CAM 44 Public Health Department, Town Hall, Camberwell, S.E.5. 18th July, 1938. To His Worship the Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Mr. Mayor, Aldermen and Councillors, I have the honour to present to you my Annual Report on the health and sanitary condition of the Borough for the year 1937. This report has been prepared on the lines indicated by the Minister of Health in Circular 1657. The population of the Borough in common with most other Metropolitan Boroughs continues to decrease. This decrease is accentuated by a low birth rate. During the year the health of the Borough continued to be satisfactory. The birth rate was 14.08, the death rate 12.83 per 1,000 of the population and the infantile mortality rate 58 per thousand live births compare favourably with London as a whole The incidence of infectious disease gave no cause for concern. Progress in slum clearance operations, the building of a new Disinfecting and Cleansing Station at Peckham Park Road Depot, and the extension of the maternity and child welfare scheme, are events in 1937 to be noted with satisfaction. Dr. William Brand, the Council's Tuberculosis Officer, retired on superannuation during the year and Dr. C. F. Price was appointed Tuberculosis Officer and Deputy Medical Officer of Health to succeed him. The work associated with the Public Health Service of this Borough continues to increase and the staff deserve praise for the willing and competent manner in which they have assisted me in maintaining a high level of efficiency. It is a pleasure to extend my thanks to them. Once again I wish to express my appreciation to the members of the Council, especially the Chairman and Members of the Public Health and the Maternity and Child Welfare Committees, for the support and consideration they have shown me throughout the year. Your obedient Servant, H. W. BARNES, Medical Officer of Health. A Staff of the Public Health Department at the end of 1937. 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 and Deputy Medical Officer of Health. C. F. Price, M.B., B.S., D.P.H. 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 Gynaecologist and Obstetrician. A. L. Walker, M.A., M.B., B.Ch., 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., B.Ch. D. Hughes, M.B., B.Ch., B.A.O., D.P.H. Medical Officer—Toddlers' Clinics. T. Colver, M.R.C.P., M.B., Ch.B. 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 „ J. F. Mackie, M.B., Ch.B. 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. Diet. No. Dist. No. 7. D. H. Pickard, M.C. a 1. H. Attwater. a 8. H. R. Weaver. a 2. D. Watkins. a 9. M. L. Malins. a 3. W. H. G. Saunders. b 10. F. Maughan. a 4. G. Topping. a 11. M. Malins. a 5. L. W. Burrell. a 12. W. T. Worsfold. b 6. W. Gilchrist. a Miss F. O'Riordan, Maxwell Lefroy Gold Medallist. a, d Housing Inspectors. A. L. Dobson. a H. W. Leonard. a Sampling Officer—Food and Drugs, etc., Acts. G. T. Dewey. c Food Inspector. R. F. Nash. a Health Visitors. Miss A. M. Stoddart. f Miss A. H. Mitchell. e Miss W. Higgins. e Miss J. Finlayson. e Miss M. I. Hughes. 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. Goodbody. Miss M. L. Thompson. R. C. Sweet. R. A. Davies. E. Harvey. Miss E. M. Watkin. T. H. Blackman (Temporary). Miss L. Brandt (Temporary). Tuberculosis Health Visitors. Miss M. Thistleton. g Miss F. M. Whitney. h Miss H. E. L. Turner. i Clerks Mrs. J. M. Leonard (Secretary Tuberculosis Care Committee), Mrs. J. M. Riome (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. SUMMARY OF STATISTICS for the Year 1937. Area of the Borough in Acres 4,480 Population (Estimated resident population mid-1937) 224,800 Population (Census 1931) 251,294 Number of inhabited houses (end of 1937) according to Rate Books 43,502 Rateable Value £1,737,712 Sum represented by a penny rate Estimated £6,950 Number of live Births 3,165 Birth Rate 14.08 Number of Deaths 2,884 Death Rate 12.83 Infantile Mortality:— Deaths under 1 year 185 Infantile Deaths per 1,000 Births 58 Maternal Mortality:— Deaths of Women from Diseases or Accidents associated with Childbirth 6 Per 1,000 live births 1.90 Maternal Death Rate Per 1,000 total births 1.84 Deaths from Phthisis 177 Phthisis Death Rate 0.79 Deaths from all forms of Tuberculosis 206 Tuberculosis Death Rate 0.92 Social Conditions including the Chief Industries carried on in the Borough. Camberwell is a district of South-east London and is one of the largest of the Metropolitan Boroughs. In outline it is pearshaped, its maximum length and breadth being 4¾ and 2½ miles respectively and covers an area of 4,480 acres. The southern part of the Borough is populated mainly by the professional and clerical sections of the community, while in the centre and northern districts the inhabitants are of the artisan class. In these districts the industries of the Borough are concentrated, viz., gas, engineering, printing, timber and laundry trades. The principal industry in the area is the South Metropolitan Gas Co.'s undertaking in Old Kent Road. 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 comparatively few small open spaces accessible to the inhabitants of these areas. In recent years, the Council has been extremely active in endeavouring to secure further open spaces in those parts of the Borough where they are most needed, and in developing existing parks, gardens and open spaces under their control. Population. The resident population of the Borough at the middle of 1937 was estimated by the Registrar-General to be 224,800 persons, 26,494 fewer than the number ascertained at the Census in 1931. WARD DENSITY OF POPULATION TABLE. Estimated Density of Population Mid-1937. (Persons per acre) Population Census, 1931. Estimated Population Mid-1937. Ward. Acreage. 125 12,963 103.7 1 14,489 2 13,016 85 11,645 137.0 3 132 13,189 11,801 89.4 4 104 14,922 13,351 128.4 5 99 14,421 12,902 130.3 6 124 12,024 10,757 86.7 7 164 14,672 13,126 80.0 8 14,274 124 12,771 103.0 9 144 14,888 13,321 92.5 10 111 7,700 6,889 62.1 137 11 10,833 9,692 70.7 12 117 12,496 11,180 95.6 13 531 11,022 9,861 18.6 14 129 10,485 9,379 72.7 15 247 12,234 10,945 44.3 16 165 13,719 12,275 74.4 17 228 13,861 12,372 54.3 18 451 16,797 15,029 19 33.3 555 12,123 10,846 19.5 20 708 4,129 3,695 5.2 Extracts from Vital Statistics of the Year. Total. M. F. Birth Rate per 1,000 of the estimated resident population 14.08. Rate per 1,000 total (live and still) births 29.73. Death rate per 1,000 of the estimated resident population 12.83. Live births Legitimate 3,029 1,577 1,452 Illegitimate 136 68 68 Stillbirths 97 61 36 Deaths 2,884 1,393 1,491 Deaths from puerperal causes (Headings 29 and 30 of the Registrar General's short list) — Deaths. Rate per 1,000 total (live and still) births. No. 29 Puerperal sepsis 3 0.92 No. 30 Other Puerperal causes 3 0.92 Total 6 1.84 Death Rate of Infants under one year of age:— All infanta per 1,000 live births 58 Legitimate infants per 1,000 legitimate live births 57 Illegitimate infants per 1,000 illegitimate live births 96 Deaths from Cancer (all ages) 407 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) 17 Deaths from Diarrhoea (under 2 years of age) 39 Sickness and Invalidity. There was no unusual or excessive sickness or invalidity in the Borough during the year and no evidence is available of any conditions of occupation having exercised a prejudicial effect on health. There is also no evidence to show that unemployment had any significant influence on the health or physique of children or adults. Through the courtesy of the Divisional Controller of the Ministry of Labour, I am able to furnish the following particulars relating to unemployment of Camberwell residents during 1937. Percentage Rate of Unemployment. Date. Males. Females. Total. Corresponding date in 1936. 1937. I" 'I I * 5,547 2,057 7,604 8.8 9.8 (10.1) 25/1/37 6,280 19/4/37 4,442 1,838 7.2 8.7 (8.8) 26/7/37 4,313 1,673 5,986 6.9 6.7 (7.0) 18/10/37 4,816 1,657 6,473 7.5 7.4 (7.3) * The method of compiling these figures was changed in 1937, with the result that the percentages quoted are not strictly comparable with those for 1936. The figures in brackets indicate the estimated percentage rates of unemployment for the corresponding dates in 1936 allowing for this change. I am also indebted to the Chief Officer of Public Assistance for the following statement showing the number of residents who were in receipt of domiciliary relief during the last week of each quarter of the year 1937:- Week ended No. of Persons in Receipt of Domiciliary Relief (excluding Medical Relief only). No. of Persons in Receipt of Medical Relief only. 27/3/37 5,449 40 26/6/37 4,767 38 25/9/37 39 4,694 25/12/37 39 4,854 Births and Birth Rate. The number of live births registered in the Borough during 1937 was 3,441. To this number it is necessary to add 613 children born to Camberwell mothers at addresses outside the Borough, and to deduct 889 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 3,165 births thus obtained shows a decrease of 29 as compared with the number registered in 1936. The birth rate for the year was 14.08 per 1,000 of the estimated population. These births distributed according to sex and legitimacy were as follows:— Male. Female. Total. Legitimate 1,452 68 1,577 68 3,029 136 Illegitimate Totals 1,645 1,520 3,165 The following table shows the number of births and the birth rate in England and Wales, London and Camberwell for the past five years:— District. 1937. Birth Rates in previous Years. Number of Births. Birthrate. 1936. 1935. 1934. 1933. England and Wales. 14.4 610,850 14.9 14.8 14.8 14.7 13.3 13.4 64,016 13.6 London 13.3 13.2 Camberwell 3,165 14.1 13.9 13.4 13.2 13.3 Stillbirths. Stillbirths registered during the year numbered 97, after adjustment by the addition of 18 stillbirths born to Camberwell mothers confined outside the Borough and the deduction of 34 stillbirths to non-residents confined in Camberwell. These stillbirths, distributed according to sex and legitimacy, were as follows: — Male. Female. Total. Legitimate 59 35 94 1 3 Illegitimate 2 97 61 36 Total Notification of Births-Public Health (London) Act, 1936. Under the provisions of this Act notifications were received of the births of 3,012 live children and 85 stillborn children. This number represents 94.9 per cent. of the total number of births registered. The following table indicates the source of notification: — Source of Notification. Number of Births Notified. Live. Stillbirths. 2,089 Medical Practitioners 67 863 Midwives 17 59 - Parents 1 Other persons 1 Deaths. The number of deaths registered in the year after adjustment for inward and outward residence transfers was 2,884. The death rate per 1,000 of the population for 1937 was therefore 12.8. For comparative purposes the number of deaths and the death rates in England and Wales, London and Camberwell in 1937 are given in the following table: — No. of deaths. Death rate. District. England and Wales 509,571 12.4 London 51,277 12.3 Camberwell 2,884 12.8 The cause of death in age groups of Camberwell residents in 1937 are summarised in the table which appears on pages 10 and 11. The principal certified causes of death at all ages were: — Deaths due to diseases of the heart 796 Deaths from malignant disease 407 Deaths attributed to bronchitis, pneumonia and other respiratory diseases 330 Deaths from all forms of tuberculosis 206 Deaths from cerebral hæmorrhage 143 Deaths from other circulatory diseases 122 Cancer. The deaths from Cancer in the Borough numbered 407 as compared with 418 in 1936. The following table shows the number of deaths from this cause and the death rate for the last 5 years:— Death Rate per 1,000 population. No. of deaths. Year. 451 1933 1.85 1934 401 1.68 1935 413 1.76 1936 418 1.82 1937 407 1.81 Maternal Mortality. The number of deaths from puerperal causes was 6 —puerperal sepsis 3, and an equal number from other puerperal causes, representing a maternal death rate of 1.84 per 1,000 live and still births. In the following table the maternal mortality rate is compared with the rates for London, England and Wales for the years 1935-37. Year. England and Wales. London. Camberwell. 1935 3.94 2.50 3.07 1936 3.65 1.86 2.12 2.22 1937 3.11 1.84 It will be seen that the maternal mortality rate for Camberwell compares favourably with that for London and England and Wales Confidential Reports on Individual Maternal Deaths. Following the usual procedure the Camberwell deaths from maternal causes were fully investigated and confidential reports were submitted to the Ministry of Health in every case. 10 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1937. Causes of Death. Sex. All Ages. 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- All causes M. 1,393 108 24 17 18 49 60 52 125 271 362 307 F. 1,491 77 13 11 20 53 54 64 125 192 354 528 Typhoid and Paratyphoid Fevers M. - - - - - - - - - - - - F. 1 - - - - - 1 - - - - - M. - - - - - - - - - - Measles - - F. - - - - - - - - - - - - Scarlet Fever M. 1 - 1 - - - - - - - - - F. 1 - 1 - - - - - - - - - Whooping Cough M. 10 4 4 2 - - - - - - - - F. 7 2 - - - - - - - - 5 - Diphtheria M. 5 - - 2 3 - - - - - - - F. 8 - - 4 - - - - - - - 4 Influenza M. 33 1 - - - 1 4 3 6 10 8 - 39 1 - - - 2 1 4 5 7 18 F. 1 Encephalitis lethargica M. 3 - - - - 1 1 1 - - - - F. 3 - - - - - 1 - - - 2 - Cerebro-spinal Fever M. 1 1 - - - - - - - - - - 7 - - - 3 - 1 - - - F. 2 1 Tuberculosis of respiratory system M. 96 1 2 - - 15 19 14 16 17 12 - F. 81 - - - 1 24 19 13 10 4 8 2 Other tuberculous diseases M. 17 - 2 1 3 3 2 - 1 3 2 - F. 12 1 1 4 - 1 - 3 - 2 - - Syphilis M. 7 - - - - 1 - 4 1 1 - - F. 2 - - - - 2 - - - - - - General paralysis of the insane,tabes dorsalis M. 5 - - - - - 2 1 1 1 - - F. 4 - - - - 2 2 - - - - - Cancer, malignant disease M. 1 - 2 1 3 3 55 71 32 183 15 - F. 224 - 1 1 - 3 3 14 29 53 66 54 Diabetes M. 11 - - - 1 - - 1 4 3 2 - F. 30 - - - - - - 1 6 13 10 - Cerebral haemorrhage, etc. M. 68 - - 1 - 2 3 10 28 24 - - F. 75 - - - - 1 3 14 23 34 - - Heart disease M. 370 - - - 2 7 6 5 30 65 135 120 F. 426 - 1 2 6 7 19 51 112 228 - - Aneurysm 7 M. - - - 1 - 1 4 1 - - - F. 4 - - - - 1 1 1 1 - - - Other circulatory diseases M. 1 61 - - - 1 2 3 15 19 20 - F. 61 - - - - - - 5 4 23 29 - Bronchitis M. 63 - - 3 - 1 2 7 15 16 19 - F. 59 3 1 - - - 1 - 2 5 15 32 Pneumonia (all forms) M. 107 22 10 4 1 2 3 4 15 24 14 8 F. 83 10 5 2 1 4 3 3 13 5 16 21 Other respiratory diseases M. 13 - - 1 — 1 6 1 2 2 - - F. 5 — - - - - 1 - 1 1 2 - Peptic Ulcer - - 2 1 2 - 11 2 2 M. 20 - - F. 11 1 - - - - - - 3 6 1 - Diarrhoea, etc. M. 30 29 - - - - - - 1 — - - - - - - - 1 - 1 - F. 12 10 - M. 10 - 1 1 1 - - - - 2 1 Appendicitis 4 F. 7 — - - 3 1 - 1 2 - - - Cirrhosis of liver M. 4 - - - - - 2 2 1 - - - 4 - - - - - - - 1 3 — F. - M. - Other diseases of liver, etc. - - - - - - - - - — - F. - - - - - 1 2 - 4 - - - DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1937—contd. 35- All Ages. 15- 25- 0- 2- 5- 55- 65- 75- Causes of Death. Sex. 1- 45- Other digestive diseases M. 23 1 - 1 3 2 2 3 3 5 3 - F. 21 2 - - - 2 - 2 7 1 7 - Acute & chronic nephritis M. 28 - - 3 - 6 8 8 3 - - - F. 43 - - 2 2 1 3 8 12 15 - - Puerperal sepsis 3 - - - 2 - - F. F. 1 - - - - Other Puerperal causes 3 - - 1 1 1 - - - - - - Congenital debility, premature birth, malformation, etc. M. 36 36 - - - - - - - - - - F. 37 36 - - - 1 - - - - - - 33 - - - - - - - 3 Senility M. 30 - - F. 58 - - - - - - 7 51 - - - Suicide M. 12 - - - - 4 1 3 3 - 1 11 - F. - - - 1 2 2 3 1 1 - 1 M. Other Violence 40 3 1 3 7 6 1 4 7 3 - 5 33 F. 1 2 3 4 2 1 1 4 5 10 - Other defined diseases M. 95 8 2 5 1 6 3 5 6 12 20 27 111 F. 7 1 1 5 5 5 15 18 14 26 14 1 - - - - - - - - 1 - Causes ill-defined or unknown M. - 1 - - - - - - F. - - 1 - - Infantile Mortality The number of deaths of infants under one year of age was 185, three less than in 1936, representing an infant mortality rate of 58 per 1,000 births. The number of deaths of illegitimate infants was 13, furnishing a death rate of 96 per 1,000 illegitimate births. The chief causes of death in infants under one year were prematurity 72 deaths, pneumonia 32 deaths, and diarrhoea and enteritis 39 deaths. A table showing the classification of the total deaths appear on page 12. Neo-Natal Deaths The number of deaths registered of infants under one month old was 62, representing a neo-natal death rate of 19.6 per 1,000 live births as compared with 25.4 in 1936. The classification of these deaths into groups of causes of death is shown in the following summary:— 1. Difficult Labour. Injury at birth 3 2. Foetal States Congenital defects 8 Atelectasis 4 Atrophy, debility and marasmus 3 Asphyxia neonatorum 3 3. Prematurity 32 4. Other causes 9 INFANTILE MORTALITY TABLE. Deaths from Stated Causes at Various Ages under One Year of Age, 1937, as classified by Medical Officer of Health. Cause of Death. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 1 month. 1 to 3 months. 3 to 6 months. 6 to 9 months. 9 to 12 months. Smallpox - - - - - - - - - Chicken Pox - - - - - - - — - Measles - - - - - - - - - Scarlet Fever - - - - - - - - - - 4 2 - Whooping Cough - - - - - - - - Diphtheria and Croup - - - - - - - - - - - — - - - Erysipelas - - - 1 - - - - Tuberculous Meningitis - - - - - - - - Abdominal Tuberculosis - - - - - - Other Tuberculous Diseases - - - - - - 1 1 3 Meningitis - - - - - - - - - Convulsions - - - - - - - - Laryngitis - - - - - - 3 2 1 2 Bronchitis 1 - - - 1 1 - - 1 Pneumonia - - - - - - 1 - - Diarrhoea - - - - - 9 17 7 5 Enteritis - - - - - 1 - - - - - - - Gastritis - - - - - Syphilis - - - - - - - - - Rickets - - - - - - - - 1 3 - - - 3 Suffocation - - - Injury at Birth 3 - - - 3 - - - - - Atelectasis 4 - - 4 - 4 2 2 - Congenital Malformation 5 1 1 1 8 3 - - Premature Birth 28 1 2 1 32 - 4 2 - - Atrophy, Debility, &c. 1 1 1 - 3 - 2 - 7 6 5 4 2 Other Diseases 5 6 10 6 4 Broncho-pneumonia - - 1 1 - - - - - Acute Lobar Pneumonia - - - - - - - - - Influenza - - - - - Totals 50 3 3 36 45 22 6 62 20 Vital Statistics (Wards). The vital and mortal statistics of every ward in the Borough for the year 1937 are given in the following table:— Wards. Estimated Population. Births. Deaths under 1 year Deaths all ages. Rate per 1,000. No. Rate per 1,000. Rate per 1,000. No. No. 18 12.49 1 12,963 225 17.36 162 80 2 11,645 190 16.30 16 84 141 12.10 11 76 169 3 11,801 12.28 14.32 145 14.53 173 13,351 194 10 52 12.95 4 12,902 188 7 161 5 14.57 37 12.48 14.87 9 131 6 10,757 160 12.17 56 17 7 13,126 212 16.15 80 141 10.74 169 13.23 13 77 8 12,771 118 9.23 13,321 195 6 31 169 9 14.63 12.68 10 82 11.90 3 37 92 13.35 6,889 9,692 145 14.96 6 41 111 11 11.45 146 13.05 12 165 14.75 12 11,180 82 13 9,861 120 12.16 126 12.77 2 16 14 9,379 15.99 67 137 14.60 150 10 20.64 49 160 14.61 15 10,945 226 11 12,275 13.44 9 55 169 13.76 16 165 12,372 12.04 15 101 174 14.06 17 149 15,029 9.91 3 203 14.50 18 149 20 10,846 123 11.34 7 57 140 12.90 19 20 3,695 26 48 12.99 7.03 - - The Borough 224,800 3,165 14.08 185 2,884 12.83 58 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. Tuesday, Thursday and Friday, at 2 p.m., Tuesday and Thursday (new cases) at 2.30 p.m. Monday, Tuesday and Friday 2-4 p.m. Tuesday 7-8 p.m. Post-Certificate Midwifery School, 77, Southampton Street, Camberwell. General Lying-in Hosp., Lambeth. Minor Ailments Clinic for children under 5 years. Cambridge House Infant Welfare Centre, 6, Addington Cambridge House— Voluntary Association. Daily 9.30-10.30 a.m. Square, S.E.5. Also L.C.C. School treatment Centres for minor ailments treatment of approved cases referred by Clinic Medical Officers of Infant Welfare Centres. Diphtheria Prevention Clinic. Mayward House Municipal Centre, 24, Mayward House, S.E.5. Every Wednesday at 2.30 p.m. Camberwell Borough Council. Artificial Sunlight and Rheumatism Clinics. Daily (except Saturday), 9 a.m. to 8.30 p.m. British Red Cross Society, 160, Peckham Rye. British Red Cross Society. Tuberculosis Dispensary. 23, Brunswick Park, 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. 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. Peckham Park Road Depot. Camberwell Borough Council. 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. 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. Dental. Monday afternoon (one in four weeks). Tuesday morning (one in four weeks). Wednesday morning. Thursday afternoon. Friday morning and afternoon. Minor Ailments. Wednesday afternoon, 2.45 p.m. Peckham Treatment Centre, 412, Old Kent Road, S.E.I. Aural. Consultation Session : Wednesday afternoon (one in four weeks). Operation Session : Wednesday afternoon (alternate weeks at Hanover Park Hospital. Children kept in for two nights). Monday afternoon. Dental. Tuesday morning and afternoon. Wednesday morning. Wednesday afternoon (once a month). Thursday morning and afternoon. Friday morning and afternoon. Vision. Monday morning, 9.30 a.m. Friday morning, 9.30 a.m. 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, S.E.15. Dental. Monday morning and afternoon. 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 200 beds plus 35 beds rented in King's College Hospital, Denmark Hill). St. Francis's Hospital (containing 647 beds). VACCINATION RETURN. The following returns have been prepared by the Vaccination Officer respecting Vaccinations performed during the period covered by this report. Registration Sub- Districts comprised in the Vaccination Officer's District. Number of Births returned in the "Birth List Sheets" as registered from January 1st to December 31st, 1936. Number of these Births duly entered by January 31st, 1938, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on January 31st, 1938, remained unentered in the "Vaccination Register" on account (as shown by "Report Book") of Number of these Births remaining on January 31st, 1938, 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 1937. 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 1937. Col. I. successfully fully Vaccinated. ted. col. II. Col. IV. Number in respect of whom Statutory Declarations of Conscientious tious Objection have been received. Col.V. Died unvaccinated. cina- ted. Postponement ment by Medical Certificate. Removal to Districts the Vaccination Officers of which have been duly apprised. Removal to places unknown, or which cannot be reached: and Cases not having been found. Had Small Pox. Insusceptible ble of Vaccination. tion. Vaccination. 17 1 2 3 5 7 8 10 11 12 13 These figures are to be obtained from columns 2 and 6 of the Summary (Form N.). 4 6 9 1. North West Camberwell 592 6 51 653 74 - 1,622 60 186 - 2. St. George's 327 94 180 14 3 3 29 4 - - 1,502 1,406 3. Peckham 365 114 201 15 - 2 29 4 - - 4. Dulwich 382 62 2 9 1,063 2 415 89 102 - Total 3,377 1,182 2 - 1,449 165 11 154 346 68 1,502 1,406 PUBLIC VACCINATORS—RETURN OF WORK, 1937. Number or Persons successfully Vaccinated and Re-vaccinated by the Medical Officers of Institutions and the Public Vaccinators during the year ended December 31st, 1937. Number of successful Re-vaccinations, i.e., successful vaccinations of persons who had been successfully vaccinated at some previous time. 4 75 - - 4 19 14 21 10 3 Numbers of successful Primary Vaccinations of persons:— One year and upwards. 22 70 6 4 8 15 13 1 - 1 Under one year of age. 845 253 20 143 108 151 169 - 1 - Name of the Medical Officer or Public Vaccinator. Dr. G. W. FitzHenry Dr. A. F. McMillan Dr. J. Mackie Dr. D. Hughes Dr. A. B. Blomfield Dr. H. J. Gater Dr. H. O. West Dr. 0. W. Roberts Dr. O. W. Roberts Total I Name of Institution or Vaccination District. Nunhead District Dulwich District East Dulwich District Peckham District St. George's District St. Giles' Hospital Camberwell District Dulwich Hospital St. Francis Hospital Health Propaganda. The Council's propaganda activities are intended to assist the inhabitants of Camberwell to become health conscious. They include a display of posters, the issue of leaflets on such subjects as Diphtheria Prevention, Tuberculosis, Cancer, Influenza, Measles, Whooping Cough, Dietary and cooking, and Rat repression. The Council also issues a health handbook which offers information of particular interest to mothers, including references to the Health Services provided by the Council. This booklet is distributed by the Health Visitors to the Mothers of Camberwell who have recently been confined. The monthly periodical of the Central Council for Health Education—" Better Health "—is also distributed to the inhabitants of the Borough through the medium of the Public Libraries, Baths, Infant Welfare Centres, Schools and various industrial undertakings in the Borough. At the Infant Welfare Centres short health talks to mothers are given by the Health Visitors as part of the health propaganda activities of the Council. In the early part of the year the Council were invited to cooperate in a national publicity campaign organised by the Central Council for Health Education on behalf of the Ministry of Health and the Board of Education. This campaign was designed to encourage the wider use of the health services, and local authorities taking part were asked to adhere as far as possible to an arranged time-table for the distribution of posters, leaflets, etc., for a period of six months commencing in October last. The Council resolved to co-operate as desired, and made financial provision to cover the cost of certain charges in connection with the conduct of this campaign locally. The subject matter of the literature displayed and distributed embraced the following services :—School Health Services, Maternity and Child Welfare Services, and Services for Adults and Adolescents, including Tuberculosis and Physical Fitness. Diabetes. Insulin was supplied by the Council to medical practitioners for the treatment of 10 patients in poor circumstances suffering from diabetes. Periodical reports obtained on the progress of these patients were submitted to the Ministry of Health. At the end of the year there were 7 patients being treated by insulin under this scheme. MATERNITY AND CHILD WELFARE SERVICES. The Council's Maternity and Child Welfare Scheme includes the following arrangements for the care of expectant and nursing mothers and children under five years of age not attending school. 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) Dental treatment including the provision of dentures. (h) Provision of Home Helps. (i) Provision of home nursing assistance. (j) Convalescent home treatment for expectant and nursing mothers. (k) Provision of milk and dinners for necessitous mothers. (l) Education on health matters. (m) Investigation of maternal deaths and cases of puerperal fever and puerperal pyrexia. (n) Contribution towards the cost of institutional maintenance of unmarried mothers. 2. Infants and Young Children. (a) Public Health (London) Act. 1936, Notification of Births administration. (6) The provision and maintenance of Infant Welfare Centres. (c) Home visits by Health Visitors. (d) Convalescent home treatment. (e) The supply of milk to children of necessitous parents. (f) Provision of home nursing services. (g) Minor ailments treatment. (h) Sunlight and massage treatment. (i) Child Life Protection. Infant Welfare Centres. In previous reports I have referred to the unsatisfactory nature of the accommodation available for the conduct of Maternity and Infant Welfare Services at certain Municipal and Voluntary Association Centres in the Borough. The buildings in which these clinics are held are not used exclusively for these purposes and they possess many disadvantages of construction and arrangement which are a decided handicap to the efficient discharge of the Work of these Centres. This matter has engaged the attention of the Council for some time past, and during the year steps were taken to provide more suitable premises for this service in the Dulwich and North Camberwell districts. Negotiations were entered into with the owners of the Dulwich Infant Welfare Centre for the sale of the existing building to the Council with a view to its demolition and the subsequent erection of an up-to-date Municipal Centre on the site. The owners of these premises were prepared to sell, and the Council has acquired the property for this purpose. In the northern district of the Borough the Council has agreed to acquire from the London County Council the cleared site of certain properties which formed the subject of action under the Clearance Area provisions of the Housing Act with a view to the erection of an Infant Welfare Centre on part of the land, to replace the existing Voluntary Association Infant Welfare Centre at Kempshead Hall, Kempshead Road. The erection of a London County Council Housing Estate at Sumner Road, Peckham, offered an opportunity to the Council of enquiring of that Authority whether suitable accommodation could be provided on the Estate for an Infant Welfare Centre to serve the needs of this district. The London County Council agreed to do so, and at the end of the year building operations were well advanced. This additional Infant Welfare Centre, which is situated in the St. Luke's Centre Area, will enable the Council to make adjustments in the boundaries of certain Infant Welfare Centre districts in the Borough. There are ten Municipal and Voluntary Associations Infant Welfare Centres in the Borough. Each of these centres serves a defined area and mothers are encouraged to attend the Centre for the district in which they live. The consultation work of the Centres is conducted by part-time Medical Officers. Tables recording the attendances and visits at these Centres during the year appear on pages 28 and 29. Health Visitors and Home Visiting. There are fifteen health visitors attached to the infant welfare centres serving the Borough. Of these five are employed by the Council and ten by Voluntary Associations undertaking Maternity and Infant Welfare services. The duties undertaken by these Officers include routine home visiting of infants and children not attending school, visits to expectant mothers, attendance at infant consultation sessions, and visiting homes and advising parents where infectious diseases occur, such as ophthalmia, measles, whooping cough, etc. The first visit of the health visitor to the mother following information of the birth of a child is made usually before the mother has resumed her household duties. This visit is of exceptional value as it takes place when the mother feels the absence of the doctor or midwife and is glad to receive expert advice concerning the baby. It is frequently found that this timely visit has saved a considerable amount of suffering and perhaps months of ill-health of the infant through injudicious feeding or lack of care and general management by the mother. In the majority of cases the health visitor is regarded as a friend of the family, and the services which her training qualifies her to render is greatly appreciated. In fact, it may be said that health visitors are the most effective agents for teaching the lessons of hygiene in the home. Health Visitors' Refresher Course. The Council has decided that the Municipal health visitors should attend in rotation annually the Refresher Courses organised by the Women Public Health Officers' Association, and in accordance with this direction, the senior health visitor attended the course held in December of the year under review. Ante-Natal Supervision. Ante-Natal consultations were held at the Clinics at St. Giles' Hospital, Dulwich Hospital, the Municipal Infant Welfare Centre, 140, Camberwell Road, the Voluntary Association Infant Welfare Centre, 616, Old Kent Road, and the General Lying-in Hospital Post Certificate School, Southampton Way, Camberwell. The number of patients who attended these Clinics during 1937 and the record of attendances are as follows :— Number of patients who attended. Number of attendances made by patients. Clinics. St. Giles' Hospital 1,357 11,369 Dulwich Hospital 1,020 5,976 Municipal Infant Welfare Centre, 140, Camberwell Road 20 34 Bird-in-Bush Voluntary Association. 616, Old Kent Road 221 451 General Lying-in Hospital Post Certificate School, Southampton Way 2,625 371 Convalescent Home Treatment. The Council's Convalescent Home treatment scheme provides for a stay in a convalescent home usually for a period of 28 days for expectant and nursing mothers and children under five years of age. A period of convalescent treatment plays an important part in restoring the health of a mother or child recovering from a serious illness or suffering from debility. In the past, treatment for children was restricted to patients recovering from specific illnesses. This part of the scheme was amended during the year to enable children under five years of age not attending school suffering from any medical condition, to receive treatment on the certificate of a Clinic Medical Officer of an Infant Welfare Centre or the Medical Officer of Health. During the year the Maternity and Child Welfare Committee approved treatment for 31 mothers and infants and 36 children separately. In 23 cases part of the cost of the treatment was recovered from the patient. Home Helps. This Scheme, which provides for the services of Home Helps at the homes of patients during pregnancy and/or childbirth, normally for a period of two weeks, was extended during the year to enable treatment to be given to expectant and nursing mothers for such periods as the Maternity and Child Welfare Committee may decide. The number of applications received during 1937 for the assistance of a home help at the time of confinement was 68. In 20 cases part of the cost of the service provided Was recovered from the patient. Home Nursing. This service was also amended during the year and made available for expectant and nursing mothers and children under five years of age not attending school whose nursing is approved by the Medical Officer of Health. Previously, Nursing Associations with which the Council have an arrangement to undertake such services at the request of private medical practitioners, hospitals, and the Public Health Department, received payment at the rate of 1s. per visit only in respect of the nursing of mothers and children under five years suffering from specified ailments such as measles, whooping cough, epidemic diarrhœa and in respect of diseases notifiable under the Public Health Infectious Diseases (London) Regulations, 1927. The number of individual patients nursed under this scheme during 1937 was 336, and the total visits numbered 4,424. The distribution of these cases, in broad groupings, is as follows:— Maternity Nursing 51 Pneumonia 45 Ophthalmia Neonatorum 16 Measles 4 Whooping Cough 7 Other Diseases 213 Maternal Mortality. Dental Treatment This controversial subject received further attention by the Minister of Health during the year resulting in the publication of Circular No. 1622. This Circular outlined the essential elements of an efficient maternity service for the guidance of Maternity and Child Welfare Authorities, and the Minister asked that such authorities would give early consideration to the suggestions made in the Circular and to inform him of the action they propose to take thereon. The Services already provided in Camberwell, however, substantially covered the suggestions contained in the Circular, but the Council in their consideration of this matter decided to promote a scheme for the provision of dental treatment, including dentures, for expectant and nursing mothers on the recommendation of Clinic Medical Officers of Infant Welfare Centres, Ante- and Post-Natal Clinics of the Municipal and Voluntary Associations Maternity and Child Welfare Centres in the Borough. Maternity Outfits. The Council's scheme provides for the issue of sterile maternity outfits for any woman to be confined in her own home. During the year 79 of these outfits were issued from the Public Health Department, 61 were distributed free of cost, 11 were sold'at half the cost price and 7 at full cost, viz. 3s. 6d. 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 880, which represents 28.4 per cent, of the total births notified. The Mid-wives Act, 1936, imposed upon the local supervising authority, which for London is the London County Council, the duty of securing that the number of certified midwives available for attendance on women in their own homes is adequate for the needs of the area. The L.C.C. have accordingly appointed midwives under the Act for duty in Camberwell commencing from January 1st, 1938. Payment of Midwives Fees. During the year the fees of private practising midwives were paid in seven cases for professional services rendered to mothers at the time of confinement following investigation into the economic circumstances of the applicants. Supply of Meals to Expectant and Nursing Mothers. In addition to the provision of milk, expectant and nursing mothers are eligible to receive a mid-day meal on the recommendation of a Clinic Medical Officer, and during the period covered by this report 39 mothers took advantage of this service. Applicants are required to attend an approved dining-room or an Invalid Kitchens of London Centre for this purpose. This scheme was reviewed during the year, the Maternity and Child Welfare Committee being empowered to grant meals to necessitous mothers for such periods as they may decide. The influence of the Council's Milk and Meals schemes on maternal mortality or morbidity cannot be accurately assessed, but it must be apparent that an adequate amount of suitable food is essential to maintain the general health and powers of resistance to disease of the mother and for the proper development of the foetus. Milk Distribution Scheme. Both dried and fresh cows' milk is provided by the Council for necessitous, expectant and nursing mothers and children under the age of five years not attending school. Applicants desiring the assistance of this scheme are required to attend the Infant Welfare Centre for the district with their children in order to obtain a certificate from the Clinic Medical Officer that an issue of milk is necessary for health reasons. The choice of the milk supplied is left to the applicant. Inquiries are made in every case into the financial circumstances of the applicants as a safeguard against any abuse of this service. Issues are made usually for a period of 28 days and during the year 5245 applications were received. The number of families benefiting under this Scheme was 1305. During the same period 17 families were supplied with milk by the Council at the request of the London County Council under that Authority's extra nourishment scheme, the cost of such issues being refunded by the Public Assistance Department. Following the receipt of Ministry of Health Circular 1519, dated April 1st, 1937, the Council gave consideration to the scale of income below which milk is supplied to expectant and nursing mothers and children under five years of age free or at half cost. The purport of this Circular was to request Authorities to review their arrangements so as to ensure that sufficient milk or other food is provided whenever this provision is necessary for the maintenance of the health of the mother or young child. It was also suggested that the scale of income adopted for this purpose should be so framed as not to render it difficult for any mother to take advantage of the Authority's arrangements. The Council increased the quantity of milk to be supplied in future to persons recommended for this service, and revised the Income Scale as follows: — Income Scale after Deduction of Rent, Fares, National Health and Unemployemnt Insurance Contributions. Amount per head. Amount per head. No. in family. Free. s. d. Half-Price. s. d. 1 16 0 18 0 2 13 0 14 0 3 10 6 11 6 4 9 6 10 6 5 8 6 9 6 6 and over 8 0 9 0 The adopted alterations of the Milk Distribution Scheme were brought to the notice of the Ministry of Health who, in a letter to the Council, stated that they were glad to note this extension of the Council's Maternity and Child Welfare Service. Treatment of Minor Ailments. In December, 1936, the Council approved a Scheme for the treatment at London County Council School Treatment Centres of children under five years of age, attending Infant Welfare Centres in the Borough and recommended by Clinic Medical Officers for treatment. The Council pays the County Council charges ranging from 7s. 7d. to 17s. 8d. for each child, such payments being inclusive of treatment for a period of six months. The following summary indicates the nature of the ailments for which treatment was given and the number of children treated in the respective groups during the year:— Minor Ailments, i.e., Skin, Eyes and Ear affections 72 Dental, including anaesthetic and extractions 91 Eye refraction 4 Tonsil and adenoid operations 20 In the early part of the year the Council gave consideration to the question of recovering from the parents of the children treated the whole or part of the cost of the treatment, and they decided not to make any charge for this service. Sunlight and Massage Treatment. During the year arrangements were made for children under five years of age, not attending school, to receive sunlight and massage treatment on the recommendation of Medical Officers of Infant Welfare Centres in the Borough, at St. Giles" Hospital and at the British Red Cross Society's Clinic, 160, Peckham Rye. These arrangements in the first place were made for a period of six months, and were subsequently approved for a further term of one year expiring in October 1938. Treatment is provided free to the patients, the Council paying 1s. 6d. per attendance at these Clinics. The number of patients treated at these Clinics during 1937 was 37, the attendances totalling 325. There were also eleven cases recommended for this service but the children concerned did not attend for treatment. Toddlers' Clinics. In the autumn of 1936 the Council approved the provision of weekly medical sessions for toddlers at each of the four Municipal Centres for an experimental period of six months. In view of the satisfactory attendances and the valuable work performed at these Clinics, the Council decided to continue them for a further term of six months and to review the matter again. A joint report by Dr. Colver and myself, accompanied by statistical tables on the medical and administrative aspects of the work performed was accordingly furnished, and the Council in their consideration of this report resolved that until such time as they may otherwise direct these special Clinics be continued weekly, except at the Camberwell Municipal Centre, 140, Camberwell Road, where it was decided to hold a session once a fortnight in view of the less satisfactory attendances in this area. It was also decided to conduct a toddlers' session on alternate Wednesday afternoons at the new Infant Welfare Centre in the course of construction at the London County Council Housing Estate, Sumner Road, Peckham. INFANT WELFARE CENTRES—CLINIC ATTENDANCES, Etc. (INCLUDING "TODDLERS" CLINICS). 1937. Infant Welfare Centres. Under 1 Year. Between 1 & 5 Years. Miscellaneous. Total Attendances. Analysis of Attendances, Children. Weighings only. Ante-Natal Clinic Attendances. Treatment Centre for Minor Ailments. Post-Natal Mothers for Advice Own Health. Health Talk and Mothercraft Sessions. First Attendances. Subsequent Attendances. First Attendances. Doctors' Consultations. Seen by Health Visitor. Subsequent Attendances. Camberwell Municipal, 140, Camberwell Road, S.E.5 195 3,147 156 2,233 214 5,945 3,082 2,649 - 34 - 86 - Dulwich Municipal, 114, Lordship Lane, S.E.22 287 4,132 1,910 6,740 3.631 2,910 - - 664 66 208 212 - May ward House Municipal, Benhill Road, S.E.5 291 1,969 335 7,880 3,135 - - 173 4,410 28 5,115 170 591 - Peckham Municipal, Clifton Congregational Church Hall, Asylum .Road, S.E.15 225 4.276 178 1,865 243 6,787 2,913 - - 162 3,631 - - Bird-in-Bush, 616, Old Kent Road. S.E.15 296 3,547 42 1,380 — 5,265 3,169 451 - 178 2,096 1,428 - Cambridge House, 6, Addington Square, S.E.5 163 2,390 39 35 4,154 1,927 - 252 222 - 1,527 2,192 - Kempshead Hall, Kempshead Road, S.E.5 159 2,121 25 461 3,567 1,406 - 247 215 1,216 2,115 - - St. Antholin's, 22, Linden Grove, S.E.15 302 67 - 9,106 4,061 - - - - 5,045 5,341 3,396 - St. Luke's, 2, Commercial Way, S.E.15 37 1,445 4,117 2,345 - - 125 189 2,446 1,772 507 - - Union of Girls' Schools, 60a, Amott Road, S.E.15 358 5,425 149 - 9,560 2,391 - - 432 3,628 7,169 - - 2,465 37,940 1,075 20,569 63,130 28,060 485 2,257 591 1,081 33,989 499 2,001 HEALTH VISITORS—RECORD OF VISITS (INCLUDING VISITS TO "TODDLERS"), 1937. To Expectant and Post-Natal Mothers and Children. Infant Welfare Centres. To Expectant Mothers. To Post-Natal Mothers. No. Births reported in the Area. To Children. Analysis of Visits to Children. Miscellaneous and Waste Visits. Visits by Voluntary Helpers. Measles. Total Visits. Under 1 Year. Between 1 and 5 Years. Under 1 Year. Between 1 and 5 Years. Total Visits. First Visits. Subsequent Visits. Attending Centre. Not Attending Centre. Attending Centre, Not Attending Centre. 272 223 233 1.947 2,684 348 734 1,213 653 - - Camberwell Municipal, 140, Camberwell Road, S.E.5 209 504 389 3,818 Dulwich Municipal, 114, Lordship Lane, S.E.22 165 442 451 513 2,330 3,299 751 1,579 284 - 21 311 658 456 4,211 May ward House Municipal, Benhill Road, S.E.5 323 342 389 386 582 2,125 3,093 186 565 1,560 286 - 1 782 4,045 Peckham Municipal, Clifton Congregational Church Hall, Asylum Road, S.E.15 335 292 309 770 1,975 3,060 829 566 1,409 431 23 4,141 256 315 - Bird-in-Bush, 616, Old Kent Road, S.E.15 327 360 5,391 1,067 1,692 1,247 - - - 409 378 2,074 2,939 1,385 6,127 Cambridge House, 6, Addington Square, S.E.5 141 232 194 199 3,662 833 872 930 1,027 44 - 4,089 1,506 1,957 10 Kempshead Hall, Kempshead Road, S.E.5 105 225 188 199 900 913 1,193 71 10 - 4,373 1,657 2,106 3,962 956 St. Antholin's, 22, Linden Grove, S.E.15 700 412 409 1,005 - 67 478 713 1,060 1,364 2,100 3,873 1,095 88 5,206 St. Luke's, 2, Commercial Way, S.E.15 492 253 252 566 333 1,674 157 271 2,257 2,007 4,535 1,962 - 5,437 - Union of Girls' Schools, 60a, Amott Road, S.E.15 328 343 385 4 08 1,420 4,871 783 869 - 3,043 1,045 2,174 66 - 5,608 Child Life Protection. The supervision of foster mothers and foster children is carried out by a qualified health visitor specially appointed by he Council for these duties. Every applicant for registration as a foster mother is required to satisfy a standard of suitability before approval, special attention being given to such matters as her state of health, freedom from onerous personal ties, age, temperament, domestic circumstances, cleanliness and comfort of the home, age and sex of the other members of the household, and sleeping arrangements. At the end of the year the number of persons on the register receiving children for reward was 165, and the number of individual children in their care was 178. The number of visits paid to the homes of these children during the year was 2,399, distributed as follows: — No. of Visits. Children under 1 year of age 462 848 Children 1 to 5 years of age 508 Children 5 to 9 years of age 85 Special visits Miscellaneous visits 300 Waste visits 196 Total visits 2,399 There are 116 foster children on the register under school age and of these 97 came under medical supervision at the Infant Welfare Centres in the Borough. During the year two foster children died, and in one case the death was the subject of a Coroner's inquest. The foster mother in each instance was deemed to be free from blame. Institutional Provision for Unmarried Mothers. The Council continued their annual contribution to the Southwark Diocesan Association for Preventive and Rescue work towards the cost of the maintenance of unmarried Camberwell girls in approved homes. Open-Air Day Nurseries in Parks and Open Spaces. The Metropolitan Boroughs' Standing Joint Committee referred for consideration the question as to the likelihood of the Metropolitan Borough Councils making use of the facility, if power were obtained, of the L.C.C. Open Spaces for open-air day nursery purposes. It was stated that in view of the success which followed the use of the site in, Battersea Park provided by the London County Council and the benefit which the children had derived from the shelter there the Society of Day Nurseries were anxious to open as many Shelters as possible during the summer of 1938, and with this purpose in view the Society had approached the London County Council to enquire whether they would allow them to open fifty shelters at various places. The General Purposes Committee of the London County Council felt that the scheme might well form the basis of a valuable social service, as not only would the proposed nurseries be intended as a method of caring for young children unable, independently, to use children's gymnasiums, but they would also provide a temporary relief for mothers and a partial substitute for the " nursing " which older children undertake for their younger brothers and sisters. The County Council were advised, however, that while no objection might be taken to the nursery established temporarily in Battersea Park, any extension of the arrangement to other spaces might lead to the Council's powers in the matter being questioned. The General Purposes Committee of the County Council were prepared to consider recommending the London County Council to seek power to allocate, by enclosure, a portion of open spaces within which the Borough Councils or Voluntary Associations could provide day nurseries under properly controlled conditions, but before considering the matter further the Metropolitan Borough Councils' views were invited. The Council, in their consideration of this matter, directed that the Metropolitan Boroughs' Standing Joint Committee be informed that they were in favour of the necessary powers being sought. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. So far as is known every house in the Borough, with the exception of one flat in a shopping thoroughfare, where the supply is obtained from an artesian well which is also the source of supply for thirteen shops adjoining, is provided with water for drinking purposes by the Metropolitan Water Board. The purity of this water supply is controlled by repeated bacteriological examinations. No complaints were received during the year as to the quality of the domestic water supply in any part of the Borough. During 1937 the Metropolitan Water Board notified the Public Health Department that the water supply had been withdrawn from 43 premises, either for non-payment of rates or on account of Waste. Appropriate action was taken in these cases by the Sanitary Inspectors under the provisions of the Public Health (London) Act, 1936. On the other hand the attention of the Metropolitan Water Board was drawn to 88 cases where a waste of water Was observed by the Sanitary Inspectors during the course of inspection of dwelling houses and other premises in the Borough. Drainage and Sewerage. At the end of the year there were only two cesspools in the Borough. These cesspools take sewage matter from conveniences attached to sports grounds ; otherwise the water carriage system for the disposal of sewage is general throughout the Borough. These cesspools are systematically emptied by the Council. The duty of supervising drainage works is carried out by the Sanitary Inspectors. During the year 70 plans were deposited and approved in relation to 208 new buildings and 270 in respect of drains which were either partially or wholly reconstructed. 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. Nine claims were received and upheld that certain drains on private premises which were in a defective condition were sewers repairable by the Council and not the liability of the owners. The Council during 1937 reconstructed 2 local sewers and replaced 556 brick road gullies by pot gullies. In addition 39 new gullies and drains were installed. Sewer Reconstruction Programme. Towards the close of the year the Council gave further consideration to a report prepared by the Borough Engineer and Surveyor at the request of the Public Health Committee on the condition of the local sewers of the Borough. This report indicated that there was a number of local sewers which were known to be in a bad condition and required attention at an early date, while other sewers under the Council's jurisdiction might also require to be reconstructed when their condition, which could not at present be determined in the absence of adequate means of access to them for examination purposes, was known. The Public Health Committee reported on this matter to the Council setting out in a comprehensive manner the measures which were contemplated to deal with this important public health service. The Council adopted the report and approved in principle a large-scale sewer reconstruction programme involving an expenditure of approximately £50,000 spread over a period of five years. Public Cleansing. This service is under the direct supervision of the Borough Engineer and Surveyor. The improvements in the public cleansing arrangements to be noted during 1937 were the replacement of a sweeping and collecting machine by an improved type of machine and two additional street refuse collecting vehicles. In addition to the routine cleansing of the highways, a motor sweeper is employed daily in the important shopping thoroughfares and main roads. Sweeping gangs are also employed at night, and the shopping centres in the Borough are swept on Sundays. Road gullies are cleared out by vacuum gully emptiers—main roads monthly and other roads every two months. Six cesspools taking sewage matter from conveniences attached to sports grounds were emptied by the Council at varying periods during the year. At the end of the year the number of cesspools had been reduced to two. The removal of domestic house refuse is also a service for which the Borough Engineer and Surveyor is responsible. The general collection is weekly, but at L.C.C. Housing Estates and similar block dwellings estates collection is made twice weekly while at hospitals a daily collection takes place. The collection of house and trade refuse is carried out by direct labour and 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 conveyed by contractors 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 Soap boilers 2 Twenty-nine inspections of these premises were made, and one notice under the provisions of the Public Health (London) Act was served. Rag and Bone Dealers. There are 24 places in the Borough where the business of a dealer in rags and bones was conducted during 1937. Forty visits of inspection were made to these premises, and three sanitary notices were served. There were three cases brought to the notice of the Public Health Committee of contraventions of the by-laws in respect of the exchange of toys for old clothes. In two instances the Committee directed that a caution be administered and in the third case a summons was issued. Sanitary Conveniences attached to Licensed Premises. The Sanitary Inspectors made 769 inspections of the sanitary conveniences of licensed premises in the Borough during 1937. It was necessary to serve 9 sanitary notices. At the end of the year there were 79 public-houses in the Borough which had urinals opening on to the public footway. Shops Act, 1934. The administration of the Shops Act, 1934, is shared in London between the County Council and the Metropolitan Borough Councils. The duty of the Borough Council is limited to the enforcement of (a) suitable and sufficient means of ventilation, (b) suitable and sufficient means of maintaining a reasonable temperature, (c) suitable and sufficient means of w.c. accommodation. The district Sanitary Inspectors made 490 inspections and 289 re-inspections of shops in 1937. The following is a summary of the works which were required to be carried out as a result of these inspections. Provision of additional water closet accommodation 2 Provision of suitable and sufficient means of maintaining a reasonable temperature 5 During the year 3 exemption certificates were granted in accordance with Section 10 (6) of the Act. Pharmacy & Poisons Act, 1933. Since this Act came into operation on the 1st May, 1936, 189 traders in poisons used mainly for household purposes such as carbolic, spirits of salts, etc., have been placed on the register. During the year the district inspectors made 118 inspections and 14 re-inspections of the premises of registered traders. Certain minor infringements of the Act came to the notice of the Public Health Department during the year, chiefly in respect of the labelling of Part II poisons, and in each case the seller was cautioned, and his attention drawn to the provisions of the Act. Smoke Abatement. Twenty-two complaints of smoke nuisances from industrial undertakings were received during the year and 81 observations of factory chimneys were carried out by the Sanitary Inspectors. In 4 instances offences were committed and notices were served on the owners of the premises concerned to abate the nuisance. No occasions arose for legal proceedings to be instituted for these offences. It has been found that when the attention of the management is directed to a smoke nuisance they are willing to accept the advice offered as to the best method of preventing the emission of smoke and grit. Some years ago, an instructional card for the use of stokers, containing practical suggestions for avoiding unnecessary smoke emission from hand-fired boilers was issued to firms in the Borough for the guidance of their employees, and there is reason to believe that the co-operation of the public health department in this matter was much appreciated. Swimming Baths. The water in all the Council's swimming baths is filtered, aerated and chemically treated. Following the usual custom samples of water from the municipal swimming baths in the Borough were chemically and bacteriologically examined at intervals during the year, such samples being taken in January, June, July, September and November from the Church Street Second Class swimming bath, and from Dulwich and Old Kent Road baths in June, July and September. The reports received of these examinations were satisfactory in every case. Eradication of Bed Bugs. Information is given to the Public Health Department of premises on this Council's Estates believed to be infested with bugs with a request for inspection of the premises by the Sanitary Inspector and for disinfestation where such action was deemed necessary. During 1937 the number of such premises disinfested by the Council's disinfecting staff was 7. Disinfection of furniture, bedding and other effects is carried out at the request of the London County Council where there is evidence of the presence of vermin in a tenant's belongings before the family moves into a London County Council dwelling. During the year 32 of these cases received attention. The disinfestation of private dwelling houses is carried out by the Council's Officers provided the owners are prepared to co-operate by stripping the walls and ceilings, easing picture-rails, skirting boards, architraves and window mouldings as may be necessary to ensure that spraying with a vermicide effectively penetrates the harbourages of these vermin. At the same time arrangements are made for the bedding, curtains and other articles to be steam disinfected at the Council's Disinfecting Station. The tenant is also requested to assist by the generous use of soap and water and a scrub brush in the rooms and articles affected. This procedure is repeated at intervals of 10 days to a fortnight until the premises are judged to be free from vermin. The owner is then requested to replace the woodwork and to distemper the walls and ceilings. Tenants are also advised as to the precautions to be taken against re-infestation and are informed that sprayers and 1 lb. tins of vermicine are available at cost prize viz. 1s. 3d. and 1s. respectively on application to the Public Health Department. As the present method of disinfestation by the Council's disinfecting staff gives satisfactory results no use has been made of hydrogen cyanide or orthodichlorbenzine for the fumigation of premises in the Borough owing to the toxicity of the fumes to human beings. Fouling of footpaths by dogs. During the year 9 summonses were issued in respect of offences against the Council's By-law prohibiting the fouling of footways by dogs on leads. Schools. The sanitary conveniences of private schools in the Borough were inspected during the year. A few minor defects were discovered which were promptly remedied. Close co-operation between the officers of the sanitary authority and those of the Education Authority exists in dealing with infectious diseases. Notices as required by the Public Health (London) Act, 1936, were sent to the head teacher of the schools attended by the patient or contacts of the patient, followed by further notices indicating the contacts of the patient who in the opinion of the Medical Officer of Health should be excluded from school on account of infectious disease. Rag Flock. The Public Health (London) Act, 1936, prohibits the sale or use for the purposes of making any article of upholstery, cushions or bedding of flock manufactured from rags unless such flock conforms to a standard of cleanliness as may be prescribed by regulations made by the Minister. There are three premises in the Borough concerned with the sale of rag flock. One sample was taken for analysis during the year and found to be satisfactory. Rag flock shall be deemed to conform to a cleanliness standard if the amount of chlorine present does not exceed 30 parts in 100,000 parts of the flock. Removal to Institutions of Aged, Infirm or Physically Incapacitated Persons. Twenty-one cases of elderly persons living alone and who were reported as being unable to devote to themselves proper care and attention came to the notice of the Public Health Department. It was not found necessary to apply for a magistrate's order under Section 224 of the Public Health (London) Act, 1936, for the compulsory removal of any of these old people. In five instances persuasion by the Council's Inspector was effective in securing removal of the person to an institution, in 8 cases arrangements were made for the cleansing of the premises thereby enabling these old people to continue to live in their own homes ; in 2 instances friends of the persons concerned undertook to supervise them, one old person agreed to obtain medical treatment and in the remaining 5 cases, no action was required by the Department's Officers. Rat Repression. During the year 197 complaints of the presence of rats were received and investigated by the district sanitary inspectors. Where the nuisance was due to the defective condition of the drains, or as a result of rats gaining access to premises from disused drains, appropriate steps were taken by the Sanitary Inspectors. In other instances, occupiers of infested premises were offered advice as to the most effective means to secure the abatement of the nuisance. The issue of poison baits from the Public Health Department was continued without charge. National Rat Week was observed from November 1st to 6th, 1937. The Council directed that measures similar to those employed in previous years be adopted to comply with the request of the Ministry of Agriculture and Fisheries for a special effort to be made to deal with the rats and mice nuisance during the period of the campaign. The following report on the steps taken by the Council in this matter was subsequently forwarded to the Ministry. NATIONAL RAT WEEK. The activities of the Officers of the Public Health Department of the Council in response to the Ministry of Agriculture and Fisheries request to local authorities to make a special effort to secure the destruction of rats and mice during National Rat Week, which was observed this year from 1st to 6th November, 1937, were as follows:— 1. The display of double-crown posters on the notice boards of the Municipal buildings and Council's sand-bins throughout the Borough. 2. The distribution of leaflets from the Public Libraries, Baths and Infant Welfare Centres on the duties of the public under the provisions of the Rats and Mice (Destruction) Act, 1919. 3. Circularising proprietors of factories, workshops, workplaces, butchers, provision dealers, bakehouses, fish shops, eating-houses, milk shops, offensive trades, and rag and bone dealers premises in the Borough, directing attention to the importance of rat destruction and inviting them to seek the co-operation of the Council's Officers in dealing with nuisances from this cause. The number of letters despatched for this purpose was 2,617. 4. The free distribution from the Public Health Department of rat poison baits. 5. Rat poison was laid in the various sewers owned by the Council, which work was carried out in conjunction with the main drainage department of the London County Council. 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. A monthly summary of the bodies received at the mortuary during 1937 appears on the following page. PUBLIC MORTUARY, ST. GEORGE'S ROAD, PECKHAM—RETURN OF WORK—JANUARY TO DECEMBER, 1937. Month. Males. Females. Total. Inquests. Postmortems Courts. Residents. Outside Borough. Number. P.-M.'s. January 28 9 21 21 21 42 21 14 31 February 25 18 15 12 6 10 6 9 16 March 19 18 24 16 35 22 11 9 13 April 23 18 41 28 22 12 22 19 10 21 May 16 33 15 17 19 8 18 13 June 12 9 14 9 21 7 9 12 5 July COURT AND MORTUARY CLOSED FOR REPAIRS, JUNE 19th, 1937, to SEPTEMBER 15th, 1937. August 19 10 September 10 11 9 5 11 8 5 40 18 October 23 17 23 7 20 20 9 November 26 17 43 21 27 9 17 26 13 59 25 December 28 31 37 13 30 29 15 358 199 Totals 194 164 216 85 165 193 103 39 Factories and Workshops. The Council's inspectors paid 782 visits to factories and 988 visits to workshops and workplaces. The following tables show the various trades and occupations carried on in factories, workshops and workplaces in the Borough where men and women are employed. Factory and Workshop Act, 1901. FACTORIES, WORKSHOPS AND WORKPLACES ON THE REGISTER AT THE END OF 1937. INSPECTED BY THE COUNCIL'S MALE SANITARY INSPECTORS. Factories. Workshops and Workplaces. Total. Trade. 5 9 14 Blacksmiths 38 Bootmakers and Repairers 40 78 Brush Trades 2 4 6 12 40 52 Building Trades Chemical Trades 4 3 7 Engineering Trades 48 18 66 Gas Works 1 - 1 Glass Blowing 1 - 1 1 35 Laundries 34 441 Miscellaneous 239 2 680 6 Offensive Trades 8 Preparations of Foodstuffs 18 12 30 Printing and Lithography 46 10 56 Sweet Manufacturers 4 5 9 Timberyards and Woodworkers 47 29 76 Toymakers 1 4 5 Upholsterers - 12 12 Wearing Apparel 22 29 51 524 TOTAL 663 1,187 INSPECTED BY THE COUNCIL'S WOMAN SANITARY INSPECTOR. Factories. Workshops and Workplaces. Total. Trade. Brush Trades 2 2 - 1 3 Chemical Trades 2 1 1 2 Furriers 39 37 Laundries 2 12 12 Milliners - 265 120 145 Miscellaneous Offensive Trades 2 - 2 26 Preparation of Foodstuffs 26 - - Printing and Lithography 14 14 5 Sweet Manufacturers 3 2 88 178 Wearing Apparel 90 297 251 548 TOTAL Factory and Workshop Act, 1901. The following tables are presented in the form required by the Home Office. 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES INSPECTIONS MADE BY SANITARY INSPECTORS IN 1937. Number of Written Notices. (3) Inspections. (2) Prosecutions. (4) Premises. (1) - Factories (including Factory Laundries) Workshops (including Workshop Laundries) 782 59 - 988 70 Workplaces (other than Outworkers premises) - TOTAL 1,770 129 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Number of Defects. Particulars. (1) Remedied. (3) Referred to H.M. Inspector. (4) Number of Prosecutions. (5) Found. (2) Nuisances under the Public Health Acts: —* - Want of cleanliness 163 154 - Want of ventilation 8 8 - - Overcrowding 1 1 - - Want of drainage floors - Other nuisances - 104 - 91 - - - Sanitary accommodation— 6 Insufficient 6 - - Unsuitable or defective Not separate for sexes - - 54 49 - - - - 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] 8 8 - 8 - TOTAL 344 317 8 * 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. Information came to the knowledge of the Public Health Department that 630 persons residing in Camberwell were employed in carrying out work in their own homes on behalf of employers in this Borough and elsewhere. Eleven cautionary letters were sent 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 following is an analysis of the industries in which these workers were engaged. TABLE SHOWING TRADES OF OUTWORKERS IN EMPLOYMENT AT THE END OF 1937. Art publishing 1 Artificial Flowers 2 Baby linen 12 Berets 4 Blinds 1 Blouses 10 Boots and shoes 7 Braces 3 Brassieres 1 Brushes 4 Cardboard boxes 10 Card lacing 3 Chemist 1 Chemists' sundries 1 Coathangers 27 Collars 8 Crocheting 3 Downquilts 5 Drapery 2 Dresses 22 Dressing gowns 8 Dyeing and cleaning 3 Embroidery 8 Engraving jewellery 2 Fancy goods 9 Feather curling 2 Gloves 1 Gold lace 1 Gowns 21 Hairnets and combs 1 Handbags 2 Handkerchief sachets 2 Hats 3 Hosiers 2 Ivory and bone goods 1 Knitted goods 2 Label cutting 1 Lampshades 2 Leatherwork 3 Mantles 144 Millinery 1 Mounting animal-skin rugs 1 Needlework 3 Novelties 2 Outfitting I Overalls 2 Paper bags 7 Polishing and fitting 1 Pyjamas 2 Rag dolls 2 Shirts 16 Skirts 5 Stationery 2 Tailoring 25 Ties 39 Toys 2 Umbrellas 4 Underclothing 13 Upholstery 2 Veils 1 Wearing apparel 22 Woollen goods 1 499 HOUSING. The number of dwelling houses inspected under the provisions of the Public Health (London) Act, 1936, and the Housing Act, 1936, was 8,684. Intimation notices requiring the abatement of sanitary nuisances and the repair of dwelling houses numbered 6,539 affecting 3,830 properties. It was necessary to follow up these intimations by the service of statutory notices in 2,181 instances, and in 77 cases summonses were issued before securing compliance with the Council's requirements. A summary of the work of the Sanitary Inspectors and Housing Inspectors appears in the tables on pages 50, 53-57. Insanitary Areas. The declaration of small unhealthy areas was continued during the year, and in December last the activities of this authority under the Housing Acts, 1930-36 from the date of the first declaration of an Insanitary Area in 1934 were reviewed in the following report to the Public Health Committee of the Council. December 1st, 1937. To the Chairman and Members of the Public Health Committee. ALDERMEN AND COUNCILLORS, INSANITARY AREAS PROGRAMME. In January last I reported to the Public Health Committee that with the exception of one area in the North-West Division of Camberwell the Council had completed the clearance programme mutually agreed upon with the London County Council. This programme was made up of small groups of badly arranged houses in courts, mews, alleys, etc., so small or so placed that rehousing on the sites was considered impracticable, and was submitted by the London County Council at a conference held at County Hall in July 1934, between representatives of the two Authorities, as part of the County Council's clearance areas programme in Camberwell following consideration of Ministry of Health Circular No. 1331, dated April 6th, 1933, dealing with the question of the clearance of slums and the improvement of bad housing conditions. In October 1934, this Council resolved to deal with small clearance areas in the Borough in accordance with the provisions of the Housing Acts, and at a further conference held a month later between representatives of both Authorities, terms were arranged upon which the London County Council would provide re-housing accommodation in respect of persons displaced by the housing operations of the Council. From that date official representations under the provisions of the Housing Acts have been made systematically of areas comprising this programme—which, however, has been subject to modifications and additions agreed upon in consultation with the Officers of the London County Council—on the basis of rehousing accommodation being available for approximately 20 families per month. In the following table particulars are given of the areas in this Borough which have been dealt with by the Council under the clearance area provisions of the Housing Acts. BOROUGH OF CAMBERWELL. INSANITARY AREAS CLEARANCE SCHEMES. No. of persons displaced or to be displaced. No. of Dwelling Houses. Date of Declaration. Description of Area. Position at November 30th, 1937. Redevelopment approved for erection of garage and workshop. Site cleared. Tiger Yard 13/6/34 17 41 13/6/34 33 Woodland Cottages Joiners' Arms Yard 10 13/6/34 6 25 Redevelopment approved for erection of permanent structure for sale of furniture on site of Nos. 1-4. Nos. 5 and 6 converted for business purposes. Site cleared. Boyton Cottages 9/1/35 11 49 9/1/35 Redevelopment approved for storage of motor cars. Station Vale 8 31 8 Redevelopment approved for the erection of builders' workshop and roof on a strip of land in the clearance area. Redcar Cottages 6/2/35 2 6/2/35 Ebenezer Cottages 3 12 Extension to gardens of Nos. 1 and 2, Ebenezer Cottages. (Nos. 1 and 2 Ebenezer Cottages subsequently included in Neate Street Clearance Area.) Ormond Place 6/2/35 7 Redevelopment approved for extension of factory over whole of site. Site Cleared. 2 6/2/35 Glengall Cottages 3 11 Dalbiac Street 6/2/35 13 57 Redevelopment approved for factory extension over the site of Nos. 1 and 7, Dalbiac Street. Site of Nos. 2-10, Dalbiac Street and Nos. 12 and 14, Goldie Street, purchased by Council for open space purposes. 6/3/35 19 5 Redevelopment approved for extension to gardens of houses in Nunhead Grove. Cemetery Cottages No. of persons displaced or to be displaced. No. of Dwelling Houses. Description of Area. Date of Declaration. Position at November 30th, 1937. James Cottages 6/3/35 10 35 Erection of wall on site in connection with adjoining factory premises approved. Site cleared. Nungate 3/4/35 10 34 Lansdowne Place 3/4/35 7 35 Redevelopment approved for storage of builders' materials and subsequently for storing lorries, cars, vans, etc. Site cleared. Site cleared. Bowyer Street 3/4/35 4 18 Absolom Place 15/5/35 12 49 Acock's Cottages 15/5/35 4 Use of site by owners as vacant land in connection with their business as transport contractors approved. Site cleared. 10 Hearsey Place 15/5/35 4 5 24 Surrey Place 19/6/35 20 Redevelopment approved for storing and showing for sale second-hand motor cars. Garden Street 19/6/35 8 34 Redevelopment by London County Council. Housing Scheme operations proceeding. Site cleared. Melon Road 19/6/35 4 24 Herring Street 19/6/35 5 15 Redevelopment by London County Council. This Council has agreed to acquire part of site for Maternity and Child Welfare purposes. Pleasant Place 19/6/35 3 16 Redevelopment approved for storage of materials and plant. Site cleared. Site of Nos. 2-22 being acquired by Council for redevelopment (open space purposes). Lomond Place 17/7/35 11 53 Cobourg Road 18/9/35 8 28 Redeveloped by Council as open space. Frensham Street 16/10/35 4 19 Redevelopment by Council in connection with reconstruction of Peckham Park Road Depot. No. of persons displaced or to be displaced. No. of Dwelling Houses. Description of Area. Date of Declaration. Position at November 30th, 1937. 16/10/35 21 Lovegrove Street (3 areas). 97 Site cleared. Redevelopment approved for garaging of motor vehicles on site of Nos. 8, 9 and 10, Lovegrove Street (No. 2 Area), or alternatively for storage of building materials. 11/12/35 25 Albany Road 126 Clearance by London County Council. Large part of area proposed to be conveyed to Borough Council for open space purposes. 16 {15/l/36} {2l/10/36} Wingfield Mews 51 Confirming Order. Awaiting result of appeal to High Court. 12/2/36 25 Camberwell Station Road. 124 Redevelopment approved for part of the site for use as an approach to a building adjoining the Clearance Area. 6 12/2/36 Southampton Street 25 Redevelopment approved for erection of flats on the site. 9 11/3/36 Dalwood Street 26 Area vacated and awaiting demolition. 11/3/36 9 Harders Road 28 Redevelopment approved for extension of laundry premises. 8/4/36 Boathouse Walk 18 72 Taken over by London County Council. Cleared site to be conveyed to Borough Council for proposed extension of Sumner Road Recreation Ground. 8/4/36 Gervase Street 2 8 Area vacated and awaiting demolition. 13/5/36 Meeting House Lane (3 areas). 10 36 No. 1 Area—Site cleared. No. 2 Area—One building still occupied. No. 3 Area—Site cleared Site cleared. 13/5/36 Lettsom Street 4 25 Grove Lane 13/5/36 8 23 One building still occupied. No. of persons displaced or to be displaced. No. of dwelling houses. Description of Area. Position at November 30th, 1937. Date of declaration. 17/6/36 8 Sandgate Street (2 areas). 43 17/6/36 6 Areas declared by this Council, but taken over by London County Council under Section 33 of the Housing Act, 1936. Triangle 25 4 25 17/6/36 Muscatel Place Order now operative—rehousing of tenants proceeding. 15/7/36 15 39 Victoria Road (2 areas). Order now operative—rehousing of tenants proceeding. Restrictions placed on No. 1 Area are the subject of an appeal to the Minister of Health. 39 Dalwood Street (6 areas). 13/1/37 141 Orders now operative—rehousing of tenants proceeding. 42 Neate Street 10/3/37 226 Area declared by this Council, but to be redeveloped by London County Council. Possible development for open space purposes. 14/7/37 2 11 Banstead Street Clearance Order made, but not yet confirmed. 14/7/37 6 35 Penry Place Clearance Order made, but not yet confirmed. 454 1,893 TOTALS It will be observed that in respect of six areas in this list, viz., Garden Street, Herring Street, Albany Road, Boathouse Walk, Sandgate Street and Neate Street, the London County Council made use of the appropriate section of the Housing Act, and notified this Council that they themselves intended to deal with each of these areas as a clearance area or as part of a clearance area. In the case of the Garden Street Scheme, this area was eventually included in a London County Council larger area scheme, and building operations are at the present time proceeding. At Herring Street the Council has agreed to acquire from the London County Council part of the cleared site for Maternity and Child Welfare purposes. With regard to the Albany Road proposals, the London County Council's offer to convey part of this site to the Council for open space purposes has been accepted, and a similar offer in respect of the whole of the Boathouse Walk area has also been accepted by the Council. The redevelopment of the Neate Street clearance area scheme is still the subject of consideration by the London County Council. That authority has, however, notified the Council that they are prepared to convey part of this area north of Neate Street to the Council. The Public Health Committee at their meeting on June 4th, 1937, decided that they were disposed to recommend the Council to agree to the London County Council's offer but asked for an estimate of the cost to be furnished which is not yet to hand. I am not in possession of any information relating to the present position concerning the Sandgate Street areas. It might also be of interest to furnish the following contemporary activities of the London County Council in Camberwell, excluding development schemes, so that a complete picture may be presented of the slum clearance operations in the area from the beginning of 1934. LONDON COUNTY COUNCIL. INSANITARY AREAS CLEARANCE SCHEMES. No. of persons displaced or to be displaced. No. of Dwelling Houses. Description of Area. Date of Declaration. Position at November 30th, 1937. Levant Street 27/2/34 182 Building operations in progress. 968 19/6/34 Nigel Buildings 4 Blocks contain-57 tenements. 257 Clearance Order. Site cleared, but not redeveloped. Rill Street 9/4/35 65 Clearance and demolition proceeding and building operations in progress. 262 (anticipated) Garden Street 19/11/35 28 139 Site cleared. Building operations in progress. Clearance operations proceeding. Herring Street 19/11/35 32 166 19/11/35 Area cleared. Building operations in progress. Sumner Road 293 1,198 Juniper Place Public Local Inquiry to be held—20/12/37. 24/11/36 41 212 Albany Road 23/2/37 No. 1 Area. 26 120 Part of area to be conveyed to Borough Council as an open space —remainder of site to be redeveloped for rehousing purposes. Sultan Terrace 2/3/37 161 839 Clearance Order made. Boathouse Walk 30/7/37 25 110 Clearance Order not yet made. Cleared site to be conveyed to Borough Council for open space purposes. TOTALS 910 4,271 The stage has now been reached when it seems appropriate to invite your Committee to review the question of clearance operations in the Borough with a view of sanctioning the preparation of a further insanitary areas programme on similar lines to the programme which has received attention. In my opinion it is impossible to prepare a clearance area programme to operate from a given date which, on completion, would dispose of every unfit house in the Borough. As I see the position, these operations must continue until a standard is reached below which a dwelling of a type suitable for working-class occupation can be said to be unfit, no longer exists. It is obvious that working-class houses in the Borough built shortly after those which have been the subject of clearance area procedure, and possessing similar undesirable features of construction, which at the present time yield to repair treatment, must sooner or later fail to conform to a satisfactory standard. Accordingly my departmental procedure in this matter has been to cause periodical housing surveys to be carried out, and to keep records of "potential" clearance areas for official action at the appropriate time. There are at least a dozen small areas in Camberwell involving approximately 125 dwelling houses of an age and type similar to those previously dealt with within the terms of the Housing Acts, which at some time or other during the course of the next five years should be considered for action in accordance with the provisions of Section 25 of the Housing Act, 1936. In this connection, I am prepared to submit official representations forthwith in respect of three of these areas, that the dwelling houses therein are unfit for human habitation. It should be remembered that before a Medical Officer of Health represents an area for clearance purposes, he must satisfy himself that the most satisfactory method of dealing with the conditions in the area is the demolition of all the buildings in the area. Finally, I deem it necessary to refer to the obligation which devolves upon the Council to provide re-housing accommodation for persons to be displaced from working-class houses. The previous Council made an arrangement with the London County Council to supply such accommodation on payment by this Council of the sum of £1 17s. 6d. per year for a period of 40 years for every dwelling provided. Your obedient Servant, H. W. BARNES, Medical Officer of Health. Individual Houses Repairable at Reasonable Cost. During the year 279 informal notices were served requiring repairs to be carried out at houses occupied by members of the working class, and in 35 cases the service of a formal notice under the provisions of Section 9 of the Housing Act, 1936, was necessary. The number of premises in the Borough repaired during the twelve months ended December last was 252 —190 as the result of informal action, 57 following the service of a formal notice, and in 5 instances by the Council carrying out the works in default of the owner. Underground Rooms. In 1934 a survey was carried out by the Sanitary Inspectors for the purpose of providing information as to the number of D 49 RECORD OF WORK CARRIED OUT DURING THE YEAR BY THE COUNCIL'S HOUSING INSPECTORS. HOUSING ACT, 1936. Individual Unfit Houses. Underground Rooms and Parts of Premises. Clearance Areas. Miscellaneous Visits. Section 11. Section 9. Section 12. Inspns. Re-Inspns. Re-Ingpns. Inspns. Re-Inspns. Inspns. Re-Inspns. Inspns. 384 888 316 183 272 3,264 16 66 52 Noticed Served, Section 9. Houses repaired, Sections 9 and 10. Houses Demolished. Following Informal Notice. Following Formal Notice. By Council in Default of Owners. Formal. Informal. Clearance Areas. Section 11. 279 35 5 190 57 124 7 underground rooms in the Borough used for living and/or sleeping purposes when it was found that there were 5,273 such rooms in Camberwell. Of these there were 557 cases where the height of the room was less than 7 ft., and 90 instances where the occupation of the room infringed the provisions of the Public Health (London) Act. The sanitary defects usually found in underground rooms which render their use undesirable for these purposes are dampness owing to the absence of damp-proof courses and concrete over-site, inadequate natural lighting and ventilation due to the height of the rooms, size and positioning of windows, and an impure atmosphere caused by the entry to the rooms of dust and other impurities from the street level. During the period covered by this Report action has been taken and is continuing in respect of rooms under 7 ft. in height in use for human habitation. In view of present unsatisfactory lack of uniformity of procedure which is largely due to uncertainty arising from the varying opinions regarding the interpretation of the definition of an underground room, as well as the different standards to be found in individual regulations relating to underground rooms, the Metropolitan Boroughs' Standing Joint Committee has invited the Town Clerks' Association and the Medical Advisory Body to the Metropolitan Boroughs' Standing Joint Committee to put forward suggestions which would lead to a uniform manner of dealing with underground rooms in London to replace the widely diverse procedures now adopted by the individual Borough Councils. Parts of Premises not Repairable at Reasonable Cost. The Council made a closing order in one case prohibiting the use of part of one dwelling house which was certified to be unfit for human habitation. Common Lodging Houses. There is only one common lodging house in the Borough, at 124, Camberwell Road, which is licensed for 228 male persons. During 1937, sixty inspections were made of this lodging house including one night inspection. Houses Let in Lodgings. The number of houses on the register at the close of the year was 245. The number of inspections of these premises was 112 and 50 notices were served for nuisances and contraventions of the By-laws. Housing Applications. During the year 578 applications were received for housing accommodation on London County Council estates and were forwarded to that authority for attention. These applications were to abate overcrowding in 351 instances and the remainder were recommendations for preferential consideration for rehousing on the grounds of ill-health and/or unhealthy housing conditions. At the close of the year 222 of these applications had been satisfactorily dealt with by the L.C.C. There were also 311 applications received during 1937 for housing accommodation in properties owned by this Council. Overcrowding. It became necessary during the year to make arrangements for room measurements of approximately 28,000 houses in view of July Ist, 1937, being fixed as the " appointed day " under the provisions of Part IV of the Housing Act, 1936, so as to enable information as to the number of persons constituting the permitted number entitled to occupy working class dwelling houses to be made available for owners and occupiers on request. These duties involved the appointment of a temporary staff of measuring assistants and clerks for a period of approximately five months. The Council also authorised the display of posters throughout the Borough outlining the overcrowding provisions of the Housing Act, and the publication of a leaflet for distribution for the information of owners and occupiers of working class dwellings. In view of the large number of enquiries from tenants and other persons for information as to their rights and duties under the provisions of the Housing Act which the Council anticipated would be received, arrangements were made for the use of a room on the ground floor of the Town Hall as an enquiry office for this purpose and for similar enquiries such as those with regard to the application of the Rent and Mortgage Interest (Restrictions) Acts. SUMMARY OF NOTICES SERVED. PUBLIC HEALTH (LONDON) ACT, 1936 District No. 1. 2. 3. 4. 5. 6. 7. 8 & 10. 9. 11. 12. Miss F. O'Riordan. W. T. Worsfold. D. V. Watkins. G. N. Topping. H. R. Weaver. D. H. Pickard. L. W. Burrell. - H. Attwater. W. Gilchrist. M. L. Malins. F. Maughan. M. Malins. Intimations, Public Health (London) Act; By-laws, etc. 613 473 725 797 430 716 448 905 502 440 154 57 Statutory Notices do. do. 263 124 180 192 175 224 152 385 213 188 43 7 Public Health (London) Act, 1936 (Part 2) - - - 8 4 - - 3 - - - - 1 1 Section 4, Housing Act, 1936 6 14 1 1 3 6 5 21 2 4 Promises in respect of which notices were served and complied with during 1937, including notices which were outstanding at December 31st, 1936 671 610 489 395 1,058 448 462 248 55 635 475 459 Premises in respect of which works in compliance with notices served during the year 1937, were outstanding at December 31st, 1937 109 56 156 75 136 127 137 190 109 69 43 13 54 55 SANITARY INSPECTOR'S SUMMARY OF WORK CARRIED OUT DURING THE YEAR 1937. 1. 2. 3. 4. 5 6. 7. 8 & 10. 9. 11. 12. District No. H. Attwater. D. V. Watkins. w. Gilchrist. G. N. Topping. L. W. Burrell. H. R. Weaver. D. H. Pickard. F. Maughan. M. L. Malins. M. Malins W. T. Worsfold. O'Riordan. (Miss F.) Totals. Description of Sanitary Improvements effected during the Year — Number of rooms cleansed 275 218 313 299 228 297 194 466 211 183 83 28 2,795 Defective roofs repaired or rainwater pipes provided or repaired 192 122 195 182 150 175 239 136 143 42 149 2 1,727 Dampness abated 139 53 185 186 2 1,742 151 241 111 340 143 116 75 Yards and forecourts paved or paving repaired 71 6 63 80 52 36 44 110 91 59 12 - 624 Water fittings repaired 47 71 66 45 36 65 60 65 56 39 11 10 571 Drains entirely reconstructed 17 15 7 1 2 32 10 9 2 11 16 - 122 Drains partially reconstructed 62 19 20 8 46 100 28 50 20 69 55 - 477 Soil, vent pipes, sinks and waste pipes renewed or repaired 104 56 93 61 42 128 130 89 104 48 - 59 914 Premises in which repairs were effected to w.c.'s 158 147 166 186 81 162 90 229 126 128 33 24 1,530 84 89 128 162 26 128 45 104 55 51 16 2 890 Dustbins provided Repairs effected to windows 149 63 233 166 59 222 58 257 107 74 26 4 1,418 Stoves and coppers repaired 99 49 75 91 61 84 53 214 74 59 8 - 867 Flooring repaired or renewed, repairs to woodwork (stairs, etc.) 105 40 121 112 5 2 94 184 53 57 16 44 4 883 Ventilation and lighting improved 7 4 4 2 12 6 8 5 6 1 55 - - 20 12 14 Offensive accumulation removed 14 3 10 14 7 16 3 1 - 114 Miscellaneous repairs and improvements effected 178 51 112 266 62 158 102 259 138 126 44 9 1,505 1,701 1,002 1,791 1,863 1,058 1,950 2,684 1,318 487 85 1,056 1,239 16,234 Total repairs and improvements effected Inspections— Following complaint 579 557 420 863 334 361 187 31 5,454 514 399 529 680 80 70 48 9 108 133 25 - 866 House-to-house —(1) Where defects found 93 57 96 147 1 1 31 8 35 4 - 257 (2) Where no defects found 15 59 4 83 16 92 123 88 110 81 43 49 13 888 On occurrence of infection 72 106 47 64 Houses divided into separate tenements 17 34 10 - 2 2 12 3 16 12 - 4 112 Factories 44 70 62 93 12 81 23 41 36 37 15 268 782 13 27 32 24 31 30 25 128 587 Workshops 80 55 58 84 Workplaces 29 29 15 14 5 44 13 76 34 7 8 127 401 Rent (Restrictions) Act - 3 4 2 2 6 2 7 - 1 2 - 29 58 39 14 7 1 8 46 - 208 New buildings 16 8 9 2 48 110 95 133 88 97 74 - 1,158 Milk premises 82 78 105 248 Offensive trades 5 2 3 19 - - - - - - - 29 - - - - - - 617 617 Outworkers' premises - - 1 - - - Rag and bone dealers 6 3 1 15 - 9 2 3 - 1 - 207 40 Conveniences (public and private) 44 47 16 225 89 58 112 35 26 63 83 207 1,005 1 5 35 Schools - - - - - - - - - 41 33 5 70 4 156 60 28 - 490 Shops Act 9 42 57 26 118 Pharmacy and Poisons Act 6 17 3 15 7 6 12 1 25 25 1 - Child Life Protection 2 2 1 1 2 2 8 8 11 1 - 38 - 60 Common lodging houses 47 10 - - - 3 - - — - — - Miscellaneous 205 97 225 207 366 232 370 78 173 79 64 708 2,804 Housing Act, 1936—re Overcrowding 348 554 772 636 372 370 463 192 505 508 388 - 5,108 1,634 1,672 2,017 2,561 1,761 1,745 1,815 1,602 1,641 1,502 2,138 1,004 21,092 Total Inspections 3,400 2,634 2,836 3,344 2,932 3,336 2,567 3,874 2,593 3,121 34,243 3,103 503 Re-inspections, calls, etc. Smoke observations 15 9 3 - 7 26 2 18 1 - - - 81 Housing Statistics, 1937. 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) 8,684 (6) Number of inspections made for the purpose 27,279 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,123 (b) Number of inspections made for the purpose 3,802 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 89 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation, and Intimation Notices served 3,830 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 —Public Health (London) Act 504 3. Action under Statutory Powers during the Year : — (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: — (1) Number of dwelling houses in respect of which notices were served requiring repairs 279 (2) Number of dwelling houses which were rendered fit after service of — Informal notices 190 Formal notices 57 (a) By owners 247 (b) By Local Authority in default of owners 5 (b) Proceedings under Public Health Acts :— (1) Number of dwelling houses in respect of which statutory notices were served requiring defects to be remedied 2,146 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (a) By owners 2,331 (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936 :— (1) Number of dwelling houses in respect of which Demolition Orders were made Nil (2) Number of dwelling houses demolished in pursuance of Demolition Orders 7 (d) Proceedings under Section 12 of the Housing Act, 1936 :— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 9 (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, 1936, Part IV. Overcrowding :— (a) (i) No. of houses overcrowded at the end of the year 1,688 (ii) No. of overcrowded families dwelling therein 1,799 (iii) No. of persons in such families Actual 10,972 Equivalent 9,834 (6) No. of new cases of overcrowding reported during the year *38 * 35 of these cases were due to children in the family attaining the age of one or ten years. The remaining three were fresh cases and were reported to the Public Health Committee, who directed that notices be served on the landlord and occupier in each case. One of these overcrowded families subsequently removed. (c) (i) No. of cases relieved by action of the London County Council on behalf of the Local Authority 159 (ii) No. of cases relieved by action of the Borough Council 2 (iii) No. of persons concerned in such cases Actual 935 Equivalent 786 (d) Particulars of cases in which dwelling houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding : — One overcrowded family was re-housed by the London County Council following a recommendation by this Authority. The vacated premises again became overcrowded and the Public Health Committee directed that notices be served upon the landlord and occupier requiring the abatement of the offence. A recommendation for rehousing accommodation for this family was subsequently forwarded to the London County Council. SUMMARY OF LEGAL PROCEEDINGS, 1937. Dist. No. Address. Complaint. Magistrate's Decision. 11 6, Constance Road Sanitary defect Withdrawn. Work done. 6 23, Ledbury Street Do. 21 days' Order. 18, Haymerle Road Do. Withdrawn. Work done. 6 11 246, Lordship Lane Do. Do. 5 151, Cronin Road Do. 21 days' Order. 10, Cronin Road 5 Do. Withdrawn. Work done. 6 36, Garsdale Road Do. Do. 11 58, Landcroft Road Do. Do. 11 320, Crystal Palace Road Do. Do. 9 75, Fenwick Road Do. Do. 9 66, Crystal Palace Road Do. Do. 9 181, Crystal Palace Road Do. Do. 9 185, Crystal Palace Road Do. Do 9 191, Crystal Palace Road Do. Do. Do Withdrawn. 1 64, Wyndham Road 421, Rotherhithe New Rd. Do. Withdrawn. Work done 4 5 13, Cronin Road Do. Do. 4, Alder Street Do. Do. 5 1 131, Farmers Road Do. Do. 8 30, Atwell Road Do. Do. 8 30, Atwell Road Do. Do. 2 219, Camberwell Road Do. 21 days' Order 11 279, Crystal Palace Road Do. 14 days' Order. 9 3, Solway Maisonettes Do. Withdrawn. Work done. 42, Goldsmith Road Do. Do. 6 6 68, Bird-in-Bush Road Do. Do. 7 27, Choumert Square Do. Do. 30, Choumert Square Do. 7 Do. 12 223, Dunstans Road Do. 14 days' Order. 6 3, Naylor Road Do. Withdrawn. Work done. 5 19, Stanton Street Do. 7 days' Order. 1 68, Crawford Road Do. Withdrawn. Work done. SUMMARY OF LEGAL PROCEEDINGS, 1937—continued. Address. Complaint. Magistrate's Decision. Fine. Costs. Dist. No. £ s. d. £ s. d. 4 409, Rotherhithe New Rd. Withdrawn. Work done. - 13 6 Sanitary defect 39, Cator Street 14 days' Order. - 5 Do. 1 1 0 Withdrawn. Work done. - 11 296, Crystal Palace Road Do. 13 6 3 228, Rolls Road Do. Do. - 13 6 Do. - 5 53, Cator Street Do. 13 6 Do. 6 49, Friary Road Do. - 13 6 7 days' Order. 6 Do. - 23, Garsdale Road 1 1 0 8 Do. Withdrawn. Work done. 4, Sunwell Street - 13 6 9 25, Waghorn Street Do. Do. 13 6 - Dismissed under P. of 0. Act. 19, Stanton Street Non-compliance with Magistrate's Order - 5 - 12 Sanitary defect Withdrawn. Work done. - 109, Overhill Road 13 6 Do. 86, Landcroft Road Do. - 13 6 11 421, Rotherhithe New Rd. Do. 4 Do. - 13 6 4 423. Rotherhithe New Rd. Do. Do. - 13 6 5 21, Stanton Street Non-compliance with Magistrate's Order Dismissed under P. of 0. Act. - - 7 61, Choumert Road Sanitary defect Withdrawn. Work done. - 13 6 3 Sanitary defect Withdrawn. Work done 38, Sandover Road 13 6 - 1 24, Crown Street Do. 14 days' order - 1 1 0 16, Canal Street Do. Withdrawn. Work done. - 2 13 6 - 2 18, Sears Street Do. 13 6 Do. 5, Devonshire Terrace Do. - 1 1 0 9 14 days' Order. Withdrawn. Work done. 7 207, Camberwell Grove Do. - 13 6 Do. 13 6 7 17, Lyndhurst Grove Do. - 28 days' Order. 48, Garsdale Road - 1 9 0 6 Do. 21 days' Order. 4 11, Clifton Crescent Do. - No costs owing to poverty. Do. 246, Lordship Lane - 11 Withdrawn. Work done. 13 6 13 6 11 240, Lordship Lane Do. Do. - Non-compliance with Magistrate's Order 5 0 0 11 279, Crystal Palace Rd. - - 23, Garsdale Road Do. 6 Dismissed under P. of 0. Act. - 10 6 Sanitary defect 7 9, Fearnley Road Withdrawn. Work done. - 13 6 SUMMARY OF LEGAL PROCEEDINGS, 1937—continued. Dist. No. Address. Magistrate's Decision. Fine. Costs. Complaint. __ £ s. d. £ s. d. 3 3 0 5 39, Cator Street Non-compliance with Magistrate's Order 3 0 0 - 3 22, Calmington Road Sanitary defect 14 days' Order. 1 9 0 - 32, South Grove Do. Do. 1 1 0 7 - 13 6 Do. 5 92, Cator Street Withdrawn. Work done. - 10 15, Gibbon Road Do. Do. 13 6 - 10 15, Gibbon Road Do. Do. 13 6 - 47, Garsdale Road 14 days' Order. 1 9 0 6 Do. - 3 24, Calmington Road Do. Do. 1 9 0 - 11 51, Herne Hill Failure to deposit plans Distress, 12.10.37. House empty—no trace. 2 0 0 1 1 0 - 2 0 0 2 2 0 3 22, Calmington Road Non-compliance with Magistrate's Order 20, Calmington Road 3 Sanitary defect Work done, order for costs. 1 9 0 - 20, Calmington Road Neglecting to supply dustbin - 2 0 0 2 2 0 3 51, Goodrich Road Withdrawn. Work done. 13 6 11 Sanitary defect - 11 49, Goodrich Road Do. Do. 13 6 - 48, Garsdale Road Non-compliance with Magistrate's Order. 1 0 0 1 1 0 6 21 days' Order. 1 1 0 11 107, Holmdene Avenue Sanitary defect 21 days' Order. - 5 122, Gloucester Road Do. Work done. Order for costs. 1 1 0 - - 47, Garsdale Road 5 0 0 6 Non-compliance with Magistrate's Order 2 2 0 13 6 10 24, Tresco Road Sanitary defect Withdrawn. Work done. - 10 1, Mays Place Do. Do. 13 6 - Do 6 102, Furley Road Do. 13 6 - Do. 104, Furley Road Do. 13 6 6 - 102, Woodland Road 12 Do. Do. 13 6 - 6 47, Garsdale Road Non-compliance with Magistrate's Order 7 0 0 2 2 0 - 2 0 0 6 48, Garsdale Road Do. - - 54, Warrior Road Withdrawn. Work done. - 1 Sanitary defect 13 6 54, Warrior Road 1 Dustbin Do. 13 6 - 6, Sultan Terrace 1 0 0 1 Do. - - 44, Garsdale Road Withdrawn. Work done. 6 Sanitary defect - 13 6 INSPECTION AND SUPERVISION OF FOOD. Supervision of Food. There are two officers of the Council whose duties are mainly concerned with the supervision of food—the Food and Drugs Inspector and Sampling Officer and the Food Inspector. Broadly speaking, the duties of these appointments are divided as follows : the former officer being responsible for obtaining samples of food and drugs for analysis and the latter the supervision of premises in which food is stored, sold or prepared for sale. Chemical and Bacteriological Examination of Food. The chemical and bacteriological analyses of samples submitted under the provisions of the Food and Drugs (Adulteration) Act, 1928, and the various Food Regulations were conducted by the Public Analyst, Mr. Martin Priest, F.I.C., and by the Council's Bacteriologist, Dr. G. Bousfield respectively. Particulars of the samples analysed appear on pages 66 and 67. Nutrition. Knowledge of the subject of nutrition is conveyed to the residents of the Borough by the general distribution of a leaflet entitled " The Housewife and her food problems " and by diet sheets prepared by Clinic Medical Officers for circulation to mothers attending the Infant Welfare Centres. Milk Supply. In previous Annual Reports I have referred to the necessity for compulsory pasteurisation as an effective measure of protection against contamination of milk from human and other sources. In view of the importance of ensuring a safe milk supply, it is hoped that in the near future legislation will be passed enabling local authorities to require the efficient pasteurisation of milk sold by retail in its area. The inspection of dairies and milkshops is undertaken by the District Sanitary Inspectors. There is one cowhouse in the Borough licensed for 47 cows. The bulk of the milk produced at this establishment is retailed to families living in close proximity to these premises. The cowhouse and the attached dairy were inspected on 12 occasions during the year, usually while milking was in progress. Milk and Dairies Order, 1926. Under the provisions of this Order a register is required to be kept of all persons in the Borough carrying on the trade of cowkeeper, dairyman or purveyor of milk and all premises used as dairies. The following summary shows the comparative state of the register at December 31st, 1936 and 1937. 1936. 1937 Cowkeepers 1 1 Cowsheds 1 1 Dairies and Milkshops 335 333 Dairymen with premises in the Borough 351 349 Dairymen with premises outside the Borough 27 13 205 215 Purveyors of milk in sealed bottles Routine inspections of all premises on the Council's register are made from time to time and the number of such inspections carried out in 1937 was 1158. It was necessary to serve notices requiring cleansing and repairs to be carried out at 15 premises as a result of the Inspectors' visits. Composition of Milk Samples. Of the 613 samples taken during the year 26 (4.24 per cent.) were found to be not of the substance, nature or quality demanded by the purchaser. Included in this total were 61 samples of pasteurised milk taken in course of delivery to St. Giles', Dulwich, and St. Francis' Hospitals, and the various L.C.C. Schools in the Borough. With the exception of one sample taken of a school supply, all were reported as genuine. Milk (Special Designations) Order, 1936. The licences issued by the Council under this Order during the year were as follows:— Principal Licences. Supplementary Licences. Licences to sell Tuberculin Tested Milk 28 - „ „ „ Accredited Milk 1 - „ „ „ Tuberculin Tested Milk, Pasteurised 6 - 93 „ „ „ Pasteurised Milk - „ „ „ Tuberculin Tested - 3 - „ „ „ Pasteurised 4 Milk Adulteration. The percentage of adulteration of formal samples, i.e. 4.24, is the highest recorded during the past 17 years. Ten samples were reported against owing to the fat content being below the standard of 3 per cent., and 16 owing to the presence of added water. Of the former, the deficiency of fat varied from 5 to 55 per cent., and of those containing added water, five samples each contained 1 per cent.; one, 1.30 per cent.; five, 2 per cent.; one, 2.8 per cent. ; two, 4 per cent. ; and two, 19 and 20 per cent, respectively. (See Table " B.") One informal sample was certified to contain 14 per cent, of added water, and was submitted for analysis, in conjunction with formal Samples Nos. 448 and 449. (See Table " B.") Although in the majority of the above cases, the amount of added water was very small, it should be borne in mind that the presence of any extraneous water is estimated on genuine milk containing the minimum amount of non-fatty solids permitted, viz., 8.5 per cent. As genuine milk, almost without exception, contains a higher percentage of non-fatty solids than 8.5 per cent., it is only reasonable to assume that a far greater quantity of water had been added to the samples in question than the figures indicate. The samples containing extraneous water were sold as follows : Six from open receptacles, 10 from sealed bottles, and those found to be deficient in fat, from open receptacles 4, and from sealed bottles, 6. Following the practice adopted for many years of informing retailers when samples obtained from them Were reported as genuine, 628 notifications were sent to vendors during the year under review. Bacteriological Examination of Milk. The manner of carrying out the tests to ascertain the number of bacteria and the number of coliform organisms present in bacteriologically examined samples was in accordance with the method laid down in Memorandum 139 (January, 1937) —Foods. During the year 61 samples of Pasteurised milk were taken for the purpose of ascertaining whether they complied with the bacteriological standards laid down by the Milk (Special Designations) Order, 1936. Of these 25 samples were taken in course of delivery to schools. All the samples complied with the required standards. Four samples of tuberculin tested milk were submitted for examination with the results as set out in the following table:— Satisfied or did not satisfy Methylene blue test. Sample Marked. Absence or presence of Coliform bacillus in 1/100 th millilitre. Satisfied or did not satisfy the coliform test. Present in 1 tube. No. 1 Satisfied. Satisfied. No. 2 Do. Do. Do. No. 3 Do. Not found. Do. No. 4 Do. Do. Do. 63 Bacteriological Examination of Other Milk. No bacteriological standard exists for ungraded milk and two such samples were taken during the year with the following results:— Date Sample obtained. No. of bacteria per millilitre. November 4th, 1937 1,900 November 8th, 1937 5,200 Examination of Milk for the Presence of Tubercle Bacilli. Five samples of raw milk including one from the dairy attached to the licensed cowhouse in the Borough and one ungraded milk were examined by means of the animal test for the presence of Tubercle Bacillus. In no instance was the presence of this Bacillus reported. Bacteriological Examination of Ice Cream. No standard either chemical or bacteriological has yet been prescribed for ice cream. The practice of issuing a Memorandum to manufacturers and vendors of ice cream outlining suggestions for adoption as a means of preventing contamination was continued throughout the year. Six samples of this commodity were submitted for bacteriological examination with the following results: — Sample Marked. Date Obtained. Where Purchased. Bacteria per c.c. Presence of Bacillus Coli. No. 1 390,000 Present in 1/100th c.c. July 29th Shop No. 2 July 29th 190,000 Present in 1/10th c.c. Shop No. 3 July 29th Barrow in a public thoroughfare. 1,300,000 Absence in 1/10th c.c. Present in 1/100th c.c. No. 4 180,000 July 29th Shop 430,000 No. 5 July 29th Shop Present in 1/10th c.c. No. 6 July 29th Shop 1,600,000 Present in 1/100 th c.c. Food and Drugs Adulteration. The number of food samples taken (formally) under the Food and Drugs (Adulteration) Act, 1928, was 989, of which 43 or 4.3 per cent, were certified by the Public Analyst to be adulterated. Thirty-four informal samples were also analysed of which 4 or 11-76 per cent, were reported against. A description of the articles of food submitted to the Public Analyst for analysis appears in Table " A." In Table "B" on pages 68-71 a description of the formal and informal samples found to be adulterated is given and the result of proceedings or other action taken in connection therewith. Artificial Cream Act, 1929. This enactment provides for the regulation of the manufacture and sale of artificial cream. No application for registration for the purpose of the sale of artificial cream was received during the year under review. Public Health (Condensed Milk) Regulations, 1923 and 1927. During the year four samples of condensed full cream milk sweetened were taken and in each case the sample complied in every respect with these regulations. Butter Factories. Wholesale Dealers in Margarine. No application for registration, under the provisions of the Food and Drugs (Adulteration) Act, 1928, was received during the year. At the end of 1937 there were 19 wholesale dealers in margarine on the register of this Authority. Public Health (Dried Milk) Regulations, 1923 and 1927. One formal sample of dried full cream milk, and one informal sample of dried half cream milk were submitted for examination during the year, 1937. Both samples were found to conform to the prescribed composition. Public Health (Preservatives in Food) Regulations, 1925-1927. With few exceptions all samples taken under the Food and Drugs (Adulteration) Act were examined by the Public Analyst for the presence of preservatives. Seven samples of sausages were found to contain a permitted preservative, viz., sulphur dioxide. In each of these cases the amount of the preservative was below the maximum allowed, viz. 450 parts per million, but the provisions of the Regulations had not been complied with inasmuch as the purchaser was not given notice of the presence of a preservative. All other samples taken for analysis under these regulations were reported free from any preservative. Agricultural Produce (Grading and Marking) Act, 1928. No legal action was found necessary during the year under review in regard to the various orders made by the Minister of Agriculture and Fisheries for the grading and marking of agricultural produce of England and Wales. Merchandise Marks Act, 1926. Frequent inspections were made during the year to ensure that the requirements of the Orders in Council were being observed prohibiting the sale or exposure for sale in the United Kingdom of imported foodstuffs unless bearing an indication of the Country of origin. In the comparatively few instances where foodstuffs were exposed for sale, and not properly marked, written and verbal cautions were given. E 65 TABLE "A." Formal and Informal Samples submitted for Analysis tor the year ended December 31st, 1937. Article. Number Adulterated, etc. Percentage of Adulteration. Number Examined. Formal. Informal. Private. Total. Formal. Informal. Private. Total. Formal. Informal. 613 4 617 1 27 4.24 25.00 Milk 26 - - 88 1 - 89 4 - - 4 4.54 - Butter 41 2 43 - - Lard - - - - - 3 - - 3 9.09 - 33 2 35 Wood Vinegar - 33 5 29 2 2 - 4 8.33 40.00 - Malt Vinegar 23 1 24 - - - - - - Margarine - 18 - 18 - - - - - - - Self-Raising Flour 11 - 11 - - - - - - White Pepper - 9 - - 9 Fishpaste - - - 7 77.77 - 66 9 - - 9 7 - - 7 77.77 - Sausages (Beef) 9 - - 9 Tea - - - - - - Ground Almonds 8 - 8 - - - - - - - - - Dripping 8 - - 8 - - - - - - - - - Cream 6 - - 6 - 6 - - 6 - - - - - Cornflour - - - - - - - 6 1 - 7 Cocoa 5 - - 5 - - - - - Coffee - - - - - - Raspberry Jam 5 - - 5 - 1 - 2 20.0 12.50 5 8 - 13 1 Whisky 4 - - 4 - - - - - - Condensed Full Cream Milk, sweetened Rice 4 - - 4 - - - - - - 4 1 5 - - - - - - Camphorated Oil - 3 - - - - - - Brawn 3 - - Baking Powder 3 3 - - - - - - - - Flour 3 - - 3 - - - - - - Custard Powder 3 3 - - - - - - - - Lemonade Powder 3 - - 3 - - - - - - - - - - - - - 3 - Arrowroot 3 2 - 2 - - - - - - - Shredded Suet Ground Ginger 2 - - 2 - - - - - - - - - - Sherbet 2 - - 2 - - - - - Lemon Cheese 2 - - 2 - - - 2 Olive Oil 1 3 Prescriptions - - - - - - - 2 1 - 2 - - - Strawberry Jam (Full Fruit Standard) - - - 2 - - 2 - - - - - - 1 - - 1 „ „ (Lower „ „ - - Gin 2 - - 2 - - - - Mixed Herbs - - - - - - 1 - - 1 - - "Gravy Thick" - - - - 1 - - 1 Cheese - - - - - - 1 - - 1 - - - Cake Mixture - - - 1 - - 1 Egg (Substitute) Powder - - - - - - 1 - - 1 - - Sultanas - - - - 1 - - 1 - - - - - Mincemeat (Fruit) 1 - - 1 - - Mustard - - - - - 1 1 - 2 Preserved Beef Sausages - - - - - - 1 - - 1 - Oxtail (Flavour) Soup Powder 1 - - 1 - - - - - Lard Substitute - - - - - 1 - - 1 - - Dried Full Cream Milk - - - - - 1 - - 1 Citrate of Magnesia - - - - - - 1 - - 1 Epsom Salts - - - - - - 1 - - 1 - - - - Compound Liquorice Powder 1 - - 1 - - - - - - - - Tinned Fish - 2 2 - - - - - - Half-Cream Dried Milk - 1 - 1 - - - - - - - Grouna Almonds Substitute - 1 - 1 1 - - - 67 Rum - 3 - 3 - - - - - - - - 989 34 - 43 4 - 47 4.34 11.76 1,023 68 69 TABLE " B" SAMPLES ADULTERATED, Etc. Nature of Adulteration or Irregularity. Serial No. Article. Whether Formal, Informal or Private. Observations. Result of Proceedings or other Action taken. 6 Milk Informal Sample contained 14 per cent, of added water. See formal Samples Nos. 448 and 449 - Formal 27 per cent, of the original fat of the article abstracted. Summons dismissed under the Probation of Offenders Act. Defendant to pay £1 Is. costs. 2 Do. - Previously cautioned Defendant fined £2 and £1 Is. costs. Do. Do. Sample contained 4 per cent, of added water. 15 Sample contained 1.3 per cent, of added water. 34 Do. 80. - Caution. Resolution of the Public Health Committee. - Do. Sample contained 2.0 per cent, of added water. 87 Do. Do. Do. - 10 per cent, of the original fat of the article abstracted. Do. Do. Defendant fined 10s. and 10s. 6d. costs. 120 - Sample contained 1.0 per cent, of added water. 232 Do. Do. Caution. Resolution of the Public Health Committee. - 22 per cent. of the original fat of the article abstracted. Do. Defendant fined £1. 240 Do. - Sample contained 1-0 per cent, of added water. Do. Do. Caution. Resolution of the Public Health Committee. 249 Do. Sample contained 1.0 per cent, of added water. - 264 Do. Do. Do. - Do. Do. Sample contained 2.0 per cent, of added water. Do. Do. 312 - Sample contained 1.0 per cent, of added water. Do. Do. Do. Do. 313 - 55 per cent, of the original fat of the article abstracted. 322 Do. Do. Defendant fined 10s. and 10s. 6d. costs, - Do. 40 per cent, of the original fat of the article abstracted. Defendant fined 10s. and 10s. 6d. costs. 405 Do . Same defendant Do. Do. Sample contained 19 per cent, of added water. Defendant fined £10 and £2 2s. costs. 448 Previous convictions. Sample contained 20 per cent, of added water. 449 Do. Do. Defendant fined £10. Do. - Caution. Resolution of the Public Health Committee. 451 Do. Sample contained 1.0 per cent, of added water. Previous convictions. Do. Do. 5 per cent, of the original fat of the article abstracted. Defendant fined £1 and £1 1s. costs. 525 Do. Sample contained 2.0 per cent, of added water. - 526 Do. Caution. Resolution of the Public Health Committee. - Sample contained 2.0 per cent, of added water. Do. Do. Do. Do. 543 - Do. Do. Sample contained 4.0 per cent, of added water. Summons dismissed under the Probation of Offenders Act. Defendant to pay £1 Is. costs. 601 - Sample contained 2-0 per cent, of added water. Caution. Resolution of the Public Health Committee. 620 Do. Do. - Do. Do. 8 per cent, of the original fat of the article abstracted. Do. Do. 644 - 8 per cent, of the original fat of the article abstracted. Do. Do. Defendant fined £1 and £1 1s. costs. 666 - Do. 11 per cent, of the original fat of the article abstracted. Caution. Resolution of the Public Health Committee. 790 Do. 70 71 TABLE "B" SAMPLES I ADULTERATED -continued. Whether Formal, Informal or Private. Serial No. Article. Nature of Adulteration or Irregularity. Observations. Result of Proceedings or other Action taken. 842 Milk Formal Sample contained 2.0 per cent, of added water. Caution. Resolution of the Public Health Committee. - Do. 892 Do. 20 per cent, of the original fat of the article abstracted. - Simmons dismissed under the Probation of Offenders Act. Defendant to pay 10s.6d. costs. Informal Whisky 3 38.5 degrees under proof. See Formal Sample No. 60. - Formal 60 Do. 36.5 degrees under proof. - Summons issued, but not served. Unable to trace defendant, 80 Butter Do. Sample contained 1.9 per cent, of excess water. - Caution. Resolution of the Public Health Committee. Do. 109 Do. Sample contained 1.5 per cent, of excess water. - Do. 233 Do. Do. Sample contained 0.9 per cent, of excess water. Do. Do. - 374 Do. Do. Sample contained 2.o per cent, of excess water. - Do. Do. Beef Sausages 308 Do. Sample contained sulphur dioxide to the extent of 240 parts per million. Sold without notice of the presence of a preservative. Do. Do. Do. 347 Do. Sample contained sulphur dioxide to the extent of 180 parts per million. Do. Do. Do. Do. 388 Do. Sample contained sulphur dioxide to the extent of 171 parts per million. Do. Do. Do. Do. 396 Do. Sample contained sulphur dioxide to the extent of 98 parts per million. Do. Do. Do. Do. Do. Do. 865 Sample contained sulphur dioxide to the extent of 58 parts per million. Do. Do. Do. 887 Do. Do. Sample contained sulphur dioxide to the extent of 85 parts per million. Do. Do. Do. Do. 898 Do. Sample contained sulphur dioxide to the extent of 75 parts per million. Do. Do. Do. Wood Vinegar 321 Sample deficient in Acetic Acid to the extent of 3*7 per cent, of the amount that should have been present. - Do. Do. - Do. 512 Do. Sample deficient in Acetic Acid to the extent of 2.7 per cent, of the amount that should have been present. Do. Do. - Do. 772 Do. Sample deficient in Acetic Acid to the extent of 2-0 per cent, of the amount that should have been present. Do. Do. Malt Vinegar Informal Sample deficient in Acetic Acid to the extent of 20.0 per cent, of the amount that should have been present. 8 Same Vendor. Formal Sample No. 603 Genuine - 12 Do. Do. Sample 100 per cent. Vinegar, other than Malt Vinegar. - 324 Do. - Summons dismissed under the Probation of Offenders Act, Defendant to pay 10s. 6d. costs. Formal Sample contained 75 per cent, of Vinegar other than Malt Vinegar. - 391 Do. Do. A sample of Vinegar, other than Malt Vinegar. Defendant fined 10s. and 10s. 6d. costs. TABLE "C" Percentage of Adulteration of Formal Samples during the past five years:- Year. 1933 1934 1935 1936 1937 Percentage of Adulteration 2.44 1.80 3.64 2.66 4.34 TABLE "D" Percentage of Adulteration of Formal Samples of milk during the past five years:— Year. 1933 1934 1935 1936 1937 Percentage of Adulteration 1.57 1.42 3.62 2.09 4.24 SUMMARY. Formal samples submitted for analysis 989 Informal samples submitted for analysis 34 Formal samples adulterated, etc 43 Informal samples adulterated, etc. 4 Written cautions administered (Food and Drugs (Adulteration) Act, 1928) 21 Written cautions administered (Public Health (Preservatives in Food) Regulations, 1925/27) 7 Written caution administered (Merchandise Marks Act, 1926) 1 Summonses issued (Food and Drugs (Adulteration) Act, 1928) 15 RESULT OF PROCEEDINGS. Fines. Costs. Act, Regulation or Order under which proceedings were taken. No. of Summonses. s. £ d. £ d. s. Food and Drugs (Adulteration) Act, 1928 15 27 0 0 10 10 0 MEAT AND OTHER FOODS. Registration of Food Premises. The following is a summary of premises in the Borough which have been registered in accordance with the provisions of Section 187 of the Public Health (London) Act, 1936. Manufacturer of Ice Cream 185* Storage and Sale of Ice Cream 214 Manufacture of Sausages 163 Preparation or Manufacture of Potted or Preserved Meat or Fish 319 Cooked Meat Shops 156 Fishmonger Shops 58 Fried Fish Shops 89 * Ice Cream was not prepared or sold at 94 of these registered premises. All these premises were regularly inspected by the Food Inspector, and it was found necessary to serve 125 notices during the period January to December, 1937, in respect of unsatisfactory conditions existing at certain of these premises. Meat Regulations, 1924. These regulations provide that no person may slaughter an animal for sale for human consumption without first giving notice to the Council of his intention to do so ; they are also designed to protect meat from contamination in shops, on stalls and during transit. A register is kept of all meat vendors and the number of entries appearing in this register at the end of 1937 was 163. Regular visits of inspection to these premises and stalls were made during the year. There were no infringements of the regulations to record which justified the institution of legal proceedings. Slaughterhouses. There are two licensed slaughterhouses in the Borough. Seventy-six inspections of these premises were made during the year while slaughtering was in progress. The number of animals slaughtered during the period January to December, 1937, totalled 523. Summary Showing the Number of Animals Slaughtered in 1937. Month. Cattle. Sheep & Lambs. Pigs. Calves. Totals. January 7 30 11 - 48 February 4 15 5 24 - March 2 19 57 78 - 2 April 20 21 43 - May 2 20 1 - 23 June 21 - 21 - - July - 6 1 7 - August - 10 10 - - September 1 50 18 31 - October 77 16 - 93 - November 4 71 - 1 76 December 3 7 40 50 - 293 205 1 523 Totals 24 The following table shows the number of organs condemned and destroyed and the diseases with which they were affected. Carcases Inspected and Condemned. Cattle, excluding Cows. Cows. Sheep and Lambs. Calves. Pigs. Number killed 24 Nil 1 293 205 1 Number inspected 24 Nil 293 205 Nil Nil Nil Nil All diseases except Tuberculosis. Nil Whole carcases condemned Carcases of which some part or organ was condemned 3 Nil 96 Nil 13 Percentage of the number inspected affected with disease other than tuberculosis 12.5 Nil Nil 32.7 6.3 Nil Nil Nil Nil 2 Tuberculosis only. Whole carcases condemned Carcases of which some part or organ was condemned 5 Nil Nil Nil Nil Percentage of the number inspected affected with tuberculosis Nil Nil 20.8 Nil 0.97 During the period covered by this report, 43 pigs were inspected, ante- and post-mortem, and were condemned and destroyed in accordance with the provisions of the Swine Fever Order, 1908, made under the Diseases of Animals Acts, 1894- 1903. Street Markets. The market stalls licensed to sell articles of food were periodically inspected, particularly on Saturday evenings. The nature of the food sold from these stalls is set out in the following table: — Fruit 51 Greengrocery 41 Salads 28 Fish 11 Groceries 12 Rabbits, Eggs and Poultry 9 Confectionery 7 Meat 1 Shellfish 1 Coffee Stalls 9 Total 170 Certification of Meat Food Products. The Medical Officer of Health in his capacity as Designated Officer for Food Inspection issued 26 certificates during the year ended 1937 in respect of food prepared in this Borough for export to America and Australia. Slaughter of Animals Act, 1933. The Council received and granted applications from two slaughtermen for licences to follow the occupation of a slaughterer of animals. Restaurants and Eating Houses. Routine inspections were carried out of premises where food is prepared for sale, such as bakehouses, the kitchens of restaurants, coffee shops, and public houses, and where action was necessary to remedy any unsatisfactory conditions existing at these premises, appropriate steps were taken by the Food Inspector. The total number of inspections of food premises of every description in the Borough was 8,515. Unsound Food. No instances arose during 1937 necessitating proceedings in respect of food which was deemed to be unfit for human consumption. The following articles of food were surrendered and destroyed at the Council's Depot. q. 1. T. c. FISH— Skate - 1 22½ Surrendered. Destroyed at Disinfecting Depot - - 1 22 ½ - FRUIT— ; Do. Do. Pulp 1 19 2 22 Do. Grapes - 12 Do. Do. - - Peaches - 7 1 0 Do. Do. Apples - 5 1 10 Do. Do. - 3 22 Do. Do. Strawberries - 2 13 1 10 MEAT— . Butcher's meat - 6 0 1 Do. Do. Offal - 5 1 2 Do. Do. Sausages - 2 0 0 Do. Do. Rabbit (cut) Do. Do. - 1 14 - - 13 2 17 J L TINNED FOODS— Condensed and Evaporated Milk 1,049 tins - 8 0 13 Do. Do. - 5¼ Do. Do. Fruit 1,547 tins 16 3 Fruit Salad 132 tins - 1 0 3 Do. Do. Fish 482 tins Do. Do. - 3 2 19½ Meat 25 tins - 1 3 4 Do. Do. Vegetables 111 tins - 1 0 1 Do. Do. Fish and Meat paste 1,052 tins - 1 3 3 Do. Do. Desiccated Whole Eggs 17 cases - 11 3 4 Do. Do. 2 5 3 24¾ POULTRY— _ Chicken - 4 Do. Do. - - - - 4 - MISCELLANEOUS— Vegetables (potatoes) Do. - Do. 1 3 21 Mayonnaise (356 bottles) Pickles (67 jars) Oats 16¼ Do. Do. 7 0 - 9 0 9¼ 6 2 2 3½ Summary of Work of Food Inspector for 52 Weeks ended December 31st, 1937. Complaints received 25 Complaints found to be justificd 10 Inspections : — Street markets 2,116 Bakehouses 236 Fish curers' premises 260 Fried fish shops 461 Ice cream premises 681 Restaurants and eating houses 582 Slaughterhouses 76 Other food premises 4,077 Carcases inspected 519 Organs inspected 1,151 Carcases condemned 2 Organs condemned 181 Inspections not defined 137 Re-inspections 545 Food surrendered (parcels of varying weights) 43 Certificates granted for Foodstuffs for export 26 Number of food premises defects found and remedied 172 Number of intimations served 125 Number of Statutory Notices served 3 - Merchandise Marks Order Imported Goods 33 Shops Act, 1934 18 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Notifiable Diseases. The following diseases are compulsorily notifiable to the Medical Officer of Health. Acute Polio-encephalitis. Membranous Croup. Acute Poliomyelitis. Ophthalmia Neonatorum. Anthrax. Plague. Cerebro-Spinal Fever. Pneumonia- Acute Primary. Cholera. Pneumonia— Acute Influenzal. Continued Fever. Puerperal Fever. Diphtheria. Puerperal Pyrexia. Dysentery. Relapsing Fever. Encephalitis Lethargica. Scarlet Fever or Scarlatina. Smallpox. Erysipelas. Food Poisoning. Tuberculosis. Typhoid or Enteric Fever. Glanders. Typhus Fever. Hydrophobia. Malaria. Hospital Accommodation for Infectious Diseases. In December, 1937, a communication was received from the London County Council stating that owing to the difficulty of securing nurses for infectious diseases in the number necessary to make full use of the accommodation provided in their hospitals, and in order that such accommodation as was available could be utilised to the greatest advantage, it was decided that until further notice the admission of patients suffering from scarlet fever, measles, whooping cough and dysentery to the Council's Hospitals should be limited to those cases in which hospital treatment was in the opinion of the Borough Medical Officer of Health required owing to the severity of the illness and/or the home conditions, and in the case of measles the age of the patient, having regard to the high mortality from this disease of children under two years of age. The terms of this communication were brought to the notice of every private medical practitioner practising in the Borough. Smallpox. There were no cases of smallpox notified in the Borough during 1937, neither was the Medical Officer of Health requested to perform any vaccinations under the Public Health (Smallpox Prevention) Regulations, 1917. Diphtheria. During the year there were 346 cases of diphtheria notified and every one of these patients was removed to an isolation hospital for treatment. Forty-five cases were subsequently found not to be suffering from the disease for which they Were admitted to hospital. The attack rate per 1,000 population was 1.33. The return cases numbered two. A "return case" is one which occurs in the same household within 28 days of the discharge from hospital or release from isolation of a patient certified to have recovered from the disease. The comparative figure of cases notified in 1936 was 278. The fatal cases numbered 13 giving a fatality rate of 4.3 per cent, as compared with 5.07 per cent, in 1936. Facilities for early diagnosis. The services of the Medical Officer of Health are placed at the disposal of private medical practitioners in a consultative capacity in doubtful cases. Throat and nose swabs forwarded to the Council's Research Laboratories, 134, Denmark Hill, S.E.5, are dealt with immediately up to midnight including Saturdays and Sundays. Anti-toxin is also available for distribution to general medical practitioners and can be obtained at any hour of the day and night from the Town Hall or during the day at the Dulwich Municipal Baths. I have previously referred to the importance of administering anti-toxin whenever this disease is suspected and to the necessity of not waiting for the result of the bacteriological report of the swab, when there are clinical signs and symptoms of the disease present. During the year 102 phials of 8,000 units and 27 phials of 500 units of anti-toxin were issued to medical practitioners. Diphtheria Carriers. Some children harbour virulent diphtheria bacilli for prolonged periods in their throat and nose and are a source of potential danger to persons with whom they come into contact. The London County Council has established special out-patient clinics at certain hospitals for the treatment of these cases. Diphtheria Immunisation Clinic. Facilities for immunisation treatment without any charge to the residents of Camberwell have been available in this Borough since 1926. This clinic is held weekly at the Mayward House Infant Welfare Centre and it is gratifying to note that the number of children who passed through the Clinic during 1937 constituted a record. An endeavour has recently been made to confer a degree of protection hitherto unattempted anywhere in dipththeria immunisation clinics. A course of three injections of Alum Precipitated Toxoid has been given to those attending in a dosage of 0.1 c.c., 0.3 c.c. and 0.5 c.c. at fortnightly intervals. In the past this substance has been extensively given as one or at the most two injections. Sufficient children have not yet been re-tested for an authoritative statement to be made, but results so far are most promising. It is hoped that a degree of immunity will be produced which will serve to protect children from even the most virulent forms of diphtheria infection. The older methods have been proved to protect quite adequately against the ordinary moderate forms of diphtheria attack, but occasionally the defence has broken down in the face of attacks by the more virulent strains of the organism. Time alone can prove how far the new method will succeed in its object, but theoretically there should be a marked improvement in the defence against grave diphtheria. Certificates are issued to the parents of children immunised and those found to be naturally immune to the disease. This certificate serves as a valuable guide to medical practitioners when they are asked to see patients with doubtful throats. The certificates read as follows:— This is to certify that the above-named child has been tested and immunised and is believed to be protected against 80 81 DIPHTHERIA IMMUNI- SATION CLINIC. RETURN OF 1 WORK, 1937. TABLE I.—AGES OF PERSONS SCHICK j| TESTED WITH RESULT OF tf.st ■ i i i i ' 14 to 5 yrs. 5 to 6 yrs. 6 to 7 yrs. 7 to 8 yrs. 6 to 12 mtha. 1to 2 yrs. 3 to 4 yrs. 8 to 9 yrs. 9 to 10 yrs. 15 yre. and above. 10 to 11 VIS. 11 to 12 yrs. 12 to 13 yrs. 13 to14 yrs. 14 to 15 yrs. 2 to 3 yrs. Total 18 64 47 69 62 33 31 15 9 18 9 5 3 3 22 50 458 Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Not read. Pos. Neg. Not read. Pos. Notread. Not read. Pos. Not read. Pos. Neg. Not read. Pos. Neg. Not read. Pos. Neg. Not read. POs. Neg. Not read. POB. Neg. Not read. Pos- Neg. Not read. Neg. Pos. Neg. Notread. Neg. Not read. Positive 365 Negative 74 Not read 19 Neg. Neg. Neg. Pos. Pos. 9 6 3 6 3 - 2 3 - - 3 - 2 1 2 8 13 3 60 2 2 44 2 1 45 4 1 61 4 4 1 51 9 2 22 20 1 24 7 - 9 5 1 7 2 - 1 15 - TABLE II.—IMMUNISATION TREATMENT TABLE. 6 to 7 yrs. 7 to 8 yrs. 8 to 9 yrs. 9 to 10 yrs. 6 to 12 1 to 2 2 to 3 yrs. 3 to 4 yrs. 4 to 5 yrs. 5 to 6 I yrs. 12 to 13 yrs. 13 to 14 yrs. 10 to 11 yr 114 to 15 yrs. 116 yrs, and above. 11 to 12 yrs. Totals 2nd „ 3rd „ 1st Injection. 3rd „ 1st Injection 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 3rd „ 1st Injection. 2nd „ 3rd „ 2nd „ 3rd „ 3rd „ 1st Injection 2nd „ 2nd „ 1st Injection. 2nd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 2nd „ 3rd „ 1st Injection. 1st Injections 365 2nd „ 325 3rd „ 264 4th „ 5 5th „ 1 8 8 7 6 6 5 2 2 1 - - 1 2 2 2 8 8 7 16 15 14 60 52 45 44 36 29 45 43 32 61 55 38 51 41 37 22 21 15 24 22 19 9 7 6 7 7 6 4th 3 I 4th 1 5th 1 I I 4th 1 ! □ I TABLE lII.—AGES OF PERSONS RE-SCHICKED AFTER TREATMENT AND FOUND TO BE NEGATIVE. 6 to 12 mths. 3 to 4 y rs. 5 to 6 yrs. 6 to 7 yrs. 15 yrs. and above. 7 to 8 yrs. 8 to 9 yrs. 9 to 10 yrs. 10 to 11 yrs. 11 to 12 yrs. 12 to 13 yrs. 13 to 14 yra. 14 to 15 yra. Total 1 to 2 yrs. 2 to 3 yrs. 4 to 5 yrs. 11 45 26 36 33 21 15 7 7 8 6 2 2 1 6 254 28 diphtheria. In the event of your being ill in the future and the doctor suspects you to be suffering from diphtheria, kindly draw his attention to this certificate, in order that he may acquaint the Medical Officer of Health or the Bacteriologist of the Borough in which you reside (without delay). For those persons found to be naturally immune a similar certificate is issued except that the words "and immunised" are deleted. Three cases of diphtheria were notified among children who had been immunised, viz. children who had received injections and were subsequently tested and found to be "Schick" negative. Diagnosis. Sex. Age. Treatment. Re-Schick test negative in 1935 (in Lambeth). Not severe attack + swabs. F. 7 Re-Schick test negative in 1936. Mild Diphtheria + swabs. M. 7 Re-Schick test negative in 1936. Modified Diphtheria. Only 1 +swab. Subsequently considered severe streptococcal tonsillitis. M. 4 The total attendances at the Council's Diphtheria Immunisation Clinic in 1937 was 2,061. A table recording the number of persons in age groups who attended to receive the Schick Test and immunisation treatment appears on pages 80 and 81. Scarlet Fever. It is generally accepted that the disease known as scarlet fever is due to the invasion of the body by certain types of germs known as streptococcus pyogenes. This infection usually gives rise to a tonsillitis and a characteristic rash. In certain instances the same causal agent produces an acute pharyngitis or tonsillitis without the presence of a rash. Cases of this nature should be regarded as infectious as those with an erythema, necessitating strict precautions and isolation to prevent them from being a focus for the spread of scarlatinal infection. In 1937 there Were 424 notifications of scarlet fever received as compared with 722 in 1936. The number of patients removed to isolation hospitals for treatment was 364, and the cases effectively isolated and treated at home numbered 60. There were 23 instances of patients who were subsequently diagnosed as not suffering from the disease as certified. There were 22 instances in which multiple cases occurred in the household. The number of "Return" cases was eight. Scarlet fever to-day is a mild disease and causes few deaths. The fatal cases numbered two, representing a fatality rate of 0.49 per cent, as compared with 0.28 per cent, in 1936. Enteric Fever. During the year two cases of typhoid fever and five cases of paratyphoid B were notified. All these patients were removed to hospital for treatment and one case terminated fatally. The source of infection in this disease is usually an article of food or drink becoming infected by the dejecta of a patient or carrier and consumed with possibly unfortunate consequences to the person concerned. ENTERIC FEVER CASES TABLE. Results of Bacteriological Examination. Source of Infection. Date of Notification. Sex. Age. Notified as M 8/12 7/2/37 Para-typhoid. Bac. Para. "B" - F 12 5/3/37 Do. Do. - Do. F 35 10/3/37 Do. - M 3 6/8/37 Do. Do. - M 22 8/9/37 Typhoid. Bac. typhosus "O" + " H " - F 45 15/11/37 Para-typhoid. Bac. Para. "B" - M 11 16/11/37 Typhoid. Bac. Typhosus. Boarder at a Croydon School during epidemic. Cerebro-Spinal Fever. Fourteen cases of this disease were notified during 1937 and every patient was removed to hospital for treatment. There were seven deaths of which three were cases which had not been notified to this Department. Dysentery The number of cases of dysentery notified during the year was 21 as compared with 3 cases in 1936. Seventeen cases were removed to hospital for treatment. In the majority of cases the attack was mild in nature. All the notified cases were probably due to the Sonne Bacillus although bacteriological confirmation of the presence of the dysentery bacillus in the stools was only established in 17 cases. A small outbreak of this disease occurred in a children's ward at a local L.C.C. Hospital. When dysentery occurs in a hospital it is extremely difficult to prevent its spread. As a precautionary measure a routine examination of abnormal stools for the presence of dysentery bacillus should be made, but there is always a possibility that an epidemic in a ward of children may be started by the admission of a carrier who has never suffered a recognisable attack of the disease. Towards the end of the year there was a marked increase in the incidence of dysentery. A letter was accordingly sent to private medical practitioners in the Borough drawing attention to the prevalence of dysentery in London and reminding them that the stools of suspicious cases could be sent to the Borough Bacteriologist for examination. Encephalitis Lethargica. No cases of this disease were notified during the year. There were three deaths of Camberwell residents certified as being due to encephalitis lethargica, none of whom had ever been notified in Camberwell. The department keeps in touch with known cases of encephalitis lethargica and during 1937 periodical visits were made to 14 of these patients. Erysipelas. Of the 79 cases of erysipelas notified during the year 50 were removed to hospital. Food Poisoning. Food poisoning is a notifiable disease under the Public Health (London) Act, 1936. During the year 37 notifications were received of patients who in the opinion of a qualified medical practitioner were suffering from food poisoning. In the majority of cases the illness was confined to an individual member of the household, and was possibly due to some physical idiosyncrasy of the person attacked. The articles of food stated to be the incriminating agent of the illness of the persons notified were chiefly meat, fish and sweets. Malaria. Two cases of malaria induced for therapeutic purposes of patients in Mental Hospitals outside the Borough were notified before discharge in accordance with the requirements of Article 5 of the Infectious Diseases (London) Regulations, 1927. Ophthalmia Neonatorum. The number of cases notified during 1937 was sixteen. Cases of ophthalmia neonatorum require constant attention and skilled nursing. The admission to hospital of both the mother and infant offers the most satisfactory method of treatment. During the year this arrangement Was followed in 12 instances. Where treatment was carried out at home the health visitor visited the home immediately the case was notified to offer the assistance of a visiting nurse under the Council's Home Nursing Scheme where such services were deemed to be necessary. Continued supervision was carried out by the health visitor until the child was well on the way to recovery. Cases of inflammation of the eyes reported by the Medical Officer of Health of the London County Council were also supervised by the Health Visitors and the number of such cases brought to the attention of the Public Health Department during the year under review was 22. Twenty-four cases were also reported by the district nursing associations operating in Camberwell. SUMMARY OF NOTIFIED CASES TABLE. No. of Cases Notified. Cases Treated. Vision. Total Blindness. No. of Deaths. At Home. In Hospital. Unimpaired. Impaired. - 16 4 12 15 - 1 Pneumonia. Pneumonia is still one of the greatest menaces to human life and health. Its prevalence and mortality follow very closely seasonal temperatures. The compulsorily notifiable types of this disease are acute primary pneumonia and acute influenzal pneumonia. There were 103 cases of acute primary and 50 of influenzal pneumonia notified in 1937. As an aid to diagnosis the Council provides facilities for the bacteriological examination of sputum. Eighty-six of these patients were treated in institutions. Skilled nursing is of primary importance in the treatment of the disease. Home nursing services were provided by the Council in all cases when requested. Anti-pneumococcic Serum. Increased use is being made of serum in the treatment of cases of pneumococcus pneumonia which is usually administered intravenously. Patients should receive the serum at the earliest possible moment provided serum therapy is not contra-indicated. No demand by private medical practitioners for the provision of anti-pneumococcic serum has yet been made to this authority. Polio-Myelitis and Polio-Encephalitis. Three cases of polio-myelitis were notified during the year, two of these patients were removed to hospital for treatment. There were no deaths. No cases of acute polio-encephalitis were reported. The practice of keeping in touch with patients notified in previous years with a view to rendering them advice and assistance was continued. A revised memorandum on polio-myelitis was issued by the Ministry of Health during the year which dealt with the subject of precautions against infection and the necessity for endeavours to be made to discover missed cases in the area. Puerperal Fever. There were 17 cases of puerperal fever notified during 1937. Eight of these cases occurred in hospital, three in nursing homes subsequently removed to hospitals, and the remaining six patients were removed from their own homes to hospital for treatment. As far as could be ascertained none of these patients was a contact, direct or indirect, of a person suffering from scarlet fever or of a person who had recently suffered from a sore throat. One patient died. The majority of deaths from this cause are due to infection by hemolytic streptococci organisms. The discovery of the susceptibility of this type of streptococci to the drug "prontosil" raises the hope that by its use in the treatment of this disease a fall in the death rate may be anticipated. Puerperal Pyrexia. The number of cases of this disease notified in 1937 was 23. Seventeen notifications were in respect of patients confined in hospitals and six of patients, confined in their own homes. Of these latter cases five were subsequently removed to hospital. Two patients died. No requests were made by private medical practitioners for the opinion of the consulting gynæcologist appointed by the Council for the purpose of rendering assistance in diagnosis and treatment of patients suffering from puerperal fever and puerperal pyrexia. SUMMARY OF NOTIFICATIONS OF NOTIFIABLE INFECTIOUS DISEASES RECEIVED DURING PERIOD JANUARY-DECEMBER, 1937, SHOWING DISTRIBUTION OF CASES IN WARDS. Disease. WARDS. Total 1 2 3 4 5 3 7 8 9 10 12 13 14 15 16 17 18 19 11 20 Diphtheria and Croup 53 23 26 36 8 5 23 3 8 15 16 13 9 6 - 346 37 30 7 22 6 Scarlet Fever 18 27 26 18 19 21 26 23 21 32 20 18 21 23 18 12 29 25 24 3 424 Enteric Fover and Para-typhoid - - - 1 - 1 1 1 - 1 - 2 - - - - - - - - 7 2 3 7 2 9 2 2 1 Pneumonia -j Acute Influenzal 7 2 2 5 1 3 - - 1 - 1 50 - 4 7 8 12 Acute Primary 5 11 4 6 4 2 2 4 3 7 3 2 6 9 3 1 103 9 9 7 3 2 4 4 2 9 4 3 3 2 3 8 3 - 1 2 Erysipelas 1 79 Cerebro-Spinal Meningitis 2 1 2 1 1 - - - 1 1 1 1 3 - - - - - 14 - 1 — 1 Poliomyelitis - - - 1 - - - - - - - - - - - - - 3 Malaria (induced) - - - - 1 - 1 - - - - - - - - - - - - - 2 - 3 3 1 1 - - Dysentery 1 3 3 - 2 - 2 1 1 - - 21 - - 4 Ophthalmia Neonatorum 1 1 2 2 - 1 1 - 2 1 - - - 1 - - - 16 - - Puerperal Fever 2 1 2 - 1 2 1 1 - 1 1 - 1 1 - 1 - - - 2 17 Puerperal Pyrexia - - 1 5 3 1 3 3 - 1 1 - 2 - 1 - 1 1 - 23 - - Continued Fever - - - - - - - - - - - - - - 1 - - - - - 103 75 71 69 67 53 72 94 49 36 36 67 33 33 53 54 48 46 39 8 1,106 Totals REFERENCE TO WARDS. No. No. No. No. 1. West. 6. Marlborough. 11. St. Mary's. 16. St. John's. 2. Addington. 7. North Peckham. 12. Nunhead. 17. Alleyn. 3. Town Hall. 13. The Rye. 8. Goldsmith. 18. Ruskin. 4. St. George's. 9. Clifton. 14. St. Giles'. 19. The Hamlet. 5. Cobourg. 10. Rye Lane. 15. Lyndhurst, 20. The College. INFECTIOUS DISEASES, 1937. SUMMARY OF NOTIFICATIONS RECEIVED AND DEATHS FROM THESE CAUSES AMONG NOTIFIED CASES CLASSIFIED IN AGE GROUPS. Admitted to Hospital. Found to be not suffering from the Disease. _ Deaths of notified cases. Notifications and Age Distributions. Disea&c. Total Cases Notified. Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Notifications. Diphtheria and Croup 346 364 45 13 1 14 19 39 27 157 40 22 20 364 23 5 20 47 48 173 63 25 22 424 3 16 Scarlet Fever 1 2 1 Enteric Fever & Para-typhoid 7 7 - 1 1 - - - - - 1 1 50 27 - 2 1 4 1 12 Pneumonia Acute Influenzal 10 - - 103 59 - 15 9 6 8 5 2 9 2 17 Acute Primary 4 1 1 - 12 79 50 2 - 2 - 2 2 erysipelas - 1 Cerebrospinal Meningitis 14 14 - †6 5 2 1 - - - - 4 - 1 2 1 - - 1 - Poliomyelitis 3 - - - - - - - - Malaria (induced) 2 2 - - - - - - - 3 21 17 - ‡1 - 2 5 1 5 - 4 Dysentery - 9 16 - - - - - Ophthalmia Neonatorum 16 - 1 - - - 17 17 - - 2 11 Puerperal Fever - 1 - - - - - Puerperal Pyrexia 23 22 - 2 - - - - - - 2 18 - Continued Fever 1 - - - - - - - - - - - - 1,106 936 69 55 40 41 56 98 83 344 110 58 121 Totals † Including 2 cases not confirmed as C.S.M. NON-NOTIFIABLE DISEASES Measles. The number of cases of measles reported from various sources in 1937 was 221. Twenty-three of these patients were removed to hospital for treatment. Every reported case was visited by a Health Visitor, and where skilled nursing assistance was considered necessary the services of the district nurse were offered, and in cases where the home conditions did not allow of the patient being suitably nursed at home, or in view of the severity of the illness, removal to hospital provided the best means for treatment and recovery, arrangements for hospital treatment were made. Measles occurs in epidemic form in London regularly every two years and the biennial epidemic was expected at the end of the year under review. During the term of the epidemic which usually lasts for a period of three to five months, control measures are applied in co-operation with the L.C.C. Education Authority. This control scheme was put into operation at the end of December last. Whooping Cough. Whooping cough, like measles, is a universal disease. It is extremely fatal among young children. Complications and sequelae frequently occur. The number of cases that came to the knowledge of the Health Department during the year was 437. This number probably only accounts for a small percentage of actual cases as many patients are not seen by a doctor unless some complication occurs and even when seen the characteristic whoop may not be present in some cases and consequently a diagnosis of whooping cough is not made. The deaths from this cause numbered 17. The age distribution of patients whose illness proved fatal is given in the following table: — Under 1 year. 2-5 years. Total. 1-2 years. 17 9 6 2 Diarrhoea and Enteritis. During the year, 39 deaths of children under two years of age were certified to be due to diarrhoea and enteritis as compared with 32 in 1936. The following table shows the monthly incidence of the deaths from enteritis for the year 1937. Jan. Feb. Mar. April May June July Au g. Sept. Oct. Nov. Dec. Total - 1 3 4 5 2 2 2 5 5 4 6 39 Influenza. Since influenza is not a notifiable disease it is not possible to obtain precise information as to its prevalence except by inference from the number of deaths and the notifications of its complication, pneumonia. During 1937 there were 72 deaths in the Borough from this disease. Fortunately the type was not severe, and complications were not frequent. Of these deaths 52 occurred in the first month of the year when influenza was present in epidemic proportions. The following table gives the age distribution of the persons who died from influenza in 1937:— Under 25 yrs. 25-35 yrs. 35-45 yrs. 45-55 yrs. 55-65 yrs. 65-75 yrs. Over75 4 2 5 7 11 17 26 It will be seen that most of the deaths occurred in the age groups over 55 years. A leaflet on this disease is distributed from the Public Health Department outlining suggestions for adoption as a means of preventing attacks of this illness, namely, the avoidance of stuffy atmospheric conditions, the necessity for not mixing with other persons once the prodromal malaise has appeared, and the importance of not returning to work immediately after the temperature becomes normal. New Disinfecting Station. It is satisfactory to report that building operations are proceeding on the new disinfecting and disinfestation stations at Peckham Park Road Depot. The new building which will house the two services under one roof will be provided with up-to-date accommodation and equipment to replace the existing disinfecting and cleansing stations which have outlived the period of their useful life, and which possess all the disadvantages of limitation of space, bad arrangement, and obsolete equipment. The features of the new Station comprise accommodation for a disinfecting station divided into infected and disinfected sides, a formalin chamber, hair-Washing room, bathrooms and dressing rooms, nurses' office and lavatory, waiting rooms and lavatories, boiler house, coal and coke store, office and staff mess room, staff lavatories and bathroom, and garages. The equipment to be provided is as follows:— Two Aveling- Barford Disinfectors, one sterilizing and washing machine, one power hydro, one power mangle, and drying horses. Disinfection The following is a summary of the work carried out by the disinfecting staff during 1937: — Number of houses visited following infectious disease 1,326 Number of visits to these premises 2,702 Number of houses visited following other diseases 336 Number of visits to these premises 629 Number of houses visited for miscellaneous purposes 492 Number of visits to these premises 886 Number of rooms disinfected. Infectious disease 1,951 Number of houses visited. Verminous 980 Number of rooms disinfected. Verminous 1,320 Number of articles disinfected (steam disinfected) 60,819 Number of articles disinfected (formalin) 2,014 Number of books disinfected 787 Number of articles destroyed 2,230 Weight of furniture, etc., destroyed 4 tons 5 cwts. 3 qrs. 4 lbs. Weight of unsound food destroyed (see Food Inspector's report) 6 tons 2 cwts. 2 qrs. 3½ lbs. Weight of dead animals destroyed 5 cwt. Cleansing Station. In the following table particulars are given of the attendances at the Cleansing Station during 1937. Every individual who attended received a bath and his personal clothing was disinfected. Scabies. Vermin. Children. Adults. Children. Adults. Males. Females. Males. Females. Males. Females. Males. Females. 8 3 396 1,585 42 50 1,561 2,037 Scabies. An increase in the number of cases of scabies has been observed during recent years in children attending the London County Council Schools. Scabies occasionally appears in a form highly resistant to treatment and in spite of the careful observance of the rules of personal hygiene by the patient a recurrence of the symptoms may take place. By arrangement with the London County Council the facilities of the Council's Cleansing Station at Peckham Park Road Depot are available for the treatment of school children suffering from this complaint. In every case the home of the sufferer is visited and the infected bedding and clothing are disinfected at the Council's Disinfecting Station. Bacteriological Examinations. Report on Bacteriological Examinations performed during the Year ended December 31st, 1937. The number of specimens submitted for examination during the year was 4,702. Details as to the way in which this number was made up are appended. Diphtheria Swabs 2,835 Percentage positive 5.4 Sputa for tubercle 1,768 13.3 Faeces for paratyphoid, etc. 6 33.3 Bloods for Widal's reaction 6 0.0 Milks, bacteriological 67 Bath waters „ 12 Ice creams „ 6 Miscellaneous specimens 2 Total 4,702 A curious feature of the specimens submitted during the last four years has been the steady decline in the number of sputum specimens. In 1934 there were 2,648 sputum examinations, but by the end of 1937 the annual number had fallen to 1,768 or 880 less than in 1934. The fact that the total numbers of examinations are well sustained is purely owing to the increase of diphtheria swabs and other specimens of a more complicated nature. In view of the prevalence of Sonne dysentery in the country at large, it is interesting to note that none of the samples of faeces submitted in this Borough were found to contain the dysentery bacilli, nor were any typhoid bacilli found, the only organism of this description found being paratyphoid "B" on two occasions in the same patient. GUY BOUSFIELD, M.D.Lond., Borough Bacteriologist. Tuberculosis. During the year under review 296 cases of pulmonary tuberculosis and 55 of non-pulmonary tuberculosis were formally notified under the Public Health (Tuberculosis) Regulations, 1930 In cases where a positive sputum report was received from the Bacteriologist and the patient was not notified within a reasonable period, the medical practitioner was requested to formally notify the case. The number of cases which came to light otherwise than by formal notifications comprised 33 transfers from other boroughs, 15 posthumous notifications and 14 non-notified deaths from the registrars'returns. The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths for 1937 was 1 to 14.7 as compared with 1 to 10.2 in 1936. There was no evidence of wilful neglect or refusal to notify cases on the part of medical practitioners. The number of deaths from tuberculosis in each of the past five years is given in the following table:— Year. Pumonary Tuberculosis. Non-Pulmonary Tuberculosis. Total. 1933 221 22 243 1934 202 29 231 1935 26 166 192 1936 166 19 185 1937 177 29 206 The Tuberculosis death rate for 1937 was therefore 0.92 per 1,000 of the population. There has been a steady decline in mortality from Tuberculosis in recent years. The growth of knowledge in the treatment of this disease, combined with the education of the public in matters relating to tuberculosis have resulted in this satisfactory state of affairs. While the future offers every reason for optimism in the treatment of this disease, yet there should be no diminution of our efforts to prevent tuberculosis. Of these the most important are the segregation of patients who are capable of spreading the disease to others, a tubercle free milk supply, proper housing conditions and an improved standard of hygiene and nutrition. New Cases and Mortality during 1937. Particulars of new cases of tuberculosis and deaths from the disease during 1937 are given in the following table:— New Cases* Deaths† Age Periods. Respiratory. Non-Respiratory. Non-Respiratory. Respiratory. M. F. M. F. M. F. M. F. 0- 1 1 - - - 1 - 1 - 1- 5 2 7 8 2 3 1 7 5- 8 10 7 - 1 3 4 8 15- 46 57 8 15 24 3 - 2 19 1 25- 38 42 7 2 19 2 13 - 3 35- 25 20 2 14 - 1 45- 10 2 2 10 28 16 1 - 55- 21 5 4 17 4 3 13 65 and upwards 12 1 1 12 10 2 2 185 41 32 96 81 17 12 Totals 155 * Includes primary formal notifications and cases which came to the knowledge of the Medical Officer of Health from other sources. † After corrections for Inward and Outward Transfers. Public Health (Prevention of Tuberculosis) Regulations, 1925. These regulations relate to the prevention of Tuberculous persons engaging in the production and handling of milk. No occasion arose in 1937, for any action to be taken by this authority under these regulations. Tuberculosis Dispensary. The Tuberculosis Dispensary is situated at No. 23, Brunswick Park. Dr. William Brand the Council's Tuberculosis Officer retired in September of the year under review having completed over 16 years' service with this Authority, and 25 years in the service of the ratepayers of Camberwell, all of which time was devoted to combating tuberculosis. Dr. C. F. Price was appointed as his successor and as Deputy Medical Officer of Health and took up his duties on the 1st November last. He is assisted in his work as Tuberculosis Officer by Dr. Eleanor Gorrie who is also a wholetime officer. REPORT OF THE TUBERCULOSIS MEDICAL OFFICER FOR THE YEAR, 1937. The current list of Notifications of Tuberculosis in Camberwell as at December 31st, 1937. On December 31st, 1937, there were 2,043 cases of tuberculosis on the current list in Camberwell. There were 1,531 cases of pulmonary tuberculosis — 871 males and 660 females; 512 cases of non-pulmonary tuberculosis — 268 males and 244 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, 1937. Age Periods. 0- 1- 5- 10- 65- Total (all Ages) 15- 25- 35- 45- 55- 20- Pulmonary— 132 150 156 57 21 2 14 22 195 117 871 Males 5 142 120 39 Females 8 16 40 147 100 29 19 660 - Non-Pulmonary— 50 I - 22 27 50 44 13 10 3 6 58 21 14 268 Males 5 Females 3 25 33 36 39 39 35 14 13 2 244 TABLE II. Individual Notified Patients on Current List at December 31st, 1937, ALLOCATED TO THE WARDS OF THE BOROUGH. Wards. Pulmonary. Other Forms. Grand Total. Males. Females. Total. Males. Females. Total. 1 77 63 140 28 62 202 34 1 27 10 37 1 8 9 46 3 58 36 94 25 11 36 130 4 67 58 125 14 20 34 159 28 5 43 20 63 16 12 91 6 12 41 6 19 25 66 29 48 7 70 62 132 25 23 180 29 54 84 8 25 19 11 30 21 9 40 61 14 9 23 84 28 10 34 62 8 4 12 74 28 12 25 11 47 75 13 100 31 12 26 42 68 17 14 99 13 41 45 86 9 9 18 104 14 56 36 92 20 12 32 124 15 41 82 22 41 11 11 104 16 50 38 88 13 8 21 109 17 38 25 63 15 16 31 94 18 64 101 6 15 21 122 37 19 37 58 1 2 3 61 21 20 1 8 9 1 1 10 - The Notification of Tuberculosis in Camberwell in 1937. The number of primary notifications of tuberculosis received in Camberwell in 1937 was 351, comprising 296 cases of pulmonary tuberculosis and 55 cases of non-pulmonary tuberculosis. In Table III the number of primary notifications received for each of the last seventeen years are compared. TABLE III. Comparative Table of Primary Notifications for past Seventeen Years. Year. All Forms. Pulmonary Tuberculosis. Other Forms. 1921 750 595 155 1922 653 506 147 1923 657 505 152 1924 559 416 143 373 1925 491 118 1926 506 394 112 451 1927 353 98 1928 465 363 102 1929 495 393 102 1930 483 393 90 1931 414 333 81 386 1932 314 72 1933 363 290 73 57 1934 341 284 1935 333 275 58 1936 299 260 39 1937 351 296 55 In Table IV is given the primary notification rate (per 1,000 population of Camberwell) for the last seventeen years. TABLE IV. Showing Annual Primary Notification Rate of Tuberculosis (All Forms) 1921-1937. Pulmonary Tuberculosis. Other Forms. Population. Year. All Forms. 0.58 1921 267,198 270,300a 272,300a 273,700a 275,400a 275,400a 271,100a 260,400a 256,900a 256,900a 252,100* 248,000a 243,700a 238,360a 234,400a 229,300 224,800 2.80 2.22 1.87 0.54 1922 2.41 2.40 1.85 0.55 1923 2.04 1.52 0.52 1924 1.35 0.42 1925 1.78 1.80 1.43 0.40 1926 1.66 1.30 0.36 1927 1.78 1.39 0.39 1928 1.52 1.92 0.39 1929 1.53 0.35 1930 1.88 1.32 0.32 1931 1.64 1.56 1.27 0.29 1932 1.49 1.19 0.30 1933 1.43 1.19 0.24 1934 1.41 1.17 0.24 1935 1.30 1.13 0.17 1936 1.56 1.32 0.24 1937 * Census, 1931. a Estimated. In Table V the primary notifications of 1937 are allocated to the Wards of the Borough. TABLE V. Showing No. of Primary Notifications Received during 1937 and Ward Allocation. Pulmonary. Non-Pulmonary. Grand Total. Wards. Males. Females. Total. Males. Females. Total. 1 8 15 23 3 2 5 28 11 6 17 1 1 2 19 2 28 13 9 22 5 1 6 3 1 1 22 10 10 20 2 4 1 17 8 7 15 1 2 5 6 12 7 4 11 - 1 1 2 6 2 4 17 7 7 13 8 2 1 3 17 10 4 14 9 3 3 15 7 5 12 - 10 4 2 6 - - 6 1 - 6 11 1 2 13 11 5 10 17 2 2 19 12 7 - 13 19 1 1 2 21 10 9 7 10 17 4 2 6 23 14 19 3 3 22 15 12 7 - 13 - 1 14 16 5 8 1 2 3 16 17 8 3 11 5 5 5 18 6 8 14 - 19 17 19 8 9 17 - - - 1 4 20 2 1 3 1 - One Pulmonary Male Un-attached. One Pulmonary Female Un-attached. In Table VI the summary of notifications received for the year 1937 is treated in more detail. Summary of Notifications during the Period from January 1st. 1937 to December 31st, 1937. Sanatoria. 137 10 145 8 Poor Law Institutions. tions. 115 6 86 11 Formal Notifications under Article 5. Notifications under Article 5. 198 30 180 32 Number of Primary Notifications. Total Primary Notifications. 158 28 27 138 65 and upwards. 10 1 9 - 55 - 65 18 1 4 2 45 - 55 25 9 1 2 35 - 45 20 18 2 1 TABLE VI. 25 - 35 30 39 7 2 20 - 25 24 5 29 3 15 - 20 18 3 3 22 10 - 15 4 5 2 1 5 - 10 4 5 4 1 1 - 5 4 7 2 3 0 - 1 1 - - - Age Periods. Pulmonary— Males „ Females Non-Pulmonary— Males „ Females G 97 TABLE VII. Supplemental Return Showing Cases Added to Register otherwise than by Formal Notification. 0 - 1 - 10 - 15 - 20 - 25 - 35 - 45 - 55 - 65 — Total. Age Periods. 5 - - 1 - - 4 8 5 3 3 3 27 Pulmonary—Males - 1 „ Females - - - 1 1 5 3 2 1 3 17 4 1 2 1 1 2 1 13 Non-Pulmonary—Males - 1 - - „ „ Females 1 1 2 - 1 5 - - - - - - The source or sources from which information as to the above-mentioned cases was obtained is stated below:_ No. of Cases. Source of Information. Non- Pulmonary. Pulmonary. 8 1 Death Returns {From Local Registrars {Transferable deaths from Registrar-General 1 4 5 10 Posthumous notifications 30 3 "Transfers" from other areas (other than transferable deaths) Other Sources if any (specify) - - Table VII. Supplemental Return. New cases of tuberculosis coming to the knowledge of the Medical Officer of Health during 1937 otherwise than by notification under the Public Health (Tuberculosis) Regulations, 1930. The information in this Table was obtained from the certificates of death, from irregular notifications made after death, and cases coming into the Borough previously notified. Deaths from Tuberculosis (Camberwell), 1937. The number of deaths from tuberculosis in Camberwell during 1937, as stated by the Registrar-General was 206. Of these 177 occurred from pulmonary tuberculosis and 29 from other forms of the disease. Fourteen cases were not notified during life as suffering from the form of tuberculosis of which they died. TABLE VIII. Deaths from Tuberculosis (All Forms) 1937 Allocated to the Wards of the Borough. Wards. Pulmonary. Non-Pulmonary. Grand Total. Males. Females. Total. Males. Females. Total. 1 1 9 10 - 2 2 12 2 - 5 6 11 1 1 13 3 13 6 19 2 - 2 21 2 4 9 8 17 - 2 19 6 1 1 11 5 4 10 1 6 4 1 2 4 8 1 9 1 7 6 5 11 2 13 1 8 3 1 4 2 2 6 - 9 2 5 7 - - 7 - 10 2 2 - 2 - - - 11 3 2 5 - - 5 - 2 7 12 4 11 2 - 13 1 2 13 5 2 7 1 9 1 14 5 2 7 2 3 10 15 12 12 4 8 - - - 16 7 5 12 - - 12 - 1 17 5 2 7 1 - 8 2 2 18 3 5 - 2 7 9 - 1 10 19 3 6 1 - - - - 20 - - - H 99 TABLE IX. DEATHS FROM TUBERCULOSIS, 1937. Classified in Age Groups in Accordance with Particulars Provided by Registrar-General. Age Periods. Under 1 1 - 2 2 - 5 75 and upwards 45 - 55 15 - 25 25 - 35 35 - 45 55 - 65 65 - 75 Totals. 5 - 15 12 Pulmonary—Males 1 2 15 19 16 17 - 14 96 - - 24 10 8 2 „ Females 1 19 13 4 81 - - - 2 1 - Non-Pulmonary—Males - 2 1 3 3 2 3 17 - 1 1 3 12 „ Females 1 4 2 - - - - - 100 TABLE X. Dispensary Record Showing the Occupation of Males who died from Tuberculosis in 1937. Accountant 1 Baker's Hand 1 Bath Attendant 1 Cabinet Maker 1 Caretaker 1 Carman 2 Chemist Assistant 1 Collier 1 Clerk 15 Compositor 1 Commercial Traveller 2 Electrical Fitter 1 Electrical Engineer 1 Ex-Service Pensioner 1 Foreman 1 Fishmonger 1 French Polisher 1 Gas Workers 3 Gardener 1 Garage Hand 1 General Dealer 2 Glove Examiner 1 Goods Checker 1 Hatter 1 Hairdresser 1 Hawker 1 Insurance Agent 1 Insurance Inspector 1 Labourers, General 8 Lift Attendant 1 Law Writer 1 Library Assistant 1 Mechanic 1 Medical Practitioner 1 Milk Roundsman 1 Music Hall Artist 1 Newspaper Publisher 1 No occupation 3 Packer 2 Porter 3 Police Constable 2 Printer's Machine Hand 1 „ Reader 1 Radio Fitter 1 Railway Vanguard 1 Salesman 5 School Age 6 Sign Writer 1 Sheet Metal Worker 1 Stoker 2 Steward 1 Stereotyper 1 Tailor's Cutter 1 Timekeeper 1 Telephonist 1 Typewriter Mechanic 1 Under School Age 2 Warehouseman 5 Waiter 3 TABLE XI. Dispensary Record Showing the Occupation of Females who Died from Tuberculosis in 1937. Book Keeper 1 Machinist 2 Cleaner 1 No occupation 5 Clerk 4 Packer 4 Corset Examiner 1 Powder Box Fitter 1 Dairy Hand 1 Printer's Labeller 1 Dressmaker 2 Shop Assistant 2 Handbag Repairer 1 School Age 6 Housewife 48 Under School Age 2 Waitress 2 Knitter 1 Laundry Worker 6 7 102 TABLE XII. Return showing the Work of the Dispensary DURING THE YEAR 1937. Diagnosis. Nonpulmonary. Pulmonary. Total. Adults. Child, ren. AdultsJ Children. Children Adults. a M. F. M. F. M M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts) I 5 (a Definitely tuberculous 64 71 4 11 8 5 4 7 5 79 - 8 (6) Diagnosis not completed - - 3 - - - - - - - - - - - 186 (cj Non-tuberculous - - - - 221 59 42 - - B.—Contacts examined during the year:— I I I 2 19 2 1 (a) Definitely tuberculous 19 17 1 - - 17 - - (6) Diagnosis not completed - - - - - - 1 1 3 — - - (c) Noil-tuberculous - 135 212 149 172 - - - - - - - C.—Casks written off the Dispensary Register as:— I I I I I I II I 2 6 1 1 3 4 7 4 (a) Recovered 7 3 4 8 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) 447 218 - - 336 212 - - - - - - D.—Number of Cases on Dispensary Register on December 31st:— I II I I I I I 1 II I I 114 123 738 582 459 44 87 78 (a) Definitely tuberculous 624 39 126 122 (b) Diagnosis not completed - - - - - 4 1 3 - - - - 1. Number of cases on Dispensary Register on January 1st 7. Number of consultations with medical practitioners 1,655 (a) Personal 34 (b) Other 702 2. Number of cases transferred. from other areas and cases returned after discharge under Head 3 in previous years 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 667 58 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3. Number of cases transferred to other areas, cases not desiring further assistance under the tuberculosis scheme, and cases "lost sight of " 8,967 10. Number of: — 162 (a) Specimens of sputum, &c., examined 1,069 (b) X-ray examinations made in connection with Dispensary work 4. Cases written off during the year as Dead (all causes) 751 127 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 5. Number of attendances at the Dispensary (including Contacts) 5,620 3 6. Number of Insured Persons under Domiciliary Treatment on December 31st 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 662 243 TABLE XIII. Number of Families occupying. 1 Room. 2 Rooms. 3 Rooms. 4 Rooms. 5 Rooms. 6 Rooms or more. Particulars of housing accommodation of 351 families in which there was a Primary Notification of Tuberculosis received in 1937. Patient living alone 8 24 5 - - - 18 14 4 „ „ with 1 other 9 5 5 4 16 3 „ „ „ 2 others 14 26 6 24 17 10 „ „ „ 3 „ 2 5 11 14 9 - 2 14 8 „ „ „ 4 „ 12 11 „ „ „ 5 „ 3 5 7 - 2 8 4 4 „ „ „ 6 „ - - 1 1 2 3 2 - „ „ „ 7 „ 1 1 1 - - - „ „ „ 8 „ 1 - 2 „ „ „ 9 „ - - - 1 2 „ „ „ 10 „ - - - - 41 51 92 76 52 39 Total TABLE XIV. Particulars of the sleeping arrangements of the cases referred to in Table XIII, as ascertained at the first home visit to patient. In separate room In 112 cases. Alone in bed with 1 other in room „ 45 „ „ „ 2 others „ „ 19 „ „ „ 3 „ „ „ 7 „ In bed with 1 person and no others in room „ 110 „ „ „ 1 „ 1 other in room „ 19 „ „ „ 1 „ 2 others „ „ 20 „ „ „ 1 „ 3 „ „ „ 9 „ In bed with 2 persons and no others in room „ 7 „ „ „ 2other „ „ 2 „ „ „ 2 „ 2 others „ „ - „ „ „ 2 „ 3 „ „ „ - „ In bed with 3 persons and no others in room „ 1 „ 351 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, 671 Dispensary patients were sent to hospital in 1937 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: — Sick Children's Hospital, Great Ormond Street. St. Thomas's. Guy's. Charing Cross. Throat Hospital, Golden Square. Brompton. South London Hospital for Women. Evelina. Royal Waterloo City of London. Belgrave. All Saints'. 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. The number of new patients sent by practitioners to the Dispensary for diagnosis or seen in consultation at their homes was 588. Classification of New Patients. (a) Pulmonary Tuberculosis. During the year 185 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) 80, or 43.2 per cent. T.B. plus 1 (early cases, sputum positive) 9, or 4.9 per cent. T.B. plus 2 (intermediate cases, sputum positive) 79, or 42.7 per cent. T.B. plus 3 (advanced cases, sputum positive) 17, or 9.2 per cent. (b) Non-Pulmonary Tuberculosis. There were 30 cases of non-pulmonary 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 difficult to persuade contacts, especially young adults, to submit to 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. With children it is possible in certain cases to arrange for their boarding out under the London County Council scheme thus removing them from the infectious atmosphere at home. Twenty-two children were so boarded out in 1937. The number of persons living in contact with tuberculous patients which came to the notice of the Department for the first time during 1937 was 662. Of this number 463 were examined at or in connection with the Tuberculosis Dispensary during the year, and in 13 cases found to be tuberculous there was a record of contact with a sufferer from tuberculosis. In 3 cases the diagnosis was not completed at December 31st, 1937. Mantoux diagnostic tests were done in 63 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 1937 20 tuberculous families living in the Borough received improved housing accommodation from the London County Council. There were also two open shelters in use by patients living and sleeping out of doors. The Necessity for Early Treatment to Ensure the Prospects of Recovery. Under the London County Council 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. By experience it has been found that X-rays and repeated sputum examination are essential for accurate diagnosis of tuberculosis in its early stage and throughout the year more and more use was made of the facilities available. During the 10 months expiring at October 31st last, 600 patients were examined by X-ray at King's College Hospital under a previous arrangement. As from Nov. Ist the facilities at St. Giles' Hospital were placed at the disposal of the Council under the L.C.C. treatment of tuberculosis scheme for the X-ray examinations of all patients and contacts referred to the X-ray department by the Tuberculosis Officer—151 such examinations were made in November and December making a total of 751 for the year. The facilities at St. Giles' Hospital are very satisfactory and it is now only in special circumstances that a case does not receive the benefit of an X-ray examination at that Hospital. The Tuberculosis Officer receives all films at the Dispensary and they are interpreted and reported on by him. All patients while under residential treatment were X-rayed on various occasions. The same applies to artificial pneumothorax 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 Hospital, St. Giles'. During 1937, 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 treat ment in a sanatorium at December 31st, 1937. Again, in November, use was made of the facilities offered by the London County Council at St. Giles' Hospital and an artificial pneumothorax refill clinic was established there under the direction of the Tuberculosis Officer who carries out the refill. In future all patients discharged from hospital or sanatorium who require artificial pneumothorax refills will be referred to the St. Giles' artificial pneumothorax clinic for treatment unless special circumstances necessitate other arrangements. Such surgical methods as phrenic evulsion, thoracoplasty and the more recent extra-pleural artificial pneumothorax are carried out when necessary during residential treatment. In the event of a patient requiring refills for extra-pleural pneumothorax on returning home, arrangements are made for his attendance at the St. Giles' artificial pneumothorax clinic where the treatment can be given by the Tuberculosis Officer. 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 8,967 visits to the homes where there was a case of tuberculosis during the year 1937. 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 to hospital of a patient who is confined to bed. Nature and Extent of any Dental Treatment. Twelve patients received dental treatment 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 150 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. The number of outfits supplied in connection with sputum examinations for Dispensary patients was 1,069. Supply of Extra Nourishment during 1937. Action is taken by the Tuberculosis Officer to secure the grant of extra nourishment in the following cases: — (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. The number of Camberwell patients who received extra nourishment in 1937 was 80. Institutional (Residential) Treatment of Camberwell Patients in 1937 through the London County Council. 1. Adult Males:— Number of applicants for residential treatment 162 Number who received residential treatment 148 Number who did not receive residential treatment: — Not accepted 2 Failed to enter 11 Awaiting residential treatment December 31st, 1937 1 Classification of Adult Males who received, Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 31 Pulmonary cases in which tubercle bacilli had been found in the sputum 83 Early pulmonary tuberculosis 12 Moderately advanced pulmonary tuberculosis 64 Advanced pulmonary tuberculosis 7 Surgical tuberculosis 16 Diagnosis of tuberculosis 12 Not classified 6 2. Adult Females:— Number of applicants for residential treatment 150 Number who received residential treatment 143 Number who did not receive residential treatment:— Not accepted — Failed to enter 4 Awaiting residential treatment December 31st, 1937 3 Classification of Adult Females who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 29 Pulmonary cases in which tubercle bacilli had been found in the sputum 88 Early pulmonary tuberculosis 20 Moderately advanced pulmonary tuberculosis 60 Advanced pulmonary tuberculosis 8 Surgical tuberculosis 13 Diagnosis of tuberculosis 3 Not classified 10 108 3. Boys:— Number of applicants for residential treatment 25 Number who received residential treatment 25 Classification of Boys who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 7 Pulmonary cases in which tubercle bacilli had been found in the sputum 1 Early pulmonary tuberculosis - Moderately advanced pulmonary tuberculosis — Advanced pulmonary tuberculosis 1 Surgical tuberculosis 12 Diagnosis of tuberculosis 1 Not classified 4 4. Girls:— Number of applicants for residential treatment 23 Number who received residential treatment 23 Classification of Girls who received Residential Treatment. Pulmonary cases in which tubercle bacilli had not been found in the sputum 4 Pulmonary cases in which tubercle bacilli had been found in the sputum 1 Early pulmonary tuberculosis 1 Moderately advanced pulmonary tuberculosis — Advanced pulmonary tuberculosis - Surgical tuberculosis 10 Diagnosis of tuberculosis - Not classified 8 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 Rushdene St. Luke's Hawthorndene St. Mary Abbott East Anglian St. Giles' Ipswich St. James's Tehidy St. Michael's Mount St. Olave's Barrowmore Hall St. Nicholas' Liverpool St. Alfege's St. Stephen's St. Vincent Colonies. Homes. St. Barnabas Burrow Hill Papworth Bishopsbourne Preston Hall St. George's Firs Douglas Victoria Hampshire St. Luke's Children. Hospitals. Sanatoria and Homes. High wood Naylands Heatherwood Millfields Queen Mary's East Anglian Princess Elizabeth of York Victoria Royal Waterloo The average duration of residential treatment given by the London County Council in 1937 to 291 adults was 17.7 weeks. The average duration of residential treatment given to 48 children by the London County Council in 1937 was 17.5 weeks. This refers only to those who began treatment in that year. Many of these will remain in institutions during varying periods of 1938. Some will probably remain the whole year. The ultimate averages are therefore to be reckoned as considerably higher. It should be remembered that a good many patients took their discharge before completion of treatment thereby' reducing the possible averages. The Work of the Tuberculosis Care Committee. Christmas Seal Sale 1937. For the fifth year in succession a Christmas Seal Sale was organised in Camberwell. The receipts were £388 5s. 9½d. and the payments £128 8s. IId. leaving a clear profit of £259 16s. 10½d. The profits of the Seal Sale have increased each year. Again thanks are due to the ladies of the Inner Circle of the Rotary Club who addressed 7,000 envelopes. To the L.C.C. schools in Camberwell who collected £37 2s. 5d. —to six cinemas (Astoria, Coronet, Gaumont, Golden Domes, New Grand Hall and Tower), who so kindly showed free of charge a film advertising the Seal Sale. The Secretary of the Care Committee has compiled the following figures and items of information in relation to some of its work in 1937:— One hundred and forty-one cases were helped in their applications to the Public Assistance Committee. Thus patients received money, food, extra diet, etc. Nine cases were assisted in their applications to the British Red Cross Emergency Fund. Seventeen 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 339 patients. Efforts were made to settle all difficulties which threatened to bring patients home from sanatoria too soon. Co-operation took place with the Charity Organisation Society in 12 cases and with the Invalid Children's Aid Association in 55 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. To a large number of patients personal help in discussing their difficulties was given in addition to the above. The Following Items will show how Part of the Christmas Seal Fund was Spent. The provision of pocket money to 36 more or less destitute patients while they were receiving institutional treatment. Clothing to 68 patients. Mothers' Help in the case of 3 patients while awaiting sanatorium treatment or as a convalescent measure for a short period after leaving the sanatorium. Payment of fares in 35 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 8 cases. Purchase of bedding and the loan of a bed in 16 cases. Purchase of spectacles in 3 cases. Payment for cost of household removals in 9 cases. Payment of key money and rent in 2 cases. The Handicraft Class. Meetings were continued on Friday afternoons throughout the year with an approximate attendance of 10 students per session. A variety of articles were produced under the supervision of the teacher and 5 students sent goods valued at £45 12s. 10d. to the Ex-Service men's Exhibition held at the Imperial Institute on December 20th, 1937. Articles to the value of £30 17s. 4d. were sold and in addition orders were received for stools valued at £1 11s. Throughout the year the class proved its value as a means of maintaining the interest and skill of the craftsman and as an encouragement to the patient to develop a more specialised means of livelihood. C. FREDERICK PRICE, Tuberculosis Officer. INDEX. PAGE Aged and Infirm Persons 37 Agricultural Produce (Grading and Marking) 65 Ante-natal Supervision 22 Ante-natal Clinics Return 22 Anti-pneumococcic Serum 86 Ambulance Facilities 14 Artificial Cream Act 64 Bacteriological Examinations 92 Births and Birth Rates 7 Notification Public Health (London) Act 8 Still-births 8 Bugs, Eradication of 36 Cerebro-spinal fever 83 Child Life Protection 30 Cleansing Station 91 Clinics and Treatment Centres 14 Common Lodging Houses 51 Convalescent Home Treatment 23 Day Nurseries, Open-air 30 Dental Treatment 24 Deaths 8 Cancer Deaths 9 General Table of 10-11 Infantile Mortality 11 Infantile Mortality Table 12 Inquiry into Maternal Deaths 9 Maternal Mortality 9 Neo-natal 11 Diabetes 19 Diarrhoea and Enteritis 89 Diphtheria 78-82 Carriers 79 Facilities for Early Diagnosis 78 Immunisation Clinic 79 Return of Work, Table 80-81 Disinfecting Station, New 90 Disinfection 91 Dogs, Fouling of Footpaths 36 INDEX—continued. PAGE Drainage and Sewerage 32 Dysentery 83 Eating Houses and Restaurants 75 Encephalitis Lethargica 84 Enteric Fever 83 Enteritis and Diarrhoea 89 Erysipelas 84 Factories and Workshops 40-41 Food— Chemical and Bacteriological Examination 61 Meat Food Products, Certification 75 Meat Regulations 73 Milk 63-64 Nutrition 61 Poisoning 84 Registration of Food Premises 73 Restaurants and Eating Houses 75 Street Markets 75 Summary of Work, Table 77 Supervision 61 Unsound food 75 Unsound food destroyed, table 76 Food and Drugs Acts— Adulteration 64 Agricultural Produce Act 65 Artificial Cream Act 64 Butter Factories, etc. 65 Condensed Milk Regulations 65 Dried Milk Regulations 65 Ice Cream 64 Merchandise Marks Act 65 Preservatives, etc., Regulations 65 Proceedings, Table 72 Samples Adulterated, Table 68-72 Samples, Table 66-67 Health Propaganda 19 Health Visitors 21 Health Visitors Refresher Course 22 Home Helps 23 Home Nursing 14, 23 Home Visiting 21 INDEX—continued. PAGE Hospital Accommodation for Infectious Disease 78 Hospitals 16 Housing 43-52 Applications for Re-housing 52 Common Lodging Houses 51 Houses let in Lodgings 51 Houses Repairable at Reasonable Cost 49 Insanitary Areas 43-49 Inspectors' Record of Work 50 Overcrowding 52 Parts of Premises not Repairable 51 Statistics 56-57 Underground Rooms 49 Ice Cream 64 Infant Welfare Centres 20 Returns 28-29 Infantile Mortality 11 Table 12 Infectious Diseases 77-92 Hospital Accommodation 78 Non-notifiable 89 Notifiable 77 Tables 87-88 Influenza 90 Insanitary Areas 43-49 Laboratory Facilities 14 Malaria 84 Massage and Sunlight Treatment 27 Maternal Mortality 9 Dental Treatment 24 Maternity and Child Welfare 20-31 Maternity Outfits 24 Meals for Expectant and Nursing Mothers 25 Measles 89 Meat and Other Foods 73 Meat Food Products, Certification 75 Meat Regulations 73 Merchandise Marks Act 65 Midwifery, Domiciliary 24 Midwives' Fees, Payment of 25 INDEX —continued. Milk— PAGE Adulteration 62 Bacteriological Examination 63-64 Examination for Tubercle 64 Milk (Samples) 62 Milk (Special Designations) Order 62 Supply 61 Milk Distribution Scheme 25 Minor Ailments, Treatment of 26 Mortuary, Public 38 Return of Work 39 Nursing in the Home 14, 23 Nutrition 61 Offensive Trades 34 Open-air Day Nurseries in Parks, etc. 30 Ophthalmia Neonatorum 85 Outworkers 42 Overcrowding 52 Pharmacy and Poisons Act 35 Pneumonia 85 Anti-pneumococcic serum 86 Polio-Myelitis and Polio-Encephalitis 86 Population 5 Public Assistance 7 Public Cleansing 33 Puerperal Fever and Pyrexia 86 Rag and Bone Dealers 34 Rag Flock 37 Rat Repression 37 Restaurants and Eating Houses 75 Sanitary Circumstances of the Area 32-60 Inspection Tables 54—55 Summary of Legal Proceedings 58-60 Summary of Notices Served 53 Sanitary Conveniences attached to Licensed Premises 34 Scabies 91 Schools 36 School Treatment Centres 15 Sewerage and Drainage 32 Sewer Re-construction Programme 33 Shops Act 34 Sickness and Invalidity 6 INDEX—continued. PAGE Slaughterhouses 73 Animals Slaughtered, Table 74 Slaughter of Animals Act 75 Smallpox 78 Smoke Abatement 35 Social Conditions and Chief Industries 5 Staff 2-3 Statistics — Summary 4 Vital, Extracts from 6 Vital, Wards Table 13 Street Markets 75 Sunlight and Massage Treatment 27 Swimming Baths 35 Toddlers' Clinics 27 Tuberculosis 92-111 Care Work 110 Classification of New Patients 105 Deaths 99, 100 Dental Treatment 107 Dispensary 94 Return of Work 102-103 Extra Nourishment 107 Handicraft Class 111 Home Contacts, Examination of 105 Housing Accommodation of Patients, Table 103-104 Housing and Tuberculosis 105 Institutional Treatment 108-110 New Cases and Mortality 93 Notification 94—97 Occupational Table, Deaths 101 Prevention Regulations 94 Report of T.B. Officer 94-111 Supplemental Return 98 Underground Rooms 49 Unemployment 6 Unmarried Mothers, Institutional Provision 30 Vaccination, Table 17 Vaccinators, Public, Return of Work 18 Verminous Persons, Cleansing 91 Water Supply 32 Whooping Cough 89