79 LIBRARY 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 1945 CAM 34 Public Health Department, Town Hall, Camberwell, S.E. 5. 20th August 1946. The Worshipful the Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Mr. Mayor, Aldermen and Councillors, I have pleasure in presenting to you. my annual report on the work of the public health services of the Borough for the year 1945. This report has been prepared on the lines of those previously submitted during the war years and is in accordance with the directions of Ministry of Health Circular 28/46 dated the 11th February, 1946. There were no matters of particular significance affecting the health of the inhabitants of Camberwell which require Special reference. Although the majority of the people gave the appearance of mental and physical tiredness result from the strain of war the health of the Borough was satisfactory. The birth rate shows an increase from 18.9 in 1944 to 19.5 per 1000 o f the population, and the death rate fell to 14.5 as compared with 18.7 in the previous year. The infantile mortality rate dropped from 52 in 1944 to 34 per 1000 live births in the year under review, the lowest figure ever recorded, in Camborwell. The deaths from pulmonary tuberculosis totalled 118 as compared with 96 in the previous year and the deaths from all forms of tuborculosis 126 as against 109 in the previous year. The death rates from these causes were 0.8 and 0.9 per 1000 of the population respectively as compared with 0.7 and 0.8 in 1944. There was an Increase in the number or cases of infections and other diseasos reported during the year, viz. 2363 as compered with 1712 in 1944. This increase was mainly due to the incidence of measles throughout the year, the highest recording of cases occurring in the months of March and April, and to the notification of approximately 100 additional cases of seabies. It is pleasing to record that the number of cases of diphthoria continues to fall, the number notified during the year was only 54; there were two deaths from this cause. Efforts to stimulate public interest in the Diphtheria Imminisation Campaign were continued and the statistics published on page 4 of this report reflect the measure of success of these activities. The sanitary administration in spite of the many difficulties arising from war conditions was maintained at a satisfactory level. With the cessation of hostilities the Council gave early consideration to the need for additional Infant Welfare Centre facilities in view of the return of evacuees to the Metropolis and an anticipated rise in the birth rate. As a result the Amott Road Voluntary Association Centre which was closed during the war was re-opened under Municipal direction; the possibility of establishing an additional Infant Welfare Centre in the Northern part of the Borough was explored and the St. Antholin's Centre which for a number of years was conducted by a Voluntary Association was transferred to Municipal control during the year. The "Toddlers" clinics, which were such an important and popular feature of the Infant Welfare Service before the war, were also re-established. Difficulty continued to bo experienced in the recruitment of suitable persons to undertake Home Help duties and at the end of the year under review the number of persons available for this service was three full-time and two part-time workers. There is, however, reason to hope that in the process of time it will be possible to meet all demands for assistance of this kind, in fact at the time of the preparation of this report the number of persons now available for these duties is four full-time and five part-time workers. In these general observations I desire to take the opportunity of expressing my thanks and appreciation to the Members of the Council for the support and encouragement they extended to mo throughout the year in the discharge of try duties as Medical Officer of Health. I also wish to thank the staff of the Public Health Department both permanent and temporary for their loyal co-operation given freely and willingly in difficult times. Your obedient Servant, H. W. BARNES. Medical Officer of Health. SUMMARY OF STATISTICS. FOR THE YEAR 1945. Area of the Borough in acres 4,480 Registrar Generalls estimate of civilian population 135,460 Number of live births 2,646 Birth rate 19.5 Number of deaths 1,968 Death rate 14.5 Infantile Mortality- Deaths under 1 year 91 Infantile deaths per 1,000 births (live) 34 Maternal Mortality- Deaths of women from diseases or accidents associated with childbirth 6 Maternal death rate (per 1,000 total births) 2.21 Deaths from phthisis 118 Phthisis death rate 0.8 Deaths from all forms of tuberculosis 126 Tuberculosis death rate 0.9 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1945. Causes of Death Sex All ages 0- 1- 5- 15- 45- 65- All causes 298 215 7 8 563 575 86 103 M F 1027 941 61 30 12 10 Typhoid and paratyphoid fevers - - - - M - - - - - - - - F - Cerebro-spinal fever - - - - M - - - - Scarlet fever 1 - - F 1 - - - - M - - - - - - - F - - - - - Whooping Cough - M 1 - - - 1 - - 1 - - - Diphtheria F 1 - - 1 - M 1 - - - - 1 F 1 - - Tuberculosis of respiratory system - - - M 65 - - - 30 30 5 F 53 - - - 39 9 5 Other forms of tuberculosis M 4 1 - 1 1 1 - 1 F - Syphilitic diseases 4 - 3 - - M - - - - 3 1 4 - - 1 F 4 - - 3 Influenza - - M 6 - - 4 2 - - 2 F 5 1 - 2 Measles - - M 2 2 - - - 1 - Acute Polio-myelitis and polio—encephalitis F 1 - - - - M - - - - - - - F - - - - - - - Ac: inf: enceph: M - 1 2 3 - - - F 1 - - - - 1 - Cancer of buo: cav: & oesoph:(M) uterus (F) 15 M 19 - - - - 4 F 1 15 - - 7 7 - Cancer of stomach & duodenum M 30 - - - 1 13 16 F 20 - - - 6 14 Cancer of breast - M 1 - - - 1 - - Cancer of all other sites F 20 - - - 2 8 10 M 120 1 1 9 - 48 61 F 83 1 6 33 43 Diabetes - - M 3 - - - - - 3 F - 1 2 - 1 Intracranial vasoular lesions - - - M 77 - - 1 24 52 87 F - - 1 - 22 64 2. DEATHS, CAUSES OF, AND AGES A T, DURING THE YEAR 1945. Causes of Death Sex All ages 0- 1- 5- 15- 45- 65- 54 186 - Heart disease 8 M 248 - - 41 239 Other Dis: of circ : system F 292 12 - - - 8 27 M 35 - - - - 9 36 F 45 Bronchitis - - - - 33 57 M 97 3 - 4 - 38 1 F 55 5 11 Pneumonia - - 38 M 68 8 3 2 17 - 7 23 F 41 9 2 Other resp: diseases - - M 1 5 4 10 - - - 1 1 1 6 3 Ulcer of stomach or duodenum F 12 - 12 9 M 25 - 4 - - Diarrhoea under 2 years F 6 1 2 3 - - - M 9 9 - - - - - F 2 2 - - - - - 1 Appendicitis M 2 1 - - - F 3 1 1 - 1 - - - M 14 1 2 4 7 Other digestive diseases - - 15 4 13 Nephritis F 32 - - - 2 4 6 M 12 - - - F 1 4 7 12 Puer: and post-abort: sepsis Other maternal causes - - - - F 2 - 2 - - - - F 4 4 - - - - Premature birth M 13 13 - - - - - - F 5 5 - Con: Mal: birth inj: infant dis: - - - - M 22 21 1 - - - F 10 7 1 2 - - - 5 M 3 Suicide 9 - - 1 - F - 3 6 - 3 - Road traffic acc: - M - 6 14 2 2 4 - F 3 7 1 1 2 - - Other violent causes M 36 2 2 8 11 13 - 21 F 45 2 1 3 6 12 All other causes 49 M 77 - 6 2 8 7 12 1 39 F 64 2 2 13 INFECTIOUS AND OTHER DISEASES. NOTIFICATIONS. The number of notifications (2363) during the year was made up as follows: - Diphtheria and Croup 54 Scarlet fever 141 Measles 1119 Whooping Cough 140 Enterie fever & Paratyphoid 3 (Acute Influenzal 12 Pneumonia (Acute Primary 68 Erysipelas 25 Cerebro-Spinal Meningitis 10 Malaria 2 Dysentery 30 Ophthalmia Neonatorum 10 Puerperal fever 8 Puerperal Pyrexia 20 Scabies 716 Polio-Myelitis 1 smallbox 4 Total. 2363 In forty-three (43) instances it was found that the patient was not suffering from the disease notified. SCABIES & VERMIN. There were over 2000 fewer attendances for treatment for Seabies at the Council's Cleansing Station during 1945 than in the previous year. The attendances for the treatment of verminous conditions were also over 700 less than in 1944. Follow-up visits were paid by the Sanitary Inspectors to all these cases. The Health Visitors also concentrated largely in their visiting on the homes which they knew to be the least satisfactory, particularly in the case of children between 2 and 5 years of age. The issue of small tooth combs and Lethane Oil continued as an activity of the Infant Welfare centre service. DISINFECTING STATION - RETURN OF WORK. Other Diseases. Miscellaneous. Vermin. Total all cases I " " "" ! Notified Infectious Diseases. Rooms disinfected 1,761 1,106 588 49 18 Lots of bedding disinfected 1,591 352 49 564 626 Total visits 897 3,092 1,024 1,078 93 Number of articles disinfected by steam 3,352 „ „ „ formalin 961 „ „ books disinfected 133 Beds and mattresses destroyed 204 Miscellaneous goods destroyed 180 T. C. qr. 1b. Weight of unsound foods condemned 6 12 2 27½ „ „ miscellaneous foods damaged by enemy action 6 7 0 10 „ „ old end verminous furniture etc. destroyed 1 17 0 0 „ „ dead animals destroyed - 3 0 0 „ „ hospital dressings destroyed 3 2 0 0 CLEANSING STATION. Number of attendances Persons cleansed Seabies Vermin Females Males Females Males Adults 609 12 949 153 Children 1,440 1,614 1,973 374 NUMBER OF BACTERIOLOGICAL EXAMINATIONS PERFORIED 1945. Swabs for diphtheria 864 Sputa for tubercle 994 Milks 45 Ice Creams 5 Faeces for Typhoid Group 5 „ „ sonne Dysentery 10 „ „ Ova of parasites 2 „ „ Food Poisoning 1 Miscellaneous specimens 31 Total 1957 RETURN OF WORK OF THE VACCINATION OFFICER 1945. No. of names received in birth lists 2328 Certificates of Successful Vaceination received 1446 „ „ Postponement received 16 „ „ Insusceptibility received 5 Statutory Declarations, of Objection received 574 IMMUNISATION AGAINST DIPHTHERIA. A continuous campaign was conducted throughout the year by means of poster displays, sending birthday cards to children on reaching their first birthday and by personal contact with parents of children in the susceptible age groups by Health Visitors and Sanitary Inspectors, urging acceptance of the facilities provided by the Council for protective treatment against diphtheria. The result of these aetivities is shown in the following table. Summary of persons immunised 1945. 0 - 5. yrs 5 - 15 yrs Total 1. At Borough Council Clinies etc. 1161 20 1181 2. At L.C.C. schools and Clinics. 56 405 461 3. Under Private Practitioners Scheme 42 9 51 Totals. 1259 434 1693 MATERNITY AND CHILD WELFARE. Infant Welfare Centres - Clinic Attendances etc. 1945. Attendances of Children (i) Under 1 year 25,869 (ii) Between 1 & 5 years 7,928 Miscellaneous attendances 1,837 Total attendances 35,634 Analysis of Attendances - Doctors' Consultations 10,407 Seen by Health Visitor 23,390 Health Visitors - Record of Visits. 1945. No. of Births reported in the area 1.984 Visits to Expectant Mothers 1,052 „ „Post-natal Mothers 1,831 „ „ Children- (I) Under 1 year 6,854 (ii) Between 1 & 5 years 9,749 Total 16,605 Miscellaneous Visits 2,472 Total Visits 21,958 PREMATU RE BIRTHS. The number of premature births notified during the year was 193, of which 155 survived the first month of life. Special attention was paid to these cases by the Council's Health Visitors. Detailed particulars of these cases appear in the following table. No. of premature babies notified during 1945 who weighed 5½ lbs or less at birth:- (i) Born at home 33 * (ii) Born in hospital 160 † No. of those born at home:- (i) who were nursed entirely at home 31 (ii) who died during the first 24 hours 4 (iii) who survived at the end of one month 28 No. of those born in hospital:- (i) who died during the first 24 hours 17 (ii) who survived at the end of one month 127 * Two of these cases were subsequently removed to hospital. †In three instances It was not possible to "follow up' , to ascertain whether or not the child survived. CHILD LIFE PROTECTION. The supervision of foster mothers and children is undertaken by the Municipal Health Visitors. Visits to foster mothers and children 167 Foster mothers under supervision at the end of 1945 14 Foster children under supervision at the end of 1945 18 CARE OF ILLEGITIMATE CHILDREN. Close co-operation continued between the Public Health Department and the Moral Welfare Worker of the Southwark .Diocesan Association for Moral Welfare in all matters relating to the care of the illegitimate child and its mother. Information of all notified births of illegitimate children were forwarded to the Moral Welfare Worker. Guaranteed payments to foster mothers undertaking the care of illegitimate children were made under this Scheme during the year, and at the end of the year 4 foster mothers were receiving payment in respect of 4 children, contributions towards the cost of this service being recovered by the Council from the natural mother in each case. ANCILLARY SERVICES . In 73 instances the services of a Home Help were provided for mothers, either before, during or after confinement. In two instances the services of a Domestic Help were provided in homos where there was sickness. Nineteen expectant or nursing mothers were provided with dental treatment. Priority dockets were issued to 464 expectant mothers to enable them to purchase sheets for their confinements. The District Nursing Associations paid a total of 2,805 visits to 238 approved cases under the Council's Domiciliary Nursing Scheme. A total of 73 patients benefitted under the Council's Treatment of Minor Ailments Scheme. Eleven children 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 SUBMETTED FOR ANALYSIS - YEAR ENDED 31.12.45. Number examined Percentage of adulteration. Number adulterated etc. Formal Informal Total Formal Informal Total Formal Informal 17 19 675 472 1147 36 3.60 2.81 COMPOSITION OF MILK SAMPLES. Four hundred and fifty-four formal and three informal samples of milk were taken during the year. Three formal samples were found not to conform with requirements. MILK ADULTERATION. Three formal samples were reported against, all being found to contain extraneous water. The percentage of adulteration was 0,66. THE MILK (SPECIAL DESIGNATIONS) ORDER 1936. The following table shows the number of licences issued under these Regulations during 1945. Tuberculin Tested Accredited Pasteurised Producers - - 1 21 42 Dealers - 15 Supplementary 14 - Totals 35 1 57 Samples of Designated Milk were submitted for bacteriological examination as follows:- Pasteurised 29 Tuberculin tested 1 Tuberculin tested pasteurised 5 From an accredited herd 1 36 All these samples were reported to be satisfactory. Two samples of pasteurised milk were examined by the phosphatase test, and were reported to be sufficiently heat treated. BACTERIOLOGICAL EXAMINATION OF MILK. Number of samples submitted for examination- Pasteurised milk 29 Tuberculin tested pasteurised milk 5 All were found to comply with the standard for pasteurised milk laid down in the Milk (Special Designations) Order, 1936; in addition, eleven samples of pasteurised milk were submitted to the phosphatase test. All samples were found to be adequately pasteurised. One sample of Tuberculin Tested Milk, one sample of milk from an accredited herd and nine samples of sterilised milk were submitted for the Methylene Blue test and found to be satisfactory. 6. 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. MERCHANDISE MARKS ACT. No infringements of the Merchandise Marks Act were recorded during the year or of the various orders under the Agricultural Produce (Grading end Marking) Act, 1928. BAKEHOUSES. The number of bakehouses on the register at the end of the year was 66 overground and 27 Underground. PARTICULARS OF INSPECTION & SUPERVISION OF FOOD 1945. No. of Registered Food Premises. Manufacturers of ice cream 49 Manufacture of sausages 144 Fish Curers 33 Fish fryers 60 Miscellaneous food factories & wholesale warehouses 38 Storage & sale of ice cream 211 Preparation or manufacture of potted or preserved meat or fish 285 Eating houses 235 Dairies & milkshops 267 RETURN OF WORK 1945. Street markets inspections 1988 Food Places - inspections Bakehouses 117 Fish Curers' premises 56 Fried Fish shops 64 Ice cream premises 252 Restaurants & eating houses 235 Milk shops 347 Slaughterhouses 8 Carcases inspected 13 „ condemned with organs 4 Organs inspected 49 „ condemned 3 Other food premises 4210 Food surrendered 603 Food contamination certificates issued 1111 No. food premises repaired 48 Shops Act inspections 596 Food Poisoning investigations 23 Inspections not defined 447 PARTICULARS OF UNSOUND FOOD CONDEHNED. tons cwt lbs qrs Meat 6 1 2 11 Fish 12 0 11 - Canned & Miscellaneous foods 12 9 2 0 Total. 19 3 0 22 REPAIRS TO FOOD PREMISES. Many food premises were destroyed or damaged by enemy action. A number of the damaged premises have been repaired to a reasonable standard without resorting to the service of notices, but in 149 cases it was necessary to serve intimations and notices requiring work to bo carrie d out. In 48 instances the work has been completed and in a certain number of cases work is in progress while in other cases the essential work awaits the issue of building licences. SANITARY INSPECTION. No. of complaints received 4387 Inspections under Shops Act, 1934 596 „ „ Pharmacy and Poisons Act, 1933 139 „ of Milkshops 347 Factories Act, 1937- No. of inspections of factories 56 „ „ „ „ Out workors Premises - Intimations served 1 No. of Intimations, P.H. (London) Act, 1936 2928 „ „ Statutory Notices 611 „ „ Rein sp ections (all enactments) 7708 Total number of visits 22746 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 Camberwell receive a direct supply. RODENT CONTROL SCHEME. During 1945 a further four special areas were defined in connection with this Scheme, making a total of 14 special areas. Initial treatments ware carried out to a further 28 areas and follow-up treatments to 36 areas. Investigation revealed that in 9 areas surface follow-up treatments were not necessary. In addition to area treatment for rat infestation, 511 complaints were received of rat infestation at individual properties, all of which received attention. During the year the Rodent Officer made 416 surveys and inspections; 40,412 calls were made by the Investigators and 29,565 visits were paid by Operators; the baits laid numbered 53,745. TUBERCULOSTS PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS 1930. NEW CASES during 1945. Three hundred and twenty fresh cases of Tuberculesis come to the notice of the Dispensary during the year. Two hundred and fifty seven of these cases ware primary notifications 47 inward transfers, 4 posthumous notifications and 12 non-notified death 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 Total M. F. M. F. 0 - 1 - - - - - 1 - 5 2 5 1 4 12 5 - 15 5 9 3 7 24 15 - 45 111 80 9 11 211 45 - 65 11 1 42 3 57 65 - 10 5 - 1 16 Total 170 104 20 320 26 MORTALITY during 1945.There were 126 deaths from all forms of tuberculosis after correction for inward and outward transfers, equal to a death rate of 0.93 per 1000 of population (0.84 per 1000 in 1944). Of these, 118 were pulmonary cases and 8 non-pulmonary cases. The age groups in which these deaths occurred appear in the sub-joined table. Age periods Deaths. Respiratory Non respiratory Total M. F. M. F. - 1 0 - 1 - - 1 1 - 5 - - 3 3 - 5 - 15 - - 1 1 - 30 15 - 45 39 1 - 70 45 - 65 30 9 1 - 40 65 - 5 5 1 - 11 Total 65 53 4 4 126 9. 10. The total number of cases on the Notification Register at the end of the year was 1,792, i.e., 1,467 pulmonary, 325 non-pulmonary. The ratio of non-notified deaths to the total deaths was 1 to 10.6 as compared with 1 to 8.4 in 1944. WORK OF THE TUBIRCULOSIS DISPEN SARY DURING 1945. Diagn osis Pulmonary Non-Pulmonary Total total Adults Children Adults Children Adults Children M. F. N. F. M. F. M. F. M. F. M. F. A- New Cases examined during the year (excluding contacts) :- .-.- -a. -. 1 I 1 74 53 5 3 4 4 4 3 78 57 9 6 150 (a) Definitely Tuberculous (b) Diagnosis is not completed 13 - 50 - - - - 47 14 124 - - - (c) Non-tuberculous - - 252 366 15 6 639 - - - - - - B- Contacts examined. during the year:- ] - 16 1 22 16 1 - (a) Definitely tuberculous 41 2 22 2 - - (b) Diagnosis not completed - 21 11 - - - - 68 23 13 - - - (c) Non -tuberculous - - - 104 177 62 68 411 - - - - - C- Cases written off the Dispen sary Register as:- 10 23 9 25 1 1 (a) Recovered 1 2 38 1 1 2 - (b) Non-tuberculous including any such cases previously diagnosed and entered on the Dispensary Register as tuberoulous) - 86 389 579 - - - - 89 1143 - - - ———+ ... D- Number of cases on Dispensary Register on December 31st :- 541 70 118 659 611 89 700 127 (a) Definitely tuberculous 1602 76 40 57 116 (b) Diagnosis not completed 27 24 71 70 - - - - - 1 92 - - - 1. Number of cases on Dispensary Register on January 1st 1945. 2. Number of cases transferred from other areas and cases returned after dischanged under Head 3. in previous years. 4. Cases written off during the year as Dead (all causes). 1640 69 3. Number of cases transferred to other areas, cases not desirous of further assistance under the scheme and cases "lost sight of". 70 97 7105 5. Number of attendances at the Dispensary ( including contacts). 6. Number of consultations with Medical practitioners. (a) Personal (b) Other 2567 7. Number of visits by Tuberculosis Officers to homes (including per sonal consultations). 8. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes. 175 6979 932 - 10. Number of cases "recovered" restored to Dispensary Register and included in A (a) and A(b) above 9. Number of:- (a) Specimens of sputum etc examined (b) No. found to be positive 101 (c) X-ray examinations made in connection with Dispensary work. 2898 11. Number of "T.B.plus" cases on Dispensary Register at December 31st. 1945. 305 ARTIFICIAL PNEUMOTHORAX TREATMENT. A total of 2,163 refill treatments were given to Camberwell patients as compared with 2,250 in 1944. One patient received Finsen Light treatment and seven patients dental treatment. Extra diet was given to 77 patients and 30 pocket flasks were supplied. X-RAY. Every new case of "contact" attending the Dispensary during 1945 received X-ray examination. TUBERCUIOSIS ALLOWANCES. Memo 266/T, The Government scheme of monetary payment to patients suffering from pulmonary tuberculosis receiving approved treatment, and their dependents, which commenced in June 1943, continued to work smoothly. Particulars of the cases dealt with under scheme during 1945 appear in the sub-Joined table. 1. Number of applications considered 195 2. Number of applications found to be eligible 170 3. Number found to bo ineligible but became entitled to an allowance at a later date 2 4. Number of applications approved and subsequently lapsed as a result of altered circumstances 102 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. CHRISTHAS SEAL SALE. The receipts were £526. 15. 1., and the expenses £76. 7. 0., the balance of £450. 8. 1. being- disbursed in the provision of bedding and other comforts for tuberculous patients. 11.