½ 4376 METROPOLITAN BROUGH OF CAMBERWELL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1960 H. D. CHALKE CAM 55 PUBLIC HEALTH DEPARTMENT, TOWN HALL, CAMBEFWELL, S.E.5 June, 1961 To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Camberwell. MR. MAYOR, ALDERMEN AND COUNCILLORS, I have much pleasure in presenting my Annual Report for 1960. The general standard of health of the population maintained a satisfactory level and the vital statistics showed no significant change. The population, as estimated by the Registrar-General at mid-1960 was 175,020 - a further reduction of 1,080. The general death rate fell to 10.8 as compared with 11.4 last year and there was a reduction of three points in the birth rate (17.6). Deaths of infants under one year numbered 76, equivalent to 24.7 per 1,000 live births and it is gratifying to record that for the first time no maternal deaths were reported. There was a slight increase in the number of deaths from tuberculosis (18 as compared with 14 in 1959) but the previous year's figure was an exceptionally low one. Cancer of the lung and bronchus was responsible for the death of 95 men and 25 women, whereas in 1959 the corresponding figures were 105 and 16; this is the first time for some years that there has been a decrease in the number of male deaths from this cause, and the increase in the number of female deaths is an exceptionally large one. It would be rash to suggest any possible reason for this change of pattern as the figures for 1960 may be coincidental, but if this trend continues, and is general it may provide further clues as to the causative factor and, in particular, the part played by cigarette smoking. It is unfortunate that there was another small outbreak of diphtheria at the end of the year. The circumstances were similar to those of the outbreak which occurred twelve months previously, but prompt action by the public health officers of both the Borough Council and the London County Council, working in collaboration, prevented the spread of the disease. Nevertheless, 13 cases and 25 'carriers' were removed to hospital before the outbreak was brought under control; unfortunately, one unimmunised child died. The Council's first Smoke Control Order under the Clean Air Act, 1956, came into operation during the year. The experience gained in establishing this area is proving of considerable value in furthering the Council's Smoke Control Programme. Many problems and difficulties have been encountered and overcome: they provide a precedent for future action in similar circumstances. I think it is fair to say that the scheme has been well-received by the residents in the area who have co-operated whole-heartedly. Health education again played a large part in the activities of the Public Health Department and particular attention was directed to Home Safety and Clean Air. There is an increasing demand by schools, clubs and other organisations for speakers to address their members on matters of public health importance, and I would like to pay tribute to the enthusiasm of my staff, many of whom have given up their own time in the evenings and week-ends to give talks, film shows and demonstrations. The housing situation, although steadily improving, will remain one of the major public health and social problems for many years. The Council continued their unceasing efforts to deal with it by the provision of new housing accommodation, the conversion of existing properties into flats, and the clearance and development of slum areas. The last of the areas to be dealt with by this Council in the five-year slum clearance programme 1956/60 were represented during the year and the areas for the next five years (1961/65) were agreed with the London County Council. The full-scale working of the Department was again hampered by the shortage of Public Health Inspectors, but the Council's scheme for the training of such officers made excellent progress and within the next year or two should prove of considerable benefit. 2 The appointment of two qualified nurses to undertake the investigation of infectious disease as well as the visiting of old people, did much to relieve the pressure on the outside staff. Indeed, these appointments have already proved of immense value, particularly during the outbreaks of diphtheria and dysentery which occurred during the year. In conclusion, may I express my appreciation and thanks to the members of the Council, the other Chief Officers and their staffs for their co-operation during the year. I would also like to record my grateful thanks to the staff of the Public Health Department for the loyal and competent manner in which they have carried out their duties. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, H.D. CHALKE Medical Officer of Health. 3 PUBLIC HEALTH COMMITTEE Constitution at the end of 1960 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 Councillor H.H. Guichard " E.L.G. Poidevin " Mrs. B.E. Knight Councillor Mrs. A. Blosse " F.E. Lee " Mrs. E.M. Dalton " Mrs. M.U. Nelson " Mrs. E.S. Daymond " Mrs. F.E. Sampson " F.A. Fairhead " Mrs. S.M. Terry " W.G. Gibbs " Miss D.M. Walker S.H. Gilbert Ex Officio: Alderman G. S. Burden, J. P., B.Sc.(Econ.) Mayor of Camberwell Councillor R.W. Brown, A.M.I.E.D., GRAD.I.E.E. Leader of the Council Councillor C.W. Baker, J.P., F.C.I.S. Leader of the Opposition 4. Staff of the Public Health Department (As at 31.12.60) 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. Eurrell a Deputy Chief Public Health Inspector H.W. Leonard a Sampling Officer H.R. Weaver a Food Inspector D.V. Watkins a Smoke Control Inspectors: A.G. 0' Gilvie a c F. Dray a c Technical Assistant W.A. Arrow Public Health Inspectors H. Attwater a,c E.C. George a,c J.E. Millway a F. Duggins a H.M. Hough a H.F. Williams a G.A. Fraser a M. McSweeney b C.H. Medland a (Four vacancies) A. Gartside, D.P.A. a Student Public Health Inspectors P. Frost T. McCarthy M. Stevenson Miss J.Harris Infectious Disease Visitors Mrs. E.L.M. Falloon Miss B.E. Brooks Senior Clerk C. Burgess Clerical Staff P.A.S. Kirrage Miss E.M. Lawrence A. Beare D. Dantor Mrs. M. Findlay Miss J. Jakes W. Everett Mrs. A.D. Dormer (One vacancy) Rodent Control Rodent Officer W.H.G. Saunders b Rodent Investigator Mrs. M.J. Kenny Rodent Operators F.G. Rulbert, R. Humphreys, Mrs. A. Grice, Mrs. E.M. Lloyd (One vacancy) Disinfecting and Cleansing Station Superintendent Disinfector A. Thomas Stoker/Disinfector Apparatus Attendant B. Russell Disinfectors R.T.J. Hodgson, E. Manning A.E. Kenny, E. Duffett 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. 5 SANITARY CIRCUMSTANCES Water Supply Every dwelling house in the Borough is provided with a water supply direct from the mains of the Metropolitan Water Board and no complaints were received during the year concerning its purity. Drainage and Sewerage Four hundred and seventy-five applications were received for approval in respect of the drainage of new buildings or the reconstruction of existing drains. All the works were carried out under the supervision of the Public Health Inspectors. The Council's Sewers Reconstruction programme proceeded according to plan and 4,163 feet of sewers were renewed. Noise Nuisances The Noise Abatement Act, 1960, which came into operation on 27th November 1960, enables noise or vibration which would amount to a nuisance at common law to be dealt with by the Local Authority as a statutory nuisance. In London, similar provision was already contained in Section 66 of the L.C.C. (General Powers) Act, 1937, but the new legislation has amended this to include vibration and to substitute for the words 'excessive or unreasonable or unnecessary noise which is injurious or dangerous to health' the words 'noise which is a nuisance'. It is still a defence, however, in any proceedings for the defendant to prove that the best practicable means have been used for preventing, and for counteracting, the effect of the noise or vibration. Although during the year several complaints were received of noise from factories, it did not become necessary to take any statutory action. With the co-operation and goodwill of the management every effort was made to reduce any noise or annoyance to aminimum, and the premises concerned are being kept under observation to see what further action, if any, may become necessary. There is no doubt that noise in built-up areas is a growing problem, particularly in districts where factories 6 and houses are in close proximity. The solution would appear to be in planning but this is a long term view, and it will be many years before the re-zoning of industrial and residential buildings can be put into practice generally. The construction and design of houses and flats, with soundproofing, is also an important factor in the elimination of nuisances due to noise and vibration and architectural design is already moving rapidly to this end. Offices Act, 1960 This Act, which will come into operation on Ist January 1962, is designed to regulate the health, safety and welfare of persons employed in offices. It empowers the Home Secretary to make regulations for this purpose and in particular:- (a) for the provision of sufficient and suitable sanitary conveniences with separate accommodation for persons of each sex; (b) for the provision of adequate and suitable facilities for washing which shall include hot and cold water and soap and clean towels or other suitable means of cleaning and drying; (c) for the prevention of overcrowding; (d) for the provision of sufficient and suitable lighting in every part of the premises in which persons are working or passing; (e) for the provision of a standard of reasonable temperature; (f) for the provision of effective and suitable methods of maintaining adequate ventilation; (g) for the provision of adequate and suitable accommodation for clothing not worn by employees during working hours; (h) for ensuring that all offices shall be kept clean; (i) to provide for efficient means of escape in the event of fire;- (j) to ensure the provision of adequate supplies of drinking water; (k) for the maintenance of adequate and suitable first-aid equipment; (l) for the regular inspection and maintenance of electrical equipment; (m) to provide for the fencing of dangerous parts of any machinery or equipment used in offices. 7 Such regulations have not yet been prescribed but will no doubt be ready by the time the Act becomes operative. Generally speaking, this legislation provides for similar control of working conditions in offices as is already in existence for factories. Caravan Sites The Caravan Sites and Control of Development Act, 1960 came into operation on 29th August 1960. This Act, however, does not apply to London except for Section 24 which gives local authorities, including metropolitan borough, councils, power to provide sites where caravans may be brought and to manage them or to lease them to some other person. In London, the control of movable dwellings is provided for in Sections 22 and 23 of the L. C. C. (General Powers) Act, 1959, which came into operation on 1st October 1960. These empower the local authority to grant licences authorising the use of sites for movable dwellings within their area, and prohibits any person from erecting, stationing or retaining and using a movable dwelling on any land in the borough unless such a licence has been granted. The Council may attach to any licence such conditions as they think fit with respect to the number and classes of movable dwellings, spacing, water supply, fire protection, sanitary conditions and prevention of nuisance from noise. In this connection the Metropolitan Boroughs' Standing Joint Committee suggested certain standards for caravan sites and these have been adopted by this Council. Four applications for licences were received, two of which were granted. In the other two instances, the sites did not conform with the standards adopted, in fact they had for some time been the subject of complaints from residents in the vicinity; the applications were therefore refused and steps were taken to secure the removal of the caravans from these sites. Oil Burners (Standards) Act, 1960 This Act empowers the Home Secretary to make regulations requiring oil heaters or component parts thereof to comply with such safety standards as he considers appropriate, and the local authority may authorise an officer or officers to inspect or test such heaters or 8 parts thereof to determine whether they comply with the regulations. Since the public health inspectors are already authorised to carry out similar duties under the Heating Appliances (Fireguards) Act, it was felt that it would be appropriate for them to carry out the duties under the Oil Burners (Standards) Act. Rodent Control There was no reduction in the number of complaints received of rat infestation in spite of continued efforts to eradicate these pests. One of the reasons for such complaints is no doubt the disturbance of drains and sewers during the extensive building development which is taking place. In time, however, this should assist in controlling the rat population by replacing old disused and defective drains by new rat-proof systems which will help to contain them. It is of the utmost importance, however, that all old drains be properly sealed off at their point of entry into the sewer to prevent the egress of rats. In many instances, persistent infestations have been found to be associated with old, disused and unsealed drains, the existence of which was not suspected until they were discovered in the course of excavation to trace rat-runs. Systematic baiting of sewers was carried out four times during the year in conjunction with the Borough Engineer and Surveyor's Department in an effort to prevent rat activity increasing. Complaints of mice infestations have also shown a tendency to increase and it is significant that most of these concern houses where there are coloured tenants. As suggested elsewhere in this report coloured immigrants, generally speaking, have lower hygienic standards and live in overcrowded communities; they are less careful in protecting food and disposing of food waste. This gives easy access to food for these rodents which are thus encouraged to live and breed under most favourable conditions. The eradication of mice is therefore not a diminishing problem, involving as it does not only regular methods of control, but also the health education of the immigrant population in food hygiene and waste disposal. Control of Insects and Mites The number of infestations by bed bugs and fleas has been reduced very considerably since the Second World War 9 and they are much less severe than formerly. The services of the officers of the public health department are, however, frequently sought by householders for the eradication of other pests such as cockroaches, beetles, ants, wasps and fruitflies. The following table shows the number of premises inspected and the visits made during 1960 to deal with these infestations. Type of Infestation Number of Premises Number of Visits Bed Bugs 219 275 Fleas 14 16 Lice 2 2 Cockroaches 5 9 Beetles 33 36 Wasps 37 37 Maggots 5 5 Ants 56 66 Moths 4 4 Clover Mite 24 31 Flies 9 10 Silver Fish 8 8 Mosquitoes 12 12 Other Arthropods 4 4 432 515 It is not generally realised by the public that under the provisions of Section 123 of the Public Health (London) Act, 1936, the responsibility for ridding premises of vermin rests with the owner or occupier, and the local authority is empowered to serve a notice requiring him to take such steps as may be necessary to destroy and remove the vermin. The Council's Disinfecting Staff can, however, much more readily and efficiently achieve this and no resident who asks for their assistance is refused. Neverselves theless, householders are encouraged to take steps themto deal with such pests and tins of insecticide and sprayers are available at the Public Health Department at cost-price for any ratepayers who wish to take advantage of this facility. Many sprayers and tins of insecticide are sold every year, particularly during the warm weather. Routine inspection and regular spraying of the few static water tanks still remaining in the Borough was carried out during the summer months to prevent the breeding of mosquitoes. When necessary the London Fire Brigade were requested to pump the water from these tanks and the 10 Borough Engineer and Surveyor arranged for the removal of any offensive refuse which might give rise to a public health nuisance or encourage the breeding of flies. Control measures have been revolutionised by the introduction of the new 'contact' insecticides, of which D.D.T. was the first. Their great advantage is their persistance; that is, their power to remain lethal to insects for long periods after they have been applied to surfaces. They can thus destroy successive generations of insects and mites as they hatch. It has been found desirable to use many varieties of the contact insecticides because they vary in their lethal effect on different insects; another reason is to prevent the development of insect resistance, which has made its appearance in many parts of the world. Resistance has not been encountered so far in dealing with nuisances in Camberwell. Malathion, an insecticide of different chemical composition, has been used with success in the elimination of pests such as fruit flies. Vermin and Scabies The table on page 56 shows the number of attendances at the Council's Cleansing Station, Peckham Park Road, for treatment for vermin (head and body lice) and scabies. It will be noted that the numbers are still falling: there were 146 attendances for vermin against 388 the previous year and 85 for scabies compared with 148 in 1959. The reduction was notable among female children but the figures of 22 male and 80 female children are still far too high and a reflection on the lack of hygiene consciousness in certain families. It is surprising and inexcusable that there should be any head louse infestation in this country today. 11 PUBLIC SWIMMING BATHS The Council's two swimming baths situated at Camberwell Church Street and East Dulwich Road each have two pools. Both the pools at Camberwell and the first-class pool at Dulwich have a capacity of 118,125 gallons and the second class pool at Dulwich 88,590 gallons. Disinfectant footbaths and showers are provided for each pool and dressing cubicles are sited around the pools at bath level. Both establishments have filtration plants and chlorinators (with break-point operation) with a rate of turnover of 30,000 gallons an hour. The filters are cleaned by back-washing twice weekly. The bottoms of the pools are swept every morning with heavily weighted brushes and the surfaces are hosed-off down the scum trough drains. The first class pool at Dulwich and the front pool at Camberwell are closed during the months of October to April when they are emptied and floored over, so that the halls may be used for dances, meetings and other indoor activities. At the end of the Winter the wells of the pools are thoroughly cleansed and disinfected and any necessary repairs and re-painting carried out before the baths are again brought into use for swimming. The second class pool at Dulwich and the rear pool at Camberwell remain open throughout the year except for two weeks in October when the wells are emptied, cleansed and disinfected. Any necessary repairs and re-painting are carried out at the same time. Over the past few years there has been a steady increase in the number of persons who use the swimming baths, but last year the attendances dropped considerably; this was no doubt due to the exceptionally cold and wet summer. The following are the approximate number of bathers at each establishment during the past three years. Year Camberwell Dulwich 1958 147,000 154,000 1959 176,000 156,000 1960 162,000 135,500 12 Examination of Water The water for the swimming baths is obtained from the mains of the Metropolitan Water Board. Four times every day ortho-tolidine colour tests and phenol red pH tests are carried out by the Baths' staff and every month whilst the baths are in use samples of water are taken from each pool for bacteriological and chemical analysis. During 1960, thirty-six samples were examined and found to be satisfactory. A summary of the bacteriological findings appears on page 57. 13 CLEAN AIR Smoke Control Areas On the Ist October 1960, Camberwell's first Smoke Control Order came into operation. This Order covers an area of 1,025 acres at the southern end of the Borough and involves about 3,000 properties. The detailed survey of the second area in the Council's programme was well advanced at the end of the year. This next area is contiguous with Area No. 1 and comprises 230 acres in the Herne Hill district; it is anticipated that it will become the subject of an operative Order at the end of 1961. During the year the Public Health Committee gave consideration to the possibility of speeding up the smoke control area programme. At their meeting in March 1960 they reviewed the position which at that time was up to the schedule already approved, viz., four areas to be established in 1959, 1961, 1962 and 1963 respectively, with 1975 as the target year for covering the whole of the Borough. In an endeavour to accelerate the progress of smoke control areas the appointment of a technical assistant was authorised to help the Stroke Inspectors in their duties. At the same time, bearing in mind that almost all the properties in area No. 4 comprise local authority estates, it was decided to bring this forward one year and combine it with area N0.3 for action in 1962. This would mean that by 1962 approximately one-third of the Borough (1,607 acres) would be smoke controlled. The estimated number of properties involved, however, is 9,600, which represents less than one-sixth of the total number of dwellings and other premises in the Borough. Not unexpectedly, there have been some administrative difficulties in connection with the establishment of the first smoke control area and it is anticipated that as progress is made northwards to the more densely populated and industrial districts of Camberwell, there will be others. Nevertheless, the experience already gained is of great value and will undoubtedly prove to be of assistance in any efforts to accelerate the work. Another factor which will influence the progress of smoke control areas is the number of housing estates erected in the Borough since the war which are already virtually smokeless. One of the main difficulties in the establishment of the first Smoke Control Area was the failure of so many 14 residents to appreciate that expenditure on works of conversion had to be incurred before the appointed day (of which they were given nearly twelve months notice) in order to qualify for grant. Many applications for approval were received on and after the appointed day and were therefore invalid. In most of these cases, notices were served requiring the carrying out of adaptations reasonably necessary to avoid contravention of Section 11 of the Act, but it had to be pointed out that these works only would qualify for grant and that if any different or more extensive works were executed the whole of the cost would have to be borne by the owner or occupier. It is to be hoped that in all future smoke control areas owners and occupiers of premises will take advantage of the minimum period of six months allowed between the date of confirmation of the Order and the date it becomes operative, in which to carry out any necessary adaptations or conversion works. Means of Ignition The question of compulsory provision of gas ignition to approved heating appliances in smoke control areas has been under consideration for some time and in July 1960 the Ministry of Housing and Local Government issued a circular to give guidance to local authorities on this matter. It seems that at present gas is the most convenient smokeless method of igniting solid smokeless fuel, but there are houses which have no supply of town gas and which cannot be provided with it at reasonable cost. Some people, too, may object to having gas in their homes at all, and it is felt that it would be unreasonable to insist that they should. In such cases, it is likely that paper and kindling wood will be commonly used and in the Minister's view the small amount of smoke thus caused must be accepted in the general interest of progress in the creation of smoke control areas. The Minister has, however, recently authorised that approved methods of electrical ignition should rank for grant. New Furnaces Three applications were received during the year for prior approval to the installation of new furnaces under the provisions of Section 3 of the Clean Air Act, 1956. The plans and specifications were of furnaces which were 15 capable of being operated continuously without emitting smoke when burning fuel of a type for which they were designed; the applications were accordingly approved by the Council. Atmospheric Pollution Investigation of the degree of atmospheric pollution was continued throughout the year with the volumetric instruments sited at the Town Hall and at 475 Lordship Lane, and the deposit gauge and lead peroxide apparatus on the roof of the Queen's Road Centre, St.Mary's Road, Peckham. The results obtained from these instruments, which are shown in graph form on pages 50/53 are forwarded monthly to the Department of Scientific and Industrial Research. With regard to the two volumetric instruments, it has been the practice to assess the amount of pollution by visual comparison of the filter papers with a scale of shades. In December, however, a letter was received from the Department of Scientific and Industrial Research indicating that this method of assessment was not scientifically accurate and that after March 1961 no further records made in this way could be accepted. It was recommended that the stains on the filter papers should be read by a reflectometer, and the Department offered to arrange to do this at its Warren Spring Laboratory, Stevenage, Herts, if the Council so desired. In order, however, to standardise the results it was decided to purchase a reflectometer for use in the Public Health Department. 16 CARE OF THE AGED Co-ordination of the Services for Old People The adequate care of old people is one of the most difficult medico-social problems of the times. It is also a problem which is increasing as the proportion, and the actual number, of people of pensionable age in the community becomes greater. The services available should act in two main directions. Firstly, in the provision of adequate domiciliary care, not only when old people have become physically handicapped and infirm, but in the earlier stages in order that the premature onset of disability, which results in their being house-bound or bed-ridden, may be prevented. Secondly, in the making of appropriate arrangements for hospitalisation and temporary or long-stay institutional care when illness or frailty make it necessary. There are many agencies concerned with these mattersboth voluntary and statutory. It is of the utmost importance that they should work in a fully co-ordinated manner in order that old people receive the maximum benefit from their efforts. Camberwell is very fortunate in having wellorganised local services including a geriatric hospital, an oldpeople's welfare committee, old people's clubs (including one for handicapped persons), an employment scheme for the elderly, meals-on-wheals and chiropody services, holiday schemes and arrangements for the cleansing of soiled linen. The London County Council provides an efficient and extensive domestic help service. (There are, of course, many other voluntary activities which play a conspicuous but insufficiently recognised part). These schemes are wholly or partly directed by the London County Council Health and Welfare Departments, the Hospitals' Management Committee, the Old People's Welfare Committee and voluntary bodies. The Camberwell Dorough Council participates by giving financial grants to the Old People's Welfare Committee, the Employment Scheme for the Elderly and the King George VI Club. The Council itself provides facilities for cleansing and disinfestation. A great deal of work is also done in the assessment of applications for housing on medical grounds, a large number of which are from old folk who require more suitable accommodation on the ground floor. 17 In addition, the Council's medical and inspectorial staff pay very many visits to the homes of old people, andregular investigations have been carried out in order to find out more about the domestic background. Early in the year a visitor was appointed to undertake home visits of old people in appropriate cases as well as duties in connection with the control of infectious diseases. The aim of these activities has been to rectify adverse home conditions and to arrange for early help for those old people who need it, and there is little doubt that this has met with a measure of success. All these services are of immense value, but in view of the many agencies concerned with them the Council gave consideration to what steps could be taken to ensure coordination and prevent overlapping, or overlooking any old people in need. It was decided to appoint an additional visitor whose duties, under the direction of the Medical Officer of Health, would be to carry out home visits as necessary and to act as a link between the various agencies, especially the Geriatric Unit at St. Francis' Hospital, the Divisional Medical Officer and her Divisional Nursing Officer and Home Help Organiser, the Secretary of the Old People's Welfare Committee, the Organiser of the Employment Scheme for the Elderly, the Wardens of Old People's Clubs and members of other voluntary bodies. It was also agreed to establish a central bureau in the Public Health Department where full information about as many old people as possible who are in need, ormight be in need, of assistance could be kept on a card index system. This has already been put into operation and is proving well worth-while. In addition, a small medical liaison committee was set up, comprising a general practitioner, the Geriatrician at St. Francis' Hospital, the Divisional Medical Officer and the Medical Officer of Health, which meets regularly to good purpose. Workrooms for the Elderly The Camberwell Association for Employment of the Elderly commenced its Scheme at Cambridge House, Camberwell Road, on 2nd May, 1960. About 40 old folk attend, 20 at the morning session (10 a.m. - 12 noon) and 20 at the afternoon session (1-3 p.m.). There is no doubt that this scheme is meeting a need which has existed for a long time in this Borough. Seven old people were sufficiently 18 rehabilitated to return to normal full-time employment; nine others were able to undertake full-time employment during the Christmas period. Although 30 old people left owing to travelling difficulties during the winter months their places were quickly taken. Two elderly patients from Maudsley Hospital so benefited from the scheme that they were discharged and two further patients from the same hospital were accepted. Schemes of this nature are becoming a major part of the work of promoting the health and welfare of people of pensionable age and more particularly those who have made no preparation for retirement and have few, or no, outside interests. They can have a dual purpose - to provide a little light work and prevent premature physical and mental deterioration in those who have nothing to occupy their time, and to aid in the process of rehabilitation of those who have been ill. For these reasons selection of patients and medical supervision are necessary, and in this scheme the advice of the non-medical adviser and that of the two other doctors on the Committee (one a general practitioner) is always available. In the majority of cases the health of these old folk has improved very considerably since they first attended, particularly in cases of arthritis and rheumatism, and their working capacity has increased three to four hundred per cent. There would seem to be no doubt that this Workroom for the Elderly is of considerable value and fulfils a long standing need in Camberwell. It is hoped that it will be possible to extend these activities and set up similar work centres in other parts of the Borough. Gompulsory Removal of Aged Persons In spite of all the services provided for old people it is sometimes inevitable, where a person is unco-operative, or has reached such a state of senility, ill-health or frailty that they can no longer be adequately cared for in their own homes and refuse to enter a suitable home or hospital voluntarily, that a Court Order must be sought for their compulsory removal. 19 It became necessary to take such action in two instances during the year. Both were urgent and action was taken under the National Assistance (Amendment) Act which enabled the persons concerned to be removed to hospital within a few hours of their condition being brought to the notice of the Public Health Department. Unfortunately, one old lady died in hospital on the evening of the day she was admitted. 20 INFECTIOUS DISEASES Diphtheria The continued occurrence of outbreaks of diphtheria in London and other parts of the Country is disturbing. Between 1943 and 1957 the number of notifications in England and Wales diminished each year, but in 1958 there was a sharp increase and there were eight diphtheria deaths. Camberwell was free from diphtheria from 1948 to 1959, but from November of that year until early in February 1960, six cases were reported, all in non-immunised children and 70 others were found to be harbouring the organism. The outbreak was confined to one corner of the Borough and was linked with a primary school. There were no further cases until the 19th December, 1960, when a child aged 7 years, living in another part of the Borough about away and attending a different primary school, was notified. Hie child had been ill for five days and went to school on the second day of her illness before being sent to a children's hospital where the disease was diagnosed. The school closed for the Christmas holidays on the 21st December, and all the school contacts therefore had to be visited and swabbed at their homes. Within a few days several more cases occurred and other children were found to be harbouring the diphtheria organism. All were at once removed to hospital. This outbreak continued into the New Year and in all 13 children, one of whom unfortunately died, and 25 'carriers' were hospitalised before it was brought under control. In four instances 'carriers' again produced positive swabs a few days after discharge from hospital; these were readmitted for further treatment. It was necessary to remove one of these children to hospital four times and another three times. A chronological table of cases and 'carriers' appears on page 23. It does not appear that this outbreak was in any way connected with the previous one. The causative organism in both was of the same type, but the cases in the later outbreak tended to be more severe, many of them presenting the classical signs and symptoms, which fortunately are seldom seen today. 21 Whilst many of the 'carriers' had received primary immunisation, in only two of the clinical cases was there any record of this, but a reinforcing injection had not been given. It is estimated that over 70 per cent of children in this part of London have been immunised in infancy, but the proportion protected by a 'boosting dose' at school age must have been very much less before these two episodes. It is significant that nearly all the children affected in both outbreaks were of primary school age. Investigation and swabbing of the school contacts were complicated by the closure of the school during the Christmas holiday, but by close co-operation between the Public Health Department and the Divisional Health Office of the L.C.C. the investigation of both school and home contacts was accomplished quickly. Active and passive immunisation was begun with a minimum of delay. A special clinic was set up by the L.C.C. at the affected school for the benefit of families living in the area and was attended by some hundreds of children. The attendances at other immunisation clinics in the Borough also showed a gratifying increase. The publicity given in the local and national press, on radio and television no doubt played a large part in stimulating the public to co-operate in this matter. It is extremely fortunate that the disease did not spread outside the area, particularly in view of the excessive activity of visiting among friends and relations which normally takes place during the festive season. As it was, a number of contacts were traced outside theBorough, even as far as the West Country and the Midlands where the appropriate Medical Officers of Health were notified by telephone. All the contacts, however, were reported to be negative. It is some compensation for evils that they enforce lessons, and outbreaks such as this serve as a stern reminder that failure to maintain a high rate of immunisation or re-immunisation may have disastrous consequences. In addition, they serve as a valuable exercise in that co-operation between the general medical, public health, hospital and laboratory services which has now become an essential factor in progressive preventive medicine. DIPHTHERIA CHRONOLOGICAL TABLE OF CASES AND 'CARRIERS' Cases 'Carriers' Date Sex Age Sex Age 1960 December 19th F 7 - - F 6 " 20th - - M,F,M 9,7,6 - " 21st - " 22nd F 7 10 M " 23rd M,F,M 11,9,6 M,F 6*, 6 " 24th - - F,F,M,M 6,6,6,*,6 " 25th - - M 6* - M " 26th 6 - - M 15 " 27th - - " 28th - M 5 M 5 " 29th - - - " 30th - 6,6,3 F,M,M 1961 January 2nd F 7 (died) - - - F 10 " 4th - - - M 6 6th - - 5,5 " 9th M,M " 18th - F 8 - F,M 13,7 " 19th - - " 20th - - 6 F F " 21st 6* - - " 23rd 6 - F - M 13 " 27th - - " 28th M - 3 - 10 - - March 14th M *Return case, i.e. found to be 'positive' after discharge from hospital and re-admitted. 23 Smallpox On two occasions during the year the Medical Officer of Health was called into consultation to see suspected cases of smallpox. Fortunately, in neither case was the diagnosis confirmed. A case of smallpox did occur, however, in a London Borough in the person of a Dutch business man who arrived in this country by air from Colombo. Seventeen contacts of this case were Camberwell residents and all of these, with one exception, were visited and kept under surveillance during the period of quarantine. The exception was a man whose address was given as the Common Lodging House, but in the meanwhile he had left and his whereabouts were not known. Although the police were notified, every Medical Officer of Health in the Metropolitan area was alerted and a careful check was kept on all common lodging houses and reception centres in London, the contact was not traced. Luckily, however, there were no further developments. Anthrax On the 1st December, 1960 the Public Health (Infectious Diseases) Amendment Regulations, 1960, came into operation. The effect of these is to require any medical practitioner attending or called in to visit a patient suffering from anthrax to send notification thereof to the Medical Officer of Health for the District. This is in addition to the provisions contained in the Factories Act, 1937, which require cases of anthrax, which is primarily an industrial disease, to be notified to the Chief Inspector of Factories, No cases were reported during the year under review. Bacillary Dysentery During the past two or three years sharp outbreaks of bacillary dysentery (Sonne) have been occurring during the winter and spring. These outbreaks have usually occurred among school children - which is typical of Sonne dysenterybut, not unexpectedly, the disease was often conveyed to adult direct contacts in the home. Food or articles contaminated by the infected hands of a sufferer or carrier give rise to rapid spreading of the disease. The essence of prevention is personal cleanliness and the importance of washing the hands after using the toilet and before handling and/or eating food cannot be too strongly emphasised. It is imperative also that food should be properly stored in a cool larder or refrigerator and protected from contamin. ation. During the summer months flies act as a transmitting agent. During 1960, 276 notifications of bacillary dysentery were received at the Public Health Department, although 117 of these were not bacteriologically confirmed. In the previous year the notifications numbered less than half of those in 1960. Poliomyelitis It is pleasing to record that only one case of poliomyelitis (in a female child of 5 years) occurred during the year. Notifications during the preceding five years numbered 4, 10, 16, 11 and 25 respectively, It is too much to hope that the introduction of vaccination and its increased availability have in such a short period removed the menace of this disease, for cases have occurred in considerable numbers in other parts of the country. The value of this new weapon cannot, however, be overrated, and the public are urged to continue to take the fullest advantage of it in protecting themselves and their families. A vaccine which can be taken by the mouth is now being perfected, and may become available in the near future in those areas in which poliomyelitis becomes prevalent. Venereal Disease There has been a progressive increase since 1950 in the number of patients attending out-patients clinics in London for the treatment of gonorrhoea - 6,800 in 1950 and 14,000 in 1959; it is expected that a further increase will have occurred in 1960. During the same period, however, cases of syphilis fell from 1,900 to 1,300. It is not easy to estimate the prevalence of venereal disease (which is not notifiable) in the Borough, but returns kindly furnished by three Venereal Diseases Departments of Hospitals which serve the area indicate that the incidence of gonorrhoea and other venereal conditions is considerable, and that West Indian immigrants form a very high percentage of new cases. The main difficulties in respect of the immigrant population are the frequent change of address and the marked tendency to discontinue treatment. It is hoped that as increasing liaison with the hospital departments concerned is established, it will be possible to get a more accurate picture of the incidence of venereal disease, and of those chiefly involved, in the near future. This will aid in the planning of health educational programmes which are fundamental in the prevention of this group of infections. Arrangements for tracing contacts and following up defaulting patients are undertaken by the London County Council Health Department under the provisions of Section 28 of the National Health Service Act, 1946. Respiratory Tuberculosis The table on page 27 gives the number of notifications of respiratory tuberculosis in age and sex groups for the past five years. Although the total figures for 1960 show a slight increase over those for 1959 (some of which are not real but due to a review of the register) the steady downward trend continues. Of the 118 male notifications in 1960, 92 (78%) were in respect of men aged 35 years and over (13 of these were above 65 years) - a preponderance which is found in each of the previous four years. Female notifications, on the other hand, numbered less than one-third of the total and more than half were in respect of patients below 45 years. These figures confirm the continuing importance of older males as reservoirs of infection. Thirty-five (or 30%) of the 118 males notified in 1960 were inmates of the Camberwell Reception Centre giving a discovery rate of *27 per 1,000 at this Institution which shows little change from previous years. Relatively few of the new patients were coloured immigrants who may be a susceptible group, but it is gratifying to note the remarks of the Chest Physician regarding their co-operation. * Compared with 2 cases of active tuberculosis per 1,000 examinations by mass radiography. NOTIFICATIONS OF RESPIRATORY TUBERCULOSIS Age Periods 1956 1957 1958 1959 M F Total M F Total M F Total M F 0 - 1 yr. - - - - - - - - - 1 - 3 3 1 - 5 yrs. 2 3 4 7 2 5 1 - 1 5 - 15 " 2 4 1 4 4 6 6 10 3 5 8 27 16 16 15 - 25 " 9 11 22 49 32 14 18 32 17 17 36 25 - 35 " 19 13 31 48 12 16 18 34 12 21 8 29 14 35 - 45 " 3 45 57 13 12 25 6 45-55 " 6 40 34 27 43 49 24 5 29 1 10 5 47 25 55-65 " 37 51 56 25 6 31 3 65 & over 8 21 2 23 27 35 12 7 19 14 2 67 71 179 106 39 TOTAL 227 80 307 155 222 108 THE ROLE OF THE MEDICAL OFFICER OF HEALTH AS INDUSTRIAL MEDICAL OFFICER TO THE COUNCIL For very many years it has been the practice in this Borough for the Medical Officer of Health to undertake the medical examination of all applicants, both officers and workmen, who are appointed to the permanent establishment. In addition, he is required to see and report on all employees who have been absent from duty owing to illness or injury for more than fourteen days. In 1948, these responsibilities were augmented by the requirement to medically examine all temporary employees prior to their acceptance into the Council s Sickness Pay Scheme after six months'" service, and, subsequently, all temporary officers eligible for admission to the unestablished staff. The Medical Officer of Health is also frequently asked by the Establishment Committee to make special reports in cases where officers and workmen have been absent from duty for a considerable time and the question arises as to whether they should be superannuated, or, in the case of workmen, whether they could undertake light work, if available. It will be readily realised that, with the increase in the number of staff engaged by the Council in recent years and the frequent 'turn-over' of temporary employees, these duties and responsibilities have considerably increased. The work is time-absorbing, not only for the Medical Officer of Health and his Deputy, but also for the administrative staff, since it involves a comprehensive system of confidential record keeping and a great deal of correspondence with hospitals and general practitioners. Each medical examination includes a radiological examination of the chest for which an appointment is made for attendance at the Camberwell Chest Clinic, St. Giles Hospital. The figures set out in the table on pages 70/71 in the statistical appendix to this Report give some idea of the extent to which the medical supervision of the Council' s staff has grown; they do not, however, reflect the whole of the work involved. For example, the table indicates that 467 sick employees were seen during the year, but there were a further 572 who did not attend for examination, many of them were too ill to do so or were in hospital and it was consequently necessary to seek information about their condition from their own doctors. The services of the Medical Officer of Health or his Deputy are rightly, frequently sought when members of the staff are taken ill whilst on duty, and they are often consulted by officers about personal health problems. These arrangements, which are working admirably, are undoubtedly of considerable value both to the staff and to the Council. They ensure that sick members of the staff are receiving proper medical attention and treatment with a view of speeding their recovery, thus ensuring that their absence from duty is reduced to a minimum. Naturally, there have been instances where the medical examination has revealed the presence of an abnormality of which the subject was unaware; this has enabled prompt referral to be made to the family doctor who arranges the necessary further investigation and treatment. In addition, Dr. Marsh, the Consultant Chest Physician at the Camberwell Chest Clinic, is kind enough to provide information of the progress and condition of any Council employee who is under his care, although he or she may not be absent from duty. It will be seen, therefore, that the Medical Officer of Health and his Deputy occupy a position in relation to the Council's staff similar to that of a medical officer of a large industrial concern to the mutual benefit of both the employer and the employed. Useful information is also obtained on the incidence and causes of absences from work. HEALTH EDUCATION The activities of the Public Health Department in the field of health education continued vigorously throughout the year. Posters, pamphlets and bookmarks in great numbers were displayed and distributed at the Town Hall, Public Libraries, Child Welfare Centres and other suitable places. Articles on health matters have been published in 'Camberwell Calling', the Council's Diary of local events, which has a wide distribution throughout the Borough. The Medical Officer of Health and members of his staff gave frequent talks at schools, clubs, women's organisations etc., in the Borough. The subject of these talks included Clean Air', 'Accidents in the Home', 'Food Hygiene', 'Rodent Control', 'Insects and Medicine', and Public Health' . They were supplemented by sound films, film strips, flannelgraphs and other visual aids. It is unfortunate that talks to clubs and similar organisations are not better attended, but the interest shown in the subject is generally keen and the talks are always followed by group discussions which must be of value not only to the listeners, but to the Department in its assessment of health educational needs. Discussions conducted in the intimate atmosphere of the small group, which lead to a lively interchange of information and ideas, are, indeed, more rewarding than the long and formal lecture. The emphasis has been, of course, on the promotion of health of adolescents and young adults. Talks to school children and young people are always well received and the results are encouraging; but this is still new ground which must be explored with care and energy. In particular, a series of talks given at a secondary modern school was greatly appreciated and the interest shown was demonstrated by the large and varied number of questions asked by the pupils. Where talks are given to schools these are often followed by visits to the Town Hall and other Council buildings by parties of the school children, which foster a better acquaintance with the work of a health department and the help and service it can give to the community. Towards the end of the year talks were held with members of the clergy with a view to setting up home and family groups', the aim being to arrange for parents to participate in a series of talks and discussions on matters concerning the physical and mental health of their children. Arrangements were made to launch a pilot scheme in the new year comprising four meetings at weekly intervals to which all parents of children up to 18 years of age would be invited and arrangements would be made for a number of distinguished persons to attend to give talks and take part in the discussion on various aspects of family care. Those who kindly gave their services included doctors, clergymen, a juvenile court magistrate, social workers, and a head teacher. In the early part of November the Council held a Jubilee Exhibition at the Town Hall. Hie contribution made by the Public Health Department included displays on clean food, rodent control, clean air, infectious diseases, general sanitation and vital statistics, which outlined the progress made during the past 60 years. The opportunity was also taken to further health education by the display of posters and the distribution of literature on a wide variety of health matters. In last year's report details were given of the results of a survey carried out in this Borough in an attempt to assess the public response to different methods of health education. This is being followed by a further and wider investigation. A questionnaire has been prepared which it is hoped to complete in respect of a ten per cent sample of the population. The first survey revealed that television is the most acceptable medium for the public for health education, and the questionnaire now being used refers mainly to the public reaction to health topics on television and the impact of the commercial advertising of food and drugs. This is, of course, a considerable undertaking and will take some months to accomplish. Home Safety The prevention of accidents in the home has received particular attention in recent years and special efforts have been made by the Public Health Department in the investigation of causative factors and the dissemination of information to the public with a view of a reduction in the number of persons affected. The work of the Department and the domiciliary activities of the Public Health Inspectors and Old People' s Visitors have been, closely co-ordinated with the Divisional Health Service of the London County Council and the activities of the Health Visitors and Home Helps. A comprehensive service for the dissemination of advice and information on matters of home safety has thus been set up. HOUSING New Houses Daring 1960, the Council completed the building of 415 new dwellings and 626 were in the course of construction at the end of the year. In addition 355 properties, acquired by the Council for conversion into flats, were adapted to provide 629 units of accommodation. Slum Clearance Two clearance areas, Goldsmith Mansions and Albert Buildings, were declared during the year to complete the five-year programme 1956/60 agreed between this Council and the London County Council. The following table gives particulars of the areas covered by this Council's programme:- SLUM CLEARANCE 1956/1960 Area Date of Declaration No. of Dwelling Houses No. of Persons to be Displaced Mawbey Place 25.7.56 2 5 24.10.56 12 32 Acorn Place 13.3.57 12 46 Gervase Street Lettsom Street (No.1) 3.7.57 2 2 Lettsom Street (No.2) 3.7.57 8 20 New James Street 31.7.57 9 32 Havil Street 31.7.57 5 18 Hornby Road 31.7.57 3 8 Elmington Road (No.1) 23.10.57 6 22 Elmington Road (No.2) 23.10.57 4 10 Elmington Road (No.3) 23.10.57 4 13 3 Nunhead Green (No. 1) 23.10.57 3 Nunhead Green (No.2) 2 2 23.10.57 Mays Place 6 23.10.57 20 Old James Street 8.1.58 11 37 Royal Oak Place 22.10.58 13 11 41 King Arthur Street 4.2.59 33 11.3.59 6 18 Commercial Way Blenheim Grove 25.11.59 2 10 Goldsmith Mansions 162 9.3.60 Albert Buildings 3 (36 flats) 53 29.6.60 3 (15 flats) TOTALS 127 587 An attempt was first made by the Council to deal with Albert Buildings by the service of notices under the provisions of Section 9 of the Housing Act, 1957, requiring the premises to be repaired and rendered fit for human habitation, The owners, however, appealed against these notices on the grounds that the property was not repairable at reasonable cost and the Court upheld their appeal. The Council had no alternative, therefore, but to declare Albert Buildings, on representation by the Medical Officer of Health, a Clearance Area. The Blenheim Grove area was the subject of a public local enquiry and the Minister decided that the Order be not confirmed, but that the owners of the premises be allowed an opportunity of putting them into a state of repair. They were accordingly notified that the Public Health Committee would review the matter again in six months. Although some works were carried out by the owners, they subsequently informed the Council that the repair of the property was not an economic proposition and that they intended to provide alternative accommodation for the occupants and to demolish the houses themselves,, The survey for the preparation of the next five-year slum clearance programme (1961/65) was completed and submitted to the London County Council. After consultation between the appropriate officers of the two authorities it was agreed to deal with 31 areas in Camberwell comprising houses. At the end of the year negotiations were in progress to agree as to which areas should be dealt with by each Council. Housing (Financial Provisions) Act, 1958 Certificates of unfitness in accordance with the provisions of this Act were given by the Medical Officer of in respect of 7 houses owned by the Council and in addition, 9 groups of properties comprising 20 houses were represented as unfit and the Council accordingly passed resolutions that they should be demolished Overcrowding Only 42 cases of statutory overcrowding came to the notice of the Public Health Department during the year, and certificates in respect of all these cases were forwarded to the Housing Departments of both the Borough Council and the London County Council. Statutory overcrowding is far less prevalent in the Borough now-a-days, but it must be remembered that the standard for overcrowding which was first laid down in the Housing Act, 1935 is a very low one, and in the past 25 years housing and living standards have risen very considerably. There are many families, who, whilst not statutorily overcrowded, are nevertheless living in very cramped and unsatisfactory circumstances as judged by present-day standards. There has been a marked increase in the immigrant population of the Borough whose level of health education and hygiene standards is on the whole lower than those of people born here. They have a tendency to live in overcrowded and unsatisfactory housing conditions, but it is extremely difficult to establish an overcrowding offence owing to their frequent movement from one dwelling to another and their repeated changes of employment. It is also difficult to discover with any certainly whether the coloured occupants of a house are residents or temporary visitors. Certificates of Disrepair As forecast in last year' s Annual Report the demand for Certificates of Disrepair under the provisions of the Rent Act, 1957, diminished still further. The following table shows the yearly figures since the Act came into operation on 6th July, 1957. 1957 from 1958 1959 1960 Total 6.7.57 No.of applications for Certificates of Disrepair 414 411 100 49 974 No.of undertakings received from Landlords 220 284 59 25 588 No.of Certificates of Disrepair issued 105 157 44 24 330 No.of Certificates of Disrepair refused 3 6 3 1 13 No.of Certificates of Disrepair cancelled 16 75 52 13 156 Applications for Rehousing on Medical Grounds One hundred and forty-four housing applications were referred by the Director of Housing during the year for assessment of priority on medical grounds. Following the usual practice an inspection was made of the applicant's present accommodation in every case and details entered on the special form which was then sent to the general practitioner for a confidential report. From this information the degree of priority (if any) was assessed and a suitable recommendation forwarded to the Director of Housing. The following table summarises the cases dealt with during 1960 and shows the medical conditions and degrees of priority recommended:- MEDICAL PRIORITIES FOR REHOUSING 1960 Category 1 Category 2 Category 3 Category 4 Medical Condition Reccomdn Reccomdn Reccomdn Reccomdn G.P. M.O.H. G.P. M.O.H. G.P. M.O.H. G.P. M.O.H. Tuberculosis 2 2 2 1 8 9 3 3 Bronchitis and/ or Asthma 6 2 9 3 6 15 - 1 1 1 2 1 2 3 - - Other Respirator Conditions Heart Conditions 2 1 1 3 3 - - 2 Physical Disabilities (bad legs, etc) - 5 3 3 5 - - - 7 1 19 10 8 21 3 5 Nervous Disorders - - 8 5 2 5 - - Rheumatic Conditions 6 23 13 12 22 1 3 Other Medical Conditions 4 There were three instances where friction was reported between tenants living in the same house, and one of these involved a coloured family. Pecommendations for the provision of ground floor accommodation numbered 15, and there were 3 recommendations for an exchange to smaller accommodation. In addition to the above, 23 applications were reviewed following the submission of further medical evidence for priority; in 11 cases the original recommendation was raised to a higher category; in 10 instances no change was suggested, and in the remaining 2 the priority was reduced. During the year 38 families who had received priority on medical grounds were rehoused; one within six months of the recommendation, 3 within nine months and 34 after nine months. Closing and Demolition Orders - Rehousing Where, on representation by the Medical Officer of Health that a house or part of a building used as a dwelling, is unfit for human habitation, and is not capable of being rendered so fit at a reasonable cost, the Council makes a closing or demolition order, there is no legal obligation for the local authority to rehouse the occupants. In order, therefore, to avoid any hardship being imposed, it has been the practice for some years for every such case to be considered by a joint sub-committee of the Housing Management and Public Health Committees to decide whether there were good grounds for offering alternative housing accommodation to the displaced persons. This practice was reviewed in the early àpart of the year following correspondence in which the Ministry of Housing and Local Government had stated that it was understood that the Metropolitan Boroughs' Standing Joint Committee had accepted, on behalf of the constituent Councils, amoral obligation to rehouse bona fide occupiers of properties closed or demolished under Part II of the Housing Act, 1957. Further information was therefore sought from the Metropolitan Boroughs Standing Joint Committee and from the Association of Municipal Corporations. It would appear that whilst neither of these bodies has ever formally acknowledged such an obligation on behalf of its members, it was agreed that the general practice of local authorities throughout the country is to rehouse tenants displaced by closing or demolition orders except in such cases in which it is clear that the tenant in question has improperly placed himself in the property with the sole object of being rehoused. In the circumstances, the Council agreed that there appeared to be little reason to maintain the joint subcommittee on Housing Act cases and it was discontinued. FOOD AND DRUGS During the year 502 informal and 379 formal samples of foods and drugs were submitted to the Public Analyst; 6 informal and 5 formal samples received adverse reports, The samples reported against covered a wide range including non-brewed condiment deficient in acetic acid; dirty milk bottles, and raspberries in syrup containing colouring matter which was not revealed by the label, but it was considered sufficient to caution the firms concerned in all except one case. In this case a sample of blackcurrants in syrup was found to contain 7.5 parts of lead per million whereas in the opinion of the Public Analyst canned fruit should not contain more than 2 parts per million. Legal proceedings were authorised but since warranties could be produced throughout the chain of sale back to the exporters in Australia and the distributors had called in all available stocks in this country the case was withdrawn. A number of samples of instant coffee were found to be incorrectly labelled but in each case the manufacturers amended the description to meet the Council s requirements. Particular attention continues to be paid to the possibility of metallic contamination of canned and other foods and to the presence of artificial colours, especially in the highly-coloured varieties of confectionery which are on sale in some shops. In general, manufacturers seem to be using only those colours permitted by the Regulations and very few cases arose in which non-permitted colours were found. When this occurred it was almost invariably in products manufactured before the Regulations were in force. Much work was done on the composition of various types of canned meats. British manufacturers have agreed that products described as Luncheon Meat shall contain at least 80% of meat and most foreign producers have fallen into line but there are numerous other canned meat preparations for which no standards exist and while many of these are of reasonable composition the quality of some leaves much to be desired. It may be hoped that, as the result of negotiations now in progress, some measure of agreement as to the composition of these and certain other products may be reached. New legislation during the year has included the Food Hygiene (General) and the Food Hygiene (Docks, Carriers, etc.) Regulations which consolidate and amend previous regulations, the Arsenic in Food (Amendment) Regulations which increase from 2 to 5 parts per million the maximum amount of arsenic permitted in brewers' yeast products and the Meat (Staining and Sterilization) Regulations which (with certain exceptions) require all butchers meat and imported meat which is unfit for human consumption to be sterilized and all knackers meat to be stained and sterilized before it enters the chain of distribution. The Ministries of Health and of Agriculture, Fisheries and Food in consultation with the local authority and trade associations concerned produced Codes of Practice for hygiene in the retail meat and fish trades and for the hygienic handling and transport of meat and fish. Milk The Milk (Special Designation) Regulations, 1960 which were promulgated during the year consolidate and re-enact with amendments the Raw Milk Regulations, 1948 to 1954 and the Pasteurised and Sterilised Milk Regulations, 1949 to 1953. The principal changes are a modification of the Phosphatase test for heated milk, the discontinuance of supplementary licences for the sale of milk within the Borough from premises outside the Borough, the introduction of a dealer's (pre-packed milk) licence to permit the sale of all three kinds of designated milk and the extension of the licence period from one year to five years. One hundred and ninety seven of these pre-packed milk licences were issued. Food Poisoning During the year, 64 cases of food poisoning were reported as compared with 109 in 1959. Despite prompt and careful investigation efforts to trace the causative agent were generally unsuccessful. Where single cases of a mild nature occur, the sufferers do not usually seek medical advice early with the result that none of the suspected food is any longer available for examination. In some instances a diagnosis has only been made bacteriologically on isolating a food poisoning organism from the faeces of the patient. There was, unfortunately, one death from this cause a baby aged six months. The day after it was taken ill this child was removed to hospital where a food poisoning organism was isolated from the stools. Investigations were carried out immediately, and specimens of faeces from the other four members of the family revealed the presence of the same organism. Samples of various foods consumed by members of the family were obtained and examined, but with negative results. All efforts to trace the source of infection were therefore unsuccessful. The investigation was followed up, however, until specimens from each member of the family proved negative. REPORT OF CONSULTANT PHYSICIAN, CAMBERWELL CHEST CLINIC The year 1960 was quite mild in terms of chest illness for the citizens of Camberwell, although there was a small epidemic of influenza in February. There were no serious episodes of smog which could have led to an exacerbation of symptoms among patients with chronic bronchitis. Units of X-ray work carried out numbered 15,602 during the year and there were 12,903 attendances. Six thousand, nine hundred and sixteen new cases were X-rayed and as a result 1,898 new patients had full clinical examinations. All these figures show a slight reduction on those for the previous year. The cases on the tuberculosis register fell from 1,190 to 1,012. Details of newly notified cases appear on page 61 in the appendix to this report. In all, there were 18 deaths due to tuberculosis, 11 men and 7 women. Although some cases of severe tuberculosis have been discovered, especially among young females, in only one instance was it found that the organism had become resistant, and then only to a slight extent, to the three standard anti-tuberculosis drugs. It must be admitted that the extensive and prolonged anti-tuberculous chemotherapy that is administered to many patients, especially those who do not have overt tuberculosis, is a cause for concern in case strains of tubercle bacilli are produced that are resistant. In connection with this problem of tuberculosis control, this department has been co-operating in the Medical Research Council's Trials and arranging for specimens of sputum from all newly notified cases to be examined to find out whether they contain organisms which are resistant. In this way it is hoped to assess the size of the problem on a national scale. It is gratifying to note the extension of the B.C.G. vaccination programme in schools to younger age groups. Meanwhile, the B.C.G. vaccination of newborn infants in the maternity department of St. Giles' Hospital continues and 587 babies were vaccinated during the year. The work of the health visitors shows no diminution, 2, 474 visits being made, and there is a general impression that it has become more difficult because of the lack of co-operation among certain families. In this connection it should be pointed out that the West Indians are always very co-operative and there is never any difficulty in arranging for extensive contact examination. Once again I wish to thank Dr. Chalke and Dr. Mower-White and their respective staffs for their help throughout the year. I also wish to thank the District Nursing Organisations and the London County Council Ambulance Service for their continued co-operation. KENNETH MARSH Chest Department, St. Giles' Hospital. Consultant Physician. ANNUAL REPORT OF THE CAMBERWELL TUBERCULOSIS CARE COMMITTEE FOR 1960 Changes in the membership of the Committee during the year were as follows:- Disablement Resettlement Officer: Mr. C.F. Dixey took the place of Mr. J. Hill. Area Officer, National Assistance Board for Camberwell (South): Mr. F.L. Willsher resigned and was succeeded by Mr. P.G. Thatcher. Camberwell Borough Council: Two vacancies arose owing to the resignations of Councillors Mrs. M.V. Goldwin and Mrs. E. Thorne, Nominations were awaited from the Council at the end of the year. We noted with great pleasure that one of our members, Alderman George Burden, was elected Mayor of Camberwell for the municipal year 1960/61. We congratulate Alderman Burden and the Mayoress (Mrs. S.K. Burden) and wish them a happy and successful year of office. In July, it was decided that the scope of the Committee's work be enlarged to enable help to be given to non-tuberculous chest patients, provided no help could be obtained from specialised funds or other sources. The Committee are pleased to report their continued activities during the past year. 1,242 cases were interviewed by the Secretary and the tabulated summary below shows the type of assistance given:- Pocket money while in hospital 19 Taxi fares 8 Lodgings and meals 9 Help with furnishings and decorations 5 Clothing and footwear 25 Fares of relatives to distant sanatoria 19 Loan of beds to new cases 4 Supply of bedding 48 Payment of outstanding accounts 4 Loan of dressing gowns 6 Loan of bedside comforts 6 Pyjamas for those confined to bed or on admission to hospital 16 Supply of towels 7 Payment of prescription fees 7 Christmas food parcels 100 It is of interest to know that included in the figure 1,242 mentioned above, 116 interviews were with patients about to be admitted to hospitals or sanatoria, many of whom were helped by the provision of clothing, slippers, toilet requisites and pocket money before entry. Arrangements were made and information given as to the best means of transport (ambulance, coach or train) according to the requirements of the Chest Physicians. It was found necessary to refer 57 new cases to the National Assistance Board. The Committee, as always, were greatly assisted by the recommendations submitted by the Chest Physicians and Health Visitors of the Chest Clinic. They not only see patients at the Clinic, but visit them in their homes on an official and friendly basis. This personal contact often reveals the needs of patients and their families who may be reluctant to apply to us for assistance. These Officers are also able through their professional knowledge to give the Committee valuable guidance. The Committee are represented on the Rotary Club's 'Wireless for the Bedridden' and are therefore able to submit the names of patients. The Health Visitors bring cases to the Committee s attention, and many patients have been fortunate to receive the loan (and maintenance) of a radio set through this source. In our Report for 1959 we indicated that we had vacated the premises loaned us by the Camberwell Borough Council as they were making extensive alterations to the whole of the building. This year we are happy to report that the Council have again been most generous in leasing us accommodation at 23a Brunswick Park, which is large enough for our handicraft class and also allows storage space for beds, bedding and other stocks. We moved in on 25th May, 1960, and wish here to record our gratitude and appreciation to the Borough Council for their valuable help with this. The Handicraft Class continued to meet at Cambridge House each Friday afternoon until the accommodation at Brunswick Park was available. The students have settled comfortably into their new quarters and work is progressing steadily. Members of the class and other patients were invited to two outings. In July there was a day at the seaside and just prior to Christmas there was a visit to a theatre. For the 28th consecutive year we took part in the National Seal Sale and although the receipts were a little lower than in previous years - probably due to similar appeals by other charitable organisations - we feel that the citizens of Camberwell donate in a very generous way to help us maintain our main source of income. Having found that the Christmas food parcels issued to needy patients last year were so warmly received it was decided to increase the number of parcels distributed from 50 to 100. We wish to thank the voluntary organisations and the official bodies in the Borough for their valuable cooperation and help during the year. We know that they will continue to assist our efforts. In concluding this report we place on record our thanks to the Honorary Officers: The Worshipful the Mayor of Camberwell (Patron of the Seal Sale), Mrs. Lilian Reddeford, Organiser of the Seal Sale; Mr. H. Smith, the Borough Treasurer, who is our Honorary Treasurer; and Mr. P.. A. Hughes, our Honorary Auditor. We must again thank the Camberwell Borough Council for allowing the Committee to meet at the Town Hall. Dr. H.D. Chalke, Medical Officer of Health for Camberwell, was again good enough to include the Care Committee's Annual Report for 1959 in his own Annual Report for that year. This recognition of our work is much appreciated. AMY CROSSMAN, Chairman J.M. LEONARD, Secretary STATISTICAL APPENDIX Summary of Statistics for the year 1960. 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-1960) 175,020 Number of inhabitated houses (April 1960) 45,239 Rateable value (April 1960) £2,563,106 Sum represented by a penny rate (estimated) £10,200 Number of live births 3,078 Birth rate 17.6 Number of deaths 1,902 Death rate 10.8 Infantile Mortality:- Deaths under 1 year 76 Infant deaths per 1,000 live births 24.7 Maternal Mortality:- Deaths of women from diseases or accidents associated with childbirth Nil Maternal death rate per 1,000 total births Nil Deaths from Pulmonary Tuberculosis 15 Pulmonary Tuberculosis death rate 0.08 Deaths from all forms of Tuberculosis 18 Tuberculosis death rate 0.10 TABLE SHOWING CLASSIFIED CAUSES OF DEATHS IN AGE GROUPS IN CAMBERWELL DURING 1960 15- 25- 45- 65- 75- Causes of death Sex All ages 0- 1- 5- M. 959 44 2 6 8 33 310 253 303 All causes 3 462 F. 943 32 6 4 44 175 217 3 M. 11 5 3 Tuberculosis, respiratory - - - - - 1 1 1 F. - - - 1 - 4 Tuberculosis,other M. - - - - - - - - - 3 2 - 1 F. - - - - - Syphilitic disease 4 2 M. 8 - - - - 2 - - F. 1 - - - 1 - - - Diphtheria - - M. - - - - - - - - F. - - - - - - - - Whooping Cough - M. - - - - - - - - - - - - F. - - - - - Meningococcal infections - - M. - - - - - - - - F. 1 - - - - - 1 - Acute poliomyelitis - - - 1 - M. 1 - - - F. - - - - - - - - - Measles - - - - M. - - - - - F. - - - - - - - - - Other infective and parasitic diseases - 1 1 - - M. - - - - - - - - - F. - - - - Malignant neoplasm, stomach 29 - 12 10 - - - 7 M. - - 5 16 F. 30 - - - - 9 Malignant neoplasm,lung, bronchus 11 - 26 M. 95 - - - 2 56 F. - - 5 9 7 4 25 - - Malignant neoplasm, breast - - - M. - - - - - - 2 F. 24 - - 4 15 3 - - Malignant neoplasm,uterus Other malignant and lymphatic neoplasms - - 5 4 2 F. 17 - - 6 105 5 43 - - - 1 28 28 M. 28 F. 85 - - 8 20 29 Leukaemia, aleukaemia - - 6 3 2 M. - 1 - - - - 1 2 F. 3 - - - - - - - Diabetes 5 - 1 - 2 2 M. - - - 1 1 5 F. 7 - - - - Vascular lesions of nervous system 19 28 95 - 1 4 43 M. - - 22 30 117 - - - - 65 F. - 49 Coronary disease, angina 188 - - - - 6 75 58 M. - 21 50 76 F. 147 - - - - Hypertension with heart disease - - 5 4 M. - - 16 25 - - - - 4 3 25 F. 32 - - 12 30 Other heart diseases 59 - - - - 2 15 M. 84 - - 3 18 18 F. 123 - - Other circulatory disease 1 13 11 14 M. 39 - - - - - 1 7 19 31 F. 58 - - - Influenza - - - - - - - M. - - 1 2 - - 1 F. - - - - Pneumonia 1 1 - 7 15 15 M. 39 - - 47 Causes of death Sex All ages 0- 1- 5- 15- 25- 45- 65- 75- Bronchitis M. 89 - - - - 1 23 27 38 1 F. 40 - - Other diseases of respiratory system - - 5 9 25 10 M. - - 2 - - - 4 4 F. 6 - 1 2 Ulcer of stomach and duodenum - - - 3 - M. 13 - - - - - 3 5 5 F. - Gastritis,enteritis and diarrhoea 9 - - - - - 1 8 M. 2 - - - - - - 2 1 - F. 7 - 2 Nephritis and nephrosis - - - 4 - M. 7 1 - - - 2 2 2 - F. 9 - - - 2 3 3 1 Hyperplasia of prostate Pregnancy, childbirth, abortion - M. 8 - - - 4 - - - 4 - - - - F. - - - - Congenital malformations - M. 10 9 - - 1 - - - - F. 10 4 2 1 1 1 - 1 Other defined and illdefined diseases - 72 M. 34 - 1 3 8 13 - 13 F. 87 2 6 22 1 - 14 12 30 Motor vehicle accidents M. 16 - 1 3 2 3 3 - 4 F. 11 1 2 4 3 1 All other accidents - - - M. 17 1 1 - - 4 6 4 1 F. 17 - - 2 1 2 1 4 7 Suicide M. 9 - - - 2 1 4 1 1 F. - Homicide and operations of war 8 - - 1 2 2 3 - M. - - - - - - - - - F. - - - - - - - - - Births Live Births Still Births Total M. F. F. M. M. F. Legitimate 1,431 1,352 35 32 1.466 1,384 Illegitimate 135 160 4 4 139 164 Total 1,566 1,512 39 36 1,605 1,548 J 3,078 75 3,153 Medical Examinations carried out by the Medical Officer of Health or his Deputy Officers for admission to the Permanent Establishment 45 Officers for admission to the Unestablished Staff 17 Employees for admission to Sick Pay Scheme 290 Employees for admission to Permanent Establishment 48 467 Employees absent from duty owing to sickness Cremation Certificates No.of cremations authorised during the year by the Medical Referee or his Deputy 1,993 Water Certificates No.of Water Certificates issued 119 No.of dwellings concerned 543 Drainage and Sewerage No.of drainage applications received 475 Length of sewers reconstructed 4,163 ft. No.of brick gullies replaced by pot gullies 79 No.of defective pot gullies renewed 2 No.of new pot gullies installed 11 Public Cleansing Amount of house refuse collected 44,557 tons Amount of trade refuse collected 823 ton Examination of Water from the Council's Swimming Baths Bacteriological examination Chemical examination No.of Samples No. Satis. No.of Samples No. Satis. 7 7 7 7 Camberwell Front Swimming Bath Camberwell Rear Swimming Bath Dulwich First Class Swimming Bath Dulwich Second Class Swimming Bath 13 13 13 13 5 5 5 5 11 11 11 11 36 36 36 36 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 Filling Materials Act, 1951. Type of Material No.of Samples examined No. Satisfactory Rag flock (layered) 2 2 1 1 Jute felt Woollen mixture felt 4 4 Sized cotton felt 1 1 5 Cotton felt 5 Coir fibre 1 1 2 2 Coir fibre (pad) 1 1 Cotton millpuffs Totals 17 17 Offensive Trades Type of Business No. on Register Skin dressers 3 Soap boilers 1 Total 4 Pet Animals Act, 1952 No.of licences issued 2 No.of licences renewed 9 Total No.of pet shops licensed 11 Pharmacy and Poisons Act, 1933 No. of applications received for registration 10 No. of applications received for renewal of registration. 154 London County Council (General Powers) Act, 1954 No.of hairdressers and barbers premises registered 144 ATMOSPHERIC POLLUTION, 1960 Estimation of Sulphur by Lead Peroxide Method. Apparatus Installed at Queens Road Health Centre ATMOSPHERIC POLLUTION, 1960 Total Solids Deposited Tons Per Square Mile SOLIDS DEPOSITED RAINFALL Apparatus Installed at Queens Road Health Centre ATMOSPHERIC POLLUTION, 1960 Average Concentration of Sulphur Dioxide in Parts Per Hundred Million Volumes of Air Apparatus Installed at Town Hall and 475 Lordship Lane TOWN HALL 475 LORDSHIP LANE ATMOSPHERIC POLLUTION, 1960 Average Concentration of Smoke in Milligrams Per Hundred Cubic Metres Apparatus Installed at Town Hall and 475 Lordship Lane TOWN HALL 475 LORDSHIP LANE 54 Sanitary Inspection of the Area No. of complaints received 3,025 Summary of work carried out during the year 1960 Inspections Nuisance inspections 3,405 Offensive trades 27 Smoke observations 152 Drainage, new and existing 10,054 Overcrowding 716 Factories and workplaces 1,278 Outworkers' premises 314 Rag dealers. 87 Infectious and other diseases 758 Verminous premises and persons 311 Aged and infirm persons 490 Common lodging houses 35 Conveniences, public and private 312 Heating Appliances (Fireguards) Act, 1952 176 Rent Act, 1957 225 Shops Act 1,178 Hairdressers and barbers 405 Voluntary work 74 Inspections not defined 1,547 Re-inspections 12,220 Total inspections 33,764 Works supervised Tests applied to drains (existing premises) 1,207 Drains found defective 119 Drains totally reconstructed 10 Drains repaired or partially reconstructed 652 Test's applied to drains (new buildings) 3,045 Drains constructed 1,561 Total works supervised 6,594 Description of sanitary improvements ordered during the year:- 279 Cleanse and repair walls and ceilings Repair roofs, gutterings, etc. 577 Abate dampness 851 Repaid stoves, fireplaces and coppers 81 Repair windows, sashlines, sills, etc. 244 Repair flooring, stairs, doors, etc. 173 Provide sufficient light and ventilation 7 Provide dustbin 54 Remove offensive matter 24 Provide or repair yard paving 22 Provide or render accessible water supply 4 Cleanse, cover or render accessible water cistern 2 Repair water pipes and fittings 33 Clear premises of vermin 3 Cleanse or repair water closets and flushing apparatus 169 Repair or clear defective or obstructed drains 47 Repair soil pipes, waste pipes, sinks, etc 53 Abate nuisances caused by animals improperly kept 1 Miscellaneous 21 Total repairs and improvements ordered 2,645 SUMMARY OF NOTICES SERVED, 1960 Intimations, Public Health (London) Act, 1936 Byelaws, etc. 1,210 Statutory Notices, Public Health (London) Act, 1936 Byelaws, etc. 619 London County Council (General Powers) Act, 1955 166 Public Health (London) Act, 1936 (Part II) 31 Section 8, Housing Act, 1957 16 Clean Air Act, 1956 1 No. of Summonses issued 66 Factories Acts, 1937-1948 1.- INSPECTIONS, 1960 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 344 212 1 - Factories not included above in which Section 7 is enforced by the Local Authority 967 1,064 - 6 Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 31 5 - - Totals 1,342 1,281 7 - 2.- CASES IN WHICH DEFECTS WERE FOUND, 1960 No. of cases in which defects were Number of cases in which prosecutions were instituted Found Remedied Referred Particulars To H.M. Inspector By H.M. Inspector Want of cleanliness 3 3 1 - - Overcrowding - - - - Unreasonable temperature - - - - - Inadequate ventilation - Ineffective drainage of floors Sanitary conveniences - - - - - - - - - - - - (a) insufficient - - - (b) unsuitable or defective 4 4 - - - (c) not separate for sexes - - - - - - 5 Other offences against the Act (not including offences relating to outwork) 5 - - - Total 12 12 - 1 - Summary of Outworkers classified by Trades. Artificial flowers 2 Cardboard boxes 34 Card lacing 7 Curtains, etc. 1 Household lines 2 Lampshades 8 Novelties 16 Umbrellas 1 Wearing apparel 355 Total 426 Summary of work of the Rodent Control Staff No.of complaints received 1,190 No.of inspections 3,890 No.of Operators' calls 9,560 No.of private premises baited 1,488 No.of business premises baited 189 No.of baits laid 7,246 Vermin and Scabies ATTENDANCES AT CLEANSING STATION Vermin Scabies Male Female Total Male Female Total Adults 36 8 44 21 17 38 80 102 16 Children 22 31 47 Total 58 88 146 52 33 85 Disinfection RETURN OF WORK CARRIED OUT BY DISINFECTING STAFF Notified Infectious Diseases Other Diseases Miscellaneous Vermin Total all Cases Booms disinfected Lots of bedding disinfected 85 24 12 5 15 27 1,850 83 1,962 139 Total visits 147 19 2,586 816 3,568 Number of articles disinfected by steam 1,133 Number of articles disinfected by formalin 322 Number of books disinfected 68 Number of towels washed 4,333 Number of soiled articles washed 6,535 Number of overalls washed 175 Number of covering sheets washed 233 Beds and mattresses destroyed 281 Miscellaneous articles destroyed 842 Weight of:- tons cwts. qtrs. lbs. Unsound foods destroyed 31 15 2 5¼ Hospital bedding, etc. disinfected 1 5 2 0 Old clothing, lino,paper, etc. destroyed 1 10 2 0 Furniture and effects destroyed 10 17 0 0 Dead animals destroyed - 6 1 0 Hospital dressings etc. destroyed - 13 0 0 Wood chips from workshops destroyed 1 10 0 0 Total 47 17 3 5¼ 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. 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. Probable No. of coliform bacilli MacConkey 48 hrs. 37°C colonies per 100 ml. January - - 1 0 February - - 0 0 March - - 5 0 April - 0 2 0 May 0 0 2 0 June 3 0 0 0 July 0 0 2 0 August 5 0 2 0 September 1 0 - October - - - 50 0 November - - 1 December 0 - - 10 0 Camberwell Baths Front Bath Rear Bath Plate count yeastrel agar 48 hrs. 37°C. aerobically colonies per ml. Probable No. 0of coliform bacilli MacConkey 48 hrs. 37°C. colonies per 100 ml. Plate count yeastrel agar 48 hrs. 370 C. aerobically colonies per ml. Probable No. of coliform bacilli MacConkey 48 hrs. 37°C. colonies per 100 ml. January - - - 2 0 - February 0 - 0 March - 2 0 April - 3 0 May 0 - 2 1 0 June 1 0 2 0 " 0 0 July 0 0 2 0 7 0 " 4 0 5 0 August 2 0 1 0 September 1 0 1 0 October - - - - November - - 2 0 December 25 - 0 - HOUSING Record of work of Housing Inspector, 1960 Inspections Re-inspections Total Clearance areas 246 78 168 38 Individual unfit houses - Section 9 1 39 8 103 11l Section 16 Underground rooms and parts of premises Section 18 - 384 08 4 804 111 693 Total Housing Statistics, 1960 1. Inspection of Dwelling Houses during the Year:- (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Act) 3,846 (b) Number of inspections made for the purpose 16,452 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 2,454 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 339 3. Action under Statutory Powers during the year:- (a) Proceedings under Public Health (London) Act:- (1) Number of dwelling-houses in respect of which statutory notices were served requiring defects to be remedied 619 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By owners 1,394 (b) By Local Authority in default of owners 5 (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 11 (b) By Local Authority in default of owners Nil (2) Houses demolished as a result of formal or informal procedure under Section 17 12 (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 2 (b) Other rooms 9 (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 23 (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) 3 (4) Closing Orders determined 8 (5) Closing Orders revoked and Demolition Orders made Nil Certificates of Disrepair No.of applications for Certificates of Disrepair 49 No.of Undertakings received from landlords 25 No.of Certificates of Disrepair issued 24 No.of Certificates of Disrepair refused 1 No.of Certificates of Disrepair cancelled 13 No. of Notifications Treated in Hospital Found not to be suffering from the disease Deaths of Notified Cases Age Distribution of Notifications 15 to 20 4 to 5 5 to 10 10 to 15 20 to 35 35 to 45 45 to 65 Under 1 2 to 3 65 and upwards 1 to 2 3 to 4 Disease Scarlet Fever 1 - 4 7 12 49 11 2 1 - - - 87 2 - - 196 5 - 30 20 28 25 21 57 12 - - 1 - Whooping Cough - 2 - - - - - - - - - - - - - - - (1) Poliomyelitis & Polioencephalitis - 1 683 - 81 89 66 348 7 1 - 1 - Measles - - 25 64 21 - - - - - 15 5 1 - - - - Diphtheria 21 13* - 1 - - - - - - - - - - 1 1 3 - - Pneumonia (Acute Influenzal ( Acute p rimary 3 - 1 6 - 1 4 1 9 3 25 - - - - - - 10 25 17 32 4 34 16 19 4 (2) Dysentery 276 29 117 18 83 - - - - - - - 1 Typhoid & Paratyphoid Fever 1 1 - - - - - - 4 18 - - - - - - - - - - 5 8 Erysipelas - - - 1 - - - - 1 Meningococcal Infection 1 1 - - - - - - - 124 - - - - 24 88 12 - - (3) Puerperal Pyrexiar 118 - - - - - - - - - - - - - - Ophthalmia Neonatorum 13 9 - 13 - - - - - - - - 2 - 1 2 3 4 1 1 Scabies 14 - - 1,462 189 130 - 79 1 27 142 117 559 41 12 Totals 69 36 136 35 (1) One case of a Camberwell resident occurred in a hospital outside the Borough and was notified to the Medical Officer of Health for the area in which the hospital was situated. (2) In addition, 12 cases of Camberwell residents were diagnosed in hospitals outside the Borough. (3) Includes 53 cases of non-residents occurring in hospitals in this Borough, and in addition 4 cases of Camberwell residents were diagnosed in hospitals outside the Borough. * These were not clinical cases, but were found to be harbouring the diphtheria organism ('carriers'). 109 14 FOOD POISONING Annual Return of cases of Food Poisoning, 1960 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total (a) Food poisoning notifications (corrected) as returned to R.G. 12 20 13 10 55 (b) Cases otherwise ascertained - - - 9 9 (c) Symptomless excreters - - - - - (d) Fatal cases - - 1 - 1 2. Particulars of outbreaks No.of outbreaks No.of cases Total No. of cases Other outbreaks Otherwise ascertained Family outbreaks Notified Agent - - - Agent identified: (a) Chemical poisons - - (b) Salmonella - - - - - (c) Staphylococci (inc. toxin) - - - - - (d) Cl. Botulinum - - - - - (e) Cl. Welchii - 1 - 9 9 (f) Other bacteria - - - - - - 1 - 9 9 Totals Agent not identified 4 - 4 2 1 3. Single cases No.of Cases Total No. of cases Otherwise ascertained Agent Notified Agent identified: (a) Chemical poisons - - (b) Salmonella: Typhimurium 5 1* 6 Manchester 1 1 - Group B - 1* 1 (c) Staphylococci (inc. toxin) - - - (d) Cl. Botulinum - (e) Cl. Welchii - - 1 1 - (f) Other bacteria - - - Totals 7 2 9 Agent not identified 44 - 44 * Camberwell residents notified in another Borough. Tuberculosis TABLE SHOWING SEX AND AGE DISTRIBUTION OF ALL PRIMARY NOTIFICATIONS AND DEATHS FROM TUBERCULOSIS DURING 1960. Notifications Deaths Nonpulmonary Pulmonary Nonpulmonary Age Periods Pulmonary Male Female Male Female Male Female Male Female - - - - - 0-1 yr. - - - 3 - 2 - - 1 - 1-5 " - 5-15 " 4 - - - - - - - 10 - 15-25 " 7 3 - - - - 13 15 3 - 25-35 " 4 - - - 1 - 1 - 35-45 " 26 12 - - 3 1 2 - - 2 45-55 " 26 - 3 55-65 " 27 5 1 - 1 - - 1 1 65 and over 13 2 - 6 - 1 Totals 118 48 12 4 11 4 3 - / After correction for inward and outward transfers. TABLE SHOWING NOTIFICATIONS AND DEATHS, TOGETHER WITH THE ESTIMATED POPULATION DURING THE PAST FIVE YEARS No. of Deaths Death Rate per 1,000 Population Notification Rate per 1,000 Population No. of Primary Notifications Year Estimated Population 330 1.8 25 0.13 1956 177,800 26 0.14 1957 177,700 240 1.3 1.1 32 0.18 1958 177,300 193 14 0.08 1959 0.9 176,100 162 1960 183 1.0 18 0.10 175,020 Food and Drugs Adulteration Summary of Samples obtained for examination Percentage of adulteration Number examined Number adulterated etc. Informal Total Formal Informal Total Informal Formal Formal 1.2 379 502 5 6 11 881 1.3 Particulars of the adulterated samples and the action taken are set out on pages 65 and 66. Registered Purveyors of Milk Dairies 23 Distributors of milk in the Borough 198 Distributors of milk dealing from premises outside the Borough 14 Special Designated Milk Summary of Licences issued Tuberculin Tested Type of Licence Sterilised Pasteurised Dealers 216 99 202 Supplementary 27 26 26 243 228 125 Results of Tests Phosphatase Test Turbidity Test Methylene Blue Test Designation Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 86 - 87 - - - Tuberculin tested pasteurised 24 24 - - - - Tuberculin tested 1 - - - - - 20 Sterilised - - - - - Samples of milk taken in course of delivery to Hospitals and Schools. Methylene Blue Test Phosphatase Test Chemical Test Hospitals 26 27 34 54 56 Schools 54 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 Grade I Grade II Grade III Grade IV Satisfactory Unsatisfactory 38 14 13 9 Nil 33 Ice Lollies and Water Ices Summary of samples submitted for examination. Bacteriological Examination Chemical Analysis Satisfactory Unsatisfactory Satisfactory Unsatisfactory 16 - - Ice Lollies - Cream Lollies 14 - - - 37 Assorted Lollies - - - 8 - - Water (Lemon) Ices - PARTICULARS OF ADULTERATED SAMPLES Article Whether Formal or Informal Nature of Adulteration or irregularity Observations Result of proceedings or other action taken Instant coffee Informal Incorrectly labelled - Reported to Public Health Committee Cautionary letter sent to manufacturer. Label amended to satisfaction of Council. Contained undeclared colouring matter Raspberries in syrup Informal - ditto Reported to Public Health Committee Cautionary letter sent to Dairy Company. - Milk Formal Bottle contaminated with mould - Instant coffee Informal Incorrectly labelled Reported to Public Health Committee Cautionary letter sent to manufacturer. Label amended to satisfaction of Council. Canned blackcurrants in syrup Formal Lead - 7.5 parts per million - Reported to Public Health Committee Legal proceedings instituted against the wholesalers, the Council being reasonably satisfied that the retailer could establish a defence under Sub Section (1) of Section 113 of the Food & Drugs Act 1955 The wholesalers served notice on the Council that they held a warranty from the importers and the importers in turn gave notice that they held a warranty from the exporters. The warranties being a good defence and the exporters being in Article Milk Milk Canned black berries in syrup Instant coffee Non-brewed condiment Instant coffee Whether Formal or Informal Formal Formal Informal Informal Formal Informal Nature of Adulteration or irregularity Bottle contaminated with mould ditto Lead - 5.5 parts per million Contained 240 parts per million sulphur dioxide 17.5 per cent deficient in acetic acid Incorrectly labelled Observations - - See Formal Sample No. 227 Information was received that the presence of sulphur dioxide was due to the fuel oil used in drying the coffee and that the use of such fuel oil had been discontinued. A formal sample was subsequently procured and found to be free from preservative and to be genuine 'Instant Coffee'. - - Result of proceedings or other action taken Australia and therefore outside the jurisdiction of the Court, the case was withdrawn. The wholesalers withdrew drew all unused stocks of this commodity from sale. Reported to Public Health Committee Cautionary letter sent to Dairy Company. ditto - Reported to Public Health Committee Cautionary letter sent to retailer. Formal sample subsequently taken and found to be genuine. Reported to Public Health Committee Cautionary letter sent to retailer/ wholesaler. Label amended to the satisfaction of the Council. 66 REGISTRATION OF FOOD PREMISES Premises registered under the provisions of Section 16 of the Food and Drugs Act, 1955, as at December 31st, 1960. Sale, manufacture and storage of ice cream 528 Preparation or manufacture of:- Potted, pressed, pickled or preserved meat 228 Potted, pickled or preserved fish 64 Potted, pickled or preserved other foods 33 Supervision of Food Premises Number of visits paid to each type of food premises by the Council's Public Health Inspectors. Type of premises No. of Inspections Bakehouses 222 Eakers and Confectioners 550 Butchers 772 Cooked and Preserved Meat Shops 612 Dairies and Milkshops 422 Fishmongers and Shell Fish Vendors 261 Fish Fryers 245 Fish Curers 138 Food Factories 236 Ice Cream Vendors 532 Public Houses 658 Restaurants and Eating Houses 664 Street Markets 534 Street Traders Food Stores 96 Other Food Premises 734 Total 6,726 Unsound Food No.of condemnation Certificates issued 1,922 Particulars of Unsound Food Destroyed Weight Total Weight Description Tons cwts. qtrs. lbs. Tons cwts. qtrs. lbs. Meat Beef - 4 1 19 Pork (loin) - 2 2 4 Pork (legs) - - - 23½ Lamb - 1 3 24 Ox liver - - 1 20½ Pig's melts - - 2 0 Lamb (pluck) - - 1 15 Bacon - - - 2½ - 10 2 24½ Trotters - - 1 0 Poultry Chickens livers (frosted) - 5 1 8 Chickens - - 3 0½ - 6 0 8½ Vegetables Potatoes 2 6 1 2 Broccoli (frosted) 3 1 0 0 Cauliflowers - - - 4 5 7 1 6 Fish Skate - - 1 14 Haddocks (cutting) - - 1 0 Cod fillets - - - 14 - - 3 0 Fruit Apples - - 2 6 Prunes - - 1 17 - - 3 23 Tinned Foods Meat (Asstd) 3,412 tins 2 15 1 20½ Ham 45 tins - 4 2 26 Vegetables (Asstd) 5,238 tins 2 10 0 7 Fruit (Asstd) 26,844 tins 13 2 1 27¾ Milk (Cond.& Evap) 1,425 tins - 10 3 16 Fish (Asstd) 7,807 tins 2 5 0 9¼ Rice (Creamed) 145 tins - 1 0 13 Cream 46 tins - - - 18¾ Marmalade 3 tins - - - 21 Jam 2 tins - - 1 8 Syrup 1 tin - - - 2 Treacle 1 tin - - - 2 Butter 1 tin - - - 2 21 10 2 5¼ Miscellaneous Confectionery, salad cream, tomato paste, french mustard, frozen foods (various) cheese trimmings, sago, drugs (various), jars of fish, mincemeat, jam, caviar & piccalilli, animal foods, 162 galls, beer & other foods etc. 3 19 0 22 3 19 0 22 Gross Weight 31 15 2 5¼ Summary of work of Food Inspector Complaints received 36 Complaints found to be justified 22 Visits:- Bakehouses 1 Bakers and Confectioners 12 Butchers 78 Cooked and Preserved Meat 12 Dairies and Milkshops 10 Fish Curers 1 Fish Fryers 4 Fishmongers 4 Food Factories 83 Public Houses 6 Restaurants and Eating Houses 19 Shell-fish Vendors - Street Markets 423 Street Traders Food Stores - Other Food Premises 251 Inspections not defined 172 Re-inspections 3 Food surrendered 286 Foodstuffs certified for export 3 Food condemnation certificates issued 1,922 TABLE OF CONTENTS Page Care of the Aged 17 Clean Air 14 Food and Drugs 37 Health Education 30 Housing 32 Infectious Diseases 21 Public Health Committee - Constitution 4 Public Swimming Baths 12 Report of the Consultant Chest Physician 40 Report of the Tuberculosis Care Committee 42 Role of the M.O.H. as Industrial Medical Officer to the Council 28 Sanitary Circumstances 6 Staff of the Public Health Department 5 INDEX TO STATISTICAL APPENDIX Atmospheric pollution - graphs 50-53 Births 47 Certificates of Disrepair 59 Cremation Certificates 48 Deaths - Causes and Age Distribution 46-47 Disinfection 56 Drainage and Sewerage 48 Factories Acts 55 Food & Drugs Adulteration 63 Adulterated Samples Table 65-66 Food Inspector - Return of Work 69 Food Poisoning 61 Food Premises - Registration and Supervision 67 Hairdressers and Barbers 49 Housing Inspector - Return of Work 58 Housing Statistics 58 Ice Cream and Lollies 64 Infectious Diseases 60 Medical Examinations 47 Milk - Registered Purveyors 63 Special Designated 63 Results of Tests 64 Offensive Trades 49 INDEX TO STATISTICAL APPENDIX - continued Page Outworkers 56 Pet Animals Act 49 Pharmacy and Poisons Act 49 Public Cleansing 48 Rag Flock & Other Filling Materials 49 Rodent Control - Return of work 56 Sanitary Inspection of the Area 54 Statistics - Summary of 45 Swimming Bath Water - Examination of 48 &57 Tuberculosis 62 Unsound Food Certificates 67 Unsound Food Destroyed 68 Vermin and Scabies (Attendances) 56 Water Certificates 48