CAM 43 Public Health Department, Town Hall, Camberwell, S.E.5. 12th July, 1937. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my 15th Annual Report as Medical Officer of Health for the Metropolitan Borough of Camberwell. The resident population of the Borough at the middle of 1936, as estimated by the Registrar-General, was 229,300 as compared with 234,400 at the same period in 1935—a decrease of 5,100. The birth rate was 13.9 and the death rate 12.6 per 1,000 of the population, as compared with 13.6 and 12.5 respectively for London as a whole. The infantile mortality rate was 59 per 1,000 births, the rate for London being 66. It is gratifying to record that the maternal death rate was 2.12 as compared with 3.07 per 1,000 total births in 1935. Except for the biennial measles epidemic which commenced in November, 1935 and continued until August, 1936, there is no call for any special comment in respect of the occurrence of infectious diseases during the year. The year 1936 will stand out prominently as the year in which steps were taken to secure the abatement of overcrowding. The inspection of working-class dwelling-houses for the purpose of ascertaining the extent of overcrowding existing in the Borough which was commenced at the latter end of 1935 was completed in the early days of the year under review. This inspection of the district revealed that there were 2,950 tenancies overcrowded in accordance with the standard of the Housing Act, 1935. The Maternity and Child Welfare Services were further con- sidered and developed during the year, the most notable extension of these services being the approval by the Council of the establish- ment of Toddlers' Clinics at the Municipal Infant Welfare Centres for an experimental period of six months. The result of this experiment is awaited with considerable interest. I wish to thank the members of the Council, especially the Chairman and members of the Public Health and the Maternity and Child Welfare Committees for the encouragement and assistance I have received from them throughout the year. I also desire to place on record my appreciation of the help I have received from the staff of the Public Health Department, who at all times in a very busy year have given loyal and efficient service to the Council. Your obedient Servant, H. W. BARNES, Medical Officer of Health. Staff of the Public Health Department at the end of 1936. 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. a 10. H. C. Green. a 4. G. Topping. 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. H. W. Leonard. a A. L. Dobson. 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 Child Life Protection Visitor. Miss N. G. Cooke, e Chief Clerk. F. T. Harman. Clerks. H. J. Hurst. S. F. Hislam. S. A. Cranfield. A. E. Pooley. A. J. Carly. R. G. Good body. Miss M. L. Thompson. R. C. Sweet. R. A. Davies. A. J. Baker (Temporary). Miss E. M. Watkin. 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. Biggs (Temporary). Porter William J. Cripps. Disinfecting and Cleansing Stations. Superintendent Disinfector A. Franklin. Assistants J. Conner, A. Thomas, R.J. Hodgson and J.Sawyer, J.Ledwidge (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 Certificate. d General Training Certificate, C.M.B. Health Visitors' Certificate, Royal Sanitary Institute, Maternity and Child Welfare Certificate, Royal Sanitary Institute. e General Training Certificate C.M.B.; Royal Sanitary Institute (New) Health 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 1936. Area of the Borough in Acres 4,480 Population (Estimated resident population mid-1936) 229,300 Population (Census 1931) 251,294 Number of inhabited houses (end of 1936) according to Rate Books 43,575 Rateable Value £1,729,942 Sum represented by a penny rate Estimated £6,950 Number of live Births 3,194 Birth Rate 13.93 Number of Deaths 2,898 Death Rate 12.64 Infantile Mortality:— Deaths under 1 year 188 Infantile Deaths per 1,000 Births 59 Maternal Mortality:— Deaths of Women from Diseases or Accidents associated with Childbirth 7 Maternal Death Rate {Per 1,000 live births 2.19 {Per 1,000 total births 2.12 Deaths from Phthisis 166 Phthisis Death Rate 0.72 Deaths from all forms of Tuberculosis 185 Tuberculosis Death Rate 0.81 Social Conditions. The Metropolitan Borough of Camberwell covers an area of 4,480 acres and is divided into 20 wards. The number of persons per acre at the Census enumeration in 1931 was 56, and compares favourably with the average density of London as a whole which was 58.7 persons per acre at that time. The corresponding figure for Camberwell in 1936, based on the Registrar-General's estimated population figure was 51, the greatest density existing in the northern part of the Borough. It will be seen, however, on reference to the following table that five wards in the Borough have a density of population figure of over 100 persons per acre. Estimated Density of Population Mid-1936. (Persons per acre) Population Census, 1931. Estimated Population Mid-1936. Ward. Acreage. 1 125 14,489 13,225 105·8 85 13,016 2 11,882 139·7 3 132 13,189 12,031 91·1 4 104 14,922 13,614 130·8 5 99 14,421 13,163 132·9 6 124 12,024 10,972 88·4 7 164 14,672 13,396 81·0 8 124 14,274 13,021 105·0 9 144 14,888 13,584 94.3 10 111 7,700 7,028 63.3 11 137 10,833 9,881 72.1 12 117 12,496 11,402 97·5 13 531 11,022 10,061 18·9 14 129 10,485 9,567 74·1 15 247 12,234 11,163 45·1 16 165 13,719 12,515 75·8 17 228 13,861 12,648 55·4 18 451 16,797 15,319 33·9 19 12,123 555 11,061 19·9 20 708 4,129 3,767 5·3 The chief industries in the Borough are the manufacture of gas and its associated products, engineering, laundries and printing. None of the industries carried on in the area appears to have had a prejudicial effect on the health of the workers engaged in them. Extracts from Vital Statistics of the Year. Total. M. F. Live births {Legitimate {Illegitimate 3,067 127 1,551 59 1,516 68 Birth Rate per 1,000 of the estimated resident population 13.93 Rate per 1,000 total (live and still) births 31.53 Stillbirths 104 48 56 Deaths 2,898 1,490 1,408 Death rate per 1,000 of the estimated resident population 12.64 Deaths from puerperal causes (Headings 29 and 30 of the Registrar General's short list) — Rate per 1,000 total (live and still) births. Deaths. No. 29 Puerperal sepsis 1 0.30 No. 30 Other Puerperal causes 6 1.82 Total 7 2.12 Death Rate of Infants under one year of age :— All infants per 1,000 live births 59 Legitimate infants per 1,000 legitimate live births 55 Illegitimate infants per 1,000 illegitimate live births 142 Deaths from Cancer (all ages) 418 Deaths from Measles (all ages) 32 Deaths from Whooping Cough (all ages) 12 Deaths from Diarrhoea (under 2 years of age) 27 Particulars of any unusual or excessive mortality during the year which has received or required comment. —Nil. Sickness and Invalidity. There was no unusual or excessive sickness or invalidity in the area and no evidence is available of any conditions of occupation or environment having exercised a prejudicial effect on health, or that unemployment had any significant influence on the health or physique of children or adults during the year. By the courtesy of the Manager of the local Ministry of Labour Exchange I am able to furnish the following particulars relating to unemployment of Camberwell residents during 1936. Men. Boys. Women. Girls. Total. Quarter ended March 4,384 48 1,687 55 6,174 Quarter ended June 3,430 53 1,443 22 4,948 Quarter ended September 3,157 38 1,258 45 4,498 Quarter ended December 3,276 26 1,140 18 4,460 These figures expressed as a percentage of the insured population of Camberwell show that the number of unemployed at December 31st, 1936, was 6.3, as compared with 8.4 in 1935. I am also indebted to the local Public Assistance Officer for the information that the number of residents in receipt of domiciliary relief, including those in receipt of medical relief during the last week in December 1936 was 5,445. The corresponding figure for 1935 was 5,911. Population. The resident population of the Borough at the middle of 1936 was estimated by the Registrar-General to be 229,300 persons, 21,994 fewer than the number ascertained at the Census in 1931. Births and Birth Rate. The number of live births registered in the Borough during 1936 was 3,375. To this number it is necessary to add 574 children born to Camberwell mothers at addresses outside the Borough, and to deduct 755 births of non-residents confined in the Borough to obtain the correct number of births among the resident population of Camberwell. The corrected total of 3,194 births thus obtained shows an increase of 39 as compared with the number registered in 1935. The birth rate for the year was 13.9 per 1,000 of the estimated population. These births distributed according to sex and legitimacy were as follows: — Female. Total. Male. 1,516 3,067 Legitimate 1,551 Illegitimate 59 68 127 1,610 1,584 3,194 Totals The following table shows the number of births and the birth rate in England and Wales, London and Camberwell for the past five years: — Birth Rates in previous Years. 1936. District. Number of Births. Birthrate. 1935. 1934. 1933. 1932. 14·7 14·8 14·4 15·3 England and Wales. 605,292 14·8 . London 121,486 13·6 13·9 13·3 13·4 13·2 14·3 Camberwell 3,194 13·4 13·2 13·3 14·6 Stillbirths. Stillbirths registered during the year numbered 104, after adjustment by the addition of 19 stillbirths born to Camberwell mothers confined outside the Borough and the deduction of 24 stillbirths to non-residents confined in Camberwell. These stillbirths, distributed according to sex and legitimacy, were as follows:— Male. Female. Total. Legitimate 46 51 97 Illegitimate 2 5 7 Total 48 56 104 Notification of Births Act, 1907, and Public Health (London) Act, 1936. Under the provisions of these Acts notifications were received of the births of 2,947 live children and 86 stillborn children. This number represents 91.9 per cent, of the total number of births registered. The following table indicates the source of notification: — Number of Births Notified. Source of Notification. Live. Stillbirths. 2,024 Medical Practitioners 68 Midwives 859 17 63 1 Parents 1 - Other persons Deaths. The number of deaths registered in the year after adjustment for inward and outward residence transfers was 2,898. The death rate per 1,000 of the population for 1936 was therefore 12.6. For comparative purposes the number of deaths and the death rates in England and Wales, London and Camberwell in 1936 are given in the following table: — District. No. of deaths. Death rate. 12·1 England and Wales Provisional figures {495,764 51,142 2,898 12·5 London 12·6 Camberwell The cause of death in age groups of Camberwell residents in 1936 are summarised in the table which appears on pages 9 and 10. The principal certified causes of death at all ages were: — Deaths due to diseases of the heart 797x Deaths from malignant disease 418 Deaths attributed to bronchitis pneumonia and other respiratory diseases 340 Deaths from all forms of tuberculosis 185 Deaths from influenza 26 8 9 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1936. Causes of Death. Sex. All Ages. 0- 1- 2- 6- 15- 25- 35- 45- 55- 65- 75- All causes M. 110 1,490 15 16 17 47 54 77 177 284 375 318 F. 1,408 78 19 21 26 52 60 51 109 216 322 454 Typhoid and Paratyphoid Fevers M. - - - — - - - - — — - - F. 1 — - - 1 — - — — — — - Measles M. 14 6 5 2 1 - - - - - - - F. 18 1 7 7 3 - - - - - - - Scarlet Fever M. - - - - - - - — — - - F. 1 - 1 - - - - - - — - - Whooping Cough M. 3 3 - - - - - - - - - - 9 F. 5 2 1 1 - - - - - - - Diphtheria M. 7 — 3 4 - - - — - — - — F. 5 3 - - - 1 1 - — - - — Influenza M. 8 - 1 - 1 5 1 - — - - - F. 18 - 1 1 1 6 5 4 - - - — Encephalitis lethargica M. 3 - 1 - - - - - 1 - 1 — F. 2 - - - 1 - 1 - - - - — Cerebro-spinal Fever M. 3 2 - 1 - - - - - - - - F. 1 1 - - - - - - - - — - Tuberculosis of respiratory system M. 104 — - 1 - 19 21 13 23 21 4 2 F. 62 - - - - 23 18 9 5 4 3 - Other tuberculous diseases M. 9 - 1 1 2 - 1 2 - 1 1 - F. 10 1 1 2 2 3 1 - - - - - Syphilis M. 6 - - - - - - 2 1 3 - - F. 3 - - - - - - - 1 1 1 - General paralysis of the insane, tabes dorsalis M. 9 - - - - - 1 1 - 3 4 - F. - - - - - - - - - - - - Cancer, malignant disease M. 211 - - - - 1 3 4 35 64 76 28 F. 207 - - - - - 8 9 27 54 68 41 Diabetes M. 15 - - - - - - - 2 4 3 6 F. 22 - - - - - 1 1 1 7 10 2 Cerebral haemorrhage, etc. M. 59 - - - - 1 - 1 4 7 24 22 F. 66 - - - - - - 4 14 28 19 - Heart disease M. 380 - - - - 3 3 11 34 83 124 122 F. 417 - - - 3 11 8 12 21 52 110 200 Aneurysm M. 8 - - - - 1 2 - 2 3 - - F. 5 - - 1 1 - — - - 1 - 2 Other circulatory diseases M. 69 - - - - - 1 2 9 31 26 - F. 60 - - - - - - - 4 12 15 29 Bronchitis M. 66 3 - - - 2 - 2 5 13 18 23 F. 51 1 - - Pneumonia (all forms) - - - - - 6 17 27 M. 115 21 5 1 - 3 2 6 21 20 22 14 F. 84 13 3 4 2 1 3 1 9 11 15 22 Other respiratory diseases M. 13 — - 1 1 1 1 - 3 3 3 - F. 11 - - 1 - - - 1 2 1 1 5 Peptic Ulcer M. 28 - - - - 2 4 9 4 2 7 - F. 17 - 1 - - - 2 1 7 3 3 - Diarrhoea, etc. M. 19 14 2 - - 1 1 - - - - 1 F. 13 11 - - - - 1 1 - - Appendicitis - - M. 9 - - 1 - 1 2 - 3 2 - - F. - - - 1 1 - - 4 1 - 1 - Cirrhosis of liver M. 2 - - - — - - - 1 1 - - F. 3 - — - - - — 1 1 1 - - Other diseases of liver, etc. M. 4 - - - - - 1 1 2 - - - F. 10 - - - - - - 1 1 3 4 1 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1936—contd. All Ages. 0- 1- 2- 5- 15— 25- 35- 45- 55- 65— 75- Sex. Causes of Death. M. F. Other digestive diseases 25 25 3 - 1 3 2 6 1 1 5 3 - 2 1 1 1 - 4 5 4 6 - 1 Acute & chronic nephritis M. F. 39 41 - - 1 1 1 - 4 7 7 14 4 - - - 1 1 1 4 6 4 8 16 Puerperal sepsis 1 F. - - 1 - — - - - - - - Other Puerperal causes 6 F. - - - 1 3 2 - - - - - Congenital debility, premature birth, malformation, etc. - 1 - — - - - 54 39 - - - - M. F. 53 38 - - 1 - - - - - - - - M. F. 28 50 - - - - - - Senility - - - - - - 3 2 25 48 - - - — Suicide 24 8 5 - 7 1 1 1 - - M. F. - - - - 4 2 - - 3 — 3 4 1 - Other Violence M. F. 47 30 5 1 7 2 4 1 9 4 7 4 — - 2 4 4 3 - - 5 2 4 9 Other defined diseases 109 109 1 4 M. F. 8 5 2 1 1 6 5 5 5 7 17 22 27 21 25 23 7 5 11 10 Causes ill-defined or unknown M. F. - - - - - - - - - — - - - - - - - - - - - - - - Infantile Mortality The number of deaths of infants under one year of age was 188, three less than in 1935, representing an infant mortality rate of 59 per 1,000 births. The number of deaths of illegitimate infants was 18, furnishing a death rate of 142 per 1,000 illegitimate births. The chief causes of death in infants under one year were prematurity 91 deaths, pneumonia 34 deaths, and diarrhoea and enteritis 25 deaths. Neo-Natal Deaths The number of deaths registered of infants under one month old was 81, representing a neo-natal death rate of 25.4 per 1,000 live births as compared with 23.1 in 1935. The classification of these deaths into groups of causes of death is shown in the following summary:— 1. Difficult Labour. Trauma at birth 6 2. Foetal States Congenital defects 20 Atelectasis 4 Atrophy, debility and marasmus 3 Asphyxia neonatorum 2 3. Prematurity 34 4. Other causes 12 INFANTILE MORTALITY TABLE. Deaths FROM Stated Causes AT Various Ages UNDER One Year OF Age, 1936, AS CLASSIFIED BY Medical Officer OF Health. 3 to 6 months. 6 to 9 months. 9 to 12 months. Total under 1 year. under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 1 month. 1 to 3 months. Cause of Death. - - - - Smallpox - - - - - - Chicken Pox - - - - - - - - - - 2 3 5 Measles - - - - - - - - Scarlet Fever - - - - - - - - - Whooping Cough 1 3 1 5 - - — - - - - - Diphtheria and Croup - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - 1 - 1 - - - - - Abdominal Tuberculosis - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis - - 2 1 1 4 - - - - Convulsions 1 1 - - - 1 - - - - - - - - - 11 Laryngitis - - 1 - - 1 2 1 - 1 5 Bronchitis - 1 - - 1 1 2 3 11 Pneumonia 3 - 1 4 - 1 - - 1 2 Diarrhoea - - - - - 6 10 2 3 21 Enteritis - - - - - - - - - Gastritis - - - - - - - - - - Syphilis - - - - - - - - - Rickets - - - - - - - Suffocation 2 - - 2 - - - 2 - - - 6 Injury at Birth 6 - - 6 - - - - - - - 4 Atelectasis 4 4 - - - - Congenital Malformation 13 4 1 2 20 4 1 1 - 26 Premature Birth 32 2 34 6 - - 40 - - - 7 2 1 - 13 Atrophy, Debility, &c. 1 1 1 3 - 1 1 2 5 3 4 1 15 Other Disease - - 6 7 4 6 27 Broncho-pneumonia 1 1 2 4 - - - - Acute Lobar Pneumonia - - - - - - - - - - - Influenza - - - - - - 39 27 21 20 188 61 5 TOTALS 7 8 81 Vital Statistics (Wards). The vital and mortal statistics of every ward in the Borough for the year 1936 are given in the following table: — Births. Deaths under 1 year Deaths all ages. Estimated Population. Wards. Rate Per 1,000. Rate per 1,000. Rate per 1,000. No. No. No. 1 13,225 202 15·3 13 64 160 12·1 13 62 2 11,882 209 17·6 144 12·1 15 3 12,031 174 14·5 86 164 13·6 82 4 13,614 184 13·5 15 160 11·7 13,163 13 70 5 187 14·2 146 11·1 10,972 184 6 33 6 16·8 132 12·0 13,396 173 12 69 7 12·9 164 12.2 13,021 168 13 77 11·9 8 12·9 156 13,584 214 15·7 9 42 185 13·6 9 10 7,028 97 13·8 5 50 106 15·1 11 9,881 157 15·9 6 38 131 13·3 12 11,402 169 14·8 7 41 152 13·3 13 10,061 126 12·5 9 71 137 13·6 14 9,567 159 16.6 10 63 122 12.7 11,163 15 195 17·5 8 41 156 13·9 16 12,515 149 11·9 11 74 172 13·7 150 66 17 12,648 11·9 10 158 11·9 15,319 150 18 9·8 7 46 185 12.1 11,061 114 6 52 19 10·3 129 11·7 3,767 33 8.8 20 - - 39 10·4 The Borough 229,300 3,194 13·9 188 59 2,898 12·6 Maternal Mortality. The number of Camberwell women whose deaths were attributed to childbirth was 7. Of these, one was due to puerperal sepsis and six to other puerperal causes. The mortality rate per 1,000 live and still births was therefore 2.12. In the following table, the maternal mortality rate is compared with the rates for London and England and Wales. Year. England and Wales. London. Camberwell. 3·94 3·07 1935 2.50 1936 3·65 1·86 2·12 Enquiry into Maternal Deaths. A confidential investigation report is forwarded to the Ministry of Health in all cases of death from maternal causes occurring among Camberwell mothers. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Laboratory Facilities. The bacteriological work of the Council is undertaken by Dr. Guy Bousfield at his laboratory 134, Denmark Hill, S.E.5. The chemical analysis of food and drugs, etc., is carried out by the Public Analyst, Mr. Martin Priest, at his laboratory 4, Obelisk Parade, Lewisham. Particulars of the examinations conducted by these Officers of the Council appear in the appropriate sections of this report. Ambulance Facilities. The London County Council provide ambulances for infectious, non-infectious, maternity and accident cases. This ambulance service is considered to be adequate for the requirements of the area. Nursing in the Home. Home nursing services are provided by the following District Nursing Associations: — The 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. By whom provided. Sessions. Ante-natal Clinics. Camberwell Municipal Centre, 140, Camberwell Road. Camberwell Borough Council. Second and fourth Thursdays in every month at 11 a.m. 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, Thursday and Friday, at 2 p.m., Monday (new cases) at 2 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. Daily 9.30-10.30 a.m. Cambridge House Infant Welfare Centre, 6, Addington Square, 5.E.5. Cambridge House- Voluntary Association. Diphtheria Prevention Clinic. Camberwell Municipal Centre, 24, Mayward House, 5.E.5. Camberwell Borough Council. Every Wednesday at 2.30 p.m. Artificial Sunlight and Rheumatism Clinics. British Red Cross Society, 160, Peckham Rye. British Red Cross Society. Daily (except Saturday), 9 a.m. to 8.30 p.m. Tuberculosis Dispensary. 35, 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 School Treatment Centre, 7, Addington Square, S.E.5. Dental. Monday morning. Tuesday morning and afternoon. Wednesday morning and afternoon. Thursday morning. Thursday afternoon (one in four weeks). Friday morning (one in four weeks). Friday afternoon. Monday afternoon (one in four weeks). Aural. Minor Ailments. Tuesday afternoon, 3.30 p.m. Friday afternoon, 3.30 p.m. Camberwell Sub-Centre, Comber Grove School, Camberwell New Road, S.E.5. Minor Ailments. Wednesday afternoon, 4 p.m. East Dulwich Treatment Centre, 29, Amott Road, S.E.15. Monday morning (two in four weeks). Dental. Monday afternoon (one in four weeks). Tuesday morning (one in four weeks). Wednesday morning. Thursday afternoon. Friday morning and afternoon. Wednesday afternoon, 2.45 p.m. Minor Ailments. Peckham Treatment Centre, 412, Old Kent Road, S.E.1. Aural. Consultation Session: Wednesday afternoon (one in four weeks). Operation Sessions: Wednesday afternoon (alternate weeks at Hanover Park Hospital. Children kept in for two nights). Dental. Monday afternoon. Tuesday morning and afternoon. Wednesday morning. Tuesday morning and afternoon. Friday morning and afternoon. Vision. Monday morning, 9.30 a.m. Friday morning. Friday afternoon, 1.30 p.m. (alternate weeks). Minor Ailments. Monday afternoon, 3 p.m. Thursday afternoon, 3 p.m. Rye Lane Treatment Centre, 7, Hanover Park, Rye Lane, 5.E.15. Monday morning and afternoon. Dental. Tuesday morning. Tuesday afternoon (alternate weeks). Wednesday morning. Thursday morning and afternoon. Friday morning and afternoon. Vision. Tuesday morning, 9.30 a.m. Thursday morning, 9.30 a.m. Minor Ailments Monday afternoon, 2.45 p.m. Thursday afternoon, 2.45 p.m. Aural. Consultation Session: Tuesday afternoon (alternate weeks). Operation Session: Thursday afternoon (at Hanover Park Hospital). Nurses attend daily for treatment of minor ailment cases at all the Centres. Hospitals. The following London County Council Hospitals are situated within the Borough of Camberwell:— St. Giles' Hospital (containing 810 beds). Dulwich Hospital (containing 728 beds). Maudsley Hospital (Neurological) (containing 235 beds). Constance Road Institution (now St. Francis's Hospital) (containing 647 beds). Open Spaces. The area of Camberwell is 4,480 acres, and there are 231 acres of open spaces land distributed as follows:— Maintained by Borough Council. Maintained by L.C.C. Division. Total. Acres. Acres. Acres. Dulwich 7 78 85 North Camberwell 3 - 3 North-West Camberwell 9 9 - Peckham 20 114 134 Totals 39 192 231 It will be seen on examination of the map which appears opposite this page, that by far the largest open spaces are situated in that part of the Borough south of Peckham Road, and in the more densely populated districts in the north and north-west divisions there are only a few small open spaces readily accessible to the inhabitants of these areas, varying from one quarter of an acre to four acres in extent. It is beyond dispute that among the most vital needs of the population of large congested districts are fresh air to breathe and open spaces for rest and recreation. The question of the adequacy of the open spaces provision for the Borough is being considered by the Council, and it is hoped that no opportunity will be lost of acquiring suitable sites in the Borough for development as open spaces or playing grounds, particularly in the districts referred to. The provision of additional small open spaces would in my opinion provide safe retreats for recreation for both the young and the old from the ever increasing danger of the streets. Vaccination The latest annual return available respecting the vaccination of children whose births were registered in the Borough relates to the year 1935. This return indicates that 37 per cent, of the children registered were successfully vaccinated and that 42 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. Public Vaccinators. A table showing the number of persons successfully vaccinated and re-vaccinated by the Medical Officers of Institutions and the B VACCINATION RETURN. Registration SubDistricts comprised in the Vaccination Officer's District. Number of Births returned in the "Birth List Sheets" as registered from January Ist to December 31st, 1935. Number of these Births duly entered by January 31st, 1937, in Columns I, 11, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on January 31st, 1937, remained unentered in the "Vaccination Register" on account (as shown by "Report Book") of Number of these Births remaining on January 31st, 1937, 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 1936. 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 1936. Col. I. Successfully Vaccinated. Col. II. Col. IV. Number in respect of whom Statutory Declarations of Conscientious Objection have been received. Col.V. Died unvaceinated. Postponement 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 not having been found. Insusceptible of Vaccination. Had Small Pox. 1 2 3 4 5 6 7 8 9 10 11 12 13 These figures are to be btained from columns 2 and 6 of the Summary (Form N.). 1. North West Camberwell 1,448 568 87 6 170 41 - - 539 37 1,486 1,356 110 2. St. George's 362 196 17 30 5 2 2 - - 3. Peckham 140 20 5 411 - 30 1 - 213 2 4. Dulwich 2 65 97 971 349 - 385 58 11 4 Total 1,486 1,356 3,192 1,167 5 - 1,333 10 106 327 62 182 Public Vaccinators during the year ended December 31st, 1936, appears on this page. PUBLIC VACCINATORS—RETURN OF WORK, 1936. Number of Persons successfully Vaccinated and Re-vaccinated by the Medical Officers of Institutions and the Public Vaccinators during the year ended December 31st, 1936. Number of successful Re-vaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. - 129 48 2 4 19 29 20 7 One year and upwards. Numbers of successful Primary Vaccinations of persons:— - 27 14 3 27 25 6 3 1 106 Under one year of age. - 177 112 17 180 110 184 1 59 840 Name of the Medical Officer or Public Vaccinator. A. B. Blomfield Dr. G. H. Fisher Dr. G. W. FitzHenry Dr. H. J. Gater Dr. A. F. McMillan Dr. D. Hughes Dr. H. 0. West Dr. 0. W. Roberts Dr. 0. W. Roberts Total Camberwell District Peckham District Nunhead District Dulwich District St. George's District East Dulwich district St. Giles' Hospital Dulwich Hospital Constance Road Institution Name of Institution or Vaccination District. Health Propaganda. The Council's propaganda activities in 1936 were as follows:— a poster display, the distribution of a health handbook, and the issue of leaflets on the subjects of Diphtheria Prevention, Tuberculosis, Cancer, Influenza, Measles, Whooping Cough, Dietary and Cooking, and Rat repression. The Council's health handbook contains a synopsis of the health services of the Borough and general information on health matters with references of particular interest to mothers. It is interesting to record that the acknowledgments received at the Public Health Department from inhabitants of the Borough from time to time is conclusive of the value of the information provided in this booklet. Better Health, the official monthly journal of the Central Council for Health Education, was also distributed to the ratepayers through the medium of the Public Libraries, Baths, Infant Welfare Centres, Schools and the various industrial undertakings in the Borough. Short talks to mothers on health matters were also given by the Health Visitors at certain of the Infant Welfare Centres in the Borough. B2 MATERNITY AND CHILD WELFARE SERVICES. The Council's Maternity and Child Welfare Scheme provides the following services for expectant and nursing mothers and children under 5 years of age. 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 own' homes. (e) Payment of compensation to midwives for loss of patients. (f) Provision of sterilised maternity outfits. (g) 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) Public Health (London) Act, Notification of Births 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. (e) 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) Child Life Protection. The following Maternity and Child Welfare Services received the attention of the Council in the year. Salaried Service of Midwives. In January of the year under review the Council considered a letter from the Metropolitan Boroughs' Standing Joint Committee, and an accompanying memorandum on the subject of a salaried service of midwives, inviting the views of the constituent Councils on a recommendation by the Joint Council of Midwifery that the local supervisory authority under the Midwives Acts (in London the County Council) should be the authority to administer the suggested salaried service of midwives. This Council however expressed the opinion that the administration of a service of this kind should be entrusted to the Metropolitan Borough Councils and not the London County Council. The Midwives Act received the Royal Assent on July 31st, 1936. The Authorities for the purposes of this Act are the Local Supervisory Authorities under the Midwives Act, 1902. It will accordingly become the duty of the London County Council to make arrangements for the employment of certified midwives as whole time servants for attendance on women in their own homes as midwives or as maternity nurses during child-birth and from time to time thereafter during a period not less than the lying-in period. CARE OF CHILDREN UNDER SCHOOL AGE. Toddlers' Clinics. In October of the year under review the Council considered Circular No. 1550 received from the Minister of Health, in which the Council were requested to review their arrangements for supervising the health of children under school age, and to inform him as soon as possible of the results of their consideration of this Circular. Among other matters referred to in the Circular, the Minister stated that although he was convinced that arrangements for safeguarding the health of children up to the age of 18 months or two years were generally satisfactory, he was nevertheless concerned to find that in many areas insufficient attention was given to the health of children between the ages of 18 months and five years, as a large number of children on admission to school —some 16 per cent, of admissions—were found to require treatment for some disease or defect. The Minister stated that arrangements should exist for the systematic periodical health visiting of young children under the age of five, who remain at home and who do not attend a Nursery School or the infants' department of elementary schools, and referred in appreciative terms to arrangements made for conducting Toddlers' Clinics for this purpose. The statement was also made that it should be the duty of the Health Visitor on paying a visit not only to make inquiries as to the state of health of the children, but also to be on the look-out for any signs or symptoms which suggested a departure from normal health, and where necessary to advise the mother to consult the family doctor or to take the child to the appropriate clinic for medical examination without delay. Some years ago a Toddlers' Medical Clinic was established at the Peckham Municipal Centre, and parents were invited by letter to bring their children for examination on their birthdays. This invitation was timed to reach, the child on the morning of its birthday. This form of propaganda was not, however, a success, and it was found after an extended trial that the attendances did not justify the continuance of this clinic for toddlers only. A Toddlers' Medical Clinic was also tried at a Voluntary Centre with the same disappointing result. In recent years it has been the practice to send a birthday greeting card to every child in the Borough on reaching its first birthday. On this card there is a photograph of a healthy Camberwell Toddler who had regularly attended an Infant Welfare Centre, and the following greeting: "I have been protected against diphtheria, have you ? I am also taken to the Infant Welfare Centre, are you ?" It is difficult to measure, the practical results of this form of propaganda, but it provides evidence of the endeavours of the Council to stimulate interest in these essential public health services. Experience has proved that to secure the attendance of toddlers for periodical medical overhaul at special clinics is slow uphill work. Unfortunately mothers are not convinced that continued attendance at an infant welfare centre is necessary when their children pass the age of one year, or if they do desire to continue attendance, it is frequently found that a mother finds it difficult to arrange to bring her young infant on one day, and attend again with a toddler at a special session on another day. In my report to the Council on Circular No. 1550 I stated that although in the past toddlers' consultation clinics have not been as successful as anticipated, and the scheme at present in operation for the supervision of toddlers at the infant consultation sessions, at those Centres where special toddlers' clinics have not been established is working satisfactorily, I suggested that as a further experiment toddlers' clinics be provided for a period of, say, six months, at the four Municipal Infant Welfare Centres. I was also of opinion that the setting-up of such clinics would tend to relieve the congestion at the general medical sessions, particularly at the Mayward House and Dulwich Centres. It is pleasing to report that the Council at their meeting in December approved the establishment of toddlers' clinics on the lines suggested, and decided to appoint a temporary medical officer specially qualified for these duties and a temporary health visitor. Supply of Meals to Expectant and Nursing Mothers. In 1935, arrangements were made by the Council with the Invalid Kitchens of London to supply mid-day meals at their kitchen at 10A, Huguenot Road, Peckham, to expectant and nursing mothers in necessitous circumstances recommended for this service by Clinic Medical Officers of ante-natal and infant welfare clinics in the Borough. In the early days of this scheme it was found that in some cases mothers could only take advantage of this service by incurring expenditure on travelling which they could not reasonably afford. The Council accordingly authorised payment of the patients' fares to and from the Invalid Kitchen Centre, and further extended the scheme enabling patients to attend an approved dining-room in the neighbourhood of their own homes, if desired. It was also decided to supply mid-day meals to expectant and nursing mothers attending Maternity and Child Welfare Centres, notwithstanding that they may be in receipt of Public Assistance relief. The number of patients who received meals under this scheme during 1930 was 54. Infant Welfare Centres. The desirability of providing up-to-date Municipal Infant Welfare Centres in the north-western and southern districts of the Borough to replace Clinics held at church premises in these areas, was a matter which engaged the attention of the appropriate Committee of the Council during the year. Possible sites in each district were surveyed for this purpose, and at the end of the year this matter was still under consideration. The Council has also been in communication with the London County Council with regard to the possibility of obtaining suitable accommodation in the housing estate which is in course of erection at Sumner Road. Peckham, for the purposes of an Infant Welfare Centre, and plans have been furnished by the County Council indicating the kind of accommodation which might be provided by them. Ante-Natal Services Scheme. The Council decided to continue the scheme for the provision by the London County Council at St. Giles' and Dulwich Hospitals of ante- and post-natal examinations and supervision (including dental treatment) of Camberwell Maternity patients to be confined in their own homes either by a private medical practitioner or by a practising midwife for a further period of twelve months. The original scheme provided for the payment by this Authority of an agreed annual sum, viz., £75 for these services, but in view of the disappointing attendances at these clinics payment is now made on the basis of 2s. for each attendance by a patient. Ante-natal Supervision. The ante-natal services provided by the Council consist of medical examinations and supervision at ante-natal clinics and home visiting, by health visitors. The educational and social training of pregnant women as a complement of the medical examination is of the utmost importance in the efforts to secure an improvement in the maternal mortality and morbidity rates. The total number of visits paid by the Health Visitors to expectant mothers in 1936 was 3,233. There are five ante-natal clinics in the Borough and the number of individual patients who attended these clinics, and the total attendances recorded during 1936 are set out in the subjoined table. Ante-natal supervision of patients is also carried out by the Medical Officers at the Kempshead Hall and Cambridge House Voluntary Association Centres at the regular infant clinic sessions. The Council also has an arrangement with the London County Council whereby that authority's ante-natal clinics at St. Giles' and Dulwich Hospitals are placed at the disposal of private medical practitioners and practising midwives for patients who have arranged to be confined in their own homes. This arrangement also includes post-natal supervision and dental treatment, but not the provision of dentures. During the year 2,013 or 61 per cent, of the total births took place in institutions, and 1,285 or 39 per cent, in the homes of the patients. Ante-natal Clinics Returns. Number of patients who attended. Number of attendances made by patients. Clinics. *St. Giles' Hospital 1,318 9,516 6,077 *Dulwich Hospital 862 Municipal Ante-natal Clinic, 140, Camberwell Road 31 23 Bird-in-Bush Voluntary Association Antenatal Clinic, 616, Old Kent Road 235 438 General Lying-in Hospital Post-Certificate School, Southampton Street 315 3,169 *Including patients attending from areas outside Camberwell. Consultant Services. Mr. Arnold Walker was appointed Obstetric Consultant in 1931 to render assistance to any doctor in the Borough requiring specialist services in cases of difficulty or complications arising during pregnancy or at or after confinement. No application was, however, received by the Council for these services during 1936. Minor Ailments Treatment. The Council, as the result of their consideration of Ministry of Health Circular No. 1550, directed that negotiations be entered into with the London County Council with a view to the promotion of temporary schemes for the treatment at St. Giles' and Dulwich Hospitals of children under five years of age, not attending school, recommended for sunlight or massage treatment by Medical Officers of Infant Welfare Centres, and of minor ailments of children in this age group at L.C.C. School Treatment Centres in the Borough. At the meeting of the Council in December of the year under review the London County Council's offer to provide treatment for children suffering from minor ailments in accordance with the following scale of charges was accepted. Charge per child for six months or part thereof. Treatment. s. d. Minor ailments, i.e., skin, eyes and ears affections 7 7 Dental, including anaesthetic and extractions 7 2 Eye refraction, but not including the provision of spectacles 6 6 Tonsils and adenoids operation, including two days' in-patient treatment 17 8 The terms upon which the County Council would be prepared to provide sunlight and massage treatment for children had not been considered by that authority at the close of the year. Treatment of affections of the skin, eyes and ears has been available for many years at the Camberwell Municipal, Cambridge House and Kempshead Hall Centres, but unfortunately full use has not been made of the facilities provided at these Centres. A statement of the attendances during 1936 appears in the subjoined table. Number of children attending for minor ailments treatment. Infant Welfare Centre. Camberwell Municipal 41 Cambridge House 244 Kempshead Hall 147 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. Domiciliary Midwifery. The number of midwives in private practice who notified the London County Council of their intention to practise in the Borough during the year was 30. The number of births attended by midwives was 876, which represents 28.9 per cent, of the total births notified during the year. Payment of Midwives Fees. The Council's Maternity and Child Welfare Scheme provides for payment of the whole or part of the fee of a midwife for professional services rendered to an indigent mother at the time of confinement. During the year the Maternity and Child Welfare Committee authorised payment of a midwife's fee in 4 instances following investigation into the economic circumstances of the applicant. Compensation to Midwives for Loss of Patients. The Council makes a compensation payment of 10s. to a midwife for the loss of a patient who for medical reasons is recommended to enter hospital for her confinement. There were however no such payments made during 1936. Provision of Maternity Outfits. During the year 47 applications were received from expectant mothers for the issue of a sterile maternity outfit. In 33 cases the outfit was supplied free of cost, in 5 instances at half-cost, and in 9 cases at cost price. Home Helps. In 1935, the Council decided to provide a service of home helps at the homes of patients during pregnancy and at the time of childbirth. During the year 21 applications were received and, except in one instance, Home Help Services were provided by the Council. In 11 cases part of the cost of the service provided was recovered from the patient. Convalescent Home Treatment for Expectant and Nursing Mothers and Children under School Age. Under the Council's Scheme patients for this service who desire convalescent treatment are required to be recommended to the appropriate Committee by the Medical Officers of Infant Welfare Centres. During the year arrangements were made with various convalescent homes for the treatment of 18 nursing mothers and 23 children under five years of age. In 12 cases part of the cost of the treatment was recovered. In the remaining cases the financial circumstances of the family did not justify a charge being made. Infant Welfare Centres. There are ten Infant Welfare Centres in the Borough. Four of these Centres are municipally directed, the remainder being conducted by Voluntary Associations supported by grants made by the Council under the provisions of the Local Government Act, 1929. Each Infant Welfare Centre serves a defined area, and mothers are encouraged to attend the Centre for the area in which they live. At two of the Centres three medical consultation sessions are held each week; at five Centres there are two medical sessions per week; at one Centre there are three sessions one week and two sessions the following week; one Centre has one medical session per week with an extra session alternate weeks, and the remaining Centre has only one medical session per week. Mothercraft and Health Talk Sessions. Classes in mothercraft and health talks have been given at three centres during the year. Facilities are also provided at these sessions for making infant garments under supervision. Particulars as to the number of sessions and attendances at these sessions during the year appear in the following table. Infant Welfare Centre. Number of Sessions. Number of Attendances. Dulwich Municipal 46 613 Bird-in-Bush 94 1,434 St. Luke's 43 510 Toddlers' Clinics. Medical Sessions for the examination of toddlers are held weekly at the Amott Road and Bird-in-Bush Voluntary Associations' Infant Welfare Centres. The table on page 30 shows the number of sessions, individual children who attended, and the total attendances at these sessions during 1936. INFANT WELFARE CENTRES—CLINIC ATTENDANCES, Etc., 1936. Miscellaneous. Health Talk and Mothercraft Sessions. Treatment Centre for Minor Ailments. Post-Natal Mothers for Advice Own Health. Total Attendances. Ante-Natal Clinic Attendances. Under 1 Year. Between 1 & 5 Years. Analysis of Attendances, Children. Weighings only. Infant Welfare Centres. Seen by Health Visitor. First Attendances. Subsequent Attendances. First Attendances. Subsequent Attendances. Doctors' Consultations. Camber-well Municipal, 140, Camberwell Road, S.E.5 184 3,023 69 1,901 163 5,340 2,582 2,595 31 41 50 38 - Dulwich Municipal, 114, Lordship Lane, S.E.22 244 3,647 35 1,598 196 5,720 2,971 2,553 556 613 - - - Mayward House Municipal, Brunswick Square, S.E.5 283 4,591 28 1,462 328 228 6,692 2,729 3,635 - - - - Peckham Municipal, Clifton Congregational Church Hall, Asylum Road, S.E.15 227 3,305 27 1,675 280 5,514 2,339 174 2,895 - - - - Bird-in-Bush, 616, Old Kent Road. S.E.15 230 3,054 24 1,424 4,732 3,027 1,705 438 - - - - - Cambridge House, 6, Addington Square, S.E.5 153 2,110 30 1,702 244 208 - 3,995 1,877 2,118 - - - Kempshead Hall, Kempshead Road,S.E.5 180 130 1,706 14 1,205 3,055 1,259 1,796 147 - - - - St. Antholin's, 22, Linden Grove, S.E.15 305 5,352 52 2,978 8,687 3,663 5,024 - - - - - - St. Luke's, 2, Commercial Road, S.E.15 164 2,188 22 1,274 2,188 1,460 105 510 - 3,648 - - - Union of Girls' Schools, 60A, Amott Road, S.E.15 281 4,051 73 2,587 6,992 2,085 4,907 - - - - - - 2,201 33,027 374 17,806 967 469 54,375 24,720 28,688 - 432 1,501 1,161 HEALTH VISITORS—RECORD OF VISITS, 1936, To Expectant and Post-Natal Mothers and Children. Visits by Voluntary Helpers. No. Births reported in the Area. To Post-Natal Mothers. Infant Welfare Centres. To Children. Analysis of Visits to Children. Miscellaneous Visits. Total Visits. To Expectant Mothers. Measles. Under 1 Year. Under 1 Year. Between 1 and 5 Years. Between 1 and 5 Years. Total Visits. Subsequent Visits. Not Attending Centre. Not Attending Centre. First Visits. Attending Centre. Attending Centre. Camberwell Municipal, 140, Camberwell Road, S.E.5 323 1,044 204 190 3,114 232 270 199 218 633 1,367 2,218 384 467 - Dulwich Municipal, 114, Lordship Lane, S.E.22 399 201 477 286 1,167 204 221 3,070 115 438 413 265 1,453 2,131 - Mayward House Municipal, Brunswick Square, S.E.5 361 406 338 297 3,851 620 1,502 2,526 179 845 140 1,362 329 404 - Peckham Municipal, Clifton Congregational Church Hall, Asylum Road, S.E.15 339 313 329 255 3,427 337 636 1,207 2,180 132 841 141 1,0C6 324 - Bird-in-Bush, 616, Old Kent Road, S.E.15 418 351 1,959 1,252 6,178 335 383 1,831 3,211 5,425 1,250 964 - - - Cambridge House, 6, Addington Square, S.E.5 206 243 676 1,022 1,137 93 125 4,341 140 221 1,360 2,159 3,740 905 - Kempshead Hall, Kempshead Road, S.E.5 184 201 88 35 4,356 212 1,369 2,322 3,892 811 759 853 1,469 129 - St. Antholin's, 22, Linden Grove, S.E.15 523 975 20 10 5,078 730 443 435 1,355 2,005 3,795 695 1,095 1,030 - St. Luke's, 2, Commercial Road, S.E.15 244 244 1,814 623 1,014 292 223 5,377 516 248 2,217 1,637 4,102 651 - Union of Girls' Schools, 60A, Amott Road, S.E.15 326 354 108 1,354 3,020 4,724 692 1,012 836 2,184 310 5,851 383 350 - 7,213 12,670 1,878 1,304 44,643 3,335 3,138 3,210 11640 19883 34733 5,900 8,950 160 Number of Sessions held 1936. Number of individual children attending these Sessions. Infant Welfare Centre. Total Attendances. Amott Road 49 480 1,133 Bird-in-Bush 47 322 636 Reference is made elsewhere in this report to the proposed establishment of Toddlers' Consultation Clinics at the Municipal Infant Welfare Centres for an experimental period of six months. It is intended that the medical supervision of toddlers at these clinics should follow on the lines of the school medical examination, particular attention being directed to such matters as weight, nutrition, appetite, diet, clothing, sleep, hygiene, exercise, physical and mental development, behaviour and habits. This scheme will provide the parents of toddlers Math an opportunity of obtaining information as to the progress and health of their children, and it remains to be seen whether they will avail themselves of the facilities offered by the Council. Home Nursing. The several District Nursing Associations in the Borough undertake the home nursing of cases referred to them by medical practitioners and the Public Health Department. No grant is made by the Council to these Nursing Associations, but payment of one shilling per visit, less any contributions received by the Nursing Association from the patient, is paid by the Council to each of the associations, with the exception of the East Dulwich and Dulwich Village Nursing Association, who have not approached the Council for payment for their services, for the nursing of specified ailments in children under five years, such as measles, whooping cough, epidemic diarrhoea and diseases notifiable under the Public Health Infectious Diseases (London) Regulations, 1927. The following table provides particulars of the cases nursed and the number of visits paid by the nurses of these associations on behalf of the Council during the year 1936. Disease. Number of Cases Nursed. Number of Visits Paid. Maternity Nursing 34 568 Ophthalmia Neonatorum 30 568 Measles 65 699 Whooping Cough 2 26 Pneumonia 32 543 Provision of Milk to Necessitous, Expectant and Nursing Mothers and Children under 5 Years of Age. The Council's Maternity and Child Welfare Scheme includes the provision of milk for necessitous, expectant and nursing mothers and children under the age of 5 years. During the year under review 3,992 applications were received from 1,002 families for this service. It is a condition of issue that the applicant attends the Infant Welfare Centre for the district with her child or children under 5 years of age for the purpose of obtaining a medical certificate that a grant of milk is essential on grounds of health. The choice of milk, wet or dried, is left to the applicant, and in cases where dried milk is desired such issues are made at the discretion of the applicant either at the Town Hall or at the Infant Welfare Centre. Milk is also supplied by the Council to certain families in receipt of Public Assistance Relief, the cost of such issues being refunded by the London County Council. Health Visiting Staff and Home Visiting. There are eleven full-time and four part-time Health Visitors engaged in the home visiting of children under five years of age. The Council employs five of these officers, and the Voluntary Associations undertaking Maternity and Infant Welfare services the remainder. Health Visitors' duties include attendance at Infant Welfare Centre sessions, visits and re-visits to children who have not attained the age of five years and who are not being educated in schools recognised by the Board of Education as well as to children suffering from measles, whooping cough and diarrhoea. A table setting out the visits made by Health Visitors during 1936 appears on page 29. Child Life Protection. At the end of the year 1936 there were 162 foster mothers on the Council's Register, who together had 207 children in their care for reward. The number of visits paid to the homes of these children by the Infant Life Protection Visitor during the year was 2,273. The following is a summary of these visits: — No. of Visits. Children under 1 year of age 566 Children 1 to 5 years of age 711 Children 5 to 9 years of age 448 Special visits 69 Miscellaneous visits 278 Waste visits 201 Total visits 2,273 The homes of 45 applicants desiring to become foster mothers were inspected by the district Sanitary Inspectors for the purpose of ascertaining as to the suitability of the premises for the reception of children for reward. It is satisfactory to report that of 139 foster children under school age 115 attended an Infant Welfare Centre during 1936. The following legal infringements were brought to the attention of the Maternity and Child Welfare Committee during the year. Nature of Infringement. Number. Failure by foster mothers to notify the acceptance of a child for reward 3 Failure by foster mother to give the required notice of change of address 2 There was one prosecution and an Order was made by a Stipendiary Magistrate for the removal of the child to a place of safety. In 2 instances the appropriate Committee of the Council directed that a cautionary letter be sent to the foster mother for neglecting to comply with the requirements of the Acts. There were 5 deaths of foster children reported, and in one case the death was the subject of a Coroner's Inquiry. The foster mother was, however, exonerated from any blame. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. The water supply to premises in the Borough is provided by the Metropolitan Water Board. During the year 450 new houses were certified as having a proper and sufficient water supply. Complaints of defective fittings received during the year numbered 90, which were forwarded to the Metropolitan Water Board for attention. Drainage and Seweraĝe. There are only a few houses in the outlying parts of Dulwich which are not connected to the water carriage system for the disposal of sewage matter. During the year the total reconstruction of drains of premises was carried out in 99 instances and partial reconstruction of drains in 492 cases. All drainage work carried out was supervised by the Sanitary Inspectors. In one instance a caution was sent at the direction of the Public Health Committee to a builder who failed to submit plans of drainage work executed by him. Eight claims were received from owners of properties in the Borough that certain drains on their premises which were found to be in a defective condition were sewers repairable by the Council and were upheld. During the year 3 sewers belonging to the Council were reconstructed and 523 brick road gullies were replaced by pot gullies. Public Cleansing. The domestic refuse in the majority of the houses is stored in movable ash bins, but in London County Council housing estates and similar block dwelling estates, dust chutes are installed. A weekly collection of domestic refuse is the rule, but more frequent collections are made in the case of tenement dwellings. The refuse is then taken by a fleet of end-loading mechanical tipping refuse vehicles and loaded into barges on the Grand Surrey Canal or into railway trucks at the Bricklayer's Arms siding and taken to refuse dumps at Crayford and Sittingbourne. C 33 Offensive Trades. During the year the following offensive trades were carried on in the Borough:— Skin dressers 6 Skin merchants 1 Sheep skin rug-makers 1 Soap boilers 2 Fellmongers 1 Twenty-one inspections of these premises were made, and two notices under the provisions of the Public Health (London) Act were served. Rag and Bone Dealers. There are 25 places in the Borough where the business of a dealer in rags and bones was conducted during 1936. Fifty-two visits of inspection were made to these premises, and three sanitary notices were served. On two occasions during 1936 the Public Health Committee directed that cautions be administered for contraventions of the by-laws in respect of the exchange of toys for old clothes. Sanitary Conveniences attached to Licensed Premises. The Sanitary Inspectors made 795 inspections of the sanitary conveniences of licensed premises in the Borough during 1936. It was necessary to serve 17 sanitary notices. At the end of the year there were 88 public-houses in the Borough which had urinals opening on to the public footway. Shops Act, 1934. The provisions of this Act relating to sanitary arrangements, ventilation and temperature in shops are administered in London by sanitary authorities. Inspection duties of these premises are carried out by the district Sanitary Inspectors, and during 1936 706 inspections and 243 re-inspections were made. Suitable and sufficient sanitary conveniences and washing facilities must be provided in a shop unless a certificate of exemption is granted. The duty of requiring compliance with the Act in respect of the provision of washing facilities rests with the London County Council. Such a certificate may only be granted where the authority are satisfied that, by reason of restricted accommodation or other special circumstances affecting the shop, it is reasonable that a certificate should be in force, and that suitable and sufficient sanitary conveniences or washing facilities are otherwise conveniently available. The Council granted 8 exemption certificates during the year in respect of the provision of w.c. accommodation at premises where suitable alternative sanitary arrangements were available for the use of the employees. Three of these certificates were issued in the case of shops, and five in respect of kiosks and lock-up shops. The provision of additional water-closet accommodation was required in five cases; in two instances suitable and sufficient means of ventilation, and in 12 cases suitable and sufficient means of maintaining a reasonable temperature. Pharmacy and Poisons Act, 1933. The duty is laid upon local authorities by Section 25 (5) of the Act by inspection and otherwise to take all reasonable steps to secure compliance, by persons not being authorised sellers of poisons, with the provisions of Part II of the Act, and with the Rules made under the Act so far as those provisions relate to poisons included in Part II of the Poisons List. An inspector of a local authority has power at all reasonable times to enter any premises on which any person whose name is entered in a local authority's list carries on business, and any premises on which the inspector has reasonable cause to suspect that a breach of the law has been committed in respect of any poisons included in Part II of the Poisons List. In either case he shall have power to make such examination and enquiry and to do such other things, including the taking on payment therefor of samples, as may be necessary for the purposes of the inspection. All the district Sanitary Inspectors have been appointed as officers under this Act. Lining the year, 177 applications were received from persons desiring to be placed on the Register for the sale of Part II poisons which were approved by the Council. It was not necessary to remove from the list the name of any person previously registered. The inspectors made 620 inspections and 48 re-inspections of these premises during 1936. One sample in the phenol group of poisons was submitted for analysis and was formally reported upon by the Public Analyst. No infringement of the provisions of the Act came to the notice of the Public Health Department during the year. c2 35 Rag Flock Acts, 1911-1928, and the Public Health (London) Act, 1936. During the year under review the Rag Flock Acts were repealed by the Public Health (London) Act, 1936. Sub-section (1) of Section 136 of the Public Health (London) Act, 1936, provides:— No person shall— (a) sell rag flock; or (6) have rag flock in his possession for the purpose of selling it; or (c) use rag flock for the purpose of making bedding, cushions or any article of upholstery, or have in his possession rag flock intended to be used for that purpose. unless the flock conforms to such standard of cleanliness as may be prescribed by regulations made by the Minister. In this connection 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 during the year which conformed to the required standard of cleanliness. Smoke Abatement. The number of observations of factory chimneys for possible infringements of the provisions of the Smoke Abatement Act, 1926, was 193. In 50 instances nuisances were recorded. The attention of the management was directed to these nuisances in every case and advice was offered by the Sanitary Inspector as to the best method of preventing the emission of smoke or grit. Number of intimation notices served 10 Number of statutory notices served 4 Number of proceedings taken Nil Swimming Baths and Pools. There are 5 bathing establishments in the Borough, all of which are municipally controlled, four by this Council and one an open-air bath at Peckham Rye by the London County Council. Camberwell Municipal Baths, Church Street. In addition to 59 warm baths and a public washhouse there are two swimming baths, each with a capacity of 130,000 gallons, which are available for the use of the public throughout the year. Municipal Baths, Old Kent Road. Provision is made at this bathing establishment for Turkish, Russian and Foam Baths, 98 warm baths and a public washhouse. There are also two swimming baths. The first-class swimming pool has a capacity of 75,000 gallons, and the second-class pool a capacity of 70,000 gallons. These pools are open to the public during the period April to September. The Municipal Baths, Goose Green, Dulwich. At these baths, in addition to 53 warm baths there are two swimming baths. The first-class swimming pool has a capacity of 120,000 gallons, and the second-class pool a capacity of 98,000 gallons. The swimming season is from April to the end of September. The Municipal Baths, Wells Street. Forty-nine warm baths are available at these baths as well as provision for the washing of clothes. No swimming facilities are, however, provided at this establishment. The number of bathers using the swimming baths in 1936 is shown in the following table: — Number of persons using the 1st class baths. Number of persons using the 2nd class baths. Baths. Church Street 42,878 88,588 Old Kent Road 11,118 45,924 Dulwich 35,928 62,723 The water in all the Council's swimming baths is filtered, aerated and chemically treated. In the absence of scum troughs or overflow channels, the surface of the water is skimmed every morning. A daily record is kept of the chlorine content of the water. The practice of obtaining samples of the water from the swimming baths monthly during the summer and alternate months during the winter for chemical and bacteriological examination was continued. The reports of these examinations were satisfactory in every instance, thus proving that the installation of filtration and aeration plants ensures a clean and pure water for bathing. The London County Council's Open Air Swimming Bath, Peckham Rye. This bath has a capacity of 360,000 gallons, and the water is filtered, aerated and chemically treated. Eradication of Bed Bugs As a means of assisting occupiers and owners in ridding their premises of vermin the following procedure is adopted. A Sanitary Inspector visits the premises to ascertain the extent of the vermin infestation and, if necessary, the owner is urged to co-operate with the Public Health Department in the destruction of the vermin. For this purpose he is asked to ease all picture rails, skirting boards, architraves and window mouldings, and to strip the walls and ceilings, if papered, so that the work of spraying can be effectively carried out by the Officers of the Council. Arrangements are also made for the bedding, curtains and other drapery to be steam disinfected at the Council's Disinfecting Station and, at the same time, the tenant is requested to thoroughly scrub and clean all articles of furniture with soap and water. This procedure is repeated at intervals of two weeks and in some cases ten days, until the premises are judged to be free from vermin; the owner is then instructed to replace the woodwork and to distemper the walls and ceilings. The work of disinfestation is carried out by the Council's Officers, and no charge is made for these services. Tenants are informed that sprayers and 1-lb. tins of vermicide are available at cost price, viz.: — ls. each, on application to the Public Health Department. During the year 296 tins of vermicide and 91 sprayers were sold to residents of the Borough. Properties belonging to the Borough Council were dealt with in a similar manner and, when requested by the London County Council, this Council undertook the disinfestation of furniture, bedding and other effects in cases where a family was moving to a London County Council dwelling. Sixty-seven of these cases were dealt with during 1936. The number of Council houses and other houses found to be infested with vermin and disinfested, is shown in the following table:— Premises. Found to be Infested. Disinfested. Borough Council 34 34 973 973 Other houses No use has been made of hydrogen cyanide or orthodichlorbenzene by the Council for the fumigation of premises in the Borough, owing to the toxicity of the fumes to human beings. A Public Utility Society undertaking rehousing operations, remove and disinfest by hydrogen cyanide the furniture and effects belonging to a prospective tenant, and by arrangement the bedding is steam disinfected at this Council's Disinfecting Station. There were 19 cases of this kind during 1936. It was necessary to serve 223 Intimation Notices in respect of verminous rooms in 1936, and during the same period the Council's staff sprayed 1,542 rooms. Inspection of Schools The sanitary conveniences of private schools in the Borough were inspected during the year. It was necessary to draw the attention of the Head Teacher to sanitary defects existing in 5 cases which forthwith received attention. Exclusion from School of Contacts of Infectious Disease. The control of infectious disease is a duty resting upon the Borough Medical Officer of Health. In the latter part of the year the following revised procedure was applied, with the concurrence of the School Medical Officer, in connection with the exclusion from school of contacts of infectious disease. 1. The names of the children who in the opinion of the Borough Medical Officer of Health should be excluded from attendance at school as contacts of cases of infectious disease notified under the Public Health (London) Act, to be forwarded by him to the Head Teacher concerned. 2. Head Teachers to be informed that only those children who are named by the Borough Medical Officer of Health as contacts of cases of infectious disease notified under the Public Health (London) Act, 1936, to be excluded from attendance at school. A total of 1,285 notices relating to cases of infectious disease were sent to the Head Teachers of both public elementary and private schools attended by the patients or contacts of infectious diseases. Rats and Mice (Destruction) Act. 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. 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. It is not generally realised that the responsibility for clearing premises of rats rests with the occupier, unless it is found that the infestation is due to the defective condition of the drains. The Sanitary Inspectors are available to assist owners and occupiers of buildings by offering advice as to the most suitable methods to be employed to destroy these vermin. The Council also issues an advisory leaflet on this subject, and poison baits are issued free from the Public Health Department. During the year 173 complaints were received relating to this form of nuisance and were investigated. The activities of the Council during National Rat Week were reported to the Ministry of Agriculture and Fisheries as follows: — National Rat Week. I desire to report upon the special measures employed during the period November 2nd to 7th, 1936, to give effect to the request of the Ministry of Agriculture and Fisheries for concerted action during Rat Week with a view to the destruction of rats and mice. These were as follows: — 1, The specially designed double-crown poster which was displayed for the first time last year was again posted on the Notice Boards at the Municipal Buildings and on the Council's sand-bins throughout the Borough. 2. Handbills containing notes on rat repression and on the duties of the public under the provisions of the Rats and Mice (Destruction) Act, 1919, were distributed from the Public Libraries, Baths and Infant Welfare Centres in the Borough during Rat Week. 3. A personal appeal was made 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, to co-operate with the Council's Officers in the special efforts which were being directed during that week to exterminate rats. The number of such letters sent out by my department was 2,170. 4. Rat poison baits were available for issue free on application to the Public Health Department, and I understand from the Borough Engineer and Surveyor that the sewers of the Council were baited during Rat Week, such work being carried out in conjunction with the Main Drainage Department of the London County Council. Your obedient Servant, (Signed) H. W. BARNES, Medical Officer of Health. Nuisances Caused from Pigeons Two complaints were received of nuisances caused by the presence of pigeons having or believed to have no owner. In one case the Public Health Committee directed the Borough Engineer and Surveyor to take appropriate action in accordance with the provisions of Section 121 of the Public Health (London) Act, 1936. No action was, however, taken by the Council in respect of the other complaint as proof was not established that the number of pigeons present was in excess of a reasonable number. Fouling of Footpaths by dogs Summary proceedings were taken in 5 cases during the year for non-compliance with the Council's by-law prohibiting the fouling of footways by dogs on a lead. Removal to Institutions of Aged, Infirm or Physically Incapacitated Persons During the year 29 complaints were received alleging that aged or infirm persons were living in insanitary conditions. These complaints were investigated, and it is satisfactory to record that in no case was it necessary to take steps to secure the compulsory removal of the person to an Institution. Public Mortuary. The Council's mortuary adjoins the Coroner's Court at St. George's Road, Peckham, and is equipped with a preservation chamber containing nine compartments. This cooling plant enables bodies received in varying stages of decomposition to be kept for an indefinite period without further physical changes taking place. A monthly summary of the bodies received at the Mortuary during 1936 appears on the following page. Cremation. In my report last year I drew attention to the advantages of the disposal of the dead by cremation, and expressed the view that on health grounds cremation has everything to commend it when compared with earth burial. At the December meeting of the Council plans were approved of a proposed Crematorium and Garden of Remembrance in the Council's New Cemetery at Honor Oak, and application has been made to the Minister of Health for his approval of the proposals. The type of furnace to be installed at the Crematorium has received careful consideration, and in the opinion of the Council the clean radiant heat of an electric furnace has distinct advantages over any form of fuel-fired furnaces, both from the aesthetic point of view and the probable low maintenance charges. Exhumations. During the year two bodies were exhumed at the Cemeteries in the Borough for burial elsewhere on the authority of the Secretary of the Home Office. A Sanitary Inspector was present at these exhumations to ensure that the terms of the Home Office license were complied with in each case. Factories and Workshops During the year the Inspectors paid 790 visits to factories and 963 visits to workshops and workplaces. The following tables show the various trades and occupations carried on in factories, workshops and workplaces where men and women are employed. Month. Males. Females. Total. Inquests. Residents. Outside Borough. Courts. Postmortems Number. P.-M.'s. January 19 19 38 17 24 18 6 20 11 February 24 16 40 19 28 8 23 17 12 March 31 13 44 19 32 7 25 19 13 April 23 16 39 18 26 9 20 19 12 May 24 16 40 19 24 9 25 15 10 June 14 25 39 23 22 12 23 16 9 July 26 18 44 20 28 10 26 18 10 August CLOSED September 17 33 17 11 16 18 8 20 13 October 18 42 19 35 15 24 8 27 11 November 15 41 20 23 16 26 7 25 10 December 26 60 28 32 34 24 41 13 21 Totals 261 199 460 215 301 97 262 130 198 Factory and Workshop Act. FACTORIES, WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1936. Inspected by the Council's Male Sanitary Inspectors. Workshops and Workplaces. Total. Trade. Factories. Blacksmiths 5 8 13 Bootmakers and Repairers 35 43 78 Brush Trades 3 4 7 Building Trades 12 39 51 Chemical Trades 7 4 11 Engineering Trades 64 20 84 Gas Works 1 - 1 Glass Blowing 1 - 1 Laundries 35 2 37 Miscellaneous 216 466 682 Offensive Trades 5 6 11 Preparations of Foodstuffs 21 2 23 Printing and Lithography 49 10 59 Sweet Manufacturers 3 4 7 Timberyards and Woodworkers 49 80 31 Toymakers 1 4 5 Upholsterers 1 14 15 Varnish and Colour Works 1 1 2 Wearing Apparel 23 28 51 Total 532 686 1,218 Inspected by the Council's Woman Sanitary Inspector. Workshops and Workplaces. Trade. Factories. Total. Brush Trades 2 - 2 Chemical Trades 5 1 6 Furriers 1 1 2 Laundries 2 39 41 Milliners 14 - 14 Miscellaneous 124 139 263 Offensive Trades 3 - 3 Preparation of Foodstuffs 4 28 24 Printing and Lithography 15 15 - Sweet Manufacturers 2 3 5 Wearing Apparel 91 100 191 306 264 Total 570 Factory and Workshop Act, 1901. The following tables are required to be submitted annually to the Secretary of State for the Home Department and contain a summary of the inspections made and the defects found and remedied in factories and workshops within the Borough. 44 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Inspections MADE BY Sanitary Inspectors IN 1936. Number of Premises. (1) Written Notices. (3) Inspections. (2) Prosecutions. (4) - Factories (including Factory Laundries) Workshops (including Workshop Laundries) 790 106 963 - 95 Workplaces (other than Outworkers' premises) Total 1,753 201 - 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Number of Defects. Number of Prosecutions. (5) Particulars. (1) Referred to H.M. Inspector. (4) Found. (2) I "j Remedied. (3) Nuisances under the Public Health Acts: —* - Want of cleanliness 182 159 - Want of ventilation 8 7 - - Overcrowding - - - - Want of drainage floors 2 1 - - 108 - Other nuisances 129 - Sanitary accommodation — Insufficient 3 3 - - Unsuitable or defective 75 65 - - Not separate for sexes 2 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] 4 4 4 - Total 405 348 4 - *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. Outworkers The names of 635 outworkers and their addresses in the Borough were reported by local employers and by Medical Officers of Health of other districts. It was necessary to send six cautionary letters to employers in the Borough for neglecting to send a list of the names and addresses of outworkers employed as required by Section 107 of the Factory and Workshop Act, 1901. The number of visits paid to outworkers' premises in 1936 was 633. It was necessary to serve 34 notices under the provisions of the Public Health (London) Act to remedy sanitary defects. Three cases of infectious disease were reported during the year from premises where home work was carried on. The following table shows the nature of the work conducted by these persons in their own homes. Table showing Trades of Outworkers in Employment at the end of 1936. Art publishing 1 Artificial Flowers 1 Baby linen 4 Berets 1 Blinds 1 Blouses 11 Boots and shoes 6 Braces 3 Brushes 3 Button holes 1 Cardboard boxes 9 Card lacing 1 Chemist 1 Coathangers 9 Collars 7 Confetti bags 2 Crocheting 4 Downquilts 5 Drapery 2 Dresses 23 Dressing gowns 8 Dyeing and cleaning 2 Embroidery 10 Engraving jewellery 2 Fancy goods 14 Furs 1 Gloves 1 Gold lace 1 1 Gowns 20 Hairnets and combs 1 Handkerchief sachets 4 Hassocks 1 Hats 3 Hosiers 2 Household linen 1 Ivory and bone goods 1 Lampshades 1 Leatherwork 3 Machine belting 1 Mantles 152 Needlework 4 Novelties 2 Nurses' dresses 2 Outfitting 1 Overalls 3 Paper bags 8 Picot edging 1 1 Polishing and fitting 1 Pyjamas 2 Rag dolls 1 Shirts 20 Skirts 3 Tailoring 32 Ties 35 Toys 4 Umbrella covers 3 Underclothing 18 Veils 1 Watch repairs 1 Wearing apparel 28 Woollen goods 1 495 HOUSING. During the year the Council's Sanitary Inspectors inspected 5,760 houses, including 1,703 house-to-house visits under the Public Health (London) Act, 1936. The number of intimation notices served under the provisions of the Public Health (London) Act requiring the abatement of nuisances in these dwelling-houses was 7,624. It was necessary to serve 2,655 statutory notices, and to issue 94 summonses m order to secure the abatement of the nuisances existing. A summary of the work carried out by the Sanitary Inspectors and Housing Inspectors appears on pages 58, 59 and 48, respectively, Clearance Areas. In my report for the year 1935, I outlined the Council's slum clearance proposals and furnished particulars in respect of 27 areas declared as clearance areas during the period January to December, 1935, see page 49. During the year under review the declaration of small unhealthy areas involving the re-housing of families and the demolition of the buildings on these sites was continued by the Council, and from January 1935 to date these operations have involved the displacement of 401 families representing 1,480 persons. The re-housing of families displaced from Clearance Area Schemes is carried out by arrangement with the London County Council, to whom the Council pays £1 17s. 6d. a year for a period of 40 years for every dwelling provided. A table showing the areas declared to be clearance areas by this Council under the provisions of Section 1 of the Housing Act, 1930, during the year ended December 1936 appears on the following page. A map of the Borough is also reproduced in this section of the report indicating the situation of the unhealthy areas schemes which have received attention by this Authority and the London County Council since January 1935, including Tiger Yard, Joiner's Arms Yard and Woodland Cottages, which were represented in 1934. Public Local Inquiries were held by Inspectors appointed by the Minister of Health in respect of one unhealthy area declared by the Council in 1935 and 6 areas declared during the period covered by this report. With one exception the Clearance Orders were confirmed by the Minister. During the year payments were made by the Council at the direction of the Minister of Health in accordance with the provisions of Section 64 of the Housing Act, 1935, to the owner and the tenant of one dwelling-house in an area which was the subject of a Clearance Order, and to the owner of two houses and the tenant of one of these houses in another area, on the ground that notwithstanding the existence of sanitary defects, the properties had been well maintained. Unhealthy Areas. No. of persons to be displaced. Date of declaration. No. of dwelling houses. Position at December 31st, 1936. Description of Area. Wingfield Mews 15/1/1936 16 51 Original Order not confirmed by Minister of Health. Re-declared and confirmation of Order awaited. 21/10/1936 16 37 Camberwell Station Road 12/2/1936 25 124 Rehousing in progress. 12/2/1936 Southampton Street Dalwood Street (1936) 6 25 Do. 11/3/1936 9 Do. 26 Harders Road 11/3/1936 9 28 Do. Boathouse Walk 8/4/1936 18 72 Negotiations proceeding for acquisition and clearance by L.C.C. Gervase Street 8/4/1936 2 8 Confirmation of Order awaited. Meeting House Lane — No. 1 13/5/1936 27 Do. 5 No. 2 13/5/1936 3 7 Do. No. 3 13/5/1936 2 2 Do. Lettsom Street 13/5/1936 4 25 Do. Grove Lane 13/5/1936 8 23 Do. Sandgate Street— 17/6/1936 _L No. 1 17/6/1936 3 13 Possible action by L.C.C. No. 2 17/6/1936 5 30 Do. Triangle 17/6/1936 6 25 Do. Muscatel Place 17/6/1936 4 25 Confirmation of Order awaited. Victoria Road— No. 1 15/7/1936 8 28 Do. No. 2 15/7/1936 7 Do. 11 Individual Unfit Houses. During the year 12 houses were dealt with under Section 19 of the Housing Act, 1930. In 6 instances the Council made Orders requiring the demolition of the premises and in 5 cases undertakings were accepted from the owners that the houses in question would not be used for human habitation. In the remaining case, the owner's offer to render the house fit for human habitation was accepted by the Council. Record of Work carried out during the year by the Council's Housing Inspectors. Re-inspections not defined. Section 19, 1930 Act. 17 Houses demolished. 3 Inspections not defined. 38 Clearance Areas, 1930 Act. 77 Overcrowding. Part I, 1935 Act. Reinspns. 4 Houses repaired Sec. 17, 1930 Act. Following Formal Notice. 36 29 Inspns. Reinspns. 131 Underground Rooms. Following Informal Notice. 64 Inspns. 69 Sec. 19, 1930 Act. Reinspns. 108 Notices served Sec. 17, 1930 Act. Formal. 101 Individual Unfit Houses. Inspns. 39 Sec. 17, 1930 Act. Reinspns. 2,278 Informal. 249 Inspns. 303 Reinspns. 173 Clearance Areas. 1,463 Miscellaneous Visits. Inspns. 925 Lansdowne Place Do. Bowyer Street 3/4/1935 9/5/1935 4 18 Absolom Place 15/5/1935 11/7/1935 12 49 Rehousing in progress. 4 Acocks Cottages 15/5/1935 11/7/1935 10 Demolished. Hearsey Place 15/5/1935 11/7/1935 4 24 Do. Surrey Place 19/6/1935 12/9/1935 5 20 Rehousing in progress. Taken over by L.C.C. Garden Street 19/6/1935 8 34 - Melon Road 19/6/1935 12/9/1935 4 24 Rehousing in progress. Herring Street 19/6/1935 - 5 15 Taken over by L.C.C. Pleasant Place 19/6/1935 12/9/1935 3 16 Demolished. Lomond Place 17/7/1935 12/9/1935 11 53 Rehousing in progress. Cobourg Road l7/7/1935 17/10/1935 8 28 Vacated. 18/9/1935 Frensham Street 16/10/1935 - Rehousing in progress. 4 19 Lovegrove Street—No. 1 6 27 Do. 16/10/1935 12/12/1935 Lovergrove Street-No. 1 12/12/1935 13 60 Do. 16/10/1935 No. 3 16/10/1935 12/12/1935 2 10 Vacated. Albany Road 11/12/1935 25 126 Negotiations proceeding for acquisition and clearance by L.C.C. - Underground Rooms and Parts of Houses. The following are particulars of the action taken by the Council during the year in respect of underground rooms and parts of premises. Total number of underground rooms inspected 69 Number found to be unfit 20 Number of closing orders made in respect of separate rooms 10 Number of underground rooms rendered fit for human habitation by structural alterations carried out by owners at the request of the Council 10 Number of families accommodated by the L.C.C. 1 Number of parts of buildings closed by closing orders or as the result of undertakings accepted by the Council not to use such parts of premises for human habitation 4 Unfit Houses Repairable at Reasonable Cost. The Council commenced to enforce the repair of houses by the service of Housing Act notices in the latter part of 1932, and since that date 284 working-class dwelling-houses have been dealt with under the provisions of the Housing Acts, 1925-35. The following is a summary of the Notices served (informal and formal) during 1936 under the repair section of the Housing Act, 1930, and the position in respect of these notices at December 31st, 1936. Notices served during 1935 which were outstanding at January 1st, 1936 11 Notices served under Section 17 of the Housing Act, 1930, period January 1st to December 31st, 1936 — Informal 249 Formal 101* Number of notices complied with during 1936 — Informal 64 Formal 36 Notices outstanding at end of year at which works were in progress at December 31st, 1936 160 * This figure is included in Informal total. Houses Let in Lodgings. It is proposed in the course of time to add to the register of houses-let-in-lodgings those premises in the Borough which are deemed to come within the provisions of the by-laws relating to tenement houses. During 1936, 242 such premises were placed on the register. The number of tenement houses entered in this register is now 428. The number of inspection visits of these premises was 361, and 161 notices were served. Common Lodging Houses. At the end of 1935 there were 5 common lodging houses in the Borough. Three of these premises have since been closed voluntarily by the respective owners and one lodging house was included in a clearance order which has been confirmed by the Minister of Health. These common lodging houses were inspected on 136 occasions, and 7 notices were served. The remaining common lodging house is situated at 124, Camberwell Road and is licensed for 245 male persons. Properties owned and managed by the Camberwell Borough Council. Houses. Flats. Tenements. Grove Vale Estate 7 174 - Wyndham Road Area 63 40 287 Peckham Area 1 - - Sunray Estate 252 40 - Newlands Estate 134 16 - Barry Road 2 - - 459 Total 270 287 Increase of Rent and Mortgage (Restrictions) Acts. During the year 53 applications for certificates under these enactments were received. There were also 13 applications from owners of property for certificates stating that the requirements of the Sanitary Authority had been complied with in respect of certificates issued to tenants under these Acts. In every case a certificate was issued. Housing Applications. During the year 379 applications were received at the Public Health Department for re-housing accommodation on the grounds of ill-health, bad housing conditions or overcrowding and were forwarded to the London County Council for attention. At December 31st last, 159 of these applications had been satisfactorily dealt with by that Authority. There were also 438 applications received during the year for housing accommodation in properties owned by this Council. Housing Act, 1935. Prevention and Abatement of Overcrowding. The survey of the Borough which was carried out in accordance with the provisions of Section 1 of the Housing Act, 1935, was completed on January 31st, 1936. Section 2 of the Housing Act, 1935, defines overcrowding as follows:— 1. A dwelling-house shall be deemed for the purposes of this Act to be overcrowded at anytime when the number of persons sleeping in the house either — (a) Is such that any two of those persons, being persons 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 D2 51 (b) Is, in relation to the number and floor area of the rooms of which the house consists, in excess of the permitted number of persons as defined in the First Schedule to this Act. 2. In determining for the purposes of this section 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. It will be observed that the overcrowding standard consists of two parts: (a) that there must be sufficient sleeping accommodation in a house to secure proper sex separation; (6) a standard of capacity which fixes in relation to the accommodation in any particular house the maximum number of persons, irrespective of sex, who may be permitted to sleep in the house at one time. For the purposes of arriving at the "permitted number of persons" in relation to any dwelling house, computation tables appear in the First Schedule to the Act, which are here reproduced:— TABLE I. The permitted number of persons is Where a house consists of 2 (a) One room (6) Two rooms 3 (c) Three rooms 5 (d) Four rooms 7½ (e) Five rooms or more 10 with an additional 2 in respect of each room in excess of 5. (In using this Table, a room of less than 50 square feet is not counted as a room.) TABLE II. The permitted number of persons is Where a room in a house has a floor area of 2 (a) 110 sq. ft. or more 1½ (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 ½ (e) Under 50 sq. ft. Nil In the application of these tables account is only to be taken of a room which is normally used in the locality either as a living room or as a bedroom. The survey was conducted in two stages: the first stage consisting of a house-to-house visitation of all working-class houses for the purpose of ascertaining the number of families and of persons in each family, and the number of rooms occupied by each family in such dwelling houses. This enumeration was made in respect of 38,490 structurally separate dwellings, and revealed the following particulars: — Number of structurally separate premises visited 38,490 Number of families in occupation of these premises 60,043 Number of families found to be overcrowded irrespective of the size of the rooms occupied 1,749 Percentage of overcrowding on examination of the returns of the enumeration 2.9 Number of doubtful cases of overcrowding requiring a measurement inspection of the habitable rooms in the dwelling 6,934 The second stage of the survey involved the measurement of all habitable rooms in 6,934 houses where possible cases of overcrowding existed in order to apply the standard of Table II. These duties brought to light a further 1,201 eases of families living in overcrowded conditions, bringing the total number of cases of overcrowding in the Borough to 2,950 families, or 4.91 per cent. The combined result of the two stages of the survey is shown in Table A. TABLE A Number of structurally separate premises visited. Number of empty dwellings. Number of families found to be overcrowded. Number of families not overcrowded. Percentage of overcrowding. Number of tenancies inspected. 38,490 933 60,043 2,950 57,093 4.91 TABLE B— Ward Distribution Number of tenancies inspected. Number of families not overcrowded. Number of families overcrowded. Percentage of overcrowding. Ward. 334 3,392 8.96 1. The West 3,726 3,228 378 2,850 11.71 2. Addington 3,358 196 3,162 5.83 3. Town Hall 3,557 230 3,327 6.46 4. St. George's 3,427 316 3,111 9.22 5. Cobourg 2,992 129 2,863 4.31 6. Marlborough 7. North Peckham 3,477 308 3,169 8.85 8. Goldsmith 3,470 275 3,195 7.92 9. Clifton 3,879 140 3,739 3.60 10. Rye Lane 2,047 73 1,974 3.56 11. St. Mary's 2,916 69 2,847 2.36 12. Nunhead 3,225 123 3,102 3.81 13. The Rye 2,931 21 2,910 0.71 14. St. Giles' 3,080 104 2,976 3.37 2.25 15. Lyndhurst 3,461 78 3,383 4,017 16. St. John's 4,057 40 0.98 69 17. Alleyn 3,228 3,159 2.13 52 2,150 2.36 18. Ruskin 2,202 19. The Hamlet 1,448 7 1,441 0.48 326 2.39 20. The College 334 8 2,950 60,043 57,093 4.91 The Borough 53 The information obtained from the survey is summarised in Table C on pages 56 and 57, which shows the distribution of workingclass families in relation to the size of the families and the size of the dwellings occupied to a maximum permitted number of 13 equivalent persons. The figures to the left of the black diagonal line indicate the number of overcrowded families in size of family (in equivalent number of persons) in relation to the size of the dwelling occupied, in terms of the maximum "equivalent number" of persons permitted to occupy such dwelling without causing it to be overcrowded. The figures to the right of the diagonal line show the families which were not overcrowded. The entries in this table show as regards each overcrowded family the accommodation which it occupies and the extent of the deficiency which has to be made up. To abate the overcrowded conditions in Camberwell it has been estimated that 868 additional dwellings of the following sizes would be required. This figure was arrived at by a method of calculation suggested by the London County Council. 295 — 3 rooms. 210 — 4 rooms. 251 — 5 rooms. 56 — 6 rooms. 44 — 7 rooms. 9 — 8 rooms. 3 — 9 rooms. The following table provides information relating to overcrowded tenancies in the Borough belonging to the Council, the London County Council and other local authorities. TABLE D. Number of such tenancies found to be overcrowded. Percentage of overcrowding. Local Authority. Number of tenancies. Camberwell Borough Council 1,022 91 8.90 London County Council 1,233 136 11.03 Bermondsey Borough Council 4 4 100.00 City of London 131 7 5.34 Re-Housing of Overcrowded Families. Section 21 of the Housing Act, 1935, places on the Council the duty of enforcing the provisions of the Act relating to overcrowding, and on the London County Council the duty of providing the new accommodation required after having regard to any proposals which may be put forward by the Council to provide houses themselves. In the early part of the year the Council were notified by the London County Council that as and when dwellings become available nominations of families in overcrowded houses for tenancies in dwellings of the County Council would be invited. The County Council's general pool of housing accommodation would be utilised for this purpose and it was stated that while it was not possible to say in advance where overcrowded families would be re-housed, yet every endeavour would be made to satisfy the special needs of each case. The first nominations for improved housing accommodation were submitted in June, and the number of Camberwell families nominated for tenancies in dwellings of the County Council to December 31st, 1936, was 261. The number of families re-housed under this arrangement during this period was 132. Fixing of Appointed Days. At a later date consideration was given to the question of fixing the appointed day for the purposes of Sections 3, 4, 8 and 68 of the Act, and July Ist, 1937, was suggested by the London County Council—the authority for the submission of re-housing proposals— as the appointed day as regards this and certain other Boroughs in the Metropolis. The Council agreed with this proposal, and the Order fixing the appointed day as July 1st, 1937, was subsequently made by the Minister of Health on December 22nd, 1936. It therefore became necessary for the Council to consider making arrangements for the room measurements of approximately 28,000 houses in the Borough to be carried out to enable information to be furnished to owners and occupiers if requested as to the number of persons constituting the "permitted number" in relation to dwelling-houses to which the Act applies. The necessary staff arrangements were accordingly authorised by the Council for these duties. 56 57 TABLE C. HOUSING ACT, 1935.- O VERCROWDING SURVEY. TABLE SHOWING THE DISTRIBUTION OF WORKING-CLASS FAMILIES IN RELAT ION TO THE FAMILIES AND THE SIZE OF THE DWELLINGS OCCUPIED. Metropolitan B orough OF Camberwell. Size of family (in equivalent No. of persons). Size of dwelling occupied, in terms of the maximum " equivalent number" of Persons permitted to occupy it without causing it to be overcrowded. Total of Families. 7 No Overcrowded 7½ 0 ½ 1½ 2 2½ 5 5½ 6 6½ 8 8½ 9 9½ 10 10½ 11 11½ 12 12½ 13 Overcrowded Total 1 3 3½ 4 4½ 6 3 10 125 - 1 1 18 60 3,397 563 1,875 262 3 1,145 28 86 1 400 1 81 1 22 1 11 19 8,081 8,100 - - - - - 1½ - 3 9 22 50 22 1 29 1 7 4 - 3 2 1 1 3 152 155 - - 35 - - - - - - - 38 88 2 - 4 9 44 *416 3,284 1,004 16 5,737 112 597 15 2,624 797 3 5 594 7 2 166 5 57 *65 15,594 15,659 16 - - 10 16 2½ - - 70 56 26 1,314 10 2,269 62 221 6 827 222 1 110 1 30 5 126 5,146 5,272 - 86 - - - - - 70 128 1,223 3 - - - 33 31 31 911 22 3,500 120 499 24 3,067 14 17 933 16 1 294 9 118 95 11,052 11,147 27 - - 19 35 3½ - 1 6 3 277 97 7 834 37 191 6 634 247 3 1 150 2 32 13 384 2,238 2,622 - 9 6 - - - - 124 81 4 - - - 9 3 227 104 22 73 225 1,081 22 1,872 1,120 17 17 1,003 17 2 303 2 2 1 136 365 6,194 6,559 14 16 31 4½ - - 1 68 36 8 23 55 287 6 365 224 3 3 162 5 50 1 1 20 136 1,243 1,379 - - 60 - - 37 74 5 - 2 67 30 18 38 81 434 12 1,003 752 15 11 778 10 3 203 1 2 83 236 3,478 3,714 - - - 18 - 16 32 5½ - - 27 13 4 171 11 62 8 257 90 151 7 3 130 5 2 36 2 1 11 288 679 967 - - - - 82 124 6 - - - 1 - 27 14 6 259 15 75 22 64 20 378 11 8 426 14 3 151 1 64 419 1,416 1,835 - - 28 39 6½ - 12 2 1 96 11 28 13 15 104 1 2 95 3 1 31 1 14 178 339 517 - - - - 46 - - 31 61 7 - - 6 3 1 83 7 26 15 24 21 175 5 10 223 7 2 72 35 196 636 832 - - - - - - 9 16 7½ - 8 2 1 26 2 10 6 10 13 49 5 2 54 4 1 19 6 95 156 251 - - - - - - - 4 20 8 - 2 1 23 1 4 1 73 1 9 9 12 100 9 1 36 1 2 14 142 193 335 - - - - - - - 3 8½ - 1 13 3 2 34 6 3 4 4 30 3 1 11 1 7 66 61 127 - - - - - - - - - 4 7 - 1 1 10 2 24 2 4 6 5 33 4 4 19 1 8 65 74 139 9 - - - - - - - - - - 1 1 - - 1 1 7 4 4 6 3 1 1 7 3 26 15 41 9½ - - - - - - - - - - - 2 3 3 6 1 1 2 2 2 2 5 2 1 4 21 16 37 10 - - - - - - - - - - - - - 1 4 - - 7 1 1 1 2 1 1 14 5 19 10½ - - - - - - - - - - - - - - - - - - 1 2 1 2 1 1 1 1 1 7 4 11 11 - - - - - - - - - - - - - - - - - - 1 1 1 11½ - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 1 12½ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 13 - - - - - - - - - F DW 50 - - - - - - - - *1 *2 - 2 - - - LS O 50 ELLIN 35 GS. 21 TOTA 198 //////// //////// //////// //////// //////// //////// 211 59 12 11 5 1 Overcrowded 1 22 13 166 *101 755 302 62 746 128 - - - - - 1 **2,950 514 400 Not 778 //////// //////// //////// //////// 11,117 5,579 100 98 101 4,907 11l 27 1,491 11 29 - - 60 3,406 993 5,235 3,513 59 13,587 640 3,403 1 612 56,772 5 64 450 813 //////// //////// //////// 11,315 //////// //////// //////// 5,600 Total 1 22 73 3,572 1,094 5,990 3,815 121 14,333 768 3,614 159 110 112 4,912 112 27 1,491 11 29 1 613 59,722 † Including 8 overcrowded families with insufficient accommodation to secure proper sex sepa ration. * Including one overcrowded family of 13½ equivalent persons. 58 59 SUMMARY OF SANITARY WORK CARRIED OUT DURING THE YEAR 1936. Inspectors. Attwater. Watkins. Gilchrist. Topping. Maughan. Malins, L. Malins, M. O'Riordan. (Miss) Worsfold. Weaver. Pickard. X Burrell. Green. TOTALS. Description of Sanitary Improvements effected during the Year — 363 366 204 332 334 403 205 408 248 283 232 101 Number of rooms cleansed 52 3,531 Defective roofs repaired or rainwater pipes provided or repaired 200 224 145 230 225 224 118 170 165 145 158 28 2 2,034 21 144 57- 218 Dampness abated 208 258 103 278 187 158 140 99 1 2,068 107 Yards and forecourts paved or paving repaired 119 7 68 53 138 48 118 136 121 70 35 1,020 41 - 63 62 76 Water fittings repaired 44 58 52 61 50 20 46 15 5 593 1 9 4 5 12 Drains entirely reconstructed 12 24 6 6 6 99 7 7 12 3 - 36 7 98 Drains partially reconstructed 88 38 21 15 67 61 46 492 - Soil, vent pipes, sinks and waste pipes renewed or repaired 120 111 68 79 66 164 57 124 124 101 145 78 2 1,239 167 269 188 154 156 Premises in which repairs were effected to w.c.'s 226 103 190 157 157 148 63 47 2,025 173 79 98 132 Dustbins provided 34 78 68 98 52 110 52 39 2 232 1,015 229 80 269 Repairs effected to windows 126 291 77 250 163 129 136 58 1 2,041 136 166 59 87 108 211 Stoves and coppers repaired 146 41 98 81 67 36 1 1,237 Flooring repaired or renewed, repairs to woodwork (stairs, etc.) 194 161 45 132 94 202 32 181 102 106 70 36 4 1,359 8 2 4 16 Ventilation and lighting improved - 37 9 6 4 4 13 2 105 20 - 10 2 9 Offensive accumulation removed 7 23 5 4 7 9 13 2 173 111 137 26 47 - Miscellaneous repairs and improvements effected 43 82 60 136 142 57 108 18 5 1,034 2,261 Total repairs and improvements effected 2,036 1,023 1,866 1,624 2,442 ] ,028 2,262 1,656 1,562 1,458 661 124 20,003 —t — . \ ) ] r 1 i I Inspections— 678 515 458 549 Following complaint 680 447 398 640 399 364 346 184 36 5,694 66 111 220 House-to-house —(1) Where defects found 36 127 65 92 71 95 144 165 134 92 1,323 - 28 77 24 (2) Where no defects found - 3 31 38 16 25 24 19 380 109 - 88 156 51 105 On occurrence of infection 121 125 76 73 82 45 38 12 1,073 44 - 202 35 1 6 5 Houses divided into separate tenements 106 23 5 3 336 - - - 38 47 33 37 43 Factories 68 34 61 35 16 22 250 790 93 91 23 24 22 Workshops 28 31 50 19 29 47 22 13 135 614 Workplaces 22 27 14 8 38 14 62 12 11 1 18 109 349 52 13 - 28 Underground living and sleeping rooms - 25 39 71 8 32 1 269 - - - 1 2 2 2 Rent (Restrictions) Act 8 2 8 8 1 1 8 35 6 21 - - 15 287 5 175 25 New buildings 5 6 30 2 78 376 - 97 75 68 89 102 Milk premises 5 123 105 21 89 102 95 1,253 - 1 Offensive trades - 1 1 1 12 21 - - - - - - - Outworkers' premises - - - 10 - 633 633 - - - - - - - 13 2 Rag and bone dealers - - 3 2 2 20 160 - - 52 22 42 149 - - 45 63 173 31 23 129 Conveniences (public and private) 78 94 167 1,176 - - Schools - - - 16 1 4 43 - - - - - 48 20 3 5 46 Shops Act 13 49 111 216 40 164 23 77 706 23 79 68 - Pharmacy and Poisons Act 68 24 84 63 17 1 64 40 13 620 3 - 3 2 5 Infant Life Protection 4 3 9 12 4 1 6 53 - 58 - Common lodging houses - - - 31 45 2 90 - - - - 136 298 373 374 385 - Miscellaneous 279 492 57 400 276 307 288 200 774 4,301 253 159 235 184 151 Housing Act, 1935 —Room Measurement Duties 217 228 202 204 179 186 2,474 - 2,265 1,712 1,917 Total Inspections 1,917 1,588 1,676 1,966 1,628 1,724 1,536 1,568 1,089 2,151 22,737 3,955 3,244 3,180 2,480 2,994 3,533 4,059 Re-inspections, calls, etc 2,466 3,099 2,708 3,405 2,928 8 88 629 38,680 3 - Smoke observations 3 23 4 28 1 35 193 - - - Housing Statistics, 1936. 1. Inspection of Dwelling Houses during the Year: — (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 8,897 (b) Number of inspections made for the purpose 28,734 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,703 (b) Number of inspections made for the purpose 5,557 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 152 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation, and Intimation Notices served 4,297 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— P.H. (London) Act 391 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 249 (2) Number of dwelling houses which were rendered fit after service of formal notices: — (a) By owners 36 (b) 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 2,655 (2) Number of dwelling houses in which defects were remedied after service of formal notices: — (a) By owners 2,844 (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 7 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 2 (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 14 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 1 4. Housing Act, 1935. Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 2,955 (ii) Number of families dwelling therein 2,955 (b) Number of new cases of overcrowding reported during the year 163 (c) (i) Number of cases of overcrowding relieved during the year 158 (ii) Number of persons concerned in such cases 944 SUMMARY OF NOTICES SERVED. H. At twater. D. V. Watkins. W. Gilchrist. L. W. Burrell. D. H. Pickard. F. Maughan. M. L. Malins. H. C. Green. M. Malins. W. T. Worsfold. F. O'Riordan. Totals. G. N. Topping. H. R. Weaver. - Intimations, Public Health (London) Act; By-laws, etc. 670 500 638 932 476 576 628 238 7,624 775 841 690 581 79 Statutory Notices do. do. 237 168 231 278 205 352 147 212 243 256 5 235 86 2,655 Metropolis Management Act, 1855, and Public Health (London) Act,1936 (Part 2) - - - 5 - 1 1 2 - - - - 9 - Section 5, Housing Act, 1925 9 1 4 6 8 21 3 21 5 4 9 1 6 98 Premises in respect of which notices were served and complied with during 1936, including notices which were outstanding at December 31st, 1935 538 418 454 746 595 464 360 531 329 6,078 674 361 517 91 Premises in respect of which works in compliance with notices served during the year 1936, were outstanding at December 31st, 1936 128 66 127 140 175 146 173 136 126 76 11 107 42 1,453 61 SUMMARY OF LEGAL PROCEEDINGS DURING 1936. Dist. No. Address. Complaint. Magistrate's Decision. Fine. Costs. — i r £ £ s. d. d. s. 6 27, Haymerle Road 13 6 Sanitary defects Withdrawn. Work done. 0 - 1 24, Crown Street Do. 21 days' Order. 2 2 0 - 9 46, Atwell Road Do. Withdrawn. Work done. 0 13 6 - 7 days' Order. 2 9 75, Fen wick Road Do. 2 0 - 11 86, Landcroft Road Do. Withdrawn. Work done. 0 13 6 - 10 Do. Do. 0 13 6 27, Rye Hill Park - 12 25, Crebor Street Do. Do. 0 13 6 - 4 7, Manor Grove Do. Do. 0 13 6 - 5, Manor Grove Do. Do. 0 13 6 4 - Do. Do. 11 296, Crystal Palace Road 0 13 6 - 185, Queen's Road Do. 14 days' Order. 1 1 0 4 - Non-compliance with Magistrate's Order Sanitary defects 7 0 0 3 3 0 1 25, Hollington Street - Withdrawn. Work done. 11 302, Crystal Palace Road Sanitary defects 0 13 6 - 60, Silvester Road Do. 0 13 6 11 Do. - Do. 7 days' Order. 1 1 0 1 135, Farmers Road - Withdrawn. Work done. 1 129, Farmers Road Do. 0 13 6 - 13 1 131, Farmers Road 80. Do. 0 6 - Do. Do. 0 13 6 8 30, Claude Road - Do. 7 74, Choumert Road Do. 0 13 6 - Do. 4 12, Carlton Square Do. 0 13 6 - 4 Do. Do. 0 13 6 9, Ruby Street - 7 days' Order 7 1, Fearnley Road Do. 1 1 0 - 12 264, Upland Road Do. Adjourned sine die. 0 13 6 - 200, Albert Road Do. Withdrawn. Work done. 0 13 6 8 - - 196, Albert Road Neglecting to pave yard 1 0 0 2 2 0 8 4, Choumert Square Sanitary defects Withdrawn. Work done. 0 13 6 7 - 14 days' Order. 2 2 0 11 160, Lordship Lane DO. - 2 11 164, Lordship Lane Do. Do. 2 0 - 0 242, Lordship Lane Do. Withdrawn. Work done. 13 6 11 - 29, Culmore Road 2 0 4 Do. 14 days 1 Order. 2 - 0 6 45, Hill Street Do. "Withdrawn. Work done. 13 6 - 1 6 64, Colegrove Road Do. 14 days' Order, 1 0 - SUMMARY OF LEGAL PROCEEDINGS DURING 1936—continued. Dist. No. Address. Complaint. Magistrate's Decision. Fine. Costs. — — 26, Brymer Road £ d. £ s. d. 3 Sanitary defects s. Withdrawn. Work done. 7 0 13 6 1, Fearnley Road Do. - Do. 1 0 31, Camberwell Station Road - 13 6 Do. 8 Do. 30, Atwell Road 0 13 6 Do. - 6 Do. 6 7, Naylor Road 0 13 Do. - Do. 8 32, Atwell Road - 0 13 6 Do. Do. 8 258, Albert Road 0 13 6 Do. - Do. 5 21, Stanton Street 0 13 6 Do. - Do. 5 21, Stanton Street - 0 13 6 Neglecting to provide sufficient ashpit 5 Do. 19, Stanton Street 0 13 6 Sanitary defects - Adjourned sine die. 5 21, Stanton Street Do. - Do. - 6 23, Ledbury Street Do. - 21 days' Order. - 3 76, Ossory Road 1 1 0 Do. - Withdrawn. Work done. 3 226, Rolls Road 0 13 6 Do. - 11 Do. 261, Crystal Palace Road 0 13 6 Do. - Do. 11 242, Lordship Lane 0 13 6 Do. - Do. 12 2, Melford Road 0 13 6 Do. - Do. 5 19, Stanton Street do. 0 13 6 - 5 28 days' Order. 21, Stanton Street 1 1 0 Do. - Do. 5 151, Cronin Road 1 1 Do. - 0 21 days' Order. 5 10, Cronin Road 1 1 0 Do. - Withdrawn. Work done. 5 53, Cator Street 0 13 6 Do. - Adjourned sine die. 6 36, Garsdale Road Do. - - Withdrawn. Work done. 11 58, Landcroft Road 0 13 6 Do. - Do. 11 6, Constance Road 0 13 6 Do. - Withdrawn. 11 320, Crystal Palace Road - - Do. Withdrawn. Work done. 9 75, Fenwick Road 0 13 6 Do. - 9 Do. 66, Crystal Palace Road 0 13 6 Do. - Do. 9 0 13 6 181, Crystal Palace Road - Do. Do. 9 185, Crystal Palace Road Do. 0 13 6 - Do. 9 191, Crystal Palace Road 0 13 6 Do. - Do. 1 64, Wyndham Road 0 13 do. - 6 Withdrawn. 4 421, Rotherhithe New Road Do. - - Withdrawn. Work done. 0 13 6 - d. 6 6 0 6 0 0 6 6 6 6 6 6 6 6 0 0 6 0 6 0 0 0 0 0 6 6 Costs. - - s. 13 13 2 13 2 1 13 13 13 13 13 13 13 13 1 1 13 1 13 1 1 1 1 - 1 13 13 0 0 £ 0 0 2 0 2 1 0 0 0 0 0 0 0 0 1 1 0 1 0 1 1 1 1 1 0 0 0 0 0 d. Fine. - - - - - - - - - - - s. - 0 - - - - - - - - - 0 0 - - 0 0 - £ 3 2 1 1 1 Magistrate's Decision. Dismissed under the Probation of Offenders Act. Work done. Order for costs only. Withdrawn. Premises vacated. Work done. Order for costs only. Withdrawn. Work done. Withdrawn. Work done. Withdrawn. Work done. Withdrawn. Work done. Withdrawn. Work done. Withdrawn. Work done. SUMMARY OF LEGAL PROCEEDINGS DURING 1936— continued. Adjourned sine die. - - - - - 14 days' Order. 14 days' Order. 7 days' Order Do. Do. Do. Do. Do. Do. Do. Do. Do. Do. Complaint. Sanitary defects Do. Do. Non-compliance with Magistrate's Order Do. Do. Do. Do. Do. Do. Do. Do. Do. Do. Non-compliance with Magistrate's Order Do. do. Do. do. Sanitary defects Non-compliance with Magistrate's Order Sanitary defects Non-compliance with Magistrate's Order Do. do. Sanitary defects Do. Do. Sanitary defects Do. Do. Do. 8, Canal Place 9, Canal Place 36, Rye Hill Park 27, Hichisson Road 185, Queen's Road 30, Gloucester Road 409, Rotherhithe New Road 305, Lordship Lane 305, Lordship Lane 78, Brayards Road 96, Adys Road. 87, Scylla Road 93, Scylla Road 53, Bridson Street 44, Tustin Street 9, Stanton Street 36, Rye Hill Park 160, Lordship Lane 164, Lordship Lane 1D, Havil Street 75, Fenwick Road 93, Scylla Road 87, Scylla Road 45, Garsdale Road 57, St. George's Road 61, St. George's Road 8, Forester Road 260, Lordship Lane 304, Crystal Palace Road Address. Dist. No. 3 3 10 10 4 5 4 5 5 11 11 11 8 9 8 8 4 4 5 10 11 11 5 9 10 8 8 11 6 INSPECTION AND SUPERVISION OF FOOD. The Food Inspector— Mr.Nash— is responsible for supervising premises in which food is stored, sold or prepared for sale. He also inspects regularly the various street markets in the Borough. Inspections are made to ensure that articles of food stored, sold or prepared for sale are sound, free from disease and fit in every respect for the food of man. He is also required to carry out duties under the Merchandise Marks Act, 1926, the Agricultural Produce (Grading and Marking) Act, 1928, and the Shops Act, 1934. The inspection of dairies and milk shops is undertaken by the district Sanitary Inspectors. A summary of the duties performed by the Food Inspector during the year is given in the following table:— Summary of Work of Food Inspector for 52 weeks ended Dec.31st, 1936. Complaints received 17 Complaints found to be justified 7 Inspections:— Street markets 2,122 Bakehouses 262 Fish curers' premises 260 Fried fish shops 435 Ice cream premises 539 Restaurants and eating houses 310 Slaughterhouses 95 Other food premises 3,918 Carcases inspected 558 Organs inspected 1,179 Carcases condemned (part) 3 Organs condemned 86 Inspections not defined 156 Re-inspections 732 Food surrendered (parcels of varying weights) 39 Certificates granted for Foodstuffs for export 24 Number of food premises defects found and remedied 260 Number of intimations served 166 Number of Statutory Notices served 2 Merchandise Marks Order Imported Goods 26 Shops Act, 1934 124 The Sampling Officer— Mr.Dewey— is responsible for obtaining samples of food and drugs for chemical analysis by the Public Analyst; collecting samples of milk, ice-cream and public baths water for examination by the Borough Bacteriologist, furnishing E 65 reports on applications for registration of dairymen and purveyors of milk and duties arising under the Merchandise Marks Act, 1926, and the Agriculture Produce (Grading and Marking) Act, 1928. Number of Samples taken— Formal 1,013 Informal 46 Milk Supply. There is one cowhouse in the Borough licensed for 47 cows. The district Sanitary Inspector inspected these premises on 12 occasions during the past twelve months, usually at the time of milking, and it is satisfactory to report that all operations associated with milk production were carried out in a maimer which did not call for any criticism. The majority of the milk produced at this establishment is retailed to families living in the neighbourhood of the cowhouse. One sample of milk was examined for the presence of tubercle bacilli by the animal test with a negative result. Milk and Dairies Order, 1926. The Borough Council is required under the provisions of the Milk and Dairies Order, 1926, to keep a register of all persons in their district carrying on the trade of cowkeeper or dairyman, and all premises which are used as dairies. The following summary shows the state of the register at the end of 1936 as compared with the previous year:— 1936. 1935. Cowkeepers 1 1 Cowsheds 1 1 Dairies and Milkshops 335 367 Dairymen with premises in the Borough 351 395 Dairymen with premises outside the Borough 27 24 Purveyors of milk in sealed bottles 205 150 The number of visits paid by the district Sanitary Inspectors to the dairies and milkshops was 1,253. There were 31 instances in which it was necessary to serve notices to remedy defects found at the time of the visit of the Inspector. Milk. During the year 574 formal and 2 informal samples were submitted for analysis. Twelve formal samples failed to comply with requirements. Of this number eight were reported against, owing to the presence of added water, and four in consequence of the fat content falling below the 3 per cent, minimum standard. The samples containing extraneous water were sold from:— open receptacles, 3; sealed bottles, 5; and those showing a fat deficiency:— open receptacles, 2; sealed bottles, 2. Milk (Special Designations) Orders, 1923 and 1936. Under the Milk (Special Designations) Order, 1923, the Council were 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. The Milk (Special Designations) Order, 1936, which came into force on 1st June, 1936, revokes the Orders of 1923 and 1934, and provides for :— (a) the transfer from the Ministry of Health to local authorities the duty of granting licences to producers of certain grades of milk; (b) The improvement and simplification of the existing milk designations by reducing the number of grades from five to three, as follows: (1) Tuberculin-tested, (2) Accredited, and (3) Pasteurised. Tuberculin-tested Milk. Tuberculin-tested milk replaces Certified and Grade "A" (T.T.) milks, and is now the only designation for milk obtained from tuberculin-tested cows. This designated milk may be pasteurised, but must then be so designated and sold as Tuberculin-tested Milk (Pasteurised). Where Tuberculin-tested milk is bottled on a farm the Order permits it to be described as Tuberculin-tested Milk (Certified). From December 31st, 1936, the present method of prescribing the bacteriological standard by a plate count test of 200,000 bacteria per millilitre is to be superseded for Tuberculin-tested and Accredited Milks by the methylene blue test; the coliform test is however to be retained for the present. Accredited Milk. This designation is to be used for milk previously termed Grade A, i.e., milk from cows which are regularly inspected by a veterinary inspector but are not tuberculin tested. This designated milk may or may not be pasteurised. Where accredited milk is bottled on the farm, the Order permits the words "farm bottled" to be added to the designation. Pasteurised Milk. This designation still refers to milk which has been held at a temperature of 145° — 150° F. for at least thirty minutes and immediately cooled to a temperature of not more than 55°F. Further conditions are imposed under the new order as to the provision of E2 67 indicating and recording thermometers and the keeping of temperature records. Stricter surveillance of pasteurising establishments to ensure the continued efficiency of the plant, the methods employed, and the use of the phosphatase test for determining whether or not milk has been properly pasteurised are required by this Order. Alteration in the requirements for capping milk bottles has also been permitted. Plate count tests are prescribed for "Tuberculin-tested Milk (Pasteurised)" and for the "Pasteurised" grades. This Council as a licensing authority has decided to charge five shillings per annum for each licence issued by them other than supplementary licences, for which a charge of two shillings is to be made. Licences expire on December 31st in each year. Licences were granted under the Milk (Special Designations) Order, 1923, in respect of the period 1st January—3lst May, 1936, as set out in the subjoined table. Principal License. Supplementary Licenses. Nature of License. Licenses to — Sell Certified Milk 6 - Bottle and sell Grade "A" (T.T.) Milk 2 - Sell Grade "A" (T.T.) Milk 25 2 Sell Grade "A" Milk 3 - Sell Grade "A" (Pasteurised) Milk 9 - Sell Pasteurised Milk 4 77 122 6 Totals The following licences were granted under the Milk (Special Designations) Order, 1936, during the period 1st June —31st December, 1936. Nature of License. Principal License. Supplementary License. - Licenses to— Sell Tuberculin-Tested Milk 1 Sell Pasteurised Milk 5 - 6 Totals - Total for Year 134 Bacteriological and Chemical Analysis of Milk. During the year 16 samples of Grade "A" (Tuberculin Tested) Milk and 65 samples of Pasteurised Milk were submitted to the Council's Bacteriologist for examination for the purpose of ascertaining whether they complied with the bacteriological standards laid down in the Milk (Special Designations) Order, 1923, which are as follows:— Maximum Number of Bacteria permitted per c.c. Standard for B. Coli. Grade of Milk. Grade "A" (T.T.) Milk 200,000 Must not be found in 1/100th c.c. Pasteurised Milk 100,000 No standard prescribed. All samples of Grade "A" (Tuberculin Tested) and Pasteurised Milks submitted for examination complied with the requirements of the Order. Twelve of the 16 samples of Grade "A" (Tuberculin Tested) Milk were examined at the request of the Minister of Health to whom the reports thereon were forwarded. Examination of Milk for the Presence of Tubercle Bacilli. Six samples of milk were submitted to the Bacteriologist for examination for the presence of tubercle bacilli by means of the animal test, but in no instance was the presence of tubercle bacilli reported. Chemical Analysis of Milk Supplied to School Children and L.C.C. Hospitals. During 1936, 65 samples of pasteurised milk were taken in course of delivery to St. Giles, Dulwich, Constance Road Institution, and the various L.C.C. schools in the Borough. With the exception of one school milk, all complied with the recognised standard. OTHER SAMPLES Raspberry Jam. Of four samples reported against, two contained an excess of preservative and two (one of which was sold as "Full Fruit" Standard Jam) were deficient in fruit. A sample of arrowroot was certified to contain a somewhat unusual foreign ingredient, viz.: Boric Acid. A further reference is made to the above three samples in the section of this Report dealing with the Public Health (Preservatives, etc., in Food) Regulations. One prescription was found on analysis to have been incorrectly dispensed. MEAT AND OTHER FOODS. Registration of Food Premises. In accordance with the provisions of Section 187 of the Public Health (London) Act, 1936, the number of premises entered in the register at the end of 1936 for these purposes was:— Manufacture of sausages 170 Preparation or manufacture of potted, pickled or preserved meat and fish 298 Fried fish shops 92 *Sale, manufacture or storage of ice cream 387 All these premises were regularly inspected by the Food Inspector throughout the year. * Note. — Ice Cream was not made nor sold at 113 premises. At the end of 1936 there were 141 street traders licensed to sell articles of food from stalls in the market places of this Borough. Fruit 47 Greengrocery 31 Salads 18 Fish 11 Groceries 10 Coffee stalls 9 Rabbits, eggs and poultry 8 Confectionery 5 Meat 1 Shellfish 1 Total 141 The inspection of food offered for sale in street markets occupies an important part of the Food Inspector's duties and often necessitates his working in the evenings, particularly on Saturdays. The quality of the goods sold at these markets is maintained at a high standard and if by chance a bad purchase is made by the trader at the wholesale market he invariably takes steps to surrender the unsound articles of food and to obtain a condemnation certificate from this department. This certificate is generally all that is needed to enable the trader to recover the cost of his purchase from the wholesaler. Butcher Shops and Meat Stalls. There were 163 retail butcher shops and one butcher's stall in the Borough at the end of the year. There were also 3 shops from which the sale of butchers' offal was conducted. These shops and stalls were continuously under supervision and 20 notices were served for various purposes during the year. On one occasion meat was surrendered by the retailer as unfit for food. Slaughter of Animals Act, 1933. Licences were granted by this Authority under the provisions of this Act to three slaughtermen employed at the two slaughter houses in the Borough. Public Health (Meat) Regulations, 1924. These regulations were designed to protect meat from contamination in shops, on stalls and during transit. Although a glazed front to a butcher's shop is not compulsory it is pleasing to report that of the 163 butchers' shops in the Borough, there are now only 18 shops where this structural improvement has not been carried out. On 4 occasions during the year it was necessary for the Inspector to administer a caution to carmen for carelessness in the handling of meat during transit. Slaughterhouses. There were two licensed slaughter houses on the register at the end of 1936. The Food Inspector paid 95 visits to these premises and was present on every occasion when slaughtering was in progress for the purpose of inspecting the carcases and organs for the presence of disease. The number of animals killed at these establishments was 558. Summary Showing the Number of Animals Slaughtered and Inspected During 1936. Cattle. Sheep. Lambs. Pigs. Calves. Totals. Month. January 2 21 1 1 25 4 February 26 21 51 - 2 March 29 21 52 - 2 April 15 5 1 23 May 2 19 1 22 - June 3 24 22 49 - July 1 25 14 40 - August 2 19 3 24 - 25 September 3 26 54 - 2 25 24 October - 51 20 37 November 2 59 - December 11 71 108 26 - Totals 36 275 245 2 558 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 removed and destroyed at the Council's Depot at Peckham Park Road. Carcases, including organs. Hind-quarters. Head. Lungs. Liver. Stomach. Mesenteries. Kidneys. Heart. Spleen. Udders. Fore-quarters. Tongue. Intestines. Cause of destruction Cattle. 2 - Tuberculosis 2 - - - - - - - - - - - Fluke 3 - - - - - - - - - - - - - Abscess 1 - 2 - - - - - - - - - - - SHEEP. Parasitic diseases - - 15 1 - - - - - - - - - - PIGS. - 2 13 7 7 7 7 Tuberculosis - - - - - - - Cirrhosis - - 4 - - - - - - - - - - - Abscess 1 1 1 1 - - - - - - - - - - Pneumonia - 3 3 3 - - - - - - - - - - - 32 13 18 - 7 - - Totals - 2 1 13 - - Poultry Slaughtering. There is no poultry slaughterhouse in the Borough. Meat Marking Scheme under Part III of the Public Health (Meat) Regulations, 1924. This part of the Regulations enables a local authority where a competent Inspector is employed to cause carcases to be stamped with a distinctive mark, the purport of which is to declare that the meat is free from disease and fit for the food of man. The mark can only be applied under the following conditions: — (1) That the marking of the carcase or part thereof is requested by the owner. (2) That the Inspector can only apply the mark after having inspected the whole of the carcase with the organs in position. Under this part of the Order no application was received by this authority during the year. Certification of Meat Food Products. The Medical Officer of Health as Designated Officer for Food Inspection issued 24 certificates during 1936 in respect of foods prepared in the Borough for export to America and Australia. Ice Cream. The commodity known as "Ice Cream" includes:— (а) "Water ice" containing little more than water, sugar and a flavouring agent. (б) Custard ice made from corn-flower or other starchy constituent, (c) Cream ice in which milk fat forms one of the main ingredients. The number of premises other than hotels, clubs and restaurants used for the manufacture, storage and sale of ice cream entered on the register at the end of 1936 was as follows:— Storage 1 Manufacture and storage Nil Manufacture and sale 218 Manufacture, storage and sale 20 Storage and sale 132 Sale 16 The usual strict surveillance of these premises, especially small shops, was carried out during the year, and a copy of the following memorandum on the prevention of contamination of ice cream was issued to all manufacturers and vendors of this article of food. The food inspector made 539 inspections of these premises. Enquiries as to the conditions under which this commodity was made were instituted of the Medical Officers of Health concerned in cases where ice cream sold in this Borough was manufactured elsewhere. To Manufacturers and Vendors of Ice Cream. ICE CREAM. Prevention of Contamination. It is not generally known that ice cream like milk forms a most favourable breeding ground for germs, many of which give rise to disease and sometimes fatal epidemics. These germs or bacteria gain access to the "mix" and to the ice cream product through contact with unclean hands, through the medium of spray from the coughing or sneezing of workers, through dirty plant and equipment and through dust and dirt from unclean surroundings. Samples of ice cream submitted to the Borough Bacteriologist in recent years have given a very high bacterial count, implying that the ice cream is not of a high standard of purity. The following suggestions on the prevention of bacterial contamination are submitted for your consideration and adoption to protect the health of the public. 1. Personal cleanliness and health of attendants. The hands and nails of all attendants should be kept scrupulously clean. A clean white apron should be worn by the person preparing this commodity. No one suffering from sore throat, contagious disease or skin disease should engage in the manufacture, storage or retailing of ice cream. 2. Cleanliness should be observed in the preparation and storage of ice cream. The floors, walls and ceiling of the place used for manufacture or storage should be composed of materials which can be easily cleansed and thus kept free from dust and dirt; utensils, plant and equipment and all metal surfaces which come in contact with ice cream should be thoroughly scrubbed and cleansed and then sterilised by steam or by boiling water. 3. Selection and care of ingredients during preparation of ice cream. Raw materials such as cream, butter and gelatine should be fresh and pure and all milk used should be pasteurised. The "mix" should be pasteurised, a temperature not lower than 150 deg. F. for 30 minutes is suggested. As soon as the "mix" is prepared rapid cooling to freezing point is essential. After which the temperature should be maintained at 35 deg. F. 4. Retailing. The most hygienic method of retailing ice cream is by packings which protect against contamination. Such packings should be stored and maintained in a clean condition. It is not desirable for packaged goods to be opened and sold in parts by the retailer. When the ice cream is sold otherwise than in a wrapped form the utensils used as well as the containers in which it is stored should be frequently sterilised by steam or boiling water. Containers should be protected from road dust. Care should be taken to prevent the ice cream from melting as the raising of the temperature allows bacteria to multiply rapidly. Fresh ice cream should not be added to containers in which any previous "mix" remains. It cannot be too strongly emphasised that freedom from contamination of ice cream by bacteria can only be secured by exercising the utmost care and vigilance in its preparation, and in using ingredients of the best quality. Bacteriological Examination of Ice Cream. Six samples of ice cream 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 July 30th Shop 50,000 Present in 1/10th c.c. July 30th Private house 100,000 Present in 1 /100th c.c. No. 2 No. 3 July 30th Barrow in a public thoroughfare. 40,000 Absent in 1/10th c.c. Shop No. 4 August 6th 60,000 Do. Shop No. 5 August 6th 90,000 Present in 1/100th c.c. No. 6 Barrow in a public thoroughfare. 80,000 Absent in 1/10th c.c. August 6th Bakehouses. There are 114 registered bakehouses, 79 of these premises being classified as factory bakehouses. The number of underground bakehouses in the Borough is 38. During 1936, 262 visits of inspection were made and 78 notices were served principally for limewashing and cleansing of the interior of the bakehouses. Fried Fish Shops and Fish Curing Premises At the end of 1938, there were 91 fried fish vendors' premises and 51 fish curers' premises in the Borough. The number of visits to these premises was 695 and 39 notices were served for insanitary conditions. Restaurants and Eating Houses. During the year all restaurants and eating houses were inspected by the Food Inspector. Special attention was paid during these visits of inspection to the observance of a standard of cleanliness in the kitchens and to the arrangements made for the storage of food. It was necessary to serve 14 notices concerning unsatisfactory conditions existing at these premises. Unsound Food. During the year the Food Inspector examined and condemned the articles of food set out in the following table, all of which were surrendered and destroyed at the Council's Depot. Certificates were granted in 36 instances in respect of food surrendered as unfit for human consumption. No occasion arose during the year for summary proceedings to be instituted in regard to food exposed for sale which was unfit for human consumption. The following foodstuffs were surrendered during 1936. Weight. Nature of Food. Surrendered or Seized. Result of action taken. q. 1. T. c. FISH— Rock Salmon 1 16 Surrendered. Destroyed at Disinfecting Depot - - Do. Cod (fillets) 3 0 Do. - - Mussels 2 0 Do. Do. - - Kippers 10 Do. Do. - - - Do. Winkles 1 2 0 Do. - Skate 1 22 Do. Do. - - Do. Offal 1 2 0 Do. - 5 0 20 - FRUIT— Pulp 6 2 0 Do. Do. - 4 3 0 Do. Do. Tomatoes - Do. Do. Grapes 3 0 - - 12 - - - 76 UNSOUND FOOD—Continued. Result of action taken. Weight. Surrendered or Seized. Nature of Foods. T. q. 1. c. MEAT— Butcher's meat 6 2 3½ Do. Do. - Cooked meat 3 3 7½ Do. Do. - Bacon Do. Do. 11 - - - Offal 12 Do. 9 3 Do. - 1 0 1 6 Chocolate (Asstd.) 3 Do. Do. - - - 2 Do. Toffees (Asstd.) Do. - - - 5 - - - TINNED FOODS— Condensed and Evaporated Milk 715 tins 5 2 22 Do. Do. - Vegetables 233 tins 2 2 4 Do. Do. - Fruit Salad 21 tins 16 Do. Do. - - - Fruit 1,084 tins 8¾ Do. Do. 11 2 - Fish 1,328 tins 6 1 21 Do. Do. - Meat 16 tins 3 12 Do. Do. - - Fish paste 200 tins 1 12 Do. Do. - - Treacle 8 tins - 7 Do. Do. - - 3 Mustard 12 tins Do. Do. - - - 1 7 2 21¾ Do. Do. POULTRY— Turkeys (35) Do. 2 0 5 Do. - Do. Chickens (3) 9¼ Do. - - Duck (1) 3½ Do. Do. - - - 2 17¾ - - MISCELLANEOUS— Vegetables (greens) Do. 1 0 12 Do. - Sauce (3 bottles) 2 Do. Do. - - - Oats (rolled) 1 16 1 0 Do. Do. 1 17 1 14 Total 5 9 2 23½ Samples of Food for Chemical Examination. Samples of food were submitted by the Food Inspector to the Council's Analyst, Mr. Martin Priest, for chemical analysis, particulars of which are as follows:— Date. Sample. Results of Analysis. Action taken. 1/1/36 29/1/36 29/1/36 29/1/36 30/3/36 30/3/36 30/3/36 30/3/36 30/3/36 30/3/36 13/5/36 13/5/36 13/5/36 24/7/36 6/8/36 18/8/36 18/8/36 18/8/36 22/9/36 22/9/36 22/9/36 22/9/36 Silds in tomato (Lacquered tin). Tinned oranges (2 samples). Tinned oranges (2 samples). Tinned oranges Silds Silds Silds Silds Silds Silds Barbados soft sugar. Barbados soft sugar. Barbados soft sugar. Chocolates (2 samples). Silds (4 samples) Silds Silds Silds Silds Silds Silds Silds Tin 1.7 grains per 1b. Copper 4 parts per million. Tin 0.82 grains per 1b. Free from compounds of Antimony and lead. Tin 1.58 grains per lb. Free from compounds of Antimony and lead. Tin 1.61 grains per lb. Free from compounds of Antimony and lead. Tin 0.40 grains per lb. Tin 0.88 grains per lb. Tin 0.82 grains per lb. Tin trace only Tin 0.75 grains per lb. Tin 0.46 grains per lb. Tin 1.18 grains per lb. Sulphur Dioxide traces only. Tin 0.70 grains per lb. Sulphur Dioxide traces only. Tin 1.29 grains per lb. Sulphur Dioxide traces only. Free from poisonous metals. No other harmful compounds were detected. Tin 3.41 grains per lb. Tin 3.25 grains per lb. Tin 0.93 grains per lb. Tin 5.17 grains per lb. Tin 1.43 grains per lb. Tin 3.58 grains per lb. Tin 1.10 grains per lb. Tin 2.69 grains per lb. Tin 2.96 grains per lb. Tin 3.57 grains per lb. Tin 2.63 grains per lb. None. None. None. None. None. None. None. None. None. None. None. None. None. None. Remainder of stock surrendered and destroyed. None. Remainder of stock surrendered, and destroyed. None. Remainder of stock surrendered and destroyed. Do. Do. Do. Adulteration of Food and Drugs. Samples taken in strict conformity with the requirements of the Food and Drugs (Adulteration) Act, 1928, are described as formal samples, and samples purchased without disclosing to the vendor the fact that such samples are being taken for analysis are referred to as "informal samples." During the year 1,059 samples of various articles of food were obtained for analysis by the Public Analyst of which 46 were informally procured. Particulars as to the nature of these samples and the results of the examination of them are set out in Table "A" on pages 80 and 81. Details are given in Table "B" on pages 82 - 85 in respect of formal samples found to be adulterated and the action taken in connection therewith. The percentage of samples reported as adulterated was 2.66. (See table A.) Butter Factories, Wholesale Dealers in Margarine. No certificates of registration under the provisions of the Food and Drugs (Adulteration) Act, 1928, were issued during the year. At the end of 1936 there were 19 wholesale dealers in margarine on the register of this Authority. Artificial Cream Act, 1929. No applications for the registration of premises under the Act were received during 1936. Public Health (Condensed Milk) Regulations, 1923 and 1927. Four samples of condensed full-cream milk were taken during the year, and all were found to comply with the regulations. Public Health (Dried Milk) Regulations, 1923 and 1927. One sample of full-cream dried milk was submitted for examination. The sample conformed to the prescribed composition. Agricultural Products (Grading and Marking) Act, 1925. Under the provisions of this Act, there is one premises registered by this authority, for the purposes of cold storage or chemical storage of eggs. Merchandise Marks Act, 1926. Orders in Council under Section 2 of the Act of 1926 have been made prohibiting the sale or exposure for sale in the United Kingdom of imported goods such as honey, fresh apples, currants, sultanas, eggs, tomatoes, butter, bacon, ham, poultry, chilled beef, frozen mutton, and pork, frozen and chilled salmon, sea trout, unless such goods have an indication of the country of origin. It is satisfactory to report that traders in the Borough are carrying out the requirements of these Orders. Frequent inspections were made throughout the year to ensure that the requirements of these Orders were being observed. Verbal and written cautions were given where necessary. Proceedings were taken against one retailer for failing to mark a sample of imported butter with a declaration of the country of origin. The defendant was ordered to pay 10s. 6d. costs. Public Health (Preservatives in Food, etc.) Regulations, 1925-1927. All food samples were examined by the Public Analyst for any contravention of these Regulations, and 7 were found to contain proportions of preservatives contrary to the standards as follows:— Raspberry Jam. Two samples of raspberry jam, Nos. 163 and 202 were found to contain 39 and 45 parts respectively, of sulphur dioxide, above the maximum amount allowed. Proceedings were taken in both cases against the manufacturer. See Table "B." Arrowroot. A sample of arrowroot was found to contain a prohibited preservative, viz., boric acid to the extent of 3.75 per cent. Proceedings were taken — see Table "B." Beef Sausages. Four samples Nos. 248, 290, 358 and 782 were reported as containing respectively 98, 338, 91 and 110 parts of sulphur dioxide per million. The amounts in each instance were below the maximum amount allowed, viz., 450 parts per million, but were sold without notice to the purchaser of the presence of a preservative. The Public Health Committee directed that in three cases cautions in writing be administered, and in the other (No. 290) proceedings be taken (see Table "B"). TABLE "A." Formal and Informal Samples submitted for Analysis for the year ended December 31st, 1036. Article. Number Adulterated, etc. Percentage of Adulteration. Number Examined. Informal. Informal. Informal. Total. Formal. Total. Formal. Private. Formal. Private. 2.09 12 12 - 574 2 576 - - - Milk 72 - - - - - 71 1 - - 2.04 Butter 1 1 - 49 4 53 - - - Vinegar 40 - - - - - 40 - - - 4 10.81 Lard 4 - 37 37 - - - - Malt Vinegar 1 23 - - - - 22 - - - Self-Raising Flour - - 18 18 - - - - - - Dripping 1 18 - - - - 17 - - - - - Margarine 11 1 12 - - - - - White Pepper 11 - - - - 11 - - - - Cocoa - - 11 11 - - - - - - Custard Powder 10 - - - - 10 - - - - Cornflour - - 8 8 - - - - - - 4 57.14 80 Cream 1 8 4 - - 7 - - Raspberry Jam - - 6 3 9 - - - - - 4 66.66 Whiskey 6 4 - - 6 - - - Beef Sausages - - 6 6 - - - - - - Lemonade Powder 6 - - - - 6 - - - - Sultanas - - 5 5 - - - - - - 1 20.00 Ground Almonds 5 1 - - 5 - - - Arrowroot - - 5 - - - - 5 - - Tea 5 - - - - 5 - - - - - - Fishpaste 5 1 6 - - - - - Camphorated Oil 5 - - - - 5 - - - - - - Brawn 4 - - - - 4 - - Condensed Full Cream Milk, sweetened 4 - - - - 4 - - - Preserved Sausages - - - 4 4 - - - - - - Coffee 5 - - - - 4 1 - - - Tincture of Iodine - - 3 3 - - - - - - Lemon Curd, and Cheese 3 - - - - 3 - - - Strawberry Jam - - - 3 3 - - - - - - Sherbet 2 - - - - 2 - - - Crushed Linseed - - - 2 2 - - - - - - Boric Acid Ointment 2 - - - - 2 - - - - 50.00 1 - Citrate of Magnesia 2 2 1 - - - - Prescription 2 - - - - 2 - - - Glauber Salts - - - 2 2 - - - - - - Ground Ginger Flour 2 - - 2 Sponge Mixture - - - 2 2 - - - - - - Rice 2 - - - - - - 2 - Blackcurrant Jam - - - 2 2 - - - - - - Dutch Cheese 2 - - - - - - 2 - Curry Powder - - - 1 1 - - - - - - Tomato Sauce 1 - - - - - - 1 - Ketchup 1 - - - 1 - - - Gravy Essence - - - 1 - - - - - - 1 - Minced Meat - - - 1 1 - - - - - - Raisin Wine 1 - - - - - - 1 - Plum Jam - - 1 1 - - - - Apricot Jam - - - 1 - - - - - 1 - Lemon Squash - - - - 1 1 - - - Table Jelly - - - 1 - - - - Fruit Treacle - 1 - - - - - 1 1 - - - Pearl Barley - - - 1 - - - - - - 1 - Mustard - - 1 1 - - - - Sage - - - 1 - - - - - - 1 - Barbadoes Raw Soft Sugar - - - 1 3 4 - - - Desiccated Cocoanut - - 1 - - - - - - 1 - Baking Powder - - - 1 1 - - - Confectionery - - - 1 3 - - - - - 4 - Pork Sausages - - 1 1 - - - - Veal Loaf - - - 1 - - - - - - 1 - 81 Egg (Substitute) Powder - - - 1 1 - - - Mincemeat (Fruit) - - - 1 - - - - - - 1 - Full Cream Dried Milk - - - 1 1 - - - Cream of Tartar - - - 1 - - - - - - 1 - Epsom Salts - - - 1 1 - - - Gin - - - 2 - - - - 1 - 3 - Tinned Sild - - - 18 - - - Rum - - 18 - 8 8 1 - - 44.44 - - 1 Tinned Fruit (Mandarin Oranges) - - - - 3 3 - - - - - - - - - - - 1,013 46 1,059 27 - 8 35 2.66 - 17.39 TABLE "B" SAMPLES ADULTERATED, Etc. Whether Formal, Informal or Private. Nature of Adulteration or Irregularity. Observations. Serial No. Article. Result of Proceedings or other Action taken. Article contained 1 per cent, of added water. 8 Milk Formal - Caution. Resolution of the Public Health Committee. Do. 48 per cent, of the original fat abstracted. - Summons dismissed under the Probation of Offenders Act. Defendant to pay 10s. 6d. costs. 41 Do Do. Do. Article contained 1 per cent, of added water. - Caution. Resolution of the Public Health Committee. 52 Article contained 0.8 per cent, of added water. Do Do. - 69 Do. Do. 4 per cent, of the original fat abstracted. Do. Do. - 99 Do. Do. 11 per cent. of the original fat abstracted. - 139 Do. Do. Summons dismissed under the Probation of Offenders Act. Defendant to pay 10s. 6d. costs. - Article contained 1.3 per cent. of added water. 149 Do. Do. Caution. Resolution of the Public Health Committee. Do. Article contained 2.0 per cent, of added water. 204 Do. - Do. Do. Article contained 3.3 per cent, of added water. - 343 Do. Do. 12 per cent, of the original fat abstracted. - 530 Do. Do. Summons dismissed under the Probation of Offenders Act. Defendant to pay 10s. 6d. costs. Do. Article contained 1.1 per cent, of added water. Caution. Resolution of the Public Health Committee. 717 Do. - Do. Do. Article contained 1.0 per cent, of added water. - 972 Do. Do. Deficient in Acetic Acid to the extent of 11 per cent. Vinegar Do. Do. Do. 134 - A sample of Vinegar, other than Malt Vinegar. - Malt Vinegar Do. Do. Do. 185 Do. Do. - 191 Do. Do. Summons dismissed under the Probation of Offenders Act. Defendant to pay 10s. 6d. costs. Sample deficient in Acetic Acid to the extent of 8 per cent. 197 Do. Do. - Caution. Resolution of the Public Health Committee. Do. Sample deficient in Acetic Acid to the extent of 31 per cent. - 531 Do. Summons dismissed under the Probation of Offenders Act. Defendant to pay 10s. 6d. costs. Raspberry Jam Do. Article contained excess of 39 parts per million of Sulphur Dioxide. Proceedings taken against the wholesale firm. 163 Summons dismissed under the Probation of Offenders Act. Defendant to pay 21s. costs. Summons dismissed under the Probation of Offenders Act. Defendant to pay 21s. costs. Do. Do. Article contained excess of 45 parts per million of Sulphur Dioxide. 202 F2 TABLE "B" SAMPLES ADULTERATED, Etc.—continued. Article. Whether Formal, Informal or Private. Nature of Adulteration or Irregularity. Serial No. Observations. Result of Proceedings or other Action taken. Raspberry Jam Caution. Resolution of the Public Health Committee. Formal Deficient in fruit to the extent of 28 per cent. of the amount that should have been present. - 398 Do. Do. Do. 983 - Article deficient in Raspberries to the extent of 15 per cent. Do. Do. Do. Beef Sausages Sold without notice of the presence of a preservative. 248 Article contained Sulphur Dioxide to the extent of 98 parts per million. Do. Summons dismissed under the Probation of Offenders Act. Defendant to pay 10s. 6d. costs. Caution. Resolution of the Public Health Committee. Do. 290 Article contained Sulphur Dioxide to the extent of 338 parts per million. Do. Do. Do. 358 Do. Article contained Sulphur Dioxide to the extent of 91 parts per million. Do. Do. 782 Do. Do. Do. Article contained Sulphur Dioxide to the extent of 110 parts per million. 354 Defendant ordered to pay 25s. fine and 21s. costs. - Do. Article contained 3.75 per cent, of Boric Acid. Arrowroot Caution. Resolution of the Public Health Committee. 928 Article contained excess of Hydrochloric Acid to the extent of 30 per cent, of the amount prescribed. - Do. Prescription 24 Tinned Fish - - Article contained 3.41 grains per lb. of tin. Informal - 25 Do. Article contained 3.25 grains per lb. of tin. - Do. - 27 Do. - Article contained 5.17 grains per lb. of tin. Do. - Do. - 31 Do. Article contained 3.58 grains per lb. of tin. Do. - - 32 Do. Article contained 2.69 grains per lb. of tin. - Do. 33 Do. Article contained 2.96 grains per lb. of tin. - - Do. Do. Article contained 3.57 grains per lb. of tin. - 34 Do. - Do. Article contained 2.63 grains per lb. of tin. - 35 TABLE "C" TABLE "D" Percentage of Adulteration of Formal Samples of milk during the past five years:— Percentage of Adulteration of Formal Samples during the past five years:- Year. 1932 1933 1934 1935 1936 Year. 1932 1933 1934 1935 1936 Percentage of Adulteration 0.98 3.62 1.57 Percentage of Adulteration 2.30 2.44 1.80 3.64 2.66 1.42 2.09 SUMMARY. Formal samples submitted for analysis 1,013 Informal samples submitted for analysis 46 Formal samples adulterated 27 Informal samples (tinned fish) 8 Written cautions administered (Food and Drugs (Adulteration) Act, 1928) 15 Written cautions administered (Public Health (Preservatives, etc., in Food) Regulations) 3 Written cautions administered (Merchandise Marks Act, 1926) 1 Summonses issued (Food and Drugs (Adulteration) Act, 1928) 6 Summonses issued under the Merchandise Marks Act, 1926 1 Summonses issued under the Preservatives, etc.. in Food Regulations 3 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 6 1 5 0 3 13 6 Public Health (Preservatives, etc., in Food) Regulations, 1925/7 3 - 2 12 6 Merchandise Marks Act, 1926 1 0 10 6 - Chemical and Bacteriological Examination of Food. The chemical analysis of food was carried out by Mr. Martin Priest, F.I.C., the Public Analyst—see Tables "A" and "B" in this section of the report. In addition to the examination of samples of milk and ice-cream the following article of confectionery was bacteriologically examined by Dr. Guy Bousfield, the Council's Bacteriologist, for the presence of deleterious organisms. Date. Nature of Food. No. of Sample. Bacteria discovered. 24/7/36 Chocolate Confectionery. 2761—2762 Aerobic and anaerobic cultures made from chocolates selected from both boxes did not show lasting fermenting or other definitely pathogenic organisms after prolonged incubation. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE AND OTHER DISEASES. Notifiable Diseases. The following diseases are compulsorily notifiable in Camberwell:— Acute Polio-encephalitis. Membranous Croup. Acute Poliomyelitis. Anthrax. Ophthalmia Neonatorum. Plague. Cerebro-Spinal Fever. Pneumonia— Acute Primary. Cholera. Pneumonia— Acute Influenzal. Continued Fever. Puerperal Fever. Diphtheria. Puerperal Pyrexia. Dysentery. Relapsing Fever. Encephalitis Lethargica. Scarlet Fever or Scarlatina. Erysipelas. Smallpox. Food Poisoning. Tuberculosis. Glanders. Typhoid or Enteric Fever. Hydrophobia. Typhus Fever. Malaria. It is very satisfactory to report once again that the number of notifications of infectious disease received shows a reduction, viz., 1,289, as compared with 1,317 in 1935. There was a marked decrease in the number of notifications of Diphtheria, from 363 in 1935 to 278 in 1936. There was, however, an increase in the number of notifications of Scarlet Fever, viz., 722, as compared with 605 in 1935. The remaining principal infectious diseases showed no unusual features. 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—Precautions) Regulations, 1917. Diphtheria. The number of cases of this disease notified during the year was 278, and with three exceptions the patients were removed to isolation hospitals for treatment. Twenty-two cases were subsequently regarded as not suffering from Diphtheria. The actual number of cases was therefore 256, as compared with 333 in 1935. This is equal to an attack rate of 1.16 per 1,000 population. Thirteen deaths occurred, representing a case mortality rate of 5.7 per cent. Diphtheria anti-toxin for treatment and for prophylactic purposes is available free of charge to medical practitioners during the day and night at the Town 88 89 DIPHTHERIA IMMUNI-SATION CLINIC. RETURN OF WORK. TABLE I.—AGES OF PERSONS SCHICK TESTED WITH RESULT OF TEST. 15 yrs. and above. 8 to 9 yrs. 9 to 10 yrs. 10 to 11 yrs. 11 to 12 yrs. 12 to 13 yrs. 13 to 14 yrs. 14 to 15 yrs. 1 to 2 yrs. 2 to 3 yrs. 3 to 4 yrs. 4 to 5 yrs. 5 to 6 yrs. 6 to 7 yrs. 7 to 8 yrs. Total 6 to 12 mths. 9 6 8 6 32 49 25 23 15 11 15 15 295 13 42 26 - Not read. Not read. Not read. Not read. Not read. Not read. Not read. Not read. Not read. Not read. Positive 219 Negative 69 Not read 7 Not read. Not read. Not read. Not read. Not read. Not read. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Pos. Neg. Neg. Neg. Neg. Neg. Neg. Neg. Pos. Pos. Pos. Pos. Pos. Pos. Pos. Pos. Pos. Pos. Pos. Pos. Pos. Pos. Pos. 1 5 9 1 5 4 - 3 3 2 6 - 1 5 7 7 - 23 2 1 28 4 41 8 21 3 1 18 4 1 10 5 0 3 7 - - - - - 1 12 - 1 40 2 - - TABLE II.—IMMUNISATION TREATMENT TABLE. 10 to 11 yrs. 13 to 14 yrs. 14 to 15 yrs. 15 yrs. and above. 12 to 13 yrs. 3 to 4 yrs. 11 to 12 yrs. 5 to 6 yrs. 6 to 7 yrs. 7 to 8 yrs. 8 to 9 yrs. 9 to 10 yrs. Totals 6 to 12 mths. 1 to 2 yrs. 2 to 3 yrs. 4 to 5 yrs. T.A.M. T.A.M. T.A.M. T.A.M. T.A.M. T.A.M. T.A.M. T.A.M. T.A.M. T.A.M. T.A.M. T.A.M. T.A.M. T.A.M. T.A.M. T.A.M. 1st Injections 219 2nd „ 210 3rd „ 18 4th „ 8 sth „ 8 3rd „ 3rd „ 3rd „ 3rd„ 2nd „ 3rd„ 2nd „ 2nd „ 2nd „ 2nd „ 1st Injection. 1st Injection. 1st Injection. 1st Injection. 1st Injection. Ist Injection. 1st Injection. 1st Injection. 1st Injection. 3rd „ 1st Injection. 3rd „ 1st Injection. 1st Injection. 1st Injection. 2nd „ 1st Injection. 2nd „ 3rd „ 2nd „ 1st Injection 1st Injection 2nd „ 2nd „ 3rd „ 3rd „ 3rd „ 3rd „ 2nd „ 2nd „ 2nd „ 2nd „ 3rd „ 2nd „ 3rd „ 3rd „ 3rd „ 2nd „ 5 4 4 22 19 27 26 23 22 16 18 17 16 9 9 3 3 2 6 6 5 3 3 3 2 2 2 1 1 1 - - 7 7 6 12 10 10 39 38 34 22 28 41 39 36 9 - 4th 1 5th 1 4th 1 5th 1 4th 1 5th 1 4th 4 5th 4 4th 1 5th 1 TABLE III.—AGES OF PERSONS RE-SCHICKED AFTER TREATMENT AND FOUND TO BE NEGATIVE. 15 yrs. and above. 9 to 10 yrs. 10 to 11 yrs. 6 to 7 yrs. 7 to 8 yrs. 8 to 9 yrs. 11 to 12 yrs. 12 to 13 yrs. 13 to 14 yrs. 14 to 15 yrs. Total 1 to 2 yrs. 2 to 3 yrs. 3 to 4 yrs. 4 to 5 yrs. 5 to 6 yrs. 6 to 12 mths. 11 4 2 3 1 2 171 19 26 4 - - 6 26 21 20 26 Hall, and during the day at the Dulwich Baths. During the year 119 phials of 8,000 units and 37 phials of 500 units were issued. In previous reports reference lias been made to the necessity of administering anti-toxin whenever this disease is suspected without waiting for bacteriological confirmation of the diagnosis. The swab report should, as a rule, be regarded as providing confirmatory evidence of the disease. The non-detection in the laboratory of organisms morphologically resembling the diphtheria bacillus does not necessarily exclude diphtheria as the disease from which the patient is suffering. Diphtheria Prevention. The attendances at the Council's Diphtheria Prevention Clinic in 1936 numbered 1,449. A table recording the number of persons in age groups who attended to receive the Schick test and immunisation treatment appears on the preceding pages. Daring the last year various types of diphtheria prophylactic have been employed at the clinic. Toxoid Anti-toxin mixture has been used for many years with excellent results, but it was desired to determine whether these results could be improved upon. Goat serum Toxoid Anti-toxin mixture was given a trial by Dr. Guy Bousfield, the Clinic Medical Officer, in the same dosage and at the same interval as the Toxoid Anti-toxin mixture formerly used. The results were strictly comparable, it being found that in each case 3 or 4 per cent, of children were not effectively immunised by the routine course. It would appear that this percentage of failure ought not to be regarded as casting a slur on the effectivity of the prophylactics. The reason is rather that a few children in every hundred are exceptionally difficult to immunise, and often a considerable number of extra injections is required in such cases to effect the end in view. Recently an attempt has been made to produce a very high standard of immunity by the employment of one of the new preparations, Alum-precipitated-toxoid, administered in a different manner from that advocated by the manufacturers. This product has hitherto been used either as a single injection, which has not proved sufficiently satisfactory to recommend the procedure, or as two injections, one of o'l c.c. followed by 0-5 c.c. at two or three weeks' interval. The latter method has produced results fully comparable with the old three-injection procedure with Toxoid Anti-toxin mixture. In view of the fact that the more serious types of diphtheria infection require a greater degree of immunity to give protection against them, it was decided to attempt to achieve this high degree of immunity by the routine use of three doses of this most powerful prophylactic, Alum-precipated Toxoid. These have been given at intervals of a fortnight, the dosage being 0·1 + c.c., 0·3 c.c., and 0·5 c.c. It is as yet too early to make any comments on the results of this new procedure, but early re-Schick tests are proving promising. It will be noted that the first dose is marked 0·1 + c.c. The reason for this is that in certain children a drop or two of the prophylactic is liable to run out through the needle puncture, and in order to ensure that a full 0·1 c.c. remains in the body, it has been the practice to give a little extra, in fact nearly 0·2 as the first injection. Only by patient work and careful observation can the very best possible protection be given to children, and all work at this clinic is directed to the determination of what is actually best, both in the immediate future and after a lapse of years. Scarlet Fever. The number of cases of this disease notified during 1936 was 722, as compared with 605 in 1935. Only 72 of these patients were treated at home, the remainder being removed to the London County Council isolation hospitals for treatment. Twenty of these patients were subsequently discharged from hospital certified as not suffering from this disease. The number of return cases was 20. A "return case" is one which occurs in the same household within 28 days of the discharge from hospital of a patient certified to have recovered from this disease. Multiple cases in one house are not frequent and during 1936 there were 34 such cases reported. There were 2 deaths. It is generally accepted that a haemolytic streptococcus is the causative agent of the disease known as Scarlet Fever. A typical case of Scarlet Fever with the characteristic history of onset, the changes in the throat and tongue, the presence of a scarlatiniform rash followed by typical desquamation is easy to diagnose. Frequently, however, cases are met where some of the cardinal signs and symptoms are absent, thereby presenting a doubt as to diagnosis. These patients may be infectious, and it is desirable that they should be isolated in a separate room with the attendant on the patient taking precautions to prevent any spread of the disease. Enteric Fever (including Paratyphoid). One case of typhoid fever and 5 cases of paratyphoid fever were notified. All of these patients were removed to hospital. There was one death. In the case of epidemics of typhoid or paratyphoid fever it is usually easy to trace the infection. Sporadic cases on the other hand present great difficulties. These cases frequently occur from contamination of food by carriers of these diseases engaged in handling articles of food who may not be too careful in matters relating to personal hygiene, and the source of infection is consequently often not discovered. Typhoid and Paratyphoid Fever Cases Table. Age. Date of Notification. Notified as Results of Bacteriological Examinations. Source of Infection. Sex. 4 Bac. Para. "B" F 8/5/36 Paratyphoid Fever. - Bac. Typh. 16/6/36 26 - F Typhoid Fever 20/6/36 Bac. Para. "B" - 5 M Paratyphoid Fever Do. 20 18/7/36 - F Do. 7/12 18/8/36 Do. Do. M - 3/9/36 Do. Do. F 6 - Dysentery. Three cases of dysentery were notified during 1936. One of these cases occurred in hospital. All were of the bacillary type. There were no deaths. Pneumonia. The number of cases of acute primary pneumonia notified in 1936 was 107, as compared with 117 in 1935. Fifty-one of these patients were nursed in institutions. The number of notifications of acute influenzal pneumonia received during the year was the same as in 1935, viz. 41. Nineteen of these cases were nursed in institutions. Home nursing services were provided in 32 cases. Pneumonia is still a disease which takes a heavy toll at all ages. The number of deaths from pneumonia all forms was 199, as compared with 157 deaths in 1935. Malaria. One case of Induced Malaria of a Camberwell resident was notified from a mental institution not in the area. Cerebro- Spinal Meningitis. There were 6 notifications of this disease received during the year, and the relevant particulars relating to these cases are set out in the following table: — Sex. Age. Date Removed to Hospital. Bacteriologically Confirmed. Result. Date of Notification. F 3 18/1/36 18/1/36 Yes Recovered. M. Died. 11/12 29/1/36 27/1/36 Yes F. 12 22/2/36 22/2/36 No Died.* 18 No M. 31/8/36 31/8/36 Recovered.† 27/10/36 M. 40 27/10/36 Yes Died. M. 8½ 15/12/36 Yes Recovered. 16/12/36 * Cause of death, Pneumococcal Meningitis. † Regarded as an abortive type. Polio-Myelitis and Polio-Encephalitis. The majority of sufferers from this disease are young children. A considerable proportion of the patients who recover from the acute stage are crippled for life. Owing to the serious after effects of this disease it is the practice of the department to keep in touch with patients notified in previous years with a view of offering advice and assisting the patients to obtain remedial treatment if necessary. There were no deaths recorded of polio-myelitis; there was, however, one death from polio-encephalitis which had not been notified. Encephalitis Lethargica. No new cases of this disease were notified during 1936, but 16 known cases of encephalitis lethargica were visited by the staff of the department during the year for the purpose of offering advice and rendering assistance to the patient. The number of deaths was 2. One of these cases had never been notified to this department. Erysipelas. This disease is caused by streptococcal organisms which are similar to those which cause scarlet fever and puerperal septicaemia. There were 89 cases of Erysipelas notified, and 2 of the patients died. The comparative figures for 1935 were 117 cases and 3 deaths. Puerperal Fever. In 1936, there were 7 notifications of Puerperal Fever. Five of these cases occurred in institutions, and 2 were reported of patients confined at home who were subsequently removed to hospital for treatment. There was one death from this cause during the year. The Council provides anti-streptococcic serum for prophylactic or treatment purposes free of charge to private medical practitioners. One request was received in 1936 for a supply of this serum. Puerperal Pyrexia. This condition is defined as any febrile condition (other than a condition which is required to be notified as puerperal fever) occurring in a woman within 21 days after childbirth or miscarriage in which a temperature of 100-4° Fall, or more has been sustained during a period of 24 hours, or has recurred during that period. The number of cases of Puerperal Pyrexia notified during 1936 was 15. With one exception all these cases were reported from hospital, the remaining patient being subsequently removed to hospital for treatment. None of the notified cases proved fatal. Ophthalmia Neonatorum. This disease is characterised by an inflammation of the eyes of a newly-born infant resulting in a purulent discharge. The number of notified cases of this disease during 1936 was 13. Immediately on the receipt of a notification of a patient to be nursed at home, a Health Visitor visits the address for the purpose of ensuring that the child receives proper treatment and to offer the assistance of the Council's Home Nursing Scheme in cases where such services are deemed to be necessary. Visits to the patient are continued daily until the child is considered to be well on the way to recovery. Notification of this disease and the supervision of affected infants has been accompanied by almost total avoidance of blindness following Ophthalmia Neonatorum. In addition to the notified cases 35 cases of slight discharge from the eyes of infants came to the knowledge of the Public Health Department and received attention. During 1936, 568 visits were paid by the nurses of the District Nursing Associations in the Borough to 30 patients suffering from discharging eyes. The following table gives particulars of the notified cases in 1936 and the result of the treatment of these patients. Cases Treated. Vision. No. of Cases Notified. No. of Deaths. Unimpaired. Impaired. Total Blindness. At Home. In Hospital. 13 - - 10* 3 - 12* * One case moved from the district, vision believed unimpaired. Food Poisoning. Cases of food poisoning and suspected food poisoning are notifiable in London under Section 7 of the L.C.C. General Powers Act, 1932. (Since October 1st, 1936, Section 182 of the Public Health (London) Act, 1936.) Only one case of food poisoning was notified by a medical practitioner during the year. The article of food consumed which was suspected to be responsible for the illness, which was however slight in character, was bloater paste. NON-NOTIFIABLE DISEASES. Measles. Information as to the incidence of measles in the Borough is obtained through the School Medical Service and from the Health Visitors, and during the year 2,058 cases were reported from these sources. This disease occurs in epidemic form every two years. The epidemic which commenced in November 1935 continued until August 1936, the peak being reached in March 1936, when over 100 cases a week were being reported. The Measles Scheme of Control was put into force at the commencement of the epidemic which worked well on the whole as an instrument to secure effective control of the disease. At the end of the epidemic period statistical particulars were furnished to the London County Council at their request as in previous epidemic periods. The Health Visitors visited every case of suspected measles brought to the notice of the Department and home nursing services were provided in 65 instances. The number of children admitted to fever hospitals was 440. There were 32 deaths from measles during the year. The age distribution of patients who died from this disease is given in the following table. Under 1 year. 1 - 2 years. 5 - 15 years. 2 - 5 years. Total. 7 12 9 4 32 Measles Prophylaxis. The efficiency of measles anti-serum is beyond dispute. The prophylactic use of serum obtained from convalescent measles patients and from adults who in childhood have suffered from measles does not seem to have found favour with general medical practitioners in the Borough, as during the year only one enquiry was received at the Public Health Department for this serum. Whooping Cough. Whooping Cough like measles is a highly infectious disease and is responsible for a number of deaths in children under five years of age. During the year 535 cases of Whooping Cough came to the knowledge of the Public Health Department, chiefly through the School Medical Service. The number of children removed to hospital for treatment was 120. There were 12 deaths certified to be due to this disease as compared with 13 in 1935. The age distribution of patients whose illness proved fatal is given in the following table. Under 1 year. 2 - 5 years. 5 - 15 years. 1 - 2 years. Total. 8 2 1 1 12 Compulsory Notification. Many parents unfortunately continue to allow their children who may be suffering from Whooping Cough to mingle with other children in public places. It cannot be emphasised too strongly that in view of the highly infectious nature of this disease, children suspected to be suffering from Whooping Cough should not mix with other children. Compulsory notification, which is viewed more favourably at the present time, having regard to the accommodation available in L.C.C. hospitals for the treatment of this disease, would, in my opinion, materially assist in securing better control of this disease. Diarrhoea (under 2 years of age). Two of the main causes of acute diarrhoea in infants are gastroenteritis and ileo-colitis. Gastro-enteritis is mainly attributable to improper feeding and seldom occurs in breast-fed children living under reasonably good hygienic conditions. Ileo-colitis is now recognised as an infection due to the dysentery bacillus. The following table shows the monthly occurrence of deaths from diarrhoea and enteritis during the last two years. Year. Jan. Feb. Mar. April May June July Aug. Sept. Oct. Nov. Dec. Total. 1935 4 2 5 3 2 2 1 3 3 2 5 3 35 1936 2 1 4 3 4 6 1 - 1 2 4 4 32 INFECTIOUS DISEASES, 1936. TABLE OF NOTIFICATIONS RECEIVED AND DEATHS FROM THESE CAUSES. Admitted to Hospital. Disease. Total Cases Notified. Deaths Notifications and Age Distributions. Discharged from Hospital as not suffering from the Disease. 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 Under 1. 1 to 2. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Diphtheria and Croup 278 275 3 10 18 23 38 113 33 11 23 4 2 22 *13 - Scarlet Fever 722 650 6 23 48 56 79 289 93 42 68 12 6 20 2 - Enteric Fever & Para-typhoid 6 6 1 1 2 2 1 - - - - - - - - - Pneumonia Acute Influenzal 41 19 1 3 1 1 1 2 7 10 12 3 10 - - - 12 Acute Primary 107 51 10 11 5 3 10 22 1 5 9 2 17 16 - 9 11 17 Erysipelas 89 57 2 2 1 3 4 2 38 2 - - - Cerebro-spinal Meningitis 6 6 1 1 1 †3 1 1 1 - - - - - - - ‡1 Poliomyelitis 1 1 - - - - - - - - - - - - - Malaria (induced) 1 1 1 - - - - - - - - - - - - - 3 3 1 1 Dysentery 1 - - - - - - - - - - - Encephalitis Lethargica §2 - - - - - - - - - - - - - - - Ophthalmia Neonatorum 13 3 13 - - - - - - - - - - - - - Puerperal Fever 7 7 6 1 1 - - - - - - - - - - - Puerperal Pyrexia 15 15 3 12 - - - - - - - - - - - - Totals 1,289 1,093 37 42 51 46 75 84 131 432 132 66 136 42 76 32 *Includes three non-notified deaths. † One instance certified cause of death was Pneumococcal Meningitis. † One non-notified death from Polio-encephalitis. (P.M.) § One non-notified death (P.M.) and one old case previously known. TABLE OF NOTIFIABLE INFECTIOUS DISEASES, 1936. Showing Distribution or Cases in Wards. WARDS. Total Disease. 8 9 10 11 12 13 14 15 20 1 2 3 4 5 6 7 16 17 18 19 Diphtheria and Croup 19 37 34 19 20 16 17 14 13 4 6 14 1 23 19 5 5 6 4 2 278 66 43 40 27 22 46 22 26 43 36 35 38 33 4 Scarlet Fever 36 42 49 39 31 44 722 Enteric Fever and Para-typhoid 1 1 1 2 1 6 - - - - - - - - - - - - - - - Acute Influenzal 2 2 1 4 9 4 3 1 3 6 1 2 1 2 41 Pneumonia - - - - - - Acute Primary 9 7 2 10 19 3 2 1 3 7 1 3 4 1 1 2 9 13 8 2 107 2 2 Erysipelas 7 7 8 1 4 5 7 7 3 3 6 3 2 6 3 4 6 3 89 1 Cerebro-Spinal Meningitis - 1 1 1 1 1 6 - - - - - - - - - - - - - - - 1 1 Poliomyelitis - - - - - - - - - - - - - - - - - 1 Malaria (induced) - 1 - - - - - - - - - - - - - - - - - - Dysentery - 1 2 3 - - - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - 1 1 1 1 Ophthalmia Neonatorum 1 1 1 1 2 1 1 1 13 - - - - - - - - Puerperal Fever - 1 1 1 1 2 1 7 - - - - - - - - - - - - - 1 3 2 1 3 1 1 1 2 15 Puerperal Pyrexia - - - - - - - - - - - Totals 75 104 102 75 59 86 102 90 66 37 38 77 29 63 77 54 49 52 42 12 1,289 REFERENCE TO WARDS. No. No. No. No. 1. West. 6. Marlborough. 11. St. Mary's. 16. St. John's. 2. Addington. 17. Alleyn. 7. North Peckham. 12. Nunhead. 3. Town Hall. 8. Goldsmith. 13. The Rye. 18. Ruskin. 4. St. George's. 9. Clifton. 14. St. Giles'. 19. The Hamlet. 5. Cobourg. 10. Rye Lane. 15. Lyndhurst. 20. The College. Influenza. The type of influenza prevailing during the year 1936 was mild. There were 26 deaths. The following table shows the monthly distribution of the deaths from this cause. Jan. April May June July Sept. Oct. Nov. Dec. Total. Feb. Mar. Aug. 1 4 5 2 1 1 1 1 1 2 2 4 26 Diabetes. The Council, with the approval of the Minister of Health, continued to supply Insulin to medical practitioners for the treatment of the poorer inhabitants of the Borough suffering from diabetes. Appropriate issues were made during the year for the treatment of 7 patients. Quarterly reports obtained from medical practitioners treating these patients were submitted to the Ministry of Health at their request. Cancer. There were 418 deaths from malignant disease in the Borough during the year, representing a percentage of 14.4 per cent, of the total deaths. These deaths were distributed as follows: Males 211, females 207. The comparative figures for 1935 were total deaths 413, males 201, female 212. Cancer is chiefly a disease of middle age and onwards. The higher the average age of the population the greater is the liability of cancer developing. When this factor is taken into consideration as well as the increased ability to recognise the disease there is no justification for undue alarm. There exist in London to-day greater facilities than ever for the diagnosis and treatment of cancer. The Council also endeavours by a leaflet distribution to educate the public as to the early symptoms and signs of the disease in various parts of the body and to impress upon them the necessity of losing no time in seeking medical aid as soon as any physical condition manifests itself which suggests that "something is not quite right" Much of the non-success of present-day treatment is due to the advanced stage of the disease at the time a patient applies for treatment. It cannot be emphasised too strongly, therefore, that delay in seeking medical advice often results in unnecessary suffering and frequently ends in disaster. G2 99 The following table furnishes an analysis of the sites of the body affected in these cases: — Site of Disease. 15- 25- 35- 45- 55- 65- 75- All Agea. M. F. F. M. M. F. M. F. M. F. M. F. F. M. M. F. Buccal Cavity and Pharynx - - - 6 2 2 1 - 13 3 - - - 2 - 3 2 5 2 18 9 36 26 51 35 14 21 124 98 Digestive Organs 3 - - 11 5 6 - 1 13 1 1 2 3 31 12 Respiratory Organs - - - - 8 - 12 14 Female Genital Organs - - 1 - 5 - 3 - - - 43 - - 10 7 33 - - - 1 - 3 3 9 - - Breast - - - 25 Male Genitourinary Organs - - 1 1 9 - 7 - 7 - - - - - - 2 7 - - - Skin - - - 1 - - - - - - - 1 1 2 4 5 3 4 15 18 Other Organs - - 1 1 - 4 64 54 76 68 28 41 211 Totals 1 - 3 8 4 9 35 27 207 Disinfecting and Cleansing Stations. These buildings are situated at Peckham Park Road Depot. Disinfection. The bedding, clothing, etc., of cases of infectious diseases are disinfected by means of a Manlove Alliott super-heated steam and an Equifex saturated steam machines. No charge is made for these services. Books, furs and other articles which would be injured by steam are disinfected by formaldehyde generated in a formalin chamber. Infectious rooms are sprayed with formalin. The following is a summary of the work carried out by the disinfecting staff during 1936: — Number of houses visited following infectious disease 1,538 Number of visits to these premises 2,510 Number of houses visited following other diseases 278 Number of visits to these premises 431 Number of houses visited for miscellaneous purposes 599 Number of visits to these premises 1,743 Number of rooms disinfected. Infectious disease 2,227 Number of houses visited. Verminous 1,153 Number of rooms disinfected. Verminous 1,542 Number of articles disinfected (steam disinfected) 62,044 Number of articles disinfected (formalin) 2,036 Number of books disinfected 1,251 Number of articles destroyed 1,270 Weight of furniture, etc., destroyed 3 tons 16 cwt. Weight of unsound foods destroyed (see Food Inspector's report) 5 tons 9 cwts. 2 qrs. 23½ lbs. Weight of dead animals destroyed 3¾ cwt. Cleansing Station. In the following table particulars are given of the attendances at the Cleansing Station during 1936. Every individual who attended received a bath and his personal clothing was disinfected. Vermin. Scabies. Adults. Children. Adults. Children. Males. Females. Males. Females. Males. Females. Males. Females. 13 41 1,514 5 6 506 1,898 1,094 The majority of the children who visited the station during 1936 were attending public elementary schools. The necessary cleansing was carried out by the staff of the Council on behalf of the London County Council, who pay this Council £375 per annum for these services. The bedding of these persons is disinfested where necessary. Bacteriological Examination. Report on examination of Bacteriological Specimens received during the year ended December 31st, 1936. The total number of specimens received amounted to 4,368. The number was composed as follows: — Swabs for diphtheria 2,432 Percentage positive 5.42 Sputa for tubercle 1,827 15.32 Milks (bacteriological) 81 Bath waters (bacteriological) 12 Ice creams (bacteriological) 6 Miscellaneous 7 Bloods for Widal's Reaction 3 Percentage positive, Nil. Total 4,368 The low percentage of positive results to swabs for diphtheria is an interesting and outstanding feature of 1936. In spite of the relatively low diphtheria rate, the number of swabs from suspicious cases is little below the usual average. Requests for sputum examinations were, however, about 450 fewer than the average for the last five years. Other work remains at about a constant level. G. BOUSFIELD, M.D., B.S.(Lond.), Borough Bacteriologist. Prevention of Blindness. The London County Council is the Authority discharging the duties in connection with the welfare of blind persons. Tuberculosis Two hundred and sixty cases of Pulmonary Tuberculosis and 39 cases of Non-Pulmonary Tuberculosis were notified for the first time in 1936. In addition to these, 75 cases of Tuberculosis came to the notice of the Department otherwise than by formal notification. The sources from which information of these cases was obtained were as follows:— Source of Information. Pulmonary. Non-Pulmonary. Transfers from other areas, now living in the Borough 7 38 Death returns from local registrars and from Registrar-General 4 14 Posthumous notifications 7 5 The 14 cases of Pulmonary Tuberculosis and four cases of NonPulmonary Tuberculosis who died without having been previously notified, represent 9.7 per cent, of the total Tuberculosis deaths. Twenty-six deaths were formally notified within one month of death. Thirteen deaths were formally notified within three months of death. Eighteen deaths were formally notified within six months of death. Ninety-eight deaths were formally notified within more than six months of death. The total deaths from Tuberculosis numbered 185, 166 of which were due to Pulmonary and 19 to Non-Pulmonary Tuberculosis. The mortality rate per 1,000 inhabitants was therefore 0.81. The number of deaths from tuberculosis in each of the past four years is given in the following table. Year. Pulmonary. Non-Pulmonary. Total. 214 1932 34 248 1933 221 22 243 1934 202 29 231 1935 166 26 192 1936 19 185 166 New Cases and Mortality during 1936 Particulars of all new cases of tuberculosis and of deaths from this disease as reported by the Registrar-General, in age groups, are as follows:— Age Periods. New Cases. Notifications and otherwise. Deaths. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. - - 1 - - 1 0- - - 3 2 4 3 1 2 1- - - 3 8 7 8 2 5- - - 2 44 49 7 11 19 23 - 3 15- 25- 34 43 1 4 21 18 1 1 35- 26 14 3 2 13 9 2 - 45- 30 15 1 - 23 5 - - 55- 29 6 1 - 21 4 1 - 65 and upwards 1 1 3 7 9 1 6 - Totals 175 30 104 62 9 144 25 10 Disinfection. Disinfection of rooms and their contents is offered in all cases of pulmonary tuberculosis following the death of a patient, removal to hospital, or sanatorium. Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not necessary to take action under these Regulations during 1936, which relate to persons suffering from pulmonary tuberculosis employed in the milk industry. Tuberculosis Dispensary. The Tuberculosis Dispensary which for some years was situated at No. 19, Brunswick Square was transferred to Nos. 34 - 35, Brunswick Square in May of the year under review. It was generally agreed when the question of the transfer of these premises was considered that the new premises were not suitable as a permanent home for the Tuberculosis Dispensary and that better accommodation must sooner or later be found. REPORT OF THE TUBERCULOSIS MEDICAL OFFICER FOR THE YEAR 1936. The current list of Notifications of Tuberculosis in Camberwell as at December 31st, 1936. On December 31st, 1936, there were 2,048 cases of tuberculosis on the current list in Camberwell. There were 1,520 cases of pulmonary tuberculosis —859 males and 661 females; 528 cases of non-pulmonary tuberculosis—280 males and 248 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, 1936. Age Periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- Total (all Ages) 65- Pulmonary— 129 Males 1 2 18 21 138 205 156 111 58 20 859 105 Females 5 18 42 140 114 145 40 32 20 661 - Non-Pulmonary— Males 5 25 55 65 50 22 16 14 15 10 3 280 36 41 15 Females 2 21 43 37 35 11 2 5 248 TABLE II. Individual Notified Patients on Current List at December 31st, 1936, ALLOCATED TO THE Wards OF THE Borough. Wards. Pulmonary. Non-Pulmonary. Grand Total. Males. Females. Total. Males. Females. Total. 1 76 58 134 64 33 31 198 2 25 12 37 3 11 51 14 3 59 39 98 26 10 36 134 4 72 64 136 14 21 35 171 5 44 18 62 14 12 26 88 6 31 13 44 10 17 27 71 7 74 59 133 28 24 52 185 8 25 30 55 22 12 34 89 38 9 22 60 14 8 22 82 32 84 10 34 66 11 7 18 12 11 48 30 78 15 27 105 12 28 42 70 15 14 29 99 13 39 38 77 10 18 95 8 14 46 35 81 16 11 27 108 46 15 37 83 10 12 22 105 89 16 52 37 14 8 22 111 17 38 26 64 15 14 29 93 63 18 30 93 8 11 19 112 52 19 32 20 3 3 - 6 58 20 8 8 1 1 9 - The Notification of Tuberculosis in Camberwell in 1936. The number of primary notifications of tuberculosis received in Camberwell in 1936 was 299, comprising 260 cases of pulmonary tuberculosis and 39 cases of non-pulmonary tuberculosis. On Table III the number of primary notifications for each of the last sixteen years are compared. TABLE III. Comparative Table of Primary Notifications for past Sixteen Years. Year. All Forms. Other Forms. Pulmonary Tuberculosis. 1921 595 155 750 506 147 1922 653 657 505 152 1923 1924 559 416 143 1925 491 373 118 1926 506 394 112 1927 451 353 98 1928 465 363 102 495 1929 393 102 393 1930 483 90 1931 414 333 81 72 1932 386 314 1933 363 290 73 1934 341 284 57 1935 333 275 58 39 1936 299 260 On Table IV is given the primary notification rate (per 1,000 population of Camberwell) for the last sixteen years. TABLE IV. Showing Annual Primary Notification Rate of Tuberculosis (All Forms). 1921-1936. Pulmonary Tuberculosis. Year. Population. All Forms. Other Forms. 1921 267,198 2.80 2.22 0.58 1922 270,300a 2.41 1.87 0.54 1923 2.40 1.85 0.55 272,300a 1924 273,700a 2.04 0.52 1.52 1925 275,400a 1.78 1.35 0.42 0.40 1926 275,400a 1.80 1.43 1927 271,100a 1.66 1.30 0.36 1928 260,400a 1.78 1.39 0.39 1.92 1929 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 0.30 243,700a 1.49 1.19 1934 238,360a 1.43 1.19 0.24 1935 234,400a 1.41 1.17 0.24 1936 1.13 229,300 1.30 0.17 * Census, 1931. a Estimated. On Table V the primary notifications of 1936 are allocated to the Wards of the Borough. TABLE V. Showing No. of Primary Notifications Received during 1936 and Ward Allocation. Pulmonary. Non-Pulmonary. Wards. Grand Total. Males. Females. Total. Males. Females. Total. 1 7 2 11 18 - 2 20 2 9 7 16 1 1 2 18 23 3 10 8 18 4 1 5 10 6 2 18 4 16 1 1 11 2 13 3 3 16 5 - 6 6 7 13 2 4 17 2 7 4 6 10 3 1 4 14 8 10 8 18 2 2 20 - 9 10 2 12 1 1 13 - 10 4 4 8 - 8 - - 11 6 5 11 1 1 2 13 15 1 1 16 12 10 5 - 1 2 13 12 1 13 1 15 1 13 14 8 4 12 - 1 13 1 21 15 7 20 1 - 12 2 1 3 15 16 6 6 17 5 12 12 7 - - - 4 2 2 10 18 4 8 - 19 10 3 13 1 14 1 - 20 2 2 1 1 3 - - On Table VI the summary of notifications for the year 1936 is treated in more detail. Sanatoria. 176 137 10 11 117 101 8 7 Poor Law Istitutions. Formal Notifications under Article 5. Notifications under Article 5. 208 147 Summary or Notifications during the Period from January 1st, 1936 to December 31st, 1936. 24 26 Number of Primary Notifications. Total Primary Notifications. 151 20 109 19 5 6 - 1 65 and upwards. 55 - 65 24 - 3 1 45 - 55 26 14 1 - 24 10 35 - 45 2 1 25 - 35 28 TABLE VI. 32 1 3 20 - 25 3 23 2 21 15 - 20 4 17 16 4 10 - 15 6 4 1 2 - 1 1 5 - 10 5 1 - 5 2 2 - 3 - - - - 0 - 1 Non-Pulmonary— Males Pulmonary— Males „ Females „ Females Age Periods. TABLE VII. SUPPLEMENTAL RETURN FOR THE YEAR 1936. Information of New Cases discovered otherwise than by Formal Notification. Age Periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total. Pulmonary—Males - - - 1 2 2 6 2 4 5 2 24 „ Females - - - 1 4 8 11 4 1 3 3 35 Non-Pulmonary—Males 1 1 2 - 1 - - 1 - - 1 6 Females 1 1 2 - 1 3 1 1 - - - 10 Table VII. Supplemental Return. New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during 1936 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), 1936. The number of deaths from tuberculosis in Camberwell during 1936, as stated by the Registrar-General, was 185. Of these 113 were from pulmonary tuberculosis and 72 from other forms of the disease. 18 were not notified during life as suffering from the tuberculosis of which they died. TABLE VIII. Deaths from Tuberculosis (All Forms) 1936 Allocated to the Wards or the Borough. Wards. Pulmonary. Non-Pulmonary. Grand Total. Males. Females. Total. Males. Females. Total. 1 10 6 3 9 - 1 1 7 2 4 3 1 2 3 10 3 6 4 10 1 1 2 12 4 3 3 6 1 1 7 - 8 2 5 10 1 1 11 - 6 5 2 7 - 1 1 8 7 3 3 6 1 1 7 - 8 2 5 7 - 1 1 8 9 7 7 14 1 1 15 - 10 1 6 7 7 - - - 11 2 4 6 6 - - - 12 8 8 16 - - 16 - 13 6 2 2 11 3 9 - 14 10 1 11 - 11 - - 15 7 2 9 1 3 4 13 16 5 2 7 1 1 8 - 17 6 3 9 - 9 - - 4 18 3 7 3 3 10 - 19 2 - 3 - 5 1 1 6 - 20 - - - - - 55 - 65 2 - 5 5 - 15 15 - 25 45 - 55 Under 1 25 - 35 35 - 45 75 and upwards Totals. 1 - 2 Age Periods. 65 - 75 1 21 - 23 104 19 Pulmonary—Males 21 2 13 4 - - 9 5 62 - - 23 18 - „ Females 4 3 - - - 1 1 - 9 Non-Pulmonary—Males 1 - 2 2 1 1 - 3 1 - - 10 1 - - „ Females 1 2 2 - 110 TABLE X. Showing the Occupation of 110 Males who died from Tuberculosis in 1936. Accountant 1 Army Pensioner 1 Ashphalt Worker 1 Bookbinder 2 Boot Repairer 2 Bottle Washer 1 Bricklayer 2 Butcher's Assistant 3 Cabman 1 Carpenter 1 Chauffeur 1 Clerk, Commercial 7 „ Borough Treasurer's 1 „ Bookmaker's 1 „ Solicitor's 2 „ Stockbroker's 1 Commercial Traveller 1 Commissionaire 1 Cone Maker 1 Counter Hand 1 Draper's Assistant 1 Engineer, Mechanical 1 „ Fitter 2 Export Packer 1 Fish Fryer 1 Greengrocer 1 Gardener 1 House Decorator 4 „ Demolisher 1 „ Painter 2 Iron Moulder 1 Insurance Agent 1 Labourer, General 8 „ Builder's 2 Leather Dresser 1 Lamp Attendant 1 Lift Fitter 1 Laundry Washer 1 Motor Driver 3 „ Cab Fitter 1 „ Mechanic 1 Mosaic Worker 1 No Occupation 2 Omnibus Conductor 1 Porter, Railway 1 „ G.P.O. 1 „ Clothiers 2 „ Market 2 Plasterer 1 Police Constable 1 Press Reporter 1 Printer's Foreman 1 Pastry Cook Rubber Tube Worker 1 Salesman 1 School Age 2 „ Master 1 „ Teacher 1 Sheet Metal Worker 1 Shop Assistant 1 Sign Writer 1 Skin Dresser 1 Stereotyper 1 Surveyor 1 Tailor's Messenger 1 „ Manager 1 Translator 1 Under School Age 4 Waiter 1 Warehouseman 2 Wagon Driver 1 Window Cleaner 2 Wireman, G.P.O. 1 Wireworker 1 TABLE XI. Showing the Occupation of 75 Females who died from Tuberculosis in 1936. Biscuit Packer 1 Book Binder 1 „ Seller 1 „ Folder 1 Chambermaid 1 Charge Hand 1 Clerks 6 Domestic Servant 3 Dressmaker 1 Duplicator Worker 1 Factory Hand 2 Grill Hand 1 Housewife 29 Kitchen Hand 1 Laundry Hand 4 Lapshade Maker 1 Mantle Presser 1 Milliner 1 Needleworker 2 No Occupation 6 Piemaker 1 Perfume Finisher 1 School Age 2 Shorthand Typist 1 Shuttlecock Maker 1 Sorter, Rags 1 Under School Age 3 112 TABLE XII. Return showing the Work of the Dispensary DURING THE Year 1936. Nonpulmonary. Total. Diagnosis. Pulmonary. Adults. Children. Adults. Children. Adults. Children. M F. M. F. M. F. M. F. M. F. M. F. A. —New Cases examined during the year (excluding contacts): — (a) Definitely tuberculous 79 48 1 4 12 9 10 5 91 57 11 9 (b)Diagnosis not completed - - - - 11 9 - - - - - - (c) Non-tuberculous - - - - - - - 206 170 70 61 - B. —Contacts examined during the year:— (a) Definitely tuberculous 19 20 1 1 2 2 2 21 20 3 3 - (b) Diagnosis not completed - - - - - - 3 3 1 2 - - (c) Non-tuberculous - - 128 180 167 178 - - - - - - C. —Cases written off the Dispensary Register as:— (a) Recovered 3 1 1 - 2 2 6 3 5 3 7 3 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - 347 353 238 239 - D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 645 473 43 53 115 117 97 83 760 590 140 136 (b) Diagnosis not completed - - — - - - - - 14 12 1 2 1. Number of eases on Dispensary Register on January 1st . 7. Number of consultations with medical practitioners:— 1,689 (a) Personal 20 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years (b) Other 589 50 626 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 9,223 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 166 1,357 10. Number of:— (a) Specimens of sputum, &c., examined 127 4. Cases written off during the year as Dead (all causes) (b) X-ray examinations made in connexion with Dispensary work 666 1 5. Number of attendances at the Dispensary (including Contacts) 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A(b) above 5,896 6. Number of Insured Persons under Domiciliary Treatment on December 31st 284 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 724 TABLE XIII. Number of Families occupying 1 Room. 2 Rooms 3 Rooms. 4 Rooms. 5 Rooms. 6 Rooms or more. Housing accommodation of 299 families in which there was a Primary Notification of Tuberculosis in 1936. Patient living alone 32 12 5 3 1 1 „ „ with 1 other 5 17 8 10 - 1 „ „ „ 2 „ 6 1 29 15 4 5 „ „ „ 3 „ 3 1 20 16 3 3 „ „ „ 4 „ 2 - 9 22 9 7 „ „ „ 5 „ 2 2 10 6 - - „ „ „ 6 „ - 7 2 3 3 - „ „ „ 7 „ 3 - 1 3 2 - „ „ „ 8 „ - - - 1 2 - „ „ „ 9 „ - - - 2 - - „ „ „ 10 „ - - - - - - 39 Total 40 76 87 29 28 H TABLE XIV. Sleeping accommodation for 299 tuberculous cases notified for the first time in 1936. The figures refer to the tuberculosis Nurses' first home visit. The patient slept— In separate room In 110 cases. Alone in bed with 1 other in room „ 22 „ „ „ 2 others „ „ 22 „ „ „ 3 „ „ „ 3 „ „ „ 4 „ „ „ 2 „ In bed with 1 person and no others in room „ 95 „ „ „ 1 „ 1 other in room „ 27 „ „ „ 1 „ 2 others „ 13 „ „ „ 1 „ 3 „ „ „ 3 „ In bed with 2 persons and no others in room „ 2 „ „ „ 2 „ 1 other „ „ - „ „ „ 2 „ 2 others „ „ - „ „ „ 2 „ 3 „ „ „ - „ In bed with 3 persons and no others in room „ - „ 299 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, 735 Dispensary patients were sent to hospital in 1936 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 the following hospitals were selected: — St. Thomas's. Sick Children's Hospital, Great Ormond Street. Guy's. Throat Hospital, Golden Square. Charing Cross. Brompton. Miller. Evelina. South London Hospital for Women. Belgrave. All Saints'. Royal Waterloo. Grosvenor Hospital for Women. 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. Doubtful cases of tuberculosis are referred back to the Dispensary for special examination. Co-operation with Medical Practitioners. 609 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 1936, 188 patients who attended the Dispensary for the first time and were found to be suffering from tuberculosis were reported by the Tuberculosis Officer to be in the undermentioned stages of the disease at the time of diagnosis:— T.B. minus (sputum negative or absent) 58, or 30.9 per cent. T.B. plus 1 (early cases, sputum positive) 19, or 10.1 per cent. T.B. plus 2 (intermediate cases, sputum positive) 94, or 50.0 per cent. T.B. plus 3 (advanced cases, sputum positive) 17, or 9.0 per cent. (b) Non-Pulmonary Tuberculosis. There were 49 cases of nonpulmonary tuberculosis in the following forms: — Bones and joints. Peripheral glands. Abdomen. Skin. Other organs. Examination of Home Contacts. Tuberculosis claims its victims in early manhood and womanhood. The source of infection of a patient, apart from the consumption of tuberculous milk, is by contact with a person suffering from active pulmonary tuberculosis. It is therefore essential for all persons.to be examined and re-examined until at least four years have passed from the time they were known to be last exposed to infection. It is difficult to persuade contacts, especially young adults, to submit to such periodical examination. They do not realise how important it is to detect the disease in its early stages for a cure to be effected or to arrest the disease. Education is, however, playing its part and the public is gradually beginning to realise the value of contact examination. The number of persons living in contact with tuberculous patients which came to the notice of the Department for the first time during 1936 was 630. Of this number 407 were examined at or in connection with the tuberculosis dispensary during the year. 1.72 per cent, of these cases were found to be definitely tuberculous. In 5 cases the diagnosis was not completed at December 31st, 1936. Mantoux tests were done in 72 cases. Housing and Tuberculosis. The spread of this disease by environmental causes such as bad housing is well known. Healthy conditions with separate bedroom accommodation for the patient is a safeguard against other members of the family being exposed to the risk of infection. During 1936, 28 tuberculous families living in the borough received improved housing accommodation from the London County Council. H2 115 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. 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 patients. During 1936, 666 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 receiving general treatment at home Brompton, St. Thomas's, Guy's, Grove Park, Colindale, King's College, Margaret Street. During 1936, 69 dispensary patients had artificial pneumothorax treatment at one or the other of these hospitals. This does not include dispensary patients who were receiving artificial pneumothorax treatment in sanatoria at December 31st, 1936. 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 9,223 visits to the homes of tuberculous patients during the year 1936. 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. Seven patients received dentures through the Tuberculosis Dispensary scheme of the Borough. Approved Societies contributed part of the cost in the case of insured persons, and patients who could afford it also contributed. Supply of Sputum Pocket Flasks and Outfits for Sputum Examinations. Approximately 156 pocket flasks were supplied to patients during the year. Patients, of course, obtained pocket flasks from other sources; for example, residential institutions and private sources. 1,357 outfits were supplied in connection with sputum examinations. Supply of Extra Nourishment during 1936. 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 sanatoria. (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, as these receive extra diet from the Public Assistance Committee on the recommendation of the Tuberculosis Officer. 80 Camberwell patients received extra nourishment in 1936. Institutional (Residential) Treatment of Camberwell Patients in 1936 through the London County Council. 1. Adult Males:— Number of applicants for residential treatment 187 Number who received residential treatment 181 Number who did not receive residential treatment:— Not accepted 1 Failed to enter 5 Awaiting residential treatment December 31st, 1936 Classification of Adult Males who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 30 Pulmonary cases in which tubercle bacilli had been found in the sputum 126 Early pulmonary tuberculosis 25 Moderately advanced pulmonary tuberculosis 92 Advanced pulmonary tuberculosis 9 Surgical tuberculosis 11 Diagnosis of tuberculosis 7 Not classified 7 2. Adult Females:— Number of applicants for residential treatment 135 Number who received residential treatment 131 Number who did not receive residential treatment:— Not accepted 1 Failed to enter 3 Awaiting residential treatment December 31st, 1936 — Classification of Adult Females who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 21 Pulmonary cases in which tubercle bacilli had been found in the sputum 89 Early pulmonary tuberculosis 15 Moderately advanced pulmonary tuberculosis 67 Advanced pulmonary tuberculosis 7 Surgical tuberculosis 11 Diagnosis of tuberculosis 5 Not classified 5 3. Boys:— Number of applicants for residential treatment 22 Number who received residential treatment 20 Number who did not receive residential treatment:— Not accepted Failed to enter 2 Awaiting residential treatment December 31st, 1936 Classification of Boys who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 5 Pulmonary cases in which tubercle bacilli had been found in the sputum Early pulmonary tuberculosis Moderately advanced pulmonary tuberculosis Advanced pulmonary tuberculosis Surgical tuberculosis 7 Diagnosis of tuberculosis 1 Not classified 7 4. Girls: — Number of applicants for residential treatment 16 Number who received residential treatment 16 Number who did not receive treatment:— Not accepted Failed to enter Awaiting residential treatment December 31st, 1936 Classification of Girls who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 5 Pulmonary cases in which tubercle bacilli had been found in the sputum 1 Early pulmonary tuberculosis Moderately advanced pulmonary tuberculosis 1 Advanced pulmonary tuberculosis Surgical tuberculosis 8 Diagnosis of tuberculosis Not classified 1 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 Chest Maltings Farm Royal National Pinewood Dulwich National Lambeth Old Manor House Lewisham Fairlight St. Anthony's Fairholme St. Luke's Marillac St. Mary's Abbott Rushdene St. Giles' Hawthorndene St. James's St. Olave's St. Nicholas' St. Alfege's Homes. Colonies. St. Barnabas Burrow Hill Bishopsbourne Papworth St. George's Preston Hall. Firs Tait Douglas Children. Hospitals. Sanatoria and Homes. Highwood Naylands Heatherwood Millfield Princess Mary's East Anglian Queen Mary's Victoria Royal Waterloo The average duration of residential treatment given by the London County Council in 1936 to 312 adults was 17.7 weeks. The average duration of residential treatment given to 36 children by the London County Council in 1936 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 1937. home 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. Christmas Seal Sale 1936. For the fourth year in succession a Christmas Seal Sale was organised in Camberwell. The receipts were £387 5s. 4½d. and the payments £72 16s. 8d., leaving a clear profit of £314 8s. 8s 8½d. The profits of the Seal Sale have increased steadily each year. This year thanks are due to the ladies of the Inner Circle of the Rotary Club who addressed 5.000 envelopes—to the L.C.C. schools in Camberwell who collected £45 7s. Id. —to five cinemas (Astoria, Coronet, Golden Domes, New Grand Hall and Tower), who so kindly showed free of charge a film advertising the Seal Sale —to members of the Handicraft Class and their parents who helped to make a card index of 5,800 names and addresses, and to all those patients and friends who helped to sell the seals. The Secretary of the Care Committee has compiled the following figures and items of information in relation to some of its work in 1936:— 104 cases were helped in their applications to the Public Assistance Committee. Thus patients received money, food, extra diet, clothes, etc. 13 cases were assisted in their applications to the British Red Cross Emergency Fund. 22 cases were assisted in their applications to the United Services Fund. The Care Committee assisted the London County Council in making arrangements for the institutional treatment of 348 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 7 cases, and with the Invalid Children's Aid Association in 70 cases. The Committee co-operated with many families in which there was a tuberculous member by endeavouring to obtain new homes for them on the housing estates of the L.C.C. and elsewhere. Patients were advised on questions concerning their employment. Many patients were helped from private sources, for example, in the way of the provision of clothing, boots, beds, etc. To a large number of patients personal help in discussing difficulties was given in addition to the above. The following items will show how part of the Christmas Seal Fund was spent: — Pocket money to 20 more or less destitute patients while they were receiving treatment at a sanatorium. Clothing to 28 patients. Mothers' Help in the case of 2 patients while awaiting sanatorium treatment or as a convalescent measure for a short period after leaving the sanatorium. Payment of fares in 25 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 12 cases. Payment of arrears of National Health Insurance stamps in 4 cases. Board and lodging in one case. Purchase of spectacles in one case. Purchase of beds and bedding in 15 cases. Paying for cost of household removals in 9 cases Payment of key money and rent in 8 cases. Handicraft Class. The Handicraft Class meets at the Tuberculosis Dispensary on Friday afternoons from 2 - 4. On June 24th and 25th a combined sale was held at Carpenters' Hall, Throgmorton Avenue, by kind permission of the Worshipful Company of Carpenters. Twelve of the London Tuberculosis Dispensary Handicraft classes took part. The sale was opened on the first day by H.R.H. Princess Alice, Countess of Athlone, and on the second day by the Marchioness of Titchfield. The Camberwell class made £36 7s. 4d. by sales and took orders to the amount of £4 13s. Od. WILLIAM BRAND, Tuberculosis Officer. INDEX. PAGE Aged and Infirm Persons 41 Agriculture (Grading, etc.) Act 79 Ambulance Facilities 13 Ante-natal Services Scheme 23 Ante-natal Supervision 23 Ante-natal Clinics Return 24 Bacteriological Examination 101 Bakehouses 66 Baths, Public 36,3 Births and Birth Rate 7 Notification of Births 8 Still Births 7 Blindness, Prevention of 101 Butcher Shops and Meat Stalls 70 Cancer 99 Cancer Table 100 Cerebro-Spinal Meningitis 93 Child Life Protection 31 Cleansing Station 101 Clinics and Treatment Centres 13-15 Common Lodging Houses 50 Consultant Services 24 Convalescent Home Treatment 26 Cremation 41 Deaths 8 Enquiry into Maternal Deaths 12 General Table of 9 Infantile 10,11 Maternal 12 Neo-Natal 10 Diabetes 99 Diarrhoea 96 Diphtheria 87 Prevention 90 Immunisation Table 88 - 89 Disinfection 100 Dogs, Fouling of Footways 4 0 Domiciliary Midwifery 26 INDEX—continued. PAGE Drainage and Sewerage 33 Dysentery 92 Encephalitis Lethargica 93 Enteric Fever 91 Eradication of Bed Bugs 38 Erysipelas 93 Exhumations 41 Factories and Workshops 41, 43-45 Food 65-86 Arrowroot 79 Beef Sausages 79 Butcher Shops and Meat Stalls 70 Chemical Examination of 77, 86 Fish— Fried Fish Shops and Fish Curing Premises 75 Milk 66 - 69 (Preservatives in Food, etc.) Regulations 79 Raspberry Jam 69,79 Summary of Work 65 Unsound Food Table 75,76 Food and Drags Acts: Adulteration Act 77 Artificial Cream Act 78 Butter Factories, etc. 78 Condensed Milk Regulations 78 Dried Milk Regulations 78 Sample Tables 80-81 Sample Adulteration Table 82 - 86 Food Poisoning 95 Health Propaganda 19 Health Visiting, Record of Visits 29 Health Visiting Staff and Home Visiting 31 Home Helps 26 Home Nursing 13, 30 Hospitals 15 Houses Let in Lodgings 5 0 Housing 46 -64 Clearance Areas 46, 49 Individual Unfit Houses 47 Housing Estates 5 1 Return of Work INDEX—continued. PAGE Housing— Underground Rooms and Parts of Houses 50 untit Houses Repairable at Reasonable Cost 50 Housing Applications 51 Statistics 60 Ice Cream 73 Bacteriological Examination 74 Infant Welfare Centres 23,27 Clinic Attendances 28 Infectious Diseases 87-94 Exclusion of Contacts 39 Non-Notifiable 95 Notifiable 87 Tables 97 - 98 Typhoid and Paratyphoid Fever Table 92 Influenza 89 Laboratory Facilities 13 Malaria 92 Maternal Mortality 12 Maternity and Child Welfare 20 - 32 Maternity Outfits 26 Meals for Expectant and Nursing Mothers 22 Measles 95 Prophylaxis 95 Meat and Other Foods 70 Meat Food Products, Certification of 73 Meat Marketing Scheme 72 Merchandise Marks Act 79 Midwives 20,26 Salaried Service 20 Compensation for loss of Patients 26 Payment of Fees 26 Milk- Bacteriological and Chemical Analysis 68,69 Milk and Dairies Order 66 Milk (Special Designations) Order 67 Grade "A" (Tuberculin Tested) 67 Accredited 67 Pasteurised 67 Samples of 66 Supply 66 INDEX—continued. PAGE Milk for Necessitous Persons 31 Minor Ailments Treatment 25 Mothereraft and Health Talk Sessions 27 Nursing in the Home 13,30 Offensive Trades 34 Open Spaces 16 Ophthalmia Neonatorum 94 Outworkers 45 Overcrowding, Housing Act, 1935 51 - 57 Fixing of Appointed Days 55 Pharmacy and Poisons Act 35 Pigeons, Nuisances from 40 Pneumonia 92 Polio-myelitis and Polio-encephalitis 93 Population 7 Poultry Slaughtering 72 Public Cleansing 33 Public Mortuary and Return of Work 41,42 Public Vaccinators'Return of Work 17, 18 Puerperal Fever 93 Puerperal Pyrexia 94 Rag and Bone Dealers 34 Rag Flock Acts 36 Rats and Mice (Destruction) Act 39 Rent Restriction Acts 51 Re-Housing of Overcrowded Families 54 Report of Tuberculosis Officer 104 - 121 Restaurants and Eating Houses 75 Sanitary Circumstances of the Area 33 - 45 Inspection Tables 58 - 59 Legal Proceedings 62 - 64 Summary of Notices Served 61 Scarlet Fever 91 School Treatment Centres 14 Schools, Inspection of 39 Shops Act 34 Sickness and Invalidity 6 Slaughterhouses 71 Slaughter of Animals Act 71 Smallpox 87 Smoke Abatement 36 INDEX—continued. PAGE Social Conditions 5 Staff 2 - 3 Statistics, Vital and Mortal 4 - 6,12 Street Markets 70 Swimming Baths and Pools 36 Toddlers' Clinics 21, 27 Tuberculosis 102 — 121 Care Committee Work 120 Dental Treatment 117 Diagnosis and Treatment 116 Disinfection 103 Typhoid and Paratyphoid Fever Table 92 Unmarried Mothers 25 Urinals —Public Houses 34 Vaccination 16 Returns 17,18 Water Supply 33 Whooping Cough 96 Compulsory Notification 96