LIBRARY AC 4376 Metropolitan Borough of Camberwell REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1949 HOWELL W. BARNES, B.A., M.B, B.Ch.,D.P.H. Printed by London, Public Health Department, Town Hall, Camberwell, S.E.5. September 1st, 1950. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Mr. Mayor, Aldermen and Councillors, This report on the health of the inhabitants of the Borough in 1949, has been prepared in accordance with the directions of the Ministry of Health. On the whole, the health of the Borough continued to be satisfactory, as evidenced by the vital statistics. The general death rate was 11.9 per 1,000 total population compared with 11.4 in the previous year. The infant mortality rate of 24 per 1,000 live births was the lowest ever recorded in Camberwell. There was a substantial decrease in the number of deaths from respiratory tuberculosis —79 as compared with 101 in 1948. Deaths from non-respiratory tuberculosis numbered 15 as against 16 in the previous year. Deaths attributed to poliomyelitis (including polio-encephalitis) numbered 2 as compared with one in the previous year, and diphtheria was responsible for only one death. The total number of deaths was 2,135, as against 2,032 in 1948. The number of cases of infectious diseases which occurred in the Borough during the year included 1,200 measles, 229 whooping cough, 340 scarlet fever, 13 diphtheria, 26 acute poliomyelitis, 9 dysentery and 2 paratyphoid fever. Notifications of tuberculosis numbered 478 in 1949 and 391 in the previous year. The birth rate of 16.7 was the lowest since 1945. The Council continued to devote a great deal of attention to the housing problem and much progress was made. One hundred and thirty new houses were completed and 216 were in the course of erection at the end of the year under review. Alternative housing accommodation was provided for 390 families. The total number of families for whom accommodation had been provided up to 31st December, 1949, was 9,705. The reasonable maintenance of the properties requisitioned by the Council presents some difficult problems. Defects in a large number of these houses appear frequently and this can readily be understood when it is remembered that most of them are old properties and had been damaged by bombing. The supervision of other properties in the Borough has thrown a heavy burden on to the District Sanitary Inspectors. Complaints numbered 8,024 in 1949. The continued maintenance of old houses in a proper sanitary condition is becoming an intolerable financial burden upon owners. At the request of the London County Council, a discussion took place in November at officer level on the projected resumption of slum clearance operations in the Borough and the action to be taken. The London County Council asked, in the first place, for information concerning areas requiring urgent attention and for the preparation of a map indicating areas already being dealt with and areas which are in a condition to be dealt with immediately or in the near future. It was pointed out that it would be open to the Borough Council to recommence slum clearance operations concurrently with the steps which the County Council proposed to take, and it was suggested that, as before the war, this Authority should deal with small areas, leaving the County Council to undertake the larger areas of more than 10 houses. On the question of rehousing persons displaced by slum clearance operations, the London County Council stated that approximately 25 percent. of the dwellings built by them would be available to Borough Councils for this purpose, and such quota could not be increased. In the early part of the year, I submitted a report to the Public Health Committee, on the Disposal of Fluorescent Lamp Tubes, with the object of warning the public of the possible danger arising from tubes which might contain beryllium compounds and drawing attention to the precautions which should be taken in the disposal of such tubes. (A copy of this report appears in the Appendix.) A memorandum was also issued to the Council's dust and salvage collectors, setting out the precautions to be taken in dealing with any disused tubes they may collect in the course of their duties and arrangements were made for the proper disposal of such tubes at the Council's Depots. On 1st October, 1949, new registation came into operation in relation to milk, comprising the Food and Drugs (Milk and Dairies) Act, 1944 (Appointed Day) Order, 1949, the Milk (Special Designations) Act, 1949, the Milk and Dairies Regulations, 1949, the Milk (Special Designations) (Raw Milk) Regulations, 1949 and the Milk (Special Designations) (Pasteurised and Sterilised, Milk) Regulations, 1949. Under the last-named Regulations, Food and Drug Authorities were made responsible for licensing, pasteurising and sterilising establishments within their areas and conditions were laid down concerning milk to which the special description "pasteurised" or "sterilised" is applied; fees for licences were dispensed with. During the year 246 applications were received for licences by sellers of pasteurised and/or sterilised milk. In conclusion, I wish to record a tribute to the staff of the Public Health Department for their unfailing loyalty and assistance to me throughout the year and to thank the members of the Council for the courtesy and co-operation which they have extended to me. I am, Mr. Mayor, Aldermen and Councillors, Your obedient servant, H. W. BARNES, Medical Officer of Health. Staff of the Public Health Department at the end of 1949. Medical Officer of Health. H. W. Barnes, B.A., M.B, B.Ch., M.R.C.S., L.R.C.P., D.P.H. Public Analyst. J. E. Woodhead, B.Sc., F.I.C, Ph.C. Food Inspector and Senior Sanitary Inspector. R. F. Nash, a Sanitary Inspectors. Dist. No. Dist. No. 1. R. C. Charlton.b 6. H. M. Hough.a 2. A. G. O'Gilvie. b 7. F. Maughan. a 3. J. H. Prosser. b 8. M. L. Malins. a 4. D. V. Watkins. a 9. H. Attwater. a 5. L. A. Biggs. b 10. L. W. Burrell. a 11. G. W. Thomas b Housing Inspector. H. W. Leonard.a Sampling Officer —Foods and Drugs Act, etc. H.R. Weaver, a Chief Clerk. S. A. Cranfield. Senior Clerk. A. J. Carly. Clerks. N. Westley. Miss G. M. Trim. Miss M. Laws. (Temp.) D. Danter. Mrs. M. Findlay. Miss S. Gee. (Temp.) Rodent Control Staff. Rodent Officer ... ... W. H. G. Saunders, b Rodent Investigator ... Mrs. M. J. Kenny Rodent Operators ... ... C. Green (Working Foreman), A. P. Abrahams, P. Collins, G. Glazebrook, R. Humphreys, J. Carver. Bait Preparer ... ... Mrs. A. Grice. Disinfecting and Cleansing Station. Superintendent Disinfector ... A. Franklin. Disinfector Apparatus Attendant... B. Russell. 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 and Meat and other Foods Certificate. (b) Certificate Sanitary Inspectors Examination Board. Cremation Certificates. The Medical Officer of Health is the Medical Referee for the Council's Crematorium at Honor Oak. During 1949 1,738 bodies were cremated as compared with 1,404 in 1948. Staff Medical Examinations. During 1949, the Medical Officer of Health carried out the medical examination of 151 employees for appointment to the permanent staff and 87 for admission to the Council's Sick Pay Scheme. It was necessary for many of these to be seen more than once before a recommendation could be made. In addition, 41 applicants were examined prior to admission to the permanent official establishment of the Council. Arrangements were made for X-ray examinations to be carried out in every case. Employees receiving benefit under the Council's Sick Pay Scheme who have been absent from duty in excess of 14 days are required to be examined by the Medical Officer of Health, who reports to the appropriate Committee. Such persons made 326 attendances during the year for this purpose. DUTIES OF THE PUBLIC HEALTH DEPARTMENT 1. Sanitary Circumstances of the Borough. (a) The supervision of all drainage work. (b) The provision of a pure water supply for each dwelling house and the supervision of wells supplying water for domestic purposes. (c) The sanitary inspection of the Borough for the abatement of nuisances including those caused by smoke, noise and pigeons. (d) The inspection of sanitary conveniences attached to factories, schools and licensed premises. The supervision of health conditions in workshops. (e) The enforcement of sanitary and hygienic conditions in shops. (f) The inspection of the homes of outworkers. (g) Administration of the Prevention of Damage by Pests Act, 1949, the Infestation Order, 1943, the Rag Flock Provisions of the Public Health (London) Act, 1936, and the Pharmacy and Poisons Act, 1933. (h) The licensing and supervision of Offensive Trades, Slaughterhouses and Common Lodging Houses. (i) Compulsory removal of aged and infirm persons to institutions. (j) The supervision of water in swimming baths. 2. Provision of Health Services in the Borough. (a) Disinfecting Station. (b) Cleansing Station. 3. Health Propaganda. (a) Education to ensure the health of the public. 4. Housing. (a) Repair of houses under the Housing and Public Health Acts. (b) The closure of insanitary houses and parts of houses unfit for human habitation. (c) Clearance of small insanitary areas. (d) The abatement of overcrowding. (e) Investigations and recommendations for rehousing. 5. Inspection and Supervision of Food and Food Premises. (a) Sampling of food to prevent adulteration. (b) Condemnation of unsound food. (c) The registration and inspection of premises where food is prepared, manufactured, stored or sold. (d) The investigation of food poisoning. 6. Prevalence and Control of Infectious and other Diseases. (a) The receipt of notifications. (b) The prevention of the spread of infection. (c) Arrangements for disinfection of rooms, bedding and clothes, and disinfestation of persons and houses. GENERAL INFORMATION AND STATISTICS. The Borough of Camberwell covers approximately 4,480 acres (seven square miles). Its maximum length and breadth are 4¾ and 2½ miles respectively. Practically the whole of the Borough is situated on a clay sub-soil. Here and there, a few pockets of gravel are to be found. The highest altitude is 365 feet above ordnance datum at the top of Sydenham Hill near the site of the Crystal Palace and the lowest point is in the northeast corner of the Borough, which is only 3.9 feet above ordnance datum. The total area of open spaces, including those of the L.C.C., comprises 234.64 acres. While the southern part of the Borough is well catered for in the way of parks and open spaces, the northern area is sadly deficient of these amenities. Public Parks and Open Spaces. Name of Open Space. Area. Acres. 1.74 0.63 0.3 2.1 4.0 2.5 0.5 2.58 0.5 0.5 0.2 1.6 0.1 1.25 15.2 0.26 1.0 1.92 0.8 1.1 4.0 0.3 0.06 72.0 6.25 112.75 0.5 Camberwell Borough Council:— Addington Square Garden Albany Road Azenby Square Brenchley Gardens Brunswick Park Camberwell Green Central Library Garden Cox's Walk Downes Place Open Space Dulwich Library Garden Dulwich Village Green Leyton Square Garden Lyndhurst Square Nunhead Green One Tree Hill Rolls Garden St. George's Churchyard St. Giles' Churchyard South Grove Shrubbery Sumner Road Recreation Ground Sunray Garden Varcoe Road Garden Woolcombe Garden London County Council: — Dulwich Park Goose Green Peckham Rye and Peckham Park Soarsdale Road Summary of vital statistics for the year 1949, with comparative figures for the previous four years. 1949. 1948 1947 1946 1945 178,200 Population 178,310 175,060 164,380 135,460 3,848 No. of Live Births 3,185 3,396 4,278 2,435 70 No. of Still Births 64 66 87 63 No. of Legitimate Births 3,087 3,295 4,120 3,686 2,279 162 228 249 No. of Illegitimate Births 167 219 Birth rate (per 1,000 population) 17.8 19.0 19.5 24.4 23.4 No. of Deaths 2,218 2,135 2,032 2,336 1,968 Death rate (per 1,000 population) 11.9 11.4 13.5 14.5 13.3 77 105 Deaths of infants under 1 year 91 167 148 Infant death rate per 1,000 live births 24 34 31 38 39 163 134 Deaths of legitimate infants 70 84 101 7 4 14 7 Deaths of illegitimate infants 4 Death rate of legitimate infants per 1,000 legitimate live births 34 31 23 40 37 Death rate of illegitimate infants per 1,000 illegitimate live births 44 33 24 18 58 Deaths of women from diseases or accidents associated with childbirth 4 6 4 5 5 Maternal death rate per 1,000 total births 2.2 1.2 1.1 1.1 1.2 Deaths from pulmonary tuberculosis 79 118 101 119 89 0.8 Death rate from pulmonary tuberculosis 0.4 0.5 0.6 0.5 94 Deaths from all forms of tuberculosis 117 126 135 99 Death rate from all forms of tuberculosis 0.5 0.9 0.6 0.6 0.7 Births. The number of registered live births after adjustment for inward and outward transfers was 3,185, giving a rate of 17.8 per 1,000 total population. Of these, 1,652 were males and 1,533 females. The number of illegitimate live births was 159 or 5 per cent, of the total live births registered. The birth rates in England and Wales, London and Camberbell, for the past five years, are shown below :— 1949 1948 1947 1946 1945 England and Wales 17.9 20.5 19.1 16.1 16.7 21.5 15.7 18.5 20.1 22.7 London Camberwell 9 Deaths. Deaths registered during the year, adjusted for inward and outward transfers, are shown in the following table:— DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1949. Causes of Death. Sex. All Ages. 0- 1- 5- 15- 45- 65- All causes M. 12 11 80 310 642 1,110 55 F. 1,025 22 3 70 184 738 8 - - - - M. - - - Typhoid and paratyphoid fevers - - F. 1 - - 1 - 1 1 - - - - Cerebro-spinal fever M. - - F. - - 1 1 - - - - - Scarlet fever M. - - - - F. - - - - - - - Whooping cough M. - - - - - - - 1 - F. 1 - - - - 1 Diphtheria M. 1 - - - - - - - - F. - - - - 16 25 Tuberculosis of respiratory system M. 52 - 11 - - F. 27 18 5 - - 4 - Other forms of tuberculosis M. 4 8 1 3 - - - F. 7 2 1 1 3 - - Syphilitic diseases M. 8 - 6 2 - - - F. - 1 1 2 - - - - 4 Influenza M. 9 1 4 - - F. - 5 9 2 2 - - Measles M. - - - - - - - F. 1 1 - - - - - Acute poliomyelitis and polio-encephalitis M. - - - - - - - 1 1 F. 2 - - - - M. Acute infantile encephalitis - - - - - - - F. - - - - - - - Cancer of buc. cav. and œsoph. (M.), uterus (F.) - - M. 17 3 14 - - 1 F. 20 - 10 9 - - Cancer of stomach and duodenum M. 32 - 3 11 18 - - - 1 F. 24 4 19 - - Cancer of breast M. - - — - - - - F. - 19 19 40 - 2 - Cancer of all other sites 153 3 55 M. - 10 85 - F. 86 1 6 26 53 - - Diabetes 1 M. 5 - - - 4 - 6 F. - 1 5 - - - 1 Intracranial vascular lesions M. 74 1 18 54 - - F. 137 - 1 20 - 116 - Heart disease 271 M. - 1 12 55 203 - F. 316 - 8 32 276 - - Other diseases of circulatory system M. 46 - - 39 7 - 52 - F. - 10 42 - - Bronchitis M. 122 1 - 3 77 - 41 - F. 73 1 - 3 8 61 Pneumonia 2 M. 6 1 15 30 54 - F. 49 4 1 - 2 6 36 Other respiratory diseases 19 1 - M. 1 - 8 9 9 F. - - 1 3 5 - DEATHS, CAUSES OF, AND AGES AT, DURING THE YEAR 1949—contd. All Ages. Causes of Death. Sex. 0- 1- 5- 15- 45- 65- Ulcer of stomach or duodenum M. - - - 27 1 14 12 F. 3 - - 1 1 1 - Diarrhœa under 2 years M. 3 3 - - - - - - F. 2 2 - - - — Appendicitis M. 2 - 1 1 - - - F. 1 1 - - - - - Other digestive diseases M. 21 2 1 1 7 10 - F. 31 - - - - 11 20 Nephritis M. 21 - 1 13 - - 7 F. 18 1 4 4 9 - - Puerperal and post-abortive sepsis F. 2 - - - 2 - - Other maternal causes F. 2 - 2 - - - - Premature birth M. 18 18 - - - - - F. 4 4 - - - - - Congenital malformation, birth injury, infant diseases M. 24 22 - 1 - 1 - F. - 11 6 - 1 1 3 Suicide M. 17 2 10 - - - 5 F. 5 - - 2 2 1 - Road traffic accidents M. 13 - - - 6 5 2 F. 9 1 1 2 5 - - Other violent causes M. 20 1 1 2 4 6 6 F. 2 11 - - — 1 8 All other causes M. 72 2 2 2 12 12 42 F. 11 12 63 — 2 38 - The chief causes of death were:— Diseases of the heart and circulatory system 685 Malignant disease 372 Bronchitis, pneumonia and other respiratory diseases (except phthisis) 326 The death rates for England and Wales, London and Camber-well in the past five years were as follows : — 1949 1948 1947 1946 1945 England and Wales 11.7 10.8 12.0 11.5 12.7 11.4 12.8 London 12.2 11.6 13.8 Camberwell 11.9 11.4 13.3 13.5 14.5 Infantile Mortality. The number of deaths of children tinder one year of age in 1949 was 77, which includes 47 infants who died before attaining the age of one month. The infantile mortality rate of 31 in 1948 was, up to that time, the lowest ever recorded in Camberwell, but during 1949 a new low record was reached with a rate of only 24 infant deaths per 1,000 live births. The infant mortality rates in England and Wales, London and Camberwell for the past five years are given below : — 1949 1948 1947 1946 1945 34 41 46 England and Wales 32 43 37 London 29 31 41 53 24 39 38 34 Camberwell 31 Maternal Mortality. There were four maternal deaths during the year, two of which were due to puerperal sepsis and two to accidents and diseases of pregnancy. The maternal mortality rate was 1.2 per 1,000 live and still births. The maternal mortality rates in Camberwell for the previous four years were as follows :— 1948. 1947. 1946. 1945. 1.1 1.1 1.2 2.2 Cancer. Cancer was responsible for a total of 372 deaths during the year under review, with a death rate of 2.l per 1,000 of the population. The deaths from malignant diseases during the previous four years numbered : — 1948. 1947. 1946. 1945. 370 390 364 308 SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. Every dwelling house in the Borough is provided with a domestic water supply from the Metropolitan Water Board mains. In addition, there are seven wells in operation in the Borough, but the water from them is used solely for industrial purposes. Ninety Water Certificates, involving 486 new dwellings, were issued under the provisions of the Public Health (London), Act, 1936. Drainage and Sewerage. One hundred and sixty plans of drainage relating to existing and new buildings were examined and approved. Six hundred and twelve yards of sewers were reconstructed during 1949; 49 brick road gullies were replaced by pot gullies, 13 defective pot gullies were renewed and 3 new pot gullies installed. Public Cleansing. This service is under the control of the Borough Engineer and Surveyor, who has kindly furnished the following information:- Amount of house refuse (including salvage and kitchen waste) collected during the year 42,941 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. Smoke Abatement. Twenty-one complaints were received in respect of smoke nuisances and 91 observations were kept by the district sanitary inspectors. On 11 occasions, it was necessary to serve notices and in every instance, with one exception, the nuisance was abated or reduced by the inspector making a personal call and offering advice. In this exception, the nuisance was caused by a firm burning sawdust and wood shavings in a defective incinerator. It became necessary to institute legal proceedings and the offender was fined and ordered by the Magistrate to abate the nuisance. Summary of Sanitary Work Carried Out During the Year 1949. Description of Sanitary Improvements ordered during the Year. Number of rooms cleansed, walls repaired 2,675 Defective roofs repaired or rainwater pipes provided or repaired 2,385 Dampness abated 1,996 Yards and forecourts paved or paving repaired 171 Water fittings repaired 175 Drains entirely reconstructed 51 Drains partially reconstructed 302 Soil, vent pipes, sinks and waste pipes renewed or repaired 376 Premises in which repairs were effected to water closets 1,159 Dustbins provided 169 Repairs effected to windows 1,214 Stoves and coppers repaired 1,023 Flooring repaired or renewed, repairs to woodwork (stairs, etc.) 1,133 Ventilation and lighting improved 79 Offensive accumulations removed 34 Miscellaneous repairs and improvements ordered 701 Total repairs and improvements ordered 13,643 Inspections. Following complaint 8,024 Following cases of notifiable infectious disease 1,252 Factories 364 Rent (Restrictions) Act 62 New buildings and conversions into flats and business premises 373 Rag and bone dealers 21 Conveniences (public and private) 142 Shops Act 207 Child Life Protection 2 Common Lodging Houses 16 Aged and infirm persons 41 Cases of overcrowding and miscellaneous housing inquiries 2,163 Miscellaneous 4,406 Total inspections 17,073 Re-inspections, calls, etc. 28,271 Smoke observations 91 SUMMARY OF NOTICES SERVED, 1949. Intimations, Public Health (London) Act, Byelaws, etc. 5,326 Statutory Notices, Public Health (London) Act, Byelaws, etc. 2,585 Public Health (London) Act, 1936, (Part II) 40 Section 4, Housing Act, 1936 132 13 The following table indicates the extent of the Inspectors' work during the past four years. 1949 1948 1947 1946 No. of complaints received 8,672 8,024 8,823 7,489 No. of visits by Inspectors 45,344 39,687 35,612 25,618 5,326 6,274 5,044 Intimation Notices served 5,088 No. of Statutory Notices served 2,585 2,687 1,807 1,811 248 177 74 No. of Police Court Procedings 85 Nuisances arising from Bomb Damaged Buildings, Vacant Sites and Static Water Tanks. Many complaints continued to be received, particularly during the warm weather, concerning rubbish deposited on bombed sites, stagnant water in static water tanks, etc. At the request of the Public Health Department, the Borough Engineer and Surveyor arranged for the removal of any putrescible matter which might attract flies and rats or otherwise give rise to a public health nuisance, and the London Fire Brigade pumped the water from the tanks. Extensive rat baiting of bombed sites was also carried out by the Bodent Control Staff. Although prompt action is taken on the receipt of every complaint, sooner or later these sites will have to be dealt with from the prevention point of view. Most of them are eyesores and are detrimental to the amenities of the district, even where no public health nuisance exists. Kitchen Waste Bins. Nuisances from flies and foul smells arising from pig bins formed the subject of a number of complaints during the warm weather It is the practice during the summer months for these bins to be hosed out after emptying and treated with "Ozonal." Swimming Bath Water. During 1949, 27 samples of water were taken from the Dulwich and Camberwell Baths for bacteriological examination and 22 for chemical analysis. All reports were satisfactory with one exception, and the bath concerned was accordingly drained, cleansed and refilled. Offensive Trades. There are five registered premises in the Borough, at which offensive trades are conducted, as follows : — Skin Dressers 4 Soap boilers 1 The premises are kept under supervision by the district Sanitary Inspectors but it did not become necessary to take formal action in respect of any of these businesses. Rag and Bone Dealers. During the year, 21 inspections of the eight premises occupied by Bag and Bone Dealers were made. Any irregularities found to exist were remedied without recourse to formal action. Shops Act, 1934. Inspections under this Act numbered 207. Two exemp-tion certificates were granted under the provisions of Section 10 (6) of the Act, where it was impracticable to provide sanitary accommodation and such facilities were otherwise conveniently available. Pharmacy and Poisons Act, 1933. During the year, the following applications were received for retention or entry in the Council's Register of Persons entitled to sell poisons included in Part II of the above Act : — Retentions 165 New Entries 20 Observation was kept of stalls and shops for unauthorised sellers but no infringement of the Act was reported. Aged Persons. During the year, 29 aged persons, who were suffering from chronic diseases or were infirm or physically incapacitated and living in insanitary conditions came to the notice of the Health Department. Arrangements for their proper care and attention were made in co-operation with the London County Council's Domestic Help and Home Nursing Services. In one instance, it was necessary to take action under Section 47 of the National Assistance Act, 1948, for compulsory removal to an Institution. At the beginning of the year a communication was received from the Union of Girls' Schools for Social Service on behalf of the Camberwell Old People's Welfare Association, stating that it was proposed to purchase a motor van for the provision of a "Meals on Wheels" service for old people living in the Borough, and requesting the Council to make a contribution to the Association for the maintenance of the vehicle. This appeal was favourably considered by the Public Health Committee and a grant was made in accordance with the powers vested in the local authority under the provisions of Section 31 of the National Assistance Act, 1948. The meals supplied by the U.G.S. under this Scheme were prepared in the kitchen at their Staffordshire Street Settlement, where there is also an old people's dinner club. A similar service is conducted by the Women's Voluntary Services but, in this case, the meals are obtained from the Londoners' Meals Service kitchens and distributed by W.V.S. cars. The U.G.S. serves the areas of Peckham and Nunhead, and the W.V.S. the remainder of the Borough. Rodent Control. Eat infestations were dealt with in accordance with the procedure recommended by the Ministry of Agriculture and Fisheries. Each complaint was investigated with a view of tracing the source from which the rats were gaining access to the building. Tests were applied to drains in 821 instances and in 143 cases, positive results were obtained. Where defective drains were found to be the source of infestation, steps were taken to secure their repair or renewal. Maintenance treatment of the Council's sewers by the laying of baits in manholes and side entrances was carried out in June and December. Four thousand six hundred and sixty poison baits were supplied to tenants of premises infested with mice. The following is a summary of the work carried out during the year: — No. of complaints received 1,617 No. of inspections 4,119 No. of operators calls 18,427 No. of private premises baited 1,661 No. of business premises baited 188 No. of pre-baits laid 39,786 No. of poison baits laid 23,700 Factories Act, 1937. The Borough Council is charged with the duty of enforcing the provisions of this Act in regard to : — Sanitary conveniences —in all factories. Cleanliness, ventilation, temperature, overcrowding and drainage of floors in all factories where mechanical power is not used. Water supply (where derived from a source other than public mains) —in all factories. Factories Act, 1937. 1.—INSPECTIONS, 1949. Number on Register. Number of Inspections. Written Notices. Occupiers prosecuted. Premises. Factories in which Sections 1, 2, 3, 4 and 6 of the Act are to be enforced by Local Authorities 13 Nil 816 216 Factories not included above in which Section 7 of the Act is enforced by the Local Authority 771 195 8 Nil Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - 3 - Totals 1,590 411 21 Nil 2.—CASES IN WHICH DEFECTS WERE FOUND, 1949. No. of cases in which defects were found. Number of cases in which prosecutions were instituted. Found. Referred Particulars. Remedied. To H.M. Inspector. By H.M. Inspector. Want of cleanliness 26 25 22 - - Overcrowding - - - - - 1 Unreasonable temperature 1 - 1 - 6 Inadequate ventilation 3 - - - Ineffective drainage of floors 7 7 3 - - Sanitary conveniences— l n 13 13 9 (a) insufficient - - 14 (b) unsuitable or defective 14 - 12 - (c) not separate for sexes - - - - - Other offences against the Act (not including offences relating to outwork) 21 18 3 - - Total 88 50 - 81 - Outworkers. Lists containing the names and addresses of home workers employed in certain industries, specified in the Factories Act, must be forwarded by employers or contractors to the Local Authority, with the object of preventing work from being carried out in premises which are insanitary or in which infectious disease is present. Table showing Trades of Outworkers in Employment at the end of 1949. Needlework 5 Novelties 9 Overalls 6 Paper bags 7 Shoulder pads 1 Surgical shoes 1 Stationery 3 Tailoring 19 Ties 5 Uniform caps 2 Wearing apparel 124 Miscellaneous 98 338 Artificial flowers 4 Baby linen 1 Belts 3 Blouses 4 Brushes 3 Cardboard Boxes 18 Card lacing 2 Coathangers 1 Diaries 1 Embroidery 3 Hats 2 Hosiers 2 Lampshades 7 Linens 7 PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES During the year under review, 2,107 notifications of infectious diseases (excluding tuberculosis) were received at the Public Health Department. Fifty-seven of the notified cases were found not to be suffering from the disease stated on the certificate. Diphtheria. As there is no doubt of the great value of inoculation for the prevention of diphtheria, an active campaign to encourage immunisation should at all times be waged and no opportunity should be lost in drawing the attention of the public to the danger of leaving their children unprotected. Of the 32 cases notified during the year, an amended diagnosis was made in 19 instances, thus reducing the number of confirmed cases to 13 as against 15 in 1948. A small outbreak involving 6 cases occurred in an L.C.C. school at the end of the year. Swabbing of all contacts was considered to be advisable. Five of these cases had never been immunised and one had received immunisation treatment about five years previously, but had not received a reinforcing injection after entering school. One of the unprotected patients died. Scarlet Fever. The number of cases notified was 348, of which 8 were subsequently not confirmed. Sixty-two of the patients were removed to hospital for treatment; there were no deaths. Scarlet fever, like all streptococcal diseases is diminishing in virulence and the type of scarlet fever now prevailing continues to be mild in character. It is extremely rare to discover a patient with the septic type of fever. The majority of cases without complications were nursed at home. The adoption of penicillin treatment has greatly reduced the length of time necessary for cases to be isolated at home or detained in hospital. INFECTIOUS DISEASES, 1949. 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. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 348 62 8 - - 8 19 47 33 216 15 5 5 - Scarlet Fever Whooping Cough 232 23 3 1 22 33 50 32 28 59 6 - 2 - Poliomyelitis & Polio-encephalitis 37 37 11 2 1 1 6 5 1 15 1 - 5 1 Measles 1,202 29 2 - 68 164 189 175 157 416 17 6 9 - Diphtheria 32 32 19 1 1 1 - 2 1 9 5 - 5 4 Pneumonia Acute Influenzal 29 - - - 1 1 - 1 1 1 - 1 6 5 Acute Primary 48 3 - - 2 5 2 - 1 1 2 2 7 8 Dysentery 12 9 3 - - 1 2 - 1 2 1 1 4 - Paratyphoid Fever 4 4 2 - 1 - - - - - 1 - 1 1 Erysipelas 33 10 3 - 1 - - 2 5 - 1 - - - Cerebro-Spinal Fever 9 9 5 1 1 1 - - - 2 1 2 - - 1 Puerperal Pyrexia 29 27 - - - - - - - - 4 20 5 - Ophthalmia Neonatorum 7 - - - 7 - - - - - - - - - Scabies 84 1 - - - 1 7 6 6 10 10 4 19 8 Malaria 1 - - - - - - - - - - - 1 - 2,107 246 56 5 105 217 275 269 229 731 59 25 86 37 Totals Measles. Confirmed cases of measles numbered 1,200, of which 29 were treated in hospital ; there was one death. Deaths from measles nearly all occur in children under five years of age and are frequently due to respiratory complications. Since the war, there has been a marked fall in fatality, but this disease is still capable of causing permanent damage to the lungs, middle ear and eyes. Whooping Cough There were 229 confirmed cases of whooping cough during the year, compared with 541 in 1948 ; only one death occurred from this disease. In children under five years, whooping cough is a dangerous menace to life and a satisfactory prophylactic has not yet been discovered. It is customary at the L.C.C. Clinics in the borough to use a combined diphtheria-pertussis prophylactic. The necessity for separate courses of injections against these two diseases is thus avoided. Acute Poliomyelitis (including Acute Polio-encephalitis). During the year, 37 cases were notified and removed to hospital, of which 26 were confirmed. Two of the patients died. In this country almost every year there has been a summer rise in notifications usually starting in the second half of the month of July. The reason for the seasonal incidence remains obscure. In the outbreak of 1949, however, the summer rise commenced earlier—in the second half of June—and the maximum number of cases occurring during any week was three, i.e., the weeks ended 25th June and 24th September. In 1947, the peak of 6 cases occurred during the week ended 9th August, and thereafter declined. The incidence of confirmed cases of poliomyelitis during the year is indicated in the following graph. Table showing Age Distribution of Confirmed Cases Compared with those in 1947. 1947. 1949. Age Groups. Percentage. Deaths. Percentage. Deaths. Cases. Cases. 1 Under 1 year - - - 2.9 - 14 53.9 1 11 32.4 1 1-5 years 3 8 30.8 8.8 - 5-10 years - 3.8 2 5.9 10-15 years 1 - - - 3 8.8 1 15-20 years - - 7.7 10 2 20-30 years 2 - 29.4 3.8 4 11.8 Over 30 years 1 1 - Totals 26 100.0 2 34 100.0 4 It will be seen that while the attack rate was low in infants, higher in children of school age and highest in the 1-5 and 20—30 age groups during the year 1947, in the year under review, the majority of cases occurred in the 1 —5 age group and in schoolchildren under 10 years. Preventive Measures Adopted. At the onset of the 1949 outbreak, as in 1947, all local medical practitioners were informed and the importance of the removal to hospital of suspect minor illness was stressed. A pamphlet on Anterior Poliomyelitis prepared by the Central Council for Health Education was distributed to the medical practitioners in the Borough and at the same time copies of this pamphlet were made available to the public by distributing supplies at the Public Libraries and Infant Welfare Centres. It was deemed advisable to increase the amount of chlorine in the water at the Council's Swimming Pools and steps were taken to prevent overcrowding of the Public Baths. In July, your Medical Officer of Health attended a meeting at County Hall convened for the purpose of considering the position relating to Poliomyelitis at that time and the possibility of an epidemic occurring. The adoption of preventive measures which with advantage could be directed towards limiting the spread of infection was also discussed. In addition to the film, "Polio Diagnosis and Management" which was exhibited in London for members of the medical profession, a short film for the general public, entitled Johnny Green in his Fighting Chance," was shown in public cinemas in August. The apparent ineffectiveness of the public health measures to control the spread of this disease is due, to a large extent, to the fact that for every case diagnosed as Poliomyelitis there are many cases of abortive infection capable of spreading the disease which remain undiscovered. As long as cases occur, sensible precautions should be taken. Included among these are special attention to personal hygiene, the avoidance of over-fatigue and the isolation and medical supervision, at home or in hospital, of children who develop minor illness until a diagnosis of the ailment can be made. Smallpox. No case of this disease occurred in the Borough during the year, but from time to time information was received from other authorities of contacts who were residing or staying in Camberwell. These persons were kept under daily surveillance by the Sanitary Inspectors until any danger of smallpox developing had passed. Typhoid Fever and Paratyphoid Fever. There were no cases of typhoid fever notified in 1949. Four notifications of paratyphoid were received however, two of which were subsequently found not to be suffering from the disease. Dysentery. There were 12 cases of dysentery notified but in 3 instances the preliminary diagnosis was not confirmed. There were no deaths from this disease. Cerebro-Spinal Fever. Nine notifications were received of persons suffering from cerebro-spinal meningitis, only four of which were confirmed. There was one death. Malaria. Only one notification of malaria was received, the patient having contracted the disease abroad. Ophthalmia Neonatorum. Seven cases of ophthalmia neonatorum were notified during the year. The instillation of penicillin drops in the treatment of this disease has brought about vastly improved results. There was no case of blindness resulting from ophthalmia neonatorum in 1949. Puerperal Pyrexia. Ante-natal supervision of pregnant women and the delivery of infants with adequate precautions against infection have resulted in a considerable decrease in the number of notifications of puerperal pyrexia in recent years ; such notifications numbered 29 in 1949. Deaths from puerperal pyrexia numbered 2. The satisfactory decline in deaths from this cause is largely due to the discovery of the sulphonamides and penicillin. Pneumonia. Only the acute primary and acute influenzal forms of this disease are notifiable and cases notified during 1949 numbered 48 and 29 respectively. Deaths from all forms of pneumonia numbered 103. Food Poisoning. Section 17 (1) of the Food and Drugs Act, 1938, provides that if a medical practitioner suspects that a patient whom lie is attending is suffering from food poisoning, he shall forthwith send to the Medical Officer of Health a certificate stating (a) the name, age, sex and address of the patient and (b) particulars of the food poisoning from which he is, or is suspected to be, suffering. The purpose of such notification is to enable prompt steps to be taken to investigate all the circumstances, with a view to endeavouring to identify the causative agent and prevent the possibility of further cases occurring. It is of maximum importance, therefore, that information should reach the Medical Officer of Health speedily, preferably by telephonic communication. As the result of changing social habits, the communal kitchen has to some extent replaced home cooking. This practice affords a greater opportunity for the spread of infections. Communal outbreaks of food poisoning have now replaced family outbreaks. In May, 1949, the Ministry of Health issued a Circular and Revised Memorandum on steps to he taken by Medical Officers of Health in suspected food poisoning cases, and requested that information of such cases should be forwarded to the Ministry in accordance with forms prescribed in the Memorandum. The following is a copy of the Annual Return of Food Poisoning Notifications, which was submitted in respect of the year 1949 : — 1. Local Authority—CAMBERWELL. Year: 1949. 2. FOOD POISONING NOTIFICATIONS (Corrected) RETURNED TO R.G. 2nd Quarter 3rd Quarter 4th Quarter TOTAL 1st Quarter 4 8 13 1 - 3. OUTBREAKS DUE TO IDENTIFIED AGENTS. Total Outbreaks — 1. Total Cases — 4. Outbreaks Due to :— (a) Chemical Poisons Nil. (b) Salmonella Organisms Nil. (c) Staphyloccoci (including toxin) Nil. (d) CI. botulinum Nil. (e) Other bacteria —Non-specific organisms 1. 4. OUTBREAKS OF UNDISCOVERED CAUSE. Total outbreaks — 2. Total Cases approx. — 80* 5. SINGLE CASES. Agent identified — Nil. Unknown cause — 9. Total —9. * No notification was received in respect of any of these cases. The outbreaks included under item 4 in the foregoing table occurred among scholars and staff at two schools in the Borough following the consumption of mid-day meals prepared by the L.C.C. School Meals Service. Where possible, specimens of food, faeces and vomit were obtained, and submitted for bacteriological and chemical examination, but no agent likely to be responsible for food poisoning was discovered. The affected persons suffered from diarrhœa and vomiting of a mild character and recovered rapidly. Scabies. Eighty-four cases of scabies were notified during the year, compared with 111 in 1918. A visit was paid by an Inspector in every case to try and arrange for the treatment of members of the family to be carried out simultaneously at the Council's Cleansing Station, with a view to reducing the number of occurrences and recurrences. It is not generally realised that the parasites which cause the disease may be present for some time before producing recognisable signs and symptoms. CLEANSING STATION ATTENDANCES (SCABIES). Female. Total. Male. 98 Adults 100 198 387 235 Children 152 333 585 Total 252 TUBERCULOSIS. During the year, 430 cases of pulmonary tuberculosis and 48 cases of non-pulmonary tuberculosis were notified. Deaths from all forms of tuberculosis during the year numbered 94, equal to a death rate of 0.5 per 1,000 of the population. There were 15 deaths from tuberculosis in persons not notified before death. Information with regard to age distribution and sex of new cases and deaths from all forms of tuberculosis are given in the following table New Cases.* Deaths.† Non-Pulmonary. Age Periods. Pulmonary. Non-Pulmonary. Pulmonary. Male. Female. Female. Male. Female. Male. Female. Male. 1 - - - 0- 1 yr. - - - - 2 1- 5 yrs. 21 13 3 4 - - 1 10 3 1 5-15 „ 20 17 7 - 3 49 4 - 71 8 5 1 - 15-25 „ 7 1 1 25-35 „ 59 63 4 8 8 35 2 1 6 5 2 35-45 „ 62 - 1 3 2 37 7 13 - 45-55 „ - 12 2 1 55-65 „ 25 14 1 1 - - 10 4 - 11 4 65 and over - - 7 Totals 283 225 21 33 52 27 8 * 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. The following table gives particulars of the notifications and deaths from all forms of tuberculosis during the past five years : — Estimated Population. No. of Primary notifications. Notification Rate per 1,000 Population. No. of Deaths. Death Rate per 1,000 Population. Year. 1945 135,460 257 1.9 126 0.9 0.6 1946 164,380 336 2.0 99 356 2.0 135 0.7 1947 175,060 1948 178,200 391 2.2 117 0.6 178,310 2.7 94 0.5 1949 478 26 The number of cases on the Tuberculosis Register at the end of 1948 and 1949 are indicated hereunder : — No. of Cases on the Register at 31st December, 1949. • 1948. Female. Total. Male. Male. Female. Total. 1,806 Pulmonary 890 743 1,633 804 1,002 129 150 279 95 126 221 Non-Pulmonary Total 1,019 893 1,912 1,097 930 2,027 Prevention of Tuberculosis Arrangements were made in the year under review for introducing B.C.G. vaccination for the protection of those groups of persons considered to live at a more than average risk of tuberculosis infection. This constitutes an important advance and no one can find fault with the decision to carry out a scientific investigation of its efficiency. Mortality figures are regarded as the most valuable criterion of the trend of tuberculosis. Notifications are not always an accurate reflection of the incidence of this disease. Mass Miniature Radiography. The South-East Metropolitan Regional Hospital Board's Mass Miniature Radiography Unit was established in Camberwell from 16th May to 27th July, 1949. During the first half of this period the Unit was set up at the L.C.C. Divisional Offices, 29 Peckham Road, and for the remainder of the time it was operated at Dulwich Hospital, East Dulwich Grove. This free and confidential service was offered to everybody who wished to take advantage of its facilities and evening sessions were held for those persons who were unable to attend during the daytime. The Public Health Department co-operated in making appointments for residents to visit the Unit on a day and time convenient to them. I am indebted to Dr. F. D. Beddard, the Unit's Medical Director, for the following information : — Total No. of Persons examined :— Males 4,122 Females 4,182 Total 8,304 No. of Persons probably tuberculous : — Males 73 Females 63 Total 136 The following table shows the percentage of probable tuberculosis among those examined : — Per cent. Males—Private residents 2.4 Others (excluding schoolchildren) 1.6 Females—Private residents 1.4 Others (excluding schoolchildren) ... ... 1.7 Totals (Males and Females): — Private residents 1-9 Others (excluding schoolchildren) 1-55 In addition to the above, 21 men and 21 women were referred to their private doctors for other abnormalities found. NON-NOTIFIABLE DISEASES. Influenza. Influenza was responsible for 18 deaths as compared with 2 in the preceding year. Prophylaxis with an anti-influenzal vaccine has not yet met with much success. Cancer. There is no simple test for establishing the presence of this dread disease. It is, therefore, imperative that any suspicious signs or symptoms should be brought to the notice of a medical practitioner as early as possible, in order that prompt treatment may be provided. The earlier the diagnosis, the greater is the chance of recovery. Malignant disease, including cancer, was responsible for 372 deaths in the year under review. Head Lice. This menace although easy to abolish yet remains with us in spite of the availability of insecticides which act rapidly and are simple to apply. Propaganda for the purpose of instilling the desire for clean heads has resulted in a reduction of the number of persons affected, but there is as yet little indication of complete freedom from infestation in the near future. CLEANSING STATION ATTENDANCES (VERMIN). Male. Female. Total. Adults 28 8 36 1,588 357 1,945 Children 1,596 1,981 Totals 385 t n Disinfection. The following is a summary of the work carried out by the Disinfecting Staff during 1949 : — Notified Infectious Diseases. Other Diseases. Miscellaneous. Total. All Cases. Vermin. 105 2,661 Rooms disinfected 1,225 22 1,309 Lots of bedding disinfected 548 84 55 107 794 Total visits 1,624 121 1.104 1,002 3,851 Number of articles disinfected by steam 2,321 Number of articles disinfected by formalin 1,105 Number of books disinfected 733 Number of towels washed 4,782 Number of gowns washed 893 Number of mattress covers washed 198 Number of overalls washed 145 Number of covering sheets washed 366 Beds and mattresses destroyed 183 Miscellaneous goods destroyed 4 48 Weight of Tons. Cwts. Qtrs. Lbs. Unsound food dealt with 30 16 1 18¾ 10 12 Hospital dressings destroyed 0 0 Furniture, etc., destroyed 4 - 6 2 0 15 3 Dead animals destroyed 0 Hospital bedding disinfected 8 - 2 0 18 Felting disinfected 2 2 0 29 HOUSING The Housing Situation reports at December 31st, 1948 and 1949, were as follows :— 1948. 1949. Number of applicants outstanding 7,670 7,223 Houses requisitioned (net) 3,278 3,271 Number of tenancies — Requisitioned properties 5,668 5,703 Prefabricated bungalows 519 519 Permanent housing 691 780 Total number of families rehoused 9,315 9,705 Provision of new accommodation by the Council. It is extremely gratifying to report that of the Council's Housing Schemes, 130 new dwellings were completed during the year and are now occupied. In addition, 10 of the Council's houses which were demolished by enemy action were rebuilt. At the end of the year, 216 new dwellings were in the course of erection by this Authority. The following housing schemes have been undertaken by the Council since the termination of the war:— No. of dwellings. Site No. 1 (Ablett Street and Barkworth Road) 24 Site No. 5 (Rainbow Street and Bonsor Street) 12 Site No. 6 (Cator Street and East Surrey Grove) 54 Site No. 8 (Alder Street and Cator Street) 24 Site No. 13 (Crofton Road) 9 Site No. 20 (Adys Road) 6 Site No. 21 (Manaton Road and Philip Road) 16 Site No. 24/5/6 (Playfield Crescent and Lytcott Grove) 56 Site No. 27 /28 (Hawkslade Road and Athenlay Road) 20 Site No. 30 (Mundania Road and Therapia Road) 36 Site No. 31 (Melford Road) 50 Site No. 42 (Heme Hill) 44 Site No. 45 (Barry Road) 29 Denmark Hill Estate 670 Lordship Lane Estate 233 Sydenham Hill Estate 117 Cleve Hall Estate 151 Peckham Rye Estate Not settled Site No. 48 (Camberwell Grove) Not settled Site No. 50 (Pelican Yard) Not settled Site No. 51 (Kimberley Avenue and Evelina Road) 24 Site No. 52 (Danby Street and Avondale Rise) Not settled Site No. 53 (Azenby Road and Lyndhurst Way) Not settled Site No. 54 (Naylor Road) Not settled Site No. 55 (Hanover Park and Raul Road) Not settled Site No. 56 (Reedham Street) Not settled Site No. 58 (Evelina Road) Not settled Site No. 59 (Hollydale Road) Not settled Site No. 61 (Stuart Road) Not settled Site No. 62 (Gowlett Road) Not settled Site No. 63 (Ondine Road) Not settled Site No. 64 (Crawthew Grove) Not settled Individual Unfit Houses capable of being rendered fit at reasonable expense. During the year, 14 houses were represented as unfit for human habitation but capable of repair at reasonable expense. Informal action was taken for the repair of seven houses and ten formal notices were served under the provisions of Section 9 of the Housing Act, 1936. Three houses were made fit, two by the owners on informal action and, one by the Council in default of the owner. Individual Unfit Houses not capable of being rendered fit at reasonable expense. Representations were made during the year in relation to 16 houses which were not capable of being rendered fit at reasonable expense. One house was demolished as a result of action taken under the provisions of Section 11 of the Housing Act, 1936. One demolition order was made by the Council, and in one case an undertaking by the owner to render a house fit for habitation was accepted. Parts of buildings used as dwellings not capable of being rendered fit at reasonable expense. There were five parts of buildings represented as unfit for human habitation and not capable of being rendered fit at reasonable expense. The Council made one closing order and accepted one undertaking from an owner not to use the part of premises concerned for human habitation. Underground Rooms. Seven underground rooms involving five houses were brought to the notice of the Council by representation. The Council made closing orders in respect of five of these rooms and accepted an owner's undertaking not to use two rooms for human habitation. Review of Individual Houses, Parts of Premises and Underground Rooms closed by Undertaking or Order before the War. All premises and parts of premises closed prior to the War, were reviewed for the first time since 1939. The number of premises involved were seven individual houses, 16 parts of premises and 42 underground rooms. It was found that of the seven individual houses, one had been demolished, one rebuilt, two repaired and the remaining three were unoccupied. With regard to the 16 parts of premises, demolition had occurred of the entire building in three cases, two parts were found to be occupied and the remaining 11 unoccupied. With regard to the underground rooms, demolition had removed six, 12 were found to be occupied and 24 unoccupied. Steps were taken by the Council to secure compliance with the pre-war action and, except in one case, all parts of premises (including underground rooms) were vacated. Overcrowding. Three hundred and seventy-eight cases of overcrowding came to the notice of the Public Health Department in consequence of applications for housing accommodation made to this Council or to the London County Council. Each case necessitated an enquiry by the Sanitary Inspector before a certificate of overcrowding could be forwarded to the Director of Housing and Valuer, London County Council. One hundred and ninety-nine overcrowded families were rehoused during the year, 51 by this Council and 148 by the London County Council. Rehousing Applications. One of the duties of the Medical Officer of Health is to give his opinion as to whether an applicant for alternative housing accommodation should receive priority consideration on medical grounds. Recommendations are based on medical certificates obtained by the applicants from hospitals or private practitioners in support of their application. During the year, 892 cases were referred to the Medical Officer of Health for this purpose. Rent and Mortgage Interest (Restrictions) Act. During 1949, 68 certificates of disrepair were issued under this Act on application by the tenants of dwelling-houses. Common Lodging House There is one Common Lodging House in the Borough which is licensed for the accommodation of 224 male persons. Sixteen visits of inspection were made during the year but on no occasion was it found necessary to take action in respect of any infringement of the byelaws governing such establishments. Section 9. Section 11. Inspections. Re- Inspections. Inspections. Re- Inspections. Inspections. Re- Inspections. Inspections. Re- Inspections. Re- Inspections. Inspections. 36 125 18 73 24 39 128 52 27 154 Housing Statistics, 1949. 1. Inspection of Dwelling Houses during the Year:— (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 8,311 (b) Number of inspections made for the purpose 32,473 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 6,344 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 251 3. Action under Statutory Powers during the year:— (a) Proceedings under Public Health (London) Act:— (1) Number of dwelling-houses in respect of which statutory notices were served requiring defects to be remedied 2,585 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 3,467 (b) By local Authority in default of owners Nil (b) 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 7 Formal Notices 10 (2) Number of dwelling-houses which were rendered fit after service of: — Informal Notices 2 Formal Notices 1 (a) By owners Nil (b) By Local Authority in default of owners 1 (c) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements and/or underground rooms:- (a) in respect of which Closing Orders were made 6 (6) in respect of which undertakings not to use for habitation were accepted 3 (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 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES. Provision of a Safe Milk Supply. Every year deaths occur in this country due to milk infected with bovine tuberculosis. At present, the Ministry of Agriculture and Fisheries is responsible for all matters directly affecting the health of cattle. Until it is possible to eradicate tuberculosis from cattle, all milk intended for human consumption should be subjected to heat treatment in licensed plants under adequate supervision. It is the practice for the Sampling Officer to submit samples of raw milk taken from cows kept in the cowshed in this Borough, for biological testing for the detection of tubercle bacilli. During 1949, 11 samples of raw milk were taken for this purpose and of that number one was found to contain tubercle bacilli. Prior to the Ist October, 1949, if a sample was found to be positive, particulars were forwarded immediately to the County Medical Officer of Health and the Divisional Veterinary Officer of the Ministry of Agriculture and Fisheries, who arranged for one of the Ministry's Veterinary Officers to visit the cowshed and carry out both clinical examination of the cattle and sampling of the milk from individual cows or groups of cows. Since the Ist October, 1949, power has been vested in the Medical Officer of Health, under the Milk and Dairies Regulations, 1949, to enable him to prevent the sale of milk for human consumption or to require such milk to be heat-treated, if there is evidence that it is infected with disease communicable to man. In the course of time, under the provisions of the Milk (Special Designations) Act, 1949, Camberwell may be declared a "specified area," i.e., an area in which the retail sale of milk will be restricted to special designated milk. When this occurs, then, and only then, can Camberwell be considered a "safe milk area." Milk (Special Designations) Act, 1949. This Act, which came into operation on Ist October, 1949, provides that the use of a special designation in relation to milk sold retail shall be compulsory in areas to be specified by the Minister of Food, but it is within the power of the Minister to consent to the sale of milk without the use of a special designation in certain circumstances. Camberwell has not yet been specified as an area for this purpose. Milk and Dairies Regulations, 1949. These Regulations came into operation on the first day of October, 1949, and provide that the Minister of Agriculture and Fisheries shall be responsible for the registration of dairy farmers and dairy farms, the inspection and health of cattle on dairy farms, but the Local Authority is responsible for the registration of milk distributors and of dairies. These Regulations also deal with the condition and cleanliness of the buildings, water supplies, the production, treatment, handling and storage of milk. Provision is made for protecting milk against contamination or infection, the cleansing and storage of vessels, utensils and appliances and the conveyance and distribution of milk. It is possible under these Regulations for the Medical Officer of Health of a district, where he is in possession of evidence which satisfies him that any person is suffering from disease caused by the consumption of milk supplied within the district from any registered premises or that milk at any registered premises within the district is infected with disease communicable to man, to require, by a notice in writing to the occupier of the premises, that no milk from those premises, or that no such milk therefrom as is specified, shall be sold for human consumption, or used in the manufacture of products for human consumption, unless it has been treated in such a way as to secure to his satisfaction that it may be disposed of with safety. Similar action may be taken where the Medical Officer of Health, without being in possession of evidence, has reasonable grounds for suspecting that any person is so suffering or that any milk is so infected. Where any such notice is served under these Regulations a copy of it must be forwarded forthwith to the Minister of Food, and, if the premises concerned are not within the district, to the Medical Officer of Health of the district in which they are situated. In certain circumstances compensation may have to be paid for any loss sustained by a person upon whom a notice is served. It did not become necessary for the Medical Officer of Health to exercise the powers vested in him by these Regulations in relation to milk infected with any disease, bovine or human. The Milk (Special Designations) (Raw Milk) Regulations, 1949. Under these Regulations, which came into force on the 1st October, 1949, the licensing of producers of "Tuberculin Tested" and "Accredited" milk is undertaken by the Ministry of Agriculture and Fisheries. The issue of dealers licences and supplementary licences continues to be the responsibility of the local authority. During 1949, 38 dealers licences and 13 supplementary licences were issued in respect of "Tuberculin Tested" milk. The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. Under these Regulations, Food and Drugs Authorities are responsible for the licensing of dealers who use a special designation in relation to milk which is pasteurised or sterilised on the premises of the applicant and for the inspection and approval of the premises for this purpose. Pasteurised milk is defined as milk retained at a temperature of not less than 145 deg. F. and not more than 150 deg. F. for at least 30 minutes and immediately cooled to a temperature of not more than 50 deg. F. or milk retained at a temperature of not less than 161 deg. F. for at least 15 seconds and immediately cooled to a temperature of not more than 50 deg. F. or milk retained at such temperature for such period as may be specified by the licensing authority with the approval of the Minister of Food. Sterilised milk is defined as milk filtered or clarified, homogenised and heated to and maintained at such a temperature, not less than 212 deg. F. for such a period as to ensure that it will comply with the turbidity test. These Regulations include provisions as to the sampling and testing of pasteurised and sterilised milk. There are no pasteurising or sterilising establishments in Camberwell but the following table shows the number of licences issued by the Council authorising the use of the special designations "pasteurised" or "sterilised" in relation to milk sold in the Borough. Special Designation of Milk. Type of Licence. Sterilised. Pasteurised. Dealers 131 81 18 Supplementary 16 149 97 Total Milk Supply The Milk Marketing Board is responsible for the supply of milk in the Borough. The bulk of the milk supplied is pasteurised but raw milk continued to be sold to families living in the vicinity of the cowhouse which is licensed for 53 cows. All efforts to persuade the owner of the cowhouse to instal a pasteurising plant met with no success. Dairies and Milkshops Register. Cowkeepers 1 Cowsheds 2 Dairies 33 Registered purveyors of milk dealing from registered premises in the Borough 141 Registered purveyors of milk dealing from registered premises outside the Borough 12 Special Designated Milk. The following table shows details of various tests carried out in respect of special designated milk during the year : — Turbidity Test. Designation. Methylene Blue Test. Phosphatase Test. Satisfactory. Unsatis factory. Satisfactory. Satisfactory. Unsatis factory. Unsatisfactory. Pasteurised 92 4 82 - - - Tuberculin tested pasteurised 12 2 8 - - - 5 2 Sterilised 9 - - - 1 1 6 Heat treated - - - Accredited 8 1 - - - - Supply of Milk to Schools and Hospitals. During the year, 36 samples were taken from hospitals and 35 from schools in the Borough and submitted to the Phosphatase Test. All were satisfactory. In addition, 36 samples were taken from hospitals and 37 from schools for bacteriological examination. Two hospital and three school samples failed to comply with the Methylene Blue Test. Examination of Milk for the presence of Tubercle Bacilli. Of the 11 samples of milk submitted for examination by means of the animal test for the presence of tubercle bacilli, one was found to be positive. In this instance, the unsatisfactory sample was that of raw milk obtained from the cowhouse in the Borough. The attention of the County Medical Officer of Health and the Divisional Veterinary Inspector of the Ministry of Agriculture and Fisheries was immediately drawn to this positive result. Following investigations by the Ministry's inspector, an affected cow was eventually identified and slaughtered under the Tuberculosis Order, 1938. FOOD AND DRUGS ADULTERATION. The total number of formal samples procured by the Sampling Officer and submitted to the Public Analyst under the provisiones of the Food and Drugs Act, 1938, was 500. Informal samples numbered 692. Number examined. Number adulterated, etc. Percentage of adulteration. Formal. Informal. Total. Formal. Informal. Total. Formal. Informal. 500 692 1,192 2 19 21 0.4 2.74 The percentage of samples reported by the Public Analyst to be adulterated for the years 1946-49 was:— Year. Formal samples. (per cent.) Informal samples. (per cent.) 1946 2.19 1.97 1947 2.60 1.85 1948 3.2 2.95 1949 0.4 2.74 A table giving details of the formal and informal samples found to be adulterated, together with the action taken and the results of proceedings will be found on pages 40-43. 40 41 Article. Whether Formal or Informal. Nature of Adulteration or Irregularity. Observations. Result of Proceedings or other Action taken. Milk bottle Informal Complaint of blue colouring matter added to milk. No action. Investigations showed colouring matter added after contents of bottle had been emptied. Seed tapioca Informal Commodity was "Sago." Matter referred to Ministry of Food by Public Analyst. - Commodity was "Sago." Seed tapioca Informal - Do. do. Informal - Remainder of stock surrendered and destroyed. Salad dressing powder. Contaminated with rust derived from metal lid. Milk Formal 4 per cent. deficient in fat. - Cautionary letter sent by Public Health Committee. Informal Contained wax; no taste of mint. All stook cleared. Unable to obtain formal sample. - Mint chews Milk bottle Informal Full bottle contained floating grey particles. Cautionary letter sent by Public Health Committee. Due to defective aluminium cap, which had partially disintegrated. Non-brewed vinegar. Informal - 5 per cent, deficient in acetic acid. Further sample taken and found to be genuine. Lemonade Informal Cautionary letter sent by Public Health Committee. Deposit of grit and fine dirt found in bottle, also abundant yeast cells. - - Milk bottle Informal Contained deposit of grit, sand and other inorganic matter. Do. do. - Tomato juice Informal Trace only of Vitamin C, copper excessive. Stock collected and returned to country of origin. 42 Whether Formal or Informal. Article. Nature o Adulteration or Irregularity. Milk bottle Informal Contained large pieces of mould and fragments of household dirt. Informal Milk bottle Contained deposit of sand, carbonated lime, brick dust, etc. Gin Informal 1.9 degrees excess water. Extrait de tomato. Informal Excess of copper (175 p.p.m.) and tin (5.8 grains per 1b.). Green Goddess cocktail. Informal Labelling offences. Informal Gin vermouth Labelling offence. Sweet pickle Informal Unfit for consumption. Coffee and chicory essence. Informal Fermented. Rum Informal 2.4 degrees excess water. Rum Formal 2 degrees excess water. 43 Result of Proceedings of other Action taken. Observations. - Cautionary letter sent by Public Health. Committee. - Do. do. Do. do. Formal sample taken and found to be genuine. Stock surrendered and destroyed. - Matter considered by Public Health Committee who referred it to the Ministry of Pood. - - Do. do. Remainder surrendered and destroyed. Old stock - Stock cleared at time of visit. - See Formal Sample No. 488. - Summons:—£3 0s. 0d. fine and £3 3s. 0d. costs. MEAT AND OTHER FOODS. Registration of Food Premises. At the end of December, 1949, the premises registered by this Authority in accordance with the provisions of Section 14 of the Food and Drugs Act, 1938, comprised the following: — Sale, manufacture or storage of ice cream 323 Manufacture of sausages 144 Preparation or manufacture of potted, pressed, pickled or preserved meat 220 Preparation or manufacture of potted, pressed, pickled or preserved fish 101 Preparation or manufacture of potted, pressed, pickled or preserved other foods 30 Supervision of Food Premises. It is the duty of each District Inspector to pay close attention to the manufacture, storage, distribution and sale of all foods. The following table shows the number of inspections carried out at various food premises in the Borough during the year:— No. of Inspections. Type of Premises. Bakehouses 149 Butchers 70 Restaurants and eating houses 476 Dairies and milkshops 310 139 Fried fish shops Fish curers' premises 228 Ice cream premises 579 Other premises where food is sold 3,608 Total 5,559 Clean Food Campaign. It is essential that every effort should be made to ensure that the conditions under which food is prepared for human consumption are beyond reproach, and to educate all persons engaged in the handling of food as to the methods to be adopted to prevent contamination and the importance of personal hygiene. In November of the year under review, the Council considered a report by their Medical Officer of Health as to the desirability and possibility of conducting a Clean Food Campaign in the Borough. It was decided that a Camberwell Clean Food Association should be set up on the lines suggested in the report and the initial steps in its formation have been taken. The objects of this Association will be:— (a) To promote clean methods of handling food among persons engaged in the food trades in the Borough. (b) To encourage the observance of all statutory standards of food hygiene. (c) To urge all food traders in Camberwell to become members. Membership will be conditional upon the applicant undertaking to observe the Code of Practice laid down and will be subject to the applicant's premises complying with the requirments of the Food and Drugs Act, 1938, and any other legislation in force. Mineral Oil in Food. This Authority has been concerned for some time on medical grounds about the practice of using paraffin and other such commodities in the preparation of food. It is considered that medicinal paraffin, even if deposited in various organs in the body, would not be harmful, but the same cannot be said for other mineral oils. Nevertheless, the regular consumption of paraffin, whether medicinal or not, dissolves Vitamins A and D and inhibits the assimilation of these vitamins by the digestive system. Having regard to the harmful effects which might result from the indiscriminate use of mineral oils, its use in the composition or preparation of any food intended for sale or sold for human consumption was prohibited under the Mineral Oil in Food Order, 1949, with the exception that it is allowed to be present in a very small proportion where its presence is due, not to inclusion as an ingredient, but to its use as a lubricant or greasing agent on a surface with which the article of food necessarily comes into contact during preparation. During the year, 102 samples, comprising cakes (various) 60, potatoes (chipped and crisped) 32, doughnuts 6, Swiss rolls 2, shortcakes 1, and jam tarts 1, were examined for the presence of mineral oil, but in no case was a positive reaction obtained. Food Inspection. The Food Inspector undertakes the examination of any food suspected to be unsound and if found to be unfit for human consumption he issues a condemnation certificate. During 1949 he issued 2,593 such certificates in respect of unsound food surrendered. Meat inspection, ice cream sampling, enquiries with regard to food poisoning and other special duties associated with food products are also the Food Inspector's responsibilities. Particulars of Unsound Food Condemned. Tons cwt. lbs. qrs. Meat 1 14 2 26½ 3 9 3 16½ Fish 4 1 1 18½ Fruit 13 Canned Foods 9 2 1 12 8 0 0¼ Miscellaneous foods Total 30 16 1 18¾ Slaughterhouses. There are three licensed slaughterhouses in the Borough, only one of which was in use during the year. Particulars of the animals slaughtered are set out in the following table. Carcases Inspected and Condemned. Cattle, excluding Cows. Sheep and Lambs. Cows. Calves. Pigs. Number killed Nil Nil Nil 43 Nil Number inspected - - - 43 - All diseases except Tuberculosis. - - Whole carcases condemned - 2 - Carcases of which some part or organ was condemned - - - Nil. - Percentage of the number inspected affected with disease other than tuberculosis - - 4.65 - - Tuberculosis only. Whole carcases condemned - - Nil. - - Carcases of which some part or organ was condemned - - - - Nil. Percentage of the number inspected affected with tuberculosis - - Nil. - - Public Health (Meat) Regulations. These regulations provide for the supervision of butchers' shops and stalls and the protection of meat from contamination in transport and handling. The Inspectors kept all such premises under observation but no infringements of the regulations were reported which necessitated formal action by this department. Merchandise Marks Act, 1926 The Orders in Council made under this Act require that where imported food is sold or exposed for sale, the country of origin shall be clearly indicated thereon. Regular inspections were made for the purpose of discovering any irregularities but on no occasion was it found necessary to proceed against any trader for failure to comply with this legislation. Ice Cream. The Ministry of Food, in a Circular dated Ist April, 1949, indicated that additional supplies of sugar, and in certain cases fats, had been made available to ice cream manufacturers who had signed an undertaking that their ice cream would have a minimum fat content of 2½ per cent. In order to secure observance of the undertakings, local authorities were invited to co-operate by supplying copies of analyses showing fat content of any samples of ice cream that may be taken by their officers in the normal course of their duties. Such information is forwarded to the Ministry monthly by the Public Health Department. It was pointed out, however, that the use of a minimum fat content of 2½ per cent. for this purpose must not be interpreted as meaning that this figure is regarded by the Ministry as a proper standard for ice cream. The Food Standards Committee appointed by the Minister of Food to review the composition of foods and to recommend standards, considered proposals that a statutory standard of composition should be prescribed for ice cream. The Committee, while of opinion that a standard for ice cream is desirable in principle, recommend that action should be deferred as owing to the scarcity of ingredients, especially fats and milk solids, a satisfactory standard could be prescribed at the present time only at the expense of a reduction of supplies. The number of premises in the Borough registered for the sale of ice cream was 323 at the end of the year. Seventy-six samples of ice cream were submitted for examination by the Methylene Blue Test with the following results. Grade. No. of Samples. I 21 II 19 III 20 IV 16 On receipt of an unsatisfactory report, steps were taken by this department to endeavour to ascertain the reason and to remedy any faults in the manufacture and handling of the commodity. In those cases where the sample was not manufactured in this Borough, particulars were forwarded to the Medical Officer of Health of the area in which the ice cream was made. In addition 56 samples of ice cream were submitted for chemical analysis but only three were found to have a fat content below 2½ per cent. Copies of these analyses were forwarded monthly to the Ministry of Food. Bakehouses. There were 77 bakehouses in the Borough at the end of the year, 14 of which were underground. Two of the latter, however, were not in use and have since been removed from the register. Regular inspections were carried out and, where necessary, notices were served to remedy any unsatisfactory conditions. Street Traders. There were 106 licensed street traders in the Borough engaged in the sale of foodstuffs from barrows and stalls in the streets and market places. These were kept under constant supervision, as well as the premises used by them for storage purposes. Restaurants and Eating Houses. The number of restaurants and cafes on the register at the end of the year was 251. These were visited by the District Sanitary Inspectors and, where necessary, action was taken to remedy any unsatisfactory conditions. Particular attention was given to the provision of adequate W.C. accommodation and washing facilities for the staff and to the methods employed for the cleansing of crockery and cutlery. APPENDIX. 24th February, 1949. To the Chairman and Members of the Public Health Committee. Aldermen and Councillors, Disposal of Fluorescent Lamp Tubes. With the increasing use of fluorescent lighting in factories, offices, libraries, shops, etc., throughout the Borough and the serious health hazards caused by beryllium compounds which may be contained in these tubes it is considered expedient to bring to the notice of the Committee the necessity for great care to be exercised in the disposal of burnt-out tubes. Attention is directed to this matter in the Industrial Accident Prevention Bulletin dated January, 1949, which recommends the following procedure for this purpose:— The tubes should be broken up under water as this is the only positive way of preventing the dust of beryllium compounds from freeing itself and being inhaled. Breaking up a tube in the open air or in front of an exhaust fan is not considered sufficient, as even the smallest particle of inhaled dust may be harmful. Moreover, if one person is selected to dispose of all tubes in this way he will be periodically and frequently exposed to such minute quantities and they may have a cumulative effect. A drum filled with water and containing a removable fine wire mesh basket should be set aside for the breaking up of tubes. The vacuum of the lamp should be broken by knocking the cap off smartly and the rest of the tube can then be broken up. The fragments of glass collected in the mesh basket should be buried in waste ground. If they are dumped or put in a dustbin someone may accidentally get a cut or puncture from the broken glass. An alternative to the above method is to put the tube in a sackcloth bag, immerse it in a shallow tank or trough of water, and break it up with an iron bar or similar object. The bag can then be buried. The wearing of goggles and gloves as protection against flying glass is desirable because it occasionally happens that a tube, although under vacuum, will explode instead of collapsing inwards. Where it is necessary to dispose of large numbers of burnt-out tubes it may be worth while to construct a special cabinet the door of which, when closed, breaks the tube into small fragments. These are collected into a basket which is immersed in water at the bottom of the cabinet, and are then removed and buried. In no circumstances should tubes be set aside for dustmen or salvage collectors who may not know of the hazards connected with these tubes, nor of the correct methods of disposal. If, in spite of all precautions, anyone is cut by a broken tube, normal First Aid treatment should be given. If the cut is very bad, or if there is any possibility that glass remains in the wound, hospital treatment should be given. A careful watch must be kept on all wounds and if, at a later date, a lump forms under the skin the patient should report to hospital. (Such lumps may appear weeks, or even months, after the original injury.) Whenever injured persons are taken to hospital, whether immediately or after a lapse of time, the hospital authorities should be told that the wound has been caused by a fluorescent tube and not by ordinary glass. In conclusion, it may be said, that some manufacturers of fluorescent tubes have now discontinued the use of beryllium compounds. Tubes containing these compounds will, however, naturally remain in use for some time to come and the above precautions should therefore be taken unless it is known for certain that the tubes being disposed of do not contain any harmful substance. I am therefore, bringing this matter to the notice of the Committee in order that consideration may be given to (i) the desirability of referring the question of the disposal of fluorescent lamp tubes to the Metropolitan Boroughs Standing Joint Committee, and (ii) warning the public of the possible danger arising from the improper disposal of such tubes. For the latter purpose, it is suggested that a communication be addressed to the proprietor or person in charge of premises where fluorescent lighting is installed giving advice as to the proper handling of the tubes and the correct method of disposal if broken or burnt out. It is also recommended that when lighting of this nature is to be installed in any public building under the Council's control, the firms tendering should be asked to state whether their tubes contain beryllium compounds or any other harmful substance. A memorandum has been prepared for distribution to the Council's dustmen and salvage collectors setting out the precautions to be taken in dealing with any tubes they may collect in the course of their duties. Arrangements should also be made to dispose of any fluorescent lamp tubes brought to the Council's Depots in accordance with the suggestions contained m the Bulletin referred to above. I understand that the Council's workmen have not so far been called upon to deal with any such tubes. Beryllium poisoning has been added to the list of industrial diseases prescribed under the National Insurance (Industrial Injuries) Act. Yours faithfully, H. W. BARNES, Medical Officer of Health. INDEX PAGE Aged Persons 15 Bakehouses 48 Births 8 Bombed Sites, etc. 14 Cancer 11, 28 Cerebro-Spinal Fever 23 Clean Food Campaign 44 Cleansing Station 25 Common Lodging House 32 Cremation Certificates 5 Deaths 9 - 11 Cancer 11 Infantile Mortality 10 Maternal Mortality 11 Table of Causes and Ages 9 - 10 Diphtheria 19 Disinfection 29 Drainage and Sewerage 12 Duties of Public Health Department 5 Dysentery 23 Eating Houses and Restaurants 48 Factories Act 16 - 18 Inspection Tables 17 Outworkers 17 - 18 Fluorescent Lamp Tubes, Disposal of 49 - 50 Food Poisoning 24 - 25 Food and Food Premises 35 - 48 Adulteration 39 „ Table of Proceedings 40 - 43 Bakehouses 48 Clean Food Campaign 44 Ice-Cream 47 Inspection of Food 46 Milk Supply 35 - 38 Merchandise Marks Act 47 Mineral Oil in Food 45 Public Health (Meat) Regulations 47 Registration of Food Premises 44 Restaurants and Eating Houses 48 INDEX —continued. PAGE Food and Food Premises—continued. Slaughterhouses 46 Street Traders 48 Supervision of Food Premises 44 General Information and Statistics 7 Housing 30 - 34 Applications for rehousing 32 Common Lodging House 32 Individual Unfit Houses, etc. 31 Overcrowding 32 Provision of New Accommodation 30 Rent and Mortgage Interest (Restrictions) Act 32 Statistics 34 Underground Rooms 31 Work of Housing Inspector, Table 33 Ice-Cream 47 Infantile Mortality 10 Infectious Diseases 19 - 29 Disinfection 29 Non-notifiable 28 Notifiable 19 - 25 Table 20 Tuberculosis 26 - 28 Influenza 28 Kitchen Waste Bins 14 Lice, Head 28 Malaria 23 Maternal Mortality 11 Measles 21 Medical Examinations, Staff 5 Merchandise Marks Act 47 Milk 35 - 38 Milk and Dairies Regulations 36 Milk (Special Designations) Act 35 Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations 37 Milk (Special Designations) (Raw Milk) Regulations 36 Special Designated Milk-Tests 38 Supply 35,37 Supply of Milk to Schools and Hospitals 38 Tubercle Bacilli, Examination for 38 INDEX —continued. PAGE Offensive Trades 15 Ophthalmia Neonatorum 24 Outworkers 17 - 18 Overcrowding 32 Parks and Open Spaces 7 Pharmacy and Poisons Act 15 Poliomylitis and Polio-encephalitis 21 - 23 Pneumonia 24 Public Cleansing 12 Puerperal Pyrexia 24 Rag and Bone Dealers 15 Rent and Mortgage Interest (Restrictions) Act 32 Restaurants and Eating Houses 48 Rodent Control 16 Sanitary Circumstances of the Area 12 - 18 Sanitary Inspection, Tables 13 Summary of Notices Served 13 Summary of Work 14 Scabies 25 Scarlet Fever 19 Sewerage and Drainage 12 Shops Act 15 Skin Dressers 15 Slaughterhouses 46 Smallpox 23 Smoke Abatement 12 Soap Boilers 15 Staff of Public Health Department 4 Staff Medical Examinations 5 Static Water Tanks, etc. 14 Statistics, Vital 8 Street Traders 48 Swimming Bath Water 14 Tuberculosis 26 - 28 Mass Miniature Radiography 27 Notifications 26 Prevention 27 Typhoid and Paratyphoid Fever 23 Underground Rooms 31 Water Supply 12 Whooping Cough 21