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 1942 CAM 31 CAM 31 Public Health Department, Town Hall, Camberwell, S.E.5. 30th September, 1943. To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Camberwell. Mr. Mayor, Aldermen and Councillors, This report, like those previously Issued during the War merely records in statistical form the work carried out during the year in connection with the more important services and follows the Ministry of Health's suggestions for the preparation of annual reports during War time. The respite from sustained nightly bombing enabled more attention to be given to the repair of War damaged houses and particularly to such basic Public Health Services as Sanitary Inspection, Infant Welfare and the Prevention and Control of Infectious and other Diseases. The year's work also included breaking new ground by the initiation and development of a scheme for the establishment of a number of War-time nurseries in various parts of the Borough. This programme contemplated the establishment of twelve Nurseries and at this date there remains one Nursery to be opened in the North Peckham district, which it is hoped will be ready for occupation in the course of the next week or two, to complete the scheme. In response to the appeal by the Minister of Health to Local Authorities to secure the immunisation of the greatest possible number of children against Diphtheria during the summer months, an intensive propaganda campaign was conducted throughout the Borough by leaflet distribution, poster displays, and personal contacts by the Health Visitors and Sanitary Inspectors. As a result of these activities it became necessary to establish a chain of Clinics to meet the demand for treatment. It is extremely satisfying to note that the interest of the parents in this all important matter of securing protection for their children is well sustained as the attendances at the Clinics continue to show. An increase in the number of cases of Scabies and Vermin ifestations has to be reported and was reflected in the work of the Cleansing Centre at Peckham Park Road Depot. In some cases patients were unable to leave their work to attend the Centre for treatment at the appointed times and in the interests of the War effort and of the affected persons themselves facilities were offered for treatment in the evenings, an arrangement which proved its value and was much appreciated by the persons concerned. A re-arrangement of the Tuberculosis work of the Borough followed on the release for Military Service of Dr. C. F. Price, the Tuberculosis Officer and Deputy Medical Officer of Health. To assist Dr. Eleanor Gorrie the Assistant Tuberculosis Officer, the Council of the neighbouring Borough of Southwark approved the loan of the services of their Tuberculosis Officer, Dr. Pritchard, for the purpose of conducting one clinic session weekly at the Camberwell Tuberculosis Dispensary and to undertake the A.P. Clinics, formerly conductcd by Dr. Price at the Southwark Health Centre on Wednesday afternoons and evenings. The L.C.C. also arranged for the reading of the X-ray films taken at St. Giles' Hospital, by their own Radiologist, three times a week. These readings were previously done by Dr. Price. I am pleased to report that these revised arrangements have proved very satisfactory in maintaining the Tuberculosis Service of the Council at an efficient level. As has always been my practice when submitting the annual report on the health of the Borough, I again wish to acknowledge my indebtedness to the staff of the Public Health Department for their invaluable help to me in administering the health services of Camberwell. Extra duties arising from the War, together with the call-up of many of the staff for service in the Armed Forces, have naturally added to the burdens of the few remaining established members of the staff. In no respect, however, has the work of the Public Health Service suffered, thanks to their unstinted efforts during the year. I also wish to express my appreciation to the members of the Council and to the Chairmen of the Standing Committees 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 1942. 1. Area of the Borough in acres 4,480 Number of live births 2,357 Birth rate 18.14 Number of deaths 2,032 Death rate 15.64 Infantile Mortality- Deaths under 1 year 127 Infantile deaths per 1,000 births (live) 53.88 Maternal Mortality- Deaths of women from diseases or accidents associated with childbirth 6 Maternal death rate (per 1,000 total births) 2.47 Deaths from phthisis 118 Phthisis death rate 0.90 Deaths from all forms of tuberculosis 130 Tuberculosis death rate 1.00 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1942 Causes of Death Sex All ages 0- 1- 5- 15- 45- 65- All causes M. 1074 11 528 68 9 116 342 F. 958 59 4 4 94 214 583 - - Typhoid and paratyphoid fevers M. - - - - - F. - - - - - - - Cerebro-spinal fever M. 2 2 - - - - - F. - - - - - - - Scarlet Fever M. - - - - - - - F. - - - - - - - Whooping cough M. 1 - 1 - - - - F. 1 1 - - - - - Diphtheria M. 1 - 1 - - - - F. 2 - 1 - - 1 - Tuberculosis of respiratory system M. 79 - - 1 41 28 9 F. 39 - - - 30 7 2 Other forms of tuberculosis M. 9 - 2 - 7 - - 3 - - 1 2 - - F. Syphilitic diseases M. 7 - - - - 5 3 F. 7 - - - - 6 1 Influenza 3 1 - - 1 - 1 M. F. 6 - - - - 1 5 Measles M. 1 - 1 - - - - F. 1 1 - - - - - Acute Polio-myelitis and polio-encephalitis. M. - - - - - - - F. - - - - - - - Ac: inf: enceph: M. - - - - - - - F. - - - - - - - Cancer of buc : cav:& oesph: (M) uterus (F) M. 12 - - - - 3 9 F. 18 - - - 2 9 7 Cancer of stomach & Duodenum M. 45 - - - 2 23 20 F. 12 - - - 1 6 5 Cancer of breast M. - - - - - - - F. 34 - - - 4 18 12 Cancer of all other sites M. 113 - - - 5 55 53 F. 81 - - 1 7 30 43 Diabetes M. 4 - - - - 2 2 F. 3 - - - 1 - 2 Intracranial vascular lesions M. 69 - - - - 16 53 F. 88 - - 1 16 71 - DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1942. 2. Causes of Death Sex All Ages 0- 1- 5- 15- 45- 65- Heart disease M. 289 - - - 9 66 214 F. 324 - 1 13 47 263 - Other Dis: of circ: system M. 28 - - 1 14 13 - F. 28 - - - 2 6 20 Bronchitis M. 95 2 1 - 3 37 52 F. 60 3 - - 2 5 50 Pneumonia 52 9 1 - 17 19 M. 6 26 F. 48 11 1 - 2 8 Other resp: diseases M. 15 - - - - 7 8 F. 7 1 - - - 3 3 Ulcer of stomach or duodenum M. 25 - - - 7 13 5 F. 8 - - - 1 5 2 Diarrhoea under 2 years M. 15 15 - - - - - F. 5 5 - - - - - Appendicitis M. 3 - - - 1 1 1 F. 3 - - 1 - 1 1 Other digestive diseases M. 21 2 - - 4 9 6 F. 20 - - - 2 7 11 Nephritis 7 - - - 1 2 4 M. F. 20 - - 2 7 11 - Puer: and post-abort: sepsis M. - - - - - - - F. 3 - - - 2 1 - Other maternal causes M. - - - - - - - F. 3 - - 2 1 - - Premature birth M. 17 17 - - - - - F. 20 20 - - - - - Con: Mal: birth inj: infant dis: M. 16 15 - - - - 1 F. 18 13 - - 1 4 - Suicide M. 6 - - - 2 2 2 F. 6 - - - 1 4 1 Road Traffic acc: M. 13 - - 1 4 3 5 F. 4 - - - 3 1 - Other violent causes M. 30 3 1 4 9 9 4 F. 15 2 - - 2 3 8 All other causes M. 95 2 3 3 13 30 44 F. 59 2 1 - 7 17 32 INFECTIOUS DISEASES SUMMARY OF NOTIFICATONS RECEIVED. No.of cases notified Treated in Hospital Found to be not suffering from the disease Diphtheria and Croup 155 4 159 Scarlet Fever 249 227 2 Measles 907 145 - Whooping Cough 310 84 - Enteric Fever & Para-typhoid 3 3 - Pneumonia Acute Influenzal 7 2 - Acute Primary 51 44 - Erysipelas 51 23 - Cerebro-Spinal Meningitis 25 25 1 Polio-Myelitis 2 2 - Dysentery 14 14 - Ophthalmia Neonatorum 7 3 - Puerperal Fever 9 9 - Puerperal Pyrexia 20 19 - Totals 1,814 755 7 Notified Infectious Diseases Other Diseases Miscellaneous A. R. P. Disinfecting and washing Scabies Vermin Total all cases Rooms disinfected 18 16 717 1052 2636 593 240 203 Lots of bedding disinfected 311 473 282 1788 371 148 883 618 1686 997 Total Visits 605 561 5350 Number of articles disinfected by steam 83,973 „ „ „ „ „ formalin 5,346 „ „ books disinfected 154 Beds and Mattresses destroyed 163 Miscellaneous goods destroyed 232 T. C. qr. 1b. Weight of Unsound foods destroyed 21 2 2 2½ „ „ Old and verminous furniture etc. destroyed 3 7 0 0¼ „ „ dead animals destroyed 1 3 0 CLEANSING STATION. Number of attendances Scabies Vermin Persons cleansed Males Females Males Females Adults 633 890 17 12 Children 5,196 5,459 573 1,473 NUMBER OF BACTERIOLOGICAL EXAMINATIONS PERFORMED 1942. Swabs for diphtheria 871 Sputa for tubercle 596 Milks 42 Bath waters 4 Miscellaneous specimens 42 Total 1,555 VACCINATION 1942. No. of names received in birth lists 1,365 Certificates of Successful Vaccination received 939 " " Postponement received 12 „ „ Insusceptibility received 3 Statutory Declarations of Objection received 446 MATERNITY AND CHILD WELFARE. Infant Welfare Centres - Clinic Attendances etc. 1942. Attendances of Children (i) Under 1 year 23,922 (ii) Between 1 & 5 years 6,674 Miscellaneous attendances 2,697 Total attendances 33,293 Analysis of Attendances- Doctors' Consultations 11,530 Seen by Health Visitor 19,066 Health Visitors - Record of Visits, 1942. Visits to Expectant Mothers 1,729 „ „ Post-natal Mothers 1,931 No. of Births reported in the Area 2,357 Visits to Children- (i) Under 1 year 9,89l (ii) Between 1 and 5 years 12,564 Total 22,455 Miscellaneous Visits 3,260 Total Visits 31,732 Ancillary Services. In 190 instances the services of a Home Help were provided for mothers, either before, during or after confinement. 24 expectant or nursing mothers were provided with dental treatment. The District Nursing Associations paid a total of 3,039 visits to 235 approved cases under the Council's Domiciliary Nursing Scheme. A total of 75 patients benefitted under the Council's Treatment of Minor Ailments Scheme. FOOD AND DRUGS. FORMAL AND INFORMAL SAMPLES SUBMITTED FOR ANALYSISYEAR ENDED 31. 12. 42. Number examined Number adulterated. etc. Percentage of adulteration. Formal Informal Total Formal Informal Total Formal Informal 1093 20 32 52 7.54 3.86 266 827 The analysis of one formal sample was not completed owing to the rapid fermentation of the sample. COMPOSITION OF MILK SAMPLES. 235 formal and 25 informal samples of milk were taken during the year. One formal sample was found not to conform with requirements. 4. MILK ADULTERATION. One formal sample was reported against, it being found to contain extraneous water. The percentage of adulteration being 0.42. 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 42 Two samples were found not to comply with the standard for pasteurised milk laid down in the Milk (Special Designations) Order, 1936, the number of bacteria per millilitre being 192,000 and 217,600 respectively. No tuberculin tested milk was sold in the Borough. EXAMINATION OF MILK FOR THE PRESENCE OF TUBERCLE BACILLI. Five 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 70 overground and 29 underground. SUMMARY OF INSPECTION Street Markets Inspections 2117 FOOD PLACES - Inspections: Bakehouses 186 Fish Curers' Premises 71 Fried Fish Shops 125 Ice Cream Premises 297 Restaurants and Eating Houses 261 SANITARY INSPECTION. No. of complaints received 3052 Inspections under Shops Act, 1934 662 „ „ Pharmacy and Poisons Ac t, 1933. 158 „ „ Milkshops 442 Factories Act, 1937. No. of inspections, of Factories 73 „ „ „ „ Outworkers' Premises 37 Intimations served 12 No. of Intimations, P.H. (London) Act, 1936 2555 „ „ Statutory Notices 399 „ „ Reinspections (all Enactments) 9928 Total number of visits 17777 5. TUBERCULOSIS. Public Health (Tuberculosis) Regulations, 1930. NEW CASES during 1942. 404 fresh cases of tuberculosis came to the notice of the Dispensary during the year. 305 of these cases were primary notifications, 59 inward transfers, 9 posthumous notifications and 31 non-notified deaths obtained from the local Registrar's returns. The distribution of these cases in age groups distinguishing pulmonary and non-pulmonary forms is set out in the following table. Age periods Fresh Cases. Respiratory Non Respiratory F. M. F. M. Total 1 - 1 - 2 0... 1 5 1 5 12 1... 7 5 36 9 15 5... 121 10 267 15... 116 20 67 45... 50 16 - 1 1 20 65... 13 4 2 Total 157 24 29 404 194 MORTALITY during 1942. There were 130 deaths from all forms of tuberculosis after correction for Inward and Outward Transfers, equal to a death rate of 1.00 per 1,000 of population (1.31 per 1,000 in 1941). Of these 118 were pulmonary cases and 12 non-pulmonary cases. The age groups in which these deaths occurred appear in the sub-joined table. Age periods Deaths. Respiratory Non Respiratory M. F. M. F. Total - - - - - 0... - - 2 - 2 1... 1 2 5... 1 - - 7 80 15... 41 30 2 - 35 45... 28 7 - 11 65... 9 2 - - 6. The total number of cases on the Tuberculosis Register at the end of the year was 1,723 i.e. 1,401 pulmonary, 327 non-pulmonary. The rate of non-notified deaths to the total deaths was 1 to 4.19 compared with 1 to 9.8. in 1941. No case of wilful neglect or refusal to' notify cases on the part of medical practitioners occurred. No occasion arose during 1942 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 1942. Diagnosis. Pulmonary Non-Pulmonery Total Adults Children Adults Children Adults Children M. F. M. F. M. F. M. F. M. F. M. F. A. New cases examined during the year excluding contacts: (a) definitely tuberculous 70 59 11 6 9 6 2 76 68 17 10 8 (b) diagnosis not completed - - - - - - - - 10 4 1 - (c) non-tuberculous - - - - - - - 165 173 8 23 - B. Contacts examined during the year:- (a) definitely tuberculous 18 16 3 1 1 - - - 19 16 3 .1 (b) diagnosis not completed - - - - - - - - 3 19 4 7 (c) non-tuberculous - - - - - - 113 151 56 53 - - C. Cases written off the Dispensary register as:- (a) recovered 11 16 2 1 6 7 11 2 17 23 13 3 (b) non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 280 329 67 77 D. Number of cases on Dispensary register on 31st December:- (a) Definitely tuberculous 589 462 61 91 109 41 54 680 571 102 116 62 1. Number of cases on dispensary Register on 1st January 1,580 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 94 3. Number of cases transferred to other areas, cases not desirous of further assistance under the Scheme and cases "lost sight of" 243 4. Cases written off during the year as Dead, (all causes) 105 6. Number of Insured persons under domiciliary treatment on 31st December 235 5. Number of attendances at the dispensary (Including contacts) 6.424 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 341 7. Number of consultations with medical practitioners:- (A) Personal 12 (B) Other 1,691 9. Number of visits by Nurses or Health Visitors to homes for dispensary purposes 6,776 10. Number of:- (a) Specimens of sputum examined 412 (b) X-ray examinations made in connection with dispensary work 1,757 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 31st December 473 ARTIFICIAL PNEUMOTHORAX TREATMENT. A total of 1,502 refill treatments were given to" Camberwell patients as compared with 1,089 in 1941. Three patients received FINSEN LIGHT TREATMENT and ten patients DENTAL TREATMENT. EXTRA DIET was given to 65 patients and 62 pocket flasks were supplied. X-RAY. Every new case or 'contact' attending the Dispensary during 1942 received X-ray examination. CARE COMMITTEE. Christmas Seal Sale. The receipts were £439.11.4. and expenses £55.14.2½. leaving a profit of £383.17.1½. which provided beds, bedding and other comforts for tuberculous patients. HANDICRAFT CLASS. The Handicraft Class continued to meet the Dispensary on Friday afternoons throughout the year and the students maintained their interest and attendance. The number of classes hold was 50 and the average attendance 10. All the goods made in this class found a ready market.