AC 437C ? Metropolitan Borough of Camberwell REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1948 HOWELL W. BARNES, B.A., M.B., B.Ch., D.P.H. PRINTED BY MERITT & HATCHER, LTD. LONDON, S.E.10 CAM 37 Public Health Department, Town Hall, Camberwell, S.E.5. September 26th, 1949. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Mr. Mayor, Aldermen and Councillors, I have the honour to submit my Report on the public health and sanitary conditions in the Metropolitan Borough of Camberwell during the year 1948. It is gratifying to be able to report that the health of the inhabitants of the Borough was maintained at a satisfactory standard. The population, estimated by the Registrar-General to be 178,200, showed an increase of 3,140 over the estimated figure for the previous year. Although the birth rate fell from 24.4 per 1,000 of the population in 1947 to 19.0 last year, yet this figure considerably exceeded the death rate of 11.4. The infantile mortality rate of 31 per 1,000 live births is the lowest ever recorded in Camberwell. Infectious diseases showed no cause for alarm during the year. Notifications rose from 1,972 (1947) to 2,754 but this increase was mainly due to an epidemic of measles of a mild character. There was no serious outbreak of food poisoning during the year, but a number of instances were brought to the notice of the Public Health Department of the occurrence of cases of sickness and diarrhoea at institutions in the Borough which were investigated. The increase in the number of restaurants and other catering establishments and the demand for an improvement in restaurant hygiene generally called for close attention to be paid to the storage, preparation and handling of food in public eating places in the Borough. Complaints of sanitary defects in houses for the abatement of which the assistance of the Public Health Department was sought numbered 8,823. This number causes no surprise when it is remembered that there are still many houses in the Borough which can only be described as old and worn out. Unfortunately with such property the abatement of nuisances is frequently followed within a short space of time by the occurrence of further nuisances which require attention. As a result, the investigation of complaints and repeated visits absorbed a large proportion of the Sanitary Inspectors' time and it was not possible for them to carry out house-to-house inspections in their districts. Repairs were not always expeditiously carried out owing to a variety of factors such as the shortage of materials, the necessity for securing a building licence and prolonged negotiations between property owners and the War Damage Commission for agreement as to which items of repair were properly attributable to enemy action damage. At the end of the year there were 7,670 families on the Council's waiting list for alternative housing accommodation, a large proportion of whom had based their claims upon the insanitary conditions under which they were living. Every effort has been made to remedy these defects in order to provide the inhabitants with tolerable comfort. Co-operation continued with the Council's Housing Deparment in connection with recommendations for rehousing on medical grounds or on account of overcrowding. The campaign to clear premises and bombed sites of rats and mice was actively pursued. A consolidated grant of 50 per cent. of the approved expenditure incurred by the Local Authority is now available subject to compliance with the conditions laid down by the Ministry of Agriculture and Fisheries. Operations were continued for the treatment of block areas and investigations were carried out to ascertain the reason for repeated infestations of particular premises in order to remove the cause of the nuisance. Systematic sewer baiting took place throughout the year. Many complaints were received concerning the deposit of rubbish on bombed sites throughout the Borough. The Sanitary Inspectors visited the sites concerned in every instance and where public health nuisances were found to exist, the Borough Engineer and Surveyor was requested to arrange for the removal of the offensive matter by the Council's workmen. The Council adopted a Bye-law which became operative on the 1st May, 1948, governing the Deposit of Litter to the Detriment of Public Amenities. A number of complaints were also received with regard to pleasure fairs held in various open spaces in the Borough. By-laws were made by the Council under Section 68 of the London County Council (General Powers) Act, 1939, and confirmed by the Secretary of State, for regulating the hours during which pleasure fairs may remain open to the public, securing safe and adequate means of egress to and from the ground upon which any pleasure fair is held, preventing nuisances, supervising and P reservin g sanitary conditions and cleanliness at any such fair. Bye- were also made under Section 135(2) of the Public Health (London) Act, 1936, and confirmed by the Minister of Health, to promote cleanliness in, and the habitable condition of tents, vans, sheds and other similar structures used for human habitation, for preventing the spread of infectious diseases by the persons inhabiting them, and generally for the prevention of nuisances in connection therewith. During the latter part of year arran gements were made by the South-East Metropolitan Regional Hospitals Board for Miniature Radiography Unit to be installed at the South-Eastern Hospital, S.E.14. The Public Health Department recruited nearly 4,000 volunteers from factories and workplaces in the Borough to attend for examination. The retirement of four senior officers took place during the year-Mr.F.T. Harman, the Assistant Administrative Officer; Mr. A. L. Dobson, Mr. M. Malins and Mr. D. H. Pickard, Sanitary Inspectors. Each of them had rendered faithful service for a period of over 40 years. The year also saw the resignation of Dr. D. C. Garrett, the Public Analyst, and of Dr. G. W. Bousfield, the Borough Bacteriologist. Dr. Bousfield had been in the service of the Council for many years. His father, the late Dr. D. C. Bousfield, was appointed as Bacteriologist by the Camberwell Vestry in the late 'nineties; I understand that this was the first appointment of its kind to be made in this country. It is a matter of satisfaction that Dr. Guy Bousfield will continue to serve the inhabitants of the Borough as an officer of the Public Health Laboratory Service. On the 5th july, 1948 , various responsibilities in connection with the care of individuals were transferred from the Council to other authorities under the National Health Service Act, 1946, as follows:— To the London County Council. (I) Clerical, dispensary and allied services : (a) Maternity and Child Welfare, Health Visiting and Home Nursing. (b) After-care, including social and preventive work relating to Tuberculosis (c) Domestic helps. (II) Notification of Births. (III) Child Life Protection (Part XIII, Public Health (London) Act, 1936). (IV) Infectious diseases (non-institutional). (a) Diphtheria Immunisation. (b) Vaccination. To the Regional Hospitals Board. Tuberculosis Dispensary. (The tuberculosis notification register and the preparation of returns, etc., as well as measures for the prevention of tuberculosis, remain the responsibility of the Borough Council.) Included as an appendix to this report will be found a review of the Maternity and Child Welfare, Tuberculosis and Diphtheria Immunisation Services since their inception, from which it may be seen that a progressive improvement has been effected in the infant mortality figures, diphtheria has been almost eliminated, and the outlook for the tuberculous patient is more hopeful although the number of notifications of this disease may not have been dramatically reduced. The transfer of these services necessitated a staff reorganisation of the Public Health Department. A scheme was outlined by the Metropolitan Boroughs' Standing Joint Commiţtee for the services of the Metropolitan Borough Medical Officers of Health to be made available to the London County Council in connection with the day-to-day administration of its Personal Health Services under this Act, and the London County Council were informed that, pending a final decision on this scheme, the Council were willing to arrange for their Medical Officer of Health to co-operate with the L.C.C. Divisional Medical Officer on the lines suggested, the terms to be subsequently agreed. By arrangement with the South-East Metropolitan Regional Hospitals Board the services of Dr. Price as Deputy Medical Officer of Health were retained after the 5th July, pending permanent arrangements being made for carrying out these duties. Consideration was g iven to the future staffing requirements of the Public Health Department and the following establishment was authorised:- Sanitary Inspectors. 10 District Inspectors. 1 Rodent Officer. 2 Housing Inspectors. 1 Sampling Officer. 1 Food Inspector. 1 Woman Sanitary Inspector. Clerical Staff. 1 Chief Clerk. 1 Infectious Diseases Clerk. 1 Senior Clerk. 1 Shorthand-typist. 1 Sanitary Administration Clerk. 3 General Division Clerks. Owing to a general shortage of Inspectors, it was not possible by the end of the year to bring the staff of I ns P e ctors up to the approved establishment. It was therefore necessary to reorganise the work to suit the prevailing conditions. In recent years there have been two Ins pectors to supervise food and food establishments in the Borough, but following the retirement of one of these, each District Inspector was made responsible for supervising food premises in his area, leaving the Food Inspector to devote himself to the examination and certification of unsound food and other special duties associated with food products The administrative changes changes which took place under the Health Service Act also involved the transfer of 72 full-time and 51 part-time members of the Public Health Department to the South-East the London country council and 6 full-time officers staff to the London Metropolitan Regional Hospitals Board. These authorities may be regarded as fortunate in securing the services of such highly experienced and efficient officers who, in the past by their enthusiasm have materially assisted in bringing about the satisfactiory sitaution existing at the time of the transfer. I am confident that the members of the transferred staff individually and collectively will continue to render the same loyal service and thus ensure that the Personal Health Services continue to operate successfully. I should like to place on record my acknowledgement of the valuable service they have rendered to this Authority I cannot speak less highly of the WOrk of those remain in the Public Health Department; they deserve a tribute as warm and as sincere. To the staff of the Department, therefore, I express my appreciation of their assistance and I desire to thank the Chief Officers and members of all Departments of the Borough Council on behalf of myself and the Public Health Department for the co-operation they have so willingly given. Finally, I desire to thank the members of the Council for the support, encouragement and sympathetic consideration which have been extended to me at all times. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. W. BARNES, Medical Officer of Health. Staff of the Public Health Department at the end of 1948. Medical Officer of Health. H. W. Barnes, B.A., M.B., B.Ch., M.R.C.S., L.R.C.P., D.P.H. Deputy Medical Officer of Health. C. Frederick Price, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Public Analyst. J. E. VVoodhead, B.Sc., F.I.C., Ph.C. Sanitary Inspectors. Dist. No. Dist. No. 1. L. A. Biggs. b 6. H. Attwater. a 2. A. G. O'Gilvie. b 7. F. Maughan. a 3. H. M. Hough. a 8. M. L. Malins. a 4. D. V. Watkins. a 9 H. W. Leonard, a 5. D. M. Skinner. a 10. L. W. Burrell. a Housing Inspector. H. w. Leonard, a (Also undertaking district duties.) Sampling Officer —Foods and Drugs Act, etc. H. R. Weaver, a Food Inspector and Senior Sanitary Inspector. R. F. Nash. a Chief Clerk. S. A. Cranfield. Senior Clerk. A. J. Carly. Clerks. J. F. Clarke D. Danter. Mrs. M. Findlay. (Temp.) N. Westley. Miss B. M. Thompson. Miss S.Gee. (Temp.) Rodent Control Staff. Rodent Officer W. H. G. Saunders. b Rodent Investigator Mrs. M. J. Kenny Rodent Operators C. Green, A. P. Abrahams, P. Collins, E. H. Rigg, G. Glazebrook, R. Humphreys Bait Preparer Disinfecting and Cleansing Station. Superintendent Disinfector A. Franklin. Disinfector B. Russell. Assistant Disinfectors R. T. J. Hodgson, A. Thomas, E. Manning, A. E. Kenny. Motor Driver H. King. Cleansing Station Attendants. Mrs. D. O. Farmer. Mrs. E. E. Doe (a) certificate Sanitary Inspectors Examination Board an Meat and other Food certificate (b) Certificate Sanitary Inspectors ExaminationBoard. STATISTICS AND GENERAL INFORMATION. The Metropolitan Borough of Camberwell, which is situated in the south-east part of the County of London, is 4¾ miles in length; its greatest breadth is 2½ miles. In outline it roughly resembles the shape of a pear. The subsoil of the area is clay with a few pockets of gravel here and there. Although recognised as a dormitory borough nevertheless a great variety of industries are carried on in its 1,324 factories. The largest industrial undertaking is the Gas Works in Old Kent Road. A summary of the important vital statistics for the year 1948 together with comparative figures for the previous three years is given below. 1948 1947 1946 1945 Population 178,200 175,060 164,380 135,460 2,435 No. of Live Births No. of Still Births 3,396 4,278 3,848 66 70 87 63 No. of Legitimate Births 3,295 4,120 3,686 2,279 219 No. of Illegitimate Births 167 228 249 24.4 Birth rate (per 1,000 population) 19.0 23.4 19.5 No. of Deaths 2,032 2,336 2,218 1,968 Death rate (per 1,000 population) 11.4 13.3 13.5 14.5 Death of infants under 1 year 105 167 148 91 39 Infant death rate per 1,000 live births Deaths of legitimate infants 31 38 34 134 101 163 84 Deaths of illegitimate infants 4 4 14 7 Death rate of legitimate infants per 1,000 legitimate live births 31 40 37 34 Death rate of illegitimate infants per 1,000 illegitimate live births 58 18 24 33 Deaths of women from diseases or accidents associated with childbirth Maternal death rate per 1,000 total births 5 5 6 4 1.1 1.2 2.2 1.1 Deaths from pulmonary tuberculosis Death rate from pulmonary tuberculosis 118 101 119 89 0.5 0.6 0.5 0.8 Deaths from all forms of tuberculosis Death rate from all forms of tuberculosis 117 135 99 126 0.6 0.7 0.6 0.9 The birth rates in England and Wales, London and Camberwell for the past four years are shown below. 1947 1946 1948 1945 England and Wales 17.9 20.5 19.1 16.1 22.7 21.5 15.7 London 20.1 Camberwell 19.0 24.4 23.4 19.5 Still Births. The number of still births registered during the year was 66 comprising 1.9 per cent, of the total births. In 1938 the number of still births was 103 representing 3.3 per cent. of the total births. The fall in the percentage of still births is the result of many factors such as good obstetrics and improvement in the health of mothers owing to supervision during pregnancy. This low figure should be further reduced during the next ten years. Deaths. The total deaths of Camberwell residents which occurred during 1948 numbered 2,032, representing a death rate of 11.4 per thousand of the population. The death rates in England and Wales, London and Camberwell in the past four years were as follows:— 1948 1947 1945 1946 England and Wales 10.8 12.0 11.4 11.5 London 11.6 12.8 12.7 13.8 Camberwell 11.4 13.3 13.5 14.5 DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1948. Causes of Death. All Ages. 5- 15- Sex. 0- 1- 45- 65- All causes 1,056 976 61 44 13 11 9 6 92 84 273 202 608 629 M. F. Typhoid and paratyphoid fevers M. - - - - - - - F. - - - - - - Cerebro-spinal fever - M. 1 - - - 1 - - F. Scarlet fever - - - - - - - M. - - - - - - - F. - - - Whooping cough - - - - M. 1 1 - - - - - F. 3 1 2 Diphtheria - - - - M. - - - - - - - F. - - T uberculosis of respiratory system M. - - - - - 60 1 27 - - 26 6 F. 41 28 10 3 Other forms of tuberculosis - - - M. 1 7 - 3 - 3 F. - 9 2 2 1 Syphilitic diseases - 2 2 M. 9 - 4 5 - - - F. Influenza 1 - - - - 1 - M. 1 1 - - - - F. - 1 - - 1 Measles - - - M. - - - - - - F. - 1 1 - - - - - DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1948—contd. Sex. All Ages. 1- 5- 15- 65- Causes of Death. 0- 45- M. 1 Acute polio-myelitis and polio-encephalitis - 1 - - - - F. - - - - - - - Acute infantile encephalitis M. - - - - - - - M. 2 - - - 1 1 - M. 15 - 1 Cancer of buc. cav. and œsoph. (M.), uterus (F.) - 3 11 - - F. 12 - - 2 4 6 20 Cancer of stomach and duodenum M. 35 - 2 13 - - F. 38 - - 1 10 27 - 1 - Cancer of breast M. - - - 1 - F. - - - 1 10 17 28 Cancer of all other sites M. 139 51 80 - 1 7 - 102 F. - - - 7 36 59 4 Diabetes M. 5 - - - - 1 F. - - 1 5 4 10 - M. 1 Intracranial vascular lesions 79 - - 2 17 59 97 26 F. - 71 - - - M. 283 Heart disease 1 10 58 214 - - F. 303 - 9 39 255 - - M. 4 Other diseases of circulatory system 54 - 9 41 - - F. 50 4 10 36 - - - Bronchitis M. - 24 64 94 3 - 3 F. 43 2 - 1 7 33 — Pneumonia M. 59 10 2 1 3 14 29 F. 42 1 1 2 24 11 3 11 - Other respiratory diseases M. 1 2 4 4 - F. 8 - 1 3 4 - - 9 Ulcer of stomach or duodenum M. - - 1 8 18 - F. 1 5 - 2 2 - - Diarrhœa under 2 years M. 4 3 1 - - - - F. 4 4 - - - - - M. 5 1 Appendicitis 1 1 2 - - F. 4 - 2 2 - 1 - Other digestive diseases M. 32 5 15 1 11 - - 1 3 F. 31 1 - 9 17 Nephritis M. 18 1 - 5 5 7 - F. 21 1 4 6 10 - — Puerperal and post-abortive sepsis F. - 2 - 2 - - - F. Other maternal causes 2 - 2 - - - - M. 15 - - - Premature birth 15 - - F. - 8 8 - - - - M. - Congenital malformation, birth injury, infant diseases 22 19 1 1 - 1 F. 22 16 2 - 3 1 - M. 13 - - 3 - 5 5 Suicide F. 6 - - - 2 3 1 Road traffic accidents M. 8 - 1 2 5 - - F. 6 - 1 5 - — - M. 21 2 Other violent causes 4 2 7 6 - F. 17 1 - 1 3 12 - All other causes M. 45 2 4 4 9 26 - F. - 2 39 57 - 7 9 From this Table it will be seen that the chief causes of death were:— Diseases of the heart and circulatory system 690 Malignant disease 370 Bronchitis, pneumonia and other respiratory diseases (except phthisis) 257 Cancer. Deaths classified as due to cancer numbered 370 in 1948. Of these 221 occurred in persons over 65 years of age. The average individual does not yet appear to have grasped the salient fact that the cure of cancer is related to early diagnosis and that early treatment is essential. Maternal Mortality. The number of deaths from puerperal sepsis was 2 and from other accidents and diseases of pregnancy 2, making a total of 4. This represents a death rate of 11 mothers per 1,000 total births Infant Mortality. A low infant mortality rate is a reflection of the satisfactory health of a community. The number of deaths of infants under one year of age was 105 which is equivalent to an infant mortality rate of 31 per 1,000 live births. This is the lowest ever recorded in the Borough, but is capable of still further reduction. The infant mortality rates in England and Wales, London and Camberwell for the past four years are given below:- 1948 1947 1946 1945 England and Wales 34 41 43 46 London 31 37 41 53 Camberwell 31 39 38 34 SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. A domestic water supply is provided for every house in the Borough by the Metropolitan Water Board. No complaint was received during the year of the condition of this water supply. There are also seven wells in operation in the Borough, but the water drawn from them is used solely for industrial purposes. In accordance with the provisions of the Public Health (London) Act, 1936, twenty Water Certificates involving 187 dwellings were issued. During the year notifications were received from the Metropolitan Water Board that the water supply of 125 occupied houses had been withdrawn. Action was taken under the provisions of the Public Health (London) Act, 1936, for the reinstatement of the water supply to these homes. Swimming Bath Water. The water in the Council's swimming baths is filtered, aerated and chemically treated. Samples of water are taken periodically from the Dulwich and Camberwell Baths for bacteriological and chemical examination. During 1948 sixteen such samples were submitted for analysis and all were reported to be satisfactory. Drainage and Sewerage. One hundred and twenty-nine plans of drainage work to existing and new buildings were submitted and approved. Under the Council's programme, sewers totalling 873 yards in length were reconstructed during 1948. Whilst this work was in progress the frontage drains of the houses connected to these sewers were examined and if found to be defective, the necessary work of repair was carried out simultaneously with the relaying of the sewers. Twenty-eight brick road gullies were replaced by pot gullies and ten defective gullies were renewed during the year. No new road gullies were provided. Public Cleansing. The collection and disposal of house refuse is under the control of the Borough Engineer and Surveyor who has kindly furnished the following information relating to the year 1948: — Amount of house refuse (including salvage) collected during the year 39,983 tons. Method of disposal Removed by barges from Honduras Wharf, Bankside, to a controlled tip. Frequency of collection Weekly from dwelling houses and twice weekly from blocks of flats and tenements. The need for improved methods for the collection of refuse has in recent years become more urgent. This essential service, vital to public health, continues to receive attention and much improvement has been effected. There is a general demand for something more hygienic to replace the ashbin of the household equipment and the refuse chute of the modern flat. A combined system of refuse disposal and drainage has been tried out in the development of new towns but has not yet reached perfection. The most serious objection to this system appears to be the loss of salvage. The indiscriminate placing of house refuse of every description into the dustbin for collection by a motor vehicle is similarly wasteful. The present economic needs of the country require the adoption of a system providing maximum salvage recovery. Improved methods of refuse collection linked to salvage collection would seem to be the solution. Sorted refuse is of commercial value, but the education of the ratepayers as to the proper way to sort their refuse to enable it to be collected as raw material for utilisation is not easy. Their co-operation is essential to obtain an improved method of collection, and it is for the local authority to provide a frequent collection service. SANITARY INSPECTION OF THE AREA. Reference to the table on page 14 shows that 6,274 intimation notices and 2,687 statutory notices were served during 1948. Complaints registered were 8,823 as compared with 4,625 in the pre-war year 1938. Various adverse circumstances combine to make the work of the sanitary inspector difficult. In spite of every effort the number of sanitary inspectors continued to be below establishment and consequently urgent attention could not always be given to these complaints. It is greatly to the credit of the inspectors that nuisances were attended to as expeditiously as they were. Summary of Sanitary Work Carried Out During the Year 1948. Description of Sanitary Improvements effected during the Year. Number of rooms cleansed, walls repaired 3,560 Defective roofs repaired or rainwater pipes provided or repaired 2,955 Dampness abated 2,395 Yards and forecourts paved or paving repaired 248 Water fittings repaired 231 Drains entirely reconstructed 28 Drains partially reconstructed 375 Soil, vent pipes, sinks and waste pipes renewed or repaired 593 Premises in which repairs were effected to water closets 1,628 Dustbins provided 230 Repairs effected to windows 1,682 Stoves and coppers repaired 1,140 Flooring repaired or renewed, repairs to woodwork (stairs, etc.) 1,532 Ventilation and lighting improved 125 Offensive accumulators removed 57 Miscellaneous repairs and improvements effected 366 Total repairs and improvements effected 17,142 Inspections. Following complaint 8,823 Following cases of notifiable infectious disease 655 Factories 237 Rent (Restrictions) Act 41 New buildings and conversions into flats and business premises 92 Rag and bone dealers 3 Conveniences (public and private) 198 Shops Act 18 Child Life Protection 10 Common Lodging Houses 38 Aged and infirm persons 13 Cases of overcrowding and miscellaneous housing inquiries 1,882 Inauiries concerning priority allocation of building materials 90 Miscellaneou 2,670 Total inspections 14,770 Re-inspections, calls, etc 24,917 Smoke observations 41 SUMMARY OF NOTICES SERVED, 1948. Intimations, Public Health (London) Act, Byelaws,etc. 6,274 Statutory Notices, Public Health (London) Act, Byelaws,etc. 2,687 Public Health (London) Act, 1936, (Part II) 47 Section 4, Housing Act, 1936 26 Factories Act, 1937. The Borough Council is charged with the duties of enforcing the legislation as to sanitary accommodation in all factories in its area and in those factories where mechanical power is not used, for maintaining a satisfactory standard of cleanliness and ventilation, ensuring the effective drainage of floors, and preventing overcrowded conditions. The following tables are presented in the form required by the Home Office. Factories Act, 1937. I.—INSPECTIONS. Number of Premises. Number on Register. Inspections. Written Notices. Occupiers prosecuted. Factories in which Sections 1, 2, 3, 4 and 6 of the Act are to be enforced by Local Authorities 860 166 37 Nil Factories not included above in which Section 7 of the Act is enforced by the Local Authority 71 Nil 461 13 Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 3 - - - 237 50 Nil Totals 1,324 2.—CASES IN WHICH DEFECTS WERE FOUND. Particulars. No. of cases in which defects were found. Number of cases in which prosecutions were instituted. Remedied. Referred Found. To H.M. Inspector. By H.M. Inspector. Want of cleanliness 67 42 - 9 - Overcrowding - - - - Unreasonable temperature Inadequate ventilation 1 - 1 - 1 - 30 2 26 - - Ineffective drainage of floors 1 - 1 - 1 Sanitary conveniences— (a) insufficient 24 - 20 - 11 (b) unsuitable or defective 82 20 - 61 - (c) not separate for sexes 8 3 - - 5 Other offences against the Act (not including offences relating to outwork) - 2 1 2 - Total 215 158 - - 48 15 Outworkers. During the year lists containing the names of 178 outworkers residing in Camberwell were received from employers carrying on business in the Borough and from other local sanitary authorities. The following table indicates the nature of the work undertaken by these persons. Table showing Trades of Outworkers in Employment at the End of 1948. Artificial flowers 5 Needlework 1 Baby linen 2 Novelties 2 Belts 1 Overalls 1 Blinds 1 Paper bags 6 Blouses 1 Shoulder pads 1 Brushes 2 Surgical shoes 2 Cardboard Boxes 13 Stationery 5 Card lacing 3 Tailoring 10 Coathangers 1 Ties 12 Diaries 1 Uniform caps 2 Embroidery 4 Wearing apparel 74 Hats 2 Miscellaneous 17 Hosiers 1 Lampshades . 3 178 Linens 5 Offensive Trades, etc. The following businesses carried on in the Borough are classified as offensive trades: — Skin dressers 4 Soap boilers 1 In addition there are 23 premises in which the business of rag and bone dealer is conducted. All these premises are subject to supervision and.periodical inspection by the district Sanitary Inspectors. Rag Flock. Five samples of rag flock were obtained during the year and submitted to the Public Analyst for examination. The standard permitted at present is a maximum of 30 parts per 100,000 of soluble chlorides as chlorine. It will be seen from the following table that all the samples were satisfactory. Sample No. Soluble chlorides as chlorine. Parts per 100,000. 1 5.0 2 4.5 3 12.0 4 11.0 5 5.0 Shops Act, 1934. The duties of the Borough Council under the provisions of this Act are to secure and maintain sanitary and hygienic conditions in shops. Two exemption certificates were granted under the provisions of Section 10 of the Act. Pharmacy and Poisons Act, 1933. At the end of the year the names of 176 traders were registered for the sale of poisons included in Part II of the above Act. Observation was kept of stalls and shops for unauthorised sellers but no infringement of the Act was reported. Smoke Abatement. The abatement of the evils of atmospheric pollution is a vital necessity not only from a public health consideration but also for the purpose of saving fuel. It is not always realised that domestic chimneys as well as factory chimneys are responsible for the production of much soot owing to the main fuel supply continuing to be raw bituminous coal. During the year 40 smoke observations were made on factory chimneys in the Borough. In two instances an intimation notice was served. When offences occur the Sanitary Inspector makes a personal call at the factory with a view to offering advice and practical suggestions for the prevention of a recurrence of the nuisance. Such advice is invariably welcomed and acted upon by the management. Fouling of Footpaths by Dogs. No contravention was reported of the byelaw relating to the fouling of footways by dogs on leads. Destruction of Bed Bugs. The work of disinfestation is carried out by the Council's Disinfecting Staff. The following table shows the number of premises treated during 1948. Borough Council Houses (requisitioned) 25 London County Council dwellings 15 Other dwelling houses 645 Method of Treatment.—The Disinfecting Staff calls at the premises and sprays the infested room or rooms with an insecticide to which 5 per cent. D.D.T. has been added. The use of D.D.T. has rendered obsolete the old method of stripping walls and ceilings and lifting skirting boards, etc., before spraying. Infested bedding and other articles are removed for steam disinfestation at the Council's Disinfecting Station. Tenants are also requested to co-operate in these measures by undertaking "spring-cleaning" of the house. Tins of insecticide and sprayers are available at cost price to any resident in the Borough on application to the Public Health Department. Removal to Institutions of Aged, Infirm or Physically Incapacitated Persons. During the year 25 cases were brought to the notice of the Public Health Department of aged and infirm persons living in unsatisfactory conditions. The homes of these aged people were visited by the Sanitary Inspectors and every possible step was taken to assist them. The considerable increase in the number of old people in recent years is giving rise to new social and public health problems. As people get older they become more and more dependent on others for assistance. Their physical condition does not allow them to continue to perform manual work and eventually the time arrives when they can no longer keep their homes or themselves clean. There was a time when old people were respected members of the family and it was considered a pleasant duty for relatives to look after them. This state of affairs, for a variety of reasons, no longer exists in many cases, and more and more does the duty of caring for these old people fall upon the public health authorities. Such duty should be the provision of accommodation specially designed for old people on a community basis, the establishment of hostels, rest rooms, and amenities such as domestic helps to assist them in carrying out those household duties of which they are no longer physically capable, and arrangements for the provision of hot meals delivered in containers at the door. Medical and nursing attention are now available under the provisions of the National Health Service Act, 1946. By the provision and extension of these services the last years of poor and lonely old people who are apparently healthy, although feeble or infirm, can be made happy and comfortable until near the time of their deaths. In spite of all the attention that can be given to old persons at home, cases are discovered where institutional care is the only solution. Included among these are patients with an acute illness and chronics suffering from crippledom, mental derangements of various forms, incontinence, etc., for whom continuous hospital treatment is necessary. Occasionally old people are found who resent assistance of any kind and repeatedly refuse the offer of institutional accommodation. In these instances action eventually has to be taken under Section 47 of the National Assistance Act, 1948, for their compulsory removal from the premises in which they are residing in their own interests and in order to prevent injury to the health of, or serious nuisance to, other persons living in the house. Fortunately, it did not become necessary during the year to deal with any case in this way. Rodent Control. The staff engaged in rodent control duties under the direction of a Sanitary Inspector comprised, at the beginning of 1948, 8 operators, 1 clerk, 3 investigators (one of whom undertook part-time clerical duties), and 1 bait preparer. During the year, however, this staff was reduced to 6 operators, 1 clerk, 1 investigator and 1 bait preparer. The procedure for rodent control is laid down by the Ministry of Agriculture and Fisheries and consists of four days pre-baiting and one day poison-baiting, the residual poison being collected and "takes" recorded on the sixth day. Complaints of infestation by rats and mice numbered 1,341. The following is a summary of the work carried out during the year. No. of Inspections. No. of Operators Calls. No. of Premises Baited. No. of Pre-Baits Laid. No. of Poison Baits Laid. Private. Business. Total. 5,890 17,414 1,904 176 2,080 18,276 45,231 Arising out of these investigations a number of infestations were traced to defective drains. A total of 671 drain tests were carried out and positive results were obtained in 164 instances. In addition to the treatment of surface infestations, maintenance treatment of the sewers was carried out twice during the year. During the week ended 6th June baits were laid in 1,268 manholes and side-entrances and during the week ended 4th December, 1,219 manholes and side-entrances were treated. Two thousand three hundred and forty-four poison baits were also supplied to tenants of premises infested with mice. MATERNITY AND CHILD WELFARE. The arrangements for Maternity and Child Welfare passed to the control of the London County Council on 5th July, 1948 under the provisions of the National Health Service Act, 1946, and the following information relates only to that period of the year during which this Council was responsible for these services. Infant Welfare Centres and Health Visiting. At the time of their transfer there were five municipal and one voluntary association infant welfare centres operating in the Borough. Endeavours had been made for some considerable time to secure more suitable premises for the Municipal Centre in the Dulwich area, situated at 114 Lordship Lane, and in the early part of the year improved, though not ideal, accommodation was obtained at the Dulwich Grove Congregational Church Hall, Tell Grove. At the end of June, 1948, there were ten health visitors attached to the Infant Welfare Centres serving the Borough, nine of whom were employed by the Council and one by the Bird-in-Bush Voluntary Association. Continuous efforts were made to increase the establishment of Health Visitors without success. The tables appearing on pages 21 and 22 show the number of attendances at Infant Welfare Centres and the record of Health Visitors' visits during the period 1st January to 4th June, 1948. Child Life Protection. The Municipal Health Visitors undertook the supervision of foster mothers and children during the first half of the year at the end of which time there were 16 foster children in the care of 14 foster mothers in the Borough. Infant Welfare Centre. Under 1 Year. Between 1 and 5 Years. Total Attendances. Analysis of Attendances. First Attendances. Subsequent Attendances. First Attendances. Subsequent Attendances. Doctors' Consultations. Seen by Health Visitor. Amott Road Municipal, 60a Amott Road, S.E.15 5,210 4,006 1,204 219 3,486 31 1,474 Dulwich Municipal, Dulwich Grove Congregational Church, Tell Grove, S.E.22 3,376 450 4,119 990 3,129 271 22 4,123 346 4,379 839 5,573 1,450 Mayward House Municipal, Benhill Road, S.E.5 9 215 2,924 St. Antholin's Municipal, Barforth Hall, Barforth Road, S.E.15 1,108 3,110 4,262 15 1,152 261 4,544 Sumner Municipal, Basingstoke House, Jocelyn Street, S.E.15 3,793 16 474 1,186 3,358 235 Bird-in-Bush Voluntary Association, 616 Old Kent Road, S.E.15 2,791 873 3,930 31 772 3,158 27,638 Totals 5,218 1,547 124 20,749 6,754 20,884 21 RECORD OF HEALTH VISITORS' VISITS 1st JANUARY, to 4th JULY, 1948. To Expectant Mothers. Infant Welfare Centre. To Post-Natal Mothers. To Children. Analysis of Visits to Children. Under 1 Year. Between 1 & 5 Years. Under 1 Year. Between 1 & 5 Years. Total Visits. First Visits. Subsequent Visits. Attending Centre. Not Attending Centre. Attending Centre. Not Attending Centre. 229 250 Amott Road Municipal, 60a Amott Road, S.E.15 63 168 172 342 791 1,305 541 285 Dulwich Municipal, Dulwich Grove Congregational Church, Tell Grove, S.E.22 1,125 393 1,725 1,104 385 914 247 3,235 596 621 Mayward House Municipal, Benhill Road, S.E.5 811 1,410 417 974 541 16 442 2,663 712 436 St. Antholin's Municipal, Barforth Hall, Barforth Road, S.E.15 823 265 242 717 535 419 163 1,358 2,317 540 833 Sumner Municipal, Basingstoke House, Jocelyn Street, S.E.15 314 309 824 911 727 191 1,638 2,780 318 496 Bird-in-Bush Voluntary Association, 616 Old Kent Road, S.E.15 244 772 318 321 560 297 1,332 2,149 573 4,324 3,342 977 1,875 1,871 3,313 Totals 8,254 2,853 4,941 Care of Illegitimate Children. Information of all notified births of illegitimate children were forwarded to the Moral Welfare Worker of the Southwark Diocesan Association for Moral Welfare who co-operated with the Public Health Department in all matters relating to the care of the illegitimate child and its mother. Guaranteed payments to foster mothers undertaking the care of illegitimate children were made by the Council, contributions towards the cost of this service being recovered from the natural mother in each case. At the end of June four foster mothers were receiving payment under this Scheme in respect of five children. Home and Domestic Helps. The services of a Home Help were provided by the Council for 79 mothers, either before, during or after confinement, and in 86 instances the services of a Domestic Help were provided in homes where there was sickness. Dental Treatment. Dental treatment was provided for expectant or nursing mothers in four cases. Part of the cost of the treatment, which was carried out by private dentists or at a hospital, was recovered from the patients. Sunlight and Massage Treatment. Sunlight and massage treatment for children under five years of age not attending school was provided by arrangement with the London County Council at St. Giles' Hospital on the recommendation of the Medical Officers of Infant Welfare Centres. Eight children benefited under this Scheme making a total of 64 attendances. Minor Ailments Treatment. The treatment of certain ailments in children under five years of age was carried out at the London County Council School Treatment Centres on the recommendation of Clinic Medical Officers of Infant Welfare Centres under the terms of an agreement between this Council and the County Council. The number of children who received treatment under this Scheme was 155. Domiciliary Nursing. Home Nursing services were provided in approved cases by arrangement with various Nursing Associations operating in the Borough. The District Nurses paid a total of 2048 visits to such cases. Convalescent Treatment. Children under 5 years of age not attending school who were recommended for convalescent treatment by the Clinic Medical Officers of Infant Welfare Centres were referred to the Invalid Children's Aid Association to whom the Council paid a grant in respect of this service. PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES. During the year 2,751 notifications of infectious diseases (excluding tuberculosis) were received at the Public Health Department. Of these cases 62 were subsequently found not to be suffering from the disease stated on the certificate. A table of infectious diseases notifications showing the cases not confirmed, those treated in hospitals, deaths and age distribution appears on page 27. It will be seen that no cases of the following diseases were notified : — Smallpox. Continued Fever. Relapsing Fever. Hydrophobia. Glanders. Typhus Fever. Acute Polio-Encephalitis. Plague. Cholera. Anthrax. Diphtheria. In areas such as Camberwell where immunisation treatment has been available to the inhabitants for many years, the incidence of diphtheria has fallen considerably. Of the 46 patients notified by medical practitioners as suffering from diphtheria, an amended diagnosis was made in 31 instances, thus reducing the number of confirmed cases to 15. In only one instance had the patient previously received immunisation treatment; the attack was not severe. There were no deaths from this disease. Diphtheria Anti-Toxin. Diphtheria anti-toxin was provided by the Council free of charge for the use of general medical practitioners. Diphtheria is difficult to diagnose clinically, and if there is any suspicion of this disease, anti-toxin should be given as early as possible and the patient admitted to hospital for observation. Diphtheria Immunisation. On July 5th this service, which was established in Camberwell in 1925, was transferred to the London County Council. Clinic facilities provided by the Council were available at the Sumner Road, Amott Road and Dulwich Infant Welfare Centres. A "Family Doctors Scheme" was also in operation whereby residents who so desired could receive immunisation treatment from their own private doctor, whose fee for this service was paid by the Council. Medical practitioners taking part in this Scheme were also provided with the necessary prophylactic free of charge. The following table shows the number of persons immunised during the first six months of the year : — 0 to 5 years. 5 to 15 years. Total. At Borough Council Clinics 3 745 742 191 375 At L.C.C. Schools and Clinics 184 Under Private Practitioners Scheme 44 1 45 Totals 977 188 1,165 Scarlet Fever. The number of cases notified was 303 of which 8 were not subsequently confirmed. No deaths occurred from this disease. Scarlet fever is to-day such a relatively mild infection that it is difficult to decide whether notification, hospitalisation and home disinfection is at present justifiable. Although it may he argued that the isolation, in hospital, of patients with scarlet fever does not prevent the occurrence of further cases of the disease, yet isolation does reduce the spread of streptococci. SUMMARY OF NOTIFICATIONS RECEIVED AND DEATHS FROM THESE CAUSES AMONG NOTIFIED CASES Disease. No. of Notifications. Treated in Hospital. Found not to be suffering from the Disease. Deaths of Notified Cases. Age Distribution of Notifications. Under 1. 1 to 2. 3 to 4. 10 to 15. 20 to 35. 65 and upwards 2 to 3. 4 to 5. 45 to 65. 15 to 20. 35 to 45. 5 to 10. 2 7 14 24 38 142 51 10 7 303 64 6 2 - Scarlet Fever 8 - 91 74 124 1 Whooping Cough 545 59 4 3 75 101 71 3 - 5 - - 8 1 1 2 1 1 4 - 1 Poliomyelitis 16 15 1 1 1 3 - 197 16 68 6 - 109 239 201 233 547 6 8 1 2 - Measles 1,559 ‡1 4 8 9 3 46 46 31 - 8 3 4 6 1 - - Diphtheria 3 2 - 3 4 2 4 Pneumonia {Acute Influenzal 18 - - - - - - - - 17 6 2 4 4 3 7 1 7 3 - 6 5 11 {Acute Primary 68 - - - 1 6 Dysentery 16 2 - - - - - 1 - 5 3 - - 1 1 - 1 - - Encephalitis Lethargica - - - - - - - - - 4 - 1 4 1 1 - - - - 2 - - Paratyphoid Fever - - - - 4 9 12 30 5 - - - - - - 1 - - 4 Erysipelas 9 9 4 - 2 1 2 1 - 3 - Cerebro-Spinal Fever - - - - - 2 - - - - - - - 2 - - - *Puerperal Fever 2 - - - 15 12 - Puerperal Pyrexia 14 - - - - - - - - - 1 2 - 9 4 9 - - - - - - Ophthalmia Neonatorum - - - - - - - 4 18 6 22 4 Scabies 111 - - - 3 2 7 5 24 8 8 1 - - - 1 Malaria 2† - - - - - - - 1 - - 87 319 206 352 335 348 861 102 28 39 48 29 Totals 2,754 300 62 7 * Ceased to be notifiable July 30th, 1948. ‡ Case not confirmed. † One case induced and one case contracted abroad. Measles. Of all specific diseases measles is the most common. Measles became notifiable in London in 1938 and. since then all cases which receive medical attention are made known to the Public Health Department. The incidence of this disease does not alter to any great extent but of late years its severity and fatality have fallen considerably. The number of confirmed cases of measles was 1,553 and of these 870 cases occurred in children of one to five years of age. Until July 5th, 1948, the home visiting of all cases of measles was carried out by the Health Visitors. They were responsible for ascertaining the source of infection, ensuring the isolation of the case, and advising as to the hygiene of the sick room. By arrangement with the London County Council, the health visitors now undertake domiciliary visiting of cases of measles in children under five years of age. Whooping Cough. Whooping cough is a very infectious disease with a high mortality rate in children under the age of one year. Early diagnosis with segregation of cases reduces the risk of infection to other persons. Unfortunately parents do not always seek medical advice when their children first have frequent spasms of coughing during the day or night, but wait until the characteristic whoop has developed, and the patient has been infectious for some time. Of the 545 cases notified during the year three died and four were not confirmed. In recent years an attempt has been made to immunise children against whooping cough. The injection for this purpose is usually given in combination with the Diphtheria prophylactic. This treatment is still in the experimental stage, but some authorities claim to have obtained good results. The vaccine should be given as early as possible in infancy as a large number of deaths from this disease occur in the first year of life. Typhoid and Paratyphoid Fever. Typhoid fever is becoming rare in this country. Paratyphoid cases usually result from the consumption of food contaminated by a carrier or sufferer from a mild attack of the disease. There were only four cases of paratyphoid fever notified during the year, one of which was not confirmed. Investigations were carried out to ascertain the cause of the illness in each case. Good personal hygiene plays an important part in preventing the spread of paratyphoid by food handlers. TABLE OF NOTIFIED CASES OF PARATYPHOID FEVER. Results of Bacteriological Examinations. Sex. Age. Date of Notification. Notified as 19 18/8/48 B. Paratyphosum B. isolated from blood and faeces. M. Paratyphoid M. 9 1/10/48 Do. Not paratyphoid. F. 7/12 4/11/48 Do. B. Paratyphosum B. isolated from faeces. F. 6 7/12/48 Do. Do. do. Dysentery. Dysentery is an endemic disease in this country. Of the 16 cases notified, 15 occurred amongst the staff of a nursing home in the Borough. None of these cases was severe, however, and the outbreak was rapidly brought under control. There is reason to believe that many adult cases do not seek medical attention because signs and symptoms of the disease are not evident. The following table shows the number of notifications of this disease for the past four years:— Year. No. of Cases. 1945 30 1946 22 1947 10 1948 16 Acute Anterior Poliomyelitis and Polio-Encephalitis. Camberwell suffered from its worst outbreak of anterior poliomyelitis and polio-encephalitis during 1947 when 34 definite cases occurred throughout the Borough. In 1948 16 notifications of poliomyelitis were received and only eight of these were subsequently confirmed. There was one death. The disease is due to a virus, but fortunately everyone infected with the virus does not develop paralysis. Most cases are removed to hospital; cases which remain at home are isolated and the attendants are recommended to wear masks and gowns on entering the sick room, to wash their hands on leaving, to see that the patient's eating utensils are kept for his sole use and to arrange for the faeces to be disinfected as the virus is excreted in the stools. Cerebro-Spinal Fever. Nine cases were notified as compared with 12 in 1947. The diagnosis was not confirmed in four instances. In every case the patient was removed to hospital. Malaria. Two cases of malaria were notified and the diagnosis confirmed. One patient contracted the disease while serving with H.M. Forces abroad, and in the other case the disease was induced for therapeutic purposes. Ophthalmia Neonatorum. There were nine cases notified in 1948, all of which were followed up and kept under observation until recovery. NOTIFIED CASES OF OPHTHALMIA NEONATORUM. Treated at Hospital. Vision. Treated at Home. Unimpaired. Impaired. Blind. 4 9 5 - - Ophthalmia Neonatorum is no longer one of the most frequent causes of blindness. This is due to the great improvement in treatment and the introduction of penicillin. Puerperal Fever and Pyrexia. Under the provisions of Section 50 of the London County Council (General Powers) Act, 1948, puerperal fever ceased to be notifiable in London in July, 1948. The effect of this change was that the County of London was brought into line with the rest of the country. Puerperal pyrexia, however, remains notifiable. The definition of puerperal pyrexia is any febrile condition occurring in a woman within 21 days after childbirth or miscarriage in which a temperature of 100.4 degrees Fahrenheit has been sustained for 24 hours. The Medical Practitioners practising within the Borough were informed accordingly. Fifteen cases of puerperal pyrexia and two cases of puerperal fever were notified. Fourteen of these cases were treated in hospital. There were no deaths among the notified cases. The methods adopted to prevent the occurrence of puerperal sepsis and the treatment of septic conditions by the sulphonamides and penicillin has resulted in a substantial decline in the mortality from this cause. Pneumonia. Only the acute influenzal and acute primary forms of pneumonia are notifiable. There were 18 notifications of acute influenzal and 68 of acute primary pneumonia received. Pneumonia (all forms) was responsible for 101 deaths during the year. Scabies. In August, 1943, scabies became compulsorily notifiable in London and the following table shows the number of notifications of this disease received annually since that year:— Year. No. of Notifications. 1944 617 1945 716 1946 534 1947 242 1948 111 As scabies is a household disease all cases are visited at home. Any person suffering from this affliction can be treated at the Council's Cleansing Station at Peckham Park Road. The facilities of this service are also placed at the disposal of the London County Council for the treatment of schoolchildren. The following table shows the number of attendances made during the year:— CLEANSING STATION ATTENDANCES (SCABIES). Male. Female. Total. 164 285 Adults 121 Children 235 361 596 356 881 Total 525 Smallpox and Vaccination. There was no case of smallpox notified during the year. Contacts of cases of this disease arriving in the Borough from abroad were kept under observation. On July 5th, 1948, the vaccination of infants ceased to be obligatory by law. For many years there has been a waning resort to vaccination, probably due in the present generation to the lack of experience of malignant smallpox and a fear of vaccination causing ill effects such as post-vaccinal encephalitis. Adequate facilities for those desirous of being vaccinated have been provided by the London County Council. It is not considered that these vaccination clinics will be utilised to any great extent until the occurrence of smallpox in the Borough acts as an incentive to the population to avail themselves of the facilities for protection against the disease. Food Poisoning. There were nine notifications of food poisoning received during the year. Each case was investigated with a view to ascertaining the source of infection, but as specimens of food, faeces and vomit were unobtainable, the incriminating organism could not be ascertained. With the exception of two notifications received in respect of the consumption of the same article of food, each of the notifications represented an isolated case, no other instances of illness being reported in connection with them. There is reason to believe that medical practitioners frequently fail to notify cases, probably because they are clinically not serious. Notifications, to give the best results, should not be delayed otherwise investigations cannot satisfactorily be completed as samples of the suspected food and vomit may not be available. In addition to these individual cases, however, there were five outbreaks of sickness and diarrhoea reported to the Public Health Department as having occurred among scholars and staffs of various schools in the Borough after partaking of a meal prepared by the London County Council School Meals Service. Particulars of these outbreaks are set out in the following table : — Date. No. of Notifications. No. of Cases Reported. No. of Deaths. Organisms or Other Agents Responsible and Foods Involved. 4/3/48 Nil 22 Nil Cultures of minced steamed bacon yielded an organism giving the reactions of a bacillus of the "atypical dysentery" group, also hæmolytic streptococci and staphylococcus aureus. 18/3/48 6 Nil Nil Specimens of food, vomit and faeces unobtainable. 14 19/4/48 Samples of dried milk yielded cultures of a hæmolytic streptococcus. Nil Nil 153 22/4/48 Nil Do. do. Nil 22/6/48 Nil 4 Nil Specimens of food, vomit and faeces unobtainable. All the attacks were of a mild character and the patients recovered rapidly. Advice was offered as to precautionary measures to be adopted in respect of the storage and handling of the food in the meals centres, the necessity for handwashing after use of the W.C., and the importance of reporting any attacks of diarrhoea, however mild, among the kitchen staff. The cause of outbreaks of this nature is frequently staphylococcic toxin. It cannot be urged too strongly that meat products should not be prepared in advance of the time when they are required for consumption. Overnight storage of cooked food in bulk is dangerous as bacterial multiplication may easily occur in made-up meat dishes and cooked meats even in a refrigerator. Measures to prevent outbreaks should always be in force and should include:— (i) Premises in which food is prepared or served should at all times be clean and free from rats and flies. Provision should be made for proper storage refrigerator accommodation, adequate washing facilities with soap and towels, a continuous supply of running hot water, and sufficient refuse bins for all waste matter. (ii) Persons engaged in food handling should be carefully supervised, educated in personal hygiene and medically examined periodically. Any attack of vomiting, diarrhoea or any septic condition should be reported immediately and the individual suspended from the handling of food. Any absence from duty by reason of sickness should be investigated. The washing of hands after visiting the water closet should be compulsory. Coughing and sneezing should always be into a handkerchief. (iii) The provision of a dish washing machine for the cleansing of crockery and other utensils in communal use. NON-NOTIFIABLE DISEASES. Diarrhœa and Enteritis. The deaths from diarrhoea in children under two years of age numbered eight. There is a concensus of opinion that if all mothers breast-fed their babies for six months there would be a diminution in the incidence of these diseases. Influenza. Influenza, unless complicated by pneumonia, is not notifiable. No outbreak of influenza in epidemic form has occurred in London since 1937. At the end of the year under review influenza was very prevalent on the Continent but had not reached England. In view of the possibility of the epidemic reaching this country preparations were made to limit the spread of the infection and to lessen the risk of secondary complications. Influenza is usually spread from one person to another by droplets and for that reason infected persons should go to bed from the onset of the symptoms. Although influenza does not exact a heavy toll of life yet every year it is responsible for a great loss of working days. During 1948 there were two deaths in the Borough from this disease. Verminous Persons. The total number of treatments carried out during the year at the Council's Cleansing Station is shown below: — CLEANSING STATION ATTENDANCES (VERMIN). Male. Female. Total. Adults 11 59 48 Children 405 1,455 1,860 Totals 453 1,466 1,919 Disinfection. The following is a summary of the work carried out by the Disinfecting Staff during 1948: — Notified Infectious Diseases. Other Diseases. Miscellaneous. Vermin. Total. All Cases. Room disinfected 1,079 84 26 983 2,172 1,582 93 905 798 3,378 Lots of bedding disinfected 253 52 96 201 602 Total visits Number of articles disinfected by steam 3,364 Number of articles disinfected by formalin 1,321 Number of books disinfected 211 Number of towels washed 3,717 Number of gowns washed 694 Number of mattress covers washed 215 Number of overalls washed 185 Number of covering sheets washed 178 Beds and mattresses destroyed 563 Miscellaneous goods destroyed 377 Weight of Tons. Cwts. Qtrs. Lbs. 17½ Unsound food dealt with 61 19 1 Public Baths towels disinfected - 18 1 0 8 1 Mattresses and pillows destroyed 5 0 Hospital dressings destroyed 1 18 0 0 3 Furniture, etc., destroyed 3 3 0 Dead animals destroyed - 9 3 0 Rubbish destroyed - 2 2 0 Bacteriological Examinations. On October 1st, 1948, the Borough Bacteriologist's laboratory at 134 Denmark Hill was taken over by the Medical Research Council on behalf of the Ministry of Health. The effect of this change of administration is that the facilities of this laboratory are now available to this Council free of charge. The following is a table of specimens examined by the Council's Bacteriologist during the period January 1st to September 30th, 1948. Swabs for diphtheria 836 Sputa for tubercle 674 Milk (bacteriological) 43 Bath water (bacteriological) 15 Ice cream (bacteriological) 91 Fæces for typhoid group 6 Fæces for dysentery 25 Miscellaneous specimens 96 Total 1,786 Certificates of Vaccination and Inoculation. A number of requests were received from residents in the Borough for a certificate of vaccination or inoculation to be authenticated for the purpose of travel abroad. The signature of the person issuing the certificate was verified in each case as that of a registered medical practitioner practising in Camberwell and the certificate was endorsed accordingly. Mass Miniature Radiography. Ministry of Health Memorandum dated August 24th, 1944, points out that the primary purpose of mass radiography is not diagnosis in the ordinary sense; its true function is to discover, in a group of ostensibly healthy persons, those who have any sign indicating the possibility of any incipient disease which should be further investigated by more intensive means of diagnosis. The Miniature Mass Radiography Unit provided by the South-East Metropolitan Regional Hospitals Board was in operation at the South-Eastern Hospital during the months of September and October, 1948. The Camberwell Public Health Department was asked to recruit approximately 3,000 volunteers from factories and workplaces to attend for examination. A subsequent request was received to increase this figure if possible. Letters were accordingly addressed to the managements of factories, offices and shops in the Borough drawing attention to the facilities which were being provided for any of their employees who wished to take advantage of this service, and a total of 3,898 persons (2,305 men and 1,593 women) attended for examination. Of this number 15 men (0.65 per cent.) and 17 women (1.06 per cent.) were found to be probably tuberculous and were referred to their own medical practitioners. In addition, two men and five women were referred to their doctors for other abnormalities discovered. The response to mass radiography by the inhabitants of Camberwell has so far been satisfactory. To be effective in helping to eradicate tuberculosis in a community, however, Mass Radiography must be a continuous process. It is of little use, except for statistical purposes, to examine a cross-section of the population at one particular period unless it is intended to follow this up with further surveys at appropriate intervals. A negative result from one examination is no guarantee that tuberculosis will not develop in the future. Serial examinations are desirable over a considerable period of time. HOUSING. The Housing Situation Report submitted by the Housing Committee to the Council showing the position at December 31st, 1948 gives some idea of the difficulties which still confront the Council. Number of applications outstanding 7,670 Houses requisitioned (net) 3,278 Number of tenancies— Requisitioned properties 5,668 Prefabricated bungalows 519 Permanent housing 641 Total 6,828 Total number of families rehoused (representing 34,163 persons) 9,315 At the end of the year under review 254 houses were in the course of erection by the Council. Conditions associated with or resulting from war damage present a complex problem the solution of which still causes anxiety. Many dwellings were destroyed, many so badly damaged as to be in a state of disintegration, and others, by far the greatest number, requiring repairs. Many houses scheduled as unfit for habitation remain occupied as the procedure for their demolition must remain in abeyance for the present. The shortage of labour and materials has made it most difficult to cope with the accumulated dilapidations and a long time will elapse, in spite of the employment of all available building labour, before the effects of the air raids can be relieved to such an extent that numerous nuisances do not arise during inclement weather. Housing Statistics, 1948. 1. Inspection of Dwelling Houses during the Year :— (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 8,826 (b) Number of inspections made for the purpose 30,856 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 7,198 2. Remedy of defects during the year without service of Formal Notices:— Number of dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers—Public Health (London) Act 301 3. Action under Statutory Powers during the year :— (a) Proceedings under Sections 9 and 10 of the Housing Act, 1936 :— (1) Number of dwelling houses in respect of which notices were served requiring repairs:— Informal Notices 5 Formal Notices 3 (2) Number of dwelling houses which were rendered fit after service of:— Informal Notices Nil Formal Notices 1 (a) By owners 1 (6) By Local Authority in default of owners Nil (b) Proceedings under Public Health (London) Act: — (1) Number of dwelling houses in respect of which statutory notices were served requiring defects to be remedied 2,677 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 4,573 (b) By Local Authority in default of owners Nil (c) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements and/or underground rooms in respect of which Closing Orders were made 2 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil Underground Rooms. Three basement rooms were represented as actionable under Section 12 of the Housing Act, 1936. Individual Houses Repairable at a Reasonable Cost. During the year five informal and three formal notices were served under the provisions of Section 9 of the Housing Act, 1936, requiring repairs to be carried out to houses occupied by the working classes. Premises not Repairable at a Reasonable Cost. One house was represented as unfit for human habitation and not capable at a reasonable expense of being rendered so fit. Overcrowding. Three hundred and eighty-three instances of families living in overcrowded conditions were brought to the notice of the Public Health Department. In every case a certificate of overcrowding was forwarded to the Director of Housing and Valuer, London County Council, in order that priority consideration might be given to the provision of alternative housing accomodation for these families. The number of overcrowded families who obtained alternative accomodation during the year was 234. Common Lodging Houses. There is only one Common Lodging House in the Borough, winch is situated at 124 Camberwell Road and licensed for 224 male persons. Thirty-eight visits were made to the premises during the year including one night inspection. Rent and Mortgage Interest (Restrictions) Act. During the year 14 certificates of disrepair were issued under this Act. These have enabled the tenants to withhold payment of certain of the permitted increases of rent pending the repair of the living accommodation occupied by them. INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES. The inspection of food and food premises was carried out by Mr. Nash, the Food Inspector, assisted by Mr. M. L. Malins until the date of the latter's retirement on June 23rd, 1948. Owing to the difficulty of obtaining Sanitary Inspectors at that time, it was deemed advisable for the inspection of food premises to be undertaken by the district Sanitary Inspectors leaving the Food Inspector to devote himself to the examination and certification of unsound food, meat inspection, ice cream sampling, food poisoning enquiries and other special duties associated with food products. The Sampling Officer is responsible for obtaining samples of food and drugs at all stages for bacteriological and chemical examination. This Officer also deals with the registration of dairymen and purveyors of milk and the registration of persons and premises for the sale of certain poisons under the Pharmacy and Poisons Act, 1933. It is also his duty to secure samples of water from the Council's Swimming Baths for bacteriological and chemical analysis and samples of rag flock under Section 136 of the Public Health (London) Act, 1936. Milk Supply. The bulk of the milk supply for the Borough is pasteurised There is, however, one cowhouse in the area licensed for 53 cows. The milk from these cows is retailed to families living in the vicinity. The dairyman concerned, although advised to do so, has not yet installed a pasteurising plant. Five samples of the milk were tested for the presence of tubercle bacilli, two of which were reported to be positive. The attention of the London County Council and the Ministry of Agriculture and Fisheries was drawn to these adverse reports for the necessary action to be taken. The Milk and Dairies Order, 1926, requires the Sanitary Authority to keep a register of persons in the Borough carrying on the trade of cowkeeper or dairyman and all premises used in this connection. Summary of Register. Cowkeepers 1 Cowsheds 2 Dairies and milkshops 56 Registered purveyors of milk dealing from registered premises within the Borough 105 Registered purveyors of milk dealing from registered premises outside the Borough 7 Heat Treated Milk (Prescribed Tests) Order, 1944. During the year 63 samples were taken under this Order. All the samples conformed to the Phosphatase test but two failed the Methylene Blue test. Analytical Examination of Milk. Four hundred and fifty-seven formal and five informal samples of milk were examined by the Public Analyst. Three of the samples were found not to conform to requirements, and legal proceedings were taken in one instance. The following table shows the percentage of adulteration of formal samples of milk during the past four years. 1945 1946 1947 1948 Percentage of adulteration 0.66 0.81 0.82 0.65 Bacteriological Examination of Milk. Seventy-one samples of designated milk were submitted to the Bacteriologist for the Methylene Blue test (indicating the keeping quality of the milk), including 36 taken at Institutions in the Borough and 8 taken in the course of delivery to schools. Sixty-three samples were submitted to the Phosphatase test (indicating the efficiency of the method of heat treatment). The results of these tests are shown in the following table. Methylene Blue Test. Phosphatase Test. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Total. Total. 46 Pasteurised 2 48 44 44 - Tuberculin tested pasteurised 7 - 7 - 8 8 10 Sterilised 10 10 - 10 - Heat treated 2 2 - 1 1 - Accredited 4 - 4 - - - 71 63 Totals 69 2 63 - Examination of Milk for the Presence of Tubercle Bacilli. Four samples of heat treated milk from bulk and five samples of raw milk were examined by means of the animal test for the presence of tubercle bacilli. In two instances the presence of this bacillus was discovered. These were samples of milk obtained from the cowhouse in the Borough to which reference is made on page 40. Milk (Special Designations) Order. The following table shows the number of licences issued by the Council. Tuberculin Tested. Pasteurised. Accredited. I. Producers - 1 - Dealers 45 - 59 Supplementary 14 - 16 Totals 59 1 75 Public Health (Condensed Milk) Regulations. Seven samples were taken and found to comply with the Regulations. FOOD AND DRUGS ADULTERATION. Formal and informal samples submitted for analysis during the year ended December 31st, 1948. Number adulterated, etc. Percentage of adulteration. Number examined. Formal. Informal. Total. Formal. Informal. Total. Formal. Informal. 16 500 645 19 35 3.2 2.95 1,145 The percentage of adulteration remains low. It is to the credit of the tradesmen in this Borough engaged in the retail distribution of food that they endeavour to sell to the public an article of the nature, substance and quality demanded by them. The following table gives a description of the formal and informal samples found to be adulterated together with the results of proceedings and other action taken. Serial No. Article. Whether Formal or Informal. Nature of Adulteration or Irregularity. 30 Ruby wine Informal 12 per cent. deficient of the declared amount of alcohol. Milk Formal 3.5 per cent. of extraneous water. 33 Milk Formal 1 per cent. of extraneous water. 34 49 The Prescription Formal 11 per cent, deficient of potassium bromide. Wine cocktail 49 Informal 47 per cent, deficient of the declared amount of alcohol. Informal 50 Wine cocktail 48 per cent, deficient of the declared amount of alcohol. Formal 47 per cent, deficient of the declared amount of alcohol. Wine cocktail 64 Formal 65 Wine cocktail 48 per cent, deficient of the declared amount of alcohol. Informal Cake Unsaponifiable matter (not edible) is excessive. 90 Informal Cake Do. do. 100 Do. do. Cake Formal 87 Cake Formal Do. do 89 175 Blackcurrant gums Medicated, sold as confectionery. Informal Formal Blackcurrant gums Medicated, sold as confectionery. 180 188 Milk Formal 17 per cent, deficient in fat. 196 Curry powder Informal Lead, 20 parts per million. Thyme Informal 214 Siliceous matter, 6.8 per cent. Thyme Formal 220 Siliceous matter, 5.1 per cent. Observations. Result of Proceedings of other Action taken. Formal sample taken and found to be genuine. Routine sample. Formal sample taken; see No. 64. Formal sample taken; see No. 65. - - Formal sample taken; see No. 87. Formal sample taken; see No. 89. - - Formal sample taken; see No. 180. - Routine Sample. Last of old stock; unable to obtain formal sample. Formal sample taken; see No. 220. Summons. £20 fine and 3 guineas costs. This milkman appeared before the Public Health Committee, who subsequently cancelled his registration as a retail purveyor of milk: he appealed to a Court of Summary Jurisdiction against this decision, but his appeal was dismissed. Cautionary letter sent by Public Health Committee. Cautionary letter sent by Public Health Committee. Two summonses; £1 fine for alcoholic deficiency; summons in respect of offence under the Min. of Food Labelling of Food Order, 1946, dismissed. Two summonses; £1 fine for alcoholic deficiency; summons in respect of offence under the Min. of Food Labelling of Food Order, 1946, dismissed. Matter considered by Public Health Committee, who referred the question to the Ministry of Food. Matter considered by Public Health Committee, who referred the question to the Ministry of Food. Summons; case dismissed without costs. Cautionary letter sent by Public Health Committee. Cautionary letter sent by Public Health Committee. Serial No. Article. Whether Formal or Informal. Nature of Adulteration or Irregularity. 348 Coffee and chicory extract. Informal 24 per cent, deficient of caffeine. Informal 210 p.p.m. sulphur dioxide in excess. 421 Lemon squash 435 Informal 64 per cent. by weight deficient in edible oil. Salad cream 360 Formal 64 per cent. by weight deficient in edible oil. Salad cream 442 Informal Peroxide of hydrogen. Entirely deficient of active ingredient. Informal 48 per cent, deficient of sulphur. 447 Compound powder of liquorice. Formal 32 per cent. deficient in peroxide. 375 Peroxide of hydrogen (20 vols.) 467 Informal Unfit for sale. Contained a dead larva. Lemon-flavoured linctus. Labelling of Food Order not observed. 500 Informal Toffee crisp Compound powder of liquorice B.P. Formal 405 44 per cent, deficient in sulphur. 553 Informal Blackcurrant flavour wine. Contains excessive benzoic acid. 606 Gin Informal 2.1 degrees of proof spirit below legal limit. Gin Formal 475 4.0 degrees of proof spirit below legal limit. Salad cream Informal 623 56 per cent, deficient in oil. Formal Salad cream 482 56 per cent, deficient in oil. Informal French peel 645 Misdescribed, consists of melon. French peel Formal 500 Do. do. 46 Observations. Formal sample taken and found to be genuine. Do. Formal sample taken; see No. 360. Formal sample taken; see No. 375. Formal sample taken; see No. 405. Matter taken up with retail chemist and with manufacturer. Matter referred to Div. Office of Min. of Food. Formal sample taken and found to be genuine. Formal sample taken; see No. 475. Formal sample taken; see No. 482. Formal sample taken; see No. 500. Result of Proceedings or other Action taken. Cautionary letter sent by Public Health Committee. Cautionary letter sent by Public Health Committee. Cautionary letter sent by Public Health Committee. Summons; dismissed under the Probation of Offenders Act; 15 guineas costs to Council. Public Health Committee decided to prosecute; summons was not issued, however, as manufacturers discontinued business. Cautionary letter sent by Public Health Committee. MEAT AND OTHER FOODS. Registration of Food Premises. Premises used for the sale, manufacture and storage of ice cream or similar commodity, the manufacture of sausages, the preparation or manufacture of potted, pressed, pickled or preserved meat, fish or other food are required to be registered. The number of such premises on the register at the end of the year are set out below:— Sale, manufacture or storage of ice cream 320 Manufacture of sausages 138 Preparation or manufacture of potted, pressed, pickled or preserved meat 250 Preparation or manufacture of potted, pressed, pickled or preserved fish 96 Preparation or manufacture of potted, pressed, pickled or preserved other foods 24 Public Health (Meat) Regulations, 1924-1933. These Regulations provide for the supervision of slaughterhouses, butchers' shops and stalls, and the protection of meat against contamination by dirt or flies in transport and handling. Regular inspections were made and no infringements of the Regulations were reported which justified any legal action being taken. Slaughterhouses. There are three licensed slaughterhouses in the Borough. The proprietors of one of these are pig breeders on a considerable scale and at the request of the Ministry of Food were asked by the Food Control Committee whether they would consent to the slaughterhouse at their premises, which was used during the war for emergency pig killing, being utilised as a licensed slaughtering point in the Borough in order to lessen the possibility of illegal pig killing. The nearest Government slaughtering centre is at Woolwich and the other two licensed slaughterhouses in Camberwell could not be used owing to damage by enemy action. The proprietors agreed and applied for a licence which was granted. During the year under review 14 pigs were slaughtered for pig keepers in the Borough. Bakehouses. At the end of 1948 there were 78 registered bakehouses in the Borough, 57 of which were classified as factory bakehouses. The number of underground bakehouses in use at December 31st was 14. Street Traders. There are 103 licensed street traders engaged in selling articles of food. The food, stalls and the premises where the food is stored are kept under regular supervision by the Inspectors. Restaurants and Eating Houses. A number of complaints were received during the year as to the use of cracked and chipped crockery in catering establishments. These establishments were visited and recommendations made by the Sanitary Inspector with a view of securing the observance of sanitary and cleanly conditions. The replacement of crockery is not now so difficult owing to increased supplies becoming available. During the year various restaurants and canteens were visited and the methods of cleaning the crockery and cutlery were investigated. In a number of instances the utensils after preliminary washing in water containing a detergent were not rinsed in fresh water and allowed to drain but were dried with dirty cloths. There is a pressing need for kitchen and canteen workers to be educated in personal hygiene and their responsibility in the prevention of infection in the food prepared by them. Two golden rules should always be observed by individuals employed in eating houses. Firstly, the thorough washing of hands by the staff after using the toilet, and secondly, the efficient cleansing of dishes, etc., so as to prevent the use of unclean eating utensils. Ice Cream. At the end of 1948 there were 320 premises registered for the sale of ice cream in the Borough. Of these 33 were manufacturers premises. Eighty-seven samples of ice cream were submitted for examination by the methylene blue test, a test well suited for the routine examination of large numbers of samples. The results were as follows:— Grade. No. of Samples. I 14 II 24 38 satisfactory. 111 14 IV 35 49 unsatisfactory. Where a sample was deemed to be unsatisfactory a visit was made to the premises by the Inspector and advice was offered as to the steps which should be taken to effect an improvement. Letters were sent to the manufacturers and managers of shops giving the results of the examination of samples in every case. On the whole manufacturers and vendors of ice cream were anxious to co-operate in any way with the authority in improving the grade of ice cream. Supervision of Food Premises during 1948. The following table shows the number of visits of inspection carried out at various food premises in the Borough:— No. of Inspections. Type of Premises. Bakehouses 105 Butchers 71 Restaurants and eating houses 421 Dairies and milkshops 92 Fried fish shops 106 Fish curers' premises 176 Ice cream premises 670 Other premises where food is sold 2,947 Total 4,588 Unsound Food. During the year the Food Inspector issued 3,095 certificates in respect of food found to be unfit for human consumption and surrendered by the owners. Much of this food was salvaged and used for animal feeding; the remainder was destroyed at the Council's Depot at Frensham Street, S.E.15. Particulars of Unsound Food Condemned. Tons cwt. lbs. qrs. Meat 4 2 2 7 Fish 3 4 2 22½ Fruit 1 12 21 1 Canned Foods 48 0 1 13 Miscellaneous foods 4 19 1 10 19 1 17½ Total 61 Carcases Inspected and Condemned. Cattle, excluding Cows. Calves. Cows. Sheep and Lambs. Pigs. Nil Nil Number killed 14 Nil Nil - - - - 14 Number inspected All diseases except Tuberculosis. - - 1 Whole carcases condemned - - Carcases of which some part or organ was condemned - - - 2 - Percentage of the number inspected affected with disease other than tuberculosis - - - - 14.3 - - - - Nil. Tuberculosis only. Whole carcases condemned Carcases of which some part or organ was condemned - - - Nil. - Percentage of the number inspected affected with tuberculosis - - - - Nil. TUBERCULOSIS. Particulars of all new cases of tuberculosis and of all deaths from this disease during 1948 are given in the following table:— Deaths†. I New Cases*. Pulmonary. Non-Pulmonary. Age Periods. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. Male. Female. Male. Female. 0 - 1 yr. 1 - 1 - - 3 1 - 14 1 - 5 yrs. 17 2 4 - 3 2 - 5 - 15 „ 17 14 3 6 - - 2 - 15 - 25 „ 35 59 5 8 5 10 1 - 25 - 35 „ 61 56 3 4 9 8 - - 35 - 45 „ 40 27 1 13 10 - - 1 17 45-55 „ 31 9 1 6 3 - - 55-65 „ 22 3 1 1 9 4 - 1 4 65 and over 11 1 6 3 1 2 - Totals 187 60 41 7 9 237 15 26 * Including primary formal notifications and cases which came to the knowledge of the Medical Officer of Health from other sources. † After correction for inward and outward transfers. During the year under review 391 primary notifications of tuberculosis were received, of which 359 were cases of pulmonary tuberculosis and 32 non-pulmonary. No instance occurred where there was evidence of wilful neglect or refusal on the part of a medical practitioner to notify a case. Deaths from all forms of tuberculosis during the year numbered 117 equal to a death rate of 0.6 per 1000 of the population. Twenty-two of these cases had not been notified as persons suffering from tuberculosis. The following table gives particulars of the prevalence and fatality of tuberculosis since 1945: — Year. Estimated Population. No. of Primary notifications. No. of Deaths. Notification Rate per 1,000 Population. Death Rate per 1,000 Population. 1945 135,460 126 1.9 0.9 257 164,380 1946 336 2.0 99 0.6 1947 175,060 356 135 2.0 0.7 1948 178,200 391 117 2.2 0.6 Tuberculosis Allowances. The Government Scheme of monetary payments to persons suffering from pulmonary tuberculosis and receiving approved treatment, which commenced in June, 1943, ceased on July 5th, 1948 when the National Assistance Act, 1948, came into force. On that date 124 Camberwell patients were in receipt of allowances and these were transferred to the National Assistance Board, the Body authorised under the new Act to take over the management of allowances to tuberculous persons. The transfer of these cases was regulated prior to July 5th, 1948 so that on that date all details were in the hands of the Assistance Board and continuity of payment to the patients was uninterrupted. Occupational Therapy. The Handicraft Class met each Friday from 2 to 4 in the afternoon. The London County Council continued its assistance to the Class by placing at its disposal the services of one of its Arts and Crafts teachers. The Class roll numbered 16 and there was an average attendance of 10 patients. Christmas Seal Sale. As in previous years a Christmas Seal Sale was organised under the auspices of the National Association for the Prevention of Tuberculosis. The receipts amounted to £621 16s. 7d. (the highest for the Metropolitan Boroughs) and payments totalled £103 2s. 8d. leaving a profit of £518 13s. 11d. The following items indicate how the Care Committee used their Fund which was built up on Christmas Seal Sales:— Pocket money was paid to 20 necessitous patients whilst receiving institutional treatment. Clothing was provided for 64 patients. Domestic Helps were arranged in two cases while awaiting sanatorium treatment or as a convalescent measure after leaving the sanatorium. Payment of fares in 15 cases—many at some considerable distance from London. The purchase of surgical appliances and the loan of bedside comforts in 51 cases. Board and lodging was provided in one instance. The supply of beds and bedding in 34 cases. Payment for the cost of household removals in 5 cases. The purchase of a second-hand auto-cycle to enable a patient to carry on his work as a Club Agent. Other General Assistance to Patients. Recommendations were made in respect of 188 patients for priority consideration to be given to their applications for the provision of alternative housing accommodation. Extra diet was provided for 58 patients. In eight instances the services of a domestic help were arranged to assist patients who were unable to continue to carry out their normal household duties. APPENDIX NO. 1. 14TH JUNE, 1948. To the Chairman and Members of the Public Health Committee. Aldermen and Councillors, The Maternity and Child Welfare Services, 1920-1947. The Maternity and Child Welfare Services like other services for which the Public Health Department is responsible have undergone vast changes during the years between 1920-1947. The Notification of Births (Extension) Act, 1915, which made universal throughout the country the system of giving early information to the Medical Officer of Health of all births occurring in the area of a local authority was the stepping stone to the Maternity and Child Welfare Services as they exist to-day. This Act also enabled local authorities to make arrangements for the care of mothers including expectant mothers and young children. To encourage the promotion of schemes the Government of that day agreed to provide, by means of annual grants, payment to local authorities of one-half the cost of the whole or any part of schemes for Maternity and Child Welfare approved by the Local Government Board. It was not until the year 1920 when the Council appointed an Assistant Medical Officer of Health, followed by the appointment of two Health Visitors in 1921, that the foundations were laid for a service which eventually has grown to cover a wide field of activities and has touched every aspect of the health of the mother and child. Previously the Council's activities were limited to the administration of the Milk (Mothers and Children) Order, 1919, the payment of grants to various Voluntary Associations in aid of their work of maintaining Infant Welfare Centres and the employment of Health Visitors in certain areas of the Borough. Two hostels whose special care was the well-being of mothers and their illegitimate infants received financial assistance from the Council as well as the authorities of two day nurseries and a Nursing Association undertaking the nursing care of certain ailments in children. The year 1921 saw the establishment of the first Municipal Infant Welfare Centre and the provision of a Municipal Ante-natal Clinic at the same premises in Camberwell Road. These premises, although far from being ideal for the purpose for which they were used, had the great advantage of being ready for occupation. Later in the same year another Municipal Infant Welfare Centre was opened in Lordship Lane, East Dulwich, at premises belonging to the Trustees of the Wesleyan Mission Hall. Here again the premises left much to be desired for the service to be undertaken, but the need for a Centre in that part of the Borough was so great that as there was no alternative premises available in the district, the Council considered it desirable to enter into a tenancy agreement with the Trustees. This agreement continued to the time of the purchase by the Council of the freehold interest in the property in 1938. In 1922 a third Municipal Infant Welfare Centre was opened ; the premises in this case was a Church Hall at Meeting House Lane, Peckham. The Council this appointed another Health Visitor for duty at this Centre. A further extension of the Borough's Maternity and Child Welfare Scheme took place in the same year, the Council agreeing to provide- (a) convalescent treatment in special cases for mothers after confinement and for some conditions in young children; (b) payment of midwives fees for services rendered to necessitous mothers; and (c) the utilisation of the dental clinic at the Cobourg School for Mothers for expectant and nursing mothers requiring dental treatment (including the provision of dentures) referred for treatment by Clinic Medical Officers at the Municipal Centres. The outstanding event in the year 1923 was the provision, by arrangement with the Camberwell Board of Guardians of a Municipal Maternity Ward of six beds and a labour room equipped with all modern appliances at St. Giles' Hospital , Brunswick Square. This accommodation was provided for patients whose domestic circumstances were of a character that made it almost impossible for the confinement to take place in their own homes and for patients who, for medical reasons either during pregnancy or at the time of labour, it was desirable in the patients' interest for them to be confined in hospital. In 1924 arrangements were completed for people living in the north-eastern part of the Borough to have similar nursing facilities for their children as were provided for the remainder of the Borough. At the end of 1925 anot h er Infant Welfare Centre was opened by the Authorities of the Union of Girls Schools' Settlement at Amott Road, East Dulwich, the Council contributing, as in other similar cases, an annual sum towards the administration charges. The agr eement which the Council had previously entered into with the Camberwell Board of Guardians for the provision of a maternity ward in St. Giles' Hospital was renewed in 1926. Under the new agreement the accommodation was increased to two six-bed wards in view of the popularity of the Scheme and to meet the increasing demand for institutional accommodation for patients conforming to the qualifications for admission under this Scheme. There were no noteworthy extensions of the Council's Maternity and Child Welfare Scheme during the next six years ; nevertheless during these years considerable energy was directed to the development of the existing services with satisfactory results. As a result of the Local Government Act, 1929, the Boards of Guardians transferred to the London County Council as from the 1st April, 1930. The council, however were able to continue to reserve maternity beds in St. Giles' Hospital for patients nominated by the Council for the next three years. At the end of this period the Council were advised that as the further retention of these wards would seriously hamper the L.C.C. in making the best use of the Hospital, the agreement was terminated by arrangement on the 31st March, 1934. In 1933 the functions relating to Infant Life Protection were transferred from the London County Council to the Metropolitan Borough Councils under the transfer of powers Order, 1933, made under Section 64 of the Local Government Act, 1929. In the following year the Council entered into an arrangement with the L.C.C. for the use of that Authority's Ante- and Post-Natal Clinics at St. Giles' and Dulwich Hospitals for the medical examination, including dental treatment, and the supervision of pregnant women who had arranged to be confined in their own homes either by a private medical practitioner or a practising midwife. At these hospitals special facilities existed for X-ray examinations and observation ante-natal beds were also available. This arrangement was additional to the facilities provided for ante- and post-natal supervision at the Municipal Clinic, 140 Camberwell Road and at the Bird-in-Bush Voluntary Association Clinic in the Old Kent Road. The Clinic at Camberwell Road was, however, discontinued in 1938 in view of the provisions of the L.C.C. Domiciliary Midwifery Service and the Ante-natal Services Scheme at the two local hospitals. The year 1935 saw the launching of a social service of inestimable benefit to mothers, particularly the poorer working-class mothers, as it offered the prospect of a longer convalescence after childbirth without any anxieties as to whether her family and the household duties were being neglected during her lying-in. This Scheme, accurately described as the "Home Helps Service" made provision for domestic assistance at the homes of patients during pregnancy and/or childbirth, the Municipal Help performing duties similar to those normally undertaken by the mother, viz., general home management including cooking, marketing, washing and the care of the children. The supply of meals to expectant and nursing mothers was also a service initiated by the Council in 1935, and in the same year the Union of Girls' Schools Authorities gave notice of their intention to close the Infant Welfare Centre at 24 Mayward House, and to discontinue Maternity and Child Welfare Services in that part of the North-western Division of the Borough which the Centre in Benhill Road served as a pivotal point. The Council therefore decided to enter into a tenancy agreement with the L.C.C. for the use of the premises and the work was continued without interruption under Municipal direction. There were then four municipally directed centres, the remaining six being conducted by Voluntary Associations supported by grants made by the Council. The year 1936 will stand out prominently as the year in which the Council established "Toddlers" Clinics at the four Municipal Infant Welfare Centres, and approved a scheme for the treatment at the London County Council School Treatment Centres of children under five years of age attending Infant Welfare Centres in the Borough and recommended by Clinic Medical Officers for treatment. The year 1937 was characterised by the Council taking steps to improve the unsatisfactory nature of the accommodation at the Municipal Centres. Negotiations were entered into with the owners of the Dulwich Infant Welfare Centre premises for the sale of the building to the Council with a view to its demolition and the subsequent erection of an up-to-date Municipal Centre on the site. In the northern area of the Borough the Council decided to acquire from the London County Council the cleared site of certain properties dealt with under the Housing Act for the purpose of erecting an Infant Welfare Centre on part of the land to replace an existing Voluntary Centre in Kempshead Road. The erection of a London County Council Estate in Sumner Road, Peckham, offered an opportunity to the Council of obtaining suitable accommodation in the Basingstoke House block of flats for an Infant Welfare Centre to serve the needs of that part of the Borough, and in the following year the Centre was opened. Arrangements were also made in the same year for children under five years of age to receive sunlight and massage treatment at St. Giles' Hospital and at the British Red Cross Society Clinic, Peckham Rye. The Council during 1938 acquired a site in Camberwell Road for the purpose of building thereon a Health Centre. Among the services to be provided were an Infant Welfare Centre, a special clinic for women (Gynaecological), the treatment of minor ailments in children under five years of age including sunlight and massage treatment, dental, child guidance, and breast feeding clinics, a health exhibition and lecture room, a day nursery and departments for bacteriological and chemical examination of specimens. In the following year further progress was made and plans of the building were under consideration, when unfortunately, war was declared and the scheme was abandoned. At the time of the outbreak of war the Maternity and Child Welfare arrangements as they existed at that time for the care of expectant and nursing mothers and children under five years of age not attending school were:— 1. Maternity. (a) Medical examination and supervision of pregnant women, and following confinement, at ante-natal and post-natal Clinics held at an Infant Welfare Centre and at the L.C.C. St. Giles' and Dulwich Hospitals. (b) The services of a Consultant at the request of a private practitioner for any condition arising during pregnancy, parturition or during the puerperium of patients confined at home. (c) Home visits by Health Visitors to pregnant women. (d) Payment of compensation to midwives for loss of patients. (e) Provision of sterilised maternity outfits. (f) Dental treatment including the provision of dentures. (g) Provision of Home Helps. (h) Provision of home nursing assistance. (i) Convalescent home treatment for expectant and nursing mothers. (j) Provision of milk and dinners for necessitous mothers. (k) Education in health matters. (l) Investigation of maternal deaths and cases of puerperal fever and puerperal pyrexia. (m) Financial assistance towards the cost of institutional maintenance of unmarried mothers. 2. Infants and Young Children. (a) Public Health (London) Act, 1936, Notification of Birth administration. (b) The provision and maintenance of Infant Welfare Centres. (c) Home visits by Health Visitors. (d) Convalescent home treatment. (e) The supply of milk to children of necessitous parents. (f) Provision of home nursing services. (g) Minor ailments treatment. (h) Sunlight and massage treatment. (i) Child Life Protection. As was to be expected, during the first months of the war the Maternity and Child Welfare Services were disorganised. The services of the Municipal Health Visitors were utilised as nurses in charge of first aid posts, but at the end of the same year there was a drift back of families from the reception areas and the Health Visitors returned to their normal duties. The intensive air raid attacks on London towards the end of 1940 in which Camberwell suffered very severely caused the normal working of the Maternity and Child Welfare services to be again interrupted. In the early part of 1941 the Council, with the approval of the Ministry of Health, regrouped the Infant Welfare Centre districts of the Borough. This resulted in the work being directed from five Centres instead of eleven and the curtailment of other services. In the following year the Council, at the request of the Ministry of Labour and National Service, initiated and developed a scheme for the establishment of a number of war-time nurseries in various parts of the Borough. This programme was completed during 1943 when there were twelve nurseries available for mothers employed in the war effort, seven Municipally directed on behalf of the Ministry of Health, and five, which were set up in Rest Centres, being under the control of the L.C.C.; the Council, however, were responsible for the admission and medical supervision of the children entering the Rest Centre Nurseries. The total place capacity of the nurseries was 395 children. Unfortunately, in the following year, two of the Municipal nurseries were irreparably damaged and a rest centre nursery was temporarily closed following enemy action damage. In spite of the bombing that took place in 1944 efforts were made by the Council to bring within the Home Help Scheme cases of sickness of mothers who had living with them children under five years of age for whom no alternative arrangements could be made, but this extension of the Service was subject to the needs of expectant mothers having first been met from -the limited panel of helpers available for this Service. The Problem of the illegitimate child also received attention the Council deciding to guarantee payments to fost( r mothers for their services. Closer supervision by the Health Visitors of premature infants and measures to secure greater co-operation between the Maternity Units of the various hospitals receiving Camberwell mothers for confinement and the Public Health Department were also features of the year's work. With the cessation of hostilities in 1945 the Council gave early consideration to the need for additional Infant Welfare 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 had been used as a Wardens Post during the war, was re-opened as an Infant Welfare Centre under Municipal direction. The possibility of establishing an additional Infant Welfare Centre in the northern part of the Borough was investigated and the St. Antholin's Centre in the Nunhead area was taken over by the Council from the Voluntary Association and developed on Municipal lines. The Toddlers Clinics, which were such an important and popular feature of the Infant Welfare Centre service before the war were also re-established in this year. In 1946 the Council decided, in view of the strong demand for women in industry, to continue the Municipally directed War-time Day Nurseries as a postwar feature of the Maternity and Child Welfare Scheme, but decided to return the Staffordshire Street Nursery to the pre-war controlling authorities of this institution in order that the nursery school activities which were interrupted by the war might be resumed. There are now four Municipal Nurseries in the Borough with a total place capacity of 180 children. Careful consideration was given to the suggestions outlined in a Ministry of Health Circular for implementing the Nursery Service by the provision of schemes of registered daily guardians, evening "sitters-in" and the establishment of afternoon creches at Maternity and Child Welfare Centres. Past failures to recruit a sufficient number of suitable persons to act as foster mothers did not encourage the belief that the response to an appeal for persons to enrol as daily minders would justify a scheme for this analogous service, nor was it considered practicable to arrange for a scheme of "sitters-in" or for the use of Infant Welfare Centres as afternoon creches; consequently the Council decided against promoting any of these suggested supplementary services. On the other hand, a close scrutiny of all applications for admission to the Nurseries was undertaken, and a scheme was adopted which provided for a proportionate allocation of places to cases falling within four priority categories as follows:— 1. Mothers employed in industries vital to production. 2. Widows, unmarried mothers and separated wives. 3. Insufficient income. 4. Mothers who for some good reason were incapable of undertaking the full care of their children. As a result of the application of this priority scheme many mothers were unfortunately compelled to withdraw their children from the Nurseries to make room for other mothers whose circumstances conformed to the Council's revised arrangements for admission. Nevertheless, the altered arrangements for admission has made no difference to the length of the waiting list for accommodation, but the new Scheme has ensured an equitable distribution of the available provision to applicants most in need of the Nursery Service. An active propaganda campaign was undertaken in this year for recruiting suitable women to undertake Home and Domestic Help duties which resulted in the Council being able to build up the panel of Helps and to meet all demands for assistance in the home during the confinement of the mother and in special cases of illness of members of the family. Every endeavour was made in 1947 to dispose of the outstanding problem of replacing the unserviceable premises used as an Infant Welfare Centre at 114 Lordship Lane. An approach was made to the Authorities of the Tell Grove Congregational Church which had recently been repaired following enemy action damage, and it is satisfactory to record that negotiations for the transfer of the Centre's work to these premises resulted in a tenancy arrangement being concluded for the use of the premises for Infant Welfare and Diphtheria Prevention Services for the Dulwich district from September 3rd last. 61 To-day, on the verge of handing over the Maternity and Child Welfare Services to the London County Council, it can truly be said that the bearing of children is no longer a perilous undertaking, that infants get a better start in life, a better chance of survival and are less likely to be handicapped through life by deformities. The statistical references in the appendix to this report point to the progressive improvement in the birth and infant death rates in the Borough during the period of the past 28 years. Looking back over the past 20 years I esteem it a privilege in being permitted to assist in building the Maternity and Infant Welfare structure as it is to-day, which, although not perfect, yet in my opinion, compares favourably with any to be found in the Metropolitan Boroughs and of which the Council might justly feel satisfied. On July 5th, 1948, there will be a new " set-up " of this service as a result of the National Health Service Act, 1946. Whether this change will provide a better service only time will show. Yours faithfully, H. W. BARNES, Medical Officer of Health. Births and Infantile Deaths. Year. Estimated population. Births. Deaths under 1 year. Number. Rate per 1,000 population. Number. Rate per 1,000 population. 284,995 26.3 7,505 1920 526 71 1921 23.5 269,600 6,301 462 74 5,802 21.4 1922 270,300 454 78 272,300 5,657 1923 20.7 321 56 70 1924 273,700 5,146 18.8 361 265,400 4,877 316 1925 17.7 64 275,400 294 1926 4,584 16.6 64 1927 271,100 4,232 15.6 223 52 25.5 1928 260,400 4,135 15.8 61 256,900 3,934 268 68 1929 15.3 51 1930 256,900 3,809 14.8 197 252,100 3,704 208 56 1931 14.7 3,614 234 1932 248,000 14.6 65 3,247 1933 243,700 13.3 160 49 238,360 3,152 13.2 214 67 1934 3,155 60 1935 234,400 13.4 191 188 1936 229,300 3,194 13.9 59 224,800 3,165 14.0 185 58 1937 191 61 1938 222,400 3,106 13.9 13.8 108 1939 219,500 3,040 36 173,750 2,767 15.9 118 46 1940 1,990 15.6 88 58 1941 127,570 127 1942 129,900 2,357 18.1 53 1943 132,330 2,483 18.7 120 48 2,459 52 1944 129,880 18.9 128 1945 135,460 2,646 19.5 91 34 1946 164,380 3,848 23.4 148 38 175,060 167 1947 4,278 24.4 39 62 Maternal Mortality. Year. Deaths from Puerperal Sepsis. Deaths from other Puerperal causes. Maternal Mortality rate. 1920 8 6 1.8 1921 9 7 1.7 1922 7 8 2.6 1923 9 11 3.5 1924 7 3.3 10 2.6 1925 6 7 8 1926 7 3.2 1927 9 8 4.0 1928 10 4.3 8 1929 7 6 3.4 1930 4 4 2.1 1931 10 6 4.7 2.4 1932 5 3 1933 6 4.7 10 5 2.4 1934 3 4 1935 6 3.0 1936 1 6 2.1 3 1937 3 1.8 1 1938 7 2.5 2 1939 4 2.0 1940 4 1 1.7 6.5 1941 5 5 1942 3 3 2.4 1943 2 1.2 1 1944 2 2 1.5 2 4 2.2 1945 1946 2 3 1.2 1947 1 4 1.1 Stillbirths : Illegitimate Births and Deaths. Year. No. of Illegitimate Births. No. of Deaths of Illegitimate Infants. Death Rate per 1,000 Illegitimate Births. No. of Stillbirths. 1922 135 27 176 153 1923 144 135 13 96 1924 96 114 141 16 1925 126 13 127 103 1926 97 18 128 140 1927 105 17 125 136 14 1928 102 122 114 1929 120 119 17 143 96 12 1930 99 121 1931 127 136 14 103 1932 106 120 12 100 106 10 101 1933 99 94 12 1934 133 90 96 15 106 1935 141 104 142 1936 127 18 97 1937 136 13 96 103 1938 131 15 115 1939 103 100 110 11 1940 51 10 102 98 36 1941 79 8 101 92 9 70 98 1942 53 9 66 1943 160 60 10 1944 178 56 1945 63 211 7 33 1946 87 14 58 242 1947 70 221 4 18 Figures not available for years 1920 and 1921. APPENDIX NO. 2 June 22nd, 1948. To the Chairman and Members of the Public Health Committee. Aldermen and Councillors, The Tuberculosis Services of the Borough. The Tuberculosis Services in the Borough owe their origin to a local committee formed at the Cambridge University Settlement, Cambridge House, Camberwell Road, in 1912. The work was centred in the Dispensary premises at No. 19 Brunswick Square. The Central Fund for the Promotion of the Dispensary System for the Prevention of Consumption in London supplied threequarters of the capital and working expenditure. The Council subsequently helped in the work by granting financial aid to the Voluntary Committee, and were given representation on the Committee. The staff at that time consisted of a Tuberculosis Officer, an Assistant Tuberculosis Officer, three nurses, a dispenser, a porter and an honorary Secretary. Institutional treatment was provided by the London County Council. An interim Tuberculosis Care Committee assisted in the work of the Dispensary and the institutional schemes of the London County Council. At the end of 1920 it was intimated to the Council that the voluntary organisation which had so long carried out the work, could no longer be responsible for its continuance. The Council, therefore, had no alternative but to continue the work under their control, and to be responsible for the cost. A Scheme was therefore prepared and approved by the Council and in the following year the whole of the local administrative arrangements for this disease was municipally directed. A dental scheme for giving dental treatment to tuberculosis patients came into operation during that year. An opportunity was taken in 1922 to develop, with satisfactory results, the existing services of the Dispensary and to ensure that the co-ordination between the tuberculosis department and that of the Public Health Department was in no way lacking. As there seemed to be some misunderstanding of the functions of the Dispensary , the aims of the Tuberculosis Dispensary as a Centre of diagnosis and treatment were outlined in my Annual Report for that year. The Dispensary arrangements at that time included the provision of dental treatment, the pneumothorax treatment at Brompton Hospital of selected cases of pulmonary tuberculosis , X-ray aid in diagnosis at King's College Hospital, and Finsen Light treatment for cases of Lupus at the London Hospital. In 1956 the Dispensary was transferred from No. 19 to Nos. 34/35 Brunswick Square, premises in use by the Public Health Department staff pending the rebuilding of the Town Hall. At that time it was generally agreed that these premises were not suitable as a permanent home for the Tuberculosis Dispensary and that better accommodation must sooner or later be found. In 1938 the London County Council placed at the disposal of the Council the facilities at St. Giles' Hospital for the X-ray examination of all patients and contacts referred by the Tuberculosis Officer, and in the same year an Artificial Pneumothorax Refill Clinic was established at the same hospital under the direction of the Council's Tuberculosis Officer. The provision of these services locally served to emphasise the importance and advantages of a properly equipped Tuberculosis Dispensary offering to patients medical treatment and the complementary welfare and social services. These services the Council planned to provide in a Health Centre Scheme; indeed, the Council's intention was that the tuberculous patient should regard the Dispensary as the Centre in his Borough where he could go for the settlement of his problems both medical and otherwise, but unfortunately the Scheme had to be abandoned shortly after the outbreak of hostilities. In 1940 the number of X-ray examinations conducted of Dispensary patients was 1410, whilst the Tuberculosis Officer performed 877 artificial pneumothorax refill treatments at the St. Giles' Hospital Clinic. There were also 586 refill treatments carried out at various other hospitals in London during this year. In 1942 a re-arrangement of the Tuberculosis work of the Borough followed on the release for military service of the Tuberculosis Officer and Deputy Medical Officer of Health. To assist the Assistant Tuberculosis Officer, the Council of the neighbouring Borough of Southwark approved the loan of the services of their Tuberculosis Officer for the purpose of conducting one clinic session weekly at the Camberwell Dispensary and to undertake the Artificial Pneumothorax Clinics at the Southwark Health Centre on Wednesday afternoons and evenings. The London County Council also arranged for the interpretation by their own radiologist of the X-ray films taken at St. Giles' Hospital three times a week. The general arrangements proved very satisfactory and made possible the maintenance of the Tuberculosis Service of the Council at an efficient level. In 1944 the Council were invited to make use of the Mass Miniature Radiography Unit for the detection of pulmonary tuberculosis which the London County Council were arranging to establish for a period of two months at the South- Eastern Hospital for the benefit of industrial workers in the Borough. The Council accepted the offer and were able to arrange for the examination of 1,123 men and 867 women volunteers drawn from a variety of employments in the Borough. Of the number examined, 11 males and 7 females were reported on as probably suffering from tuberculosis. In 1946 this Unit was again made available for a period of three months and on this occasion of the 1,506 men and 1,310 women who submitted themselves for examination, 8 men and 12 women were found to be probably suffering from tuberculosis. On the return of the Tuberculosis Officer from the Services in 1946, the temporary arrangements made for the conduct of the work of the Dispensary during his absence were terminated and patients were once more sent to St. Giles Hospital for X-ray examinations, the interpretation of the films being undertaken' as formerly by the Tuberculosis Officer. Artificial pneumothorax clinics were also conducted at the Dispensary. As a result of the increase in the number of X-ray examinations, the Council, in the following year, made arrangements with the London County Council and King's College Hospital Governors for the facilities of the X-ray department at Dulwich and King's College Hospitals respectively to be made available for use of the Tuberculosis Dispensary. An X-ray screening apparatus was also installed at the Dispensary in the same year as a diagnostic aid in the detection of tuberculosis. A reference to the statistics shows how this dread disease which was once rampant and claimed victims in large numbers at all ages has declined during the past quarter of a century. It will be seen that the mortality figures show a progressive decline and one is consequently forced to ask oneself these questions:— (a) Can this figure be further reduced and how ? (b) Should tuberculosis be regarded like other infectious diseases and steps be taken to prevent tubercle bacilli from being transferred from infectious persons to other healthy members of the community at home and at work? 65 On and after July 5th next the responsibility for the local Dispensary Service will pass into other hands under the provisions of the National Health Service Act, 1946 ; the clinical work of the Dispensary to the Regional Hospitals Board and the duties of domiciliary visiting and after care to the London County Council. The part that the Council, assisted by the many voluntary workers, has played in building up so satisfactorily the tuberculosis services in Camberwell will, I am sure, be remembered with justifiable pride by patients, the local doctors, and by everyone interested in the civic affairs of Camberwell. Yours faithfully. H. W. BARNES, Medical Officer of Health. The Notification or tuberculosis in Camberwell, 1921-1947. No. of Notifications. Rate per 1,000 population. Year. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. 1921 595 155 2.22 0.58 l55 1922 506 1.87 0.54 505 152 1923 1.85 0.55 1924 416 143 1.52 0.52 1925 373 118 1.35 0.42 112 1926 394 1.43 0.40 1927 353 98 1.30 0.36 1928 363 102 1.39 0.39 393 102 1929 1.52 0.39 1930 393 90 1.53 0.35 81 1931 333 1.32 0.32 314 72 1932 1.27 0.29 290 1933 73 1.19 0.30 1934 284 57 1.19 0.24 275 58 1935 1.17 0.24 39 1936 260 1.13 0.17 296 55 1.32 0.24 1937 39 1938 294 1.30 0.17 28 0.14 1939 248 1.13 1940 206 30 1.18 0.17 226 1941 25 1.77 0.19 1942 258 47 1.99 0.36 232 42 1.75 0.32 1943 261 34 2.01 1944 0.26 0.23 1945 225 32 1.66 1946 315 21 1.91 0.13 1947 1.84 0.19 66 No. of cases on Dispensary Register 1.1.25 to 1.1.47. No. of X-ray examinations carried out on Dispensary patients, contacts and other persons 1925-1947. Year. 1925 1,587 118 2,057 209 1926 2,048 100 1927 2,012 128 1928 128 2,060 1929 230 1930 2,162 1931 2,226 456 1932 1,737 423 1,670 432 1933 577 1934 1,696 1,680 756 1935 1,689 666 1936 1937 1,655 751 1938 1,576 1,260 1939 i hja 1,618 1,452 1,680 1,410 1940 1,569 1,289 1941 1,580 1,757 1942 1,517 2,401 1943 1,610 2,412 1944 1,640 2898 1945 1946 1,794 4,441 5,600 1947 1,903 Figures not available for years 1921-1924. Deaths from Tuberculosis in Cambekwell 1921-1947. Pulmonary. Death rates per 1,000 of the population. All forms. NonPulmonary. Year. Pulmonary. All forms. 273 1921 352 79 1.02 1.31 282 59 1922 341 1.04 1.25 1923 305 0.92 252 53 1.12 1924 311 268 43 0.98 1.13 305 260 0.91 1.03 1925 45 104 1926 286 251 35 0.91 1927 285 253 32 0.93 105 1928 242 279 37 0.92 1.07 280 239 0.92 1929 41 1.09 1930 265 222 43 0.86 1.03 268 241 0.96 1931 27 1.06 248 214 1932 34 0.86 1.00 1933 245 223 22 0.91 1.00 1934 231 202 29 0.85 0.97 166 1935 192 26 0.71 0.82 1936 185 166 19 0.72 0.81 1937 206 177 29 0.79 0.92 179 152 0.68 1938 27 0.80 165 1939 145 20 0.69 0.79 1940 150 140 10 0.80 0.86 167 145 1941 22 1.01 1.03 130 118 1942 12 0.90 1.00 119 1943 138 19 0.89 1.04 109 1944 96 13 0.74 0.84 126 0.87 1945 118 8 0.93 1946 99 89 10 0.54 O.6O 135 119 16 0.68 1947 0.77 APPENDIX NO. 3. July 12th, 1948. To the Chairman and Members of the Public Health Committee. Aldermen and Councillors, Diphtheria Immunisation. I drew attention in my Annual Report for 1925 to the research work recently carried out for the purpose of determining the susceptibility of individuals to diphtheria and of immunising positive reactors. Emphasis was laid on the fact that the medical profession was becoming more convinced that the Schick Test did distinguish between the susceptible and the immune, that the process of immunisation did render the susceptible immune, that this immunity Was of sufficient duration to be of real value, and that the whole process was free from risk. Attention was drawn to the probable difficulty of persuading the public in a community where there was already a strong feeling against vaccination to accept the introduction of this new principle. Nevertheless the necessity for the provision of facilities for immunisation against diphtheria, especially for children under five years who are very susceptible to this disease, was stressed and an accompanying intensive propaganda campaign was recommended. In the following year after considering a report on the claims of artificial immunisation the Council, with the approval of the Ministry of Health, established an immunisation clinic at the Municipal Infant Welfare Centre at 140 Camberwell Road. Children of school age were also treated at this clinic as the London County Council at that time had unfortunately not provided facilities for this preventive treatment. Had such facilities been provided by the L.C.C. parents would have realised the importance of having their younger children protected before reaching school age and so avoiding the risk of their developing diphtheria. Consequently it took some years for parents to acquire a "preventive consciousness." In 1935 the Immunisation Clinic was transferred from 140 Camberwell Road to more suitable premises at Mayward House Infant Welfare Centre, Brunswick Square. From the time of moving the attendances gradually increased until the outbreak of war when the number of attendances fell as a result of the evacuation of Camberwell mothers and children to safe areas. In the year 1941 the London County Council inaugurated a scheme for diphtheria immunisation treatment of school-children to be undertaken by the School Medical Service. In response to the appeal by the Ministry of Health to local authorities in 1942 to secure the immunisation of the greatest number of children against diphtheria during the summer months, an intensive propaganda campaign was conducted throughout the Borough. This campaign was so successful that it became necessary to establish additional clinics and arrangements were made to hold six sessions weekly—three at the Sumner Infant Welfare Centre, and one each at the Dulwich and Mayward House Infact Welfare Centres and the St. Antholin's First Aid Post. The Council, in 1943, approved a scheme for treatment to be carried out by private medical practitioners in the Borough, the Council supplying the immunising material and undertaking responsibility for the payment of a fee to the private doctor for each injection administered. This Scheme provided facilities for the treatment of persons who for any reason were unable to attend at the Municipal Clinics. The weekly number of sessions was reduced to three by 1945, but towards the end of 1947 the number of children awaiting treatment had again increased to such an extent as to necessitate the establishment of another clinic. There are at present four sessions held every week, two at the Sumner Centre, and one each at the Dulwich and Amott Road Centres. I am indebted to Dr. G. Bousfield, who is an acknowledged authority and one of the pioneers in this branch of medical development, for the following references to the technique employed in the Council's Clinics under his control: — Procedure carried out at Clinics conducted by Dr. Guy Bousfield. A Schick Test is carried out for the purpose of demonstrating susceptibility to diphtheria or otherwise. 0.2 c.c. of Burroughs Wellcome diluted toxin is given intradermally into the skin of the left forearm and o.2 c.c. of heated toxin as a control into the skin of the right forearm. The readings of these tests are carried out a week later. Immunisation Treatment for Children. The original procedure consisted of swabbing the skin over the deltoid region with iodine solution and injecting 1 c.c. of toxoid anti-toxin intramuscularly into the deltoid, the site of injection afterwards being touched with iodine. Three doses of 1 c.c. toxoid anti-toxin were given at weekly intervals. At the end of three months the child was re-Schicked to assess the efficiency of the treatment and additional injections given if necessary until an immunity certificate could be issued. In 1933 a larger final dose of toxoid anti-toxin, i.e. 1.5 c.c. instead of 1 c.c. was adopted and a fortnight's interval allowed between the 2nd and 3rd doses. This procedure produced the satisfactory result that far less children than previously were found to be positive on re-Schicking. I n 1936 various types of diphtheria prophylactic were employed at the Clinic including Alum-precipitated Toxoid for children. The product was not given in a single or two injections but by the routine use of three doses at intervals of a fortnight, the dosage being 0.1 c.c., 0.3 c.c. and 0.5 c.c., for the purpose of conferring immunity against the more serious types of diphtheria infection. Toxoid Anti-toxin Floccules were employed for adult patients in three doses of 1.0 c.c. at intervals of two weeks. Later (1940) in treating children the recommended dosage of 0.1 c.c. and 0.3 c.c. of A.P.T. at one-month intervals was adopted but found to be unsatisfactory. Subsequently it was demonstrated that 0.2 c.c. and 0.5 c.c. of A.P.T. at one-month intervals was reliable. In the early days of the war, some of the prophylactics on the market were either of poor or of very variable quality. Much patient investigation was performed in the clinics to decide which preparations were most universally reliable. An endeavour was made to solve some of the unknown problems of diphtheria immunisation, e.g., optimal dosage of A.P.T. and the most satisfactory intervals at which to give injections. The latest and most powerful immunising agent. Purified Toxoid, Aluminium Phosphate Precipitated, produced by Mr. L. B. Holt in the Wright-Fleming Institute of Microbiology under the direction of Sir Alexander Fleming, is also at present under investigation with a view of finding out whether one really powerful injection will prove adequate instead of the two now generally used; this would save the mother's time by diminishing the number of attendances and make it possible to deal with a correspondingly larger number of children at the clinics in a given period of time. It should be emphasised that no child is discharged from the Council's Clinics as adequately treated, or is given a certificate until it has proved negative to the Schick Test following treatment. In the 22 years that the Council's Clinics have been in operation there is only one instance of a child previously immunised dying of diphtheria. Even in this case there were factors which make it somewhat doubtful that the child did, in fact, actually die of diphtheria. However, even if this case be assumed to be a failure of our attempt to protect infants and children from dying of the disease—only one failure in 22 years is a truly remarkable record. It fully justifies the fact that in the Council's Clinics the most scientific technique known has always been adopted. Protection given by the treatment tends to wane as time goes on and to ensure the greatest amount of resistance a child immunised before the age of one year should receive a reinforcing dose at school age and again at puberty. It is gratifying to report that diphtheria no longer presents a problem to the Health Department. The public realise that fatal or even serious cases of diphtheria do not occur in children whose resistance is kept at the highest point of efficiency by immunisation treatment. Confirmation of this statement is to be found in the accompanying statistics where it will be seen that the number of deaths in these days is negligible. Yours faithfully, H. W. BARNES, Medical Officer of Health. Summary or Persons Immunised 1947. 0-5 years. 5-15 years. Total. At Borough Council Clinics, etc. 1,209 2 1,211 At L.C.C. Schools and Clinics 106 577 471 Under Private Practitioners Scheme 89 8 97 1,404 481 1,885 Totals Table showing the number of children in the Borough who had completed a full course of immunisation treatment at any time up to December 31st, 1947, together with the estimated mid-1947 child population. Age at 31/12/47 Under 1 1 2 3 4 5-9 Total under 15 10-14 No. immunised 40 1,231 1,334 1,431 1,219 8,050 5,599 18,904 Estimated population mid-1947 15,380 20,890 36,270 Percentage of children under 5 years of age living in Camberwell protected 34.1 per cent. Percentage of children living in Camberwell protected 52.1 per cent. Diphtheria—Notifications and Deaths, 1925-1947. Year. Notifications. Deaths. 1925 934 40 1926 1,063 54 768 1927 23 1928 744 22 1929 669 16 1930 625 21 1931 456 17 1932 483 14 1933 507 20 1934 520 20 1935 363 20 1936 278 13 1937 346 13 1938 439 20 1939 212 8 1940 124 3 1941 3 114 1942 159 3 1943 81 - 1944 59 2 1945 54 2 1946 64 1 1947 35 2 INDEX PAGE Aged and Infirm Persons 18 Bacteriological Examinations 35 Bakehouses 49 Bugs, Destruction of 17 Cancer 11 Cerebro-Spinal Fever 29 Child Life Protection 20 Common Lodging Houses 39 Convalescent Treatment 24 Deaths 9 - 11 Infant Mortality 11 Maternal Mortality 11 Table of Causes and Ages 9 - 10 Dental Treatment 23 Diarrhœa and Enteritis 34 Diphtheria 25 Anti-toxin 25 Immunisation 26, 67 - 69 Disinfection 35 Domestic and Home Helps 23 Domiciliary Nursing 24 Drainage and Sewerage 12 Dysentery 29 Factories 15 Food and Food Premises 40 - 51 Adulteration 43 „ Tables 44 - 47 Bakehouses 49 IceCream 50 Milk Supply 40 Public Health (Meat) Regulations 48 Registration of Food Premises 48 INDEX—continued. PAGE Food and Food Premises —continued. Restaurants and Eating Houses 49 Slaughterhouses 48 Street Traders 49 Supervision of Food Premises 50 Unsound Food 51 Unsound Food condemned, Table 51 Food Poisoning 32 Fouling of Footpaths by Dogs 17 Home and Domestic Helps 23 Housing 37 - 39 Common Lodging Houses 39 Individual Houses Repairable at Reasonable Cost 39 Individual Unfit Houses 39 Overcrowding 39 Rent and Mortgage Interest (Restrictions) Act 39 Statistics 38 Underground Rooms 39 Ice Cream 50 Illegitimate Children, Care of 23 Infant Mortality 11 Infant Welfare Centres and Health Visiting 20 Clinic Attendances Table 21 Health Visitors' Visits Table 22 Infectious Diseases 25 - 36 Notifiable 25 - 33 Non-Notifiable 34 Table 27 Influenza 34 Malaria 30 Mass Miniature Radiography 36 Maternal Mortality 11 Maternity and Child Welfare 20 - 24, 55 - 62 Measles 28 Milk 40 - 42 Analytical Examination 41 Bacteriological Examination 41 Heat Treated (Prescribed Tests) Order 41 Milk (Special Designations) Order 42 Presence of Tubercle Bacilli 41 Public Health (Condensed Milk) Regulations 42 Supply 40 INDEX—continued. PAGE Minor Ailments Treatment 23 Offensive Trades 16 Ophthalmia Neonatorum 30 Outworkers 16 Overcrowding 39 Pharmacy and Poisons Act 17 Pneumonia 31 Poliomyelitis and Polio-Encephalitis 29 Public Cleansing 13 Puerperal Fever and Pyrexia 30 Rag Flock 16 Rent and Mortgage Interest (Restrictions) Act 39 Restaurants and Eating Houses 49 Rodent Control 19 Sanitary Circumstances of the Area 12 - 13 Sanitary Inspection of the Area 13 - 19 Inspection Tables 14 Summary of Notices Served 14 Scabies 31 Scarlet Fever 26 Shops Act 17 Slaughterhouses 48 Smallpox and Vaccination 31 Smoke Abatement 17 Staff 7 Statistics and General Information 8 Still Births 9 Street Traders 49 Sunlight and Massage Treatment 23 Swimming Bath Water 12 Tuberculosis 52 - 54, 63 - 66 Allowances 53 Assistance to Patients 54 Christmas Seal Sale 53 Occupational Therapy 53 Typhoid and Paratyphoid 28 Underground Rooms 39 Vaccination and Inoculation 31 - 36 Verminous Persons 34 Water Supply 12 Whooping Cough 28