Library AC. 4376 METROPOLITAN BOROUGH OF CAMBERWELL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1961 H.D.CHALKE O.B.E. (Mil.) T.D., M.A., M.R.C.P., D.P.H. CAM 56 PUBLIC HEALTH DEPARTMENT, TOWN HALL, CAMBERWELL, S.E.5. June, 1962 To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Camberwell. MR. MAYOR, ALDERMEN AND COUNCILLORS, I have the honour to present to you my Annual Report for 1961 which has been prepared in similar form to that of the preceding few years. There was no major occurrence affecting the health of the Borough and the vital statistics showed little change. According to the estimates of the Registrar-General at mid-year the population again fell by 1,040 persons - 173,980 as compared with 175,020 the previous year. The birth rate increased from 17.6 in 1960 to 19.3 in 1961 but the death rate also rose from 10.8 to 11.8. It is gratifying to record, however, that the infantile death rate reached a record low level of 19.4 per 1,000 live births. The smoke control programme continued to progress and the effects of the operation of the first Smoke Control Order in the southern end of the Borough are already becoming noticeable. Further strides were made in all aspects of health education, particularly by an increased number of talks and film-shows to schools and other organisations. The health exhibition set up at the Trade Fair at Camberwell Baths in October also proved to be popular and attracted much interest. A pleasing feature of the work of the Department in recent years is the increasing co-operation which is being built up with other bodies - both statutory and voluntary. One example of this is the small medical group which meets periodically to discuss matters pertaining to old people, and in which hospital, public health and general practitioner interests are represented. Other spheres of activity are those in connection with the Camberwell Samaritans Group, initiated by the Vicar of Camberwell (the Rev. John Nicholls), and the project for the care of alcoholics. The need for a health and welfare services index has shown itself more and more as these activities increase, and such an index has been prepared and will be found at the end of the statistical appendix to this report. This is an elaboration of a card giving similar details, which was distributed to general practitioners, hospitals and voluntary bodies. In the latter half of the year the Mass X-ray unit paid one of its periodical visits to Camberwell and set up in premises in Rye Lane, Peckham. A total of 5,828 persons were X-rayed (2,253 men and 3,575 women) of whom 148 were recalled for large films. The opportunity was taken for members of the Council's staff to be examined and 188 of them attended the unit for this purpose. Members of the staff were also offered facilities for inoculation against poliomyelitis, and sessions were held in the medical examination room where the Deputy Medical Officer of Health gave immunising injections to 90 officers. Members of the staff of the Public Health Department are regularly vaccinated against smallpox - an important precaution in view of the increased risks of imported smallpox in an age of swift air travel. Recognising the increasing need for additional transport for public health work, and for the delivery of meals to old people, the Public Health Committee authorised the purchase of a light van. This has greatly facilitated the work of the Department. The new examination for the Diploma of Public Health Inspectors' Education Board presented some problems in relation to the Council's scheme for training student public health inspectors. The extended syllabus rendered it necessary to make arrangements with other local authorities, and bodies other than local authorities, for additional practical training, which is not available in this Borough; this includes meat inspection in slaughterhouses, port health duties, conservancy systems of sewage, domestic plants for sewage disposal and the control of milk and milk products. Some difficulty was experienced in arranging the training programme of a newly appointed student, but thanks to the co-operation of colleagues in other authorities (including the Armed Forces) it was possible to draw up an adequate and comprehensive course which was approved by the Board. These difficulties formed the subject of a report to the Public Health Committee who decided to make representations to the Metropolitan Boroughs' Standing Joint Committee with a view of setting up a joint scheme for the training of student public health inspectors in London and the Home Counties. Finally, I would like to take this opportunity of expressing to the members of the Council, the other Chief Officers and their staffs my appreciation for their support and co-operation throughout the year. The staff of the Public Health Department - although below establishment - have again earned my grateful thanks for their unfailing loyalty and competent service at all times. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, H. D. CHALKE, Medical Officer of Health. PUBLIC HEALTH COMMITTEE Constitution at the end of 1961 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. Dal ton " 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: Councillor T. A. Smith, J.P. 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 Staff of the Public Health Department (As at 31.12.61) 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 H. Attwater, a, c. Deputy Chief Public Health Inspector H.W. Leonard, a. Sampling Officer H.R. Weaver, a. Food Inspector D.V. Watkins, a. Smoke Control Inspector Technical Assistants: A.G. O'Gilvie, a, c. W.A. Arrow, P. Syrett, J. Baillie Public Health Inspectors F. Duggins, a. E.C. George, a, c. J.E. Millway, a. F. Dray, a, c. H.M. Hough, a. H.F. Williams, a. G.A. Fraser, a. T. McCarthy, b. (Five vacancies) A. Gartside, D.P.A. a. C.H. Medland, a. Student Public Health Inspectors P. Frost A.J. Hughes M Stevenson Miss J. Harris M. Stevenson Miss J.Harris Infectious Disease Visitors Mrs. E.L.M. Falloon, S.R.N. Miss B.E. Brooks, S.R.N., R.F.N. Senior Clerk C. Burgess Clerical Staff P.A.S. Kirrage, D.M.A. Miss E.M. Lawrence A. Beare D. Danter Mrs. M. Findlay Miss J. Jakes W. Everett Mrs. A.D. Dormer F. Grace (temp) W. Everett Mrs. A.D. Dormer F. Grace (temp) Rodent Control Rodent Officer W.H.G. Saunders, b. Rodent Investigator Mrs. M.J. Kenny Rodent Operators F.G. Hulber, R. Humphreys, G. Marshall Mrs. E.M. Lloyd. Mrs. A. Grice (part-time). Disinfecting and Cleansing, Station Superintendent Disinfector A. Thomas Stoker/Disinfector Apparatus Attendant E. Manning Disinfectors Motor Driver H. King Cleansing Station Attendant Mrs. E.M. Norman Also Assistant Medical Officer. London County Council, Division 7. (a) Certificate Sanitary Inspectors Examination Joint Board and Meat and other Foods Certificate. (b) Certificate Sanitary Inspectors Examination Joint Board, (c) Royal Society of Health Smoke Inspectors Certificate. SANITARY CIRCUMSTANCES Water Supply No complaints were received during the year concerning the quality or quantity of the water supply. Every dwelling house in the Borough is provided with an adequate water supply direct from the mains of the Metropolitan Water Board. Drainage and Sewerage Applications for approval in respect of the drainage of new buildings or the reconstruction of existing drains numbered 300. All the works were executed under the supervision of the public health inspectors. Five thousand one hundred and thirty lineal feet of the Council's sewers were reconstructed and 71 brick gullies were replaced by pot gullies. Nuisances from Noise It did not become necessary to take statutory action under the Noise Abatement Act during the year, although complaints were received of alleged nuisance from noise. Most of these related to noise from factories and workplaces and it is gratifying to report that an informal approach to the managements always succeeded in securing their whole- hearted co-operation; indeed in some instances the firms concerned went to considerable trouble and expense to overcome the source of the annoyance and obviate any further cause for complaint. It is inevitable that complaints will continue from time to time where industrial premises are located in close proximity to residential property. This is a problem that can only be solved by effective town planning. It is not surprising that such complaints frequently arise when pressure of business necessitates the continuation of work in the evening or during the night - these are the times when noise is accentuated and there may be interference with leisure and sleep. Provided, however, that the 'best practicable means have been used for preventing, and for counteracting, the effect of the noise or vibration', it would seem that there would be little to gain by taking legal action. Factories are not always the subject of complaints of this nature; there were also complaints of noise from residents in a block of flats, and from a social club where music from a record player late at night disturbed the occupants of nearby dwelling houses. Here again, the officers of the Public Health Department were successful in securing the co-operation of the offenders. Caravan Sites The unauthorised use as a caravan standing of the land at the junction of New Church Road and Southampton Way continued to give rise to complaints. Statutory action was taken against the offenders, however, and eventually all the caravans were removed from the site. Towards the end of the year, a similar problem arose on a site at the corner of Benhill Road and Elmington Road. Here some 'squatters' occupied a caravan, erected a tent, lit bonfires and generally caused considerable nuisance and annoyance to local residents. The photograph facing page 8 shows the general disorderliness and unpleasant appearance of this plot of land. In this instance, too, it became necessary to serve notices and take legal proceedings to secure their removal. After their departure, the Borough Engineer and Surveyor arranged for the clearance of the offensive refuse from the site, which was then protected by fencing. Underground Bakehouses There is only one underground bakehouse still in use in the Borough with a Certificate of Suitability issued by the Council under the Factory and Workshop Act, 1901, and renewed at a quinquennial review of such establishments in accordance with the Factories Acts, 1937 and 1961. During the year, it was found that a basement bakehouse, which had been discontinued in 1954, had again been brought into operation in contravention of the Factories Act, which prohibits the use of a basement bakehouse as such if it has been discontinued for a period exceeding twelve months. The owner appealed to the Council to allow him to continue to use the bakehouse as he had expended money in carrying out improvements. He was informed, however, that the Council had no power to permit the use of this bakehouse to be resumed and unless its operation were discontinued forthwith, legal proceedings would be taken. The owner ceased to use the bakehouse and no further action was necessary. Common Lodging House There is only one common lodging house in the Borough, This is licensed for the accommodation of 224 men. The premises were inspected on thirty-two occasions during the year, but it did not become necessary to take any statutory action for offences or contraventions of the Bylaws. It is unfortunate that there have been so many changes in the supervisory staff in recent years: this has obvious disadvantages. Nevertheless, there is good co-operation in the conduct of this lodging house which is a reasonably good establishment of its kind. It is a sound structure with well-proportioned windows giving good light and ventilation on all sides. Radio and television are provided in the common rooms and facilities are available for cooking. For the most part this lodging house has a regular clientele; there are relatively few casual occupants. Poultry Slaughtering Following a complaint that poultry slaughtering was tailing place at the rear of a private dwelling house in the north-west of the orough, investigation revealed that the occupier had about forty chickens housed in the open yard. It was evident from the blood-stained condition of the yard that slaughtering was being carried out and the occupier admitted that he 'slaughtered a few' which were then sold. Legal proceedings were instituted against the occupier for Barryingon a business of poultry slaughtering without the consent of the Council. The offender was fined and the slaughtering discontinued. Rodent Control The work of the rodent control staff showed little variation from the previous year. As hitherto, systematic baiting of sewers was carried out four times during the year in conjunction with the Borough Engineer and Surveyor's Department. There appears to have been a steady improvement in the occurrence of rodent infestation in dwellings occupied by coloured immigrants; in fact, during the first six months of 1962 the number of complaints of rats or mice in immigrants' homes represented only a little over 7% of the total. This may well be evidence of the effectiveness of health education and of the co-operation of the immigrants themselves. SITE CORNER OF ELMINGTON AND BENHILL ROADS OCCUPIED BY "SQUATTERS" 9 CLEAN AIR Smoke Control Areas Considerable progress was made in the Council's programme for the establishment of smoke control areas. During the year under review, Smoke Control Orders were made by the Council in respect of the following:- Smoke Control Area No. 2. Bounded by Turney Road, Dulwich Village, Red Post Hill, Sunray Avenue and the Borough boundary. Area in acres 230 No. of dwellings 2,183 No. of commercial and other premises 127 Date of operation Ist September, 1962. Smoke Control Area N0.3 Pounded by Sunray Avenue, Red Post Hill, Dulwich Village, Court Lane, Lordship Lane, Melbourne Grove, Grove Vale, Dog Kennel Hill, Grove Lane, Champion Park and the Borough boundary. Area in acres 352 No. of dwellings 3,637 No. of commercial and other premises 149 Date of operation Ist November, 1962. Both of these Orders have since been confirmed by the Minister without modification. At the end of the year the detailed survey of Area No.4 was in progress. Investigation of Atmospheric Pollution For some considerable time the Council had four instruments for measuring atmospheric pollution. There were two volumetric instruments situated at 475 Lordship Lane and the Town Hall respectively, as well as a deposit gauge and lead peroxide instrument on the roof of the Queen s Road Centre, St, Mary's Road, Peckham. In March, 1961, a communication was received from the Department of Scientific and Industrial Research expressing their gratitude to the Council for making available the results obtained. It pointed out, however, that whilst the deposit gauge and lead peroxide instrument had been of great value, the introduction of the volumetric apparatus had rendered the latter instrument obsolescent and the deposit gauge would now only serve a useful purpose locally to measure grit and dust arising from individual factories. In the circumstances, the Committee decided to discontinue the use of these two instruments as from the Ist April, 1961, leaving only the volumetric instruments which still provide valuable data, Graphs showing the 'readings' obtained from them appear in the appendix to this report. After one year's operation of the Council's Smoke Control Order No. 1, which covers 1,025 acres in the extreme south of the Borough, it is encouraging to note that the instrument at 475 Lordship Lane indicated a distinct improvement in both the concentration of zsulphur dioxide and smoke in the atmoshpere. Indeed, the amount of smoke recorded averaged little more than half of the previous year's figures. Since climatic conditions are so closely allied to atmospheric pollution, however, it will be necessary to compare records over a period of several years before the long-term effect of smoke control measures on atmospheric pollution can be demonstrated adequately. Dark Smoke (Permitted Periods) Regulations, 1958 Four instances of contravention of these Regulations were reported to the Public Health Committee during the year, two of them in respect of the same factory. On the first occasion, a cautionery letter was sent to the management, but when a further offence occurred, legal proceedings were instituted and fines of £5 and £1 imposed with £1 ls.Od. costs. In another case, a cautionery letter was sent and no further contraventions have been observed. Legal proceedings were taken against the management of the factory where the fourth offence occurred and £1 fine and £l costs were imposed FOOD AND DRUGS Samples of food and drugs submitted to the Public Analyst during the year numbered 434 formal and 471 informal. Two formal and six informal samples received adverse reports. These included bread containing mouldy dough and insect fragments, canned corned beef containing an excess of lead, and incorrectly labelled condensed milk, Appropriate action was taken in all cases. Foreign objects are found in food from time to time and during the year complaints were investigated of glass in a milk bottle, a cigarette end in a loaf and a needle in a biscuit. Legal proceedings were instituted in the first two cases, but in the third case the complainant was not prepared to give evidence. With regard to unsound food, legal proceedings were authorised in respect of the sale of a sliced wrapped loaf affected by mould. The firm concerned, however, undertook to date-stamp all wrapped bread in future and no further action was taken. A number of cans of corned beef in Leicester which were sold from Camberwell were found to have been labelled as produce of Argentina whereas the tins were stamped 'produce of Australia'. The tins, which were old stock, had been re-labelled in error, but following the investigation the firm concerned decided to cease this part of its business. Several complaints regarding the quality of food were made by members of the public. This is an important aspect of the work and all such complaints are fully and carefully investigated. This has a double value in that it not only protects the public if any form of adulteration or contamination is detected, but equally protects the good name of the manufacturer or vendor if the complaint proves to be unjustified. New legislation concerning the composition of food included the Lead in Food Regulations, which control the amount of lead permitted to be present in any article of food. Lead is a cumulative poison and even though the quantity present in individual articles may be minute the total amount ingested over a period of time may, unless its occurrence is strictly controlled, rise to a dangerous level. For many years it has been the practice to examine samples of food for possible contamination with lead and other toxic metals, but this is the first time that legal standards applicable to foods in general have been laid down. Proposals for new Regulations concerning preservatives, bread, flour and soft drinks were published and it is likely that these will be implemented in the near future. The first of these are particularly important, since several new preservatives will be permitted. The poor quality, particularly with regard to non-fatty solids content, of some of the milk sold, especially during the winter and early spring continue to give cause for concern; it is satisfactory to note that this matter is now the subject of Ministerial consideration. Attention continued to be given to the composition of canned foods, particularly meat products and the use of artificial colours. The labelling and composition of pre-packed foods is also a matter to which close attention must be given, and from time to time manufacturers or packers have been advised as to the correct labelling of their products. Particular regard is paid to the vitamin content, and in this and other aspects of food analyses close liaison is maintained with the public health departments of other boroughs. This procedure obviates the need for duplication of analysis. HOUSING Slum Clearance The new five-year programme of slum clearance for 1961/65 agreed between this Council and the London County Council was put into operation during the year and five areas comprising 48 houses were declared: - No. of persons to be displaced Date of declaration No. of dwelling houses Area Hornby Road. No. 1. 8.3.61 18 79 Hornby Road. No. 2. 8.3.61 5 24 Hornby Road. No. 3. 8.3.61 12 43 Whateley Road. No. 1. 4.7.61 2 15 Whateley Road. No. 2. 4.7.61 11 83 Housing Act, 1961 This Act, which came into operation on the 24th November, 1961, gives wider powers to local authorities to deal with unsatisfactory conditions in houses in multiple occupation and provides for Regulations to be prescribed by the Minister of Housing and Local Government to ensure proper standards of management. Section 15 of the Act empowers local authorities to require the execution of works in such houses to ensure adequate natural and artificial lighting, ventilation, water supply, personal washing facilities, drainage and sanitary conveniences, facilities for the storage, preparation and cooking of food, and for the disposal of waste water, or installations for space heating or for the use of space heating appliances, having regard to the number of individuals or households, or both, accommodated for the time being on the premises. A house in multiple occupation is defined as a house occupied by members of more than one family, and probably more than fifty per cent of the dwellings in Camberwell would fall into this category. However, there are comparatively few where squalid conditions pertain which would require to be dealt with under the new legislation. Nevertheless, there is no doubt that this is a growing problem. In recent years there has been a considerable increase in the number of persons who have bought fairly large houses, a part of which they occupy with their families, letting the remainder in one or two room units. This type of landlord frequently has very little experience of property maintenance and is concerned mainly in obtaining an adequate income from the rents of the sub-lettings, particularly where mortgage repayments have to be made. Inconsequence, there is a tendency for these houses to become over-occupied, if not overcrowded, with inadequate amenities for the number of occupants. It is hoped that the new powers will enable local authorities to control this type of multiple-occupied dwelling and bring about an improvement in the standards of management and maintenance. This may well involve a requirement to reduce the number of persons or families in the premises and thus impose an additional burden on the rehousing activities of the Council. Of course, many of the families to be displaced will already be on the Council's housing list, but it will be necessary to ensure that the implementation of this part of the Act is linked with the availability of housing accommodation. Underground Room Regulations. Following the Housing (Underground Rooms) Act, 1959, the Minister of Housing and Local Government issued revised model Underground Rooms Regulations and asked local authorities to revise their existing regulations to bring them into conformity with present day standards. It was felt that in some respects, particularly in relation to the ventilation and lighting of rooms not used as living rooms, the revised model regulations fell far short of the previous model upon which most metropolitan boroughs (including Camberwell) had based their existing regulations. The Metropolitan Eoroughs' Standing Joint Committee made representations to the Minister suggesting certain amendments. The Minister replied that the purpose of the revised model was to enable underground rooms to be dealt with more flexibly and that a return to the rigidly defined standards of the past would frustrate this aim. He indicated, however, that he was prepared to consent to certain amendments, including that relating to the ventilation and lighting of rooms not used as living rooms, and the Council submitted revised regulations which were approved by the Minister on the 28th .August, 1961. Housing Priorities on Medical Grounds Two hundred and fifty-two applications for alternative housing accommodation supported by medical certificates were referred to the Medical Officer of Health for assessment of medical priority. The procedure for dealing with them, which has been described in previous reports, was continued and the following table summarises the medical conditions and the categories recommended. MEDICAL PRIORITIES FOR REHOUSING 1961. Medical Condition Category 1 Reccomdn Category 2 Category 3 Category 4 Reccomdn Reccomdn Reccomdn G.P. M.O.H. G.P. M.O.H. G.P. M.O.H. G.P. M.O.H. Tuberculosis 3 2 2 3 1 10 11 2 Bronchitis and/ or Asthma 8 3 18 2 15 25 4 11 Other Respiratory Conditions 1 4 1 7 5 1 3 6 Heart Conditions 9 5 2 5 2 2 3 4 2 2 - - Physical Disabilities (bad legs, etc.) 2 1 1 2 Nervous Disorders 15 6 24 2 5 13 11 16 3 1 6 7 5 7 2 1 Rheumatic Conditions Other Medical Conditions 18 18 31 31 25 28 21 18 In 30 cases recommendations were made for the provision of ground floor accommodation. In 10 instances applicants who claimed priority on grounds of tuberculosis were found not to be on the tuberculosis register. Hiring the year, alternative accommodation was provided for 150 families whose applications had been recommended for priority on medical grounds. The following analysis showing the medical conditions is of interest; the high proportion of applicants with 'nervous disorders' will be noted. Tuberculosis 13 Bronchitis and/or Asthma 21 Other Respiratory conditions 6 Heart conditions 13 Physical disabilities (bad legs, etc.) 8 Nervous disorders 36 Rheumatic conditions 11 Other medical conditions 42 Medical Condition No. of families rehoused. 150 WELFARE OF OLD PEOPLE Meals Service In March of the year under review, the authorities of the U.G.S. Settlement, Staffordshire Street, expressed to the Council their desire to be relieved of the responsibility for the meals service operating from their premises. The U.G.S. kitchen was providing meals for part of Camberwell and the Dept ford Meals-on-Wheels Services. Following discussion with representatives of the Dept ford Borough Council, that authority subsequently notified this Council that alternative arrangements had been made for the Dept ford Meals Service. Since this authority had no powers to operate a Mealson-Wheels Service itself, it was considered that the best solution would be for the Council to sponsor an ad hoc body to administer the service as an interim measure. In this connection, it was agreed that a van which it was proposed to purchase for public health use could be suitably adapted and used for the delivery of meals produced at the U.G.S. kitchen. Home Bathing A report was submitted to the Public Health Committee in June drawing attention to the steadily increasing need for the provision of a home bathing service to alleviate the difficulties of some of Camberwell's old people. The old people who need such a service may be divided into two categories:- (a) the sick and frail (b) the mobile, but housebound. Those in the first category are usually under the care of their family doctor and may also be receiving home nursing. For them the indiscriminate provision of a home bathing service without trained supervision by nursing staff would be open to objection, but it was believed that with the approval of their medical attendant, when nursingsupervision of the actual bathing process could be arranged, many could make use of the scheme with advantage. The second category, which is by far the larger group, comprises those old people who are unable by reason of age and infirmity to attend at the cleansing station or public baths, but could bath themselves in their own homes with the assistance of a visiting bathing attendant. Many of these people were already receiving 'Meals-on-Wheels', home help services, etc., and it was felt that the facility of a home bathing service would be an additional factor in the prevention of deterioration. Tnis commenced towards the end of the year, and has gradually expanded as adequate transport for the carrying of equipment, and the services of a bathing attendant became available. This innovation is proving to be well worthwhile. The King George VI Club for housebound old people, among its many valuable activities, also provides bathing facilities on the club premises. Visiting The appointment by the Council of two state registered nurses to undertake the visiting of old people has proved to be of inestimable benefit. During 1961, these visitors paid 837 visits to old people, in addition to those in connection with infectious diseases and other cases. By close liaison with other statutory and voluntary bodies such as the L.C.C. Home Help Department, health visitors, the U.G.S. Settlement, the W.V.S., the Camberwell Old People's Welfare Association, almoners of local hospitals, general practitioners, and so on, a comprehensive register of old people in Camberwell is gradually being compiled. Cases referred by any of these agencies, as well as those notified by relatives, friends and neighbours, are visited promptly. Any services already being received are carefully recorded and an endeavour made to arrange for the provision of any further assistance they may need. They are re-visited as often as may be necessary to ensure that they are as healthy and comfortable as possible. This enables the Council's visitors to note any deterioration in their condition which may not otherwise be discovered, and by speedy reference to their general practitioners, early treatment is established. This has often prevented further deterioration and forestalled the necessity for hospital treatment; it has also reduced to a minimum the number of cases which would ultimately have been dealt with under Section 47 of the National Assistance Act, 1948; in fact, it did not become necessary to make use of these compulsory powers during the year under review. One of the major problems with old people today is loneliness. Many of them are reluctant to take advantage of the many services available or to join old people's clubs. In a number of cases, the Council's visitors have been able to establish a friendly relationship and confidence which has done much to overcome this difficulty. They have personally taken many old people, who have been hesitant to join, to introduce them to the organisers of clubs and to meet the other members. This has helped them to decide to attend regularly and opened up for them a new interest. Due to their knowledge of many housebound old people, they have been instrumental in helping a number of them to have a holiday for the first time for many years, through the U.G. S. or the Old People's Welfare Association. Close attention is also given to the prevention of home accidents. Where necessary, arrangements are made through the L. C. C. Divisional Office for the provision of fire-guards; the Gas Board also co-operate by re-siting slot meters where they are not readily accessible and attending promptly to defective appliances. Housing defects are referred to the public health inspectors who serve notices on the owners to remedy them. Much of the work carried out by the Council's visitors is of a personal nature, but there is no doubt that it is welcomed by the majority of old people and the number of letters received at the Public Health Department expressing their grateful thanks and appreciation bears testimony to its need and value. Employment Scheme for the Elderly The Camberwell Association for Employment for the Elderly, which was sponsored by the Council, continued its activities at Cambridge House throughout the year with considerable success. There are two groups - each of 25 elderly men and women - who undertake two hours light work per day for a five-day week. Outings are arranged and a happy club-like atmosphere prevails. Mid-day meals are provided at a nominal charge of elevenpence. The whole scheme is under medical supervision and it has frequently been possible to rehabilitate those who have lost wife or husband or who have suffered mental ill health and feel that life has nothing more to offer them. The friendship and sense of being of value to the community contributes greatly to the happiness of the participants in the Scheme. HEALTH EDUCATION The dissemination of information on matters relating to health has become one of the major activities of the public health service. Every available medium for doing this is used by the Council's officers - posters, pamphlets, booklets, films and film strips, slides, flannelgraphs, charts, diagrams, talks, group discussions, demonstrations, exhibitions, etc. It is almost impossible to assess the effect of these efforts, but there is evidence generally that the public is becoming increasingly health conscious. Attendances at meetings, talks, film shows, etc., are often discouraging, but the interest and enthusiasm displayed by those who attend serves as a spur to further effort. Health education is of particular importance among the immigrant population, many of whom are unused to the standards of living which prevail in this country. The position in relation to coloured immigrants is, however, improving and, in general, they are co-operative and readily put into practice the fundamental rules of hygiene. In the early part of the year, a conference for West Indians was arranged to take place at the Town Hall to explain our way of life to students and immigrants. This conference was sponsored by the Commission for the West Indies, British Guiana and British Honduras and the speakers included the Medical Officer of Health, the Divisional Education Officer, the Manager of the Camberwell Employment Exchange and representatives of local government and the police. Unfortunately, only sixteen of the better educated type of West Indians attended. They took a lively interest in the proceedings, however, and were urged to spread information among their fellow-countrymen and to try to form a Camberwell West Indian Group to take an interest in civic affairs. During the year under review, the Medical Officer of Health and his staff gave twenty-seven talks to various groups, including women's organisations and schools. Most of these were supplemented by sound films, film strips, demonstrations and other visual aids and were followed by group discussions. The subjects included Public Health, Housing and Sanitation, Clean Air, Home Safety, Food Hygiene and Rodent Control. The Camberwel 1, Peckham and Dulwich Chamber of Commerce arranged to hold a Trade Fair at Camberwell Baths from the 7th to 14th October, 1961, (inclusive) and invited the Council to take part. With the approval of the Public Health Committee, four stands were taken for health education purposes. Two of the stands were used entirely for the display of propaganda for the prevention of accidents in and around the home: the other two were devoted to food hygiene and clean air respectively. Officers from the Public Health Department were in attendance during the whole of the time that the exhibition was open to give advice and information to the public. A National Fire Prevention Week was held from the 30th October to the 4th November, 1961, and the Public Health Department co-operated by arranging for the display of posters and the distribution of leaflets and other literature on this subject in conjunction with publicity material on home safety with which fire prevention is so closely associated. A number of health visitor students from the Battersea College of Technology kindly volunteered to visit homes in the Borough in connection with the campaign for the prevention of home accidents. This proved to be a valuable addition to the routine work carried out in this direction. These ladies also helped in the completion of a questionnaire aimed at assessing the results of health education procedures. PARENTS' GROUP In December, 1960, the Vicar of a Peckham Church sought the assistance of the Medical Officer of Health in setting up a night school for parents in an endeavour to diminish the prevalence of juvenile delinquency. It was suggested that he and any of his colleagues who were interested should come to the Town Hall to discuss the matter. He and four vicars of neighbouring parishes subsequently did so and following a full discussion, it was agreed that the idea of a 'school' for parents might not be attractive to the type of people for whom it was intended. As an experiment, however, it was decided to organise a family discussion group in an informal and friendly manner and two of the vicars agreed to seek the collaboration of their parishioners. Arrangements were made to hold meetings on four successive Thursday evenings at the Union of Girls' Schools Settlement, Staffordshire Street, the Warden of which kindly offered to make accommodation available and to provide light refreshments, and experts in different fields of sociology were invited to attend and guide the discussions. Although this project was given considerable publicity, which included the display of posters, the distribution of handbills and comment in the local press, only twelve parents attended the first meeting. This attendance was, however, maintained throughout the series and proved, in fact, to be an ideal number. A large audience would have defeated the aim of this experiment, as it would not have been so conducive to the creation of a friendly and intimate atmosphere in which parents could be prevailed upon to unburden themselves of their anxieties and perplexities, and discuss them freely with one another. The guest advisers included a juvenile court magistrate, a school-mistress, the wife of a bishop, a canon, the editor of 'Family Doctor' (Dr. Harvey Flack) and the medical director of the Central Council for Health Education (Dr. Dalzell-Ward). As had been hoped, there was a gradual shedding of reserve by the parents who soon became very interested, participating eagerly and giving full rein to their opinions. At the last meeting when they discussed among themselves a short health education film which they were shown, they revealed an interest and understanding which four weeks previously would hardly have seemed possible. It was evident from these results that the venture merited further exploration for there appeared to be no doubt that there was a real requirement for health propaganda of this kind. It was also established that there was a need to create a friendly atmosphere at the beginning, which a cup of tea and introductions before the meeting helped to bring about, Finally, there was ample confirmation of the important principle that wise direction and counselling must be available, given by experts who participate rather than instruct - a lesson quickly learned by the organisers themselves. It was accordingly decided to continue the experiment and to try to set up a further group in a neighbouring parish, where the experience gained could be applied. Dr. Dalzell-Ward was keenly interested in the experiment and he and his colleagues consented to be responsible for the actual conduct of the meetings. The Vicar of the adjoining parish was approached and a preliminary meeting was held in the church hall at which Dr. Dal zell- Ward addressed a number of church officers and workers and explained the principles behind the scheme and the manner in which the meetings might be conducted, There was enthusiastic support and subsequently handbills were prepared and distributed by those present to members of the church, inviting them to attend on five evenings at weekly intervals to ; talk over parents' problems in the I96o's': light refreshments, films and music were offered These invitations were signed jointly by the Vicar and the Medical Officer of Health. As before, the attendances were small, averaging fourteen, only three of whom were males. It is significant, however, that with one or two exceptions, those who came to the opening meeting were present at all the others, including a sixth session, which they themselves requested should be held. It was unfortunate that so few fathers attended It was understood that many would have liked to do so, but they had to stay at home to look after the children. It was suggested, also, that but for the attractions of 'Bingu', the numbers would have been much greater. It is paradoxical that, for reasons already given, a larger concourse might well have defeated the object of the exercise. All the members of the group took part in the discussions on incidents in films which they were shown and on topics suggested to them, diffidently at first, but with rapidly increasing enthusiasm and spontaneity. Later, they discussed some of their own problems and took part in role-playing without obvious self-consciousness or embarrassment. A full record was made on film and tape which formed part of the demonstration of the work of the Camberwell Parents' Group at the annual conference of the Central Council for Health Education at the National Film Theatre on the 28th January, 1962. Discussion This experiment on one aspect of health education, in collaboration with parish priests, showed that with the right approach, individual reticence can be overcome and parents benefit from full discussion of their problems, not only under the guidance of experts, but among themselves. The people concerned were, admittedly, a selected group, and as church members in the presence of their priest, may have been more amenable to guidance than others in greater need of advice. To gather together these others in a similar way - through their clubs and other organisations - would appear to justify more attention than is devoted to it at present. It entails a great deal of work, however, and involves attendance at many evening meetings which, with a shortage of experts (and wise supervision is essential), is not easy to arrange. This work does not encroach on the present field of activity of health visitors and others concerned with the promotion of health. It runs in conjunction with it, catering mainly for those who may not feel that they are in need of outside help, and who do not therefore seek it. Their problems are generally beneath the surface. As their children grow up, the mothers cease to attend the child welfare centres and many of them lose touch with the health visitor; this was the case with the members of the group under discussion. If, however, more groups are to be setup, the assistance of health visitors and other social workers, as members of the supervisory teams, will be of considerable assistance in overcoming the shortage of suitable helpers. Many of them, no doubt, are already engaged in additional evening work of a similar nature. The members of the second group were most anxious to continue and a doctor living locally, who is specially interested in this work, has now associated herself with the group - which still meets regularly. It is hoped to start groups in other churches in the Borough and a meeting is to be called of representatives of all religious denomina- tions. There is every indication that the suggestion will be enthusiastically received and its practical application will be controlled only by the amount of expert help available. The topics discussed at the six meetings of the group were as follows: - 1. The child's discovery of sex. This was introduced by the film 'Larry' (distributed by the British Film Institute) which illustrates simply and sympathetically the relationship between a young boy and his mother. This started a discussion on the need for sexual instruction to young children and the parents' attitude to sexual manifestations in their children. There was also a brief discussion on the psychology of sex in children. 2. Development of personality. A flannelgraph was used to illustrate some of the basic concepts of human psychology. Discussion centred on the interaction of personalities within the family and how parents could help their children to develop mentally and psychologically. The conflict of personalities within families and how this had been dealt with was described by various members of the group. 3. Fostering independence. The Central Council for Health Education s film Hie Way to Independence' was shown to stimulate discussion. Again, many members gave examples of difficulties that had been experienced when adolescent children insisted on gaining independence of their parents Al though in most cases this had produced no major problems friction had been experienced over small details such as the wearing of lipstick by young girls, boy and girl friends who were not approved by the parents, and the time at which young people returned home at night. Role-playing, which was introduced at the first meeting, was now engaged in freely and proved to be a valuable means of gaining insight into motives and behaviour. 4. Preparation for marriage. A sound filmstrip 'For For Worse ', produced by the Central Council for Health Education, provoked a lively discussion on the amount of preparation for marriage needed by young people. At first, this was thought to consist of training in cooking, house-management and budgeting, but subsequently there was some consideration of personality problems and conflicts between married couples and how these could be resolved. 5. Ihe family and the community. This was to have been the last meeting of the series and discussion centred on the relationship between families and the community in which they lived. Happy, adjusted families were the backbone of a healthy community the social changes of the past fifty years and their effect on family life were considered. The group's opinion of the morality of modern society was illustrated by role-playing. 6. Discipline. As this topic had provoked the most discussion and difference of opinion, an extra session was devoted to discipline in the home. The subject was suffici ently stimulating and the group now rel axed enough to permit free discussion without any aids. Role-playing again allowed insight to be gained and, possibly, attitudes to be modified REPORT OF CONSULTANT PHYSICIAN CAMBERWELL CHEST CLINIC. The work of this Department continued to run at a high level. During the year 15,268 units of X ray work were carried out and there were 12,225 outpatient attendances. Five thousand five hundred and twenty-two new cases were X-rayed and a total of 2,001 newpatients had full clinical examinations. One hundred and fifty four patients were admitted to St. Giles Hospital for treatment and 142 to neighbouring hospitals. Sixty-nine patients were admitted to sanatoria for treatment of their tuberculosis, The number of cases on the tuberculosis register fell to and the details of the newly-notified cases appear on page 60 in the appendix to this report. There were 20 deaths due to tuberculosis - 17 men, an increase of 6 over the previous year, and 3 women, 4 less than the previous year. The incidence of carcinoma of the lung continues at its high rate. Many patients are referred for investigation of their chronic bronchitis and those who give up smoking are willing to admit that they feel better in every way. General practitioners are very co-operative in treating the secondary infection that is so troublesome in the winter among bronchi tics and one has the impression that the number of cases of acute pneumonia has not been great during the winter of 1961. There was a small epidemic of influenza and those bronchitic patients who had received influenza vaccine did acquire some resistance to the influenza virus. The occasional case of acute pulmonary tuberculosis has occurred but no case where the organisms are resistant to the usual three anti tuberculous drugs has been found. Ten patients are known to be excreting tubercle bacilli resistant to one of the three drugs - these patients certainly present a public health hazard and the health visitors pi ay a large part in ensuring that these patients take every precaution in the disposal of their sputum and in matters of general hygiene. It is probable that some form of national registration of patients excreting resistant tubercle bacilli will be evolved in order that the size of the problem can be assessed and methods for coping with it devised. * *(A Ministry circular of 6.6.62 announces the setting up of such a central register.) Hie incidence of tuberculous disease among West Indians has not been high but a number of cases of acute disease have been found among Africans. Chronic, fairly longstanding disease, has been found among Cypriots, especially those of Turkish origin. Six hundred and ninety-six newly-born infants were vaccinated with B.C.G. in the Maternity Department at St. Giles' Hospital and 724 others were vaccinated as contacts, or schoolchildren who did not receive the vaccination from the B.C.G. team on its visit to their school. The health visitors made 1,831 visits which is a noticeable drop from the previous year (2,474), and can be explained in part by the fact that the health visitors' staffing has not been up to strength, due chiefly to illness. 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 Camberwell District Nursing and the Flanyard Nursing organisations and the London County Council Ambulance Service for their continued cooperation. Chest Department, KENNETH MARSH. St, Giles Hospital Consultant Physician INFECTIOUS DISEASES Diphtheria The outbreakof di P h theria which occurred from December 1960 to January 1961 was fully discussed in the annual report lor 1960; I am, however, indebted to Dr. B.H. Pentney for the following notes on the outbreak from the general practitioners' point of view:- The outbreak of diphtheria in Camberwell presented features of particular interest. It was centred around one primary school. In all, thirty-eight patients had positive throat swabs. Of these 13 were clinical cases of the disease and 25 were carriers. One general practice was concerned with nine clinical cases and seventeen carriers All cases occurred in children between the ages of five and nine years There was one death - a girl of eight years who had not been immunised. As a clinical type the disease was mainly tonsillar coimiencing insidiously, there being no complaint of severe sore throat or pain. In the early stages the tonsils showed some swelling with a smooth patch of deposit on the mucosa. In most cases this was ivory white with a fine red margin Later this membrane appeared thicker and of creamy colour - well defined. It was not frequently seen to have spread to the soft palate. In a later stage all showed congestion and oedema, and in some cases this was most marked. The lymph nodes were always palpable in the early stage, and later became swollen remarkably quickly; this sudden enlargement was on some occasions the presenting feature. In no case was there noted the characteristic foetor. There was always a raised temperature, and in some cases this was quite high. In general practice the throat and nose were swabbed, and the case notified to the local public health authorities and admitted to hospital. Contacts were also swabbed. The first case arousing suspicion was diagnosed on the 17th December, 1960, and admitted to hospital; two days later it was transferred to the Infectious Disease Centre at Hither Green. On the 20th December, 1960 the first clinical case was diagnosed and admitted direct to the same hospital The absence of notorious and characteristic features un- doubtedly led to the initial delays in recognition of the disease, and in retrospect there can be little doubt that one or two cases had occurred in the previous ten days. Although at least one of these patients had been swabbed, no pathogen of the particular variety had been found, and this organism was apparently atypical. The Bacteriologists reported that it had many of the characteristics of a harmless diphtheroid, and thus its sinister significance was easily missed. In these early cases the oral penicillin which was prescribed had in most cases enabled the patients to overcome the disease satisfactorily, while others who were later swabbed as contacts and found to be positive were referred to as 'carriers' . It was important to note that several carriers with clear swabs subsequent to treatment in hospital, when returned to their homes rapidly developed a positive throat swab again, and in one of these children such re-infection occurred three times. The speedy limitation of this outbreak could only be attributed to the system of swabbing for identification, the rapid and complete removal and isolation of cases and carriers, together with the increased immunisation measures which raised the already high level existing in the area. In July 1961 a further case of diphtheria was reported in the person of the sister of a child who had been treated in hospital as a 'carrier' during the previous outbreak. Swabbing of other members of the family produced negative results, but investigation of contacts at school revealed several carriers'. Two boys aged 3 and 5 years, who had been admitted to hospital the previous December and produced negative swabs after being discharged, were again found to be 'carriers'. In the same family, the mother, father, grandmother and two other siblings were found to be positive. This outbreak was rapidly brought under control the last case occurring less than three weeks after the first, fifteen patients were involved, including four adults. All were admitted to hospital with the exception of the grandmother, who was treated at home by the family doctor, An outbreak of diphtheria at a school in an adjoining borough led to the discovery of three carriers' living in Canberwell, one of whom was a teacher at the school and the other two pupils. All three were removed to hospital for treatment. The surveillance of diphtheria cases and contacts (including the taking of swabs) entailed 475 visits to homes. Bacillary Dysentery Hiring the past two or three years small outbreaks of Sonne dysentery have been occurring during the winter and spring, when fly-borne infection could not have been responsible. These outbreaks have usually occurred among children of early school age, and sometimes conveyed to other persons in the home. There is little doubt that poor health habits, particularly the failure to cleanse the hands after defaecation and before eating, have contributed largely to the transmission of infection. Adequate washing facilities, with disposable towels, together with health education, are basic preventive measures. Notifications of bacillary dysentery during 1961 numbered thirty, but eighteen of these were not confirmed bacteriologically. Nine of the confirmed cases occurred in three families. Food poisoning Food poisoning notifications numbered 32; an additional 10 cases were ascertained as a result of visits of investi gation There was a small outbreak of CL Welchii infection (10 cases). This occurred among the staff of a fire station. All those affected 9 out of 10 on night duty - had at 8 p.m. eaten a meal of which the main dish was a meat pie. About nine hours later the men became ill with mild to moderate symptoms of colic and diarrhoea. Investigation revealed the presence of CI. Welchii in the stools of all those affected including the cook (who said she had not eaten the pie); the organism was also isolated from a sample of the minced meat obtained from the butcher and from the beef in the remaining portion of the pie. The meat was purchased on the previous day, cooked an hour or so later, and left to cool in the kitchen before being placed in the refrigerator. The next morning it was made into a pie with vegetables and left at room temperature until the evening when it was heated just before consumption. Instructions on the preparation and storage of food, with particular reference to made-up dishes, were given to the kitchen staff. Measles This disease occurs epidemically every two years and 1961 was an epidemic year when 2,741 cases were notified. This is the highest figure since 1957 and the second highest in the past twenty years. The graph on page 36 shows the number of notifications and deaths from this disease for the years 1942-1961 and although there is no indication of any decrease in incidence, it is noteworthy that the fatality rate has been substantially reduced. The severity of measles has been controlled by modern methods of treatment which have saved lives and prevented disabling sequelae such as blindness and deafness, but it is still a serious illness requiring prompt medical attention. Last year there was only one death, the first from this disease since 1957. Trials of a vaccine against measles have given encouraging results, but it is too early to say whether it will be generally available in the near future. Poliomyelitis Only two cases of this disease occurred during the year, both in children under two years of age. One was unimmunised and the other had had its first injection only two weeks before contracting the disease. Both were cases of paralytic poliomyelitis. Smallpox No cases of this disease occurred in Camberwell during the year, although the Medical Officer of Health was called into consultation in several instances of suspected smallpox. Severe chicken-pox in coloured persons was the diagnosis inmost of these cases. It was necessary, however, to keep under surveillance several smallpox contacts from a ship which arrived in London with the report that a member of the crew had been landed at Suez suffering from modified smallpox. Fortunately, none of them contracted the disease. Tuberculosis Of the 17 male deaths from respiratory tuberculosis (slightly above the average of 15 for the past five years), 15 were in persons aged 45 years or more. Two females died of this disease. These figures direct attention to the major part that older males now play in disseminating this infection. Notifications of respiratory tuberculosis numbered 95 males and 42 females. The decline in incidence continues, the total number of cases notified being 20 less than in the previous year and 75 less than in 1957. It is unfortunate that from time to time cases of open tuberculosis are brought to notice in which the sufferer is unco-operative and will not accept treatment. There is no provision in the Public Health (London) Act for dealing with such patients. Other notifiable diseases During the year 8 notifications were made of acute influenzal pneumonia, 26 of acute primary pneumonia, and 6 of meningococcal infection. Non notifiable infectious diseases In order to obtain a picture of the incidence of nonnotifiable infections - of which those caused by viruses are becoming of increasing public health importance - much reliance must be placed on the co-operation of general practitioners and hospital doctors. This co-operation is acknowledged with gratitude. it has proved most valuable in the past, for example, in giving early information about influenza, and details of possible cases of virus encephalitis and meningitis. In 1961, there was no evidence to suggest that such conditions as virus infections of the throat and nose - particularly in youngpeople - virus pneumonia, encephalitis and meningitis, and winter vomiting were unduly prevalent MEASLES INCIDENCE DURING THE PAST 20 YEARS VENEREAL DISEASES Prior to the second world war, the incidence of venereal disease in this country had steadily decreased. There was a considerable rise in the number of cases in the war years, as is always the case during such times, but after the cessation of hostilities, the figures declined rapidly until about 1955 when they again began to rise. They have continued to do so to the present time. This increase is most disturbing and at first sight not easy to understand in an age when social progress and medical advances have been so remarkable. Venereal diseases are not notifiable and there is no statistical information available of the total number of cases among Camberwell residents. An endeavour was made during the year to secure some information on this matter and the physicians in charge of the V. D. Clinics at two hospitals which serve the Borough have kindly provided monthly particulars of first attendances of patients, differentiating between immigrants and others, these are shown in the chart on page 40 for the period May-December, 1961. The numbers represent a proportion only of the total cases, for it is known that Camberwell patients attend other hospitals, and some are treated by general practitioners. The chart indicates that there was a welcome - even though slight - falling off in the number of cases attending for the first time (a trend which continued in the early months of 1962) but this is almost entirely among persons born in the United Kingdom. During the eight months in which records were kept, immigrants accounted for more than 55% of fresh cases, and in December 1961, they made up two thirds of the total. It appears also that this group includes a large number of the patients with repeated infections. The proportion of males to females who sought examination or treatment was slightly more than three to two in both groups, this is a higher proportion of females than seems to be the case elsewhere. Of a total of 378 first attenders at one V. D. Clinic, 128 suffered from gonorrhoea, 23 from syphilis and 86 from other conditions which required treatment. In 141 persons, no treatment was found to be necessary; presumably, they had exposed themselves to a risk of infection but, by good fortune, had escaped it. It has been noted in another part of London that more immigrant women with gonorrhoea are now being seen at the Clinics. The following table gives a significant picture of the ages of the patients who attended. It shows that more than a third of the women were aged 20 or under; fifteen per cent of the males were in this age group; between them, they provided a quarter of those who visited the Clinics. These figures highlight the part young people may now be playing in the dissemination of infection. First attendances at V.D. Clinics at two hospitals May - December 1961. Age Groups Sex 0 - 20 21 - 30 51 - 60 61 and up Total 31 - 40 41 - 50 Male 39 141 46 21 8 3 258 Female 57 70 24 5 - 1 157 Total 211 70 26 8 4 415 96 The available evidence supports the view that most of the immigrants were, infected after arrival in this country: however, four of them showed evidence of previous infection with yaws, a non-venereal condition common in tropical countries where hygiene standards are poor. In the absence of notification, and without accurate knowledge of the numbers in the population - white and coloured - not born in the United Kingdom (the estimation of which is complicated by frequent change of residence), it is not possible to assess the true and comparative incidence of venereal diseases in Camberwell. The actual numbers recorded by two hospitals (and returns from a third for a short period) show, nevertheless, that in Camberwell as in most of the other large towns in this country, the amount of venereal disease is such as to cause considerable anxiety. The information available suggests that promiscuity among young people (of which the high proportion of illegitimate births is a further index) and the impact of a large immigrant population are two of the major causes. The first is closely linked with sociological and moral standards, it also calls for a more intensive effort in the health education of young people in the schools and elsewhere, and of parents, many of whom have little knowledge of the risks and dangerous long-term effects of the venereal infections. Immigrants have been made up largely of young people, many with no home ties, and living in crowded conditions. Under such circumstances, male promiscuity is always common, and the vicious circle is set up in which prostitutes, and other promiscuous women who become infected, infect others in their turn. It is hoped that as the immigrants settle down and their mode of life becomes more stable (and this can be accelerated by wise social work) many of these factors will operate to a decreasing extent and the venereal diseases will diminish (Immigrant Population. Accurate information is not yet available as to the immigrant population of the Borough. Some indication of the position is shown in the following figures which relate to attendances of immigrants at the L.C.C. Child Welfare Centres in the Borough and the per centage of immigrant patients at the local hospitals. During one week in July, 1961, the number of children of immigrant parents who attended child welfare centres in Camberwell was fourteen; the figure for a similar period in July, 1962, was one hundred and thirty. At the local hospitals the attendances during comparable periods during 1961 and 1962 showed that the per centage of immigrant outpatients increased from 10.7 to 13.7. The attendances at the hospital ante natal clinic are of particular interest - in 1961 a little over a quarter of the patients were immigrants but a year later this had increased to more than one-third. Additional information relating to school attendances, which will clarify the picture still further, is awaited.)' VENEREAL DISEASES First attendances of Camberwell residents at V. D. Clinics at two hospitals serving the Borough MAY - DECEMBER, 1961 DEATHS FROM OTHER CAUSES As the infectious diseases which formerly took such a heavy toll of human life are being conquered, non-infectious complaints assume greater public health prominence and demand more research as to their cause and prevention. Coronary disease and angina again formed the biggest single cause of death - 225 males and 116 females. There has been a marked increase during the past ten years; the figure for males (225) may be compared with that recorded in 1952 (154), and that for females (116) with 89 in the earlier year. More than a third of the male deaths were in persons aged 45 and 65 years. The high incidence of degenerative heart complaints in the middle years of life falls heavily on the professional and business groups; in old age the sex differences are not so marked. This seems to be another legacy of civilisation. Much more needs to be learned about its causes, but it appears that dietary factors, heavy smoking, tension, and sedentary work with too little exercise may all be implicated. Good, healthy living is more important than ever when middle age is approached. Cancer of the lung and bronchus. The deaths among males from cancer of the lung has also increased - from 80 in 1954(62 in 1951) to 105. Female deaths from this condition (16) are very much less, and show only a slight increase since 1954 when the number was 13. These figures focus attention again on the association between cigarette smoking and malignant disease of the lung and bronchus. Bronchitis also affects men more than women (in 1961 there were 119 male and 43 female deaths), it also causes a great deal of chronic sickness, disablement and absence from work. It is significant that abroad it is known as 'The English disease', a reminder of the very high death rate here compared with that in other countries. Whilst heavy smoking aggravates bronchitis, and probably helps to bring it about in the first place, atmospheric pollution is the most important factor. The need to cleanse the atmosphere with all speed is imperative if the amount of ill-health and the number of deaths from bronchitis is to be reduced to a level comparable with that of other more fortunate countries. Snoke control areas are now being established in the Borough as quickly as possible, but the success of the drive for clean air depends on full co-operation by the public. Already there is a welcome improvement in this direction. Accidents Home accidents in Camberwell have been the subject of special enquiry over the past few years and the results have already been recorded (see Annual Report for 1958). The number of deaths during the past five years from (1) motor vehicle accidents and (2) all other accidents (the greater number of which are in or around the home) is shown below - 1961 1960 1959 1958 1957 Motor Other Motor Other Motor Other Motor Other Motor Other 15 10 20 14 16 11 17 17 21 10 17 7 11 7 11 1 10 8 Males Females 18 14 Totals 25 34 27 34 31 24 18 32 12 18 Despite intensive propaganda 'other' fatal accidents do not diminish. It has to be remembered also that for every death recorded there is a number of serious cases, and a still large number of patients who require medical attention at hospital or from the family doctor, many for long periods. Of the 34 fatal accidents, 26 were in persons above 45 years of age, and 18 in those over 65. Three children under 5 years of age died; this may be compared with a single death in this age group from an infectious disease which again emphasises the changing and widening spheres of activity demanded of preventive medicine today. Suicide. Notification of disease, so that the incidence of any particular illness in the community may be known, is one of the most useful sources of information available to the Medical Officer of Health in his efforts to reduce morbidity. The incidence of mental illnesses in the community is known to be increasing, but since these illnesses are not notifiable, it is difficult to gather data which will reliably show the people at risk and suggest the remedial measures which can be taken to help both the individual and the community. The number of persons who die by committing suicide may, however, give some indication of the problem, since this will show the trend in this extreme manifestation of mental and social illness. The graph on page 44 shows such statistics for the past ten years in Camberwell. It is disturbing to find that the number of suicides in 1961 (32) is almost double that in 1960 (17). It is interesting to note that the increase is particularly marked in the 25 - 65 year age groups, rather than in those over 65 years, who tend to be the more lonely members of the community and therefore are more likely to brood over their troubles. A further factor is that the usual male/female ratio for those who take their own lives has now been reversed for the first time since 1952. It must be remembered that there is a positive relationship between suicide and the social conditions which disrupt family life - divorce and illegitimacy, also between suicide and loneliness, and movements of the population, that is, immigration, which requires the individual to make a major adjustment to a new way of life in unfamiliar surroundings. DEATHS FROM SUICIDE 1952-1961 TOTAL (ALL AGES) 45-65 YEARS 25-45 YEARS OVER 75 YEARS STATISTICAL APPENDIX Summary of Statistics for the year 1961. 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 1961) 174,697 (Estimated by Registrar-General mid/1961) 173,980 Number of inhabitated houses (April 1961) 45,239 Rateable value (April 1961) £2,578,961 Sum represented by a penny rate (Estimated) £10,350 Number of live births 3,352 Birth rate 19.3 Number of deaths 2,054 Death rate 11.8 Infantile Mortality:- Deaths under 1 year 65 Infant deaths per 1,000 live births 19.4 Maternal Mortality:- Deaths of women from diseases or accidents associated with childbirth 4 Maternal death rate per 1,000 total births 1.2 Deaths from Pulmonary Tuberculosis 19 Pulmonary Tuberculosis death rate 0.11 Deaths from all forms of Tuberculosis 20 Tuberculosis death rate 0.12 46 TABLE SHOWING CLASSIFIED CAUSES OF DEATHS IN AGE GROUPS IN CAMBERWELL DURING 1961 Causes of death Sex All ages 0- 1- 5- 15- 25- 45- 65- 75- All causes M. 1065 37 4 10 38 290 5 336 345 F. 989 28 3 2 7 36 160 232 521 M. 1 1 7 - - - 6 Tuberculosis, respiratory 17 2 - 1 F. 2 - 1 - Tuberculosis, other - - - - - - - M. - - - - - 1 1 F. - - - - - Syphilitic disease - - - - - M. - - - - - - - - - 1 2 F. 3 - - - Diphtheria - - M. - - - - - - - 1 F. 1 - - - Whooping Cough - - - - M. - - - - - - - - - F. - - - - - - - - - Meningococcal infections M. 1 - - - - 1 - - - - - - F. - - - - Acute poliomyelitis - - - M. - - - - - - - - F. - - - - - - - Measles - - M. - - - - - - - - - 1 Other infective and parasitic diseases F. 1 - - - - - - - - - - - - M. 1 - 1 - F. - - - - - - Malignant neoplasm, stomach - - - - 9 - - 2 15 M. 35 9 - F. 15 - - - - 2 7 6 Malignant neoplasm, lung, bronchus - 2 105 - - - 40 51 M. 12 - F. 16 - - - - 3 4 4 5 Malignant neoplasm, breast - - - - - - M. - - - - - - F. 30 - 2 12 10 6 Malignant neoplasm, uterus - - - - 1 8 6 F. 19 4 Other malignant and lymphatic neoplasms. - 1 6 - - 34 30 M. 33 104 - 26 F. 91 - - 1 5 27 32 Leukaemia, aleukaemia M. - - - 3 2 1 - - - F. - 1 - - - 1 Diabetes - - - M. - 1 - - - - 1 - - 4 F. 10 - - 5 - - 1 - 1 Vascular lesions of nervous system - 33 - 24 M. 102 - 3 41 F. - - - - 19 33 90 142 Coronary disease, angina - - M. 225 - - 5 86 70 64 - F. - - - 21 98 168 - - 49 Hypertension with heart disease - - - 3 1 - - M. 8 4 - F. - - - 1 14 15 - - Other heart diseases - - - M. 57 - 3 15 11 28 F. 1 13 116 - - - 2 23 77 Other circulatory disease Influenza M. 51 - - - - 2 16 12 21 F. 69 - - - 11 40 - - 18 1 M. - 1 2 4 - - - - F. 2 4 - 2 - 47 Causes of death Sex All ages 0- 1- 5- 15- 25- 45 - 65- 75- Pneumonia M. 50 7 - - - - 10 11 22 F. 79 1 - - Bronchitis - - 4 9 65 M. 119 - - - 2 26 35 56 - Other diseases of respiratory system F. 43 - - - - 5 12 - 26 - - M. - - 2 2 12 4 4 1 F. 9 - - - 1 2 5 - Ulcer of stomach and duodenum - - - - - 6 M. 16 2 8 F. 8 - - - - 1 1 6 - Gastritis,enteritis and diarrhoea - - M. 8 - 1 3 - - 4 F. - - - 5 - - 1 2 2 Nephritis and nephrosis 1 M. 5 - - - - 4 - - F. 5 - - - - - 2 2 2 Hyperplasia of prostate Pregnancy,childbirth, abortion M. - - - 13 - - - 3 10 - F. - 4 4 - - - - M. - Congenital malformations 4 1 1 7 - - 1 - - F. 11 7 1 - - 2 1 Other defined and illdefined diseases - - M. - 3 15 1 - 8 73 25 21 F. 76 19 - 2 2 12 14 27 Motor vehicle accidents - M. 15 1 - 4 3 4 1 2 - F. 10 - - 1 4 3 - - 2 All other accidents M. 20 1 1 - 3 7 4 1 3 F. 14 1 Suicide - 1 - 1 4 7 - M. 13 - - 3 3 - - 5 2 Homicide and operations of war F. 19 - 2 1 - - 6 8 2 - M. - - - - - - - - F. 1 - 1 - - - - - - Births Live Births Still Births Total M F M F M F Legitimate Illegitimate 1,501 1,483 16 22 1,517 1,505 178 190 5 2 183 192 Total 1,679 21 24 1,700 1,697 1,673 3,352 45 3,397 Medical Examinations carried out by the Medical Officer of Health or his Deputy Officers for admission to the Permanent Establishment 21 Officers for admission to the Unestablished Staff 12 Employees for admission to Sick Pay Scheme 275 Employees for admission to Permanent Establishment 69 hmployees absent from duty owing to sickness,. 577* * In addition, 654 who were requested to attend failed to do so. Cremation Certificates No. of cremations authorised during the year by the Medical Referee or his Deputy 2,128 Water Certificates No.of Water Certificates issued 55 No. of dwellings concerned 278 Drainage and Sewerage No.of drainage applications received 300 Length of sewers reconstructed 5,130 ft. No.of brick gullies replaced by pot gullies 71 No.of defective pot gullies renewed 3 No. of new pot gullies installed 9 Public Cleansing Amount of house refuse collected 42,299 tons Amount of trade refuse collected 1,011 tons Examination of Water from the Council's Swimming Baths Bacteriological examination Chemical examination No. of Samples No. Satis. No. of Samples No. Satis. Camberwell Front Swimming Bath 5 5 5 5 Camberwell Rear Swimming Bath 12 12 12 12 Dulwich First Class Swimming Bath 5 5 5 5 Dulwich Second Class Swimming Bath 12 12 12 12 Total 34 34 34 34 In addition, water from the Swimming Bath at Mary Datchelor Girls' School, Camberwell Grove, was chemically and bacteriologically examined on four 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) 4 4 Rag flock (loose) 1 1 Woollen mixture felt 1 1 Sized cotton wadding 2 2 Cotton felt (new) 6 5 Coir fibre 2 2 Coir fibre (pad) 1 1 Feathers 1 1 Totals 18 17 One sample of new cotton felt failed to meet the requirements of the Rag Flock and Other Filling Materials Regulations, 1961, in respect of the trash content. The test figure for this sample was 7.7%; the permitted figure under the Regulations is 7.5%. Four further samples of this new cotton felt were taken and found to be satisfactory. Offensive Trades Type of Business No. on Register Skin dressers 3 Soap boilers 1 Total 4 Pet Animals Act, 1952 No.of licences issued - No. of licences renewed 10 Total No.of pet shops licensed 10 Pharmacy and Poisons Act. 1933 No.of applications received for registration 12 No.of applications received for renewal of registration 142 London County Council (General Powers) Act, 1954 No,of hairdressers and barbers premises registered 137 ATMOSPHERIC POLLUTION, 1961 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, 1961 Average Concentration of Smoke in Milligrams Per Hundred Cubic Metres Apparatus Installed at Town Hall and 475 Lordship Lane TOWN HALL 475 LORDSHIP LANE Sanitary Inspection of the Area No.of complaints received 3,254 Summary of work carried out during the year 1961 Inspections: - Nuisance inspections 3,59 3,598 Offensive trades 81 Smoke observations 279 Drainage, new and existing 10,985 Overcrowding 650 Factories and workplaces 1,655 Outworkers' premises 584 Rag dealers 94 Infectious and other diseases 18 Verminous premises and persons 249 Aged and infirm persons 62 Common lodging houses 32 Conveniences, public and private 373 Heating Appliances (Fireguards) Act, 1952 182 Rent Act, 1957 108 Shops Act 1,520 Hairdressers and barbers 463 Voluntary work 233 Inspections not defined 1,915 Re-inspections 13,430 Total inspections 36,511 Works supervisied Tests applied to drains (existing premises) 1,403 Drains found defective 155 Drains totally reconstructed 22 Drains repaired or partially reconstructed 1,004 Tests applied to drains (new buildings) 2,378 Drains constructed 1,693 Total works supervised 6,655 Description of sanitary improvements ordered during the year Cleanse and repair walls and ceilings 250 Repair roofs, gutterings, etc. 367 Abate dampness 529 Repair stoves, fireplaces and coppers 46 Repair windows, sashlines, sills, etc. 235 Repair flooring, stairs, doors, etc. 172 Provide sufficient light and ventilation 10 Provide dustbin 35 Remove offensive matter 50 Provide or repair yard paving 12 Provide or render accessible water supply 10 Cleanse, cover or render accessible water cistern 1 Repair water pipes and fittings 31 Clear premises of vermin - Cleanse or repair water closets and flushing apparatus 180 Repair or clear defective or obstructed drains 35 Repair soil pipes, waste pipes, sinks, etc. 63 Abate nuisances caused by animals improperly kept 2 Miscellaneous 73 Total repairs and improvements ordered 2,101 SUMMARY OF NOTICES SERVED, 1961 Intimations, Public Health (London) Act, 1936 Byelaws, etc. Statutory'Notices, Public Health (London) Act, 1936 1,026 Byelaws, etc. 548 London County Council (General Powers) Act, 1955 275 Public Health (London) Act, 1936 (Part II) 67 Section 8, Housing Act, 1957 30 Clean Air Act, 1956 1 No.of Summonses issued 73 Factories Act, 1961. 1.- INSPECTIONS, 1961 Number on Register Number of Premises Inspections Written Notices Occupiers Prosecuted Factories in which Sections 1,2,3,4 and 6 are to be enforced by Local Authorities 342 178 - 5 Factories not included above in which Section 7 is enforced by the Local Authority 31 955 985 - Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers premises) 41 5 - - Totals 1,338 1,168 36 - 2.- CASES IN WHICH DEFECTS WERE FOUND, 1961 No. of cases in which defects were Number of cases in which prosecutions were instituted Referred Found Remedied Particulars To H.M. Inspector By H.M. Inspector Want of cleanliness 1 - - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors - - - - - Sanitary (a) insufficient 3 4 - - - (b) unsuitable or defective 33 21 - - - (c) not separate for sexes 4 2 - - - Other offences against the Act (not including offences relating to outwork) 1 - 19 10 - Total 60 33 - 5 - Summary of Outworkers classified by Trades. Artificial flowers 3 Lampshades 22 Buttons 1 Toys 2 Cardboard boxes 67 Wearing apparel 226 Carding 1 Weaving 1 Christmas stockings & crackers 7 Household linen 4 Total 334 Summary of work of the Rodent Control Staff No.of complaints received 1,232 No.of inspections 4,969 No.of Operators' calls 9,982 No.of private premises baited 1,417 No.of business premises baited 183 No. of baits laid 6,684 Vermin and Scabies ATTENDANCES AT CLEANSING STATION Vermin Scabies Male Female Total Male Female Total Adults 47 3 50 22 20 42 Children 26 54 80 45 59 104 Total 73 57 130 79 146 67 Disinfection RETURN OF WORK CARRIED OUT BY DISINFECTING STAFF Notified Infectious Diseases Other Diseases Miscellaneous Vermin Total all Cases Rooms disinfected Lots of bedding disinfected 10 3 1,024 59 1,198 106 132 32 32 12 Total visits 141 18 3,674 534 4,367 Number of articles disinfected by steam 1,423 Number of articles disinfected by formalin 823 Number of books disinfected 272 Number of towels washed 2,990 Number of soiled articles washed 11,437 Number of overalls washed 105 Number of covering sheets washed 172 Beds and mattresses destroyed 163 Miscellaneous articles destroyed 570 Weight of tons cwts. qtrs. lbs. Unsound foods destroyed 48 2 3 7 Hospital bedding, etc. disinfected 1 0 1 0 Furniture and effects destroyed 98 15 3 0 Dead animals destroyed - 19 0 0 Hospital dressings etc. destroyed - 17 0 0 Wood chips from workshops destroyed - 15 0 0 Miscellaneous articles destroyed 13 11 3 0 Total 164 1 2 7 54 Bacteriological Reports on Samples of Swimming Bath Waters taken throughout the Year. Dulwich Baths First Class Bath Second Class Bath Plate count yeastrel agar 48 hrs. 37°C. aerobically colonies per ml. Probable No. of coliform bacilli MacConkey 48 hrs. 37°C. colonies per 100 ml. Plate count yeastrel agar 48 hrs. 37°C. aerobically colonies per ml. Probable No. of coliform bacilli MacConkey 48 hrs. 37°C. colonies per 100 ml. January - — 2 0 February - - 0 0 March - - 1 0 April - - 1 0 May 5 3 1 0 June 0 0 1 0 July 34 0 2 0 August 0 0 0 0 September 1 0 0 0 October November December 0 0 0 - - - - - - 0 0 0 Camberwell Baths Front Bath Rear Bath Plate count yeastrel agar 48 hrs. 37°C. aerobically colonies per ml. Probable No. of coliform bacilli MacConkey 48 hrs. 37°C. colonies per 100 ml. Plate count yeastrel agar 48 hrs. 37°C. aerobically colonies per ml. Probable No. of coliform bacilli MacConkey 48 hrs. 37°C. colonies per 100 ml. January - - 0 0 February 3 - - 0 March - - 2 0 April - - 0 May 0 0 0 1 0 June 1 0 4 0 July 3 0 0 0 August 0 0 1 0 September 0 0 0 0 October 0 - - 0 November - - 1 0 December - - 0 0 HOUSING Record of work of Housing Inspector, 1961 Inspections Re-inspections Total Clearance areas 45 234 279 Individual unfit Section 9 - - - Section 16 58 67 125 Underground rooms and parts of premises Section 18 4 320 324 Total 107 621 728 Housing Statistics, 1961 1. Inspection of Dwelling Houses daring the Year:- (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Act) 3,869 (b) Number of inspections made for the purpose 17,920 (c) Number of dwelling-houses found not to be in all respects rasonably fit for human habitation 2,830 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 446 3. Action under Statutory Powers daring 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 548 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By owners 1,593 (b) By Local Authority in default of owners 4 (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 9 (b) By Local Authority in default of owners Nil (2) Houses demolished as a result of formal or informal procedure under Section 17 3 (3) Houses closed in pursuance of an undertaking given by the owners under Section 16 and still in force Nil (4) Parts of buildings closed by Closing Orders (Section 18):- (a) Underground rooms Nil (b) Other rooms 1 (5) Undertakings not to use parts of buildings for human habitation accepted:- (a) Underground rooms Nil (b) Other rooms 1 (6) Houses demolished under Section 42 68 (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) 2 (4) Closing Orders determined 5 (5) Closing Orders revoked and Demolition Orders made 1 Certificates of Disrepair No. of applications for Certificates of Disrepair 38 No.of Undertakings received from landlords 20 No. of Certificates of Disrepair issued 15 No.of Certificates of Disrepair refused 2 No.of Certificates of Disrepair cancelled 31 INFECTIOUS DISEASES 1961 SUMMARY OF NOTIFICATIONS RECEIVED AND DEATHS FROM THESE CAUSES AMONG NOTIFIED CASES Disease No. of Notifications Treated in Hospital Found not to be suffering from the disease Deaths of Notified Cases Age Distribution of Notifications Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and upwards Scarlet Fever - 1 4 6 6 22 7 2 3 - - - 51 - - - 17 - 6 15 12 - Whooping Cough 91 11 28 - 2 - - - - - (1) Poliomyelitis & Polioencephalitis 1 1 - 2 2 - - - - - - - - - - - Measles 2741 5 97 398 430 383 1056 37 7 16 4 1 312 *6 1 - Diphtheria 15 22 *6 1 - 2 14 4 - 1 1 - - - - - Pneumonia (Acute Influenzal 8 1 - - 1 1 3 3 - - - - - - - - ( Acute Primary 26 3 1 1 - 1 3 4 11 4 1 - - - - - 30 6 18 4 3 5 1 1 (2) Dysentery 2 - 1 3 5 5 - - Typhoid & Paratyphoid Fever - - - - - - - - - - - - - - - - - Erysipelas 9 1 - 1 1 1 5 1 - - - - - - - (3) Meningococcal Infection 6 1 - 1 1 1 6 1 1 - - - - - - - 133 (4) Puerperal Pyrexia 139 - - - - 16 110 12 1 - - - - - - Ophthalmia Neonatorum 3 1 3 - - - - - - - - - - - - - Scabies 11 - - 1 5 1 3 - - 1 - - - - - - Totals 173 24 111 332 451 56 27 18 3139 1 422 406 1131 29 16 140 "These were not clinical cases, but were found to be harbouring the diphtheria organism ('carriers'). (1) Two cases of Camberwell residents occurred in hospitals outside the Borough and were notified to the medical officers of health for the respective boroughs. (2) Includes one case of a non-resident and one case of a Camberwell resident which occurred in a hospital outside the Borough. (3) Includes three cases of Camberwell residents that were diagnosed in hospitals outside the Borough and were notified to the Medical Officer of Health for those Boroughs. (4) Includes 36 cases of non-residents occuring in hospitals in this Borough, also four cases of Camberwell residents that occurred in hospitals outside the Borough. FOOD POISONING Annual Return of cases of Food Poisoning, 1961 (a) Food poisoning notifications (corrected) as returned to R.G. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total 6 6 16 4 32 (b) Cases otherwise ascertained - - 10 10 - (c) Symptomless excreters - - - - - (d) Fatal cases - - - - - 2. Particulars of outbreaks Agent Agent identified: — (a) Chemical poisons (b) Salmonella (c) Staphylococci (inc. toxin) (d) Cl. Botulinum (e) Cl. Welchii (f) Other bacteria No.of outbreaks Family outbreaks Other outbreaks - - - - - - - - 1 - - - No. of cases Notified Otherwise ascertained - - - - - - - - 10 - Total No. of cases - - - - 10 - - - Totals - 1 - 10 10 Agent not identified 5 - 16 - 16 3. Single cases No. of Cases Total No. of cases Notified Otherwise ascertained Agent Agent identified: (a) Chemical poisons - - - (b) Salmonella: Typhimurium 2 - 2 Newport 1 - 1 (c) Staphylococci (inc. toxin) - - - (d) Cl. Botulinum - - - (e) Cl. Welchii - - - (f) Other bacteria - - - Totals 3 - 3 Agent not identified 13 - 13 Tuberculosis TABLE SHOWING SEX AND AGE DISTRIBUTION OF ALL PRIMARY NOTIFICATIONS AND DEATHS FROM TUBERCULOSIS DURING 1961. Deaths - Age Periods Notifications Pulmonary Nonpulmonary Pulmonary Nonpulmonary Male Female Male Female Male Female Male Female 0- 1 yr. - - - - - - - - 1 - 5 " 2 3 4 1 - - - - 5 - 15 " 2 - 1 - - - - - - 15 - 25 " 10 18 3 3 - - - 1 1 - 1 25 - 35 " 9 11 - - 12 9 - - - 35 - 45 " 1 3 - 2 - 3 3 1 45 - 55 " 29 - - 55 - 65 " 17 3 - - 3 - - - 2 9 - 65 and over 16 4 1 - - 1 Totals 95 52 9 17 2 - 9 - After correction for inward and outward transfers. TABLE SHOWING NOTIFICATIONS AND DEATHS, TOGETHER WITH THE ESTIMATED POPULATION DURING THE PAST FIVE YEARS Notification Rate per 1,000 Population No. of Deaths Death Rate per 1,000 Population Year Estimated Population No. of Primary Notifications 177,700 240 1.3 26 0.14 1957 193 1.1 32 0.18 1958 177,300 0.08 1959 176,100 162 0.9 14 0.10 175,020 183 1.0 18 1960 0.9 20 0.12 1961 173,980 165 RETURN OF VISITS - INFECTIOUS DISEASES AND OLD PERSONS Scarlet Fever Scabies Diphtheria Smallpox Other Diseases Aged and Infirm Persons Miscellaneous Total Visits Food Poisoning Dysentery Poliomyelitis Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts 64 18 56 7 10 5 35 - 10 3 74 401 - 27 20 22 837 494 2,083 Food and Drugs Adulteration Summary of Samples obtained for examination Number examined Number adulterated etc. Percentage of adulteration Formal Informal Formal Informal Total Formal Informal Total 471 905 2 6 8 0.46 1.27 434 Particulars of the adulterated samples and the action taken are set out on page 63. Registered Purveyors of Milk Distributors of milk in the Borough 226 No.of pre-packed licences issued 226 Results of Tests Methylene Blue Test Phosphatase Test Turbidity Test Designation Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 92 - 94 - - - Tuberculin tested pasteurised - - - 28 29 - Tuberculin tested - 2 - - - - Sterilised - - 19 - - - Samples of milk taken in course of delivery to Hospitals and Schools:- Methylene Blue Test Phosphatase Test Chemical Test Hospitals 34 37 37 Schools 54 54 87 All the above samples proved to be satisfactory. Ice Cream Summary of samples submitted for Methylene Blue Test and Chemical Examination. Chemical Examination Methylene Blue Test Satisfactory Unsatisfactory Grade I Grade II Grade III Grade IV Nil 32 9 46 5 9 Ice Lollies and water Ices Summary of samples submitted for examination. Bacteriological Examination Chemical Analysis Satisfactory Unsatisfactory Satisfactory Unsatisfactory Ice Lollies 21 - - - Cream Lollies 6 - - - 39 Assorted Lollies - - - 7 Water (Lemon) Ices - - - Article Bread Canned Corned Beef Canned Corned Eeef Canned Corned Beef Canned Corned Beef Canned Corned Beef Evaporated separated milk with vegetable fat. Bread Whether Formal or Informal Informal Informal Formal Formal Informal Informal Informal Informal Nature of Adulteration or Irregularity Contaminated with mouldy dough Lead - 8 parts per million Lead - 6 parts pers million - Lead- 10 parts per million Lead - 6.4 parts per million Lead - 5.5 parts per million Incorrectly labelled Contained insect fragments PARTICULARS OF ADULTERATED SAMPLES Observations As this loaf was baked at premises situated outside Camberwell, appropriate action was taken by the local Medical Officer of Health. Sample taken before Regulations became operative on 19th Sept. 1961. Fragments probably part of a small beetle. Result of Proceedings or other action taken - (The Ministry of Health informed (the Medical Officer of Health (that draft regulations were (proposing that the limit of (lead allowed to be present in (canned meat be raised to 10 (parts per million for an interim (period of two years. In the (circumstances therefore no (action was taken excepting that (in the case of Informal Samples (No.119 and No. 122, (taken from (bulk supplies) it was suggested (that this meat should not be (sold by retail but sent direct (to a meat paste manufacturers. Manufacturers agreed to introduce an entirely new label which would conform to the Regulations. Attention of baker drawn to matter. REGISTRATION OF FOOD PREMISES Premises registered under the provisions of Section 16 of the Food and Drugs Act, 1955, as at December 31st, 1961. Sale, manufacture and storage of ice cream 524 Preparation or manufacture of:- Potted, pressed, pickled or preserved meat 226 Potted, pickled or preserved fish 58 Potted, pickled or preserved other foods 36 Supervision of Food Premises Number of visits paid to each type of food premises by the Council's Public Health Inspectors. Type of premises No. of Inspections Bakehouses 238 Bakers and Confectioners 515 Butchers 676 Cooked and Preserved Meat Shops 891 Dairies and Milkshops 666 Fishmongers and Shell Fish Vendors 416 Fish Fryers 265 Fish Curers 219 Food Factories 208 Ice Cream Vendors 899 Public Houses 654 Restaurants and Eating Houses 875 Street Markets 736 Street Traders Food Stores 62 Other Food Premises 910 Total 8,230 Unsound Food No.of condemnation Certificates issued 1,895 65 Particulars of Unsound flood Destroyed Weight Total Weight Description Tons cwts. qtrs. lbs. Tons cwts. qtrs. Meat Venison 9 1 19 - Beef 9 3 9½ - Beef (trimmings) 1 0 - - Beef (steak) 25 - - - Lamb 3 0 27 - Pork 2 3 27¼ - Bacon 2 17 - - Sausages 1 - - - Babbits 1 0 - - Suet 14 - - - Pigs' kidneys 2 7¼ - - Ox liver 10¾ - - - Lambs' liver - 1½ - - Ham (sliced) 14 - - - Offal 8 1 7 3 - - - Poultry Chickens' offal 1 15 3 10 Turkeys - - 19 - 12 Chickens - - - Ducks 10¾ 1 16 3 - - - Vegetables Beans 4 9 0 12 Potatoes 5 0 1 26 Onions 15 2 0 6 9 3 - Fruit Prunes 2 0 16 - Currants 3 12 - - Apples 3 6 - - Bananas 10 3 3 - - - - Fish Skate wings 1 1 14 - Rock Salmon 1 0 1 2 - - - Tinned Foods Meat (Asstd) 3,833 tins 4 16 0 17¾ Ham 44 tins 3 2 0¼ - Vegetables (Asstd) 6,797 tins 2 17 0 23¾ Fruit (Asstd) 5,324 tins 0 15 8 24½ Milk (Cond. & Evap.) 1,425 tins 6 1 27¼ - Fish (Asstd) 1,006 tins 3 22¾ - 1 Rice (Creamed) 702 tins 6 0 12¾ - Cream 40 tins 19½ - - - Jam 9 tins 9½ - - - Marmalade 1 tin 2 24 1 1 - - - Miscellaneous Frozen foods (assorted), confectionery, rice, processed cheeses, butter margarine, cereals, jams, marmalade, pickles. sauces, chutney, mixed herbs, etc. 1 18 0 23¾ 1 18 0 Gross Weight 35 19 3 Summary of work of Food Inspector Complaints received 45 Complaints found to be justified 27 Visits: - Bakehouses 8 Bakers and Confectioners 31 Butchers 44 Cooked and Preserved Meat 17 Dairies and Milkshops 6 Fish Curers - Fish Fryers 8 Fishmongers 15 Food Factories 70 Public Houses 16 Restaurants and Eating Houses 31 Shell-fish Vendors 7 Street Markets 347 Street Traders' Food Stores - Other Food Premises 198 Inspections not defined 247 Re-inspections 4 Food surrendered 253 Foodstuffs certified for export 1 Food condemnation certificates issued 1,895 HEALTH AND WELFARE SERVICES Statutory Authorities and Voluntary Organisations (See Index for details) Authority or Organisation T el. No 1. London County Council Divisional Health Office No.7, 29 Peckham Road, S.E. 5. 2. London County Council Hop. 1772 3. London County Council, New.7771 Children's Department, 219 Queen's Road, S.E. 15. London County Council, Emergency 999 Ambulance Service Urgent cases Wat.6000 Patients for whom hospital admission has been arranged. Wat.3311 5. Camberwell Borough Council Rod.6311 Public Health Department, Town Hall, Peckham Road, S.E. 5. 6. Camberwell Borough Council Rod. 6311 Housing Department, 32/34 Peckham Road, S.E.5. 7. National Assistance Board North Camberwell: - 1/15 Bournemouth Road, S.E. 15. New.2261 South Camberweĺ:- 3 Blenheim Grove, S.W.15 New.0420 8. Ministry of Pensions and National Insurance S.E.1.part):- 202 Old kent Road,S.E.22:- Rod.6001 5.E.5., S.E. 15 and 5.E.22:- 1/15 Bournemouth Road, S.E. 15. New.2261 S.E. 19 and S.E.24:- 250 Norwood Road, S.E.27. Gip.4241 S.E.23:- 9/19Rushey Green, S.E.6. Hit.6144 9.Hospitals (General, Mental and Geriatric) Dulwich Hospital, New.4333 East Dulwich S.E.22. King's College Hospital, Denmark Hill, S.E.5. pri.6222 Maudsley Hospital, Denmark Hill, S.E. 5. Rod.6333 New Cross General Hospital, Avonley Road, S.E.14. New 4380 St. Francis' Hospital Constance Road, S.E. 22. p ri .9941 Authority or Organisation Tel.No. 9. Hospitals (continued) St. Giles' Hospital, Rod.4221 St. Giles' Road, S.E.5. Emergency Bed Service H0p.7181 10. Old People's Welfare Association Rod. 6106 Central House, Peckham Road, S.E. 5. 11. Enployment Scheme for the Elderly Rod. 4207 Cambridge House, Camberwell Road, S.E.5. 12. Women's Voluntary Services Rod. 5295 Central House, Peckham Road, S.E.5. 13. Family Welfare Association Rod.5561 Central House, Peckham Road, S.E.5. 14. Soldiers' , Sailors' and Airmen's Families Association Rod.5095 15. British Legion H.Q.:- 49 Pall Mall, S.W. 1. Whi.8131 Dulwich Branch: - 97 Barry Road, S.E. 22. New.1005 16. British Red Cross Society New. 4512 160 Peckham Rye, S.E.22. 17. Union of Girls' Schools Settlement New. 1823 Staffordshire Street, S.E.15. 18. National Society for the Prevention of Cruelty to Children Rod.4741 14 Talfourd Road, S.E. 15. 19. Alcoholics Anonymous F1a.9669 11 Redcliffe Gardens, S.W. 10. (Camberwell Scheme at present being formed. Chairman:- Rev. McGregor Lewis, Rod.4915 St. Mark's Vicarage, Cobourg Road, S.E.5.) 20. Salvation Army „ , Men:- 110 Middlesex Street, E.1. Bis.6831 Women:- 220 Mare Street, E.8. 21. Invalid Children's Aid Association Rod.0011 Central House, Peckham Road, S.E. 5. 22. London Marriage Guidance Council Lan.1087 96a New Cavendish Street, W.1. 23. London Probation Service Lambeth Magistrates' Court, Re.4721 1 Renfrew Road, S.E.11. Juvenile Courts:- _ , 8a Camberwell Green, S.E.5. Rod.6065 348 Camberwell New Road, S.E.5 Bri.1139 11 Grove Lane, S.E.5. Rod.9041 HEALTH AND WELFARE SERVICES INDEX Service: Index No.of Authority or Organisation Alcoholics 19 Ambulance Service 4 Blind Persons, Welfare of 2 Children - Adoption of 3 Child Guidance Clinics 1 Child Welfare 1 Cruelty, Prevention of 18 Day nurseries 1 Deprived or Neglected Children, Care of 3 Dental treatment 1 Foster Mothers and Child-Minders 1 Health Visiting 1 Invalid Children 21 Probation Officer 23 School Health Service 1 Family Welfare 12, 13, 14, 15, 17 Family Planning 22 Housing - Applications for 6 Defects 5 Disinfection and disinfestation 5 Drainage and sanitation 5 Fitness for habitation 5 Overcrowding 5 Recommendations on medical grounds 5 Repairs 5 Rodent Control 5 Infectious Diseases - Control of 5 Disinfection 5 Notification of 5 immunisation 1 Vaccination 1 Marriage Guidance 22 Maternity - Ambulance service 4 Ante- or Post-Natal Clinics 1 Dental treatment 1 Emergency Obstetric Unit 4 Home Helps 1 Mothercraft classes 1 Mental Health 1 Old People - Appliances and adaptations in the home Bathing centre 5 Chiropody 1, 10 Clubs 10. 17 Compulsory removal 5 Disinfestation 5 Employment scheme 11 Financial assistance 7 Fireguards, provision of 1 Health visiting 1 Holidays 10 Home Bathing 5 Home Helps 1 Service: Index No.of Authority or Organisation Old People (continued) - Home Nursing 1 Housing 6 Meals 10, 12, 17 Night sitters-in 1, 10 Pensions 8 Recreation 1, 10, 17 Residential accommodation 2 Visiting 5, 10, 12, 17 Welfare 1, 2, 5, 10 Persons in need - Financial assistance 7 Homeless persons 2, 20 Reception Centres 2 Re-establishment Centres 7 Rehabilitation Units 2 Physically handicapped persons - Appliances and adaptations in the home 7 Disability Pensions 8 Welfare arrangements 2 Probation Service 23 Rodent Control (rats and mice) 5 Sickness - Ambulance Service 4 Home Helps 1 Home Nursing 1 Hospitals 9 Medical practitioners 8 National insurance payments 8 Night sitters-in 1 Recuperative holidays 1 Sick room appliances, loan of 16 Vermin eradication (bugs, lice, fleas, etc.) 5 TABLE OF CONTENTS Page Clean Air .. .. 10 Deaths from other causes 41 Food and Drugs 13 Health Education 22 Housing 15 Infectious Diseases 31 Parents' Group 24 Public Health Committee - Constitution 4 Report of the Consultant Chest Physician 29 Sanitary Circumstances 6 Staff of the Public Health Department 5 Venereal Diseases 37 Welfare of Old People 19 INDEX TO STATISTICAL APPENDIX Atmospheric pollution graphs 50-51 Births 47 Certificates of Disrepair 57 Cremation Certificates 48 Deaths Causes and Age Distribution 46-47 Disinfection 54 Drainage and Sewerage 48 Factories Acts 53 Food & Drugs Adulteration 61 Adulterated Samples Table 53 Food Inspector - Return of Work 69 Food Poisoning 59 Food Premises - Registration and Supervision 64 Hairdressers and Barbers 49 Health & Welfares Services 67-70 Housing Inspector Return of Work 56 Housing Statistics 56 Ice Cream and Lollies 62 Infectious Diseases 58 Infectious Diseases Visitors - Return of Work 60 Medical Examinations 47 Milk - Registered Purveyors 61 Results of Tests 61 Offensive Trades 49 INDEX TO STATISTICAL APPENDIX - continued Page Outworkers 54 Pet Animals Act 49 Pharmacy and Poisons Act 49 Public Cleansing 48 Rag Flock & Other Filling Materials 49 Rodent Control - Return of work 54 Sanitary Inspection of the Area 52 Statistics - Summary of 45 Swimming Bath Water - Examination of 48 & 55 Tuberculosis 60 Unsound Food Certificates 64 Unsound Food Destroyed 65 Vermin and Scabies (Attendances) 54 Water Certificates 48