3 4 6 14 6 14 - - F. 48 - 1 1 2 4 9 9 22 - - - F. - - Puerperal sepsis 5 2 3 - - - - - - - 2 Other Puerperal causes ... F. 3 - 1 - - - - - - - - M. 50 49 - 1 Congenital debility, premature birth, malformations, etc. - - - - - - - - - F. 34 34 - - - - - - - - - - M. 32 1 31 Senility - - - - - - - - F. 50 - - 6 44 - - - - - - - 3 Suicide M. 18 1 7 2 2 3 - - - - - 5 - 2 3 - F. - - - - - - - M. 7 Other Violence 54 3 1 2 1 11 5 2 4 10 8 29 2 3 7 F. 2 2 1 4 8 - - - 10 Other defined diseases M. 135 9 1 1 6 11 12 11 23 28 23 F. 7 3 11 96 1 4 5 3 8 17 16 21 Causes ill-defined or unknown M. - - - - - - - - - - - - - F. - - - - - - - - - - - Maternal Mortality. The number of Camberwell women who died from maternal causes dining the year was 8, representing a maternal mortality rate of 2.46 per 1,000 total live and still births. The cause of death in 5 cases was due to puerperal sepsis representing a mortality rate of 1.54, the remaining 3 deaths being due to causes classified as other complications of pregnancy, producing a mortality rate of 0.92. For the purposes of comparison the maternal mortality rates per 1,000 total births in Camberwell, London and England and Wales for the last five years are as follows: — Year. Camberwell. London. England and Wales. 1930 5·25 3·33 4·22 1931 3·39 3·81 3·94 1932 2·15 2·99 4·04 1933 4·77 3·67 4·32 2·70 1934 2·46 4·41 Inquiry into Maternal Deaths. Confidential reports on the Maternal deaths occurring in the Borough were submitted as in past years to the Ministry of Health. Infantile Mortality. The number of deaths of infants under one year of age was 214, an increase of 54 as compared with 1933. The infant mortality rate was 67 per 1,000 births. The mortality rate for 1933 was 49. The mortality rates for the past five years are shewn in the subjoined table:— Year. Camberwell. London England and Wales. 1930 52 59 60 66 1931 56 65 65 1932 65 66 64 1933 49 59 67 1934 67 59 WARD DISTRIBUTION OF DEATHS Wards No. of Births. No. of Deaths Under 1 month. (Age at Death) Between 1 & 3 months. Between 3 & 12 months 1 239 16 3 5 8 2 217 14 5 4 5 3 142 17 3 4 10 4 195 21 5 8 8 7 5 216 20 3 10 6 154 9 2 4 3 7 186 14 3 3 8 206 4 4 8 12 4 13 4 3 6 9 214 10 106 8 2 1 5 11 130 8 4 2 2 12 143 10 4 2 4 13 104 8 4 1 3 14 168 12 4 2 6 15 162 11 2 5 4 16 164 6 2 1 3 1 17 146 5 3 1 2 18 142 5 2 1 - 2 19 93 3 1 20 25 2 1 1 - Examination of the 214 deaths of infants under one year discloses that 65 occurred during the first four weeks after birth; 55 between 4 weeks and 3 months, and 94 between the period of 3 months and 1 year. The increase in the number of deaths was mainly attributable to pneumonia and premature births. Neo-Natal Mortality. The neo-natal mortality, i.e., the deaths occurring in the first four weeks of life, has not decreased in the same proportion in recent years as the number of deaths recorded in the first year of life. The following table provides particulars of the neo-natal mortality rates for the last five years:— No. of deaths within Neo-Mortality Year. the first month of life. Rate. 1930 85 22·3 1931 78 21·0 1932 87 24·0 1933 67 20·6 1934 65 20·6 An additional table is appended showing the causes responsible for the death of these infants in this age group:— Difficult labour— Trauma at birth 5 Foetal and Infantile states— Congenital defects 11 Atelectasis 2 Prematurity 30 Atrophy and Debility 4 Enteritis 3 Other diseases 10 Infantile Diarrhoea and Enteritis. The number of deaths from these causes in children under 2 years of age was 35 as compared with 33 in 1933. Of these 32 died in hospital. There can be no doubt that many of these deaths could be prevented by early medical treatment and nursing attention. During the months of August and September last year, when the weather was exceptionally warm, the number of deaths from diarrhoea only numbered 6. The total deaths are summarised in the following table showing the wards of the Borough in which they occurred and when they took place. Ward. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. The West - 1 1 - - - - - - - - - 1 1 Addington - - - - - - - - - - Town Hall - 1 - - - - - - - - - - St. George's 1 1 1 - - - - - - - - - Cobourg 1 1 - - - - - - - - - - Marlborough 1 - - - - - - - - - - - 2 1 1 North Peckham 1 - - - - - - - - Goldsmith 1 - - - - - - - - - - - Clifton 1 1 1 - - - - - - - - - 1 1 Rye Lane 1 - - - - - - - - - St. Mary's - - - - - - - - - - - - Nunhead - - - - - - - - - - - - 1 The Rye - - - - - - - - - - - St. Giles's 1 1 1 - - - - - - - - - 1 1 1 Lyndhurst - - - - - - - - - St. John's 1 - - - - - - - - - - - Alleyn 1 1 - - - - - - - - - - Ruskin 1 - - - - - - - - - - - The Hamlet - - - - - - - - - - - - The College 1 - - - - - - - - - - - INFANTILE MORTALITY TABLE. Deaths from Stated Causes at Various Ages under One Year of Aoe, 1934. 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. 6 to 9 months. Total under 1 year. 3 to 6 months. 9 to 12 months. Smallpox - - - - - - - - - - Chicken Pox - - - - - - - - - - Measles 1 1 2 - - - - - - - Scarlet Fever - - - - - - - - - 3 Whooping Cough 1 2 3 - - - - - - - Diphtheria and Croup - - - - - - - - - - Erysipelas - - - - - - - - - - 1 Tuberculous Meningitis - 1 - - - - - - - Abdominal Tuberculosis - - - - - - - - 1 1 Other Tuberculous Diseases - - - - - - - - 1 1 Meningitis 1 1 2 - - - - - - - 1 Convulsions 1 - - - - - - - - Laryngitis - - - - - - - - - - 15 2 Bronchitis 1 4 1 8 - - - - - Pneumonia 1 1 3 1 1 6 - - - - Diarrhoea 1 4 1 2 8 - - - - - Enteritis 1 1 3 10 7 4 2 1 26 - 2 Gastritis 1 1 - - - - - - - Syphilis - - - - - - - - - - Rickets - 2 2 - - - - - - - Suffocation 2 2 - - - 1 - - - 3 4 Injury at Birth 1 5 1 6 - - 1 - - Atelectasis 2 2 1 3 - - - - - - 1 Congenital Malformation 8 1 1 11 6 2 1 20 - 1 11 37 Premature Birth 25 1 3 5 2 - - 2 1 1 4 3 Atrophy, Debility, &c. 6 1 14 - - Other Diseases 3 1 1 5 5 3 7 2 22 - Bronchopneumonia 1 1 2 16 11 13 5 47 - - Acute Lobar Pneumonia - - - - - - - - - - Influenza - - - - - - - - - - 6 Totals 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 134, Denmark Hill, S.E.5. Particulars of the bacteriological examinations carried out during 1934 will be found on page 93. The chemical analysis of food, etc., is performed by Mr. Martin Priest at his laboratory, 4, Obelisk Parade, Lewisham. Details of these examinations appear in Table "A" on pages 72 and 73. Ambulance Facilities. The London County Council provide ambulances for infectious, non-infectious, and maternity and accident cases. Nursing in the Home. It was not necessary during 1934 to make any alteration in the arrangements 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 in respect of home nursing services. These Associations, in the order named, undertake nursing services in the following districts of the Borough:- Peckham, Camberwell, N.W., Camberwell, N., Herne Hill and Dulwich. With the exception of the East Dulwich and Dulwich Village Nursing Association who render professional services in the homes without financial assistance from this Authority, the Council pays each Nursing Association one shilling per visit, less contributions made by the patients or their relatives towards the cost of such services, for the nursing of maternity cases and specified cases of illness in children under five years referred to them by the Public Health Department, hospitals and general practitioners, as well as to notifiable diseases under the Infectious Diseases (Lond.) Regulations, 1927. In January of the present year the Council authorised payment for similar services to be rendered by the nurses of the Catholic Nursing Institute. These Associations do not, however receive any grant from the Borough Council for general nursing. 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. Do. Dulwich Hospital, East Dulwich Grove. 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. Diphtheria Prevention Clinic. Camberwell Municipal Centre, 140, Camberwell Road. Artificial Sunlight Clinics. Union of Girls' Schools' Mayward House Centre British Red Cross Society, 160, Peckham Rye. Tuberculosis Dispensary. 19, Brunswick Square, S.E.5. Cleansing Station for Verminous Persons. Peckham Park Road Depot. Camberwell Borough Council. School Treatment Centres. 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. Camberwell Borough Council. Union of Girls' Schools Settlement British Red Cross Society Camberwell Borough Council. Second and fourth Thursdays in every month at 11 a.m. Every Friday at 2 p.m. Monday and Thursday (new cases) at 10 a.m., Tuesday, Wednesday and Friday at 2 p.m. Monday, Tuesday, and Friday at 2 p.m., Thursday (new cases) at 2 p.m. Monday, Tuesday and Friday at 2 p.m. Daily 9-10 a.m. Daily 9.30 10.30 a.m. Every Wednesday at 2 p.m. Tuesday and Friday at 2 p.m. Daily. 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. Daily—Tuesday, Wednesday and Thursday (Vermin). Monday and Friday (Scabies). Adults, Saturday 9-12 noon. Camberwell Treatment Centre, 7, Addington Square, S.E.5. Aural —Tuesday (once a month), 2 p.m. (Operations— alternate Wednesdays, 2 p.m., at Hanover Park.) Minor Ailments. —Monday, Wednesday and Friday, 3.30 p.m. B Sessions. 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— Thursday, 1.30 p.m. and alternate Fridays, 9.30 a.m. East Dulwich Treatment Centre, 29, Amott Road, S.E.15. Minor Ailments.—Wednesday, 3 p.m. Dental. —Monday, Wednesday, and Friday, 9.30 a.m. Thursday (3 times a month) and 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.—Wednesday (once a month), 2 p.m. (OperationsAlternate Tuesdays, 2 p.m., at Hanover Park.) Minor Ailments.—Monday and Thursday, 3 p.m. Dental.—Monday, Tuesday, Wednesday and Thursday, 9.30 a.m. Monday, Thursdays (3 times a month) and Friday, 1.30 p.m. Gas —Tuesday (3 times a month), 1.30 p.m., Thursday (3 times a month), 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, Thursday, 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—Tuesday (once a month), 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. Dulwich Hospital: containing 733 beds. Maudsley Hospital (Neurological): containing 242 beds. 18 During Med. St. Antholin's, 22, Linden Grove Church Hall, Barforth Road and rooms in Institute, 22, Linden Grove. do. do. Wednesday and Friday. Sessions. Thursday. St. Luke's, 2, Commercial Road 2 rooms and hut in garden Ground floor of premises do. Wednesday. Tuesday and Friday. "Toddlers" alternate Thursdays. Union of Girls' Schools Infant Welfare Centres, Mayward House, Brunswick Square. Tuesday & Friday. Do. Amott Road, Peckham Waiting room; weighing room; consultation room. do. Monday and Wednesday. "Toddlers" alternate Thursdays. - Camberwell Municipal, 140, Camberwell Road. do. do. Rented by Camberwell Boro' Council. Every Monday and Friday; ante-natal, 2nd and 4th Thursdays at 11 a.m. Every Wednesday and Thursday. Dulwich Municipal, 114, Lordship Lane do. do. do. do. Tuesday. do. do. Every Tuesday and Thursday. - Peckham Municipal, Clifton Congregational Church Hall, Studholme St., Peckham, S.E. do. do. Health Propaganda. To-day the health of the individual is in his own keeping to maintain or to lose. There can be no doubt that a large amount of invalidism in the population need not occur. Instruction of the public in the principles and practice of hygiene and the importance of the personal culture of health are matters occupying an important place in the realm of preventive medicine. No matter how judicious the teaching, no great advance can be made without the intelligent co-operation of the individual himself. To obtain the maximum result from health education, instruction must be given at an early age—the earlier the better. In Camberwell advice is given to mothers daily in their own homes by the health visitors concerning the maintenance of their own, and their children's health; health talks to mothers are also given at the infant welfare centres in this borough, and a booklet containing general information and hints for the expectant mother and on the management of infants is distributed. This Council's activities to stimulate interest in the subject of healthy citizenship also includes a poster display and a leaflet distribution. During the year arrangements were made at no cost to the Council for the distribution of 2,500 copies monthly of the periodical Better Health, the official journal of the Central Council for Health Education to which organisation the Council also agreed to contribute a donation of £5 5s. The dissemination of knowledge on matters relating to feeding, cooking and marketing: diphtheria prevention: cancer, etc., has formed part of the propaganda activities of this department for some years past, and these activities should not be relaxed. In this regard I am of opinion that the Local Education Authority has an unrivalled opportunity of assisting local authorities in their endeavour to create a national health conscience by providing instruction in hygiene and habits of healthy living to the pupils attending the public elementary schools. Cleansing Station. A cleansing station consisting of a nurses room, a reception room, 2 baths, and a discharge room adjoins the disinfecting station in Peckham Park Road and was installed for the purpose of dealing with verminous conditions in children and adults. The Council by arrangement with the London County Council undertakes the disinfestation of children attending the elementary schools in Camberwell found to be in a verminous condition. The cleansing and treatment of these school children is carried out under the supervision of the nurses of the London County Council, while the disinfestation of the clothing and of the homes is carried out by the Borough Council's sanitary staff. The following table gives particulars of the number of persons who attended the cleansing station during the year. Persons cleansed, verminous— Adults— Males 13 Females 2 Children— Males 433 Females 1,775 Total 2,223 Persons cleansed, scabies— Adults — Males 12 Females 14 Children— Males 1,132 Females 1,606 Total 2,764 Public Baths and Washhouses. The three Municipal swimming baths situated at Church Street, Camberwell, Goose Green, East Dulwich, and at Old Kent Road, are fitted with a filtration and aeration plant and the water in the swimming pools is chlorinated to ensure the provision of a satisfactory water for the bathers. The bacteriological and chemical examinations of samples of the water obtained from each bath periodically during the year showed that the filtration plants were at all times functioning efficiently. The number of bathers who used these baths during 1934 is shown in the following table: — No. of persons No. of persons. Bath. using swimming baths, using warm baths. Church Street 144,914 79,479 Old Kent Road 69,618 63,587 Dulwich 129,526 44,690 Wells Street — 33,224 Facilities for washing clothes are provided at Camberwell, Old Kent Road, and Wells Street Baths. The number of users of these facilities in 1934 was 57,172. Public Mortuary. An important improvement at the Public Mortuary resulted from the remodelling of the existing rooms during the year to allow for the inclusion of a preservation chamber. This cooling plant which contains nine compartments enables bodies received in varying stages of decomposition to be kept for an indefinite period, without further physical changes taking place, and is extremely valuable in affording facilities for the identification of unknown bodies. A monthly summary of the bodies received at the mortuary during 1934 is appended:— MORTUARY RETURN. Month. Males. Females. Total. Burial only. Inquests. Postmortems Courts. Residents. Outside Borough Number. P.-M.'s. 44 January 22 22 44 13 19 9 Nil. 28 25 20 Nil. 31 17 10 19 12 February 7 11 31 March 27 Nil. 47 28 18 8 11 29 20 47 April 13 7 20 Nil. 20 5 9 9 11 1 May 14 29 Nil. 29 15 9 9 2 15 20 June - - Mortuary Closed. Installation of refrigeration plant and repairs. - July - - do. - - - - - - - - - - do. - - - - August - - - - - - - - do. - - September - 21 6 27 17 3 Nil. 19 11 9 October 10 November 20 Nil. 15 9 11 3 18 38 27 27 38 13 December 22 21 23 16 Nil. 11 25 5 Dr. G. H. Fisher 122 Nunhead District 1 2 Dr. G. W. FitzHenry 22 Dulwich District 33 7 St. George's District Dr. H. J. Gater 198 22 21 East Dulwich District Dr. A. F. McMillan 169 212 23 12 Camberwell District Dr. E. W. G. Masterman - Dr. H. O. West 46 12 St. Giles' Hospital - 1 4 Dulwich Hospital Dr. 0. W. Roberts - Dr. 0. W. Roberts - Constance Road Institution - - 71 Total 904 177 23 7 MATERNITY AND CHILD WELFARE SERVICES. The Council's Maternity and Child Welfare Scheme includes the provision of Infant Welfare Centres where medical consultation sessions are held for the purpose of giving instruction to mothers in the feeding and management of infants; ante-natal clinics have also been established at two of these centres for the medical supervision and instruction of expectant mothers in the hygiene of pregnancy; home visiting by health visitors; convalescent treatment for mothers and infants; home nursing services; the supply of milk to expectant and nursing mothers and children in necessitous circumstances; consultant services for private medical practitioners who require assistance in cases of difficulty before, during or after confinement of a patient; institutional provision for unmarried mothers, and other ancillary services. Infant Welfare Centres. The Borough has been mapped out into ten areas with an Infant Welfare Centre in each. In seven of the Infant Welfare areas the work is carried out by voluntary associations, who are responsible for the Centre premises, the appointment of Medical Officers and Health Visitors. The Council makes an annual contribution to each voluntary association under the terms of a scheme made by the Minister of Health under Section 101 (6) of the Local Government Act, 1929, such contribution being dependent on a satisfactory report of the infant welfare service provided by the Association. The Council also requires to be advised of any changes in the personnel, and to approve all appointments to the professional staff at these Centres. The Centres in the remaining three areas are municipal premises and staffed by the Council. Unfortunately the majority of these Centres, for various reasons, are not so situated as to be readily accessible to all the mothers living in the Centre's district. In previous Annual Reports I have referred to the unsuitability of two of the buildings rented by the Council for use as Infant Welfare Centres and at the time of the preparation of this Report, efforts are being made to obtain other premises which might overcome the deficiencies of the existing premises. I am also of opinion that the premises used by four of the Voluntary Associations are not ideally planned or constructed for their purpose, and should be replaced by more suitable buildings. Ante-Natal Supervision. Ante-natal consultations are at present held at the Municipal Infant Welfare Centre, 140, Camberwell Road, and at the Voluntary Association Centre, 616, Old Kent Road. Expectant mothers are also examined by the Medical Officers at the Cambridge House and the Kempshead Hall Voluntary Centres at the weekly Infant Clinic Sessions. Women attend the ante-natal clinics at these Centres either of their own accord or are referred to them by doctors and midwives practising in the Borough, or by the Health Visitors. During the year 228 women made a total of 703 attendances at these ante-natal clinics. Ante-natal supervision of women to be confined in their own homes is also given by midwives of the General Lying-in Hospital Post-Certificate School, 77, Southampton Street, and ante-natal clinics are attached to the St. Giles' and Dulwich Hospitals for patients to be confined in these hospitals. Early in the present year the Council decided, subject to the approval of the Ministry of Health, to adopt, with the exception of recommendation (c), the proposals outlined in the following report on Ante-natal Services which was submitted to the Maternity and Child Welfare Committee for consideration during the year under review. To the Chairman and Members of the Maternity and Child Welfare Committee. Ladies and Gentlemen, April, 1934. Ante-Natal Services. Your Committee will remember that the L.C.C. in a communication dated August 10th, 1933, indicated that the maternity work at St. Giles' Hospital was increasing to such an extent that certain structural alterations were being made at the Hospital which would have the effect of increasing the maternity accommodation available. Similar structural alterations for the same purpose are at present in progress at the Dulwich Hospital. The additional accommodation at St. Giles' Hospital will be available at the end of this month, and I am accordingly of opinion that it is an appropriate time to bring to your notice the various ante-natal services in Camberwell for the purpose of considering whether any possible improvement of these services could be effected by the utilisation of these revised facilities by arrangement with that Authority. Ante-Natal Clinics are established at the L.C.C., St. Giles' and Dulwich Hospitals for patients entering these Institutions for their confinement: the General Lying-in Hospital Post-Certificate Midwifery School, Southampton Street, for patients confined in their own homes by the midwives of this School; at the Camberwell Municipal Centre, 140, Camberwell Road, and at the Bird-in- Bush Voluntary Association Centre, 616, Old Kent Road. Ante-natal advice is also given to expectant mothers by the Clinic Medical Officers at the Cambridge House and Kempshead Hall Centres at the ordinary infant consultation sessions. Further, the Council has appointed an Obstetric Specialist whose services are available for any medical practitioner in cases of difficulty arising during pregnancy, parturition or during the puerperium period. There occurred in Camberwell last year 3,247 births. Information is available in respect of 3,108 of these births that 1,740 occurred in L.C.C. Hospitals and Nursing Homes in this Borough, and Maternity and General Hospital and Nursing Homes in various parts of London; private medical practitioners were in attendance at 300 births, and practising midwives 1,068. Patients booked for admission to hospitals for their confinement receive systematic ante-natal supervision, and there is no reason to doubt that similar supervision is given to patients who engage their own medical attendant for the confinement. There is no means of ascertaining the extent of pre-confinement supervision given to patients by practising midwives, except those attended by the midwives of the Post-Certificate School, which numbered 400 in 1933. It is interesting to note that the individual attendances of expectant mothers at AnteNatal Clinics in this Borough, attached to Infant Welfare Centres, only numbered 259 during 1933. The establishment of Ante-Natal Clinics at Infant Welfare Centres in Camberwell was to a large extent for the purpose of placing the facilities of these clinics at the disposal of midwives who were unable to do ante-natal work of the required standard, and for women who had no family doctor. It was not intended that a midwife should no longer carry out her obligation of routine examinations, but that she should bring or send her patients to the Medical Officer at the Clinic for the purpose of confirming whether her conclusions concerning the patient's health and progress of the pregnancy were correct, as well as to receive advice in cases where special treatment might be deemed necessary. In my opinion, the work of these Ante-Natal Clinics is excellently carried out, yet an improvement from the point of view of individual attendances is clearly indicated. Past endeavours to encourage greater use of the Clinics at the Maternity and Infant Welfare Centres have unfortunately been disappointing. This lack of co-operation, particularly on the part of midwives, is probably due to the fear of losing the monetary consideration of confining a woman should the Clinic Medical Officer decide, in the interest of the patient's health, to refer her to a doctor or a hospital for her confinement. The fact that the L.C.C. is the supervising authority of midwives may also influence their attitude to the Centre Clinics, or they may have other reasons to offer why they do not bring or send their patients to these Clinics. There is a steadily increasing desire by women to-day to enter hospitals for their confinement, and to take advantage of the fully equipped Ante-Natal Clinic attached to these institutions with its facilities for diagnosis and treatment of abnormal physical conditions during pregnancy and to receive the benefit of a medical examination following confinement. I would accordingly suggest for consideration that the L.C.C. be approached to enquire whether they would be willing to place their Hospital Clinics at the disposal of private medical practitioners and practising midwives in the Borough for patients who have made arrangements to be confined in their own homes. It is difficult to indicate the number of such patients who might be referred to these Clinics, as well as to judge the number of attendances necessary for each patient, but I should think that at least 300 patients a year, and on the assumption that each patient would be required to attend at least three times, I am of opinion that the sum of £100 should be sufficient to provide these services, subject to agreement. If this suggested Scheme is approved it is not unlikely that a percentage of midwives' patients may be recommended by the Hospital Clinic Medical Officer to enter the Hospital for their confinement. In such cases I would suggest that a compensation payment of 10s. per case be paid to the midwife. Ido not anticipate that this should cost more than, say, £10 per annum, and I base this figure on information obtained of the experience of certain Metropolitan Boroughs where provision is made for such payments to midwives for the loss of a patient. The proposals outlined in this report may therefore be summarised as follows: — (a) That the L.C.C. be asked to enter into an agreement with this Council to undertake the medical examination and supervision at their Hospital Ante-Natal Clinics of patients to be confined in their own homes either by a private medical practitioner or a practising midwife, such services to include a post-natal examination of every patient. I suggest that this service could perhaps be provided at a cost of £100 per annum. (6) That compensation payments be made by this Council to midwives for the loss of a patient in the event of an institutional confinement being recommended by the Hospital Clinic Medical Officer, at an estimated cost of £10 per annum. (c) That the existing ante-natal clinic services provided as part of the Maternity and Child Welfare Scheme be discontinued in the event of the adoption of the proposals contained in (a) above. Your obedient Servant, H. W. BARNES, Medical Officer of Health. In my opinion, the ideal place for the supervision of pregnant women is the clinic attached to hospitals which reserve accommodation for maternity patients. At these hospitals special facilities exist for X-ray examinations and the provision of Ante-natal beds. I am convinced that the ante-natal care which the women of Camberwell will receive at these hospitals will reach the highest possible standard, and it only remains for them to take full advantage of the facilities of this service. Any scheme, however efficient , will of course fail if the whole-hearted co-operation of the people for whom the scheme was promoted is lacking. Lectures by Health Visitors at the mother craft sessions conducted at Infant Welfare Centres should, however, assist in achieving the object of educating women as to the necessity for early and systematic ante-natal care. Post-Natal Supervision. The number of Camberwell mothers who were confined in the Borough and elsewhere was 1,552. These patients were medically examined before discharge. Under the terms of the arrangement with the London County Council as outlined in that portion of this Report dealing with ante-natal services, there will be an opportunity for any mother living in Camberwell to be examined at St. Giles' or Dulwich 'Hospitals after her confinement, and to receive early treatment if she suffers from impairment of health resulting from childbirth. The practice of enquiry by the Health Visitor at the first visit following the notification of birth as to the state of health of the mother after her confinement was continued, and in cases where the mother was found to be suffering from backache, prolapse, phlebitis, debility, urinary or intestinal troubles, she was urged to seek medical advice from her own doctor or at a general hospital, unless the mother was confined in the local hospitals. In these cases the patients' attendance at the Post-Natal Clinic at St. Giles' or Dulwich Hospitals was stressed. During the year 775 mothers with impaired health resulting from childbirth were advised by the Health Visitors to seek medical attention. Health Visiting. Three Health Visitors are employed by the Council and eleven by the Voluntary Associations undertaking Maternity and Child Welfare work in the area. In addition, part of the time of the Borough's Infant Life Protection Visitor is occupied in visiting cases of Ophthalmia Neonatorum, and assisting in district visiting duties in one of the Municipal Infant Welfare areas. During the period of a measles epidemic the woman Sanitary Inspector also assists in visiting cases of this disease. Approximately two-thirds of the time of the Health Visitors is spent in visiting the homes of expectant and nursing mothers, and children under the age of five years, the remainder of their time being devoted to attendance at the various sessions at the Infant Welfare Centres. Infant visiting is carried out on a systematic basis. The first visit is paid as soon as possible after the infant reaches the age of 14 days, and routine visits are continued until the child goes to school or reaches the age of five years. Tables showing the visits made by the Health Visitors and the total attendances of mothers and infants at the Infant Welfare Centres during the year appears on pages 32 and 33. Pre-School Child. Special medical sessions for pre-school children ("toddlers") are held at three Infant Welfare Centres in the Borough, for the purposes of providing for the medical inspection of children between one and five years and to assist in reducing the amount of physical defects and disease in children in this age group. At the other Centres "toddlers "attend the ordinary Infant Medical Sessions. If mothers would realise that a careful physical examination is made of each child by the Medical Officer, at these special sessions, there is no doubt that more mothers would bring their children to these clinics for examination. Individual instruction is also given to mothers at these sessions on the subject of how to maintain the child in a state of good health. Toddlers Clinics. Attendances Table. Infant Welfare Centre. Number of Sessions held 1934. Number of Individual Children attending these Sessions. Total Attendances. Amott Road 49 545 841 308 692 Bird-in-Bush 44 1,490 Mayward House, Brunswick Square 49 699 Mothercraft and Health Talk Sessions. Advice to mothers by the Medical Officers at the clinics and by the Health Visitors in the homes on matters connected with pregnancy and the care of infants is supplemented by collective instruction in the form of short educational talks at special sessions held at five of the Infant Welfare Centres in the Borough. The opportunity to demonstrate to mothers, garments suitable for children and to provide facilities for making them under expert supervision is also taken at these sessions. The following table summarises the number of sessions and attendances recorded at these special sessions during the year:— Infant Welfare Centre. No. of Sessions. No. of Attendances. Average Attendance. Amott Road 11 58 5 Bird-in-Bush 99 2,354 23 32 Kempshead Road 620 19 Lordship Lane 46 588 12 St. Lukes 41 707 17 Convalescent Home Treatment. Expectant or nursing mothers and children under five years of age recommended for convalescent treatment by the Medical Officers at the Infant Welfare Centres are sent to the following Homes: The All Saints Hospital, Eastbourne; The London Mothers Convalescent Home, Sunningdale; The Hertfordshire County Council Home, St. Leonards-on-Sea, and to Homes of the Invalid Children's Aid Association. The period of stay in a home is usually 28 days, but an extension of treatment may be authorised by the appropriate Committee of the Council in special circumstances. A contribution towards the cost of the treatment is recovered from the patient in cases where the financial circumstances permit of payment of a proportion of the charges. During 1934 six mothers with their infants and 18 children under five years received treatment. The total cost to the Council lor convalescent treatment during the year was £166. Home Nursing. The following table shows the number of cases attended and visits paid by the staff of the District Nursing Associations under taking home nursing duties on behalf of the Borough Council. Children. Adults. Disease. No. Cases. No. Visits. No. Cases. No. Visits. Measles 51 620 - - Whooping Cough 3 - 54 - Ophthalmia Neonatorum and Discharging Eyes 30 - 639 - Pneumonia 511 - 17 338 Mastitis 8 166 Maternity 43 650 - - Totals 112 1,154 68 1,824 - 28 29 Provision of Milk to Necessitous, Expectant, and Nursing Mothers and Children under Five Years of Age. In my Annual Report for 1933 the Council's Milk Distribution Scheme, which provides for the issue of dried milk, and in exceptional medical circumstances fluid milk, free or at half-price according to an income scale, to expectant mothers during the last three months of pregnancy, nursing mothers and children under five years was fully reported on. During the year under review no alteration was made in this scheme. The approximate cost of this service to the Council during the year was £1,130 0s. 0d. Infant Life Protection. At the end of 1934 there were 119 foster mothers on the register of persons receiving children for reward complying with the provisions of the Children and Young Persons Acts 1908 to 1932. The number of children in the care of these foster mothers at December 31st, 1934, was 133. During the year, 1,535 visits were paid by the Infant Life Protection Visitor, who is a qualified Health Visitor, to the homes of these boarded-out children. The Sanitary Inspectors also visited the premises of every applicant desirous to act as a foster mother for the first time, and in cases where the foster mother moved to another address in the area, for the purpose of furnishing a report as to the suitability or otherwise of the environmental circumstances, before authority was given for the acceptance of a nurse child. These inspections numbered 63. Every foster child under two years was visited by the Infant Life Protection Visitor on an average once a month, and children between two and nine years of age every two months. In ten instances visits were paid between the hours of 7 and 9 p.m. The number of foster children under five years of age who attended the Infant Welfare Centres in the Borough was 77. One child died during 1934, whilst in the care of a foster mother, and the facts were duly reported to the Coroner for the District, as required by Section 6 (1) of the 1908 Act. It is satisfactory to report that there was no cause for complaint against the foster mother in this case. The number and nature of the infringements by foster mothers of the requirements of the Children and Young Persons Acts discovered during the year were as follows:— Neglecting to notify the acceptance of a nurse child for reward 9 Failing to give the required notice of change of address 2 Failing to notify removal of nurse child to the care of other persons 2 Infants kept in excess of number fixed 1 No legal proceedings were instituted nor was it necessary to compulsorily remove any child to a place of safety. The following is a record of the work carried out by the Infant Life Protection Visitor during the year:— Number of first visits to infants under 1 year of age 54 Subsequent visits to infants under 1 year of age 391 Number of visits to children 1 to 5 years of age 759 Number of visits to children 5to 9 years of age 256 Special visits 75 Number of cases in which there was cause for complaint 3 Number of cases recommended for prosecution Nil Midwives. The number of midwives who notified the London County Council, the Supervising Authority for Midwives, of their intention to practise in this Borough during 1934 was 41. Of this number 31 were engaged in private practice. Midwifery Assistance. The Council's Maternity and Child Welfare Scheme provides for the payment of the whole or part of the fee of a midwife for professional services rendered to mothers who desire to be confined in their own homes and who are unable to pay for such services. Three applications for assistance under this scheme were made during the year and in every case payment of the midwife's fee in full was authorised by the appropriate committee. Maternity Outfits. A stock of sterilised maternity outfits is kept at the Public Health Department for sale at cost price or at less than cost price to expectant mothers who have arranged to be confined at home. These are supplied on the recommendation of the doctor or midwife by whom the confinement is to be conducted. During the year under review no demand was made for an outfit nor was there any request for the sterilisation of bed linen. Consultant for Difficult Maternity Cases. During the year the services of the Council's Obstetric Specialist were required by general practitioners in 5 cases of difficult labour. Institutional Provision for Unmarried Mothers. This Local Authority continued to make an annual contribution towards the cost of the maintenance of unmarried Camberwell girls boarded out by the Southwark Diocesan Association for Preventive and Rescue Work. During the year 16 Camberwell girls were placed in approved homes and hostels. INFANT WELFARE CENTRES—CLINIC ATTENDANCES, Etc., 1934. Infant Welfare Centres. Under 1 Year. Between 1 & 5 Years. Miscellaneous. Total Attendances. Analysis of Attendances, Children. Weighings only. Ante-Natal Clinic Attendances. Treatment Centre for Minor Ailments. Post-Natal Mothers for Advice Own Health. Doctors' Consultations. Seen by Health Visitor. First Attendances. Subsequent Attendances. First Attendances. Subsequent Attendances. Camberwell Municipal, 140, Cambervell Road, S.E.5 168 2,297 1,441 233 4,166 2,461 1,472 - 50 84 108 27 Dulwich Municipal, 114, Lordship Lane, S.E.22 1,691 - 227 45 238 5,101 - - 2,880 1,983 221 2,9001 Peckham Municipal, Clifton Congregational Church Hall, Asylum Road. S.E.15 3,279 271 26 1,248 298 64 5,078 2,257 2,523 - - - 239 653 - Bird-in-Bush, 616, Old Kent Road. S.E.15 2,734 27 323 1,824 - 1,986 - 4,824 2,838 Cambridge House, 6, Addington Square, S.E.5 2,144 1,839 218 154 2,178 99 - 4,137 - - - 1,959 1,457 K-empshead Hall, Kempshead Road, S.E.5 1,434 - 1,133 - 136 195 2,695 - 128 - 1,238 - 1,200 St. Antholin's, 22, Linden Grove, S.E. 15 4,350 36 2,507 3,362 - - 253 7,146 2,584 - St. Luke's, 2, Commercial Road, S.E.15 178 1,500 - 2,220 21 3,919 - - 68 2,372 1,547 - - Union of Girls' Schools, 60A, Amott Road, S.E.15 3,626 35 - 6,147 3,976 266 232 2,254 2,171 - - Mayward House, Brunswick Square, S.E.5 - 5,435 - 175 312 63 8,449 3,014 3,656 - - 4,418 280 23,774 23,757 703 319 HEALTH VISITORS—RECORD OF VISITS, 1934, 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. Measles and Whooping Cough. Total Visits. Under 1 Year. Between 1 and 5 Years. Total Visits. Under 1 Year. Between 1 and 5 Years. First Visits. Attending Centre. Not Attending Centre. Attending. Centre. Not Attending Centre. Subsequent Visits. Camberwell Municipal, 140, Camberwell Road, 5.E.5 510 239 3,165 508 - 1,875 319 276 1,014 347 911 266 1,641 172 4,674 Dulwich Municipal, 1l4, Lordship Lane, 5.E.22 407 202 406 1,589 2,247 184 - 1,233 258 3,242 146 456 236 401 377 Pcckham Municipal, Ciifton Congregational Church Hall, Asylum Road, 5.E.15 — 893 354 2,098 346 260 356 3,404 3315 356 849 179 1,026 115 778 Bird-in-Bush, 616, Old Kent Road, 5.E.15 20 59 340 3,285 5,922 119 2,308 265 329 1,420 1,217 1,576 1,709 6,385 - Cambridge House 6 Addington Square, S.E.5 217 228 2,214 - 163 283 3,792 158 260 1,318 765 813 1,066 1,148 4,624 Kempshead Hall, Kempshead Road, S.E.5 3,818 268 216 1,214 186 2,369 - 209 1,490 176 235 641 828 859 4,657 St. Antholin's, 22, Linden Grove, 5.E.15 431 377 3,779 1,207 - 663 970 1,009 1,153 - 5,348 475, 405 2,167 647 St. Luke's, 2, Commercial Road, 5.E.15 1,890 2681 269 4,249 174 238 351 388 281 2,078 782 1,577 701 1,189 5,668 390 Union of Girls' Schools, 60a, Amott Road, 5.E.15 340 3,315 — 4,615 363 78 1,769 469 338 1,208 575 971 584 1,185 114 Mayward House, Brunswick Square, 5.E.5 2,164 3,850 560 383 402 1,290 - 395 5,302 717 1,447 396 592 1,094 36235 13,873 1,204 47,919 3,326 12688 20215 786 3,071 3,297 3,152 3,332 6,184 9,808 7,270 o SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. Owing to the drought in the summer and the shortage of water, a request was received from the owner of a well in a private house for an examination of this well water to determine its suitability for drinking purposes. It was stated that this well had not been used for a considerable number of years. Samples of the water were taken for analysis, chemically and bacteriologically, and the result of these examinations showed that it was inadvisable to use this water for drinking purposes. In another instance the Metropolitan Water Board supply had been withdrawn from a dwelling house and replaced by water drawn from an artesian well which also supplied water for cleansing a market place. At times the supply of water from this well was inadequate, samples were occasionally found to be discoloured and to contain a sedimentary deposit. Repeated bacteriological examinations showed, however, that this water could be used for drinking purposes. The owner was nevertheless approached and requested to consider the desirability of obtaining his supply for drinking and domestic purposes from the Metropolitan Water Board. During 1934, certificates stating that a house newly erected was provided with an efficient water supply were issued in respect of 347 new houses and tenements. Closet Accommodation. The water carriage system is general throughout Camberwell except in a few instances where it is difficult to establish such system owing to the distance of the nearest sewer. Drainage. During the year drains were constructed to 347 dwelling houses and tenement buildings. The drainage systems of 145 existing premises were entirely reconstructed and in 452 instances partly reconstructed. In 2 cases proceedings were instituted against builders who failed to submit plans of drainage works executed by them. In 3 instances work to drains and sanitary fittings was found to have been carried out without notice being given or plans submitted to the Council in accordance with the requirements of the drainage by-laws. These cases were reported to the Public Health Committee who ordered the offenders to be cautioned. Public Cleansing. This service is under the control of the Borough Engineer and Surveyor of this Council. House refuse is stored in movable ash bins. The removal of house and trade refuse is carried out weekly by a fleet of end-loading, mechanical tipping refuse vehicles except in the case of blocks of dwellings, schools, etc., where the collection is carried out more frequently. The method of disposal of refuse is by loading into barges on the Grand Surrey Canal and by loading into railway trucks at the Bricklayer's Arms Siding. Sanitary Inspection of the Area. Staff. At the end of the year there were 10 male and 1 woman Sanitary Inspectors on the Staff of this Department. A summary of the inspections carried out by these Officers, appears in the following pages:— C2 35 36 37 SUMMARY OF SANITARY WORK CARRIED OUT DURING THE YEAR 1934. Inspectors. Dobson. Burrell. Glenday. Pickard. Malins, L. Maughan. Leonard. Worsfold. Green. Malins, M. Weaver. Miss O'Riordan. Totals. I I j i i i i i I I I r i i Description of Sanitary Improvements effected during the year— 357 295 154 201 317 178 - 347 358 377 32 2,848 Number of rooms cleansed 232 Defective roofs repaired, gutters or rain water pipes provided or repaired 164 202 154 200 168 59 142 82 175 111 - 1 1,458 159 153 24 63 145 Dampness abated 92 169 160 71 100 139 36 - 1,204 11 32 Yards and forecourts paved or paving repaired 101 94 64 65 81 66 - 22 Water fittings repaired 15 19 12 12 9 10 5 9 - - 621 11 - 27 33 - 124 6 12 18 Drains entirely reconstructed 2 13 2 16 16 25 17 - 68 43 - 145 Drains partially reconstructed 18 30 46 95 14 94 2 - 452 Soil, vent pipes, sinks and waste pipes renewed or repaired 60 126 136 97 37 18 65 142 89 2 - 825 53 256 149 58 114 118 Premises in which repairs were effected to w.c.'s 251 200 284 141 194 37 136 35 23 - 1,742 Dustbins provided 121 118 162 64 82 94 75 208 125 43 80 - 2 96 85 972 Repairs effected to windows 223 151 280 99 72 28 - 1 88 47 1,391 Stoves and coppers repaired 149 187 129 67 80 77 1 - 925 Flooring repaired or renewed, repairs to woodwork (stairs, etc.) 170 139 125 84 150 40 51 107 77 - - 53 4 4 - 2 1 996 Ventilation and lighting improved 5 8 2 4 20 9 - 2 4 2 8 52 1 10 Offensive accumulation removed 10 10 56 153 26 11 - - 20 71 38 51 121 Miscellaneous repairs and improvements effected 172 129 174 62 - 9 905 1,880 1,936 2,225 1,979 1,319 512 1,005 1,240 1,337 1,261 4 14,781 Total repairs and improvements effected 83 ... m I I Inspections— ~n 467 566 148 425 Following complaint 528 535 362 546 65 473 336 20 - 112 66 63 4,406 House-to-house —(1) Where defects found 82 185 110 - 44 78 70 - 17 3 25 20 - 875 (2) Where no defects found - - 1 14 161 149 10 - 202 110 - 90 On occurrence of infection 167 215 167 144 247 92 7 - 12 22 14 1,680 - Houses divided into separate tenements 212 4 - - - - - - 177 38 Factories 62 25 15 35 245 54 48 48 49 24 268 25 1 794 Workshops 43 21 13 12 25 31 36 80 30 170 36 2 1 Workplaces 87 72 11 20 10 5 10 456 16 19 74 407 - - Tenements - 21 3 - 16 107 82 163 - 25 Underground living and sleeping rooms 58 17 178 107 - 25 125 128 1 - 34 - 4 7 - 874 - - 1 4 7 - Rent (Restrictions) Acts - - 5 1 3 78 - — 17 New buildings 3 2 1 3 30 274 155 - 133 200 228 - Milk premises 130 170 120 90 170 122 24 3 - - 1,659 - - - 4 - Offensive trades 1 - 3 - - - - - - - 35 Outworker's premises - - - 40 - - 2 757 - 6 - 757 Rag and bone dealers 18 1 - - 5 1 219 211 264 539 - - 73 Conveniences (public and private) 100 10 57 70 178 1 110 206 1,964 Schools - 2 1 - - 1 - - - 8 - - 80 75 Common Lodging Houses 25 42 - 40 - 88 - - - - 430 645 643 - 187 601 623 625 520 468 697 Miscellaneous 603 666 1 2,037 6,522 2,201 1,505 Total Inspections 2,109 1,982 1,865 2,189 1,679 2,093 1,438 2,255 34 39 38 SUMMARY OF SANITARY WORK CARRIED OUT DURING THE YEAR 1934—continued. Inspectors Dobson. Burrell. Malins, L. Maughan. Leonard. Glenday. Pickard. I Wo rsfold. Green. Ma lins, M. Weaver. Miss O'Riordan. Totals. 4,118 3,260 2,156 4,270 3,003 2,727 2,932 Re-inspections, Calls, &c. 2,533 3,723 85 4,123 643 33,573 16 2 5 8 2 2 15 10 - - - 60 Smoke observations ... ! I — I 786 545 Notices served— 701 1,007 255 779 446 494 608 - 248 137 496 32 Intimations 135 350 6,149 242 49 138 180 216 145 5 1,845 Statutory - 1 - 4 - - 3 - 3 - 3 Under Metropolis Management Act 1855 13 - - - 11 9 7 - - 7 2 5 - - 1 Under Sec. 5 Housing Act, 1925 1 - - 47 - - 1 - - - - - Under Sec. 17 Housing Act 1930 - - - 1 - 2 1 - - - Under Sees. 19 and 20 Housing Act 1930 - - - - 4 Premises in respect of which notices were served and complied with during 1934, including notices which were outstanding at December 31st, 1933 600 - 676 566 773 37 815 932 181 457 512 434 5,983 128 Premises in respect of which works in compliance with notices served during the year 1934, were outstanding at the 31st December, 1934 - 155 231 87 153 3 151 98 72 100 115 1,293 REFERENCE TO DISTRICTS. Inspector. Wards. Wards. Pickard Inspector. Rye Lane and PartS of Lyndhurst, St , Giles,s and st. Mary's. The West and part of St. Giles's. Malins, L. Addington, Town Hall and St. Giles' s (parts of). Worsfold Maughan Alleyn and parts of Lyndhurst, St. John's and Ruskin. Cobourg and parts of Marlborough and Addington. Green Leonard North Peckham, Clifton, Marlborough and St. Mary's (part of ). Nunhead, The Rye and part, of St. Mary's. Dobson Malins, M. The Hamltet, The Colle g e and parts of Ruskin and St. Jonhn's. Burrell Glenday and Weaver St. George's and parts of Town Hall and Goldsmith. Goldsmith, North Peckham and Clifton (parts of). Miss O'Riordan Whole Borough. SUMMARY OF LEGAL PROCEEDINGS DURING 1934. Dist. No. Address. Complaint. Magistrate's decision. Fine. Costs. £ s. d. £ d. s. Sanitary defects 1 292, Camberwell New Road 14 days order. 3 3 0 - Do. 13 6 9 118, St. Mary's Road Withdrawn. Work done. 0 - 3 214, Neate Street Do Do. 0 13 6 - 0 36a, The Gardens 7 days order. 1 1 8 Do. - Do. 14 days order. 1 0 9 25, Manaton Road 1 - 5 Overcrowded condition of first floor front and back rooms. 14 days order, 16, Tilson Road - 15 0 7 0 114, Albert Road Constructing W.C. contrary to By-laws 15 0 0 1 1 0 - 7 114, Albert Road Do. 0 1 0 - 15 0 1 7 114, Albert Road Do. - 1 1 0 - 5 Sanitary defects Withdrawn. Work done. 0 13 6 4, Alder Street 40 - 2, Alder Street 1 0 5 Do. 14 days order. 1 - Withdrawn. Work done. 9 7, Nunhead Grove Do. 0 13 6 - 13 12, Copeland Road Do. Withdrawn. Work done. 0 6 9 - Withdrawn. Work done. 0 13 6 9 26, Barforth Road Do. - 7 42, Atwell Road Do. 7 days order. 4 4 0 - Withdrawn. Work done. 5 0 13 10 221/223, Dunstans Road Obstructed forecourt drain 0 0 6 9 25, Manaton Road Non-compliance with Magistrate's Order 5 5 0 - - Withdrawn. Work done. 6 4 49, Barkwort Road Sanitary defects 0 13 - 10 11, Whateley Road Do. 14 days order. 1 1 0 - 7 27, Hichisson Road Do. Withdrawn. Work done. 0 13 6 - 9 17, Hooks Road 0 13 6 Do. Withdrawn. Work done. - 8 57, Oakhurst Grove Constructing W.C. on first floor contrary to By-law. Dismissed. - - 27, Medlar Street 1 Sanitary defects Withdrawn. Work done. 0 13 6 - 3 4, Canal Place Do. Withdrawn. Work done. 0 13 6 - 4 35, Montpelier Road Do. 14 days order. 4 4 0 - 4 35, Montpelier Road Neglecting to pave yard 14 days order. 4 4 0 - SUMMARY OF LEGAL PROCEEDINGS DURING 1934—continued. Dist. No. Address. Complaint. Magistrate's Decision. Fine. Costs. r £ s. d. £ s. d. Sanitary defects 0 13 6 3 214, Rolls Road Withdrawn. Work done. - 3 222, Rolls Road Do. Withdrawn. Work done. 0 13 6 - 5 44, Sedgmoor Place Do. Withdrawn. Work done. 0 13 6 - 1 1 0 5 57, St. George's Road Do. 14 days order. - 3 224, Neate Street Neglecting to provide a sufficient ash-pit contrary to By-law. - 2 0 0 - 214, Neate Street Withdrawn. Work done. 0 13 6 3 Sanitary defects - 5 57, St. George's Road Do. Withdrawn. Work done. 0 13 6 - 3 214, Neate Street Neglecting to provide a sufficient ash-pit contrary to By-laws. 3 10 0 - - 0 5 114, St. George's Road Neglecting to pave yard contrary to By-laws Withdrawn. Work done. 13 6 - 41 6 82, Marmont Road Sanitary defects Withdrawn. Work done. 0 13 6 - 45, Dunstan's Road Withdrawn. Work done. 0 13 6 10 Do. - 3 49, Avondale Square Do. Withdrawn. Work done. 0 13 6 - 13 3 222, Neate Street Do. Withdrawn. Work done. 0 6 - 14 days order. 1 0 8 21, Tarbert Road Do. 1 - 0 5 16, Tilson Road Non-compliance with Magistrate's Order re overcrowding. - 15 0 - 81, Dunstans Road Sanitary defects Withdrawn. Work done. 13 6 10 0 - Withdrawn. Work done. 10 79, Dunstans Road 0 13 6 Do. - 5 59, St. George's Road Defective water service pipe in washhouse causing dampness. Withdrawn. Work done. 0 13 6 - Dismissed. Order made against R. J. Langridge. 6, Blake's Road 5 Sanitary defects - - Do. 66, Blake's Road Adjourned sine die. 5 - - 8 47, East Dulwich Grove Unlawfully constructing certain drainage work without depositing plans. - 2 0 0 - 5, Canal Place Main roof defective 14 days order. 1 0 3 1 - SUMMARY OF LEGAL PROCEEDINGS DURING 1934—continued. Dist. No. Address. Complaint. Magistrate's Decision. Fine. Costs. £ s. d. £ s. d. 7 49, Blenheim Grove Defective condition of roof 1 1 0 14 days order. - 2 13, Dagmar Road 1 0 Sanitary defects 14 days order. 1 - 3 - 216, Neate Street Failure to cleanse verminous rooms 5 0 0 - 9 198, Albert Road Sanitary defects Withdrawn. Work done. 0 13 6 - 6 14, Upper Hall Street 0 13 6 Do. Withdrawn. Work done. - 6 15, Upper Hall Street 0 Do. Withdrawn. Work done. 13 6 - 13, The Avenue 0 10 Do. Withdrawn. Work done. 13 6 - 5 55, St. George's Road Do. 0 13 6 Withdrawn. Work done. - Withdrawn. Work done. 0 5 61, St. George's Road Do. 13 6 - 4, Hornby Road 5 Do. 14 days order. 1 1 0 - 5 16, Blake's Road Do. 14 days order. 2 2 0 - 42 5 W.C. in yard—flush-pipe, joint and pan defective. Withdrawn. Work done 0 13 6 72, Stanton Street 1 0 110, Camberwell Road Sanitary defects Withdrawn. Work done. 13 6 - 1 108, Camberwell Road Do. Withdrawn. Work done. 0 13 6 - 8 Withdrawn. Work done. 8, Tarbert Road Do. 0 13 6 - 8 19, Tarbert Road Do. Withdrawn. Work done. 0 13 6 - 0 3 11, Canal Place Withdrawn. Work done. 13 6 Do. - 3 1 0 13, Canal Place 7 days order. 1 Do. - 7 44a, Choumert Road Roof defective 7 days order 1 1 0 - 9 93, Scylla Road Damp ground floor flank wall 14 days order 2 2 0 9 91, Seylla Road Sanitary defects 14 days order. - 0 66, Kirkwood Road 9 Do. Withdrawn. Work done. 13 6 - 10 6, Alleyn Park Defective main roof and skylight Withdrawn. Work done. 0 13 6 - 5 Unlawfully constructing certain drainage work, without depositing plans. 1 1 0 2 2 0 117, Coleman Road - 0 1 12, Mansion Street Sanitary defects Withdrawn. Work done. 13 6 - 6 1 5, Crown Street Main roof defective Withdrawn. Work done. 0 13 - 9 16, Copeland Road Withdrawn. Work done. 0 6 Sanitary defects 13 - Smoke Abatement. Every effort is made to reduce to a minimum the nuisance caused by the emission of smoke from chimneys of industrial undertakings in this Borough. During the year 1934,10 complaints were reported and received attention by the Sanitary Inspectors. On 60 occasions during the year the Inspectors also kept under observation factory chimney shafts in various parts of the Borough and in cases where any infringement of the law was proved the attention of the offender was drawn to the matter. Advice was also offered to the management of the undertaking as to the method of preventing the nuisance and its possible recurrence. It was necessary to serve 8 intimations and 1 statutory notice for such nuisances; no legal proceedings were however instituted. Schools. The London County Council carry out periodical inspections of the elementary schools in this Borough. The annual inspection of private schools revealed that the accommodation at each was sufficient, the water supply and sanitary arrangements were adequate, and were being maintained in a satisfactory condition. Common Lodging Houses. Applications for renewal of licences were received in respect of the five lodging houses in the Borough, and a licence was granted in each case; 187 inspections of these lodging houses including night inspections were made during the year. Particulars as to the situation of these common lodging houses and the licensed accommodation available at these premises are shown in the following table:— Ward. Situation of house. Number of lodgers for which licensed. No 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 Increase of Rent and Mortgage Interest (Restriction) Acts. During 1934, 28 applications were made to the Sanitary Authority by the occupiers of dwelling houses for certificates under these Acts, and the required certificates were issued. Up to the time of the preparation of this report 14 certificates have been issued to owners of properties stating that the requirements of the Sanitary Authority had been complied with. Rag Flock Acts, 1911-28. One sample of rag flock was submitted for examination and was found to comply in all respects with the requirements of the above Acts. The Rats and Mice (Destruction) Act, 1919. During the year 139 complaints were received as to the presence of rats on land or premises. In every case the complaint was fully investigated by a Sanitary Inspector, and where rat runs were found to exist these were traced as far as possible to their source and appropriate action was taken to abate the nuisance. In many instances the presence of rats is due to the defective condition of the drains, but where this is not the case the tenant is supplied with poison baits and instructed by the Inspectors how to use them. Advice is also given as to the necessity for keeping all foodstuff under cover and the importance of not leaving waste particles of food lying about overnight is stressed so as to avoid attracting rats. When information is requested the names of reputable rat catchers living in the Borough are supplied. In seven 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 requiring the abatement of the nuisance. With a view to securing concerted action for the destruction of rats and mice, National Rat Week was observed in this Borough at the suggestion of the Ministry of Agriculture, during the week commencing Monday, November 5th, 1934. During this period rat poison was laid in the various sewers owned by the Council, which work was carried out in conjunction with the main drainage department of the L.C.C. Editors of local newspapers were invited to direct the attention of their readers to National Rat Week ; posters were displayed on the Council's sand-bins and at the Public Libraries and Baths and Underground Conveniences ; copies of the Ministry of Agriculture and Fisheries bulletin on " Rats and how to exterminate them " were distributed by the Sanitary Inspectors to the proprietors of factories, workshops and food places in the Borough, and the use of rat poison was continued. Removal of Aged, Infirm or Physically Incapacitated Persons. Under the provisions of Section 28 of the London County Council (General Powers) Act, 1928, the Borough Council is authorised to obtain the removal to an institution of aged, infirm or physically incapacitated persons living under insanitary conditions. During the year 22 cases of this character came to the notice of the Public Health Department. Satisfactory arrangements were made to secure better care and attention for five of these old people in their own homes, six were persuaded to enter an institution voluntarily, five were taken charge of by relatives or friends, and in two other instances the persons concerned entered a hospital. In one case it was necessary to secure the person's compulsory removal to an Institution on the order of a Stipendiary Magistrate. In the remaining three cases, two removed from the district, and no action was called for in respect of the remaining case. Offensive Trades. The following offensive trades are carried on in the Borough: — Skin Dressers 6 Skin Merchants 1 Sheep Skin Rugmakers 1 Soap Boilers 2 Fellmongers 1 The number of inspections made of these premises during the year was 35. At the end of the year the Public Health Committee decided to recommend the Council to sanction the establishment anew of the business of a soap boiler in the Peckham district of Camberwell. Sanitary Conveniences attached to Licensed Premises. During 1934 the Sanitary Inspectors made 1,521 inspections of the public house urinals in the Borough. In 130 instances these conveniences open on to the public footway. This undesirable condition of affairs easily permits of nuisances and other abuses taking place. Whenever plans are submitted for a reconstruction of this type of urinal, care should be taken to prevent any continuation of this practice. It is satisfactory to record that during the period under review the Public Health Committee of this Council refused the applications of owners who made requests that such urinals be allowed to continue to open on the public footway. Fouling of Footways by Dogs. This by-law which was made by the Council and approved by the Home Office in 1926, does not appear to have resulted in any appreciable diminution of this objectionable form of nuisance. The duty of enforcing the provisions of this by-law was delegated by the Council to the Sanitary Inspectors and the Street Keeper. It is apparently not understood however, that it is permissible for anyone to institute proceedings against offenders of this by-law. The By-law provides: — No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. Any person offending against this By-law shall be liable to a penalty not exceeding 40s. HOUSING. Slum Clearance. Further consideration was given to Ministry of Health Circular 1331 dated April 6th, 1933, during the year under review, and the Council at their meeting in October 1934, decided to deal with a number of small insanitary areas in the Borough in accordance with the provisions of the Housing Acts, 1925 and 1930, in addition to three areas described in the following table which the Council in June 1934, decided to declare as Clearance Areas. Area. Dwelling houses. No. of person to be displaced. Tiger Yard. 17 41 Joiner's Arms Yard 6 25 Woodland Cottages 10 33 Under the arrangement which has been made with the London County Council, this Council agreed to pay to the County Council a sum of £1 17s. 6d. a year for forty years in respect of every dwelling which that authority provides to re-house persons displaced as the result of slum clearance operations by this Council. The question of the number of dwellings which the London County Council would be able to offer in respect of representations made by your Medical Officer of Health under the Housing Act, 1930, was also considered. That authority anticipated that they could provide re-housing accommodation for approximately 20 Camberwell families per month. Representations have accordingly been timed to correspond with this arrangement, and at the 1st June, 1935, 20 small insanitary areas involving 123 dwelling houses have been represented in accordance with the provisions of Section 1 (2) of the Housing Act, 1930. The question of the provision of alternative accommodation for families displaced by the closure of individual unfit houses was at the time of the preparation of this report still under consideration by this Authority and the London County Council. The following areas in Camberwell were also declared by the London County Council to be clearance areas during 1934: — No. of premises. No. of persons to be displaced and rehoused. Date when declared. Area. 185 968 27/2/34 Levant Street 57 257 19/6/34 Nigel Buildings 46 Overcrowding. Much of the property in the north and north-west parts of the Borough is old with defects associated with age. These properties are for the most part overcrowded and occupied by two or more families. The extent of overcrowding conditions existing in the Borough cannot be ascertained otherwise than by a survey of the area. At the time of writing this Report, a new Housing Bill is before Parliament in which there is a provision requiring every local authority to cause an inspection of their district to be made, with a view to ascertaining what dwelling houses therein are overcrowded. It will also be the duty of metropolitan local authorities to prepare and submit to the London County Council a report showing the result of the inspection and the number of new houses which will be required in order to abate such overcrowding. The abatement of overcrowding by the provision of new dwellings will materially assist local authorities to deal with the remaining problems associated with housing conditions in Camberwell, now that a definite programme of action has been settled with regard to slum clearance and the rehousing of displaced persons. During the year 102 fresh cases of overcrowding came to the notice of this department, and in these cases the attention of the tenants and owners was drawn to the existence of the nuisance, but no pressure was brought to bear on families requiring the abatement of the nuisance, whose financial circumstances did not permit of any additional charge being incurred for additional accommodation. In 16 instances the nuisance was abated by the families themselves and the London County Council provided houses or flats in 26 cases. In one case legal proceedings were taken to require the abatement of the nuisance. The standard adopted in determining whether a dwelling house is overcrowded is that applying to the amount of free air space per person as required by the London County Council by-laws relating to houses divided into separate tenements. Houses Divided into Separate Tenements. There are many areas in Camberwell containing houses designed for one family which are now occupied by several families, without structural alteration to provide for adequate sanitary accommodation, washing facilities and proper food storage arrangements for each family. There were at the end of 1934, 239 tenement houses on the register. The London County Council by-laws relating to houses divided into separate tenements enable this type of premises to be dealt with, but it would not be possible to undertake the additional duties which would arise from the general enforcement of these by-laws without increasing the present staff of Sanitary Inspectors. It is difficult to foreshadow the staff requirements which may be necessary in connection with the survey to be undertaken to ascertain the extent of overcrowding existing in the area in accordance with the provisions of the Housing Bill which is now before Parliament, but in my opinion, co-incident with these duties which local authorities will be called upon to carry out, consideration should be given to the question of the registration of all dwelling-houses which come within the definition of houses divided into separate tenements. Verminous Rooms. It is well known that a number of the older houses in certain parts of the Borough are infested with bed bugs, and that some of the tenants become so accustomed to their presence that they make no serious effort to get rid of them. Realising that the presence of these insects is frequently a misfortune, the Health Department is at all times willing to assist owners and tenants in the work of disinfestation. The sanitary inspectors have instructions, in such cases, to arrange for the steam disinfection of all bedding, the dismantling and thorough washing of bedsteads, the cleansing of all furniture and effects, the removal of picture rails, skirting boards, architraves of doorways, dadoes and wall paper, and if necessary to advise the use of the painters blowlamp to chinks and crevices. The spraying of the infected rooms at intervals of three weeks until extermination is complete is also undertaken by the Health Department. It is stated in a memorandum circulated to Local Authorities by the Ministry of Health, on the bed bug and how deal with it, that there is no agent more effective in ridding a house of bugs than the application of soap and water to which a little washing soda has been added. Occupiers of infested premises are accordingly urged to apply these suggestions as a means of assisting in ridding themselves of these pests. Hydrocyanic acid gas and ethylene-oxide mixed with carbondioxide are not used as fumigants in this Borough on account of their danger to human beings. During the year 984 verminous rooms were disinfested. Underground Rooms used for Sleeping Purposes. A survey of the Borough was made in 1934 by the sanitary inspectors for the purpose of providing information as to the number of underground rooms used for sleeping purposes, distinguishing those contravening the provisions of the Public Health (London) Act, 1891, and/or the Housing Act, 1925. These particulars are summarised in the subjoined table:— UNDERGROUND ROOMS. Housing Act, 1925 (Section 18), and Public Health (London) Act, 1891 (Section 96). P.H. (Lond.) Act, 1891. †‡90 90 * Includes 6 also not complying with P.H. (Lond.) Act, 1891. No. Rooms not complying with provisions of Housing Act, 1925 *43 43 No. Rooms ‡ Includes 31 probable contraventions of the P.H. (Lond.) Act, 1891. illegally occupied. 127 127 † Includes 6 also not complying with Housing Act, 1925. 1,033 No. Rooms used for sleeping purposes. P.H. (Lond.) Act. 132 Housing Act. 901 No. Rooms 3 ft. below ground. Totals 5,273 Under 7 ft. in height. 557 Over 7 ft. in height. 4,716 During the year one underground room in the Northern part of the Borough, used for the purposes of a sleeping place, was closed by order of the Council in pursuance of Sect. 20 of the Housing Act, 1930. Housing Statistics, 1934. 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) 7,407 (b) Number of inspections made for the purpose 23,642 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,276 (b) Number of inspections made for the purpose 2,718 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 105 (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 3,643 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 397 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 1 (b) By Local Authority in default of owners Nil (6) Proceedings under Public Health Acts: — (1) Number of dwelling houses in respect of which statutory notices were served requiring defects to be remedied 1,428 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 2,350 (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 (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 2 *Notices served under Sec. 19 in respect of one house, undertaking received that this property will not be re-let for human habitation. (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 (b) By Local Authority in default of owners Nil (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil (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. The following report is required to be submitted annually to the Secretary of State for the Home Department and contains a summary of the inspections made and the defects found and remedied in factories and workshops within the Borough. I.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Inspections made by Sanitary Inspectors in 1934. Number of Premises. (1) Inspections. (2) Written Notices. (3) Prosecutions. (4) 794 - Factories (including Factory Laundries) Workshops (including Workshop Laundries) 43 863 - 54 Workplaces (other than Outworkers' premises) - 97 Total 1,657 D2 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Number of Defects. Particulars. (1) Found. (2) Remedied. (3) Number of Prosecutions. (5) Referred to H.M. Inspector. (4) - Nuisances under the Public Health Acts: — !... Want of cleanliness 112 104 - 5 Want of ventilation 6 - - - - - Overcrowding Want of drainage floors - - - - - 70 Other nuisances 73 - - Sanitary accommodation — Insufficient 8 5 - - 33 31 Unsuitable or defective - - 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 20 20 20 - 255 237 20 Total - * Including those specified in sections 2,3, 7 and 8 of the Factory and workshop Act, 1901, as remediable under the Public Health Acts. Factory and Workshop Act. FACTORIES, WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1934. Inspected by the Council's Male Sanitary Inspectors. Workshops and Workplaces. Trade. Factories. Total. Blacksmiths 4 13 17 Bootmakers and Repairers 13 22 35 1 3 4 Brush Trades 44 Building Trades 8 52 Chemical Trades 5 8 13 Engineering Trades 68 47 115 Gas Works 1 1 Glass Blowing 33 1 Laundries 33 - - 2 35 Miscellaneous 214 403 617 Offensive Trades 5 6 11 Preparations of Foodstuffs 18 8 26 37 10 47 Printing and Lithography Sweet Manufacturers 2 4 6 77 Timberyards and Woodworkers 49 28 3 Toymakers 3 Upholsterers - 1 9 10 Varnish and Colour Works 4 2 6 18 30 48 Wearing Apparel Total 1,124 482 642 Inspected by the Council's Woman Sanitary Inspector. Factories. Workshops and Workplaces. Trade. Total. Brush Trades 2 - 2 Chemical Trades 3 3 - 1 Furriers 1 Laundries - 37 2 39 Milliners 12 12 - Miscellaneous 97 109 - 206 Offensive Trades 3 3 20 1 Preparation of Foodstuffs 21 Printing and Lithography 13 13 - 4 Sweet Manufacturers 2 6 68 151 Wearing Apparel 83 212 457 Total 245 During the year 74 factory premises and 79 workshops were added to the registers, and 50 factories and 68 workshops were removed. The number of inspections made of factories, workshops and workplaces was 1,657; by the male inspectors 1,145, and by the woman inspector 512. Outworkers. During 1934, 785 names and addresses of outworkers residing in Camberwell were reported by employers and the Medical Officers of Health of other districts. There are 545 premises in this Borough where outwork is being conducted. The number of inspections of these premises was 757, and 23 notices under the Public Health (London) Act, 1891, were served to remedy sanitary defects existing at these premises. Six cases of infectious disease were reported during the year from premises where home work was carried on, and the necessary precautionary measures were taken to prevent the spread of infection. In no instance during the year was it necessary to send a cautionary letter to employers for neglecting to comply with the provisions of Section 107 of the Factory and Workshop Act, 1901, which requires all contractors employing outworkers to send on February Ist, and August Ist, in each year a list of the names and addresses of such outworkers to the Medical Officer of Health of the district. The following table shows the nature of the work conducted by outworkers in this Borough. Table showing Trades of Outworkers in Employment at the end of 1934. Art publishing 1 Baby linen 9 Belts 1 Blinds 1 Blouses 17 Boots and shoes 8 Braces 1 Brushes 2 Button holes 1 Cardboard boxes 8 Card lacing 1 Chemist 1 Chemists' sundries 1 Clothing 1 Coathangers 7 Collars 6 Crocheting 3 Downquilts 5 Drapery 6 Dresses 22 Dressing gowns 8 Dyeing and cleaning 2 Embroidery 5 Engraving Jewellery 2 Fancy goods 13 Furs 3 Garters 6 Gloves 1 Gold lace 1 Gowns 33 Hair nets and combs 1 Handbags 1 Handkerchief sachets 1 Hats 6 Hosiers 2 Household linen 1 Ivory and bone goods 2 Jumpers 1 Leatherwork 2 Mantles 165 Machinery belting 1 Millinery 2 Ladies' neckwear 5 Gents' neckwear 7 Needlework 8 Novelties 2 Outfitting 1 Overalls 6 Paper bags 5 Polishing and fitting 1 Pyjamas 3 Rag dolls 2 Shirts 15 Skirts 4 Stationery 1 Tailoring 32 Ties 30 Toys 4 Umbrellas 2 Underclothing 28 Wearing apparel 27 Woollen goods 1 545 54 INSPECTION AND SUPERVISION OF FOOD. Administration. The sampling of food to determine its composition and purity is entrusted to the Food and Drugs Inspector. The Food Inspector is responsible for keeping under observation food premises and slaughterhouses in the Borough and the inspection of all food stored, sold or prepared for sale in Camberwell. All shops where milk is sold are visited periodically by the District Sanitary Inspectors. Milk. Bacteriological Examinations. In every instance the bacteriological examination of milk was carried out in accordance with the technique suggested by the Ministry of Health in Memo. 139/Foods. Milk (Not Designated). One sample of milk not designated, contained in a sealed bottle was submitted for bacteriological examination and was well within the standard prescribed by the Milk (Special Designations) Order, for pasteurised milk. No bacteriological standard is laid down for milk not designated. Milk (Designated and Ordinary) Examination for Tubercle Bacilli. Six samples of milk were submitted to the Bacteriologist for examination for the presence of tubercle bacilli by means of the animal test. In no instance was tubercle bacilli found. The reports of the samples are appended. Sample marked Date submitted. Designation. Result of Examination "A" August 24th "Certified" No evidence of Tuberculous infection. "B" August 24th "Raw "milk Ditto "C" August 24th Grade "A" (T.T.) Ditto "D" November 5th Milk (Not-designated) Ditto "E" November 5th Milk (Not-designated) Ditto "F" November 8th "Raw" milk Ditto Administration of Milk and Dairies Order, 1926. The provisions of this Order require the keeping by the Council of registers of all persons carrying on in the Borough the trade of cowkeeper or dairyman and of all premises which are used as dairies. Premises proposed to be used for dairy purposes are inspected and if found to be satisfactory for the purpose registration is recommended. The following summary shows the comparative state of the registers at the end of 1933 and 1934: — Year 1933. Year 1934. Cowkeepers 1 1 Cowsheds 1 1 Dairies and Milk shops 368 366 Dairymen with premises in the Borough 415 394 Dairymen with premises outside the Borough 20 23 Purveyors of milk in sealed bottles 113 135 There is one licensed cowshed in the Borough which was inspected on 15 occasions during the year. The standard of cleanliness of this cowshed was satisfactory at every visit. The inspections of milk premises numbered 1,659. It was found necessary to serve 30 notices for minor defects. Milk (Special Designations) Order, 1923. Under this Order the Council granted the following licences for the sale of designated milk. Certified Milk 8 „ „ (supplementary) 1 Grade "A" 0 „ (supplementary) 1 „ (Pasteurised) 8 „ (Tuberculin Tested) 23 „ (supplementary) 5 Pasteurised 63 „ (supplementary) 5 Total 114 The increase in the number of licences for the sale of pasteurised milk is explained by the decision that all milk supplied to Schools under the jurisdiction of the London County Council is required to be pasteurised. One application was received and granted for a licence to set up a pasteurising establishment within the area of the Borough. Designated Milk. No sample of Certified Milk was examined at the request of the Ministry. Grade "A" (Tuberculin Tested) Milk. Fifteen samples of this grade of milk bottled and sealed by a producer on the farm and consigned to a licensed dealer in the Borough, were at the request of the Ministry of Health examined by this Council's Bacteriologist. Of the number submitted 12 failed to comply with the standard and were brought to the notice of the Ministry. Owing to the repeated failure of this producer to comply with the prescribed conditions the Ministry revoked the license. Grade "A" (Tuberculin Tested) Milk must not contain more than 200,000 bacteria per cubic centimetre and Coliform Bacillus must not be found in 1 /100th cubic centimetre. The reports of the 12 samples which failed to comply are appended:— Sample marked. Date obtained. Bacteria per c.c. Presence of Coliform Bacillus. No. 1 21,000 February 8th Present in 1 /100 cc. Ditto. No. 2 March 15th 280,000 Ditto No. 3 May 10th 26,000 170,000 Ditto No. 7 June 21st 50,000 Ditto No. 8 June 28th 10,000 Ditto No. 9 July 12th July 19th 100,000 Ditto No. 10 Ditto August 16th 40,000 No. 11 August 20th 70,000 Ditto No. 12 Ditto September 13th 120,000 No. 13 Ditto September 20th 990,000 No. 14 October 11th 380,000 Ditto No. 15 In addition to the above, 4 samples, 2 from each of the two licensed bottling establishments in the Borough were bacteriologically examined and were found to be satisfactory. Pasteurised Milk. During the year 36 samples of pasteurised milk in sealed churns supplied to institutions, and 14 in sealed bottles supplied to school children, were taken for the purpose of ascertaining whether they complied with the bacteriological standard laid down in the Milk (Special Designations) Order, viz., that the maximum number of bacteria permitted per cubic centimetre should not exceed 100,000. There is no standard for Bacillus Coli. Of these, 49 samples conformed to the required standard. One sample, taken from a sealed churn, exceeded by 165,000 the maximum number of bacteria allowed under the order. The appropriate committee directed that a letter of caution be sent to the vendors. Milk. The campaign to secure a clean and safe milk supply continued throughout the year. Whilst milk is a most valuable article of food, yet unfortunately it is a vehicle for the spread of tuberculosis and numerous infections such as undulant fever and septic sore throat. A committee appointed by the People's League of Health to review the question of tuberculosis of bovine origin in Great Britain estimated that about 2,000 human deaths are caused annually by the bovine type of tubercle bacillus, and about 4,000 fresh cases of human tuberculosis of bovine infection develop each year. It is essential therefore to institute more effective measures than are at present at our disposal to prevent milk from being the cause of a considerable percentage of human deaths from tuberculosis and of a large amount of invalidity. The Economic Advisory Council Committee appointed in 1932, in their report published in 1934, suggested in their recommendations that regulations should be made governing the grading of milk and the granting to large urban authorities of the right to require pasteurisation of milk other than that produced by herds free from tuberculosis. In London a large proportion of the milk supply is already pasteurised by the method as defined by the Milk (Special Designations) Order. Until the entire supply for London is pasteurised in the manner prescribed, the risk of milk causing disease will always be present. Milk Act, 1934. The above Act became operative on August 15th, 1934. This Act introduces new legislation with a view to increasing the demand for milk, for improving the quality of the milk supply, and for regulating the manner in which milk is described. Section 10 introduces provisions in substitution of section 3 of the Milk and Dairies (Amendment) Act, 1922, with regard to Milk (Special Designation) Orders, made by the Ministry of Health, after consultation with the Ministry of Agriculture and Fisheries, which are briefly referred to hereunder, viz.:— The granting by the Minister of Health, or local authorities, of milk licences as respects any special designation, and prescribes the conditions under which any particular milk licence is granted, including the fees payable, the period for which such licences shall be granted, and for the revocation or suspension of a milk licence, in the event of a breach of any condition, subject to any person aggrieved by the refusal, suspension, or revocation, of a milk licence by a local authority, to appeal to the Minister of Health. Amongst other provisions, the Act provides for temporarily securing to producers of milk, by means of payments out of moneys provided by Parliament, payments for the purpose of improving the quality of the milk supply, and for increasing the demand for milk. Under section 11, it is provided that contributions from the Exchequer towards expenses of Milk Marketing Boards, are allowed in connection with schemes for increasing the demand for milk, and a scheme is referred to in another part of this report, whereby the Milk Marketing Board, with the approval of the Ministry of Agriculture, has introduced a scheme for the supply of milk to school children at a reduced rate. Milk for School Children. A daily ration of milk given to children, particularly to those who are living on the borderline of undernourishment exerts a beneficial action in their physical development. In this connection, the scheme of the Milk Marketing Board approved by the Ministry of Agriculture, is briefly referred to. This scheme came into operation on October 1st, 1934, and provides for a supply of milk to school children, at the reduced rate of ½d. per third of a pint. The amount of milk consumed at each school, or other approved centre, is certified by the Head Teacher, or other person approved by the Local Education Authority. In the case of children found to be subnormal, more than one third of a pint a day may be granted, and in necessitous cases issue is made free. The scheme further provides that at every school, the source of supply of the milk, shall be approved by the School Medical Officer, after consultation with the Medical Officer of Health of the area in which the school is situated. Subject to the above, the selection of the particular dairyman is usually left to the Head Teachers of the respective schools. The Board of Education desired that in areas where a supply of efficiently pasteurised milk was available, such grade of milk should in all cases be provided. So far as this Borough is concerned, all milk delivered to the schools under this scheme is supplied by purveyors licensed by this Authority, under the Milk (Special Designations) Order, 1923, to sell pasteurised milk, which must be in conformity with the prescribed conditions, set out in the Order. The milk is delivered to the schools in bottles, each containing one-third of a pint, sealed with a cardboard disc, bearing the words "pasteurised milk." Administration From October 1st to December 31st, seven samples of this particular grade of milk were taken for bacteriological examination, and a similar number of samples for chemical analysis. These samples were taken in the course of delivery at the respective schools. Some of these samples were taken from the same consignment of bulk milk, which was delivered to eleven other schools, and therefore formed an index to the quality of the milk being supplied to eighteen schools in all. The samples so taken complied with the requirements of the Sale of Milk Regulations, 1901, and the Milk (Special Designations) Order, 1923. In addition to the above, seven samples of pasteurised milk, and one sample of milk, not designated, consigned to schools, were taken during the earlier part of the year, and all complied with the bacteriological and chemical standards. Meat and other Foods. The London County Council (General Powers) Act, 1932, requires the registration with the Sanitary Authority 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. At December 31st, 1934, the number of premises on the register used or proposed to be used for the purposes stated in Section 5 of the above-named Act, was as follows: — For the sale, manufacture or storage of ice cream 335 For the preparation or manufacture of sausages 167 For the preparation or manufacture of potted, pressed, pickled or preserved meat 266 For the preparation or manufacture of potted, pressed, pickled or preserved fish 9 It should be noted that premises used for the purpose of fish frying are not included in this table. During the year 30 fresh applications were received for the registration of premises in accordance with the provisions of this Act. In each of these cases the premises were carefully inspected by the Food Inspector and where repair or cleansing work was found to be necessary such work was required to be carried out before the premises were registered by this Authority. In addition to these first inspections, the number of inspections of registered food premises in the Borough totalled 3,546 during 1934. Ice Cream. All premises, except Hotels, Clubs and Restaurants, which are used for the manufacture, storage or sale of ice cream are required to be registered by the Sanitary Authority in accordance with the provisions of the London County Council (General Powers) Act, 1932. The number of such premises which appeared on the register at December 31st, 1934, was as follows:- Manufacture and sale 188 Storage and sale 112 Sale 35 The number of inspections of these premises during 1934 was 371. Six samples of ice cream were submitted for examination by the Council's Bacteriologist, and the result of these examinations appears in the following table:— Sample marked. Date obtained. Where purchased. Bacteria per c.c. Presence of Bacillus Coli. No. 1 July 12th Shop 5,600,000 Absent in 1/10 cc. No. 2 July 12th Shop 60,000 Present in 1/100 cc. No. 3 July 12th Barrow in a public thoroughfare 50,000 Absent in 1/10 cc. No. 4 July 19th Shop 15,000 Absent in 1/10 cc. No. 5 July 19th Barrow in a public thoroughfare. 2,000,000 Present in 1/100 cc. No. 6 July 19th Barrow in a public thoroughfare. 5,000,000 Present in 1/100 cc. Bakehouses. The number of bakehouses on the Register at the end of 1934 was 133; of these 42 are situated underground. The Food Inspector made 278 visits of inspection of these premises and 68 intimation notices were served for the cleansing of walls and ceilings. Butcher Shops and Meat Stalls. Frequent visits of inspection were made by the Food Inspector to the 164 butcher shops and 4 stalls in the Borough from which meat was sold. During the year it was necessary to serve 32 notices for infringements of the London County Council (General Powers) Act, 1932, Sect. 5. Fish Curers. At the end of 1934 there were 52 premises in the Borough at which the curing of fish was conducted. The Food Inspector paid 234 visits to these premises during the year, and it was necessary to serve 10 notices for cleansing work and other sanitary nuisances. Fish Shops and Stalls. The 62 fishmongers' shops and 15 fish stalls in the Borough were regularly kept under observation during 1934, and on six occasions parcels of fish were surrendered by the owners as unfit for food. Condemnation certificates were granted in every case. Fried Fish Shops. During the year, 456 inspections of the 98 fried fish shops were made of these premises. It was necessary to serve 22 notices requiring cleansing work to be carried out. Restaurants and Eating Houses. The kitchens of restaurants and eating houses in this Borough were regularly inspected to ensure that a reasonable standard of cleanliness was maintained. It was necessary in 19 instances to serve notices respecting unsatisfactory conditions found to exist at these premises during the year under review. Slaughterhouses. The Public Health (Meat) Regulations, 1924, provide that no person may slaughter any animal without giving notice to the Sanitary Authority of his intention to slaughter. A summary shewing the number of animals slaughtered and inspected by the Council's Food Inspector at the two slaughterhouses during the year, appears in the table below:— Month. Cattle. Sheep. Lambs. Pigs. Calves. Totals. January 5 40 12 4 61 February 4 30 21 4 59 March 4 47 16 3 70 April 4 37 4 2 47 May 4 37 — 4 45 June 4 42 — 4 50 July 3 39 — 2 44 August 3 41 — 3 47 September 4 32 11 2 49 October 4 25 14 2 45 November 3 32 12 3 50 December 5 26 18 1 50 Totals 47 428 108 34 617 The following table provides information relating to the nature of the diseased meat condemned by the Food Inspector at the time of slaughtering and which was subsequently destroyed at the Council's Depot at Peckham Park Road, during the period January to December, 1934. Carcases, including organs. Fore-quarters. Hind-quarters. Head. Tongue. Heart. Liver. Stomach. Spleen. Mesenteries. Intestines. kidneys. Udders. Cause of destruction. Lungs. Cattle. Cirrhosis 1 - - - - - - - - - - - - - Tuberculosis 1 1 1 1 - - - - - - - - - - Fluke 13 - - - - - - - - - - - - - Abscess 1 1 - - - - - - - - - - - - Sheep. Parasitic diseases - - - 57 - - - - - - - - - - Fluke 1 - - - - 1 - - - - - - - Pigs. Tuberculosis 3 2 10 3 8 8 - 8 3 4 5 3 3 3 Pneumonia 2 2 2 8 2 - - 2 2 2 2 2 2 2 Pyaemia 1 1 1 1 1 1 - - 1 1 - 1 1 1 1 Cirrhosis 1 - - - - - - - - - - - - Calves. Tuberculosis 2 3 2 2 2 2 2 2 3 - - 2 2 2 Totals 8 2 - 79 14 30 11 8 17 9 8 9 8 8 Slaughter of Animals Act, 1933. This Act which came into force on January Ist, 1934, includes provisions as to the slaughter of certain animals in Slaughterhouses and Knackers Yards and the prohibition of slaughter and stunning except by licensed slaughtermen. Humane slaughtering of animals (not including sheep) by mechanically operated instruments is made compulsory with the exception of any animal slaughtered for consumption by members of the Jewish or Mahomedan faiths. Section 3 of this Act requires Local Authorities to license slaughtermen and during the year this Council issued licenses for a period expiring at December 31st, 1934, to three approved persons. The Pood Inspector satisfied himself on every occasion when slaughtering was being carried out, that the work was being performed by licensed persons and by humane methods in the manner prescribed by Section I of the Act. In this Borough sheep are also required to be slaughtered by mechanically operated instruments. The Transfer of Powers (London) Order, 1933, transferred from the London County Council to the Metropolitan Borough Councils the function of licensing Slaughterhouses and licenses were granted by the Council during the year in respect of the two slaughterhouses in the Borough. There are no Poultry Slaughterhouses in Camber well. Street Trading. The various articles of food sold by street traders, and the number of such persons licensed by this Authority as street traders, in accordance with the provisions of the London County Council (General Powers) Act, 1927, Part VI —Regulation of Street Trading are summarised in the following table: — Coffee stalls 11 Confectionery and drinks 5 Fish 15 Fruit and vegetable 108 Groceries 10 Ice Cream 7 Meat 4 Poultry, eggs, etc. 7 These stalls were regularly inspected by the Food Inspector. The storage places in this Borough used by the vendors otherwise than at the licensed street stands were also systematically inspected. Where storage places were situated outside the Borough information was obtained from the Officers of the Public Health Department in the area as to the suitability of the storage arrangements of the trader. Notification of Food Poisoning. During the year 22 cases of food poisoning were notified in the Borough. Careful enquiries were made in every case. In three instances there was a doubt as to whether the illness was due to some dietetic indiscretion or to the peculiar sensitiveness of the person to the article of food consumed. In September last several cases of illness were reported of persons residing in Camberwell and in adjoining Boroughs which were suspected to be due to the consumption of certain cooked meats prepared for sale by a firm in this Borough. These cases occurred at intervals between September 10th and 22nd, the patients suffering from vomiting and diarrhoea within a few hours after eating the meat. In some instances the patients suffered a certain amount of collapse. In view of the occurrence of similar cases of illness three months earlier resulting from the consumption of cooked meat prepared and by the same firm trading in this Borough, the facts relating to this further outbreak were brought to the attention of the Ministry of Health. Every step was taken by the Officials of the Ministry of Health and of this Council with a view of ascertaining the possible cause of the illness of these patients. Portions of the incriminating articles of food and other specimens were obtained for bacteriological and chemical analysis, as well as specimens of the faeces of certain of the sufferers. As far as could be ascertained every person affected The predominating bacteria found at the Pathological Laboratory of the Ministry of Health was Staphylococcus Aureus. The hygienic standard of the factory where these articles of food were prepared for sale was satisfactory, and every precaution appeared to have been taken by the management to prevent the possibility of infection occurring in the various processes of preparation and cooking of the meat foods in question. The liability of rats causing the infection was inquired into, but this line of investigation was not conclusive. Table showing particulars op cases of Food Poisoning notified during The year in accordance with the requirements of the London county Council (General Powers) Act, 1932. No. Date notified. Food suspected. Remarks. 1 15/3/34 Cocoanut Ice Patient stated to have always suffered from weak stomach. 2 19/4/34 Fried fish Illness slight. 3 23/4/34 Tinned herrings Illness slight. 4 14/5/34 Steak and Kidney pie. Illness slight. 5 17/5/34 Beef sausages Illness severe. Patient in delicate health. 6 18/5/34 Faggot B. Aertrycke isolated from stool. 7 22/5/34 Duck egg 5/7/34 Two members of one household. 8 Pork or clotted cream. 5/7/34 9 Do. 10 6/7/34 Tinned salmon Illness slight. 11 18/7/34 *Stewed Eels — 12 16/7/34 Tinned salmon Patient stated to have suffered from digestive disorder for some time. 13 7/8/34 Stewed plums Illness severe. 15/8/34 14 Fish pie Illness slight. 15 15/8/34 Pork chops Illness slight. 16 21/9/34 Fried fish Illness slight. 17 12/8/34 Sausages Two members of a family. 12/8/34 18 Do. 19 14/10/34 Meat pie Illness slight. 11/12/34 20 Tinned Pineapple Illness slight. 19/12/34 21 Mince pie Illness slight. 22 29/12/34 Shell fish Illness slight. *Patient died. The stated cause of death was:—(a) Acute Pulmonary Oedema, (b) Acute Nephritis. E The inquiries continued for some time and finally certain suggestions were made to this firm at the request of the Ministry of Health for the purpose of providing additional safeguards against possible contamination of their food products. It should be noted that the proprietors of this firm co-operated wholeheartedly throughout the period of these investigations, and they were at all times willing to consider and adopt any practicable proposal to prevent the possible recurrence of similar outbreaks. Food Offered as Prizes. The London County Council (General Powers) Act, 1932, extends the scope of Section 47 of the Public Health (London) Act, 1891, so as to include articles of food offered as prizes at any entertainment or given away for advertisement purposes. Unsound Food. No seizures of unsound food were made during the year. The following unsound food was, however, voluntarily surrendered to the Council for destruction during the year 1934: — Weight. Surrendered or Seized. Result of action taken. Nature of Food. T. l. c. q. FISH— Surrendered. Destroyed at Council's Depot. Skate 1 7 — — Halibut 2 13½ Do. Do. - - Haddocks (smoked) 14 Do. — Do. - - Eels 3 14 Do. Do. — — Mussels 3 1 Do. Do. — - Fillets 1 3 Do. Do. — — - 5 1 23½ FRUIT— Do. Pulp 2 4 1 Do. — Tomatoes 2 8 Do. Do. — - 2 12 3 - MEAT— Butcher's meat 7 25½ Do. Do. — — Cooked meat 12 11 Do. Do. — — Chicken (1) 2½ Do. Do. - - - Offal 6 Do. Do. _ — — 1 5 1 11 UNSOUND FOOD—Continued. Name of Food. Weight. Surrendered or Seized. Result of Action taken. T. c. q. l. TINNED FOODS— I I Condensed and Evaporated milk 2,057 tins 15 27½ Do. - - Do. Cream 806 tins 3 9½ Do. - - Do. Liquid eggs 487 tins 3 2 3 Do. 14 Do. Fruit 2,083 tins 1 9 2 10 Do. Do. ½ Fish 1,799 tins 13 3 Do. Do. - Meat 15 tins 1 3 Do. Do. - - 6 4 3 8½ MISCELLANEOUS— Jams, Pickles, Jellies (various), Custard powders, Soap powder, Maize, 173 bottles Lemon Squash, 52 bottles Orange Squash, and 44 bottles Pineapple Cordial 1 16 1 4½ Do. Do. Total 12 4 2 19½ Summary of Work of Food Inspector for 52 weeks ended Dec. 31st, 1934. Complaints received 12 Complaints found to be justified 4 Inspections:— Street markets 2,024 Bakehouses 278 Fish curers' premises 234 Fried fish shops 456 Ice cream premises 371 Restaurants and eating houses 315 Slaughterhouses 121 Other food premises 3,546 Carcases inspected 599 Organs inspected 1,099 Inspections not defined 163 Re-inspections 593 Organs condemned 211 Food surrendered (parcels of varying weights) 20 Certificates granted for Foodstuffs for export 20 Number of food premises defects found and remedied 181 Number of intimations served 185 Number of Statutory Notices served 7 E2 Food and Drugs (Adulteration) Act, 1928. During the year under review 1,028 samples were submitted for analysis. Of this number 942 were formal, and 86 informal samples. These samples are set out in table "A" and those not complying with requirements, are shown in table "B". In the latter table, the action that the Public Health Committee directed should be taken in cases where infringements occurred is also shown, together with the result of legal proceedings instituted. These tables are compiled in the form suggested by the Ministry of Health memorandum No. 36, dated January 1929, on procedure under the Pood and Drugs Act. The practice, as in former years, of sending cards to the vendors of samples reported as genuine, was carried out. The cards so sent numbered 621. Milk. In the course of the year 561 formal samples (including one separated milk) were chemically examined. Of this number 8 failed to comply with the requirements of the Sale of Milk Regulations, 1901, giving a percentage of adulteration of 1.42. In six of these instances, failure to comply with requirements was due to the "abstraction" of fat. Three of these samples were sold from bottles, and three from counter pans. The remaining two samples, which were sold from counter pans, were adulterated by the addition of water. Of the 11 informal samples, two were adulterated by the addition of water, one being sold in a bottle, and the other from a counter pan. Under sections 21 and 29, and the 2nd schedule of the above Act, it is provided that a retailer, from whom a sample of milk has been taken, may within 60 hours from the time of taking such sample, request the Local Authority to take a sample of milk, in the course of delivery, from the wholesale suppliers. If the purveyor fails to avail himself of this provision, and in the event of his sample being other than genuine, he would be precluded from using a warranty, as a defence, in any proceedings. Three purveyors availed themselves of these provisions, but as their samples were certified as genuine, they were forthwith informed that under the circumstances, the necessity to take samples in the course of delivery did not arise. Artificial Cream Act, 1929. No application for registration for the manufacture and sale of artificial cream was received during the year under review. The Public Health (Condensed Milk) Regulations, 1923 and 1927. Seven samples of condensed full cream milk, sweetened, were submitted for analysis and all were found to comply with the required composition. Public Health (Dried Milk) Regulations, 1923 and 1927. One sample of full cream dried milk was examined and reported as complying with requirements. Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. All samples of food submitted for analysis were examined for the presence of a preservative. One sample of beef sausages (No. 828) was certified to contain a permitted preservative, viz., sulphur dioxide, to the extent of 110 parts per million, this amount being well below the maximum amount allowed under the Regulations, viz., 450 parts per million. Contrary to the provisions of the Regulations, no declaration was made at the time of purchase, of the presence of a preservative. The appropriate Committee directed that a caution be sent to the vendor. Thirteen samples of cream were examined and all were reported to be free from any preservative. Merchandise Marks Act, 1926, and Imported Goods Orders made thereunder. Under section 9, Local Authorities, authorised to appoint an Analyst for the purposes of the Food and Drugs Act, may so far as relates to any goods being food stuffs to which an Order in Council under this Act applies, execute any of the provisions of this Act, other than provisions relating to the importation of goods. Imported Goods Orders are made in accordance with the provisions of sub-section 1 of section 2. The Sampling Officer and the Food Inspector have been authorised to act as officers under this Act. Prior to the year under review, Orders were in force relating to Currants, Sultanas, Raisins, Eggs in shell, and Dried Eggs, Oat Products, Malt Products, Honey, Fresh Apples, Raw Tomatoes, frozen or chilled Salmon, and Sea Trout, and Butter. Orders that became operative during the year 1934, relate to Bacon and Ham, and dead Poultry. Shops and stalls in the Borough were periodically visited to ascertain whether the provisions of the various Imported Goods Orders (Marking Orders) were being observed. It was found that in the majority of cases, the requirements were being carried out. In those instances of non-observance, the provisions of the Orders were explained to the traders, and cautions, either verbally, or in writing were administered. In this connection, the appropriate Committee directed that cautions in writing be sent to six traders, who had failed to comply with the Orders relating to Butter (3), Imported fresh Apples and Tomatoes (3). In no instance was it found necessary to institute proceedings. Agriculture Produce (Grading and Marking) Act, 1928. The Minister of Agriculture and Fisheries may by Regulation prescribe grade designations as he may consider appropriate to indicate the quality of any articles of agriculture produce. A grade designation so applied shall be deemed to be a term of contract of sale that the quality of the article complies with the statutory definition indicated by the grade designation. No instance has been discovered of the improper use of the National Mark by unauthorised persons, or the Mark falsely applied, or a Mark calculated to mislead. Section 3 provides for the marking of eggs, on sale, or exposure for sale, that have been subjected to any process of preservation, and section (4) provides for the registration by the Local Authority of any premises used or intended to be used, by way of trade, or for purposes of gain, for cold or chemical storage of eggs. One premises, used for these purposes, has been registered by this authority, and is periodically inspected. Butter Factories and Wholesale Dealers in Margarine. Section 8 of the Food and Drugs (Adulteration) Act provides that all butter factories, and wholesale dealers in margarine, shall be registered by the Local Authority. At the end of the year 1934, there were 22 wholesale dealers of margarine entered upon the register of this Authority. TABLE "A" Formal and Informal Samples submitted for Analysis for the year ended December 31st, 1934. Article. Number Examined. Number Adulterated, etc. Formal. Informal. Private. Total. Formal. Informal. Private. Total. Milk 560 11 - 571 8 2 - 10 - - Butter 68 29 - 97 - - 33 3 - 3 Malt Vinegar 32 1 - - 31 32 - 2 1 - 1 1 Lard 14 - 14 - - - - Cocoa - 14 13 - - - - - - Cream 13 - 13 - - - Self-Raising Flour - - - - Dripping 11 - - 11 - - 9 - - - coffee 9 - - - 8 8 - - - - - - Brawn 9 1 - 1 Vinegar 8 1 - - 3 Whisky 7 10 - 17 2 1 - 7 - - 7 - - - - Tea - 7 - - 7 - - - Blackcurrant Jam 7 7 - - - Condensed Full Cream Milk Sweetened - - - - - 7 - 7 - - Fish Paste - - - - - Corn Flour 7 - 1 - 7 - 7 - - - - Custard Powder - - 6 - - - Pearl Barley 6 - - 6 - 6 - - - - Margarine - 6 - - - 6 - - - Olive Oil - - - 6 2 - 8 Camphorated Oil - 5 5 - - - - - - Sultanas - - - - 5 - - White Pepper 5 - - - Baking Powder 5 - - 5 - - 5 - - 5 - - - Arrowroot 1 - 1 5 - - 5 - Beef Sausages - 4 - 4 - - - Minced Meat - 4 - - 4 - - - - Ground Almonds 1 - 5 - - - - Purified Epsom Salts 4 - 3 - - 3 - - - Lemonade Powder 3 - - 3 - - - - Lemon Card and Cheese - - - Ground Ginger 3 2 5 - - 3 - 3 - - - - Ground Rice - - Pork Sausages 3 - - 3 - - - - - 3 - - 2 - - Cheese - - - - 2 - 2 - Sage - 2 - Crushed Linseed 2 - - - Blackcurrant Jelly - 2 - - 2 - - Blanc-Mange Powder 2 - - - 2 - - - Coffee and Chicory 2 - - - - 2 - Rice 2 - - - - 2 - - - Sago - - 2 - - 2 - Prescriptions - - - 2 - - - Aspirin Tablets 2 - - 2 - 1 - 3 - Tincture of lodine - - - 1 7 - 8 1 1 2 Glauber Salts - - 1 - 1 - Citrate of Magnesia - - - 1 - - 1 - Sherbet 1 - - - - - Mustard 1 - - - - 1 - 1 - Mustard Sauce - - 1 - - - - 1 - - - - Chop Sauce 1 - 1 - - Horse-Radish Sauce 1 - - - - - - - - - - Thyme 1 - - - 1 Desiccated Cocoanut 1 - - - 1 - - - Sponge Mixture - - - 1 - - 1 - - Egg (Substitute) Powder - - - 1 - 1 - Flour - - - 1 - 1 - - - Tomato Soup 1 - - - 1 - - Potted Ham - - - 1 - 1 - - - Lemon Squash 1 - - 1 - - - Ginger Wine - - - 1 - 1 - - - Apple Jam - - 1 - 1 - Plum Jam - - - - 1 - 1 - - - Apple Jelly - - 1 - 1 - Redcurrant Jelly - - - - 1 - 1 - - - Raspberry Jelly - - 1 - 1 - - - - Mincemeat (Fruit) 1 1 2 - - - - Glazed Cherries - - 1 - 1 - Beef Suet (with Rice Flour) - - - 1 1 - - - - Pineapple Jelly Crystals 1 - - - - - - Preserved Sausages - - - 1 - - - 1 - Separated Milk 1 - - - - 1 - Full Cream Dried Milk - - - 1 - - - 1 - Rum 3 - - - 1 4 - Gin - - - - 5 5 - - - Purified Borax - - - - 4 4 Gregory Powder - - - - - 4 4 - - 1 Cascara Sagrada Tablets - - - - 1 - - - - - Cherry Cake 1 - - - 1 - - - - 942 86 - 1,028 17 6 23 - 74 75 TABLE "B" SAMPLES I ADULTERATED, Etc. Observations. Result of Proceedings, or other Action taken. Serial No. Whether Formal, Informal or Private. Nature of Adulteration or Irregularity. Article. - 1 17 Milk Informal Article contained 9 per cent, of added water. 75 Do. Do. Do. do. 3 per cent. do. do. - 39 per cent. of the original fat abstracted Fined £3. Costs £1 1s. Formal - 6 Do. 109 Do. Do. 20 Do. do. - Caution. Resolution, Public Health Committee. Article contained 8 per cent, of added water Do. 152 Do. Fined £4. Costs £2 - Do. 8 per cent. of the original fat abstracted Fined £1. Costs 10s. 6d. Do. - 378 594 Do. Article contained 4 per cent, of added water Do. Caution. Resolution, Public Health Committee. 789 Do. 27 per cent, of the original fat abstracted Do. - Fined 10s. Costs £1 1s. 807 Do. 6 Do. do. Fined 10s. Costs £1 1s. Do. - Do. 13 Do. do. Defendant ordered to pay £1 1s. costs. 863 Do. - A sample of Vinegar, other than Malt Vinegar 180 Do. Malt Vinegar Caution. Resolution, Public Health Committee. - 422 Do. Do. do. do. Summons dismissed. £3 3s. costs against Council. Do. - Do. do. do. Fined £1 10s. Costs £1 1s. 525 Do. - Do. Article deficient in Acetic Acid to the extent of 11 per cent. 893 Do. Vinegar Caution. Resolution, Public Health Committee. 84 Whisky - Caution. Resolution, Public Health Committee. Article 36.9 degrees under proof Formal sample genuine. Informal Article 36-6 Do. do. 23 Formal Fined £2. Costs £1 Is. Do. - Do. Article 43 Do. do. - Fined £5. Costs £5 5s. 58 Do. Article 8 per cent, deficient in Iodine - 63 Tincture of lodine Informal - Formal Article 3 per cent. Do. do. Caution. Resolution, Public Health Committee. 468 Do. Article contained Sulphur Dioxide to the extent of 110 parts per million Article sold without notice of the presence of preservative. Do. Do. 828 Beef Sausages Article contained not less than 23 per cent. of fat foreign to genuine Lard Informal - I 82 Lard - I Fined £1. Costs £1 Is. Do. do. do. Formal 846 Do. Unable to obtain formal sample, Stock all sold. Article consisted of 100 per cent. Compound Liquorice Powder Informal 34 Gregory Powder TABLE "C." Percentages of Adulteration of Formal Samples during the past five years:— Year. 1930 1931 1932 1933 1934 Percentage of Adulteration 3·03 4·50 2·30 2·44 1·80 TABLE "D." Percentage of Adulteration of Formal Samples of Milk, during the past five years: — Year. 1932 1933 1934 1930 1931 Percentage of Adulteration 1·58 2·04 0·98 1·57 1·42 SUMMARY. Formal samples submitted for analysis 942 Informal samples submitted for analysis 86 Formal samples adulterated 17 Informal samples adulterated 6 Written cautions administered (Food and Drugs (Adulteration) Act, 1928) 6 Written cautions administered (Merchandise Marks Act. 1926) 6 Summonses issued (Food and Drugs (Adulteration) Act,) 1928 11 Summonses issued (Merchandise Marks Act, 1926) 0 RESULT OF PROCEEDINGS. Act, Regulation or Order under which proceedings were taken. Number of Summonses. Fines. Costs. £ d. £ s. d. s. Food and Drugs (Adulteration) Act, 1928 11 6 18 10 0 15 2 Chemical and Bacteriological Examination of Food. The bacteriological and chemical examinations of food for the purposes of the Food and Drugs (Adulteration) Act, 1928, and Public Health (Preservatives, etc., in Food) Regulations, and samples submitted in connection with the notification of food poisoning are carried out by the Borough Bacteriologist, Dr. Bousfield, and by the Public Analyst, Mr. Martin Priest. See also under Laboratory facilities, page 16. Nutrition. The public continue to be interested in the question of how much and what sort of food the human body requires in times of health and disease and the problem of wise buying. Dissemination of knowledge and instruction on matters affecting nutrition is included in the general scheme of health propaganda. Throughout the year talks upon diets suitable for infants and nursing mothers, food values and cooking were carried out at certain of the Infant Welfare Centres in Camberwell. In addition booklets and leaflets appertaining to the subject of nutrition were distributed. 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. Anthrax. Plague. Cerebro-Spinal Fever. Pneumonia—Acute Primary. Cholera. Pneumonia—Acute Influenzal. Continued Fever. Puerperal Fever. Diphtheria. Puerperal Pyrexia. Dysentery. Relapsing Fever. Encephalitis Lethargica. Scarlet Fever or Scarlatina. Erysipelas. Smallpox. Food Poisoning. Tuberculosis. Glanders. Typhoid or Enteric Fever. Hydrophobia. Typhus Fever. Malaria. The notification of infectious diseases to the Medical Officer of Health is designed to prevent the spread of disease and to facilitate institutional treatment of patients in their own interest. The Medical Officer of Health is available for consultation purposes in cases of doubtful diagnosis. The number of capes of infectious diseases notified in 1934 was 857 fewer than in the previous year, viz., 1,892 as compared with 2,749. Smallpox (Variola Minor) which had been prevalent in the Borough since 1928, gradually subsided, and no case was notified after the week ended June 23rd. The number of cases reported from the beginning of the year to that date was 18. There were no deaths. The following figures record the number of cases of mild smallpox notified since the outbreak of this disease in the Borough in 1928. Year. Cases. Deaths. 1928 2 - 1929 119 - 1930 288 1 1931 111 - 1932 64 1 1933 51 - 1934 18 - 78 Variola Minor. Table showing vaccinal condition of patients, Vaccinal condition at time of infection. Ages. (a) Successfully vaccinated. (b) Successfully re-vaccinated. (c) Unvaccinated. (d) Doubtful. 24 - - × - 13 - - × - 20 × - - - 12 × - - - 9 × - - - 16 × - - - 8 × - - - 9 × - - - 62 × × - - 42 × - - - 24 × - - - 17 - × - - 17 - - × - 84 × - - - 57 × × - - 26 - - × - 10 - - × - 12 - - × - The incidence of scarlet fever remained heavy as in previous years, but with a low fatality rate. A slight increase was recorded in the number of cases of diphtheria. There was a marked decrease in the number of notifications of pneumonia, which may be attributed to the absence of an influenzal epidemic during the year. Ophthalmia notifications numbered 20 as compared with 14 in 1933. Among the infectious diseases which affect the nervous system, there was a decrease in the number of cases of cerebro-spinal meningitis reported, and no cases of encephalitis lethargica were notified. There was an increase in the number of cases of poliomyelitis in 1934, viz., five as compared with two in 1933. Post-Vaccinal Encephalitis. One case of post-vaccinal encephalitis came to the notice of this department and the facts of the case were submitted to the Ministry. It appeared that a boy aged 6 years was primarily vaccinated by a private practitioner on September 9th, 1934. Government lymph was not used. He became ill approximately three weeks later with headache and fever. He was admitted to hospital and died on September 29th, 1934. The cause of death was stated to be due to Broncho-Pneumonia supervening on encephalitis following vaccination performed on September 9th, 1934. The danger of encephalitis following vaccination is very slight when it is performed early in life, but the danger is not so negligible when primary vaccination is carried out during school age and adolescence. The recognition of cases of post-vaccinal encephalitis, although few in number, has raised the question as to the necessity of vaccination for contacts of cases of variola minor. This latter disease is so trivial that it was difficult to press vigorously for the vaccination of persons of adolescence and school age who had not previously been vaccinated even if they had been in personal contact with a case of mild smallpox. Should an outbreak of serious smallpox (variola major) occur at any time, every effort should be made to acquaint the public of the protective value of vaccination. It is generally agreed that vaccination gives complete protection against variola major and variola minor for several years, and partial protection for many more years. Diphtheria. In 1934 520 cases of diphtheria were notified as compared with 507 in 1933. Of the 505 patients removed to an isolation Hospital 26 (5.1 per cent.) were subsequently discharged as not suffering from diphtheria. The number of "Return" cases was 10. The deaths numbered 20, representing a mortality rate of 3.8 per cent, as compared with 3.9 per cent, in 1933. Although the type of this disease in the Borough was generally speaking mild, in various parts of England with large centres of population there was evidence that diphtheria was increasing in prevalence and severe in type. In view of the possibility of this disease becoming more severe in London, it was thought advisable to bring to the notice of medical practitioners in the Borough that the experience of this Council's Bacteriologist was that the bacillus of the virulent type does not grow well or typically, on a cultured medium, and consequently it was essential neither to wait for the Bacteriologist's report, nor to be influenced by the report in the face of contrary clinical evidence, but to take steps forthwith to treat the case and/or to have it removed to hospital on the slightest evidence of diphtheria. Anti-diphtheritic serum 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 and night at the Town Hall and at Dulwich Baths. In 1934 155 phials of 8,000 units and 49 phials of 500 units of anti-toxin were supplied to medical practitioners for patients resident in the Borough. Diphtheria Immunisation. Diphtheria immunisation has held a recognised place in preventive medicine for some years. A Clinic was established at 140, Camberwell Road in 1926 for the purpose of providing artificial immunity treatment against diphtheria. A session is held every Wednesday afternoon. The Health Department makes every effort to educate parents that diphtheria is a preventable disease, and can be controlled by the active immunisation of susceptible children. The number of children immunised in the Borough is still lamentably small. I am of opinion that the deaths which occurred from diphtheria in 1934 might have been prevented had the advantages of immunisation treatment provided by the Borough Council been accepted. Scarlet Fever. There were 916 cases of scarlet fever notified during the year as compared with 1,564 in 1933. Of these, 789 patients were removed to hospital and 32 were subsequently discharged as not suffering from scarlet fever. The number of "Return" cases was 38 as compared with 72 in 1933. The deaths from this disease numbered 4, equivalent to a case mortality rate of 0.4 per cent. The type of this disease remained mild and no pressure was exerted to remove cases to hospital for treatment which could be nursed at home. There were 22 instances of secondary cases occurring in families where the first case was removed to hospital, as compared with 6 secondary cases following notification of the primary case and the isolation of the patient at home. Immunisation against Scarlet Fever. As long as the existing type of scarlet fever remains mild there seems to be no necessity for the establishment of a Clinic for the immunisation of children against this disease by the use of scarlet fever antitoxin. Enteric Fever (Typhoid and Para-Typhoid Fever). One case of para-typhoid was notified. The particulars of this case are as follows: — Results of Bacteriological Examination. Source of infection. Date of Notification. Notified as. Sex. Age. Positive for Para. B. Not traced. 20/7/34 F. 23 Paratyphoid B. F 82 83 DIPHTHERIA IMMUNISATION CLINIC. RETURN OF WORK TABLE I.—AGES OF PERSONS SCHICK-TE STED WITH RESULT OF TEST. 8 to 9 yrs. 6 to 12 mths. 1 to 2 yrs. 2 to 3 yrs. 3 to 4 yrs. 4 to 5 yrs. 5 to 6 yrs. 9 to 10 yrs. 6 to 7 yrs. 7 to 8 yrs. 10 to 11 yrs. 11 to 12 yrs. 12 to 13 yrs. 13 to 14 yrs. 15 yrs. and above. 14 to 15 yrs. Total 10 29 19 21 35 25 19 20 8 16 6 5 6 5 3 23 250 Not read. Pos. Neg. Not read. Po s. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Neg. Pos. Ne g. Not read. Pos. Neg. Not read. Pos. Neg. Neg. Not read. Pos. Not read. Notread. Neg. Pos. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Not read. Pos. Neg. Positive 176 Negative 69 Not read 5 Pos. 5 2 - 9 1 - 27 1 1 18 - 19 2 28 20 4 1 15 3 1 12 6 2 8 8 - 1 - 8 - 4 - 1 4 - 3 3 - 2 1 - 5 - 1 4 - 18 2 TABLE II.—IMMUNISATION TREATMENT TABLE. 6 to 12 mths. 1 to 2 yrs. 2 to 3 yrs. 3 to 4 yrs. 4 to 5 yrs. 5 to 6 yrs. 6 to 7 yrs. 7 to 8 yrs. 8 to 9 yrs. 9 to 10 yrs. 10 to 11 yrs. 11 to 12 yrs. 12 to 13 yrs. 113 to 14 yrs. 14 to 15 yrs. 115 yrs. and above. Totals T.j .A.' H It. '.A.' .T. T. A .T. E '.a: 3 K: .a.: 3 T. '.A/ ■A T. '.A.' T. A. T. H ■A.' .T. T. .T. T. A. T. A T. A .T. A. T. J*-: .A.I il Jjr.. .A. -T. I T. T. '.A/ ,T. Ist Injections, 176 2nd „ 171 3rd „ 153 4th „ 9 5th „ 3 6th „ 1 3rd „ 1st Injection 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection 2nd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ I 3rd „ i 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 3rd „ 1st Injection. 2nd „ 1st Injection. 3rd „ 1st Injection. 2nd „ 3rd „ 2nd „ 1st Injection. 2nd „ 3rd „ 2nd 1st injection. 3rd „ 1st Injection. 2nd „ 3rd „ 3rd „ 4th „ 1st Injection. 2nd „ 8 7 6 27 25 22 21 18 14 20 20 18 27 20 20 20 15 16 18 12 13 9 6 6 5 23 27 8 8 8 2 2 1 1 1 2 2 1 1 1 1 1 - - 5 5 6 5 1 L_ 4th 1 4th 1 5th 1 4th 1 5th 1 6th 1 4th 1 5th 1 0 L_i I j TABLE III.—AGES OF PERSONS RE-SCHICKED AFTER TREATMENT AND FOUND TO BE NEGATIVE. 6 to 12 mths. 1 to 2 yrs. 2 to 3 yrs. 3 to 4 yrs. 4 to 5 yrs. 5 to 6 yrs. 6 to 7 yrs. 7 to 8 yrs. 9 to 10 yrs. 10 to 11 yrs. 11 to 12 yrs. 12 to 13 yrs. 13 to 14 y r s. 8 to 9 yr s. 114 to 15 yrs. 15 yrs. and above. Total 5 14 13 17 17 8 18 16 6 6 1 2 1 1 Pneumonia. The number of notifications of this disease received during the year in accordance with the provisions of the Infectious Diseases (London) Regulations, 1927, was 179 of the acute primary form and 28 of the acute influenzal form of pneumonia. Twenty of these cases proved fatal, 16 being due to acute primary pneumonia and 4 to influenzal pneumonia. Cerebro-Spinal Meningitis. During the year six cases of cerebro-spinal meningitis were reported, and except in one instance the notifications were received after the admission of the patients to hospital. Particulars of these cases appear in the subjoined table: — Date of notification Date Removed to hospital. Bacteriologically confirmed. Result. Sex. Age. M. 7/12 3/1/34 31/12/33 Yes. Died. M. 27 24/1/34 22/1/34 No. Died. M. 9/12 23/2/34 23/2/34 Yes. Died. F. 1 22/5/34 13/5/34 Yes. Died. F. 3/12 2/6/34 28/5/34 Yes. Died. F. 8 4/8/34 4/8/34 No. Diagnosis subsequently amended to T.B Meningitis. Died.* *Certified cause of death: T.B. Meningitis. Poliomyelitis and Polio-encephalitis. Five cases of poliomyelitis were notified during 1934. Three of these cases were removed to hospital for treatment. Notified cases of this disease are followed up by the Sanitary Inspectors to ensure that children who are paralysed continue to receive medical treatment. Anthrax. One case of anthrax was notified and removed to hospital. This patient, who was employed by a firm of skin merchants outside the Borough, died three days after admission to hospital. Dysentery. During the year one case of dysentery was notified. This patient was removed to hospital and subsequently discharged as having suffered from acute colitis. Encephalitis Lethargica No case of this disease was notified during 1934, but one death was certified by the Registrar-General to be due to encephalitis lethargica. All cases notified in previous years and patients who had removed from other districts to Camberwell were visited periodically for the purpose of rendering assistance to the patient and the family. The following table provides information respecting the state of health of these patients at the end of 1934: — Number recovered 4 Number died 0 Number in L.C.C. Institutions 5 Number attending hospital or otherwise undergoing treatment 13 Number left district 2 Malaria. There was one case of malaria notified during the year. It was ascertained that the patient contracted the disease whilst residing in India. Ophthalmia Neonatorum. Twenty notifications of ophthalmia neonatorum were received during 1934. Four of these patients were still under treatment at the end of the year. Information was also received from the London County Council concerning 48 infants found to be suffering from inflammation of the eyes. These cases were systematically visited by the health visitors for the purpose of ensuring that the patient received continuous professional treatment until certified to have recovered. The District Nursing Associations treated 30 cases of discharging eyes in young infants, paying 639 visits to the homes for this purpose. Analysis of Cases Table. No. of Cases. Notified. Cases Treated. Vision Unimpaired. Vision Impaired. Total. Blindness. Deaths. At Home. In Hospital. *20 16 4 15 1 - - *Five patients still under observation. One of these patients has a scar as the result of a corneal ulcer. 86 87 INFECTIOUS DISEASES. TABLE OF NOTIFICATIONS RECEIVED AND DEATHS FROM THESE CAUSES. Notifications and Age Distributions. Admitted to Hospital. Total Cases Notified. Disease. Discharged from Hospital as not suffering from the Disease. Deaths. Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and upwards Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Small Pox 18 16 - - - - - 4 3 1 3 4 2 1 505 - Diphtheria and Croup 520 4 26 46 56 39 202 - 86 22 30 7 2 - 20 25 52 75 107 21 Scarlet Fever 916 789 6 331 179 55 71 12 3 - 32 4 Enteric Fever & Para-typhoid 1 1 - - - - - - - 1 2 1 - - 28 1 2 - - - - Pneumonia Acute Influenzal 11 - 1 1 7 - 4 6 - 10 12 9 3 4 Acute Primary 179 102 18 11 27 4 8 18 17 33 12 - 143 90 1 - 3 - - 1 16 Erysipelas 7 6 22 26 47 30 Cerebro-spinal Meningitis 6 3 1 - - - 3 6 - 1 - - 1 - - 1 1 - - - 6* Poliomyelitis 5 3 - - 2 - 1 - - - - - Malaria 1 - - - - - - - - 1 - - - - - 1 1 - - Dysentery - - - - - - - - - - - 1 Encephalitis Lethargica 1 - - - - - - - - - - - - - 20 - - - Ophthalmia Neonatorum 20 4 - - - 1 † - - - - - - - 16 16 - - - — - Puerperal Fever - - - - - - 14 2 37 34 - - - 3‡ Puerperal Pyrexia - - - - - 1 - - 30 6 - - 2 1 1 - - - - - Anthrax - - 1 - - - - - - 1 64 1,892 1,579 53 116 142 157 567 281 Totals 97 200 75 93 60 47 54 *In one instance certified cause of death was T.B. Meningitis † Included in Registrar-General 's classification of deaths. ‡ Includes one case notified after death. TABLE OF NOTIFIABLE INFECTIOUS DISEASES. Showing Distribution of Cases in Wards. Disease. I 1- WARDS. -i 1 1 I 1 Total. 4 5 7 12 13 1 2 3 14 15 16 6 17 18 20 9 10 11 19 8 4 1 - - Small Pox - 1 - - - - 6 - - - - - 3 1 - 18 51 36 23 12 14 2 67 29 51 26 27 18 44 43 19 15 Diphtheria and Croup 16 15 10 49 46 48 43 38 3 1 520 53 78 47 49 65 44 61 59 43 40 26 Scarlet Fever - - 55 31 27 14 916 - - - - - - - - Enteric Fever and Para-typhoid - - - - - - 1 4 5 2 1 - 1 - - 1 1 - 1 2 7 2 - - Acute Influenzal - - - 1 Pneumonia 22 13 11 2 8 - - 1 28 14 18 12 4 17 1 11 7 3 4 8 Acute Primary 16 8 13 6 7 9 6 6 3 179 5 8 1 5 11 14 8 9 3 8 Erysipelas 5 11 1 4 1 1 - 2 143 - - - 1 - - - - - - - - 1 Cerebro-Spinal Meningitis - - 1 - - 6 - - - - 1 - 1 - - - 1 - - Poliomyelitis - - - - 1 5 - - - - - - - 1 - - - - - - - - - - - Malaria - - - - - 1 - - - - 1 - - - - - - - Dysentery - - - 1 - - - - - - - - - - - - - - - - Encephalitis Lethargica - 3 - - - - - 1 - 4 - 1 2 3 1 - 1 2 - 1 - - - 1 - 20 Ophthalmia Neonatorum - 4 2 1 - 1 2 - - 2 1 - - - - - 1 - - 1 Puerperal Fever 1 2 3 1 16 2 3 3 - 2 2 1 5 1 - 2 - 1 4 1 Puerperal Pyrexia 2 2 37 1 - - - - - - - - - - - - - - - - - 1 Anthrax - - - 124 104 129 109 72 58 78 141 108 121 135 124 77 74 87 54 46 21 1,892 156 74 Totals REFERENCE TO WARDS. No. No. No. No. 6. Marlborough. 11. St. Mary's. 16. St. John's. 1. West. 7. North Peckham. 12. Nunhead. 17. Alleyn. 2. Addington. 8. Goldsmith. 13. The Rye. 3. Town Hall. 18. Ruskin. 14. St. Giles'. 9. Clifton. 4. St. George's. 19. The Hamlet. 15. Lyndhurst. 10. Rye Lane. 20. The College. 5. Cobourg. Puerperal Pyrexia and Puerperal Fever. During the year 39 cases of puerperal pyrexia, and 14 oases of puerperal fever were notified. In two cases the diagnosis of puerperal pyrexia was subsequently amended by hospital Medical Superintendents to puerperal fever. Except in 3 instances all these patients reported as suffering from puerperal pyrexia were treated in hospital. Every patient notified as suffering from puerperal fever received institutional treatment. Two patients notified as suffering from puerperal pyrexia subsequently died, the certified causes of death were as follows:— 1. 1(a) Lobar pneumonia (b) septic endometritis (following full term labour). 2. Septicaemia following pregnancy. Multipara. On the receipt of a notification of puerperal pyrexia or fever, the home is visited and enquiries are made with a view of endeavouring to ascertain the cause of the pyrexia. Six cases of puerperal pyrexia and nine of puerperal fever occurred in patients who were confined at home; the remaining cases were reported following confinement in hospital. No evidence was obtained bearing upon the relation between cases of scarlet fever and puerperal fever. Five deaths were certified to be due to puerperal sepsis. It cannot be over-emphasised that hospital treatment at the earliest stage of the disease increases the hope of recovery of patients suffering from puerperal causes. INFECTIOUS DISEASES NOT NOTIFIABLE IN CAMBERWELL. Measles. The year 1934 was epidemic year and during the period January to December 2,449 cases of measles were brought to the notice of the Public Health Department, mainly through the agency of the School authorities. These cases were visited by the health visitors with a view of arranging for home nursing treatment or removal to hospital of the patient in cases where such services were deemed to be necessary, and for the purpose of offering advice to parents as to the means of preventing the spread of the disease to younger members of the family, especially children under five —an age period during which measles is likely to be a dangerous disease. The number of patients who were removed to hospitals of the London County Council was 374, and in 51 instances nursing assistance was provided. There were 30 deaths during the year as compared with 4 in 1933. The Measles Scheme of Control has for its object the early submission to the Medical Officer of Health of the names and addresses of suspected cases of measles among young children, so that the necessary administrative action can be taken by him to lessen the spread of the disease, to prevent the development of complications and to reduce the mortality. These include the early visitation to the homes of all known or suspected cases to ensure adequate medical and nursing attention of the patient; instructing households with young children in infected areas as to the signs and symptoms of this disease; the means of obtaining nursing assistance and how to secure the removal of particular cases to hospital. This scheme of co-operation between the School Medical Authority and the Borough Council was put into operation in November 1933, soon after the commencement of the epidemic, and was continued until about the end of June of the year under review. The epidemic finally ceased in July 1934. The following information was furnished to the London County Council at the request of that authority as to the number of cases of measles that came to the notice of this Department, the age distribution of these cases, and the number of deaths from this disease, during the period November 1st, 1933, to August 31st, 1934: — Ages. Under 1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-14 14 & over. Total. No. of cases. 34 73 87 285 590 830 440 149 195 9 2,692 No. of deaths. 2 10 4 5 2 6 - - 2 1 32 Measles Serum. Protection of non-immune children from an attack of measles and the attenuation of an attack by the injection of convalescent and adult serum is now possible, and it is to be regretted that parents have not given more consideration to the question of obtaining this protective treatment for their children in view of the number of deaths that take place every year from this cause. No applications were received from medical practitioners for measles serum, which is available for issue from the Hospital for Sick Children, Great Ormond Street. Whooping Cough. The number of cases of this disease which came to the notice of the Health Department during the year through the agency of the school authorities and health visitors was 272. The homes of these patients were visited either by the Health Visitors or the Sanitary Inspectors, who explained to the parents the infectious nature of whooping cough and how to prevent the spread of this disease. Home nursing treatment was also offered in certain cases, and where the home conditions or the severity of the illness warranted removal of the patient to hospital the required arrangements were made. Hospital treatment was provided in 48 instances. The deaths recorded during the year as due to whooping cough numbered 10 as compared with 20 in 1933. The propaganda activities of the Department include the distribution by the health visitors of pamphlets containing information relating to whooping cough as well as measles, at the homes visited by the Health Visitors. Influenza. During 1934, influenza was not unduly prevalent, and was mild in type. The number of deaths attributed to this disease was 28. Other Diseases. No case of epidemic jaundice, rheumatic fever, undulant fever, glandular fever or psittacosis came to the notice of the Health Department in 1934. Cancer. Cancer was responsible for 401 deaths or 13.6 per cent. of the total deaths in the Borough. Our knowledge of the causes of cancer still remains obscure with the exception that irritants such as tar oils, and excessive exposure to X-rays are known to give rise to cancer of the skin. The Health Department endeavours to instruct the public as to the signs and symptoms of this disease in various sites of the body most commonly affected, by the distribution of leaflets prepared specially for both men and women. Cancer, if taken in time, is frequently amenable to treatment by modern methods, and this fact should never be overlooked. Delay in seeking medical advice is usually prompted by fear, and often results in unnecessary suffering and frequently in disaster to the patient. Bacteriological Examinations. The report of the Council's Bacteriologist on examinations carried out during the year ended December 31st, 1934, is as follows: The number of specimens received and examined during the year amounted to 5,513. This number was composed as follows: — Swabs for diphtheria 2,731 Percentage positive 10.3 Sputa for tubercle 2,648 „ „ 18.8 Bloods for Widal's test 1 „ „ 0.0 Milks (Bacteriological) 70 Bath Waters (Bacteriological) 14 Well Waters (Bacteriological) 5 Ice Creams (Bacteriological) 6 Milks (Special tubercle test) 6 Other specimens (miscellaneous) 31 Total 5,512 The work has shewn a definite increase on last year's figure of 4,914. It appears that the demands of medical practitioners in the Borough have increased, and this appears to be the main factor in the higher figure for 1934. G. BOUSFIELD, M.D., B.S.Lond., Borough Bacteriologist. 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 1934. DISINFECTING DEPARTMENT. Return of Work, 1934. Number of houses visited following Infectious Disease 1,863 Number of visits to these premises 3,896 Number of houses visited following other diseases 196 Number of visits to these premises 455 Number of houses visited for miscellaneous purposes 643 Number of visits to these premises 744 Number of rooms disinfected. Infectious Disease 2,662 Number of houses visited. Verminous 782 Number of rooms disinfected. Verminous 989 Number of articles disinfected (steam disinfected) 60,763 Number of articles disinfected (formalin) 2,056 Number of books disinfected 1,220 Number of articles destroyed 3,018 Prevention of Blindness. The health visitors are instructed to report all cases of blindness in children under the age of 5 years. As from April 1st, 1935, the London County Council propose to discharge the duties in connection with the welfare of blind persons in the County of London hitherto performed by the Metropolitan Society for the Blind on its behalf. TUBERCULOSIS. Notification of Tuberculosis. During 1934, 419 new cases of this disease came to the notice of this department, comprising 284 notifications of pulmonary tuberculosis and 57 notifications of non-pulmonary tuberculosis; 12 posthumous notifications; information relating to 40 persons who had been notified in other areas outside the Borough and now resident in Camberwell, and 26 persons who had died from tuberculosis and not previously notified. The comparative figure of new cases for 1933 was 429. During the year 202 deaths from pulmonary tuberculosis and 29 deaths from non-pulmonary forms were registered. The deaths from all forms of tuberculosis during the past five years were as follows:— Pulmonary. Non-Pulmonary. Total. 1930 222 43 265 1931 241 27 268 1932 214 34 248 1933 221 22 243 1934 202 29 231 The following table shows the period between the receipt of the primary notification and the death of the patient. Pulmonary. Non-Pulmonary. 23 7 - - Notified within one month of death Notified within three months of death 20 Notified within six months 17 4 Notified more than six months 114 Not notified 9 17 Notified after death 6 6 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths was 1 to 8.88 as compared with 1 to 11.57 in 1933. The fault of late notification usually does not lie with the medical practitioner, but is due to the unwillingness of the patients themselves to seek medical aid until the disease has advanced to a stage that recovery is improbable. This can be understood as the average individual dreads to learn that he is suffering from tuberculosis. The Health Department's aim has been and always will be to educate the public that the prospects of recovery are more favourable in the early stages of pulmonary tuberculosis, and that a patient serves his own interest best and that of preventing the spread of this disease to others by submitting himself for examination when the slightest suspicion exists that he may be suffering from tuberculosis. The following table gives particulars of new cases of tuberculosis notified in accordance with the provisions of the Tuberculosis Regulations, 1930, and of the deaths in Camberwell from these causes as furnished by the Registrar-General. New cases. Deaths. Age Periods. Age Periods. Respiratory. Nonrespiratory. Nonrespiratory. Respiratory. F. F. F. M. M. F. M. M. 0- 1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 & up 0 - 1 - - - 1 1 - 3 2 - 8 - 2 1-2 - 1 - 2 - 3 - 6 4 2-5 - 2 - 6 2 3 1 5-15 - 1 3 4 18 31 3 6 2 15-25 28 24 4 24 23 19 3 5 25-35 20 1 - - 39 29 7 5 35-45 24 3 - 26 9 1 1 45-55 34 7 - 1 27 4 1 4 1 55-65 28 2 - 23 8 1 - 2 65-75 8 1 - 7 - 75 & up 1 - - - 1 1 The number of cases of tuberculosis on the register at December 31st, 1934, and the changes which have taken place appear in the following table:— Pulmonary. Non-pulmonary. Totals. Males. Females. Males. Females. 664 312 261 2,135 No. of cases on the Register of notifications on January 1st, 1933 898 No. of new cases notified during the year 112 172 36 21 341 No. of cases brought to notice other than by formal notification 18 40 9 11 78 No. of cases replaced on register during the year 20 15 2 2 4 41 No. of cases removed from register during the year:— 1. Cured - - - 2 2. Removed from district and lost sight of 82 74 30 21 207 3. Dead 153 61 14 17 245 4. Incorrectly diagnosed 1 5 1 4 11 No. of cases on the register on January 1st, 1934 887 674 314 255 2,130 95 Public Health (Prevention of Tuberculosis) Regulations, 1925. No person suffering from pulmonary tuberculosis and employed in the milk trade came to the notice of the department during the year. Tuberculosis Dispensary. The following report of the work carried out at the Tuberculosis Dispensary 19, Brunswick Square, S.E.5, has been prepared by Dr. Brand, the Council's Tuberculosis Officer. REPORT OF THE TUBERCULOSIS MEDICAL OFFICER FOR THE YEAR 1934. The current list of Notifications of Tuberculosis in Camberwell as at December 31st, 1934. On December 31st, 1934, there were 2,130 cases of tuberculosis on the current list in Camberwell. There were 1,561 cases of pulmonary tuberculosis—887 males and 674 females; 569 cases of non-pulmonary tuberculosis—3l4 males and 255 females. Table 1. supplies an analysis under age periods, sex, and the broad grouping of pulmonary and non-pulmonary forms. 0- 1- 5- 15- 20- 25- 35- 45- 55- 65- Totals (all ages) Age Periods. 10- 1 120 133 208 175 127 57 21 887 Pulmonary—Males 2 21 22 - 674 „ Females 41 32 7 14 139 122 159 112 39 9 4 314 Non-Pulmonary—Males 31 72 69 49 21 21 15 17 13 2 „ Females 2 25 46 255 38 43 33 34 15 11 2 6 97 TABLE II. Individual Notified Patients on Current List at December 31st, 1934, allocated to the Wards of the Borough. Wards. Pulmonary. Non-Pulmonary. Grand Total. Males. Females. Total. Males. Females. Total. 203 1 79 56 135 40 28 68 48 2 34 14 7 10 17 65 3 62 37 99 24 12 36 135 4 74 65 139 14 21 35 174 20 19 5 47 67 12 31 32 98 16 6 28 11 39 16 71 30 188 7 75 59 134 24 54 43 29 72 21 12 33 105 8 9 33 75 18 10 28 42 103 10 26 30 56 16 11 27 83 11 53 36 89 15 12 27 116 12 39 48 87 17 12 116 29 13 34 41 75 12 9 21 96 14 45 31 76 18 14 32 108 15 26 35 61 8 10 18 79 16 47 37 84 13 8 21 105 40 17 23 63 18 15 33 96 120 18 67 34 101 6 13 19 19 6 7 60 26 27 53 1 8 - 20 - 8 1 1 9 The Notification of Tuberculosis in Camberwell in 1934. The number of primary notifications of tuberculosis received in Camberwell in 1934 was 341, comprising 284 cases of pulmonary tuberculosis and 57 cases of non-pulmonary tuberculosis. On Table III. the number of primary notifications for each of the last fourteen years are compared. TABLE III. Comparative Table of Primary Notifications for past Fourteen Years. Year. All Forms. Pulmonary Tuberculosis. Other Forms. 1921 595 750 155 506 1922 653 147 505 152 1923 657 1924 559 416 143 491 373 118 1925 1926 506 394 112 1927 451 353 98 1928 465 363 102 1929 495 393 102 1930 483 393 90 333 81 1931 414 1932 386 314 72 363 290 73 1933 284 57 1934 341 98 On Table IV. is given the primary notification rate (per 1,000 population of Camberwell) for the last fourteen years. TABLE IV. Showing Annual Primary Notification Rate of Tuberculosis (All Forms) 1921-1934. Pulmonary Tuberculosis. Other Forms. Year. Population. All Forms. 0.58 2.22 1921 267,198 2.80 270,300a 2.41 1.87 0.54 1922 272,300a 2.40 1.85 0.55 1923 273,700a 2.04 1.52 0.52 1924 1.78 1.35 0.42 1925 275,400a 0.40 275,400a 1.80 1.43 1926 0.36 271,100a 1.66 1.30 1927 0.39 260,400a 1.78 1.39 1928 0.39 256,900a 1.92 1.52 1929 0.35 256,900a 1.88 1.53 1930 0.32 252,100* 1.64 1.32 1931 248,000a 0.29 1.56 1.27 1932 1.19 0.30 1933 243,700a 1.49 238,360a 1.43 1.19 0.24 1934 * Census, 1931. a Estimated. On Table V. the primary notifications of 1934 are allocated to the Wards of the Borough. TABLE V. Showing No. of Primary Notifications Received during 1934 and Ward Allocation. Wards. Pulmonary. Non-Pulmonary. Grand Total. Males. Females. Total. Males. Females. Total. 1 15 6 4 1 5 26 21 17 11 1 5 6 2 6 5 17 7 16 - 1 1 3 9 23 9 22 1 - 1 4 13 - 5 10 8 18 5 23 5 9 3 7 1 1 2 6 4 1 3 15 5 12 2 7 7 3 4 22 8 11 7 18 1 19 8 7 15 3 1 4 9 2 3 6 10 2 1 3 1 19 16 1 3 11 10 6 2 19 1 3 22 12 12 7 2 10 10 - 13 8 2 - - 18 16 1 2 14 10 6 1 26 21 1 5 15 13 8 4 21 18 3 3 16 11 7 - 4 12 1 1 2 14 17 8 23 8 19 1 3 4 18 11 5 8 - - 8 19 3 - - 1 2 1 1 1 20 - One Pulmonary Male unattached. G2 99 On Table VI. the summary of notifications for the year 1934 is treated in more detail. TABLE VI. during Summary of Notifications the Period from January 1st, 1934 to December 31st, 1934. . Formal Notifications under Article 5. 185 13 9 Sanatoria. 151 Poor Law Institutions. 147 97 13 11 Notifications under Article 5. 221 149 45 26 Number of Primary Notifications. 172 36 21 Total Primary Notifications. 112 7 - - - 65 and upwards. 55-65 23 - 8 1 45-55 27 4 1 1 35-45 26 9 1 1 25-35 39 5 29 7 24 23 3 5 20-25 15-20 18 31 6 2 2 3 1 10-15 6 3 5-10 4 - 6 1-5 3 2 8 2 0-1 - - - - Age Periods. Pulmonary— Males „ Females Non-Pulmonary— Males „ Females TABLE VII. SUPPLEMENTAL RETURN FOR THE YEAR 1934. Information of New Cases discovered otherwise than by Formal Notification. Age Periods. 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55—65 65 and upwards Total. Pulmonary —Males - - - - 1 6 10 8 5 9 1 40 „ Females - 1 2 1 6 2 - 3 2 - - 1 18 - 4 Non-Pulmonary—Males 1 1 2 - - 1 9 - - 1 „ „ Females 3 - 2 1 2 2 11 - - - - The source or sources from which information as to the above-mentioned cases was obtained stated below:— No. of Cases. Source of Information. Non- Pulmonary. Pulmonary. 10 5 Death Returns From Local Registrars Transferable deaths from Registrar-General 7 4 Table VII. Supplemental Return. New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during 1934 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), 1934. The number of deaths from tuberculosis in Camberwell during 1934 as stated by the Registrar-General was 231. Of these 202 were from pulmonary tuberculosis and 29 from other forms of the disease. 26 were not notified during life as suffering from the tuberculosis of which they died. TABLE VIII. Deaths from Tuberculosis (All Forms) 1934 Allocated to the Wards of the Borough. Pulmonary. Non-Pulmonary. Grand Total. Wards. Males. Females. Total. Males. Females. Total. 15 1 9 4 13 1 1 2 6 1 3 2 5 11 2 14 8 4 12 1 2 14 3 1 4 13 6 19 1 1 20 - 5 9 1 10 1 3 13 2 6 3 1 4 - 4 - - 8 7 2 10 2 2 12 - 12 8 8 4 1 1 13 - 11 9 6 17 - 17 - - 3 3 6 10 - 3 3 - 7 9 11 2 - 9 - - 12 10 1 11 2 1 1 13 3 9 1 1 13 6 10 - 14 6 - 6 1 1 7 - 15 5 6 11 2 2 13 - 16 8 5 13 2 - 2 15 17 5 2 7 - - 7 - 1 18 8 4 12 1 13 - 5 19 2 7 - - 7 - 20 - - - - - - - One Pulmonary Male unattached. - - - - - Pulmonary—Males 28 20 24 34 28 8 142 „ Females - - - 1 24 19 3 7 4 1 1 60 Non-Pulmonary—Males 1 1 2 - - - - 3 4 1 1 13 - „ Females 1 2 4 - - 3 1 2 2 1 16 103 TABLE X. Showing the Occupation of 151 Males who died from Tuberculosis in 1934. Asphalter 1 Aircraftsman R. A. F. 1 Bookbinder 2 Bookmaker 1 Blacksmith 1 Basket Maker 1 Barman 2 Butcher 2 Builder 1 Clerk 11 Checker 1 Chimney Sweep 1 Chair Attendant 1 Carpenter 2 Coffin Maker 1 Carman 2 Canvasser 1 Compositor 1 Cinema Attendant 1 Cinema Operator 2 Chemist 1 Clothier 1 Draper 1 Draughtsman 2 Ex-service Pensioner 5 Fitter, Water 1 „ Permanent Way 1 Film Cleaner 1 Flower Seller 1 Gas Fitter 1 Gold Nib Grinder 1 General Dealer 2 House Decorator 3 Hawker 1 Hairdresser 1 Hammerman 1 Insurance Agent 1 Labourer 7 „ Builder 3 „ General 2 „ Dock 1 „ Gas Co. 1 „ Railway 1 Leatherworker 3 Lodging House Keeper 1 Laundryman 2 Licensed Victualler 2 Manager 2 Metallurgist 1 Mechanic, Motor 3 Metal Polisher 1 Motor Driver 1 Meat Sorter 1 No Occupation 7 Newsagent 1 Nurse 1 Night Watchman. 1 Printer 3 „ Assistant 4 „ Machine Minder 2 Postman 1 Porter Hospital 1 „ Hall 1 „ Railway 2 Paint Sprayer 1 Pastry Cook 1 Railway Shunter 1 „ Ticket Collector 2 „ Overhead Linesman 1 „ Inspector 1 „ Guard 1 Storekeeper 1 Sawyer 1 School Child 3 Soldier 1 Salesman 4 Ship Steward 1 Solicitor 1 Stone Carver 1 Traveller 2 Tea Packer 1 Taxicab Driver 1 Tram Conductor 1 Tailor's Cutter 1 Under School Age 4 Variety Artist 1 Wood Machinist 1 Warehouseman 1 TABLE XI. Showing the Occupation of 72 Females who died from Tuberculosis in 1934. Bookbinder 1 Housewife. 27 Bookfolder 1 Laundry Hand 1 Brass Filer 1 Machinist 1 Clerk 5 Machine Minder 1 Collar Turner 1 Mantle Maker 1 Corset Maker 2 Milliner 1 Domestic Servant 5 No Occupation 6 Disc Maker 1 Packer 1 Dress Matcher 1 Pastry Maker 1 Factory Hand 2 School Child 6 Florist 1 Shop Assistant 1 Hairdresser 1 Under School Age 3 TABLE XII. Return showing the Work of the Dispensary during the Year 1934. Pulmonary. Nonpulmonary. Total. Grand Total. Diagnosis. Adults. Children. Adults. Children. Children Adults. M F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts): — -L ! n (a) Definitely tuberculous 80 63 2 3 8 7 9 4 88 70 11 7 176 (b) Diagnosis not completed - - - - - - - - 7 2 1 - 10 (c) Non-tuberculous - - - - - - - - 160 177 65 30 432 B.—Contacts examined during the year:— I I I I II ! I II (a) Definitely tuberculous 25 20 1 3 3 2 - 1 28 22 1 4 55 (b) Diagnosis not completed - - - - - - - 2 2 1 2 - 7 (c) Non-tuberculous - 115 182 166 171 - - - - - - - 634 C.—Cases written off the Dispen- ! sary Register as: — I I I ! I i il I I II II (a) Recovered 3 2 - 1 - 3 1 - 3 5 1 1 10 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 288 371 235 202 1096 D.—Number of Cases on Dispensary Register on December 31st:— I i ! II I I (a) Definitely tuberculous 653 43 109 118 590 145 481 53 114 92 767 161 1663 17 (b) Diagnosis not completed - - - - - - - 9 4 2 2 - 105 1. Number of cases on Dispensary Register on January 1st 1,696 7. Number of consultations with medical practitioners:— (a) Personal 46 (6) Other 580 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 64 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 424 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 9,009 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 148 10. Number of: — (a) Specimens of sputum, &c., examined 1,718 (6) X-ray examinations made in connexion with Dispensary work 577 4. Cases written off during the year as Dead (all causes) 140 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 4 5. Number of attendances at the Dispensary (including Contacts) 6,087 6. Number of Insured Persons under Domiciliary Treatment on December 31st 337 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 788 TABLE XIII. Housing accommodation of 341 families in which there was a Primary Notification of Tuberculosis in 1934. Number of Families occupying 6 Rooms. or more. 5 Rooms. 1 Room. 2 Rooms. 3 Rooms. 4 Rooms. Patient living alone 27 12 3 1 - - 10 13 18 10 3 6 „ „ with 1 other 3 18 23 1 „ „ „ 2 „ 27 2 2 10 18 14 15 7 „ „ „ 3 „ 1 4 12 21 2 7 „ „ „ 4 „ 1 6 7 3 7 „ „ „ 5 „ - „ „ „ 6 „ 1 2 4 4 2 - - - - 1 „ „ „ 7 „ - 1 3 3 „ „ „ 8 „ - - 1 - 2 1 „ „ „ 9 „ - 1 - - „ „ „ 10 „ - - - - - 1 Total 83 32 36 43 68 79 TABLE XIV. Sleeping accommodation for 341 tuberculous cases notified for the first time in 1934. The figures refer to the tuberculosis Nurses' first home visit. The patient slept— In separate room In 118 cases. Alone in bed with 1 other in room „ 40 „ „ „ 2 others „ 23 „ „ „ 3 „ „ „ 2 „ „ „ 4 „ „ „ - „ In bed with 1 person and no others in room „ 87 „ „ „ 1 „ 1 other in room „ 32 „ „ „ 1 „ 2 others „ „ 15 „ „ „ 1 „ 3 „ „ „ 2 „ „ „ 1 „ 4 „ „ „ 1 „ In bed with 2 persons and no others in room „ 14 „ „ „ 2 „ 1 other „ „ 2 „ „ „ 2 „ 2 other „ „ 3 „ „ „ 2 „ 3 „ „ „ - „ In bed with 3 persons and no others in room „ 2 „ 341 The Nature and Extent of Co-operation with General and Special Hospitals, School Clinic and other Institutions. 1. With General and Special Hospitals. (a) King's College Hospital. Including cases sent to the X-ray Department, 656 Dispensary patients were sent to hospital in 1934 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: — Sick Children's Hospital, Great Ormond Street. St. Thomas's Guy's Throat Hospital, Golden Square. Charing Cross. Westminster. Miller. Brompton South London Hospital for Women. Evelina. Belgrave. All Saints'. Royal Waterloo Elizabeth Garrett Anderson 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 cases may be referred back to the Dispensary for special examination. Co-operation with Medical Practitioners. 626 new patients were sent by practitioners to the Dispensary for diagnosis or seen in consultation at their homes. Classification of new Patients. (a) Pulmonary Tuberculosis. During 1934, 217 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) 69, or 31,8 per cent. T.B. plus 1 (early cases, sputum positive) 13, or 6.0 per cent. T.B. plus 2 (intermediate cases, positive) 114, or 52.5 per cent. T.B. plus 3 (advanced cases, sputum positive) 21, or 9.7 per cent. (6) Non-Pulmonary Tuberculosis. There were 38 new cases of non-pulmonary tuberculosis in the following forms: — Bones, joints and spine. Peripheral glands. Abdomen. Skin. Other organs. 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, as a rule, sent away 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 symptons, 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 1934, 577 patients were sent to King's College Hospital for X-ray examination. All our patients while under Residential treatment were X-rayed on various occasions. The same applies to A.P. cases. 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, Grove Park and Colindale. During 1934, 50 dispensary patients had artificial pneumothorax treatment at one or the other of these hospitals. This does not include dispensary patients who were on artificial pneumothorax treatment in sanatorium at December 31st, 1934. 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. Three dispensary patients had this treatment at the London Hospital during the year. Work of Tuberculosis Nurses. The tuberculosis nurses paid 9,009 visits to the homes of tuberculous patients during the year. Nursing Patients. We have also been able to obtain a District Nurse whenever one was 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. Fourteen patients received dentures through the Tuberculosis Dispensary scheme of the Borough. Approved Societies contributed part of the cost in the case of the insured, and patients who could afford it also contributed. Supply of Extra Nourishment during 1934. Sixty-four dispensary patients received extra diet (Borough scheme). Supply of Sputum Pocket Flasks and Outfits for Sputum Examinations. Approximately 145 pocket flasks were supplied to patients during the year. Patients, of course, obtain pocket flasks from other sources, for example, residential institutions and private sources. 1,718 outfits were supplied in connection with sputum examinations. Institutional (Residential) Treatment of Camberwell Patients in 1934 through the London County Council. 1. Adult Males:— Number of applicants for residential treatment 239 Number who received residential treatment 219 Number who did not receive residential treatment:— Not accepted 7 Failed to enter 10 Awaiting residential treatment December 31st, 1934 3 Classification of Adult Males who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 21 Pulmonary cases in which tubercle bacilli had been found in the sputum 173 Early pulmonary tuberculosis 24 Moderately advanced pulmonary tuberculosis 129 Advanced pulmonary tuberculosis 20 Surgical tuberculosis 10 Diagnosis of tuberculosis 15 Not classified — 2. Adult Females:— Number of applicants for residential treatment 157 Number who received residential treatment 146 Number who did not receive residential treatment:— Not accepted 1 Failed to enter 4 Awaiting residential treatment December 31st, 1934 6 Classification of Adult Females who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 20 Pulmonary cases in which tubercle bacilli had been found in the sputum 104 Early pulmonary tuberculosis 16 Moderately advanced pulmonary tuberculosis 79 Advanced pulmonary tuberculosis 9 Surgical tuberculosis 12 Diagnosis of tuberculosis 10 Not classified — 3. Boys:— Number of applicants for residential treatment 22 Number who received residential treatment 22 Number who did not receive residential treatment:— Not accepted — Failed to enter — Awaiting residential treatment December 31st, 1934 — Classification of Boys who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 6 Pulmonary cases in which tubercle bacilli had been found in the sputum — Early pulmonary tuberculosis — Moderately advanced pulmonary tuberculosis - Advanced pulmonary tuberculosis — Surgical tuberculosis 10 Diagnosis of tuberculosis 6 Not classified — 4. Girls:— Number of applicants for residential treatment 15 Number who received residential treatment 15 Number who did not receive residential treatment:— Not accepted — Failed to enter — Awaiting residential treatment December 31st, 1934 — Classification of Girls who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 6 Pulmonary cases in which tubercle bacilli had been found in the sputum 1 Early pulmonary tuberculosis 1 Moderately advanced pulmonary tuberculosis — Advanced pulmonary tuberculosis - Surgical tuberculosis 6 Diagnosis of tuberculosis 2 Not classified - The London County Council used beds in the following institutions. Adults. Hospitals. Sanatoria. King George V. Brompton Frimley Eversfield Holy Cross Northern Northamptonshire, Creaton Grove Park Grosvenor. Colindale Kelling. Royal Sea Bathing. Royal National. Maltings Farm. Robert Jones and Agnes Hunt Orthopaedic. Pinewood. National. Dulwich Old Manor House. Lewisham. Fairlight. Fairholme. Westminster. Mount. Whitstable and Tankerton. Liverpool. St. Luke's. St. Giles'. St. James's. St. Olave's. St. Nicholas'. St. Alfege's. Homes. Colonies. St. Barnabas. Burrow Hill. Bishopsbourne. Papworth. Preston Hall. St. George's. Hampshire Home of Recovery. Children. Hospitals. Sanatoria and Homes. Highwood. Naylands. Heatherwood. Millfields. Princess Mary's. Metropolitan Convalescent. Queen Mary's East Anglian. Victoria. The average duration of residential treatment given by the London County Council in 1934 to 365 adults was 22.3 weeks. The average duration of residential treatment given to 37 children by the London County Council in 1934 was 28 weeks. This refers only to those who began treatment in that year. Many of these patients will remain in institutions during varying periods of 1935 — 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. In July of the year under review, the London County Council decided that in future no contribution should be required from patients, or persons legally responsible for them, towards the cost of the residential treatment of tuberculosis (except in respect of the provision of dentures during treatment), or towards the cost of the boarding-out of children under the powers conferred by the County of London (Tuberculosis) Regulations, 1930. Voluntary contributions will however be accepted by the London County Council from patients or their relatives or guardians who feel that they would like to make a payment and can afford to do so. The Work of the Tuberculosis Care Committee. A fund is required to carry out care work in tuberculosis. In 1934 the Care Committee took part in the Scheme of the National Association for the Prevention of Tuberculosis, for the sale of Christmas seals. After deduction of expenses amounting to £24 18s. 3d. the Committee had a surplus of £153 13s. 7d. towards its work. The Secretary of the Care Committee has compiled the following figures and items of information in relation to some of the work in 1934:— 161 cases were helped in their application to the Public Assistance Committee. Thus patients received money, food, extra diet, clothes, etc. 4 cases were assisted in their application to the British Red Cross Emergency Fund. 8 cases were assisted in their application to the United Services Fund. The Care Committee assisted the London County Council in making arrangements for the institutional treatment of 393 patients. Efforts were made to settle all difficulties that threatened to bring patients home from sanatoria too soon. Co-operation took place with the Charity Organisation Society in 12 cases and with the Invalid Children's Aid Association in 64 cases. The Committee co-operated with many families in which there was a tuberculous member by endeavouring to obtain new homes for them on the housing estates of the L.C.C. and elsewhere. Patients were advised on questions concerning their employment. Many patients were helped from private sources, for example, in the way of clothing, boots, beds, etc. To a large number of patients personal help in discussing difficulties was given in addition to the above. The following items will show how part of the Christmas Seal Fund was spent:— Pocket money to 19 more or less destitute patients while they were away at sanatorium. Clothing to 15 patients. Mothers' Help in the case of 10 patients while awaiting sanatorium treatment or as a convalescent measure for a short period after leaving sanatorium. Payment of fares in 36 cases where relations would otherwise have been unable to visit patients in sanatoria —many at some considerable distance from London. Purchase of surgical appliances and bed comforts in 18 cases. Paying arrears of National Health Insurance stamps in 10 cases. Paying for board and lodging in 6 cases. Purchase of spectacles in one case. Advertising for jobs in 2 cases. Purchase of beds and bedding in 7 cases. The Handicraft Class. The Handicraft Class has enjoyed its work and done it well. Prizes were won at an Exhibition held at County Hall and ex-service men gained certificates at the Ward Industries Exhibition. An Exhibition and Sale of handicraft work was held at Carpenters' Hall, Throgmorton Avenue, on October 24th and 25th. The handicraft classes of 13 boroughs took part. The Camberwell class sold £30 3s. 6d. worth of goods and took orders to the value of £8 19s. 6d. WILLIAM BRAND, Tuberculosis Officer. INDEX. PAGE Aged and Infirm Persons 44 Agriculture (Grading, etc.) Act 70 Ambulance Facilities 16 Ante-Natal Supervision 24-27 Anthrax 84 Bacteriological Examinations 92,93 Bakehouses 61 Births and Birth Rates 8 Notification of Births Act 9 Illegitimate Births 9 Still Births 9 Blindness, Prevention of 93 Butchers' Shops and Stalls 61 Cancer 92 Cerebro-Spinal Meningitis 84 Cleansing Station 20 Clinics and Treatment Centres 17 Closet Accommodation 34 Common Lodging Houses 43 Convalescent Treatment 29 Deaths 9 General Table of 10 Illegitimate Infants 9 Infantile 12,15 Inquiry into Maternal Death 12 Maternal 11 Neo-Natal Mortality 13 Ward Distribution, Table 12 Diarrhoea and Enteritis 13 Diphtheria 80 Immunisation 81, 82-83 Disinfection 93 Drainage 34 Dysentery 84 Eating Houses 62 Encephalitis Lethargica 85 Enteric Fever 81 INDEX—continued. PAGE Factory and Workshop Act 51-54 Fish — Curers 61 Fried Fish Shops 62 Shops and Stalls 61 Food— Chemical and Bacteriological Examination of 76 Food offered as Prizes 66 Poisoning, Notification of 64-66 Preservatives, etc., Regulations 69 Summary of work, Table 67 Unsound Food Table 66,67 Food and Drugs Acts — Adulteration Act 68 Artificial Cream Act 68 Butter Factories, etc. 71 Condensed Milk Regulations 69 Dried Milk Regulations 69 Proceedings Table 76 Samples, Tables 72,73 Samples, Adulteration Tables 74-76 Fouling of Footways by Dogs 45 Health Propaganda 20 Health Services, General Provision of 16-23 Health Visiting 27,28 Home Nursing 29 Hospitals 18 Housing 46-51 Houses Divided into Separate Tenements 47 Overcrowding 47 Slum Clearance 46 Statistics 50,51 Underground Rooms 48-50 Verminous Rooms 48 IceCream 60,61 Infant Life Protection 30,31 Infant Welfare Centres 19,24 Mothercraft and Health Talk Sessions 28,29 Returns 32,33 "Toddlers" Clinics 28 INDEX —continued. PAGE Infectious Diseases 78-93 Non-Notifiable 90—92 Notifiable 78 Tables 86-80 Infirm Persons 44 Influenza 92 Inspection and Supervision of Food 55-77 Administration 55 Laboratory Facilities 16 Malaria 85 Maternal Mortality 11 Maternity and Child Welfare 24-33 Maternity Outfits 31 Measles 90,91 Serum 91 Meat and Other Foods 60 Merchandise Marks Act 69,70 Midwives 31 Midwifery Assistance 31 Milk- Bacteriological Examinations 55 Dairies, Milkshops and Cowhouses 55 Designations Order 56 Examination for Tubercle 55 Grade "A" (Tuberculin Tested) Milk 56,57 Milk Act, 1934 58 Milk and Diaries Order 55 Milk for School Children 59,60 Milk (Not Designated) 55 Pasteurised Milk 57 Milk for Necessitous Persons 30 Mortuary 21,22 Mothercraft Sessions 28,29 Neo-Natal Mortality 13 Non-Notifiable Infectious Diseases 90-92 Nursing in the Home 16 Nutrition 77 Obstetric Specialist 31 Offensive Trades 45 Ophthalmia Neonatorum 85 INDEX— continued. PAGE Out workers 54 Pneumonia 84 Poliomyelitis and Polio-encephalitis 84 Population 7 Post-Natal Supervision 27 Post-Vaccinal Encephalitis 79 Pre-School Child 28 Public Baths and Washhouses 21 Public Cleansing 35 Puerperal Fever and Pyrexia 90 Rag Flock Acts 43 Rats and Mice Destruction Act 44 Rent Restriction Acts 43 Restaurants and Eating Houses 62 Sanitary Circumstances of the Area 34-45 Inspection of the Area (Staff) 35 Inspection Tables 36-39 Summary of Legal Proceedings 40-42 Sanitary Conveniences attached to Licensed Premises 45 Scarlet Fever 81 Immunisation 81 School Treatment Centres 17,18 Schools, Inspection of 43 Sickness and Invalidity 6 Slaughterhouses 62,63 Slaughter of Animals Act 63 Slum Clearance 46 Smallpox 78,79 Smoke Abatement 43 Social Conditions of Area 6 Staff 3 Statistics, Summary of 5 Statistics, Extracts from 6 Statistics, Vital 8 Street Trading 64 Tuberculosis 94-113 Care Work 112 Classification of New Patients 108 Co-operation with Hospitals, Medical Practitioners, etc. 107 Dental Treatment 109 INDEX—continued. PAGE Diagnosis and Treatment 108 Dispensary Table of Work 105,106 Extra Nourishment 109 Handicraft Class 113 Individual Notified Patients Table 97,98 Institutional Treatment 109—112 Mortality 102,103 Notification 94,95,98-100 Occupational Table, Deaths 104,105 Prevention Regulations 96 Report of T.B. Officer 96-113 Sputum Flasks, etc., Supply of 109 Supplemental Return 101 Typhoid Fever 81 Unemployment 6 Unmarried Mothers 31 Vaccinators, Public— Return of Work 23 Verminous Persons 20 Water Supply 34 Whooping Cough 91