CAM 28 METROPOLITAN BOROUGH OF CAMBERWELL ANNUAL (ABRIDGED) REPORT OF THE MEDICAL OFFICER OF HEALTH, H. W. BARNES, M.B., B.Ch., D.P.H., for the year 1939. CAM 28 Public Health Department, Town Hall, Camberwell, S.E.5. 23rd December, 1940. To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Camberwell. Mr. Mayor, Aldermen and Councillors, For reasons which I am sure will be readily understood it has not been possible to prepare a report on customary lines upon the health of the Borough for the year 1939. Indeed, the Ministry of Health, realising the increasing pressure of work in Public Health Departments resulting from the war, issued a further circular on the subject of the preparation of Annual Reports of Medical Officers of Health in which it was suggested that the report for 1939 only be an interim report, typewritten if desired, and confined to essential and urgent matters affecting the Public Health during the year. For many months before the outbreak of war the activities of the D e partment were divided between the performance of duties normally undertaken and those of a war-time character. In this latter group fell such duties as the training of Civil Defence Volunteers in anti-gas measures and first aid, the selection, adaptation and equipping of premises for use as Stretcher Party Depots and First Aid Posts. When war was declared on September 3rd, 1940, practically the whole of the staff of the Department were allocated to Civil Defence duties - the Sanitary Inspectors acting as Superintendents of Stretcher Party Depots and the Municipal Health Visitors and the female Sanitary Inspector as Nurses in Charge of First Aid Posts. These staff arrangements continued until the end of the year when it became necessary, in view of the drift back of families from reception areas, to re-open some of the Infant Welfare Centres and to arrange for the return of the Health Visitors to their normal duties. The arrears of work in the sanitary districts also compelled attention to the question of appointing Superintendents of Stretcher Party Depots so as to enable the Sanitary Inspectors engaged in these duties to be released. The estimated resident population of Camberwell at the middle of 1938 was 222,400. The Registrar-General has furnished the following figures for statistical purposes for the year 1939 upon which information the birth and death rates in this report have been calculated :- Estimated population (a) for birth rate 219,500 (b) for death rate 208,500. The comparative birth and death rates for 1938 and 1939 are as follows: 1938 . 1939. Birth Rate 13.97 13.85 Death Rate 12.27 12.43 It has always been my P ractice in the Annual Report on the health of the Borough to express my indebtedness to the Staff for their valuable help in the administration of the health services. For their work during 1939, which bore little or no resemblance to the tasks normally undertaken, I cannot speak too highly; the whole Staff were frequently called upon to work long hours and at week-ends which they did without even a suspicion of a grumble. I accordingly take this opportunity of tendering to them my sincere thanks for their excellent services throughout the year, particularly during that Period of the change-over from peace to war-time conditions. I also wish to express my thanks to the Members of the Council especially the Members of the Emergency Committee and the A.R.P.Controller, for their kind consideration and support in all matters relating to the discharge of the duties of my appointment as Medical Officer of Health. Your obedient Servant, H.W. Barnes. MEDICAL OFFICER OF HEALTH. SUMMARY OF STATISTICS FOR THE YEAR 1939 1. Area of the Borough in acres ... ... ... ... ... ... 4,480 Population (estimated resident population) - for birth rate ... ... ... ... ... ... 219,500 for death rate ... ... ... ... ... ... 208,500 Population (Census 1931) ... ... ... ... ... ... ... 251,294 Number of live births - for birth rate ... ... ... ... ... ... ... ... 3,040 for infant & maternal mortality rates ... ... 2,926 Birth rate ... ... ... ... ... ... ... ... ... 13,85 Number of deaths ... ... ... ... ... ... ... ... 2,592 Death rate ... ... ... ... ... ... ... ... ... 12.43 Infantile Mortality:- Deaths under 1 year ... ... ... ... ... ... 108 Infantile deaths per 1,000 births ... ... ... 36 Maternal Mortality:- Deaths of women from diseases or accidents associated with childbirth ... ... 6 (per 1,000 live births ... 2.05 Maternal death rate (per 1,000 births ... 2.04 Deaths from phthisis ... ... ... ... ... ... ... 145 Phthisis death rate ... ... ... ... ... ... ... 0.69 Deaths from all forms of tuberculosis... ... ... ... ... 165 Tuberculosis death rate ... ... ... ... ... ... ... 0.79 DEATH, CAUSES OF, AND AGES AT, DURING THE YEAR 1939 Causes of Death Sex All Ages 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- M. F. 141 262 324 336 57 6 12 2l 39 35 All causes 1,292 59 1,300 51 5 8 10 42 35 93 307 61 188 500 Typhoid and Paratyphoid Fevers M. - - - - - - - - - - - - F. 1 - - - - - 1 - - - - - - - Measles M. - - - - - - - - - - F. - - - - - - - - - - - - Scarlet Fever M. 2 - - 1 1 - - - - - - - - - - F. 1 1 M. - - - - - - - 1 1 Whooping Cough 2 - - - - - - - - - - F. 4 1 2 1 - - - - - - - 2 Diphtheria 5 - - M. - 3 - - - - - - - - 2 F. 3 1 - - - - - - - - 7 Influenza M. 18 - - 1 1 3 3 3 - - 24 1 F. - - 1 1 6 8 1 1 5 - Encephalitis lethargica M. - - - 2 - 1 1 - - - - - 1 - - - F. - 1 - - - - - - Cerebro-spinal Fever - M. 2 1 1 - - - - - - - - - - - F. - - - - - - - - - Tuberculosis of respiratory system 9 M. 90 - 1 16 19 21 16 8 - - - F. 1 55 16 12 5 2 - - - 9 7 3 Other tuberculous diseases M. 11 - 2 1 3 3 1 - - 1 - - F. 1 3 3 1 9 - 1 - - - - - M. Syphilis 6 - - - - - - - 1 3 2 - 1 - 1 - F. 4 - - 1 1 - - - General paralysis of the insane, tabes dorsalis M. - 7 - - - - 1 1 4 1 - - - F. 4 - - - 1 2 1 - - - - M. 179 Cancer, malignant disease - - - 1 1 25 - 4 30 59 59 F. - 1 3 3 28 39 191 1 - 12 51 53 Diabetes M. 15 - - - - - 2 2 7 4 - - - F. 23 - - 2 - 8 - 1 1 3 10 M. Cerebral Haemorrhage, etc. 62 - - - - - - 1 5 16 19 21 91 - - F. - - 1 8 17 27 38 - - Heart disease 403 2 M. F. - 3 5 7 34 165 - - 68 119 457 3 4 249 - - - 1 15 18 44 123 Aneurysm M. F. 8 - - - - 1 3 2 2 2 - - - - - - 1 6 - - - - 1 2 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1939 Causes of Death Sex All Ages 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- Other circulatory diseases M. 60 - - - - - - 1 2 11 23 23 F. 64 - - - 1 3 18 33 - - - 9 Bronchitis - - - - - - 1 8 6 17 13 M. 45 1 - - - - 11 16 F. 35 1 - - 6 Pneumonia (all forms) M. 73 8 3 2 - 2 1 - 1 8 18 15 16 F. 57 5 1 2 - 1 3 1 21 9 13 M. 10 - 1 1 1 - - 1 2 2 2 - Other respiratory diseases 1 - F. 5 - - - - 1 2 1 - - Peptic Ulcer M. 24 - - - - 1 2 4 10 3 4 - F. 3 - - - 1 - - 1 1 - - - Diarrhoea, etc. M. - 7 6 - 1 - - - - - - - F. 11 8 1 - 2 - - - - - - - - - 1 Appendicitis M. 3 - 1 1 - - - - - 1 F. 9 - 1 1 2 2 2 - - - - M. Cirrhosis of liver 2 - - 2 - - - - - - - - 4 - - - F. 1 3 - - - - - - Other diseases of liver etc. M. 3 - - - 2 1 - - - - - - F. - 6 1 3 2 - - - - - - - 3 Other digestive diseases M. 19 2 - 2 1 2 3 6 - - - - 4 F. 26 1 2 1 7 7 4 - - - - 5 Acute & chronic nephritis M. 21 1 1 1 1 4 5 3 - - F. 27 - - 1 3 6 6 6 5 - - - M. 2 - 1 1 - Puerperal sepsis Other Puerperal causes - - - - - - - F. 4 - - 3 1 - - - - - - - M. - Congenital debility, premature birth, malformation etc. 34 34 - - - - - - - - - F. 27 27 - - - - - - - - - - Senility M. 22 - - - - - 2 20 - - - - F. 51 - - - - - 5 46 - - - - M. Suicide 19 - - 1 1 4 4 3 4 2 - - - F. 7 - 1 2 3 1 - - - 6 - - 6 Other violence M. 65 2 1 - 8 5 10 9 7 11 F. - 1 16 1 - 1 1 - 3 5 4 - 3 1 3 2 4 Other defined diseases M. 73 5 4 17 16 18 - F. 5 72 4 1 - 2 2 9 8 11 11 19 Causes ill-defined or unknown M. - - - - - - - - - - - - - - F. - - - - - - - - - - INFECTIOUS DISEASES SUMMARY OF NOTIFIC ATIONS RECEIVED. No. of cases notified. Treated in Hospital Found to be not suffering from the disease Diphtheria and Croup 212 212 33 Scarlet Fever 343 295 27 29 Measles 7 3 132 Whooping Cough 571 6 Enteric Fever & Para-typhoid 8 8 2 (Acute Influenzal - 51 22 Pneumonia (Acute Primary 104 75 Erysipelas - 71 35 2 Cerebro-spinal Meningitis 9 9 - Poliomyelitis 17 5 15 Polio-Encephalitis 2 2 1 Anthrax 2 2 Dysentery - 3 3 1 Ophthalmia Neonatorum 10 7 - Puerperal Fever 5 5 29 - Puerperal Pyrexia 32 - Totals 858 80 1,469 2. DISINFECTING STATION - RETURN OF WORK Other diseases Miscellaneous Total All Cases Notified Infectious diseases Scabies Vermin Rooms disinfected 952 934 22 2,508 343 257 316 210 1,607 Lots of bedding disinfected 629 254 198 548 Total Visits 1,277 1,273 509 803 4,410 Number of articles disinfected by steam ... ... ... 36,080 Number of articles disinfected by formalin ... ... 2,017 Number of books disinfected ... ... ... ... ... 627 Beds and mattresses destroyed ... ... ... ... 721 Miscellaneous goods destroyed ... ... ... ... 1,579 T. C. qr. 1b. Weight of Unsound foods destroyed ... ... ... ... 22. 7. 0. 14¾ Weight of furniture etc., destroyed ... ... ... 6, 5. 0. 0. weight of dead animals destroyed ... ... ... ... 3.14. 2. 0½ Cleansing Station. Persons cleansed Adults Children Number of attendances. Scabies Vermin Females Males Females Males 1 54 83 84 2,036 1,063 216 2,248 NUMBER OF BACTERIOLOGICAL EXAMINATIONS PERFORMED 1939 Swabs for diphtheria ... ... ... ... ... ... 1905 Sputa for tubercle ... ... ... ... ... ... 1431 Blood for Widal test ... ... ... ... ... ... 3 Faeces for Typhoid-paratyphoid group ... ... ... 3 Milks (bacteriological) ... ... ... ... ... 40 Bath waters " ... ... ... ... ... ... 14 Well waters " ... ... ... ... ... ... 16 Ice Cream " ... ... ... ... ... ... 6 Miscellaneous specimens ... ... ... ... ... 11 Total ... ... 3429 VACCINATION 1939. No. of names received in birth lists ... ... ... 3288 Certificates of Successful Vaccination received 1273 Certificates of Postponement received ... ... ... 4 Certificates Of Insusceptibility received ... ... 4 Statutory Declarations of Objection received ... 1407 3. MATERNITY AND CHILD WEL FARE. Infant Welfare Centres - Clinic Attendances etc. (including "Toddlers" Clinics), 1939. Attendances of Children (i) Under 1 year ... ... ... 35,978 (ii) Between 1 & 5 years ... ... 23,288 Miscellaneous attendances ... ... ... ... ... ... ... 2,918 Total attendances ... 62,184 Analysis of Attendances - Doctors' Consultations ... ... ... ... ... 23,777 Seen by Health Visitor ... ... ... ... ... 34,850 Weighings only ... ... ... ... ... ... ... 639 Health Visitors - Record of Visits _( including visits to "Toddlers") 1939 Visits to Expectant Mothers ... ... ... ... ... 3,751 " " Post-natal Mothers ... ... ... ... ... 2,756 No. of Births reported in the Area ... ... ... ... 2,759 Visits to Children - (i) Under 1 year ... ... 14,310 (ii) Between 1 & 5 years ... 17,356 Total ... ... 31,666 Miscellaneous Visits ... ... ... ... ... ... ... 1,743 Total Visits ... 39,916 Ancillary Services. During the year convalescent treatment was provided for 16 mothers and babies, and 26 children separately. In 115 instances the services of a Home Help were provided for mothers, either before, during or after confinement. Mid-day meals were also supplied in 54 cases. In 14 cases expectant or nursing mothers were provided with dental treatment. The District Nursing Associations paid a total of 4848 visits to 390 approved cases under the Council's Domiciliary Nursing Scheme. A total of 129 patients benefitted under the Council's Treatment of Minor Ailments Scheme, and 72 individual children received Sunlight and Massage Treatment whose collective attendances at the Clinics numbered 581, FOOD AND DRUGS. FORMAL AND INFORMAL SAMPLES SUBMITTED FOR ANALYSIS - YEAR ENDED 31.12.39 Number examined Number adulterated etc. Formal Informal Total Formal Informal Total Formal Informal 589 121 710 10 4.13 5 15 1.69 COMPOSITION OF MILK SAMPLES. 371 formal and 26 informal samples of milk taken during the year and four formal samples were found not to conform with requirements. Percentage of Adult eration. 4. MILK ADULTERATION. Four formal samples were reported against, the percentage of adulteration being 1.07. Each sample reported against was deficient in milk fat. MERCHANDISE MARKS ACT. Two samples of butter were purchased which did not comply with the provisions of this Act. AGRICULTURAL PRODUCE (GRADING AND MARKING) ACT, 1928. There were no infringements of the various orders to be recorded. BACTERIOLOGICAL EXAMINATION OF MILK. Number of samples submitted for examination - Pasteurised milk 37 Tuberculin tested 4 All graded milks complied with the standards laid down in the Milk (Special Designations) Order, 1936. EXAMINATION OF MILK FOR THE PRESENCE OF TUBERCLE BACILLI One sample of Tuberculin tested milk and five samples of raw milk were examined by means of the animal test for the presence of tubercle bacillus with negative results, except in one case of raw milk obtained from the licensed cowhouse in the Borough. The report in this case showed typical tuberculous lesions. The result of the examination of this sample was reported to the Ministry of Agriculture and Fisheries who undertook a clinical examination of the herd concerned and further samples were taken by the Ministry's Inspector. These samples were all certified to be nontuberculous. MEAT AND OTHER FOODS. The number of animals slaughtered at the two licensed slaughter houses during 1939 was 856. Of these 1 cow, whole carcase, and 1 pig, whole carcase, were condemned as unfit for human food; also in 106 cases some part or or g an of the carcase of the animals slaughtered was affected by disease. The following table shows the number of carcases and organs condemned and destroyed. Cattle, excluding Cows Calves Sheep and Lambs Pigs Cows Number killed and inspected Nil 35 15 287 519 All diseases except Tuberculosis. Nil Nil Nil 1 Whole carcases condemned ... Nil Carcases of which some part or organ was condemned ... 1 Nil 38 14 Percentage of the number inspected affected with disease other than tuberculosis ... ... ... ... 11.42 Nil 6.66 2.89 7.55 Tuberculosis only. Whole carcases condemned Nil Nil 1 Nil 2 Carcases of which some part or organ was condemned ... 6 4 Nil 39 Nil 4 5. Cattle, excluding Cows Cows Calves Sheep and Lambs Pigs Percentage of the number inspected affected with tuberculosis ... ... Nil 11.42 40.00 Nil 7.89 BAKEHOUSES. The number of bakehouses on the register at the end of the year was 78 overground and 36 underground. SUMMARY OF INSPECTION. Street Markets Inspections ... ... ... 2,092 FOOD PLACES - Inspections : Bakehouses ... ... ... ... ... ... 125 Fish Curer's Premises ... ... ... ... 202 Fried Fish Shops ... ... ... ... ... 280 Ice Cream Premises ... ... ... ... 359 Restaurants and Eating Houses ... ... 301 No. of complaints received 4119 Inspections under Shops Act, 1934 324 " " Pharmacy and Poisons Act, 1933 51 " " Milkshops 497 Factories Act, 1937:- No. of inspections of Factories 844 " " " " Outworker Premises 601 Intimations served 30 House to House Inspections, P.H. (London) Act, 1936 125 No. of Intimations, P.H. (London) Act, 1936 3868 " " Statutory Notices 1334 " " Notices (Sec 9) Housing Act, 1936 59 " " Re inspections (all enactments) 19836 Total number of visits 30772 TUBERCULOSIS Public Health (Tuberculosis) Regulations, 1930. New eases during 1939. There was a total of 351 new cases including 248 primary notifications of pulmonary tuberculosis, 28 non-pulmonary tuberculosis, 65 inward transfers, 5 posthumous notifications and 5 non-notified deaths obtained from the Registrar's returns. MORTALITY during 1939. There were 165 deaths from all forms of tuberculosis equal to a dea th rate of 0-79 per 1,000 of population (0.8 per 1,000 in 1938). Of these 145 were pulmonary cases and 20 non-pulmonary cases. SANITARY INSECTION NOTIFICATION REGISTER. Age Periods New Cases.* Deaths † Respiratory Non Respiratory Respiratory Non Respiratory M F M F M F M F 0 ... - - - 2 1 1 - - 2 5 2 - 2 3 1 ... 1 - 8 2 4 1 - 1 - 5 ... 5 31 9 16 3 15 ... 39 - 3 3 16 12 25 ... 21 5 1 3 1 35 24 9 1 19 - 35 ... 9 1 - 29 45 ... 4 3 3 21 5 1 - 4 55 ... 19 1 16 7 - - - 8 5 8 - - 5 - 1 65 and upwards 153 95 13 15 90 55 11 9 Totals 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. The total number of cases on the register at the end of the year was 2,054, i.e. 1,565 pulmonary, 489 non-pulmonary. The rate of non-notified deaths to the total deaths was 1 to 33 as compared with 1 to 12.8 in 1938. No case of wilful neglect or refusal to notify cases on the part of medical practitioners occurred. No occasion arose during 1939 for any action under the Public Health (Prevention of Tuberculosis) Regulations 1925 or the Public Health Act 1936. Sect on 172. WORK of the TUBERCULOSIS DISPENSARY during 1939. i Pulmonary Non-Pulmonary Total Grand Total Children. Adults Children. Adults Children. Adults M. F. M. F. M. F. M. F. M. F. M. F. A - New cases examined during the year (excluding contacts):- 12 (a) Definitely tuberculous ....... 6 4 1 88 6 12 114 220 108 8 5 76 (b) Diagnosis not completed ......... - 3 - 9 - - - 5 1 18 - - - (c) Non-tuberculous - - - 43 44 - - - - - 261 246 594 B - Contacts examined during the year:- 3 10 - 2 3 (a) Definitely tuberculous ....... - - - 2 2 2 3 3 (b) Diagnosis not completed ......... - - - - - - - - 1 - 1 63 - - (c) Non-tuberculous - - - - 100 65 - - 66 294 - - 6 26 - 2 - 12 3 12 3 3 6 5 (a) Recovered ..... - C - Cases written off the Dispensary Register as:- 7. (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dis- pensary Register as tuberculous).......... Pulmonary Non-Pulmonary Total Adults Child- ren. Adults Child- ren. Grand Total Adults Child- ren. M. F. M. F. M. F. M. F. M. F. M. F. - - - - - - - - 336 352 109 113 910 D - Number of Cases on Dispensary Register on December 31st:- (a) Definitely tuberculous ....... 649 497 54 52 114 128 90 77 763 625 144 129 1661 (b) Diagnosis not completed......... - - - - - - 10 5 1 3 19 - - 1. Number of cases on Dispensary Register on January 1st ... 1,618 2. Number of cases trans- ferred from other areas and cases returned after discharge under Head 3 in previous years ... 105 3. Number of cases transferred to other areas, cases not des- iring further assistance under the scheme and cases "lost sight of" ... ... .... ... 132 112 4. Cases written off during the year as Dead (all causes) ... ... ... 5. Number of attendances at the Dispensary (including Contacts) ... ... ... 297 5,772 6. Number of Insured Per- sons under Domiciliary Treatment on the 31st December ... ... ... 7. Number of consultations with medical practitioners:- (a) Personal ... ... (b) Other ... ... ... 305 905 8. Number of visits by Tuberculosis Officers to homes (including personal consultations 515 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes ... 7,387 10. Number of:- (a) Specimens of sputum etc. examined ... (b) X-ray examination made in connection with dispensary work 865 1,452 4 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above ... ... 12. Number of "T.B. plus" cases on Dispensary Register on December 31st ... ... ... 650 HOSPITAL CONSULTATION. The L.C.C. renewed the appointment of the Tuberculosis Officer as Honorary Consultant Tuberculosis Officer to St. Giles' Hospital and 244 cases were seen there in consultation with the Hospital Medical Officer. ARTIFICIAL PNEUMOTHORAX. A total of 612 refill treatments were given by the Tuberculosis Officer at the St. Giles' Hospital clinic (compared with 401 in 1938 and nil in 1937). There were also 751 refills carried out at various other hospitals. 8. One patient received FINSEN LIGHT TREATMENT and 16 patients DENTAL TREATMENT, EXTRA DIET was given to 126 patients and 152 POCKET FLASKS were supplied. X-RAY. Every new case or "contact" attending the dispensary during 1939 received X-ray examination. CARE COMMITTEE. Christmas Seal Sale. The receipts were £267. 5s. 11d. and payments £106. 17s. 9d. leaving a clear profit of £160. 8s. 2d. which was spent in providing beds, bedding and other comforts for tuberculous patients. HANDICRAFT CLASS. An Exhibition and Sale of Work held at the Town Hall on December 3rd and 4th produced the sum of £30.