CAM 33 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 1944. CAM 33 Public Health Department. Town Hall, Camberwell, S.E.5. 27th September, 1945. To His Worship the Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Mr. Mayor, Aldermen and Councillors, This report like the reports on the health of the Borough and the work of the Public Health Department for the years 1939-43 is an abridged war-time report. The health of the inhabitants of the Borough throughout the year gave no cause for anxiety. An outbreak of influenza which started at the end of 1943 continued in the early part of the year. Local arrangements were made at the suggestion of the Ministry of Health to overcome the difficulties arising out of the shortage under War conditions of medical and nursing assistance, help in the home and the provision of meals in affected households. The local doctors were fortunately able to meet all demands for their services and the local branch of the Womens Voluntary Services dealt with the few requests received for domestic help and the provision ox meals in the homos of the afflicted. The number of deaths was 18. It is now possible to publish the population figures which had been previously withheld during the war years for security reasons. Those figures relate solely to the civilian population of the Borough. The birth and death rates are reprinted for the years 1939-43 together with the corresponding rates for 1944. 1939. 1940. 1941. 1942. 1943. 1944. Population. 219,500 173,750 127,570 129,900 132,330 129,880 Birth rate. 13.85 15.90 15.60 18.14 18.76 18.93 Death rate. 12.43 19.13 19.90 15.64 16.00 18.70 Infantile Mortality rate. 36.00 46.6 58.82 53.88 48.32 52.05 Maternal Mortality rate. 2.04 1.77 6.52 2.47 1.18 1.58 Tuberculosis Mortality rate. 0.79 0.86 1.03 1.00 1.04 0.84 The number of cases of infectious disease in 1944 remained at a low level. The number of new cases of pulmonary tuberculosis was more than in 1943. The London County Council's Mass Miniature Radiography Unit for the detection of pulmonary tuberculosis was available in April for two months 10 South Eastern Hospital for the examination of Camberwell workers. 1123 men and 867 women volunteers employed In industrial undertakings in the Borough were examined. The number of cases referred to the employees own medical attendant following the X-Ray examination as "probably suffering from tuberculosis" was:- Males 11, Females 7. The Council decided during the year to bring within the Home Helps Scheme, cases of sickness of mothers who have living with them children under five years of age for whose care no alternative arrangements can be made, always provided that the needs of expectant and nursing mothers have already been met. Every endeavour was made to add to the number of persons on the panel available for these services to meet the requirements of this extension of the Scheme, but without success. Consequently it has not been possible to implement the Council's desire to extend the Service in the manner indicated. Indeed, it frequently happens that the demands of the expectant mothers cannot be met in view of the small number of Home Helps available to undertake the duties of these appointments. The problem of the illegitimate child also received attention by the Council and a Scheme was adopted embodying the recommendations submitted by the Metropolitan Boroughs' Standing Joint Committee to the Constituent Councils in the interest of uniformity of practice throughout the Metropolis. The principal features of the Scheme are guaranteed payments by the local authority to Poster Mothers for their services and closer co-operation between the Moral Welfare Worker of the Southwark Diocesan Association and the Public Health Department in all matters affecting the mother and her illegitimate child. The Ministry of Health Circular on the care of Premature Infants was also reviewed and instructions were given for the weight of the baby at birth to be included in future in the particulars required to be furnished by a person giving notice of the birth of a child and for arrangements to be made as far as possible for the admission of selected cases to hospital. Close co-operation exists between the Maternity Units of the various hospitals receiving Camberwell mothers for confinement and the Public Health Department. On leaving hospital, these infants are closely followed up by the Health Visitors, Two of the twelve War-time Nurseries in the Borough were irreparably damaged by flying bombs during the year and a Rest Centre Nursery was temporarily closed as a result of enemy action damage. The Nurseries destroyed received children in the 0-5 years of age group. A deputy matron and nursery nurse were loaned for temporary service at Nurseries outside London in view of the exodus of mothers and children from the Borough during Fly-bombing. The nursing staff of the War-time Nurseries were examined at the Tuberculosis Dispensary in accordance with the suggestions made by the Ministry of Health in their Circular 111/44. Miss K. Harris, a temporary Health Visitor was at the request of the Ministry of Health loaned to supplement the health visiting staff at Northampton. In conclusion I wish to thank the members of the Cornell and the Chairmen of the Standing Committees for their continued support and encouragement and the staff of the Public Health Department for their loyal co-operation throughout the year. I am, your obedient servant, H. W. BARNES. MEDICAL OFFICER OP HEALTH. 2 SUMMARY OF STATISTICS. FOR THE YEAR 1944. Area of the Borough in acres ... ... ... ... ... ... 4,480 Registrar General 's estimate of civilian population . 129,880 Number of live births ... ... ... ... ... ... ... ... 2,459 Birth rate .. ... ... ... ... ... ... ... ... ... ... 18.93 Number of deaths ... ... ... ... ... ... ... ... ... 2,429 Death rate .. ... ... ... ... ... ... ... ... ... ... 18.70 Infantile Mortality - Deaths under 1 year ... ... ... ... ... ... 12 8 Infantile deaths per 1,000 births (live) ... ... 52.05 Maternal Mortality - Deaths of women from diseases or accidents associated with childbirth ... ... 4 Maternal death rate (per 1,000 total births) 1.58 Deaths from phthisis ... ... ... ... ... ... ... ... 96 Phthisis death rate ... ... ... ... ... ... ... ... 0.74 Deaths from all forms of tuberculosis ... ... ... ... 109 Tuberculosis death rate ... ... ... ... ... ... ... 0.84 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1944. Sex All ages. 0- 1- 5- 15- 45- 65- Causes of Death M. 1287 72 18 129 373 663 All causes 32 F. 1142 56 17 19 169 249 632 Typhoid and paratyphoid fevers. M. - - - - - - - F. - - - - - - - Cerebro-spinal fever M. - - - - - - - F. 3 2 - - 1 - - Scarlet Fever M. - - - - - - - Whooping Cough F. - - - - - - - M. 7 5 2 - - - - F. 2 2 - - - - - Diphtheria M. 2 - 1 1 - - - F. - - - - - - - Tuberculosis of respiratory system M. 70 - - - 25 32 13 F. 26 - - - 17 7 2 Other forms of tuberculosis M. 5 - 1 1 1 2 - Syphilitic diseases F. 8 - 1 1 5 1 - M. 14 - - 1 - 5 8 F. 6 - - - 1 1 4 Influenza M. 9 1 - - 1 4 3 F. 9 - 1 - 1 - 7 Measles M. - - - - - - - F. - - - - - - - Acute Polio-myelitis and polio-encephalitis. M. - - - - - - - F. - - - - - - - Ac: inf: enceph: M. - - - - - - - F. 1 - - - - 1 - Cancer of buc: cav: & oesoph: (M) uterus (F) M. 10 - - - - 4 6 F. 14 - 1 - 1 6 6 Cancer of stomach & Duodenum M. 28 - - - 1 12 15 F. 25 - - - 1 6 18 Cancer of breast M. 2 - - - - 1 1 F. 25 - - - 7 9 9 Cancer of all other sites M. 117 - 1 - 10 44 62 Diabetes F. 88 - - - 6 35 47 M. 5 - - - - 3 2 F. 7 - - - - 2 5 Intracranial vascular lesions M. 93 - _ - 2 20 71 F. 90 - - - — 25 65 1. DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1944 Causes of Death Sex All ages 0- 1- 5- 15- 45- 65- Heart disease M. 315 - - 10 57 248 - F. 14 313 - - - 35 264 Other Dis: of circ: system 1 M. 29 - - 10 18 - - F. 30 - - - 9 21 Bronchitis - M. 114 1 5 45 63 - F. 54 - 1 4 49 - - Pneumonia 2 M. 67 8 - 3 19 35 F. 45 6 2 - 3 10 Other resp: diseases 24 - 7 - 1 1 5 M. - 9 - - 2 4 F. 3 - 36 - 23 9 Ulcer of stomach or duodenum M. 4 - - 9 - 3 5 F. - - 1 - Diarrhoea under 2 years M. 16 15 1 - - - - F. 18 17 1 - - - Appendicitis M. 8 - - 1 3 4 - 5 2 - - 2 1 F. - Other digestive diseases 20 1 3 7 M. 1 - 8 F. 24 - - 7 12 2 3 17 - - 2 4 6 Nephritis M. 5 - 1 3 F. 10 - 2 4 - Puer: and post-abort: sepsis M. - - - - - - 2 2 F. - - - - - M. - - - - Other maternal causes - - - 2 - - 2 F. - - - - Premature birth 15 15 - - M. - - 13 13 - - F. - - - Con: Mal: birth inj: infant dis: 21 17 2 - M. 2 - - 7 2 1 F. 10 - - - 2 7 M. 10 - 1 Suicide - - 2 - F. 3 - 1 - - 2 Road Traffic acc: Other violent causes 2 - 3 M. 9 - 2 1 2 F. 7 - - 1 3 20 44 41 M. 178 5 8 60 87 54 F. 227 3 10 13 60 All other causes 4 1 1 8 14 35 M. 63 57 4 1 1 8 15 28 F. INFECTIOUS AND OTHER DISEASES. NOTIFICATIONS. The number of notifications during the year (1712) was made up as follows:- Diphtheria and Group ... ... ... 59 Scarlet Fever .. ... ... ... ... 192 Measles ... ... ... ... ... ... 304 Whooping Cough . ... ... ... ... 328 Enteric Fever & Para-typhoid ... 3 (Acute Influenzal . ... 16 Pneumonia (Acute Primary ... ... 68 Erysipelas . ... ... ... ... ... 45 Cerebro-Spinal Meningitis .. ... 15 Malaria ... ... ... ... ... ... 1 Dysentery .. ... ... ... ... ... 42 Ophthalmia Neonatorum .. ... ... 6 Puerperal Fever ... ... ... ... 6 Puerperal Pyrexia .. ... ... ... 10 Scabies ... ... ... ... ... ... 617 Total. 1712 In sixty instances it was found that the patient was not suffering from the disease notified. 2. DISINFECTING STATION - RETURN OF WORK. Notified Infectious Diseases Other Diseases Miscellaneous A.R.P. Disinfecting and washing Scabies Vermin Total all cases Rooms disinfected 582 66 13 21 863 1598 53 Lots of bedding disinfected 378 82 272 391 464 1683 96 Number of articles disinfected by steam . ... ... ... ... 6,686 " " " " " formalin ... ... ... ... 997 " . " books disinfected ... ... ... ... ... ... ... ...228 Beds and Mattresses destroyed . ... ... ... ... ... ... ... 63 Miscellaneous goods destroyed . ... ... ... ... ... ... ... 138 T. C. qr. lb. Weight of Unsound foods destroyed . ... ... ... ... 8 8 0 .12 " " Old and verminous furniture etc. destroyed ... 5 0 0 " " dead animals destroyed .. ... ... ... ... 3 0 0 CLEANSING STATION Persons cleansed Number of attendances Scabies Vermin Males Females Females Males Adults 714 885 257 133 3,003 Children 2,800 708 1,593 NUMBER OF BACTERIOLOGICAL EXAMINATIONS PERFORMED 1944 Swabs for diphtheria ... ... ... ... ... ... ... ... 721 Sputa for tubercle... ... ... ... ... ... ... ... ... 766 Milks ... ... ... ... ... ... ... ... ... ... ... ... 36 Faeces for Typhoid Group ... ... ... ... ... ... ... 6 " " Sonne dysentery .. ... ... ... ... ... ... 132 Urine for Dysentery . ... ... ... ... ... ... ... ... 1 Bath waters. ... ... ... ... ... ... ... .... ... ... 2 Miscellaneous specimens . ... ... ... ... ... ... ... 52 Total 1,716 VACCINATION 1944. No. of names received in birth lists ... ... ... ... 1,872 Certificates of Successful Vaccination received . ... 1,359 " " Postponement received ... ... ... ... ... 15 " " Insusceptibility received ... ... ... 4 Statutory Declarations of Objection received ... ... 493 3. IMMUNISTION ACAIFST DIPHTHERIA . Summary of cases immunised. 0-5 yrs. 5-15 yrs. Total. 1. At Borough Council Clinics. 754 37 791 2. At L.C.C. Clinics. 30 366 396 3. By Private Practitioners. 16 4 20 Totals. 800 407 1207 MATRNITY. ND CHILD WALFARE. Infant Welfare Centres - Clinic Attendances etc. 1944. Attendances of Children (i) Under 1 year .. ... ... ... 19,033 (ii) Between I & 5 years 5,645 miscellaneous attendances .. ... ... .. . ... ... ... 2,266 Total attendances.. ... ... 26,944 Analysis of Attendances - Doctors' Consultations.. ... ... ... ... ... 5,806 Seen by Health Visitor.. ... ... ... ... ... 12,244 Health Visitors - Record of Visits, 1944. Visits to Expectant Mothers ... ... ... ... ... ... 1,440 " Post-natal Mothers ... ... ... ... ... ... ... 1,428 No. of Births reported In the Area .. ... ... ... ... ... 2,459 Visits to Children - (I) Under 1 year . ... ... 5,805 (II) Between 1 and 5 years 11,867 Total 17,672 Miscellaneous Visits ... ... ... ... ... ... ... ... ... 1,331 24,330 Child Life Protection. The Health Visitors are authorised by the Council to exercise the powers of Child Protection Visitors under the Public Health (London) Act, 1936. Visits to Poster mothers and children .. ... ... ... ... 424 Foster mothers under supervision 1944... ... ... ... ... 16 Foster children under supervision 1944 .. ... ... ... ... 21 Ancillary Services. In 96 instances the services of a Homo Help were provided for mothers, either before, during or after confinement. 7 expectant or nursing mothers were provided with dental treatment. Priority dockets were Issued to 6 expectant mothers to enable them, to purchase sheets for their confinements. The District Nursing Associations paid a total of 2,972 visits to 214 approved cases under the Council's Domiciliary Nursing Scheme A total of 50 patients benefitted under the Council's Treatment of Minor Ailments Scheme. 7 cases were sent during the year through the agency of the Invalid Children's Aid Association to convalescent homes. FOOD AND DRUGS. FORMAL AND INFORMAL SAMPLES SUBMITTED FOR ANALYSIS - YEAR ENDED 31.12.44. Number examined Number adulterated etc . Percentage of adulteration. Formal Informal Total. Formal Informal Total Formal Informal 680 462 1142 12 10 22 2.59 1.47 COMPOSITION OF MILK SAMPLES. 431 formal and 12 informal samples of milk were taken during the year. Seven formal samples wore found not to conform with requirements. MILK ADULTERAION. Seven formal samples were reported against, three being found to contain extraneous water and four being deficient in fat. The percentage of adulteration was 1.62. No infringements of the MERCHANDISE MARKS ACT wore 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 30 Tuberculin tested " " 5 All were found to comply with the standard for pasteurised milk laid down in the Milk (Special Designations) Order, 1936; in addition twelve samples of pasteurised milk were submitted to the Phosphatase test. All samples were found to be adequately pasteurised. One sample of Tuberculin Tested Milk was submitted for the Methylene Blue test, and found to be satisfactory. 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 70 overground and 27 underground. SUMMARY OF INSPECTION AND SUPERVISION OF FOOD. Street Markets Inspections ... ... ... 1,820 FOOD PLACES - Inspections: Bakehouses ... ... ... ... ... ... ... 145 Fish Curers Premises ... ... ... ... 44 Fried Fish Shops ... ... ... ... ... 81 Ice Cream Premises ... ... ... ... ... 2 Restaurants and Eating Houses ... ... 120 5. SANITARY INSPECTION. No. of complaints received 1,945 Inspections under Shops Act, 1934 259 " " Pharmacy and Poisons Act, 1933. 143 " " Milkshops 148 Factories Act, 1937 :- No. of inspections of Factories 21 " " " " Outworkers Premises - Intimations served 1 No. of Intimations, P.H. (London) Act, 1936 1,263 " " Statutory Notices 306 " " Reinspections (all Enactments) 3,731 Total number of visits 14,282 WATER SUPPLY. No complaints were made to the Public Health Department as to the purity of the water supply provided by the Metropolitan Water Board. All houses in Gamberwell receive a direct supply. RODENT CONTROL SCHEME. A comprehensive scheme was launched in the early part of the year to deal with the rat infestation of the Borough. The preliminary work of obtaining and training staff for the surface treatment of the Borough on "Block Control" lines as advocated by the Ministry of Food commenced in December, 1943. A separate Office at the Camberwell Municipal Baths, a bait preparing room and a stores building adjoining the Baths were provided for the purposes of the Scheme One of the Council's Sanitary Inspectors was appointed as Rodent Officer who devotes the whole of his time to the duties arising from the investigation of complaints and the organisation of the work of surface treatment of the Borough. Co-operation was maintained with the Borough Engineer's Department to ensure the treatment of sewers when "Block" treatments were in progress. To assist the Rodent Officer a staff of 3 clerical assistants, 3 investigators and 8 operators were engaged. The Borough was divided into 38 areas and 10 special areas were formed. During the year 320 surveys and inspections were made by the Rodent Officer, 18,240 calls were made by the Investigators and 11,878 visits were paid by the Operators. The number of baits laid was 20,929 and traps were set whore necessary. At the end of the year 21 areas had been treated and 3 were in the course of treatment. In conformity with the Ministry of Food directions the initial treatment of sewers in the Borough was followed in February by a second treatment. There were 614 complaints received during the year at the Public Health Department of the presence of rats at premises in the Borough which received attention. As a result of Fly-bomb raids in the summer months the work of the Scheme was slowed down by the withdrawal of the majority of the staff for duties connected with rehousing of bombed-out families and furniture storage. TUBERCULOSIS. Public Health (Tuberculosis) Regulations, 1930. NEW CASES during 1944. 354 fresh cases of Tuberculosis came to the notice of the Dispensary during the year. 295 of these cases were primary notifications, 40 inward transfers, 6 posthumous notifications and 13 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. Fresh Cases. Age periods Respiratory Non Respiratory Total M. F. M. F. - 0-1 - - - - 3 3 2 10 1 - 5 2 8 7 31 5 - 15 10 6 96 13 226 15-45 108 9 45-65 48 16 1 - 65 65- 13 4 3 2 22 24 24 181 354 Total 125 MORTALITY during 1944. There were 109 deaths from all forms of tuberculosis after correction for Inward and Outward Transfers, equal to a death rate of 0.84 per 1,000 of population (1.04 per 1,000 in 1943). Of these, 96 were pulmonary cases and 13 nonpulmonary cases. The age groups in which these deaths occurred appear in the sub-joined table. Age periods Deaths Respiratory Total Non Respiratory M. F. M. F. 0-1 - - - - - 1 - 5 - - 1 1 2 5 - 15 - - 1 1 2 15-45 25 17 1 5 48 45-65 32 7 2 1 42 65- 13 2 - - 15 Total 70 26 5 8 109 The total number of cares on the Tuberculosis Register at the end of the year was 1,727 i.e., 1,422 pulmonary, 305 non-pulmonary. The ratio of non-notified deaths to the total deaths was 1 to 8.4 as compared with 1 to 12.5 in 1943. No case of wilful-neglect or refusal to notify casus on the part of medical practitioners occurred. No occasion arose during 1944 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- 1944. Pulmonary Non-Pulmonary Total Diagnosis Adults Child- ren. Adults Child- ren. Adults Child- ren. Grand Total M. F. M. F. M. F. M. F. M. F. M. F. A - New Cases examined during the year (ex- cluding contacts):- (a) Definitely Tuberculous... 71 143 5 8 79 52 48 2 5 4 - 10 2 (b) Diagnosis not completed .... - - 23 25 - - - - - - 55 3 4 (c) Non-tuberculous - - - - - 252 36 24 682 - - - 370 B-Contacts examined during the year:- (a) Definitely Tuberculosis .. 31 - - 63 2 4 3 21 21 2 31 4 7 (b) Diagnosis not completed .... - - - - - - 38 - - 11 9 10 8 (c) Non-tuberculous - - - - 58 - - - - 92 171 43 364 C-Cases written off the Dispensary Register as:- - 2 44 11 - 21 14 3 4 (a ) Recovered .... 3 24 4 2 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous). - - — - - 1099 - - 361 562 100 76 - D - Number of cases on Dispensary Register on December 31st:- 682 1547 518 590 68 638 (a) Definitely Tuberculous 72 35 52 92 120 107 120 (b) Diagnosis not completed .... 93 - - 33 36 - - — 12 - - 12 - 8. 1. Number of Cases on Dispensary Register on January 1st, 1944 1,610 2. Number of cases transferred from other areas and cases returned after discharged under Head 3 in previous years. 71 164 79 3. Number of cases transferred to other areas, cases not desirous of further assistance under the Scheme and cases "lost sight of". 4. Cases written off during the year as Dead (all causes) 5. Number of attendances at the Dispensary (including contacts) 7. Number of visits by Tuberculosis Officers to homes (including personal consultations) 6. Number of consultations with Medical Practitioners:- (a) Personal (b) Other 8. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes. - 1,535 6,683 8,906 176 9. Number of:- (a) Specimens of sputum etc, examined (b) X-ray examinations made in connection with Dis- pensary work 654 2,412 1 10. Number of "recovered" cases restored to Dispensary Register and included in A (a) and A (b) above. 11.Number of "T.B.plus" cases on Dispensary Register at December 31st, 1944. 367 ARTIFICIAL PNEUMOTHORAX TREATMENT. A total of 2,250 refill treatments were given to Camberwell patients as compared with 1,925 in 1943. Three patients received Finsen Light treatment and six patients dental treatment. Extra diet was given to 62 patients and 33 pocket flasks were supplied. X-ray. Every new case of "contact" attending the dispensary during 1944 received X-ray examination. TUBERCULOSIS ALLOWANCES. Memo 266/ T. The Government scheme of monetary payments to patients suffering from pulmonary tuberculosis receiving approved treatment, and their dependents, commenced in June 1943. The operation of the scheme has worked smoothly. Particulars of the cases dealt with under the scheme during 1944 appear in the sub-joined table. 1. Number of applications considered. ... ... ... 186 2, Number of applications found to be eligible ... 161 3. Number found to be ineligible but became entitled to an allowance at a later date. ... 1 4. Number of applications approved and subsequently lapsed as a result of altered circumstances ... ... ... ... ... ... ... ... 88 HANDICRAFT CLASS. The members of the class continued their high standard of work, and a ready market for the articles made by them was found. The Friday afternoon class continued throughout the year and there were 50 sessions; the average attendance was 10 members. CHRISTMAS SEALS SALE. The receipts were £408.13.4½d., and the expenses £76.7.6d., the balance of £332,5.10½d. being disbursed in the provision of bedding and other comforts for tuberculous patients. 9.