4376 CAM 54 RLKBA METROPOLITAN BOROUGH OF CAMBERWELL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1959 H.D.CHALKE O.B.E.(Mil.) T.D., M.A., M.R.C.P., D.P.H. 68611 CAM 54 PUBLIC HEALTH DEPARTMENT, TOWN HALL, CAMBERWELL, S.E. 5 To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Camberwell. MR. MAYOR, ALDERMEN AND COUNCILLORS, I have pleasure in presenting my Annual Report for 1959. The Registrar General' s Estimate of the population at midyear showed a further fall from 177,300 to 176,100; this decline in the population figure has been progressive since 1952 when the estimate was 181,200, although the Census figure in 1951 was 179,777. The general death rate at 11.4 was one point lower than the previous year, but the infant mortality rate jumped from 21.5 in 1958 to 26.9 last year; there were three maternal deaths giving a rate of 0.93 per thousand total births. There was a very considerable reduction in the number of deaths from tuberculosis which fell to 14 less than half the previous year's figure, but unfortunately mortality from cancer of the lung and bronchus continued to rise reaching a figure of 121 as compared with 104 in 1958. In this connection it would seem that the campaign against cigarette smoking is having little influence, in fact, this habit appears to be on the increase among young persons, it is reported that 30% of boys and 15% of girls are now regular smokers. Notifications of infectious diseases numbered 1, 915 as compared with 1,238 for the previous year. Since, however, the biennial measles epidemic accounted for 1,322 of these, it will be seen that the total for other notifiable diseases did not show much variation. There was, however, a 50% increase in the number of dysentery notifications. The hot, dry summer of 1959 may possibly have been a contributory factor, but the best weapon against this disease is scrupulous cleanliness the importance of washing the hands before handling food cannot be over-stressed and a great deal of the Public Health Department s health education activities has been devoted to this matter for some considerable time. The occurrence of cases of diphtheria in the Borough after nine years clear of this disease was disappointing, but it has demonstrated the importance of maintaining a high level of immunisation particularly in the child population. Fortunately, all of the clinical cases were mild and made rapid and complete recoveries. The Council's programme for the establishment of smoke control areas continued with unabated energy and, with the co-operation of all concerned, it is hoped to speed up this work so that the whole of the Borough may be rendered smokeless as soon as possible. The first Smoke Control Order was made and confirmed and the preliminary survey of the second area was well in hand before the end of the year. On the 4th April 1959 the Public Health Department moved from the Town Hall into Camberwell House West. The staff quickly settled down in their new quarters and the work continued without interruption. Whilst there are certain adverse features in the layout of the new accommodation, it is, on the whole, a considerable improvement on the offices formerly occupied. There are now waiting and interviewing rooms for the convenience of the public and the opportunity has been taken of providing a properly equipped medical examination room which also serves as an office for the Deputy Medical Officer of Health. The public waiting room on the ground floor is also being used for the display of posters, and other health education material. Health education continues to be a very important function of the Public Health Department and in addition to the general publicity by the distribution of posters, pamphlets, bookmarks and so on, a number of talks, demonstrations and film shows were given to schools and various organisations in the Borough. An endeavour was made to ascertain what methods of health education had the greatest impact on the public, by conducting an enquiry in which questionnaires were completed by members of the public visiting the Town Hall, Public Libraries, Child Welfare Centres, a department store as well as by members of Clubs and by pupils at a Secondary Modern School. An analysis of the replies, which are very enlightening, appears in the body of this report. The problem of noise has continued to engage the close attention of the Public Health Department. The solution is full of difficulties, but some success has been achieved in one direction with the co-operation of industrial concerns. The Noise Abatement Society (I have the honour to be a member of the National Council) is prosecuting a vigorous policy in its attempt to rid the country of excessive noise. It is to be hoped that it will have full public support, and that it will not have to wait as long as did its elder cousin, the former Smoke Abatement Society, before the seeds it sows produce a rich, harvest. It may be a good augury that within nine months of the inauguration of the Society a Noise Abatement Bill was placed before Parliament. The shortage of Public Health Inspectors continued to inconvenience the full scale working of the Department. The Council s training scheme is, however, proceeding very well and one trainee who qualified during the year was appointed to fill one of the vacancies. There are now four students undergoing instruction. May I once more express to the members of the Council and the other Chief Officers and their staffs my sincere thanks for their support and co-operation throughout the year, and to the staff of the Public Health Department my grateful appreciation for the loyal and efficient assistance which they have at all times so willingly afforded me. 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 1959 Chairman: Councillor H.G.Lamborn, L.C.C. ,M.R.S.H. Vice Chairman: Councillor Mrs.R.E.Pritchard Members: Alderman T.W.C. Ashby " "E.L.G. Poidevin Councillor Mrs. B.E. Knight " F. E. Lee " Mrs.M.U.Nelson Councillor Mrs. E.S. Daymond " F. Robbins " F.A. Fairhead " W.G. Gibbs " Mrs.F.E. Sampson " S.H. Gilbert " Mrs. S.M. Terry " Mrs.M.V. Goldwin " Miss D.M. Walker " H.H. Guichard Ex-Officio: Councillor T.J.Wallis, J.P. ... Mayor of Camberwell Alderman G.S. Burden, B.Sc.(Econ.) ... ... Leader of the Council Councillor C.W. Baker, J.P.,F.C.I.S. ... ... Leader of the Opposition Staff of the Public Health Department (As at 31. 12.59) 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 *R. W. Watton, M. B., B. S., D. P. H., D. C. H. Public Analyst: D. F.H. Button, A.R.C.S. , F.R. I.C. Chief Administrative Assistant S. A. Cranfield Chief Public Health Inspector: L.W. Burrell a Deputy Chief Public Health Inspector: H.W.Leonard a Sampling Officer - Food and Drugs Act, etc.: H. R. Weaver a Food Inspector D. V. Watkins a Smoke Inspectors: F.Dray a c A.G.O Gilvie a c Public Health Inspectors: E.C. George a, c H. Attwater a, c J.E. Millway a F. Duggins a H.M.Hough a R. Sheppard a G. A. Fraser a M. McSweeney b H. F. Williams a A. Gartside D.P.A. a C.H. Medland a (Three vacancies) Student Public Health Inspectors: P.Frost T. McCarthy Miss J.Harris M.Stevenson Senior Clerk C. Burgess Clerical Staff: D. Danter Miss E.M. Lawrence A. Beare P. A. S. Kirrage Miss J. Jakes Mrs.M. Findlay W. Everett Mrs. A. D. Dormer Miss K. Clews Rodent Control Staff Rodent Officer W.H. G. Saunders b Rodent Investigator Mrs. M. J. Kenny Rodent Operators J.W. Frost, F.G. Hulbert, R. Humphreys, J.P.Timmins Bait Preparer Mrs. A. Grice Disinfecting and Cleansing Station: Superintendent Disinfector A. Thomas Stoker/Disinfector Apparatus Attendant B. Russell Disinfectors R. T.J. Hodgson, E. Manning, A.E. Kenny, T.W. Whitfield Motor Driver H. King Cleansing Station Attendant Mrs. E.E. Doe *Also Assistant Medical Officer, 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. (c) Royal Society of Health Smoke Inspectors Certificate. SANITARY CIRCUMSTANCES Water Supply. No complaints were received during the year with regard to the purity of the water supply which is provided to every dwelling house in the Borough direct from the mains of the Metropolitan Water Board. Drainage and Sewerage. Applications for approval in respect of the drainage of new buildings and alterations to the drainage of existing buildings numbered 414 during the year. No new sewers were constructed but 4,874 ft. of existing sewers were renewed. Sanitary accommodation in houses in multiple occupation. When the by-law relating to the provision of water closets was superseded by Section 11 of the Housing Repairs and Rents Act, 1954, the Council gave consideration to the standard to be applied for the provision of such sanitary accommodation, and adopted the recommendation of the Metropolitan Boroughs Standing Joint Committee viz, one water closet for each household where practicable, and where premises are let in lodgings at least one water closet for every eight persons or one water closet for every four rooms whichever is the higher standard. In order to secure compliance with these requirements it is necessary for the Council to serve a notice under Section 36 of the Housing Act 1557, but this section provides that the landlord may meet the requirements of the notice either by carrying out the necessary works or by reducing the number of occupants. It is apparent therefore, that extensive use of this legislation may well result in hardship by the eviction of occupants and a consequent increase in the demand for housing accommodation. Fortunately, only a very few cases have come to the notice of the Public Health Department where the sanitary accomodation was so inadequate as to justify action under Section 36 but in one instance where the landlord indicated his intention of evicting some of the occupants in the event of such a notice being served, the Council refrained from taking statutory action for the time being. Basement bakehouses. The quinquennial review of basement bakehouses for the continuance of Certificates of Suitability issued under the Factory and Workshop Act, 1901, revealed that only one basement bakehouse was still in use. As, however, its condition was in conformity with the standard recommended by the Metropolitan Boroughs' Standing Joint Committee, the Council authorised that the Certificate of Suitability should be continued. This will fall due for further consideration in 1964 if the bakehouse is still in use, but in the meanwhile the premises will be kept under close surveillance. Nuisances from noise. Complaints of nuisances from noise at factories continued to be received during the year and each case was carefully investigated. In many instances an informal approach to the Management was successful in bringing about a diminution of the nuisance, but in one case where the noise of machinery appeared to be causing considerable distress to the occupants of a house adjoining the factory, the Committee authorised that legal proceedings should be instituted if necessary. Before such action could be taken, however, the management submitted a scheme to remove the machinery to another part of their premises away from the dwelling houses. This involved the installation of a 3 phase electrical supply and the erection of a transformer chamber. Plans have been prepared and submitted to the L.C.C. whose approval of these works under the Town Planning Acts is awaited. The problem of noise nuisances is growing and giving Public Health authorities throughout the country considerable cause for concern. Towards the end of the year the Council accepted an invitation from the Noise Abatement Society to take up membership. Several Metropolitan Boroughs have become members of this newly formed body whose immediate aims are to take all possible steps under existing law to protect the public from assault by noise, to inform the public of the dangers to health arising from noise and of the legal action which can be taken in this respect and to press for the enforcement of the present laws against noise and for new byelaws where appropriate. It has already been demonstrated that the provisions of the existing laws render it very difficult to deal successfully with noise nuisances; there is no doubt that little progress can be made until additional legislation is available to deal adequately with this important matter. Rodent Control The most reliable index to the extent of rodent infestation is the number of complaints received of such infestations. Ten years ago (1949) these numbered 1,617, but by 1958 the number had been reduced to 962. Unfortunately there was a slight increase in 1959 when 1,161 complaints were received. This was largely accounted for by staff shortage through illness and injury in the early months of the year which gave rise to delay in carrying out “follow-up” treatments with a consequent possible increase in the rat population. By the end of the year, however, these difficulties had been overcome. The arrangements for baiting the sewers every three months with sodium fluoracetate were continued throughout the year. The system evolved for keeping a close check on this dangerous poison is operating very satisfactorily and the safety measures have been most carefully observed. Disinfecting Station - Incinerator. The incinerator at the Disinfecting Station, Frensham Street, which has been used for many years for the destruction of condemned food, infested articles of bedding, furniture and other items was found to be in need of repair. In view of the age of this out of date plant is was considered that even when repaired, its operation would give rise to offences against the Clean Air Act, 1956. It was decided, therefore, to arrange for its replacement by a modern type of incinerator. Since the proposed new installation would be capable, when in full use, of dealing with more material than this Borough could provide, and in order to offset the initial cost, adjoining local authorities were asked if they would wish to make use of it at a suitable charge, particularly for the destruction of condemned foodstuffs. Only one Borough (Lambeth) indicated that they would be interested in the service and it has been agreed that a charge of £1 per ton will be made for any material destroyed for that authority. The construction of the new incinerator commenced in March 1960 and it is anticipated that it will be completed in 3-4 months. HEALTH EDUCATION In the ever widening scope of public health activities, health education is becoming of increasing importance. During the year a number of talks, film shows and demonstrations were given by the staff of the Public Health Department to schools, clubs and other organisations these have proved to be ofconsiderable interest and value and have been appreciated by those who have attended. Unfortunately, at some of the clubs the size of the audience was disappointingly poor and in one or two instances it only just reached double figures. Nevertheless, this has not acted as a deterrent for it has been found that small groups of this kind often show greater interest and enthusiasm than some larger audiences, and the discussions which usually follow these talks are stimulated by the intimate and informal atmosphere. Posters, leaflets, book-marks and so on were displayed and distributed through the usual channels and with the removal of the Public Health Department into new offices in Camberwell House, the opportunity was taken of providing a public waiting room and enquiry office which also serves as an exhibition room for the display and distribution of publicity material on various health topics. In addition, articles were published in many of the supplements to Camberwell Calling", the Council s Diary of Local Events. The most rewarding aspect of health education is that which is directed at the younger members of the community. Talks to school children and members of youth clubs were found to be fruitful. The receptivity of school children was demonstrated in the case of the clean air exhibit mentioned below. It is unfortunate that there were not more requests from youth organisations for the services of lecturers from the Public Health Department. In view of the greater emphasis which is being laid on health education and the increasing use of up to date methods, including visual aids, it was decided to endeavour to assess the public response to health propaganda. For this purpose, a questionnaire was devised for completion by members of the public, 3,700 copies of which were made available for a period of approximately one month at public libraries, clubs, child welfare centres, a secondary modern school, a departmental store, and in the entrance of the Town Hall. Of these, 16% were completed. A sealed ballot box was provided at each place. Approximately 57% of the adult population consists of persons in Group III (skilled workers) and 71% of the replies from adults were from members of this group. In the first two groups, the corresponding figures are 2% and 4% for Group I and 11% and 14% for Group II. With regard to semi-skilled and unskilled workers, who comprise about 30% of the population, only 11% who completed questionnaires were in these groups, yet there is no doubt that it is here that the need for health education is greatest. An analysis of the replies is given below and in Table I the answers to the first question are summarised, Table II gives similar information by occupation and age groups (including school children who were treated separately). Analysis of Replies. Question 1. Please give your own view of the order of importance of the following as a means of health education (a) magazines such as Family Doctor' (b) newspaper articles, (c) pamphlets, (d) posters, (e) films, (f) exhibitions, (g) radio programmes, (h) television programmes, (i) visits to maternity and child welfare centres, (j) talks at clubs, (k) talks at school. Television programmes were voted first in every group except two. School children favoured films and television almost equally, but males over 60 years gave a first preference to newspaper articles, although television and radio programmes were hardly less popular. Women over 60 years put television at the head of the list newspaper articles were well behind. Pamphlets do not appear to be specially acceptable to any group, nor are exhibitions rated very high, which is significant in view of the heavy expenditure their organisation usually entails. Talks at clubs also came very low on the list, except in the replies from club members, who nevertheless placed them only fourth. Women over 60 years - who have a number of old people's clubs available to them in this area - gave them sixth place. This suggests that more attention should be directed to the quality and frequency of these talks. Pupils at the secondary modern school surprisingly, perhaps, placed films first, although school children as a whole gave them second place. It is probable that the votes by scholars for this medium were influenced by film shows at school rather than by visits to the cinema where they are less likely to see films of an educational nature. Other students relegated films to fifth place on the list. It is interesting to note that magazines such as 'Family Doctor' proved third in popularity with school children, particularly girls, and with unskilled workers. It might have been anticipated that they would have been better favoured by those attending welfare centres, who gave them only sixth place. The departmental store group evinced some interest in this medium by voting it fifth. It is noteworthy that health magazines proved quite popular with females in the younger age groups, due, no doubt, to the emphasis laid in these publications on maternity and child welfare matters. For no apparent reason rather more men than women over 60 years gave a vote for this type of publication. Talks at school were well placed on the list by all age groups; happily, the junior and senior students themselves gave them a high priority. Radio programmes also received fairly high marks and proved progressively more attractive with increasing age. In the first four occupational groups they were well favoured, but Group V (unskilled workers) reduced them to seventh place. Senior students gave them more prominence than did school children. Newspaper articles came fifth in over-all popularity but were better favoured by the middle-aged, and, as one might expect, by the professional and intermediate occupational groups. Men over 60 years placed them first. Posters, on the whole, do not seem to have much impact on the public, although the group voting varied from third to eleventh place. School children placed posters last - a fact which suggests that greater regard should be paid to their design and method of presentation. It may well be that numbers of posters on a variety of topics, displayed at the same time, confuse rather than impress. The health educational value of maternity and child welfare centres is emphasised only by those who attend them. Presumably, those who placed them low on the list all males and most females - had only meagre knowledge of their activities. Question 2. Have you been visited by a health visitor or other social worker and did you find the advice of benefit? Ninety-one persons said they had been visited by a health visitor or other social worker. Of these, 73 found the advice beneficial. Question 3. What recent item of health propaganda impressed you most? The recent items of health propaganda which impressed most people (32%) were those concerned with poliomyelitis and its prevention. Since this disease is now receiving a good deal of publicity in the national press and elsewhere, and the enquiry was held during an intensive national campaign for immunisation, this is not an unexpected result. The association of smoking and lung cancer was frequently mentioned (9.5%) and this also coincided with increased publicity on this subject. Despite intensive local publicity, clean air was mentioned by only nine persons. A wide variety of subjects were quoted, including a number of references to articles in 'Family Doctor'. The impact of commercial television advertising on the public mind is demonstrated by the statement of a respondent who was most impressed by an advertisement for an analgesic. Question 4. Is commercial advertising more effective than health propaganda? Sixty-one percent. (367) considered commercial advertising more effective than health propaganda (78 did not answer this question). In the older age-groups, the majority took the opposite view. Although no direct question was asked about television advertising, it may well be that this had an influence on the answers. Question 5. Should more money be spent on advertising health; if so, have you any suggestions on how to spend it? In all age and occupational groups in both sexes the general opinion was that more money should be spent on health education; 74% (450) were in favour of it, and only 13% (78) further 13% (76) made no comment. Of the 450 people who thought that there should be more expenditure on health publicity, 113 (25%) considered it should be spent on television programmes - a view shared by all the occupational, age and sex groups. This is consistent with the opinions expressed in Table I that television is the most favourable medium for this purpose. fecial mention was made of documentary films and government advertising on commercial television. Conspicuous among the replies was the suggestion (notably from respondents of both sexes in the 26-35 age group), that there should be more health instruction in schools by means of talks and films. This was suggested also as a desirable activity at scout and youth organisations. Films on health subjects were recommended by 6½% (39) of the respondents, and other recommended vehicles for health education were newspapers and magazines, mobile health exhibitions, and radio programmes. There was rather more reference to posters and pamphlets than was to have been expected in the light of the answers to the first question. The suggestions made embraced most of the aspects of health promotion, such as cancer prevention, smoking dangers, hygiene certificates for food shops, and the free distribution of health magazines. Remarks. The entries under 'Remarks' covered a very wide range and were frequently not relevant to health education. They often reflected the particular grievances of the respondents, such as complaints about litter on waste land, and inadequate housing. Matters most often mentioned were more research on cancer, tuberculosis, etc., the provision of more hospitals, and the modernisation of existing ones. More health instruction in schools and improvements in housing and living conditions were also frequent pleas. Summary Although the number of questionnaires returned is comparatively small, those that were returned were completed carefully in a manner which showed evidence of interest and enthusiasm. The findings direct attention again to the health education of children and young people, who, it is gratifying to observe, welcome it themselves. This was exemplified at a secondary modern school where, subsequent to this enquiry, talks were given to the pupils and an exhibit on Clean Air was placed in a central position in the entrance hall and left for three days. Two weeks afterwards, the Headmaster, using the public address system without warning, posed five questions, covering the salient points, to the whole school (over 1,500 pupils ranging from eleven to eighteen years.). An analysis of the answers indicated the intelligent interest shown in the subject the knowledge thus acquired will undoubtedly find its way back to many of the pupils homes. The popularity of television as a health educational medium cannot be overlooked; it must surely serve as a guide to future activities in health promotion. It is significant also that there is a strong feeling that more money should be spent, and that health matters should be placed before the public in a manner which will compete with commercial advertising. The enthusiasm for programmes on poliomyelitis demonstrates the undue public interest in this as compared with other diseases, for example, only a very few respondents mentioned diphtheria immunisation and B.C.G. vaccination for tuberculosis. As was expected, posters and pamphlets are not regarded as a good health educational medium. It is realised that these results give the views of only a small section of the population of a London Borough, and the findings make it clear that the adult respondents who were in far greater proportion in the professional and skilled groups, were those who were sufficiently interested in health promotion to make comment on it. Unfortunately the semi-skilled and unskilled, who require health education most, took only a small part in the enquiry, but their addiction to television is well known and there can be little doubt that their view, had it been given by a greater number, would be in strong support of this medium. Although methods of health education will always need to conform with local characteristics and conditions, the background propaganda is on a much wider basis, and it would seem that since the public are responsive to instruction by television, health magazines, and modern commercial advertising, a great deal more use should be made of them. To bring health education up to date will cost a lot of money; but it will be well repaid, as those who advertise expensively on commercial television and elsewhere have no doubt discovered. Order of preference of means of health education. FIRST (h) Television programmes SECOND (e) Films THIRD (k) Talks at schools FOURTH (g) Radio programmes FIFTH (b) Newspaper articles SIXTH (d) Posters SEVENTH (a) Magazines such as 'Family Doctor' EIGHTH (i) Visits to welfare centres NINTH (f) Exhibitions TENTH (j) Talks at clubs ELEVENTH (c) Pamphlets TABLE I 16 TABLE II Order of Preference by Centre, Occupation, Age and Sex Groups GROUP (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) Distribution Centres Town Hall 7 6 11 4 5 10 3 1 9 8 2 10 Public Libraries 8 3 11 5 6 9 2 1 7 4 Secondary Modern School 2 7 3 8 9 11 1 6 5 10 4 5 1 Department Store 2 10 6 3 9 7 8 11 4 9 Clubs 2 6 7 10 5 1 3 11 8 4 6 9 1 2 Welfare Centres 3 11 8 4 5 10 7 Occupational Groups 1 I Professional 8 2 10 4 6 9 3 7 11 5 II Intermediate 8 2 10 4 6 11 3 1 7 5 9 III Skilled 7 3 11 6 5 2 1 10 9 8 4 3 1 IV Semi-Skilled 10 4 8 6 9 2 7 11 5 6 V Unskilled 3 5 10 4 2 8 7 1 9 11 1 VI Senior Students 7 8 3 11 6 5 9 4 10 2 VII School Children 1 9 3 8 10 11 2 7 6 5 4 Age and Sex Groups 6 0-15 years Male 10 11 9 2 4 5 1 8 7 3 Female 3 5 11 4 8 9 10 2 7 6 1 6 16-20 years Male 8 4 11 5 2 3 1 9 10 7 Female 6 4 10 7 3 11 5 1 8 9 2 10 3 9 2 7 1 5 21-25 years Male 4 6 11 8 Female 8 2 10 5 4 11 6 1 7 9 3 26-35 years 7 2 10 5 6 4 1 8 11 3 Male 9 8 4 6 10 3 5 11 7 Female 2 9 1 1 36-45 years Male 10 2 9 5 6 7 3 8 11 4 Female 10 11 4 6 8 2 1 7 3 9 5 8 9 10 5 46-60 years Male 7 2 6 3 4 1 11 Female 7 3 11 5 4 10 2 1 8 9 6 6 61 and over Male 1 8 5 9 3 2 10 11 7 4 Female 9 11 8 7 2 1 3 4 10 5 6 Age and/or Sex not given 1 11 6 7 8 3 9 2 5 10 4 (a) Magazines such as 'Family Doctor'. (b) Newspaper articles. (c) Pamphlets. (d) Posters. (e) Films. (f) Exhibitions. (g) Radio programmes (h) Television programmes (i) Visits to Maternity and Child Welfare Centres. (j) Talks at Clubs (k) Talks at Schools. CLEAN AIR Smoke Control Areas The detailed survey of Smoke Control Area No. 1 comprising 1,025 acres in the Southern end of the Borough, was completed in June 1959 when the Council made a Smoke Control Order to operate from 1st October 1960 and submitted it to the Minister for approval which was received in October. The occupier of every property in the area was then notified accordingly by letter, and where adaptation or replacement of heating appliances was considered necessary the occupier was informed accordingly and advised as to the procedure for applying for grant; appropriate forms for this purpose were enclosed with the communication. By the end of the year a number of claims had been dealt with. The Ministry of Housing and Local Government invited local authorities in "Black" areas to inform the Minister by 30th June 1959 of their programme for establishing smoke control areas over the next five years. The Public Health Committee gave consideration to this matter and recommended the Council to deal with the following areas by 1963. Smoke Control Area No. 2. (1961). Bounded by Turney Road, Dulwich Village, Red Post Hill, Sunray Avenue and the Borough boundary. Size 230 acres Estimated No. of premises 2,500 E stimated No. of dwellings 2,400 Smoke Control Area No.3. (1962). Bounded by Grove Vale, Melbourne Grove, Lordship Lane, Court Lane, Dulwich Village, Red Post Hill and the Railway line between North Dulwich and East Dulwich Stations. Size 191 acres Estimated No. of premises : 2, 400 Estimated No. of dwellings 2,300 Smoke Control Area No. 4. (1963) Bounded by Champion Park, Grove Lane, Dog Kennel Hill the railway line between East Dulwich and North Dulwich stations, Red Post Hill, Sunray Avenue and the Borough boundary. Size 184 acres Estimated No. of premises 1,700 Estimated No. of dwellings 1,620 Before the end of the year under review, the preliminary survey of Area No. 2 had been completed and the Minister's approval in principle was sought. This was received early in the new year and the detailed survey was put in hand forthwith. Railways In view of the complaints of smoke from railway engines received from residents in the vicinity of the Victoria to Kent Coast railway line which runs through the Council's Smoke Control Area No.1, an approach was made to British Railways. At an interview on 8th June 1959 with the Assistant to the Traffic Superintendent, it was stated that electrification of this line was being introduced that very day and that by the end of 1959 the steam services on this line would have been reduced by 50%. It was anticipated that steam services would be completely eliminated by 1962 at the latest. It was pointed out that firing of engines was necessary to negotiate the up-gradient from Herne Hill Station to Penge East Station, a journey which takes about 7½ minutes for passenger trains and 11½ minutes for freight trains. Firing, however, should not be necessary on the up journey and consequently there should be no smoke emission. It was further stated that the British Railways firemen were properly trained in methods of stoking to eliminate smoke emission and every effort was being made to observe the requirements of the Clean Air Act. The other railway lines in the Borough carry mainly electric passenger trains and only a very few steam freight services. With regard to the heating of stations and other railway buildings in the Smoke Control Area, an assurance was given that only an authorised smokeless fuel would be used in the future. Smoke Control Areas (Exempted Fireplaces) Order, 1959. This Order, which came into operation on the 17th July 1959, exempts from the provisions of section 11 of the Clean Air Act, 1956 (which relate to smoke control areas), furnaces installed on or after the 31st December 1956, which are equipped with mechanical stokers and do not burn pulverised fuel provided they are installed, maintained and operated so as to minimise the emission of smoke and provided they use fuels for which the mechanical stoker was designed. In an accompanying Circular the Minister pointed out the desirability for local authorities to exempt on similar conditions under Section 11(3) of the Act all coal burning furnaces fired by mechanical stokers which are capable of working as smokelessly in smoke control areas as those exempted by the Order, but which were installed before 31st December 1956. It became necessary, therefore, to give consideration to the advisability of exempting the furnaces at the Council's Sydenham Hill Estate. In view, however, of the complaints which had been received in the past of the emission of smoke and soot from the chimney and the difficulties which had been experienced in operating this plant smokelessly it was decided to seek expert guidance and the assistance of the National Industrial Fuel Efficiency Service was sought. The report of their engineer indicated that some modification would be necessary in order to comply with the requirements of the Clean Air Act and recommended that a full investigation with combustion efficiency tests should be carried out. In the circumstances, the furnaces were not exempted from the Smoke Control Order and arrangements were made for the suggested investigation to be undertaken prior to making any alterations to the plant. New Furnaces Two applications were received for prior approval to the installation of new furnaces under the provisions of Section 3 of the Clean Air Act, 1956. In both cases the plans and specifications were for furnaces which were capable of being operated continuously without emitting smoke when burning fuel of a type for which the furnaces were designed, and the applications were therefore approved by the Council. FOOD AND DRUGS During the year, 403 formal and 499 informal samples of foods and drugs were submitted to the Public Analyst for examination; 9 formal and 13 informal samples were given adverse reports. Of the formal samples reported against three were of minced meat and three of pearl barley which were found to contain a prohibited preservative; a tin of Cream of Asparagus and two tins of instant coffee were incorrectly labelled. Among the informal samples were two of milk which contained foreign matter, one of currants which were maggoty, one of pickling spice and one of curry powder infested with beetles, and one of pork sausages which contained only 55 per cent. meat. The composition of milk, especially during the spring months, has caused concern for several years past. In a considerable proportion of samples the non-fatty solids fall below the presumptive minimum of 8.5 per cent, though the application of the Hortvet freezing point test has shown that in almost every case the milk is free from added water. It is not an offence to sell poor quality milk provided it can be shown that water has not been added or fat abstracted, but the quality of much milk sold seems to reflect on modern methods of production. Artificial food colourings have received much attention. The Colouring Matter in Foods Regulations came into full operation during the year, replacing the provisions of the Preservatives Regulations, and since a high proportion of prepared foods contain artificial colouring a considerable amount of work has had to be carried out. The separation and indentification of these colouring substances is often a process presenting some difficulty, involving the techniques of paper chromatography and spectro-photometry. So far none of the many samples examined has contained “non-permitted” colour. Other recent amendments of food legislation concern the use of diphenyl and related compounds in citrus and certain other fruits and antioxidants in foods; it has been found necessary to carry out a considerable amount of research in order to establish rapid and reliable methods for routine use in detecting and determining these chemicals. Owing to the large consumption of canned foods nowadays, particular attention is paid to the risk of metallic contamination, but it is not only food in cans which may become contaminated by metals. Almost any manufactured food may come into contact with metals at some stage of processing - e.g. during grinding (as in the case of spices and similar products), mixing, boiling or moulding, the last particularly in the case of the popular ice lolly. Atmospheric dust may also contain appreciable amounts of lead and other metals, and protection from such dust during manufacture should be an important factor in food hygiene. All samples of canned foods and very many others are examined for metallic contamination, but during the year under review none were found to contain metals in excess of the recommended limits. There is still some controversy about the allowable meat content of sausages. No standard has existed since the repeal of the Meat Products Order, but it may be argued that a peace-time sausage should at least be not inferior in composition to a war-time one. Sausages on sale in the Borough are regularly sampled and analysed, and attention is drawn to any case where the meat content falls significantly below the old standards of 65 per cent, for pork and 50 per cent for beef sausages. Many of the better quality sausages have been found to have meat contents notably higher than these figures. The composition of ice cream is controlled by the Ice Cream Order of 1953, but during 1959 a new category known as Dairy Ice Cream, was introduced. The fat of this product must be exclusively milk fat, and a number of samples sold under this description have been examined, all of which complied with the Regulations, and most of which contained milk fat considerably in excess of the legal minimum of 5 per cent. This is gratifying in view of the increased consumption of ice cream and its value as a food. PUBLIC SWIMMING BATHS The Council has two public swimming baths - one at Goose Green, East Dulwich Road and the other at Camberwell Church Street. There are two swimming pools at each establishment; the two at Camberwell and the first class pool at Dulwich each have a capacity of 118,125 gallons and the second class pool at Dulwich 88, 590 gallons. In every case the dressing cubicles are sited around the pools at bath level. Disinfectant foot baths and showers are provided for each pool. The swimming baths are used mainly by school children from 9 a.m. to 4.30 p.m. Mondays to Fridays; they attend in parties of 20 to 40 at half hourly intervals and receive swimming tuition either from their own teacher or from an L.C.C. instructor. After the pools are closed to the public in the evenings, they are booked by swimming clubs abd youth organisations for swimming practice and water polo activities. Swimming galas are also held on some evenings during the summer season. The number of persons who use the baths has been steadily increasing. The following shows the approximate number of bathers at each establishment during the past 3 years. Year Camberwell Dulwich 135,000 131,000 1957 1958 147,000 154,000 1959 176,000 156,000 The first class pool at Dulwich baths and the front pool at Camberwell Baths are closed during the winter (October to April). During this time the pools are emptied and floored over and used for indoor activities such as dances, meetings, indoor bowls, badminton, table tennis, boxing and wrestling tournaments and so on. At the end of the winter the wells of these pools are thoroughly cleansed and disinfected, and any necessary repairs and re-painting is then carried out before they are again used for aquatic activities. The second class pool at Dulwich Baths and the rear pool at Camberwell Baths are closed for a fortnight in October when the wells are emptied, cleansed and disinfected. Any necessary repairs and re-painting are also undertaken during this period. Filtration Plants. Filtration plants and chlorinators (with break-point operation) are installed in both establishments and the rate of turnover is 30,000 gallons per hour. The filters are cleaned by back-washing twice weekly. Every morning the bottoms of the pools are swept by heavily weighted brushes and the surfaces are hosed off down the scum trough drains. Examination of water. Ortho-tolidine colour tests and phenol red pH tests are carried out by the Baths staff four times daily. In addition, samples of water from all the pools are obtained every month whilst the baths are in use and submitted for bacteriological and chemical analysis. As will be seen from the table on page 54 thirty-three such samples were examined during 1959 and all proved to be satisfactory. The following is a summary of the bacteriological findings: - BACTERIOLOGICAL REPORTS ON SAMPLES OF SWIMMING BATH WATERS TAKEN THROUGHOUT THE YEAR DULWICH BATHS FIRST CLASS BATH SECOND CLASS BATH Plate count yeastrel agar 48 hrs. 37°C aerobically colonies per ml. Probable No. of coliform bacilli MacConkey 48 hrs. 37°C colonies per 100 ml. Plate count yeastrel agar 48 hrs. 37°C aerobically colonies per ml. Probable No. of coliform bacilli MacConkey 48 hrs. 37°C colonies per 100 ml. January - - 0 1 February - - 6 0 March - - 5 0 April - 3 - 0 0 May 0 0 12 0 June 3 0 0 July 3 0 4 1 0 13 August 0 0 September 2 0 12 0 October - - 0 0 November - 7 - 0 December - - 2 0 CAMBERWELL BATHS FRONT BATH REAR BATH Plate count yeastrel agar 48 hrs. 37°C aerobically colonies per ml. Probable No. of coliform bacilli MacConkey 48 hrs. 37ºC colonies per 100 ml. Plate count yeastrel agar 48 hrs. 37°C aerobically colonies per ml. Probable No. of coliform bacilli MacConkey 48 hrs. 37ºC colonies per 100 ml. 0 - 10 January - 0 0 February - - 3 0 - March - - - 0 0 0 April 0 6 May 5 0 1 0 June 1 0 0 3 July 5 0 0 1 August September 2 0 1 - - 0 4 October - - 2 0 November - - 0 - 1 December - HOUSING New Houses. The Council continued to direct considerable energy to the furtherance of their programme for the provision of new houses. During the year under review, 583 new dwellings were completed and at the end of the year 526 were in the course of erection. In addition, 99 existing properties were acquired for conversion into flats and 183 units of accommodation were thus provides. Slum Clearance. Three clearance areas were declared by the Council during the year as follows:- Area Date of Declaration No. of Dwelling Houses No. of Persons to be Displaced King Arthur Street 4. 2.59 11 33 Commercial Way 11. 3.59 6 18 Blenheim Grove 25.11.59 2 10 The first two areas completed this Authority's responsibilities in the five year programme (1956-60) agreed with the London County Council. The Blenheim Grove area was additional and was represented with the concurrence of the County Council who by agreement undertake the rehousing of the displaced persons from clearance areas of less than 10 houses. The preparation of the programme for the five years 1961/65 was almost completed by the end of the year. Certificates of Disrepair The following table shows the extent of the Council's activities under the Rent Act, 1957, in respect of the issue of Certificates of Disrepair, from the date the Act became operative. 1957 (from 6.7.57) 1958 1959 Total No. of applications for Certificates of Disrepair 414 411 100 925 No. of undertakings received from Landlords 220 284 59 563 No. of Certificates of Disrepair issued 105 157 44 306 No. of Certificates of Disrepair refused 3 3 12 6 No. of Certificates of Disrepair cancelled 16 75 52 143 25 It will be seen that there has been a considerable reduction in the demand for the Council's assistance in this matter. After two and a half years administration of the Act, this is not unexpected. It is probable that the number of applications for certificates of disrepair has now reached a level which will remain fairly constant; there may even be a further gradual reduction year by year as more houses become decontrolled. Overcrowding. Certificates of overcrowding were forwarded to the L.C.C. and the Borough Council Housing Department in respect of 56 cases which came to the notice of the Department during the year. This compares with 51 in 1958 and 74 in the previous year. Twenty three overcrowded families were rehoused during 1959; 11 by the Borough Council and 12 by the County Council. A number of complaints were made alleging overcrowding in houses occupied by West Indians, but close enquiries failed to confirm any offence against Part IV of the Housing Act, 1957. It may be that some of the complaints were prompted by colour prejudice, but the statutory standard for overcrowding is a very modest one and complainants who are not familiar with it may well have considered premises to be overcrowded even where the standard was not contravened. On the other hand, there were instances where it was suspected that overcrowding existed although an offence could not be established. It is extremely difficult in these cases to ascertain the actual residents in the dwellings as the coloured population fluctuates considerably and many of the occupants are temporary visitors who may stay only a few days. Underground Room Regulations Prior to 1957 local authorities had at their disposal a simple and quick means of closing unhealthy underground rooms. These powers were (contained in Section 12(2) of the Housing Act 1936 and the Regulations made thereunder. In 1957, however, the Court of Appeal took the view that as a result of the Housing Repairs and Rents Act, 1954, the exercise of these powers became subject to the application of the general standards of fitness set out in the Housing Act 1957, and the regulations previously made became ineffectual. The Housing (Underground Rooms) Act, 1959, which came into operation on June 14th 1959, restored the previous position, however, and the Minister of Housing and Local Government indicated that he was prepared to consider any new regulations which authorities may wish to make. In this connection, attention was directed to the existing model regulations which had been revised to bring them in conformity with present-day standards, and local authorities were asked to review their own regulations in the light of the revised model. The Advisory Body of Borough Medical Officers considered the revised model regulations and reported to the Metropolitan Boroughs' Standing Joint Committee that in some respects they fall far short of the previous model upon which most Metropolitan Boroughs based their existing regulations. The Advisory Body suggested various amendments which the Standing Joint Committee have submitted to the Minister for his consideration and suggest that the model regulations should be amended accordingly. The Assessment of Applications for Rehousing on Medical Grounds. The housing problem is still a long way from solution. It has considerable public health implications, and places heavy responsibilities on the Medical Officer of Health, who must assess the degree of priority to be awarded to applicants furnishing medical certificates in support of their rehousing claims. The number of these certificates has increased steadily in the London area since the war. Many patients believed that the greater the number of certificates the more priority was obtained and the quicker the rehousing. Although this was not so, it was difficult to explain the real situation to them. The variety of certificates submitted was considerable and their value and accuracy were sometimes obviously doubtful. It was clearly necessary for some regulation to be introduced to produce conformity and a substantial measure of fairness in allocating priority and also to allow the family doctor a chance to give his objective recommendation confidentially. Between 1955 and 1958, 3,235 applications for rehousing were received by the Borough of Camberwell; during the same period, 1,623 housing applicants claimed medical priority. The applications were accompanied by certificates from the family doctor and to a lesser extent from hospital doctors and almoners. After consultations with general practitioners and hospital staffs it was decided to introduce a new system in Camberwell which should prove more equitable. It was agreed that the form of medical certificate for housing should be the same for all cases and that only one certificate should be submitted for each patient unless the medical condition changed. Certificate In 1955 the following Housing Form was devised and brought into use:- BOROUGH OF CAMBERWELL CONFIDENTIAL No.__________ For Official use only APPLICATION FOR PRIORITY REHOUSING ON MEDICAL GROUNDS Recomm. Date PART I Name of applicant__________ Address__________ PART II To be completed by MEDICAL PRACTITIONER Name of patient __________ Age __________ This patient suffers from __________ As a result of your visits, what housing features do you consider adversely affect this condition? __________________________________________________ __________________________________________________ __________________________________________________ Bearing in mind your knowledge and experience of other cases requiring rehousing, into which of the following categories of medical priority should this patient's name be placed - 1. Most urgent __________ 2. Urgent __________ 3. Soon __________ 4. No priority __________ Date __________ Signed __________ Medical Practitioner It is regretted that no fee can be paid for this certificate. PLEASE RETURN FORM IN THE ENCLOSED STAMPED ADDRESSED ENVELOPE PART III To be completed by PUBLIC HEALTH INSPECTOR (a) Family for whom accommodation is required:- __________ adults __________ male children aged __________ __________ female children aged __________ (b) Present accommodation:- Room Living room Bedroom Scullery W.C. Number Floor Whether shared Total persons __________ Equivalent number __________ Total number of rooms __________ Permitted number __________ Statutory Overcrowding? ____________________ (c) Standard of present accommodation:- 1. Is separate sleeping room available for patient(s)? ____________________ 2. Is there serious dampness? ____________________ 3. Is water supply readily accessible? ______________________________ 4. Any other serious defects? ____________________ 5. CAN POINTS BE AWARDED FOR BAD CONDITIONS? ______________________________ (d) REMARKS:- ______________________________ Date __________ Signed __________ Public Health Inspector RECOMMENDATION BY MEDICAL OFFICER OF HEALTH I recommend that this application should be placed in the following category of medical priority:- 1. IMMEDIATE __________ 2. URGENT __________ 3. LESS URGENT __________ 4. NO RECOMMENDATION __________ Date __________ Signed __________ Medical Officer of Health Part I shows that a responsible person makes the application. Part II is the information given by the family doctor and the answers show without doubt or possibility of confusion from what the patient is suffering and how this condition is affected by his or her present dwelling. It was expected that the practitioner signing the certificate would have visited and seen these conditions. The practitioner is then invited to assess in which of four grades the amount of priority the patient and the condition warrant, bearing in mind his knowledge of other cases and applications. It was fully realised that most practitioners were not always aware of statutory or accepted standards. Part III is usually completed by the public health inspector before the certificate reaches the doctor, who is therefore in the happy position of knowing whether there is any statutory overcrowding or structural defect recognised by the Borough, and he does not have to rely on the patients' own statements. Assessment of Certificates. It was felt that a Panel should be set up to review the certificates and decide the assessment of priority in one of four categories. The Panel consisted of the Medical Officer of Health, a Medical Consultant, and a General Practitioner. One thousand, six hundred and twenty-three of these assessments were made up to 31st December 1958 and the following in an analysis of the results. Tables showing Classification of Results - Overleaf HOUSING APPLICATIONS FOR MEDICAL PRIORITY JULY 1955 TO DECEMBER, 1958. TABLE I Classification by types of disease - and priority given by applicants own G.P. Disease I II III IV Total % of Total 14.4 Tuberculosis 31 49 88 233 65 54 123 128 18 323 19.9 Functional Nervous Disorders 25 266 Bronchitis (excluding Tuberculosis) 43 104 94 16.4 103 Cardio-vascular 20 52 28 3 6.3 100 6.2 Diseases of bones and joints 15 35 42 8 - 49 3.0 Organic Diseases of the nervous system 16 20 13 28 5 14 6 3 1.7 1.6 Pregnancy 26 Diseases of the digestive system 1 11 3 11 13 30 11 98 6.0 *Other 44 2 39 44 36 121 7.5 Unclassified Diseases Died, gone away, forms not returned; rehoused; no residential qualifications - - - 276 17.0 - TOTALS 200 12.3 491 484 172 1,623 100.0 10.6 rn % OF TOTALS 29.8 30.3 TABLE II Classification by types of Disease - and priority given by the Panel. Disease I II III IV Total % of Total 35 83 68 233 14.4 Tuberculosis 47 71 Functional Nervous Disorders 21 118 113 323 19.9 Bronchitis (excluding Tuberculosis) 16 79 88 83 16.4 266 Cardio-vascular 13 49 19 103 6.3 22 100 Diseases of bones and joints 6 39 38 17 6.2 49 Organic Diseases of the nervous system 10 18 14 3.0 7 2 14 5 7 28 1.7 Pregnancy Diseases of the digestive system - 10 7 9 26 1.6 28 98 *Other 7 30 33 6.0 7.5 Unclassified Diseases 2 34 48 37 121 - - - 276 17.0 Died, gone away, forms not returned; rehoused; no residential qualifications - TOTALS 112 391 456 388 1,623 100.0 24.0 24.0 a % OF TOTALS 6.9 28.1 * Defective sight, blood dyscrasias, senility, neoplasms, skin conditions, poliòmyelitis paralyses. Discussion. The system described has proved to have many advantages. The special form which gives general practitioners accurate information on overcrowding and sanitary circumstances was appreciated by them: its introduction was followed by a marked reduction in the number of "medical" applications; indeed, in a number of cases the form was returned with the recommendation "no priority". This was hardly possible previously when the doctor handed his certificate to the patient. Many "medical reasons" given by patients themselves were groundless. However, a fair measure of agreement was found between the assessment of the family doctor and that of the Panel using this method of arbitration. There was also some progressive diminution in the number of applications in which the Panel gave a lower recommendation than the general practitioner. In addition to the personal medical category, the description of the environmental conditions found by the public health inspector (see Form, Part III) was of great benefit in arriving at the final priority. Many remediable housing defects were discovered pari passu and appropriate action taken. (a) Dampness was cited in support of some 159 cases (10%). After public health inspectors' visits confirmation was obtained in 137 of these. (b) Overcrowding. The family doctor gave evidence of this in 305 cases. Confirmation by public health inspectors was made in 280 of these and notification of statutory overcrowding was then sent to the housing authorities concerned. However, the limits of statutory overcrowding are by no means liberal and many border-line cases are seriously affected. It is natural that family doctors should deem overcrowding to exist, even though by reason of the age of the children the legal limits are not exceeded. (c) Friction. This was an aggravating factor in 75 applications. The problem of young couples sharing houses and flats with "in-laws" or of two women being forced to use a common kitchen occured frequently. It became obvious that the "colour bar" problem was increasing in south-east London. Examples quoted included coloured and white tenants in adjacent rooms having to share W.C. accommodation. The purchase of a house by a coloured person caused resentment amongst the white tenants, many of whom had lived there for a number of years; it was often alleged that there was victimisation in order to evict them in favour of coloured tenants, the latter often being willing to pay higher rents. (d) Tuberculosis. A special points system for Tuberculous applicants was devised in 1953 and this with some modification, has proved successful and has been continued. By this method of assessment, families at the greatest risk by reason of the age and sex of the members, and adverse living conditions, were given the highest priorities. The outmoded, and often, only criterion of " positive sputum with no separate bedroom" has thus been considerably modified. The special forms were completed at the Chest Clinic and the number of points calculated at the same time. This simplified the work of the Panel and no instance occurred in which the recommended and final assessment of priority differed. Fourteen per cent of all recommendations were in respect of tuberculous disease. (e) Nervous Disorders. In 20% of the applications, the disability was given as mental illness - chiefly nervous debility or anxiety neurosis. These cases presented the biggest assessment problems, for whilst in a number of instances the effects of malhousing were very real, in others there were no grounds for believing that this was so, or indeed that the diagnosis could be accepted as anything but an attempt to accelerate rehousing. In these cases, the opinion of consultant psychiatrists was invaluable although, unfortunately rehousing could not be assured in all the deserving cases. (f) Bronchitis. Patients suffering from bronchitis formed the second largest number (16.4%) of applicants. Dampness (although its presence was not always confirmed) was alleged frequently to be a causative or aggravating factor. (g) Accidents. In a previous report the value of public health inspectors' visits in remedying defects was shown. In addition to their routine and statutory visits, these specific housing inspections in respect of medical priorities gave the inspectors opportunities for giving householders much useful advice. Doctors are becoming increasingly aware of the difficult housing situation, and of the necessity for taking it into account when giving a medical priority. When they appreciate this to the full, a final assessment by an independent medical panel will cease to be required. Exchange of Accommodation. Even when no over-riding medical factor could justify a priority, in 74 cases (5%), simple exchange was recommended. Usually, the need is for ground floor accommodation e.g. old people or persons with locomotor difficulties. In many instances, the provision of such exchange would release additional housing units. This aspect of rehousing, although it is administratively complex, merits more attention; its wider application would be advantageous. CONTROL OF INSECTS The incidence of bed-bugs and fleas has reduced very considerably since the introduction and development of contact insecticides of which D.D.T. was the first. Nevertheless, the services of the officers of the Public Health Department are still called upon frequently to deal with infestations of these pests and also to assist in the eradication of other insects such as cockroaches, ants, flies, beetles and so on. The following table shows the number of premises visited and the total visits during 1959 to deal with such pests. Type of Infestation No. of Premises No. of Visits 207 251 Bed-bugs 30 Fleas 26 2 3 Lice 6 Cockroaches 5 17 34 Beetles 74 67 Wasps 12 12 Slugs and maggots 42 47 Ants 5 7 Moths 10 14 Clover mite 18 24 Flies 8 9 Silver fish 8 Other insects 8 519 Totals: 427 These figures indicate that a considerable amount of work is undertaken by the local authority to reduce vermin and insect infestations, although under the provisions of section 123 of the Public Health (London) Act, 1936, the responsibility for ridding dwelling houses of vermin rests with the owner or occupier. In order to encourage residents to take steps themselves to deal with any such pests it has for many years been the practice to make available to them at the Public Health Department tins of insecticide and sprayers which they may purchase at cost price. A number of ratepayers take advantage of this facility every year. Mosquitoes. Three or four years ago mosquito larvae were found to be present in the rain water which had accumulated in some of the static water tanks in the Borough. The water was treated by the staff of the Public Health Department and the co-operation of the London Fire Brigade was sought to empty these tanks. It has since been the practice each summer to carry out routine inspections and regular spraying of the water in the tanks to prevent the breeding of mosquitoes; as a result no complaints have been received of any nuisance from these insects arising from this source. The summer of 1959 was very warm and dry and there were few occasions on which rain water collected in the tanks. During that year, however, 39 visits were made to the nine tanks still remaining in the Borough and on 28 occasions the accumulated water was sprayed with oil and insecticide. Complaints of infestation by mosquitoes were, however, received from residents in the blocks of flats adjoining the Grand Surrey Canal at Canal Head, Peckham. Since there was some evidence that these insects were breeding in the water of the canal, the Port of London Authority were informed and they arranged for preventive treatment to be carried out. EMPLOYMENT FOR THE ELDERLY Suitable occupation is an essential for a healthy existence. The majority of people who reach pensionable age continue to be fit for work for some years, but as they become older, frailty, failing eyesight and a slowing down of mental faculties determine the amount and type of work they can do. Employment schemes for the elderly are particularly important for those who have made no preparation for retirement and have no hobbies or outside interests. People in this category need an opportunity of doing a little work immediately after retirement otherwise mental and physical changes are liable to take plåce prematurely. Loneliness is one of the main factors in precipitating senility, and light work in company with others is one of the most useful means of combatting it. The psychological effects of occupation are considerable; they offsèt the feeling of not being wanted and no longer being a useful member of the community. The Council recognised the need in this Borough for providing light occupation for the elderly and at their instigation an Association was formed, representing various organisations in the area, to set up a suitable scheme. The objects of this Association, which is subsidised by the Council, are to promote, manage and assist a scheme to provide elderly persons resident in the Borough through the medium of remunerative employment under protected conditions with facilities for physical and mental recreation, to relieve poverty and distress, provide meals and to pursue any objects which are deemed to be charitable. Arrangements were put in hand to establish a centre at Cambridge House, Camberwell Road, and it is hoped that when this project has been successfully launched, similar centres will be set up in other parts of the Borough. It must be remembered that the success of a venture of this kind depends on the co-operation of industrial undertakings in providing suitable outwork for these old people. However, similar schemes are already in operation in some other areas, and whilst they meet only a very small proportion of the need, they are proving extremely successful and are greatly appreciated by the elderly people for whom they provide healthy and profitable activity. It should be emphasised that this scheme is basically a medical one - it is designed to prevent premature disability and to play a part in rehabilitation. For this reason a geriatrician, a general practitioner and the medical officer of health are closely associated with its activities. INFECTIOUS DISEASES Diphtheria and its prevention. T he Camberwell Borough Council were pioneers in diphtheria prevention and set up an immunisation clinic under the late Dr. Barnes as long ago as 1926. Unfortunately, there was for some years a disappointing response on the part of the public, and it was not until 1942, when an intensive country-wide campaign was commenced, that more and more parents realised that the prophylaxis being offered for their children was both safe and effective. The following table shows that there has been a remarkable reduction in the incidence of diphtheria particularly since 1943. However, public apathy and complacency have grown concomitantly with the diminution of a disease, the ravages of which are unknown to the young parents of today. In the last few years public health authorities have been much concerned with the sequel to this attitude, viz., the decreasing number of children being presented by parents for immunisation. Sharp localised outbreaks of diphtheria recently, with deaths in some places, have underlined the ever-present need for vigilance in the fight. Our best weapon is still immunisation. Ideally, the child should receive a primary course of preventive injections in the first year of life, followed by a reinforcing dose at 5 years of age and a further "booster" at 10 years if required. The duty and responsibility of ensuring protection for the child against this dangerous disease lies with the parents or guardians. The re-appearance of diphtheria in north-west Camberwell after a lapse of nine years has brought home these facts. In November 1959, two children were found to be mild clinical cases of diphtheria - neither had been immunised. Investigations at the schools they attended 1959 7 Nil 1957 Nil Nil 1948 15 Nil 1943 64 Nil 1938 394 20 1928 744 22 1921 870 64 Year Deaths Corrected Notifications brought to light 12 positive carriers of the disease in one school. Further swabbing of home contacts and pupils at two other schools produced a total of 67 persons who were harbouring the organism by the end of the year - 56 children, 4 pre-school children and 7 adults. The majority of these cases were treated in hospital to render them free from infection and to prevent them from being a danger to others, particularly unimmunised children. There was a sharp fall in the number of "carriers" discovered in the early weeks of 1960. Intensive work by local general practitioners and the public health staffs of both the Borough Council and the L.C.C. was carried out to discover cases in the community and to provide immunisation for many children who had not been so protected. By the end of January 1960 some 76 positive cases were known, including 17 patients who had been re-infected on return home from hospital. Up to that time 236 swabs had been taken for bacteriological examination. There were very few clinical cases of diphtheria in this outbreak, and those only mild in character, probably due to the resistance acquired by the community by immunisation in the past, but this occurrence has emphasised the importance of maintaining a high level of immunity in the child population against this dangerous disease. It serves as a dramatic reminder, also, of the damage that can follow unbelief in the efficacy of immunisation - the unnecessary occupation of hospital beds, the needless taking up of the time of health workers, the avoidable absence from school, and the risks to health and life. These are some of the things that one or two people, lacking a communal health consciousness, can bring about. Compulsory removal of tuberculous patients. Section 172 of the Public Health Act, 1936, empowers a local authority to secure the compulsory removal to hospital of a tuberculous patient who is in an infectious state, but this Act does not apply to London, and the Public Health (London) Act, 1936, does not contain any similar provisions. It was therefore, not possible to take any action in a case brought to the notice of the Department by the Consultant Chest Physician where the patient had proved to be most unco-operative. This infectious tuberculous patient was a mother of three grownup and three small children; she had discharged herself from hospital against medical advice and returned home. This anomalous position was reported to the Public Health Committee who decided to ask the Metropolitan Boroughs' Standing Joint Committee to press for legislation which would give local authorities in London similar powers in this respect to those outside the Metropolis. The Standing Joint Committee made enquiries from constituent councils from which it appeared that over the past few years only a small number of cases had arisen either of patients refusing treatment or of discharging themselves from hospital. In view of this, and having regard to the cautionary note in some of the replies about the need for care in exercising compulsory powers of this nature and the likelihood that a patient, in hospital on a Court Order would not take kindly to treatment or derive benefit there from, the Standing Joint Committee considered that any cases of this nature should continue to be dealt with by persuasive means. The position remains, therefore, that an infectious tuberculous patient living outside London can, if necessary, be compulsorily removed to hospital, but one residing in the densely populated area of the Metropolis cannot be so controlled. At a time like the present when there is every hope that, if rigorous control measures are pursued, tuberculosis may be reduced to negligible proportions within a generation, it would seem that every available weapon should be used to give this age-old scourge its coup-de-grace. Typhoid Fever. In September a notification was received of a case of typhoid fever in a young child in Peckham. Specimens of faeces obtained from the mother were examined and found to be negative. The father was working and lodging away from home, but as he had recently visited his home the Medical Officer of Health for the area in which he was staying was informed. Specimens from the father, however, also proved to be negative. Further careful enquiries revealed that members of another large family living in the same house as the patient were, in fact, close relatives, and on examining specimens from each of them it was found that the patient's grandfather was a typhoid carrier. He was admitted to hospital for treatment. Soon after returning home, however, further specimens of his stools were found to contain the typhoid organism. The house in which he lived contained only one W.C. and it was thought desirable that there should be another for his exclusive use to avoid the possibility of any other member of the household contracting the disease. Since the number of occupants in the house was in excess of the number laid down in the standard for sanitary accommodation adopted by the Council, the matter was brought to the notice of the Public Health Committee and a notice was served on the owner under the provisions of Section 36 of the Housing Act, 1957. In the meanwhile, however, the typhoid carrier who is practically confined to the house because of other disability, agreed to live apart from his family if a oneroom letting could be found for him in the near vicinity. The desirability of this course of action was made known to the Director of Housing who was most helpful in being able to provide the necessary alternative accommodation. The patient has since been kept under periodic surveillance and specimens of faeces are being regularly submitted for bacteriological examination; so far, however, the infection has persisted although the patient himself has no symptoms. Dysentery. There was a considerable increase in the incidence of dysentery in 1959 when 120 cases were notified. This was the highest number for many years, with the exception of 1956 when 256 notifications were received. The following table shows by age distribution the notifications of this disease received during the past 11 years. 44 Notifications of Dysentery 1949-1958 Year No. of notifications Age Distribution 1-2 2-3 5- 10 10- 15 15- 20 20- 35 35- 45 45- 65 65 + Under 1 3-4 4-5 1 4 - 1949 12 - 2 1 1 - 1 2 - - 17 1 3 1950 1 2 2 6 1 1 - - - - 6 5 7 1951 55 8 2 13 2 1 3 5 2 1 6 2 3 1952 47 3 2 12 6 4 5 1 3 - 1953 1 5 50 3 6 4 3 13 4 7 2 1 1 9 9 4 2 1954 51 3 1 5 11 6 1 - - 10 3 98 9 7 1955 13 11 8 21 2 7 6 1 1956 18 256 16 21 8 10 26 27 14 67 6 38 5 5 79 6 3 6 2 1957 8 8 4 22 9 6 - 79 7 3 1958 8 6 6 1 7 3 20 4 10 4 120 3 10 9 1959 9 3 11 7 7 28 3 19 11 40 Totals 59 74 60 108 18 864 88 78 215 48 55 21 The age distribution pattern has been fairly consistent. Seventy-three per cent, of the cases occurred in children and there were rather more notifications in respect of pre-school children than of children of school age. From the histograms showing the monthly incidence of dysentery during 1958 and 1959, it will be seen that this disease is showing a tendency to increase during the winter and spring, and this upward trend continued to a marked extent in the early months of 1960 which appears to be a record incidence for this time of the year. This is significant, since it is evident that such increase could not have arisen from fly-borne organisms, but as a result of infection from person to person. It is reason able to suppose, therefore, that many of the outbreaks which occur during the summer months may also be caused by this means. Outbreaks of this disease usually occur among school-children but the infection may be rapidly conveyed to other persons in the home. This emphasises once again the importance of personal hygiene in the prevention of dysentery and other similar diseases, particularly washing the hands after using the toilet and before eating or handling food. The public health authorities in their efforts to combat this disease have given, and continue to give, considerable attention to this aspect of health education, yet the incidence of dysentery does not diminish. MONTHLY INCIDENCE OF DYSENTERY 1958 MONTHLY INCIDENCE OF DYSENTERY 1959 REPORT OF CONSULTANT PHYSICIAN CAMBERWELL CHEST CLINIC The year 1959 was quite a healthy one in Camberwell from the point of view of chest illnesses, chiefly because there was no serious influenza epidemic and the weather during the winter months was mild. In consequence, the exacerbations of symptoms in patients who had chronic bronchitis were neither very marked nor very frequent. During the year 17,270 units of X-ray work were carried out and there were 15,168 attendances. X-ray examinations of new cases numbered 8,184 and as a result, 1,912 new patients had a full clinical examination. The cases on the tuberculosis register showed a further decline from 1,698 to 1,190. One hundred and sixty-two new cases were added to the register and this figure includes 17 non-pulmonary cases. The notifications were greatest for men in the 45-65 group (53 cases), and among women there were 27 cases in the age group 15-35. There were 12 deaths due to pulmonary tuberculosis, 10 being among men over 45, and only 1 female death. The total number of deaths - fourteen - is the lowest recorded and gives a death rate of 0.08 per 1,000 population. Although these figures are encouraging, it is unfortunate that tuberculosis has not yet been eradicated in this country. Many factors are responsible for this unhappy state of affairs - public apathy, absence of an intense case-finding programme for the whole country, poor response to propaganda about B.C.G. vaccination and, more particularly, the absence in London of adequate Public Health laws under which an unco-operative infectious patient can be detained in hospital. In Camberwell there are at least five such patients who are a public danger. Propaganda about B.C.G. vaccination is given to all mothers who attend for routine ante-natal chest X-rays and 677 babies born in the maternity department of St. Giles' Hospital were vaccinated during the year. In addition a large number of children who are either contacts or were not vaccinated by the school B.C.G. teams, attended for vaccination. Once again this department was asked to co-operate in a therapeutic trial of various antibiotics for patients who had severe disabling chronic bronchitis. It will be difficult to assess the value of the various drugs because as pointed out earlier, the weather during the winter months was mild and the incidence of exacerbations was much lower than usual. It would seem, however, that bronchitic patients can be given some protection against secondary lung infections if they are given a prolonged course of antibiotics, and especially if the course is begun in September, that is before the weather is likely to become bad, and the course is maintained until the late spring. Health Visitors made 3,506 visits; these were chiefly connected with patients on the tuberculosis register and families where tuberculin positive children were known to be living. A survey of patients on the register who are over 60 carried out with the help of the Health Visitors and the Lady Almoner, has shown that there are a number who could benefit from the extra assistance they are entitled to from the National Assistance Board and the Ministry of Pensions & National Insurance. In some instances it has been possible to interest patients in outside activities and it is to be hoped that a number of them will be persuaded to attend the projected Camberwell Association for Employment for the Elderly. Dr. Mower White and her staff have been most helpful and so too has Dr. Chalke and his staff. We wish to thank the District Nursing organisations and the London County Council Ambulance Service for their co-operation throughout the year. KENNETH MARSH Consultant Physician Chest Department, St. Giles Hospital. ANNUAL REPORT OF THE CAMBERWELL TUBERCULOSIS CARE COMMITTEE FOR 1959. During the year changes took place in the membership of the Committee. Miss S. Burkin, representing the Banyard Nurses, Alderman Mrs. Jessie Burgess, J.P., representing the Divisional Health Committee, L.C.C. Division 7, and Mr. P. Lippiatt, representing the National Assistance Board (Camberwell South), resigned. The vacancies were filled by the following members: Miss S. Hughes, the Banyard Nurses. Alderman W. Allen, O.B.E., Divisional Health Committee, L.C.C. Division 7. Mr. F. Willsher, Area Officer, National Assistance Board, (Camberwell South). The continued aims of the Committee are to help patients to rehabilitate themselves after a long illness, to relieve the stress of financial burdens with financial assistance during treatment, to organise and maintain an occupational therapy class, and to raise sufficient funds by means of the Christmas Seal Sale to finance these aims. Although the number of cases on the Tuberculosis Register is diminishing the activities of the Committee and the work of assistance continued on much the same scale. The secretary interviewed 1,312 cases. The majority of these required communication with assisting Bodies, both public and voluntary, including Almoners of hospitals and public officials. Help and advice is given to patients applying to the London County Council or Camberwell Borough Council for assistance in re-housing. In addition the Secretary receives many enquiries for advice outside the scope of the Committee's work and it is gratifying to know that we are able to guide the enquirer into the right channels for help and advice. The following is a list of the types of assistance given and the number of patients assisted by the Committee:- Pocket money while in hospital 19 Taxi Fares 7 Lodging and meals 15 Household removals and help with furnishings 7 Clothing 34 Wireless licences 3 Fares of relatives to distant sanatoria 15 Loan of beds to new cases 4 Supply of bedding 21 Settlement of hire-purchase arrears, payment of arrears of rent and other outstanding accounts 6 Loan of dressing gowns 7 Pyjamas for those confined to bed or on admission to hospital 17 Towards cost of child's funeral 1 Supply of towels 8 Christmas food parcels 50 Of the total number of cases interviewed during the year 79 were referred to the National Assistance Board for the first time. In some cases they were able to give additional monies for clothing, bedding and hirepurchase payments. The occupational therapy class which meets each Friday afternoon is a means of giving happy hours of occupation and diversion to those not yet fit for work. In addition to the usual types of handicrafts dressmaking has been very successful. At the close of the year the number on the Roll was 19. The work is of a high standard and the goods were readily sold. During October it was necessary to vacate the premises at No.23 Brunswick Park owing to conversion work being undertaken by the Camberwell Borough Council. The Committee were very pleased to receive the assistance of Cambridge House, who kindly invited us to use their premises as temporary accommodation on a small rental for the therapy class. It is understood that the Camberwell Borough Council will permit us to re-use the improved accommodation at 23 Brunswick Park when completed in the New Year. The Committee arranged the usual summer and winter social events for students in the therapy class. During July they had a day's outing to Brighton and early in December a visit to a theatre followed by supper in town. The amount received from the Christmas Seal Sale which closed on 31st March, 1959, was £1,092. 18s. 7d., a decrease over the previous year. At Christmas time the Committee distributed fifty food parcels to needy patients and many expressions of thanks and appreciation were received. The Committee were pleased to have gifts of clothing, furniture, bedding and books from their many friends. We thank the Chest Physicians and Health Visitors at the Chest Clinic for their valued assistance by bringing to our notice the needs of their patients and for their useful suggestions in special cases. In concluding this report the Committee wish to thank the voluntary associations in the Borough, 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 for their close co-operation. 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. We also place on record our thanks to the Honorary Officers: The Worshipful the Mayor of Camberwell (Councillor T.J. Wallis, J.P.,), Patron of the Christmas Seal Sale; Mrs. Lilian Reddeford, Organiser of the Seal Sale; Mr. H. Smith, Borough Treasurer, who is our Honorary Treasurer; and Mr. R.A. Hughes, our Honorary Auditor; and the Camberwell Borough Council for affording us accommodation for our meetings and for the use of the premises at 23 Brunswick Park. We also thank Dr. H.D. Chalke, Medical Officer of Health for Camberwell, for including the Care Committee's Annual Report for 1958 in his Annual Report for the same year. AMY CROSSMAN, Chairman J.M. LEONARD, Secretary STATISTICAL APPENDIX Summary of Statistics for the year 1959. 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-1959) 176,100 Number of inhabitated houses (April 1959) 44,841 Rateable value (April 1959) £2,533,403 Sum represented by a penny rate (estimated) £10,050 Number of live births 3,156 Birth rate 17.9 Number of deaths 2,011 Death rate 11.4 Infantile Mortality:- Deaths under 1 year 85 Infant deaths per 1,000 live births 26.9 Maternal Mortality:- Deaths of women from diseases or accidents associated with childbirth 3 Maternal death rate per 1,000 total births 0.93 Deaths from Phthisis 12 Phthisis death rate 0.07 Deaths from all forms of Tuberculosis 14 Tuberculosis death rate 0.08 52 TABLE SHOWING CLASSIFIED CAUSES OF DEATHS IN AGE GROUPS IN CAMBERWELL DURING 1959 All ages 0- 1- 5- 15- 25- 45- 65- 75- Causes of death Sex M. 55 3 3 7 52 325 268 315 All causes 1028 30 3 1 33 155 251 506 F. 983 4 5 - - 1 4 1 Tuberculosis,respiratory M. 1 - 11 1 F. 1 - - - - - - - Tuberculosis, other 1 - - - 1 - M. - - - 1 - 1 - - F. - - - - 2 1 3 Syphilitic disease M. 6 - - - - - - F. - - - - - - - - M. - - - Diphtheria - - - - - - F. - - - - - - - - - - Whooping Cough M. - - - - - - - - - - - - F. - - - - - Meningococcal infections 1 - - - - M. 1 - - - F. - - - - - - - - - 1 - - - 1 - - Acute poliomyelitis M. - - - F. - - - - - - - - M. - - - - - Measles - - - - - - - F. - - - - - - Other infective and parasitic diseases - - - - M. - - - - - 1 - F. 1 - - - - - - Malignant neoplasm, stomach M. - - 13 5 25 1 6 - - - 13 5 15 F. 33 - - - - Malignant neoplasm, lung, bronchus M. 20 105 - 3 48 34 - - - 5 16 1 4 6 F. - - - - Malignant neoplasm, breast - M. - - - - - - - - 10 F. 38 4 14 10 - - - - 5 F. 12 - - 1 3 3 Malignant neoplasm,uterus - - Other malignant and lymphatic neoplasms 35 33 M. 103 - - - 1 3 31 5 33 F. 100 1 29 32 - - - 3 1 1 Leukaemia, aleukaemia M. - 1 - - - - - F. 6 1 4 1 - - - - M. - 1 1 Diabetes 2 - - - - - - 4 2 F. 6 - - - - - Vascular lesions of nervous system M. - 3 25 24 31 83 - - - 117 33 71 F. 3 10 - - - - 8 39 162 65 50 Coronary disease,angina M. - - - - 124 1 14 33 76 F. - - - - Hypertension with heart disease M. 18 - 5 6 7 - - - - - - 8 12 F. 20 - - - - 27 Other heart disease M. 56 - 2 13 14 - - - F. 117 5 14 19 79 - - - - 24 M. 1 2 8 10 Other circulatory disease 45 - - - 7 39 F. 64 - 2 16 - - - 1 4 2 1 Influenza M. - - - - - 5 3 7 16 1 F. - - - - M. 8 1 3 16 18 39 Pneumonia. 85 - - F. 1 10 21 104 5 67 - - - 53 Causes of death Sex All ages 0- 5- 15- 25- 45- 65- 75- 1- 115 - 31 36 44 Bronchitis M. 3 - 1 1 1 58 - 6 20 30 F. - 1 - Other diseases of respiratory system M. - 20 1 9 5 5 - - - 5 - 2 1 2 F. - - - - Ulcer of stomach and duodenum M. - 1 1 24 11 6 5 - - - 5 F. 11 - - 2 4 - - M. - Gastritis, enteritis and diarrhoea - - - - 2 2 - - F. - 2 5 2 - - 1 - - M. 1 Nephritis and nephrosis 4 1 2 - - - F. - - 7 - 1 1 - 2 3 - - 12 Hyperplasia of prostate Pregnancy, childbirth, abortion M. - - - 2 2 8 - - 3 2 F. - 1 - - - - - 15 - Congenital malformations M. 13 1 - - - 1 - F. 8 1 - - - 2 5 - - Other defined and illdefined diseases 1 73 29 - - 13 11 6 M. 13 87 17 - 20 36 F. - - 3 11 M. - 3 3 Motor vehicle accidents 21 - - 8 5 2 - 4 F. 10 - - - 2 4 - All other accidents M. 17 1 1 1 2 8 - - 4 F. 7 - 1 - - - 1 - 5 14 Suicide M. - - - 4 7 2 1 - - F. 6 - - - 3 2 1 - Homicide and operations of war M. - - - - - - - - - F. - - - - - - - - - Births Live Births Still Births Total M. F. M. F. M. F. Legitimate 1464 1421 33 27 1497 1448 Illegitimate 125 146 3 2 128 148 1589 29 Total 1567 36 1625 1596 I 3156 65 3221 Medical Examinations carried out by the Medical Officer of Health or his Deputy Officers for admission to the Permanent Establishment 26 Officers for admission to the Unestablished Staff 8 Employees for admission to Sick Pay Scheme 164 Employees for admission to Permanent Establishment 42 Employees absent from duty owing to sickness 430 Cremation Certificates No.of cremations authorised during the year by the Medical Referee or his Deputy 1,987 Water Certificates No. of Water Certificates issued 159 No. of dwellings concerned 876 Drainage and Sewerage No.of drainage applications received 414 Length of sewers reconstructed 4,874 ft. No.of brick gullies replaced by pot gullies 83 No.of defective pot gullies renewed 4 Public Cleansing Amount of house refuse collected 42,801 tons Amount of trade refuse collected 772 tons Examination of Water from the Council's Swimming Baths Bacteriological examination Chemical examination No. of Samples No. Satis. No. of Samples No. Satis. 5 Camberwell Front Swimming Bath 5 5 5 11 11 11 11 Camberwell Rear Swimming Bath 5 Dulwich First Class Swimming Bath 5 5 5 12 12 12 12 Dulwich Second Class Swimming Bath 33 33 33 33 Total In addition, water from the Swimming Bath at Mary Datchelor Girls' School, Camberwell Grove, was chemically and bacteriologically examined on five occasions. All the samples were satisfactory. Rag Flock and other Pilling Materials Act, 1951. No. of Samples examined No. Satisfactory Type of Material Rag flock (loose) 2 2 Rag flock (layered) 5 5 Jute felt 1 1 Woollen mixture felt 5 5 Sized cotton felt 2 2 Cotton felt 4 4 Algerian fibre 1 1 Coir fibre 3 3 Coir fibre (pad) 1 1 Black hair (pad) 1 1 Totals 25 25 Offensive Trades Type of Business No.on Register Skin dressers 4 Soap boilers 1 Total 5 Pet Animals Act, 1952 No.of licences issued Nil No.of licences renewed 9 Total No.of pet shops licensed 9 Pharmacy and Poisons Act, 1933 No. of applications received for registration 6 No. of applications received for renewal of registration 168 London County Council (General Powers) Act, 1954 No. of hairdressers and barbers premises registered 140 ATMOSPHERIC POLLUTION 1959 Estimation of Sulphur by Lead Peroxide Method Apparatus Installed at Queens Road Health Centre ATMOSPHERIC POLLUTION 1959 Total Solids Deposited - Tons Per Square Mile SOLIDS DEPOSITED - = RAINFALL Apparatus Installed at Queens Road Health Centre ATMOSPHERIC POLLUTION 1959 Average Concentration of Sulphur Dioxide in Parts Per Hundred Million Volumes of Air Apparatus Installed at Town Hall and 475 Lordship Lane ATMOSPHERIC POLLUTION 1959 Average Concentration of Smoke in Milligrams Per Hundred Cubic Metres ADDaratus Installed at Town Hall and 475 Lordship Lane Sanitary Inspection of the Area No.of complaints received 2,833 Summary of Work carried out during the year 1959 Inspections:- Nuisance inspections 2,732 Offensive trades 26 Smoke observations 279 Drainage, new and existing 8,783 Overcrowding 316 Factories and workplaces 953 Outworkers' premises 450 Rag dealers 60 infectious and other diseases 540 Verminous premises and persons 330 Aged and infirm persons 181 Common lodging houses 41 Conveniences, public and private 284 Heating Appliances (Fireguards) Act, 1952 93 Rent Act, 1957 494 Shops Act 1,021 Hairdressers and barbers 239 Voluntary work 146 Inspections not defined 1,262 Re-inspections 14,185 Total inspections 32,415 Works supervised:- Tests applied to drains (existing premises) 493 Drains found defective 130 Drains totally reconstructed 19 Drains repaired or partially reconstructed 308 Tests applied to drains (new buildings) 3,115 Drains constructed 1,486 Total works supervised 5,551 Description of Sanitary Improvements ordered during the year:- Cleanse and repair walls and ceilings 263 Repair roofs, gutterings, etc. 454 Abate dampness 752 Repair stoves, fireplaces and coppers 108 Repair windows, sashlines, sills, etc. 281 Repair flooring, stairs, doors, etc. 191 Provide sufficient light and ventilation 6 Provide dustbin 16 Remove offensive matter 35 Provide or repair yard paving 19 Provide or render accessible water supply 5 Cleanse, cover or render accessible water cistern 2 Repair water pipes and fittings 39 Clear premises of vermin 2 Cleanse or repair water closets and flushing apparatus 151 Repair or clear defective or obstructed drains 45 Repair soil pipes, waste pipes, sinks, etc. 54 Abate nuisances caused by animals improperly kept 2 30 Miscellaneous Total repairs and improvements ordered 2,455 SUMMARY OF NOTICES SERVED, 1959 Intimations, Public Health (London) Act, 1936. Byelaws, etc. 1,120 Statutory notices, Public Health (London) Act, 1936. Byelaws, etc. 553 London County Council (General Powers) Act, 1955 136 Public Health (London) Act. 1936 (Part II) 57 Section 8, Housing Act, 1957 18 Clean Air Act, 1956 6 No.of Summonses issued 80 Factories Acts, 1937-1948 1. - INSPECTIONS, 1959 Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted Factories in which Sections 1,2,3,4 and 6 are to be enforced by Local Authorities 289 102 - - Factories not included above in which Section 7 is enforced by the Local Authority 1,120 686 6 - Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers premises) 37 4* - - Totals 1,446 792 6 - *Figures for visits to building sites not available. 2. - CASES IN WHICH DEFECTS WERE FOUND, 1959 No.of cases in which defects were Number of cases in which prosecutions were instituted Particulars Found Remedied Referred To H.M. Inspector By H.M. Inspector — 3 3 Want of cleanliness - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation 2 2 - - - Ineffective drainage of floors - - - - - Sanitary (a) insufficient - - - - - 1 1 unsuitable or defective - - - (c) not separate for sexes - - - - Other offences against the Act (not including offences relating to outwork) 4 4 - - Total 10 10 - - Summary of Outworkers classified by Trades Novelties 33 Artificial flowers 4 Toys 1 Cardboard boxes 69 Card lacing 18 Umbrellas 1 A c\n Curtains, etc 2 Wearing apparel 427 Feather sorting 1 Household linen 7 Lampshades 90 Total 653 Summary of work of the Rodent Control Staff No.of complaints received 1,161 No. of inspections 4,367 No.of Operators' calls 10,882 No.of private premises baited 1,488 No. of business premises baited 166 No.of baits laid 7,432 Vermin and Scabies ATTENDANCES AT CLEANSING STATION Vermin Scabies Male Male Female Total Female Total 43 76 53 335 28 54 Adults Children 10 259 21 45 49 99 119 269 66 82 148 Total 388 Disinfection RETURN OF WORK CARRIED OUT BY DISINFECTING STAFF Notified Infectious Diseases Other Diseases Miscellaneous Vermin Total all Cases 165 61 22 6 10 13 1,667 99 1,864 179 Rooms disinfected Lots of bedding disinfected 2,361 3,621 Total visits 302 921 37 Number of articles disinfected by steam 1,899 Number of articles disinfected by formalin 234 Number of books disinfected 141 Number of towels washed 5,068 Number of soiled articles washed 6,977 Number of overalls washed 561 Number of covering sheets washed 487 Beds and mattresses destroyed 285 Miscellaneous articles destroyed 797 Weight of:- Tons Cwts. Qtrs. Lbs. Unsound foods destroyed 24 1 1 13¼ Hospital bedding, etc., disinfected 2 7 3 0 Old clothing, lino, paper etc., destroyed 2 1 3 0 Furniture and effects destroyed 15 9 0 0 Dead animals destroyed 14 3 0 Hospital dressings etc., destroyed 13 0 0 62 HOUSING Record of work of Housing Inspector, 1959 Inspections. 44 Re-inspections 188 Total Clearance areas 232 Individual unfit houses Section 9 22 136 158 112 119 Section 16 7 Underground rooms and parts of premises! Section 18 339 412 73 775 146 921 Total. Housing Statistics, 1959 1. Inspection of Dwelling Houses during the Year:- (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Act) 3,223 (b) Number of inspections made for the purpose 18,044 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 2,569 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 Act 302 3. Action under Statutory Powers during the year:- (a) Proceedings under Public Health Act:- (1) Number of dwelling-houses in respect of which statutory notices were served requiring defects to be remedied 553 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By owners 1,262 (b) Ey local Authority in default of owners 1 (b) Proceedings under Housing Act, 1957:- (1) Number of houses made fit after service of formal notices (Sections 9, 16 and 18) (a) By owners 13 (b) By local Authority in default of owners 1 (2) Houses demolished as a result of formal or informal procedure under Section 17 27 (3) Houses closed in pursuance of an undertaking given by the owners under Section 16 and still in force Nil (4) Parts of buildings closed by Closing Orders (Section 18):- (a) Underground rooms Nil (b) Other rooms 16 (5) Undertakings not to use parts of buildings for human habitation accepted:- (a) Underground rooms Nil (b) Other rooms Nil (6) Houses demolished under Section 42 12 (c) Proceedings under Housing Act, 1957:- (1) Closing Orders made under Section 17 (3) Nil (2) Demolition Orders determined and Closing Orders substituted under Section 26 Nil (3) Closing Orders made under Section 17 (1) 1 (4) Closing Orders determined 19 (5) Closing Orders revoked and Demolition Orders made Nil Certificates of Disrepair No.of applications for Certificates of Disrepair 100 No. of Undertakings received from landlords 59 No. of Certificates of Disrepair issued 44 No.of Certificates of Disrepair refused 3 No. of Certificates of Disrepair cancelled 52 Overcrowding No.of cases of overcrowding found 56 No. of overcrowded families rehoused:- By Borough Council 11 By London County Council 12 INFECTIOUS DISEASES 1959 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 142 6 — 13 85 1 - - 10 - - 17 16 - - - Whooping Cough 93 10 11 13 7 15 8 32 3 2 2 - - - - - (1) Poliomyelitis & Polioencephalitis - 1 - 4 4 3 1 2 - - - - - - - - 1,322 8 54 159 193 200 185 513 16 1 1 Measles - - - - - Diphtheria 7 7 - - - - - 6 1 - - - - - - - Pneumonia ( Acute Influenzal 22 13 - - - - - 1 1 3 1 9 7 - - - ( Acute Primary 38 12 2 - - - 5 - 1 1 8 6 9 - - - 3 120 17 - 11 10 7 7 28 9 3 19 11 9 3 (2) Dysentery - 7 2 - 1 Typhoid & Paratyhoid Fever 7 1 - - - - 1 3 - - - - - 4 Erysipelas 16 1 - - - - - - - - 9 3 - - 1 - - - - (3) Meningococcal Infection 1 1 - - - - - - - - - 19 96 1 (4) Puerperal Pyrexia 121 - - - - - - - - 5 113 - - - (5) Ophthalmia Neonatorum 5 1 5 - - - - - - - - - - - - 1 7 Scabies 17 - - - - - 1 3 5 - - - - - Totals 1,915 200 - 78 183 223 232 218 673 27 139 29 37 4 54 22 (1) In addition, 3 cases of Camberwell residents occurred in a hospital outside the Borough and were notified to the Medical Officer of Health for the area in which the hospital was situated; one of these died. (2) In addition, 9 cases of Camberwell residents were diagnosed in hospitals outside the Borough. (3) In addition, 4 cases of Camberwell residents were diagnosed in hospitals outside the Borough. (4) Includes 38 cases of non-residents occurring in hospitals in this Borough, and in addition 16 cases of Camberwell residents were diagnosed in hospitals outside the Borough. (5) Includes 1 case of non-resident which occurred in a hospital in this Borough, and in addition, 2 cases of Camberwell residents were diagnosed in hospitals outside the Borough. FOOD POISONING Annual Return of cases of Pood Poisoning, 1959 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total (a) Food poisoning notifications (corrected) as returned to R.G 6 63 25 14 108 (b) Cases otherwise ascertained - 1 - - 1 - (c) Symptomless excreters - - - - (d) Fatal cases - - - - - 2. Particulars of outbreaks Agent No. of outbreaks No. of cases Total No. of cases Family outbreaks Other outbreaks Notified Otherwise ascer tained Agent identified: (a) Chemical poisons - - — - (b) Salmonella - - - - - (c) Staphylococci (inc. toxin) - - - - (d) Cl.Botulinum - - - - - - - (e) Cl.Welchii - - - - (f) Other bacteria - - - - - Totals - - - - - Agent not identified 12 - - 30 30 3. Single cases No. of Cases Total No. of cases Agent Notified I Otherwise ascertained Agent identified: - - - (a) Chemical poisons 3 (b) Salmonella: . 1* 4 Typhimurium Newport Thompson 1 1 - - 1* 1 - - (c) Staphylococci (inc.toxin) - (d) Cl.Botulinum - - - 5 (e) Cl.Welchii - 5 (f) Other bacteria B.Coli 1 - - 1 - Totals 9 3 12 69 - Agent not identified 69 * Camberwell residents notified in another Borough. MASS RADIOGRAPHY Summary of results of surveys carried out in the Borough during 1959 by the South East London Mass Radiography Units. (These figures were kindly provided by Dr. J.M. Morgan, Director of the M.R.U.) Part I General Analysis Men Women Total (a) Total X-rayed 510 124 634 (b) Total previously surveyed 324 74 398 (c) Total recalled for large film 39 8 47 (d) Number normal on large film 5 6 11 (e) Number abnormal on large film 33 2 35 (f) Not yet attended for large film - - - Part II Analysis of Abnormal Large Films (1) Cases considered tuberculous and referred elsewhere (a) No further action required - - - (b) Occasional supervision only 2 - 2 (c) Requiring treatment 12 - 12 (d) Still under investigation - - - (e) Refused further investigation - - - (2) Previously known tuberculous cases 13 - 13 (3) Non-tuberculous cases (a) Investigated 2 - 2 (b) Still under investigation - - - (4) Cardio vascular lesions 1 1 2 (5) Abnormalities requiring no action 4 1 5 Tuberculosis TABLE SHOWING SEX AND AGE DISTRIBUTION OF ALL PRIMARY NOTIFICATIONS AND DEATHS FROM TUBERCULOSIS DURING 1959 Age Periods Notifications Deaths Pulmonary Nonpulmonary Pulmonary Nonpulmonary Male Female Male Female Male Female Male Female 0- 1 yr. - - - - 1 - - - 2 - - - 1-5" 3 - - - 2 5-15 " 1 4 1 - - - - 9 1 1 - 15-25 " 2 - - - 25-35 " 13 12 1 1 - 3 - 14 35-45 " 3 3 2 - - 1 27 1 - 45-55 " 1 - - - 25 3 - 1 55-65 " - - - 14 2 - 1 65 and over - - - 39 9 8 - 1 1 3 6 11 1 106 1 1 Totals /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 178,400 1.8 30 0.16 318 1955 25 1956 177,800 330 1.8 0.13 177,700 1957 240 1.3 26 0.14 1958 177.300 1.1 32 14 0.18 193 1959 | 176100 162 0.9 0.08 Food and Drugs Adulteration Summary of Samples obtained for examination Number examined Number adulterated etc. Percentage of adulteration Formal Informal Total Formal Informal Total Formal Informal 403 500 903 10 12 22 2.48 2 40 Particulars of the adulterated samples and the action taken are set out on pages 70 and 71. Registered Purveyors of Milk Dairies 23 Distributors of milk in the Borough 196 Distributors of milk dealing from premises outside the Borough 14 Special Designated Milk Summary of Licences issued Tuberculin Tested Type of Licence Sterilised Pasteurised 203 187 89 Dealers Supplementary 26 25 25 229 212 114 Results of Tests Methylene Blue Test Phosphatase Test Turbidity Test Designation Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 96 - 103 - - - Tuberculin tested paseurised - - 35 39 - - - Tuberculin tested 1 - - - - Sterilised 29 - - - - - Samples of milk taken in course of delivery to Hospitals and Schools. Methylene Blue Test Phosphatase Test Chemical Test Hospitals 31 33 33 55 58 59 Schools All the above samples proved to be satisfactory. Ice Cream Summary of samples submitted for Methylene Blue Test and Chemical Examination. Chemical Examination Methylene Blue Test Satisfactory Unsatisfactory Grade I Grade II Grade III Grade IV 39 Nil 42 33 21 19 Ice Lollies and Water Ices Summary of samples submitted for examination. Bacteriological Examination Chemical Analysis Satisfactory Unsatisfactory Satisfactory Unsatisfactory Ice Lollies 26 - - - Cream Lollies 21 - - - 41 Assorted Lollies - - - Water (Lemon) Ices 12 - - - Margarine Three samples were examined for vitamin content and found to comply with the requirements of the Food Standards (Margarine) Order, 1954. 71 70 Particulars of Adulterated Samples Whether Formal or Informal Result of Proceedings or other action taken Serial No. Nature of Adulteration or Irregularity Observations Article Reported to Public Health Committee: cautionary letter sent to Dairy Company. 44 Milk Formal Contained coloured chalk - Samples taken from the same wholesaler Reported to Public Health Committee: cautionary letters sent to wholesaler and importer. Commodity withdrawn from sale. 101 Pearl Barley Formal Contained 430 parts per million ) of sulphur dioxide ) Contained 580 parts per million of sulphur dioxide 102 Pearl Barley Formal 103 Pearl Barley Formal Contained 380 parts per million ) of sulphur dioxide ) Reported to Public Health Committee: cautionary letter sent to butcher. 249 Minced meat Formal Contained 960 parts per million of sulphur dioxide - Remainder of retailer's stock inspected. All infested stock removed and destroyed. 257 Pickling spice Informal Contained a number of living beetles. - - Remainder of retailer's stock inspected. All infested stock removed and destroyed. 258 Curry Powder Informal Contained a number of living beetles and larvae - 270 Steak Mince Formal Contained 110 parts per million of sulphur dioxide Reported to Public Health Committee: cautionary letter sent to butcher - 273 Milk Informal Contained foreign matter Matter taken up by the Medical Officer of Health with the Dairy Company - 282 Steak Mince Formal Contained 40 parts per million of sulphur dioxide Reported to Public Health Committee: cautionary letter sent to butcher. - 327 Informal Contained maggots Retailer's stock inspected and found to be similarly infested; withdrawn from sale and returned to wholesaler. Currants Contained 195 parts per million of sulphur dioxide See formal Sample No. 249 - 341 Minced Meat Informal Contained 175 parts per million of sulphur dioxide Formal sample taken and found to be free from preservative - 343 Minced Meat Informal Summons issued against retailer who relied on a warranty and issued a summons against the manufacturer. Summons against retailer dismissed. Manufacturer found guilty and granted an absolute discharge with 10 guineas costs to Council. 349 Cream of Asparagus Formal Misleading description - contained no fat - Reported to Public Health Committee: cautionary letter sent to the retailer/ manufacturer. Label amended to the satisfaction of the Council. 350 Instant Coffee Formal Incorrectly labelled - - Incorrectly labelled ditto. 351 Instant Coffee Formal - See formal Samples Nos.270 & 282 375 Minced Meat Informal Contained 210 parts per million of sulphur dioxide 15 per cent deficient in meat Formal sample taken, and found to be satisfactory (66.1% meat) - 397 Pork Sausages Informal - See formal sample No. 349 411 Cream of Asparagus Informal Misleading description contained no fat See formal sample No. 351 - 421 Instant Coffee Informal Incorrectly labelled See formal sample No.350 422 Instant Coffee Informal Incorrectly labelled Reported to Public Health Committee: cautionary letter sent to the retailer/ manufacturer. Label amended to the satisfaction of the Council. 472 Instant Coffee Informal Incorrectly labelled - REGISTRATION OF FOOD PREMISES Premises registered under the provisions of Section 16 of the Food and Drugs Act, 1955, as at December 31st, 1958. Sale, manufacture and storage of ice cream 530 Preparation or manufacture of:- Potted, pressed, pickled or preserved meat 228 Potted, pickled or preserved fish 66 Potted, pickled or preserved other foods 34 Supervision of Food Premises Number of visits paid to each type of food premises by the Council's Public Health Inspectors. No. of Inspections Type of Premises Bakehouses 196 Bakers and Confectioners 366 Butchers 578 Cooked and Preserved Meat Shops 412 Dairies and Milkshops 367 Fishmongers and Shell Fish Vendors 253 181 Fish Fryers Fish Curers 101 Food Factories 216 Ice Cream Vendors 432 Public Houses 411 Restaurants and Eating Houses 584 Street Markets 870 Street Traders Food Stores Other food premises 152 980 Total 6,099 Unsound Food No.of condemnation Certificates issued 2,240 Particulars of Unsound Food Destroyed Weight Total Weight Description Tons cwts. qtrs. lbs. Tons cwts. qtrs. lbs. MEAT Beef - 6 2 18 Pork - 8 1 5 Mutton - 2 1 0 Lamb - - - 18 Veal -- - 3 8 Sausages( various) - - - 14 Pig s kidneys - 1 0½ Liver (various) - - - 23 Pig s melts - - - 22 Ox tongue - - - 4½ Gammon (cooked) - - 5¾ Bacon 8 3 5 1 7 3 11¾ POULTRY Chickens (229) - 6 2 6 - 6 2 6 FISH Skate - - 3 20 Cod - - 2 5 Pock Salmon - - 2 0 Plaice - - 1 0 - 2 0 25 FRUIT Peanut kernels - 4 0 0 Raisins - 2 2 1 26 Prunes - - 3 6 Raspberries - - - 16 - 7 2 20 TINNED FOODS Meat (various) 2,517 tins 2 15 2 22 Ham 104 tins - 9 2 20¾ Vegetables (asstd) 6,089 tins 2 14 0 5¾ Fruit (various) 14,854 tins 7 1 2 5¼ Milk (Evap.& Cond.) 1,717 tins - 2 3 26 Cream 32 tins - - - 13¼ Fish (various) 4,650 tins - 10 0 8¾ Jam (asstd) 4 tins - - - 9¼ Marmalade 5 tins - - - 24¾ 14 4 1 23¾ MISCELLANEOUS Potatoes, green vegetables, confectionery, fruit & fish pastes, cheese (various) sauces, salad cream, pickles, chutney, mayonnaise, cereals, spaghetti, jams (various),.syrups, coffee, animal foods, other foods, etc. 7 12 2 10¾ 7 12 2 10¾ GROSS WEIGHT 24 1 1 13¼ 73 Summary of work of Food Inspector Complaints received 56 Complaints found to be justified 38 Visits:- Bakehouses 1 Bakers and Confectioners 28 Butchers 133 Cooked and preserved meat 53 Dairies and Milkshops 7 Fish Curers 2 Fish Fryers 8 Fishmongers 21 Food factories 82 Public houses 12 Restaurants and eating houses 39 Shell-fish vendors 19 Street markets 702 Street traders' food stores 1 Other food premises 444 Inspections not defined 239 239 Re-inspections 1 Food surrendered 392 Foodstuffs certified for export 5 Food condemnation certificates issued 2,240 TABLE OF CONTENTS Page Clear Air 17 Control of Insects 35 Employment for the Elderly 33 Food and Drugs 20 Health Education 9 Housing 25 Infectious Diseases 40 Public Health Committee - Constitution 4 Public Swimming Baths 22 Report of the Consultant Chest Physician 46 Report of the Tuberculosis Care Committee 48 Sanitary Circumstances 6 Staff of the Public Health Department 5 INDEX TO STATISTICAL APPENDIX Atmospheric Pollution - graphs 6-59 Births 53 Certifi0ates of Disrepair 64 Cremation Certificates 54 Deaths - Causes and Age Distribution 52-53 Disinfection 62 Drainage and Sewerage 54 Factories Acts 61 Food and Drugs Adulteration 68 Adulterated samples table 70-71 Food Inspectors - Return of Work 74 Food Poisoning 66 Food Premises - Registration and Supervision 72 Hairdressers and Barbers 55 Housing Inspector - Return of Work 63 Housing Statistics 63-64 Ice Cream 69 Ice Lollies 69 Infectious Diseases 65 Margarine 69 Mass Radiography 67 Medical Examinations 53 Index to Statistical Appendix - continued Page Milk - Registered Purveyors 68 Special Designated 68 Results of Tests 69 Offensive Trades 55 Outworkers 62 Overcrowding 64 Pet Animals Act 55 Pharmacy and Poisons Act 55 Public Cleansing Rag Flock and Other Filling Materials 55 Rodent Control - Return of Work 62 Sanitary Inspection of the Area 60-61 Statistics - Summary of 51 Swimming Bath Water - Examination of 54 Tuberculosis 67-68 Unsound Food Certificates 72 Unsound Food Destroyed 62 Vermin and Scabies (Attendances) 62 Water Certificates 54