CAM 42. Report of the Medical Officer of Health. Public Health Department, Town Hall. Camberwell, S.E.5. 1st July, 1936. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my 14th Annual Report on the sanitary circumstances, the sanitary administration, and the vital statistics of the area of the Metropolitan Borough of Camberwell. The arrangement of the contents of this report for 1935 follows that of my last report and is in accordance with the instructions laid down in Ministry of Health Circular No. 1492. The year has been one of steady progress. New schemes have been introduced and existing schemes strengthened for securing the health of the inhabitants of the Borough. A summary of the vital statistics appears on page 4, and in this connection it is satisfactory to refer to the improvement which took place in 1935 in the birth, death and infantile mortality rates. The representation of insanitary areas and individual unfit houses has been carried out energetically, and the re-housing of the occupants of these insanitary dwellings in modern homes has proceeded satisfactorily. The inspection of the district which was carried out in accordance with the provisions of Section 1 of the Housing Act, 1935, for the purpose of ascertaining the number of dwelling-houses which were overcrowded, was commenced on November 1st, 1935, and was well advanced at the end of the year. The public health services generally are reviewed in the respective sections of this report, and it only remains for me to record that the work of a very busy year has been greatly facilitated by the unfailing support and kind consideration afforded me by the Chairmen and Members of the Public Health and the Maternity and Child Welfare Committees of the Council, and by the loyal and valuable assistance given cheerfully at all times by the staff of the Public Health Department. Your obedient Servant, H. W. BARNES, Medical Officer of Health. A Staff of the Public Health Department at the end of 1935. 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 and Medical Officer Diphtheria Prevention Clinic. 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. 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. D. Hughes, M.B., B.Ch., B.A.O., D.P.H. Public Vaccinators. St. George's District H. J. Gater, L.M.S.S.A., L.S.A. Camberwell „ D. Hughes, M.B., B.Ch., B.A.O., D.P.H. 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. 7. D. H. Pickard, M.C. a 1. H. Attwater. a 8. F. Maughan. a 2. D. Watkins. a 9. M. L. Malins. a 3. W. Gilchrist. b 10. H. C. Green. a 4. G. Topping. a 11. M. Malins. a 5. L. W. Burrell. a 12. W. T. Worsfold. b 6. H. R. Weaver. a Miss F. O'Riordan, Maxwell Lefroy, Gold Medallist. a, d Housing Inspectors. A. L. Dobson. a H. W. Leonard, a Sampling Officer—Food and Drugs, etc. Acts. G. T. Dewey. c Food Inspector. R. F. Nash. a Health Visitors. Miss A. M. Stoddart. f Miss A. H. Mitchell. e Miss W. Higgins. e Miss J. Finlayson. e Infant Life Protection Visitor. Miss N. G. Cooke. e Chief Clerk. F. T. Harman. Clerks. H. J. Hurst. S. F. Hislam. A. E. Pooley. S. A. Cranfield. A. J. Carly. R. G. Goodbody. R. C. Sweet. Miss M. L. Thompson. R. A. Davies. Miss E. M. Watkin. 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 Mrs. F. Bitts (Temporary). Porter William J. Cripps. Disinfecting and Cleansing Station. Superintendent Disinfector A. Franklin. Assistants J. Conner, A. Thomas, R. J. Hodgson and J. Sawyer, A. Pepler (motor driver), W. Marchant (Temporary). Women Assistants. Mrs. D. Farmer (Temporary). Mrs. E. Payton (Temporary). Mortuary Keeper. W. R. Mottram 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. A2 3 SUMMARY OF STATISTICS for the Year 1935. Area of the Borough in Acres 4,480 Population (Estimated resident population mid-1935) 234,400 Population (Census 1931) 251,294 No. of inhabited houses (end of 1935) according to Rate Books 43, 468 Rateable Value £1,651,199 Sum represented by a penny rate £6,950 Number of live Births 3,155 Birth Rate 13. 46 Number of Deaths 2,769 Death Rate 11.81 Infantile Mortality:— Deaths under 1 year 191 Infantile Deaths per 1,000 Births 60 Maternal Mortality:— Deaths of Women from Diseases or Accidents associated with Childbirth 10 Per 1,000 live births 3.16 Maternal Death Rate Per 1,000 total births 3.07 Deaths from Phthisis 166 Phthisis Death Rate 0.71 Deaths from all forms of Tuberculosis 192 Tuberculosis Death Rate 0.82 Social Conditions and Vital Statistics of the Borough. The Metropolitan Borough of Camberwell is 4¾ miles in length, 2½ miles in width, and covers an area of 4,480 acres. The Borough is divided into 20 wards. The chief industries in the area are as follows: the manufacture of gas and its associated products, engineering, laundries, and printing. No particular industry can be stated to affect the public health prejudicially. Indifferent housing conditions prevail principally in the northern part of the Borough. The older type of two-storey dwelling with its small back yard is slowly being replaced by blocks of tenement buildings. The density of population (number of persons per acre) in Camberwell as shown in the 1931 Census Returns was 56 as compared with 58.7 for London as a whole. The greatest density exists in the northern part of the Borough, as will be observed by reference to the subjoined table. Population Density of Ward. Acreage. (Census Population. 1931). 1. The West 125 14,489 116 2. Addington 85 13,016 153 3. Town Hall 132 13,189 100 4. St. George's 104 14,922 143 5. Cobourg 99 14,421 145 6. Marlborough 124 12,024 97 7. North Peckham 164 14,672 89 8. Goldsmith 124 14,274 115 9. Clifton 144 14,888 103 Extracts from Vital Statistics of the Year. Total. M. F. Legitimate 3,014 1,582 1,432 Birth Rate per 1,000 of the estimated resident population, 13.4. Live births Illegitimate 141 77 64 Still births 96 62 34 Rate per 1,000 total (live and still) births, 29.5. Deaths 2,769 1,410 1,359 Death Rate per 1,000 of the estimated resident population, 11.8. Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 6 1.84 Other puerperal causes 4 1.23 Total 10 3.07 Death Rate of Infants under one year of age:— All infants per 1,000 live births 60 Legitimate infants per 1,000 legitimate live births 58 Illegitimate infants per 1,000 illegitimate live births 106 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) 13 Deaths from Diarrhoea (under 2 years of age) 47 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. Although parts of the Borough are inhabited by persons in good financial circumstances there is a considerable working-class population in the area. The information appearing in the following tables indicates the extent of unemployment among Camberwell residents and I am indebted to the Manager of the local Ministry of Labour Exchange for furnishing these particulars. Men. Boys. Women. Girls. Total. October 4,439 136 1,600 66 6,241 November 4,613 81 1,686 38 6,418 December 4,396 49 1,614 48 6,107 Average for quarter 4,482 89 1,633 51 6,255 The number of unemployed persons stated as a percentage of the insured population in the Borough equalled 8.4. I am also indebted to the Local Public Assistance Officer for information that the number of persons in receipt of domiciliary relief in the Borough averaged 6,038 weekly throughout the year as compared with 6,183 in 1934. Population. The population of the Borough as ascertained at the census in 1931 was 251,294 persons. The Registrar-General's estimate of the population for 1935 (middle of the year) was 234,400, and this figure has been taken for the purpose of providing statistical information in this Report. The following table compares the population of the different wards calculated from this estimated figure with the ward census enumeration. Wards. Population at the Census, 1931. Estimated Population, 1935. (Middle of the Year). 14,489 13,515 1 13,016 12,141 2 3 13,189 12,302 14,922 13,919 4 5 14,421 13,452 6 12,024 11,216 13,686 7 14,672 8 14,274 13,314 9 14,888 13,887 7,700 10 7,182 10,105 11 10,833 12 12,496 11,656 13 11,022 10,281 9,780 14 10,485 12,234 15 11,411 13,719 12,797 16 17 13,861 12,929 18 16,797 15,668 19 12,123 11,308 20 4,129 3,851 Total 251,294 234,400 Vital Statistics. The chief features of the vital statistics of the year under review are a decrease in population, a birth rate which is slightly higher, a death rate and infantile mortality rate each of which is lower than the rates for the previous year. The vital and mortal statistics of every ward in the Borough for the year 1935 are given in the following table:— Wards. Births. Deaths under 1 year Deaths all ages. Estimated Population. No. Rate per 1,000. No. Rate per 1,000. No. Rate per 1,000. 1 13,515 210 171 12.6 76 15.5 16 174 128 2 3 12,141 14.3 12 68 10.5 68 135 12,302 145 11.8 10 10.9 4 13,919 13.2 65 154 11.0 184 12 5 13,452 190 14.1 10 52 155 11.5 11,216 178 15.8 10 56 139 12.4 6 7 13,686 205 15.0 13 63 135 9.8 8 180 13.5 15 83 154 11.5 13,314 18 13,887 202 14.5 89 187 13.4 9 10 7,182 101 14.0 5 49 103 14.3 11 10,105 155 15.3 7 45 97 9.6 20 166 12 11,656 149 12.8 3 14.2 13 14 10,281 125 12.1 7 56 96 9.3 9,780 11,411 154 15.7 13 84 148 15.1 15 201 17.6 4 19 124 10.8 16 12,797 157 12.2 9 57 175 13.6 17 155 134 12,929 11.9 12 77 10.3 18 144 9.2 4 27 194 15,668 12.3 19 111 45 11,308 9.8 5 126 11.1 20 35 9.0 6 48 3,851 171 12.4 60 2,769 The Borough 234,400 3,155 13.4 191 11.8 Births and Birth Rates. The number of live births registered during 1935 after adjustment by the addition of 568 children born of Camberwell mothers confined outside the Borough and the deduction of 603 children of non-residents confined in the Camberwell area, numbered 3,155. These births comprised 1,659 males and 1,496 females—a proportion of 1,109 males to 1,000 females. The birth rate per 1,000 of the estimated resident population was, therefore, 13.4 as compared with 13.2 in 1934. Illegitimate Births. The number of illegitimate live births was 141 or 4.4 per cent, of the total births as compared with 4.21 in 1934. Still Births. There were 96 still births registered during the year, and of these 6 were in respect of illegitimate births. Notification of Births Act. This Act imposes a duty upon the father of the child or of any person in attendance upon the mother at the time of or within six hours after the birth, to give notice in writing of the birth to the Medical Officer of Health of the district within thirty-six hours of its occurrence, and any person who fails to give the required notice is liable to a penalty. During the year 3,022 births were notified representing 92.9 per cent. of the total number of births registered in the Borough. The following table indicates the sources of notification:— No of Births notified. Source of notification. Live Births. Still Births. 2,004 68 By Medical Practioners and Parents 934 13 „ Midwives „ Other Persons 3 — Deaths. The following table shows the number of deaths and the death rates in England and Wales, London and Camberwell in 1935: No. of deaths. Death rate. District. 11.7 England and Wales 477,398 11.4 London 47,847 11.8 2,769 Camberwell The Registrar-General's diseases classification of deaths is set out in the table on pages 9 and 10. The number of deaths in each ward and the corresponding death rate appear in the Vital Statistics table on page 7. The chief causes of death and the number of such deaths are shown in the following summary:— Deaths due to diseases of the heart 778 Deaths from malignant disease 413 Deaths attributed to bronchitis pneumonia and other respiratory diseases 276 Deaths from all forms of tuberculosis 192 Deaths from influenza 29 Deaths from influenza in the previous year 28 Deaths of Illegitimate Infants. The deaths of illegitimate infants numbered 15 during the year, representing a mortality rate of 106 per 1,000 illegitimate births. The infantile mortality rate for legitimate and illegitimate births was 60. A table showing the age distribution of these deaths in each quarter of the year is appended:— Period. Under 4 weeks. 4 weeks and under 3 months. 3 months and under 12 months. Legit. Illegit. Legit. Illegit. Legit. Illegit. 15 2 15 1 22 3 1st Quarter 21 2 8 — 19 3 2nd „ 3rd „ 12 3 8 — 15 — 4th „ 16 2 6 1 19 1 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1935. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— M. 1,410 110 23 37 54 57 64 263 330 All causes 139 319 14 1,359 6 62 318 F. 81 13 14 46 58 124 203 434 Typhoid and Paratyphoid Fevers M. — — — — — — — — — — — — F. — — — — — — — — — — — — Measles M. 1 1 — 2 — — — — — — — — F. — — — — — — — — — — — — Scarlet Fever M. — — — - — — — — — — F. — 1 — 1 — — — — Whooping Cough — — — — — — M. 4 2 1 — — — — 1 — — — — — — — F. 9 6 3 — — — — — — — Diphtheria M. 14 1 5 8 — — — — — — — F. 6 5 1 — — — 5 — — — — — — Influenza 2 M. 16 1 6 — — — — — — 2 13 — F. — 3 — 3 2 5 — — — — 13 — Encephalitis lethargica M. — — — — — — — — — — — 1 Cerebro-spinal Fever F. 1 — — — — — — — — — M. 1 — 1 — — — — — — — — — — F. 1 1 — — — — — — — — — 10 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1935—contd. Causes of Death. Sex. All Ages. 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- Tuberculosis of respiratory system M. 93 — — — 1 18 19 10 21 15 5 4 F. 73 2 — 3 - 24 21 8 10 3 5 — Other tuberculous diseases M. 18 1 — 3 6 3 2 2 — 1 — — F. 8 — 1 2 1 2 — — 1 1 — — Syphilis M. 8 — 1 — — 1 2 2 1 — 1 — F. 3 — — — — — — 2 1 — — — General paralysis of the insane, tabes dorsalis M. 7 — — — — — 1 2 3 — 1 — F. — — — — — — — — — — — — Cancer, malignant disease M. 201 — — — — — 4 32 62 66 37 — F. 212 — — 6 7 37 54 61 47 — — — Diabetes M. 15 — — — — 1 — 1 3 5 5 — F. 27 — — — — 1 1 4 9 4 8 — Cerebral haemorrhage, etc. M. 49 — — — — 2 3 12 20 12 — — F. 78 — — — — — 5 15 32 26 — — Heart disease M. 360 — — 2 5 8 9 36 65 106 129 — F. 402 — — 3 10 56 8 11 22 106 186 — Aneurysm M. 11 — — — 1 — — 2 4 4 — — F. 5 — — — — — 1 1 1 — 1 1 Other circulatory diseases M. 51 1 — 1 1 2 9 23 15 — — — F. 62 1 — — — 2 5 7 18 29 — — Bronchitis M. 51 6 — 1 3 4 8 7 22 — — — F. 48 4 — — — 1 — 3 2 9 29 — Pneumonia (all forms) M. 97 16 6 3 2 1 2 3 10 24 18 12 F. 9 2 3 2 1 1 4 4 12 11 11 60 Other respiratory diseases M. 10 — 1 — 1 2 1 1 3 1 — — F. 10 1 — — — — 1 3 3 2 — — Peptic Ulcer M. 2 5 — — — — 1 1 4 10 6 3 — F. 6 — — — 1 1 4 — — — — — Diarrhoea, etc. M. 28 22 3 — — 2 — — 1 — — — F. 19 15 1 — 1 — 1 — — 1 — — Appendicitis M. 6 — 1 — 2 2 — 1 — — — — F. 7 — — 1 — — — 2 2 1 1 — Cirrhosis of liver M. 3 — — — — — — — 3 — — — F. 3 — — — — — — 1 1 — 1 — Other diseases of liver, etc. M. 4 — — — — — — — — 3 1 — F. 10 — — — 1 — — 2 1 2 4 — Other digestive diseases M. 23 3 — 1 — — 1 — 4 5 9 — F. 20 3 1 — 2 1 — 4 3 6 — — Acute & chronic nephritis M. 42 — — — — 2 1 3 3 9 10 14 F. 50 — — — — 3 5 5 10 16 11 — Puerperal sepsis Other Puerperal causes F. 6 — — — — 2 2 2 — — — — F. 4 — — — — 4 — — — — — — Congenital debility, premature birth, malformations, etc. M. 51 50 — — — 1 — — — — — — F. 32 30 — — 2 — — — — — — — Senility M. 30 — — — — — — — — 6 24 — F. 43 — — — — — 8 35 — — — — Suicide M. 17 — — — — 1 2 5 3 5 1 — F. 7 — — — 1 1 1 3 1 — — — Other Violence M. 67 4 2 1 5 12 13 7 4 6 6 7 F. 33 — — 2 1 1 2 3 2 2 8 12 Other defined diseases M. 104 5 1 3 12 6 3 10 6 13 27 18 F. 100 10 — — 4 3 7 6 16 18 19 17 Causes ill-defined or unknown M. 2 — — — — — — — — 2 — — F. — — — — — — — — — — — — Maternal Mortality. A maternal mortality rate below 2 is very exceptional. Although Camberwell cannot be stated to have a high maternal mortality rate, and compares favourably with other Metropolitan Boroughs, yet there is a certain amount of disappointment that the maternal mortality rate has failed to respond to the strenuous measures employed in recent years to secure a reduction in the number of deaths from maternal causes. Ignorance on the part of mothers and their relations as to the necessity for skilled advice throughout pregnancy has still to be combated. An improvement in the mortality rate might be effected if every pregnant woman would safeguard herself by insisting on receiving ante-natal supervision by her own doctor or by attending an ante-natal clinic. In Camberwell, every endeavour is made to persuade the pregnant woman to secure early and continuous ante-natal supervision. In addition to the ante-natal clinics which are held at Infant Welfare Centres in the Borough, the Clinics at St. Giles' and Dulwich Hospitals are by arrangement with the London County Council placed at the disposal of private medical practitioners and practising midwives for patients who have made arrangements to be confined in their own homes. Practising midwives in the Borough have been requested on many occasions to avail themselves of the facilities provided by the Council to obtain for their patients ante-natal supervision at these well-equipped clinics, but, unfortunately, these appeals have not been very successful. The Council also places at the disposal of pregnant women the services of an obstetric specialist in cases of difficulty before, during and after labour. The establishment of a Municipal Midwives Service should, however, assist in the effort which is being made to keep the maternal mortality and morbidity rates at the lowest figure possible. There were ten maternal deaths in Camberwell during 1935, representing a maternal mortality rate of 3.07 per 1,000 live and still births as compared with 2.46 in 1934, 4.77 in 1933, 2.15 in 1932, and 3.39 in 1931. The following maternal mortality rate figures enable a comparison to be made with the position of Camberwell and London as a whole, as well as England and Wales. Death rate from Death rate from other Total. Puerperal Sepsis. Puerperal Causes. The Borough 1.84 1-23 3.07 London 1.11 1.23 3.07 England and Wales 1.61 2.32 3.93 Inquiry into Maternal Deaths. Confidential reports relating to maternal deaths occurring in the Borough were submitted as in past years to the Ministry of Health. Infantile Mortality. It is satisfactory to report that the number of deaths of children under one year of age fell from 214 in 1934 to 191 in 1935. These deaths expressed in relation to the registered live births represent an infantile mortality rate of 60 per 1,000. The causes of and ages at deaths of infants under one year of age during 1935 are shown in the table appearing on page 14. The infantile mortality rate is to some extent an index of the efficiency of the Maternity and Child Welfare Service in the area, and whilst there are fluctuations in the mortality rate year by year, yet there can be little doubt that the remarkable decrease which has taken place in the infantile mortality rate in the last 20 years is directly attributable to this important public health service. The deaths of illegitimate children under one year numbered 15 representing a mortality rate of 106 per 1,000 total births. For comparative purposes the infantile deaths and death rates in the Borough, London, and England and Wales for the past five years are given in the following table: — The Borough. London. England and Wales. No. of No. of No. of deaths of deaths of deaths of children Infantile children Infantile children Infantile Year. under 1 Mortality under 1 Mortality under 1 Mortality year of Rate. year of Rate. year of Hate, age. age. age. 1931 208 56 4,270 65 41,939 66 1932 234 65 4,143 66 39,933 65 1933 160 49 3,377 59 36,960 64 1934 214 67 3,832 67 35,017 59 1935 191 60 3,229 58 33,884 57 The highest number of deaths among infants under one year were those relating to enteritis and premature birth which were 31 and 28 respectively. The following table gives the Ward distribution of deaths. 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 5 2 9 210 16 2 2 1 9 174 12 3 3 4 3 145 10 5 4 184 12 4 3 10 3 2 5 5 190 6 178 10 7 - 3 5 7 205 13 3 5 8 180 15 6 1 8 9 202 18 6 4 8 10 101 5 2 2 1 4 1 11 155 7 2 1 1 12 149 3 1 4 1 2 13 125 7 154 13 2 6 14 5 4 2 1 1 15 201 157 9 3 4 2 16 155 12 5 2 5 17 4 2 1 1 18 144 5 1 3 1 19 111 35 6 2 1 3 20 Neo-natal Deaths. These are deaths occurring in the first four weeks of life. In 1935 the number of deaths registered of infants under 1 month old was 73, representing a neo-mortality rate of 23.1 as compared with 65 deaths and a rate of 20.6 in 1934. The classification of these cases in groups of causes of death is shown in the following summary:— 1. Difficult Labour. Trauma at birth 8 2. Foetal States. Congenital defects 13 Atelectasis 1 Atrophy, debility and marasmus 7 Asphyxia neonatorum 4 3. Prematurity 27 4. Other causes 13 Diarrhoea and Enteritis. The number of deaths of children under two years of age from diarrhoea and enteritis was the same as in 1934, viz., 35. The following table shows the monthly distribution of these deaths, and in this connection it is interesting to observe that the hot summer did not appear to influence the number of deaths from these causes. Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 1 2 5 3 2 2 1 3 3 2 5 3 35 13 INFANTILE MORTALITY TABLE. Deaths from Stated Causes at Various Ages under One Year of Age, 1935. Cause of Death. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 1 month. 1 to 3 months. 3 to 6 months. 6 to 9 months. Smallpox - - - - - - - - Chicken Pox - - - - - - - - Measles - - - - - - - - Scarlet Fever - - - - - - - - 6 Whooping Cough - - - - - - 2 - Diphtheria and Croup - - - - - - - Erysipelas - - - - - - - - Tuberculous Meningitis - - - - - - - - Abdominal Tuberculosis - - - - - - - - 1 Other Tuberculous Diseases - - - 2 - - - Meningitis - - - - 1 - - - Convulsions 1 - - - 1 1 - - Laryngitis - - - - - - - - Bronchitis - - 1 - 1 2 3 2 Pneumonia - 1 - - 1 - 1 - Diarrhoea - - - - 1 - 2 - Enteritis - 1 9 1 1 3 8 9 Gastritis - - 1 1 - - - - Syphilis - - - - - - - - Rickets - - - - - - - - Suffocation 3 1 - - 4 - - - 1 Injury at Birth 7 1 - - 8 - - 1 Atelectasis 1 - - 1 3 - - Congenital Malformation 12 1 - 13 6 3 - - Premature Birth 22 3 - 2 27 - - 1 Atrophy, Debility, &c. 5 - 7 6 1 1 2 - Other Diseases 2 1 2 5 3 12 4 - 1 2 8 7 1 Broncho-pneumonia - - 1 Acute Lobar Pneumonia - - - - - - - - Influenza - - - - - - - - Totals 54 10 3 6 73 39 39 29 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Laboratory Facilities. Bacteriological examinations are carried out by the Council's Bacteriologist, Dr. Guy Bousfield, at his laboratory 134, Denmark Hill, S.E.5, and the chemical analysis of food and drugs is undertaken by the Public Analyst, Mr. Martin Priest, at his laboratory 4, Obelisk Parade, Lewisham. A description of the specimens and articles submitted for examination by these Officers of the Council appears in the tables on pages 74, 75 and 94. Ambulance Facilities. Ambulances for the removal of infectious, non-infectious, accident and maternity cases are provided by the London County Council. Nursing in the Home. The following District Nursing Associations perform home nursing services in various parts of the Borough : — Ranyard Nurses. Camberwell District Nursing Association. Rotherhithe District Nursing Association. The Catholic Nursing Institute. The Brixton Nursing Association. The East Dulwich and Dulwich Village Nursing Association. Clinics and Treatment Centres. Name and Situation. Ante-natal Clinics. By whom provided. Sessions. Camberwell Borough Council. Second and fourth Thursdays in every month at 10.30 a.m. Camberwell Municipal Centre, 140, Camberwell Road. Bird-in-Bush, 616, Old Kent Road. Voluntary Infant Welfare Association. Every Friday at 2 p.m. St. Giles' Hospital, Camberwell. London County Council. Monday, Wednesday and Friday at 1.30 p.m. Dulwich Hospital, East Dulwich Grove. Do. Monday, Tuesday, and Friday, at 1.30 p.m. Thursday (new cases) at 1.30 p.m. Post-Certificate Midwifery School, 77, Southampton Street, Camberwell. General Lying-in Hosp., Lambeth. Monday, Tuesday and Friday at 2 p.m. Minor Ailments Clinic for children under 5 years. Camberwell Municipal Infant Welfare Centre, 140, Camberwell Road. Camberwell Council. Borough Daily 9-10 a.m. Daily 9.30-10.30 a.m. Cambridge House Infant Welfare Centre, 6, Addington Square, S.E.5. Cambridge Voluntary House — Association. Diphtheria Prevention Clinic. Every Wednesday at 2.30 p.m. Camberwell Municipal Centre, 24, Mayward House, S.E.5. Camberwell Council. Borough Artificial Sunlight and Rheumatism Clinics. British Red Cross Society. Daily (except Saturday), 9 a.m. to 8.30 p.m. British Red Cross Society, 160, Peckham Rye. Tuberculosis Dispensary. 19, Brunswick Square, S.E.5. Camberwell Borough Council. 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. Cleansing Station for Verminous Persons. Peckham Park Road Depot. Camberwell Borough Council. Daily—Tuesday, Wednesday and Thursday (Vermin). Children, 9 a.m. to 4 p.m. Adults 4 to 5 p.m. Monday and Friday (Scabies). Children, 9 a.m. to 4 p.m. Adults, 4 to 5 p.m. Adults, Saturday 9-12 noon. School Treatment Centres. Camberwell Treatment Centre, 7, Addington Square, S.E.5. Aural —Tuesday (once a month), 2 p.m. (Operationsalternate Wednesdays, 2 p.m., at Hanover Park.) Minor Ailments.—Monday, Wednesday and Friday, 3.30 p.m. Dental. —Monday, Tuesday, Wednesday, Thursday and Friday (once a month), 9.30 a.m., Monday, Wednesday, Thursday (once a month), and Friday, 1.30 p.m. Gas —Thursday (3 times a month), 1.30 p.m. and Friday (3 times a month), 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, 1.30 p.m. Peckham Treatment Centre, 412, Old Kent Road, S.E.1. 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. (Operations— Alternate 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.—Tuesday (once a month), 2 p.m. (Operations— Alternate Thursdays, 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. Large hall; weighing room; consultation room; dental work room. During Med. Sessions. St. Antholin's, 22, Linden Grove Church Hall, Barforth Road and rooms in Institute, 22, Linden Grove. do. Tuesday, Thursday and Friday. Health Propaganda. Among the important sections of the work of the Public Health Department is that of educating the public in matters appertaining to their health. A large amount of invalidism among the population could be prevented if the individual would take an interest in the principles and practice of hygiene. Health topics of interest and importance are brought to the attention of the public by the distribution of the Camberwell edition of the Monthly Journal Better Health, a journal published by the Central Council for Health Education. Two thousand five hundred copies of this publication are received each month at the Public Health Department, and distribution is arranged through the following agencies:— Infant Welfare Centres; Tuberculosis Dispensary; Libraries; Schools, and Factories in the Borough. Posters are displayed and leaflets distributed containing useful information on the subjects of diphtheria prevention, tuberculosis, cancer, measles, whooping cough, simple diets and cooking. Talks to mothers at the Infant Welfare Centres, and daily instruction to mothers in their own homes on health matters by the Health Visitors are also included in the Council's activities of health education. During the year the Council authorised the re-publication of the Health Handbook which contains useful hints for the expectant and nursing mother; advice on the subject of the rearing of infants, and references to domestic hygiene. Information is also included in respect of the health services of the Council. Cleansing Station. The Cleansing Station situated in Peckham Park Road consists of a nurses' room, a reception room, a bathroom with two baths and a discharge room. The present building is old and is not satisfactory for the purpose for which it is used, and should be replaced by a modern building with up-to-date equipment. At the time of preparation of this report a scheme is being prepared which will include the erection of a new Disinfecting and Cleansing Station on the site of the existing buildings. The following table gives particulars of the number of persons who attended at the Cleansing Station during the year 1935: — Persons cleansed, verminous— Adults — Males 5 Females 1 Children — Males 458 Females 1,904 Total 2,368 B2 19 Persons cleansed, scabies — Adults — 30 Males 16 Females Children — 1,054 Males Females 1,373 Total 2,473 Public Mortuary. A refrigerating plant, designed for the reception of nine bodies was installed at the public mortuary in 1934 and has proved extremely satisfactory. This plant has enabled bodies received in varying stages of decomposition to be kept for an indefinite period without further physical changes taking place. The Coroner's Court at St. George's Road, Peckham adjoins the mortuary buildings. A monthly summary of the bodies received at the mortuary during 1935 appears on the following page:- MORTUARY RETURN. Month. Males. Residents. Females. Inquests. Postmortems Courts. Outside Borough. Number. P.-M.'s. Total. January 24 14 38 25 18 14 17 21 8 February 26 22 27 11 26 13 13 39 9 March 24 20 11 27 15 18 42 30 10 April 23 16 39 20 28 10 20 19 13 May 22 18 40 20 25 12 20 20 15 21 June 21 15 36 23 20 9 22 14 8 July 24 27 51 28 35 11 21 30 10 August 29 45 28 24 10 24 16 21 11 September 15 16 31 18 18 6 20 11 5 October 19 19 33 7 20 27 46 26 13 November 19 37 18 21 19 18 18 6 12 December 36 23 59 27 38 14 30 29 19 Totals 290 213 503 268 317 121 281 222 133 Number of these Births duly entered by January 31st, 1936, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on January 31st, 1936, remained unentered in the "Vaccination Register" on account (as shown by "Report Book") of Number of these Births remaining on January 31st, 1936, neither duly entered in the "Vaccination Register" (columns, 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the "Report Book" (columns 8, 9 and 10 of this Return). Total number of Certificates and copies of Certificates of Successful Primary Vaccination of Children under 14 received during the Calendar Year 1935. Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate, during the Calendar Year 1935. The latest annual return available respecting the vaccination of children whose births were registered in the Borough relates to the year 1934. This return indicates that 38 per cent. of the children registered were successfully vaccinated and that 41 per cent. were exempted vaccination on the production of a statutory declaration of conscientious objection. No legal proceedings were taken for non-compliance with the provisions of the Vaccination Acts. Registration Sub- Districts comprised in the Vaccination Officer's District. Number of Births returned in the "Birth List Sheets" as registered from January 1st to December 31st, 1934. Vaccination. Col. I. Successfully fully Vaccinated. Col. II. Col. IV. Number in respect of whom Statutory Declarations of Conscientious tious Objection have been received. Col. V. Died unvaccinated. cinated. Postponement ment by Medical Certificate. Removal to Districts the Vaccination Officers of which have been duly apprised. Removal to places unknown, or which cannot be reached: and Cases nothaving been found. Insusceptible of Vaccination. Had Small Pox. 22 1 3 4 5 6 7 8 9 10 11 12 13 These figures are to be obtained from columns 2 and 6 of the Summary (Form N.) 2 3 1. North West Camberwell 1,373 43 520 5 - 553 81 136 32 1,531 1,278 2. St. George's 408 141 - 197 17 2 6 - 3 42 - 249 18 1 4 37 3. Peckham 481 167 - 5 4. Dulwich 46 2 9 781 1 - 264 37 84 338 Total 3,043 1,166 6 - 1,263 162 76 299 63 1,531 1,278 8 Public Vaccinators. A table showing the number of persons successfully vaccinated and re-vaccinated by the Medical Officers of Institutions and the Public Vaccinators during the year ended December 31st, 1935, appears on this page. PUBLIC VACCINATORS—RETURN OF WORK, 1935. Number Of Persons Successfully Vaccinated And Re-Vaccinated By The Medical Officers of Institutions And The Public Vaccinators During The Year Ended December 31st, 1935. Number of successful Re-vaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. 9 69 6 3 10 25 6 6 4 - Numbers of successful Primary Vaccinations of persons:— One year and upwards. 25 6 2 23 8 19 4 1 - 88 Under one year of age. 119 116 24 172 147 233 - 4 - 815 Name of the Medical Officer or Public Vaccinator. Dr. A. B. Blomfield Total Dr. H. O. West Dr. O. W. Roberts Dr. G. H. Fisher Dr. G. W. FitzHenry Dr. H.J. Gater Dr. A. E. McMillan Dr. O. W. Roberts Dr. E. W. G. Masterman Name of Institution or Vaccination District. Peckham District Nunhead District Dulwich District St. George's District East Dulwich District Camberwell District St. Giles' Hospital Dulwich Hospital Constance Road Institution MATERNITY AND CHILD WELFARE SERVICES. The Council's existing Maternity and Child Welfare Scheme can be summarised under the following headings :— 1. Maternity. (a) Medical examination and supervision of pregnant women, and following confinement, at ante-natal and post-natal Clinics held at Infant Welfare Centres and at the L.C.C. St. Giles' and Dulwich Hospitals. (b) The services of a Consultant at the request of a private medical practitioner for any condition arising during pregnancy, parturition or during the puerperium of patients confined at home. (c) Home visits by Health Visitors to pregnant women. (d) Payment of midwives' fees for confinements of necessitous persons in their homes. (e) Payment of compensation to midwives for loss of patients. (f) Provision of sterilised maternity outfits. (a) Provision of Home Helps. (h) Provision of nursing assistance for mothers. (i) Convalescent home treatment for expectant and nursing mothers. (j) Provision of milk and dinners for necessitous mothers. (k) Education on health matters. (I) Investigation of maternal deaths and cases of puerperal fever and puerperal pyrexia. (m) Contribution towards the cost of institutional maintenance of unmarried mothers. 2. Infants and Young Children. (a) Notification of Births Act administration. (b) The provision and maintenance of Infant Welfare Centres. (c) Home Visits by Health Visitors to infants and young children. (d) Convalescent home treatment for children. (c) The supply of milk to children of necessitous parents. (f) Provision of nursing assistance for patients suffering from certain diseases. (g) Treatment of minor ailments. (h) Infant Life Protection. During 1935 the Council had under consideration Ministry of Health Circular 1433 and the Memorandum 156/M.C.W. which contained suggestions for improving and developing the Maternity Services of Local Authorities, and this Authority decided to extend the existing midwifery services of the Borough by the promotion of schemes for the provision of home helps; the supply of meals to expectant and nursing mothers ; the issue of anti-streptococcic serum and the provision of additional facilities for ante-natal and post-natal examination including payment to midwives for loss of patients recommended to enter hospitals for their confinements. Infant Welfare Centres. There are ten Infant Welfare Centres in the Borough staffed by temporary part-time Medical Officers. Four of these Centres are Municipally directed, the remainder being conducted by Voluntary Associations supported by grants made by the Council. Each Infant Welfare Centre serves a defined district and mothers are encouraged to attend the Centre for the area in which they live. The work carried out at the Infant Welfare Centres during the year is shown in the tables appearing on pages 36 and 37. The number of first attendances of infants and children during 1935 was 2,608 as compared with 2,398 in 1934. The total attendances numbered 51,938 as compared with 51,662 in 1934. In the early part of the year the Union of Girls' Schools' Authorities gave notice of their intention to close the Infant Welfare Centre at 24, Mayward House at the end of the June quarter, and to discontinue maternity and child welfare services in the area from that date. The Council therefore decided to continue the work in this part of the north-west area of the Borough under Municipal auspices, and a tenancy agreement was entered into with the London County Council, the owners of the centre premises, such agreement operating from the date of vacation of the premises by the Union of Girls' Schools' Association. The Maternity and Child Welfare Committee have also had under consideration the question of finding a suitable site for the erection of an Infant Welfare Centre to replace the Centre at 140, Camberwell Road, where the accommodation leaves much to be desired. Various sites have been inspected in No. 1 Ward for this purpose, and at the time of the preparation of this report, this matter was still under consideration. Treatment of Minor Ailments. Medical and surgical treatment for minor ailments is available at the following Infant Welfare Centres : — . Camberwell Municipal ... Daily 9.30 to 10.30 a.m. Cambridge House Do. do. Ante-Natal Services. In the early part of the year the Council entered into an arrangement with the London County Council for a period of one year for the use of that authority's ante-natal clinics at St. Giles' and Dulwich Hospitals, for the medical examination, including dental treatment, and supervision of pregnant women, who have arranged to be confined in their own homes either by a private medical practitioner or a practising midwife. Consultations are also held at the Municipal Ante-Natal Clinic, 140, Camberwell Road, and at the Voluntary Association Clinic, 616, Old Kent Road. Expectant mothers are also supervised by the Medical Officers at the Cambridge House and the Kempshead Hall Voluntary Centres at the regular Infant Clinic Sessions. These arrangements offer an efficient ante-natal care service to every pregnant woman in the Borough who prefers to remain at home for her confinement, but unfortunately the attendances at the hospital clinics during the year were extremely disappointing as the information provided in the following return shows. Ante-Natal Clinics Return. Clinic. No. of patients who attended. No. of attendances paid by patients. St. Giles' Hospital 35 81 1 1 Dulwich Hospital Municipal Infant Welfare Centre, 140, Camberwell Road 29 41 Bird-in-Bush Voluntary Association Infant Welfare Centre, Old Kent Road 252 427 General Lying-in Hospital Post-Certificate School, Southampton Street 342 4,321 These figures do not include the number of women who made arrangements to enter St. Giles' and Dulwich Hospitals for their confinements and who received ante-natal supervision at these hospitals. Post-Natal. Post-natal clinic services are also included in the St. Giles' and Dulwich Hospitals Scheme of supervision of patients referred to these hospitals by private medical practitioners and practising midwives under the terms of the agreement existing between the County Council and this Authority. Post-natal care is essential in order to promote recovery of overstretched muscles, for the treatment of injuries, displacements ; chronic infections, and other sequelae resulting from child-bearing. During the year the Health Visitors, at their first visit to the patients' homes, advised 700 mothers to seek medical attention owing to the state of their health after confinement. Pre-School Child (Toddler). The large number of children found every year to have physical defects at their first medical examination in school acquire these defects during the age when they are under the supervision of the child welfare authority. It is in this period of life that infirmities such as postural errors, rickets, defective teeth, and tonsils and adenoids make their appearance. Many of these defects could be prevented by an adequate system of medical supervision during the pre-school period. This condition of affairs naturally raises the question, what are we doing and what further can we do for the pre-school child ? The supervision of the toddler can be secured through the medical sessions at the Infant Welfare Centres which are available not only for infants under one year, but also for pre-school children. It is disappointing to find that the number of toddlers attending the general clinic session is small. In 1935 the number of individual children between one and five years attending the various Centres in Camberwell was only 3,533. Sessions for toddlers are now held at two of the Voluntary Association Welfare Centres in the Borough. The number of individual children who attended these special sessions during 1935, of which there were three in existence up to the time of the transfer of the Mayward House Infant Welfare Centre to Municipal control in June last, was 1401. The total attendances of these children numbered 2,347. Some years ago a special toddlers clinic was started at the Peckham Municipal Centre, and parents were invited by letter to bring their children for examination on their birthdays. By means of the departmental record of births the invitation to the parents was timed to reach the child on the morning of its birthday. This form of propaganda was not, however, a great success, and it was found after an extended trial that the attendances did not justify the continuance of this Clinic for Toddlers only. It was decided, therefore, to discontinue this clinic, and to make use of the premises in the afternoon set apart for this purpose as an ordinary infant welfare session in order to relieve the congestion existing at the weekly session at this Centre. The decision reached in this matter was that the lack of support accorded this Clinic for Toddlers was to some extent due to the inability of the mothers to find time to bring their older children for examination on the special clinic day. The real reason was in all probability the absence of appreciation on the part of the mothers that the medical supervision and other services obtainable at the Centre are as necessary for the toddler as for the infant. The Health Visitors were accordingly instructed to intensify their efforts to encourage mothers to bring their toddlers to the clinics. This form of propaganda has been supplemented by sending a birthday card to every child in the Borough on reaching its first birthday on which the question is asked —Is the child taken to an Infant Welfare Centre and has it been protected against diphtheria ? Should this propaganda result in a substantial increase in the number of toddlers' attendances at the general medical sessions further consideration will have to be given to the question of the establishment of “ Toddlers” clinics. Toddlers Visitations. The number of visits paid by the Health Visitors to toddlers during the year was 20,539. Mothers were invited at these visits to bring their children to the Infant Welfare Centres. These visits also provided the opportunity to the Health Visitor of influencing the mothers to seek appropriate treatment for any physical defects discovered in the child. Facilities for the supervision of toddlers are also available at day nurseries, nursery classes and nursery schools. The authority responsible for the establishment of day nurseries for infants under school age is the Maternity and Child Welfare Authority, nursery classes and nursery schools are supervised by the local Education Authority. Experience has shown that these institutions have frequently to be closed owing to an outbreak of infectious disease. Nevertheless marked improvement in health, intelligence and happiness results in children attending day nurseries. Nursery classes established in public elementary schools for infants from 3 to 5 years of age also play their part, but have at the present moment limitations which cause them to be less valuable than nursery schools. Educational establishments for infants from 2 to 5 years of age not only assist in the work of prevention of physical deterioration but they also serve as training centres for the mental development and habit formation of the child. Toddlers Clinics. Attendances Table. Number of Individual Children attending these Sessions. Number of Sessions held 1935. Total Attendances. Infant Welfare Centre. Amott Road 1,073 50 601 Bird-in-Bush 47 370 793 23 430 481 Mayward House, Brunswick Square Mothercraft and Health Talk Sessions. Classes in mothercraft are held at various Centres where an opportunity is taken of demonstrating to expectant and nursing mothers garments suitable for infants; facilities are also provided at these sessions for making garments under supervision. Talks on the principles of health, and on occasions formal lectures, are also given. The following table summarises the number of sessions and attendances recorded at these sessions during the year. Infant Welfare Centre. No. of Sessions. No. of attendances. Dulwich Municipal 47 579 Bird-in-Bush 96 1,421 11 Kempshead Hall 180 St. Luke's 31 486 Convalescent Home Treatment. During 1935 arrangements were made for the convalescent treatment of 22 nursing mothers with their babies, and 15 children under 5 years of age. All cases requiring convalescent treatment are recommended by the Medical Officers at the Infant Welfare Centres. Patients were sent to the following homes :— All Saints' Hospital, Eastbourne. Women's Holiday Home, St. Leonards-on-Sea. London Mothers' Convalescent Home, Sunningdale. Hertfordshire County Council Home, St. Leonards-on-Sea. A contribution towards the cost of the treatment is recovered from the applicant whose financial circumstances permit of the payment of a proportion of the charges. Home Nursing. The fee paid by the Council to the District Nursing Associations undertaking home nursing services at the request of private medical practitioners and clinic medical officers is one shilling per visit less contributions made by the patients or their relatives towards the cost of the services provided. The East Dulwich and Dulwich Village Nursing Association renders professional nursing services in the homes without financial assistance from this Authority. No grant is made by the Council to the Nursing Associations for general nursing services. The nature of the illnesses eligible for payment by the Council are maternity and infectious diseases arising therefrom ; specified diseases in children under five years such as measles, whooping cough and epidemic diarrhoea, and diseases notifiable under the Public Health Infectious Diseases (London) Regulations, 1927, referred to the Nursing Associations by the Public Health Department, Hospitals and general practitioners. Home Nursing Services. Visits Table. — f No. of cases nursed. No. of visits paid. 48 753 Maternity nursing 30 676 Ophthalmia Neonatorum 22 208 Measles 5 44 Whooping Cough 43 726 Pneumonia Provision of Milk to Necessitous Expectant and Nursing Mothers and Children under 5 years of age. The beneficial influence of grants of milk has been proved without doubt. During the year the Council reviewed the existing scheme for the provision of milk to necessitous expectant and nursing mothers and children under 5 years of age, and decided to modify the scheme as follows : — (a) That milk either wet or dried to be supplied upon the production of a certificate from the Medical Officer of Health or the Medical Officer of an Infant Welfare Centre recommending the issue of milk. (b) That the applicant shall be entitled on the production of a medical certificate and such application approved by the Maternity and Child Welfare Committee to receive wet or dried milk as he or she desires and in the cases of applications for dried milk the applicant shall be entitled to receive the brand he or she desires. (c) That in the case of wet milk the milk shall be pasteurised or humanised milk supplied by a licensed vendor of pasteurised milk at the home of the applicant; and in the case of dried milk at the Infant Welfare Centre at which the applicant attends, or at the Town Hall if more convenient to the applicant. Midwives. There were 31 midwives in private practice who notified the London County Council, the supervising authority for midwives, of their intention to practise in the Borough during the year. The number of births attended by midwives was 947 which represents 31.3 per cent, of the total births notified during the year. The Council requested the Metropolitan Boroughs' Standing Joint Committee to consider the advisability of Metropolitan Borough Councils as a whole preparing in co-operation with the London County Council a scheme for the provision of midwives either salaried or subsidised throughout the area of the administrative County of London. The establishment of a salaried service of midwives in Camberwell would undoubtedly improve the midwifery services available, and would also assist in the effort which is being made to secure a reduction in the maternal mortality and morbidity rates. Such a service would also enable the advantages of the antenatal and post-natal services established by the Council at St. Giles' and Dulwich Hospitals to be fully secured, as this scheme would ensure the provision of skilled attendance at fully equipped clinics for the patient who cannot afford to pay for such services. Further, the salaried midwife would be available to act when required as a maternity nurse for patients who engage a medical practitioner for their confinement but whose financial circumstances do not allow of the payment for a trained nursing attendant. Midwifery Assistance. During the year 5 applications were received under the Council's Scheme which provides for the payment of the whole or part of the fees of a midwife for professional services rendered to necessitous mothers who are unable to pay for such services, and the appropriate Committee authorised payment in full of the midwife's fee in every instance following investigation into the economic circumstances of the applicant. Provision of Meals to Necessitous Expectant and Nursing Mothers. At the end of the year arrangements were made by the Council with the Invalid Kitchens of London to supply midday meals at their local kitchen, 10a, Huguenot Road, Peckham, to expectant and nursing mothers in necessitous circumstances for whom such meals were recommended by the Clinic Medical Officer of an AnteNatal Clinic, or the Medical Officer of an Infant Welfare Centre. The Milk Applications Sub-Committee were authorised to consider applications received and to deal with them on similar lines to applications received in connection with the Council's Milk Distribution Scheme. Although only two applications for dinners were granted during the period to which this report refers, the Scheme is becoming deservedly popular, and at the time of writing applications are considered weekly by the appropriate Committee. There is no doubt that this addition to the Maternity and Child Welfare Services of the Council is much appreciated by Clinic Medical Officers and the patients. Home Helps. During the year arrangements were made by the Council for the provision of Home Helps at the homes of patients during pregnancy and/or childbirth. The Maternity and Child Welfare Committee was authorised to appoint suitable persons to be placed on a Panel and to make the necessary administrative arrangements in order to give effect to the scheme. The Committee decided to establish the following conditions in connection with this service : — (a) The Home Help to be selected by the patient from a panel to be provided by the Council of persons willing to undertake these duties. (6) The Home Help, before taking up her duties, to be approved by the Medical Officer of Health after a satisfactory report from the Health Visitor as to character and proof of practical experience in domestic duties. (c) The Home Help to be supervised during the performance of her duties by a Municipal Health Visitor. (d) The period of engagement of a Home Help to be for a period of two weeks, subject to variation in exceptional medical circumstances, the working time not to exceed forty hours per week unless specially authorised. (e) Payment for such services to be at the rate of 1s. per hour with a maximum of £2 per week. (f) Payment by the Council to the Home Help on receipt of a weekly time sheet duly certified. (g) Recovery from the patient of all or part of the cost of the services provided, to be judged on the merits of each case. The income scale as applied to the Milk Distribution Scheme to serve as a guide in the assessment of charges for such services. The duties of a Home Help are as follows : — On being summoned to the case, she must as soon as possible inform the Medical Officer of Health at the Town Hall. A stamped addressed envelope will be given for this purpose. She must not attend the case until the confinement is over, unless her services are specially authorised during pregnancy, and such services are only to be given as required between the ho11urs of 7 a.m. and 7 p.m. (except in special circumstances). A Home Help must, however, attend the home of the patient not later than 8 a.m. each day after the day of confinement. She is only expected to attend for a period of 40 hours per week for two weeks. Any time in excess of this will not be paid for unless special authority is given. The times of attendances must be entered on a time-sheet daily, which sheet should be signed by the patient or some responsible person on her behalf and presented at the Town Hall for payment as each week is completed. The duties consist of general home management, including cooking, marketing, not more than two weeks' washing, and the care of the children (she will not undertake arrears of washing). A doctor and a nurse, or midwife will be in attendance, and it must be fully understood that no nursing duties are to be undertaken by the Home Help. If there are not suitable facilities for washing in the house, the Home Help will wash elsewhere (Baths, etc.) and out-of-pocket expenses, if any, will be paid. Patients are not expected to provide meals for Home Helps. A Home Help must undertake to inform the Medical Officer of Health at once in writing if for any reason she is unable to carry out the duties ; also that she will not attend other confinement cases while engaged at the home of a patient. Institutional Provision for Unmarried Mothers. An annual contribution towards the cost of the maintenance of unmarried Camberwell girls in suitable homes is made by the Council to the Southwark Diocesan Association for Preventive and Rescue Work. Health Visiting. At the end of the year there were four municipal Health Visitors and ten Health Visitors employed by voluntary associations undertaking Maternity and Child Welfare duties in the area The Council's Infant Life Protection Visitor also devotes part of her time to visiting children under 5 years of age in the extreme south of the Borough, and cases of ophthalmia neonatorum. A standard of one Health Visitor to 250 births is considered reasonable. The number of births registered in 1935 was 3,155. The Health Visitors divide their time between attendance at Clinic Sessions at the Infant Welfare Centre and visiting the homes of mothers and children in the district. The number of visits recorded in 1935 to children and expectant mothers was 36,465 and 3,576 respectively.A summary of the attendances and visits in respect of each Infant Welfare Centre in the Borough appears on pages 36 and 37. Infant Life Protection. This important branch of Child Welfare work received the usual care and attention. At the end of 1935 the names of 122 persons appeared in the register of foster mothers. These persons collectively have in their care 177 children under the age of 9 years The corresponding figures for 1934 were 119 foster mothers and 133 foster children. The Infant Life Protection Visitor who is a qualified Health Visitor pays frequent visits to every home where a foster child is kept for reward. The number of visits paid was 1,087. The houses of 59 new foster mothers were inspected by the district Sanitary Inspectors before the arrival of a foster child, who furnished in each case a report as to the suitability of the premises. These reports are required in addition to the reports of the Protection Visitor. All foster mothers are urged to take the foster children under school age in their care to the Infant Welfare Centre in the district in which they live. The departmental records show that 93 of these children attended the Infant Welfare Centre during 1935 for the district in which they live. Notices of removal of foster mothers and children to other Boroughs were notified to the Medical Officer of Health concerned. Section 6 (1) of the Children Act, 1908, requires the death of a foster child to be reported to the Coroner for the district; there were, however, no deaths of foster children to record in 1935. Apart from the following technical offences by foster mothers during the year, it was necessary in four cases to take steps to secure the removal of a foster child to more suitable surroundings. Neglecting to notify the acceptance of a nurse child for reward 2 Failing to give the required notice of change of address ... 2 Infant kept in excess of number fixed 1 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 72 Subsequent visits to infants under 1 year of age 287 Number of visits to children 1 to 5 years of age 526 Number of visits to children 5 to 9 years of age 146 Special visits 56 C2 35 INFANT WELFARE CENTRES—CLINIC ATTENDANCES, Etc., 1935. Infant Welfare Centres. Under 1 Year. Between 1 & 5 Years. Miscellaneous. Total Attendances. Analysis of Attendances, Children. Ante-Natal Clinic Attendances. Treatment Centre for Minor Ailments. Post-Natal Mothers for Advice Own Health. Weighings only. Health Talk and Mothercraft Sessions. First Attendances. Subsequent Attendances. First Attendances. Subsequent Attendances. Doctors' Consultations. Seen by Health Visitor. Camberwell Municipal, 140, Camberwel Road, S.E.5 162 1,954 31 1,380 298 2,254 1,273 39 35 — 3,825 220 - Duhwich Municipal, 114, Lordship Lane, S.E.22 214 3,010 39 1,935 252 5,450 2,782 2,416 - - - 388 579 Mayward House Municipal, Brunswick Square, S.E.5 311 3,947 54 2,116 63 6,491 2,658 3,770 - - - - 65 Peckham Municipal, Clifton Congregational Church Hall, Asylum Road, S.E.15 233 3,201 24 1,447 335 5,240 2,284 2,621 - - - - - Bird-in-Bush, 616, Old Kent Road. S.E.15 264 2,982 44 1,852 - 5,142 3,133 2,009 - - 334 1,421 393 Cambridge House, 6, Addington Square, S.E.5 155 2,392 30 1,771 - 4,348 1,791 2,557 - - 222 - - Kempshead Hall, Kempshead Road, S.E.5 134 2,095 21 1,273 - 3,523 1,281 2,242 - - 436 180 174 St. Antholin's, 22, Linden Grove, S.E.15 285 4,356 - 7,558 2,721 4,215 622 - 512 - 51 2,860 - St. Luke's, 2, Commercial Road, S.E.15 167 2,372 27 1,552 4,118 1,578 - - - 244 2,540 486 - Union of Girls' Schools, 60A, Amott Road, S.E.15 280 3,710 82 6,243 2,201 393 - 4,042 - 2,171 - - - 2,205 30,019 403 18,363 948 51,938 23,645 26,723 622 432 471 2,552 2,666 HEALTH VISITORS-RECORD OF VISITS, 1935, To Expectant and Post-Natal Mothers and Children. Infant Welfare Centres. To Post-Natal Mothers. No. Births reported in the Area. Miscellaneous Visits. Visits by Voluntary Helpers. To Expectant Mothers. To Children. Analysis of Visits to Children. Under 1 Year. Between 1 and 5 Years. Total Visits. Under 1 Year. Between 1 and 5 Years. First Visits. Subsequent Visits. Attending Centre. Not Attending. Centre. Attending Centre. Not Attending Centre. Camberwell Municipal, 140, Cainberwell Road, S.E.5 337 200 210 242 778 3,020 776 395 334 - 2,000 236 1,613 Dulwich Municipal, 114, Lordship Lane, S.E.22 122 387 445 441 255 1,657 2,353 378 1,082 206 - 217 320 Mayward House Municipal, Brunswick Square, S.E.5 436 420 393 388 754 2,618 880 1,179 127 47 1,476 246 313 Peckham Municipal, Clifton Congregational Church Hall, Asylum Road, S.E.15 324 314 317 1,074 2,257 966 132 993 371 - 846 337 166 Bird-in-Bush, 616, Old Kent Road, S.E.15 347 26 383 355 2,379 3,621 6,355 1,473 1,261 2,319 1,302 - - Cambridge House. 6, Addington Square, S.E.5 144 214 174 222 2,016 3,606 847 908 - 220 1,109 1,368 742 Kempshead Hall, Kempshead Road, S.E.5 138 203 190 3,846 833 876 1,385 - 130 218 2,261 1,367 752 St. Antholin's, 22, Linden Grove, S.E.15 704 512 429 4,249 1,027 1,200 1,247 - - 436 1,366 2,447 775 St. Luke's, 2, Commercial Road, S.E.15 508 244 249 2,132 4,097 1,667 588 16 - 247 1,718 712 1,130 Union of Girls' Schools, 60A, Amott Road, S.E.15 393 365 4,064 1,139 795 - 178 1,433 516 362 2,269 656 1,474 3,576 2,913 3,155 3,248 20539 36465 9,669 7,846 12,514 575 12678 6,080 1,054 SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. With few exceptions the water supply to premises in the Borough is provided by the Metropolitan Water Board. During the year certificates stating that the premises to which the certificate referred was provided with a suitable and sufficient water supply were issued in respect of 431 newly erected houses and tenements. Complaints of defective water fittings at 94 premises in the Borough were forwarded during the year to the Metropolitan Water Board for attention. Drainage and Sewerage. Every house in the Borough, except in a few instances in the outlying parts of Dulwich, is connected with the water carriage system for the disposal of sewage. The number of complaints received during the year alleging that the drains of the premises were in a defective condition was 70. The extent of drainage operations carried out in the Borough in 1935 was as follows :— Reconstruction of the drains of the premises, 115. Partial reconstruction of drains, 526. These works were carried out under the supervision of the Sanitary Inspectors. In 5 instances cautions were sent at the direction of the Public Health Committee to builders who failed to submit plans of drainage work executed by them. Cautions were also administered to 5 builders for carrying out work to drains and sanitary fittings without giving notice to the Sanitary Authority During the year the drains of 16 premises which were adjudged to be sewers were repaired by the Borough Engineer and Surveyor on behalf of the Council. The reconstruction of 7 of the Council's sewers was also carried out during the year, and 458 brick road gullies were replaced by pot gullies. 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 12 male and 1 woman Sanitary Inspectors and 2 Housing Inspectors on the Staff of this Department. A summary of the inspections carried out by these Officers appears on pages 40 and 41. 40 41 SUMMARY OF SANITARY WORK CARRIED OUT DURING THE YEAR 1935. Inspectors. Attwatere. Watkins. Topping. Burrell. Maughan. Malins, L. Green. Malins, M. Worsfold. Dobson. to 30/11/35. O'Riordan. (Miss) Gilchrist. Weaver. Pickard. Leonard. to 30/11/35. Totals. J I J J. I Description of Sanitary Improvements effected during the Year — 343 391 302 26 9 19 376 240 334 202 231 15 198 300 45 Number of rooms cleansed 3,031 Defective roofs repaired or rainwater pipes provided or repaired 13 184 240 233 135 145 97 217 211 1 12 8 13 247 212 1,968 4 3 11 222 143 8 115 124 93 93 117 180 169 122 Dampness abated 1 1,405 54 5 1 - 10 119 53 56 83 65 73 Yards and forecourts paved or paving repaired 65 97 61 - 742 - 22 16 18 47 12 21 7 20 13 - 1 - - 25 Water fittings repaired 202 - 4 20 4 10 5 15 - 1 15 20 8 13 - Drains entirely reconstructed - 1 9 44 49 40 21 115 1 65 3 117 74 Drains partially reconstructed 18 84 - - 526 5 54 143 Soil, vent pipes, sinks and waste pipes renewed or repaired 5 1 3 57 108 83 113 106 2 69 118 91 19 7 256 958 13 18 173 162 249 245 93 157 128 231 Premises in which repairs were effected to w.c.'s 207 45 101 2,003 2 22 129 81 103 60 Dustbins provided 9 6 64 59 67 135 132 - 970 10 10 132 236 92 198 20 8 178 68 117 189 Repairs effected to windows 101 182 2 88 160 1,543 14 5 8 3 48 171 99 56 58 Stoves and coppers repaired 88 101 98 2 999 75 Flooring repaired or renewed, repairs to woodwork (stairs, etc.) 188 7 5 135 91 124 6 11 93 119 14 5 126 1 63 3 12 4 1,126 1 1 8 4 - Ventilation and lighting improved 12 1 6 1 - - - 53 1 9 15 8 3 14 8 11 1 3 20 16 Offensive accumulation removed - - 1 110 13 83 111 90 140 Miscellaneous repairs and improvements effected 18 7 9 125 47 119 13 44 139 151 1,109 85 140 1,691 2,134 1,332 75 2,004 1,711 1,003 1,862 1,821 112 1,429 1,312 Total repairs and improvements effected 149 16,860 I I [ 'I I" Inspections— 529 29 29 48 780 596 669 410 32 345 411 458 454 37 Following complaint 605 5,432 53 18 28 59 - 6 - 7 40 82 30 72 16 House-to-house—(1) Where defects found 22 - 3 15 433 - - 17 - 7 (2) Where no defects found - - - 4 6 32 - - 84 6 6 14 14 129 119 125 174 On occurrence of infection 149 66 91 86 116 118 14 1,227 14 12 6 17 174 - - 1 2 6 Houses divided into separate tenements - - 24 - 28 284 77 40 2 - 20 3 22 75 23 Factories - 33 27 143 26 247 42 46 738 4 1 4 27 9 87 30 35 21 67 11 Workshops - 153 537 1 42 3 90 15 6 - 5 59 Workplaces - - - 9 6 102 1 12 3 338 - 1 3 1 Underground living and sleeping rooms - - - 16 - 8 5 - 50 - 5 4 7 2 4 Rent (Restrictions) Act - 1 12 2 2 - - - - 39 10 76 300 7 18 4 39 13 33 New buildings - - - - 8 - 158 185 78 508 3 45 75 144 85 238 Milk premises 36 - 117 200 60 - 1,424 - - 1 144 2 - - - 1 25 - Offensive trades - - - 3 32 - - - - - - - 685 685 Outworkers' premises - - - - - - 3 19 1 - - - 3 33 Rag and bone dealers - - 8 - 1 - - 169 - 68 2 7 54 311 25 92 Conveniences (public and private) 6 1 141 103 58 186 176 I 28 1,359 - - - - - - - - 73 Schools - - 3 3 - 79 113 114 - - 1 - 97 111 167 123 130 154 Shops Act - 97 77 - 4 4 1,184 - - 11 11 3 10 10 3 3 - Infant Life Protection - - - 59 - 77 29 29 1 - 37 - Common lodging houses - - - - - - - 197 389 278 173 29 1 15 1 87 339 345 Miscellaneous 353 54 174 370 634 3,266 1,623 65 146 130 1,866 1,868 1,532 1,707 1,223 1,384 1,099 44 1,800 2,149 17,999 Total Inspections 1,363 305 285 3,307 2,969 2,685 328 2,896 3,016 3,265 Re-inspections, calls, etc 267 3,121 4,256 3,489 559 4,084 34,832 - 70 7 1 3 4 - 5 10 2 - 34 Smoke observations - - 3 - 148 "KEY" TO TABLE SUMMARY OF SANITARY WORK Wards. Inspector. Attwater, H. The West and part of St. Giles'. Addington and parts of Town Hall and St. Giles'. Watkins, D. V. Gilchrist, W. Cobourg and part of Marlborough. North Peckham and parts of Clifton and Marlborough. Topping, G. N. Burrell, L.W. St. George's and parts of Town Hall and Goldsmith. Weaver, H. R Goldsmith, North Peckham and Clifton (parts of). Pickard, D. H Rye Lane, Lyndhurst and St. Giles' (parts of). St. Mary's and Nunhead and Rye Lane (parts of). Maughan, F. M. Malins, M. L Rye Lane, Lyndhurst and St. John's (parts of). The Rye and parts of St. John's, The Hamlet, Nunhead and Alleyn. Green, H. C. Malins, M. Alleyn, Ruskin and The Hamlet (parts of). The College and parts of Ruskin and The Hamlet. Worsfold, W. T. Dobson, A. L. Leonard, H. W. Housing Whole Borough. Inspectors Whole Borough. Miss O'Riordan Whole Borough. * Appointed December 1935. SUMMARY OF NOTICES SERVED. H. Attwater. D. V. Watkins. W. Gilchrist. G. N. Topping. L. W. Burrell. H. R. Weaver. D. H. Pickard. F. Maughan. M. L. Malins. H. C. Green. M. Malins. W. T. Worsfold. H. W. Leonard. To Nov. 30th, 1935. A. L. Dobson. To Nov. 30th, 1935. F. O'Riordan. Totals. 38 46 43 59 588 1,077 563 665 616 495 481 411 758 732 82 6,654 Intimations, Public Health (London) Act: By-Laws, etc. Statutory do. do. 15 6 23 26 182 452 172 147 212 172 231 113 258 209 8 2,226 12 Metropolis Management Act 1855 - - - - - 4 - - 7 1 - 12 - - - - 6 Sec. 5 Housing Act, 1925 - - _ 3 6 11 - 3 2 4 8 6 - 49 - Premises in respect of which notices were served and complied with during 1935, including notices which were outstanding at December 31st, 1934 21 19 23 472 562 1,062 28 535 479 6,408 695 687 457 62 649 657 Premises in respect of which works in compliance with notices served during the year 1935, were outstanding at December 31st, 1935 17 24 18 214 168 73 61 56 109 23 1,259 76 167 132 36 85 SUMMARY OF LEGAL PROCEEDINGS DURING 1935. Address. Complaint. Magistrate's Decision. Fine. Costs. Withdrawn. Work done. 28, Boathouse Walk £ s. d. Sanitary defects £ s. d. - 13 6 Do. 5, Crown Street Do 13 6 25, Hollington Street Do. Do. - - - 13 6 27, Hollington Street Do. Do. 13 6 5, Cobden Street Do. 13 6 Do. - 91, Scylla Road Non-compliance with Magistrate's Order - 1 0 0 1 1 0 - 1 0 0 93, Scylla Road Do. - 16a, Frogley Road Sanitary defects 14 days order. - - 24, Pellatt Road Do. Withdrawn. Work done. 13 6 - 216, Cator Street Do. Do. - 13 6 26, Peckham Grove Do . - 14 days order. 1 1 0 93, Seylla Road Disobedience of Magistrate's Order - Work done. Dismissed under P. of O. Act. 1 1 0 45, Grenard Road Sanitary defects - 13 6 Withdrawn. Work done. 130, East Surrey Grove Do. - 13 6 Do. 16, Ethnard Road Do. Do. - 13 6 Do. - 60, Furley Street Do. 13 6 - 13 6 58, Furley Street Do. Do. 29, Grenard Road Do. Do. 13 6 4, Edith Road - Do. Do. - 13 6 55, St. George's Road Do. Do. - 13 6 57, St. George's Road Do. - Do. 13 6 56, Hollington Street Do. Do. 13 6 - 58, Hollington Street Do. Do. 13 6 - 34, Sandover Road Do. 1 1 0 14 days order. - 90, Landcroft Road Neglecting to pave yard - 2 0 0 - 44 4, Silvester Road Do. Do. 13 1 25, Hollington Street - - - 6 Do. 3 6, Canal Place 14 days order. 2 - 2 2 0 Do. Do. 0 3 12, Canal Place Do. - - - 2 Do. 10 2 2 0 1, Silvester Road Do. - - - Work done. Order for costs. 2 2 0 8 3, Park House, Bassano Street. Do. - Withdrawn. Work done. 13 6 - Do. 6 10, Garsdale Road Do. 4 3, Carlton Square - 13 6 Do. - Withdrawn. Work done. 9 35, Linden Grove 13 0 Do. - - Adjourned sine die. 2 13 6 115, New Church Road Do. - Withdrawn. Work done. 5 51, Dragon Road 13 6 Do. - 7 42, Atwell Road Do. Do. 13 6 - 14 days order. 7 44, Atwell Road Do. 1 1 0 - Do. 1 1 0 - Shops Act, 1934. Metropolitan Borough Councils are responsible for the administration of the provisions of the Shops Act which deal with ventilation, heating and the provision of sanitary conveniences. The Sanitary Inspectors were appointed by the Council for the purposes of this Act. During the year 1,184 shops were inspected by these officers. In 28 instances exemption certificates were granted by the Public Health Committee where it was found impossible to provide suitable and sufficient sanitary conveniences for persons employed in lock-up shops and in other cases the proprietors of shop premises have complied with the requirements of the Act when requested. It was necessary to serve notices in four cases requiring the provision of suitable and sufficient sanitary accommodation at shop premises. Smoke Abatement. It is very doubtful whether the average individual realises the extent to which the emission of smoke affects health and property. The number of deaths from lung and heart disease is increased in direct proportion to the intensity and duration of fogs. The burning of coal in open grates in the homes of the people is largely responsible for this nuisance ; in fact, the domestic fireplace is still the greatest offender. If London is to be relieved of its smoke pall its inhabitants must extend their use of gas and electricity and smokeless fuels. The emission of smoke from individual chimney shafts can be prevented by enforcing the provisions of the Public Health (Smoke Abatement) Act, 1926. The number of complaints received of nuisances from smoke emission in 1935 was 20. The Sanitary Inspectors kept under observation chimneys of factories in the Borough on 148 occasions during 1935, and 29 nuisances were recorded. It was necessary to serve 6 intimations and in one instance a statutory notice requiring the abatement of a nuisance from smoke emission. It is the practice to draw the attention of offenders to nuisances discovered and to offer them advice as to the method of preventing the emission of smoke and grit. An instructional plate giving practical suggestions on the subject of preventing the emission of smoke or grit from hand-fired boilers has, in the past, been distributed to firms in the Borough for the guidance of stokers. Following the receipt of a communication from the Metropolitan Boroughs' Standing Joint Committee the Council informed that body that they were of opinion that legislation should be promoted by the Government to deal with the question of smoke emission so as to ensure that all the houses erected in the future should be of such design as would obviate atmospheric pollution by the domestic fireplace. Public Baths and Swimming Pools. The Council has provided public baths in the following districts of the Borough : —Church Street, Camberwell; Goose Green, East Dulwich ; Old Kent Road ; and Wells Street, Camberwell. At the Church Street Baths in addition to 89 warm baths and a public washhouse, a first-class swimming bath with a capacity of 130,000 gallons is available for the use of the public throughout the year. There is also a second class swimming bath at Church Street with a similar capacity, which has also been available for winter swimming during the past few years. There are 98 warm baths at the Old Kent Road Baths, and Turkish, Russian and Foam Baths, a public washhouse, a first class swimming bath with a capacity of 75,000 gallons, and a second class swimming bath with a capacity of 70,000 gallons. At Dulwich Baths, Goose Green, in addition to 53 warm baths, there is a first class swimming bath with a capacity of 120,000 gallons and a second class swimming bath with a capacity of 98,000 gallons. The swimming season at these two baths is from April to the end of September. There are 49 warm baths at the Wells Street Baths and facilities for the washing of clothes. No swimming facilities are provided at these baths. The number of bathers using the swimming baths in 1935 is shown in the following table :— Baths. No. of persons using the Ist class swimming pool. No. of persons using the 2nd class swimming pool. Church Street 50,115 92,786 Winter season 51,161 Old Kent Road Total 143,947 12,909 43,913 Dulwich 41,164 68,047 The water in all the swimming pools is purified by means of a filtration and aeration plant and is also chlorinated. Bacteriological and chemical examinations of the water are conducted monthly during the summer at all the Council's baths, and alternate months during the winter at the Church Street Baths. The reports of these examinations show that the filtration plants are efficient and ensure a clean and pure water for bathing. In addition to the Council's swimming baths arrangements the London County Council has provided an open-air bath at Peckham Rye for the use of the public. This bath has a capacity of 300,000 gallons ; it is equipped with a filter and aeration plant and the water is chemically tested. There is no privately-owned swimming bath or pool open to the public in Camberwell. Inspection of Schools. The sanitary conveniences at the Public Elementary Schools and numerous private schools in the Borough were inspected during the year and were found to be maintained in a satisfactory condition. Common Lodging Houses. There were 5 common lodging houses in the Borough at the end of the year registered for the accommodation of male lodgers. There are 428 beds available for use by lodgers in these registered houses. The Sanitary Inspectors paid 173 visits to these premises during the year. It was necessary to serve 4 notices. The following table gives particulars of the addresses of the licensed common lodging houses in Camberwell and the accommodation available at each premises : — Situation of house. Number of lodgers for which licensed. Males. Ward No. 124, Camberwell Road 245 1 168, Meeting House Lane 26 9 10 9 184, Meeting House Lane 20-22, High Street 107 10 80, Church Street 40 14 Rats and Mice Destruction Act. During the year, 194 investigations were made by the Sanitary Inspectors following complaints of alleged rat infestations. In 9 instances it was necessary to serve notices upon the occupiers of land or premises requiring the abatement of the nuisance. The period 4th to 9th November of this year was appointed by the Ministry of Agriculture and Fisheries for the observance of National Rat Week. The activities of the Council with a view to the destruction of rats and mice during this period were as follows : — Copies of a specially designed double-crown poster were displayed at the Municipal Buildings and on the Council sand-bins throughout the Borough. Five thousand copies of the following handbill were distributed from the Public Libraries, Baths, and Infant Welfare Centres in the Borough. KILL THE RAT Rats are pests which do incalculable damage : they destroy and foul food materials and are destructive to all kinds of property. They are prolific breeders and a continuous war against them is necessary. NOTES ON PREVENTION AND DESTRUCTION. Prevention.—Cut off their food supply, destroy garbage and waste food by burning. Rubblish hea ps and all P laces that m ay afford shelter for rats to breed should be cleared away. Receptacles for refuse should be covered and preferably constructed of metal. Buildings should be rendered as rat-proof as possible by means of concrete flooring, proper construction, protection and repair of drain pipes, ventilators and basement windows. Destruction. The methods usually employed for the destruction of rats are: trapping, laying of poison baits, and the employment of rat catchers. There are many varieties of traps and poisons. The ordinary wire trap is recommended as it does not cause squealing and thus warning to others. Poisoning can be done safely and simply by means of preparations of Red Squill (liquid extract and biscuits are specially recommended). These products are harmless to human beings and domestic animals yet deadly to Rats and Mice. Red Squill baits are supplied free to householders on application to the Public Health Department, Town Hall, Camberwell, S.E.5. DUTIES OF THE PUBLIC. Section 1 of the Rats and Mice (Destruction) Act, 1919, imposes a duty upon the occupiers of land and buildings to take all necessary and reasonably practicable steps to destroy rats and mice on or in any land and to prevent such land from becoming infested with rats or mice. Penalties are imposed in default. The expression "land" includes any buildings and any other erection on land, and any cellar, sewer, drain or culvert in or under land. If you desire further information on the subject of rat and mice destruction you are invited to apply to the Medical Officer of Health, Town Hall, Camberwell, S.E.5. H. W. Barnes,M.B., B.C.H., D.P.H. Medical Officer of Health. Town Hall, Camberwell, S.E.5. 2,218 personal letters were sent to proprietors of business premises in the Borough where such premises were suspected to be peculiarly liable to infestation by reason of the nature of the business carried on requesting that a special effort be made during Rat Week to exterminate these pests. Additional supplies of rat poison baits were obtained for distribution from the Public Health Department, and the sewers of the Council as well as the sewers of the London County Council in the Borough were baited during the period of Rat Week. D Rent and Mortgage Interest (Restrictions) Acts, 1920-1933. Applications for certificates under these Acts were received from 72 occupiers of dwelling-houses in this Borough, and in every case a certificate was issued to the applicant. In 10 instances certificates were issued to owners indicating that the requirements of the Sanitary Authority had been complied with in respect of the property which was the subject of the issue of a certificate to the effect that the premises were not in a reasonable state of repair. Offensive Trades. The following businesses carried on in the Borough come within the category of offensive trades : — Skin dressers 6 Skin merchants 1 Sheep skin rug-makers 1 Soap boilers 2 Fellmongers 1 These businesses were regularly inspected during the year and it was necessary to serve a notice in respect of one of these premises. Rag and Bone Dealers. The number of rag and bone dealers' premises entered in the Register at the end of 1935 was 27. Five notices were served for insanitary conditions existing at certain premises. In six instances the Public Health Committee directed that cautions be administered to rag and bone dealers for contraventions of the by-laws in respect of the exchange of toys for old clothes. Rag Flock Act, 1911-28. The above Act prohibits for the purpose of the manufacture of certain articles, the sale and use of unclean flock manufactured from rags. Rag Flock shall be deemed to conform to the standard of cleanliness, if the amount of chlorine does not exceed 30 parts of chlorine in 100,000 parts of the flock. Two samples of flock manufactured from rags, were submitted to the Public Analyst for examination. One conformed to the standard of cleanliness, and the other was reported to contain 32.2 parts of chlorine in 100,000 parts of the flock, an excess of 2.2 parts. The appropriate committee directed that a caution in writing be sent to the firm concerned. Removal to Institutions of Aged, Infirm or Physically Incapacitated Persons During the year it was necessary to obtain a Magistrate's Order for the purpose of securing the removal to an institution of one aged female person living in insanitary surroundings. Action of this nature is only taken in cases where there are no relatives or friends to supervise such persons. Twenty-three cases of this kind came to the notice of the Public Health Department during the year, and it is satisfactory to record that with the exception of the case above referred to, arrangements were made to secure proper care and attention for these old people without having recourse to compulsory removal to an Institution under the powers of Section 28 of the London County Council (General Powers) Act, 1928. Cremation. Cremation is the most hygienic and scientific of all methods employed for the disposal of the dead. Ignorance and prejudice have in the past acted as a barrier to progress of this sanitary and innocuous method of disposal of the dead with the result that large areas of valuable land have been acquired for purposes of burial in and around large centres of population. The area of land in Camberwell occupied or reserved for cemeteries is approximately 150 acres. In a space of one hour cremation performs in a clean way the same process which, in the case of earth burial, takes from 20 to 100 years to accomplish according to the nature of the soil in which the body is buried and the material with which the coffin is made. From the point of view of health, cremation has everything to commend it when compared with earth burial. A modern crematorium need not be either a source of nuisance or an eyesore and will help to settle the question of how to dispose of our dead in populous districts. Exhumations. Nine bodies were exhumed at Cemeteries in the Borough during the year for burial elsewhere. These exhumations and re-interments were carrried out on the authority of the Home Office. The District Sanitary Inspector attended to ensure that the terms of the Home Office Licence were complied with in each case. Sanitary Conveniences attached to Licensed Premises. During 1935 the Sanitary Inspectors made 998 inspections of public house urinals in the Borough. D2 51 Nuisances from Pigeons. The Council had under consideration a report adopted by the Metropolitan Boroughs' Standing Joint Committee on the question of nuisances caused by pigeons, in which this Council and other Metropolitan Borough Councils were invited to express their views on the question of the promotion of a “Pigeon Week.” The Metropolitan Boroughs' Standing Joint Committee were informed that although this Council were not in favour of the organisation of a “ pigeon week,” they were of opinion that concerted action should be taken by all the Metropolitan Boroughs with a view to abating nuisances caused by pigeons, and that the line of such concerted action might be determined by that Committee. Fouling of Footways by Dogs. In 1926 the Council made a by-law which was sanctioned by the Home Office prohibiting the fouling of footpaths by dogs on a lead. It is permissible for anyone to institute proceedings against offenders of this by-law. No prosecutions were instituted during the year. HOUSING. Clearance Areas Scheme. In July, 1934, a conference was held at the County Hall between representatives of this Council and the London County Council to discuss the question of slum clearance operations in this Borough. It was ascertained at this conference that certain areas in Camberwell had been scheduled for action under the provisions of the Housing Acts in the following classifications :— (a) Several large areas to be dealt with by the L.C.C. (b) Small areas which will not form re-housing sites, but which could be dealt with conveniently with the large areas. (c) A group of smaller areas which the Borough Council might deal with as Clearance Areas in addition to the three areas with which the Borough Council was now dealing, viz., Tiger Yard, Joiner's Arms Yard and Woodland Cottages. At the meeting of the Council in October, 1934, it was resolved:— " That the London County Council be informed that this Council is prepared to deal with small clearance areas in the Borough, subject to approval from time to time of the sizes of the areas and the intervals at which they are dealt with, and also to the arrangements to be made being timed to correspond with the London County Council's re-housing programme in Camberwell.” At a further conference held at the County Hall in November, 1934, between representatives of both authorities on the subject of the terms upon which the L.C.C. would provide re-housing accommodation in respect of persons displaced as the result of slum clearance operations by this Council, it was understood that the County Council would have available housing accommodation for approximately 20 families per month. Official representations in accordance with the provisions of Section 1 of the Housing Act, 1930, have accordingly been made by your Medical Officer of Health on this basis in respect of the small insanitary areas referred to in the L.C.C. classification in Group (c) above. It was subsequently arranged that certain small areas included in Group (c) should be transferred to Group (b) with a view of their being considered for action by the L.C.C. in their larger areas programme. As the result of a further meeting between representatives of the respective authorities, this Council decided to extend their clearance area programme by including a number of larger areas for subsequent action. During the period January 1st to December 31st, 1935, the following areas were declared by the Council to be Clearance Areas: — No. of dwellinghouses. No. of persons displaced or to be displaced. Description of Clearance Area. Boyton Cottages 49 11 31 Station Vale 8 Redear Cottages 2 8 3 Ebenezer Cottages 12 Ormond Place 2 7 Glengall Cottages 3 11 13 Dalbiac Street 57 5 Cemetery Cottages 19 James Cottages 35 10 Nungate 34 10 Lansdowne Place 7 35 Bowyer Street 4 18 49 Absolom Place 12 Acock's Cottages 4 10 Hearsey Place 4 24 20 Surrey Place 5 * Garden Street 8 34 Melon Road 4 24 *Herring Street 5 15 3 16 Pleasant Place 11 53 Lomond Place 28 Cobourg Road 8 4 Frensham Street 19 21 97 Lovegrove Street (3 areas) 25 126 Albany Road 192 831 Totals * The London County Council propose to deal with these Areas. Local Inquiries were held by Inspectors appointed by the Minister of Health in respect of 8 of these areas, and in every case the Clearance Order was confirmed by the Minister. In one instance the owner of certain properties in a Clearance Area unsuccessfully appealed to the High Court against confirmation of the Clearance Order by the Minister of Health. Included in two of the above areas were three houses which had been well maintained, and in these cases the Minister of Health directed the Council to make a payment in accordance with the provisions of Section 64 of the Housing Act, 1935. The Council has also dealt with individual houses and parts of premises under the provisions of the Housing Acts, requiring either the demolition or repair of the premises, including the closure of underground rooms illegally occupied for sleeping purposes. Housing Act, 1935. Overcrowding. This Act placed on every local authority the duty of causing an inspection of their district to be made with a view of ascertaining what dwelling-houses therein are overcrowded, and to prepare and submit to the Minister a report showing the result of the inspection and the number of new houses required in order to abate overcrowding in their district, and, unless they are satisfied that the required number of new houses will be otherwise provided, to prepare and submit to the Minister proposals for the provision thereof. For the purpose of carrying out this inspection, a temporary staff was engaged consisting of 38 enumerators, 23 survey assistants, and 9 clerical assistants. This survey which commenced on November Ist, 1935, was well advanced at the end of December 1935. A standard for determining whether a dwelling-house is overcrowded or not is laid down in the Housing Act, 1935. A dwelling-house shall be deemed for the purposes of this Act to be overcrowded at any time when the number of persons sleeping in the house either : — (a) Is such that any two of those persons being ten years old or more of opposite sexes and not being persons living together as husband and wife, must sleep in the same room, or (6) Is, in relation to the number and floor area of the rooms in the house, in excess of the permitted number of persons as defined in the First Schedule of the Act which is as follows :— TABLE I. Where a house consists of (a) One room 2 (6) Two rooms 3 (c) Three rooms 5 (d) Four rooms 7½ (e) Five rooms or more 10 TABLE II. Where a room in a house has a floor area of (a) 110 sq. ft. or more (6) 90 sq. ft. or more, but less than 110 (c) 70 sq. ft. or more, but less than 90 1 (d) 50 sq. ft. or more, but less than 70 (e) Under 50 sq. ft. The permitted number of persons is with an additional 2 in respect of each room in excess of 5. The permitted number of persons is 2 1½ 1 ½ Nil The expression the "permitted number of persons" means, in relation to any dwelling-house, either: (a) The number specified in the second column of Table I above in relation to a house consisting of the number of rooms of which that house consists, or (b) The aggregate for all the rooms in the house obtained by reckoning, for each room therein of the floor area specified in the first column of Table II above the number specified in the second column of that Table in relation to that area, whichever is the less. In computing the number of rooms in a house, for the purposes of Table I, no regard shall be had to any room having a floor area of less than 50 square feet . In determining the number of persons sleeping in a house, no account shall be taken of a child under one year old, and a child who has attained one year and is under ten years old shall be reckoned as one-half of a unit. A dwelling-house is defined as any premises used as a separate dwelling by members of the working-classes or of a type suitable for such use. Houses Let in Lodgings. At the end of 1935 the number of houses let in lodgings entered in the register was 249. The recent appointment of four additional Sanitary Inspectors will enable the Department to give more attention to this type of dwelling-house in various parts of the Borough than has been possible in the past and to add to the register premises which come within the provisions of the L.C.C. By-laws with respect to houses divided into separate tenements, etc. Included in these by-laws are requirements for providing in houses which are not subject to the provisions of the Rent and Mortgage Interest (Restrictions) Acts, adequate and readily accessible closet accommodation ; washing accommodation ; and accommodation for the storage, preparation and cooking of food to each family. Cleansing of Verminous Rooms. It was necessary to serve 297 notices under Section 10 of the London Comity Council General Powers Act, 1922, requiring the cleansing of premises infested with vermin. The Disinfecting Staff sprayed 1,260 rooms during the year with a special vermicidal solution. Disinfestation work is not usually carried out by the Officers of the Council unless the walls are stripped and all woodwork in the affected rooms is either eased or removed beforehand, so as to ensure that the harbourages of the vermin are effectively attacked. Arrangements are also made for the steam disinfection of all bedding, the dismantling and thorough washing of bedsteads, and the cleansing of all furniture, and occupiers are advised as to the steps they themselves should take to prevent re-infestation of their premises. During the year the Council authorised the distribution from the Public Health Department of sprayers and small containers of a vermicidal solution at cost price to any inhabitant of the Borough desirous of co-operating in the work of disinfestation. During the short time that this scheme has been in operation there is evidence that the facilities offered by the Council are much appreciated. Housing Statistics, 1935. 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) 7,682 (b) Number of inspections made for the purpose 24,433 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 552 (6) Number of inspections made for the purpose 1,840 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 193 (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 3,359 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 538 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 18 (2) Number of dwelling houses which were rendered fit after service of formal notices :— (a) By owners 7 (6) By Local Authority in default of owners Nil (b) Proceedings under Public Health Acts : — (1) Number of dwelling houses in respect of which statutory notices were served requiring defects to be remedied 1,675 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (a) By owners 2,100 (6) 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 5 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 5 (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 5 (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 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 1935. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including Factory Laundries) 738 76 - Workshops (including Workshop Laundries) 87 875 - Workplaces (other than Outworkers' premises) 163 - Total 1,613 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) 142 Nuisances under the Public Health Acts: —* 173 - Want of cleanliness - - Want of ventilation 2 1 - - Overcrowding - - - 1 1 Want of drainage floors - - 109 82 Other nuisances - - Sanitary accommodation — 3 . 4 Insufficient - - Unsuitable or defective 66 45 - - Not separate for sexes 1 1 - - Offences under the Factory and Workshop Acts:— - Illegal occupation of underground bakehouse (s.101) - - - Other offences excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921] 6 6 6 - Total 6 362 281 - "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 1935. Inspected by the Council's Male Sanitary Inspectors. Trade. Factories. Workshops and Workplaces. Total. Blacksmiths 4 9 5 26 Bootmakers and Repairers 29 55 Brush Trades 1 3 4 Building Trades 46 10 56 Chemical Trades 4 4 8 Engineering Trades 40 58 98 Gas Works 1 - 1 Glass Blowing 1 - 1 Laundries 33 2 35 Miscellaneous 224 413 637 Offensive Trades 5 6 11 Preparations of Foodstuffs 22 4 26 Printing and Lithography 42 10 52 Sweet Manufacturers 1 5 6 Timberyards and Woodworkers 50 32 82 Toymakers 2 4 6 Upholsterers 11 - 11 1 Varnish and Colour Works 3 4 Wearing Apparel 19 30 49 505 646 1,151 Total Inspected By The Council's Woman Sanitary Inspector. Factories. Workshops and Workplaces. Total. Trade. Brush Trades - 2 2 Chemical Trades 1 3 - 4 Furriers 1 1 Laundries 38 - 2 40 Milliners 10 10 Miscellaneous 100 110 210 Offensive Trades 3 - 3 Preparation of Foodstuffs 4 21 25 Printing and Lithography 14 - 14 Sweet Manufacturers 2 2 4 Wearing Apparel 75 81 156 Total 211 469 258 The male inspectors and the woman inspector paid 1,111 and 502 visits respectively to factories, workshops and workplaces in the Borough. Generally speaking these premises were found to be in a satisfactory condition and no evidence was obtained to show that employment in any of the industries carried on in the area exercises an adverse influence on the health of the workers engaged. Outworkers. During 1935, 720 names and addresses of outworkers residing in Camberwell were reported by employers and the Medical Officers of Health of other districts. There are 531 premises in this Borough where outwork is being conducted. The number of inspections of these premises was 685, and 28 notices under the Public Health (London) Act, 1891, were served to remedy sanitary defects existing at these premises. One case of infectious disease was 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. During the year it was necessary to send a cautionary letter to 5 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 1935. Art publishing 1 Baby linen 7 Bedding 1 Belts 1 Blinds 1 Blouses 18 Boots and shoes 8 Braces 1 Brushes 2 Cardboard boxes 6 Card lacing 1 Chemist 1 Clothing 1 Coathanger 7 Collars 4 Costumes 7 Crocheting 8 Downquilts 4 Drapery 5 Dresses 21 Dressing gowns 9 Dyeing and cleaning 2 Embroidery 7 Fancy goods 12 Furs 1 Garters 2 Gloves 1 Gold lace 1 Gowns and Robes 39 Hairnets and combs 1 Handbags 2 Handkerchief sachets 2 Hats 4 Hosiers 3 Household linen 1 Ivory and bone goods 2 Jewellery 3 Lampshades 1 Leatherwork 2 Mantles 143 M/C belting 1 Millinery 3 Ladies' neckwear 3 Gents' neckwear 6 Needlework 5 Novelties 2 Outfitting 3 Overalls 9 Paper bags 7 Polishing and fitting 1 Pyjamas 3 Rag dolls 2 Rubber Goods 2 Shirts 16 Skirts 4 Stationery 1 Tailoring 33 Ties 27 Toys 3 Umbrellas 3 Underclothing 25 Watch repairs 1 Wearing apparel 26 Woollen goods 2 531 60 INSPECTION AND SUPERVISION OF FOOD. Premises in which food is stored, sold or prepared for sale, as well as the street markets, are kept under supervision by the Food Inspector. In addition to these duties, this officer supervises the slaughtering of animals in the two licensed slaughter houses in the Borough. The Food and Drugs Inspector, also known as the Sampling Officer, in addition to taking samples for examination by the Council's Bacteriologist which include milk, ice cream, bath waters, etc., is responsible for obtaining samples of food and drugs for chemical analysis by the Public Analyst. This officer also deals with applications for registration of dairymen and purveyors of milk. The dairies, milk shops and mills utensils are inspected regularly by the District Sanitary Inspectors. Milk Supply. The bulk of the milk consumed by the inhabitants of this Borough is previously pasteurised. The campaign for a clean and safe milk supply, i.e., milk free from dust and not capable of communicating disease, continues and should continue until this aim is achieved. In my opinion all milk supplied for human consumption should be pasteurised or obtained from cows certified free from tuberculosis ; the pasteurisation process being carried out by the method as defined by the Milk (Special Designations) Order, which has the advantage of making milk safe without appreciably impairing its nutritive properties. Milk. Bacteriological Examinations. Samples of milk sold by retailers in the Borough as well as samples of milk supplied to the London County Council's hospitals and schools are taken periodically and submitted to bacteriological examination. The technique for the bacteriological examination of all milks is that as suggested by the Ministry of Health in Memo. 139 Foods. Certified Milk. The bacteriological standard laid down in the Milk (Special Designations) Order permits a maximum of 30,000 bacteria per c.c. Bacillus Coli must not be found in 1/10th c.c. No samples of certified milk were submitted for examination during the year under review. Grade “A” (Tuberculin Tested) Milk. The bacteriological standard laid down in the Milk (Special Designations) Order permits a maximum number of 200,000 bacteria per c.c. Bacillus Coli must not be found in 1/100 th c.c. At the request of the Ministry of Health, 11 samples of this grade of milk, bottled at the farm and supplied by a licensed producer to a licensed dealer in this Borough, were submitted for examination. With one exception all these samples complied with the prescribed conditions. The sample which did not comply (marked No. 7) contained Bacillus Coli in 1/100 th c.c. The result of this examination was reported to the Minister of Health as requested. Five samples of milk of this designation, bottled at licensed bottling establishments in this Borough were also submitted for examination. Four of these samples complied with the required conditions, and one failed to do so (Sample marked “C ”). This sample contained 100,000 organisms in excess of the maximum number allowed. A letter was sent to the licence holder of the bottling establishment concerned drawing his attention to the failure of the sample to comply with the requirements, and requesting him to take all necessary steps to prevent a similar occurrence in the future. In this connection a further sample of milk was taken at this bottling establishment, and was found to comply with the conditions prescribed. Pasteurised Milk. The b acteriological standard laid down in the Milk (Special Designations) Order permits a maximum number of 100,000 bacteria per c.c. No standard is prescribed for Bacillus Coli. During the year 70 samples of pasteurised milk were taken for examination, and only one sample did not comply with the prescribed conditions. This sample (No. 61) contained 10,000 organisms in excess of the maximum number allowed, and was one of many samples taken by arrangement with the L.C.C. at one of their Institutions in Camberwell. The result of the examination was reported to that Authority. Examination of Milk for Tuberculosis. The following samples were submitted to the Bacteriologist for examination for the presence of tubercle bacilli by means of the animal test. No tubercle bacilli were found in any of these samples. Sample. Designation. Result of Examination. A Milk (raw). No tubercle bacilli present. B. Do. Do. C. Do. Do. D. Do. Do. E. Grade "A" (Tuberculin Do. Tested) F. Do. Do. Milk and Dairies Order, 1926. The Milk and Dairies Order, 1926, requires the Sanitary Authority to register all persons in their district carrying on the trade of cowkeeper or dairyman and all premises which are used as dairies. The following table shows the state of the registers at the end of the year as compared with the previous year. 1935. 1934. Cowkeepers 1 1 Cowsheds 1 1 Dairies and Milkshops 367 366 Dairymen with premises in the Borough 395 394 Dairymen with premises outside the Borough 24 23 Purveyors of milk in sealed bottles 150 135 The total number of inspections of dairies and milk shops carried out in 1935 was 1,424. Thirty-six notices were served to remedy defects. Cowsheds. There is one registered cowshed in the Borough licensed for 47 cows. The bulk of the milk obtained from this source is retailed to families living in the locality. The District Sanitary Inspector paid 11 visits to this cowshed during the year, and the standard of cleanliness was found to be satisfactory at each visit. One sample of milk was obtained for examination for the presence of tubercle bacilli by the animal test. No tubercle bacilli were, however, found in this sample. Milk (Special Designations) Order, 1923. Under this Order the Council are authorised to grant annual licences to persons other than producers to sell milk under the special designations known as Certified, Grade " A " (Tuberculin Tested), Grade " A," Grade " A " (Pasteurised), and Pasteurised. Every licence granted is valid for a period ending on December 31st. The following licences were granted in respect of the year 1935:- Principal Licences. Supplementary Licences. Licences to sell Certified Milk 7 - Licences to bottle and sell Grade "A" (T.T.) Milk 2 - Licences to sell Grade "A" (T.T.) Milk 27 4 Licences to sell Grade "A" Milk - 1 - Licences to sell Grade "A" (Pasteurised) Milk 8 Licences to sell Pasteurised Milk 75 4 Licences to pasteurise milk 1 120 - 9 Totals Milk. During the year under review 580 formal and three informal samples were submitted for analysis. Of this number, 21 of the formal samples failed to comply with requirements. Eleven were reported against owing to the fat content being below 3 per cent., and 10 to the presence of added water. Of the former, 5 were sold intact in half-pint bottles sealed with the usual cardboard disc, 4 from counter pans, 1 from a partly filled quart bottle, and 1 from a partly filled pint bottle. In connection with those containing added water, 7 were sold in half-pint bottles, 1 from a churn, 1 from a hand can, and 1 from a partly filled pint bottle. The method of adulteration employed in the last instance was particularly obnoxious. As the result of a complaint, observation was kept upon a stable yard situated in this Borough. An employee of a large firm engaged in the retail sale of pasteurised milk was seen to take a quart bottle and fill it with water from a large tub standing in the stable yard from which horses were watered. The tub was old and slimy, the water being partly covered with chaff, and at least one blood worm was seen therein. A bottle of milk, nearly full, with the cardboard disc thereon partly dislodged, and bearing the words " pasteurised milk, ' was on the van. This bottle of milk was purchased for analysis. During the process of division, the roundsman stated that he had added water from the tub to the contents of the bottle. The sample was found to contain 38 per cent, of added water and gnat larvae was also discovered in the milk. Proceedings were taken and the roundsman was convicted. See sample No. 570, Table "B." Supervision of Milk Pasteurising Plants. One premises in this Borough has been licensed for the pasteurisation of milk, but at the time of the preparation of this report the plant was not operating. Meat and Other Foods. The London County Council (General Powers) Act, 1932, requires the registration with the Borough Council of any premises (other than premises used as a club, hotel, or restaurant) used or proposed to be used for the preparation or manufacture of sausages, potted, preserved pickled, or preserved meat, fish or other food intended for sale, and premises used or proposed to be used for the sale or the manufacture for the purpose of sale of ice cream or other similar commodity or the storage of ice cream or other similar commodity intended for sale. At the end of 1935 the Register contained particulars of registered premises as set out below :— Manufacture of sausages 1 191 Preparation or manufacture of potted, preserved pickled, or preserved meat 275 Preparation or manufacture of potted, preserved pickled, or preserved fish 10 Sale, manufacture or storage of ice cream 354 All these premises were regularly inspected during 1935. Ice Cream. This commodity is becoming increasingly popular as a food both among adults and children. Opportunities for contamination during and after manufacture are numerous except when sold in sealed cartons. Ice cream, like milk, constitutes a favourable medium for the growth of bacteria including disease producing germs. At present there is no bacteriological standard for ice cream. The London County Council (General Powers) Act, 1932, provides for the registration with the Sanitary Authority of premises other than hotels, clubs and restaurants used for the manufacture, storage and sale of ice cream, and gives power to the Sanitary Authority to refuse registration, and to remove from the register any premises which are deemed to be unsuitable. At the end of the year there were 354 premises entered in the register. In 96 instances ice cream was not sold during the season. Manufacture and storage Nil. Manufacture and sale 221 Manufacture, storage and sale 7 Storage and sale 117. Sale 9 Four hundred, and nine inspections of these premises were made during 1935. Enquiries as to the conditions of manufacture were made from the Medical Officers of Health of areas where ice cream sold in this Borough was manufactured elsewhere. Six samples of this commodity were submitted for bacteriological examination, with the following results. Sample marked. Date obtained. Where purchased. Bacteria per c.c. Presence of Bacillus Coli. No. 1 Aug. 8th At a Coffee Stall and Snack Bar. 900,000 Present in 1/100 c.c. 60,000 No. 2 Aug. 8th Shop Absent in 1/10 c.c. No. 3 Aug. 8th At a barrow in a public thoroughfare. 500,000 Present in 1 /100 c.c. 500,000 No. 4 Aug. 12th Shop Present in 1/10 c.c. Present in 1/10 c.c. No. 5 Aug. 12th At a Coffee Stall and Snack Bar. 150,000 120,000 No. 6 Aug. 12th Shop Present in 1/10 c.c. E Samples Nos. 1 and 5 were taken from the same vendor, and were also examined for the presence of organisms of the enteric group. The results were negative. Bakehouses. At the end of the year there were 128 bakehouses in the Borough. Bakehouses classified as factory bakehouses numbered81 and 41 of these bakehouses are situated underground. Inspections were made to ensure that these bakehouses were kept in a cleanly condition. It was found necessary to serve 64 notices. Special attention was given by the Food Inspector at his inspections to likely nuisances which might arise from the presence of beetles, cockroaches, and ants and where these pests were found, advice was given as to the best method of dealing with them. Butcher Shops and Meat Stalls. The following summary shows the number of butchers' shops and meat stalls in the Borough. Butchers' shops 165 Meat Stalls 2 Offal shops 4 All butchers' shops and meat stalls were regularly inspected, and it was necessary during the year to serve 34 notices for Various purposes, the requirements of the Inspector being complied with in each case. On two occasions meat was surrendered by owners as unfit for food. Marking of Imported Meat. The marking of imported meat as required by the Merchandise Marks (Imported Goods) No. 7 Order, 1934, was satisfactorily observed by meat traders in this Borough. Certification of Meat Food Products. The Medical Officer of Health as Designated Officer for Food Inspection issued 26 certificates in respect of foods prepared in the Borough for export to America. Fish Curers. The curing of fish is conducted at 52 premises in the Borough. The number of visits paid to these premises by the Inspector during the year was 227. Twelve notices were served requiring the abatement of sanitary nuisances. Fish Shops and Stalls. During the year inspections were made of the 63 fishmongers' shops and 16 fish stalls in the Borough. Packages of fish were surrendered on nine occasions during 1935 and certificates were issued stating that the article of food was found to be unfit for human consumption and had been destroyed. Fried Fish Shops. In recent years the number of fried fish shops in the Borough has increased considerably. At the end of 1935 there were 99 of these premises. The Food Inspector made 424 inspections of these shops to ensure that the By-laws made by the London County Council were being observed, and that the fish was sound and fit for human consumption. Twenty-six notices were served during the year. Restaurants and Eating Houses. The work of inspecting restaurant kitchens to ensure that a reasonable standard of cleanliness is maintained in the kitchens is entrusted to the Food Inspector. Twenty-three notices were served during the year in respect of unsatisfactory conditions existing at certain of these premises. Slaughterhouses. There are two licensed slaughterhouses in the Borough and the Inspector paid 101 visits to these premises during the year. The Public Health (Meat) Regulations, 1924, provide that no person may slaughter any animal without giving prior notice of such intention to the Sanitary Authority. A summary showing the number of animals slaughtered and inspected by the Council's Food Inspector at these slaughterhouses during 1935 appears in the following table. Month. Cattle. Sheep. Lambs. Pigs. Calves. Totals. January 5 9 4 40 58 February 3 24 4 3 34 March 4 25 5 2 36 April 4 31 4 5 44 May 3 43 3 49 - June 3 32 - 3 38 July 2 15 2 - 19 August 3 2 42 - 47 Sptember 2 26 16 1 45 October 3 28 15 3 49 November 3 24 14 2 43 December 5 20 33 1 59 Totals 40 350 100 31 521 E2 67 The following table shows the number of organs condemned at the time of slaughtering and the disease with which they were affected. The diseased meat was destroyed at the Council's Depot at Peckham Park Road. Carcases, including organs. Fore-quarters. Hind-quarters. Head. Tongue. Lungs. Liver. Stomach. Spleen. Mesenteries. Intestines. Kidneys. Heart. Cause of destruction. Udders. Cattle. - - - 3 - - I - 1 1 - 2 Tuberculosis 3 1 - - - 2 - - - - - Fluke - - - - - - - 1 - - - - Abscess - - 2 - - - - - - - - - - - Pleurisy 1 - - - - - - - - - 1 - - - Cirrhosis - - - - 2 - - - Sheep. - - - - - - Parasitic diseases Pigs. - - - - - - - - 35 4 - - 2 - - - 1 - 1 3 - Tuberculosis - 4 3 3 3 - - - - Cirrhosis - 1 - - - - - - - - Pneumonia Calves. - - - - - 1 5 - - - - - I - - - I_l - - - - - - - Tuberculosis - 1 - 6 46 1 4 - - - - 4 12 10 Totals - 1 Slaughter of Animals Act, 1933. The purpose of this Act is to provide for the humane and painless slaughter of animals and for the licensing of slaughtermen. Licences were granted by the Council in 1935 to 3 slaughtermen. Poultry Slaughtering. There is no poultry slaughterhouse in the Borough. Street Trading. The London County Council (General Powers) Act, 1927, makes provision for the licensing of Street Traders. During the year 265 licences as follows were issued to street traders by the Works and General Purposes Committee of the Council. Coffee stalls 11 Confectionery and soft drinks 3 Fish 14 Fruit and vegetables 108 Groceries 12 Ice Cream 11 Meat 3 Poultry, eggs, etc. 9 All food stalls were inspected regularly, a special feature being made of inspection on Saturday evenings. Personal Hygiene for Food Handlers. Placards emphasising the importance of personal cleanliness on the part of food handlers have been issued by the Health Department to proprietors for display in the domestic offices of eating places and other premises where food is prepared. Food Poisoning. The London County Council (General Powers) Act, 1932, requires medical practitioners to notify to the Medical Officer of Health cases of food poisoning or suspected food poisoning. A memorandum describing the steps to be taken by Medical Officers of Health in and outside London in suspected cases of food poisoning has been issued by the Ministry of Health. Outbreaks of food poisoning often occur after the consumption of apparently sound food in which there were no signs of decomposition. No outbreak of food poisoning occurred in the Borough, but 17 cases of illness suspected to have been caused by the consumption of a particular article of food were notified during the year. Careful enquiries were made in every case notified, and in a number of instances the illness was probably not due to " food poisoning " but was caused by some dietetic indiscretion or to the peculiar sensitiveness of the person to the article of food consumed. 70 Food Poisoning—Table of Notified Cases. No. Date notified. Food suspected. Remarks. Tinned Salmon 1 16/1/35 Illness slight. 2 31/1/35 Tinned Peaches Do. 15/3/35 Pork 3 Do. 27/3/35 Pork 4 Do. 25/5/35 Rabbit Do. 5 6 25/6/35 Tinned Salmon Do. 20/7/35 Fried Fish 7 Do. 8 23/7/35 Tinned Salmon Do. 9 25/7/35 Preserved Meat Do. 15/8/35 Cockles 10 Do. 11 25/8/35 Sausages Do. 12 27/8/35 Vegetable Marrow Do. 13 15/9/35 Saveloys Do. 9/10/35 Tinned Soup 14 Do. 15 21/10/35 Saveloys Do. 16 22/10/35 Steak and Kidney Do. Pie. 17 11/11/35 Fried Fish Do. Unsound Food. One seizure of unsound food was made during the year. On a great many occasions the Food Inspector was called in by vendors to examine articles of food and to accept surrender of such as were unfit for food, for destruction at the Council's Depot. The following foodstuffs were surrendered during 1935. Weight. Surrendered or Seized. Result of action taken. Nature of Food. T. c. q. l. I FISH— Surrendered. Rock Salmon 1 1 22 Destroyed at Council's Depot. - Do. Plaice 2 21 Do. - - Cod 2 7 Do. Do. - - Haddocks (smoked) 16 Do. Do. - - - Shrimps 1 2 Do. Do. - - Kippers 26 Do. Do. - - - Winkles 24 Do. Do. - - - Skate 21 Do. Do. 1 - - Offal Do. 2 0 Do. - - - 4 1 27 FRUIT— Pulp 14 2 0 Do. Do. - Pears 17 3 0 Do. Do. - Cherries 2 3 0 Do. Do. - r 1 15 0 0 71 UNSOUND FOOD—Continued. Weight. T. c. q. l. Surrendered or Seized. Result of action taken. Nature of Foods. 1 Butcher's meat 12 1 22½ Do. Do. - Cooked meat 3 Do. Do. - 10 2 Sausage casing 10 2 0 Do. Do. - Offal 1 1 Do. Do. - - 1 3 0 26½ CONFECTIONERY— Chocolate (Asstd.) 8 3 14 Do. Do. - Sweets (Asstd.) 27 Do. Do. - - - — 9 0 13 TINNED FOODS— Condensed and Evaporated milk. 2,324 tins 19 2 12¾ Do. Do. - Cream 18 tins 6 Do. Do. - - - Soup 40 tins 1 8 Do. Do. - - Fruit 1,592 tins 17 1 8¼ Do. Do. - Fish 12,549 tins 1 19 1 11½ Do. Do. Meat 88 tins 1 2 0 Do. Do. - 3 18 0 18½ FOOD IN JARS AND BOTTLES— Meat (various) 84 jars - 1 0 18 Do. Do. Fish (various) 56 jars - 1 0 27 Do. Do. Jam (various) 91 jars - Do. Do. 2 6 - Pickles (various) 644 jars - - 3 4 Do. Do. Sauce (various) 357 botts. - Do. 1 1 9 Do. Fruit Salad 477 botts. - 12 3 3 Do. Do. - 17 3 11 1 MISCELLANEOUS— Dried Fruit (various) - 1 0 7 Do. Do. 2 8 Lemonade 48 botts. Do. Do. - - Oats (flaked) 2 0 Do. Do. - - 2 0 15 - Total 8 9 3 27 Summary of Work of Food Inspector for 52 weeks ended Dec. 31st, 1935. Complaints received 20 Complaints found to be justified 6 Inspections : — 1,956 Street markets 277 Bakehouses 227 Fish curers' premises 424 Fried fish shops Ice cream premises 409 Restaurants and eating houses 337 Slaughterhouses 101 Other food premises 3,466 Carcases inspected 508 994 Organs inspected 184 Inspections not defined 497 Re-inspections Organs condemned 39 33 Food surrendered (parcels of varying weights) Certificates granted for Foodstuffs for export 26 Number of food premises defects found and remedied 156 Number of intimations served 166 Number of Statutory Notices served 10 The Food and Drugs (Adulteration) Act, 1923. During the year the Food and Drugs Inspector and Sampling Officer submitted 1,036 samples to the Public Analyst for examination, of which 49 were informal samples. A wide selection of articles were sampled, the varieties numbering 80. Of the total samples taken, 981 were reported to be genuine, and 55 adulterated, equivalent to 5.30 per cent. The samples taken during the year are set out in Table "A." In Table "B" are shown those not complying, with a record of the action taken by the Public Health Committee on behalf of the Council. Following the practice adopted for many years of informing dairymen when samples were reported as genuine, 608 such notifications were sent to vendors during the year under review. Samples of milk from institutions and schools are taken periodically, and during 1935 70 samples were taken from 3 institutions and 54 schools in the Borough. All complied with the chemical standard. In connection with the supply of milk to school children under the Milk Marketing Board Scheme, 34 samples were taken in the course of delivery at various schools in this Borough, and in no instance did the milk fall below the recognised standard. The Agricultural 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 agricultural produce. No instance was discovered in 1935 of the improper use of the National Mark by unauthorised persons, of the Mark being falsely applied, or the use of a Mark calculated to mislead. Section 3 provides for the marking of British eggs, on sale, or exposed for sale that have been subjected to any process of preservation. There is one premises in this Borough, registered for this purpose, and no British eggs were deposited for preservation, during the year under review. Butter Factories, and Wholesale Dealers in Margarine. Section 8 of the Food and Drugs (Adulteration) Act, 1928, provides that all butter factories, and wholesale dealers in margarine, shall be registered by the local authority. At the end of the year 1935, there were 19 wholesale dealers in margarine on the register of this authority. Artificial Cream Act, 1929. The Borough Council are required under the provisions of this Act to register all premises in which Artificial Cream is manufactured, sold or exposed for sale for human consumption. Section 2 (1) of the Artificial Cream Act, 1929, states : — Artificial cream shall not be manufactured, sold or exposed or kept for sale for human consumption except at premises registered with the Food and Drugs Authority : Provided that this requirement shall not apply— (a) to the manufacture of artificial cream, by any person solely for his domestic purposes; or (b) to the manufacture on any premises of artificial cream for use in the preparation on those premises of some other article of food ; or (c) to the sale, exposure or keeping for sale of artificial cream on any premises where it is not supplied otherwise than in the properly closed and unopened receptacles in which it was delivered to those premises. Public Health (Condensed Milk) Regulations, 1923 to 1927, and Public Health (Dried Milk) Regulations, 1923 to 1927. Three samples of condensed full cream milk sweetened, and one sample of dried full cream milk, were submitted for examination, and all conformed to the prescribed composition. TABLE "A" Formal and Informal Samples submitted for Analysis for the year ended December 31st, 1935. Article. Number Adulterated, etc. Percentage of Adulteration. Number Examined. Formal. Informal. Private. Total. Formal. Informal. Total. Formal Informal. Private. 21 3.62 580 3 583 21 - - - Milk - 73 - Butter 73 - - - - - - - 35 1 3.03 33 2 1 - - - Vinegar - 11.11 27 27 3 3 Malt Vinegar - - - - - 21 Lard 21 - - - - - - - - 21 - Self-Raising Flour 20 1 - - - - - - 17 17 - - - - - Margarine - - - 16 - Dripping 16 - - - - - - - 7 63.63 11 11 7 - - Beef Sausages - - - - 11 Cream 10 1 - - - - - - 74 Coffee 10 10 - - - - - - - - 10 - Custard Powder - - 10 - - - - - 10 10.00 10 1 - 1 - Camphorated Oil - - - 8 Ground Ginger 8 - - - - - - - - 7 - - - - Flour 7 - - - - 7 Cocoa 7 - - - - - - - - Corned Beef and Brawn 7 7 - - - - - - - - 7 Tea 7 - - - - - - - - 6 6 - - - - Strawberry Jam - - - - 6 6 Cornflour - - - - - - - - 6 6 - - - Olive Oil - - - - - 5 Fish Paste 5 - - - - - - - - 4 4 - - - Glauber Salts - - - - - 4 Cheese 4 - - - - - - - - 4 4 2 2 50.00 - Boric Acid Ointment - - - - 4 Lemonade Powder 4 - - - - - - - - 13 9 - Whisky 4 - - - - - - 3 White Pepper 3 - - - - - - - - Condensed Full Cream Milk Sweetened 3 3 - - - - - - - - 3 3 Purified Epsom Salts - - - - - - - - 3 3 - - Mustard - - - - - - 3 Sultanas 3 - - - - - - - - 3 3 - - Ground Almonds - - - - - - 2 Ground Rice 2 - - - - - - - - Lard Substitute 2 2 - - - - - - - - 2 2 - - Loganberry Jam - - - - - - Glacé Cherries 2 - 2 - - - - - - - 2 2 - - - - - - Gravy Thick - - 2 2 - - - - - - Rice - - 2 2 - - - Sardine and Tomato Paste - - - - - 2 Sardine ana Tomato Paste 2 - - - - - - - - Crushed Linseed 2 2 - - - - - - - - 2 2 - Citrate of Magnesia - - - - - - - 2 Sherbet 2 - - - - - - - - 2 Prescriptions 2 - - - - - - - - 1 - - - - - Bakina Powder 1 - - - 1 - Bottled Prawns 1 - - - - - - - 1 100.00 1 1 1 - - - Pork Sausages - - 1 - Chicken Ham & Tongue Galantine 1 - - - - - - - 1 - - - - - Veal Loaf 1 - - - 1 1 Preserved Beef Sausages - - - - - - - - 1 1 - - - - Mixed Veal Stuffing - - - - 1 Horse Radish Sauce 1 - - - - - - - 1 - 1 - - - - Dried Mint - - - - 1 - 1 - - - - - - Egg (substitute) Powder - 1 1 - - - Egg (substitute) Self-Raising Flour - - - - - 1 - 1 - - - - - - Pea Flour - 1 - - - - Shredded Suet (with Rice Flour) 1 - - - - 1 Pickling Spice 1 - - - - - - - - 1 - - - Sago 1 - - - - - 1 Arrowroot 1 - - - - - - - - 1 - - - - Dried Full Cream Milk 1 - - - - 1 Foot Sugar 1 - - - - - - 75 - 1 - - - Golden Syrup 1 - - - - - Marmalade 1 1 - - - - - - - - Raspberry Jam 1 - - 1 - - - - - - 1 Greengage Jam 1 - - - - - - - - 1 1 - - - Lemon Curd - - - - - Coffee Cream 1 1 - - - - - - - - Stainless Iodine 1 1 - - - - - - - - Purified Borax 1 - - - - - - 1 - - Bi-carbonate of Soda 1 1 - - - - - - - - 1 5 1 1 100.00 Rum 4 - - - - - 3 3 - - Gin - - - - - 1 Confectionery 1 - - - - - - - - Mincemeat (Fruit) 1 - - - 1 - - - - - 15 10 10 66.66 Norwegian Silds 15 - - - - - 3 75.00 Small Silds 4 3 - 4 - - - - Fat Herrings - 4 100.00 4 4 - 4 - - - 1 1 1 100.00 Crab and Lobster - 1 - - - - 987 49 - - 3.64 1,036 36 19 55 38.77 76 77 TABLE "B" SAMPLES ADULTERATED. Etc. Formal, Informal or Private. Nature of Adulteration or Irregularity. Observations. Result of proceedings or other Action taken. Serial No. Article. 97 No notice to the purchaser of the presence of a preservative. Pork Sausages Formal Sample contained Sulphur Dioxide to the extent of 115 parts per million Vendor cautioned. Resolution, Public Health Committee. Beef Sausages 420 Do. Do. 154 parts per million Do. Do. Do. 632 Do. Do. 154 parts per million Do. Do. 691 Do. Do. Do. 102 parts per million Do. Do. 763 Do. Do. 601 parts per million Do. These two samples, both supplied by the same wholesale firm. Summons issued against wholesale firm. Summons dismissed under the Probation of Offenders Act, and defendant ordered to pay £5 5s. costs. Do. 455 parts per million Do. 775 Do. Do. do. No costs. Do. 808 Do. Do. 280 parts per million No notice of the presence of a preservative. Vendor cautioned. Resolution, Public Health Committee. Do. 975 Do. Do. 83 parts per million Do. Do. Milk Do. 126 21 per cent, of the original fat abstracted Summons dismissed under the Probation of Offenders Act and defendant ordered to pay £1 1s. costs. - Do. 156 Do. 6 Do. do. Vendor cautioned. Resolution, Public Health Committee. - Do. 205 Sample contained 1 per cent. of added water Do. These two samples supplied by the wholesale firm from whom sample No. 215 was obtained. Do. Do. 214 Do. Do. do. do. Do. 215 Do. Do. Do. do. do. Do. 297 Do. - Do. Do. 2 per cent. Do. Do. 301 - Do. Do. do. do. Do. Do. 305 - Do. Do. Do. 3.6 per cent. Do. Do. Do These two samples supplied by the same wholesale firm. 352 Do. Do. 5 per cent. Do. Do. Do. 452 Do. 3 per cent. of the original fat abstracted Do. - 457 Do. Do. 52 Do. do. Defendant ordered to pay £1 and £1 1s. costs. Do. 5 Do. do. - 501 Do. Vendor cautioned. Resolution, Public Health Committee. - Do. 510 Do. 11 Do. do. Previous conviction. Defendant ordered to pay £4 fine. Do. Sample contained 3 per cent, of added water 514 Do. Do. Do.£2 10s. fine. Do. 535 Do. 7 per cent, of the original fat abstracted Summons dismissed under the Probation of Offenders Act, and defendant ordered to pay £1 10s. costs. - Do. 570 Do. Sample contained 38 per cent, of added water Two summonses, one against the dairyman and one against the roundsman. Roundsman ordered to pay £1 10s. fine and £1 1s. costs. Conviction against the dairy firm. No penalty. 78 79 TABLE "B" SAMPLES ADULTERATED, Etc.—continued. Formal, Informal or Private. Result of proceedings or other Action taken. Serial No. Observations. Article. Nature of Adulteration or Irregularity. 739 Milk Formal Samples contained 7.5 per cent, of added water Summons dismissed under the Probation of Offenders Act and defendant ordered to pay £1 1s. costs. - 909 Do. Do. 64 per cent, of the original fat abstracted - Do. do. do. 10s. 6d. costs. Do. do. do. £1 1s. costs. 954 Do. Do. 25 Do do. - 38 Do. do. Do. do. do. £1 1s. costs. 957 Do. Do. - Do. do. do. 10s. 6d. costs. 983 Do. Do. 23 Do. do. - Do. 129 Malt Vinegar A sample of Vinegar, other than Malt Vinegar Defendant ordered to pay £1 fine, and £1 1s. costs. - 524 Do. Do. Do. do. do. Do. £2 fine. - 599 Do. Do. Sample deficient in Acetic Acid to the extent of 21 per cent. Vendor cautioned. Resolution, Public Health Committee. - 449 Vinegar Do. Do. do. 4 per cent. Do. Do. Sample contained 11 per cent, of volatile oil, foreign to genuine Camphorated Oil Summons dismissed under the Probation of Offenders Act, and defendant ordered to pay £1 1s. costs. 191 Camphorated Oil - 281 Boric Acid Ointment Do. Vendor cautioned. Resolution, Public Health Committee. Sample deficient in Boric Acid to the extent of 10 per cent. - 517 Do. Do. Do. do. 5 per cent. Do. - Formal Sample, genuine. Rum Informal 42 Sample 36.5 degrees under proof - 14 Norwegian Silds Do. Sample contained 4.5 grains of tin per lb. - - Do. 15 Do. Do. 8.3 Do. - - Do. Do. Do. 2.8 Do. 16 - - 34 Do. 2.58 Do. Do. Do. - - 35 Do. Do. Do. 3.41 Do. - - Do. Do. Do. 2.47 Do. 36 - - Do. Do. 3.9 Do. 44 Do. - - Do. 4.3 Do. 45 Do. Do. - - Do. Do. Do. 4.7 Do. 46 - - 47 Do. Do. Do. 5.3 Do. - - Small Silds Do. Do. 3.02 Do. 28 - - Do. 2.67 Do. Do. Do. 29 - - Do. 2.80 Do. 30 Do. Do. - - 19 Tinned Fat Herrings Do. Do. 3.73 Do. - - 20 Do. Do. Do. 3.06 Do. - - Do. 6.55 Do. 21 Do. Do. - - 22 Do. Do. Do. 4.62 Do. - - Crab and Lobster Do. 2.35 Do. 18 Do. - - All samples of tinned fish were submitted by Inspector Nash. TABLE "C" Percentage of Adulteration of Formal Samples during the past five years : — Year. 1931 1933 1934 1935 1932 Percentage of Adulteration 4.50 230 2.44 1.80 3.64 TABLE "D" Percentage of Adulteration of Formal Samples of milk during the past five years:— . Year. 1931 1932 1933 1934 1935 Percentage of Adulteration 0.98 1.42 2.04 1.57 3.62 SUMMARY. Formal samples submitted for analysis 987 Informal samples submitted for analysis 49 Formal samples adulterated 36 Informal samples (including tinned fish) 19 Written cautions administered (Food and Drugs (Adulteration) Act, 1928) 14 Written cautions administered (Public Health (Preservatives, etc., in Food) Regulations) 6 Written cautions administered (Merchandise Marks Act, 1926) 7 Summonses issued (Food and Drugs (Adulteration) Act, 1928) 17 Summonses issued (Merchandise Marks Act, 1926) - RESULT OF PROCEEDINGS. Act, Regulation or Order under which proceedings were taken. No. of Summonses. Fines. Costs. £ s. d. £ s. d. Food and Drugs (Adulteration) Act, 1928 0 12 17 0 16 4 0 Chemical and Bacteriological Examination of Food. The analysis of samples taken under the Food and Drugs (Adulteration) Act, 1928, and the various Food Regulations was carried out by the Public Analyst, Mr. Martin Priest, at his laboratory, 4, Obelisk Parade, Lewisham. The results of these analytical examinations appear in Table "A" on pages 74 and 75. The Bacteriological examination of food and milk was carried out by the Borough Bacteriologist, Dr. Guy Bousfield, at his laboratory, 134, Denmark Hill, S.E.5 and this officer's report appears on page 94. Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. With few exceptions all samples taken under the Food and Drugs (Adulteration) Act were examined for the presence of preservatives. One sample of pork sausages and seven samples of beef sausages were reported to contain a permitted preservative, viz., sulphur dioxide. In 6 instances the amount of preservative contained in the samples was below the maximum amount allowed under the Regulations, viz., 450 parts per million. These sales were, however, effected without a declaration of the presence of a preservative, either by a label with the articles, or by a notice conspicuously exhibited in the shops to this effect. The appropriate Committee directed that cautions, in writing, be sent to the vendors. In the two remaining cases, the Public Analyst reported that the beef sausages contained respectively 601 and 455 parts of sulphur dioxide, both being in excess of the maximum amount allowed. Although purchased from different retailers these sausages were supplied by the same wholesale firm. The Public Health Committee instructed that proceedings be instituted against the wholesale firm. Two summonses were issued and resulted in the defendants being discharged under the Probation of Offenders Act, but ordered to pay £5 5s. costs on one summons. Merchandise Marks Act, 1926. The Council is responsible for carrying out the provisions of this Act in respect of foodstuffs which are subject to Orders in Council, but excepting any provision relating to importation. The Sampling Officer and the Food Inspector have been authorised to act as Officers for these purposes. The Orders which have been made relate to honey, fresh apples, currants, sultanas, raisins, eggs in shell and dried eggs, oat products, raw tomatoes, malt products, salmon and sea trout, butter, bacon and ham, dead poultry, maize, starch, frozen mutton, lamb, pork, beef and veal, edible offals, chilled beef, boneless beef and veal, salted beef and pork. In those cases where the provisions of the various Imported Goods Orders (Marking Orders) were not being observed, cautions either verbally or in writing were administered. In 7 instances cautions in writing in respect of dried fruit (4) and butter (3) were sent to seven traders who had failed to comply with the various marking orders. In no instance was it found necessary to institute proceedings. F PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Notifiable Diseases. The following diseases are compulsorily notifiable in Camberwell:— Membranous Croup. Acute Polio-encephalitis. Ophthalmia Neonatorum. Acute Poliomyelitis. Plague. Anthrax. Pneumonia —acute Primary. Cerebro-Spinal Fever. Pneumonia —Acute Influenzal. Cholera. Puerperal Fever. Continued Fever. Diphtheria. Puerperal Pyrexia. Relapsing Fever. Dysentery. Scarlet Fever or Scarlatina. Encephalitis Lethargica. Smallpox. Erysipelas. Tuberculosis. Food Poisoning. Typhoid or Enteric Fever. Glanders. Typhus Fever. Hydrophobia. Malaria. During the year 1935 the number of notifications of infectious diseases (excluding tuberculosis) received was 1,317 as compared with 1,892 for the year 1934. It is satisfactory to note that a reduction of 30 per cent. took place in the number of cases of infectious diseases notified during the year, scarlet fever showing the largest decrease. This disease has been noticeably less severe for many years past, and continues to be benign in character. There has been a gratifying fall in the number of cases of diphtheria with the deaths remaining at the same figure as last year, viz., 20. , The notifications received of enteric fever (typhoid and paratyphoid) were more, viz., 8 as compared with the number reported in 1934 when there was only one case notified. Of the notifiable nervous diseases, the number notified was again small and there were no cases of encephalitis lethargica reported. Smallpox. No case of this disease was notified during the year, nor were any vaccinations performed by the Medical Officer of Health under the Public Health Smallpox Prevention Regulations, 1917. Post-Vaccinal Encephalitis. No case of post-vaccinal encephalitis came to the notice of the Medical Officer of Health during the year. Diphtheria. During 1935 there were 363 cases of diphtheria notified as compared with 520 cases in 1934. Of these patients, 359 were removed to Isolation Hospitals for treatment, and 30 were subsequently discharged as not suffering from diphtheria. The deaths numbered 20. Eleven of the deaths occurred in children under the age of 5 years. The mortality rate from this disease was 5-5 per cent, as compared with 3-8 per cent, in 1934. Diphtheria Immunisation. The clinic for the immunisation of children and adults against diphtheria which was opened nine years ago at 140, Camberwell Road was transferred to more suitable premises, Mayward House, Brunswick Square, on October 2nd of this year. A session was held every Wednesday afternoon throughout the year. During 1935 365 persons attended the clinic to receive the Schick test, and 297 for the purpose of receiving immunisation treatment. The public are slow to realise that in active immunisation there is a safe and efficient method of preventing diphtheria for the vast majority of persons who have not acquired natural immunity, ana that in the very small percentage of persons who contract diphtheria after immunisation treatment through loss of resistance to a virulent organism, the character of the disease has been extraordinarily mild. F2 84 85 DIPHTHERIA IMMUNI SATION CLINIC. RETURN OF WORK. TABLE I. AGES OF PERSONS SCHICK- I TESTED WITH RESULT OF TEST. 6 to 12 mths. 1 to 2 yrs. 2 to 3 yrs. 3 to 4 yrs. 14 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 y rs. 12 to 13 yrs. 13 to 14 y rs. 14 to 15 yrs. 15 yrs. and above. Total 11 41 34 37 41 43 41 33 15 19 9 5 4 3 17 12 365 Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Not read. Pos. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Notread. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Neg. Not read. Positive 294 Negative 62 Not read 9 Neg. Neg. Pos. Neg. 11 - - 31 1 34 3 - 34 7 - 35 5 36 - 25 1 11 - 12 38 1 2 2 3 5 7 4 5 2 6 3 - 8 4 - 3 2 - 2 2 - 2 1 - 6 11 - TABLE 11. IMMUNISATION TREATMENT TABLE. 10 to 11 yrs. 12 to 13 yrs. 13 to 14 yrs. 14 to 15 yrs. 15 yrs. and above. 6 to 121 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 y rs. 8 to 9 yrs. 9 to 10 yrs. 11 to 12 yrs. Totals T. T. T. T. T. T. T. T. T . T. T. T. T. A. A. T. A. T. A. T. A. A. T. A. A. A. T. T. A. T. T. A. T. T. A. T. T. A. T. T. A. T. T. A. T. T. A. T. 1st Injections, 297 2nd „ 287 3rd „ 280 4th „ 13 5th „ 8 2nd 3rd „ 1st Injection. 1st Injection 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 3rd „ 1st Injection. 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 1st Injection. 2nd „ 3rd „ 1st Injection 1st Injection. 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 1st Injection. 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 2nd „ 3rd „ 2nd „ 2nd „ 3rd „ 2nd „ 3rd „ 2nd „ 11 8 39 38 31 31 30 34 33 34 35 37 35 32 36 30 25 23 22 11 11 40 32 33 33 11 12 13 6 6 6 8 8 8 3 5 2 2 2 3 3 4 3 3 13 13 3 3 4th 1 5th 1 4th 1 5th 1 4th 1 4th 1 5th 1 4th 1 5th 1 4th 1 5th 1 4th 3 5th 2 I 4th 1 5th 1 ■ ' I 1 I I i I I I 4th 3 TABLE III.—AGES OF PERSONS RE-SCHICKED AFTER TREATMENT AND FOUND TO BE NEGATIVE. 1 to 2 yrs. 3 to 4 yrs. 4 to 5 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 yrs. 14 to 15 yrs. 15 yrs. and above. 6 to 12 mths. 2to 3 y rs. 5 to 6 yrs. 8 to 9 yrs. 4 22 21 21 21 21 18 16 17 4 2 2 4 10 4 3 Anti-toxin Treatment. Anti-toxin if promptly given is a very potent remedy against diphtheria. Unfortunately, such circumstances as failure to summon medical aid at the onset of the disease or waiting for bacteriological confirmation of the diagnosis before anti-toxin is given, are reasons which render anti-toxin non-effective as a cure. Diphtheria anti-toxin in phials containing 8,000 units for treatment and 500 units for prophylactic purposes is available free of charge to medical practitioners during the day and night at the Town Hall and at the Dulwich Baths. In 1935, 137 phials of 8,000 units and 18 phials of 500 units of anti-toxin were issued to medical practitioners. The efficiency of the L.C.C. ambulance service, which ensures the rapid transport of patients to Isolation Hospital where anti-toxin is given on arrival, probably explains the small amount issued during the year by the local authority. Scarlet Fever. There were 605 cases of scarlet fever notified in 1935, as compared with 916 in 1934. The number of patients removed to Isolation Hospitals for treatment was 521. Thirty-one patients were subsequently discharged as not suffering from this disease. " Return " cases numbered 20. There was one death from this disease during the year. This disease is at present so mild in type that it is not considered worth while to provide facilities for immunisation nor to arrange for the removal of patients to hospital where proper facilities are available at home for isolation and treatment. Enteric Fever (including Paratyphoid). During the year under review 2 cases of typhoid fever and 6 cases of paratyphoid fever were notified. All of these cases were removed to hospital. One patient was subsequently found to he suffering from dysentery and another patient was regarded as not suffering from typhoid or paratyphoid fever. There were no deaths. Enteric Fever Cases Table. Age. Date of Notification. Notified as Results of Bacteriological Examinations. Source of infection. Sex. F. 41 24/2/35 Enteric fever. Positive for dysentery. Not traced. 26 F. 2/3/35 Do. Do. Positive for typhoid. Paratyphoid. 50 M. 15/4/35 Negative. Do. 29 Positive for Para. B. M. 3/5/35 Paratyphoid B. Do. 12 Do. F. 4/5/35 Do. Do. Do. F. 33 14/9/35 Do. Do. 26/10/35 F. 19 Do. Do. Do. F. Do. Do. 38 23/11/35 Do. Pneumonia. Lobar or Lobular pneumonia provided it is primary or secondary to influenza is notifiable. There were 41 cases of influenzal pneumonia and 117 of acute primary pneumonia notified during the year as compared with 28 and 129 respectively in 1934 ; 88 patients were nursed in institutions. Under the Council's district nursing scheme 39 patients received nursing attention in their own homes. These cases were visited by Officers of the Department, who stressed the importance of isolation in a separate room, and the provision of a sputum pot and disinfecting fluid in every case. Attendants on the patient were also recommended to gargle and to use a nasal douche, and persons in attendance on patients suffering from influenzal pneumonia were advised to wear a face mask. Pneumonia all forms was responsible for 157 deaths in 1935. Cerebro-Spinal Meningitis. Five cases of cerebro-spinal meningitis were notified. Particulars of these cases appear in the subjoined table. Age. Date of notification. Date removed to hospital. Bacteriologically confirmed. Result. Sex. M. 10 11/3/35 11/3/35 No. Died.* 11 13/4/35 13/4/35 Yes. Died. F. 20 2/5/35 Recovered. F. 2/5/35 No. F. 58 4/6/35 4/6/35 No. Recovered. F. 6/12 24/12/35 24/12/35 Yes. Died. Certified cause of death T.B. Meningitis. Discharged from hospital as not suffering from the disease. Poliomyelitis and Polio-encephalitis. During the year 5 cases of poliomyelitis were notified and except in one instance the notifications were received after admission of the patients to hospital. There was one death. Owing to the serious after effects which frequently result from this disease, all notified cases are periodically visited to ensure that they receive remedial treatment if necessary. Encephalitis Lethargica. No case of this disease was notified, but one death was reported of a case which had not been notified. Patients whose illness was notified in previous years and who are still living in Camberwell, as well as patients who moved into the Borough from other districts are visited periodically for the purpose of rendering any assistance which may be required. These cases numbered 19. Dysentery. One case of dysentery was notified during 1935. The diagnosis was bacteriologically confirmed and the patient treated at home. Ophthalmia Neonatorum. Twelve notifications of purulent eye discharge occurring in the newly born were received during 1935. In addition to these cases information reporting 42 cases of slight discharge from the eyes of infants residing in the Borough was received from the London County Council. All infants with discharging eyes who are nursed at home are visited daily by the health visitors to ensure that continuous medical treatment is received until a certificate of recovery is given. The necessary nursing attention is given through the District Nursing Associations, and in 1935 612 visits were made to the homes of 29 infants. The following table gives particulars of ophthalmia cases notified in 1935 and the results of treatment :- No. of Cases Notified. Cases Treated. Vision Unimpaired. Vision Impaired. Total. Blindness. Deaths. At Home. In Hospital. 12* 8 4 - - 10 1 * One case removed from the district. Certified cause of death 1 (a) Pyaemia, (b) Palpebral abscess. Erysipelas. There were 117 cases of erysipelas notified during 1935. The majority of cases notified occurred in persons between the ages of 45 and 65 years. Of the 117 cases notified 73 were removed to hospital. There were 3 deaths certified to be due to this disease. Puerperal Fever. There were 10 cases of puerperal fever notified during 1935. Of these cases 2 occurred in a hospital, the remaining 8 patients were removed from their own homes to hospital for treatment. No evidence could be obtained to associate this disease with cases of sore throat or scarlet fever among persons living in the homes of the patients. None of the notified cases of this disease proved fatal. The Registrar General records 10 deaths from puerperal causes during the year, 6 from puerperal sepsis and 4 from other puerperal causes. The death rate from this disease per 1,000 total births was therefore 3.07 as compared with 3.93 for England and Wales. It is appropriate to state that the Council recently approved the issue of Anti-Streptococcic Serum for prophylactic and treatment purposes which is available to general practitioners free on application to the Health Department. Puerperal Pyrexia. Thirty-three cases of puerperal pyrexia were notified during the year. Twenty-six of these notifications referred to patients confined in hospitals. Of the 7 cases confined at home 2 were removed to hospital for treatment. Three of the notified cases proved fatal. The services of the Council's Consultant Obstetrician were utilised by general practitioners during the year for one case of puerperal fever and one case of puerperal pyrexia, as well as for one case of difficult midwifery which was not subsequently notified as either puerperal fever or puerperal pyrexia. Other Notifiable Diseases. No cases of malaria, anthrax, glanders, continued fever, or typhus fever were notified during the year 1935. INFECTIOUS DISEASES. TABLE OF NOTIFICATIONS RECEIVED AND DEATHS FROM THESE CAUSES. Disease. Total Cases Notified. Admitted to Hospital. Notifications and Age Distributions. Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and upwards Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Diphtheria and Croup 363 359 5 17 22 38 50 125 53 15 35 1 2 - 4 Scarlet Fever 605 521 11 14 38 55 63 234 83 43 48 12 - Enteric Fever & Para-typhoid 1 1 3 1 8 8 2 - - - - - - - Pneumonia Acute Influenzal 41 22 1 3 2 2 4 3 2 6 15 3 - - 66 7 7 14 Acute Primary 117 7 3 4 5 17 5 16 22 10 Erysipelas 117 73 1 1 5 9 13 20 43 24 1 - - - Cerebro-spinal Meningitis 1 5 5 1 2 1 - - - - - - - - Poliomyelitis 5 5 1 1 1 2 - - - - - - - - Malaria - - - - - - - - - - - - - - Dysentery 1 1 - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - Ophthalmia Neonatorum 12 4 12 - - - - - - - - - - - Puerperal Fever 10 10 9 1 - - - - - - - - - - Puerperal Pyrexia 33 28 1 27 5 - - - - - - - - - 39 38 98 120 384 154 76 1,317 1,101 Totals 156 57 88 37 70 * Includes one case subsequently diagnosed as dysentery. In one instance certified cause of death was T.B. meningitis. Certified cause of death was abscess in Tempero Sphenoidal region of right side. Leptothrix formed in C.S.I. Bronchitis. § Certified cause of death (a) Pyaemia, (b) Palpebral Abscess. TABLE OF NOTIFIABLE INFECTIOUS DISEASES. Showing Distribution of Cases in Wards. Total Disease. WARDS. 1 2 3 4 5 6 7 8 9 10 11 13 15 16 17 18 19 20 12 14 Small Pox - - - - - - - - - - - - - - - - - - - - - Diphtheria and Croup 39 27 47 26 34 23 10 2 10 11 8 13 23 9 10 3 2 3 363 33 30 49 18 26 24 28 43 29 11 Scarlet Fever 67 27 35 34 37 37 30 27 11 26 17 29 605 1 Enteric Fever and Para-typhoid 1 2 1 1 1 1 8 - - - - - - - - - - - - - 1 2 1 4 7 7 1 1 3 9 1 1 41 Pneumonia Acute Influenzal 3 - - - - - - - Acute Primary 6 4 4 3 2 2 10 7 15 13 5 5 12 6 2 3 12 3 2 1 117 9 4 5 16 6 9 4 11 4 6 2 5 5 6 6 4 5 4 4 2 117 Erysipelas Cerebro-Spinal Meningitis 1 1 1 1 5 1 - - - - - - - - - - - - - - - Poliomyelitis 1 1 1 2 5 - - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - - - - - - - 1 Dysentery 1 - - - - - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - Ophthalmia Neonatorum 2 2 2 1 1 1 2 1 12 - - - - - - - - - - - - 2 1 1 1 1 1 1 1 1 - 10 Puerperal Fever - - - - - - - - - - 6 1 1 1 2 Puerperal Pyrexia 3 1 3 4 2 1 2 1 3 2 33 - - - - - Anthrax - - - - - - - - - - - - - - - - - - - - - 123 96 114 90 97 89 79 54 22 43 65 36 52 60 42 47 56 37 19 1,317 Totals 96 REFERENCE TO WARDS. No. No. No. No. 16. St. John's. 1. West. 6. Marlborough. 11. St. Mary's. 12. Nunhead. 2. Addington. 7. North Peckham. 17. Alleyn. 13. The Rye. 18. Ruskin. 3. Town Hall. 8. Goldsmith. 9. Clifton. 14. St. Giles'. 19. The Hamlet. 4. St. George's. 5. Cobourg. 10. Rye Lane. 15. Lyndhurst. 20. The College. NON-NOTIFIABLE DISEASES. Measles. Measles is regarded as a serious disease owing to its complications, especially pneumonia. During the year 289 cases were brought to the knowledge of the Health Department, mainly through reports from the school authorities. Seventy-nine cases received treatment in hospitals. Epidemics of measles occur in London at intervals of two years beginning in the autumn and continuing through the winter and the following spring. The last epidemic occurred in 1933-4. In November of the year under review the number of cases brought to the notice of the Department commenced to rise and at Christmas time the number of cases reported weekly was approximately 80. The machinery to combat an epidemic was forthwith put into force, including the Measles Scheme of Control which has for its object the early submission to the Medical Officer of Health of the names and addresses of cases and suspected cases of measles in children attending the Elementary Schools. The homes of these children were visited by the Health Visitors for the purpose of urging the parents to provide adequate medical and nursing attention and to arrange for the removal to hospital of patients whose environmental circumstances were not suitable for treatment at home, or where the illness was severe with a risk of complications developing. Home contacts were allowed to remain in attendance at school after arrangements had been made for their examination daily by the School Nurse. Households with young children in infected areas were also visited, and a leaflet was left at the home containing information as to the signs, symptoms, and prevention of the disease; the necessity for treatment and proper nursing should measles occur, and how to obtain the services of the district nurse. Measles Serum. The use of serum obtained from convalescent patients and adults who have had measles serves to protect non-immune children from an attack of measles or to reduce the severity of an attack. There is convincing proof that measles prophylaxis may save the lives of many children, and it would seem that the future of this protective inoculation treatment is in the hands of the general medical practitioners. Unfortunately no application was made to this Department by a medical practitioner during 1935 for a supply of measles serum for inoculation purposes. Whooping Cough. This disease is most infectious in the early catarrhal or preparoxysmal stage and the infectious stage usually lasts for a period of six weeks from the time of the commencement of these symptoms. To control the spread of infection early diagnosis and isolation are necessary. Early diagnosis before the appearance of the characteristic whoop is possible by the examination of petri dishes containing a suitable culture medium upon which a suspected patient has coughed. Colonies of this bacilli can be recognised macroscopically and the organism identified by microscopical examination. Prophylactic vaccination is stated to be useful in modifying the severity of the subsequent attack. The injection of serum of a whooping cough convalescent or of a person who has had whooping cough at some time during his life is reported as resulting in complete or partial protection in a large proportion of instances. In 1935 401 cases came to the notice of the Health Department through the agency of the School Authorities, which were visited by the Health Visitors and Sanitary Inspectors. At these visits the parents were advised as to the infectious nature of the disease and of the necessity for isolation of the patient. Home nursing treatment was offered to those patients who required it and arrangements were made for removal of the patient to hospital where the illness was severe in character. Eighty-two patients were removed to hospital for treatment. There can be little doubt that admission to hospital offers a much greater chance of recovery, and a strong case can be made out for an extension of hospital facilities for these sufferers. At the present moment the certificate of a registered medical practitioner is not sufficient to secure the admission of a patient to an L.C.C. Infectious Diseases Hospital, the sanction of the Medical Officer of Health of the Metropolitan Borough must first be obtained. There is every prospect that in the near future the selection of cases of whooping cough for hospital treatment will no longer operate and patients will be admitted on the same footing as those suffering from diphtheria or scarlet fever. The age distribution of patients whose illness proved fatal is given in the following table: — Under 1 year. 1-2 years. 2-5 years. Total. 8 4 1 13 Influenza. This disease did not assume epidemic proportions in 1935. The number of deaths which took place during the year from this cause numbered 20. Cancer. The sites of the body which were affected in the fatal cases of cancer during the year are shown in the following table: — Site of Disease. 15- 25- 35- 45- 55- 65- 75- All Ages. M. F. M. F. - M. F. M. F. M. F. M. F. M. F. M. F. Buccal Cavity and Pharynx - - - - 3 1 4 5 - 7 1 - 19 - 2 Digestive Organs - 1 - 2 11 10 30 19 41 33 17 28 99 93 - - 5 Respiratory Organs - - 2 15 5 19 2 8 3 1 49 11 - - - Female Genital Organs - - - 2 - - 2 - 8 11 - 11 - 3 - 37 8 42 Breast - - 2 - 3 - 9 - 14 - - 6 - - Male Genitourinary Organs - - - - - 1 - - - 1 - 4 7 6 19 - - - - - - 1 1 1 2 1 Skin - - - - - - - 1 1 2 4 8 4 6 2 7 26 Unspecified Organs - - 4 13 - 32 37 47 6 4 7 62 54 66 61 37 201 212 Totals - - - Leaflets providing information as to the early symptoms and signs of this disease in various sites of the body are distributed periodically. It cannot be emphasised too strongly that delay in seeking medical advice often results in unnecessary suffering and frequently ends in disaster. Prevention of Blindness. The London County Council is the Authority discharging the duties in connection with the welfare of blind persons. Bacteriological Examination. Report on Bacteriological Examinations for the year ended December 31st, 1935: — The number of specimens submitted for examination and reported upon was 4,661. There was a reduction in the requirements as regards examinations both of diphtheria swabs and sputa, and it is a significant fact that this year only 4.6 per cent, of swabs were positive to diphtheria as compared with 10.3 per cent, in the previous year. The actual number of specimens was composed as follows:— Swabs for diphtheria 2,420 Number positive 113; per cent. positive 4.6 Sputa for tubercle 2,118 „ „ 370; „ „ 17.4 Bloods for typhoid 6 „ „ 0; „ „ 0.0 Milks (bacteriological) 86 Bath waters (bacteriological) 12 Tank waters 2 Ice Creams 8 Miscellaneous specimens 9 Total 4,661 GUY BOUSFIELD, M.D., B.S.[Lond.], Borough Bacteriologist. Diabetes. During the year the Council obtained Ministry of Health sanction to supply Insulin for a period of twelve months to the poorer inhabitants of the Borough suffering from diabetes. Medical Practitioners undertaking the treatment are required to furnish a quarterly report to the Medical Officer of Health for submission to the Ministry of Health stating:— (i) The name, age and address of the patient. (ii) The number of doses of insulin administered. (iii) Whether any tests were made of the urine or of the blood of the patient, and if so by whom and with what results. (iv) A report on the progress of the patient. Supplies of Insulin were issued to 9 patients during the year. 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 1935. DISINFECTING DEPARTMENT. Return of Work, 1935. Number of houses visited following infectious Disease 1,396 Number of visits to these premises 2,942 Number of houses visited following other diseases 239 Number of visits to these premises 579 Number of houses visited for miscellaneous purposes 626 Number of visits to these premises .. 777 Number of rooms disinfected. Infectious Disease 2,039 Number of houses visited. Verminous 969 Number of rooms disinfected. Verminous 1,260 Number of articles disinfected (steam disinfected) 59,060 Number of articles disinfected (formalin) 1,997 Number of books disinfected 737 Number of articles destroyed 2,786 Weight of furniture, etc., destroyed 5 tons 16 cwt. Weight of unsound foods destroyed (see Food Inspector's report) 8 tons, 9 cwts., 3 qrs., 27 lbs. Weight of dead animals destroyed 5¼ cwt. Public Health (Prevention of Tuberculosis) Regulations, 1925. These Regulations confer powers upon local authorities which enable them to prevent persons suffering from pulmonary tuberculosis from entering the milk trade and to require persons to discontinue any occupation involving the handling of milk when they are found to be suffering from this disease in an infectious state. It was not necessary to take any action under these Regulations during the year under review. Disinfection (Tuberculosis). Disinfection of rooms and their contents is offered in all cases of death from pulmonary tuberculosis occurring at home and where patients were removed to hospital or sanatorium for treatment. Propaganda. The general public are gradually becoming alive to the dangers of tuberculosis and the campaign of education, directed from the Tuberculosis Dispensary by means of leaflet distribution and personal advice, endeavours to teach sufferers from this disease not only to regulate their own lives, but also to take every precaution to safeguard from infection those who come in contact with them. So long as a consumptive patient is able to get about and is careful to carry out the instructions of the Tuberculosis Officer, he is not to any extent a menace to the community. The helpless bedridden consumptive is the danger and requires supervision and nursing to prevent the spread of infection to other members of the household. Compulsory hospital treatment for advanced cases of tuberculosis is essential to prevent infection being conveyed to other persons, where the home conditions do not allow of segregation in a separate room and constant nursing attention, particularly in cases where children are compelled to live and sleep in the same room as the patient. Tuberculosis. During the year under review 367 cases of Pulmonary Tuberculosis and 72 cases of Non-Pulmonary were notified for the first time. In addition to these, 60 cases of Tuberculosis came to the notice of the Department otherwise than by notification. The sources of information were as follows: — "Transfers" from other areas now living in the Borough 44 Death Returns from local Registrars and Registrar-General 4 Posthumous notifications 8 In 1935 the number of deaths registered from Pulmonary Tuberculosis and Non-Pulmonary Tuberculosis were 166 and 26 respectively, representing a mortality rate from these causes of 0.82 per 1,000 inhabitants. Year. Deaths, All Forms of Tuberculosis. Total. Pulmonary. Non-Pulmonary. 1931 241 27 268 1932 214 34 248 1933 221 22 243 1934 202 29 231 1935 166 26 192 The following table gives particulars of new cases of tuberculosis; those notified in accordance with the Tuberculosis Regulations plus those discovered otherwise than by formal notification, as well as particulars of deaths from Tuberculosis of Camberwell residents, as furnished by the Registrar-General. Age New Cases. Deaths. Periods. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. 0- - 1 1 1 - 2 1 - 1- 1 2 7 3 - - 3 1 5- 6 10 10 9 1 _ 6 2 15- 46 63 11 13 18 24 3 1 25- 44 35 8 3 19 21 2 2 35- 28 18 5 2 10 8 2 - 45- 22 8 1 1 21 10 — - 55- 20 2 — — 15 3 — - 65 and upwards 8 3 — 1 9 5 1 2 Totals 175 142 43 33 93 73 18 8 The ratio of non-notified Tuberculosis deaths to the total Tuberculosis deaths was 1 to 24 as compared with 1 to 8.88 in 1934 and 1 to 11.57 in 1933. It will be seen that there has been a marked improvement in the ratio for 1935 as compared with the previous year. It is also satisfactory to record that the requirements of the Public Health (Tuberculosis) Regulations, 1930, are generally speaking closely observed by medical practitioners in the area. G 97 REPORT OF THE TUBERCULOSIS MEDICAL OFFICER FOR THE YEAR 1935. The current list of Notifications of Tuberculosis in Camberwell as at December 31st, 1935. On December 31st, 1935, there were 2,112 cases of tuberculosis on the current list in Camber well. There were 1,557 cases of pulmonary tuberculosis —873 males and 684 females; 555 cases of non-pulmonary tuberculosis —308 males and 247 females. Table I. supplies an analysis under age periods, sex, and the broad grouping of pulmonary and non-pulmonary forms. TABLE I. Individual Notified Patients on Current List at December 31st, 1935. Age Periods. 35- 45- 55- 65- Total (all Ages) 0- 1- 5- 10- 15- 20- 25- I I "I I 1 f r~ Pulmonary— 18 1 115 873 213 168 58 20 22 123 134 Males 1 147 113 35 13 684 5 17 42 125 155 32 Females - 50 18 16 11 2 308 32 66 68 23 18 Non-Pulmonary— 4 39 34 14 11 2 4 247 2 25 37 45 34 Females TABLE II. Individual Notified Patients on Current List at December 31st, 1935, ALLOCATED TO THE WARDS OF THE BOROUGH. Males. Pulmonary. Non-Pulmonary. Grand Total. Wards. Females. Males. Females. Total. Total. 57 136 68 79 31 204 1 37 9 15 62 2 28 19 47 6 36 23 11 34 128 3 58 94 17 20 37 167 4 67 63 130 93 16 10 26 5 45 22 67 33 73 10 17 6 30 40 16 53 193 78 62 140 23 25 7 36 98 8 62 24 12 29 33 7 25 100 43 32 75 18 9 25 91 10 33 33 66 16 9 28 105 29 77 17 11 11 48 13 30 110 31 49 80 17 12 100 79 9 21 13 36 43 12 106 17 29 14 45 32 77 12 18 99 42 8 10 15 39 81 111 90 13 8 21 16 54 36 33 99 40 66 17 16 17 26 17 113 33 96 6 11 18 63 5 52 27 20 47 2 3 19 7 7 1 1 8 20 - - The Notification of Tuberculosis in Camberwell in 1935. The nu mber of primary notifications of tuberculosis received in Camberwell in 1935 was 333, comprising 275 cases of pulmonary tuberculosis and 58 cases of non-pulmonary tuberculosis. On Table III. the number of primary notifications for each of the last fifteen years are compared. TABLE III. Comparative Table of Primary Notifications for past Fifteen Years. Year. All Forms. Pulmonary Tuberculosis. Other Forms. 1921 750 595 155 653 1922 506 147 1923 657 505 152 1924 559 416 143 1925 491 373 118 1926 506 394 112 1927 451 353 98 1928 465 363 102 1929 495 393 102 1930 483 393 90 1931 414 333 81 1932 386 314 72 1933 363 290 73 1934 341 284 57 1935 333 275 58 On Table IV. is given the primary notification rate (per 1,000 population of Camberwell) for the last fifteen years. TABLE IV. Showing Annual Primary Notification Rate of Tuberculosis (All Forms) 1921-1935. Population. Pulmonary Tuberculosis. Other Forms. Year. All Forms. 1921 267,198 2.80 2.22 0.58 1922 270,300a 2.41 1.87 1.85 0.54 1923 272,300a 2.40 0.55 1924 273,700a 2.04 1.52 0.52 1925 275,400a 1.78 1.35 0.42 1926 1.80 275,400a 1.43 0.40 1927 271,100a 1-66 1.30 0.36 1928 260,400a 1.78 1.39 0.39 1929 1.92 256,900a 1.52 0.39 1930 256,900a 1.88 1.53 0.35 1931 252,100* 1.64 1.32 0.32 1932 248,000a 1.56 1.27 0.29 1933 243,700a 1.49 1.19 0.30 1934 238,360a 1.43 1.19 0.24 1935 234,400a 1.41 1.17 0.24 *Census, 1931. a Estimated. G2 99 On Table V. the primary notifications of 1935 are allocated to the Wards of the Borough. TABLE V. Showing No. of Primary Notifications Received during 1935 and Ward Allocation. Non-Pulmonary. Grand Total. Wards. Pulmonary. Males. Females. Total. Males. Females. Total. 26 2 5 1 15 6 21 3 5 6 20 6 8 14 1 2 3 18 3 8 7 15 2 1 1 3 16 2 19 4 7 9 14 2 2 16 5 8 6 - 5 2 3 11 6 3 3 6 4 11 4 7 4 - 7 3 17 6 15 2 2 8 9 - 21 6 16 3 2 5 9 10 1 10 10 3 9 1 6 - 1 3 13 6 4 10 2 11 3 23 12 8 20 3 - 12 - - 11 7 4 11 13 - 2 - 2 20 11 7 18 14 29 23 3 3 6 15 12 11 2 21 2 - 16 9 10 19 1 13 10 3 17 6 4 2 21 19 - 2 2 18 10 9 11 11 - - - 19 6 5 1 - - 1 1 20 - - One Pulmonary Male unattached. On Table VI. the summary of notifications for the year 1935 is treated in more detail. r~ Formal Notifications under Article 5. Sanatoria. 181 9 166 3 Summary of Notifications during the Period from January 1st, 1935 to December 31st, 1935. Poor Law nstitutions. tions. 131 92 10 13 Notifications under Article 5. 214 153 44 28 Number of Primary Notifications. Total Primary Notifications. 155 36 22 120 - 65 and upwards. 1 - 7 - 55-65 2 - 17 45-55 1 6 1 18 1 35-45 26 2 15 3 TABLE VI. 25-35 37 8 30 7 5 20-25 29 24 4 15-20 14 6 30 10-15 2 7 2 1 5-10 5 3 4 2 2 1-5 1 2 6 - 0-1 1 - 1 Age Periods. Pulmonary— Males „ Females „ Females Non-Pulmonary— Males Pulmonary—Males - - - - 1 2 7 2 4 3 1 20 „ Females - - 1 4 5 3 2 - 2 22 - 5 1 Non-Pulmonary—Males 2 1 3 - 7 - - - - - - - „ „ Females 1 1 4 1 1 1 - 11 1 - 1 The source or sources from which information as to the above-mentioned cases was obtained stated below:— No. of Cases. Source of Information. Pulmonary. Non- Pulmonary, From Local Registrars 2 1 Death Returns Transferable deaths from Registrar-General 1 4 Posthumous notifications 4 4 "Transfers" from other areas (other than transferable deaths) 35 9 Other Sources if any (specify) - - Table VII. Supplemental Return. New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during 1935 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), 1935. The number of deaths from tuberculosis in Camberwell during 1935 as stated by the Registrar-General was 192. Of these 166 were from pulmonary tuberculosis and 26 from other forms of the disease. 8 were not notified during life as suffering from the tuberculosis of which they died. TABLE VIII. Deaths from Tuberculosis (All Forms) 1935 Allocated to the Wards of the Borough. Wards. Pulmonary. Non-Pulmonary. Grand Total. Males. Females. Total. Males. Females. Total. 1 3 5 8 2 - 10 2 2 8 3 11 1 1 2 13 3 4 3 7 3 3 10 - 11 4 5 5 10 1 - 1 5 5 2 7 3 3 10 - 7 6 3 4 - - 7 - 7 4 2 6 2 2 8 - 8 8 7 15 1 1 2 17 4 1 1 9 5 9 10 - 10 2 1 3 - 1 1 4 2 11 2 4 1 1 5 - 12 10 4 14 1 1 2 16 13 2 5 - 3 - 5 - 14 6 11 5 - 1 1 12 15 4 3 7 1 2 9 1 16 3 5 8 8 - - - 17 3 3 6 2 2 8 - 18 5 3 8 2 - 8 - 19 4 3 7 1 - 1 8 20 - - - - - - - One Pulmonary Male unattached. 65-75 75 and upwards Age Periods. Under 1 1-2 2-5 5-15 15-25 25-35 35-45 45-55 55-65 Pulmonary—Males - - - 1 18 19 10 21 15 5 4 3 5 - 2 - 24 21 8 10 „ Females - - - - 1 3 6 3 2 2 - 1 Non-Pulmonary —Males - 2 - - 1 1 „ Females - 2 1 - 1 - TABLE X. Showing the Occupation of 107 Males who died from Tuberculosis in 1935. Aircraftsman R.A.F. 1 Butcher's Assistant 1 Boot Repairer 2 Barman 1 Baker 1 Bricklayer 2 Builder 1 Clerk 9 Commercial Traveller 1 Cook 1 Cook Cutter 1 Carpet Planner 1 Cartage Contractor 1 Dye Worker 1 Engineer's Fitter 2 Steel Bender 1 „ Machinist 1 G.P.O. 1 Ex-serviee Pensioner 1 Furniture Dealer 1 Grocer 1 House Painter 4 Horse Dealer 1 Labourer 9 Leatherworker 1 Loader 1 Manager, Public House 1 Motor Driver 3 Messenger 1 No Occupation 6 Newsvendor 1 Newspaper Canvasser 1 Pawnbrokers' Assistant 1 Printers' Reader 1 Clerk 1 „ Assistant 1 Porter 3 „ Railway 2 Packer 1 Postman 1 Stained-glass Painter 1 Sign Writer 1 School Age 7 Salesman 3 Shop Assistant 5 Street Trader 2 Stonemason 1 Soldier 1 Theatre Hand 1 Tea Taster 1 Traveller 1 Under School Age 4 Vanguard 1 Wet Cooper 1 Watchman 1 Weighman (Gas Company) 1 Window Cleaner 1 Warehouseman 2 TABLE XI. Showing the Occupation of 73 Females who died from Tuberculosis in 1935. Barmaid 1 Machinist 4 Bookfolder 1 No Occupation 4 Cook 2 Packer 3 Clerk 2 Relief Stamper 1 Chocolate Dipper 1 School Teacher 1 Concert Artist 1 School Age 2 Factory Hand 1 Shorthand Typist 3 Housewife 34 Staff Maid 1 Laundry Worker 3 Typist 1 Labeller 1 Under School Age 3 Waitress 2 Label Gummer 1 106 TABLE XII. Return showing the Work of the Dispensary DURING THE YEAR 1935. Nonpulmonary. Diagnosis. Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts): — 5 85 63 2 11 8 96 71 11 (a) Definitely tuberculous 5 6 3 (6) Diagnosis not completed - - - - - - - 10 - - 1 - (c) Non-tubercuious - 76 52 - - - - - - - 168 184 B.—Contacts examined during the year:— I II I I I II I I 1 26 1 1 1 2 (a) Definitely tuberculous 26 29 - 1 - 30 (b) Diagnosis not completed - - - - 3 2 1 - - - - - - - - - 106 165 193 167 (c) Non-tuberculous - - - - I C.—Cases written off the Dispensary Register as:— I I I I I (a) Recovered 2 4 7 10 9 5 7 1 5 3 9 10 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - 281 353 221 271 - - - - I I! I D. —Number of Cases on Dispensary Register on December 31st:— I I II I I I II I 508 647 46 51 120 107 767 619 133 (a) Definitely tuberculous 111 82 153 13 3 1 (b) Diagnosis not completed - - - - - - - - - 1. Number of cases on Dispensary Register on January 1st 1,680 7. Number of consultations with medical practitioners :— (a) Personal 40 (b) Other 556 2. Number of cases trans- ferred from other areas and cases returned after discharge under Head 3 in previous years 63 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 591 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 9,255 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 142 10. Number of :— (a) Specimens of sputum, &c., examined 1,256 4. Cases written off during the year as Dead (all causes) 120 (b) X-ray examinations made in connexion with Dispensary work 756 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(6) above 2 5. Number of attendances at the Dispensary (including Contacts) 5,894 6. Number of Insured Persons under Domiciliary Treatment on December 31st 302 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 769 TABLE XIII. Number of Families occupying 1 Room. 2 Rooms. 3 Rooms. 4 Rooms. 5 Rooms. 6 Rooms or more. Housing accommodation of 333 families in which there was a Primary Notification of Tuberculosis in 1935. Patient living alone 20 14 4 1 - - „ „ with 1 other 7 19 19 10 2 - „ „ 2 „ 2 17 28 11 2 4 „ „ 3 „ - 14 22 13 6 2 „ „ „ 4 „ - 6 12 15 9 8 - 9 „ „ „ 5 „ 1 6 5 5 „ „ „ 6 „ - 1 5 5 8 5 „ „ „ 7 „ - 1 3 1 3 5 „ „ „ 8 „ - - 1 1 1 - „ „ „ 9 „ - - - - - - „ „ „ 10 „ - - - 30 - - - 29 73 103 32 66 Total TABLE XIV. Sleeping accommodation for 333 tuberculous cases notified for the first time in 1935. The figures refer to the tuberculosis Nurses' first home visit. The patient slept— In separate room In 133 cases. Alone in bed with 1 other in room „ 20 „ „ „ 2 others „ „ 20 „ „ „ 3 „ „ 8 „ „ „ 4 „ „ 2 „ In bed with 1 person and no others in room „ 95 „ „ „ 1 „ 1 other in room „ 20 „ „ „ 1 „ 2 others „ „ 26 „ „ „ 1 „ 2 others „ „ 4 „ „ 1 „ 4 „ „ 1 „ In bed with 2 persons and no others in room „ 4 „ „ „ 2 „ 1 other „ „ - „ „ „ 2 „ 2 others „ „ - „ „ „ 2 „ 3 „ „ „ — „ In bed with 3 persons and no others in room „ - „ 333 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, 824 Dispensary patients were sent to hospital in 1935 for an opinion as to diagnosis, etc. (b) Other Hospitals. Many of our patients when requested to go to a hospital for further examination and opinion, asked to be sent to the hospital they knew best, and we sent patients to the following hospitals:— St. Thomas's. Guy's. Sick Children's Hospital, Great Ormond Street. Throat Hospital, Golden Square. Charing Cross. Westminster. Brompton. Miller. South London Hospital for Women. Evelina. Belgrave. All Saints'. Royal Waterloo. Grosvenor Hospital for Women. Grosvenor Hospital for Women. Middlesex. 2. With School Clinic. 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. 596 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 1935, 235 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) 89, or 37.9 per cent. T.B. plus 1 (early cases, sputum positive) 17, or 7.2 per cent. T.B. plus 2 (intermediate cases, sputum positive) 106, or 45.1 per cent. T.B. plus 3 (advanced cases, sputum positive) 23, or 9.8 per cent. (b) Non-Pulmonary Tuberculosis. There were 34 cases of non-pulmonary tuberculosis in the following forms: — Bones and joints. 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 symptoms, temperature charting and pulse study, physical examination and repeated sputum testing in tubercle negative cases. When the above methods are not neglected in the diagnosis of a case the use of X-rays is of the highest value. Special arrangements exist with King's College Hospital for X-ray examination of dispensary patients. During 1935, 756 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, Colindale, King's College. During 1935, 57 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, 1935. Such surgical methods as phrenic evulsion and thoracoplasty are available under the scheme for dispensary patients, and the former operation is coming more and more into use. Finsen light is available for dispensary patients who have Lupus vulgaris. Two dispensary patients had this treatment at the London Hospital during the year. Work of Tuberculosis Nurses. The tuberculosis nurses paid 9,255 visits to the homes of tuberculous patients during the year 1935. Nursing Patients. We have 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. 12 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 1935. In Camberwell action is taken by the Tuberculosis Officer to secure the grant of extra nourishment in: (1) Ex-sanatorium cases where the medical condition is such that a grant of extra nourishment is necessary to enable a patient to maintain or recover full working capacity. (2) Cases with prospects of ultimate arrest of the disease who are awaiting admission to sanatorium. (3) Other cases requiring special consideration. In the case of tuberculous patients coming into the above categories patients must not be in receipt of Poor Law relief at the time of recommendation. 77 Camberwell patients received extra nourishment in 1935. Supply of Sputum Pocket Flasks and Outfits for Sputum Examinations. Approximately 148 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. 1,256 outfits were supplied in connection with sputum examinations. Institutional (Residential) Treatment of Camberwell Patients in 1935 through the London County Council. 1. Adult Males :- Number of applicants for residential treatment 179 Number who received residential treatment 167 Number who did not receive residential treatment:— Not accepted 1 Failed to enter 8 Awaiting residential treatment December 31st, 1935 3 Classification of Adult Males who received Residential Treatment Pulmonary cases in which tubercle bacilli had not been found in the sputum 12 Pulmonary cases in which tubercle bacilli had been found in the sputum 126 Early pulmonary tuberculosis 32 Moderately advanced pulmonary tuberculosis 80 Advanced pulmonary tuberculosis 14 Surgical tuberculosis 18 Diagnosis of tuberculosis 6 Not classified 5 2. Adult Females :— Number of applicants for residential treatment 144 Number who received residential treatment 137 Number who did not receive residential treatment:— Not accepted 2 Failed to enter 4 Awaiting residential treatment December 31st, 1935 1 Classification of Adult Females who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 19 Pulmonary cases in which tubercle bacilli had been found in the sputum 92 Early pulmonary tuberculosis 22 Moderately advanced pulmonary tuberculosis 65 Advanced pulmonary tuberculosis 5 Surgical tuberculosis 14 Diagnosis of tuberculosis 11 Not classified 1 3. Boys :— Number of applicants for residential treatment 19 Number who received residential treatment 19 Number who did not receive residential treatment:— ill Not accepted - Failed to enter - Awaiting residential treatment December 31st, 1935 — - Classification of Boys who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 1 Pulmonary cases in which tubercle bacilli had been found in the sputum - Early pulmonary tuberculosis - Moderately advanced pulmonary tuberculosis - Advanced pulmonary tuberculosis - Surgical tuberculosis 14 Diagnosis of tuberculosis 3 Not classified 1 4. Girls:— Number of applicants for residential treatment 19 Number who received residential treatment 19 Number who did not receive residential treatment:— Not accepted - Failed to enter - Awaiting residential treatment December 31st, 1935 - Classification of Girls who received Residential Treatment. - Pulmonary cases in which tubercle bacilli had not been found in the sputum 5 Pulmonary tuberculosis in which tubercle bacilli had been found in the sputum 2 Early pulmonary tuberculosis 2 Moderately advanced pulmonary tuberculosis — - Advanced pulmonary tuberculosis - Surgical tuberculosis 10 Diagnosis of tuberculosis 2 Not classified 2 The London County Council used beds in the following institutions:— Adults. Hospitals. Sanatoria. Brompton King George V Northern Frimley Grove Park Holy Cross Colindale Northampton, Creaton Royal Sea Bathing Grosvenor Royal National Maltings Farm Whirstable and Tankerton Pinewood Dulwich National Lewisham Old Manor House St. Luke's Fairlight St. Giles' Fairholme St. James's King George's St. Olave's St. Michael's St. Nicholas' Marillac Rushdene St. Alfege's St. Leonard's Homes. Colonies. Burrow Hill St. Barnabas Bishopsbourne Papworth St. George's Preston Hall Hampshire Home of Recovery Firs Tait Children. Hospitals. Sanatoria and Homes. Highwood Nay lands Heatherwood Millfield Princess Mary's Metropolitan Convalescent Queen Mary's East Anglian Royal Waterloo Victoria The average duration of residential treatment given by the London County Council in 1935 to 304 adults was 20.6 weeks. The average duration of residential treatment given to 38 children by the London County Council in 1935 was 21 weeks. This refers only to those who began treatment in that year. Many of these patients will remain in institutions during varying periods of 1936 —some will probably remain the whole year. The ultimate averages are therefore to be reckoned as considerably higher. It should be remembered that a good many patients took their discharge before completion of treatment, thereby reducing the possible averages. The Work of the Tuberculosis Care Committee. In 1935 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 £50 10s. 9d. the Committee had a surplus of £177 16s. 8½d. 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 1935:— 129 cases were helped in their application to the Public Assistance Committee. Thus patients received money, food, extra diet, clothes, etc. 9 cases were assisted in their application to the British Red Cross Emergency Fund. 14 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 342 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 5 cases and with the Invalid Children's Aid Association in 63 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 question 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. H 113 The following items will show how part of the Christmas Seal Fund was spent: — Pocket money to 18 more or less destitute patients while they were away at sanatorium. Clothing to 23 patients. Mothers' Help in the case of 3 patients while awaiting sanatorium treatment or as a convalescent measure for a short period after leaving sanatorium. Payment of fares in 33 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 10 cases. Paving arrears of National Health Insurance stamps in 9 cases. Paying for board and lodging in one case. Purchase of spectacles in one case. Advertising for a job in one case. Purchase of beds and bedding in 15 cases. Paying for cost of household removals in 4 cases. Payment of key money and rent in 3 cases. Payment on furniture in 2 cases. The Handicraft Class. The Handicraft Class continues to do good work. Through this class, an endeavour is made to bridge that difficult time the interval between the return from Sanatorium and the return to work. The ex-Service members of the class sent work to the Armistice Week Exhibition at the Imperial Institute and found a ready sale, particularly for hand-woven scarves and ladies handbags. WILLIAM BRAND, Tuberculosis Officer. INDEX. PAGE Aged and Infirm Persons 51 Agriculture (Grading, etc.) Act 73 Ambulance Facilities 15 Ante- and Post-natal Services 25, 20 Ante-natal Clinics Return 26 Bacteriological Examination 94 Bakehouses 66 Baths, Public 47 Birth and Birth Rates 8 Illegitimate Births 8 Notification of Births Act 8 Still Births 8 Blindness, Prevention of 94 Butcher Shops and Meat Stalls 66 Cancer 94 Cerebro-spinal Meningitis 87 Cleansing Station 19 Clearance Areas Scheme 53 Clinics and Treatment Centres 15 Common Lodging Houses 48 Convalescent Home Treatment 29 Cremation 51 Deaths 8 General Table of 9 Illegitimate Infants 9 Infantile 12, 14 Inquiry into Maternal Death 12 Maternal 11 Neo-Natal 13 Ward Distribution, Table 13 Diabetes 95 Diarrhoea and Enteritis 13 Diphtheria 83 Anti-toxin Treatment 86 Immunisation 83, 84-85 Disinfection 95, 96 Dogs, Fouling of Footways 52 INDEX —continued. PAGE Drainage and Sewerage 38 Dysentery 82, 88 Encephalitis Lethargica 88 Enteric Fever 86 Erysipelas 88 Exhumations 51 Factory and Workshop Act 58-60 Food 61-81 Butcher Shops and Meat Stalls 66 Chemical and Bacteriological Examination of 80 Fish— Curers 66 Fried Fish Shops 67 Shops and Stalls 66 Milk 61-64 Personal Hygiene for Food Handlers 69 Poisoning 69 Preservatives, etc., Regulations 81 Summary of Work, Table 72 Unsound Food, Table 70-71 Food and Drugs Acts: Adulteration Act 72 Artificial Cream Act 73 Butter Factories, etc. 73 Condensed Milk Regulations 73 Dried Milk Regulations 73 Proceedings Table 80 Samples, Table 74, 75 Samples, Adulteration Tables 76-80 Slaughterhouses 67 Health Propaganda 19 Health Visiting 34 Home Helps 32 Home Nursing 15, 29 Hospitals 17 Housing 53-57 Clearance Areas Scheme 53 Overcrowding, Housing Act, 1935 55 Houses let in Lodgings 56 Statistics 57 Ice Cream 65 INDEX—continued. PAGE Imported Meat, Marking of 66 Infant Life Protection 34 Infant Welfare Centres 18,25 "Toddlers" Chnics, Attendances Table 28 Mothercaft and Health Talk Sessions 29 Returns 36, 37 Infectious Diseases 82-93 Non-notifiable 92-93 Notifiable 82 Other Notifiable Diseases 89 Tables 90, 91 Influenza 93 Laboratory Facilities 15 Maternity and Child Welfare 24-37 Maternal Mortality 11 Maternity Outfits 33 Meals for Expectant and Nursing Mothers 31 Measles 92 Meat and Other Foods 64 Meat Food Products, Certification of 66 Merchandise Marks Act 81 Midwives 30-33 Milk- Bacteriological Examinations 61 Certified Milk 61 Cowsheds 63 Examination for Tubercle 62 Grade "A" (Tuberculin Tested) Milk 61 Milk and Dairies Order 63 Milk (Samples) 64 Milk (Special Designations) Order 63 Pasteurised Milk 62 Pasteurising Plants, Supervision of 64 Supply 61 Milk for Necessitous Persons 30 Minor Ailments, Treatment of 25 Mortuary 20, 21 Nursing in the Home 15,29 Obstetric Consultant Services 33 Offensive Trades 50 INDEX—continued. PAGE Ophthalmia Neonatorum 88 Outworkers 60 Overcrowding, Housing Act, 1935 55 Pigeons, Nuisances from 52 Pneumonia 87 Poliomyelitis and Polio-encephalitis 88 Population 6 Poultry Slaughtering 68 Pre-school Child 26 Public Baths and Swimming Pools 47 Public Cleansing 39 Puerperal Fever and Pyrexia 89 Rag and Bone Dealers 50 Rag Flock Act 50 Rats and Mice Destruction Act 48 Rent Restrictions Acts 50 Restaurants and Eating Houses 67 Sanitary Circumstances of the Area 38-52 Inspection Tables 40-41 Summary of Notices Served 43 Summary of Legal Proceedings 44-45 Scarlet Fever 86 School Treatment Centres 16 Schools, Inspection of 48 Shops Act 46 Sickness and Invalidity 6 Slaughterhouses 67 Slaughter of Animals Act 68 Smallpox 82 Smoke Abatement 46 Social Conditions 5 Staff 2, 3 Statistics, Vital and Mortal 4—7 Street Trading 68 "Toddlers" Visitations 28 Tuberculosis 95-114 Care Work 113 Dental Treatment 110 Diagnosis and Treatment 109 Dispensary, Table of Work 106-107 Disinfection 96