Ac 4376 1 ? Metropolitan Borough of Camberwell REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1955 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 50 Public Health Department, Town Hall, Camberwell, S.E.5. September, 1956. To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Camberwell. Mr. Mayor, Aldermen and Councillors, I have much pleasure in presenting my Annual Report for the year 1955. This is my first report as Medical Officer of Health of the Borough for a full year. It will be noted that this Report has been produced in a form different from that of previous years; all the usual statistical data has been included in an appendix and the remainder of the Report is devoted to information and public health features of topical interest. This new "pattern," whilst providing all the particulars normally given, eliminates repetition and will, I hope, prove to be of greater interest, not only to the members of the Council and other persons concerned with public health administration, but also to the general public. The health of the population of Camberwell was maintained at a satisfactory level throughout the year and there was no unusual occurrence which calls for special comment. The population, as estimated by the Registrar-General at mid-year showed a reduction of 900 on the previous year; there was a slight increase in the death rate from 10.1 to 10.5 but the infantile mortality rate, which fell to 21.3, was the lowest ever recorded in Camberwell. The birth rate dropped by only one point. The early part of the year saw the completion of the housing survey and after consultations with the officers of the London County Council, a joint return was made to the Minister under Section 1 of the Housing Repairs and Rents Act, 1954; a copy of the return appears in the Statistical Appendix to this Report. Negotiations with the London County Council were still proceeding at the end of the year to reach agreement on the next five-year Slum Clearance Programme. In conclusion I should like to record my thanks to the members of the Council and the other Chief Officers and their Staffs for the consideration and co-operation they have extended to me at all times, and to express my grateful appreciation of the loyal and capable assistance which I have received from the Staff of the Public Health Department. 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 1955. Chairman: Councillor H. G. Lamborn Vice-Chairman: Councillor Mrs. M. V. Goldwin. Members: Alderman Mrs. J. Burgess. Councillor D. I. Guy. „ Mrs. A. Crossman, J.P. „ W. G. Hopkins. „ A. F. Lockwood, J.P. „ G. F. Lawrence. Councillor U. G. Allender. „ Miss A. G. Liddle. „ Mrs. J. Bartlett. „ G. T. Montgomery. „ C. T. Boothby. „ C. T. Pike. „ G. Brown. „ H. A. Pook. „ J. Corrigan. „ Mrs. A. E. Pritchard. „ Mrs. E. Thorne. „ Mrs. E. S. Daymond. „ S. H. Gilbert. „ Miss D. M. Walker. „ A. L. Westcar. Ex-Officio: Alderman David Tarrant, J.P. 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. D. Chalke, O.B.E. (Mil.), T.D., M.A., M.R.C.P., M.R.C.S., D.P.H. Deputy Medical Officer of Health: *E. Margaret Cran, M.A., M.B., Ch.B., D.P.H. Public Analyst: D. F. H. Button, A.R.C.S., F.R.I.C. 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. Dray. a A. G. O'Gilvie. 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: Mrs. M. Findlay. D. Danter. Mrs. A. D. Dormer. C. Burgess. P. A. S. Kirrage. Miss E. M. Lawrence. A. Beare. Rodent Control Staff: Rodent Officer W. H. G. Saunders. b Rodent Investigator Mrs. M. J. Kenny. Rodent Operators C. Green (Working Foreman), F. G. Hulbert, P. Collins, R. Humphreys. 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. Cleansing Station Attendant 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. (b) Certificate Sanitary Inspectors Examination Joint Board. A CENTURY OF PUBLIC HEALTH. The Metropolis Local Management Act, 1855, directed each Vestry to appoint a Medical Officer of Health and to publish a report of the measures taken by them for the removal of nuisances, and the improvement of the sanitary conditions of the Parish. Camberwell's first Medical Officer of Health, Dr. J. S. Bristowe, M.D., F.R.S., was appointed in 1856. In this, the report of the Medical Officer of Health a hundred years later, it may be of interest to draw a few comparisons between the state of the public health then and now. At that time sanitary reform was at its beginning, stimulated by the work of Chadwick and others. Infectious disease was rife (the first of the great cholera outbreaks occurred in 1831) but until the bacteria that caused them were discovered they were virtually uncontrollable. When Dr. Bristowe published his first report Pasteur was formulating the germ theory of diseases, but many years were to elapse before the bacteria that caused infections like tuberculosis (1882), cholera and diphtheria (1883) and tetanus (1884) were discovered. Let us compare the death rates from the main infectious diseases and carcinoma in Camberwell in 1856 with those to-day. (There was no record of the number of cases of infectious diseases because notification did not commence until nearly fifty years later.) Cause of death 1856 1955 No. of Rate per No. of Rate per deaths 1,000 pop. deaths 1,000 pop. All causes (all ages) 1,259 20·5 1,878 10·5 Diarrhoea, bronchitis and pneumonia (under 3 years) 120 2·0 6 0·03 All causes (under 5 years) 430 7·0 70 0·4 scarlet fever 44 0·7 Nil. - Smallpox 4 0·06 Nil. — Whooping cough 30 0·5 1 0·006 Measles 7 0·1 1 0·006 Croup 15 0·2 Nil. — Tuberculosis (all forms) 179 2·9 30 0·16 Poliomyelitis No record 1 0·006 Carcinoma (all forms) No record 404 2·3 Carcinoma (of lung and bronchus) No record 114 0·6 Dr. Bristowe spoke of tuberculosis as "due to a peculiar unhealthy form of constitution, and a tendency to deposition in organs of a substance which rapidly breaks down, ulcerates and destroys the healthy tissues." Although he wrote nearly 30 years before the tubercle bacillus was discovered he noted very wisely the influence of inadequate diet, over-work, exposure to the weather and unwholesome habitation. Typhus he spoke of quite rightly as "propagated by contagion"—it was in 1902 that Nicolle showed that this disease was carried by lice. In 1856 sewage systems were primitive and water supplies were frequently contaminated, and we read in the early reports of the preparation of plans of open ditches and sewers—1¾ miles of them—and of schemes for arching them over. At that time 223 cesspools were emptied, 336 filled up and 324 closets trapped and connected with a sewer. There were numerous shallow wells polluted with sewage—cholera was the result. An out-break of typhoid in the Peckham Police Station was found to be caused by a cesspool leaking into the soil below the duty room —the "emanation from the cesspools" was of course not the cause, the shallow well was infected. The year 1859 experienced an unusually severe, prolonged and widespread invasion of diphtheria — "there can be no doubt that it is to some extent infectious and catching"—fourteen years later, when the bacillus was isolated its high infectivity was made clear. Concern was expressed at the low rate of vaccination against smallpox, a disease which was beginning to spread again. In the five years from 1861-1866 there were 135 deaths from diphtheria, 73 from smallpox and 44 from cholera. A good deal of the time of the Sanitary Inspectors, it is recorded, "was occupied with matters relating to the Cattle Plague"; they had 62 cowhouses to inspect, compared with only one to-day. The death rate among infants was very high (no records of deaths under one year are available before 1865 when the infant death rate was 162 as compared with 21 in 1955) and Dr. Bristowe was (and rightly) of the opinion that a considerable number of deaths might have been prevented. By 1906 the rate had dropped to 134, and during that year 5,000 copies of a pamphlet on infant feeding were distributed in the Borough. Dr. Stevens the Medical Officer of Health reported the recommendations of a conference he attended on the subject of infant mortality. Among the recommendations of the conference were—instruction in hygiene in the schools, the setting up of milk depots, the notification of still-births, and the certification of all preparations sold as food for infants. It was recommended also that "the appointment of qualified women, especially trained in hygiene of infancy, is necessary as an adjunct to public health work." This suggestion received only lukewarm approval from the Camberwell delegates who thought, however, that "it might be given a trial." One of the duties of the Medical Officer of Health in those early days was to make monthly tests of the quality of the gas supplied; he no longer has to do that, but accidental coal gas poisoning in the home is now very much his concern. What major changes have taken place in a hundred years? Many of the environmental factors that caused disease and high death-rates have been overcome, whilst regard to personal health and hygiene to which attention began to be directed towards the end of the century, has played a great part in this also. As some problems are being solved others are appearing. The tuberculosis death rate commenced to fall in the 1830's — it has continued ever since. Cancer of the lungs, on the other hand, is steadily increasing. Immunisation is now available against many of the infectious diseases-diphtheria, whooping cough, tuberculosis, typhus, tetanus, etc. and now poliomyelitis, in addition to smallpox vaccination —the only one available in Dr. Bristowe's time. But as he complained of the low vaccination rate so do we. A hundred years ago the infectious diseases and the effects of malnutrition were major public health problems, they were associated with poor sanitation, overcrowding, ignorance and apathy. To-day conditions due to the stress of modern life are assuming more importance — coronary disease, peptic ulcer and neurosis: cancer of the lung is now very much on the increase, and tobacco and atmospheric pollution are suggested as contributory causes. Vaccination against smallpox and immunisation against diphtheria have almost eliminated these deadly diseases, but concern is felt at the small number of persons now protected. The swiftness of modern travel from ah road increases the risk of importation of such diseases as smallpox, and a number of outbreaks have occurred in this country since the war. Whooping cough is now responsible for far more deaths than diphtheria (although only one occurred in Camberwell), food poisoning appears to be increasing (there are no figures for comparison with 1856 since the disease has only recently become notifiable), and poliomyelitis has within the past few years become prevalent all over the world; much is hoped for from the new vaccine which is just becoming available in this country. A new factor has come into being in social medicine —the increased proportion of elderly people in the community. In the middle of Queen Victoria's reign the expectation of life was only 40 years, now it is 68 for males and 73 for females. The proper care and welfare of the aged is nowadays producing problems which did not exist when Camberwell appointed its first Medical Officer of Health. In 1856 appendicitis was not known as such, and successful surgical intervention did not take place until the end of the century. At that time, however, there was no mention of the modern and increasingly "popular" complaint—the intervertebral disc (the slipped disc). Another interesting development is the steady increase in the size of children which has been taking place for nearly 100 years. This very important feature, which is evident in London school children (and in this Borough) is in line with what has been happening in Western Europe and America. Finally, whilst a hundred years ago the basis of public health work was prevention of infectious disease, the emphasis has now changed to the promotion of health; and health education is to-day one of the most important functions of the Medical Officer of Health. To prevent is negative, to promote, positive: and the widened aims of a public health department to-day may be defined broadly as the attainment, maintenance and improvement of physical and mental health as well as the prevention of ill-health. The Medical Officers of Health of the last century were faced with many difficulties; the fall in the death-rate, especially among infants, and from infectious diseases, sanitary reform and the general improvement in the health of the community is their memorial. The health problems of to-day are rather different but equally complex; there is little doubt that they will eventually be solved in the same manner. Vital Statistics. The Registrar General's estimate of the population of the Borough at Mid-1955 was 178,400 which is 1,100 less than the previous year. The figure obtained at the Census in 1951 was 179,777. The birth rate remained fairly stable, dropping by only one point from 14.8 in 1954 to 14.7. This represented a total of 2,631 live births. Although the death rate increased from 10.1 in 1954 to 10.5 last year this is the second lowest figure ever recorded in Camberwell. The total deaths numbered 1878. The infant deaths, however, which totalled 56 resulted in a new "low" in the infantile mortality rate which fell to 21.3 per thousand live births. Fifty of these infant deaths occurred during the first four weeks of life. Much has been said and written during the past year or two about the association between cigarette-smoking and the incidence of lung cancer and the findings are significant. Following the national trend the deaths from lung cancer showed a further marked increase in Camberwell last year. For the purpose of comparison the figures for the past five years are set out below: Deaths from Cancer of the Lung and Bronchus. Males Females Total Death Rate per 1,000 population Year 1951 71 12 83 0.46 1952 70 11 81 0.45 1953 69 6 75 0.42 1954 80 13 93 0.52 1955 92 22 114 0.64 A table showing classified causes of deaths in age groups appears on pages 37 & 38. SANITARY CIRCUMSTANCES. Water supply. There were no complaints received during the year concerning the purity of the domestic water supply. Every house in the Borough is provided with water direct from the mains of the Metropolitan Water Board. There are seven wells in operation in the area, but the water from them is used only for industrial purposes. Sanitary inspection. For the first time since the War it is possible to report that the establishment of Sanitary Inspectors remained at full strength throughout the year, although their numbers included an officer whose services had been retained beyond the normal retiring age. Details of the work performed by these Officers is set out in the statistical appendix to this report. Lead poisoning due to burning battery cases. In January 1955 a letter was received from the Ministry of Health drawing attention to an outbreak of lead poisoning in a Northern town which was due to the burning of old bakelite battery cases in ordinary domestic firegrates. Investigations were promptly made as to the possibility of any firm in Camberwell dealing in old batteries and disposing of the cases for fuel. No such practice was discovered, but as a precautionary measure a letter was addressed to a firm known to deal in old batteries, drawing attention to the danger and asking them to take steps to ensure that old battery cases were not disposed of by burning. Registration of Barbers and Hairdressers. The "appointed day" for the purposes of Section 18 of the London County Council (General Powers) Act, 1954, was fixed for the 1st September, 1955, and model byelaws prepared by the Metropolitan Boroughs' Standing Joint Committee were adopted by the Council and brought into operation on the 1st October, 1955. These byelaws include the following requirements. 1. For the purpose of securing the cleanliness of the premises, a hairdresser or barber shall comply with the following provisions. (a) All internal walls, partitions and ceilings shall be painted, distempered, whitewashed, papered, decorated, furnished or otherwise treated and shall be capable of being kept clean, kept in good repair and cleansed as necessary; (b) the floor and any coverings shall be kept in good repair, and shall be cleansed at least once a day and swept as necessary to prevent the accumulation of hair clippings, neck wool or other litter; (c) all such sweepings and all other litter shall be placed in suitable covered receptables, which shall be emptied as necessary and at least once a day, and kept clean; (d) every chair or seat shall be cleansed as necessary. (e) every shelf, table, cabinet, washbasin and other fitting shall be kept clean. 2. For the purpose of securing the cleanliness of any instruments, towels, materials and equipment used in the premises, a hairdresser or barber shall comply with the following provisions: (a) before use in connection with any customer — (i) Any gown, wrap, overall or other protective clothing shall be clean; (ii) any paper or other covering placed on the back of a chair and any towel, cloth, hairnet, neck wool or other article which is applied to the face, head or neck shall be clean, and shall not previously have been used in connection with any other customer unless it consists of a material (other than paper or wool) which can be and has been adequately cleansed; (iii) any metal instrument shall have been sterilised or otherwise adequately cleansed; (iv) any hairbrush, comb or similar instrument shall be clean, and shall have been sterilised, or otherwise adequately washed or cleansed at least once a day. (v) any soap in solid form shall have been adequately rinsed. (b) a fresh supply of water shall be used for purposes of shaving, shampooing or washing each customer and all articles used for purposes of shaving (including any styptic in solid form) shall be adequately cleansed immediately after use; (c) there shall be provided washing facilities which are adequate for the purposes of any cleansing carried out in pursuance of this byelaw. 3. For the purpose of securing the cleanliness of persons employed in the premises, in regard to both themselves and their clothing, a hairdresser or barber shall — (a) cause every such person to keep his hands and clothes in a clean condition; (b) provide and maintain suitable and sufficient washing facilities for the use of such persons; (c) cause any overalls worn to be clean; (d) cause every such person who has an open boil or sore on an exposed part of the body to keep such open boil or sore effectively covered by an impermeable dressing while attending to any customer. One hundred and twenty barbers and hairdressers were registered with this Authority under this Act. Drainage. A good drainage system in connection with dwelling houses, factories, etc., is a public health provision of the greatest importance. For many years the system adopted was as follows: One pipe to carry away all soil, etc., from W.C.'s and Urinals. One pipe to carry away all waste from sinks, baths, etc. This system was in universal use until 1934 when the "One Pipe" system was introduced. As its name implies this system consisted of one pipe to carry away both soil and waste from all fittings with the necessary safeguards to prevent siphonage. At the present time experiments are being carried out with a third system known as the "Single Stack" system. As in the "One Pipe" system all waste products are carried away by one pipe; the success of this system depends upon very careful planning of the length and fall of the various branch pipes. This system has not yet been statutorily recognised but it is evident that it has many features to commend it. RODENT CONTROL. The destruction of rats and mice presents a problem bristling with difficulties; these rodents are extremely prolific and can acclimatise themselves to almost any conditions. Prior to World War I little was done to cope with the ever increasing menace. Here and there some sort of local effort was made to trap and kill rats and mice, but not until after the passing of the Rats and Mice (Destruction) Act, 1919, was any national effort made, and this took the form of a National Rat Week each year. Local Authorities were circularised by the Ministry of Agriculture and Fisheries and asked to bait all the sewers in the area during that week. Posters were exhibited and pamphlets distributed to the public requesting them to make an effort to kill rats and mice. Poison baits were also made available to residents free of charge. Having regard to the extent of the problem this effort was but a "drop in the ocean," and had little effect in reducing the rat population. When World War II broke out, it was officially anticipated that serious trouble would arise from rat infestation. All Local Authorities were circularised and requested to appoint an Officer to deal with the problem. In the event of aerial attack all drains of demolished properties were to be traced and "sealed off" to prevent the escape of rats. The Ministry of Food, to whom the powers were then transferred, organised a department to carry out research, co-operate with, assist and advise Local Authorities on the measures to be taken and the materials to be used. The first attempt by Local Authorities throughout the country to rid the sewers of rats, was made in December 1943, and half yearly maintenance treatments have continued ever since. In towns and cities these "reservoir" infestations in the sewers are continually giving rise to re-infestation of properties, directly and otherwise, via defective drains or sewers, and notwithstanding the measures taken over the past 13 years, the problem is still considerable, resulting in great expense to Local Authorities and property owners. There is a residual population of rats in sewers which continues to resist the present measures. Research and experiment are progressing however, and new materials have been discovered and developed to a degree which makes them safe to handle and apply in all habitats of these rodents. There is good reason to believe that it will soon be possible to cope effectively with these resistant residual infestations. Anti-coagulants are playing an increasingly important role in present day rodent control measures, and in Camberwell these up-to-date methods have been in operation for some time with considerable success. One of the difficulties in using anti-coagulants for sewer treatment has been the prevention of the deterioration of the bait in the humid atmosphere of the sewer. The Rodent Officer has, however, devised a new block bait incorporating an anticoagulant with good keeping qualities and experiments are still being conducted in the Council's sewers in conjunction with the Technical Officers of the Ministry of Agriculture, Fisheries and Food. A summary of the work of the Rodent Control Staff appears on page 42. ATMOSPHERIC POLLUTION. At the end of 1954 the Council agreed to a suggestion by the Department of Scientific and Industrial Research to instal a volumetric apparatus to procure the measurement of smoke and sulphur dioxide in the atmosphere; this instrument was installed in the Public Health Department at the Town Hall at the end of January. The first monthly return of the daily mean concentration of sulphur dioxide and smoke in the atmosphere was made to the Department of Scientific and Industrial Research in the following month and regular monthly returns have continued since that time. During periods of fog it is necessary that measurements be taken three or four times per day, the work being done by one of the District Sanitary Inspectors, who is also a qualified Smoke Inspector. He was already in charge of the instruments provided on the roof of the Queen's Road Health Centre, St. Mary's Road, for recording the monthly deposited matter, and estimation of sulphur by the lead peroxide method. The volumetric method of measuring the daily mean concentration of smoke and sulphur dioxide in the atmosphere is expressed in milligrams per cubic metre, and parts per million of air respectively. In this connection it is interesting to note that the highest daily average of both was on 11-12th October during a period of fog at night and in the early morning, and the lowest during the week-end of 1st and 2nd August when the weather was clear and sunny. The average daily mean concentration of smoke for the eleven months recorded was .158 milligrams per cubic metre, the highest in the month of November with .296 and the lowest August with .082. The average daily mean concentration of sulphur dioxide for the eleven months recorded was .066 parts per million, the highest the month of March with .113 and the lowest August with .029. The information obtained during the year from the deposit gauge and lead peroxide instrument at Queen's Road Health Centre, and the measurements obtained from the Volumetric Apparatus are shown in graph form on the following pages. ATMOSPHERIC POLLUTION 1955 Total Solids Deposited—Tons Per Square Mile ATMOSPHERIC POLLUTION 1955 Estimation of Sulphur by Lead Peroxide Method ATMOSPHERIC POLLUTION 1955 Average Concentration of Smoke in Milligrams Per Cubic Metre Average Concentration of Sulphur Dioxide in Parts Per Million Volumes of Air HEALTH EDUCATION. The dissemination of knowledge on health matters to members of the community, is one of the most important factors in preventive medicine. The old saying that "Knowledge is Power" is very apt in this respect; the power to promote and maintain good health is surely a most worthwhile accomplishment. Although more remains to be done the sphere of Health Education has been considerably expanded by co-ordination of effort by the Borough Council, London County Council, General Practitioners, Voluntary Organisations, etc., as follows: (1) Talks, lectures, "Brains Trusts," cinema shows, film strips for — (a) The general public. (b) Clubs and Community Centres. (c) Expectant mothers and fathers. (d) School children and Youth Clubs. (2) Articles in the Press by the Medical Officer of Health. (3) Exhibitions. (4) Education by doctors in hospitals, clinics and surgeries. (5) Routine education in the home by Sanitary Inspectors, Health Visitors, District Nurses and Social Workers. One of the most important sections of the community at which to direct health propaganda is, of course, older school children; firstly because they are the citizens of to-morrow and secondly because children at school are at the most suitable age and in a suitable environment for the reception and retention of knowledge. Lectures to children must, however, be simple and interesting as well as informative—" teach them knowing not they learn it" is a sound precept. The use of models and other visual aids is of considerable value in creating a deep and lasting impression which will be remembered throughout life. The convincing of a child is often a means of educating the parents, and it often follows that the inculcation of hygienic habits in school can frequently bring about a discontinuance of bad habits at home which reflects on other members of the family. For instance a child who is taught to wash its hands after using the lavatory and before meals, by assiduously carrying out this practice in its home will often induce apathetic members of the family to follow its good example—good health habits should become automatic. During the year under review renewed efforts were made by the Medical Officer of Health and his staff to extend the scope of Health Education. At the invitation of the Public Health Committee the Central Council for Health Education arranged a two-day course for Sanitary Inspectors and Health Visitors on" Visual Aids and their Construction, Public Speaking and Group Leadership" and a short evening course for members of the Council on" Planning a Community Health Education Programme." These proved to be most interesting and instructive, and stimulated the Officers of the Public Health Department to build up a panel of lecturers on various health subjects such as general sanitation, housing, supervision of food and the prevention of food poisoning, atmospheric pollution and smoke abatement, public health administration, etc. Various organisations in the area were approached with an offer to send a lecturer to address their members on health subjects and as a result several such lectures were arranged during the year. Health talks have been given by the Medical Officer of Health to the children of certain schools in the Borough, and the extension of this means of health education would undoubtedly be in the best interests of the community as a whole. The exhibitions which are arranged outside the Council Chamber on the evenings when the Council meets have often been devoted to health matters, and on one occasion a most interesting exhibition arranged by the "Family Doctor" was left in situ for two or three days to enable more members of the public to see it. The display of posters, and distribution of leaflets is another medium used by the Council for imparting information to members of the population. This is carried out in close cooperation with Division 7 of the London County Council by an interchange of literature which is issued at the Public Libraries, Information Centre, Infant Welfare Centres, District and Nursing Associations and various Voluntary Organisations in the Borough. CARE OF THE AGED LIVING ALONE. In Great Britain nearly two-thirds of people living alone are more than 60 years old and less than one-tenth are under 40. Women have a greater expectation of life than men, and as age advances, widows outnumber widowers. In the case of a husband and wife of the same age there is a 60 per cent. chance that the wife will outlive the husband, and of women widowed at 50, three-quarters will live for 20 years. It is evident, therefore, that more women than men require outside help when they become ill, at least in the older age groups. During the past 70 years the population over 60 has doubled and it will continue to increase proportionately to the rest of the population for many years to come. By 1970 the percentage of persons of pensionable age will be as large as that of those at work, unless of course, by that time the folly of compulsory retirement at 60 to 65 has been realised. If we believe that the influence of family life, with its home comforts and adequate meals, is a factor of importance in the maintenance of health, we must assume that those who live alone are more liable to illness than the rest of the population, and recent surveys have upheld this assumption. A number of surveys made during the past few years have provided a lot of information about the prevalence of sickness and disablement among the elderly who live on their own, or with a relative who is unable to give them much attention. In an area in London, 5 per cent. of the households made up of older people living alone or practically alone needed regular nursing and domestic help. The medical practitioner was in attendance in 70 per cent. of the cases and 13 per cent. of the males and 21 per cent. of the females were confined to bed. Neglect and lack of treatment are important factors in making old people immobile, house-bound and bedridden prematurely. It has been computed that 10 per cent. would benefit very much by simple chiropody, many also by physiotherapy: a recent report by the British Medical Association has drawn attention to the need for early recognition and treatment of eye, ear, dental and other defects. One of the reasons given for the frequency with which people living alone are neglected by their relations and neighbours is the unsympathetic attitude of the modern world to those in need of assistance—that "spirit of the age" in which family ties of the past have been loosened, and children no longer accept their responsibilities to their parents. Careful enquiry in London does not altogether support this contention and many facts can be brought forward in extenuation. There is the very difficult housing situation; families are smaller and there are fewer children to take their turn in accommodating their parents, there are also more elderly people than ever. In a survey of 1,500 solitary old peple, it was found that four-fifths of the women and two-thirds of the men were visited by members of their families and these figures corresponded with the number of near relations living. About a third of the relatives lived in another part of London and a sixth elsewhere, 5 per cent. were themselves ill or aged. It is not difficult, therefore, to understand why they could not give more attention to their relatives. A certain number of sick persons will need hospital inpatient investigation and treatment, but the concern of the local health and sanitary authorities is the facilities available for providing satisfactory domiciliary care. Many agencies are involved and these have to work in close collusion. The ideal team is captained by the family doctor and among its chief members are the district nurse, the health visitor and the home help, with members of voluntary bodies, friends and neighbours playing an important part. In Camberwell there is an Old Persons' Welfare Association which receives an annual grant from the Borough Council for the purpose of providing and co-ordinating a variety of services for old people including "meals on wheels" and dinner clubs, Old Persons' Clubs, chiropody, holidays, etc. The London County Council provides home help and night sitters-in services, home visiting by Health Visitors, and the Borough Council has established a Mobile Library which attends at the homes of the house-bound. The close collaboration which exists between these bodies has made it possible for a large number of old people to be adequately looked after in their own homes instead of occupying a far more costly hospital bed at a time when there is a shortage of hospital nurses. The National Assistance Act gives power to a local sanitary authority to apply for a Court Order for the compulsory removal of a person who is ill or aged, infirm and physically incapacitated and is living in insanitary conditions. This drastic action is only taken exceptionally, when all other measures have failed and it is gratifying to record that it did not become necessary to deal with any case in this way in Camberwell during the year under review. IMMUNISATION AGAINST INFECTIOUS DISEASES. Diphtheria and Whooping Cough. Inoculation against diphtheria was introduced into Camberwell as long ago as 1926. For the first few years there was a disappointing response on the part of the public, but intensive propaganda convinced more and more parents that the prophylaxis offered them by the Council was both safe and effective with a consequent increase in the immunisation rate. In these days, inoculation against whooping cough is commonly combined with injections against diphtheria. The immunisation statistics for 1955 are set out below: Age at 31.12.55: — Born in year:- Under 1 1955 1 1954 2 1953 3 1952 4 1951 5-9 1950- 46 10-14 1945- 41 Total Under 15 Diphtheria (including combined) Immunised during year 286 1,133 103 60 40 305 8 1,935 Immunised at end of year 286 1,318 1,581 1,658 1,878 12,174 8,911 27,806 Estimated mid-year population 13,300 26,900 40,200 Whooping cough (including combined) Immunised during year (age at date of immunisation) 1,007 345 97 42 29 29 — 1,549 No confirmed case of diphtheria occurred in the Borough during the year, but it must be emphasised that the continued prevention of the occurrence of cases depends upon the maintenance of an adequate level of immunisation. Tetanus. There is a strong body of opinion in favour of protecting children against tetanus by immunisation, which could be combined with that against diphtheria and whooping cough. The high degree of protection afforded has been well demonstrated as a result of experience in the Armed Forces. At present a very large number of children who receive even minor abrasions are given serum at hospital as a precautionary measure. There are many objections to this: on the other hand fatal tetanus has often followed slight injuries for which anti-toxin serum was not given. Poliomyelitis. This disease has steadily increased in importance throughout the world. Children under five years are most often attacked by it, but the death rate is higher in older persons. The amount of poliomyelitis occurring in most places is very much lower than for other infectious diseases, but it is found that a very high proportion of the population in areas where cases have occurred have been infected and have produced anti-bodies in their blood, without showing signs of the disease. The practice in Camberwell has not been to isolate contacts of cases, except when a new case occurs in an area where there has been none for a considerable time. The following table shows the deaths from poliomyelitis and other notifiable infectious diseases which have occurred during the past ten years. Disease No. of Deaths 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 - 1 2 3 - - 1 POLIOMYELITIS & POLIO ENCEPHALITIS 5 - 1 Scarlet fever 1 - - - - - - - — - 6 4 1 2 1 1 2 1 Whooping cough 4 - 1 2 1 Measles 3 1 1 1 - - - 2 1 2 - Diphtheria Pneumonia:— 1 - - - - - 2 - - Acute primary - - - - 1 1 2 Acute influenzal - - - - - - - Dysentery - - - - - - - - - - - 1 - Typhoid and paratyphoid - 1 - - - - 1 2 - 4 5 1 3 1 1 3 Meningococcal infections Tuberculosis:— - 119 101 79 57 89 28 56 48 44 24 Respiratory 10 16 16 15 7 9 4 5 2 2 Other forms The question of preventive inoculation is now very much to the fore and inoculation of children in certain age groups is commencing. There are three types of poliomyelitis and the vaccine contains the virus of all of them. It is killed by the addition of chemicals, and apart from an unfortunate accident in America, it has had no ill effects and has been shown to have a high protection rate. This vaccine is not however the last word, and it may well be that the time is not far distant when it will be replaced by a living vaccine, which will give more lasting protection, and which can be taken by the mouth. This vaccine will correspond to B.C.G. in that it contains living organisms which as a result of repeated culturing are no longer able to produce the disease in man, but nevertheless have a very high power of protecting him against attack. Tuberculosis. B.C.G. vaccination against tuberculosis has been given to millions of people throughout the world during the past ten years. In some countries it is compulsory for all newly born children and other age groups to receive it. Caution has been the keynote in this country, because scientific proof of its value is only just being obtained. At present it is given to child contacts, children leaving school and specially exposed groups such as nurses. In Camberwell last year 201 persons received B.C.G. Vaccination at the Camberwell Chest Clinic, and the London County Council carried out 1,399 B.C.G. Vaccinations of 13 year old schoolchildren. There is a body of opinion in favour of a much wider use of B.C.G. in this country, particularly its extension to school children of all age groups and this view is fortified by the recent report of the Medical Research Council on the protective value of B.C.G. In many countries, B.C.G. is compulsory for certain age groups but generally the conditions are more primitive than here and tuberculosis control schemes are not as efficient. In countries like our own in which risks of infection are steadily diminishing, there is some doubt as to whether wide-spread vaccination would materially infuence the falling death rate. Nevertheless, the unknown reservoir of infection remains considerable and from it many young persons continue to be infected. There is a danger also that vaccination would minimise the need in the public eye for continuing to pursue other equally important, and well established personal preventive measures. A greater use of the Mass X-Ray units and regular medical examination are of the utmost importance, as is also the testing of all children at intervals to see whether they have been infected, and when evidence of this exists, to search for the infecting case. This has been the practice in Camberwell for some years, and as a result a large number of hitherto unknown cases have been brought to light. These include shopkeepers, neighbours and visiting relatives with coughs and "bronchitis." One of the most important aspects of tuberculosis at present is the prevalence of the disease among males of 50 and over; they often (and quite unknowingly) are the reservoirs of child infection. The fact that many of them are not ill, and move freely in the community, makes the problem most difficult. X-Ray examination of all men of this age would be a vital factor in hastening the end of the tuberculosis epidemic which, like most epidemics, seems to be drawing to a close as a result of prolonged preventive action and through the agency of natural causes. Smallpox. Vaccination against smallpox has been well established in this country for many years. Whilst eases of this disease rarely occur in England, the risk of its introduction from abroad has been intensified by modern rapid methods of travel, and there must not therefore, be any relaxation in the provision of protection. The number of persons vaccinated in Camberwell during 1955 is set out below. Vaccinated during the year Under (age at date of vaccination) 1 1-4 5-14 15+ Total Primary:— At clinics and day nurseries 602 96 51 16 765 By G.P.'s 363 63 51 31 508 Re-vaccination0: — At clinics and day nurseries — 1 5 39 45 By G.P.'s 1 2 19 87 109 FOOD POISONING. In spite of the efforts made by local authorities to promote "clean food," the incidence of food poisoning is still increasing. In Camberwell during 1955, 51 notifications of this disease were received. Most of these were single cases, but there were six small outbreaks involving 14 persons. One of these occurred in a hospital where three persons were affected in one ward. Although the causative agent was found to be one of the Salmonella organisms, all efforts to discover the means by which the infection was carried to the patients were unsuccessful. A copy of the Annual Return of Food Poisoning Notifications which is required to be forwarded to the Ministry of Health every year appears on page 46. HOUSING. The early part of the year saw the completion of the survey of dwelling houses in the Borough which was carried out in order to comply with the provisions of Section I of the Housing Repairs and Rents Act, 1954. Consultations took place with the London County Council at Officer level to agree the properties which should be included in the joint proposals to be submitted to the Minister. A copy of these proposals is set out on pages 45 & 46. Further consultations also took place with the County Council to decide the areas to be dealt with by each Authority during the next five years and whilst agreement was rapidly reached for the majority of the areas concerned, negotiations were still in progress at the end of the year with regard to two or three areas in which both Councils were interested. Slum Clearance. The last of the Clearance Areas to be dealt with by the Borough Council under the 1951/55 programme was represented by the Medical Officer of Health in February of the year under review; this was the Atwell Street area which involved 34 houses. The Council made a Compulsory Purchase Order in respect of the land comprised in the Clearance Area which was confirmed by the Minister after a Public Local Inquiry had been held. Individual Unfit Houses. The action taken by the Council during the year in respect of individual unfit houses and parts of premises is set out in the table appearing on pages 44 & 45. Those cases where closure or demolition of the premises was involved presented the Council with some difficult problems of rehousing. The Housing Acts do not impose any legal obligation on the local authority to rehouse the occupants of such properties or parts of buildings, as is the case with Clearance Areas, and this Council has therefore, appointed a sub-Committee consisting of representatives of the Public Health and Housing Management Committees to investigate the circumstances of each case to decide whether it would be appropriate for alternative accommodation to be offered by the Council. In the majority of instances the displaced families were rehoused by the Council when the Closing Orders became operative. Housing Applications. All applications for rehousing which are supported by medical certificates are referred to the Medical Officer of Health for a recommendation as to whether points should be awarded on medical grounds. In order that proper consideration might be given to the circumstances of each case a new form was devised and brought into use in July 1955. This form provides for a report by the Sanitary Inspector on the home conditions of the applicant; it is then sent to the applicant's private doctor who is asked to enter thereon his observations and recommendations and return it to the Public Health Department. All the circumstances are then considered by a Panel comprising the Medical Officer of Health, the Chest Physician and a local General Medical Practitioner, who decide as to the appropriate degree of priority which should be recommended, i.e. "immediate," "urgent," "less urgent" or "no recommendation. "This scheme should ensure a much fairer allocation of accommodation in such cases. During the year under review 601 applications supported on medical grounds were referred to the Medical Officer of Health. Overcrowding. Seventy-eight cases of overcrowding came to the notice of the Public Health Department during the year and in every case the Housing Departments of both the Borough Council and the London County Council were notified in order that the appropriate priority might be awarded to the housing applications of the families concerned. Sixty-five overcrowded families were rehoused during 1955, 40 by the Borough Council and 25 by the London County Council. Report of the Consultant Physician. Camberwell Chest Clinic. During 1955, 6,053 new cases were examined at the Chest Clinic compared with 5,060 in the previous year. One of the results of this increased work has been a rise in the Tuberculosis Register from 1,926 to 2,002. As in the past few years the greater part of this increase in numbers has occurred in the male age group of over 45. The total number of new cases added to the Register has fallen from 364 to 334. The inward transfer of cases from other clinics was 101: this figure in part reflects the alteration in the population in Camberwell resulting from the policy of the London County Council in rehousing the tuberculous. A study of the geographical distribution of these cases does not suggest that there is any preponderance of patients on the Tuberculosis Register in any particular housing scheme. Seventy-six cases were removed from the Tuberculosis Register as "recovered," a figure which reflects the satisfactory outcome of treatment and continuous observation over a number of years. Such patients are encouraged to attend the clinic at regular intervals during the year for X-ray to ensure that the disease has not recurred. The mortality figures are in keeping with the trend throughout the country; 46 patients on the Register died but in only 30 was death directly attributable to their tuberculous disease; 28 deaths from respiratory tuberculosis and 2 from nonrespiratory tuberculosis. The Clinic continues to provide facilities for ante-natal chest X-ray examinations as well as maintaining the service whereby General Practitioners may refer patients for a chest X-ray examination only. The number of patients referred from the Mass X-ray Units continues at the same level for the general population and also regrettably the same high level for the inmates of a Reception Centre where an attack rate of 80 cases of tuberculosis per 1,000 examined is the rule rather than the exception when the Unit visits this institution. Recently it has been questioned whether the use of Mass X-ray Units in carrying out surveys of factories and similar places where there are high population densities, is more likely to yield more cases of active tuberculosis than one of surveying certain age groups, particularly men over 45, and certain social classes, especially classes IV and V. There are admittedly administrative difficulties in persuading such people to have chest X-rays and the whole problem of propaganda directed towards these groups needs to be carefully reassessed. In this connection we have recently started in conjunction with the various Metropolitan Mass X-ray Units, a survey of the inhabitants of common lodging houses and similar institutions to determine the attack rate in such communities. It is hoped it will be possible to do similar surveys throughout the whole country in order that an estimate of the size of this population may be made and, more important, that the particular individuals found to have tuberculosis should realise the benefits of adequate treatment once they have been diagnosed. Tuberculin testing of all children attending Child Welfare Clinics has been continued and those with positive reactions are referred to the Chest Clinic; in this way a number of cases of pulmonary tuberculosis have been found. The London County Council have been giving B.C.G. vaccination to all suitable school-leavers, and as the result of preliminary tuberculin testing a number of positive cases have been referred to the Clinic. Usually they were already known as contacts of notified cases but in many instances it has been found either that the child has evidence of an active lesion or it was possible to find the primary infecting source case. We feel that this system of tuberculin testing is a most valuable means of case-finding and also reflects the degree of tuberculous infection in the community. It is desirable, therefore, that the scheme of tuberculin testing should be extended to other age groups in the schools. B.C.G. vaccination has been given to 201 children. This is a very small number but this is due to the fact that, at present, B.C.G. vaccination is restricted to certain age groups. I feel that as B.C.G. vaccination has been shown in this country to afford a high degree of protection against tuberculous infection it should be available to all. It is not, of course, the answer to the problems of tuberculosis, but it is one of the more useful weapons in the fight against this disease. The original function of the Tuberculosis Dispensary was to be a centre from which the struggle against tuberculosis could be directed but with the shifting emphasis of the disease and the increase in other respiratory infections, the work has become much more widespread. A large number of cases of chronic bronchitis and carcinoma of the lung are now seen at the Chest Clinic. It should be noted that while the deaths from bronchitis totalled 171 compared with 241 from coronary artery disease which heads the mortality table, 114 deaths from carcinoma of the lung (an increase from 80 in 1954) occurred, i.e., almost three and a half times the death rate from tuberculosis. It is possible that a number of the deaths attributed to bronchitis or pneumonia may hare had an underlying carcinomatous lesion. Ten and a half per cent, of all male deaths over 45 were due to carcinoma of the bronchus compared with 2.6 per cent, for tuberculosis. The public health aspects of tuberculosis control continue to exercise the minds of the Medical Officer of Health and the Chest Physician. The Public Health (Prevention of Tuberculosis) Regulations, 1925, make it an offence for any person who is aware that he is suffering from tuberculosis of the respiratory tract to enter upon any employment or occupation in connection with a dairy which would involve the milking of cows, the treatment of milk, or the handling of vessels used for containing milk. What is equally important, however, is the routine X-ray examination of all shopkeepers and others who are in frequent contact with the public, especially where children and young persons are concerned. It is now the policy of the Clinic to give long term ambulatory chemotherapy to patients whose lesions may be considered to be in the least bit unstable. In other patients who are known to have chronic disease and may become intermittently infectious we have endeavoured to give them ambulatory chemotherapy for as long as two years. The admission rate to sanatoria continues to be high and fortunately there is now no waiting period. Because of the policy of long term chemotherapy many patients return home and subsequently to work much more quickly than they would have done in the past and the rate of turnover of beds in chest hospitals and sanatoria has correspondingly increased. The benefits of surgical treatment are now becoming obvious to most patients and rather than have to persuade patients to go into hospital for surgical treatment, many on their admission now ask if they cannot be treated by surgical means rather than undertake a prolonged stay in bed and gradual up-grading. The results of the long term chemotherapy combined with the patient's realisation of the benefits of surgical treatment must all help to accelerate the decline of the disease but only by complete co-ordination of the preventive and clinical side of chest medicine can the disease finally be eradicated. I should like to thank the Medical Officer of Health for the whole-hearted co-operation of his departments both in the Town Hall and in the London County Council Divisional Office and also the various voluntary and nursing organisations who have helped with domiciliary treatment. A special word of thanks is due to the London County Council Ambulance Service for the way in which they bring patients to the Clinic and also take them to hospital for admission and for chest X-rays. KENNETH MARSH, Consultant Physician. Annual Report of the Camberwell Tuberculosis Care Comittee for the year 1955. On June 24th, 1955, our Chairman, Alderman A. F. Grossman, died suddenly while attending in the Town Hall This was a tragic loss to the Committee. We pay tribute to the excellent work that he did for the sufferers from tuberculosis in Camberwell. The late Alderman Crossman had been elected to the Care Committee as a Borough Council representative in 1938; later that year he was appointed Vice-Chairman and in 1939 chairmam This office he held at the time of his death. His guiding influence and the deep interest he took in the work of the Committee was always an inspiration to us all. Alderman Mrs. Amy Crossman, J.P., was unanimously elected to fill the vacancy as Chairman. The Committee wished her well during her term of office, confident that she would carry on the great work which was so much part of the public life of her late husband. The Camberwell Borough Council appointed Councillor Mrs M. V. Goldwin (Vice-Chairman of the Public Health Committee) to fill the vacancy caused by the death of Alderman Crossman. The following resignations took place during the year:- Mr. C. Evans, Area Officer, National Assistance Board. Miss Campbell, on resignation from the office of superintendent of the Camberwell District Nursing Association. Mr. J. Dewar, a Borough Council representative. The vacancies were filled by the following members:- Mr. L. Perry, Local Area Officer, National Assistance Board. Miss Baker, Superintendent, Camberwell District Nursing Association. Councillor Mrs. E. S. Daymond, Camberwell Borough Council. Councillor Miss D. M. Walker was nominated by the Camberwell Borough Council as an additional representative on the Committee. The Committee's work during the year under review covered all the known necessities among the tuberculous patients and has followed the pattern of previous years. All cases of need have been carefully considered and have been met after suitable enquiries. The number of interviews with the Secretary was 2,041. There has been a steady increase in the number of interviews over recent years. In 1952 the number was 1,479 in 1953 —1,570 and in 1954—1,824. The majority have been referred by the Medical Staff and Health Visitors of the Chest. Clinic, Almoners of Hospitals or Sanatoria, local Voluntary Organisations and the Public Bodies in the Borough. The following table gives an indication of the type of material assistance rendered by the Committee and the number of patients involved: — Clothing 67 Pocket money while in hospital 20 Wireless: repair and licences 2 Taxi fares 8 Holidays 3 Household removals, and help with furnishings 4 Loan of bedside comforts 25 Loan of beds 21 Supply of bedding 24 Supply of towels 15 Payment of rent in advance 1 Purchase of second hand pram 1 Purchase of sewing machine for home worker 1 Payment to clear balance of loan 1 Fares of relatives to distant sanatoria 40 Loan of jig-saw puzzles and books 50 Settlement of coal, electricity and water rate accounts 4 Lodgings and meals 4 The Handicraft Class continued to meet each Friday afternoon. At the end of the year the number on the Roll was 16 with an average attendance of 11.2. The high standard of work was maintained and the steady demand for goods was met, especially for the more popular articles such as handbags, wallets, purses, lampshades, gloves, cane work, needlework and various garments. Many purchases and enquiries during 1955 followed a display of the work of the class at the Exhibition arranged by the Camberwell Community Association at the Queen's Road Centre in September, 1954. The work of one of our leather workers was again highly commended and he was awarded Certificates of Merit both at the War Pensioners' Homecrafts Exhibition and Competition and at the British Homecrafts Competition. At a Sale and Exhibition of work at the Lord Roberts Workshops a member of the Royal Family purchased an article of leatherwork made by this member of the Class. Miss V. Steward, who has been instructing the students of the Handicraft Class since 1947, resigned in December and we record our grateful thanks for the help and patient assistance given by her to the students. The London County Council have appointed Miss Crossingham in her place. The visual outings during the summer and winter were arranged for the students —a day to the seaside in July, and at Christmas a light dinner in Town followed by a visit to a theatre. The students who were able to participate expressed their appreciation to the Committee. The Christmas Seal Sale which closed on March 31st, 1955, marked the twenty-third occasion in which Camberwell has taken part in the Annual Seal Sale organised by the National Association for the Prevention of Tuberculosis. The Seal Sale is the Committee's financial mainstay and the funds received help to relieve many of the patients' worries during their medical treatment. The net sum received in 1955 was £1,309 13s. 3d. which, although less than in 1954, was once again the highest sum collected in any of the Metropolitan Boroughs. We wish to place on record our thanks to the Camberwell Community Association for kindly publishing our appeal letter in their popular magazine. This publicity was of considerable help. During the year the Secretary referred 280 cases to the National Assistance Board for financial assistance and in certain cases, where circumstances permitted, the Board were able to provide clothing, pay fares and help with hire purchase payments. In 1954, a typewriter was purchased for the use of patients wishing to become typists when fit for work. It has again proved its usefulness, and it is pleasing to record that the six patients who borrowed the machine in 1955 are now in full-time employment as typists. The Care Committee has many friends and from time to time the Secretary received good secondhand clothing, books, puzzles and other articles for use of patients. On behalf of the recipients we express our grateful thanks. At Christmas the Secretary had the pleasure of receiving and distributing to children of patients, toys and books kindly given by the Mayoress of Camberwell (Mrs. M. Tarrant), and the Camberwell Community Association. A number of Christmas stockings was also received from a former patient of the Clinic. We are much indebted to the donors of these gifts at a time so dear to the hearts of children. Close co-operation has been maintained with the voluntary associations in the Borough, the British Bed 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. We gladly acknowledge their help and that of the official bodies and know that they will continue to assist our efforts on behalf of the tuberculous people of the Borough. Finally, we place on record our thanks to the Honorary Officers —The Worshipful the Mayor of Camberwell (Alderman David Tarrant, J.P.) Patron of the Christmas Seal Sale; Mrs. Cecilia Greenwell, Organiser of the Seal Sale; Mr. H. Smith, Borough Treasurer, who is our Honorary Treasurer; and Mr. A. W. J. Lamb, our Honorary Auditor ; and to the Camberwell Borough Council for affording us accommodation for our meetings. We also thank Dr. H. D. Chalke (Divisional Medical Officer, London County Council, Division 7, and Medical Officer of Health of Camberwell), for including the Care Committee's Annual Report for 1954 in his Annual Report for the same year. AMY CROSSMAN, Chairman. J. M. LEONARD, Secretary. STATISTICAL APPENDIX. Summary of Statistics, for the year 1955. Area of the Borough 4,480 acres Greatest length 4¾ miles „ breadth 2½ m il es „ height above Ordnance Datum (Sydenham Hill) 365 feet Population (Census April 1951) 179,77 7 „ (estimated by Registrar-General mid-1955) 178,400 Number of inhabitated houses (April 1955) 43,036 Rateable value (April 1955) £1,643,815 Sum represented by a penny rate (estimated) £6,700 Number of live births 2 ,631 Birth rate 14.7 Number of deaths 1,878 Death rate 10.5 Infantile Mortality:— Deaths under 1 year 56 Infant deaths per 1,000 live births 21.3 Maternal Mortality:— Deaths of women from diseases or accidents associated with childbirth 2 Maternal death rate per 1,000 total births 0.75 Deaths from Phthisis 28 Phthisis death rate 0.15 Deaths from all forms of Tuberculosis 30 Tuberculosis death rate 0.16 37 TABLE SHOWING CLASSIFIED CAUSES OF DEATHS IN AGE GROUPS IN CAMBERWELL DURING 1955 Causes of death. Sex. All Ages. 0- 1- 5- 15- 25- 45- 65- 75- 4 283 273 All causes M. 952 35 9 5 51 292 3 241 435 F. 926 21 5 5 33 183 - 14 M. 22 - - - 2 4 2 Tuberculosis, respiratory 3 1 F. 6 - - 1 1 - - Tuberculosis, other M. - 1 - - 1 - - - - F. 1 1 - - - - - - - 1 - Syphilitic disease M. 1 - - - - - - 2 - 1 F. - - 1 - - - M. - - - Diphtheria - - - - - - - - F. - - - - - - - Whooping Cough M. 1 - - - - - - - 1 F. - - - - - - - - - M. Meningococcal infections - - - - - - - - - F. - - - - - - - - - M. 1 - Acute poliomyelitis 1 - - - - - - F. - - - - - - - - - M. 1 - - - - Measles - - - - F. - - 1 - - - - - 1 Other infective and parasitic diseases M. 1 - 1 - - - - - - - - - F. - - - - - - Malignant neoplasm, stomach M. - - - 2 12 12 6 32 - F. 25 - 2 5 7 11 - - - 7 Malignant neoplasm, lung, bronchus M. 92 3 53 29 - - - - F. 22 - 9 8 5 - - - - - Malignant neoplasm, breast M. - - - - - - - - F. 28 - - 4 13 6 5 - - 2 F. 14 - - 1 8 3 Malignant neoplasm, uterus - - Other malignant and lymphatic neoplasms M. - - 6 36 32 22 100 1 3 29 F. 91 - 3 28 29 2 - - 6 1 1 Leukaemia, aleukemia M. - - 3 1 - - F. 2 - - 1 - 1 - - - M. 3 - 1 2 - Diabetes - - - - 1 4 1 F. 6 - - - - - - Vascular lesions of nervous system 69 - 1 33 M. 12 23 - - 100 - 29 F. - - 2 18 51 - 134 Coronary disease, angina M. - - 9 49 41 35 - - F. 107 49 - - - - 20 38 - Hypertension with heart disease M. 18 - - - 4 6 8 - - F. 20 - 1 9 10 - - - - Other heart disease M. 75 - - - 1 15 l7 42 - - F. 146 - 3 19 26 98 - - M. - 11 16 33 Other circulatory disease 60 - - - - F. 86 23 - - - 1 18 44 - - Influenza M. - - - - - - - - 8 5 F. - 1 - - 1 - 1 30 Pneumonia M. 59 3 - 5 10 11 - - F. 52 1 - - - 4 11 36 - Causes of death Sex All Ages 0- 1- 5- 15- 25- 45- 65- 75- M. 119 1 2 29 48 39 Bronchitis - - - 52 - - 4 17 30 F. - 1 - Other diseases of respiratory system M. 13 - 1 2 5 - - 5 - 1 F. 6 - 1 - 1 - 3 — Ulcer of stomach and duodenam 16 - - 1 M. - - 7 6 2 - - 1 5 F. 9 - - - 3 Gastritis, enteritis and diarrhoea M. 4 - - - - - 1 1 1 1 F. 6 - 1 3 2 - - - M. 1 3 2 - Nephritis and nephrosis 6 - - - - 1 3 2 F. 11 - - 5 - - 10 - - 2 2 6 Hyperplasia of prostate M. - - - Pregnancy, childbirth, abortion F. 2 - 2 - - - - - - 2 1 1 - - Congenital malformations M. - - - - 1 F. 3 2 - - - - - - Other defined and ill-defined diseases M. 65 - 1 5 10 28 2 7 12 18 27 F. 88 18 - 1 2 5 17 3 2 4 Motor vehicle accidents M. 16 1 - 2 - 4 - F. 5 - - 1 1 - - 3 3 1 1 4 2 1 All other accidents M. 14 - 2 10 F. 20 - 6 4 - - - - - 6 3 1 Suicide M. 12 2 - - F. 7 - - 2 4 1 - - - - Homicide and operations of war - M. - - - - - - - - - F. - — - - - — - - Medical Examinations carried out by the Medical Officer of Health or his Deputy. Officers for admission to the Permanent Establishment 37 Officers for admission to the Unestablished Staff 45 Employees for admission to Sick Pay Scheme 281 Employees for admission to Permanent Establishment 45 Employees absent from duty owing to sickness 410 Cremation Certificates. No. of cremations authorised during the year by the Medical Referee or his Deputy 3,451 Water Certificates. No. of Water Certificates issued 94 No. of dwellings concerned 683 Drainage and Sewerage. No. of drainage applications received 184 Length of sewers reconstructed 1,396 yards No. of brick gullies replaced by pot gullies 107 No. of defective pot gullies renewed 22 Public Cleansing. Amount of house refuse collected 42,552 tons Amount of trade refuse collected 793 „ Examination of Water from the Council's Swimming Baths. Bacteriological examination Chemical examination No. of Samples No. Satis. No. of Samples No. Satis. 5 5 Camberwell Front Swimming Bath 5 5 Camberwell Rear Swimming Bath 12 12 12 12 Dulwich First Class Swimming Bath 5 5 5 5 Dulwich Second Class Swimming Bath 8 8 8 8 Total 30 30 30 30 In addition water from the Swimming Bath at Mary Datchelor Girls' School, Camberwell Grove, was chemically and bacteriologieally examined on three occasions with satisfactory results. Rag Flock and Other Filling Materials Act, 1951 Type of Material No. of Samples examined No. Satisfactory Rag flock (Loose) 11 11 Rag flock (layered) 4 4 Woollen mixture felt 2 2 Sized cotton felt 2 2 3 Cotton felt 3 Fibre (loose) 4 4 Fibre (pad) 1 1 Kapok 1 1 Cotton millpuffs 1 1 Totals 29 29 Offensive Trades. Type of business. No. on Register. Skin dressers 4 Soap boilers 1 Total 5 Pet Animals Act, 1952 No. of licences issued 3 No. of licences renewed 14 Total No. of pet shops licensed 17 Pharmacy and Poisons Act, 1933. No. of applications received for registration 20 No. of applications received for renewal of registration 182 Sanitary Inspection of the Area. No. of complaints received 5,379 Summary of Work carried out during the year 1955. Inspections:— Nuisance inspections 4,805 Offensive trades 31 Smoke observations 232 Drainage, new and existing 7,109 Overcrowding 863 Factories and workplaces 1,343 Outworkers' premises 412 Rag dealers 65 Infectious and other diseases 446 Verminous premises and persons 75 Aged and infirm persons 209 Common lodging houses 30 Conveniences, public and private 199 Heating appliances (Fireguards) Act, 1952 86 Housing Repairs and Rents Act 433 Shops Act 1,714 Voluntary work 98 Inspections not defined 1,216 Re-inspections 16,881 Total inspections 36,247 Works supervised:— Tests applied to drains (existing premises) 286 Drains found defective 138 Drains totally reconstructed 20 Drains repaired or partially reconstructed 240 Tests applied to drains (new buildings) 4,778 Drains constructed 1,455 Total works supervised 6,917 Description of Sanitary Improvements ordered during the year:- Cleanse and repair walls and ceilings 678 Repair roofs, gutterings, etc. 1,108 Abate dampness 1,378 Repair stoves, fireplaces and coppers 281 Repair windows, sashlines, sills, etc. 557 Repair flooring, stairs, doors, etc. 423 Provide sufficient light and ventilation 30 Provide dustbin 94 Remove offensive matter 19 Provide or repair yard paving 55 Provide or render accessible water supply 37 Cleanse, cover or render accessible water cistern 3 Repair water pipes and fittings 78 Clear premises of vermin 18 Cleanse or repair water closets and flushing apparatus 345 Repair or clear defective or obstructed drains 129 Repair soil pipes, waste pipes, sinks, etc. 156 Abate nuisances caused by animals improperly kept 1 Miscellaneous 94 Total repairs and improvements ordered 5,484 SUMMARY OF NOTICES SERVED, 1955 Intimations, Public Health (London) Act, 1936. Byelaws, etc. 2,376 Statutory notices, Public Health (London) Act, 1936. Byelaws, etc. 1,295 Public Health (London) Act, 1936 (Part II) 21 Section 4, Housing Act, 1936 36 No. of Summonses issued 157 Factories Acts, 1937-1948. 1.—INSPECTIONS, 1955. Number of Premises. Occupiers prosecuted. Number on Register. Inspections. Written Notices. Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities - - 483 231 Factories not included above in which Section 7 is enforced by the Local Authority 11 - 1,065 523 Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) - 7 1 - 11 Totals 1,555 755 - 2.—CASES IN WHICH DEFECTS WERE FOUND, 1955. Particulars. No. of cases in which defects were Number of cases in which prosecutions were instituted Referred Found. To H.M. Inspector. Remedied. By H.M. Inspector. - Want of cleanliness - - - - - - - Overcrowding - - Unreasonable temperature - - - - - - - Inadequate ventilation - - - Ineffective drainage of floors - - - - - Sanitary conveniences— (a) insufficient... - 2 2 - (b) unsuitable or defective 7 - 3 - 17 - (c) not separate for sexes - - - - Other offences against the Act (not including offences relating to out-work) - - - - - Total 19 - - 9 3 Summary of Outworkers classified by trades. Artificial flowers 4 Brushes 2 Cardboard boxes 34 Card lacing 132 Curtains, etc. 1 Feather sorting 3 Lampshades 30 Linens 1 Novelties 25 Paper bags 7 Toys 11 Umbrellas 3 Wearing apparel 598 Total 851 Summary of work of the Rodent Control Staff. No. of complaints received 1,346 No. of inspections 2,284 No. of operators'calls 8,505 No. of private premises baited 1,081 No. of business premises baited 131 No. of baits laid 5,243 No. of drains tested 54 No. of positive drain teat results 29 Vermin and Scabies. ATTENDANCES AT CLEANSING STATION. Vermin. Scabies. Male. Female. Total. Male. Female. Total. Adults 24 16 8 26 25 51 Children 153 432 585 29 34 63 Total 169 440 609 59 55 114 Disinfection. RETURN OF WORK CARRIED OUT BY DISINFECTING STAFF. Notified Infectious Diseases. Other Diseases. Miscellaneous. Vermin. Total All Cases. Rooms disinfected Lots of bedding disinfected 9 1,553 2,056 473 21 264 10 162 83 519 Total visits 28 1,996 746 604 3,374 Number of articles disinfected by steam 3,028 Number of articles disinfected by formalin 841 Number of books disinfected 78 Number of towels washed 4,093 Number of soiled articles washed 2,863 Number of overalls washed 339 Number of covering sheets washed 335 Beds and mattresses destroyed 387 Miscellaneous articles destroyed 1,073 Weight of:— Tons Cwts. Qtrs. Lbs. Unsound foods destroyed 26 18 3 13 Hospital bedding, etc., disinfected 4 5 2 0 Hospital soiled dressings, etc., destroyed 18 5 0 0 Furniture and effects destroyed 14 6 0 0 Dead animals destroyed — 8 3 0 Old paper, etc., destroyed 1 15 3 0 43 HOUSING. Record of work of Housing Inspectors. Inspections Re-inspections Total 531 216 747 Clearance areas 546 Individual unfit houses — Section 9 127 419 91 113 Section 11 22 747 Underground rooms and parts of premises Section 12 72 675 1 6 Improvement Grants 5 124 124 Requisitioned Property - 2,283 Total 881 1,402 Housing Statistics, 1955. 1. Inspection of Dwelling Houses during the Year: — (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,640 (b) Number of inspections made for the purpose 24,850 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 3,416 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 355 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 1,316 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 2,779 (b) By local Authority in default of owners 9 (6) 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 7 (b) By local Authority in default of owners nil (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 nil (4) Parts of buildings closed by Closing Orders (Section 12):— (a) Underground rooms 6 (b) Other rooms 24 44 (5) Undertakings not to use parts of buildings for human habitation accepted:— (a) Underground rooms nil (6) Other rooms nil (6) Houses demolished under Section25 8 (c) Proceedings under Housing Act, 1949:— (1) Closing Orders made under Section 3 (1) nil (2) Demolition Orders determined and Closing Orders substituted 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 Certificates of Disrepair. 1954 Act 1920 Act No. of Certificates of Disrepair issued 156 9 No. of Revocation Certificates issued 99 4 Overcrowding. No. of cases of overcrowding found 78 No. of overcrowded families rehoused : — By Borough Council 40 By London County Council 25 HOUSING ACT, 1936—PARTS II AND III. HOUSING REPAIRS AND RENTS ACT, 1954—SECTION I. Form of Joint Proposals by the London County Council and Camberwell Borough Council. Total number of permanent dwellings in the Borough 41,535 Part I. The total problem— (i) Estimated number of houses unfit for human habitation within the meaning of section 9 of the Housing Repairs and Rents Act, 1954, and suitable for action under section 11 or section 25 of the Housing Act, 1936 999 (ii) Period in years which the Councils think necessary for securing the demolition of all the houses in (i) 5 Part 2. Orders already made, etc. By L.C.C. By C.B.C. (iii) Number of houses in (i) in clearance areas and already covered by operative clearance or compulsary purchase orders or owned by the local authority 137 31 45 (iv) Number of houses which are already in clearance areas and for which clearance or compulsory purchase orders have been submitted to the Minister but have not yet become operative nil nil Part 3. Action in the first five years— (v) Number of houses which are already in clearance areas and for which clearance or compulsory purchase chase orders are to be made or which are to be purchased by agreement within the five years 226 37 (vi) Number of houses which are to be included in clearance areas still to be declared and which within the five years will be owned by the local authority or will have been included in a clearanes order or a compulsory purchase order submitted to the Minister 398 116 (vii) Number of houses under (iii), (iv), (v) and (vi) to be patched (if necessary) and retained within the five years under section 2 of the Housing Repairs and Rents Act, 1954, for temporary accommodation nil n il (viii) Number of houses under (iii), (iv), (v) and (vi) to be demolished in the five years 761 184 (ix) Number of houses (including those already comprised in operative demolition orders) to be demolished in the five years as a result of action under section 11 of the Housing Act, 1936 — 54 Food Poisoning. Annual Return of Cases of Food Poisoning 1955. 1. FOOD POISONING NOTIFICATIONS (CORRECTED) RETURNED TO R.G. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 7 14 21 9 51 2. OUTBREAKS DUE TO IDENTIFIED AGENTS. Total Outbreaks: 1. Total cases: 3*. Outbreaks due to: — (a) Chemical poisons nil. (b) Salmonella organisms 1 (c) Staphylococci (including toxin) nil. (d) CI. Botulinum nil. (e) Other bacteria nil. 3. OUTBREAKS OF UNDISCOVERED CAUSE. Total Outbreaks: 5. Total cases: 11. 4. SINGLE CASES. Agent identified: 12. Unknown cause: 26. Total: 39. *Two of these cases were not notified. INFECTIOUS DISEASES, 1955. SUMMARY OF NOTIFICATIONS RECEIVED AND DEATHS FROM THESE CAUSES AMONG NOTIFIED CASES Disease. No. of Notifications. Treated in Hospital. Found not to be suffering from the Disease. Deaths of Notified Cases. Age Distribution of Notifications Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and upwards Scarlet Fever 97 1 - - 3 13 16 55 7 2 - - - - 8 1 17 14 138 6 11 13 1 1 Whooping Cough 24 55 1 - - 1 - - 4 25 25 2 2 9 1 2 2 - (1) Poliomyelitis & Polioencephalitis 1 - 8 - 2 - 326 388 Measles 2,677 2 81 286 371 32 6 10 2 - - 44 1,175 - 1 - 286 1 - - Diphtheria 1 1 - - - - - - - - 1 - 1 14 - 1 1 - - 5 - 2 3 Acute Influenzal (2) Pneumonia - - - 1 50 12 1 3 1 6 3 2 10 Acute Primary 10 7 6 - - - 98 9 13 11 2 7 3 1 Dysentery 20 2 10 8 21 7 6 - - - 1 Typhoid and Paratyphoid Fever 1 1 - - - - - - - - - - - 1 - - 1 3 2 9 Erysipelas 20 3 - - 4 - - - - 1 1 (3) Meningococcal Infection 5 5 - 2 - - - 1 - - - - - - 11 - (4) Puerperal Pyrexia 103 97 - - - 14 78 - - - - - - - 3 3 3 - - - - Ophthalmia Neonatorum - - - - - - - - - 24 1 6 1 1 Scabies - - - 1 5 5 4 - - - - - - - - - - - - - Malaria (Induced) - - - - - - - 432 Totals 14 106 412 1,330 122 3,256 225 326 365 57 33 19 33 21 - (1) Includes one case of a non-resident occurring in a hospital in this Borough, and in addition 32 cases of Camberwell residents occurred in hospitals outside the Borough and were notified to the Medical Officer of Health for the area in which the hospitals were situated. (2) In addition, 5 cases of Camberwell residents were diagnosed in hospitals outside the Borough. (3) In addition, 2 cases of Camberwell residents were diagnosed in hospitals outside the Borough. (4) Includes 48 cases of non-residents occurring in hospitals in this Borough, and in addition 24 cases of Camberwell residents were diagnosed in hospitals outside the Borough. Tuberculosis. TABLE SHOWING SEX AND AGE DISTRIBUTION OF ALL PRIMARY NOTIFICATIONS AND DEATHS FROM TUBERCULOSIS DURING 1955. Notifications Deaths.† Age Periods. Pulmonary. Non-Pulmonary. Non-Pulmonary. Pulmonary. Male. Female. Male. Female. Female. Male. Male. Female. 0- 1 yr. 1 - - - - - - - - - 4 3 1 - - 1- 5 „ - 1 1 - 5-15 „ 15 15 - 1 - - 15-25 „ 24 28 4 1 - 1 - 38 2 3 2 25-35 „ 27 - 1 - 29 20 1 2 1 - - 35-45 „ - 45-55 „ 12 - 1 2 - - - 35 34 - 12 1 - 55-65 „ 4 - - 1 9 5 - 6 1 65 and over - - 8 1 114 7 22 Totals 189 6 1 †After correction for inward and outward transfers. TABLE SHOWING NOTIFICATIONS AND DEATHS, TOGETHER WITH THE ESTIMATED POPULATION DURING THE PAST FIVE YEARS. Year. Estimated Population. No. of Primary notifications. Notification Rate per 1,000 Population. No. of Deaths. Death Rate per 1,000 Population. 65 0.36 179,500 1.7 300 1951 2.2 52 0.29 181,200 400 1952 180,200 306 1.7 49 0.27 1953 0.14 179,500 364 2.0 26 1954 1.8 30 0.16 1955 178,400 318 Mass Radiography. Analysis of results of survey carried out by South East London Mass Radiography Unit (Dulwich Mobile Survey) August 6th-9th, 1955. Part 1. General analysis. Men Women Total. (a) Total X-rayed 331 405 736 (b) Total previously X-rayed 110 108 218 (c) Total recalled for large film 10 22 32 (d) Number normal on large film 5 9 14 (e) Number abnormal on large film 5 12 17 (f) Did not attend for large film - 1 1 Part 11. Analysis of abnormal large films. a j — (1) Cases considered tuberculous and referred elsewhere. (a) No further action required - - - (b) Occasional supervision only - - - (c) Requiring treatment - 2 2 (d) Still under investigation - - - (2) Non-tuberculous cases for investigation:— (a) Benign mediastinal tumour 1 - 1 Pneumonitis - 1 1 (b) Still under investigation - - - (3) Cardio vascular lesions - 3 3 (4) Previously known tuberculous cases - 1 1 (5) Abnormalities requiring no action - - - Food and Drugs Adulteration. Summary of Samples obtained for examination. Number examined. Number adulterated, etc. Percentage of adulteration. Formal. Informal. Total. Formal. Informal. Total. Informal. Formal. 381 506 887 4 11 15 1.05 2.17 Particulars of the adulterated samples and the action taken are set out on pages 50 and 51. Registered Purveyors of Milk. Dairies 24 Distributors of milk in the Borough 202 Distributors of milk dealing from premises outside the Borough 10 Special Designated Milk. Summary of Licences issued. Type of Licence Sterilised. Pasteurised. Tuberculin Tested. 216 Dealers 180 98 Supplementary 19 21 19 237 199 117 Particulars Of Article Whether Formal or Informal Nature of Adulteration or Irregularity Serial No. Completely effloresced. 56 Glauber's Salt Informal Butter Contained 16.2 per cent, water. Informal 60 Pork sausages 15 per cent, deficient in meat. 84 Formal Pork sausages 20 per cent, deficient in meat. Informal 91 Butter Brazils Informal 7.5 per cent, deficient in fat. 96 Barbados Sugar Formal Contained flakes of iron carbonate. 98 Butter Brazils 5 per cent, deficient in fat. 107 Formal Butter Contained 16-3 per cent, water. 125 Informal Incorrectly labelled: contained no rum. Rum Butter Spread. 254 Formal Lemon Curd 45 per cent, deficient in fat. 263 Informal Influenza Mixture Decomposed and contained moulds. 291 Informal 351 Rum Butter Spread. Informal Incorrectly labelled, contained no rum. Ice Lolly Informal Lead 1.2 parts per million. 356 Ice Lolly Lead 2.8 parts per million. 377 Informal Ice Lolly Lead 1.1 parts per million. Informal 378 50 Adulterated Samples. Observations Result of Proceedings or other action taken - Formal samples taken and found to be satisfactory. Subsequent samples taken and found to be satisfactory. See formal sample No. 84. See Formal sample No. 107. - - Formal sample taken and found to be satisfactory. - Formal sample taken and found to be satisfactory. - See Formal sample No. 254 - - Remainder of stock withdrawn from sale and returned to wholesaler. - Reported to Public Health Committee and cautionary letter sent. - - Reported to Public Health Committee. Summons against retailer who joined wholesaler who in turn joined broker as co-defendants; broker fined £2 with 4 Gns. costs in favour of ech of other parties. Reported to Public Health Committee and cautionary letter sent. - Reported to Public Health Committee; letter sent to manufacturer asking for observations: cautionary letter sent. - Remainder of stock surrendered and destroyed. - Samples taken from the one shopkeeper: remainder of stock destroyed: shopkeeper agreed to stop making any more lollies pending the purchase of a plastic mould or the reconditioning of his existing mould. Results of Tests. Designation Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Unsatisfactory - - Pasteurised - 122 126 - Tuberculin tested pasteurised 1 - 58 - 58 - - - 50 - Sterilised - - Samples of milk taken in course of delivery to Hospitals and schools. Methylene Blue Test Phosphatase Test Chemical Test 6 34 Hospitals 27 70 67 69 Schools All the above samples proved to be satisfactory. Biological Examination of Milk. Eight samples of tuberculin tested raw milk were submitted for examination with negative results. Ice Cream. Summary of samples submitted for Methylene Blue Test and Chemical Examination. Chemical Examination Methylene Blue Test Satisfactory Grade III Grade IV Grade I Grade II Unsatisfactory Nil. 66 24 10 15 43 Ice Lollies. Summary of samples submitted for examination. Bacteriological Examination Chemical Analysis Satisfactory Unsatisfactory Satisfactory Unsatisfactory Ice lollies 32 - - - - 3 - - Water ices - 27 8 - Cream Lollies 3 - 48 Assorted Lollies - Margarine. Nine samples were examined for vitamin content and found to comply with the requirements of the Margarine Order. Three samples of proprietary brands, making special claims as to then vitamin content, were examined and found to be satisfactory. REGISTRATION OF FOOD PREMISES. Premises registered under the provisions of Section 14 of the Food and Drugs Act, 1938, as at December 31st, 1955. Sale, manufacture and storage of ice cream 484 Preparation or manufacture of: — Potted, pressed, pickled or preserved meat 206 Potted, pickled or preserved fish 64 Potted, pickled or preserved other foods 36 Supervision of Food Premises. Number of visits paid to each type of food premises by the Council's Sanitary Inspectors. No. of Inspections Type of Premises Bakehouses 153 348 Bakers and Confectioners Butchers 614 Cooked and Preserved Meat Shops 414 Dairies and Milkshops 538 Fishmongers and Shell Fish Vendors 265 Fish Fryers 323 108 Fish Curers Food Factories 108 509 Ice Cream Vendors Public Houses 319 Restaurants and Eating Houses 728 Slaughterhouses 5 Street Markets 1,525 255 Street Traders Food Stores Other food premises 1,223 Total 7,435 Unsound Food. No, of condemnation Certificates issued 1,881 54 Particulars of Unsound food destroyed. Weight Total Weight Description Tons cwts. qtrs. lbs. Tons cwts. qtrs. lbs. Meat 9 Beef 3 27½ - 9 Lamb 0 15½ - Lamb (Cooked) 2½ - - - Lambs liver 20½ - - - Sheeps tongues 26 - - - Sheeps liver 14 - - - Mutton. Sliced (frosted) 2 27 - - Mutton chops 3 - - - Pork 2 26 - - Sausage meat (pork) 2 24 - - Pigs kidneys 1 0 4½ - Liver 1 10¾ - - Meat (luncheon) 3¼ - - - Sausages 4 - - - Ox cheeks 1 21 3 - Bacon 20 - - - - Gammon (cooked) 6i r - - - 2 18 4 - Poultry Chickens (5) 1 11½ r - - 1 11½ - - Vegetables 0 - 0 Potatoes 13 Cabbages 3 0 a - - Onions 1 3 0 - 2 15 0 Fish Rock Salmon 4 1 7 - Skate 1 3 22 - Whiting 1 1 0 - cod 3 0 - - Roes (herring) 1 14 - - 1 Roes (Cod, frosted) 14 - - Cod fillets (smoked) 1 0 - - Haddocks (fresh) 1 14 - - Dabs 1 0 - - 1 15 11 Fruit 1 2 Kernels (Ground nut) 2 18 Salad fruit (dried) 7 2 0 - 3 14 Prunes 3 - Oranges 3 2 0 - Almonds 2 2 0 - 0 Bananas 2 1 - Pears 3 0 - - 55 Description Weight Total Weight Tons cwts. qtrs. lbs. Tons cwts. qtrs. lbs. Sultanas - - 2 4 Grapes 2 0 - - 1 Fruit Mixed (dried) 23 - - 1 2 Plums (dried) - - m Figs 7 - - - 4 2 3 12 - Canned Foods Ham, 40 tins 4 1 9¼ - Ham (in cut) 27¼ - - - Meat (Various), 1,109 tins 1 3 0 27½ 17 Vegetables, 9,814 tins 3 0 19¼ 19 Fruit, 8,230 tins 9 1 13¾ Milk (evaporated and condensed) 4,445 tins 12¼ 1 12 2 14 Cream, 34 tins - - - Fish (Various), 17,540 tins 1 14 1 14½ Jams (Various), 18 tins 26 - - - Marmalade, 48 tins 2 2 16 - Treacle, 1 tin 1 - - - Drinking Cocoa, 66 tins 2 10 - - 18 14 3 Miscellaneous Confectionery, preserved fruits, pickles (various), sauces, cheeses (various), frosted foods, meat and fish paste, puree, cereals, rice, peanut butter, margarine, yeast, flour, jams (various), marmalade, and other foods 3 13 1 3| * . o a 3 13 1 3¾ Gross Weight 26 18 3 13 Summary of work of Food Inspector. Complaints received 52 Complaints found to be justified 26 Visits:— Bakehouses 11 Bakers and Confectioners 11 Butchers 180 Fish curers 3 Fish fryers 12 Ice cream premises 9 Restaurants and eating houses 70 Slaughterhouses 4 Street markets 1,448 400 Other food premises Merchandise Marks Act 49 Inspections not defined 187 Re-inspections 24 Food surrendered 374 Foodsftuffs certified for export 3 Food condemnation certificates issued 1,881 Slaughterhouses. No slaughtering was carried out in the Borough during the year. One slaughterhouse, which had not been used for'some years did not renew the licence so that at the end of the year there were only two licensed slaughterhouses in the area. TABLE OF CONTENTS Page Atmospheric Pollution 15 Care of the Aged living alone 21 Century of Public Health 5 Food Poisoning 26 Health Education 19 Housing 27 Immunisation against Infectious Diseases 23 Public Health Committee—constitution 3 Report of the Consultant Chest Physician 29 Report of the Tuberculosis Care Committee 32 Rodent Control 13 Sanitary Circumstances 10 Staff of the Public Health Department 4 Vital Statistics 8 INDEX TO STATISTICAL APPENDIX Certificates of Disrepair 45 Cremation Certificates 38 Deaths —Causes and Age Distribution 37-38 Disinfection 43 Drainage and Sewerage 39 Factories Act 41-42 Food and Drugs Adulteration 49 Adulterated samples table 50-51 Food Inspectors—Return of Work 55 Food Poisoning 46 Food Premises—Registration and Supervision 53 Housing Inspectors—Return of Work 44 Housing Repairs and Rents Act —Proposals 45-46 Housing Statistics 44-45 Ice Cream and Lollies 52 Infectious Diseases 47 Margarine 53 Mass Radiography 48-49 Medical Examinations 38 Index to Statistical Appendix—continued. Page Milk —Registered Purveyors 49 Special Designated 49 Results of Tests 52 Offensive Trades 40 Outworkers 42 Overcrowding 45 Pet Animals Act 40 Pharmacy and Poisons Act 40 Public Cleansing 39 Bag Flock and Other Filling Materials 39 Rodent Control —Return of Work 42 Sanitary Inspection of the Area 40-41 Scabies and Vermin (Attendances) 43 Slaughterhouses 56 Statistics —Summary of 36 Swimming Bath Water —Examination of 39 Tuberculosis 48 Unsound Food Certificates 53 Unsound Food Destroyed 5 4- 55 Vermin and Scabies (Attendances) 43 Water Certificates 38