CAM 59 METROPOLITAN BOROUGH OF CAMBERWELL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1964 H.D. CHALKE O.B.E. (Mil.) T.D., M.A., M.R.C.P., D.P.H. 4376 CAM 59 PUBLIC HEALTH DEPARTMENT, TOWN HALL, CAMBERWELL, S. E. 5 March, 1965 To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Camberwell Mr. Mayor, Aldermen and Councillors, I have the honour to present my Annual Report for the year 1964, which is the last Annual Report for the Metropolitan Borough of Camberwell prior to the re-organisation of local government in London under the London Government Act, 1963 On the 1st April, 1965 the Borough of Camberwell will be merged with the Boroughs of Southwark and Bermondsey into the new London Borough of Southwark. It is 109 years since the first medical officer of health was appointed to what was then the Camberwell Vestry and reference to his report on the health of the area which was included in the Vestry's Annual Report for 1857 reveals some very interesting data The population then was 61,227 as compared with 175,740 in 1964, although it has been much higher. The death rate in 1857 was 20 whereas in 1964 it was 10.3. The real significance of the improvement brought about in the health of the community is, however, spot-lighted in the following table which shows the percentage of total deaths by age groups: 1857 1964 Age Group % of total deaths Age Group % of total deaths Under 5 years Under 5 years 34 4 5 - 55 years 5 - 50 years 30 13 Over 50 years 36 Over 55 years 83 1 Mortality from notifiable infectious diseases has been almost eliminated, diphtheria, scarlet fever whooping cough, measles and smallpox were responsible for 142 deaths in 1857, but in 1964 no deaths were recorded from these causes. Indeed the incidence of the diseases themselves has been dramatically reduced. There is no record of the deaths from malignant disease in 1857; such causes were presumably included under the heading 'other diseases chiefly chronic' which totalled 596. It would have been interesting if comparison could have been made of the prevalence of malignant disease of the lung, coronary thrombosis, and bronchitis in 1857 and today when they are the major causes of invalidism and death. The Anti-Smoking clinic which was set up in November, 1962 was discontinued during the year owing to lack of support, but the Junior League of Non-Smokers, which originated at a large comprehensive school in the Borough, continued to grow and it is hoped that it will have an impact on future generations by inculcating in children the dangers of cigarette smoking. Every effort was made to further the campaign for clean air. The programme for the establishment of smoke control areas continued and prompt action was taken to secure the abatement of smoke nuisances from whatever source they arose. The problem of the pollution of the atmosphere by diesel fumes, although not falling within the scope of the Clean Air Act, was not ignored. Whenever the Department's Officers observed black smoke being emitted from the exhausts of diesel-engined vehicles, a letter was sent to the owners drawing attention to the occurrence and seeking their co-operation in the prevention of such pollution. In many instances, replies were received assuring the Council that remedial action was being taken and expressing thanks and appreciation of the Officer's, action in bringing the matter to their notice. Most of the provisions of the Offices. Shops and Railway Premises Act, 1963, came into operation during the year. This imposed considerable additional duties upon the staff of the Public Health Department, and will necessitate the appointment of specialist officers to devote their whole time to the enforcement of this legislation. The new London Borough of Southwark have in fact already made provision for such officers on their proposed establishment. The Public Health Department played an active part in many research projects which included an investigation into the smoking habits of the population (including an assessment of the results of propaganda); the impact of drinking and alcoholism in the community (this was a survey carried out by a group of social science students from Cambridge University), and a survey of the diet of old people. Health education activities were continued and many lectures, talks film shows, and demonstrations were given to members of clubs, churches schools etc. The Medical Officer of Health broadcast on several occasions both on radio and television. The Department was visited by a number of people during the year including doctors from Canada Chile, United States. Japan and Yugoslavia as well as several army health officers. During the year, activities under the provisions of the Housing Acts was intensified, particularly in relation to houses in multiple occupation. In two extreme instances it was necessary to invoke the powers vested in the Council under the provisions of Section 73 of the Housing Act 1964 to make Control Orders. Since this is my last Annual Report for the Borough of Camberwell. I would like to take this opportunity of expressing my thanks and appreciation to the members of the Council who have always given me such support and encouragement in my efforts for the promotion of health in the Borough. I wish to thank, also the other Chief Officers and their staffs for their assistance and coperation and finally, to pay tribute to the staff of the Public Health .Department who have worked so well and consciertiously, often during their own leisure time, in the interests of the inhabitants of Camberwell- I am grateful to them and proud of their achievements. 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 1964 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.E. Nelson F. E. Rehder C. T. Robinson Mrs. F. E. Sampson Mrs. M.M. Tarrant Miss D.M. Walker Ex-Officio: Alderman W.R. Allen, M.B.E., 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 H.G. Lamborn. M.R.S.H., L.C.C. , Vice- Chairman, Finance Committee Staff of the Public Health Department (as at 31. 12. 64) Medical Officer of Health H.D. Chalke, 0. B. E. (Mil.), T. D., M.A., M.R.C.P., M.R.C.S. D.P.H. Deputy Medical Officer of Health Marjorie E. Watts, M. B., B. S., D.R.C.O.G., 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 Inspector A.G. O'Gilvie, a.c. Technical Assistants: R. Hewston, W. Cumbers B. Pye Public Health Inspectors: F. Dray, a. c. H.M. Hough, a. F. Duggins, a. J.E. Miliway, a. G. A. Fraser, a. M. Stevenson, a. P. Frost, a. H. F. Williams, a. A. Cartside, D.P.A. a. G. Matthews, a. E. C. George, a.c. A. D. Melvin, a. (2 vacancies) Student Public Health Inspectors: F. Grace E. Pain M. Lawson W. E. Samuel Infectious Diseases and Old People's Visitors: Miss B. E. Brooks, S.R.N., R.F.N. Mrs. N. Roberts, S.R.N. Miss T. Riches, S.R.N. Senior Clerk: C. Burgess Clerical Staff A. Beare Mrs. E. Cooper D. Danter Miss E. Ponder W. Everett I. Elliott Mrs. M. Findlay G.V. Ward Mrs. A. D. Dormer Miss B. Aslett (unest.) Mrs. P. Wingate (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. N.M. Mendham Mrs. D. Snetham, Mrs. F.C. Skudder Mrs. L. A. Morris Disinfecting and Cleansing Station Foreman Disinfector Vacant Stoker/Disinfector Apparatus Attendant E. Manning Disinfectors T.W. Whitfield M. Concannon (temp.), J.E. Higgott R. Gillines (temp.), R. Wainwrieht (temp.) Motor driver E. W. Bowden Cleansing Station and Home Bathing Attendants Mrs. E.M. Norman, Mrs. V. Balls (temp.) Aiso 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 There were no complaints received during the year concerning the purity of the water supply. Every dwelling in the Borough is provided with water direct from the mains of the Metropolitan Water Board. Drainage and Sewerage There were 307 applications for the approval of plans submitted in respect of the drainage of new buildings or the reconstruction of existing drains. The Council's Public Health Inspectors supervised the carrying out of all these works. The relaying of 5,219 lineal feet of sewers was carried out in accordance with the Council's sewers reconstruction programme which is under the control of the Borough Engineer and Surveyor Nuisances from pigeons Where pigeons or house doves congregate in such numbers as to cause any nuisance annoyance or damage the Council is empowered by section 121 of the Public Health (London) Act 1936 to sieze and destroy or sell or otherwise dispose of, or cause to be siezed and destroyed or sold or otherwise disposed of. any such house doves or pigeons in excess of such number as the sanitary authority consider reasonable. Nuisances by pigeons frequently do occur and it has been the practice for many years for the Council to authorise an approved person to act as pigeon catcher and arrange for him to deal with any nuisances Considerable difficulty was experienced during the year in securing the services of a suitable person to act in this capacity following the death of the Council's official pigeon catcher. It would seem that other Boroughs have experienced similar difficulties and in June consideration was given to the matter by the Metropolitan Boroughs Standing Joint Committee who informed constituent Councils that the Ministry of Agriculture. Fisheries and Food had recently organised a course for public health inspectors and pest operators in the control of feral pigeons and house sparrows. It was suggested that Boroughs who have a pigeon problem might approach the Ministry to organise another course. This Council did so, and was informed that the Ministry would be glad to arrange such a course in the autumn if there was sufficient demand. Up to th e end of the year, however, no further information had beef received. A serious problem arose in Burbage Road pigeons were nesting on the girders of the railway bridge and had become so numerous as to give rise to a considerabl e nuisance, not only as a result of the damage they wer e causing to surrounding buildings, but also from the droppings under the bridge which rendered the footways roadway foul and dangerous. It became necessary to invite tenders from p est control contractors to deal with this matter, and t he Public Health Committee authorised one of these firms to secure a reduction in the number of pigeons by shooting.' This work was in progress at the end of the year, by which time a large number of pigeons had already be en destroyed. Underground Bakehouses There is only one underground bakehouse in Camberwell and following the quinquennial review as required by the Factories Act, the Council extended the Certificate of Suitability for a further five years. Animal Boarding Establishments The Animal Boarding Establishments Act, 1963 which came into operation on 1st January 1964, provides for the licensing of such premises by local authorities, who shall specify conditions in the licence for securing the provision of suitable accommodation; adequate food, drink, bedding and exercise; reasonable precautions to prevent and control infectious or contagious diseases; appropriate measures for the protection of the animals in case of fire or other emergency; and the keeping of a register, of animals received into the establishment. The Medical Advisory Body of the Metropolitan Boroughs Standing Joint Committee considered this matter and in order to attain uniformity throughout London standard conditions were suggested for inserting in licences issued under the Act. These conditions were adopted by the Council, but as there are no such establishments in Camberwell at present it has not been necessary to invoke the new legislation. Offices, Shops and Railway Premises Act, 1963 This comprehensive legislation, designed to control working conditions in offices, shops and railway premises, requires that all such premises shall be registered with the local authority. This provision came into operation on 1st May 1964 and most of the remaining provisions on the 1st August 1964. The 'local authority' for certain classes of premises such as those occupied by Government departments, local authorities and the railways is the Factory Inspectorate, but in respect of all other offices and shops the London County Council is the enforcement authority in relation to fire precautions and the Borough Council is the enforcement authority for all other requirements. The Council is required to maintain a register of the offices and shops in respect of which they are the enforcement authority. Occupants of such premises were required to register them with the local authority between 1st May and 31st July 1964, and the Medical Officer of Health was made responsible for this matter; the public health inspectors were appointed as inspectors for the purposes of the Act. One thousand, one hundred and eleven premises were registered during the year. Compulsory Removal of aged persons It was necessary on two occasions during the year to obtain a court order for the compulsory removal of an aged, infirm person under the provisions of the National Assistance (Amendment) Act, 1951. In one case an application had to be made for an extension order under Section 47 of the National Assistance Act, 1948 in order to prevent the elderly lady concerned returning home after only three weeks in Part 111 accommodation. She subsequently settled down comfortably in her new surroundings and voluntarily gave up her flat. INFECTIOUS DISEASES The infectious diseases about which we can collect information are those which are notifiable to the Medical Officer of Health. It is becoming increasingly evident that this information about diseases occurring in the Borough is inadequate for our present needs and it is necessary to consider the collection of accurate statistics about diseases which are not infectious, but which are of considerable epidemiological importance to the community. The major 'killing diseases' today are coronary thrombosis, bronchitis and malignant conditions, notably carcinoma of the lung. Much research has been carried out and some of the causes of these diseases are now known to us. However, we still lack accurate data on the occupations, family histories and various habits of the victims of these and other non fatal conditions. For example, it was believed that coronary thrombosis was essentially a disease of the sedentary worker but medical practitioners find that an increasing number of manual workers are suffering from this condition It is important to know the reason for such trends and this we cannot discover unless we can collect information about every patient who suffers from the disease. Scarlet Fever There were 109 notified cases of scarlet fever (67 cases notified in 1963). This.disease has become much less serious during the past.15 years or so due to a change in the activity of the infecting organism and to the use of new drugs to lessen the danger of the complications which led to chronic conditions in later life. Whooping Cough There were 45 cases of whooping cough in 1964 (173 during 1963). The Health Department of the London County Council continued its intensive efforts to ensure that all infants who are fit for immunisation receive full protection at the minimum advisable age. Diphtheria and Poliomyelitis These diseases did not occur in the Borough during 1964. As in the case of whooping cough, efforts are made to ensure that all children receive protection at an early age. Measles The incidence of measles fell during 1964. 791 cases were notified (1962 during the previous year). The majority of cases occurred in children under the age of 10 years, mainly in the 5 10 year group. Efforts continue to produce a vaccine which will be effective in preventing measles without also causing unpleasant side effects in the recipients However, many still doubt whether the general use of such a vaccine would be justifiable in Western Countries, although there is the argument that measles is a more serious disease than is usually believed. The trial of measles vaccine during a year of expected high incidence of the disease should yield interesting information. Basillary Dysentery- (Some) There were 38 notified cases of dysentery during 1964 (apparently a considerable improvement on the 220 cases notified during 1963)- The word apparently' is used with deliberation since many people appear to be conditioned to the fact that a tummy upset' is not an unusual occurrence in their relatives and friends and can be regarded quite casually Such upsets' may never reach the family doctor (and hence undergo bacteriological investigation) since many are mild and can be easily treated by simple home remedies. However, these digestive disturbances can be the cause of much discomfort and distress, as well as loss of working time. They are a disgrace in a civilised community where almost everyone has access to the health education which explains frankly that such digestive troubles are caused by dirty habits in food handlers or consumers and that with care and commonsense these infections would not occur in this country. Food Poisoning Notifications of these illnesses numbered 33 during 1964 (there were 14 during 1963) with no noticeable seasonal variation In the majority of cases (22) the responsible agent could not be identified, but the fact remains that, as in the case of Dysentery these are preventable diseases, information on their mode of spread ran be widely disseminated, but if some members of the community do not cooperate we must expect needless illness to continue. PROBLEMS OF A TYPHOID CARRIER On January 29th, 1964, a Jamaican child, aged 10 months, who had been admitted to a children's hospital a week earlier, was notified as a case of typhoid fever. The child lived in a house in which there were thirteen people, all Jamaicans. Hie front room on the first floor was occupied by a man and his wife (Mrs. A) and their daughter aged 10 years.The back room was occupi ed by a woman, her daughter, aged 2½ years, and her son was the sick child admitted to hospital. The other occupaints were spread over rooms on the ground and second floors. They were interrelated and, generally speaking, lived as one family, Mrs. A doing most of the food pre paration. There was a kitchen on the ground floor which was the one mainly used, and another on the second floor which was used occasionally by some of the occupants of the upper rooms. There were also two W.C's - one on the ground floor and one on the second floor - both of which were used in common by all members of the household. The house had no bathroom and there were no wash basins. Personal ablutions were carried ait in the two kitchens, each of which had a sink and water supply. The occupants were clean in their habits, and their standards were above average. They had all been li ving in this house since September, 1963, and in this country for 3 or more years. None of them gave a history of recent illness and all were well at the time of the first and subsequent visits. The sick child had been in the care of a registered daily minder; another child in the house went to a day-nursery, and another attended school. All the contacts of these children were well, and f aeC al examinations on three occasions revealed no pathog enic organisms. Examination of the house contacts gave two positive results (Feb.5) Mrs. A and her daughter, aged 10. They lived in the room next to the mother and sister of the boy who had been taken ill, and took meals with them Both were symptomless, and gave no history of recent illness. Mrs. A. and another woman living in the house had been employed in a local pickle factory for more than a year. The sick child was transferred from the Belgrave Hospital to St. George s Hospital. Tooting, and recovered from typhoid fever. He received chloramphenicol for 14 days and nine stool and urine cultures were negative after treatment had ended. His Widal reaction remained negative throughout the illness. Mrs. A. and her daughter were also admitted to St. George's Hospital. Mrs .A. came to this country in 1956, and in 1960 had an illness diagnosed as acute cholecystitis she had severe abdominal pain but no headache, fever or diarrhoea. She was admitted to hospital for a few days and was discharged free of symptoms She was re-admitted in October : 1963, after several months of upper.abdominal pain and flatulence. After investigation her gall-bladder which was full of stones, was removed, and she had remained well since then. At St, George's Hospital Salmonella typhi was isolated from the stools, but three specimens of urine were negative on culture, Liver-function tests were normal. Intravenous cholan giography showed a grossly dilated common bileduct, containing numerous small calculi. Mrs. A. would not consent to an operation for removal of her gall-stones. Mrs. A's daughter was a healthy girl with no significant past illness. The presence of S typhi in her stools was confirmed and three specimens of urine were sterile on culture. The patient was given ampicillin 2 g. daily for 14 days. After this, six specimens of stools and three specimens of urine were negative on culture. Repeated faecal examination of home contacts though presenting difficulties and with some lack of cooperation revealed no other carriers., and it seems that Mrs. A infected the child and her own child. No history could be obtained from Mrs, A of illness in the West Indies before 1956 suggestive of typhoid. The episode in 1960 may well have been a typhoid cholecystitis followed by the formation of gall-stones, which were removed in 1963. Mrs. A was discharged from hospital early in March but was still receiving treatment as an out patient. Precautions were taken to ensure that she did not return to work in a food factory and she was found alternative employment. Rectal swabs were taken when she visited hospital and these proved to be mostly negative although on one or two occasions positive results were obtained which confirmed the suspicion that she was an intermittent excreter of typhoid organisms Early in December, however Mrs A. had further symptoms of gall stones and was readmitted to St George's Hospital, Tooting, where she underwent another operation It is hoped that after recovery she will no longer be a carrier of typhoid organisms and that the difficult public health problem she has presented will be resolved. LEAD POISONING Lead poisoning in children was the subject of an investigation by medical research workers at the Hospital for Sick Children Great Ormond Street who confirmed that there was a definite connection between mental retardation in young children and lead poisoning Nearly half of 122 mentally abnormal or retarded children examined had taken in lead earlier and the lead content of their blood was greater than that of healthy children. This gave added importance to the need to ensure that toys designed for young children should not contain lead. Two cases of lead poisoning were brought to the notice of the Public Health Department during the year The first concerned a boy aged 2 years who was removed to hospital. It was stated that he had gnawed wooden window ledges in his home thereby removing a fair quantity of paint. Samples of paint were scraped from the two window ledges concerned and submitted for analysis. One sample contained one per cent of lead and the other 5. 5 per cent , A plastic toy elephant, which the child had go chewed, proved on examination to be free of any significant quantity of lead. The British Standard Code of Safety Requirements for children's play things recommends that paint for toys should not contain more than 1.1 per cent of lead. It would seem likely in this case that paint from one of the window ledges may have been the cause of the child's illness. The other case was a girl aged 2 years and 9 months who was reported by Evelina Children's Hospital to be suffering from lead poisoning. Enquiries revealed that some plastic toys had been chewed by the child and these were submitted for analysis. One of them, a plastic toy dog on wheels - was found to contain 650 parts per million of lead in the substance and could have been the causative agent. It was believed that this toy had been purchased the previous Christmas from a stall in a market place but efforts to trade its origin were unsuccessful. The British Plastics Federation have stated that no plastic toys containing lead are made in this country, and the Home Office has recommended that imported plastic toys should not contain more than 250 parts per million of lead in their plastic SMOKING (Adapted from an article published in the Royal Society of Health Journal„ September/October, 1964) Since 1950 anti smoking propaganda has become a feature of health educational activities, which were intensified following publication of the Report of the Royal College of Physicians of London in 1962 Tobacco first came to England in Elizabethan times and since those days many voices have been raised in condemnation of the smoking habit. But nothing could retard the increasing consumption of tobacco. Army officers brought in the cigar after 1815. The cigarette made its appearance in the 1850's. The habit was acquired by soldiers in the Crimea, who rolled tobacco in pieces of newspaper. A returned soldier named Cloag who lived at Peckham, started making tubes of tobacco in yellow paper with cane mouthpieces. He later employed 100 workers and in 1884 introduced cigarette cards. Hand rolled cigarettes were replaced in 1891 by the machinemade variety and a new industry came into being. In 1902 each male in this country was consuming on an average, one pound of tobacco in a year; 60 years later this had increased tenfold. Women, who acquired the habit later, smoked a pound each in 1922, they now smoke four times as much. More than once, during the present century, doctors have drawn attention to the dangers to health of smoking- Studies were made in London in 1948, in America in 1941, and by a German physician who, in 1923, associated the increase in cancer of the lung with the rise in the amount of cigarette smoking. Much information has now been gathered about the smoking habits of persons in different age and sex groups from 10 years upwards, and among those in different walks of life. The results have not been uniform, even in relation to members of comparable group which is not surprising when full and accurate information is not easy to obtain. However, a general picture has been built up which leaves no doubt as to the magnitude of the preventive task. Children The many studies undertaken during the past five years show that at least one boy in ten has started to smoke before he leaves the primary school; it appears that less than 3 per cent of girls indulge in the occasional cigarette at this age. Surveys in Camberwell 2,000 children-have shown that at the time of entry to senior schools 11 per cent of boys and 1 per cent of girls smoke. The percentage of smokers and the number of cigarettes smoked go up sharply after the first year at school and continue to increase among both sexes. When they leave school, children are approaching the practices of adults. Figures in Camberwell, obtained shortly after anti-smoking propaganda was intensified, are a little lower than the national averages, but statistical inaccuracies cannot be ruled out. Later surveys in the same schools suggest that intensification of effort has met with a measure of success. The results of the first survey are shown in the following table. Ages and percentage of smokers Boys Girls 12 years - 11 per cent 12 years - 1.5 per cent 13 years - 25 per cent 13 years - 12 per cent 14 years - 25 per cent 14 years - 18 per cent 15 years - 26 per cent 15 years - 23 per cent 16 years - 34 per cent 16 years - 28 per cent An earlier enquiry among senior girls in another school revealed 36 per cent of smokers, but a third of this number were occasional smokers only. In an English public school 46 per cent of boys between 15 and 19 were regular smokers; 50 per cent of women students in a teachers' training college smoked. Early and excessive smoking among children is reported from many parts of the world. Why do children smoke? Special health educational campaigns pay the biggest dividends when they take account of all available knowledge bout the habits and customs contributing to the illnesses against which the preventive drive is being directed. This truism has a special bearing on antismoking measures among children and young people, a large proportion of whom have not begun smoking or, if smoking occasionally have not yet succumbed to the habit. It is agreed by those who have experience in the matter that the better education of school children about smoking and its consequences is a major objective. There is no divergence of opinion on the role of the cigarette as a status symbol the beacon that shows the world the desire of the adolescent to appear grown up and sophisticated. Curiosity is probably the chief initial incentive some children smoke for a dare'. But the young are essentially imitators and it is natural that they should ape those around them, at home, at school, at the youth club, on the street corner, and the personalities they see on the television screen. As they become older young people speak of the enjoyment, relaxation and contentment that go with the cigarette, and the way it counteracts worry, mental tension and boredom. The view that smoking at these ages expresses a rebellion against authority and a reaction against interference with their freedom by adults, cannot be accepted without reservation. But those who impute the social occasion at which everyone smokes or the difficulty of refusing a cigarette offered as a friendly gesture, have a far more real excuse. Among college students cost was an important reason for limiting the purchase of cigarettes; conversely, many young people earning good wages say they are now able to buy more. (It is relevant to mention the complaint of a South London school-master who declares that his preventive campaign is being deliberately undermined by the shopkeepers who sell cigarettes to children under age. A cigarette and a match are sold for 2d. The shops are visited, but the offence is always denied). Others point out that, smoking (like alcohol) is a necessity in their business life. The collection of coupons, which may be exchanged for free gifts, is sometimes given as an excuse. Some observers believe that there may be an inverse relationship between the smoking habits and intelligence of school-children. Support is lent to this view by the findings in a large comprehensive school in Camberwell, for every three boys in the highest academic groups who smoked, there were five in the lowest. Among the girls the differences were of no statistical significance. Impact of Health Education The health educator has many opposing forces with which to contend one of these is commercial advertising with its skills and vast resources. Young men and women are the chief objectives, and the television screen giving the advertising agent great scope for his arresting and seductive presentations, which are enhanced by repetition. We know far too little about the impact on the public of the various health educational techniques employed; this is not so in commerce, where the advertiser takes good care to discover the effects of his sales promotion. In order to try to find out something about these matters, a preliminary survey was undertaken in Camberwell with a questionnaire to a random sample of adults and children. The results leave no doubt as to the tremendous influence of television advertising on children and adults alike. The number of children unable to recall advertisements for cigarettes was negligible; most could repeat the slogans and describe the scenes. Many asked why the public health department was unable to compete with expert commercial selling devices in its health promotion projects. The great majority wanted more programmes on health, including those dealing with lung cancer. As a health educational medium, television was voted first in all but the older age groups, schoolchildren gave films second place. Posters and exhibitions were much lower in the lists. The importance of example was highlighted by the many comments on the frequency with which well-known people, at interviews or in plays, smoked cigarettes before the television cameras. A school anti-smoking society When, in October, 1962, an anti-smoking unit visited a comprehensive school in Camberwell (a school which has had a close link with the public health department for a long time) the pupils were invited to suggest ways in which they might help. An anti-smoking society was suggested at once and a boy volunteered to become the organizer. Prizes were offered for the best designs for a badge and the art room became the scene of great activity. A mixed committee of six came into being, which soon developed into an enthusiastic group, encouraged to conduct its affairs with a minimum of interference from the staff and doctors. Talks and group discussions were arranged; helped by periodic visits from doctors, sportsmen, physical educationists, beauty culturists and others A lapel badge designed in collaboration with the committee was made available by Family Doctor'. It is free but the society members (who now number 700 in the school of 1,700 pupils) decided to pay threepence each for it The token design, a red kidney shaped object with a black dot within, symbolic of a cancer cell, invites the question 'What badge are you wearing'? Publicity, limited at first, is now bringing enquiries from other schools at home and abroad, and societies on comparable lines are being formed. This venture has been most successful in the lower forms, where nearly everyone has joined after agreeing to the only rule, which is a promise not to smoke until the age of 21. (Although open to some objection, this form of words, decided only the children, was not questioned). As yet there are fewer members among the more dedicated smokers in the top forms, but this will alter, it is hoped, as time goes on. It is not being forgotten that the critical age, when the casual smoker becomes 'a regular' is at 16. The Junior League of Non-Smokers The movement has such great potential that it was decided to establish a junior league of non-smokers on a national basis. This was inaugurated at the exhibition for schoolboys and schoolgirls held at Olympia in January, 1963, in the presence of Lord Newton, Parliamentary Secretary, Ministry of Health and representatives of the health and education services. The Camberwell school committee answered questions from a large audience of school-children, enthusiastic and avid for information. One national daily noted this event, but several provincial papers reported it; many enquiries about the league have resulted. Conclusion There are certain broad conclusions to be drawn. (a) Urgent and more intensive action is necessary, at national and local levels, if this pandemic of cigarette smoking with its undeniable ill effects on the health of the Country is to be stemmed (b) The intricate task of changing public attitudes towards smoking calls for better planned and co ordinated efforts by outside bodies in support of the pressure being exercised by the medical services (c) The material aid which the personal and environ mental health services have provided increasingly in the prevention of disease and the promotion of health are too often taken as an excuse for a disregard of personal responsibility and physical morality The smoker like the alcoholic and others with behaviour problems, cannot rely on inoculation sanitation chlorination or spraying wi th D.D.T to come to his aid neither will he find treatment of much avail in the absence of will power and a sensible attitude of mind. (d) For these reasons, propaganda directed at adults must emphasise that although the maximum help and guidance is at their disposal the outcome is in their own hands At the same time parents and teachers, youth leaders and the clergy must be reminded forcibly that whatever their personal attitudes and failings, they have vital responsibilities to the rising generation which must be fulfilled by example and precept. (e) The school is well adapted for propaganda and positive action. Lines of approach need close scrutiny with the object of stimulating children to think for themselves and conduct their own campaigns. (f) Funds available for all aspects of health educa tion are most inadequate. Anti smoking propaganda is being curtailed and it is unable to off set cigarette advertising especially on television, by expertly devised publicity. (g) More information is required as to the extent to which the law against selling cigarettes to under-age children is being broken There should be heavier penalties and the minimum age may well be raised. (h) Here, and in America many other legislative procedures have been advocated, some of which may reach the Statute Book The tobacco manufacturers are searching lor the noxious elements in cigarette smoke with a view to their removal but this is a distant possibility, the worth of which some will doubt But none will dispute that ii cannot be abstinence, moderation is the next best thing. Anti-smoking Clinic The Anti-smoking Clinic which was set up in November 1962, continued to operate group therapy sessions throughout the year under the guidance and supervision of Dr. J. Griffith Edwards of the Maudsley Hospital. Each person was invited to attend for four successive weeks and was then followed up by a postal enquiry at monthly intervals for a further three months. In September 1964 an article was published in 'The Lancet' reporting the results of an investigation carried out by Dr. Griffith Edwards at the Anti-smoking Clinic the previous year into the efficacy of buffered lobeline sulphate. This was entitled 'Double-blend Trial of Lobeline in an Anti-smoking Clinic' and the following extracts are of considerable interest. Twenty-five women cigarette smokers were treated with lobeline and 25 with placebo; patients were randomly allocated to one of these groups. Patients were seen by appointment for an initial interview of 30 minutes and at this interview the dangers of continued smoking were discussed in detail. The special difficulties which giving up smoking seemed to present to the particular individual were also talked over. Patients were then offered the aid of tablets, these tablets were represented as being a powerful aid to stopping smoking, but it was stated that the tablets, although lessening the craving for cigarettes were not a 'cure' which could replace the necessity of the patient's own resolve. Patients who received lobeline were given a week's supply of tablets....... to be taken three times a day, while patients on placebo were given with the same instructions tablets which appeared identical with the lobeline and which cantained 15 mg quinine sulphate so as to give them the same taste as the lobeline tablets. Patients were seen for three further weekly appointments and the supply of tablets renewed. Diary cards were provided on which patients recorded the number of cigarettes smoked and these were handed in at the end of each week. At the end of each of the first three months after the completion of the four weeks course of treatment patients were sent a reply paid inquiry asking how much, on average they had been smoking during the previ ous months. Assessed four months after starting treatment, only 10 per cent of patients had stopped smoking completely, That so few patients were able to achieve complete success is disappointing, but the proportion of patients considerably cutting down their smoking was more impressive, and this reduction was not ephemeral so far as a three-month follow-up was concerned. The degree to which patients who cut down but did not stop their smoking would show more long-term benefit is, however, very uncertain. Whatever the therapeutic success of an anti-smoking clinic, its establishment may, as an obvious manifestation of official concern, have a valuable impact on public opinion. Furthermore, even a moderate success rate may justify the expense involved in running a clinic. That the treatment described in the present paper did not achieve better results is no reason for abandoning antismoking clinics, but provides on the contrary an urgent argument for further experiment in methods and treatment. SUMMARY (1) At an anti smoking clinic set up by the Public Health Department of Camberwell Borough Council a comparison was made of the results of four week's treatment with buffered lobeine sulphate and placebo. Postal follow up inquiry was made at one, two and three months after the end of treatment. There were 25 women in each group. (2) Neither during the four-week treatment nor at followup were there significant differences in outcome between the groups Considering the two groups together 68 per cent had by the last clinic treatment reduced their smoking to 0-33 per cent of the original level 16 per cent to 33 36 per cent and 16 per cent to 66 100 per cent of the original level Mean smoking level for patients responding to the third monthly inquiry showed a partial but not com plete relapse but at that time only five subjects (10 per cent) had completely stopped smoking. A num ber of factors which were examined did not correlate with success in stopping smoking. (3) Possible reasons were discussed for the conflict between the present findings and studies which have seemed to show that lobeline can have more than a placebo effect- (4) That better results were not obtained is an urgent argument for further research into methods of treating smoking. ACKNOWLEDGMENTS 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 conducted. I would also like to thank Mr. Cranfield and the staff of Dr Chalkes department for their great helpfulness in the running of the clinic. Messrs. Uni Pharma kindly supplied the lobeline and placebo tablets used in this study. My thanks are due to Miss K Bluk for secretarial assistance. STATISTICAL APPENDIX Summary of Statistics for the year 1964 Area of the Borough 4,480 acre, 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/1964) 175,740 Number of inhabitated houses (April 1964) 46,112 Rateable value (April 1964) £7,409.806 Sum represented by a penny rate (Estimated) £29,500 Number of live births 3,669 Birth rate 20.9 Number of deaths 1,818 Death rate 10.3 Infantile Mortality Deaths under 1 year 73 Infant deaths per 1,000 live births 19.9 Maternal Mortality Deaths of women from diseases or accidents associated with childbirth 1 Maternal death rate per 1,000 total births 0.3 Deaths from Pulmonary Tuberculosis 19 Death rate 0.1 Deaths from cancer of lung and bronchus 112 Death rate 0.6 Deaths from all forms of cancer 390 Death rate 2.2 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1964 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- 55- 35- 45- 65- 75- M 4 1. TUBERCULOSIS, RESPIRATORY 10 2 4 - - - - - - - - F 9 4 2 1 2 - - - - - - - 2. TUBERCULOSIS, OTHER M 2 - - - 1 1 - - - - - - F - - - - - - - - - - - - 3. SYPHILITIC DISEASE M 1 - - - - - - - - - 1 - - F - - - 1 1 - - - - - - M 4. DIPHTHERIA - - - - - - - - - - - - F - - - - - - - - - - - - 5. WOOPING COUGH M - - - - - - - - - - - - F - - - - - - - - - - - - M - - - - - - - - - - - 6. MENINGOCOCCAL INFECTIONS - 1 F 1 - - - - - - - - - - 7. ACUTE POLIOMYELITIS M - - - - - - - - - - - - F - - - - - - - - - - - - 8. MEASLES M 26 - - - - - - - - - - - - F - - - - - - - - - - - - 9. OTHER INFECTIVE AND PARASITIC DISEASES M 1 - - - - - - - - 1 - - F - - - - - - - - - - - - 10. MALIGNANT NEOPLASM, STOMACH M 22 - - - - - - 1 4 5 6 6 F 17 - - - - - 1 1 3 9 3 - 11. MALIGNANT NEOPLASH. LUNG, BRONCHUS 18 M 95 - - - - - - 2 39 24 12 17 - - - - 4 4 3 5 F - - 1 M 12. MALIGNANT NEOPLASM, BREAST - - - - - - - - - - - - F 30 - 4 9 8 6 3 - - - - - 13. MALIGNANT NEOPLASM, UTERUS F 13 - - - - 1 4 4 3 - - 1 14. OTHER MALIGNANT AND LYMPHATIC NEOPLASMS M 83 - 1 - - 1 3 11 19 24 24 - 105 F 4 5 8 27 32 29 - - - - - 15. LEUKARMIA. ALEUKARMIA M 4 - - 1 1 1 1 - - - - - - F 4 1 - - - - - - 1 2 - 16. DIABETES M 5 - - 1 - 1 3 - - - - - F 9 1 - 8 - - - - - - - - 17. VASOULAR LESIONS OF NERVOUS SYSTEM M 69 - 19 16 - 8 26 - - - - - F 112 1 2 3 8 74 - - - - - 24 18. CORONARY DISEASE, ANGINA M 187 - - - - - 1 8 25 59 54 40 F 151 - 7 9 46 89 - - - - - - 19. HYPERTENSION WITH HEART DISEASE M 5 2 2 1 - - - - - - - - F 1 5 7 13 - - - - - - - - 20. OTHER HEART DISEASE M 55 1 1 13 25 2 6 7 - - - - F 91 2 4 2 6 14 63 - - - - - M 21. OTHER CIRCULATORY DISEASE 39 3 16 - - - - - - 2 5 13 F 1 68 - - 3 12 52 - - - - - 22. INFLUENZA M - - - - - - - - - - - - F - - - - - - - - - - - - M 23. PNEUMONIA 73 1 3 1 6 14 48 - - - - - F 92 - - 2 1 3 14 72 - - - - 24. BRONCHITIS M 88 4 5 21 31 27 - - - - - - F 33 1 1 1 4 5 21 - - - - - 25. OTHER DISEASES OF RESPIRATORY SYSTEM M 18 2 4 4 5 - - - - - - 3 F 5 1 - - - - - - - 1 - 3 26. ULCER OF STOMACH AND DUODENUM M 13 - - - - - - 4 6 3 - - F - - - - 1 - 1 1 6 4 - - 27. GASTRITIS, ENTERITIS AND DIARRHOEA M 3 1 1 - - - - - - - 1 - 1 F 6 - - - - - - 1 4 - - 28. NEPHRITIS AND NEPHROSIS M 9 - - - 3 2 - - 1 - 2 1 F 5 - - - - - 2 - - - 1 2 - - - - - 29. HYPERPLASIA OF PROSTATE M 4 1 3 - - - - 30. PREGNANCY, CHILDBIRTH, ABORTION F 1 - 1 - - - - - - - - - M 11 7 3 - - - - - 31. CONGENITAL MALFORMATIONS - - 1 - - 1 2 F 16 7 4 - - 1 1 - - 32. OTHER DEFINED AND ILL-DEFINED DISEASES M 72 24 - 3 2 16 12 - - - 2 13 78 15 1 F - - - 1 3 10 9 34 5 M 33. MOTOR VEHICLE ACCIDENTS 11 - 1 3 1 1 1 1 2 - - 1 F 3 1 - - - - - - - - - 2 12 1 1 - 1 2 34. ALL OTHER ACCIDENTS M 1 2 1 3 - - F 16 - 1 2 1 3 3 6 - - - - M 13 - - 2 3 35. SUICIDE - - - 2 2 1 3 10 - - 1 F 1 1 2 1 4 - - - 36. HOMICIDE AND OPERATIONS OF WAR M 1 1 - - - - - - - - - - F - - - - - - - - - - - - 3 5 7 28 97 M 906 32 11 8 220 229 266 Total All Causes 8 F 912 22 2 - 5 12 29 51 102 145 486 Births Live Births Still Births Total M F M F M F 1,629 246 1, 548 246 24 5 23 1,653 1,571 Legitimate Illegitimate Total 2 251 248 1,875 1,794 29 25 1,904 1,819 3,669 3,723 54 Medical Examinations carried out by the Medical Officer of Health or his Deputy Officers for admission to the Permanent Establishment 58 Officers for admission to the Unestablished Staff 6 Employees for admission to Sick Pay Scheme 224 Employees for admission to Permanent Establishment 70 Employees absent from duty owing to sickness 482* * In addition, 589 who were requested to attend failed to do so. 28 Cremation Certificates No. of cremations authorised during the year by the Medical Referee or his Deputy 2,191 Water Certificates No. of Water Certificates issued 132 No. of dwellings concerned *Includes 22 mobile homes * 859 Drainage and Sewerage No. of drainage applications received 307 Length of sewers reconstructed 5,219 No. of brick gullies replaced by pot gullies 44 No. of defective pot gullies renewed 6 No. of new pot gullies installed 7 Public Cleansing Amount of house refuse collected 44,470 tons Amount of trade refuse collected 1,584 tons Examination of Water from the Council's Swimming Baths Bacteriological examination Chemical examination No of Samples No. Satis. No of Samp les 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 12 Dulwich Second Class Swimming Bath 12 12 12 34 34 34 34 In addition, water from the Swimming Bath at Mary Datchelor Girls School. Camberwell Grove was chemically on four and bacteriologically examined on five occasions. All the samples were satisfactory Bag Flock and Other Filling Materials Act, 1951 Type of Material No. of Samples examined No. satisfactory Woollen mixture felt 2 2 Hair pad 1 1 New cotton felt 3 3 Sized cotton wadding 2 2 Rag flock 1 1 Cotton Mill puffs 1 1 Coir fibre 2 2 Washed flock (layered) 1 1 Coir fibre pad 1 1 Totals 14 14 Offensive Trades Type of Business No. on Register Skin dressers 3 Soap boilers 1 Total 4 Pet Animals Act, 1952 No. of licences issued 2 No. of licences renewed 9 Total No. of pet shops licensed 11 Pharmacy and Poisons Act, 1933 No. of applications received for registration 7 No. of applications received for renewal of registration 113 London County Council (General Powers) Act, 1954 No. of hairdressers and barbers premises registered 154 OFFICES. SHOPS AND RAILWAY PREMISES ACT, 1963 Class of Premises Number of Premises Registered During 1964 Total Number of Registered Premises at End of Year Number of Registered Premises Receiving A General Inspection During the Year Number of Visits of all kinds by Inspectors to Registered Premises 217 217 44 44 Offices Retail Shops 753 753 455 455 Wholesale Shops Warehouses 41 41 16 16 Fuel Storage Depots 100 100 113 113 Totals 1, 111 1, 111 628 628 ATMOSPHERIC POLLUTION, 1964 At 473. Lordship Lane Average Concentration of Sulphur Dioxide in Micrograms Per Cubic Metre ATMOSPHERIC POLLUTION, 1964 At Town Hall Average Concentration of Sulphur Dioxide in Micrograms Per Cubic Metre ATMOSPHERIC POLLUTION 1964 At 475, Lordship Lane Average Concentration of Smoke in Micrograms Per Cubic Metre ATMOSPHERIC POLLUTION At Town Hall Average Concentration of Smoke in Micrograms Per Cubic Metre 1964 Sanitairy Inspection of the Area No. of complaints received 4,289 Summary of work carried out during the year 1964 Inspections:- Nuisance inspections 3,442 Offensive trades 8 Smoke observations 445 Drainage, new and existing 9, 159 Overcrowding 719 Factories and workplaces 654 Outworkers' premises 96 Rag dealers 44 Infectious and other diseases 7 Verminous premises and persons 169 Aged and infirm persons 110 Conveniences, public and private 182 Consumer Protection Act 219 Rent Act, 1957 45 Shops Act 1,464 Hairdressers and barbers 122 Voluntary work 147 Inspections not defined 1,646 Re-inspections 9,218 Total inspections 27,896 works supervised:- Tests applied to drains (existing premises) 382 Drains found defective 214 Drains totally reconstructed 39 Drains repaired or partially reconstructed 290 Tests applied to drains (new buildings) 3,172 Drains constructed 2,753 Total works supervised 6,850 Description of sanitary improvements ordered during the year:- Cleanse and repair walls and ceilings 244 Repair roofs, gutterings, etc. 185 Abate dampness 428 Repair stoves, fireplaces and coppers 35 Repair windows, sashlines, sills, etc. 214 Repair flooring, stairs, doors, etc. 188 Provide sufficient light and ventilation 5 Provide dustbin 39 Remove offensive matter 66 Provide or repair yard paving 24 Provide or render accessible water supply 4 Cleanse, cover or render accessible water cistern 1 Repair water pipes and fittings 23 Clear premises of vermin 2 Cleanse or repair water closets and flushing apparatus 77 Repair or clear defective or obstructed drains 49 Repair soil pipes, waste pipes, sinks, etc 46 Abate nuisances caused by animals improperly kept 2 Miscellaneous 145 Total repairs and improvements ordered 1,777 Smoke Control - Return of Work Visits in connection with smoke complaints 576 Smoke observations. 445 Atmospheric pollution readings 605 Smoke Control Areas - Inspections 3,123 Other Visits 1, 112 Industrial premises inspections 274 Total 6,135 SUMMARY OF NOTICES SERVED, 1964 Intimations, Public Health (London) Act, 1936 Byelaws, etc 718 Statutory Notices, Public Health (London) Act, 1936 Byelaws, etc 386 London County Council (General Powers: Act, 1955 474 Public Health (London) Act, 1936 (Part II) 82 No. of Summonses issued 23 Factories Act 1961 1. INSPECTIONS 1964 Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted 341 - Factories in which Sections 1,2,3,4 and 6 are to be enforced by Local Authorities. 119 - Factories not included above in which section 7 is enforced by the Local Authority. 902 342 32 - Other Premises in which Section 7 is enforced By the Local Authority (excluding outworkers premises). - 21 21 - - Totals 1,264 32 482 2. CASES IN WHICH DEFECTS WERE FOUND, 1964 No. of cases in which defects were Number of cases in which prosecutions were instituted Particulars Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 2 1 - 2 - - - - Overcrowding - - - - - Unreasonable temperature - - 1 - - Inadequate ventilation - - - - Ineffective drainage of floors - - - I - - Sanitary conveniences - - (a) insufficient - - 19 5 - - - (b) unsuitable or defective 2 - - - (c) not separate for sexes - Other offences against the Act (not including offences relating to outwork) - - - 22 - - Total 46 17 - 2 Summary of Outworkers classified by Trades Artificial flowers 3 Brass & brass articles 5 Cardboard boxes 25 Carding 10 Christmas stockings & crackers 1 Household linen 11 Jewellery 4 Lampshades 50 Wearing apparel 189 Total 298 Summary of work of the Rodent Control Staff No. of complaints received 1,260 No. of inspections 828 No. of Operators' calls 9,649 No of private premises baited 1,600 No, of business premises baited 191 No. of baits laid 8,424 Vermin and Scabies ATTENDANCES AT CLEANSING STATION Vermin Scabies Male Female Total Male Female Total Adults 2 16 18 12 8 20 43 106 149 50 58 108 Children Total 122 167 62 66 128 45 Disinfection RETURN OF WORK CARRIED OUT BY DISINFECTING STAFF Notified Infectious Diseases Other Diseases Miscellaneous Vermin Total all Cases 653 694 Rooms disinfected 23 6 12 97 329 591 Articles disinfected 4 1,021 39 1,334 Total visits 16 1,019 ,260 Number of books disinfected 23 Number of towels washed 4,255 Number of soiled articles washed 13,892 Number of overalls washed 122 Number of covering sheets washed 60 Beds and mattresses destroyed 99 Miscellaneous articles destroyed 363 Number of articles dried (burst pipes) 75 Weight of:- tons cwt. qtrs. lbs. Unsound foods destroyed 134 5 1 19¾ Unsound foods destroyed for Lambeth B.C. 21 18 0 27 Furniture and effects destroyed - 15 0 0 Official documents destroyed 41 15 2 0 Dead animals destroyed - 4 3 0 Wood Clippings destroyed 57 0 0 0 Total 255 18 3 18¾ Hospital bedding etc. disinfected 2 4 3 7 Bacteriological Reports on Samples of Swimming Bath Waters taken troughout the Year Dulwich Baths First Class Bath Second Class Bath 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. - Plate count yeastrel agar 24 hrs. 37°C. aerobically colonies per ml. - 0 January 2 0 - 0 February - March - 0 0 - 0 April - - 0 1 0 0 May 0 1 0 June 2 0 0 1 0 July 0 August 0 0 0 1 0 4 September 95 0 0 October - - 3 November 0 0 - - - - - - December Camberwell Baths Front Bath Rear Bath Plate count yeastrel agar 24 hrs. 37°C. aerobically colonies per 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. Probable No. of coliform bacilli MacConkey 48 hrs. 37°C. colonies per 100 ml. 0 - - 0 January 0 February 2 - - 0 March - 0 - April 1 0 - 1 0 0 1 May 1 1 0 June 0 0 1 0 July 5 0 0 0 0 August 3 2 0 2 0 September 0 0 October - - 0 0 November - - 0 0 December - - 40 HOUSING Record of work of Housing Inspector, 1964 Inspections Re-inspections Total Clearance areas 3,414 812 4,226 Individual unfit Section 9 155 279 434 Section 16 21 44 65 Underground rooms and parts of premi ses Section 18 104 136 240 Total 4,965 3,717 1,248 Housing Statistics, 1964 1. Inspection of Dwelling Houses during the Year:- (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Act) 7,283 (b) Number of inspections made for the purpose 17,749 (c) Number of dwelling-houses found not to be in all respects reasonably fit for human habitation 2,482 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 734 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 386 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By owners 1,093 (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 22 (b) By Local Authority in default of owners 5 (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 (4) Parts of buildings closed by Closing Orders (Section 18):- (a) Underground rooms 21 (b) Other rooms 8 (5) Undertakings not to use parts of buildings for human habitation accepted:- (a) Underground rooms Nil (b) Other rooms Nil (6) Houses demolished under Section 42 25 (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) 7 (4) Closing Orders determined 4 (5) Closing Orders revoked and Demolition Orders made Nil (d) Houses in Multiple Occupation:- (1) No. of inspections and re-inspections 500 (2) No. of premises found to require action 75 (3) No. of premises at which conditions were remedied as a result of informal action 53 (4) No of premises requiring formal action 22 (5) No. of Direction Orders made 20 (6) No. of Management Orders made 20 ( e) Housing Act, 1964:- No. of Control Orders under Section 73 2 Certificates of Disrepair No. of applications for Certificates of Disrepair 12 No. of Undertakings received from landlords 7 No. of Certificates of Disrepair issued 3 No. of Certificates of Disrepair refused Nil No of Certificates of Disrepair cancelled 2 INFECTIOUS DISEASES 1964. SUMMARY OF NOTIFICATIONS RECEIVED AND DEATHS FROM THESE CAUSES AMONG NOTIFIED CASES No. of Notifications Treated in Hospital Found not to be suffering from the disease Deaths of Noti fied Cases Age Distribution of Notifications Disease Under 1 3 to 4 4 to 5 15 to 20 20 to 35 35 to 45 45 to 65 1 to 2 2 to 3 5 to 10 10 to 15 65 and upwards - Scarlet Fever 109 1 3 1 9 13 69 13 - 1 - - - - - 7 Whooping Cough 45 9 6 6 7 10 - - - - - - - - - Poliomyelitis and Polioencephalitis - - - - - - - - - - - - - - - - Measles 791 1 39 101 127 128 101 285 4 1 5 - - - - - Diphtheria - - - - - - - - - - - - - - - - Pheumonia (Acute Influenzal 2 1 - - 1 - - - - - - - - - - - (Acute Primary 27 - 1 1 3 2 2 2 11 2 - - - - - 3 38 1 22 1 Dysentery 6 3 3 9 3 8 2 3 - - - - Typhoid & Paratyphoid Fever 5 5 1 2 1 1 1 - - - - - - - - - Erysinelas 3 - - - - - - 1 - 1 1 - - - - - (1) Meningococcal Infection 1 1 3 3 1 1 1 - - - - - - - - - (2) Puerperal Pyrexia 130 122 - 22 100 8 - - - - - - - - - - Ophthalmia Neonatorum 3 3 3 - - - - - - - - - - - - - Scabies 16 2 1 - - 6 3 4 2 1 - - - - - - Malaria - - - - - - - - - - - - - - - - (1) Includes one case of a Camberwell Residents that occurred in a hospital outside the Borough (2) Includes 41 cases of a non-residentd occurring in hospitals in Caraberwell, also 5 cases of Camberwell residents that occurred in hospitals outside the Borough. FOOD POISONING Annual Return of cases of Pood Poisoning, 1964 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total 7 (a) Food poisoning notifications (corrected) as returned to R.G. 7 7 9 30 3 (b) Cases otherwise ascertained - - 3 - (c) Symptomless excreters - - - - - - - (d) Fatal cases - - - 2. Particulars of outbreaks No. of outbreaks No. of cases I Family outbreaks Other outbreaks Notified Otherwise ascertained Total No. of cases Agent I — — — — Agent identified: - - - - - (a) Chemical poisons 2 (b) Salmonella Typhimurium 1 - 2 - (c) Staphylococci (inc. toxin) - - - - - (d) CL. Botulinum - - - - - (e) Cl. Welchii - - - - - (f) Other bacteria - - - - - Agent not identified 2 5 - 5 - 3 7 7 Totals - - 3. Single cases No.of Cases Total No. of cases Agent Notified Otherwi se ascertained Agent identified: - - - rr (a) Chemical poisons (b) Salmonella: I ! 5 1 6 Typhimurium Muenchen 1 - 1 1 Brandenberg - 1 1 Bareilly - 1 (c) Staphylococci (inc. toxin) - - - (d) Cl. Botulinum - - - (e) Cl. Welchii - - - - (f) Other bacteria - - 17 17 Agent not identified - 26 Totals 23 3 Tuberculosis TABLE SHOWING SEX AND AGE DISTRIBUTION OF ALL PRIMARY NOTIFICATIONS AND DEATHS FROM TURERCULOSIS DURING 1964 Deaths Notifications Pulmonary Non- Pulmonary Pulmonary Non-Pulmonary Male Female Age Periods Male Female Male Female Male Female Notified Not Notified Notified Not Notified Notified Not Notified Notified Not Notified 0 - 1 yr. - - - - - - - - - - - - 1 - - - 1 - 5 yr. 2 - - - - - - - - - 5 - 15 yr 3 3 - - - - - - - 10 4 1 - - - - - - - - - 15 - 25 yr. - - 25 - 35 yr. 14 3 1 - 1 - - - - - 35 - 45 yr. 13 - - - 2 - - - - - 6 - 14 2 - 1 1 - - - 45 - 55 yr. - - - - 1 - 55 - 65 yr. 16 2 1 - 1 3 - - - - 9 3 1 3 1 1 1 - - - - 65 and Over - Totals 80 25 5 4 1 1 - 3 1 4 - - After correction for inward and outward transfers. TABLE SHOWING NOTIFICATIONS AND DEATHS, TOGETHER WITH THE ESTIMATED POPULATION DURING THE PAST FIVE YEARS Year Estimated Population No. of Primary Notifications Notification Rate per 1,000 Population No. of Deaths Death Rate per 1,000 Population 1.0 0.10 18 1960 175,020 183 1961 0.9 20 173,980 165 0.12 1962 173,720 152 8 0.8 0.05 1963 174, 220 118 10 0.6 0.06 1964 175,740 0.6 21 109 0.12 RETURN OF VISITS - INFECTIOUS DISEASES AND OLD PERSONS Food Poisoning Dysentery Poliomyelitis Scarl et Fever Scabies Smallpox Other Diseases Aged and Infirm Persons Miscell aneou s Total Visits Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts 4 297 23 3 - 100 - 11 - - 33 79 82 2,559 259 93 3,543 46 Food and Drugs Adulteration Summary of Samples obtained for examination Percentage of adulteration Number examined Number adulterated etc. Formal Informal Total Total Formal Informal Formal Informal 148 639 787 - 17 17 - 2.66 Particulars of the adulterated samples and the action taken are set out on pages 49 and 50 Registered Purveyors of Milk Distributors of milk in the Borough 215 No. of pre-packed licences issued 215 Results of Tests Designation Methylene Blue Test Phosphatase Test Turbidity Test Unsatisfactory Satisfactory Unsatisfactory 5 Satisfactory Unsatisfactory Satisfactory Pasteurised 60 73 - - - Tuberculin tested pasteurised 47 52 - 1 - - 16 Sterilised - - - - - Samples of milk taken in course of delivery to Hospitals and Schools:- Phosphatase Test Chemical Test Methylene Blue Test Hospitals 23 23 23 Schools 35 35 36 All the above samples were satisfactory. Ice Cream Summary of samples submitted for Methylene Blue Test and Chemical Examination. Chemical Examination Methylene Blue Test Satisfactory Unsatisfactory Grade IV Grade I Grade II Grade III 41 32 14 6 9 - Ice Lollies and Water Ices Summary of samples submitted for examination. Bacteriological Examination Chemical Analysis Satisfactory Unsatisfactory Satisfactory Unsatisfactory Ice Lollies 8 - - - - Cream Lollies 7 - - Assorted Lollies - - 20 - Water (Lemon) Ices 7 - - - Syrup Cydrax Label did not bear statement of ingredients Contained a mass of moulds. 348 lnformal Matter taken up with retailers and bottlers of drink. No action. In formal 349 Wafer Biscuits Bread Contained charred starchy matter. Contained a portion of animal tissue There was a fragment of cooked meat adherent to the bread. Source unknown. Complainant did not wish further action taken. 363 Informal 400 Minced meat Informal Contained 720 parts sulphur dioxide Steps were taken to procure a formal sample but the butchers shop was found closed and the business discontinued Formal sample taken and found to be genuine. Informal 432 Rose Hip Syrup Deficient in Vitamin 'C' Label amended to satisfaction of Council. PARTICULARS OF ADULTERATED SAMPLES Serial No. Article Whether Formal or Informal Nature of Adulteration or Irregularity Observations Result of Proceedings or other action taken 439 Contaminated with iron rust. Matter taken up with baker. Steps taken to prevent recurrence. Bread Informal - 443 Deficient in Vitamin 'C'. Rose Hip Informal Syrup Formal sample taken and found to be genuine. - 521 Contained a dead bluebottle fly. - Matter reported to Public Health Committee. Upon consideration of the evidence it was decided that the matter was not one for prosecution. 594 Contained a number of animal bristles. - 595 Pork In formal Luncheon meat (canned) Remainder of stock withdrawn from sale. Matter taken up by importers with the Dutch canners concerned. Contained a number of animal bristles. 605 - Pork Informal Luncheon meat (canned) Steak & Informal Kidney Pie 50 REGISTRATION OF FOOD PREMISES Premises registered under the provisions of Section 16 of the Food and Drugs Act. 1955 as at December 31st 1964 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 37 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 147 Bakers and Confectioners 344 Butchers 497 Cooked and Preserved Meat Shops 380 Dairies and Milkshops 281 Fishmongers and Shell Fish Vendors 111 Fish Fryers 96 Fish Curers 31 Food Factories 200 Ice Cream Vendors 237 Public Houses 251 Restaurants and Eating Houses 611 Street Markets 1,032 Street Traders Food Stores 30 Other Food Premises 2,086 Total 6,334 Unsound Food No. of condemnation Certificates issued 2,569 PARTICULARS OF UNSOUND FOOD DESTROYED 1964 Type of Food Weight Qrs. Tons Cwts. lbs. Meat 11 20 ¼ 13 3 Fish - 20 4 1 Poultry - 20 - 2 Canned foods 23 24¾ 18 2 Miscellaneous foods 98 18¾ 7 2 134 5 1 19¾ TABLE OF CONTENTS Page Anti smoking clinic 22 Infectious Diseases 10 Lead Poisoning 15 Problems of a Typhoid Carrier 12 Public Health Committee - Constitution 4 Sanitary Circumstances 7 Smoking 16 Staff of the Public Health Department 5 INDEX TO STATISTICAL APPENDIX Atmospheric pollution graphs 32-35 Births 28 Certificates of Disrepair 42 Cremation Certificates 29 Deaths - Causes and Age Distribution 26-27 Disinfection 39 Drainage and Sewerage 29 Factories Acts 37-38 Food & Drugs Adulteration 47 Adulterated Samples Table 49-50 Food Poisoning 44 Food Premises - Registration and Supervision 51 Hairdressers and Barbers 30 Housing Inspector-Return of Work 41 Housing Statistics 41 - 42 Ice Cream and Lollies 48 Infectious Diseases 43 Infectious Diseases Visitors - Return of Work 46 Medical Examinations 28 Milk - Registered Purveyors 47 Results of Tests 47 INDEX TO STATISTICAL APPENDIX - continued Page Notices Served Summary 37 Offensive Trades 30 Offices, Shops & Railway Premises Act 31 Outworkers 38 Pet Animals Act 30 Pharmacy and Poisons Act 30 Public Cleansing 29 Rag Flock & Other Filling Materials 38 Rodent Control - Return of Work 37 Sanitary Inspection of the Area 36 Smoke Control - Return of Work 37 Statistics - Summary of 25 Swimming Bath Water - Examination of 29 & 40 Tuberculosis 45 - 46 Unsound Food Certificates 51 Unsound Food Destroyed 52 Vermin and Scabies (Attendances) 39 Water Certificates 29 1. Dr. Didsbury Lali C.407 2. Mr. Morley Parry A.419 3. Mr. Perry A.405 4. Miss Pidgeon A.408 JR2/60