AC 4376 UNKNOWN 2 Library CAM 49 Metropolitan Borough of Camberwell REPORT OF THE MEDICAL OFFICER FOR THE YEAR 1954 H. D. CHALKE, O.B.E. (Mil) T.D., M.A., M.R.C.P., D.P.H. PRINTED BY MERRITT & HATCHER LTD. London. CAM 49 Public Health Department, Town Hall, Camberwell, S.E.5. 31st August, 1955. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Camberwell. Mr. Mayor, Aldermen and Councillors, I have pleasure in presenting this Annual Report on the state of the public health in the Borough of Camberwell during 1954. There were no major epidemics or outbreaks of any dangerous infectious disease, and it is gratifying to report that the general death rate, the maternal and infantile mortality rates are the lowest ever recorded in Camberwell. The health of the inhabitants was maintained at a satisfactory level, a fact that is due in no small measure to the efficiency and vigilance of my predecessor, Dr. H. W. Barnes, who retired on the 30th May, 1954. Dr. Barnes capable supervision of the public health services during his 34 years as Medical Officer of Health is deserving of the highest praise. He was one of the pioneers of Diphtheria Immunisation, and the Personal Health Services, which passed to the control of the London County Council in 1948, were built up under his astute guidance. Camberwell has much for which to thank him. The difficult task of maintaining the high standard he set is nevertheless rendered easier by the work and improvements he has already effected. One of the major duties which devolved upon the Public Health Department during the year was the housing survey, resulting from the passing of the Housing Repairs and Rents Act, 1954. The issue of Certificates of Disrepair under the provisions of this Act also imposed a considerable increase of work, details of which are set out in the appropriate section of this Report. Improved technique in the elimination of rats and mice was instituted during the year with very satisfactory results and at the request of the Ministry of Agriculture and Fisheries further experiments were authorised by the Public Health Committee. May I take this opportunity of expressing my appreciation and thanks to the members of the Council for the consideration they have shown to me since taking up my duties as Medical Officer of Health, to the other Chief Officers and their staffs for their co-operation and assistance, and to the Staff of the Public Health Department for their unfailing loyalty and efficient discharge of their duties. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, H. D. CHALKE, Medical Officer of Health. PUBLIC HEALTH COMMITTEE. Constitution at the end of 1954. Chairman: Alderman A. F. Crossman (died 24th June, 1955). Vice-Chairman: Councillor G. F. Lawrence. Members: Alderman Mrs. J. Burgess. Councillor Mrs. M. V. Goldwin. A. C. Clark, J.P. „ Miss I. Griffith. „ A. F. Lockwood, J.P. „ D. I. Guy. Councillor U. G. Allender. „ H. G. Lamborn. „ Mrs. J. Bartlett. „ Miss A. G. Liddle. „ C. T. Boothby. „ C. T. Pike. „ G. Brown. „ H. A. Pook. „ Mrs. S. K. Burden. „ Mrs. A. E. Pritchard. „ J. Corrigan. „ Mrs. E. Thorne. „ Mrs. E. S. Daymond. „ Miss D. M. Walker. „ S. H. Gilbert. „ A. L. Westcar. Ex-Officio Alderman J. W. F. Lucas, J.P. (died 13th April, 1955) Mayor of Camberwell Alderman G. S. Burden, B.Sc. (Econ.) Leader of the Council Alderman C. W. Baker, J.P., F.C.I.S. Leader of the Opposition Staff of the Public Health Department. Medical Officer of Health: H. W. Barnes, B.A., M.B., B.Ch., D.P.H. (Retired 31st May, 1954.) *H. D Chalke, O.B.E. (Mil.), T.D., M.A., M.R.C.P., M.R.C.S., D.P.H. (Commenced Ist June, 1954 ) Deputy Medical Officer of Health : *E. Margaret Cran, M.A., M.B., Ch.B., D.P.H. (Commenced 1st June, 1954.) Public Analyst: D. F. H. Button, A.R.C.S., F.R.I.C. Senior Sanitary Inspector: Senior Sanitary Inspector L. W. Burrell. a Housing Inspectors H. W. Leonard. a M. L. Malins. a Sampling Officer —Food and Drugs Act, etc.: H. R. Weaver. a Food Inspector D. V. Watkins. a Sanitary Inspectors C. H. Medland. a H. Attwater. a L.A. Biggs. a J. E. Millway. a F. Maughan. a R. C. Charlton. a F. Maughan. a A. G. O'Gilvie. a F. Dray. a F. Russell. a A. Gartside, D.P.A. a H. F. Williams. a E. C. George. a H. M. Hough. a Chief Clerk S. A. Cranfield. Senior Clerk A. J. Carly. Clerks D. Danter. Mrs. M. Findlay. Mrs. A. D. Dormer. C. Burgess. P. A. S. Kirrage. Miss E. M. Lawrence. A. Beare (Temp.). Rodent Control Staff: Rodent Officer W. H. G. Saunders. b Rodent Investigator Mrs. M. J. Kenny. Rodent Operators C. Green (Worknig Foreman), F. G. Hulbert, p. Collins, R. Humphreys. Bait Preparer Mrs. A. Grice. Disinfecting and Cleansing Station Superintendent Disinfector A. Thomas. Disinfector Apparatus Attendant B. Russell. Disinfectors R.T.J. Hodgson, E. Manning, A. E. Kenny, J. Butterfield (Temp.). Motor Driver H. King. Cleansinq Station Attendants Mrs. D. O. Farmer. Mrs. E. E. Doe. * Also Divisional Medical Officer and Deputy Divisional Medical Officer respectively, London County Council, Division 7. (a) Certificate Sanitary inspectors Examination Joint Board and Meat and other Foods Certificate. (6) Certificate Sanitary Inspectors Examination Joint Board. Summary of Statistics for the year 1954. Area of the Borough 4,480 acres Greatest length 4¾ miles „ breadth 2½ miles „ height above Ordnance Datum (Sydenham Hill) 365 feet Population (Census April 1951) 179,777 „ (estimated by Registrar-General mid-1954) 179,500 Number of inhabitated houses (end of 1954) 41,535 Rateable value (April 1954) £1,617,345 Sum represented by a penny rate (estimated) £6,625 Number of live births 2,654 Birth rate 14.8 Number of deaths 1,819 Death rate 10.1 Infantile Mortality: — Deaths under 1 year 59 Infant deaths per 1,000 live births 22.2 Maternal Mortality:— Deaths of women from diseases or accidents associated with childbirth 1 Maternal death rate per 1,000 total births 0.37 Deaths from phthisis 24 Phthisis death rate 0.13 Deaths from all forms of Tuberculosis 26 Tuberculosis death rate 0.14 VITAL STATISTICS. Population. The population of Camberwell at mid-1954 as estimated by the Registrar-General was 179,500, which is only 700 less than the previous year's estimate. During the nineteen-thirties the population of Camberwell steadily decreased and the last published figure prior to the Second World War was 222,400. During the War, of course, the population fell very considerably, but with the return of evacuees at the cessation of hostilities the number of inhabitants began to rise again and has remained fairly constant for the past five years as indicated by the following mid-year figures: — Year 1950 1951 1952 1953 1954 178,900 179,500 181,200 180,200 179,500 Population Births. There was a further fall in the birth rate from 15.3 in 1953 to 14.8 during the year under review. Whilst the live births numbered 2,654 as compared with 2,764 for the previous year, the number of still births increased from 61 to 72. The following table gives details of the number of births allocated to Camberwell during 1954 : — Live Births Still Births Total M. F. M. F. F. M. 1,288 91 1,209 66 39 2 29 2 1,327 93 1,238 68 Legitimate Illegitimate 1,379 1,275 41 1,420 1,306 31 Total 2,654 72 2,726 Deaths. There was a considerable reduction in the number of deaths allocated to Camberwell during the year—1,8l9, giving a death rate of 10.1, the lowest ever recorded in this Borough. The comparable figures for the previous year were 2,187 and 12.1. The sex and age groups distribution, classified by the causes of death, are set out in the following table:— TABLE SHOWING CLASSIFIED CAUSES OF DEATHS IN AGE GROUPS IN CAMBERWELL DURING 1954 All Ages. Sex. 0- 5- 25- 7 5- 15- 45- 65- Causes of death. 1- 52 282 267 281 All causes M. 935 40 5 5 3 35 193 213 416 F. 884 19 1 2 5 16 Tuberculosis, respiratory M. - 8 3 5 - - - - 1 F. 8 1 - 4 2 - - - Tuberculosis, other M. 2 1 1 - - - - - - F. - - - - - - - - - 5 Syphilitic disease M. - - 1 4 - - - - F. 3 - - 3 - - - - - - Diphtheria M. - - - - - - - - F. - - - - - - - - - Whooping Cough M. - - - - - - - - - F. - - - - - - - - - M. Meningococcal infections 3 2 1 - - - - - - F. - - - - - - - - - M. - Acute poliomyelitis - - - - - - - - F. - - - - - - - - - M. - Measles - - - - - - - - F. - - - - - - - - - Other infective and parasitic diseases M. - - 3 1 2 - - - - 2 - F. - 1 1 - - - - Malignant neoplasm, stomach M. 34 - 1 15 10 8 - - - F. 24 2 9 4 9 - - - - 42 Malignant neoplasm, lung, bronchus M. - 80 - 3 29 6 - - 3 13 1 5 4 F. - - - - Malignant neoplasm, breast M. - - - - - - - - - F. 34 3 17 5 9 - - - - 13 3 1 Malignant neoplasm, uterus F. 17 - - - - - Other malignant and lymphatic neoplasms M. - - 91 1 2 10 21 36 21 F. 91 - 1 3 26 23 38 - - Leukaemia, aleukemia M. 5 - 1 4 - - - - - F. 4 1 1 2 - - - - - M. 2 1 1 Diabetes - - - - - - 2 F. 6 - - 1 3 - - - - Vascular lesions of nervous system 75 - M. 2 25 24 24 - - - 1 23 F. 128 42 62 - - - Coronary disease, angina 148 - 2 64 42 40 M. - - - 94 22 38 F. - - 34 - - - 5 Hypertension with heart disease - M. 22 10 7 - - - - F. - 30 1 3 5 21 - - - 14 Other heart disease M. 84 - 5 16 49 - - - F. - 9 19 154 28 98 - - - Other circulatory disease M. 55 - 12 12 31 - - - - F. 69 - 7 14 48 - - - - DEATHS —continued. All Ages. Causes of death. Sex. 0- 1- 5- 15- 25- 25- 65- 75- - Influenza - - - - 1 - - - M. F. 1 3 - 2 1 - - - M. - Pneumonia 34 3 1 4 8 18 - - - F. 28 2 - 1 1 - 3 8 13 M. 90 - - - 4 21 32 33 Bronchitis - F. 29 1 - - - 1 3 9 15 Other diseases of respiratory system - M. 15 - 1 - - 6 3 5 4 F. 7 - - - 1 1 1 - Ulcer of stomach and duodenum - - M. 22 - - 1 8 7 6 10 10 F. - - - - - - - Gastritis, enteritis and diarrhoea - - M. 4 - - - - 1 1 2 F. 4 1 1 1 1 - - - M. Nephritis and nephrosis 9 - - 1 6 1 1 - - F. 7 - - - 3 1 3 - - M. 8 1 3 4 Hyperplasia of prostate - - - - - Pregnancy, childbirth, abortion - - - - F. 1 - - 1 - M. Congenital malformations 9 8 - 1 - - - - F. 2 1 - - - 1 - - - - Other defined and ill-defined diseases M. 77 25 1 1 1 5 16 12 16 F. 83 4 21 12 33 12 - - 1 M. 5 8 - 1 - - 1 1 Motor vehicle accidents - - - F. 5 - 1 1 - 2 1 4 M. 21 2 2 1 1 6 3 2 All other accidents 6 F. 17 1 - 1 3 6 - - - 1 3 6 Suicide M. 11 - - 1 - 7 F. 11 - 2 2 - - - - M. Homicide and operations of war - 1 - 1 - - - - - - - F. - - - - - - - The principal causes of deaths in the Borough during 1953 and 1954 were as follows: — 1953 1954 Diseases of the heart and circulatory system 706 656 Respiratory diseases (excluding phthisis) 405 207 Cancer 375 384 Vascular lesions of the nervous system 228 203 It is significant to note that, whereas the other main causes were responsible for less mortality during 1954, the number of deaths attributable to cancer showed a slight increase, particularly in the case of deaths from malignant neoplasm of the lung and bronchus which has shown a general upward trend during the past few years. The marked discrepancy between male and female deaths from this cause is still evident. The figures for the past five years are set out in the following table. Deaths from Cancer of the Lung and Bronchus. Death Rate per 1,000 population Year Males Females Total 11 1950 62 73 0.41 1951 12 71 83 0.46 1952 70 11 81 0.45 1953 69 6 75 0.42 1954 80 13 93 0.52 Infantile Mortality. The deaths of children under the age of one year numbered 59, and represent another record low rate of 22.2 per 1,000 live births. (The previous lowest was 23.6 recorded in 1952). Fortyfour of these were neonatal deaths, i.e. deaths of children within one month of birth. The following table shows the numbers of neo-natal deaths, infant deaths and mortality rate in Camberwell during the past five years:— Year Neo-natal deaths Total infant deaths Infantile mortality rate 1950 26.8 55 78 76 1951 53 25.7 1952 69 49 23.6 1953 48 73 26.4 1954 44 59 22.2 Maternal Mortality. It is gratifying to be able to report yet another record for Camberwell; only one maternal death occurred during the year, thus bringing the maternal death rate down to the extremely low figure of 0.37 per thousand total births. The cause of death in this case was pulmonary embolism due to puerperal phlebothrombosis. Accidents. The following table showing the number of accidental deaths during the past five years does not indicate that the mortality from accidental causes is diminishing. Motor Vehicle Accidents Other Accidents Total Accidental Deaths Year F. Total M. F. Total M. 1950 4 3 7 16 19 35 42 22 18 40 54 1951 13 1 14 1952 6 5 11 15 10 25 36 46 1953 15 9 24 14 8 22 13 21 17 38 51 1954 8 5 The very old and the very young are particularly prone to accidents in the home. It is to be noted that three old persons died during the year as a result of accidental coal gas poisoning. THE AGEING POPULATION By producing an index figure* which is calculated by expressing the number of persons over 65 years of age as a percentage of those under 15 years of age, it can be clearly shown how the proportion of old people has increased. This index also gives an indication of the extent to which the problems presented by the care of old people may vary in different areas. In the table appearing on the following page the index has been calculated from the Census figures for 1921, 1931 and 1951 and comparison has been made of the figures for Camberwell, England and Wales, the County of London and for the five adjoining Boroughs. Unfortunately statistics on which to calculate an index for 1954 are not yet available. It will be seen that the index for Camberwell of 32 in 1921, had increased to 53 in 1931 and 74 in 1951, but this was somewhat less than the increase for the County of London as a whole. It will be noted too that the index for Camberwell is a little lower than that for Lambeth, but is higher than the other four contiguous Boroughs. Attention is also called to the very much higher figures for females than males in all the areas; in Camberwell the female index is 92 as compared with 57 for the male population. These figures forcibly illustrate that increasing problems are likely to arise in connection with the care and welfare of the older members of the community. They also suggest that the contemporary retiring ages of 60 and 65 years are no longer acceptable. The working capacity and employment of older people should be based on their "biological" and not "chronological" age. *Quoted by Fleming G. 1954. Br. Jo. Phys. Med. 9. 207. County of London 29.6 39.9 34.7 48.9 61.7 53.2 63.7 102.1 MEDICAL EXAMINATIONS. The Medical Officer of Health and Deputy Medical Officer of Health undertake the medical examination of all successful applicants for appointments on the official permanent establishment, temporary officers for the Superannuation Scheme, employees for admission to the permanent staff and the Council's Sick Pay Scheme. In every case, arrangements are also made for an X-ray examination of the chest to be carried out. In addition, employees in receipt of benefit under the Council's Sick Pay Scheme who have been absent from duty for fourteen days or more are required to be examined by the Medical Officer of Health who reports to the appropriate Committee. The numbers of persons medically examined during 1954 are set out in the following table:— Officers for admission to permanent establishment or Superannuation Scheme 55 Employees for admission to Sick Pay Scheme 213 Employees for admission to permanent establishment 35 Employees absent from duty owing to sickness 287 Cremation Certificates. The Medical Officer of Health and Deputy Medical Officer of Health are also the Medical Referee and Deputy Medical Referee respectively for the Council's Crematorium at Honor Oak. No body can be cremated until the Medical Referee or his Deputy have signed the necessary authority after examination of the appropriate forms and medical certificates. During the year under review 2,528 cremations were so authorised, an increase of 101 over the figure for the previous year. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply. Every dwelling house in the Borough is provided with a water supply direct from the mains of the Metropolitan Water Board, and no complaints were received during the year regarding its purity. Water from the seven wells in operation in the Borough is used for industrial purposes only and not for domestic consumption. Water Certificates. Under the provisions of the Public Health (London) Act, 1936, water certificates are issued in respect of new buildings on satisfactory completion. One hundred and two such certificates were issued during 1954 and involved 1,033 dwellings. Drainage and Sewerage. During 1954, 186 applications were received for approval in respect of the drainage of new buildings and alterations to the drainage of existing buildings. The length of sewers reconstructed totalled 1,643 yards and 120 yards of new sewer were laid by the Council. Ninety brick gullies were replaced by pot gullies and ten defective pot gullies were renewed. In addition, 275 yards of sewers and seven gullies were laid by the Dulwich College Estate Governors. Public Cleansing. This service is under the control of the Borough Engineer and Surveyor who has kindly furnished the following information: Amount of house refuse (including salvage) collected during the year 42,851 tons. Amount of trade refuse collected 574 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. Atmospheric Pollution. Complaints received during the year with regard to alleged nuisances caused by the emission of smoke numbered 40 : the district Sanitary Inspectors kept 127 observations and every effort was made to secure the abatement of such nuisances. Considerable attention was given to the question of smoke abatement by the Council who co-operated with the Metropolitan Boroughs' Standing Joint Committee in furnishing information to the Committee set up by the Government to inquire into this matter. A letter was received from the Southwark Borough Council stating that provisional arrangements had been made by the Principal of the Borough Polytechnic for special classes to be held at that Institute for stokers and firemen, subject to sufficient students being enrolled. An appeal to 47 local firms in Southward enquiring whether they would be prepared to arrange for their firemen and stokers to attend the proposed classes produced a promise of only seven students. This Council was, therefore, asked whether they would be willing to take similar action in an endeavour to obtain sufficient students to justify the Course being held. Accordingly 44 firms in Camberwell were circularised of which only four agreed to co-operate, involving about six or eight men. Particulars of the firms were forwarded to the Southwark Borough Council but owing to lack of support it was not possible to establish special classes; it was arranged, however, to allot two periods per week to classes for the Boiler Operatives' Certificate of the City and Guilds. Three short lectures, and a film followed by a discussion on smoke abatement were arranged at the Polytechnic on the 16th September, 1954 ; one of the lectures was given by the Medical Officer of Health for Camberwell. In September the Metropolitan Boroughs' Standing Joint Committee invited the Council to agree to a suggestion by the Department of Scientific and Industrial Research to participate in a scheme to procure the measurement of smoke by installing instruments for this purpose. This was in addition to the instruments already provided by the Council on the roof of the Queen's Road Health Centre for measuring the quantity of solid matter and sulphur dioxide in the atmosphere. The Council agreed to co-operate in this matter and at the end of the year delivery of the necessary apparatus was awaited. The information obtained during the year from the deposit gauge and lead peroxide instrument at Queen's Road Health Centre is shown in graph form on pages 18 and 19. The Committee on Air Pollution presented their final Report to the Government in November, 1954. In it, they recommend that Local Authorities should have power under general legislation by means of Orders, requiring confirmation by the appropriate Ministers, to establish:— (1) smokeless zones in which the emission of smoke from chimneys would be entirely prohibited, and: (2) smoke control areas in which the use of bituminous coal for domestic purposes would be restricted. Before action can be taken under present legislation, it is necessary to prove that a nuisance is being caused unless there are local bye-laws in force. The bye-laws in force in this Borough relate to black smoke and permit up to an aggregate of two minutes' emission in one continuous period of half an hour. Smoke from domestic chimneys is expressly exempted. If proceedings are taken in respect of a smoke nuisance, the defendant may plead that he has taken the best practicable means for preventing the nuisance. The expression "smoke" includes soot, ash, grit and gritty particles. The "Beaver" Report states that: "By 'smoke' we mean suspended particles or droplets of carbonaceous matter, grit and dust arising from the combustion of fuel", and "by 'dark smoke' we mean smoke of density equivalent to or greater than shade 2 on the Ringelman Chart." In making recommendations, the Committee are satisfied that with few exceptions no industrial chimney need normally emit more than a light haze of smoke, but as it will be necessary to make allowance for short discharges of dark smoke, it would be proper to permit a total upper limit of six minutes of dark smoke in any period of four hours, but that no single burst of dark smoke should last more than three minutes; the only defence being that the emission of dark smoke is due to lighting up the furnace from cold, or to temporary and unforeseen mechanical failure. Nearly half of all the smoke in the air comes from domestic chimneys, and, consequently, the proportion is greater where houses predominate. Most of the domestic smoke is produced during the winter months when atmospheric conditions are most likely to give rise to fog. Although the smoke from these chimneys is less dense than that from industrial chimneys, it is discharged at a low level, and its harmful effects may be accentuated. The problem of domestic smoke must be tackled. It is advocated, therefore, that the extension of smokeless zones is an admirable and effective method of securing smokelessness where local conditions permit. The scope is limited, however, since complete smokelessness is not practicable in areas which include industry as well as houses. In that case, a second type of area—a "smoke control area" in which concurrently with the measures to reduce industrial smoke, domestic users would be required to use only smokeless fuels such as bituminous coal containing not more than 20 per cent, of volatile matter (and in consequence substantially smokeless) or manufactured fuels having similar smokeless qualities. The available solid smokeless fuels are natural smokeless coal, manufactured fuels such as "Phurnacite", low temperature cokes ("Coalite" and "Rexeo"), coke from coke ovens and gas works coke. Both in "smokeless zones" and in "smoke control areas," however, house owners will be obliged to install the necessary improved appliances, where they are at present lacking, in which to burn smokeless fuels. It is already the practice of many Local Authorities at the instance of Central Government to install improved appliances capable of burning coke efficiently in the new houses and flats they build, and they have, in granting the tenancy of each post war house or flat, made it a condition that only smokeless fuel may be used by the tenant. This has resulted in the creation of large zones in many cities and towns in which no smoke is created. Although more than 4,000 deaths were associated with the 1952 "smog" in London, the precise cause of these fatalities has not been established. Expert opinion tends to the view that it was not the smoke itself but one of the contained gases such as sulphur dioxide which was chiefly responsible in causing the death of older persons with chronic pulmonary disease. The burning of smokeless fuels will not entirely remove the danger because their combustion produces gases which may be injurious to health. It has been established, however, that the concentration of sulphur dioxide and smoke in the atmosphere tend to increase and decrease together. Sulphur trioxide, and the sulphuric acid mist which is formed from it by the absorption of water from the atmosphere occur both as a result of direct emissions from some fuel burning installations and by the subsequent oxidation of sulphur dioxide in the atmosphere. This latter reaction is probably more pronounced during conditions of fog. A great deal more information is required as to the ill-effects of high concentrations of sulphur dioxide. It is understood that during the London "smog" of 1952, the concentration was not as high as might have been expected and was well below that allowable in industry. Recent work suggests that a given concentration of sulphur dioxide in the atmosphere is much more dangerous when a small quantity of sulphuric acid mist is present. It appears too that new forms of air pollution from Industry may be arising as a result of certain types of manufacturing process. Promising results have already been obtained from new methods of combustion of fumes to convert dangerous gases into less objectionable products. At the end of the year the Public Health Committee, pending further legislation in connection with the prevention of air pollution, gave consideration to the establishment of a voluntary smokeless zone or "smoke control area" bounded by Camberwell Road, Camberwell Church Street, Peckham Road, Southampton Way and New Church Road. This zone embraces the London County Council's Picton Street and Wells Way clearance areas and the Borough Council's Camberwell House site, and it was decided to seek the co-operation of the London County Council by providing all new flats with suitable appliances for burning solid smokeless fuels and making it a condition of tenancy that only smokeless fuels should be used. ATMOSPHERIC POLLUTION 1954 Total Solids Deposited—Tons Per Square Mile ATMOSPHERIC POLLUTION 1954 Estimation of Sulphur by Lead Peroxide Method In due time, it may be possible to arrange for the existing privately owned properties in the area to be equipped with improved appliances and similar conditions imposed. Bombed Sites and Static Water Tanks. Bombed sites and static water tanks were kept under close supervision by the Sanitary Inspectors, particularly during the summer months. The Borough Engineer and Surveyor was requested to arrange for the removal of offensive refuse in eight instances from bombed sites and in 21 cases from static water tanks. Where necessary, the co-operation of the London Fire Brigade was sought to pump out accumulations of stagnant water before the removal of the refuse. Mosquitoes. At the end of August the Medical Officer of Health discovered a severe infestation of culicine mosquito larvae in the rainwater which had accumulated in a static water tank. In order to prevent a serious nuisance from mosquitoes in the area, the surface of the water was treated before the tank was cleared by the Borough Engineer and Surveyor's Department. A survey of all the other static water tanks in the Borough was immediately carried out and mosquitoes were found to be breeding in seven of them, which were similarly dealt with. A close watch was kept on all static water tanks by the sanitary inspectors until the colder weather, when all danger of a mosquito nuisance developing had passed, and during this period two further tanks were found to be infested with larvae. These were also treated and cleaned out. Swimming Bath Waters. The Council's Sampling Officer obtains samples of water from each of the Council's Swimming Baths regularly once a month while the bath is in use and submits them for bacteriological and chemical examination. The following table shows the number of samples taken from each Swimming Bath during 1954: Bacteriological Examination Chemical Examination Camberwell Front Swimming Bath 5 5 Camberwell Rear Swimming Bath 12 12 Dulwich 1st Class Swimming Bath 5 5 Dulwich 2nd Class Swimming Bath 5 5 27 27 Totals The reports on all the above samples indicated that the waters were in a satisfactory condition. In addition to the above, samples of water from the swimming bath at the Mary Datchelor Girls' School, Camberwell well Grove, were submitted for bacteriological and chemical examination on three occasions during the year and found to be satisfactory. The Rag Flock and Other Filling Materials Act, 1951. There are no premises in the Borough used for the manufacture or storage of materials to which this Act applies, but at the end of the year there were seven entries in the register of premises where trades were being conducted involving the use of such materials. The Sampling Officer obtained 26 samples of filling materials from these premises for submission to the Prescribed Analyst, all of which were reported to comply with the standards of composition and purity laid down, in the Regulations made under the Act. The number of samples of each type of filling material examined is as follows:— Rag flock (loose) 7 Rag flock (layered) 3 Woollen mixture felt 2 Washed jute felt 1 Sized cotton felt 2 Cotton felt 2 Hair (pad) 1 Fibre (loose) 3 Fibre (pad) 1 Kapok 2 Cotton millpuff 2 Total 26 Offensive Trades. There were five premises on the register of offensive trades at the end of the year as follows:— Skin dressers 4 Soap boilers 1 Complaints were received of the emission of formaldehyde vapour and particles of flock from one of the skin dressers' premises, and as the result of representations by the Officers of the Public Health Department the proprietors arranged for the fume stack to be lengthened to roof-ridge height. Subsequent observations did not reveal any further nuisance from this source. Shops Act, 1950. The provisions of this Act which relate to temperature and sanitary accommodation in shops are the responsibility of the local sanitary authority. During 1954 the district sanitary inspectors paid 750 visits of inspection to shops in the Borough. In only one instance was it necessary to serve a notice for contravention of the Act, and this was promptly complied with. No applications were received for the issue of exemption certificates in accordance with Section 38 (6) of the Act. Pharmacy and Poisons Act, 1933. Applications for registration under this Act as sellers of poisons included in Part II of the Poisons List numbered 15 during the year. There were also 183 applications for the annual renewal of registrations All the premises concerned were periodically visited by the district sanitary inspectors but no infringements of the provisions of the Act were discovered. Provision of Dustbins Clauses were included in the London County Council (General Powers) Act, 1954, which simplified the procedure for the service of notices in respect of the provision of dustbins for dwelling houses. Section 12 of this Act authorises.the service of such a notice upon the owner of the premises in every case and never upon the occupier, the owner having the right of appeal where he considers it is the tenant's obligation to provide the dustbin. During 1954, 191 notices were served for the provision of sanitary dustbins. Registration of Barbers and Hairdressers Section 18 of the London County Council (General Powers) Act, 1954, requires that any person carrying on the business of a barber or hairdresser shall register himself and his premises with the Borough Council. The provisions of this section are to come into operation on a day to be fixed by the Borough Council, and enables that authority to make bye-laws to secure the cleanliness of the persons and premises concerned. In order to secure uniformity of action throughout London, the Metropolitan Boroughs' Standing Joint Committee sugested gested that it would be desirable for draft bye-laws, forms of application and certificates of registration to be prepared for use by the constituent Councils, and also that some measure of uniformity should be adopted regarding the "appointed day." This Council expressed their agreement with the views of the Metropolitan Boroughs' Standing Joint Committee and decided to accede to their request to adopt a date not before the 1st April, 1956, as the "appointed day." At the end of the year copies of the draft bye-laws and forms were still awaited. Pet Animals Act, 1952. Under the provisions of this Act, no person may keep a pet shop unless licensed to do so by the local sanitary authority. During 1954 two applications were received for the issue of such licences, and there were fifteen applications for the annual renewal of licences, making a total of seventeen licensed pet shops in the Borough at the end of the year. The district sanitary inspectors kept all these premises under observation in order to ensure that there were no infringements of the provisions of the Act or failure to comply with the conditions of the licence. Sanitary Inspection of the Area. Owing to the difficulty of securing the services of qualified sanitary inspectors, the number of such officers was below the authorised establishment for the major part of the year. Towards the end of the year, however, the Council was able to fill the vacancies and, in fact, increased the establishment by appointing another district sanitary inspector in view of the additional duties arising from the operation of the Housing Repairs and Rents Act, 1954. Complaints received numbered 5,658 during the year as compared with 5,385 in 1953. The sanitary inspectors made 33,572 visits of inspection which are summarised in the following table:— SUMMARY OF WORK CARRIED OUT DURING THE YEAR 1954. Inspections:— Nuisance inspections 5,560 Offensive trades 4 Smoke observations 127 Drainage, new and existing 6,295 Overcrowding 1,242 Factories and workplaces 865 Outworkers' premises 619 Rag and bone dealers 17 Infectious and other diseases 312 Verminous premises and persons 83 Aged and infirm persons 158 Common lodging houses 38 Conveniences, public and private 100 Heating Appliances (Fireguards) Act, 1952, inspections 74 23 Housing Repairs and Rents Act 221 Rent (Restrictions) Act 37 Shops Act 750 Voluntary work 177 Inspections not defined 998 Re-inspections 15,595 Total inspections 33,572 Works supervised:— Tests applied to drains (existing premises) 280 Drains found defective 116 Drains totally reconstructed 43 Drains repaired or partially reconstructed 263 Tests applied to drains (new buildings) 5,195 Drains constructed 1,471 Total works supervised 7,369 Description of Sanitary Improvements ordered during the year:— Cleanse and repair walls and ceilings 892 Repair roofs, gutterings, etc. 1,265 Abate dampness 1,677 Repair stoves, fireplaces and coppers 327 Repair windows, sashlines, sills, etc. 547 Repair flooring, stairs, doors, etc. 495 Provide sufficient light and ventilation 25 Provide dustbin 191 Remove offensive matter 30 Provide or repair yard paving 37 Provide or render accessible water supply 37 Cleanse, cover or render accessible water cistern 4 Repair water pipes and fittings 112 Clear premises of vermin 10 Cleanse or repair water closets and flushing apparatus 394 Repair or clear defective or obstructive drains 127 Repair soil pipes, waste pipes, sinks, etc. 163 Abate nuisances caused by animals improperly kept 2 Miscellaneous 124 Total repairs and improvements ordered 6,459 SUMMARY OF NOTICES SERVED, 1954. Intimations, Public Health (London) Act, Byelaws, etc. 2,595 Statutory Notices, Public Health (London) Act, Byelaws, etc. 1,433 Public Health (London) Act, 1936 (Part II) 17 Section 4, Housing Act, 1936 35 No. of Summonses issued 152 Factories Acts, 1937-1948. The provisions of these Acts which relate to sanitary accommodation and, in those factories where mechanical power is not used, cleanliness, ventilation, temperature, drainage of floors and overcrowding, are the responsibility of the local sanitary authority. Particulars of the work carried out by the Public Health Department in this connection are set out in the following copy of the Annual Return which is required by the Ministry of Labour and National Service:— 1.—INSPECTIONS, 1954. Number of Number on Register. Premises. Inspections. Written Notices. Occupiers prosecuted. 137 1 Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 424 - Factories not included above in which Section 7 is enforced by the Local Authority 261 22 - 1,054 Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 1 - 11 - 399 23 Totals 1,489 - 2.—CASES IN WHICH DEFECTS WERE FOUND, 1954. No. of cases in which defects were Number of cases in which prosecutions were instituted. Referred Particulars. Remedied. Found. To H.M. Inspector. By H.M. Inspector. 15 8 6 - - Want of cleanliness Overcrowding - 8 - - - Unreasonable temperature Inadequate ventilation - - - 4 3 - - - - - Ineffective drainage of floors 2 - - 2 - Sanitary conveniences— - 1 - (a) insufficient 2 - (b) unsuitable or defective 20 12 - 7 - (c) not separate for sexes - - - - - Other offences against the Act (not including offences relating to outwork) - - - - - - 14 - Total 43 25 These figures emphasize the important part played by the local sanitary authority in occupational health. Outworkers. Employers of outworkers are required to forward to the local sanitary authority in February and August each year a list of the names and addresses of such persons who have been employed by them during the preceding six months. The homes of these workers are visited periodically by the district sanitary inspectors to ensure that no unhealthy or insanitary conditions exist. The number of outworkers in Camberwell at the end of the year and the occupations in which they were employed are set out in the following table:— Artificial flowers 2 Linens 4 Baby linen 22 Needlework 2 Belts 4 Novelties 18 Blouses 8 Overalls 14 Boots and shoes 8 Paper bags 7 Brushes 2 Shoulder pads 34 Cardboard boxes 46 Tailoring 13 Card lacing 120 Ties 5 Embroidery 4 Toys 8 Feather sorting 4 Umbrellas 4 Handbags 1 Uniform caps 8 Hats 4 Wearing apparel 461 Hosiery 2 Miscellaneous 28 Industrial gloves 2 Lampshades 37 Total 872 The recent publicity given to the home wrapping of sweets that has been carried out in certain parts of London draws attention to the omission from the classes of outwork prescribed by the Secretary of State under the Factories Act of occupations connected with the wrapping and packing of sweets. This suggests that the only relative occupation at present listed, viz., "Manufacture of Chocolates and Sweetmeats," should be extended to include "preparation for sale." Additional difficulties are arising from the fact that chewing gum is not at present a "food" within the meaning of the Food and Drugs Acts, but it appears that this is to be rectified in the proposed Food Hygiene Regulations. GENERAL PROVISION FOR HEALTH SERVICES IN THE AREA. Welfare of Aged Persons. Problems in connection with the aged, particularly those "who are living alone, are increasing in complexity. It has been found, however, that by close liaison with other agencies concerned, in particular, the Personal Health Services of the London County Council many difficult situations can be alleviated and unnecessary hospitalisation prevented. The Medical Officer on the staff of the London County Council Divisional Medical Officer, Division 7, who is responsible for co-ordinating the domiciliary work in connection with the aged in need of care and attention has been most helpful. Close contact is maintained with the general practitioner in every case. On a number of occasions arrangements have been made for the Sanitary Inspector and Health Visitor to visit the house together. During the year the Sanitary Inspectors paid 158 visits to old people. This co-operation enables the persons concerned to remain in their own homes as long as possible. During 1954 it was necessary in only two instances to invoke the provisions of Section 47 of the National Assistance Act, 1948, to secure the compulsory removal of an aged person to a suitable institution. In two other cases, the Committee's authority was obtained to apply for a Magistrate's Order, but as the persons concerned were subsequently persuaded by the Officers of the Public Health Department to enter an institution voluntarily, it did not become necessary to take statutory action. In October of the year under review, the attention of the Public Health Committee was drawn to the increasing difficulty of dealing with the problem of soiled bedlinen of incontinent old people and authority was given for these soiled articles to he washed at the Council's Disinfecting and Cleansing Station in approved cases. Assistance of this kind was given in five instances which came to the notice of the Public Health Department. The soiled linen was collected twice weekly and the number of articles dealt with by the end of the year amounted to 1,519. There is also a considerable demand for expert attention to the feet of old people. Unfortunately, there are no local health authority Chiropody Clinics in the Borough, but Camberwell residents frequently use one of the foot clinics in the adjoining Borough of Lewisham in addition to the Chiropody Clinics conducted by voluntary organisations in this Borough particulars of which are set out on page 29. The Camberwell Borough Council makes an annual financial grant to the Camberwell Old People's Welfare Association which undertakes and co-ordinates a variety of services for old people. Details of these activities are set out in the following extracts from the Association's Annual Report for the year ended the 31st March, 1955. Meals on Wheels This Service takes ready-cooked dinners to elderly persons who are for any reason unable to cook for themselves or to go out to attend a local Dinner Club. The Borough of Camberwell is entirely covered by this Service and everyone eligible, receives at least two dinners per week. The charge made is 10d. for a two-course meal. The administration of the Meals Service is carried on from the Association's office, but for practical purposes the Borough is divided into two areas. Part of the Service is then run by the Association itself in conjunction with the Union of Girls' Schools for Social Service Settlement. The dinners for that section of the Meals on Wheels Service are prepared in the Settlement Kitchens and taken round by two vans on four days per week. The number of dinners served from the U.G.S. Settlement in the past year was approximately 7,824. One van belongs to the Association and the other is loaned, with driver, by the Borough Council. The Association has its own paid part-time driver. The Helpers are all volunteers. The "diet" meals service, introduced on the U.G.S. round last year for those unable to eat the ordinary dinner, has proved of benefit to those whose digestions have been impaired by age or illness. The standard meal, however, continues to be popular with the majority of the old people on the Meals on Wheels Round. The Women's Voluntary Services are also responsible for part of the Meals Service and have three private cars with volunteer drivers and helpers going round their area on two days per week. They obtain their Meals from the Troy Town Dinner Club Kitchens. The number of Dinners served by the W.V.S. in the past year was 4,402. The Women's Voluntary Services make their own arrangements with the authorities about the subsidy on the Meals supplied on their rounds, and apart from a small payment towards the costs of "washing up" do not receive any financial help from the Association. Chiropody The Red Cross Society has now two clinics per week on Thursday mornings and afternoons, and on two Thursdays per month there is a double session with a second chiropodist running a duplicate service. The clinics are very popular and there is a long waiting list. Approximately 1,395 treatments were given last year. The U.G.S. Settlement clinic is now run weekly on Tuesday mornings and approximately 480 to 500 treatments were given during the past year. This clinic also has a long waiting list. Cambridge House clinic (for Club Members only) is held on one Monday and one Wednesday per month. Patients numbering 223 were treated there during the past year. This service is extremely popular with the Club Members. Each of these three Clinics receives a Grant-in-Aid from the Association. The Association's own Foot Clinic has now two sessions per week, on Monday mornings and afternoons. This is held in the W.V.S. Centre, 47, Camberwell Church Street, S.E.5. Approximately 637 treatments were given during the past year. There is a waiting list also at this clinic. The Mobile Service has been running an average of three to four clinics per month and there is always a waiting list. Approximately 195 housebound old people have been treated during the past year. Application for treatment by this Service has to be made direct to the Association and the patient must be certified as "housebound" by a Doctor, Nurse or Health Visitor. The charge to all patients at all clinics is 1s. 6d. per treatment and this is always most cheerfully paid. Clubs The Club for lonely elderly people which was inaugurated on January 19th, 1954, at the Troy Town Communal Centre, Nigel Road, is proving a very great success. The membership is now over 90. This Club is run by an Ad Hoc Committee composed of some members chosen from the Camberwell Old People's Welfare Association, some from the Camberwell Housing Society and some co-opted members. The personnel is organised by the Women's Voluntary Services Centre, and Mrs. B. M. Johnson (herself a member of the W.V.S.) is a most competent and charming Hon. Secretary and Club Leader. Admission to the Club, which is open four days per week, from 11 a.m. to 6 p.m., is by application to the Club Secretary and the subscription is 6d. per week or 2d. per day. Dinners may be purchased at the Troy Town Dinner Club (open to non-members) on the premises. Afternoon tea is also available if desired, and is very popular. The U.G.S. Settlement have augmented their Old People's Clubs during the past year and now have four Clubs. One is held on Mondays, another is held on Tuesdays, and an extension of the Dinner Club on Wednesdays includes a sketching class. A fourth, held on Fridays, is mainly reserved for those of 75 years and over and for the physically handicapped. There are good ramps in the building for the benefit of wheelchairs, it is understood. The aged deaf also are made welcome at this club. In addition there are at least 16 other very popular Clubs for elderly people, open mainly one afternoon per week, in various parts of the borough. New Members are welcomed at most, although some have a "waiting list" mainly due to lack of space. King George VI Memorial Club The Camberwell Old People's Welfare Association has recently been asked to combine with Lambeth Old People's Welfare Association, the Civic Authorities of both Boroughs and the London Council of Social Service, to form an Ad Hoc Comittee to consider the possibility of setting up a Club which would cater specially for the needs of the elderly infirm and for those who do not usually belong to an Old Folks Club. The building would be set up and equipped by the King George VI Memorial Foundation but the running costs would have to be met locally. A site has been found for this Club by the Camberwell Borough Council and a very generous grant has been allocated by the Council towards the running expenses. It is understood that the Lambeth Borough Council have also made an allocation of this nature. The Ad Hoc Committee has had a number of meetings to date and various plans are under consideration. Dinner Clubs There are now three Dinner Clubs in the Borough of Camberwell. One, which is open five days per week, at the U.G.S. Settlement, Staffordshire Street, S.E.15, served approximately 9,634 dinners during the past year. Another, which is open at the Troy Town Centre, Nigel Road, S.E.15, on four days per week, served approximately 17,200 dinners during the past year. A third, run every Wednesday at the W.V.S. Centre, 47, Camberwell Church Street, S.E.5, has served approximately 1,917 dinners during the past year. The Association makes a subsidy payment of 8d. a meal to the first two Dinner Clubs. The W.V.S. make their subsidy claim for the same amount direct to the authorities. Office During the past year applications for advice or assistance in one form or another were received from or on behalf of approximately 850 old persons. Of these, a considerable number called for advice on more than one occasion. Some queries could be dealt with fairly quickly but others involved the writing of letters, the making of telephone calls, and several interviews either at the office or at the old person's home both with the elderly themselves and with their relatives and friends. Holidays A grant of £500 was received from the Camberwell Borough Council in the Spring of 1954 and arrangements were made to send 100 Old People to the Coast or Country therewith. A further application was then made to the Borough Council which very kindly granted an additional £150. In all, 135 old people were sent on holiday through the Association by means of this grant during the Summer of 1954. In most cases the old people were sent in small parties to private Guest Houses for a fortnight's holiday. This, judging by the many letters received from them and from the enthusiastic reports they gave in person on their return home, they appeared to have enjoyed to the full, despite the inclement weather. Rodent Control In January, 1954, the Public Health Committee adopted a recommendation by the Medical Officer of Health that a new rodenticide known as "Warfarin" should be brought into general use for the surface treatment of rodent infestations. This change of method which received the approval of the Ministry of Agriculture and Fisheries came into effect on the 1st April and resulted in considerable economy as it enabled a reduction to be made in labour charges. In treating with "Warfarin" no pre-baiting is necessary and sufficient bait can be laid to last for several days thus obviating the necessity for daily visitation by the rodent operatives. The use of this rodenticide represented a considerable advance in rodent control, as apart from the economic aspect, it has proved to be more effective than the former method of dealing with surface infestations by rats and mice. It was, however, not considered advisable to use "Warfarin" for baiting sewers as the damp and humid atmosphere in the sewers caused the bait to deteriorate rapidly. During the year, the Council's Rodent Officer devised a block bait incorporating "Warfarin" with good keeping qualities which experiments indicated would be of great value in sewer baiting. The Technical and Scientific Staff of the Ministry of Agriculture and Fisheries were keenly interested in this new development and towards the end of the year an official request was received from the Ministry asking the Council to co-operate by carrying out a large-scale experiment to test the efficiency of these "Warfarin" blocks in the Council's sewers. This was agreed to and at the end of the year the necessary arrangements were well advanced. The following table is a summary of the work of the Rodent Control staff during the past three years:— 1952 1953 1954 No. of complaints received 1,383 1,370 1,289 No. of inspections 2,802 2,391 3,049 No. of operators' calls 21,473 19,340 10,492 No. of private premises baited 1,484 1,280 1,244 No. of business premises baited 281 183 170 No. of pre-baits laid 39,884 31,101 6,204* No. of poison baits laid 16,959 16,040 8,174† *Pre-baiting discontinued 1-4-54. †Including "Warfarin" baits. In cases where rat infestations are suspected to be due to defective drains, such drains are tested. Forty-five tests were applied during the year and positive results obtained in 22 instances. Appropriate action was taken to secure the repair of the drains where necessary. Bed Bugs Infestations by bed bugs have been considerably reduced during the past few years by the development of the new contact insecticides of which D.D.T. was the first. These preparations leave a deposit which is lethal to insects coming into contact with it for many months after its application. This prolonged effectiveness results in the destruction of vermin which hatch out after spraying and also obviates the necessity for stripping walls and ceilings or easing woodwork such as door and window frames, skirting boards, picture rails, etc. During 1954, the Council's Disinfecting Staff treated a total of 1,328 rooms for bug infestation. In 110 instances, requests were received shortly afterwards for further disinfestation to be carried out, but in approximately 50 per cent. of these cases, no evidence could be found that additional treatment was necessary. There is no doubt that complaints of continued infestation are frequently due to residents having seen newly-hatched bugs which would, of course, be destroyed on coming into contact with the residual insecticide. Never-theless, secondary spraying was carried out in every case where such a request was received. Vermin and Scabies The following tables show the numbers of persons affected with vermin or scabies who received treatment at the Council's Cleansing Station during the year:— CLEANSING STATION ATTENDANCES (VERMIN) Total. Male. Female. 68 Adults 57 11 626 Children 139 487 694 Total 196 498 CLEANSING STATION ATTENDANCES (SCABIES) Male. Female. Total. Adults 30 18 48 Children 40 46 86 Total 70 64 134 The majority of these cases are children and their adult contacts who are dealt with by arrangement with the London County Council School Health Service. Disinfection The work carried out by the Disinfecting Staff during 1954 is summarised in the following table:— Notified Infectious Diseases Miscellaneous Vermin Total All Cases Other Diseases Rooms disinfected Lots of bedding disinfected 586 369 63 27 4 508 1,507 137 2,160 1,041 Total visits 930 64 1,824 797 3,615 Number of articles disinfected by steam 4,312 Number of articles disinfected by formalin 1,540 Number of books disinfected 104 Number of towels washed 3,899 Number of soiled articles washed 1,519 Number of overalls washed 316 Number of covering sheets washed 387 Beds and mattresses destroyed 370 Miscellaneous articles destroyed 779 Weight of Tons. Cwts. Qtrs. Lbs. Unsound foods destroyed 31 19 1. 18½ Hospital bedding, etc., disinfected 8 16 0 0 Hospital soiled dressings, etc., destroyed 18 5 0 0 Furniture and effects destroyed 11 16 2 0 Dead animals destroyed - 10 2 0 Old paper destroyed — 2 0 0 Old lino destroyed — 2 0 0 The importance of current disinfection in cases of infectious disease is stressed by the Council's Officers, but the demand by the public for terminal disinfection is still very considerable. This accounts for the large number of premises visited for this purpose. Although in many cases it is unnecessary, requests for terminal disinfection are seldom refused. Health Education A close liaison is maintained between the staffs of the Public Health Department and Division 7 of the London County Council in order to secure the maximum effort and prevent overlapping in the dissemination of information on health matters. Posters and pamphlets on various topics were displayed and distributed through the media of the Public Libraries, the Information Centre, Infant Welfare Centres, District Nursing Associations, and various Voluntary Organisations. A section of an Exhibition held by the Camberwell Community Association at the Queen's Road Health Centre in July was allocated to the Public Health Department and Division 7 of the London County Council. This space was used for the display of posters, pamphlets and exhibits concerned with clean food, infectious diseases, infant care, prevention of accidents in the home, etc. The Medical Officer of Health and Senior Officers of his Staff also gave talks on various health subjects to Schools, Scout Groups, Women's Organisations, etc. Arrangements were also made for small groups of school children and members of various organisations to visit the Town Hall, the Disinfecting and Cleansing Station, and the Public Analyst's Laboratory. In addition to these organised activities, individual advice and instruction is continually being given by the Sanitary Inspectors during the course of their normal visits to food premises, shops, factories, and private dwelling houses. HOUSING. Housing Survey Section 1 of the Housing Repairs and Rents Act, 1954, which came into operation on the 30th August, 1954, provides that every local authority shall within one year submit to the Minister proposals for dealing with houses in their district which are unfit for human habitation. In London, these proposals are to be submitted jointly by the London County Council and the respective Metropolitan Borough Councils. A survey of all the dwelling houses in the Borough was commenced in December, 1953, in anticipation of the passing of the Act and at the end of 1954 this task had been almost completed. Certificates of Disrepair Under the provisions of the Housing Repairs and Rents Act, 1954, a landlord may, subject to certain conditions, increase the rent of a dwellinghouse. One of the conditions is that the house shall be in good repair, and if a tenant is not satisfied that the condition of the property justifies an increase in the rent, he may on payment of a fee not exceeding one shilling apply to the local authority for a Certificate of Disrepair, which if granted, relieves him of the liability to pay the "repairs increase," until such time as the landlord has carried out the necessary works and secured from the local authority, by similar application, a Certificate of Revocation. These provisions also apply to increases of rent permitted by the Increase of Rent and Mortgage Interest (Restrictions) Act, 1920. Any certificate issued under the Rent Acts, which was in force immediately before the commencement of the Housing Repairs and Rents Act, remained effective as though it had been given under the latter Act. Certificates issued during the year under the Rent Acts, i.e. prior to the 30th August, numbered 14 Certificates of Disrepair, and 2 Revocation Certificates. With the coming into operation of the new Act, however, the number of applications rose steeply and up to the end of the year a further 107 Certificates of Disrepair and 13 Revocation Certificates had been issued. Of the 107 Certificates of Disrepair, 100 were in respect of increases of rent claimed under the 1954 Act, and 7 for increases under the Act of 1920. Slum Clearance No areas were due to be dealt with by the Borough Council during the year under the current five year programme, but in view of the deterioration of a potential clearance area known as Smith's Cottages, Lovegrove Street, it was agreed by the London County Council that this should be included in the programme, and the area, comprising two houses, was represented by the Medical Officer of Health in February, 1954. The occupants were rehoused by the London County Council and the houses demolished. Individual Unfit Houses and Parts of Premises Fourteen individual houses and 62 parts of premises were dealt with during the year. Details of the action taken are set out in the Housing Statistics table which appears on pages 37, 38. Record of Work carried out during 1954 by the Council's Housing Inspectors Inspections Re-inspections Total Clearance areas 672 38 710 Individual unfit houses — Section 9 3 79 82 Section 11 13 80 93 Underground rooms and parts of premises Section 12 71 425 496 Improvement Grants 41 2 43 Requisitioned Property - 86 86 Total 886 624 1,510 Housing Statistics, 1954. 1. Inspection of Dwelling Houses during the Year:— (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,480 (b) Number of inspections made for the purpose 22,624 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 4,630 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 and Housing Acts 569 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 1,450 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) By owners 2,737 (b) By loca l Authority in default of owners 2 (b) Proceedings under Housing Act, 1936:— (1) Number of houses made fit after service of formal notices (Sections 9, 10, 11 and 16): — (a) By owners 8 (6) By local Authority in default of owners 1 (2) Houses demolished as a result of formal or informal procedure under Section 11 2 (3) Houses closed in pursuance of an undertaking given by the owners under Section 11 and still in force 1 (4) Parts of buildings closed by Closing Orders (Section 12): — (a) Underground rooms 16 (b) Other rooms 35 (5) Undertakings not to use parts of buildings for human habitation accepted: — (a) Underground rooms Nil (b) Other rooms 11 (6) Houses demolished under Section 25 2 (c) Proceedings under Housing Act, 1949: — (1) Closing Orders made under Section 3 (1) Nil (2) Demolition Orders determined and Closing Orders sub stituted under Section 3 (2) Nil (d) Proceedings under Local Government (Miscellaneous Provisions) Act, 1953: — (1) Closing Orders made under Section 10 (1) 2 (2) Closing Orders determined Nil (3) Closing Orders revoked and Demolition Orders made Nil Underground Rooms Regulations Revised Model Regulations for rooms to which Section 12(2) of the Housing Act, 1936, applies were received from the Ministry of Housing and Local Government in June, 1954. This revision was designed to bring the Regulations into line with the new Model Building Byelaws and secure proper economy in the use of materials and also to incorporate other improvements. The main differences between these and the existing regulations concerned the prevention of dampness and minimum window area. The Model Regulation relating to the prevention of dampness, although not so specific as the existing regulation (which required, where necessary, the provision of a dampproof course) was nevertheless more comprehensive and its adoption was accordingly recommended. The existing Regulation governing the size of windows, however, required a larger minimum area than the Model Regulation and the Ministry were therefore asked for authority to retain it. In reply, the Ministry stated that it was considered sidered that the existing regulation which stipulated that the window area should be at least one-eighth of the floor area was too stringent and one-tenth was accordingly substituted. In a subsequent review the words "clear of the window frame" were incorporated with which slight relaxation the requirement was considered to be a thoroughly reasonable one. The amended Regulations were accordingly adopted. Overcrowding Ninety-three cases of overcrowding came to the notice of the Public Health Department during the year, and in every case certificates of overcrowding were forwarded to the Housing Departments of both the Borough and County Councils. Overcrowded families rehoused during 1954 numbered 118, of which 55 were provided with alternative accommodation by the London County Council and 63 by the Borough Council. During the past two or three years a large number of Cypriots have come to live in England. It is the practice for the Commissioner to the Government of Cyprus to notify the Medical Officer of Health of intending immigrants and enquire whether they can be accommodated at the addresses to which they intend to proceed on arrival without infringing the provisions of Part IV of the Housing Act, 1936. Enquiries of this nature numbered 46 during 1954 and involved 82 prospective immigrants. This precaution against the possibility of causing overcrowding does not appear to be entirely effective, however, as there is no means of controlling the movement of Cypriots after arrival in this country. One or two cases of overcrowding have already been discovered which were due to immigrant families subsequently removing to other accommodation. Applications for Rehousing The Medical Officer of Health dealt with 644 applications for rehousing supported by medical certificates recommending priority consideration on health grounds, which were referred by the Council's Housing Department. Common Lodging House The Common Lodging House situated at 124, Camberwell Road is licensed by the Council for the accommodation of 224 male persons. Thirty-eight visits of inspection were made to these premises during the year by the district sanitary inspector and on each occasion the establishment was found to be satisfactory in all respects. At the request of the owners and on payment of an agreed charge the premises are sprayed every month by the Council's Disinfecting Staff as a precaution against possible vermin infestation. NOTIFIABLE INFECTIOUS DISEASES. The number of notifications of infectious diseases received at the Public Health Department during the year was 1,202 as compared with 2,341 during the previous year. This considerable reduction is largely accounted for by a decrease of 876 in the number of cases of measles. The figures for scarlet fever and whooping cough also fell by 80 and 89 respectively. The table appearing on the following page summarises by diseases and age groups the notifications received during the year. Diphtheria. No confirmed case of diphtheria has occurred in Camberwell for the past four years. One notification of this disease was received during 1954, but after admission to hospital the patient was found not to be suffering from diphtheria and the diagnosis was altered to "glandular fever." Whilst it is very gratifying to be able to record this satisfactory position with regard to the lack of diphtheria incidence, there is a very real danger that it may give rise to an apathetic attitude to immunisation on the part of parents. The publicity campaign, which is aimed at securing the highest possible percentage of immunity among the child population, was therefore pursued with increasing vigour in close co-operation with Division 7 of the London County Council who are responsible for the Diphtheria Immunisation Service in Camberwell. The following table shows by age groups the number of young persons in Camberwell immunised, in relation to the estimated population. 0 - 4 years 5 - 14 years Age at 31st December 1954. Total under 15 years 6,674 20,724 Number immunised at 31st December 1954. 27,398 13,600 26,900 Estimated population at 30th June 1954. 40,500 Smallpox. No cases of smallpox occurred in Camberwell during the year. Early in August the Medical Officer of Health was called into consultation by a general practitioner who suspected that one of his patients might be suffering from this disease, but fortunately the diagnosis was not confirmed. INFECTIOUS DISEASES, 1954. SUMMARY OF NOTIFICATIONS RECEIVED AND DEATHS FROM THESE CAUSES AMONG NOTIFIED CASES Disease. Found not to be suffering from the Disease. No. of Notifications. Treated in Hospital. 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 139 1 5 11 13 17 81 13 - - 11 - - - Whooping Cough 370 1 1 19 - 33 49 51 49 51 124 10 1 1 Poliomyelitis & Polio-encephalitis 14 14 5 - 2 2 6 1 3 - - - - - Measles 434 - 40 222 1 2 1 10 - 10 48 45 53 11 1 1 Diphtheria 1 1 - - - - - - - - - - 12 - Pneumonia Acute Influenzal - - - 1 - 3 1 - - - - - Acute Primary 32 - 3 1 6 - 6 4 - 2 - 1 4 - 51 3 5 6 Dysentery 19 2 - 9 9 1 11 4 - 1 Typhoid and Paratyphoid Fever 1 1 - - - - 1 - - - - - - - Erysipelas 25 1 - - - 3 - - - - 1 6 - - Meningococcal Infection 9 1 - 1 - 9 - 3 2 2 - - - - 76 Puerperal Pyrexia 92 88 - - - - - - 9 7 - - - Ophthalmia Neonatorum 6 1 - 6 - - - - - - - - - - Scabies 14 - - 3 2 2 - 1 2 1 1 2 - - 2 Malaria (Induced) - - - - - - - 2 - - - - - 1,202 180 Totals 10 - 65 102 125 109 132 454 41 13 105 21 20 Notification was received from the Airport Medical Officer London Airport, of two persons proceeding to addresses in Camberwell who had arrived by air from a foreign country where cases of smallpox had been reported. These possible contacts were kept under daily surveillance by the Council's Sanitary Inspectors until all danger of smallpox developing had passed. Poliomyelitis and Polio-encephalitis. Thirteen notifications of poliomyelitis and one of infective encephalitis were received during the year. Five of the poliomyelitis cases were subsequently found not to be suffering from this disease, and of the 8 confirmed cases, 5 were paralytic and 3 non-paralytic. There were no deaths. Food Poisoning. Notifications of cases of suspected food poisoning received during the year numbered 43 as compared with 165 the previous year. Nineteen of these were single cases and there were 10 small family outbreaks involving a total of 24 persons. Every case was closely investigated and the results are summarised in the following reproduction of the Annual Return of Food Poisoning notifications which has been forwarded to the Ministry of Health in accordance with Circular 46/49 and Memo 188/Med. dated 24th May, 1949. 1. Local Authority: CAMBERWELL M.B. Year: 1954. 2. FOOD POISONING NOTIFICATIONS (CORRECTED) RETURNED TO R.G. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 11 6 10 16 43 3. OUTBREAKS DUE TO IDENTIFIED AGENTS. Total Outbreaks: 2. Total cases: 5. Outbreaks due to:— (a) Chemical poisons Nil. (b) Salmonella organisms 1 (c) Staphylococci (including toxin) 1 (d) Cl. botulinum Nil. (e) Other bacteria Nil. 4. OUTBREAKS OF UNDISCOVERED CAUSE. Total outbreaks: 8. Total cases: 19. 5. SINGLE CASES. Agent identified: 8. Unknown cause: 11. Total: 19. TUBERCULOSIS. Three hundred and thirty two primary notifications of pulmonary and 32 of non-pulmonary tuberculosis were received during the year. Comparative figures for 1953 were 286 and 20 respectively. There was a dramatic fall in the number of deaths from tuberculosis which totalled 26 (24 pulmonary and 2 non-pulmonary). This is the lowest figure ever recorded in Camberwell. The fall in the tuberculosis death rate follows the general trend in the country as a whole. The notification rate is increased slightly; this is the experience in many other areas in England and Wales and it is believed to be, partly at least, a reflection of more intensive case finding in which mass miniature radiography and routine tuberculin testing are playing an important part. TABLE SHOWING SEX AND AGE DISTRIBUTION OF ALL PRIMARY NOTIFICATIONS AND DEATHS FROM TUBERCULOSIS DURING 1954. Notifications Deaths.† Pulmonary. Non-Pulmonary. Age Periods. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. Male. Female. Male. Female. - 0 - 1 yr. 1 - 1 - - - - - 1 - 5 yrs. 4 3 - - - - - 4 3 4 - 5 - 15 „ 8 - - - 5 29 31 5 - - 15 - 25 „ - - 1 1 25 - 35 „ 28 32 6 - 4 - 3 3 2 35 - 45 „ 45 14 - - - 45 - 55 „ 41 23 - 1 3 1 - - 1 5 1 55 - 65 „ 35 6 - - - - - 65 and over 17 11 - - 8 - 20 8 Totals 204 128 16 2 - 12 † After correction for inward and outward transfers. TABLE SHOWING NOTIFICATIONS AND DEATHS, TOGETHER WITH THE ESTIMATED POPULATION DURING THE PAST FIVE YEARS. Year. No. of Primary notifications. Notification Rate per 1,000 Population. No. of Deaths. Death Rate per 1,000 Population. Estimated Population. 64 0.36 1950 178,900 325 1.8 65 0.36 1951 179,500 300 1.7 1952 400 2.2 52 0.29 181,200 0.27 1953 180,200 306 1.7 49 364 2.0 0.14 1954 179,500 26 Report of the Consultant Physician, Camberwell Chest Clinic. During the past year the work of the Chest Clinic at Brunswick Park has continued to increase. The service, which started in 1952, whereby general practitioners could refer patients for a chest X-ray report, has led to an increase in the number of new patients seen. In all, 5,060 persons attended for examination and investigation because some abnormality was noted in their initial chest X-ray, or because the general practitioner requested an examination for a specific symptom. A study of the age distribution figures for notifications shows that the danger period for women is still between 15 and 35 years. There were 63 cases compared with 37 in the age group 35-55, while in men the period comes later. There were 86 in the age group 35-55 and 52 in the over 55 group; this latter group contained only 17 women. All these figures are in keeping with the national trend and emphasize the great need for detecting cases in older persons. Ante-natal chest X-ray examination is of value in detecting cases of tuberculosis as the 20-year period 15-35 covers the child-hearing age. Routine mass X-ray examination of random populations or of school-leavers is much less likely to yield new cases of pulmonary tuberculosis than selected examinations of particular populations such as Reception Centres where a number of cases of active tuberculosis have been discovered. This source of infection is one which requires urgent attention. Furthermore, if more men who have "chronic bronchitis" or "smoker's cough" were X-rayed, there is no doubt that more cases of chronic pulmonary tuberculosis in the older age groups would be discovered. Another means of case finding is the tuberculin testing of all children attending Infant Welfare Clinics. When a positive reactor is found all the ancillary workers, such as health visitor, school nurse and clinic nurse, are called upon to find the source case, who may frequently turn out to be a grandfather or uncle, not always living in the same house. It is hoped that this form of examination can be extended to annual testing of school children because it is known that there is a conversion rate of 3 per cent, per annum, and adequate search should yield a high proportion of source cases. Contact examination by X-ray of those over 12 and tuberculin testing of younger members of a family is not only a very valuable means of finding new cases but it is a very necessary reassurance for the family. Twenty-one new cases of pulmonary tuberculosis were found as a result of contact examination at the clinic. Deaths have fallen from 52 in 1952, 49 in 1953, to 26 in 1954, which represents a rate of 14 per 100,000. An analysis of the deaths shows that of the 17 males who died, 16 were over 45 and 7 of the 8 females were under 45. There was one death in an infant, not from meningitis but from an obscure, possibly tuberculous, broncho-pneumonia. The death rate cannot be expected to go on showing this fall as long as new notifications among men over 45 remains high. Moreover, prolonged chemotherapy is now given in many instances to people in the older age groups, with the aim of rendering them sputum negative and thus lessening their danger to the community as well as improving their clinical condition. There is comparatively no waiting time for admission to a sanatorium. A number of patients, however, have to wait at home before admission for surgical treatment. On an average this wait is three months, during which the patient usually receives chemotherapy. As a consequence, nearly all patients are sputum negative when they come to operation and undoubtedly better results are obtained. Chemotherapy is also being given to increasing numbers of patients who show some radiological evidence of an extension of their original disease, but do not have a positive sputum. It is also given to most of the chronic cases who previously should have been in a sanatorium, if only for segregation, but who refused to go. In an encouraging number of instances these chronic cases have been rendered sputum negative for very long periods and despite radiological evidence of advanced disease they have been made sufficiently well to be placed in work. This problem of the chronic sputum positive case is at the centre of tuberculosis control today, and the results obtained in Camberwell are most encouraging. At any one time during the year over 100 patients were on chemotherapy. At the end of the 1952 report attention was called to the unsatisfactory working conditions at the Chest Clinic. It is a pleasure to be able to report the the Regional Hospital Board plans to alter part of St. Giles' Hospital into a new department. With improved accommodation and better facilities, the work of the department should increase even more, and the service given be more worthy of the citizens of Camberwell. My thanks are due to Dr. Chalke as Medical Officer of Health and also as Divisional Medical Officer of the London County Council for the help he and his staffs have given me, and also to the various nursing associations who have undertaken some of the domiciliary treatment. Mass Radiography. The Mass Miniature Radiography Unit made five public surveys in the Borough during the year. Of the 7,525 men and 8,171 women who were X-rayed, 48 cases (27 men and 21 women) were recommended for treatment for tuberculosis, an attack rate of 310 per 100,000. One survey of a Reception Centre was made (see above) and a number of schools, colleges, hospitals, and occupation centres were visited. Only four cases were found to require treatment out of 3,804 who were examined. This represents an attack rate of 110 per 100,000. K. MARSH, Consultant Physician. Annual Report of the Camberwell Tuberculosis Care Committee for the year 1954. During the year the Camberwell Borough Council filled the two vacancies of their representation on the Committee caused by the resignation of Councillor Mrs. M. Manning and Councillor Miss W. Cleary. The two representatives elected were Councillor Mrs. A. Pritchard and Councillor H. Lamborn. We regret to record the death of Mr. A. Robinson, J.P., a member who had served on the Committee for many years and had given much public service. Dr. Barnes resigned his office as Medical Officer of Health for Camberwell in May, 1954. He had been an ex-officio member of the Committee since its inauguration, and has always been most helpful by his assistance and guidance. We place on record our appreciation and thanks for the service he has rendered to this Committee. The work of the Committee has continued as in the past. Early in the year a typewriter was purchased for the use of patients who wished to become typists when fit for work. It is pleasing to record that four patients found employment as typist-clerks and at the close of the year two others were sharing the typewriter with a view to commencing work in the New Year. Included in the general work of the Committee the Secretary had consultations with 1,824 patients, the greater number being referred by the medical staff, health visitors of the Chest Clinic, the voluntary organisations and public Bodies in the borough. Once again Camberwell's collection in the Christmas Seal Sale for the year ended 31st March, 1954, exceeded the sum collected by any other Metropolitan Borough. The sum received was £1,474 14s. 10d. Unfortunately, the London County Council were unable to assist the Committee as in the past by contributing to the Fund from the proceeds of the Sunday Cinematograph Entertainments. The table below shows the number of patients who have been helped by the Committee during the year and the type of assistance given:— Assistance given Number Lodgings and meals 5 Loan to re-start a business 1 Purchase of spectacles 1 Clothing and footwear 69 Pocket money while in hospital 14 Wireless: repair and licences 3 Fares of relatives to distant sanatoria 47 Household removals and help with furnishings 4 Taxi fare 7 Loan of bedside comforts 26 Loan of beds 27 Supply of bedding 34 Supply of towels 28 Loan of jig-saw puzzles and books 141 Hire purchase payments 3 Fees for correspondence courses 4 Holiday 1 In addition, after investigation, the Secretary referred 248 cases to the National Assistance Board for financial or other help. The handicraft class continued to meet every Friday afternoon from 2-4 p.m. There was a roll of twenty students with an average attendance of twelve. Of the students who left the class seven became fit for work, one married, one took full time training under the Government Scheme, and two were admitted to hospital. The Camberwell Community Association arranged an exhibition of the social activities carried on in the Borough during one week in September. The Committee took part in this exhibition by displaying articles made by the students of the handicraft class. This was most helpful, firstly to the citizens of the Borough who learned of the work of the Care Committee and secondly, to the students, as the enquiries made formed an avenue of sale for their work. The Committee arranged both summer and winter social events for the students. In July a visit was made to Brighton for the day and at Christmas a tea party was held followed by a visit to the theatre. From the comments of the patients both outings were a success. The following voluntary associations in the Borough have maintained close co-operation: The British Red Cross Society; Family Welfare Association; Nursing Associations; Invalid Children's Aid Association; Soldiers, Sailors and Air Force Families' Association; and the Women's Voluntary Services. Their assistance is much appreciated. The official bodies have also continued to give their advice and help and for this we thank them. We desire to place on record our thanks to the Honorary Officers; the Worshipful the Mayor of Camberwell, Alderman J. W. F. Lucas, J.P., as Patron to the Christmas Seal Sale; Sirs. Cecelia Greenwell, as Organiser to the Christmas Seal Sale; Mr. H. Smith, Borough Treasurer, as Treasurer; and Mr. A. W. J. Lamb, as Auditor; and to the Borough Council for affording us accommodation for our meetings. We also wish to thank Dr. H. W. Barnes, Medical Officer of Health, for including the Committee's Annual Report for 1953 in his Annual Report for the same year. A. F. CROSSMAN, Chairman. J. M. LEONARD, Secretary. NON-NOTIFIABLE DISEASES. Weil's Disease. Leptospirosis Ictero-Haemorrhagica or Weil's Disease is commonly due to infection by an organism carried and excreted by rats. Although not a notifiable disease, general practitioners and hospitals almost invariably inform the Medical Officer of Health on diagnosing this condition in any of their patients. Investigation is then carried out to ascertain whether the patient's home or place of work is infested with rats, so that the necessary measures may be taken to eradicate them. In September, 1954, the death from this disease of a male patient was notified by a hospital in the Borough. Enquiries did not reveal any possible local source of infection, but the patient was stated to have bathed in the River Thames at a place in Gloucestershire a few days before the onset of the illness. The Medical Officer of Health for the area concerned was accordingly notified. FOOD AND DRUGS ADULTERATION. Three hundred and seventy four formal and 518 informal samples were obtained by the Council's Sampling Officer during the year for examination by the Public Analyst under the provisions of the Food and Drugs Act. The results of these examinations are summarised in the following table:— Number examined. Number adulterated, etc. Percentage of adulteration. Formal. Informal. Total. Formal. Informal. Total. Formal. Informal. 374 518 892 5 12 17 1.34 2.32 Particulars of the adulterated samples and the action taken are set out on pages 52 and 53. Milk. The following table shows the number of registered purveyors of milk in the Borough at the end of the year:— Dairies 27 Distributors of Milk in the Borough 206 Distributors of Milk dealing from premises outside the Borough 10 Special Designated Milk Under the provisions of the Milk (Special Designations) Act, 1949, Camberwell is a "specified area" in which only special designated milk may be sold retail. There are no pasteurizing or sterilizing establishments in the Borough, but licences were issued during the year in respect of the sale of special designated milk as follows:— Type of Licence. Sterilised. Pasteurised. Tuberculin Tested. 190 Dealers 148 90 Supplementary 21 19 19 Total 211 167 109 Serial No. 21 73 134 134 155 159 176 180 182 196 197 219 303 303 353 354 Article Glauber's Salt Fish Paste Buttered Brazils Buttered Brazils Ice cream Cocktail Gin Buttered Walnuts Oranges Buttered Brazils Buttered Brazils Buttered Brazils Buttered Brazils Ice Lolly Butter Concentrated Tomato soup (canned). Concentrated Tomato soup (canned). 381 Butter Whether Formal or Informal Informal Informal Informal Formal Informal Informal Informal Informal Formal Formal Formal Informal Informal Formal Informal Informal Informal Nature of Adulteration or Irregularity Completely effloresced. Mouldy. 62 per cent, deficient in butter fat. 17.5 per cent, deficient in butter fat. Contaminated with carbonaceous matter. Incorrectly labelled. 50 per cent, deficient in butter fat. 6 parts per million Thiourea. 60 per cent, deficient in butter fat. 11 per cent, deficient in butter fat. 50 per cent, deficient in butter fat. 17.5 per cent, deficient in butter fat. Lead 10 parts per million. 17 per cent, water. Tin 2.9 grains per pound. Tin 3.0 grains per pound. 16.4 per cent, water. 52 Observations - - See Formal Samples Nos. 182 and 196. - - - See Formal sample No. 134; taken from same manufacturer. - Owing to doubt as to manufacturer, further samples taken See Nos. 196 and 197. - - See Formal sample No. 197. - - - - See Formal sample No. 303. Result of Proceedings or other action taken Remainder of stock withdrawn from sale and returned to wholesaler. Remainder of stock examined and found to be satisfactory. - Reported to Public Health Committee and cautionary letter sent. Matter taken up with manufacturer and rectified. Batch affected withdrawn from sale. Reported to Public Health Committee and cautionary letter sent. - Reported to Public Health Committee, matter taken up with importers. - Reported to Public Health Committee and cautionary letter sent. Reported to Public Health Committee and cautionary letter sent. - Remainder of stock destroyed under supervision; mould withdrawn from use for re-tinning. Reported to Public Health Committee and cautionary letter sent. Remainder of stock surrendered and destroyed. Remainder of stock surrendered and destroyed. - The results of various tests applied to samples of special designated milk during the year are set out hereunder: — Phosphatase Test Turbidity Test Designation Methylene Blue Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 115 - 116 - - - - Tuberculin tested pas- teurised - 57 - - 54 - 67 - Sterilised - - - Supply of Milk to Schools and Hospitals The following table gives details of the numbers of samples of milk taken in the course of delivery to schools and hospitals in the Borough and submitted to various tests. All proved to be satisfactory. Phosphatase Test Chemical Test Methylene Blue Test 28 35 Hospitals 27 Schools 62 66 67 Biological Examination of Milk Eight samples of tuberculin tested raw milk were submitted to the Public Health Laboratory Service for examination during the year. In every case it was reported that animals inoculated with these milks showed no evidence of tuberculosis on postmortem examination. Ice Cream. The Sampling Officer obtained 104 samples of ice cream for examination by the methylene blue test with the following results: — Number of Samples Grade I 57 24 II 12 III 11 IV In addition, 32 samples of ice cream were examined chemically; one was found to be contaminated with carbonaceous matter and appropriate action was taken to prevent a recurrence. Ice Lollies. Twenty-three ice lollies and 3 cream lollies submitted for bacteriological examination were all reported to be satisfactory. Of 17 samples of ice lollies submitted for chemical analysis one was found to contain 10 parts per million of lead. This was apparently contaminated by the mould in which it was frozen. The manufacturers were approached and all the existing moulds were re-lined. The remainder of the stock was destroyed. Subsequent samples obtained from the same source were found to be satisfactory. Bacteriological Examination of food The following is a list of foods, samples of which were submitted for bacteriological examination for various reasons during the year:— Cream, sterilized 9 „ single 5 „ double 5 Yoghourt 1 Evaporated milk 3 Marshmallow creme 1 Sausages, preserved pork 1 „ frozen pork 1 „ preserved beef 1 Stewed steak 2 Canned corned beef 2 Fish paste 2 Fresh orange drink 1 Fortified cereal (baby food) 1 The results of these examinations produced no evidence that they were unfit for human consumption. INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES. Registration of Food Premises. The numbers of premises in Camberwell at the end of the year which were registered in accordance with the provisions of Section 14 of the Food and Drugs Act, 1938, were as follows: — Sale, manufacture and storage of ice cream 472 Preparation or manufacture of:- Potted, pressed, pickled or preserved meat 219 Potted, pickled or preserved fish 62 Potted, pickled or preserved other foods 22 Supervision of Food Premises All premises used for the manufacture, preparation, storage or sale of food are kept under supervision by the district sanitary inspectors. The numbers of visits of inspection paid to each type of premises during 1954 were as follows: — No. of Inspections Type of Premises Bakehouses 161 222 Bakers and Confectioners Butchers 476 Cooked and Preserved Meat Shops 213 Dairies and Milkshops 266 Fishmongers and Shell Fish Vendors 137 Fish Fryers 119 Fish Curers 88 Food Factories 64 260 Ice Cream Vendors Public Houses 160 Restaurants and Eating Houses 417 Slaughterhouses 5 Street Markets 1,376 Street Traders Food Stores 48 Other Food Premises 940 Total 4,952 Food and Drugs Amendment Act, 1954. This Act received the Royal assent on 25th November, 1954, but with the exception of Section 28, will not come into effect until a date to be appointed by the Minister of Food. The Act is to be consolidated with the Food and Drugs Act, 1938, the Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950 and the Slaughterhouses Act, 1954, and Food Hygiene Regulations are to be made under the consolidation measure to replace Section 13 of the Food and Drugs Act, 1938. Section 28 of the new Act, which came into force on 25th November, 1954, contains certain provisions governing the restriction of private slaughterhouses. Unsound Food. The Council's Food Inspector is responsible for examining all food which is suspected to be unsound and for issuing condemnation certificates in respect of any food which is considered to be unfit for human consumption and is surrendered for destruction. During 1954, the number of condemnation certificates issued was 2,176 and details of the foods concerned are set out in the following table. All this unsound food was destroyed by burning in the Council's incinerator. Particulars and weights of Unsound Foods destroyed at the Council's Disinfecting Department, Council Depot, Frensham Street, Peckham Park Road, S.E.15 for the year ended 31st December, 1954:— Weight Total Weight Meat Tons cwt. qrs. lbs. Tons cwt. qrs. lbs. Beef 1 4 2 27½ Pork - 10 0 7¾ Sows heads - 10 3 5 Sausage meat (frosted) - 7 1 1 Ox cheeks — 5 1 15 Sheeps carcases (3) - 1 2 27 Mutton - - 3 2 Veal - - 2 13 Rabbits - — 2 4 Ox tails - - 1 7 Ox liver — - 1 0 Pigs hearts - — - 25 Lamb - - - 14½ Bacon - - - 13¾ Sausages - - - 12 Bones - - - 8 3 3 0 14½ Poultry - - - 6 Chicken (cooked) Fish Rock salmon - - 3 0 Plaice - - 2 7 Lobster (frosted) - - 2 3 Cod - - 2 0 Skate — — 2 0 Whiting - - 2 0 Kippers 1 0 Prawns (frosted) - - - 16 Crabs - - - 16 - 3 3 14 Fruit Fruit salad (dried) - 19 1 0 Olives - 13 2 0 Coconut - 6 2 12 Raisins (seedless) — — 2 4 Dried fruit (mixed) - - 1 2 Walnuts 1 0 Prunes - - — 20 Cut P eel 11 2 0 2 21 Tinned Foods Ham, 290 tins 1 8 1 1½ Ham (in cut) - - - 21 Meat ( various), 1,928 tins 1 1 0 11¾ Vegetables, 20,925 tins 3 1 0 12½ Fruit, 28,552 tins 16 12 1 8 Milk (evaporated and condensed), 3.728 tins 1 8 2 21¼ Cream, 22 tins — — — 9 Fish, 1,074 tins - 3 1 9½ Jams (assorted), 236 tins - 2 1 9 Marmalade, 20 tins - - 1 9 23 17 3 0½ Miscellaneous Preserved fruits, cheeses (various), confectionery, chicken noodle soup powder, frozen cooked meals, rice (various), liquid eggs, biscuits, sugar, butter, pickles (various), sauces, jams (various) and a variety of other foods Gross Weight 31 19 1 18 ½ Food Inspection. The following is a summary of the work of the Food Inspector during the year under review:— Complaints received 8 Complaints found to be justified 22 Visits:— Bakehouse 5 Butchers 187 Fish curers 23 Fish fryers 9 Ice cream premises 12 Restaurants and eating houses 49 Slaughterhouses 5 Street markets 1,332 Other food premises 506 Merchandise Marks Act 52 Inspections not defined 195 Re-inspections 5 Slaughterhouses:— Carcases inspected Nil. Carcases condemned Nil. Organs inspected Nil. Organs condemned Nil. Food surrendered 384 Foodstuffs certified for export Nil. Food condemnation certificates issued 2,176 Slaughterhouses. There are three licensed slaughterhouses in the Borough, but no slaughtering was carried out at any of them during the year. Merchandise Marks Act, 1926. All imported food sold or exposed for sale is required, by Orders in Council made under the provisions of the above Act, to bear an indication of the country of origin. No contravention of the statutory requirements came to the notice of the Public Health Department during the year. By-laws for the Protection of Foods. These by-laws were made under Section 15 of the Food and Drugs Act, 1938 for securing the observance of sanitary and cleanly conditions and practices in connection with the handling, wrapping and delivery of food sold or intended for sale for human consumption, and in connection with the sale or exposure for sale in the open air of food intended for human consumption. No infringements were reported during the year. Basement Bakehouses. Under the provisions of Section 54 (2) of the Factories Act, 1937, Local Authorities are required to carry out an examination of every basement bakehouse in respect of which a Certificate of Suitability has been issued under the Factory and Workshop Act, 1901, in the year ending June 30th, 1939, and in every fifth year after that year. Following the examination of a basement bakehouse, the Local Authority have two courses open to them : — (a) If, as a result of the examination the Local Authority are not satisfied that the bakehouse is suitable for use as such as regards construction, height, light, ventilation and any hygienic respect, they must notify the occupier in writing that the certificate will cease to have effect after a period, not being less than one month, specified in the notice. (b) If suitable, they shall give notice in writing that the certificate shall continue to operate, but without prejudice to the power of the Council to revoke the Certificate as the result of a subsequent examination. Any basement bakehouse which for a period exceeding twelve months is not used as a bakehouse shall not be so used again. At the quinquennial review in 1949 the Council authorised the continuation of Certificates of Suitability in respect of 14 basement bakehouses in the Borough, but directed that the Owners be informed that all works necessary to bring their premises in conformity with the standard recommended by the Metropolitan Boroughs' Standing Joint Committee should be carried out before the next review, otherwise such certificates would be revoked. A survey of these 14 basement bakehouses in 1954, revealed that three of them had not been used for more than 12 months and the Certificates of Suitability had automatically become invalid. Seven premises were not in use and had not been brought up to the required standard and the Certificates of Suitability were accordingly revoked by the Council. At the remaining four bakehouses, all the necessary works had been carried out and they were functioning satisfactorily. Authority was therefore given for their Certificates to continue in force. Restaurants and Eating Houses. At the end of the year the records indicated that there were 341 eating houses in the Borough as compared with 339 the previous year. All these premises were kept under supervision by the district sanitary inspectors and where necessary, notices were served and action taken to ensure compliance with the requirements of the Food and Drugs Act. Street Traders. During 1954 the Council issued 73 street traders licences in respect of the sale of foodstuffs from barrows and stalls. The street markets as well as the premises used by the traders as stores were kept under supervision by the Food Inspector and the district sanitary inspectors. INDEX PAGE Accidents in the Home 10 Ageing Population 11 - 12 Aged Persons 27-31 Atmospheric Pollution 14-20 Bakehouses, Basement 59 Barbers and Hairdressers 22 Bed Bugs 32 Births 6 Bombed Sites 20 Certificates of Disrepair 36 Chiropody 29 Cleansing Station 33 Common Lodging House 40 Cremation Certificates 13 Deaths 6-9 Accidental Deaths 10 Cancer Deaths 9 Chief Causes 8 Infant Mortality 9 Maternal Mortality 9 Table of Causes and Ages 7-8 Dinner Clubs 30 Diphtheria 41 Disinfection, Return of Work 33-34 Drainage and Sewerage 14 Dustbins, Provision 0f 22 Eating Houses and Restaurants 60 Factories Act 24-26 Inspection Tables 25 Outworkers 26 Food and Drugs (Amendment) Act 56 Food and Drugs Adulteration 51-55 Bacteriological Examination 55 IceCream 54 Ice Lollies 55 Milk 51 Samples taken, Table 51 Table of Adulterated Samples 52-53 Food and Food Premises 56-61 Bakehouses, Basement 59 By-laws for protection of food 59 Food and Drugs (Amendment) Act 56 INDEX —continued. PAGE Merchandise Marks Act 59 Registration of food premises 56 Restaurants and Eating Houses 60 Slaughterhouses 59 Street Traders 60 Supervision of food premises 56 Unsound food 57-58 of Pood Inspector, Table 58-59 Food Poisoning 43 Hairdressers and Barbers 22 Health Education 34 Health Services, General provision 27-35 Holidays for Old People 31 Housing 36-40 Applications 39 Certificates of Disrepair 36 Common Lodging House 40 Individual Unfit Houses, etc. 37 Overcrowding 39 Slum Clearance 37 Statistics 37 Survey 36 Underground Rooms Regulations 38 Work of Housing Inspector, Table 37 Ice Cream 54 Infant Mortality 9 Infectious Diseases 41-49 Table of Notifications 42 Mass Radiography 46 Maternal Mortality 9 Meals on Wheels 28 Medical Examinations 13 Merchandise Marks Act 59 Milk 51-54 Biological Examination 54 Special Designated Milk 51-54 Supply to Schools and Hospitals 54 Mosquitoes 20 Offensive Trades 21 Old People's Clubs 29 Outworkers 26 Overcrowding 39 Pet Animals Act 23 Pharmacy and Poisons Act 22 Poliomyelitis and Polio-encephalitis 43 INDEX —continued. PAGE Population 6 Public Cleansing 14 Public Health Committee 3 Rag Flock, etc. 21 Restaurants and Eating Houses 60 Bodent Control 31-31 Table of Work 32 Sanitary Circumstances of the Area 14-26 Sanitary Inspection 23-26 Inspections 23 Notices served 24 Work supervised etc. 24 Scabies 33 Sewerage and Drainage 14 Shops Act 22 Slaughterhouses 59 Slum Clearance 37 Smallpox 41 Smoke Abatement 14-20 Staff of the Public Health Department 4 Static Water Tanks 20 Statistics, Summary 5 „ Vital 6 Street Traders 60 Swimming Bath Water 20 Tuberculosis 44-49 Care Committee Annual Report 47-49 Chest Physician's Report 45-47 Mass Radiography 46 Notifications, Table 44 Underground Rooms Regulations 38 Unsound food 57 - 58 Vermin 33 Water Certificates 14 Water Supply 14 Weil's Disease 50