4376 CAM 58 II METROPOLITAN BOROUGH OF CAMBERWELL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1963 H.D.CHALKE O.B.E. (Mil.) T.D., M.A.. M.R.C.P., D.P.H. 1 PUBLIC HEALTH DEPARTMENT, TOWN HALL, CAMBERWELL, S.E.5 August, 1964 o the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Camberwell R. MAYOR, ALDERMEN AND COUNCILLORS, It gives me great pleasure to present my Annual Report or the year 1963. There were no noteworthy variations in the vital statistics; both the birth and death rates increased slightly, but the infant mortality rate fell from 23.9 in 1962 to 20.2 last year. The low tuberculosis death rate of 1962 was maintained, but the number of deaths from lung cancer again increased (132 compared with 126) and special attention is drawn to this matter in the body of this Report. Infectious diseases did not present any serious problems other than the expected biennial outbreak of Measles and the unsatisfactory position in relation to ve nereal diseases. Additional responsibilities devolved upon the staff of the Public Health Department in connection with the distribution of 'Meals on Wheels'. This service, which fulfils such a great need among old people, has continued to e xpand and each of the four vans is used to its maximum capacity daily. Particular attention was given during the year to a survey of houses in multiple occupation. Details are given in the statistical section of this report of the action taken by the Council under the Housing Act, 1961, and the Regulations made thereunder in respect of premises where squalid conditions were found to exist. 2 The Anti-Smoking Clinic continued to operate throughtout the year, and there is evidence that a substantial proportion of those who attended have benefitted th e reby. Propaganda against cigarette smoking was intensified, particularly in schools where the campaign appears to be achieving considerable success. Health education activities continued to e xpand especially in co-ordinating work with outside bodies including churches, and opportunities were gi ven for speaking on public health matters to numbers of audiences of different types: the Camberwell Council on Alcoholism and the St. Giles' Centre (formerly the Camberwell Samaritans) were active and co-operative. It is unfortunate that the Smoke Control programme which had been proceeding so smoothly and effici ently, was disrupted by changes in the availability of smok eless fules, but it is hoped that these difficulties will soon be overcome and the Council's efforts to reduce atmosph eric pollution will again successfully progress. The work of the Department was again bedevill ed by staff shortages; the public health inspectors have been below full establishment for several years now, and this has rendered more difficult the proper training of student inspectors. Nevertheless, Camberwell has maintained good record for training inspectors and it is hoped that this and similar schemes in other boroughs will i n time resolve the acute shortage of these technical officers the London area. In conclusion, I should like to express my appreciation for the encouragement and assistance I have at all times received from the members of the Council, the other chief Officers and their staffs. I would also like to say thank you to the staff of the Public Health Department whose hard work and devotion to duty, often in very diff icult circumstances, have played such an outstanding p art in maintaining the health of the Borough. I am, Mr. Mayor, Aldermen and Councillors, Your Obedient Servant, H.D. CHALKE, Medical Officer of Health. 3 PUBLIC HEALTH COMMITTEE Constitution at the end of 1963 Chairman: Councillor F.J. Francis Vice-Chairman: Councillor Mrs. R.E. Pritchard Members: Alderman G.S. Burden, B.Sc. (Econ.) Alderman Mrs. J. Burgess, J.P. Councillor Mrs. A. Blosse " Mrs. E.S. Daymond " G.A. Gilbert " S.H. Gilbert " Mrs. A. Inman " Mrs. B.E. Knight " F.E. Lee " Mrs. M.U. Nelson " F.E. Rehder " C.T. Robinson " Mrs. F.E. Sampson " Mrs. M.M. Tarrant " Miss D.M. Walker Ex-Officio: Councillor H.G. Lamborn, J.P., L.C.C., Mayor of Camberwell Councillor R.W. Brown, J.P., A.M.I.E.D., GRAD.I.E.E., Leader of the Council Councillor J.F. Cullingham, J.P., F.C.A., F.C.I.S., Leader of the Opposition Councillor A.T.R. Robinson, M.A. LL.B., Vice-Chairman, Finance Committee 4. Staff of the Public Health Department (as at 31.12.63) H.D. Chalke, O.B.E.(Mil.), T.D., M.A., M.R.C.P., M.R.C.S., D.P.H. Medical Officer of Health: Deputy Medical Officer of Health: GMarjorie E. Watts, M.B., B.S., D.R.C.O.., D.P.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: C.H. Medland, a. Sampling Officer: H.R. Weaver, a. Food Inspector: D.V. Watkins, a. Housing Inspector: (vacant) Smoke Control: A.G. O'Gilvie, a.c. J. Baillie, R. Hewston, W.Cumbers Inspector: Technical Assistants: Public Health Inspectors: F. Dray, a. c. Miss J. Harris, a. F. Duggins, a. H.M. Hough, a. G.A. Fraser, a. J.E. Millway, a. P. Frost, a. M. Stevenson, b. A. Gartside, D.P.A., a. H.F. Williams, a. E.C. George, a. c. (3 vacancies) Student Public Health Inspectors. F. Grace E. Pain M. Lawson W. E. Samuel Infectious Diseases and Old People's Visitors: Mrs. E.L.M. Falloon, S.R.N. Miss E.E. Brooks, S.R.N., R.F.N. Miss E.B. Collins, S.R.N. Senior Clerk: C. Burgess 5 Clerical Staff: P.A.S. Kirrage, D.M.A. Mrs. A.D. Dormer D. Danter A. Beare W. Everett Miss J. Jakes Miss E.M. Lawrence Miss E. Ponder Mrs. M. Findlay Miss B. Aslett (temp.) I. Elliott (temp.) Rodent Control: Rodent Officer W.H.G. Saunders, b. Rodent Investigator Mrs. M.J. Kenny Rodent Operators F.G. Hulbert, R. Humphreys, G. Marshall Mrs. E.M. Lloyd (part-time) Mrs. A. Grice (part-time) Meals-on- Wheels Service: Escorts (part-time) Mrs. D.D. Scam, Mrs. W.A. Bottomley Mrs. D. Smetham, Mrs. L.A. Morris Disinfecting and Cleansing Station: Formen Disinfector Vacant Stoker/Disinfector App aratus Attendant E. Manning Disinfectors M. Concannon, A.E.Kenny, T.W. Whitfield J.E. M. Dauguet (temp.) Motor driver E.W. Bowden Cleansing Station and Home Bathing Attendants Mrs. E.M. Norman, (one vacancy) Also Assistant Medical Officer, London County Counil, 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. 6 SANITARY CIRCUMSTANCES Water Supply The water supply to every dwelling house in the Brouht is provided direct from the mains of the Metro polition Water Board, and at no time during the ye ar was it found to be unsatisfactory either in quality quantity. Drainage and Sewerage Applications for approval in respect of the drainage of new buildings or the reconstruction of existing numbered 210 during the year. These works were c arried out under the supervision of the Council's Public Health Inspectors. The programme of sewer reconstruction, which is under the control of the Borough Engineer and Surveyor, proceeded with the relaying of 3,477 lineal f eet of sewers during the year. Vacant Sites Nuisances arising from the 'dumping' of refuse on vacant sites continued to present considerable P r oblams. Although the Borough Engineer and Surveyor arrang ed for the prompt removal of offensive material from these sites on a number of occasions at the request of the M edical Officer of Health, deposits of refuse of all kinds rapidly accumulated again on many of them. Despite the vigilance of the Council's Officers it was not possible to di scover the identity of any of the persons responsible. Nuisances from Noise There were several complaints during the year of a nuisance of noise from industrial premises. In every case representations were made to the management who p r oved to be most co-operative, and undertook all reasonable staps to reduce noise to a minimum. It is inevitable that where factories are situated in close proximity to dwelling houses complaint will continue to be received from time to time. The full solution to this problem is linked with wise town Planning for tomorrow. In the meanwhile, the present pol icy of 7 seeking the co-operation of the factory management in making their processes and activities as noiseless as Possible must be continued. Above all, the prevention of nuisances from noise demands a greater realisation by the members of the public of their responsibilities as good citizens. Hie promotion of proper attitudes is a part of health education. This will also bring about a better understanding of the problems of noise prevention in this Age. In July, 1963, the Committee on the Problem of Noise (The Wilson Committee) published its report which contained suggestions and recommendations for further research, for ?eduction and for statutory control of noise. Arising from this the Council decided to support a recommendation from the Kensington Borough Council that the Metropolitan Boroughs' Standing Joint Committee be asked to make representations to the Minister of Housing and Local Government for the provision of legislation to deal with noise from industry, from construction and demolition sites and from road works. Radioactive Substances Act 1960 This Act, which came into operation on 1st December 1963, requires persons who keep or use radioactive material to register with the Minister of Housing and Local Government and to obtain authorisation from him for the accumulation or disposal of radioactive waste. Copies of any certificates issued in this respect are furnished to the Local Authority concerned. Copies of six such certificates were received up to the end of the year in respect of Premises in Camberwell. 8 HOUSING Houses in Multiple Occupation In spite of the shortage of inspectorial staff, intensive efforts were made to take advantage of the new legislation to deal with squalid conditions in houses in multiple occupation. It is gratifying to report that in 139 such premis es unsatisfactory conditions were remedied as a result of informal approaches to the owners. The tact and diplomacy exercised by the Officers in bringing this about i s a matter for congratulation. In 40 instances, however, it was necessary to r eport to the Public Health Committee with a view of statutory action being taken, and in 28 cases a Management Order was made under the provisions of Section 12 of the Housing Act 1961. In addition, Directions were made in respect of 28 of these houses under Section 19 of the same act, limiting the number of persons permitted to occupy the premises in their existing condition. Slum Clearance No representations were made for slum clearanc e purposes during the year, but these activities wer e resumed early in 1964. Half of the houses in the Council 's five year slum clearance programme for 1961/5 had already been dealt with, leaving only 64 houses to be represented during 1964 and 1965. Priorities for Rehousing The number of applications for alternative housing accommodation supported by medical certificates wh ich were referred to the Medical Officer of Health was 263 compared with 232 the previous year. Each case w as investigated in consultation with the family doctor in accordance with the scheme of Medical Priorities wh ich has been operating so successfully in this Borough f or the past few years. The following table shows the medi cal conditions and the recommendations made in each category. 9 Medical Condition *Category 1 Category 2 Category 3 Category 4 Tuberculosis 6 9 - 2 Bronchitis and/ or Asthma 15 20 14 2 Other Respiratory conditions 1 1 - 1 Heart Conditions 4 9 4 - Physical disabilities (bad legs, etc.) - 1 1 3 Nervous disorders 2 19 27 7 Rheumatic conditions 2 14 16 3 Other Medical conditions 14 19 40 7 Category 1 = 'Most Urgent'; 2 = 'Urgent'; 3 = 'Soon' and 4 = 'No Priority' Included in the above table were 74 recommendations for the provision of ground floor accommodation or accommodation with a lift. This represents 28% of the total recommendations and is an indication of the high demand for accommodation of this type. Most of these recommendations were for aged persons who find difficulty in negotiating stairs. One hundred and two families, whose applications had been recommended for priority on medical grounds were rehoused during the year. It is a pleasure to record the close co-operation given by general practitioners and hospital staffs in the successful working of this scheme. Immigrants There has been considerable improvement in the immigrants' way of living in this Borough, and now few matters of public health importance are brought to the notice of the Public Health Department. The majority of immigrants are West Indians. Housing problems are, however, still considerable and a good deal of overcrowding is known to be present. Frequent change of residence is common among coloured immigrants and it is sometimes difficult to ascertain the relationship between occupants of their houses. The question of the shared lavatory where there is joint occ upation by white and coloured people still gives rise to some difficulties but apparently to a diminishing extent. 10 SMOKE CONTROL Smoke Control Areas The Council's arrangements for the establishment of smoke control areas proceeded according to the approved programme. Orders in respect of Areas 4 and 4A came into operation on Ist October 1963, bringing the total smok econtrolled acreage to 1683 and involving 11,347 premises. On the 29th October, the Public Health Committee approved proposals for making a Smoke Control Order in respect of Area No.5 which comprises 3,745 premises in 146 acres. It was estimated that 5,400 tons of solid smokeless fuel would be required for this area, but the estimates for adaptations were based on those suitable for burning open fire coke (soft coke) which it was understood would be available in sufficient quantities. The Ministry of Housing and Local Government, however, subsequently referred back the order as they had sin ce been advised by the Ministry of Power that adequate supplies of open fire coke would not be available and suggested that the Council might wish to reconsider the matter in the light of Ministry of Housing and Local Government Circular 69/63. This Circular (dated 17th December 1963) drew attention to the changes in the availability of smokeless fuels which are anticipated as a result of rapid technological changes in the gas industry. It emphasised that sufficient supplies of solid smokeless fuels for use in 'improved' open grates will continue to be available to meet the needs of areas already subject to smoke control orders or where the orders have been confirmed but are not yet operative and that there are in most areas abundant supplies of hard coke suitable for use in openable stoves and with under floor draught open fires. It foll ows that in future smoke control areas will have to be plann ed on a different basis and that where little or no open fire gas coke is available it will be necessary to ensure that only appliances capable of using other smokeless fu els are installed. It was pointed out that gas, oil and electricity are becoming increasingly competitive in running costs with solid open fire fuels. Where electricity is chosen the installation of thermal storage space heaters should be encouraged and 11 because of the possible strain on the load, other forms of direct heating by electricity should for the present be discouraged. In view of this information, it became necessary to review the estimates for Smoke Control Area No.5, on the basis of providing appliances capable of burning hard coke, which are more costly. This has brought about a considerable delay, for reasons outside the control of the Council, in the progress of the Clean Air Programme, the benefits of which were shown during the fogs of last winter, but it is hoped that this will be no more than a temporary s etback. Atmospheric Pollution There are two volumetric instruments for measuring atmospheric pollution - one at the Town Mall and the other a t 475 Lordship Lane. The Department of Scientific and industrial Research selected both these stations to Participate in the national survey of atmospheric pollution a nd a research project involving studies in smoke and s ulphur dioxide pollution. For the latter project, threehourly samples of smoke and SO2 are recorded during Periods of persistant fog and the results are forwarded to the D.S.I.R. at Warren Spring Laboratory. Certain changes in the apparatus and techniques were necessary for this purpose in order to ensure greater accuracy and uniformity in the assessment of smoke and SO2 concentrations. For example, prior to 1963, all 'smoke stains' were recorded on filter papers held in one-inch diameter clamps by means of a five pound weight. These have now been replaced as follows:- (1) For normal week-day recordings - two inch diameter clamps. (2) For week-end recordings (two days) - four inch diameter clamps. In addition, all filter papers are now secured in screwdown, air tight clamps. On pages & of the statistical appendix there are graphs showing the readings obtained from these instruments during 1963, and for comparative purposes during 1959 - the year before the first smoke control order came into Operation in the Borough. It will be noted that the concentration of smoke shows a marked improvement. 12 In the last ten years emissions of smoke over th e whole country are reported to have fallen by 35%. In London during the same period smoke has decreased by 60%, and this reduction is attributed mainly to the establishment of smoke control areas. Industrial Smoke In recent years, a marked reduction in the emission of smoke from industrial establishments has been evident throughout the Borough. This has been brought about largely by the cordial spirit of co-operation which has been established between the Public Health Department and local industry. Many requests have been received for advice on combustion or smoke problems. There is now a successful tripartite association between the Department, local industry and the National Industrial Fuel Efficiency Service. Smoke Nuisances Complaints of nuisances from smoke other than from the chimney of a dwelling have resulted from open or closed incineration. Open incineration usually takes the form of an ordinary garden bonfire, or the burning of material i n the open for the reclamation of mineral matter as is often practised in car-breakers' and 'totters' yards. Closed incineration sometimes results in smoke being emit ted through a chimney (but not of a dwelling). These complaints at times involve not only smoke but also partly burned or charred material. These nuisances may be dealt with under Section 16 of the Clean Air Act, 1956, but it has not been necessary to take legal proceedings in any instance so far. A visit and a warning letter to the offender has always had t he effect of securing co-operation in the Council's efforts to clear the air of impurities. 13 INSECTS AND VERMIN During the year there were 115 attendances at the Disinfecting Station by persons requiring treatment for louse infestation. Apart from 7 cases of body-louse infestation (in males), the head louse was responsible, and as usual the majority of those affected were children 24 boys and 66 girls. Although there has been a marked fall in cases of pediculosis during the past ten years (from 694 in 1954 to 115 in 1963) it is to be deplored that this condition continues to exist at all in present day society in this country. Not only should standards of personal cleanliness and health knowledge make it impossible for any but occasional cases to occur, but unlike the old days when methods of treatment were not always satisfactory, the modern insecticides of which D.D.T. was the first, are fully effective. They have the Particular advantage of being persistent in their action. The head louse very soon spreads in families with poor health habits, and adults may reinfest children who have been detected at school and treated. Sharing of brushes and combs and, of course, infrequent washing of the hair contribute to this. It is hoped that there will be a rapid fall in cases in the near future. Body louse infestation, formerly a common complaint among vagrants, is fortunately seldom met with nowadays, but those affected are still those of no fixed abode. For these, the method of dusting with a persistent insecticide powder is efficacious. The need to treat a small number of cases of scabies each year continues and there is nothing to suggest that the incidence is decreasing. During the five years, 1959 to 1963 the average was 119; in the period 1954 to 1958 the average was 118. Scabies is another 'family complaint' with half the cases occurring in children. This is another condition which should have been eliminated ere now. Early diagnosis and prompt treatment are essential. Other Infestations An important part of the work of a public health department is concerned with the investigation and abatement of complaints of household nuisances from insects and other pests. During the year 557 rooms were disinfected following complaints of this nature. Apart from Dugs and fleas (which thanks to the modern insecticides are now far less frequent causes of annoyance than 14 formerly), the staff were called upon to deal with fli es, mosquitoes, beetles of many varieties, cockroaches, ants, fruit flies, clover mites and wasp's nests. Investigations were also carried out at the request of hospitals in connection with patients suffering from skin eruptions. In one such case a tiny blood-sucking mite found on budgerigars was found to be the culprit. With the removal of static water tanks, which in the early post-war years provided a ready breeding ground, the mosquito nuisance has much diminished. Fly breeding is also not as conspicuous as it was in the previous quinquennium. In 1954 the number of rooms disinfested was 1507; this may be compared with the figure of 557 during the current year. Rats and Mice The work carried out by the rodent control staff is shown on page. The number of complaints received has averaged about 1,200 over the past twelve years: there is little variation each year. About 1,000 of the complain ts relate to dwelling houses. During the past three y ea rs two thirds of the complaints relate to infestation by rats; one third by mice. The fact that the numbers show no evidence of falling, despite energetic treatment using modern techniques (one of which has been developed in the department by the Rodent Officer), may be accounted for by a combination of the following circumstances:- An increase in building land development and demolition of properties which causes a disturbance and scattering of rats and mice, e.g. from old drainage syst ems. The construction of modern buildings can provide harbourage for rodents possibly allowing them to explore the buildings. As a result of health education, householders are becoming more conscious of the need for prompt reference to the rodent control staff when there is evidence of infestation. There are topographical considerations in an area with ma n y large open spaces, hilly country, allotments and large gardens with rockeries and bankings. Cemeteries, railway embankments and disused railways can resdily harbour rats. (During the year rats in and around a disused railway embankment furnished a particularly difficult problem of control.) In a certain type of house and family, the usual pattern is reversed and two thirds of the complaints are of mice. Inadequate facilities for the preparation and 15 storage of food and less satisfactory standards of hygiene may be contributory factors. Despite the considerable problems which rodent control still poses, associated as they are with many factors some of which are mentioned above, the staff undertaking this work are tackling them energetically, making full use of up-to-date techniques. The co-operation of the public in this matter is also a valuable part of the system of control. Disinfection Not so long ago the principal work of a cleansing and disinfecting station was directed towards the control of infectious diseases. This entailed the disinfection of rooms at the termination of a notifiable disease, and the sterilisation of bedding, articles of clothing, books and so on. That the position has now changed will be evident from the following figures:- 1963 1954 Rooms disinfected 14 586 Lots of bedding disinfected 21 369 As the major infections have been brought under control terminal disinfection has been reduced to a minimum, but it has taken a little time for the public to understand that of far greater importance in any infectious condition is concurrent disinfection - the carrying out of simple Precautionary measures during an illness. Afterwards, People are encouraged to ventilate the rooms thoroughly, to cleanse with soap and water and to hang bedclothes in the open air. But for those who wish, the facilities of the disinfecting station are always available. The washing of soiled articles is now a major part of the work of the station. The 10,500 articles washed were almost entirely from the homes of the elderly. A significant item - peculiar to 1963, fortunately - is the drying of 720 articles from homes in which the pipes had burst. Finally, the incinerator destroyed 128 tons 13 cwt. of unsound food, furniture and other material, a proportion of it from other organisations. 16 CARE OF THE ELDERLY Camberwell was one of the first local authorities to take an active interest in the growing problems of the welfare of old people. From the start, the emphasis h as been laid on the need for a co-ordination of the efforts of the many statutory and voluntary bodies who have a part to play. Surveys of the home circumstances and the unmet need of the elderly conducted by the department and published, (1950, 1957 & 1959) provided essential information. Thi s knowledge enabled a progressive scheme to be built up which has aroused interest in other parts of the country and abroad. It has been a pleasure to exchange information on this subject with many visitors from other authoriti es and countries. The results of investigations of home accidents among old folk (also published) gave a guide to preventi ve measures. The finding that a third of old people had lost their sense of smell, and that another third had a marked impairment of this sense led to special efforts to prevent accidental coal-gas poisoning. These matters were the subject of a paper read by the Medical Officer of Health at the Convention on Accidents held by the Royal College of Surgeons during the year. The suggestion that local health authorities should provide fireguards on loan was made by this Council some years ago. The appointment of state registered nurses to undertake, inter alia, the visiting of old people, has proved of inestimable value. The care and welfare of the aged is becoming more demanding, imposing a steadily increasing responsibility on the local authority. In 1961, the number of visits made to old people by the Council's visitors was 837, whereas in 1962, this had increased to 1,409, and during the year under review the figure rose to 1,761. It will be appreciated that the amount of time spent on such visits varies very considerably according to the cir cum stances of the old person concerned and the duties are not limited to a purely domiciliary social visit. There are many occasions when help is needed which falls outside the normal scope of duty. For example, handicapped old P e ople have been collected from their homes and taken by the Visitors in their own cars to the U.G.S. Settlement to enable them to be taken away for a holiday. On one occasion an old man dying of cancer expressed a wish to see 17 the rhododendrons in Dulwich Park; the Visitor took him in her car. This was his first and last outing in many months and he was still speaking of it a few hours before he died which was only two weeks later. There are many other examples of the human approach to their duties which is such a commendable aspect of the visitors' work. The Visitors have close liaison with general practitioners, hospitals, the L.C.C., district nursing associations, the Camberwell Old People's Welfare Committee, and numerous other voluntary organisations, which involve them in various kinds of assistance to old people such as obtaining bedding and clothing, distributing food parcels, taking them to hospital for out-patient treatment, introducing them to old people's clubs and so on. These activities fulfil a very real need and are often instrumental in preventing, or at least delaying, the ultimate necessity for action under Section 47 of the National Assistance Act, 1948, to secure their compulsory removal to hospital. It was not necessary to take such steps in any instance during 1963. About the middle of the year the Council decided to increase the staff of Visitors from two to three. At this time the Council took over the 'Meals on Wheels' service from the Camberwell Old Peoples' Welfare Association. The service is expanding and is working efficiently. Meals on Wheels Following discussions between the London County Council and the Metropolitan Borough's Standing Joint Committee, it was agreed that with effect from the 1st April 1963, responsibility for exercising the powers contained in the National Assistance Act 1948 (Amendment) Act, 1962, should rest with the Metropolitan Borough Councils, and that the subvention P a id by the County Council towards the cost of meals for old people should cease as from that date. The meals kitchen at the U.G.S. Settlement, Staffordshire Street, was therefore taken over by the Town Clerk's Department, whilst responsibility for the distribution of the meals was vested in the Medical Officer of Health. This involved taking on to the staff of the Public Health Department, the part-time escorts and the appointment of an officer to deal with the clerical and administrative aspects of the service. 18 In part of the Borough, the meals-on-wheels service is provided by the Women's Voluntary Service, and there has been a close liaison between that organisation and the Public Health Department to ensure that there is no overlapping, nor on the other hand, that any old people in need of this service should be overlooked. An additional van purchased by the Council for this service was brought into use in September; this made it possible to re-organise the 'rounds' and reduce the demands on the other three vans. This service expanded so rapidly, however, that in a very short time all four vans were working to full capacity. The number of meals taken to old people in their own homes during the year was 32,242. Meals-on-wheels are provided by the Council on five days each week - Monday to Friday. At Easter, however, in an attempt to bridge the gap of the long week-end, a number of special packs of frozen foods was obtained and distributed to those who had indicated they would like them, o n the Thursday preceding Good Friday. Most of the recipients were delighted with them and expressed their gratitude. Unfortunately, these packs of frozen foods are no longer obtainable and for the Christmas holiday period it was only possible to provide tinned food. Nevertheless, this was very well received. Home Bathing The visiting of housebound old people to assist th em to have a bath in their own homes is of the utmost val ue in helping to keep them clean, healthy and happy. The service is greatly appreciated by the recipients and, like the meals service, is increasing rapidly. Towards the end of the year the Council authorised the appointment of an additional bathing attendant to assist in this work, but it has not yet been possible to fill the vacancy. During 1963, homebathing visits numbered 529 and involved 21 old persons. Cleansing of Soiled Linen Arrangements were continued for the cleansing of the soiled bedding and personal clothing of incontinent old people who have nobody to do this for them. The Council's disinfecting van usually calls twice weekly delivering clean linen and collecting the soiled articles at each 19 visit. During the year, 60 persons received this service and 10,523 articles of bedding and clothing were cleansed at the Council's Disinfecting Station. The very essence of work in connection with old people is a ready spirit of co-operation by the large number of agencies concerned. There has been a marked tightening of the links between these bodies within the past year, which has led to a much smoother functioning of the complex machine. In acknowledging, with gratitude, the help that the Council's officers have received it must be said, nevertheless, that even greater effort is needed in future if all the available sources of help and care are to be deployed to the fullest advantage. It must not be forgotten that there are still far too many old folk who are without visitors or friends. 20 HEALTH EDUCATION Health education - the broad thread running through the whole fabric of public health work - must move with the times, adapting itself quickly to the needs of a changing world, and making use of a variety of modern techniques. Investigations in the Borough have given many clues to the methods of health promotion which are likely to have the biggest impact on the public mind; during the year, special emphasis has been laid on these. Thus, the long lecture has been replaced by the short talk followed by group discussions; films, film strips and tap e recordings are used increasingly; visits to the Public Health Department by groups of school children and others are being made with greater frequency; there has been closer liaison with other bodies. Invitations are se nt periodically to organisations in the Borough suggesting talks and demonstrations to their members. Many have accepted; too many have not yet taken advantage of t he offer. Visits to a number of youth clubs, women 's organisations, church groups and old people's clubs ha ve proved to be evenings well spent. It has been a pleasure also to speak at rotary clubs and parents' association meetings. Opportunities to take part in sound and television programmes have been welcomed; they have resulted in many enquiries for further information. The local press has also been most helpful: the value of the newspaper as a mass medium for disseminating health information throughout the community cannot be overstressed. The exhibition of posters on the Council's notice boards throughout the Borough, the distribution of pamphlets and booklets through various agencies, the i ssue of bookmarks bearing information on health subjects at the public libraries and the publication of articles in 'Camberwell Calling' all play a useful part in informing the public. The personal side of health education is probably the most rewarding, and special emphasis is laid on it. This is part of the daily work of the doctors, public health inspectors and old people's visitors when they call at homes, shops or factories in connection with public health or housing matters, infectious diseases, infestation or home accidents. In this way contact is made with a large section of the population which is unapproachable by direct methods. Enquiries at the Public Health office also provide many opportunities for the giving of health 21 information and advice. In fact, each single member of the staff of the department is a component of the health team. These activities, in combination, are of tremendous value in counteracting the increasing amount of 'antihealth' propaganda to which members of the public are being subjected today in print and on the air. The word 'health' must be interpreted in the widest possible way. It connotes much more than the absence of physical or mental illness. A scrutiny of the tables at the end of this report gives some indication of the amount of ill-health which falls on the citizens of Camberwell but it gives no index of their health. Records of minor sickness, unhappiness, emotional disturbances, family friction, delinquency, excessive smoking and drinking are among the details that are wanting. As yet no formula has been devised which allows health to be recorded as a rate Per thousand of the population. It is not easy, therefore, for the health educationist to make more than a subjective appraisal of the results of his endeavours, and those who Sometimes cast doubts on the value of the health promotive efforts of the Public Health Department, can seldom be refuted by statistical evidence. There are many indications, nevertheless, that considerable progress is being made not only, for example, in the reduction of cases of infection or home accidents, but in improving the standards of health consciousness generally. The schools give Particular evidence of this. It is emphasised that health education is not the monopoly of the Public Health Department. It is being realised more and more that all branches of the health service have a part to play, as well as the schools, the c hurches and statutory and voluntary agencies. Special e fforts have been made to enlist help from all these Sources, and to approach the subject jointly. This has met with a good measure of success. Reference has been made already to the part that the churches are able to Play in the promotion of health. The clergy have been most ready to co-operate - indeed, approaches have been made by them for assistance in health education, especially in s uch matters as alcoholism, smoking and delinquency. A Parents' group in one church, begun two years ago, continues to flourish with great benefit. Meetings have taken place with members of the Anglican and Free Churches, one of the results of which is the formation of a working Party to explore ways of improving the doctor/clergy relationship in these matters. A pilot scheme has been 22 drawn up and joint meetings arranged to discuss matters of mutual interest: and there are many. A whole day meeting for clergymen, at which the problems of alcoholism were discussed was so successful that further such talks are being arranged at the South East London General Practitioners' Centre, St. Mary's Road. The St. Giles Centre (formerly the Camberwell Samaritans) of which the Medical Officer of Health is Vice-Chairman, is filling a long felt need, not only in providing care, help and guidance for those in trouble who do not appear to have been able to obtain help elsewhere, but also as an ancillary to the health promotional work in the Borough. Not least, it is helping doctors, clergy, social workers and others to work in collusion. A communication sent to all the churches in Camberwell is summarised below:- 'There never has been a greater need for close Cooperation by people in all works of life in the preservation of health and for the more effective care of the sick and handicapped. It is of special importance that doctors and social workers, on the one hand, and the clergy and members of their congregations, on the other, should have a real and harmonious partnership. With this object in mind, and with the knowledge regrettable though it is - that, generally speaking, there is little effective liaison between the two, a working party of doctors, clergy and church members, has been meeting in Camberwell, to discuss these matters and to suggest lines of action. The working party is in process of inaugurating a pilot scheme in an area in the Borough' details of which will be made available in due course. Account has been taken by the working party of the remarkable progress in recent years in the means of preventing and curing sickness, which a comprehensi ve health service in the welfare state enables all to share. But this service does not necessarily supply all wants: there are many gaps, and many unmet needs in the realms of physical, mental, emotional, moral and spiritual care and guidance. Voluntary effort is as needful as ever. The tremendous social changes now taking place - not all of which are beneficial to health - highlight these needs. Among the pressing problems which confront us are those related to alcoholism, cigarette smoking, promiscuity, delinquency, the aged, and community care of the mentally ill. 23 The Medical Officer of Health, if he has to work in isolation, finds his tasks of preventing illness and safegrarding the public health beset with many difficulties; the physician and surgeon can diagnose and treat expertly, but only the community can restore health. The emphasis nowadays on mental health, rehabilitation, and the welfare of the aged and handicapped, cries out for team work, not only by doctors and professional workers, but by family members, friends and colleagues and the man in the street. Here lies the church's great o pportunity. ' 24 ANTI-SMOKING CLINIC The Anti-smoking Clinic which was set up in November 1962 was referred to briefly in the Annual Report for that year. Its activities continued under the guidance of Dr. Griffith Edwards of the Maudsley Hospital until the beginning of August 1963. Up to that time sessions ha d been conducted for individual patients, but since then courses of group therapy have been held on Tuesday evening s, first under the guidance of Dr. Poole, a local general practitioner, and subsequently Dr. Griffith Edwards. I am much indebted to both of them for their valuable assistance Dr. Edwards has now made a detailed analysis of the first forty male patients who attended the Clinic whi ch was published in 'The Medical Officer' on 24th April 1964. The following extract is of considerable interest:- Summary and Conclusions (1) At an anti-smoking clinic set up by the Public Health Department of the Camberwell Borough Council a comparison was made of the results of four weeks treatment by light hypnosis and by lobeline sulpha te (2 mg. t.d.s.). Postal follow-up inquiry was made at one, two and three months after the end of treatment. There were 20 men in each group. (2) At the first visit, the doctor filled in a questionnaire on the patient's smoking habits and on reasons given for wanting to stop smoking and the patient completed the Maudsley Personality Inventory. (3) Clinic patients showed a higher mean N (neuroticism) and lower mean E (extroversion) score than a 'normal' population. (4) Comparison of treatment results with the two gro u ps showed no significant difference during the first four weeks or during subsequent follow-up. Approximately 30 per cent of patients stopped smoking, 40 per cent. considerably decreased their smoking, and 30 per cent. showed no or little change. At the end of three months there was a slight tendency toward relapse but results (over this period of follow-up) were not transient. Co-operation in treatment was similar in the two groups. (5) On the premise that response to treatment by hypnosis and by lobeline is probably determined by the same factors, correlation of various factors with success in treatment outcome was analysed for the group of 40 patients taken as a whole. No correlations 25 were found which were significant at the 5 per cent level, but there is some trend towards greater difficulty in giving up smoking being found with greater age, heavier initial smoking, and higher N (neuroticism) score. (6) Of motivating factors investigated 'other health hazards' (32/40) was given significantly more often than 'fear of cancer' (22/40) or 'financial reasons' (25/40). No one of these motives was strongly associated with a greater likelihood of giving up smoking. (7) It was concluded that hypnosis and lobeline in the particular manner in which they were each used were equally effective and that they both probably produced the same level of result as would be expected with a placebo. ACKNOWLEDGEMENTS I would like to thank Dr. H. D. Chalke, Medical Officer of Health for the Metropolitan Borough of Camberwell, under whose auspices this clinic was set up. I would also like to thank Mr. Cranfield and the staff of Dr. Chalke's department for their great helpfulness in the running of the clinic. Mrs. Frances Parsons has given me most helpful advice and criticism in the preparation of this paper. 'Cancer of the Lung' The figures showing the number of deaths from malignant neoplasms of the lung and bronchus since 1954 are:- 1954 1955 1956 1957 1958 1961 1963 1959 1960 1962 Men 80 92 77 81 95 105 95 105 112 106 Women 13 22 14 16 25 15 9 16 14 26 Total males 425 Total males 523 Total females 73 Total females 97 498 620 The increase in the number of both male and female Deaths during the last five year period is of particular significance in relation to the anti-smoking campaign. 26 A SCHOOL ANTI-SMOKING SOCIETY (Adapted from a pamphlet written for 'Family Doctor') When anti-smoking propaganda was intensified following the publication of the report of the Royal College of Physicians, special attention was directed towards the school child. It was felt that no effort should be spared to prevent children from starting to smoke and to induce those who had begun to give it up. Following a visit by the newly formed anti-smoking unit of the Central Council for Health Education in October 1962, the pupils in a comprehensive school in Camberwell were asked how they thought they could best contribute to the campaign. One or two suggested that they might form an anti-smoking club. They elected a committee of six - three boys and three girls - which was encouraged to conduct its own plan of campaign. Their activities consist of regular talks to different groups in the school, broadcasts to the whole school on the public address system, the use of posters and films and group discussions. Everything depends, in a venture such as this, on stimulating and maintaining interest. This is no easy matter, yet, thanks to the energy and enthusiasm of the chairman of the committee - a boy of 16 - and the full support of the headmaster and his staff obstacles have been overcome. The Medical Officer of Health keeps in close touch with the school, and makes available audio-visual aids. He also arranges panels of speakers to take Part in discussions and answer questions. Those who contribute include well known personalities in the field of sport, physical education experts and beauty culturists. The different branches of medicine are represented and so are dentists. The Editor of 'Family Doctor' and the Direct or of the Central Council for Health Education are regular participants. It is believed that a basic principle in this aspect of health education must be to present young people with all the facts, so that they may discuss them amongst themselves and form their own conclusions. A pontifical approach achieves no lasting conviction of the importance of this facet of health preservation. Sound and television broadcasts at home and recordings made for broadcasts over the Canadian and American syst ems 27 have proved a great stimulus to the pupils of this school, and press publicity, although more limited, has also helped. The chairman has received many letters from other schools, requesting details of organisation and reports on results achieved. He also visits schools in the neighbourhood and advises them on how to start clubs on their own. Pupils from a school in Wales, in which a club on similar lines has been started, visited the Camberwell school and exchanged ideas. The discussion was recorded and broadcast. Members of the anti-smoking society (all of whom promise they will not smoke until they are 21) are given a lapel badge. Many designs were considered but there was a general agreement that the choice should rest on a simple design without lettering. This consists of a kidney-shaped object, in red, with a black dot at one end (a cancer cell). This token design has had the desired effect - that of inviting the question 'what badge are You wearing?' It is not possible to assess the results of an experiment of this nature except over a period of years. Surveys made in the school, however, show a marked decrease in the number of pupils who smoke, and a large membership of the anti-smoking society - more than one third of the 2,000 children. Of special significance is the effect on the new entrants to the school, almost all of whom have Joined the society. Following a meeting at the Schoolboys' and Schoolgirls' Exhibition at Olympia, at which Lord Newton, the then Parliamentary Secretary to the Ministry of Health, was Present, a Junior League of Non-Smokers was inaugurated. (Lord Newton became the first honorary member and was Presented with a badge). There was considerable enthusiasm among the children and very many requests for details as to how a branch should be established. The Medical Officer of Health was elected the first President of the League. 28 ALCOHOLISM Considerable concern has been expressed in many quarters about the incidence of alcoholism, particularly the extent and effects of crude spirit drinking. During the year this Council supported the Southwark Borough Council in their request to the Metropolitan Boroughs' Standing Joint Committee to make representations to the Home Secretary on the subject. About a year previously a number of persons interested in this problem set up the Camberwell Council on Alcoholism. This is a voluntary body comprised of doctors, clergymen, probation officers, social workers and others, and the Medical Officer of Health was appointed as its Chairman. Its objects are to find out more about the impact of alcohol on the community, and by joint effort to help in the solution of some of its problems. During its first year it concentrated its efforts on a study of the homeless alcoholic - the man who 'sleeps rough' and drinks surgical spirit. A detailed scheme was drawn up for a Halfway House where such men can be cared for and treated. Thanks to the generosity of the Helping Hand Organisation this scheme is now about to be put into operation, suitable premises having already been acquired in Grove Park. The Camberwell Council on Alcoholism also publishes a quarterly Bulletin, the first issue of which was produced in June 1963. This has a very wide distribution amongst doctors, clergymen, social workers and others, and many copies go abroad. It has been commended as an interesting and informative publication. 29 INFECTIOUS DISEASES Measles As expected, the incidence of measles was much higher in 1963 than in the previous year - there were 1,962 c ases (337 in 1962) and of these 39.8% were children in the 5-10 age group. Respiratory complications of this disease are often high during the first year of life, but seldom give rise to concern after the age of three years. There were no deaths from measles in this borough in 1963. Complications of measles are not only dependent on the age of the patient, but also on the general environment and nutrition, hence they are more common in the urban population, but they do not appear to have been unduly prevalent in Camberwell. A National Inquiry was carried out during the first four months of 1963, to discover the frequency of complications in measles. It was then discovered that one in fifteen persons developed potentially serious complications and, of these twelve died. Severe bronchitis, ear infections and disorders of the nervous system were reported in this order of frequency. One per cent of all cases required admission to hospital and these patients were usually infants or adults. A live vaccine is now available for protection against me asles, but it may not be free from side effects, and is not yet obtainable for large scale immunisation. It is doubtful, however, whether its general use would be Justified in this country as it may be in countries abroad where the disease remains an important cause of deaths in infancy and childhood. Bacillary Dysentery (Sonne) gave rise to 220 sporadic cases. In accordance with the present trend the main incidence was during the early months of the year, Particularly in children in the first years of school l ife. This re-emphasises the need for good habit formation at an early age, in order to prevent the transmission of infection by unwashed hands which contaminate books, Pencils and other articles. Smallpox There were no cases of smallpox in Camberwell during 1963, but the Medical Officer of Health was consulted on 30 several occasions by local general practitioners who had patients with unusual manifestations of other diseases which could have been smallpox. Diphtheria and Poliomyelitis There were no cases of diphtheria within the Borough during 1963, but there were three cases of poliomyelitis all in patients under twenty years of age. The patients were one infant under one year, one child in the 5-10 yea r age group and one young person in the 15-20 year age group. Food Poisoning There were 15 cases of food poisoning notified in th e Borough (26 cases in 1962), but in only two cases was the infection confirmed bacteriologically (12 cases confirmed in 1962). Officers from the Department continue to give talks to local groups on the importance of food hygiene and personal hygiene in preventing the spread of these intestinal infections. The Visitors who investigate these cases have splendid opportunities for health education in this connection. Whooping Cough Of the 173 cases of whooping cough about one third occurred in children aged 5-10. There were 18 cases under one year and 24 between one and two years. There were no deaths. Scarlet Fever The majority of the cases of scarlet fever also occurred between the ages of 5/10 years. There were deaths. 31 VENEREAL DISEASES The disquieting rise in the incidence of Venereal Disease continues locally and nationally, and indeed in most countries in which records are kept a similar trend has been reported. The Public Health Department receives information on the numbers of first attenders at two Venereal Disease Clinics which serve the Borough, but these figures are necessarily incomplete and take no account of patients treated privately and in other hospitals. The pattern of figures obtained follows that noticed in previous years, i.e. the number of persons born outside Britain attending the Clinics is higher than the number of indigenous first attenders. In 1962 - 64.7% new cases. In 1963 - 62.5%. Month Immigrants Others Total Male Female Male Female Male Female 21 14 1963 January 16 7 37 21 February 25 10 37 12 4 14 March 3 7 17 14 7 14 10 April 11 10 21 23 13 8 15 23 May 16 10 26 19 14 10 19 June 9 33 30 July 18 7 47 25 17 23 12 August 14 6 35 20 9 33 September 20 13 15 24 29 October 7 31 13 36 18 28 November 16 12 12 28 16 December 20 12 5 28 8 17 Totals 244 154 134 105 378 259 32 It appears that disease is contracted generally in this country. It is anticipated that, as those from abroad settle down and adapt themselves to life in this country, the incidence of venereal disease among them will diminish. Two related factors affect the spread of venereal disease, i.e. promiscuity and the size of the infector pool. If promiscuity ceased, these diseases would disappear, likewise if all infected persons could be fully treated simultaneously venereal disease would become of historical interest only. Unfortunately, one of the serious venereal diseases is becoming resistant to treatment, but, due to the high standard of ante-natal care in this country, congenital syphilis has almost disappeared. The extent of promiscuity is a sign of personal behaviour and morals. It is vitally important that young people shall be well supplied with accurate information on the dangers of careless behaviour and the role played by alcohol and drugs in spoiling chances of happiness i n their personal relationship. The Medical Officer of Health and his Deputy have talked with young people on this subject several times during the year - it is found that formal lectures are of little value, but that adolescents welcome the opportunity to form discussion groups and are soon pouring out all the questions which have perplexed them and about which they have been unable to obtain answers elsewhere. Here again, a close link with church organisations is essential. 33 REPORT OF CONSULTANT PHYSICIAN CHEST DEPARTMENT, ST. GILES' HOSPITAL As a result of a change of policy by the South-East. Metropolitan Regional Board, the X-ray apparatus, together with the Odelca camera for the taking of miniature chest films, was transferred from the department, the large set going to the General Practitioner Centre in Queen's Road and the camera to the main X-ray department of the hospital. There was therefore an alteration in function of the department with a concurrent further falling-off of the number of patients seen. Total attendances, 8,604, showed a fall of 1,205, but there was only a slight fall of 91 in the number of new patients who had clinical examinations, the figures being 1,658 in 1962 and 1,567 in 1963. One hundred and seventeen patients were admitted to St. Giles' Hospital and 34 to other hospitals in the region for treatment of their non-tuberculous conditions. One hundred and six patients, compared with 101 in 1962, we re admitted to sanatoria for investigation and treatment of tuberculous disease. There was a further reduction in numbers on the tuberculosis register, there being 899 cases of pulmonary tuberculosis in 1962 and 845 in 1963. Cases of non-pulmonary disease showed only a very slight fall from 46 to 43. The very low death rate for tuberculosis experienced in 1962 of 6 men and 2 women was maintained, the corresponding figures in 1963 being 6 men and 3 women. Six hundred and fifty four babies born in the wards of St. Giles' Hospital received B.C.G. vaccination compared with 458. This latter figure was low in 1962 because of the smallpox scare from January to May. Two hunderd and fourteen contacts and schoolchildren were v accinated with B.C.G. bacillus. The mild winter undoubtedly made a difference to the number of patients referred to the department, but unfortunately the number of patients with cancer of the lung shows no signs of decreasing. More cases have to be r eferred for radiotherapy, or to Grove Park Hospital for treatment with special drugs because the condition is too far advanced for surgical excision. There has also been a steady increase in the number of women patients with c ancer of the lung. Bronchitis was not as great a problem is during the previous winter. 34 The Health Visitors continue to play a valuable part in the socio-medical work of the department, but th e promotion of the Almoner to another hospital was certainly the department's loss. Dr. Chalke, Medical Officer of Health for Camberwell, has, as always, given help and advice and it is a pleasure to thank him and his staff. Dr. Mower White and her staff at L.C.C. Divisional Office have been ready to gi ve assistance whenever possible. Without the Camberwell District Nursing and Ranyard Nursing organisations, a number of patients would have had to be admitted to hospital. The London County Council Ambulance Service has done well under trying circumstances. KENNETH MARSH, Consultant Physician. Chest Department, St. Giles' Hospital. 35 STATISTICAL APPENDIX Summary of Statistics for the year 1963. 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) 175,304 " (Estimated by Registrar-General mid/1963) 174, 220 Number of inhabitated houses (April 1963) 45,511 Rateable value (April 1963) £7,269,737 Sum represented by a penny rate (Estimated) £28,975 Number of live births 3,714 Birth rate 21.3 Number of deaths 2,197 Death rate 12.6 Infantile Mortality:- Deaths under 1 year 75 Infant deaths per 1,000 live births 20.2 Maternal Mortality:- Deaths of women from diseases or accidents associated with childbirth NIL Maternal death rate per 1,000 total births NIL Deaths from Pulmonary Tuberculosis 9 Death rate 0.05 Deaths from cancer of lung and bronchus 132 Death rate 0.7 Deaths from all forms of cancer 393 Death rate 2.2 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1963 IN CAMBERWELL Cause of Death Sex Total all ages Under 4 weeks 4 weeks and under 1 year Age in Years 1- 5- 15- 25- 35- 45- 55- 65- 75- M - - - - 1 - 2 1 2 - 1. TUBERCULOSIS, RESPIRATORY 6 - F 3 2 - - - - - - 1 - - - 2. TUBERCULOSIS, OTHER M - - - - - - - - - - - - F 1 - - - - - - - 1 - - - 3. SYPHILITIC DISEASE M 2 - - - - - - - 1 1 - - F 2 - - - - - 2 - - - - - 4. DIPHTHERIA M - - - - - - - - - - - - F - - - - - - - - - - - - 5. WHOOPING COUGH M - - - - - - - - - - - - F - - - - - - - - - - - - 6. MENINGOCOCCAL INFECTIONS M 1 - - - 1 - - - - - - - F 1 - - - 1 - - - - - - - 7. ACUTE POLIOMYELITIS M - - - - - - - - - - - - - F - - - - - - - - - - - 8. MEASLES M - - - - - - - - - - - - F - - - - - - - - - - - - 9. OTHER INFECTIVE AND PARASITIC DISEASES M 1 - - - - 1 - - - - - - F 2 - - - - - - - - 2 - - 10. MALIGNANT NEOPLASM, STOMACH M 32 - - - - - 3 3 9 10 7 - 9 F 14 - - - - - - - - 2 3 106 - - - - - 1 13 36 34 22 11. MALIGNANT NEOPLASM, LUNG, BRONCHUS M - F 26 - - - - - - 5 6 10 5 - 12. MALIGNANT NEOPLASM, BREAST M - - - - - - - - - - - - F 37 - - - - - - 7 4 5 9 12 13. MALIGNANT NEOPLASM, UTERUS F 13 - - - - - 1 1 4 3 4 - 14. OTHER MALIGNANT AND LYMPHATIC NEOPLASMS M 97 - - M 1 1 5 29 30 21 - 9 F 68 - 1 - - 2 3 11 14 19 18 - 15. LEUKAEMIA, ALEUKAEMIA M 8 - - - 1 1 - - - 3 1 2 F 6 - - - - - 1 1 1 - 1 2 16. DIABETES M 3 - - - - - - 1 - 1 1 - F 6 - - - - - - - - 1 - 4 17. VASCULAR LESIONS OF NERVOUS SYSTEM M 93 - - - - - - 5 17 22 49 - F 152 - - - - 1 3 13 44 91 - - 18. CORONARY DISEASE, ANGINA M 270 - - - - - - 4 23 57 80 106 F 184 - - - - - 1 1 7 14 44 117 19. HYPERTENSION WITH HEART DISEASE M 15 - - - - - - - 2 5 - 8 F 35 - - - - - - - - 1 7 27 20. OTHER HEART DISEASE M 58 - - - - 3 - 1 6 9 12 27 F 127 - - 1 - - 5 4 6 8 18 85 21. OTHER CIRCULATORY DISEASE M 49 - - - - - 2 1 2 5 14 25 F 61 - - - - - - 1 1 5 12 41 22. INFLUENZA M 5 - - - - 1 - - - 1 3 - F 3 - - - - - - - 1 1 1 - 23. PNEUMONIA M 75 - 5 1 - - 1 2 11 22 32 - F 96 - 6 - - 1 - 1 1 2 13 72 24. BRONCHITIS M 136 - 2 1 - - - - 7 24 39 63 F 58 - 5 - 1 - - - 4 3 6 39 25. OTHER DISEASES OF RESPIRATORY SYSTEM M 14 - - 1 - - - - 1 2 5 5 F 9 - - - - - - - 1 1 3 4 26. ULCER OF STOMACH AND DUODENUM M 15 - - - - - - - 1 2 4 8 F 2 - - - - - 1 1 - - - - 27. GASTRITIS, ENTERITIS AND DIARRHOEA M 4 - - - - - - - - 1 - 3 F 9 - 1 - - - - - - - 4 4 28. NEPHRITIS AND NEPHROSIS M 6 - - - - - - - 1 1 1 3 F 6 - - - 1 - 1 - - 1 - 3 29. HYPERPLASIA OF PROSTATE M 6 - - - - - - - 1 - 1 4 30. PREGNANCY, CHILDBIRTH, ABORTION F - - - - - - - - - - - - 31. CONGENITAL MALFORMATIONS M 18 7 5 1 1 1 - 1 1 - 1 - F 8 2 3 - - - - 2 - - 1 - 32. OTHER DEFINED AND ILL-DEFINED DISEASES M 79 22 - 1 1 3 2 2 7 12 10 19 F 87 13 1 - - - 2 11 2 5 20 33 33. MOTOR VEHICLE ACCIDENTS M 10 - - - 1 4 - 1 - 2 - 2 F 10 - - - 1 1 - - - 1 3 3 34. ALL OTHER ACCIDENTS M 19 - - - - 3 - 2 5 1 1 6 F 15 - - 1 - - - 1 - - 3 10 35. SUICIDE M 12 - - - - 3 2 1 2 3 1 - 13 F - - - - 1 3 2 3 1 2 1 Cause of Death Sex Total all ages Under 4 weeks 4 weeks and under 1 year Age in Years 1- 5- 15- 25- 35- 45- 55- 65- 75- 36. HOMICIDE AND OPERATIONS OF WAR M F 1 2 1 - - - - 1 - - - 1 - - - - - - - - - - - - TOTAL ALL CAUSES 30 15 13 17 20 4 9 16 414 586 M F 1,141 1,056 6 3 6 3 23 36 87 55 234 94 299 227 Births Legitimate Illegitimate Live Births Still Births Total M F M F M F 1,639 1,627 1,606 1,607 33 2 0 5 4 264 259 242 246 1,865 1,903 1,873 Total 1,849 38 24 38 3,714 62 3,776 39 Cremation Certificates No. of cremations authorised during the year by the Medical Referee or his Deputy 2,442 Water Certificates No. of Water Certificates issued 191 No. of dwellings concerned *Includes 41 mobile homes * 1,372 Drainage and Sewerage No. of drainage applications received 210 Length of sewers reconstructed 3,477 ft. No. of brick gullies replaced by pot gullies 59 No. of defective pot gullies renewed 2 No. of new pot gullies installed 3 Public Cleansing Amount of house refuse collected 43,936 tons Amount of trade refuse collected .. ,363 tons Examination of Water from the Council's Swimming Baths Bacteriological examination Chemical examination No. of Samples No. Satis. No. of Samples No. Satis. 6 Camberwell Front Swimming Bath 6 6 6 Camberwell Rear Swimming Bath 12 12 12 12 6 Dulwich First Class Swimming Bath 6 6 6 12 12 Dulwich Second Class Swimming Bath 12 12 36 36 36 36 In addition, water from the Swimming Path at Mary Datchelor Girls' School, Camberwell Grove, was chemically and bacteriologically examined on four occasions. All the samples were satisfactory. 40 Rag Flock and Other Filling Materials Act, 1951 Type of Material. No. of Samples examined No. Satisfactory 7 7 Woollen mixture felt 1 Used jute wadding 1 7 7 New cotton felt 3 3 Sized cotton wadding 1 Rag flock 1 2 Coir fibre 2 Coir fibre pad 3 3 Totals 24 24 Offensive Trades Type of Business No. on Register Skin dressers 3 1 Soap boilers Total 4 Pet Animals Act, 1952 No. of licences issued 1 No. of licences renewed 11 Total No. of pet shops licensed 12 Pharmacy and Poisons Act, 1933 No. of applications received for registration 6 No. of applications received for renewal of registration 134 London County Council (General Powers) Act, 1954 No. of hairdressers and barbers premises registered 149 41 ATMOSPHERIC POLLUTION Comparison of Years, 1959 & 1963 At 475, Lordship Lane Average Concentration of Sulphur Dioxide in Micrograms Per Cubic Metre 41a ATMOSPHERIC POLLUTION Comparison of Years, 1959 & 1963 At Town Hall Average Concentration of Sulphur Dioxide in Micrograms Per Cubic Metre 42 ATMOSPHERIC POLLUTION Comparison of Years, 1959 & 1963 At 475, Lordship Lane Average Concentration of Smoke in Micrograms Per Cubic Metre 42a ATMOSPHERIC POLLUTION Comparison of Years, 1959 & 1963 At Town Hall Average Concentration of Smoke in Micrograms Per Cubic Metre 43 Sanitary Inspection of the Area No. of complaints received 3,337 Summary of work carried out during the year 1963 Inspections:- Nuisance inspections 3,631 Offensive trades 23 Smoke observations 215 Drainage, new and existing 10,702 Overcrowding 600 Factories and workplaces 962 Outworkers' premises 320 Rag dealers 40 Infectious and other diseases 19 Verminous premises and persons 240 Aged and infirm persons 57 Common lodging houses 27 Conveniences, public and private 168 Consumer Protection Act 126 Rent Act, 1957 73 Shops Act 1,418 Hairdressers and barbers 276 Voluntary work 85 Inspections not defined 2,098 Re-inspections 11,859 Total inspections 32,939 Works supervised:- Tests applied to drains (existing premises) 499 Drains found defective 328 Drains totally reconstructed 17 Drains repaired or partially reconstructed 287 Tests applied to drains (new buildings) 2,515 Drains constructed 2,550 Total works supervised 6,196 Description of sanitary improvements ordered during the year:- Cleanse and repair walls and ceilings 298 Repair roofs, gutterings, etc. 361 Abate dampness 614 Repair stoves, fireplaces and coppers 48 Repair windows, sashlines, sills, etc. 255 Repair flooring, stairs, doors, etc. 254 Provide sufficient light and ventilation 1 Provide dustbin 36 Remove offensive matter 56 Provide or repair yard paving 37 Provide or render accessible water supply 19 Cleanse, cover or render accessible water cistern 4 Repair water pipes and fittings 51 Clear premises of vermin - Cleanse or repair water closets and flushing apparatus 200 Repair or clear defective or obstructed drains 38 Repair soil pipes, waste pipes, sinks, etc. 62 Abate nuisances caused by animals improperly kept 2 miscellaneous 80 Total repairs and improvements ordered 2,416 44 Smoke Control - Return of Work Visits in connection with smoke complaints 492 Smoke observations 215 Atmospheric pollution readings 703 Smoke Control Areas - Inspections 3,592 Other Visits 1,209 Industrial premises inspections 545 Total 6,756 SUMMARY OF NOTICES SERVED, 1963 Intimations, Public Health (London) Act, 1936 Byelaws, etc. 1,014 Statutory Notices, Public Health (London) Act, 1936 Byelaws, etc. 416 London County Council (General Powers) Act, 1955 617 Public Health (London) Act, 1936 (Part II) 130 No. of Summonses issued 19 Factories Act, 1961 1. INSPECTIONS, 1963 Premises Number on Register Number of Inspections Written Notices Occupiers Prosecut ed Factories in which Sections 1,2,3,4 and 6 are to be enforced by Local Authorities 342 159 - - Factories not included above in which Section 7 is enforced by the Local Authority 927 508 18 - Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 21 21 - - Totals 1,290 688 - 18 45 2. CASES IN WHICH DEFECTS WERE FOUND, 1963 Particulars No. of cases in which defects were Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M Inspector Want of cleanliness 3 2 - - - - - Overcrowding - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors - - - - - - - - Sanitary conveniences - (a) insufficient - - 11 (b) unsuitable or defective 4 - - - (c) not separate for sexes 3 1 - - - Other offences against the Act (not including offences relating to outwork) 23 9 - - - Total 40 16 - - - Summary of Outworkers classified by Trades Artificial flowers 3 Brass & brass articles 5 Cardboard boxes 17 Carding 6 Christmas stockings & crackers 2 Household linen 5 Lampshades 38 Wearing apparel 126 Total 202 Summary of work of the Rodent Control Staff No. of complaints received 1,223 No. of inspections 1,308 No. of Operators' calls 9,335 No. of private premises baited 1,489 No. of business premises baited 154 No. of baits laid 7,173 46 Vermin and Scabies ATTENDANCES AT CLEANSING STATION Vermin Scabies Male Female Total Male Female Total Adults 17 8 25 29 16 45 Children 24 66 90 32 49 81 Total 61 41 74 115 65 126 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 14 21 2 51 557 624 18 5 31 75 Total visits 59 397 11 750 1,217 Number of articles disinfected by steam 720 Number of articles disinfected by formalin 23 Number of books disinfected 88 Number of towels washed 5,552 Number of soiled articles washed 10,523 Number of overalls washed 96 Number of covering sheets washed 96 Beds and mattresses destroyed 55 Miscellaneous articles destroyed 131 Number of articles dried (burst pipes) 720 Weight of:- tons cwt. qtrs. lbs. Unsound foods destroyed 53 14 0 6 Unsound foods destroyed for Lambeth B.C. 15 8 3 11 Furniture and effects destroyed 43 2 3 0 Official documents destroyed 34 12 0 0 Dead animals destroyed - 3 2 0 Hospital dressings etc. destroyed 3 18 0 0 Hospital bedding etc. disinfected 1 12 3 23 Total 152 12 0 12 47 Bacteriological Reports on Samples of Swimming Bath Waters taken throughout the Year. Dulwich Baths First Class Bath Second Class Bath Plate count yeastrel agar 24 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 24 hrs. 37°C. aerobically colonies per ml. Probable No. of coliform bacilli MacConkey 48 hrs. 37°C colonies per 100 ml. January - - 1 0 February - 4 0 - March - - 2 0 April 1 0 0 0 May 1 0 2 0 June 2 0 1 3 July 0 0 0 1 August 7 3 0 0 September 24 0 16 0 October - - 6 0 November - - 0 1 December - - 1 0 Camberwell Baths Front Bath Rear Bath Plate count yeastrel agar 24 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 24 hrs. 37°C aerobically colonies per ml. Probable No. of coliform bacilli MacConkey 48 hrs. 37°C colonies per 100 ml. - - 10 0 January February - - 0 0 March - - 1 0 April 0 0 0 0 May 7 0 2 0 June 1 0 0 0 July 12 0 1 0 August 0 0 >300 0 September 14 0 3 0 October - 5 3 - November - - 0 0 December - 3 0 - 48 HOUSING Record of work of Housing Inspector, 1963 In. spections Re-inspections Total Clearance areas 579 67 646 Individual unfit houses Section 9 117 141 258 Section 16 32 22 54 Underground rooms and parts of premises Section 18 116 103 219 Total 844 333 1,177 Housing Statistics, 1963 1. Inspection of Dwelling Houses during the Year:- (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Act) 4,006 (b) Number of inspections made for the purpose 16,698 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 2,750 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 561 3. Action under Statutory Powers during the Year:- (a) Proceedings under Public Health (London) Act:- (1) Number of dwelling-houses in respect of which statutory notices were served requiring defects to be remedied 416 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By owners 1,207 (b) By Local Authority in default of owners 1 (b) Proceedings under Housing Act, 1957:- (1) Number of houses made fit after service of formal notices (Sections 9, 16 and 18):- (a) By owners 11 (b) By Local Authority in default of owners Nil (2) Houses demolished as a result of formal or informal procedure under Section 17 Nil (3) Houses closed in pursuance of an undertaking given by the owners under Section 16 and still in force Nil 49 (4) Parts of buildings closed by Closing Orders (Section 18):- (a) Underground rooms 2 (b) Other rooms 19 (5) Undertakings not to use parts of buildings for human habitation accepted:- (a) Underground rooms Nil (b) Other rooms Nil (5) Houses demolished under Section 42 26 (c) Proceedings under Housing Act, 1957:- (1) Closing Orders made under Section 17(3) Nil (2) Demolition Orders determined and Closing Orders substituted under Section 26 Nil (3) Closing Orders made under Section 17(1) 3 (4) Closing Orders determined Nil (5) Closing Orders revoked and Demolition Orders made Nil (d) Houses in Multiple Occupation:- (1) No. of inspections and re-inspections 862 (2) No. of premises found to require action 242 (3) No. of premises at which conditions were remedied as a result of informal action 139 (4) No. of premises requiring formal action 40 (5) No. of Direction Orders made 28 (6) No. of Management Orders made 28 Certificates of Disrepair No of applications for Certificates of Disrepair 15 No. of Undertakings received from landlords 8 No. of Certificates of Disrepair issued 9 No. of Certificates of Disrepair refused Nil No. of Certificates of Disrepair cancelled 6 INFECTIOUS DISEASES 1963. 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 65 and upwards Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 Scarlet Fever 67 - - - 3 5 5 4 41 6 1 - 2 - - - Whooping Cough 173 - - - 18 24 19 24 19 60 8 - 1 - - Poliomyelitis & Polioencephalitis - 3 3 3 - 1 - - - - 1 - 1 - - - - Measles 1962 - - 93 233 298 270 262 781 16 7 - 1 - - 1 Diphtheria - - - - - - - - - - - - - - - - (Acute Influenzal 50 Pneumonia 1 - - - - - - - - - - - - 1 - - (Acute Primary 32 1 - 1 - 1 - - - 1 4 3 2 13 7 - (1) Dysentery 220 5 117 - 14 16 21 23 11 40 16 10 6 38 15 10 Typhoid & Paratyphoid Fever - - - - - - - - - - - - - - - - 6 Erysipelas - - - - - - - - - - - - 1 3 2 (2) Meningococcal Infection 3 2 - - 1 1 - - - 1 - - - - - - (3) Puerperal Pyrexia 163 145 - - - - - - - - 1 28 121 13 - - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - 15 Scabies - - - - - 1 1 1 3 1 2 4 - 1 1 Malaria - - - - - - - - - - - - - - - - Totals 2645 156 120 - 128 277 345 323 297 925 48 47 178 32 29 16 (1) Includes 4 cases of Camberwell residents which occurred in hospitals outside the Borough. (2) Includes 1 case of a Camberwell resident which was diagnosed in a hospital outside the Borough. (3) Includes 59 cases of non-residents occurring in hospitals in Camberwell, also 5 cases of Camberwell residents that occurred in hospitals outside the Borough. 51 FOOD POISONING Annual Return of cases of Pood Poisoning, 1963 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total (a) Food poisoning notifications (corrected) as returned to R.G. 1 3 2 8 14 (b) Cases otherwise ascertained 1 - - - 1 (c) Symptomless excreters - - - - - (d) Fatal cases - - - - - 2. Particulars of outbreaks Agent No. of outbreaks No. of cases Family outbreaks Other outbreaks Notified Otherwise ascertained Total No. of cases Agent identified: (a) Chemical poisons - - - - - - (b) Salmonella - - - - (c) Staphylococci (inc. toxin) - - - - - (d) CI. Botulinum - - - - - (e) CI. Welchii - - - - - (f) Other bacteria - - - - - Agent not identified 2 - - 6 6 Totals 2 - 6 - 6 3. Single cases Agent No. of Cases Total No. of cases Notified Otherwise ascertained Agent identified: (a) Chemical poisons - - - (b) Salmonella: Typhimurium 1 1 2 (c) Staphylococci (inc. toxin) - - - (d) CI. Botulinum - - - (e) CI. Welchii - - - (f) Other bacteria - - - 7 7 Agent not identified - Totals 8 1 9 Tuberculosis TABLE SHOWING SEX AND AGE DISTRIBUTION OF ALL PRIMARY NOTIFICATIONS AND DEATHS FROM TUBERCULOSIS DURING 1963 Notifications Deaths* Pulmonary Non- Pulmonary Pulmonary Non-Pulmonary Age Periods Male Female Male Female Male Male Female Female Notified Not notified Notified Not Notified Notified Not Notified Notified Not Notified 0 - 1 yr. 1 - - - - - - - - - - - 1 - 5 yr. 8 2 - - - - - - - -- - 5 - 15 yr. 5 1 - 3 - - - - - - - - 15 - 25 yr. 4 7 1 1 - - - - - - - - 25 - 35 yr. 12 9 - 1 1 - - - - - - - 35 - 45 yr. 6 1 10 - - - - - - - - - 3 1 45 - 50 yr. 14 4 1 1 1 - - - - - 55 - 65 yr. 12 5 1 2 - - - - - - - - 65 and Over 3 2 5 - - - - - - - - - 71 3 2 - Totals 39 5 3 1 - 1 3 - After correction for inward and outward transfers. 53 TABLE SHOWING NOTIFICATIONS AND DEATHS, TOGETHER WITH THE ESTIMATED POPULATION DURING THE PAST FIVE YEARS Estimated Population No. of Primary Notifications Notification Rate per 1,000 Population No. of Deaths Death Rate per 1,000 Population Year 176,100 162 0.9 14 0.08 1959 175,020 183 1.0 1960 18 0.10 1961 173,980 165 0.9 20 0.12 1962 173,720 152 0.8 8 0.05 118 1963 174,220 0.6 10 0.06 RETURN OF VISITS - INFECTIOUS DISEASES AND OLD PERSONS Food Poisoning Dysentery Poliomyelitis Scarlet Fever Scabies Smallpox Other Diseases Aged and Infirm Persons Miscellaneous Total Visits Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts 34 7 684 83 4 - 55 - 20 - - 10 59 22 358 3,097 1,761 54 Food and Drugs Adulteration Summary of Samples obtained for examination Number examined Number adulterated etc. Percentage of adulteration Formal Informal Total Formal Informal Total Formal Informal - 2.98 401 503 904 - 15 15 Particulars of the adulterated samples and the action taken are set out on pages and Registered Purveyors of Milk Distributors of milk in the Borough 220 No. of pre-packed licences issued 220 Results of Tests Designation Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 82 4 86 - - - Tuberculin tested pasteurised 59 5 - - 65 - - - - - 22 Sterilised - Samples of milk taken in course of delivery to Hospitals and Schools:- Methylene Blue Test Phosphatase Test Chemical Test Hospitals *37 37 38 Schools 47 47 51 *Four of these failed to satisfy the Methylene Blue Test. 55 Ice Cream Summary of samples submitted for Methylene Blue Test and Chemical Examination. Methylene Blue Test Chemical Examination Grade I Grade II Grade III Grade IV Satisfactory Unsatisfactory 51 16 10 18 62 - Ice Lollies and Water Ices Summary of samples submitted for examination. Bacteriological Examination Chemical Analysis Satisfactory Unsatisfactory Satisfactory Unsatisfactory 18 - - - Ice Lollies - 17 - - Cream Lollies 38 - - - Assorted Lollies - 5 - - Water (Lemon) Ices PARTICULARS OF ADULTERATED SAMPLES Serial No. Article Whether Formal or Informal Nature of Adulteration of Irregularity Observations Result of Proceedings or other action taken 59 Coffee and Chicory Informal Fermented Old stock; remainder of stock in retailers' possession surrendered and destroyed. Informal 84 essence Instent coffee Incorrect label Matter taken up with manufacture label amended to satisfaction of Council. [ Informal Garlic Powder 105 Incorrect label Newly imported product: claim proposed to be made that the contents of each container were 'Equivalent of two pounds of fresh garlic'. Claim not substantiated and consequently not used. 90% extraneous water Sterilised milk Informal Letter sent to Dairy Company 115 Adulteration due to defective bottle and consequent faulty crown-cap Informal Ice Cream 159 Incorrect label Matter taken up with manufacturer wording on cartons amended to satisfaction of Council. Informal 162 Ice Cream 6% deficient in fat Formal sample taken and found to be satisfactory. Better quality mix now used. (Canned Informal 166 Lead -2.1 p.p.m. 950 tins surrended and destroyed (Tomatoes informal 167 Lead - 3.8 p.p.m. Incorrect label Matter taken up with manufacturer sale discontinued 192 French mustard Informal 193 Informal Incorrect label French Letter sent by Town Clerk to manufacturer. mustard 196 Informal Solubility unsatisfactory. Milk food Old stock; remainder of chemists stock withdrawn from sale. Informal Cream Lolly Incorrect label Matter taken up with manufacturers; new labels printed to satisfaction of Council 239 240 Cream Lolly Informal Incorrect label Informal Saccharin Tablets 266 Incorrect label Matter taken up with manufacturer label on dispenser amended to satisfaction of Council Juniper Pills 275 Informal Deficient in potassium nitrate Matter taken up with manufacturing chemist. Steps taken by manufacturers to prevent repetition of deficiency. 58 REGISTRATION OF FOOD PREMISES Premises registered under the provisions of Section 16 of the Food and Drugs Act, 1955, as at December 31st, 1963 Sale, manufacture and storage of ice cream 531 Preparation or manufacture of:- Potted, pressed, pickled or preserved meat 223 Potted, pickled or preserved fish 58 Potted, pickled or preserved other foods 36 Supervision of Flood 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 150 Bakers and Confectioners 421 Butchers 591 Cooked and Preserved Meat Shops 430 Dairies and Milkshops 338 Fishmongers and Shell Fish Vendors 264 Fish Fryers 131 Fish Curers 77 Food Factories 253 Ice Cream Vendors 332 Public Houses 273 Restaurants and Eating Houses 597 Street Markets 1,028 Street Traders Food Stores 35 Other Food Premises 2,020 Total 6,940 Unsound Food No. of condemnation Certificates issued 3,077 59 PARTICULARS OF UNSOUND FOOD DESTROYED 1963 Type of Food Weight lbs. Tons Cwts. Qrs. 18 1 13¼ Meat 9 Fish 2 2 2 6 - Poultry 1 7½ - - Fruit 1 18 - 35 13 1 27½ Canned foods Miscellaneous foods 5 18 3 17¾ 14 0 6 53 60 TABLE OF CONTENTS Page Alcoholism 28 Anti-Smoking Clinic 24 Care of the Elderly 16 Health Education 20 Housing 8 Infectious Diseases 29 Insects & Vermin 13 Public Health Committee - Constitution 3 Report of the Consultant Chest Physician 33 Sanitary Circumstances 6 School Anti-Smoking Society 26 Smoke Control 10 Staff of the Public Health Department 4 Venereal Diseases 31 INDEX TO STATISTICAL APPENDIX Atmospheric pollution - graphs 41-42 Births 38 Certificates of Disrepair 49 Cremation Certificates 39 Deaths - Causes and Age Distribution 36-38 Disinfection 46 Drainage and Sewerage 39 Factories Acts 44-45 Food & Drugs Adulteration 54 Adulterated Samples Table 56-57 Food Poisoning 51 Food Premises - Registration and Supervision 58 Hairdressers and Barbers 40 Housing Inspector - Return of Work 48 Housing Statistics 48-49 Ice Cream and Lollies 55 Infectious Diseases 50 Infectious Diseases Visitors - Return of Work .. .. 53 Medical Examinations 38 Milk - Registered Purveyors 54 Results of Tests 54 61 INDEX TO STATISTICAL APPENDIX - continued Page Notices Served - Summary 44 Offensive Trades 40 Outworkers 45 Pet Animals Act 40 Pharmacy and Poisons Act 40 Public Cleansing 39 Rag Flock & Other Filling Materials 40 Rodent Control - Return of Work 45 Sanitary Inspection of the Area 43 Smoke Control - Return of Work 44 Statistics - Summary of 35 Swimming Bath Water - Examination of 39 & 47 Tuberculosis 52 & 53 Unsound Food Certificates 58 Unsound Food Destroyed 59 Vermin and Scabies (Attendances) 46 Water Certificates 39