AC 4376 CAM 46 Metropolitan Borough of Camberwell REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1951 HOWELL W. BARNES, B.A., M.B., B.Ch., D.P.H. Printed by MERRITT & HATCHER LTD London. 65872 Public Health Department, Town Hall, Camberwell, S.E.5. August 12th, 1952. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Your Worship, Ladies and Gentlemen, In this report an endeavour is made to review the progress of the work of the Public Health Department, to emphasise the value of the health measures in operation in the Borough and to compare them with those existing at the time the present writer took office in 1922 by indicating the principal changes in the vital statistics of Camberwell since that date. The standard of sanitation and hygiene is at a higher level to-day than has ever previously existed, owing to the efforts of the preventive health service. The advance in paediatrics has been largely due to recognition of the fact that the social aspects of diseases have a considerable bearing on infant mortality. Better nutrition has also played its part. In 1921 the live birth rate was 23-5 per 1,000 total population compared with 16·4 in 1951. The expectation of life of a baby born in 1921 was 58 years if a boy or 62 years if a girl, while to-day, it is 66 and 71 years respectively. The greatest single factor contributing to this increase in the expectation of life is the reduction in the number of deaths of infants under one year of age. The infant mortality rate which was 74 per 1,000 live births in 1921 was 25·7 in 1951. The maternal death rate has during these years decreased from 2·5 for every 1,000 total births to 1·0. The general death rate in 1921 was 12·0 and in 1951 13·5. Deaths from tuberculosis (all forms) numbered 352 in 1921 as compared with 65 in 1951. The various personal health services, which were established by this Council from 1922 onwards, and handed over to the London County Council in 1948, have made an important contribution to this satisfactory state of affairs. The striking advance in medicine during recent years is the protection of the community against disease by artificial immunisation. Smallpox, diphtheria, enteric fever and tetanus have been brought under control by immunisation Although satisfactory results cannot be guaranteed in the case of whooping cough and measles, yet the position is improving, especially in the case of whooping cough. The advances in chemotherapy and the antibiotics, with the improvements in anaesthetics and blood transfusion, have combined to bring about a steady improvement in surgery. The sulphonamides and antibiotics are most effective in pyogenic coccal infections. The discovery of new drugs has revolutionised medicine, psychological medicine and dermatology and the same can be said of the advances in the treatment of tropical diseases. Similar advances have been made in the treatment of venereal diseases, owing to the improvements in bacteriological diagnosis and discoveries in specific chemotherapy. There still exists a large amount of absenteeism from work due to sickness and injury, which expressed in terms of manhours lost per annum is colossal. The question arises in how many of the milder cases, sickness could have been avoided by care or better social conditions. To what extent could even an elementary knowledge of methods of maintaining health or a talk with the family doctor avoid absence from work ? Much has yet to be achieved before perfection can be claimed, but there is no reason for gloom and foreboding. As long as an enlightened policy is laid down by the Council for the advancement of health education the health of the inhabitants of Camberwell will continue to improve. There has been a tendency in recent years to neglect the aspect of preventive medicine and to put all the emphasis on the more spectacular curative treatment of diseases. Curative medicine under the National Health Service Act may be regarded as a blessing but on no account should attention be diverted from the prevention of disease; the axiom "Prevention is better than cure" still holds good. In these days our financial position is not such that we can afford sickness. From the economic point of view, a healthy individual is an asset—a sick man a liability. A continuous process of education of the general public is necessary. The rudiments of health, knowledge of the prevention of diseases and accidents and the importance of obtaining the advice of a doctor in the early stages of an illness, should be well instilled in the minds of all children before they leave school. Above all, they should be taught that a healthy body and a healthy mind cannot be provided by the local sanitary authority without their co-operation. It should be the aim of every individual to continue to educate himself as to the methods he can employ to improve his own health and that of those nearest and dearest to him. He should learn the necessity for regarding whooping cough and measles as serious illnesses, the importance of clean food and hygienic food handling. He should become acquainted with the preventive measures to combat the spread of tuberculosis and other diseases; the value of immunisation both active and passive and the prophylactic value of vaccines in their application to whooping cough, tuberculosis and virus diseases. In conclusion, may I express my appreciation of the cooperation and encouragement that has been extended to me by the Members of the Council throughout the year and to thank the members of the Staff of the Public Health Department for the loyal and competent service they have at all times most willingly rendered. 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 1951. 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: Vacant. Public Analyst: D.F.H. Button, A.R.C.S., F.R.I.C. Food Inspector and Senior Sanitary Inspector: R.F. Nash. a Housing Inspector: H.W. Leonard. a Sampling Officer —Food and Drugs Act, etc. H. R. Weaver. a Sanitary Inspectors: Dist. No. Dist. No. 1. A.G. O'Gilvie. b 8. H. Attwater. a 2. J.H. Prosser. b 9. M.L. Malins. a 3. R.C. Charlton, b 10. H.M. Hough. a 4. D.V. Watkins. a 11. Vacant. 5. J.A. Harris. b 12. F. Maughan. a 6. L.A. Biggs. b 13. L.W. Burrell. a 7. W.C. Scales. b Chief Clerik: S.A. Cranfield. Senior Clerk: A.J. Carly. Clerks: A. M. Rowlatt. Miss M. Laws. (Temp.) D. Danter. Miss L. Burleigh (Temp.) Mrs. M. Findlay. A. Beare (Temp.) Mrs. J. Oke. Rodent Control Staff: Rodent Officer W. H. G. Saunders, b Rodent Investigator Mrs. M. J. Kenny Rodent Operators C. Green (Working Foreman), F.G. Hulbert, P. Collins, R. Humphreys, A. E. Peters, A. Peters, D. A. Garth. Bait Preparer Mrs. A. Grice. Disinfecting and Cleansing Station: Superintendent Disinfector A. Thomas. Disinfector Apparatus Attendant B. Russell. Disintectors R. T. J. Hodgson, E. Manning, A. E. Kenny. J. Butterfield. H. King. Motor Driver 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. Summary of Statistics for the year 1951. Area of the Borough 4,480 acres Greatest length 4¾ miles „ breadth 2½ miles „ height above Ordnance Datum (Sydenham Hill) 365 feet Total area of Public Parks and Open Spaces 234·64 acres Population (Census April 1951) 179,729 „ (estimated by Registrar-General mid-1951) 179,500 Number of inhabitated houses (end of 1951) 40,852 Rateable value (April 1951) £1,564,493 Sum represented by a penny rate (estimated) £6,370 Number of live births 2,951 Birth rate 16.4 Number of deaths 2,424 Death rate 13.5 Infantile Mortality:— Deaths under 1 year 76 Infant deaths per 1,000 live births 25·7 Maternal Mortality: — Deaths of women from diseases or accidents associated with childbirth 3 Maternal death rate per 1,000 total births 1.0 Deaths from phthisis 56 Phthisis death rate 0.3 Deaths from all forms of Tuberculosis 65 Tuberculosis death rate 0.3 VITAL STATISTICS. Population. The Registrar-General's estimate of the population of Camberwell in the middle of 1951 was 179,500; the Census figure in April 1951 was 179,729. The population of Camberwell has been steadily decreasing for some years. This is partly due to the transfer of population to housing estates outside the County of London. It is to be hoped that further migration will take place and thus relieve the overcrowded conditions which exist at present in the Borough. POPULATION OF CAMBERWELL, 1921-51. Year. Population. Year. Population. 269,600 1921 1937 224,800 1922 270,300 1938 222,400 1923 272,300 1939 219,500 1924 273,700 1940 173,750 1925 265,400 1941 127,570 1942 1926 275,400 129,900 1927 271,100 1943 132,330 1928 260,400 1944 129,880 1929 1945 256,900 135,460 1930 256,900 1946 164,380 1931 1947 252,100 175,060 1932 248,000 1948 178,200 1933 243,700 1949 178,310 1934 238,360 1950 178,900 1935 234,400 1951 179,500 1936 229,300 Births. The total births allocated to Camberwell for 1951 were:— Live births 2,951 Still births 57 Total 3,008 Illegitimate births numbered 176, which represents 5·8 per cent. of the total births. The live birth rate was 16·4 per 1,000 total population. The birth rate has declined since 1947 but is still above the pre-war level (13·8 in 1939). The high rates of 1946 and 1947 are explained by the return to civilian life of soldiers from overseas at the end of the war. LIVE BIRTH RATES (Per 1,000 Total Population) IN CAMBERWELL 1921-1951. Birth Rate per 1,000 Population. Birth Rate per 1,000 Population. Year. Year. 1921 23·5 1937 14·0 1922 21·4 1938 13·9 1923 20·7 1939 13·8 1924 18·8 1940 15·3 1941 1925 17·7 15·6 1942 1926 16·6 18·1 1927 15·6 1943 18·7 1928 15·8 1944 18·9 1929 15·3 1945 18·0 1946 1930 14·8 23·4 1931 14·7 1947 24·4 1932 1948 14·6 19·0 1933 13·3 1949 17·8 1934 13·2 1950 16·2 1935 13·4 1951 16·4 1936 13·9 Still Births. Still births numbered 57 in 1951 or 18·9 per 1,000 total births. TABLE SHOWING STILL BIRTHS IN CAMBERWELL 1921-51. No. of Still Births. Rate per 1,000 Total Births. No. of Still Births. Rate per 1,000 Total Birtds. Year Year. 1921 N/A - 1937 97 29·7 1922 135 22·7 1938 103 30·3 1923 144 24·8 1939 103 32·8 1924 114 21·7 1940 51 18·8 1925 127 25·4 1941 36 17·8 1926 97 20·7 1942 70 28·8 1927 105 24·2 1943 53 20·9 1928 102 24·0 1944 60 23·8 1929 120 29·6 1945 63 25·2 1930 96 24·6 1946 87 22·1 1931 127 33·1 1947 70 16·1 1932 106 28·9 1948 66 19·0 1933 106 31·6 1949 64 19·7 1934 94 28·9 1950 70 23·5 1935 96 29·5 1951 57 18·9 1936 104 31·5 A sharp fall in the still birth rate occurred in the year 1940 and the rate has remained at a much lower level since that year. There is no doubt that the reduction was to some extent due to the provision of more effective ante-natal care and a more skilled obstetric service resulting in an improvement in the health of the mother. Deaths. The total deaths in 1951 amounted to 2,424 or 13·5 per 1,000 of the population. The following table shows the trend of mortality in Camberwell since 1921. DEATH RATES (Per 1,000 Population) IN CAMBERWELL, 1921-1951. Year. Death Rate per 1,000 Population. Year. Death Rate per 1,000 Population. 1921 12·0 1937 12·8 1922 13·4 1938 12·2 1923 11·0 1939 12·4 1924 11·4 1940 19·1 1925 11·1 1941 19·9 1926 11·0 1942 15·6 1927 11·4 1943 16·0 1928 11·9 1944 18·7 1929 13·6 1945 14·5 1930 10·9 1946 13·5 1931 11·9 1947 13·3 1932 12·0 1948 11·4 1933 12·3 1949 11·9 1934 12·3 1950 11·3 1935 11·8 1951 13·5 1936 12·6 I The marked rise in the death rates for 1940-45 was to a large extent due to casualties caused by enemy action. TABLE SHOWING CLASSIFIED CAUSES OF DEATHS IN AGE GROUPS IN CAMBERWELL DURING 1951. All Ages. 15- 65- 75- Causes of death. Sex. 0- 1- 5- 25- 45- M. 1,239 45 11 7 426 All causes 5 64 318 363 339 F. 1,185 31 10 2 12 52 193 546 5 Tuberculosis, respiratory M. 34 - - 1 5 17 6 - F. 22 - - - 4 8 6 4 - Tuberculosis, other M. 4 2 1 1 - - - - - F. 5 - 1 1 - 1 1 1 - M. 10 4 4 Syphilitic disease - - - - - 2 F. 2 - - - 1 1 - - - M. Diphtheria - - - - - - - - - F. - - - - - - - - - 8 9 DEATHS—continued. Causes of Death. Sex. All Ages. 0- 1- 5- 15- 25- 45- 65- 75- M. - - - - - - - Whooping Cough - - F. 1 - 1 - - - - - - Meningococcal infections M. 2 1 1 - - - - - - F. 1 1 - - - - - - - Acute poliomyelitis M. - - - - - - - - - F. - - - - - - - - - Measles M. - - - - - - - - - F. 1 1 - - - - - - - Other infective and parasitic diseases M. 4 - 1 - 1 - - 2 - F. 2 - 1 - - - - 1 - Malignant neoplasm, stomach M. 31 - - - 2 12 10 7 - F. 32 - - - - 1 8 13 10 Malignant neoplasm, lung, bronchus 71 - M. - - - 2 38 24 7 F. 12 - - 1 - 4 6 1 - Malignant neoplasm, breast M. 1 - - - - 1 - - - F. 24 - - - - 2 8 8 6 Malignant neoplasm, uterus F. - - - - 2 3 1 6 12 Other malignant and lymphatic neoplasms 107 - - - 1 9 34 34 29 M. F. 90 - - - 2 7 29 33 19 Leukaemia, aleukemia M. 8 - 1 1 - 1 1 3 1 F. 2 - - - - 1 - 1 - M. 6 - - - 2 1 2 1 Diabetes - F. 13 - - - 1 3 5 4 - Vascular lesions of nervous system M. - - 16 82 - - _ 32 34 F. 140 - - - 2 26 50 62 - Coronary disease, angina M. 122 - - - - 3 39 47 33 F. 78 - - - - 10 37 31 - Hypertension with heart disease M. 61 - - - - 1 21 13 26 F. 63 - - - - 9 21 33 - Other heart disease M. 207 - - - 1 1 29 57 119 F. 276 - - - 8 28 51 189 - M. - - - - - 6 10 19 Other circulatory disease 35 F. 56 - - - - 2 18 36 - Influenza M. 25 1 - - - 7 9 8 - F. 28 - - - - - 4 9 15 Pneumonia M. 46 5 - 1 13 9 18 - - F. 52 3 1 - - 2 9 13 24 M. 2 - - 3 32 57 63 Bronchitis 157 - F. 93 1 - - - 1 13 28 50 Other diseases of respiratory system M. 12 - - - - 1 6 2 3 F. 7 - - - 1 1 1 4 - Ulcer of stomach and duodenum M. 21 - - - 1 13 5 2 - F. 13 - - - - - 4 6 3 Gastritis, enteritis and diarrhoea M. 4 1 - - - - 1 - 2 F. 8 1 - - - 3 2 2 - Nephritis and nephrosis M. 14 - 1 - - 5 6 2 - F. 6 - - - 1 4 1 - - DEATHS—continued Causes of Death. All Ages. 0- 1- 5- 25- 65- 75- Sex. 15- 45- M. 24 - - - 2 7 15 - - Hyperplasia of prostate Pregnancy, childbirth, abortion F. 3 - - - 1 2 - - - Congenital malformations M. 18 11 1 2 2 1 - - 1 F. 11 5 1 1 1 1 2 - - M. 23 2 2 - 11 14 11 19 Other defined and ill-defined diseases 82 F. 109 20 1 1 11 14 22 40 - Motor vehicle accidents M. 13 - - 1 4 6 - 2 - - F. 1 - - - - - 1 - All other accidents M. 22 1 - 2 1 7 4 3 4 F. 18 4 1 4 9 - - - - Suicide M. 13 - 5 2 3 3 - - - F. 3 1 - - - 1 1 - - Homicide and operations of war M. 3 - 2 1 - - - - - F. 1 - - - - 1 - - - The leading causes of deaths in Camberwell during 1951 were as follows:— Diseases of the heart 807 Pneumonia, bronchitis and influenza 401 Cancer 380 Vascular lesions of nervous system 222 Deaths from Cancer. There has been a progressive increase in mortality from cancer during the last 50 years. There is no doubt that improvements in the facilities for radiography have led to more accurate diagnosis and the ageing of the population also plays a part. The rise is not entirely due to these factors, particularly in relation to cancer of the lung, where the increase in the number of deaths is so great that it can only be explained on the grounds of higher incidence. Various reasons for this have been suggested including cigarette smoking and the constant inhalation of the exhaust fumes of motor vehicles. The last quarter of a century has witnessed striking advances in the knowledge and treatment of cancer. Although much has been achieved, much still remains to be discovered before the problems of this dread disease can be solved. Infant Mortality. The infant mortality rate in 1921 was 74 as compared with 25·7 in 1951. INFANT MORTALITY RATES (per 1,000 live births) IN CAMBERWELL 1921-51. Year. No. of Infant Deaths per 1,000 Live Births. Year. No. of Infant Deaths per 1,000 Live Births. 1937 58 1921 74 1922 78 1938 61 56 1939 36 1923 46 1924 70 1940 58 1925 64 1941 53 64 1942 1926 1943 48 1927 52 52 1928 61 1944 1929 68 1945 34 38 1930 51 1946 1947 39 1931 56 31 1948 1932 65 24 1933 49 1949 27 67 1934 1950 25 60 1951 1935 1936 59 II The gradual reduction in infant mortality since 1921 is no doubt the result of child welfare in all its various phases. Other factors have played their part, such as the fall in the case mortality of certain infectious diseases, diarrhœa and respiratory infections. Over 50 per cent, of deaths within the first few weeks of life result from prematurity, congenital malformation and birth injuries. There are indications that the education of the mother as to her health and improved ante-partum care have resulted in a diminution of the deaths in children within the first few weeks of life. Birth injuries have been minimised by the employment of specialised obstetrical assistance. Prematurity, the chief cause of deaths under the age of one month, should show a gradual fall as the knowledge of the necessity for special care of premature infants becomes more known and applied. Maternal Mortality. With the introduction of sulphonamides there was immediately a decline in the mortality from puerperal infection which can no longer be considered as a serious risk of pregnancy. The number of maternal deaths and the mortality rate in the years 1921 to 1951 are shown in the following table: — Year. No. of Maternal Deaths. Maternal Deatb Rate per 1,000 total Births. Year. No. of Maternal Deaths. Maternal Death Rate per 1,000 total Births. 1921 16 2·5 1937 6 1·8 15 2·6 1938 8 2·5 1922 1923 20 3.5 1939 6 2·0 17 3·3 1·7 1924 1940 5 1925 13 1941 2·6 10 6·5 1926 15 3·2 1942 6 2·4 1927 17 4·0 1943 3 1·2 1928 18 4·3 1944 4 1·5 1929 13 3·4 1945 6 2·2 1930 8 2·1 1946 5 1·2 1931 16 4·7 1947 5 1·1 1932 8 2·4 1948 4 1·1 1933 16 4·7 1949 4 1·2 1934 8 2·4 1950 2 0·6 1935 10 3·0 1951 3 1·0 1936 7 2·1 . SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. A water supply direct from the mains of the Metropolitan Water Board is provided for every dwelling house in the Borough. There are seven wells in operation in Camberwell, but the water from them is used for industrial purposes only. Water Certificates. Water Certificates in respect of 645 new dwellings were issued during the year under the provisions of the Public Health (London) Act, 1936. Drainage and Sewerage. During 1951, 553 yards of sewers were reconstructed, 28 brick road gullies were replaced by pot gullies and 16 defective pot gullies were renewed. Drainage plans submitted for examination and approval in respect of new and existing buildings numbered 97. Public Cleansing. This service is under the supervision 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 43,953 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. Nuisances from atmospheric pollution have greatly diminished during the present century. Considerable attention was given to the question of smoke abatement following a report issued in 1921 by the Departmental Committee on Smoke and Noxious Vapours Abatement when public opinion began to realise the injurious effect of a smoke-laden atmosphere both upon health and property. The Public Health Smoke Abatement Act, 1926, gave extended powers to local authorities to deal with this problem. During the following years the increasing use of smokeless fuel, gas and electricity both by industrial undertakings and domestic users has resulted in a considerable improvement in the purity of the atmosphere. Owing to the fuel situation following the second world war, some difficulty has been experienced in preventing smoke nuisances in view of the inferior quality of the fuel available, but the provision of modern furnace equipment and proper methods of stoking have done much to offset this. In 1951 only 11 complaints were received of nuisances caused by the emission of smoke, grit, etc., and the district sanitary inspectors kept 49 observations. Two intimation notices were served in respect of smoke nuisances. This compares with 282 notices served for a similar reason in 1922. Bombed Sites and Static Water Tanks. These sites and tanks continued to give rise to complaints of nuisances from the deposit of refuse and accumulation of stagnant water, particularly during the summer months. In July 1951, the Public Health Committee requested the Medical Officer of Health to submit a report on the static water tanks in the Borough. An inspection of the 49 tanks in the Borough revealed that in only three cases was there any offensive matter deposited in the tanks and steps were taken to secure the removal of this refuse. Twelve tanks contained an accumulation of water and the London Fire Brigade were requested to arrange for this to be pumped out. Further inspections were made of all these tanks at a later date and in only one instance was action necessary to abate a public health nuisance. The chief cause of complaint is the accumulation of rain water which in time becomes stagnant and gives rise to smell and the breeding of mosquitoes. The London Fire Brigade are most co-operative and always arrange for the water to be pumped out when requested. It is not possible, however, for all the water to be removed by their appliances, but the residue is usually treated with bleach powder to destroy any insect life. It is sometimes found when the water is removed that the brick rubble, old iron, etc., which many of these tanks contain, are covered with an evil smelling slime and the only way to abate the nuisance is for the tank to be completely cleared. Pig Keeping. Regulation 62B of the Defence (General) Regulations, 1939, suspended restrictions on the keeping of pigs, hens and rabbits by tenants and occupiers of land. This Regulation was revoked by the Defence Regulation (No. 1) Order, 1951, which came into operation on 1st July, 1951. There are no piggeries in the Borough, however, affected by this new legislation. Noise Nuisances. The Public Health Department investigated two instances where local residents complained of noise from adjoining business premises. One case concerned a firm engaged in renovating metal oil drums from which dents were being removed by hammering with rawhide hammers. As the result of representations by the Health Department, the management installed machinery to carry out this work which resulted in a considerable reduction of noise. In the other instance noise from a bakehouse during the night formed the subject of complaint by residents in the vicinity. The bakehouse in question is provided with modern equipment and the floors and yard pavings are constructed of steel plates set in concrete. Steel trolleys with cast iron wheels are used for transporting trays of bread and rolls, and the chief cause of complaint was the rattling of these trolleys when wheeled over the steel plated floors. The matter was reported to the appropriate Committee who adjourned consideration for six months to enable the proprietor to endeavour to find some means of remedying the nuisance. Swimming Bath Waters. The water in the swimming pools at the Dulwich and Camberwell Public Baths was supervised throughout the year. Twenty-nine samples were submitted for bacteriological examination and chemical analysis. No adverse reports were received. The Rag Flock and Other Filling Materials Act, 1951. This Act came into operation on 1st November, 1951, and repealed section 136 of the Public Health (London) Act, 1936. It provides for the licensing by the local authority of all premises used for the manufacture and/or storage of filling materials to which the Act applies, and for the registration by the local authority of certain premises where such materials are used in upholstering, stuffing or lining bedding, toys, baby carriages, etc. There are no premises in the Borough where rag flock or other filling materials are manufactured but one licence was issued for a rag flock store and eight premises were registered for the use of such materials in the trades conducted therein. Regulations made under this Act specify standards of cleanliness to which various filling materials must conform. Seven samples of filling materials were taken during 1951 under these Regulations, as follows: — Rag flock 2 Coir fibre 1 Hair (curled) 1 Woollen mixture felt 1 Sisal (pad) 1 Cotton felt (pad) 1 With the exception of the sample of cotton felt, all were found, upon examination by the Prescribed Analyst, to be satisfactory. So far as the cotton felt was concerned, the Analyst reported that this sample just failed to conform to the required standard of 7·5 per cent, laid down for the trash content. The matter was reported to the Public Health Committee and a cautionary letter was sent to the firm using the cotton felt. A further sample was taken early in 1952 and this was found to be satisfactory. Offensive Trades. There are only five premises in the Borough registered for the purpose of carrying on offensive trades, as follows:— Skin dressers 4 Soap boilers 1 These premises were supervised by the district sanitary inspectors but no infringements of the bye-laws were reported. Rag and Bone Dealers. There are eight rag and bone dealers carrying on business in the Borough, none of which gave rise to any nuisance or complaint requiring action by the Public Health Department. Shops Act, 1950. The district sanitary inspectors made 876 inspections of shops during the year under the provisions of the above Act. It only became necessary to serve one notice which was complied with. No applications were received for exemption certificates in accordance with Section 38 (6) of the Act. Pharmacy and Poisons Act, 1933. Applications for entry in the Council's Register as Sellers of Part II Poisons under the above Act numbered 13. There were also 154 applications for renewal of registrations. No infringement of the Act came to the notice of the Council's officers. Sanitary Inspection of the Area. Owing to the continued difficulty in securing the services of Sanitary Inspectors, the number employed fell short of the authorised establishment during the latter six months of the year. The establishment of Sanitary Inspectors in 1951 is compared with that for 1922 in the following table:— 1922 1951 District Sanitary Inspectors 11 13* Women Sanitary Inspectors 2 - Sampling Officer—Foods & Drugs Act, etc. 1 1 Food Inspector - 1 Housing Inspector — 2* Rodent Officer - 1 * One vacancy at 31.12.1952. The number of complaints received in 1922 was 3,843, whereas in 1951 they numbered 6,409. It is true that house property has suffered as the result of air raids and lack of adequate maintenance during the war but this does not entirely account for the increase in the number of complaints. There is an increasing tendency for the public to appeal to the local sanitary authority to assist in securing the abatement of nuisances by the use of their statutory powers often without having first approached the landlord. The following tables indicate the nature and extent of the work of the inspectorial staff during 1951: — SUMMARY OF WORK CARRIED OUT DURING THE YEAR 1951. Inspections:— Nuisance inspections 6,693 Offensive trades 3 Smoke observations 49 Drainage, new and existing 5,031 Overcrowding 1,244 Factories and workplaces 569 Outworkers' premises 225 Rag and bone dealers 3 Infectious and other diseases 928 Verminous premises and persons 232 Aged and infirm persons 597 Common lodging houses 52 Conveniences, public and private 101 Rent (Restrictions) Act 67 Shops Act 876 Voluntary work 1,768 Inspections not defined 1,338 Re-inspections 21,864 Total inspections 41,640 Works supervised:— Tests applied to drains (existing premises) 569 Drains found defective 144 Drains totally reconstructed 83 Drains repaired or partially reconstructed 261 Tests applied to drains (new buildings) 3,205 Drains constructed 925 Additional water supply provided 15 Description of Sanitary Imvrovements ordered during the Year:— Cleanse and repair walls and ceilings 1,988 Repair roofs, gutterings, etc 1,914 Abate dampness 2,311 Repair stoves, fireplaces and coppers 615 Repair windows, sashlines, sills, etc. 889 Repair flooring, stairs, doors, etc. 816 Provide sufficient light and ventilation 33 Provide dustbin 74 Remove offensive matter 21 Provide or repair yard paving 94 Provide or render accessible water supply 22 Repair water pipes and fittings 150 Clear premises of vermin 28 Cleanse or repair water closets and flushing apparatus 476 Repair or clear defective or obstructed drains 185 Repair soil pipes, waste pipes, sinks, etc. 303 Abate nuisances caused by animals improperly kept 4 Miscellaneous 124 Total repairs and improvements ordered 10,047 SUMMARY OF NOTICES SERVED, 1951. Intimations, Public Health (London) Act, Byelaws, etc. 4,398 Statutory Notices, Public Health (London) Act, Byelaws, etc. 2,098 Public Health (London) Act, 1936 (Part II) 25 Section 4, Housing Act, 1936 99 No. of Summonses issued 148 Factories Acts, 1937-1948. The work carried out by the Public Health Department under the provisions of the above Acts is set out in the following tables. These tables are reproductions of the form prescribed for submission to the Ministry of Labour and National Service:- I.—INSPECTIONS, 1951. Number of Number on Register, Inspections. Occupiers prosecuted. Written Notices. Premises. Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 102 - - 401 Factories not included above in which Section 7 is enforced by the Local Authority 428 10 - 1,060 Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - 13 1 10 - Totals 1,474 531 2.—CASES IN WHICH DEFECTS WERE FOUND, 1951. No. of cases in which defects were Number of cases in which prosecutions were instituted. Particulars. Referred Remedied. To H.M. Inspector. By H.M. Inspector. Found. Want of cleanliness 9 2 - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors Sanitary conveniences— ! . 1 - - - - - (a) insufficient 2 6 - - (b) unsuitable or defective 6 - 15 - - (c) not separate for sexes 3 - - 2 - Other offences against the Act (not including offences relating to outwork) 5 6 1 - - 20 - 3 Total 35 - Outworkers. Employers of home workers are required to forward to the local authority in February and August of each year a list showing the names and addresses of all such workers employed by them during the preceding six months. The homes of these persons are visited periodically by the district sanitary inspectors to ensure that the premises in which outwork is carried on are not insanitary or unhealthy. The numbers of outworkers employed in various trades in Camberwell at the end of the year are shown in the following table:— Artificial flowers 4 Linens 8 Baby linen 1 Needlework 8 Belts 3 Novelties 21 Blouses 8 Overalls 37 Boots and shoes 5 Paper bags 16 Brushes 4 Shoulder pads 36 Stationery 9 Cardboard boxes 36 Card lacing 26 Tailoring 18 Coathangers 2 Ties 8 Diaries 1 Toys 5 Embroidery 7 Umbrellas 4 Feather sorting 2 Uniform caps 5 Wearing apparel 383 Handbags 2 Hats 4 Miscellaneous 28 Hosiery 3 Lampshades 10 Total 704 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Welfare of Aged Persons. The Council pays an annual grant to the Camberwell Old People's Welfare Association for the provision of meals, recreation, etc., for old people living in the Borough. Assistance is also given to that Association by providing additional transport on four days each week for the distribution of midday meals to those persons who are unable to attend at one of the Old People's Dinner Clubs. In the early part of the year a full-time Organising Secretary was appointed to co-ordinate the work of the Association and office accommodation was provided for her in the Town Hall. This has considerably facilitated close co-operation with the Public Health Department and with the Divisional Staff of the London County Council at 29 Peckham Road. To assist in forming the nucleus of a register of old persons living in Camberwell, the Housing Department, at the request of the Medical Officer of Health, furnished a list of the names and addresses of all old-age pensioners living in properties controlled by the Council. These people were visited by the district sanitary inspectors to ensure that they were able to devote proper care and attention to themselves, and where necessary, the London County Council were requested to assist by providing home help or nursing services and the Camberwell Old People's Welfare Association were notified in order that their helpers might visit and make arrangements for the provision of meals, etc. It sometimes happens that an aged person who is unable to look after himself or herself by reason of infirmity or illhealth is unwilling to receive assistance of any kind from the authorities in spite of the persuasive efforts of all concerned. These cases gradually deteriorate until they become a danger to themselves and to the health of other people. It then becomes necessary to put into operation the provisions of Section 47 of the National Assistance Act, 1948, to secure their compulsory removal to an institution. During 1951, four old persons were dealt with under these statutory powers and were removed to Newington Lodge, 182 Westmoreland Road, S.E.17. On 1st September, 1951, the National Assistance (Amend-ment) Act, 1951, came into force. This Act gave local authorities further powers to enable them to deal expeditiously with certain cases of aged persons in need of care and attention which they are unable to provide for themselves and are not receiving from other people. Where the Medical Officer of Health and another registered medical practitioner certify in the case of a person to whom Section 47 (1) of the National Assistance Act, 1948, applies, that it is necessary in their opinion that he or she should be removed without delay from the premises in which they are residing, an application for a removal order may be made to the appropriate court of summary jurisdiction or to a single justice without giving the person whose removal it is desired to secure, or the person in charge of him or her, the seven clear days' notice required by Section 47 (7) of the 1948 Act; and the court or the justice may if necessary act ex parte. An order made under this new procedure, however, may only authorise a person's detention in a suitable institution for a period not exceeding three weeks. Any application for an order extending this period by not more than three months from time to time must be made in accordance with the provisions of Section 47 of the Act of 1948. The Council authorised the Medical Officer of Health to make applications in cases to which the amending Act applies but fortunately it did not become necessary for such emergency action to be taken in respect of any person during 1951. Infestation by Head Lice. As a result of a communication received from the Divisional Medical Officer, London County Council, drawing attention to a number of school children who were repeatedly required by the Education Authority to attend at this Council's Cleansing Station for treatment for head lice infestation, the Medical Officer of Health reported to the Public Health Committee suggesting that the families of the children concerned should be invited to co-operate in terminating these unsatisfactory conditions. For this purpose, it was suggested that for an experimental period of six months, a suitable hair emulsion should be provided free of charge to each of these families, together with a tactful letter recommending its use by all members of the family as a preventive measure. The Committee agreed to this proposal and with the approval of the Ministry of Local Government and Planning the parents of 65 children were issued with the emulsion. At the end of six months a review of the situation revealed that 23 of the children were satisfactory, six showed a definite improvement but were still infested and 36 had again been referred to the Cleansing Station (of these 15 were still frequent attenders). The experiment had, therefore, been moderately successful in reducing the incidence of head lice infestation and from an educational point of view, had been most valuable. The Public Health Committee therefore authorised the issue of a further supply of hair emulsion to the families of the unsatisfactory children and also to the parents of 15 additional children who had been notified by the London County Council as frequent attenders at the Cleansing Station and had not been previously dealt with in this scheme. Disinfecting and Cleansing Station. The Municipal Cleansing Station which is situated at Frensham Street, Peckham Park Road, S.E.15, is available for the treatment of any residents in the Borough affected with vermin or scabies. The following tables show the number of attendances made for such treatment during the year 1951:— CLEANSING STATION ATTENDANCES (VERMIN) Male. Female. Total. Adults Children 31 306 14 1,135 45 1,441 337 1,486 Total 1,149 CLEANSING STATION ATTENDANCES (SCABIES). Male. Female. Total. Adults 24 15 39 Children 45 35 80 Total 69 50 119 Disinfection. The following is a summary of the work carried out by the Disinfecting Staff during the year:— Notified Infectious Diseases. Vermin. Total. All Cases. Other Diseases. Miscellaneous. Rooms disinfected 984 77 11 1,362 2,434 Lots of bedding disinfected 1,221 57 49 183 1,510 Total visits 1,549 105 1,433 812 3,899 22 Number of articles disinfected by steam 3,562 Number of articles disinfected by formalin 1,327 Number of books disinfected 174 Number of towels washed 5,002 Number of gowns washed 253 Number of overalls washed 291 Number of covering sheets washed 396 Beds and mattresses destroyed 290 Miscellaneous goods destroyed 260 Weight of Tons. Cwts. Qtrs. Lbs. Unsound food dealt with 25 3 1 19½ Hospital dressings destroyed 18 3 0 0 Furniture, etc., destroyed 17 11 0 0 Dead animals destroyed — 19 1 0 Hospital bedding disinfected 35 7 3 0 Infestation Control. The systematic destruction of food pests is essential owing to the world shortage of food. With an increasing population the need for this destruction is more urgent than ever. The Prevention of Damage by Pests Act, 1949, which came into operation on the 31st March, 1950, placed on the Council the obligation to ensure that as far as practicable the Borough is kept free from rats and mice. It also provides that the occupier of any premises shall forthwith notify the local authority in writing if it comes to his knowledge that rats or mice are living on or resorting to the premises in substantial numbers, except in the case of food premises when such notice must be given to the Minister of Agriculture and Fisheries. A similar duty was placed upon occupiers by the Infestation Order, 1943. Systematic rodent control treatment has for its purpose the reduction of the wastage of food. Rats and mice consume food to live but at the same time they render large quantities of food unfit for human consumption by fouling. Structural damage to buildings has been caused by rats and they have even been known to undermine the foundations. From the health point of view, systematic treatment also controls the spread of diseases which may be caused by rats and mice—diseases which can be fatal to human beings. The disease of Leptospirosis is attributed to parasites of rats and mice. Weils disease (Leptospirosis icterohaemorrhagica) is recognised as a hazard of certain occupations, such as farmworkers, workers in sewers and coal miners. Bathers in canals and pools sometimes contract this disease from leptospira present in stagnant water. The risk of infection in sewer workers can be prevented by methods of personal protection and a continuous campaign against rats. Personal protection consists of the wearing of rubber boots and gloves which are washed with disinfectant before being removed, and the disinfection of cuts and abrasions. Two cases of lymphocytic choriomeningitis, one in an adult and one in a child have come to the knowledge of the Health Department within the last two years. The source of infection was a virus found in a house mouse. Transmission from the mouse to man is usually through food or dust contaminated by secretions from the mouth, nose, urine or faeces of the rodent. As this disease is identifiable only by laboratory methods, there is reason to believe that lymphocytic choriomeningitis is more common than the number of recognised cases indicates. The homes of the two Camberwell cases and adjoining houses in the same block were investigated for the presence of mice. Disinfestation treatment was carried out and continued until there was no possibility of infected mice remaining. The work of this important branch of Public Health is carried out by a staff consisting of a Rodent Officer and Sanitary Inspector, one Rodent Investigator, seven Rodent Operators, one Bait Preparer and a Rodent Control Clerk. A grant of 50 per cent, of the approved net expenditure is made to the Council by the Ministry of Agriculture and Fisheries, subject to their approval of the Rodent Control organisation set up by the Council. Expenditure on the treatment of infestations at commercial or industrial premises is recovered from the occupiers. The following is a summary of the work carried out daring the years 1949, 1950 and 1951: — 1949 1950 1951 No. of complaints received 1,617 1,546 1,383 No. of inspections 4,119 3,533 2,709 No. of operators' calls 18,427 17,554 20,257 No. of private premises baited 1,661 1,573 1,427 No. of business premises baited 188 176 216 No. of pre-baits laid 39,786 38,644 49,898 No. of poison baits laid 23,700 22,194 23,886 The number of complaints and premises treated in 1951 was less than in 1949 and 1950. This was no doubt due to the employment of an additional rodent operator which enabled “follow-up” treatments to be carried out promptly, thus controlling the spread of infestation. It will be noted that there was a considerable increase in the number of baits laid. In the months of June and December all the sewers in the Borough were treated. This was in addition to the systematic treatment of sewer manholes which is carried out in blocks weekly throughout the year. The inhabitants of the Borough are beginning to realise the value of notifying the Council of rodent infestation and of the prompt attention and treatment given by the Rodent Control staff. As the result of the intensive rodent control treatment carried out in Camberwell, no centres of major infestation exist at present. Minor infestations, however, are to be found throughout the Borough. It is impossible to eradicate these as they are being constantly replenished from underground sources such as defective drains and sewers, but the continuous action taken by the Public Health Department prevents them from becoming major infestations. Particular attention has been given to the rat- and miceproofing of factories, especially those where food is prepared. It is worthy of note that the rodent control staff handle highly dangerous poisons, such as arsenic, zinc phosphide, etc., but such care and control is exercised that no claim has ever had to be met by the Council for damage due to the accidental consumption of such poisons by domestic pets. The following reports for the nine months from the 31st March (i.e. the date of operation of the Prevention of Damage by Pests Act, 1949) to the 31st December, 1950, and for the twelve months from the 1st January to the 31st December, 1951, were submitted to the Ministry of Agriculture and Fisheries. They present a picture of the conditions which existed and serve as a guide for subsequent action. Report for Period 31st March to 31st December, 1950. 1. PREVALENCE OF RATS AND MICE. TYPE OF PROPERTY (i) (ii) (iii) (iv) Number of properties in Local Authority's Area in which infestation was (v) (vi) (vii) Analysis of Column (iv) Number infested by Total Notified by Occupier Otherwise discovered Recorded (Total of (ii) and (iii)) Rats* Major Minor 30 nil 6 nil 6 Local Authority's Property 6 40,159 843 225 1,068 nil 1,068 Dwelling House 6,879 10 111 nil 112 23 101 Business Premises Nil - - — - Agricultural Property nil 47,068 950 235 1,185 1,185 370 nil Total * Include under this heading properties infested with both rats and mice. † Includes properties where mice bait was issued to occupiers to put down. 2. MEASURES OF CONTROL BY LOCAL AUTHORITY. TYPE OF PROPERTY No. of properties inspected No. of inspections made Number of notices served under Sect. 4 Number of treatments carried out Block treatment of properties in different occupancies under Sect. 6 (1) or by informal arrangement By arrangement with occupier Under Section 5 (1) Works Rats* Mice only Rats* Mice only No. of Blocks Surface Associated sewers Treatments No. of separate occupancies No. of manholes treated 6 6 nil nil 11 2 nil nil 1 3 Local Authority's Property 2,863 1,917 2,430 nil nil 2,443 228 nil nil 203 468 Dwelling House Business Premises 240 250 nil nil 322 55 nil nil 20 40 Agricultural Property nil nil nil nil nil nil nil nil nil nil nil 2,163 2,686 nil nil 2,776 285 nil nil 224 511 2,863 Total * Include under this heading properties infested with both rats and mice. † Excluding treatments included under block treatments. Report for Year Ended 31st December, 1951. TYPE OF PROPERTY Local Authority Dwelling Houses Agricultural All other (including business and industrial) Total I. Total number of properties in Local Authority's district 30 40,852 nil 6,862 47,744 11. Number of properties inspected by the Local Authority during 1951 as a result (a) of notification or (6) otherwise (a) 8 1,249 nil 126 1,383 1,246 (b) nil 1,326 nil 80 111. Number of properties (under II) found to be infested by rats Major nil nil nil 1 1 Minor 2 934 nil 169 1,105 IV. Number of properties (under II) found to be seriously infested by mice 2 101 nil 36 139 4 1,035 nil 206 1,245 V. Number of infested properties (under 111 and IV) treated by the Local Authority f I "I VI. Number of notices served under Section 4:— (1) Treatment nil nil nil nil nil (2) Structural works (i.e., proofing) nil nil nil nil nil Total 16 4,565 nil 618 5,199 VII. Number of cases in which default action was taken by Local Authority following issue of notice under Section 4 nil nil nil nil nil nil nil nil nil nil VIII. Legal proceedings IX. Number of "block" control schemes carried out 174 Publicity on Health Matters. At the beginning of the year the Medical Officer of Health submitted to the Public Health Committee a report on this matter which included the following suggestions as to the material and means of distribution which might be utilised for health propaganda :— 1. Material— (a) Modern posters and pamphlets on various diseases. Suitable material may be obtaiued from the Central Council for Health Education. (b) The use of the local Press for publishing information on health matters; if necessary, purchasing advertisement space for this purpose. (c) Practical exhibitions, including mechanical and animate things, e.g. domestic pests. (d) The re-issue of the Digest of the Health and Social Services in the Borough. 2. Means of Distribution— (a) The display of posters, three side by side, on the various public buildings and sandbins in the Borough and on the Council's vehicles. (b) The distribution of pamphlets and leaflets at all the Local Authority's offices at which the public call, including the Libraries, Information Centre, Food Office, Housing Office and other places such as the London County Council Infant Welfare Centres, Evening Institutes, Youth Clubs, Old People's Clubs, local factories and hospitals. Copies of these pamphlets might also be sent to the Press and in certain circumstances be despatched with the rate demand notes. (c) The permanent display of practical exhibits at the Council's Libraries and the Information Centre. (d) The exhibition of films. Various films on Health Services, such as Food Hygiene, Rodent Control, Child Care, Prevention of Accidents in the Home, Prevention of Infection, Diphtheria Immunisation, Tuberculosis and general health matters. The Committee received the report and authorised the printing and distribution of 3,000 copies of the Digest of the Health and Social Services which had been revised and brought up to date. The Local Government Exhibition which was held at the Art Gallery, Peckham Road, in connection with the Festival of Britain celebrations provided an opportunity for bringing to the notice of the public certain aspects of the work of the Public Health Department. Limited space prevented a comprehensive health education campaign, but a competent display was set up which included Rodent Control, Clean Food and Infectious Diseases. This exhibition was visited by 5,278 members of the public and evoked considerable interest and favourable comment. The displays which were held at the Town Hall on the evenings of Council Meetings also included public health subjects. Personal Health Services. These services, which are the responsibility of the London County Council, include Maternity and Child Welfare, Diphtheria Immunisation, Vaccination, Day Nurseries, Foster Mothers and Child Minders, Midwifery, Home Helps, Home Nursing etc. The Medical Officer of Health assists in the day-to-day administration of these services by agreement between the Borough Council and the County Council. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notification. The introduction of compulsory notification of infectious diseases to the Medical Officer of Health of the district had for its object the isolation of the infectious sick and the destruction of the infection already existing. To be of value, therefore, for the purpose of protecting the community, notification must be accurate and speedy. While the notifications after correction of diagnosis provide a sufficiently accurate picture of such diseases as acute poliomyelitis and meningococcal infection, yet the same cannot be said of measles and whooping cough. Notification has the great drawback that only persons suffering from disease are notifiable and does not take into account those who, though they may be spreading the infection, are in good health. The following table shows the diseases which are notifiable in Camberwell, together with the statutory authority for notification. Disease. Authority for notification. Acute encephalitis Public Health Act, 1936 (Sect. 143). Regulation (No. 2259) made by Minister of Health, 1949. (1.1.50.) Acute influenzal pneumonia Public Health Act, 1936 (Sect. 143). Regulation (No. 1207) made by Minister of Health, 1927. (1.1.28.) Acute primary pneumonia Ditto ditto Acute poliomyelitis Public Health Act, 1936 (Sect. 143). Regulation (No. 2259) made by Minister of Health, 1949. (1.1.50.) Anthrax L.C.C. Order, 1909—Public Health (London) Act, 1936 (Sections 192 and 305). Cholera Public Health (London) Act, 1936 (Sections 192 and 304). Continued fever Ditto ditto Diphtheria Ditto ditto Dysentery Public Health Act, 1936 (Sect. 143). Regulation (No. 1207) made by Minister of Health, 1927. (1.1.28.) Enteric fever (includes typhoid and paratyphoid). Public Health (London) Act, 1936 (Sections 192 and 304). Regulation (No. 1207), made by the Minister of Health, 1927. (1.1.28.) Erysipelas Public Health (London) Act, 1936 (Sections 192 and 304). Disease. Authority for notification. Food poisoning Food and Drugs Act, 1938 (Sect. 17, as amended by National Health Service Act, 1946 (10th Schedule)). Glanders L.C.C. Order, 1909 —Public Health (London) Act, 1936 (Sections 192 and 305). Hydrophobia Ditto ditto *Leprosy Public Health Act, 1936 (Sect. 143). Regulation (No. 1036) made by Minister of Health, 1951. (22.6.51.) Malaria Public Health Act, 1936 (Sect. 143). Regulation (No. 1207) made by Minister of Health, 1927. (1.1.28.) Measles Public Health Act, 1936 (Sect. 143). Regulations Nos. 1100, 205 and 420) made by Minister of Health, 1938, 1940 and 1948. Membranous croup Public Health (London) Act, 1936 (Sections 192 and 304). Meningococcal infection Public Health Act, 1936 (Sect. 143). Regulation (No. 2259) made by Minister of Health, 1949. (1.1.50.) Ophthalmia neonatorum L.C.C. Order, 1910 —Public Health (London) Act, 1936 (Sections 192 and 305) and Regulation (No. 971), made by Minister of Health, 1926 (1.10.26) amended by S.R.0., 1928, No. 419, and 1937, No. 35. Plague Public Health Act, 1936 (Section 143). Regulation of Local Government Board, 1900. Puerperal pyrexia Public Health Act, 1936 (Sect. 143). Regulation made by Minister of Health, 1951, No. 1081. (1.8.51.) Relapsing Fever Public Health (London) Act, 1936 (Sections 192 and 304). Scabies (first case in house within four weeks). Public Health Act, 1936 (Sect. 143). Regulation (No. 1016) made by Minister of Health, 1943. (1.8.43.) Scarlatina or Scarlet Fever Public Health (London) Act, 1936 (Sections 192 and 304). Smallpox Ditto ditto Tuberculosis Public Health Act, 1936 (Sect. 143). Regulation (No. 572) made by Minister of Health, 1930. (1.1.31.) Typhus Fever Public Health (London) Act, 1936 (Sections 192 and 304). Whooping Cough Public Health Act, 1936 (Sect. 143). Regulalation (Nos. 1100, 205 and 420) made by Minister of Health, 1938,1940 and 1948. * This disease is not notifiable to the Medical Officer of Health but to the Chief Medical Officer of the Ministry of Health only. The isolation of all cases of contagious diseases is regarded as a most desirable measure, especially for those spread by airborne contagion, such as smallpox. Tubercular diseases are rarely isolated although unsuspected cases of open tuberculosis, especially in the latter stages, are responsible for spreading the disease. No statutory powers exist whereby a patient suffering from leprosy can be removed to hospital. INFECTIOUS DISEASES, 1951. 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. 45 to 65. Scarlet Fever 180 26 4 - 3 13 15 31 95 16 4 3 - - Whooping Cough 300 43 2 - 46 36 49 48 54 57 5 2 3 - - Poliomyelitis & Polio-encephalitis 9 9 1 - - 1 - 1 3 1 3 - - - - Measles 12,141 38 2 - 77 219 305 354 395 759 15 7 8 2 - Diphtheria 12 12 12 - 1 - - - - 1 2 2 4 2 - Pneumonia- Acute Influenzal 53 1 1 - - - 1 1 3 1 1 5 2 19 - Acute Primary 74 16 - - - 2 - 1 2 7 3 7 13 24 - Dysentery 55 20 2 - 7 6 5 8 2 13 2 1 3 5 2 Paratyphoid Fever 2 2 - - - - - 1 - 1 - 1 - - - Erysipelas 19 4 1 - - - - - - 1 - - 2 3 8 Meningococcal Infection 13 13 8 - - 1 2 2 1 1 1 3 1 1 Puerperal Pyrexia 60 57 - - - - - - - - - 6 47 7 - Ophthalmia Neonatorum 4 1 - - 4 - - - - - - - - - - Scabies 16 1 - - - 1 3 2 1 3 1 2 1 1 - Malaria 2 - - - - - - - - - - - 1 - 1 12,940 243 32 1 135 268 377 433 487 942 49 29 88 36 55 Totals Acute Poliomyelitis. In recent years cases of this disease have become more frequent in the British Isles causing great anxiety among the public. Fortunately, the risk of contracting poliomyelitis in its paralytic form is far less than people imagine. Infection is mainly spread, from person to person. In the earlier epidemics young children were the chief sufferers but of late years a higher proportion of reported cases has occurred in children of school age and the adolescent and adult population. For practical purposes cases are classified as non-paralytic and paralytic. Non-paralytic cases are those which show signs of inflammation of the central nervous system without any muscle weakness. Several immunologically distinct types of the virus which causes poliomyelitis have been identified. None of the newly discovered antibiotics have any influence on the virus nor does convalescent serum give protection against poliomyelitis or against paralysis in a case in the pre-paralytic stage. The first serious outbreak of this disease occurred in 1947 to be followed by lesser outbreaks in 1949 and 1950. The graph on page 41 shows the annual incidence of cases and deaths from this disease from 1921 to 1951. Meningococcal Infection. From the 1st January, 1950, all meningococcal infections are required to be notified as a single entity. Susceptibility to the clinical disease is slight although there may be a high carrier prevalence. The use of chemotherapeutic or antibiotic agents have been extremely useful in lowering the carrier rate and limiting the spread of the disease, (see graph page 42.) Measles. The reason why measles is now such a mild disease is not definitely known. It may be that improved social factors have influenced the mortality, but not the morbidity. Although chemoprophylaxis prevents certain serious complications of measles, nevertheless, the routine administration of chemoprophylactics to children with this complaint is not recommended. With a disease so mild, and active immunisation still in the experimental stage, the concensus of opinion is for passive immunisation to be reserved for those who are subject to special risks, such as weakly or sick children under two years of age and children in institutions and hospitals, (see graph page 43.) Typhoid and Paratyphoid Fever. The incidence and mortality rates of typhoid fever have decreased considerably since the beginning of the present century. This improvement is due to the great advance in sanitation. Cases occur occasionally and are usually due to carriers. The detection of carriers of this disease is a recognised procedure in the investigation of all cases notified. On receiving a positive report from the bacteriologist, the carriers are excluded from employment as food handlers until negative cultures of faeces and urine are obtained. In the investigation of the source of infection of any individual case phage typing has been proved to be most useful. The value of preventive inoculation against typhoid fever is well known. In civilian practice it is reserved for persons subject to unusual exposure to infection by reason of occupation or travel and family contacts of carriers, (see graph page 44.) Pneumonia. The only forms of pneumonia which are notifiable are Acute Primary and Acute Influenzal. The downward trend of the death rates of pneumonia is due to the discovery of the sulphonamides and antibiotics. The notifications of these types of pneumonia during the years 1921-51 are shown in the graph on page 45. Dysentery. The term dysentery is loosely applied to all forms of diarrhoea in which the stools contain mucous and blood. There are two known types of dysentery—bacillary and amoebic. The parasite which causes amoebic dysentery has a world-wide distribution, but fortunately, few cases are to be found in temperate regions such as England. The incidence of bacillary dysentery has increased considerably in recent years. The majority of the notifications of dysentery is due to infections with the Sonne species of the genus Shigella. There is reason to believe that the number of actual cases which occur every year is greatly in excess of the notifications. Sonne dysentery is mainly a disease of children and often occurs in close communities such as schools or day nurseries. Clinically the disease is mild in type and deaths few in number. It is believed that the spread of this disease is due to temporary excretors rather than chronic carriers. Infection is spread mainly by direct and indirect contact. With a disease of so high a degree of infectivity and so rapid in its spread, collaboration is essential between the Medical Officer of Health and the bacteriologist for the eradication of outbreaks in schools and day nurseries. Sulpha drugs have proved to be most successful from the point of view of prophylaxis and in the treatment of this disease, (see graph page 46.) Scarlet Fever. A variety of conditions are caused by haemolytic streptococci, including scarlet fever, erysipelas and puerperal infection. The distinguishing characteristics of scarlet fever are fever, sore throat, "strawberry" tongue and a rash. Scarlet fever differs from streptococcal sore throat by the presence of a rash. No disease has changed more than scarlet fever in recent years. It is, to-day, a trivial disease and is no longer regarded with dread; the fatality rate is almost nil. Notification of this disease seems hardly necessary, as streptococcal sore throat is not notifiable. Isolation and concurrent disinfection are still practised, especially in cases of severity or of an exceptional nature. With a disease so mild in nature, as scarlet fever is at. present, the question of immunisation does not arise, (see graph page 47.) Ophthalmia Neonatorum. The results of the local application of penicillin since its discovery have been most successful in the treatment of this disease. The duration of treatment is now days instead of weeks. Resulting blindness is now almost unknown. Occasionally failure is encountered owing to the presence of a penicillin-resistant organism, (see graph page 48.) The Value of Immunisation for Diphtheria. Immunity to infections such as diphtheria, scarlet fever, measles and chicken pox, normally exists in the first few months of infanthood owing to the presence of antibodies obtained from the mother. These antibodies gradually disappear and are not replaced. Immunity can, however, be induced artificially. In the past the measures used to protect the individual from diphtheria was the use of a specific antitoxin. This passive immunisation was practised when a case occurred in a family and it was necessary to protect the other children who had been exposed to infection. Passive immunisation has now been replaced by active immunisation which is best carried out in early infancy, preferably not later than 8 months of age. The resulting immunity lasts from two to four years and it is advisable to give a "booster" dose when the child commences school at the age of five years. Immunisation against diphtheria was introduced into Camberwell in the year 1926. For a few years there was a disappointing response on the part of the public. In 1942, an intensive propaganda campaign was conducted throughout the Borough and more and more mothers realised that the prophylaxis offered them by the Council was safe and effective. It gives great satisfaction to report that in the year under review there was not a single case of confirmed diphtheria. This must not be understood as implying absolute elimination of the disease. The prevention of the occurrence of cases depends upon the maintenance of an adequate level of immunisation. It is essential for parents to realise that diphtheria is still a deadly threat which can only be warded off by immunisation and that it is their duty and responsibility not to leave their children unprotected. The amount of money saved as a result of the reduction in the incidence of diphtheria can readily be realised. There is also the saving in hospital beds, doctors, nursing and domestic staff. No more suitable example of prevention being better than cure can be presented. The graphs on pages 49 and 50 indicate the trend of the incidence of diphtheria and deaths for the period 1921-51. Whooping Cough. Three hundred notifications of whooping cough were received durirg the year of which two were subsequently found not to be suffering from the disease. There were no deaths of notified cases. The characteristic paroxysmal cough is indicative of whooping cough but whooping does not occur in every case, especially in young children. Conclusive laboratory diagnosis depends upon the isolation of the whooping cough bacillus haemophilus pertussis. There is general agreement that whooping cough is at present the most serious of all infectious diseases. Not only is there a high incidence among children but it is also responsible for many deaths in children under one year of a age. The prevention of whooping cough by vaccination is possible. Controlled trials have been made to assess the prophylactic value of pertussis vaccine in children and it is generally agreed that a considerable measure of protection can be obtained with effective vaccines. Prophylactic vaccine should be given to children within the first six months of life as more than half of all the deaths occur in children under one year. In recent years diphtheria and whooping cough immunisation have been combined as one prophylactic. Recent advances in the study of antibiotics raise the hope that a most effective remedy for this disease will be found in the near future. Further, when this antibiotic is given to close contacts immediate protection will be provided, whereas immunisation by vaccine takes some weeks to develop, (see graph page 51.) Smallpox. Localised attacks of smallpox occur from time to time. Only a very small proportion of the inhabitants of the Borough have any degree of immunity against the infection. During the years 1928 to 1934 (inclusive) a modified form called alastrim was responsible for 653 cases. This outbreak caused administrative anxiety and expense before it was controlled. Vaccination, if carried out properly and at appropriate intervals, is a means of protection of the individual and the community against this disease. Vaccination should be carried out in the first year of life, preferably between the ages of three and six months when severe reactions are very rare. The immunity obtained lasts for a period of seven to ten years and vaccination should be repeated at the age of ten years. Needless to state, all individuals who have been exposed to infection should be vaccinated or re-vaccinated unless a serious contra-indication exists. Leprosy. The Public Health (Leprosy) Regulations, 1951, came into operation on the 22nd June, 1951, and require every medical practitioner attending on or called in to visit a patient suffering from leprosy to send forthwith to the Chief Medical Officer of the Ministry of Health particulars of the case in a certificate prescribed in the Regulations. The mode of transmission of this disease is by intimate and long contact with infected individuals. Communicability occurs when lesions become open and leprosy bacilli are discharged. Food Poisoning. Under the Food and Drugs Act, 1938, it is the duty of a medical practitioner on becoming aware or suspecting that a patient whom he is attending is suffering from food poisoning to forthwith send particulars of the case to the Medical Officer of Health of the district in which the patient lives. On receipt of such a notification all necessary epidemiological enquiries are made without delay, such as the investigation of possible sources of infection, and steps are taken to prevent the spread of the disease and protect the health of the public. During recent years there has been a great increase in the number of recognised outbreaks of food poisoning and this increase is associated with communal feeding. The foods commonly associated with food poisoning are those which are handled during preparation and in which bacterial multiplication can readily take place. The general measures adopted for the prevention of outbreaks of food poisoning are to ensure that food intended for human consumption is not contaminated. There can be no hesitation in saying that food poisoning outbreaks are, for the most part, due either to raw materials infected by the faeces of animals containing salmonellae, to unsatisfactory methods of food preparation or to a disregard of elementary personal hygiene. The difficulties in preventing animal faecal excretors giving rise to salmonella infection in human beings are formidable. It is essential for attention to be paid to hygiene during and after the slaughter of food animals if these dangers are to be reduced. Those engaged in the catering trade are slowly beginning to realise that food prepared some time before it is eaten, allowed to cool slowly and then reheated to a moderate temperature before it is served, is a potential danger to the consumer. The education of food handlers in personal hygiene is essential. This not only applies to food traders but also to householders. In this connection Medical Officers of Health and Sanitary Inspectors can do much by personal propaganda. The provision of hot water, soap and towels for the use of food handlers and the washing of hands thoroughly after visits to the water closet, if carried out meticulously, will help to reduce outbreaks of food poisoning. The total number of outbreaks reported in Camberwell during the year was five, involving 16 cases (4 of which were not notified). Sporadic cases numbered 31. One of the outbreaks occurred among nurses in a hospital and the remaining 4 were family outbreaks. Table giving presumed causes:— Sporadic cases Family outbreaks Presumed cause Outbreaks Total 4 - - 4 Salm. typhi murium Other salmonellœ - - - - 1 Staphylococci - - 1 Cl. welchii - - - - Other organisms - 1 - 1 (faecal coli) - Chemical - - - - 27 3 Unknown - 30 4 1 Total 31 36 The hospital outbreak was suspected to be due to tinned luncheon meat which was made up into sandwiches for members of the nursing staff. The nurse who prepared the sandwiches ate some of the meat as soon as the cans were opened and became ill the same night; the evidence therefore pointed to contamination of the meat at the canning factory. Two of the sandwiches were submitted for bacteriological examination and yielded cultures of coagulase - positive staphylococcus aureus. In one of the family outbreaks various residual foods from the meal suspected to be the cause of the poisoning were sent to the bacteriologist who reported as follows:— Gravy and fat from cooked veal, Bisto and stewed apples No organisms isolated Custard Coli of fœcal type isolated Veal (raw) Hœmolytic Cl. welchii, fœcal coli Flour A late lactose fermenting variant of coli, non-positive polyvalent salmonella agglutinations It would appear therefore that the food was probably contaminated by the member of the family who prepared the food. In four of the sporadic cases Salmonella typhimurium was isolated from the patients. The causative agent was not discovered in any of the remaining cases although samples of suspected food and specimens mens of faeces and vomit were obtained wherever possible and submitted for bacteriological examination. POLIOMYELITIS AND POLIO ENCEPHALITIS IN CAMBERWELL. INCIDENCE, 1921-1951. 41 MEASLES IN CAMBERWELL. INCIDENCE, 1939 1951. (This Disease Was Made Notifiable oh 1st October, 1938.) 44 45 DYSENTERY IN CAMBERWELL. INCIDENCE, 1921-1951. 46 47s OPHTHALMIA NEONATORUM IN CAMBERWELL. INCIDENCE, 1921-1951. 49 50 WHOOPING COUGH IN CAMBERWELL. INCIDENCE, 1939-1951. (This Disease Was Made Notifiable from 1st October, 1938.) TUBERCULOSIS. In 1921 the Tuberculosis Services centred in the dispensary premises at No. 19 Brunswick Square, were taken over by the Borough Council and the administrative arrangements for the control of this disease municipally directed. On the 5th July, 1948, consequent upon the operation of the National Health Service Act, 1946, the responsibilities of the Tuberculosis Dispensary were transferred from the Borough Council to the London County Council, with the exception of the diagnosis and treatment of tuberculosis, which was delegated to the Regional Hospitals Board. Notification, statistics and disinfection remain the duty of the Camberwell Public Health Department. It cannot be said that the present "set-up" for tuberculosis control is satisfactory and it would seem that further consideration should be given to the steps necessary to eradicate this disease with its wide-spread incidence and high mortality. Tuberculosis remains a serious menace to public health. It affects largely those age groups which are of the greatest value to the productive capacity of the nation and has a serious influence on the industrial life of the population. Poverty, overcrowding, ignorance of elementary hygiene and absence of sun are recognised to be factors which play their part in the spread of the disease. The three main lines of attack in the fight against tuberculosis are (i) the early detection of cases, (ii) prompt treatment and (iii) the prevention of new cases. Mass radiography has led to the discovery and notification of new cases at an early stage of the disease. It is essential for all cases of pulmonary and non-pulmonary tuberculosis to be notified immediately on discovery so that action can be taken to reduce the spread of infection. This includes the careful and thorough instruction of all patients in precautionary measures not only when receiving sanatorium treatment but also in their homes. Tuberculosis arises by infection from already established cases. If patients were isolated or would obey the instructions they receive and contacts were protected in every possible way, progress in reducing the incidence of this disease would be accelerated. New antibiotic and chemotherapeutic agents have been employed with a certain amount of success in reducing the infectivity in advanced cases and in curing patients in the early stages of the disease. The introduction of B.C.G. vaccination into this country offers possibilities of immunising children and those in close contact with the disease, such as nurses in sanatoria and general hospitals. The part played by milk in giving rise to non-pulmonary cases of tuberculosis is well known. The introduction in 1951 of compulsory heat treatment of all milk sold in Camberwell will go a long way in the prevention of cases of non-respiratory forms of tuberculosis. The number of notifications of the disease is not an accurate reflection of its incidence; the mortality figures are the most reliable criterion of the trend of tuberculosis. During the present century there has been a considerable reduction in the tuberculosis mortality rate. The graphs on pages 54 and 55 show the annual morbidity and mortality since 1921. Three hundred new cases of tuberculosis were notified during the year 1951 as compared with 325 last year. Two hundred and seventy-four of these were respiratory and 26 nonrespiratory cases. TABLE SHOWING SEX AND AGE DISTRIBUTION OF ALL NEW CASES AND DEATHS FROM TUBERCULOSIS DURING 1951. New Cases.* Deaths.† Age Periods. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. Male. Female. Male. Female. - 0- 1 yr. - - 1 1 1 - - 1- 5 yrs. 11 9 - - - - - 1 1 5-15 „ 9 9 3 - - 2 1 15-25 „ 40 67 1 6 1 4 - - 2 25-35 „ 49 49 6 2 3 - - 5 35-45 „ 32 16 1 3 5 1 1 45-55 „ 36 7 2 1 8 3 - - 55-65 „ 31 3 - 2 9 3 1 1 2 65 and over 1 11 2 1 11 4 - 19 Totals 220 163 15 34 22 4 5 * 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. 54 55 TABLE SHOWING NOTIFICATION AND DEATHS, TOGETHER WITH THE ESTIMATED POPULATION 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. 356 2.0 135 0.7 1947 175,060 1948 ... 178,200 391 2.2 117 0.6 178,310 478 94 1949 2.7 0.5 325 1.8 178,900 64 0.3 1950 1.7 1951 179,500 300 65 0.3 TABLE SHOWING NUMBER OF CASES ON THE TUBERCULOSIS REGISTER AT THE END OF 1950 AND 1951. No. of Cases on the Register at 31st December, 1950. 1951. Male. Female. Total. Male. Female. Total. 992 836 Pulmonary 1,828 990 851 1,841 94 127 221 Non-Pulmonary 79 110 189 Total 1,086 963 2,049 1,069 961 2,030 Annual Report of the Camberwell Tuberculosis Care Committee for the year 1951. During the year changes took place in the membership of the Committee. Miss T. Renall, representing the Family Welfare Association, and Miss M. Wilson, representing the Divisional Health Committee of the London County Council, Division 7, resigned. Councillor Miss Rosina Whyatt was appointed to fill the vacancy as the representative of the Divisional Health Committee, L.C.C., Division 7, and the other vacancy was awaiting a nomination by the Family Welfare Association at the close of the year. The Committee found it necessary to appoint an Honorary Auditor, and is pleased to record that Mr. A. W. J. Lamb, Manager of Peckham Branch of Barclays Bank Ltd., undertook to carry out the duties of this office. The Committee learned with regret of the death of Mr. Alfred Perrum, who had, for many years, given much time in assisting in the clerical work entailed with the Christmas Seal Sale. The Committee extended its functions during the year. These now include the provision of financial and other assistance to patients, the raising of funds by voluntary subscriptions through the Christmas Seal Sale, the reference of cases to other bodies and organisations, generally to see that patients' needs were met where circumstances necessitated action, the handicraft class, and the additional item being the formation of a small library for the use of patients. As before, most of the cases which the Committee considered were referred to it by the medical staff and health visitors of the Chest Clinic. The Committee's work during the year 1951 is given in detail below. The Christmas Seal Sale, which continues to be supported mainly by the generosity of the citizens of Camberwell, was the chief source of income to the Committee's fund —which enabled them to continue the work of assistance to those who are in need. Once again Camberwell's collection in the Christmas Seal Sale for the year ended 31st March exceeded the sum collected by any other Metropolitan Borough. The London County Council made another contribution of £30 from the proceeds of Sunday cinematograph entertainments, for which the Committee are grateful. The Handicraft Class continued to meet every Friday afternoon. During the first six months there were 16 students on the Roll and the average attendance per session was 12. During the second half of the year the Roll increased to 18 students with an average attendance of 13. Eight students left the class during the year, four became fit for work, three moved from the Borough, and one took full-time training under the Government Training Scheme. During the early part of the year the women students expressed a wish to make underclothing and night attire, and to assist them in this work the Committee provided the class with an electric powered sewing machine With such assistance the women students have in a practical manner turned their wish into many garments and the work has been successful. The Committee, considered “music while you work” for the students and purchased a radio receiving set for use during the class sessions. It is pleasing to record that appreciation by the students was reported to the Committee. Many ex-students have maintained contact with the class by visiting occasionally when they are able to do so. The work carried out in the class included leather work, cane work, glove making, embroidery and needlework, dressmaking, sea grass stool making, silk lampshade making and knitting. The following table indicates the number of patients who have been assisted during the year and the type of assistance provided:— Assistance given. Number. Clothing 82 Pocket money while in hospital 10 Wireless: repair, rental and licences 6 Fares of relatives to distant sanatoria 45 Taxi fare 2 Holiday for patient 1 Household removals 3 Loan of bedside comforts 144 Loan of beds 54 Supply of bedding 53 Loan of jig-saw puzzles and books 287 Hire purchase payments 8 Purchase of a wringer 1 The National Assistance Board continued to give financial assistance in certain cases and, where circumstances permitted, were able to assist in purchasing clothing, paying fares and hire purchase payments. The secretary referred 122 patients to the Board for assistance. Close co-operation with the following voluntary organisations in the Borough continued: The British Bed Cross Society; Family Welfare Association; Legal Advice Bureau; nursing associations; Invalid Children's Aid Association; Soldiers', Sailors' and Airmen's Families Association; and the Women's Voluntary Services; such co-operation is appreciated. The official bodies have continued their help and advice, for which we thank them. We desire to place on record our thanks to the honorary officers: Mrs. Cecilia Greenwell, as Organiser of the Christmas Seal Sale; Mr. H. Smith, Borough Treasurer, as Treasurer; and Mr. A. W. J. Lamb, as Auditor. We also wish to thank Dr. H. W. Barnes, Medical Officer of Health, for including the Committee's Annual Report for 1950 in his Annual Report for the same year. J. M. LEONARD, Secretary. A. F. CROSSMAN, Chairman. HOUSING, 1922-52. The Borough of Camberwell is mainly residential. The Census of 1921 revealed that the population was 267,198 persons comprising 66,104 private families who occupied 41,419 structurally separate dwellings. The number of rooms occupied was 248,529 —an average of 3.75 rooms per family. These figures proved that there was a large number of houses originally constructed for one family then occupied by two or more families. The extent of overcrowding at the time is revealed by the following facts concerning density of occupation in Camberwell : — 1,587 families consisting of 2 persons living in 1 room 903 „ „ 3 „ 271 „ „ 4 „ 74 „ „ 5 „ „ „ 26 „ „ 6 „ 3,692 „ „ 2 „ „ 2 rooms 3,023 „ „ 3 „ 1,593 „ „ 4 „ 885 „ „ 5 „ 360 „ „ 6 „ The problem of overcrowding gave rise to considerable concern long before the first world war of 1914-18, and was due to a number of causes. These causes included the increased industrialisation of the Borough resulting in dwelling houses and parts of dwelling houses being replaced by factories and workshops; the continued annual increase of births over deaths; the limited number of houses erected annually; the stoppage of building during the years 1914 to 1918; and the inability of poor people with large families to pay an economic rent for suitable accommodation. In the Annual Report for 1922 attention was drawn to the seriousness of the far-reaching moral and physical effects of overcrowding and to the probability of that deplorable state of affairs continuing until the overcrowding of London was dealt with as a whole. In the 1924 Annual Report it was emphasised that the housing shortage constituted the most pressing public health problem of the day and until it was effectively dealt with, much of the expenditure entailed by the Public Health Department would fail to produce the best results. In the Annual Report for 1929, the suggestion was made that storey-dwellings type of accommodation at low rents should be provided in districts where there is an absence of suitable building sites, and that these blocks of dwellings should be of an improved standard with as many as possible of the domestic amenities of the small dwelling house. With the erection of accommodation within and outside London by the London County Council, overcrowding became less prevalent. Nevertheless, in 1930, 400 cases of overcrowding were known to the Public Health Department of Camberwell. The Census of 1931 showed that the population of the Borough had fallen from 267,198 at the enumeration of the previous Census in 1921 to 251,294, but the number of families had increased from 66,101 to 68,435. The number of dwellings occupied was 42,114 as compared with 41,419 at the Census enumeration in 1921. The number of rooms occupied as shown by the 1931 Census was 253,360 or 0.96 persons per room as compared with 259,591 occupying 248,529 rooms or 1.04 persons per room shown by the previous Census. The following table provides evidence of the improvement in the housing conditions of Camberwell at that time. Camberwell. London. 1931 1921 1931 1921 No. of private families with density of more than, two persons per room 4,029 5,149 89,600 110,495 Percentage to total private families 5-9 7-8 7-5 9-9 Population in such families 25,331 33,321 541,352 683,498 Percentage to total private family population 10.4 12.8 131 16.1 Prior to the operation of the Housing Act, 1935, which is consolidated in the Housing Act of 1936, it was customary to determine the existence of overcrowding by applying the standard required by the London County Council's bye-laws relating to houses divided into separate tenements. The action taken to abate overcrowding was as follows: — 1. Advice by the Sanitary Inspector as to re-arrangement of the sleeping accommodation of the families found to he overcrowded, so as to prevent the improper mixing of the sexes. 2. Recommendation to the London County Council for the provision of accommodation on one of that Authority's Housing Estates, where the financial circumstances of the families permitted. The Housing Act, 1935, provided the first general standard for determining whether or not a dwelling house was overcrowded, by fixing the maximum equivalent number of persons permitted to occupy a dwelling based on the number and floor areas of the rooms contained therein. The Act also placed on every local authority the duty of causing a survey of their district to be made with a view to ascertaining what dwelling houses therein were overcrowded. This survey which was completed early in 1936, involved visiting 38,490 structurally separate buildings. Of the 60,043 families occupying these premises, 2,950, or 4.91 per cent., were found to be overcrowded. Until the outbreak of war in 1939, a considerable amount of accommodation was provided by the London County Council for the abatement of overcrowding. During the war, 5,705 Camberwell dwellings were destroyed and approximately 8,000 families were rendered homeless. With the cessation of hostilities and the return of the Forces to civilian life, many premises became overcrowded. The post-war resumption of building has to a certain extent alleviated the position. At 31st December, 1951, there were 621 dwellings in the Borough which were known to be overcrowded. The Census of 1951, when the details are available, will enable an accurate figure to be provided. In the meantime, owing to the shortage of housing accommodation, the Council has refrained from rigidly enforcing the overcrowding provisions of the Housing Act, 1936. The first world war, 1914 to 1918, was responsible for serious deterioration of many dwelling houses in the Borough. It was not until some years afterwards, when labour and material became available, that it was possible for the general standard of fitness to be improved. Unfortunately, at that time, in some parts of the Borough could be found a number of houses which were old and worn out, having come to the end of their useful life. It is interesting to quote the following extract from the Annual Report for the year 1925 : — “These old houses have deteriorated rapidly since the war owing to abnormal wear and tear, and are now in such a state, due to the lack of proper damp-proof courses, bulging masonry, settlements and grave sanitary defects, as to be insanitary. They have arrived at such a condition that no repairs can render them fit for human habitation. Overcrowding is prevalent in these houses, and they are peopled by types of tenants who are not desirous of leaving the neighbourhood. “There is no doubt in my mind that houses of this kind will have to be replaced by tenement buildings of the most modern type. It is true that small houses with gardens are much to be preferred, but it is not possible to provide these amenities in some of the Metropolitan Boroughs. “It is difficult to say how far defects are due to the lack of proper management and supervision by owners, or to the acts of waste and neglect by the tenant. In the same way as there are bad landlords who neglect their property and who are the cause of much worry to the Health Department, so there are bad tenants who pay no regard to preserving the property. Each type is known, and on the whole it may be said that both get their deserts." This type of house requires the constant vigilance of the Sanitary Inspector to maintain it in a reasonable state of repair and cleanliness. The following table gives particulars relating to the approximate number, age and general soundness of the types of dwelling houses existing in the Borough in 1930: — HOUSING—SUMMARY OF DWELLING HOUSES, SHOWING AGE, TYPE AND CONDITION, ETC., IN 1930. Approx. number of dwelling houses exclusive of shop premises 41,335 Types occupied by Residential and higher paid technical and clerical workers Artisans and others 26,216 15,119 Approximate age of types of dwelling houses Under 50 years Between 50-100 years Over 100 years 29,429 8,737 3,169 Physical condition Insanitary old & almost worn-out properties Structurally sound properties 1,371 39,964 Approx. number of known cases of overcrowding 413 Approx. number of premises without internal water supply 378 Approx. number of premises using W.C.s in common with other houses 52 Approx. number of houses with basement rooms 5,137 Slum Clearance. Following the first world war, the condition of unsatisfactory houses, in many cases constituting slums, began to be realised by the Government, and legislation was introduced to do away with them and to rehouse the residents in healthier conditions. As a result, in 1922 various unhealthy areas were inspected by the Medical Officer of Health. Five of these areas were represented to the Council who submitted a scheme to the Minister of Health which embraced those areas and they were the subject of a local enquiry by the Ministry of Health in 1923. All the areas were condemned as unfit for human habitation, viz.:— Woodland Cottages 10 houses Tiger Yard 17 houses Joiner's Arms Yard 6 houses *Mayhew's Buildings 14 houses Levant Street Island site 18 houses Total 65 houses occupied by 341 working-class — persons. * Subsequently included in the Wyndham Road Area Improvement Scheme. The Minister refused to pass the schemes as drafted and stipulated that alternative accommodation should be provided in new buildings for the persons to be displaced. Unfortunately, the areas in question were quite unsuitable for the erection of new dwelling houses. Eventually, those families who were living in these areas were rehoused under an arrangement which was entered into with the London County Council whereby this Council agreed to pay a fixed annual sum for forty years in respect of every dwelling which the London County Council provided to rehouse persons displaced as the result of slum clearance operations by this Council. In 1924, the London County Council decided, following a request by the Camberwell Borough Council, to effect an improvement scheme in the Wyndham Road Area under Part I of the Housing of the Working Classes Act, 1890. In the past, difficulty had been experienced in dealing with insanitary areas owing to the impossibility of providing suitable alternative accommodation for the persons who would be displaced. To overcome this difficulty, the London County Council in their scheme provided for the acquisition of an additional four acres of adjacent lands and premises. The total number of acres of the site to be cleared for rehousing purposes was thus increased to seven. The following table shows the number of houses in the insanitary areas represented by me to the London County Council, the number of families and persons living in the houses in these areas, and the number of houses, families and persons living in the adjacent area of four acres acquired by the London County Council for the provision of accommodation for the persons displaced. In this scheme arrangements were made for the accommodation of 2,020 persons in six blocks of buildings. No. of Houses No. of Families No. of Persons "A" Insanitary Area: 3 Acres— Bowyer Street 14 14 92 6 7 28 Crown Street 45 Mayhews Buildings 12 12 38 38 168 Wyndham Road 9 12 42 Pinto Place 17 68 Pallador Place 11 4 4 15 Comber Grove Totals 84 104 458 “B” Area to be Acquired: 4 Acres — Comber Grove 39 80 254 23 3 5 3 5 19 Blucher Road Aliens Cottages 296 Totals 45 90 Grand Totals 129 194 754 By an Order, dated. 2nd May, 1927, the Minister of Health confirmed this scheme with modifications. In 1926 a representation was made to the London County Council pursuant to the provisions of Section 35 of the Housing Act 1925, for an improvement scheme embodying the unhealthy sites known as Basing Place and Blue Anchor Lane areas. The London County Council submitted an improvement scheme which provided for the rehousing in the Blue Anchor Lane area of a number of persons not fewer than the number to be displaced under the scheme. The Minister of Health, after holding a public local enquiry sanctioned the scheme, with certain modifications, by an Order dated 23rd September, 1927. The number of houses, families and. persons living m these two insanitary areas are shown in the following table:- No. of Families No. of Persons No. of Houses 48 61 248 Basing Place area 510 Blue Anchor Lane area 77 121 In 1934, the Council resolved to deal with small insanitary areas in the Borough and arrangements were made for the Lon- don County Council to provide rehousing accommodation for the persons displaced by the housing operations of the Council. In the year 1935 an intensive effort was made to deal with the insanitary areas in the Borough in conjunction with the London County Council. Twenty-seven areas were declared by the Camberwell Borough Council to be clearance areas. One hundred and ninety-two dwelling houses were involved, occupied by 831 persons. In 1936 a further 18 areas, comprising 140 dwelling houses, and involving the displacement of 550 persons were declared. The year 1937 saw a further 9 areas declared as insanitary—89 dwelling houses occupied by 413 persons. At the end of 1937, a report was submitted, to the Council informing them that the clearance programme of insanitary areas mutually agreed upon with the London County Council had been completed and the Council was asked to review the question of clearance operations in the Borough, with a view of sanctioning the preparation of a further insanitary areas programme involving 125 dwelling houses to be dealt with under the provisions of Section 25 of the Housing Act, 1936 in the next five wars. During 1937, five unhealthy areas, comprising 55 dwelling houses and involving the displacement of 221 persons were declared by the Council to be Clearance Areas. During the years 1934 to 1938, the London County Council had, in addition to the Borough programme, declared 12 areas as Clearance Areas. These areas involved 1,111 houses and the displacement of 5,215 persons. It can be stated without fear of contradiction that, by 1938, the majority of the slums in Camberwell had been dealt with. In 1939 the threat of the second world war prevented further insanitary area activities. At the end of the war in 1945, housing activities were reviewed and it was realised that it would not be possible to recommence the clearance area programme for some years to come. In 1949 the question of the resumption of slum clearance was given further consideration. As a result of a conference with the London County Council, a post-war slum clearance scheme for the next five years was decided upon in 1951. This programme, however, did not provide for the representation of any areas by this Council during 1951. At the end of this five-year programme, operations should continue until a standard is reached below which a dwelling can be said to be unfit no longer exists. It is impossible to prepare a clearance area programme which on completion would dispose of every unfit house in the Borough. Sufficiency of Supply of Houses. Previous to the second world war there was a considerable body of opinion who held that the London County Council was in the best position to visualise the housing situation of London as a whole, and that the most satisfactory method of dealing with the conditions existing in the Metropolitan area was to regard the problem as a matter to be considered and dealt with by treating the County of London as a single unit. The majority of the Metropolitan Boroughs are entirely built up, and the few that are not, have comparatively little vacant land left for building purposes. The view was taken that to provide additional housing accommodation, the acquisition of properties with large gardens and. the replacement of existing houses by the erection of blocks of tenement buildings on the land on which they stood was the solution in Camberwell for a further supply of dwellings. The London County Council appeared to have shared this view as they acquired 25½ acres and erected accommodation consisting of 1,173 dwellings. At the same time, houses were being erected privately for sale. Unfortunately, this rate of progress in house-building came to an abrupt end when war was declared in 1939. With the easing of the position with regard to building materials and labour after the war, the erection of new accommodation was re-commenced in 1947. The number of dwellings erected in Camberwell at 31st December, 1951, was 2,635, of which 2,098 had been built by the London County Council and 537 by the Borough Council. In addition, 1,131 prefabricated bungalows had been erected and 238 war-destroyed dwellings re-built. Additional dwellings are in the course of erection and if no further war holds up building activities, it is certain that, with the assistance of the Town Planning Scheme, Camberwell families will have far healthier conditions in which to live than they had in the years 1922 to 1952. The only criticism that may be made is that necessity will compel them to live in modern flats instead of houses with gardens. Individual Unfit Houses and Parts of Premises. From the commencement of Housing Act activities by this Council to 31st December, 1951, the following action was taken in respect of individual unfit houses and parts of premises which were not capable of being rendered fit for human habitation at a reasonable expense:— Individual unfit houses not repairable at reasonable expense:— (a) Demolition Orders made ... ... ... 28 (b) Undertakings accepted:— (i) not to use for habitation 9 (ii) to render fit 19 28 Parts of premises unfit for habitation but not capable of being rendered fit at reasonable expense: — (a) Closing Orders made 25 (b) Undertakings accepted: — (i) not to use for habitation 9 (ii) to render fit 4 13 Underground Rooms. In the year 1934 a survey carried out by the Sanitary Inspectors revealed that there were 5,273 underground rooms in the Borough used for living and/or sleeping purposes. In 557 instances the height of the rooms was less than 7 feet. Prior to the passing of the 1935 Act, action could only be taken in respect of those underground rooms which were used for sleeping purposes. Up to 31st December, 1951, Closing Orders had been made by the Council in respect of 98 underground rooms. (Two of these prohibited the use of the rooms for sleeping purposes only.) Undertakings were accepted in 10 instances not to use the rooms for human habitation and in 38 instances to render the rooms fit. In addition, 51 underground rooms were rendered fit as the result of informal action by the Public Health Department. Regulations relating to underground rooms were made by the Council in August, 1939 but, owing to the war, action under these Regulations was not taken until 1946. Housing Acts, 1936-1949. Record of Work carried out during 1951 by the Council's Housing Inspector. Inspections Re-Inspections Total 86 56 142 Clearance areas Individual unfit houses— Section 9 355 386 31 21 141 162 Section 11 Underground rooms and parts of Premises Section 12 102 391 493 Miscellaneous 181 - 181 943 421 1,364 Total Housing Statistics, 1951. 1. Inspection of Dwelling Houses during the Year:— (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 7,114 (b) Number of inspections made for the purpose 29,754 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 5,556 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 341 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 ... 2,123 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 3,482 (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 14 Formal Notices 12 (2) Number of dwelling-houses which were rendered fit after service of:— (i) Informal Notices 4 (ii) Formal Notices 13 (ii) (a) By owners 11 (b) By Local Authority in default of owners 2 (c) Proceedings under Section 11 of the Housing Act, 1936:- Number of dwelling-houses not capable of repair at reasonable expense:- (a) In respect of which demolition orders were made Nil (b) In respect of which undertakings to render house fit for human habitation were accepted 3 (c) Number of houses demolished 1 (d) Number of houses made fit 6 (e) In respect of which undertakings not to use for habitation were accepted 1 (d) 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 25 (b) in respect of which undertakings not to use for habitation were accepted Nil Nil (c) in respect of which undertakings to make fit were accepted 5 (2) Number of separate tenements or underground rooms, in respect of which Closing Orders were determined, the tenement or room having been rendered fit 2 (e) Proceedings under Section 25 of the Housing Act. 1936:— Houses demolished 16 Rehousing Applications. All applications for the provision of alternative housing accommodation which are supported by a medical certificate from the applicant's doctor are referred to the Medical Officer of Health for his recommendation as to whether or not additional points should be awarded on health grounds. Four hundred and seventy cases were dealt with in this way during 1951. In addition, certificates of overcrowding were forwarded to both the Director of Housing and Valuer, London County Council, and to this Council's Housing Department in respect of 171 applications for rehousing. Rent and Mortgage Interest (Restrictions) Act. Fifty-one certificates of disrepair under the above Act were issued during the year at the request of tenants of dwelling houses in the Borough. Common Lodging House. There is only one common lodging house in the Borough which is situated at 124 Camberwell Road, and licensed to accommodate 224 male persons. The district sanitary inspector paid 52 visits of inspection to this establishment during the year. At the beginning of the year the owners asked the Council if they would be willing to arrange for the Disinfecting Staff to spray the premises regularly every month as a preventive measure, on payment of an agreed sum. The Public Health Committee agreed to provide this service at a charge of 30s. per month. This lodging house is well conducted and is at all times kept in a satisfactory state of repair and cleanliness. FOOD AND DRUGS ADULTERATION. During the past thirty years, the frequent introduction of new legislation has assisted the Public Health Department in its unremitting efforts to effect improvements in the conditions under which food and drugs are prepared and sold, with the result that many striking changes have taken place. The trend to-day is for manufacturers and suppliers of foodstuffs to eliminate as much as possible the manual handling of their products. This has helped to produce a cleaner, more wholesome and less easily adulterated commodity. For example, the changes that have taken place in the milk trade with consequent improvement in both purity and quality, have been revolutionary. In 1922 it was the practice for milkmen in the Borough to receive milk in bulk. A churn was placed on a milk-float or barrow and taken on the “round”; customers being served from a hand-can which was filled from the churn in the public thoroughfare. Some customers had their milk poured into jugs which were not infrequently left on the doorstep overnight; others made use of a milk-can, fitted with a hinged lid. This was one of the earliest types of milk container, and was later replaced by the glass bottle and waxed cardboard carton (the latter has fallen into disuse for economic reasons). The milkfloat with churn, hand-can, counter-pan and other unhygienic methods of milk distribution, have now been entirely eliminated in Camberwell. Most milk is bottled at the pasteurising plants or, in the case of raw designated milk, on the farms, and there are few milkmen in the Borough still bottling milk on their premises. Under the provisions of the Milk and Dairies Order, 1949, from 1st October, 1954, all milk will be bottled at the pasteurising plants. Considerable improvements have also been effected in controlling the quality of food products. Statutory standards have been laid down for the composition of many foods. Legislation has been established to ensure proper labelling and to prohibit the use of false or misleading descriptions. Consequent amendments have, therefore, been rendered necessary in the principles and methods of sampling to ensure compliance with legal requirements. The purpose of sampling to-day is not so much for the detection of fraudulent adulteration, but to ascertain whether the statutory standards of composition and purity are being maintained. Whilst close supervision is still given to the chemical composition of all foods, more and more attention is being paid to sampling for bacteriological examination. In an area so large as Camberwell, the employment of a whole-time Sampling Officer is essential. Close co-operation and personal contact with the Public Analyst has enabled the Sampling Officer to select which samples should be purchased. Experience over a number of years has shown that the number of prosecutions of offenders against the Food and Drugs Act and other relevant legislation is not a satisfactory way of judging the administration which has for its purpose the prevention of substitutions which may be fraudulent or injurious, to health. Cautions to vendors have been proved to be extremely useful, especially in relation to retailers who have committed technical offences. On the other hand, prosecutions for fraudulent adulteration, such as the addition of water to milk, are always necessary and are the result of consideration by the Public Health Committee. Approximately 55 samples are examined annually for each 10,000 of the population. In 1922,1,069 samples were examined by the Analyst. Of these, 665 were milk and the percentage not genuine was 1.95. In samples other than milk, the percentage not genuine was 4.58. In 1951, 1,000 samples were examined, including 341 of milk. The percentage of milk samples reported against was 1.17 and samples other than milk 6.2. The following table summarises the results of the examination of samples taken during 1951:— Number examined. Number adulterated, etc. Percentage of adulteration. Formal. Informal. Total. Formal. Informal. Total. Formal. Informal. 400 600 1,000 18 27 45 4.5 4.5 Details of the adulterated samples, action taken and results of legal proceedings will be found on pages 72-75. 72 73 Serial No. Whether Formal or Informal. Result of Proceedings or other Action taken. Article. Nature of Adulteration or Irregularity. Observations. 10 Beef sausages 14 per cent, deficient in meat. Formal - Summons: —£3 fine, £1 1s. costs. - Bread Complaint sample Loaf contained flour bag label. Reported to Public Health Committee and cautionary letter sent. - 24 White pepper Formal Contained 2 per cent, maize starch. Summons: —£4 fine, £2 2s. costs. - - Bread Complaint sample Loaf contained portion of glass. Reported to Public Health Committee; no action taken. - 26 Milk Formal Contained mycelium and spores of a mould. Summons:—£7 fine, £6 6s. coats. - Reported to Public Health Committee and cautionary letter sent. Bread Complaint sample Loaf contained a cigarette end. - - 49 White pepper Formal Contained 5 per cent, starch foreign to pepper. Summons:—£5 fine, £7 7s. costs. - 51 White pepper Informal Contained 30 per cent, starch foreign to pepper. - See formal sample No. 49. 125 White pepper Informal Contained 50 per cent, starch foreign to pepper. This informal sample followed formal sample No. 49; on further formal visits all pepper in stock was found to be on sale as Pepper Compound. - Lincoln Cream Biscuits Informal Biscuits had an objectionable taste and showed evidence of rancidity. 156 Remainder of stock surrendered and destroyed. - Remainder of stock surrendered and destroyed. 171 Canned corned beef Informal Unpleasant odour, contained 7 parts per million lead. - 173 Ice cream Informal Contained 2.1 per cent. fat. Formal samples taken and found to be satisfactory. - 175 Pork sausages Informal 23 per cent.deficient in meat. Formal samples taken and found to be satisfactory. 179 Ice cream Formal Contained only 0.1 per cent. fat. - Purchased from shop") Reported to Public Health Committee and cautionary letter sent. 180 Ice cream Formal Contained only 0.1 per cent. fat. Purchased from same vendor as No. 179 from barrow in public park. Milk Formal Bottle contained moulds. 187 Reported to Public Heatlh Committee and cautionary letter sent. Pork sausages Formal 13 per cent, deficient in meat. - 188 - Summons £2 fine, £2 2s. costs. 189 Pork sausage meat Formal 15 per cent, deficient in meat. Summons: —£2 fine, £2 2s. costs. 190 Pork sausages Formal Contained 200 parts sulphur dioxide per million. - Sausages sold with no notice that they contained preservatives. Reported to Public Health Committee and cautionary letter sent. Milk Complaint Sample Milk sold in a dirty bottle. - Reported to Public Health Committee and cautionary letter sent. - 210 Milk Formal 3.3 per cent, deficient in fat. Reported to Public Health Committee and cautionary letter sent. - Milk Formal 214 Contained mould mycelium, and spores. Reported to Public Health Committee and cautionary letter sent. - 220 White pepper Formal Contained 80 per cent, wheat flour. Summons: —£10 10s. fine, £5 5s. costs. - 233 White pepper Formal Contained 75 per cent, wheat flour. Summons:—£6 6s. fine, £2 2s. costs. - 74 75 Result of Proceedings or other Action taken. Article. Whether Formal, or Informal. Serial No. Nature of Adulteration or Irregularity. Observations. Pork sausages ... Informal 22 per cent, deficient in meat. 239 - Formal samples taken and found to be satisfactory. 241 Pork sausages Informal 40 per cent. deficient in meat. Formal samples taken and found to be satisfactory. 241 Ice cream Formal Contained only 3.4 per cent. fat. - Reported to Public Health Committee and cautionary letter sent. - Preserved beef sausages. Formal Contained 540 parts per million of sulphur dioxide. 243 Reported to Public Health Committee and cautionary letter sent. - 257 Ice cream Informal Contained only 0.2 per cent. fat. See formal samples Nos. 179 and 180. - Pork sausages Informal 20 per cent, deficient in meat. 265 See formal samples Nos. 188 and 189. - Pork sausages Informal 20 per cent, deficient in meat. 268 See formal sample No. 190. - Ammoniated tincture of quinine. 22 per cent, deficient in ammonia. 286 Formal Reported to Public Health Committee and cautionary letter sent. - 291 Ice cream Informal Contained only 1.5 per cent. fat. - See formal sample No. 241. Ice cream Contained only 1.5 per cent. fat. 312 Informal Formal sample taken and found to be satisfactory. 312 Ammoniated tincture of ammonia. Formal 80 per cent, deficient in ammonia. - Summons: —£3 5s. fine, £3 3s. costs. - Formal samples taken and found to be satisfactory. 319 Pork sausages Informal... 10 per cent, deficient in meat. - 322 White pepper Informal Contained 75 per cent, wheat flour. See formal sample No. 210. - Pork sausages Informal Contained 840 parts per million of sulphur dioxide. 339 See formal sample No. 243. - Pork sausages Contained 800 parts per million of sulphur dioxide. 341 Informal Formal samples taken and found to be satisfactory. - White pepper Informal Contained 75 per cent, wheat flour. 353 - See formal sample No. 233. Ammoniated tincture of quinine. Informal 22 per cent, deficient in ammonia. 406 See formal sample No. 286. - Pearl barley Informal 419 Contained acari. Remainder of stock surrendered and destroyed. Pearl barley Informal Contained acari and a beetle. - 434 Remainder of stock sold as chicken food. Pearl barley Informal Contained acari. - 441 Remainder of stock surrendered and destroyed. 451 Ammoniated tincture of quinine. Informal 28 per cent, deficient in ammonia. - See formal sample No. 312. - Pork sausages Informal 23 per cent, deficient in meat. 520 Formal samples taken and found to be satisfactory. 552 Pearl barley Informal Contained acari. - Remainder of stock withdrawn from sale. Informal Consisted of ammoniated tincture of quinine. - 558 Quinine Chemist interviewed, and steps taken to prevent similar occurrence. Due to error on part of chemist's assistant in labelling Informal Contained mouse droppings. tant in labelling. Reported to Public Health Committee and cautionary letter sent. Tapioca 578 Milk. The following table shows the number of premises on the Dairies and Milkshops Register at the end of the year:— Dairies 27 Distributors of Milk in the Borough 170 Distributors of Milk dealing from premises outside the Borough 12 Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. No pasteurising or sterilising of milk is carried on in the Borough, but the numbers of licences issued during the year in respect of the sale of designated milk were as follows:— Type of Licence. Sterilised. Pasteurised. Tuberculin Tested. Dealers 132 103 64 Supplementary 20 22 20 Total 152 125 84 The following table gives details of the various tests carried out during 1951 on samples of special designated milk:— Methylene Blue Test. Phosphatase Test. Turbidity Test. Designation. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. Satisfactory. Unsatisfactory. 114 Pasteurised 5 115 1 - - Tuberculin tested pasteurised 35 1 31 - - - Sterilised - - - - 33 - Supply of Milk to Schools and Hospitals. During the year 36 samples of milk were taken from hospitals and 39 from schools in the Borough. These were submitted both to the Methylene Blue and Phosphatase Tests. All were satisfactory, with the exception of one school sample that failed to comply with the Methylene Blue test. Biological Examination of Milk. Seven samples of Tuberculin Tested (Raw) Milk and 10 samples of Tuberculin Tested (Pasteurised) Milk were taken during the year for biological examination. In no case was tubercle bacilli found on direct examination and the guinea-pig inoculation tests all proved negative. Bacteriological Examination of Food. During the year 12 samples of fish cakes were taken, some at the factory where they were manufactured and some from shops where they were exposed for sale. All were examined for the presence of Cl. Welchii hut in no case was this isolated. Samples of canned corned beef (1), cream substitute (3), synthetic cream (3), jellied veal (1), luncheon meat (2), custard (1), gravy powder (1), stewed apples (1), veal (raw) (1), flour (1) and drinking water (1) were examined and found to be satisfactory. Following a case of food poisoning, two samples of canned corned beef were obtained for examination. One sample produced cultures of coagulase positive staphylococcus aureus; the other sample gave a growth of coagulase-positive staphylococcus aureus, and anaerobic cultures produced non-haemolytic Cl. Welchii. Coagulase-positive staphylococci are a not uncommon cause of food poisoning, and Cl. Welchii is also sometimes thus incriminated. Small pieces of rather dirty-looking fibrous material were embedded in the surface of the second sample: this appeared to be some kind of cloth wrapping, presumably used before the meat was canned. As these samples had been taken from corned beef which had been removed from tins and handled by the butcher, it was decided to obtain an unopened tin of the same brand. A 6-lb. tin was submitted for examination, but all cultures from this sample, both aerobic and anaerobic, remained sterile after prolonged incubation. Particulars of the results of these examinations were forwarded to the Ministry of Food. Ice Cream. During 1951, the Sampling Officer obtained 79 samples of ice cream and 10 samples of water ices for submission to the Methylene Blue Test. In addition, 39 samples of ice cream and 2 of water ices were sent to the Public Analyst for chemical analysis. Details of the results of these examinations are as follows:— Methylene Blue Test. Water Ice Lollies. Grade. Ice Cream. 1 53 8 2 13 - 3 10 - 4 2 - Test not carried out owing to colour of sample 1 2 Total Samples 79 10 77 In addition to the above one sample of a “Milk Lolly” was taken, but owing to the colour of the sample it was not possible to carry out the test. Chemical Analysis. Formal Samples. No. adulterated, etc. Informal Samples. No. adulterated, etc. Ice cream 6 3 26 4 - - Water ices - 2 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES. Registration of Food Premises. The premises in Camberwell at the end of the year which were registered with the local authority in accordance with the requirements of Section 14 of the Food and Drugs Act, 1938, were as follows: — Sale, manufacture or storage of ice cream 388 Manufacture of sausages 143 Preparation or manufacture of: — Potted, pressed, pickled or preserved meat 222 Potted, pickled or preserved fish 101 Potted, pickled or preserved other foods 36 Supervision of Food Premises. The following table shows the numbers of visits of inspections paid during the year by the district sanitary inspectors to premises where food is manufactured, stored or sold: — Type of Premises. No. of Inspections. Bakehouses 77 77 Bakers and Confectioners 80 Butchers 41 Cooked and Preserved Meat Shops 39 Dairies and Milkshops 111 Fishmongers and Shell Fish Vendors 58 Fish Fryers 67 Fish Curers 184 Food Factories 32 Ice Cream vendors 438 Public Houses 46 Restaurants and Eating Houses 477 Slaughterhouses 16 Street Markets 1,152 Street Traders Food Stores 19 Other Food Premises 1,909 Total 4,846 Unsound Food. The services of the Food Inspector are available for any trader who has any food which is suspected to be unfit for human consumption. If the food concerned is condemned by the Food Inspector, it is surrendered and a condemnation certificate is issued. The number of certificates of condemnation issued by the Food Inspector during 1951 numbered 3,052 and involved the following foods: — 80 Ham (cut) 0 0 3 7½ Ham 2 2 1 11 Canned Foods. 1 4 1 16½ Prunes 0 0 1 2 Dates 0 0 1 12½ Figs ... ... ... ... ... 0 3 0 10 Coconut (desiccated) 0 5 0 20 Raisins 0 5 2 15 Apples 0 7 0 16 Fruits (frosted) 0 2 2 25 Fruit. 0 15 3 0 Prawns 0 0 0 15½ Dover soles 0 0 1 0 Herrings (Fresh) 0 0 1 14 Lobster (frosted) 0 0 2 0 Shrimps (frosted) 0 0 2 0 Cod 0 0 2 0 Cod fillets 0 0 2 14 Haddocks (Smoked) 0 0 3 0 Plaice 0 0 3 14 Cod roes 0 1 1 1½ Cuttings 0 1 2 0 Kippers 0 1 0 14 Skate 0 2 3 4 Rock Salmon 0 4 2 7 Fish. Rabbits 0 0 0 6¾ 0 0 2 27½ Turkey (1) 0 0 0 7½ Chickens (28) 0 0 2 20 Poultry. 1 13 0 11½ Sausages 0 0 0 10 Pork 0 0 1 7¼ Offal 0 0 1 8¼ Calf 0 0 1 9½ Bacon 0 0 1 14½ Ox cheeks 0 1 0 13 Pork (sides) 0 5 1 15 Sheep's heads 0 5 3 9 Pig's carcases 0 5 3 6 Corned beef 0 6 0 1½ Butcher's meat 0 7 2 Meat. Description. lbs_ qis. cwt. Tons Total Weight. lbs. qrs. cwt. Tons Weight. Description. Weight. Tons cwt. qrs. lbs. Total Weight. Tons cwt. qrs. lbs Meat (various) 1 4 2 19¼ Vegetables 2 14 1 15¼ Fruit 6 4 1 24 Milk (evaporated and condensed) 1 8 2 3 Fish 1 0 3 5½ Jam (various) 0 1 2 26½ Marmalade 0 1 0 23¾ Miscellaneous. Milk powder, preserved fruits, biscuits (asstd.), cooking powders, sauces, flour, cheese, eggs, liquid eggs, dripping, salad cream, confectionery, jams (various), pickles, margarine, coconut butter, butter beans, pearl barley, macaroni and various other foods 6 10 1 17½ Gross Weight 25 3 1 19½ Food Inspection. The following is a summary of the work of the Food Inspector during the year:— Complaints received 30 Complaints found to be justified 18 Visits:— Fish curers 149 Fish fryers 13 Ice cream premises 194 Restaurants and eating houses 134 Slaughterhouses 16 Street markets 1,121 Food control 311 Other food premises 1,418 Merchandise Marks Act 100 Inspections not defined 218 Re-inspections 17 Slaughterhouses:— Carcases inspected 27 Carcases condemned 8 Organs inspected 154 Organs condemned 48 Food surrendered 652 Foodstuffs certified for export 3 Food condemnation certificates issued 3,052 Slaughterhouses. There are three licensed slaughterhouses in the Borough, only one of which was in use during the year. Details of the animals slaughtered are set out in the following table which is in the form laid down in Ministry of Health Circular 42/51: — 14 18 3 23¾ Carcases Inspected and Condemned. Cattle, excluding Cows. Cows. Sheep and Lambs. Pigs. Calves. Number killed Nil Nil Nil Nil 27 Number inspected - - 27 - - 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 - - - - 7.4 Tuberculosis only. f Whole carcases condemned - - - - 5 Carcases of which some part or organ was condemned - 1 - - - Percentage of the number inspected affected with tuberculosis - - - - 22.2 Merchandise Marks Act, 1926. The Orders in Council made under the provisions of the above Act require that all imported food sold or exposed for sale should bear an indication of the country of origin. It did not become necessary to take action against any trader during the year for contravention of this legislation. Bakehouses. There were 79 bakehouses in the Borough at 31st December, 1951, and of these 12 were underground bakehouses. The district sanitary inspectors supervised these premises and where necessary, action was taken to ensure that they were kept in a satisfactory condition. Restaurants and Eating Houses. At the end of the year, the register of eating houses com prised 322 premises. These were visited by the district sanitary inspectors to ensure that they were kept in a clean condition and that hygienic practices were being observed in the preparation, cooking and serving of the food. The number of such establishments has increased considerably during the past few years and in order that the register may be kept up to date the district office of the Ministry of Food sends information to the Public Health Department of all premises for which catering liceaces are issued. In any instance where the premises have not been previously used as an eating house a report is forwarded to the Ministry as to their suitability for this purpose, prior to the issue of a licence. Street Traders. The Council issued 80 street trading licences during the year in respect of the sale of foodstuffs from barrows and stalls. Frequent inspections were made of the street markets and the premises used by the traders for storage purposes were also kept under supervision. INDEX PAGE Aged Persons 20 Bakehouses 82 Births 6 Bombed Sites 14 Cancer, Deaths from 10 Cleansing Station 22 Common Lodging House 69 Deaths 8 - 12 Cancer 10 Chief Causes 10 Infant Mortality 10 - 11 Maternal Mortality 11 - 12 Table of Causes and Ages 8 - 10 Table of Rates 8 Diphtheria and Immunisation 36, 49 - 50 Disinfecting and Cleansing Station 22 Disinfection, Return of Work 22 Drainage and Sewerage 13 Dysentery 35, 46 Eating Houses and Restaurants 82 Factories Act 18 - 19 Inspection Tables 18 - 19 Outworkers 19 Food and Drugs Adulteration 70 - 78 Bacteriological Examination 77 Ice Cream 77 Milk 71,76,78 Table of Adulterated Samples 72 - 75 Food and Food Premises 79 - 83 Bakehouses ... ... ... ... ... ... ... ... 82 Carcases inspected, Table ... ... ... ... ... ... 82 Merchandise Marks Act 82 Registration of food premises 79 Restaurants and Eating Houses 82 Slaughterhouses 81 Street Traders 83 Supervision of food premises 79 Unsound food 79 - 81 Work of Food Inspector, Table 81 INDEX—continued. PAGE Food Poisoning 38 - 40 Head Lice Infestation 21 Health Education 29 Health Services, General provision 20 - 30 Housing 59 - 69 Applications for rehousing 68 Common Lodging House 69 Individual Unfit Houses, etc. 66 Rent and Mortgage Interest (Restrictions) Act 69 Slum Clearance 63 Statistics 67 - 68 Sufficiency of Supply of Houses 65 Underground Rooms 67 Work of Housing Inspector, Table 67 Ice Cream 77 Infant Mortality 10 - 11 Infectious Diseases 31 - 58 Graphs showing incidence of various diseases 41 - 51 Table of Notifiable diseases 31 Table of Notifications 32 Leprosy 38 Maternal Mortality 11 - 12 Measles 34, 43 Meningococcal Infection 34, 42 Merchandise Marks Act 82 Milk 71,76 78 Biological Examination 76 Special Designation, etc. Regulations 76 Supply to Schools and Hospitals 76 Noise Nuisances 15 Offensive Trades 16 Ophthalmia Neonatorum 36, 48 Outworkers 19 Paratyphoid fever 35, 44 Personal Health Services 30 Pharmacy and Poisons Act 16 Pig-keeping 14 Pneumonia 35, 45 Poliomyelitis 34, 41 Population 6 Public Cleansing 13 INDEX—continued. PAGE Publicity on Health Matters 29 Rag and Bone Dealers 16 Rag Flock, etc. 15 Rent and Mortgage Interest (Restrictions) Act 69 Restaurants and Eating Houses 82 Rodent Control 23 - 28 Sanitary Circumstances of the Area 13 - 19 Sanitary Inspection 17 - 19 Inspections 17 Notices served 18 Work supervised etc. 17 - 18 Scabies 22 Scarlet Fever 36, 47 Sewerage and Drainage 13 Shops Act 16 Skin Dressers ... ... ... ... ••• ••• ••• 16 Slaughterhouses ... ... ... ... ... ... 81 Slum Clearance 63 Smallpox 38 Smoke Abatement 13 Soap Boilers 16 Staff of the Public Health Department 4 Static Water Tanks 14 Statistics, Summary 5 „ Vital 6 Still Births 7 Street Traders 83 Swimming Bath Water 15 Tuberculosis 52 - 58 Care Committee Annual Report 56 - 58 Graphs showing incidence and mortality 54 - 55 Notifications, Table 53 Typhoid and Paratyphoid fevers 35, 44 Underground Rooms 67 Unsound food 79 - 81 Vermin 22 Water Certificates 13 Water Supply 13 Whooping Cough 37, 51