LIBRARY CAM 29 METROPOLITAN BOROUGH OF CAMBER WELL ANNUAL (ABRIDGED) REPORT OF THE MEDICAL OFFICER OF HEALTH, H. W. BARNES, M.8., B.Ch., D.P.H., for the year 1940. CAM 29 Public Health Department, Town Hall, Camberwell, S.E.5. 7th November, 1941. To the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Camberwell. Mr. Mayor, Aldermen and Councillors, I have pleasure in presenting to you my report on the health of the Borough for the year 1940. It is an abridged report prepared on similar lines to the Report issued last year, and follows the policy laid down by the Ministry of Health with regard to the issue of Annual Reports during War-time. There are no matters affecting the health of the inhabitants of Camberwell requiring special reference, indeed the health of the Borough during the year was good and the sanitary administration was satisfactorily maintained. The birth rate was 15.90 per 1,000 population; the death rate was 19.13 per 1,000; the infantile mortality rate 46 per 1,000 births: and the maternal mortality rate 1.77 per 1,000 live and still-births. For comparative purposes the birth and death rates are shown for the years 1938, 1939 and 1940. 1938. 1939. 1940. 13.97 13.85 15.90 Birth rate Death rate 12.27 12.43 19.13 It will be seen that there was an increase in the birth rate in 1940 and a marked increase in the death rate which was in some measure due to deaths from enemy action. During the early days of the War a considerable amount of dislocation of the normal work of the Department took place as a result of seconding Sanitary Inspectors for service as Superintendents at Stretcher Party Depots and Health Visitors as nurses in Charge at First Aid Posts, but as the organisation of the Casualty Services developed these Officers were released from these duties to resume their normal occupations. The intensive air raid attacks on London towards the end of the year, in which Camberwell suffered very severely, caused the normal work of the Department to be again interrupted and new problems of a varying character had to be faced necessitating almost full-time service by the outdoor staff on duties associated with evacuation, billeting the homeless, Rest Centres, sanitary supervision of air raid shelters, and first aid repairs to damaged properties. Following my customary practice of taking the opportunity thus afforded in the preface to my Annual Report of paying tribute to the work of the staff of the Public Health Department throughout the year, I desire on this occasion to lay emphasis on their unstinted service and to acknowledge the valuable co-operation I have received from every member of the Department in the discharge of my duties as Medical Officer of Health. I also wish to thank the members of the Council and the members of the Emergency Committee and A.R.P. Controller for the unfailing consideration and courtesy they have shown to me during the year under review. Your obedient Servant, H. W. Barnes. MEDICAL OFFICER OF HEALTH CAM 29 SUMMARY OF STATISTICS FOR THE YEAR 1940. 1. Area of the Borough in acres 4,480 Population (estimated resident population) 173,750 Population (Census 1931) 251,294 Number of live births - * for birth rate 2,767 for infant & maternal mortality rates 2,529 Birth rate 15.90 Number of deaths 3,324 Death rate 19.13 Infantile Mortality Deaths under 1 year 118 Infantile deaths per 1,000 births 46 Maternal Mortality :- Deaths of women from diseases or accidents associated with childbirth 5 (per 1,000 live births 1.81 Maternal death rate (per 1,000 total births 1.77 Deaths from phthisis 140 Phthisis death rate 0.80 Deaths from all forms of tuberculosis 150 Tuberculosis death rate 0.86 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1940 Causes of Death Sex All ages 0- 1- 15- 45- 65- 5- All causes M. 1689 67 16 26 233 522 825 F. 1635 51 26 19 231 368 940 Typhoid and paratyphoid fevers M. - - - - - - - - - F. 1 - - 1 - Cerebro-spinal fever M. 3 - 1 2 - - - 3 F. 2 1 - - - - Scarlet Fever M. - - - - - - - F. - - - - - - - Whooping cough M. - - - - - - - - - - F. - - - - Diphtheria M. 2 - 1 1 - - - F. 1 - - 1 - - - Tuberculosis of respiratory system M. 85 - - - 46 29 10 - - - 7 F. 55 43 5 Other forms of tuberculosis M. 5 1 2 2 - - - F. 5 - 1 2 2 - - Syphilitic diseases - 10 7 3 M. - - - F. 4 - - - 2 2 - Influenza M. 11 1 - - 3 2 5 11 1 - 2 4 4 F. - Measles - M. - - - - - - F. - - - - - - - Acute Polio-myelitis and polio-encephali tis. M. - - 1 1 - - - F. - - - - - - - Ac: inf: enceph: - 2 M. 2 - - - - F. 4 - - - 2 1 1 Cancer of buc: cav: & oesoph:(M) uterus (F) - - 10 M. 29 - - 19 F. 19 - - 5 9 5 - Cancer of stomach & Duodenum M. 47 - - - 2 17 28 - 28 F. 2 6 20 - - Cancer of breast M. - - - - - - - - 3 22 F. 44 19 - - Cancer of all other sites M. 117 - 9 49 59 - - - 1 31 F. 92 - 58 2 Diabetes M. 2 9 - - 1 6 - F. 12 - - - - 4 8 Intracranial vascular lesions M. 89 - - - 23 66 - F. 111 - - - 3 30 78 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1940. 2. Causes of Death Sex All Ages 0- 1- 5- 45- 65- 15- Heart disease M. 387 - - 2 12 98 275 F. 510 - 1 18 69 422 - Other Dis: of circ: system M. 42 1 - - 15 26 - F. 34 - - - 1 5 28 Bronchitis M. 177 2 - - 4 69 102 F. 108 1 - 5 20 82 - Pneumonia M. 108 19 6 - 8 31 44 F. 79 12 6 - 8 14 39 Other resp: diseases M. 23 - - 1 10 12 - F. 12 - - 1 5 6 - - Ulcer of stomach or duodenum M. 33 - 2 19 12 - F. 6 - - 1 2 3 - Diarrhoea under 2 years M. 6 6 - - - - - F. 9 7 2 - - - - Appendicitis M. 3 - - 1 1 1 - F. 8 1 - 3 2 2 - Other digestive diseases M. 37 - 1 - 5 16 15 F. 31 - _ 3 11 17 - Nephritis M. 27 - - - 5 10 12 F. 28 - - - 5 13 10 Puer: and post-abort: sepsis M. - - - - - - - F. 4 - - 4 - - - Other maternal causes M. - - - - - - - F. 1 - - 1 - - - Premature birth M. 18 18 - - - - - F. 12 12 - - - - - Con: Mai: birth inj; infant: dis: M. 21 19 - - 1 1 - F. 14 11 1 - 1 - 1 Suicide M. 17 - - 5 9 3 - F. 4 - - 3 1 - - Road Traffic acc: M. 15 - 3 7 2 3 - F. 6 - 1 - 1 2 2 Other violent causes M. 245 - 6 14 105 77 43 F. 231 4 8 12 92 76 39 All other causes M. 120 1 - 3 10 22 84 F. 148 2 3 3 19 32 89 INFECTIOUS DISEASES SUMMARY OF NOTIFICATIONS RECEIVED. No. of cases notified. Treated in Hospital Found to be not suffering from the disease Diphtheria and Croup 124 124 22 Scarlet Fever 153 134 6 Measles 132 78 1 Whooping Cough 36 19 4 Enteric Fever & Para-typhoid 8 8 1 Pneumonia (Acute Influenzal 15 6 - (Acute Primary 60 38 - Erysipelas 46 22 2 Cerebro-spinal Meningitis 63 63 18 Polio-Encephalitis 1 1 - Anthrax 3 3 - Dysentery 3 2 - Ophthalmia Neonatorum 12 9 - Puerperal Fever 5 5 - Puerperal Pyrexia 23 - 22 Malaria 1 1 - Totals 685 535 54 DISINFECTING STATION - RETURN OF WORK. Notified Infectious Diseases Miscellaneous Scabies Vermin Total all cases A.R.P. Disinfecting and washing Other Diseases Rooms disinfected 475 332 38 170 1738 23 680 Lots of bedding disinfected 308 299 205 121 623 128 1684 763 639 635 660 4519 Total Visits 355 1447 Number of articles disinfected by steam 32,843 Number of articles disinfected by formalin 4,024 Number of books disinfected 128 Beds and mattresses destroyed 566 Miscellaneous goods destroyed 744 T. C. qr.lb. Weight of Unsound foods destroyed 106 4 3 17 Weight of furniture etc., destroyed 4 13 3 0 Weight of dead animals destroyed 1 5 3 0 Weight of laundry disinfected 14 14 0 25 CLEANSING STATION Persons cleansed Number of attendances Scabies Vermin Males Females Males Females Adults 31 134 216 22 Children 1,029 1,501 319 944 NUMBER OF BACTERIOLOGICAL EXAMINATIONS PERFORMED 1940 Swabs for diphtheria 894 Sputa for tubercle 1017 Blood for widal test 3 Faeces for Typhoid-paratyphoid group 12 Milks (bacteriological 35 Bath waters ,, 16 Well 12 Ice Cream " 1 Miscellaneous specimens 20 Total 2010 VACCINATION 1940. No. of names received in birth lists 2898 Certificates of Succcesful Vaccination received 1045 certificates of Postponement received - Certificates of Insusceptibility received 5 Statutory Declarations of Objection received 1154 3. MATERNITY AND CHILD WELFARE. Infant Welfare Centre- Clinic Attendances etc. (including "Toddlers" Clinics) 1940. Attendances of Children (i) Under 1 year 26,275 (ii) Between 1 & 5 years 16,634 Miscellaneous attendances 2,902 Total attendances 45,811 Analysis of Attendances - Doctors' Consultations 16,838 Seen by Health Visitor 26,071 Health Visitors- Record of Visits (including visits to "Toddlers" 1940. Visits to Expectant Mothers 2,195 „ „ Post-netal Mothers 2,027 No. of Births reported in the Area 2,176 Visits to Children - (i) Under 1 year 12,135 (ii) Betwèn 1 and 5 years 16,150 Total 28,285 Miscellaneous Visits 2,457 Total Visits 34,964 Ancillary Services. In 101 instances the services of a Hone Help were provided for mothers, either before, during or after confinement. Mid-day meals were also supplied in 31 cases. In 11 cases expectant or nursing mothers were provided with dental treatment. The District Nursing Associations paid a total of 2694- visits to 241 approved cases under the Council's Domiciliary Nursing Scheme. A total of 78 patients benefitted under the Council's Treatment of Minor Ailments Scheme. FOOD AND DRUGS. FORMAL AND INFORMAL SAMPLES SUBMITTED FOR ANALYSIS - YEAR ENDED 31. 12. 40. Number adulterated etc. Percentage of Adulteration. Number examined Formal Informal Total Informal Formal Informal Total Formal 616 473 1089 20 13 33 3.24 2.74 COMPOSITION OF MILK SAMPLES. 351 formal and 15 informal samples of milk were taken during the year and six formal samples and one informal sample were found not to conform with requirements. 4. MILK ADULTERATION. Six formal samples were reported against, the percentage of adulteration being 1.7. Of these six samples two were deficient in milk fat and four contained extraneous water. No infringements of the MERCHANDISE MARKS ACT were recorded during the year or of the various orders under the AGRICULTURAL PRODUCE (GRADING AND MARKING) ACT 1928. BACTERIOLOGICAL EXAMINATION OF MILK. Number of samples submitted for examination - Pasteurised milk 32 Tuberculin tested 3 All graded milks complied with the standards laid down in the Milk (Special Designations) Order, 1936. In one sample of Tuberculin Tested Milk coliform bacillus was present in 1/100th millilitre. EXAMINATION OF MILK FOR THE PRESENCE OF TUBERCLE BACILLI. Four samples of raw milk were examined by means of the animal test for the presence of tubercle bacillus, with negative results. BAKEHOUSES. The number of bakehouses on the register at the end of the year was 75 overground and 32 underground. SUMMARY OF INSPECTION. Street Markets Inspections 2707 FOOD PLACES - Inspections: Bakehouses 215 Pish Curers' Premises 144 Pried Pish Shops 253 Ice Cream Premises ... 482 Restaurants and Eating Houses 293 SANITARY INSPECTION No. of complaints received 2596 Inspections under Shops Act, 1934 835 „ „ Pharmacy and Poisons Act, 1933 81 " of Milkshops 628 Factories Act, 1937 No, of inspections of Factories 1265 " " " " Outworkers' Premises 632 Intimations served 20 House to House Inspections, P.H. (London) Act, 1936 11 No. of Intimations, P.H. (London) Act, 1936 2847 " " Statutory Notices 894 " " Reinspections (all Enactments) 17607 Total Number of Visits 27616 5. TUBERCULOSIS Public Health (Tuberculosis) Regulations,1930. New Cases during 1940. There was a total of 236 new cases including 206 primary notifications of pulmonary tuberculosis, 30 non-pulmonary tuberculosis, 39 inward transfers, 10 posthumous notifications and 8 non-notified deaths obtained from the Registrar's returns. MORTALITY during 1940. There were 150 deaths from all forms of tuber culosis equal to a death rate of 0.86 per 1,000 of population (0.79 per 1,000 in 1939). Of these 140 were pulmonary cases and 10 non-pulmonary cases. NOTIFICATION REGISTER New Cases * Deaths † Age Periods Respiratory Respiratory Non Respiratory Non Respiratory M F M F M F M F - 0 - - - - - - - 1 1 1 1 3 1 - - - 2 2 5 2 3 2 3 - - 43 2 2 37 37 1 5 46 15 19 24 6 3 - - 25 - - 2 - 25 8 1 35 - - - - 29 7 45 16 2 - - - - 2 1 55 18 2 - - - 10 5 65 and upwards 5 7 - - - - Totals 122 15 15 5 84 85 55 5 * 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 1,939, i.e. 1,464 pulmonary, 475 non-pulmonary. The rate of non-notified deaths to the total deaths was 1 to 19 compared with 1 to 33 in 1939. No case of wilful neglect or refusal to notify cases on the part of medical practitioners occurred. No occasion arose during 1940 for any action under the Public Health (Prevention of Tuberculosis) Regulations 1925 or the Public Health Act 1936, Section 172. WORK of the TUBERCULOSIS DISPENSARY during 1940. Diagnosis. Pulmonary Non-Pulmonary Total Adults Children. Adults Children. Adults Children. Grand Total M. F. M. F. M. F. M. F. M. F. M. F. A - New Cases examined during the year (excluding contacts):- (a) Definitely tuberculous 115 59 ' ; r 109 54 3 3 6 5 2 1 5 4 183 (b) Diagnosis not completed - - 10 2 1 13 - - - - - - - - 273 193 12 12 490 (c) Non-tuberculous - - - - - - - 6. 7. Diagnosis Pulmonary Non-Pulmonary Total Grand Total Adults Children. Adults Children. Adults Children. M. F. M. F. M. M. F. M. F. M. F. F. 1 i i B - Contacts examined, during the ye ar :- (a) Definitely tuberculous 13 7 1 1 - - - 13 7 1 1 22 - (b) Diagnosis not completed - - - - - - - 3 7 3 2 15 - (c) Non-tuberculous - - - - - - - 84 142 49 340 65 - r~ C - Cases written off the Dispensary Register as:- 6 8 1 - - 2 1 7 8 3 1 (a) Recovered 1 19 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) | i - - - - - 367 340 64 849 78 - - D- Number of Cases on Dispensary Register on December 31st:- (a) Definitely tuberculous 621 464 57 109 126 81 78 730 590 138 1,589 53 131 (b) Diagnosis not completed - - - - - - 13 8 5 2 * 28 - - 1. Number of cases on Dispensary Register on January 1st 1,680 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 In previous years 65 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme and cases "lost sight of" 208 4. Cases written off during the year as Dead (all causes) 115 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 346 5. Number of attendants at the Dispensary (including contacts) 5,781 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 437 7. Number of consultations with medical practitioners:- (a) Personal 62 (b) Other 1,741 10. Number of (a) Specimens of sputum - etc . examined 646 (b) X-ray examinations made in connection with dispensary Work 1,410 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 7,924 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 2 12. Number of T.B. plus" cases on Dispensary. Register on December 31st 660 HOSPITAL CONSULTATION. The L.C.C. renewed the appointment of the Tuberculosis Officer as Honorary Consultant Tuberculosis Officer to St. Giles' Hospital and 207 cases were seen there in consultation with the Hospital Medical Officer. ARTIFICIAL PNEUMOTHORAX TREATMENT. A total of 877 refill treatments were given by the Tuberculosis Officer at the St. Giles Hospital clinic (compared with 612 in 1939 and 401 in 1938), There were also 586 refills carried out at various other hospitals. Two patients received FINSEN LIGHT TREATMENT and 13 patients DENTAL TREATMENT. EXTRA DIET was given to 103 patients and 122 pocket flasks were supplied. X-RAY. Every new case or "contact" attending the dispensary during 1940 received X-ray examination. CARE COMMITTEE. Christmas Seal Sale. The receipts were £152. 4. 9d. and payments £81. 14. Id. leaving a clear profit of £70. 10. 8d. which was spent in providing beds, bedding and other comforts for tuberculous patients.