BER 70 AC 4378 METROPOLITAN BOROUGH OF BERMONDSEY ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1957 B. J. L. MOSS, M.B., B.S., D.C.H., D.P.H. Medical Officer of Health BER 70 METROPOLITAN BOROUGH OF BERMONDSEY ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1957 B. J. L. MOSS, M.B., B.S., D.C.H., D.P.H. Medical Officer of Health PUBLIC HEALTH DEPARTMENT MUNICIPAL OFFICES, SPA ROAD, S.E.16 PUBLIC HEALTH COMMITTEE (As at 31st December, 1957) Chairman Councillor W. H. WARDELL Vice-Chairman Councillor JOS. MAHONEY Councillor C. J. Lee Alderman A. M. Downing „ Mrs. A. E. Martin „ A. V. Kidd Councillor J. A. Clark „ J. H. Newbery W. L. Ellis „ W. E. Nicklin „ Miss M. A. Roll „ F. W. Florance „ L. H. George „ Miss M. Shaw „ W. Stockman L. A. J. Henley Ex-officio. Councillor T. HENDY, J.P., Mayor of Bermondsey STAFF MEDICAL OFFICER OF HEALTH B. J. L. Moss, M.B., B.S., D.C.H., D.P.H. (appointed December, 1956) ADMINISTRATIVE OFFICER J. W. J. Saward, A.F.C., M.R.I.P.H.H. PUBLIC ANALYST D. G. Allen, B.Sc., F.R.I.C. PUBLIC HEALTH INSPECTORS F. L. Richardson, Chief Public Health Inspector and Drainage Inspector. W. A. Campbell, Wharves Inspector. H. E. Butcher, Wharves Inspector. W. C. Tapsfield, Wharves Inspector. A. W. Hancock, Food and Drugs Inspector. W. A. Pilson, Drainage Inspector (Died January, 1957). L. T. Knott, District Inspector. W. F. Smith, District Inspector. S. R. Weightman, D.P.A.(Lond.), District Inspector (Resigned October, 1957). C. H. Whitelock, District Inspector. R. C. Charlton, District Inspector G. Shakespeare, District Inspector (Appointed July, 1957). A 1 CLERICAL STAFF H. D. White (Senior Clerk). A. E. Gambrell. E. T. Hodgkins. G. A. Blake. G. A. Hunt. A. J. Kiddell. E. M. Watkins. M. W. Bridgman (H.M. Forces with effect from 12th March, 1956). W. T. Evans (Student Public Health Inspector with effect from Ist October 1957). WELFARE ASSISTANTS Mrs. M. V. Reynolds, M.W.I. Miss S. A. Denham. STREET AND OPEN MARKETS J. A Hart, C. E. Featherstone—Market Collectors and Supervisors. DISINFECTING AND CLEANSING STATION R. Towll, Supervisor. 1 Foreman Disinfector & Drain Tester. 4 Disinfectors/Washing Machine Attendants. 1 Female Cleansing Charge-hand. 2 Laundresses 1 Stoker. RODENT CONTROL. H. E. Staples, Rodent Control Officer. 3 Rodent Operators. PUBLIC CONVENIENCES 16 Female Convenience Attendants. 16 Male Convenience Attendants. 2 Urinal Cleaners. Borough of Bermondsey ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH To the Mayor, Aldermen and Councillors of the Borough of Bermondsey. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Annual Report on the health and sanitary circumstances of the Borough. It was with great regret that the news of Dr. D. M. Connan's death was received. He was, indeed, a man whose integrity earned him respect from everyone who knew him and whose long service to the Borough had done much to improve conditions in the area. The immediate result of the implementation of the Rent Act, 1957, was to place a heavy burden on the staff, much of their time having been spent in giving advice, and checking and assessing the information available in regard to many properties. Insofar as the Act itself is concerned, I am happy to say that there is no firm evidence that its provisions have occasioned any great hardship although, of course, this may not be apparent in some cases. In the autumn an influenza epidemic caused considerable sickness amongst the population although, in the absence of notification, no exact idea of the incidence was obtainable. There was, however, no evidence to suggest that it in any way seriously influenced the death rate. A scheme for the registration of old people was initiated but, owing to insufficient staff, there were many setbacks. Despite this, however, contact has been made with many old people and help given to them in many ways. Some alteration has been made in the arrangement and presentation of this report and it is hoped that this will help in demonstrating the work of the department in guarding the health of the community. To the Public Health Committee and my staff I would like to express my thanks for their help and encouragement in the difficult task of picking up many threads, particularly as I am but the humble successor to such a master as the late Dr. Connan. I am, Sir, Ladies and Gentlemen, Your obedient Servant, B. J. L. MOSS. VITAL STATISTICS. AREA The area of the borough (exclusive of area covered by water) is 1,336 acres. POPULATION Census Estimate of Registrar-General 1931 to 30th June, 1957 1951 to 30th June, 1956 60,640 56,200 111,542 54,750 Rateable Value, Ist April, 1957 £1,329,232 Estimated net product of Id. rate £5,084 Estimated number of separately assessed dwellings, Ist April, 1957 15,100 BIRTHS The total number of births belonging to the borough registered during 1957 was 946 consisting of 493 males and 453 females. The number for 1956 was 913. The birth-rate for 1957 was 17-28 per thousand persons living, compared with 16-24 for 1956. Births. Registered— Live Births Total Males Females Registered- Live Births Legitimate 888 465 423 Illegitimate 40 20 20 Total Males Females Stillbirths Legitimate 16 8 8 Illegitimate 2 - 2 Rate per 1,000 total (live and still) births 19.02. The birth-rate which, in the main, has been following the London trend, had a minor upsurge in 1954 but declined again the following year. There is, however, evidence of an increase for 1957, BIRTH RATES DEATHS The total number of deaths belonging to the borough registered during 1957 was 629, consisting of 354 males and 275 females. The number for 1956 was 569. The death-rate for 1957 was 11-5 per thousand persons living, compared with 10-10 for 1956. Total Males Females Deaths 629 354 275 Maternal Deaths. Rate per 1,000 total Deaths (live and still) births Deaths from complications of pregnancy, childbirth and the puerperium 1 1·06 Total Males Females Deaths under 1 year of age 20 11 All Infants per 1,000 live births 21 ·35 Legitimate infants per 1,000 legitimate live births 21·40 Illegitimate infants per 1,000 illegitimate live births 25 MARRIAGES The total number of marriages in the borough in 1957 was 430 being 38 below the number for 1956, and 119 below the average for the last 10 years. The figures have been supplied by the Superintendent Registrar. Year No. Rate 1947 684 23·17 595 1948 19·70 1949 609 20·15 545 1950 18·23 582 1951 19·28 1952 516 17·26 1953 520 17·52 475 1954 16·21 17·40 501 1955 1956 468 16·60 Average for years 1947-1956 549 18·55 1957 430 15·7 INFANTILE MORTALITY Year Whole Borough London No. of Deaths No. of Deaths Rate per 1,000 Births Rate per 1,000 Births 1947 50 33 34 2,454 16 1948 20 1,869 31 33 1,517 27 1949 29 1,372 26 1950 20 23 1951 27 25 1,333 25 1952 20 20 1,189 23 1953 27 27 1,216 24 23 24 1,047 21 1954 1955 21 23 1,157 23 1956 18 16 1,106 21 Average for years 1946-1955 26 23 1,426 25 22 1957 20 21 1,160 TUBERCULOSIS OF THE RESPIRATORY SYSTEM In the following Table will be found particulars of deaths from Tuberculosis of the Respiratory System since the year 1947. Year Whole Borough London No. Rate No. Rate 1947 52 0·88 1,940 0·62 1948 45 0·74 2,044 0·62 41 0·68 1,900 0·57 1949 0·38 1,585 1950 23 0·47 21 0·35 1,225 0·36 1951 1952 20 0·35 1'154 0·34 0·24 933 0·28 1953 14 0·18 1954 14 0·24 596 517 1955 8 0·14 0·16 1956 0·18 423 0·13 10 Averages for years 1947-1956 25 0·42 1,232 0·37 1957 9 0·16 0·12 378 CAUSES OF, AND AGES AT, DEATHS DURING THE YEAR 1957. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District. Causes of Death 15—24 All Ages 0-4 5—14 65—74 25—44 45—64 75 & over M M F M M F M F F M F F M F M F Tuberculosis, respiratory 8 1 - 1 4 2 1 1 - - - - - - - - Tuberculosis, other - - - - - - - - - - - - - - - - 2 2 Syphilitic disease - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - Other infective and parasitic diseases 2 1 1 - - - - - - - - - - - - - Malignant neoplasm, stomach 10 6 2 1 8 4 1 - - - - - - - - - Malignant neoplasm, lung, bronchus 37 14 22 1 11 1 4 2 - - - - - - - - 7 4 2 1 Malignant neoplasm, breast - - - - - - - - - - - - Malignant neoplasm, uterus 7 2 4 1 - - - - - - - - - - - - Other malignant and lymphatic neoplasms 30 30 1 2 10 11 15 6 4 11 - - - - - - Leukaemia, aleukaemia 1 4 2 1 1 1 - - - - - - - - - - Diabetes 4 3 - 1 - - - - - - - - - - - - Vascular lesions of nervous system 23 37 7 5 4 11 12 21 - - - - - - - - Coronary disease, angina 47 31 3 16 6 13 12 15 13 - - - - - - - CAUSES OF, AND AGES AT, DEATHS DURING THE YEAR 1957—continued. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the District Causes of Death All Ages 75 & over 0-4 5—14 15—24 25—44 45—64 65—74 F M M F M F M F M F M M F F M F Hypertension with heart disease 7 16 1 1 3 7 3 8 - - - - - - - - Other heart disease 28 35 2 4 5 6 10 10 11 15 - - - - - - 1 Other circulatory disease 9 12 1 6 6 2 5 - - - - - - - - 8 5 1 2 4 2 1 2 Influenza 1 - - - - - - - Pneumonia 21 12 3 2 2 10 1 9 6 - - - - - - - 44 21 14 2 18 5 12 14 Bronchitis - - - - - - - - 10 1 1 1 4 4 1 Other diseases of respiratory system - - - - - - - - - Ulcer of stomach and duodenum 9 1 3 3 1 3 - - - - - - - - - - 1 5 1 1 3 1 Gastritis, enteritis and diarrhoea - - - - - - - - - - Nephritis and nephrosis 1 1 1 1 - - - - - - - - - - - - 2 Hyperplasia of prostate 2 - - - - - - - - - - - - - - Pregnancy, childbirth, abortion 1 1 - - - - - - - - - - - - - - Congenital malformations 4 4 3 1 1 2 1 - - - - - - - - - 28 9 1 1 2 6 3 3 4 8 5 Other defined and ill-defined diseases 17 3 - - - 1 Motor vehicle accidents 8 3 2 1 2 1 - - - - - - - - - All other accidents 14 8 1 10 1 2 1 1 6 - - - - - - - Suicide 2 2 1 1 1 1 - - - - - - - - - - Homicide and operations of war - - - - - - - - - - - - - - - - 354 Total Certified Deaths 275 13 9 1 5 3 12 114 50 118 86 91 115 - 11 629 22 1 8 23 164 204 207 DEATH RATES Graph I This graph shows the death rates for tuberculosis, cancer and cardiovascular diseases compared with the rates for England and Wales. The rates for Bermondsey are shown by a solid line and the rates for England and Wales, taken from the Registrar General's Statistical Review for 1956, are indicated by a broken line. It is of some interest that the rate for cardiovascular diseases shows a markedly favourable decline in comparison with that for the whole country. From 1953, however, the trend has again been unfavourable. Graph II The incidence rates for cancer of the lung and bronchitis in the Borough and for the country as a whole are compared Graph II. The apparent fall in bronchitis deaths from 1951 to 1955 is probably accounted for by the wider use of the antibiotics and it would appear that sufferers are now more likely to die from cardiac failure at a later age. The figures for Bermondsey shown in Graph I would tend to support this suggestion. The trend for cancer of the lung is constant and the incidence in Bermondsey is double that for the country as a whole. Graph III This graph shows the results of a small survey carried out among three departments of the Council. It is clearly shown that the incidence of spells of sickness rises with age. It is also apparent that bronchitis is not just a disease of old men but that the impact is being felt by the 40 age group. The low figure for those over the age of 65 is due to the fact that there are limited numbers of staff over this age. Death rate per 100,000 of population GRAPH II COMPARISON OF LUNG CANCER AND BRONCHITIS DEATH RATES FOR BERMONDSEY, ENGLAND AND WALES Rate per 100,000 population graph III AGE DISTRIBUTION OF BRONCHITIS AMONGST STAFF A further indication of the seriousness of the problem of bronchitis is shown in the following tables. Table A —Personnel absent through sickness Population at risk No. sick % sick No. due to Bronchitis % Sickness due to Bronchitis Dept. Bldg. Manager 345 128 36 21 16 Boro' Engineer 330 142 43 39 27 55 16 Misc. 150 82 13 352 43 73 20 Totals 825 Table B —No. of working days lost Dept. Possible days Days lost % Lost No. days lost due to Bronchitis % Bldg. Manager 125,600 2,516 2 17 440 Boro' Engineer 4,442 4 1,278 28 113,500 Misc. 516,100 2,207 4 356 16 755,200 20 Totals 9,165 3 2,074 Examination of the death returns for 1957 showed 18 deaths from bronchitis as the primary cause but, in a further 77 cases, it was a contributory factor. When it is known that bronchitis causes some 30,000 deaths a year in England and Wales, then, if the proportion is only approximately the same, the disablement caused by the disease must run into many thousands. That this is correct is supported by the Ministry of Pensions figures for 1953—54 estimating that at least one tenth of the sickness claims, causing the loss of 25 million working days, were the result of bronchitis. Still birth rate per 1,000 Live and still births Deaths In first week, per 1,000 live and still births PERINATAL DEATHS The number of still births, which has tended to be above the London average, is now nearer to the trend for the country as a whole. Deaths in the first week of life, although showing slight variations over the last few years, have remained at a fairly constant figure. When, however, the causes of these deaths are analysed, it is seen that the preponderance occurs in 3 main groups, accounting for 128 deaths during the last nine years. The main causes of death are classified in the table hereunder. 1949 1950 1951 1952 1953 1954 1955 1956 1957 13 - - 1 4 - 1 Congenital Malformations 4 5 Birth Injuries, Post Natal Asphyxia and Atelectasis 1 5 7 4 4 4 4 9 1 9 2 Other Causes 6 7 11 7 8 3 8 Among "Other Causes" is included a number of still births said to be due to prematurity. This term is not specific and may include at least some cases of induced abortion although, of course, this would be difficult to prove. In 1949, 13 children were born with congenital defects of such severity that they died. The incidence of these defects has, however, declined in subsequent years, only 5 having been recorded in 1957. It will be observed that there was a total of 39 cases in the second category. Although there has been much research into these causes of infant deaths they must in all fairness be considered as an adverse reflection on the standard of obstetric and paediatric practice. Considering si the matter from the woman's point of view, it is hard indeed if, after nine months care and attention, all her efforts are to be fruitless. Prematurity, post-maturity and the relationship to antenatal morbidity are all aspects of the problem which merit careful study. PREVENTABLE DEATHS Under this heading are included a number of deaths which it appears could have been avoided. During the last ten years over 200 Bermondsey people were killed as a result of violence. Of these, one quarter died as a result of a motor vehicle accident, a further quarter took their own lives, and the remainder died as a result of some other accident. Motor Vehicle Accidents In regard to the 49 deaths from road accidents in the last decade, there is most probably much that can be said, but the salient factors are— (1) Cars or motor-cycles are indeed lethal weapons. (2) It is doubtful whether a number of drivers are really capable of being responsible for their 'weapons on account of the fact that they are mentally or physically incapacitated. Of the motor-cycle casualties, over half are men under the age of 25 and three quarters less than 35. One can still be nearly blind, stone deaf, or suffer from a number of diseases in which sudden death may occur, but none of these factors need be divulged nor appear to prevent many people from holding a driving licence. Suicides According to a report of the World Health Organisation, there is some evidence that the trends of suicidal deaths in many countries are falling, but that does not appear to be the case in this country. In 1955 there were some 5,000 deaths reported by the Registrar General due to this cause and a further 5,280 occurred in 1956. Of the 45 that occurred in Bermondsey during the last ten years, many of them appeared to be due to a lack of security despite the so-called Welfare State. One man took his life because he was behind with the rent; another because he was unable to adjust himself to a new job; and a woman did so because she could not get on with her husband. One further point that may become of significance in regard to potential suicides is the alteration in family structure. The closely knit families of the slums are being broken up by the present housing programme whereby the various generations may e dispersed widely throughout the borough—some even going to satellite towns. The weaker members of the tribe will have to live an entirely independent existence away from Grannie or the in-laws. Some may then be unable to cope with their apparently overwhelming problems and either have a mental breakdown under the stress or go to the extreme and take their own lives. B1 This inability on the part of man to adjust himself to the problem of maintaining a stable existence is reflected both in the National Health Service drug bill and reports from the World Health Organisation. ganisation. One country alone is said to produce 800,000 lbs. of a single sleeping drug, over 60,000 lbs. of an 'awakener' and some 14,000,000 lbs. of aspirin. Similarly, the introduction of tranquilisers is only a further way of helping the population to run away from their cares. No doubt the introduction of such a euphemistic term to describe these drugs is more socially acceptable than to describe the consumer as a drug addict! Home Accidents Home accidents still account for a number of deaths in the borough. One case is reported of an old lady who was left alone for only a few minutes but, during that time, she'toppled and fell in the fire which was not protected by a fireguard, and died shortly after admission to hospital. Another old lady tripped over a rug and fractured her knee, subsequently dying of septicaemia. THE CANCERS The Statistical Review of the Registrar General reveals that, in England and Wales, 94,354 people died from various forms of cancer in 1956. The significance of this form of disease appears to be steadily increasing from year to year. Some of the increase may be due to the changing age and character of the population, because people are living longer and cancer is, largely, a disease of old age. Moreover, as many of the infectious diseases no longer cause death to anything like the extent they once did, an apparent increase in the death rate from cancer occurs. Graph I shows the rates over the last few years for four different types of cancer. Although both the bottom lines refer to females, the top two lines are not confined entirely to one sex. The considerable siderable increase in rate for carcinoma of the lung is, however, occurring mainly in males. GRAPH CANCER DEATH RATES Graph II shows the age distribution over the last five years. From this it can be seen that lung cancer easily outstiips all other types of the disease, accounting for nearly twice as many as any other form. Particularly important is the heavy incidence in the 45+ group. GRAPH II AGE DISTRIBUTION OF CANCER DEATHS In Bermondsey, cancer accounts for no less than 21% of all the deaths. During the last ten years, the number of people who died from the complaint was equivalent to one quarter of the whole of the present population. In recent years, research has begun to implicate smoking as one of the contributory factors in the causation of cancer. Despite this, however, many people are still unconvinced or, perhaps, are unwilling to be convinced. The Treasury alone would be embarrassed to the extent of some £700,000,000 per annum if they lost the income derived from tobacco taxation. Unfortunately, in this materialistic world it is too easy for the producer to turn a blind eye to the dangers run by the consumer, especially if old traditions are more lucrative. In Britain, 20,000,000 people smoke cigarettes, and 20,000 die of cancer of the lung each year. If you are a non-smoker, the chances of dying of cancer of the lung are about lin 300. It you are a smoker, the odds are reduced to 1 in 17 and if you are a heavy smoker they may fall as low as 1 in 7. Not five patients in each hundred diagnosed this year will be alive in five years. Is worship of the god of smoking really worth all this ? INFECTIOUS DISEASES NOTIFICATION OF INFECTIOUS DISEASES Every medical practitioner attending on, or called in to visit a patient, shall, as soon as he becomes aware that the patient is suffering from a notifiable infectious disease, send to the Medical Officer of Health of the district in which the disease occurs a certificate stating the name and address of the patient and the disease from which the patient is suffering. Books of certificates are available free of charge from this Department. The following diseases are notifiable:— Acute Encephalitis Malaria Acute Influenzal Pneumonia Measles Acute Primary Pneumonia Membranous Croup Acute Poliomyelitis Meningococcal Infection Anthrax Ophthalmia Neonatorum Cholera Plague Continued Fever Puerperal Pyrexia Diphtheria Relapsing Fever Dysentery *Scabies Enteric Fever (includes Typhoid and Paratyphoid) Scarlatina or Scarlet Fever Erysipelas Small-pox Food Poisoning Tuberculosis Glanders Typhus Fever Hydrophobia in Man Whooping Cough Leprosy (to be notified to Chief Medical Officer, Ministry of Health). *A notification is not required where to the knowledge of the medical practitioner, a case of scabies has occurred in the house and has been notified within the four weeks immediately preceding the date on which he first became aware of the disease in the case he is attending. FOOD POISONING Seven cases of food poisoning were notified to me during the year under The Food and Drugs Act, 1955, Section 26. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1957 Leather Market Whole Borough NUMBER OF CASES NOTIFIED Willow Walk South West Total Cases removed to Hospital At Ages—Year Raymouth Neckinger Dockyard Thorburn TOTAL At all Ages Central NOTIFIABLE DISEASE 65 and upwards Tunnel Abbey 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 Saints South Park 7 1 4 4 16 5 3 11 5 2 4 7 69 1 Scarlet Fever 69 1 28 35 5 - - - - - - - - - 4 6 29 8 3 19 6 7 4 10 113 12 113 8 52 48 5 6 4 7 Whooping Cough - - - - - - - - 69 110 81 100 57 68 44 1099 11 631 391 16 4 2 2 1 47 111 178 59 94 81 Measles 1099 52 - - - - 1 7 3 2 2 2 - Dysentery 7 1 2 2 1 1 - - - - - - - - - - - - - - - Meningococcal Infection 3 1 - 1 1 3 2 1 - - - - - - - — — - - - — - - - - - - - Pneumonia (Acute Primary and Acute Influenzal) 3 2 - 5 2 4 3 4 32 1 32 1 3 1 5 3 1 6 12 1 1 1 6 — — ­ ­ ­ Enteric or Typhoid Fever 1 1 1 1 1 - - - - - - - - ­ ­ ­ - - - - - - - - - - - - - 1 1 1 1 1 - - - - Paratyphoid Fevers - - - - - - - - - - - - - - - - - - 1 1 1 3 1 1 2 - - - Erysipelas 3 - - - - - - - - - - - - - - - - - 7 2 1 3 1 1 - 1 - - 1 Food Poisoning 7 3 1 2 - - - - - - - - - - - - - 4 Tuberculosis — 76 3 6 7 7 3 12 8 76 1 4 2 9 7 19 9 9 7 9 5 2 4 11 4 - Respiratory System Other forms of Tuberculosis - - Nil - - - Nil - - - - ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ - - - - - - - ­ 1 2 Puerperal Pyrexia 2 1 1 1 - - ­ - - ­ ­ ­ ­ ­ ­ - - - - - ­ ­ ­ ­ ­ ­ - 1 7 7 1 3 3 - - 1 5 ­ Scabies ­ - - - - ­ - - - ­ ­ ­ ­ ­ ­ ­ 243 134 90 86 115 126 78 90 73 111 1420 33 1420 62 721 480 32 19 16 28 14 10 15 23 1 59 83 131 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEARS 1948-1957 Notifiable Disease 1948 1949 1950 1951 1952 1953 1954 1955 Scarlet Fever 199 85 72 82 87 59 62 113 237 267 75 40 124 135 51 Whooping Cough 40 Acute Polio-Myelitis and Acute Polio-Encephalitis 7 4 3 2 1 2 14 - 899 771 367 1197 716 183 1271 Measles 514 Diphtheria 37 65 3 2 2 1 1 - 1 Dysentery 2 4 131 7 25 56 29 1 1 2 6 1 Meningococcal Infection 6 1 - Pneumonia (Acute Primary and Acute Influenzal) 57 43 16 28 25 40 19 23 1 Enteric or Typhoid Fever - - - - - - - Paratyphoid Fevers 2 1 - - - - - - Erysipelas 13 7 9 9 8 7 7 7 Food Poisoning 7 12 - - - - - - Tuberculosis — Respiratory System 105 120 105 89 59 72 63 54 27 12 10 9 8 10 10 6 Other Forms of Tuberculosis Anthrax 1 - - - - - - - Malaria 1 1 - 5 - - - - - Puerperal Pyrexia 5 4 18 19 1 1 1 3 1 Ophthalmia Neonatorum 5 1 2 1 1 - 5 4 Scabies 42 7 2 6 4 - Totals 1,638 1,164 863 1,656 980 857 558 1,588 NOTIFIABLE INFECTIOUS DISEASES Although some diseases are notifiable by statute and others by regulation it is freely admitted that the notification rate is usually a considerable understatement of the actual incidence of the respective diseases. In some cases the diseases themselves have changed so much, e.g. scarlet fever, that some authorities have doubts as to whether notification is worth while. In other instances, such as Acute Poliomyelitis, there are so many latent cases that many indeed must be missed. Despite these drawbacks, however, notification is still considered a useful and essential method of obtaining information in the Public Health Department provided, of course, it is received early enough and with sufficient detail. The need for immediate and full details, particularly in regard to cases of food poisoning, cannot be overstressed. That only 7 cases of food poisoning occurred in 1957 is open to considerable doubt, but any attempt at investigation tion of these cases is doomed to failure if notifications do not come in for several days after the incident, by which time any food remnants or tins will have been disposed of and the vital evidence lost. In the case of tuberculosis the dangers are no less now that the disease is less common. It is a common finding that the origin of infection in nearly every case of tuberculous meningitis treated in hospital can be traced to an elderly relative living at home who was thought "just to have a smoker's cough" or to be "bronchitic" but, on investigation, was proved to have tuberculosis. One serious problem arose during the year in regard to tuberculosis A report was received from the Mass X-Ray Unit in the area to the effect that six cases of tuberculosis had been discovered in a food factory. The authorities in charge of the Unit relieved themselves of the responsibility to notify or give any other information about these cases by saying that possibly it could be harmful to the interests of the patients. It is doubted that the other employees ployees would be comforted by this thought in the event of their becoming infected contacts. A further incidence of the same character has also occurred. A year after the actual survey took place at a food factory, information tion was received that five members of the staff were considered to require supervision as cases considered tuberculous. Further investigation elicited the fact that one of these men worked in a section of the factory where not only was he liable to cough over food but considerable handling was also entailed. The Food Hygiene Regulations specify a number of diseases that are an indication for excluding a workman from the preparation of food but mention of tuberculosis is carefully avoided; it is suggested, however, that employees should "refrain from spitting". No doubt the fact that the consumptive patient might well cough into the food he is preparing has not been thought worthy of consideration. How can the employer be expected to consider the Food Hygiene Regulations seriously if the Mass X-Ray Unit is prohibited from divulging, these cases to the Medical Officer of Health on the ground that anonymity must be maintained in regard to the findings of the Mass X-Ray Unit even at the expense of endangering the public! Two cases of typhoid were discovered during the year and removed to Hither Green Hospital. In the course of enquiries regarding the first case, the child was discovered to be the son of a publican. Immediately the contacts were carefully interrogated and an ancient relative living on the premises reported that she had had typhoid some 20 odd years ago. Examination confirmed that she was still excreting the organisms. Fortunately, among the many contacts investigated only one other case — in this instance one of salmonella typhi-murium — was discovered. Some interesting facts were discovered during the investigation of these cases. During her working days, the old lady had been employed in canteens and a hospital kitchen, and it appears remarcable able that no previous outbreaks had been related to her. As she had also served in the bar from time to time it also seems strange that no contamination had occurred there. It was possible that either she was scrupulously clean or that she was very intermittent in her excretions. The possibility that beer is sufficiently bactericidal to have annihilated all organisms indiscreetly dispensed with the customers' potions is unlikely. The family have now moved into an adjoining borough, again to manage a public house! The increasing number of immigrants to this country may be of some concern to the public health authorities as is shown by an investigation carried out by the Metropolitan Water Board indicating that a not inconsiderable number of coloured workmen were infacted fected with intestinal parasites. Quite apart from pollution of the water supply it would appear that they would also be liable to disseminate seminate these parasites through cafes or canteens where they might be employed or which they frequent. SCABIES Two interesting minor epidemics occurred during the year. Twelve local employees were found to have rashes and were referred to the Public Health Department for confirmation and treatment. After careful investigation it was found that one girl had probably acquired the infection whilst at the hopfields in September and had "hidden" her rash for nearly three months ; in the meantime she had infected her sister with whom she slept and also at least one friend who had slept at her home. It is considered that the other girls who all worked in the same office were probably infected by the use of communal hand towels. Subsequently, another family who had apparently had numerous reinfections were eventually found to be linked with the first series by the girl who had on frequent occasions slept with her friend. As lesions were apparent on the hands and wrists of many of the girls examined another possibility that had been considered was whether the infection could have been transmitted during the strenuous man-handling that occurs during "rock and roll" sessions of which all the girls were ardent fans. INFLUENZA EPIDEMIC During the latter part of the summer information was received from S. E. Asia indicating that an influenza epidemic might be expected pected to reach this country by the Autumn. Consequently, arrangements were made by the Ministry of Health and the Ministry of Pensions and National Insurance that Borough Medical Officers should be notified by the latter when the claims for benefit showed an increase of 30% on the figure for the previous week, or when they first reached 200% of the average weekly figure during the period 4th April, 1956 to 4th December, 1956. As, however, this appeared to be noting the epidemic after it had passed, other potential tial sources of information were sought. An approach was made to the College of General Practitioners for aid as it was considered that their Epidemiological Section might be interested to act as "spotters" should they have representatives in the Bermondsey area. Unfortunately, the College had no members residing in the Borough. Eventually, as no comprehensive picture could be ascertained, local schools were invited to report their sickness absences believed to be due to influenza. It was fully realised that this method of estimation of the impact of the epidemic would only reflect the effects on school children, yet it was considered to be worth while. Despite the attempts at early spotting there was little indication of an epidemic until about September 27th when the case incidence became more marked and, for a period ending on October 4th, the highest number of cases occurred amongst older children; this was followed by a rapid fall in case incidence in these age groups. Subsequently, there was a significant increase in the numbers of cases reported by junior and infant departments, the highest peak being reached on October 11th. The decline in their case rates was more prolonged and, in some junior schools, the incidence rate was as high as 50% ; the highest weekly incidence, however, averaged approximately 25% and this applied to all age groups. Amongst adults the severity of the disease varied considerably, but there was only one case in which it was the primary cause of death although complications such as bronchitis and pneumonia were not infrequent. As late as January the local office of the Ministry of Pensions stated that the claims had not yet fallen to the seasonal average. INFLUENZA EPIDEMIC The information built up at the local office of the Ministry of Pensions is not available for local analysis but is submitted to Regional Headquarters where a percentage survey is made on sickness rates. This is an unfortunate arrangement as the local sanitary authority are thereby deprived of useful morbidity statistics related to the working population of their own area. SANITARY CIRCUMSTANCES OF THE BOROUGH HOUSING During the year a small area in Rotherhithe New Road/Luxford Street/ St. Helena Road, comprising 18 dwelling houses, was represented. The Borough Council completed 235 flats, 137 were in course of erection at the end of the year and plans for 997 were prepared or in course of preparation. 309 families from the waiting list, clearance areas, etc., have been rehoused and 222 transfers and exchanges were arranged. This has resulted in 531 families being provided with improved accommodation by the Borough Council. 322 families were rehoused by the London County Council and 35 families were accommodated in new towns. 1 E.F.M. Bungalow was demolished during the year and 208 remain. HOUSING ACT, 1936—OVERCROWDING The following new cases of overcrowding have been encountered during the year:— In private dwellings 16 In Bermondsey Borough Council dwellings - In London County Council dwellings 2 Total 18 Total number of cases of overcrowding at present on the Register 451 ERADICATION OF BED BUGS The following table shows the fumigations carried out during 1956:— Disinfested Council houses or flats 48 Other houses or flats 207 (30) INSPECTIONS, PROCEEDINGS, ETC. Hereunder will be found particulars of Inspections, Proceedings, etc., for the year 1956:— Inspection of Dwelling-Houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,916 (b) Number of Inspections made for the purpose 18,179 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 280 (b) Number of Inspections made for the purpose 375 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 21 (4) Number of dwelling-houses (exclusive of those referred ferred to under the preceding subhead) found not to be in all respects reasonably fit for human habitation 74 Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 531 Action under Statutory Powers during the Year: — (A) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nill (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (B) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,427 (31) (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) By owners 338 (b) By Local Authority in default of owners 3 (C) Proceedings under Housing Acts 1936 and 1957:- (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil (3) Number of separate tenements or underground rooms in respect of which Closing Orders were made 9 (4) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil (E) Proceedings under the Local Government (Miscellaneous Provisions) Act, 1953: — (1) Number of dwelling-houses in respect of which Closing Orders were made under Section 10 (1) 21 (2) Number of dwelling-houses in respect of which undertakings were received not to use for human habitation .... .... .... .... .... .... Nil Prosecutions Under the Public Health (London) Act, 1936:- (1) Number of prosecutions 13 (2) Fines imposed - (3) Costs awarded ₤32110 REGISTERED PREMISES— Number of Inspections Number of Prosecutions Premises Number on Register at end of 1957 2 88 - Common Lodging Houses 135 121 - Milkshops 188 - 176 Ice Cream Premise - Oƒensive Trades (including Poultry Slaughter-houses) 12 8 203 - 50 Hairdressers and Barbers (32) SMOKE NUISANCES— Number of observations 69 Number of notices — Number of complaints 6 Number of summonses — SALE OF FOOD— Number of premises used other than ice-cream premises, milk-shops and cowsheds 573 Number of inspections 1,879 RAG, FLOCK AND OTHER FILLING MATERIALS ACT, 1951: Number of premises registered 3 DRAINAGE WORK Particulars of work carried out by the Drainage Inspector during 1957:— Drains Tested 677 Visits to new building works 1,319 Other Visits 362 Total visits 2,358 RAG IMPORTATION A serious nuisance and potential danger has arisen in regard to the importation of old clothing for the manufacture of flock. Many countries overseas demand a health certificate before they will allow the importation of mutton cloths, clothing or other manufactured factured commodities. Recently, bales of rags have been imported from Holland unaccompanied by any certificate that they had undergone gone any process of cleansing or disinfection. The Inter-Departmental Committee on the Rag Flock Acts in 1946 noted that such imported bales had been found to contain, amongst other things, used surgical dressings. A recent consignment, when examined, was found to contain active larvae and to be contaminated taminated with what appeared to be cattle dung. In view of this, the matter was reported to the Ministry of Agriculture and Fisheries as it was considered that a potential source of foot and mouth disease existed. The matter was considered by them to be of no concern. It is doubtful if a farmer who had lost his herd of cattle from this disease would have felt so unconcerned. The Ministry of Health appeared to be equally unconcerned about the possible importation of typhus or smallpox by this means, despite the fact that eminent bacteriologists have shown that clothing can remain a source of infection for at least a year ! It appears that legislation has been made to cover flock and all the products that are subsequently filled with flock but no acts or regulations control the importation of rags or in any way stipulate that materials imported must be free from infection. c (33) (34) WORK OF DISTRICT INSPECTORS, 1957. Mr. SHAKESPEARE Mr. WEIGHTMAN Mr. WHITELOCK Mr. CHARLTON TOTALS Mr. KNOTT Mr. SMITH 615 484 208 307 57 48 1719 1 House-to-House 588 293 1149 195 169 3094 2 Special Inspections 700 549 374 407 421 126 130 2007 3 Complaints 377 274 29 26 1532 4 Infectious Diseases 291 535 40 39 45 7 17 12 160 5 Rats 10 125 Outworkers' Inspection 13 42 12 44 4 6 48 39 39 25 6 14 171 7 Drains Tested Other Calls and Visits 3356 1139 1496 1933 469 993 9386 8 3 34 6 5 63 9 Chimneys watched 3 12 9 30 13 3 6 61 10 Bakehouses - 12 88 Common and Seamen's Lodging 36 1 39 11 - - 167 152 36 107 29 36 527 12 Butchers 170 Fishmongers, Friers and Curers 15 110 6 28 6 5 13 730 43 91 40 38 1081 14 Food Stores 139 26 177 19 17 10 7 256 15 Fruiterers and Greengrocers 2 1 69 Pet Animals 14 52 16 - - 63 23 63 112 19 280 17 Markets - 133 Restaurants and Eating Houses .... 2 124 1 3 3 18 - 26 20 37 6 1 106 19 Destruction of Food 16 39 111 12 24 9 8 203 20 Hairdressers 28 14 55 Factories 13 21 - - - 4664 1063 21286 Visits 6118 4823 3081 1537 Totals 474 256 134 396 89 78 1427 Intimation Notices Section 110 Section 111 Number of instances of work in unwholesome premises Notices served Prosecutions Number of out-workers in August list required by Section 110(1) (c) Number of cases of default in sending lists to the Council Number of prosecutions for failure to supply lists NATURE OF WORK Wearing Apparel Making 11 - - - - Sacks Carding of Buttons, etc. 17 - - - - - 11 - - - - - 32 FACTORIES AND OTHER PREMISES INSPECTION Premises Number on Register Number of Written Notices Occupiers Prosecuted Inspections (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 213 - - 220 (ii) Factories not included in (i) in which Section 7 is enforced forced by the Local Authority 411 665 - - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers premises) 218 63 - - 694 1096 - - Total DEFECTS FOUND Particulars Number of Cases in which Defects were found Number of defects in respect of which Prosecutions were cinstituted Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of Cleanliness (S.1.) - - - - - - - Overcrowding (S.2.) - - - Unreasonable Temperature (S.3.) - - - - - Inadequate Ventilation (S.4.) - - - - - Ineffective Drainage of Floors (S.6.) - - - - - - Sanitary Conveniences (S.7.) — Insufficient - - - - 1 - 1 - Unsuitable or Defective 1 - 1 1 1 Not separate for Sexes - - Other Offences (Not including offences relating to Home Work) - - - - Total 2 - 2 - 2 CLOSING ORDERS During the year, two appeals against the making of Closing Orders under the Local Government (Miscellaneous Provisions) Act 1953 were heard. In both cases the learned Judge agreed that the houses were unfit, but allowed the appeals on undertakings by the appellants to carry out extensive repairs including, in both cases, the insertion of a damp proof course. The cost of these works, which the appellants undertook to carry out, was estimated to be £300 and £350 respectively. That this is reasonable expenditure on houses which are badly settled and showing many defects can only indicate that the anticipated selling price must be very considerable. HOUSING REPAIRS AND RENTS ACT, 1954 During the period Ist January 1957 to sth July 1957, 6 application for Certificates of Disrepair and 12 applications for revocation of Certificates of Disrepair were granted. RENT ACT, 1957 This Act, which came into force on 6th July 1957, has brought additional responsibilities to the Public Health Committee, mainly in connection with the issue of Certificates under the Act. Inspection as a result of applications for these Certificates have taken much of the Inspectors' time and the administrative work has increased correspondingly. The following table gives details in respect of Certificates of Disrepair from the commencement of the Act until the end of the year under report. Number of applications for Certificates of Disrepair 104 Number of decisions not to issue Certificates - Number of decisions to issue Certificates— (a) in respect of some but not all defects 87 (b) in respect of all defects 17 Number of undertakings given by landlords 67 Number of undertakings refused — Number of Certificates issued 37 Number of applications by landlords for cancellation of certificates 3 Number of objections by tenants to cancellation of certificates - Number of decisions to cancel in spite of tenants' objection — Number of Certificates cancelled 3 (37) (38) RODENT CONTROL Prevention of Damage by Pests Act, 1949. Type of Property All other (including Business and Industrial) Local Authority Dwelling Houses I. Total number of properties in Local Authorities District 33 15,100 2,200 II. Number of properties in-S pected by the Local Authority during 1953 as a result of (a) of notification or (b) otherwise. (a) 11 314 121 (b) 18 721 - III. Number of properties (under II) found to be infested by rats. Major 1 - 16 Minor 22 223 234 IV. Number of properties (under II) found to be seriously infested by mice 6 91 135 V. Number of infested properties (under III and IV) treated by the Local Authority 17 314 226 VI. Number of Notices served under Section 4:- 1. Treatment - - - 2. Structural Works (i.e. Proofing) - - - Total - - - VII. Number of cases in which default action was taken by Local Authority following issue of Notice under Section 4 - - - VIII. Legal Proceedings - - - IX. Number of "block" control schemes carried out BAKEHOUSES These premises require constant cleansing and vigilant supervision. There is no excuse for the employment of personnel of low grade intelligence to carry out the cleansing of machinery and utensils. Both the district and food inspectors are ready and willing to advise on such problems as arise. Shortages of staff or lack of facilities are no excuse for the unsatisfactory manner in which many of these premises are run. During the year, some owners were warned of the consequences if their attitude of indifference did not show radical change. Often the unwelcome publicity which attends a Court appearance is a more satisfactory stimulant to better management than the actual fines imposed. FACTORY BAKEHOUSES There are nine factory bakehouses in use, all of them situated above ground. HOUSE, TRADE AND MARKET REFUSE The following table shows the amount of house, trade and market refuse disposed of during 1957: — Disposal Loads tons cwts. qrs. - 10,478 16,218 10 House Refuse to Barge Trade Refuse to Barge 4,584 15 6,810 - Street and Open Markets Refuse to Barge 955 498 - - - Totals 16,017 23,527 5 OFFENSIVE TRADES The offensive trades on the Register are as follows:— Fellmongers 3 Dresser of Fur Skins 4 Glue and size makers 1 PET ANIMALS ACT, 1951 During the year 7 licences to keep a pet shop were granted. Three of these were in respect of stalls in market places. Inspections are made to ensure that the terms of the licence are complied with. ATMOSPHERIC POLLUTION This has been estimated to cost the country £250 million a year. What is money, however, compared with the human suffering that illnesses such as bronchitis, asthma, and various cardiac conditions, aggravated by atmospheric pollution cause. The atmosphere has also been shown to contain detectable concentrations of benzo-pyrene and other carcinogenic compounds. There is little point in the great advances in cardiac surgery and the production of antibiotics if the population is still to be afflicted with dirty air which could be avoided by careful planning. At the present time, a small area (33.9 acres) is under consideration by the Ministry of Housing and Local Government as our first Smoke Control Area. It is essential that the establishment of these areas should be pushed forward with the greatest vigour, and it is the duty of the Public Health Committee to formulate a policy to ease the load of suffering and financial loss imposed on the community by atmospheric pollution. If one buys a suit one expects to have to pay for it. Likewise, if ratepayers wish to enjoy the advantages of clean air they will, no doubt, be prepared to meet the cost provided the position is explained to them and they see that a courageous and determined policy is to be applied. There is no denying that the cost of suitable smokeless fuels will be more expensive but, against this, one has to note the saving in laundry costs and, above all, the prevention of serious and incapacitating illnesses. Sufferers from bronchitis, asthma and cardiac conditions often dread the approach of winter and the November fogs. The health risks to these patients can be reduced to a considerable extent by active steps to reduce the emission of acrid smoke and fumes into the air by both domestic and industrial fires. The study of atmospheric pollution has been continued during the year in co-operation with the Department of Scientific and Industrial Research and the tables given hereunder show the concentration of smoke and sulphur-dioxide, as recorded at the Municipal Offices, and the amount of deposited matter recorded by the deposit gauges at Brunei Road, Rotherhithe, and the Public Health Centre, Grange Road. Concentration of Smoke and Sulphur-Dioxide Month Smoke expressed in mgs. per cubic metre Sulphur dioxide Expressed in parts per million Monthly Average Highest Daily Average Highest Daily Average Monthly Average January .281 .722 25.00 9.60 .343 .889 13.40 21.30 February .630 10.40 21.30 March .222 .353 8.40 20.20 April .134 May .066 .189 6.00 11.60 .086 5.30 June .040 13.20 July .131 6.44 20.80 .045 .131 .183 August .059 7.13 15.40 .073 6.10 16.50 September .249 October .920 11.97 32.83 .280 November .363 .641 15.83 30.92 .631 2.310 December 25.77 94.92 Matter deposited in tons per square mile Month Grange Road Brunei Road Rainfall ins. Matter deposited in tons per sq. ml. Rainfall ins. Matter deposited in tons, per sq. ml. January 1.32 17.72 1.30 18.79 1.11 16.57 February 2.59 21.44 March 0.69 20.13 0.72 22.37 April 0.08 38.32 0.19 13.68 21.82 0.19 19.77 May 0.67 June 0.65 22.83 0.89 13.54 24.94 July 3.65 4.04 23.84 August 1.43 15.50 2.12 16.71 September 2.02 12.02 1.95 17.47 October 1.67 12.02 21.78 1.54 November 1.82 27.47 1.64 21.78 24.62 December 1.70 1.73 26.68 Very foggy conditions were experienced on 3rd, 4th and 5th December 1957 and it was noted that the concentration of sulphur dioxide which, in the first two days of the month had been 10 parts per 100 million, had risen to 49 parts per 100 million on the 3rd. On the 4th and 5th it was decided to take more frequent readings and these are recorded in the table below. SO2 Date Time p.p. 100 m. 4 Dec. 9.15 73.94 11.15 84.36 1.10 37.96 3.40 63.28 5 Dec. 8.55 72.32 1.30 46.52 4.00 94.92 Not only is smog detrimental to health but the active constituents corrode metals and building materials, and damage is caused to paintwork, soil and crops. Public Health Committee, 2nd July, 1957 Clean Air Act—1956, Section 11—Smoke Control Areas At their meeting on 5th March 1957, the Committee had before them the report and recommendations of the General Purposes Sub-Committee of the Metropolitan Boroughs Standing Joint Committee, relevant extracts from which are quoted hereunder: "We have given consideration to the advice that should be given to the constituent Councils upon the adoption of a common policy for the establishment of smoke control areas, with the ultimate object that the whole of the County of London should be a smokeless zone in the course of time. It would appear that the most effective way of achieving this object would be to commence with a central smokeless zone to be extended as quickly as possible until the boundaries of the County are reached. Under Private Act of Parliament, the City of London has already been declared a smokeless zone, around which it would be possible to create further smoke control areas which themselves would gradually expand. Immediate consideration should, therefore, be given to the creation of smoke control areas in the boroughs with common boundaries with the City of London, viz., Finsbury, Holborn, Shoreditch, Stepney and Westminster (north of the River Thames), and Bermondsey and Southwark (south of the River). To that end, we consider that the Borough Councils concerned should confer together as soon as possible and produce a co-ordinated scheme. Whilst the Committee are the appropriate body for co-ordinating the establishment of smoke control areas in London, we do not consider it necessary or desirable that any elaborate machinery should be set up for this purpose. We think that it should be left to the constituent Councils themselves to initiate and then carry out co-ordinated programmes, the Committee confining themselves to the consideration of general principles, giving advice and dealing with difficulties as and when they arise. To assist the Committee in their task, it will be necessary for the constituent Councils to keep the Committee informed of action which they are proposing to take for the establishment of smoke control areas, details of such proposals, difficulties likely to be experienced and similar matters. We recommend—That (i) the constituent Councils be recommended to act in accordance with the foregoing proposals when they are considering the measures to be taken to establish smoke control areas and that they be requested to inform our Honorary Clerk at the earliest opportunity of the action they are proposing to take; (ii) the attention of those Councils whose boundaries are common with the City of London be specially drawn to the immediate action which it is suggested they should take; and (iii) that the Minister of Housing and Local Government and the London County Council be informed of the action being taken." The Public Health Committee adopted these recommendations and a meeting was subsequently held at the Westminster City Hall on 9th April 1957 at which the Boroughs having common boundaries with the City of London were represented; a report of this meeting was submitted to the Committee on 30th April 1957. Since that date a brief survey has been made of the London Bridge area and it is suggested that the Committee give consideration to the establishment of a smoke control area in that part of the Borough. The procedure for establishing smoke control areas is laid down in a memorandum issued by the Ministry of Housing and Local Government, and is in four stages, i.e.: (1) decision in principle on the location, size of the area and types of property to be included, and notification to the Minister of provisional plan; (2) after receipt of the Minister's comments on the provisional plan, the detailed survey of the area; (3) the making of the Order, the carrying out of the statutory procedure and submission of the Order for confirmation; (4) after confirmation, action to bring the Order into operation, payment of local authority grants and claiming of Exchequer contributions. At the moment we are concerned only with Stage 1, and particulars of the area in mind are as follows: The area is bounded on the north by the river, on the south by St. Thomas's Street, on the east by Morgan's Lane and Bermondsey Street, and on the west by Borough High Street. The size of the area is 33.9 acres and it comprises the types of property listed hereunder: Factories and Workplaces 14 Warehouses 25 Caretakers' flats 7 Offices 71 Shops 30 Railway Arches 60 Public Houses 5 Should the Council agree to declare the area as a smoke control area the following information is initially required by the Minister: (a) a map showing the proposed area; (b) particulars of the classes of buildings (domestic, commercial, industrial, etc.) to which the Order would apply and the approximate number in each class; (c) the best guidance possible at this stage on the cost of any adaptations in private dwellings which would qualify for grant; (d) an approximate estimate of the amount of bituminous coal or other smoky fuel to be replaced and, however roughly, the best estimate of the additional supplies of the various smokeless fuels that will be required, stating the basis of calculation; (e) the date on which it is proposed to bring the Order into operation. Public Health Committee, 26th November, 1957 CLEAN AIR ACT, 1956, SECT. 11—SMOKE CONTROL AREAS LONDON BRIDGE SMOKE CONTROL AREA As reported to the Public Health Committee on 1st October 1957 approval has been given by the Ministry of Housing and Local Government for the Council to proceed with the detailed survey of the above area with the object of making a Smoke Control Order in accordance with Section 11 of the Act. The survey has now been completed and should the Council agree to the making of the Order declaring that part of the Borough bounded on the North by the river, on the South by St. Thomas's Street, on the East by Morgans Lane and Bermondsey Street and on the West by Borough High Street-an area of 33.9 acres-the Order must be submitted to the Minister for confirmation and the procedure laid down in the 1st Schedule to the Act complied with i.e., publish notice in the press giving general effects of the Order and right of appeal and keep notices posted in the area. An order, when confirmed, shall come into operation on the date specified not earlier than six months from date of confirmation. The Memorandum on Smoke Control Areas also requires that the Order should specify the date when it is to come into operation— the date should not be earlier than nine months after its submission to the Minister. I suggest, therefore, that 1st October, 1958 should be the date submitted. The period of six months between confirmation and the coming into operation of the Order is to allow for the carrying out of adaptations to fireplaces in dwellings and other premises and for the local authority to give advice to householders about the best way to get good results from their new appliances and to give any help they can to ensure that supplies of smokeless fuels are ready when required. Generally speaking the owners or occupiers of privately owned premises will have to make their own arrangements with retailers of new appliances, builders and coal merchants; but where difficulties occur the local authority should be prepared to assist. For exmple, it might be necessary to advise people or to tell them where to go to get advice about obtaining particular appliances or on proper methods of installation and use. It may be necessary to smooth out difficulties over the supply of smokeless fuels, either with local distributors or producers or by contact with the Regional Director of the Ministry of Fuel and Power. In short, the local authority must expect to exercise a supervisory and co.-ordinating role to ensure that the works of adaptation will be completed, the arrangements for the supply and distribution of smokeless fuels operating effectively and the new fireplaces and appliances working satisfactorily before the date on which the Order is due to come into operation. The Memorandum on Smoke Control Areas Stages II and III requires that the following information be given when submitting an Order for confirmation: LONDON BRIDGE SMOKE CONTROL AREA ADDITIONAL REQUIREMENTS OF SMOKELESS FUELS Number of industrial premises 4 Number of commercial premises 144 Number of dwellings 19 Number of other premises London Bridge Railway Station and offices. London Bridge Tube Station. Southwark Cathedral Chapter House. Domestic Industrial Present annual tonnage of bituminous coal and other smoky fuels (excluding oil) 15 tons *70 tons Balance requiring to be replaced 15 tons 70 tons Additional fuels required annually to replace above (i) 3,600 units Electricity. Nil (ii) 80 therms Gas 360 therms Gas (iii) 15 tons Solid smokeless fuel for open fires. (Including coke, Coalite, &c.) 70 tons *Space heating, London Bridge Station. Used for heating of waiting rooms and offices used by staff and officials. SCHEDULE OF ESTIMATED COSTS OF ADAPTING AND REPLACING FIREPLACES Number of dwellings 5 Number of existing appliances requiring replacement or adaptation (appliances in regular use only); Open fires 7 NUMBER AND COSTS OF NEW APPLIANCES REQUIRED Open Fires Gas or Electric Fires Totals Number of appliances 6 1 7 6.10.0 Total cost of appliances (£) 41.10.0 35 Range of cost per appliance (£) 3-15 6.10.0 Total cost of other works attributable to installation of new appliances (£) 25 71 46 ESTIMATED EXCHEQUER CONTRIBUTION Total estimated cost of work above £112 10 0 Total estimated claim for Exchequer Contribution £45 0 0 INTERNATIONAL CERTIFICATES OF VACCINATION AND INOCULATION At the request of the Ministry of Health and in order to comply with the International Sanitary Regulations 164 certificates were dealt with during the year. FOOD HYGIENE REGULATIONS, 1955 All food premises are visited by the Public Health Inspectors and advice given on the requirements of the Regulations. During the year written notice of such requirements was given in respect of 58 premises. Although the Food Hygiene Regulations have been in existence for two years, the education of many cafe owners seems to be a very slow and discouraging process. It is to be hoped, however, that the steady infiltration of the self-service store and prepacked foods may raise the standards of food hygiene despite the reluctance of the public to demand a greater cleanliness both in preparation and display of food-stuffs. STREET AND OPEN MARKETS Berinondsey Square (New Caledonian) Number of licences in operation 237 Income for 1957 £3927 13 0 Street Markets Total Income for 1957 £3769 0 3 Number of licences in operation: Albion Street 5 Bermondsey Street 45 Railway Approach 15 Southwark Park Road 42 Tower Bridge Road 31 Trident Street 2 Various 15 Total 155 There were no prosecutions for unlicensed trading during 1957. FOOD CONTROL PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1937/48. FOOD AND DRUGS ACT, 1955. Ninety samples were taken during the year by the Wharves Inspectors. Article Examined No. of Samples Purpose of Examination Result Action Bamboo Shoots 1 For presence of preservatives. Satisfactory Released 2 ” For metallic contamination. ” Brisling (Canned) 19 To ascertain condition. ” ” Butter 1 ” ” To ascertain composition. Butter Flavour 1 Released with warning regarding labelling. ” Cake Slabs ” ” Moisture content 60.15% instead of not more than 1 45% 1 Re-exported (Imported without Official Certificate) To ascertain composition Cheese (Processed) with Ham 1 To ascertain condition Released Satisfactory Cheese (Smoked) 1 ” To ascertain composition ” Cheese Wafers Chemical proved to be 'spent oxide'. All contaminated foodstuffs detained. 1 Chemical (Unknown) To ascertain composition (contaminating consignment of foodstuffs). 2 Released To ascertain composition Satisfactory Chewing Gum ” To ascertain composition and for preservatives ” 1 Chicken Luncheon Meat ” 1 ” To ascertain composition and for metallic contamination Chili Con Carne Article Examined No. of Samples Purpose of Examination Result Action Released Chocolate Croquettes 1 Satisfactory To ascertain condition 1 ” ” Chocolate Eggs ” ” 5 All consignments detained. All samples contained excess Benzoic Acid Cucumbers (Pickled) For presence of preservatives 1 Consignment re-exported. Lead 40 parts per million Curry Powder For metallic contamination ” ” 1 Lead 45 parts per million ” ” ” ” ” 1 Lead 48 parts per million. ” ” ” 1 Released ” ” ” ” Satisfactory 1 ” Fruit Flavours ” To ascertain composition ” Gherkins (Pickled) 1 For presence of preservatives ” 1 Released after re-labelling Benzoic Acid 240 parts per million ” ” ” ” Granadilla Pulp .... 3 For metallic contamination For preservatives and metallic contamination Satisfactory Released 1 Herring Roes (Canned) ” ” ” 1 Honey (‘Visroyal’) For presence of preservatives Released with warning regarding labelling. ” 1 To ascertain composition Java Crackers Released 1 ” Lollipops For preservatives and metallic contamination ” 2 ” Margarine For vitamin content and to ascertain condition ” ” 4 Mustard For presence of preservatives All consignments released with warning regarding labelling 1 ” For preservatives and metallic contamination Paprika (Stuffed) Released D Article Examined No. of Samples Purpose of Examination Result Action Pepper, Black For presence of preservatives Contained 204 parts per million of Sulphur Dioxide and fragments of dead insects All consignments stopped pending action by merchants to prevent contamination 1 ” ” 7 No action Satisfactory ” ” 2 ” Pepper, White ” ” ” Pilchards in Tomato Sauce 1 ” For metallic contamination Released 1 Pork Luncheon Meat For presence of preservatives ” ” ” ” ” 3 Presence of nitrates not declared on labels Consignments rereleased after re-labelling ” ” 1 ” ” ” ” ” ” ” Consignment re-exported 1 ” ” Pork, Roast in Orange Sauce Satisfactory Released Potatoes, Whipped (Canned) 1 ” ” ” ” ” Pudding Powder 2 To ascertain composition ” Sardines 2 ” For metallic contamination ” Soup (Chicken) ” ” 1 To ascertain composition ” Soy 1 ” ” ” Soya Sauce 1 Released with warning regarding labelling ” ” ” Sprats in Edible Oil 1 For preservatives and metallic contamination ” ” 1 ” Stewed Steak (Canned) ” To ascertain meat content 1 Released with warning regarding labelling ” Tomato Puree For metallic contamination Truffles 2 For presence of preservatives Presence of salt not declared on label Released with warning regarding labelling (50) SECTION 14, FOOD & DRUGS ACT Inspections Ice Cream Premises 176 188 Preserved Food, etc. 85 284 DISPOSAL OF UNSOUND FOOD Condemned food suitable for animal feeding is disposed of for this purpose under supervision. Condemned food for destruction is collected by Council's van and barged with household refuse. FOOD PREMISES AND TYPES OF BUSINESS Restaurants, cafes and snack bars 135 Factory Canteens 79 Grocers and General Provisions 131 Butchers 52 Greengrocers and Fruiterers 79 Fishmongers and Curers 28 Bakers 30 Confectioners 80 Public Houses 152 Food Factories 178 Wholesale Food Stores 112 Food Wharves and Depots 53 CATERING ESTABLISHMENTS Inspections and re-visits 785 Notices served 57 UNSOUND FOOD The general inspection of food in shops and on stalls forms part of the duty of the District Public Health Inspectors. Food, in the quantities stated, came under the notice of the Inspectors during the year, and being found unfit for human consumption was destroyed or disposed of for purposes other than human food. tons cwts. qrs. lbs. Meat — 1 21 Meat. anned — 8 3 Poultry — — 1 15 Offals — 1 1 14 Sausages — — 1 22 Fruit, Canned — — 2 27 Fish, Canned - — 7 19 Fish — — 1 27 Milk, Canned — — 1 10 Cheese - - - 18 Vegetables - 3 - 1 Vegetables, Canned — — 1 3 Various — — 1 14 Total 17 3 0 PHARMACY AND POISONS ACT 1933 AND PHARMACY AND MEDICINES ACT 1941 56 premises were entered on the Council's list for the year under report. MILK PREMISES FOOD AND DRUGS ACT 1955 MILK AND DAIRIES REGULATIONS 1949 8 milk sellers were registered under the above Acts during 1957 and 11 were removed from the Register. There were 135 milk sellers on the Register at the end of the year. MILK (SPECIAL DESIGNATION) (RAW MILK) REGULATIONS, 1949 MILK (SPECIAL DESIGNATION) (PASTEURISED AND STERILISED) REGULATIONS, 1949 During the year under report the following licences were granted:— Weight Description of Food Dealers' Licences. To sell Tuberculin Tested Milk 41 To sell Pasteurised Milk 80 To sell Sterilised Milk 101 Supplementary Licences To sell Pasteurised Milk 17 To sell Tuberculin Tested Milk 17 To sell Sterilised Milk 22 All premises used for the sale of milk are regularly inspected to ensure that the standard of cleanliness laid down is maintained. MILK SAMPLING Samples of milk, both for bacteriological and chemical examination, are taken from milksellers and special arrangements are made for the sampling of the milk supplied to all schools, school meals services and hospitals in the borough. The total number of samples submitted for analysis during 1957 was 380 of which number 185 were taken from schools, hospitals, etc. For Chemical (i.e., Fat and non-Fatty Solids Analysis). Condensed Milk 9 Evaporated Milk 5 Sterilised Milk 13 Pasteurised Milk 140 Tuberculin Tested (Pasteurised) Milk 4 Channel Islands Milk 17 Homogenised Milk 2 Milk (undesignated) 2 Hot Milk 1 193 For Bacteriological Examination. Pasteurised Milk: For tubercle bacilli 4 For brucella abortus 2 6 (53) For Examination under Milk (Special Designations) Regulations. Pasteurised Milk (from schools, hospitals, etc.) 94 Pasteurised Milk (other than from schools) 39 Tuberculin Tested (Pasteurised) Milk 34 Sterilised Milk 18 Channel Islands (Pasteurised) Milk 2 187 ICE CREAM 58 samples of ice cream have been examined, with the following results: — 1. Bacterial Count. Up to 500 per 1 c.c. 37 Over 500 to 1,000 per 1 c.c. 7 Over 1,000 to 5,000 per 1 c.c. 7 Over 5,000 to 10,000 per 1 c.c. 3 Over 10,000 to 50,000 per 1 c.c. 4 Over 50,000 per 1 c.c - 58 2. Presence of B. Coli. B. Coli present in 1 c.c. and 1 10th c.c. and 1 100 th c.c. - B. Coli present in 1 c.c. and 1 10th c.c. — B. Coli present in 1 c.c. 1 B. Coli absent in 1 c.c., 1 10th c.c. and 1 100 th c.c. 57 58 3. Methylene Blue Grading. Grade 1 39 2 12 3 5 4 2 Not graded — 58 4. CHEMICAL ANALYSIS. Seven samples of ice cream were submitted for chemical analysis under the Food Standards (Ice Cream) Order, 1953. All samples were satisfactory. FOOD SAMPLING During the year 795 samples were taken for chemical analysis. In 44 instances the samples did not, for various reasons, comply with the food laws and details of the circumstances are set out on page 56. In many cases the infringement was of a comparatively minor nature and the co-operation of the manufacturer was obtained to put matters right. In no case was fresh milk found to be materially below the standard of 3% fat and 8.5% solids not fat, although the solids not fat content was occasionally slightly below 8.5% in the early part of the year due mainly to the seasonal "flush" of milk and the dependence of most milk producers on herds which yield large quantities of milk of rather low quality. A special investigation into the meat content of canned meats was undertaken with particular reference to stewed steak and stewed steak in gravy. At present, there is no legal standard for the meat content of these foods. Under the Meat Products (No. 2) Order 1952, since repealed, home-produced and imported canned stewed steak was required to contain not less than 95% meat and stewed steak in gravy not less than 75% meat. Seven samples of stewed steak were purchased, the countries of manufacture being: 3—Republic of Ireland 1—Northern Ireland 1—Australia 1—England 1—Not stated. With one exception they all contained at least 95% meat. The average price of the meat was 2.23 d. per oz., the cheapest being 1.81d. per oz. and the most expensive 3.2d. per oz. In addition to salt, some of the samples contained flour and spices. Six samples of stewed steak in gravy were purchased, the countries of manufacture being: 1—Republic of Ireland 3—Australia 2—England In four samples the meat content was less than 75%. The average price of the meat was 2.59d. per oz., the cheapest being 2.21d. per oz. and the most expensive 2.77 d. per oz. There was a wide range of added ingredients including salt, beef stock, flour spices, hydrolised protein and caramel. An assessment of the quality of the meat used by different manufacturers was not possible but inedible gristle and connective tissue is excluded when arriving at the meat content. Samples were taken of a range of foods for bacteriological examination. As in the past, milk featured most prominently in this type of sampling. In only one instance did the milk tall short of the desired standard and the producer's attention was drawn to the matter. Of 58 samples of ice cream taken for bacteriological examination during the year 7 were graded as unsatisfactory. In each case the attention of the manufacturer was drawn to this unsatisfactory state. Cooked meats and imitation cream cakes also examined bacteriologically with a view to ascertaining the extent of contamination of these products which are important from the food poisoning aspect. In no case were any pathogenic organisms found. It is hoped however, to extend this aspect of sampling because it offers some indication of the cleanliness with which the product is manufactured, handled and stored before it reaches the consumer. FOOD AND DRUGS During the year 795 samples were submitted by the Food and Drugs Inspector. In 44 cases the analysis disclosed an infringement of the law. Sample Infringement No. Date purchased Remarks No action Drained weight of blackberries 41.5% instead of 50% Blackberries in Syrup 199 2.1.57 200 3.1.57 Sour at time of receipt Letter to supplier Milk Letter to manufacturer 202 Buttermint Lumps No evidence of butter-fat 3.1.57 Contained 3.37% butter-fat instead of not less than 4% 231 15.1.57 Popcorn (Butterkist) ” ” 11.2.57 Pearl Barley Infested with live mites Remainder of stock destroyed 287 Contained 80.8% beef fat instead of not less than 83% Shredded Beef Suet Letter to manufacturer 14.2.57 310 337 25.2.57 ” ” ” ” Contained 81.6% beef fat instead of not less than 83% ” ” 12.3.57 Milk Chocolate Contained 3.1% whole milk solids instead of not less than 12%. 372 No. Sample Infringement Remarks Date purchased 395 19.3.57 Plain Flour Contained 108 mgms. creta preparata per 100 gms. instead of not less than 235 mgms. Letter to manufacturer 399 20.3.57 Pork Sausages ” ” Contained 58% meat instead of not less than 65% 462 4.4.57 Orange Drink Letter to manufacturer and remainder of stock destroyed Unfit for human consumption owing to decomposition 506 23.4.57 Pineapple Flavour Found to contain preservatives Letter to manufacturer 535 1.5.57 Contained 3.3% strawberries instead of not less than 10% Apple and Strawberry Jam ” ” 540 6.5.57 ” ” Pork Sausages Contained excess fat and 61.2% meat instead of not less than 65%. 14.5.57 577 Milk Chocolate Crackerjack ” ” Milk solids in chocolate derived from skim milk instead of whole milk 589 20.5.57 ” ” Shortbread Contained no butter 636 Homogenised Milk Contained piece of metal foil Letter to supplier 7.6.57 11.6.57 641 Cream of Mushroom Soup Powder Soup made from this powder would contain only 0.81% fat instead of not less than 3.5% Letter to manufacturer 24.6.57 690 Prosecution:— Absolute Discharge with £8.8.0 costs Sausage Rolls Contained 6.5% meat instead of not less than 15% 27.6.57 Pearl Barley Infested with living mites Remainder of stock destroyed 716 12.7.57 Puff Pastry Contained 20.6% fat instead of not less than 25% Letter to manufacturer 776 15.7.57 Milk Gums Contained 4.2% whole milk solids instead of not less than 10% ” ” 782 1.8.57 Currants Verbal warning to shopkeeper Contained living maggot 839 6.8.57 Dried Mint Contained earth and grit amounting to 2.68% 845 Letter to manufacturer 22.8.57 Meat Paste Contained 53% meat instead of not less than 55% 884 ” ” (57) No. Date purchased Sample Infringement Remarks Ingredients not mentioned on label 28.8.57 Gravy Salt Letter to manufacturer 895 936 9.9.57 Dried Mint Contained earth and grit amounting to 1.31% ” ” 951 17.9.57 Cream of Asparagus Soup (Powder) Soup made from this powder would contain only 1.02% fat instead of not less than 3.5% ” ” 18.9.57 954 ” ” Contained 81.2% beef fat instead of not less than 83% Shredded Suet 972 Contained only 60% meat ” ” 23.9.57 Stewed Steak (Canned) ” ” 990 Meat Pie Contained 15% meat instead of not less than 20% 25.9.57 ” ” 11 Zinc and Castor Oil Cream Contained 8.5% Zinc Oxide instead of not more than 8% 3.10.57 21 ” ” Incorrectly labelled Glucose Tablets 8.10.57 24 Contained 45% meat instead of not less than 50% ” ” 9.10.57 Beef Sausages Contained 65% meat instead of not less than 75% No action 55 21.10.57 Beef Steak with Gravy 60 ” ” 22.10.57 Contained 65% meat instead of not less than 75% Beef with Gravy 70 28.10.57 Ingredients not mentioned on label Letter to manufacturer Savoury Stuffing 92 6.11.57 Contained 550 parts per million of nitrates, presence of which was not declared on label Letter to importer Minced Meat Loaf 145 22.11.57 Letter to manufacturer Wrongly labelled in that hydrolised starch syrup was described as glucose Piping Jelly 198 9.12.57 ” ” Wrongly labelled in that hydrolised starch syrup was described as glucose. Cake Icing 203 10.12.57 ” ” Contained 57% meat instead of not less than 65% Pork Sausages 212 Remainder of stock destroyed Contained 380 parts per million of tin instead of not more than 250 parts per million Spaghetti in Tomato Sauce with Cheese 12.12.57 252 30.12.57 Contained an excess of aspirin amounting to 114.4% of the amount stated. Letter to manufacturer Children's Aspirin Three warning letters were sent to manufacturers in respect of articles of food complained of by members of the public. SAMPLING OF EGG PRODUCTS, 1957 Large consignments of egg products from various countries continued to enter the borough during 1957 and sampling was carried out to determine possible contamination by Salmonella organisms. Under the Public Health (Imported Food) Regulations local authorities are allowed only 48 hours as a period of detention for sampling purposes and, as normal routine examination might entail a delay of anything up to three weeks in releasing a consignment for distribution, the importers paid for a considerable number of the samples to be examined privately, in order to obtain a punctual examination and rapid decision. The method of sampling was by batch numbers (signifying packing dates). Where a sample showed evidence of contamination the whole batch was placed under detention and later either re-exported or released for pasteurisation before use. There has been some controversy between various authorities regarding the most satisfactory procedure for sampling but the method outlined above has been found to be the most practicable in Bermondsey. Percentage sampling has been suggested but would be unfeasible in this borough because of the very large quantities of egg involved. The following table will illustrate what increased sampling would have meant in the case of three consignments of frozen whole egg which entered one inspector's area during September 1957: — Consignment Number of packages Number of batches Number of samples taken A 1 % sampling would have meant (No. of (samples) A 5% sampling would have meant (No. of samples) No. 1 25,460 24 24 255 1,273 No! 2 331249 21 21 332 1,662 No. 3 31,496 19 19 315 1,575 Totals 90,205 64 64 902 4,510 The main importations were of frozen whole egg and laboratory results showed that from 3% to 6% of the major consignments contained Salmonellae. These figures are a little lower than the findings of the Public Health Laboratory Service, as published in their monthly bulletin. The chief exporters were China and Australia and the following table shows the number of contaminated samples found and the type of contamination in respect of each country:— China Australia (No. of contaminated samples) (No. of contaminated samples) Salmonella typhi-murium 10 18 Salmonella bareilly — 2 Salmonella thompson 12 1 Salmonella aberdeen 4 — Salmonella oranienburg — 1 Salmonella para-typhi B. 1 — 27 22 Some importers have tried to avoid detention of stock by asking that contaminated consignments be released for high temperature baking. This is not satisfactory, however, as, once the product enters a bakery, it is liable to contaminate utensils and machinery and also materials that may not be undergoing high temperature baking. The exporters are not at present prepared to carry out heat treatment at the sites of production while they know that the home produce of this country is not dealt with in a similar way. Both at home and abroad progress in egg production and preparation is being hindered on the grounds of expense, the promotion of health and improvement in hygienic methods being apparently a secondary consideration. IMPORTATION OF EGG PRODUCTS, 1957. Country of Origin No. of sampls taken No. of sampls positive Disposal of contaminated egg Quantity Imported (to nearest cwt.) Quantity of contaminated egg Type of Egg Product Re-exported Released for heat treatment Still under detention T. C. Q. L. T. C. Q. L. T. C. Q. L. T. C. Q. L. T. C. Q. L. - ARGENTINE Frozen Albumen 42 6 18 - - Dried Whole Egg 8 3 20 7 16 7 16 - - - - - - - AUSTRALIA Frozen Whole Egg 2528 15 723 22 36 8 21 9 14 19 - - - - - - - - CHINA Frozen Whole Egg 5912 12 466 28 149 2 54 9 93 15 18 - - - - - - - - - - Frozen Albumen 1613 17 241 2 13 19 8 15 5 4 - - - - - - - 50 9 Frozen Yolk - - - - Dried Whole Egg 960 2 377 16 28 8 11 1 10 7 7 - - - - Dried Albumen - - - - - - - 44 19 - - - - Dried Yolk 27 18 2 43 11 10 1 - - - - - - - - Frozen Albumen DENMARK 27 13 - - - - Frozen Whole Egg 10 1 - - - Dried Albumen 8 5 12 - - - Dried Yolk 10 1 - - - FRANCE Frozen Whole Egg 43 3 6 - - - Frozen Albumen 49 17 16 - - - 9 17 5 Frozen Yolk - - - GERMANY Frozen Albumen 3 3 4 - - - HOLLAND - Frozen Whole Egg 3 1 - - 25 Frozen Albumen 31 8 - - - Dried Whole Egg 8 9 8 - - - 8 Dried Albumen 4 5 - - - ITALY Dried Albumen 2 2 - - - - JAPAN Dried Albumen 1 7 - - - - POLAND Frozen Whole Egg 156 1 13 - - Dried Whole Egg 17 16 10 - - - SOUTH AFRICA Frozen Whole Egg 258 10 44 2 4 8 - - 4 8 - - SWEDEN - - Dried Albumen 14 1 - - - YUGOSLAVIA Dried Albumen 12 1 1 12 — 12 - - - - Totals 11820 2078 76 241 4 82 11 23 5 - - - 135 8 - - - - - - - - (62) PUBLIC HEALTH (IMPORTED FOOD) REGULATIONS, 1937/48. Disposed of for purposes other than human food Removed for sorting under Sanitary Authority Destroyed Re-exported Weight Weight Weight Weight T. C. Q. L. T. C. Q. L. T. C. Q. L. T. c. Q. L. Bacon 1 11 1 1 1 17 - - 11 24 - - - - - - Beans 18 1 1 11 19 27 1 5 4 3 26 - - - Biscuits 1 - - 1 4 ­ - - - - - - Butter - - - - - - 1 1 1 5 1 11 ­ - - Cake - - - - - - - 1 - 20 - - - - - - - - - Cheese 18 - - - - 21 6 7 25 1 12 1 5 2 23 - - - 26 Cocoa Beans - 3 22 18 17 14 - - 6 3 3 Coconut - - - - - - 7 4 1 - - - - - - - - - - - Coffee - - 2 1 2 2 17 - - - - - - - Confectionery - - - - 7 2 - - - - - Cooking Fat - - - - - - - - - 17 - - - - - - - - - - - Curry Powder - - - - 1 5 - - - - - - - 3 - Egg Albumen - - - - - 1 3 2 - - - 3 5 6 2 - - - - - - Egg, Dried 13 9 2 23 20 2 1 - - - - - - - - - Egg, Frozen 3 1 21 278 16 2 12 43 13 2 8 - - - - - Eggs, Shell 3 3 - - - Egg Yolk - - - - - - - - - - - 12 2 - - - - - - - - - - - - Fish - - 1 2 - - - - - - - - Fish, Canned - - - - - - 6 - - 3 21 - - - - - - - - - - - Flour 3 1 2 12 1 22 - - - - - Fondant - - - - - 2 - - - - - - Fruit - - - - - - - - - 4 18 - - 1 - - - - - - - - - - - Fruit, Crystallised 2 - - - - - - - - - - - - - - - Fruit, Canned 20 4 - - 1 11 - - - - - - - - - - Fruit, Dried 1 18 10 14 1 1 - - - Fruit Juice and Pulp - - - - - - - 11 - - 2 2 - - - - - - - - - - - Gherkins 13 13 8 7 4 - - - - - - Hops - - - - - 1 1 1 - - - - - Lard - - - - - - - - 2 - 2 1 17 22 8 6 5 - - - - - Macaroni - - 5 1 20 - - - - - - Meat - - - - - - - 2 16 19 1 16 - - 33 1 - Meat, Canned - - - - - - 14 14 2 7 44 4 6 11 2 23 2 - - - Milk, Canned - - - 2 17 - - - - - - Milk Powder - - - - - - - 2 6 - - - - - - - - - - - - - - Nuts 8 - 1 2 13 2 17 1 1 2 10 - - - - Offals 15 3 - 8 - - - - - - Onions 3 - - - - - - - 192 11 - - - - - - - - - - - - - 5 Parsley - - - - - - - - - - - Peas 6 19 3 12 - - - - 9 1 18 2 8 - - - 3 - - - - Pepper 2 21 - - - - - - - - - - - - - Potatoes - 18 - - - - - - - - - - Preserves - - - - - 1 13 1 2 - - - - Poultry - - - - - - - 2 2 3 6 - - - - - Poultry, Canned - - - - - - - 3 1 23 - - - - - - - - - - - - Rice 2 - 1 - - - - - - Salami - - - - - - - - 2 - - - 10 2 2 - - - - - - - - - Sausages 1 12 2 2 10 - - - - - - - Soups, Canned - - - - 1 - - - - 2 3 - - - - - - - - - Tapioca 1 3 3 9 3 19 2 - - - - - - - - - Tea 4 4 9 1 - - - - - - - - - Tomatoes, Canned - - - 3 6 - - - 3 2 - - - - - - - - - Tomato Juice 16 1 3 13 - - - - - Tomato Paste - - - - - - - 3 1 18 - - - - - - - - - - - - - Tomato Puree 14 - - 4 1 21 - - - - - - - - Various - - 71 1 11 - - - - - - Vegetables, Canned - - - - - - - 15 - - - 1 3 16 - - - - - - - - Totals 413 63 17 4 18 3 27 - 24 326 18 3 6 132 13 3 (63) WORK OF THE WHARVES AND FOOD INSPECTORS, 1957. Mr. TAPSFIELD Mr. CAMPBELL Mr. HANCOCK Mr. BUTCHER TOTALS 1061 Food Wharves and Depots 2044 1553 - 4658 Visits 168 174 135 482 Food Factories 5 Food Stores 491 345 189 4 1029 464 62 1759 Condemnation of Food 316 917 - 121 121 Milksellers - - Ice Cream Premises - 188 188 - - Pharmacy and Poisons - 14 14 - - 785 785 Catering Establishments - - - 132 91 27 682 932 Various ' I Consignments of Imported Food detained 56 89 24 169 - 1467 Certificates issued for Unsound Food 656 307 383 121 Intimations Served 53 53 - - - Number of samples taken for analysis Chemical Food and Drugs - - - 795 795 17 90 Imported Food Regulations 38 35 - Bacteriological j 102 311 172 3 588 Egg Products ­ Meat ­ 9 9 ­ 3 Canned Meat ­ 3 ­ ­ ­ ­ 14 14 Cooked Meats ­ Butter 3 ­ ­ ­ 3 Cakes containing Artificial Cream ­ ­ ­ 6 6 ­ ­ ­ 187 187 Milk (Special Designation) Regulations Milk for T.B. ­ - 4 4 - Milk for Brucella Abortus - - - 2 2 58 58 Ice Cream - - - - Swimming Bath Water - 4 4 - RODENT CONTROL In January 1957, the Council decided to promote the Investigator Rodent Control to the post of Rodent Control Officer which had previously been filled by a specialist Public Health Inspector whose death had necessitated some re-arrangement of the duties of the inspectorial staff. The officer appointed had attended a two year course on Pest Control at the Borough Polytechnic and had passed the Intermediate Examination held at its conclusion. The Rodent Control Officer, who works in close co-operation with the Wharves Inspectors and the District Public Health Inspectors, supervises the duties of the Rodent Operators and is responsible for the inspection of business premises, churches, bomb sites &c., for the purpose of Part I of the Prevention of Damage by Pests Act, 1949. The appointment has proved to be most satisfactory and, apart from a financial saving, has assisted in obviating the need for filling the vacancy on the inspectorial staff. Insofar as the treatment of business premises for rat or mice infestation is concerned, the Council has found it necessary to make an increased charge because, in practice, it was found that the full treatment costs were not being recovered. The charge for treatment of a business premises consisted of labour cost plus overheads, materials at cost, and an overall administration charge and it was decided, as an administrative economy, to make a straightforward "all in" charge of 10/- per man hour as from 1st October. Sewer Treatment The following particulars, concerning treatment of the Council's sewer system, have been supplied by the Borough Engineer. Each treatment, taking an average of 10 weeks to complete, is carried out by two men who are solely employed for the purpose. The first main treatment commenced on 5th February 1957, using damp sausage rusk as a pre-bait and damp sausage rusks, zinc phosphide and paranitrophenol as a poison bait. Takes were recorded as follows: No. of manholes baited 1,106 „ „ „ showing pre-bait take 1,031 „ „ „ „ complete take 705 „ „ „ „ no take 75 The second main treatment commenced on 29th April 1957 using pinhead oatmeal as pre-bait, and pinhead oatmeal with ANTU as a poison bait. Dehydroacetic acid was used as a preservative. Recordings of takes were as follows: No. of manholes baited 1,110 „ „ „ showing pre-bait take 916 „ „ „ „ complete take 533 „ „ „ „ no take 194 POSITIONING BAIT IN RAT RUNS COUNTING "THE BAG" RODENT CONTROL OFFICER MAKES INITIAL INSPECTION PREPARING BAIT TRAYS The third main treatment commenced on 10th July 1957, using damp sausage rusk as pre-bait and damp sausage rusk with zinc phosphide as a poison bait. Paranitrophenol was used as a bait preservative. Takes were recorded as follows: No. of manholes baited 1,118 „ „ „ showing pre-bait take 781 „ „ „ „ complete take 259 „ „ „ „ no take 337 All recordings were made seven days after pre-baiting, when poison bait was deposited. Where complete pre-baits were recorded double poison bait was used. These figures show an appreciable decline in both pre-bait and complete pre-bait take since these treatments were commenced. In a further treatment, commencing in October 1957, pinhead oatmeal, castor sugar, technical white oil and 'Warfarin' were used, with dehydroacetic acid as a preservative, 32 ozs. of bait per manhole. FREE WASHING FACILITIES In 1954, the Council introduced free handwashing facilities in the public conveniences, paper towels and liquid soap being issued. Early in 1957, the paper towels were replaced by automatic machines which dispense a clean length of linen towel to each user. Although being slightly more expensive, the improvement has helped to increase the number of persons availing themselves of the service. This is illustrated in the table given below. 1954 1955 1956 1957 Females 3,244 4,855 6,599 14,500 Males 12,976 25,840 28,670 29,500 Totals 16,220 30,695 35,269 44,000 NATIONAL ASSISTANCE ACT, 1948 Section 47 Where circumstances warrant it the Council has authority under this section of the Act to apply for a Court Order for the removal to hospital, or other institution, of an aged, infirm, or physically incapacitated person whose living conditions are insanitary. There is also provision, under the National Assistance (Amendment) Act 1951, for a magistrate to order the emergency removal of such persons to an institution for a period not exceeding twenty-one days, E on certification by the Medical Officer of Health and a general medical practitioner. During the year, 15 persons were persuaded, in their own interests, to enter institutions voluntarily. Only in the case of one old man of 82, with no known relatives, was it found to be necessary to make application to a magistrate for a commital order. This patient had been regularly visited for nearly eighteen months and there had been increasing evidence of his incontinence and inability to care for himself adequately. At the expiry of the statutory period of twenty-one days the old man was still too ill to be moved and he subsequently died. Section 50 Under the provisions of this section, it is the duty of the Council to make arrangements for burial or cremation of a person dying in the Borough where there are no relatives or friends prepared to accept the responsibility. In such cases, the costs incurred by the Council, inclusive of administrative expenses, may be recovered from the estate of the deceased. The following cases were dealt with during the year: 1. The body of Miss C. M. was found on 30th May 1957 in an empty house which had been closed preparatory to demolition. It was understood from the Coroner's Officer that, although the deceased had a brother living in Eire, it had been ascertained from the Irish police that he was financially incapable of making the funeral arrangements and that probably he would not be prepared to travel to London for the purpose in any case. In these circumstances, it was considered that there would be no object in attempting to communicate with the brother and funeral arrangements were made by the Council. The costs incurred were partly met by a death grant from the Ministry of Pensions and National Insurance. 2. At the Coroner's Officer's request, funeral arrangements were made in respect of Mr. E. A. C. who died in a common lodging house on 27th September, 1957. Expenses, less the sum of 5/5½d. found on the deceased, were borne by the Council. 3. The death of Mr. E. H. occurred in a common lodging house on 24th October 1957 and funeral arrangements were made by the Council as the nearest known relative, an elderly niece, did not feel able to accept the responsibility. The Council's expenses are recoverable from the estate. 4. The funeral of Mr. J. J. M., who died in a common lodging house on 11th November 1957, was arranged by the Council at the request of the Coroner's Officer as no relatives could be traced. It transpired, however, that the deceased had been living under an assumed name and that, in fact, he had surviving relatives who would have made the funeral arrangements. One of them offered to meet the costs but, as the Ministry of Pensions and National Insurance agreed to make a death grant which covered the Council's expenses, there was no need to take advantage of the offer. 5. The body of an unidentified man was recovered from the Thames on 26th November 1957 and funeral arrangements were made by the Council at the request of the Coroner's Officer. Expenses, less the sum of 19/4½d. found on the deceased, were borne by the Council. 6. The burial of a still-born child, whose body was taken from the Thames on 26th November 1957, was arranged at the request of the Coroner's Officer, the cost being met by the Council. 7. After a post-mortem on Mr. W. H. S. who died suddenly at his lodgings on 27th December 1957, the Council undertook funeral arrangements at the request of the nearest relatives who were old age pensioners and of very limited means. The deceased was not insured in any way and his personal effects consisted only of items of clothing, in a very dirty condition, which it was necessary to destroy. As the relatives, in company with one or two friends, wished to attend the funeral, however, they agreed to meet the cost of a limousine. The balance of the costs were partly discharged by a death grant from the Ministry of Pensions and National Insurance. Apart from the abovementioned cases, the bodies of one female and one male were conveyed to the mortuary after recovery from the Thames. The former was identified by her husband and the male person, who was identified as a Danish seaman, was buried at the expense of his employers, a London shipping company. PUBLIC HEALTH (LONDON) ACT 1936, SECTION 122 The Council is authorised to remove and cleanse an individual's personal effects where it is considered by the Medical Officer of Health that the condition of such articles is likely to cause the spread of infectious disease. During the year visits were made to the homes of 59 old people who were seriously ill, senile or incontinent. In each case quantities of soiled bedding and personal clothing were found and it was considered essential to have, these effects cleansed in the Disinfecting Station. In the majority of cases it has been necessary to arrange for the articles to be collected at regular intervals for cleansing and return to the owners. OLD PEOPLE'S WELFARE It is estimated that there are probably between four and five thousand old people, i.e., men over 65 and women over 60, in the Borough of Bermondsey and it was considered that, in view of this, a survey should be undertaken in order to assess (a) the size of the problem, (b) the needs of the old people, and (c) the facilities available for meeting such needs. The following is a provisional report on the findings of this survey to date. It relates to 982 old people of whom 960 came to the notice of the Public Health Department during the current year. Table 1—Age and Sex Distribution Male % - Female % Under 60 1 18 2 69 7 170 17 61—70 332 34 71—80 144 14 17 Over 80 79 8 169 70 293 29 689 - - - - The age and sex distribution of these old people is shown in Table I which indicates that there is a preponderance of females in all age groups. Table II —Deaths Male Female Under 60 3 - 9 7 61—70 17 71—80 14 Over 80 13 9 36 36 - - The deaths, by age groups, which have occurred amongst those who have been visited in the course of the survey are shown in Table II. Rather surprisingly the totals for both sexes are equal. Throughout the year 2,583 visits were made to old people whose need for help or advice had been drawn to the attention of the Department by Hospital Almoners, General Practitioners, or neighbours. Additional cases were brought to light during the course of house-to-house inspections by District Public Health Inspectors or were reported by Housing Estate Superintendents who have readily co-operated in this matter. So far as was possible, an assessment was made of the physical and mental condition of each patient and any special needs that age or disabilities had brought about were noted. By a friendly approach the confidence of most patients was soon gained and such help and advice as they required was given. It was found that, in many cases, they were not even aware of the facilities that were available. Where necessary, arrangements were made with the London County Council for the service of a home-help and, in appropriate cases, hot meals were provided on five days per week by the "mealson-wheels" service which is operated on behalf of the Council for the Welfare of Old People. Recreational facilities at Old People's Clubs were made known and the Welfare Assistants were often able to advise on the intricate problems concerning pensions, National Assistance and other benefits. Where it was necessary, arrangements were also made for patients to be bathed regularly in the Disinfecting Station or in their own homes. Not infrequently, clothing was also provided. On the basis of the assessment made during the first visits, patients were classified into groups according to the urgency and frequency of visiting required. It soon became apparent, however, that the case load of a visitor could not be too great or otherwise the quality of her work would inevitably suffer. With this in mind, other means of maintaining contact with old people were sought. Like many other Boroughs, Bermondsey has initiated a small workshop scheme but, owing to accommodation difficulties and the problem of obtaining suitable work, this aspect of welfare has not been developed to any great extent. Both increased club facilities and an enlarged workshop are under earnest consideration. Table III —Mobility Male Female Total % Mobile 486 74 222 House-bound 53 163 22.5 Bed-bound 9 25 3.5 Table III indicates that, although the majority of both men and women are mobile, the house-bound and bed-bound are by no means insignificant in numbers, representing 26% of those on the register. This proportion may appear to be rather high, bearing in mind that many of these cases have been specifically brought to our notice, but it has been more or less confirmed when a whole housing estate has been surveyed. With the ageing of the population which is occurring, the problem of catering for these groups, insofar as housing and other matters are concerned, will inevitably become more serious within the next few years. The considerable excess of house-bound women is probably due, in part, to the preponderance of females in the total population and to the fact that they have a greater life expectancy. Similarly, these factors will apply to the bed-bound group. Table IV —Living Alone Male Female 91 343 The males and females living entirely alone, as shown in Table IV, are potentially a greater problem. Should they fall sick, or suffer an accident at home, there is no spouse or other relative to care for them. Again, it is apparent from the table how much greater is the number of women living in these conditions; unfortunately, the men living on their own are usually far less able to look after themselves, tending to become dirty and neglectful. Table V —Provision Male Female Total 53 85 Meals 33 Home-Help 75 216 291 District Nurse 15 48 63 Table V shows the provision of welfare facilities among those studied during the survey. The total figure given for home-helps is probably rather higher than actual fact as some of their visits may be to old couples. Table VI —National Assistance Male Female 336 146 Table VI shows the number of old people requiring National Assistance. This figure, which represents 49% of those visited during the survey, is a sad reflection on the adequacy of the Retirement Pension, particularly as it is known that many more people should be receiving help but decline, through pride, to accept "charity" or "relief". Table VII—Housing Female Male 315 Borough Council 127 London County Council 37 20 306 Private 132 Table VII shows the distribution amongst local authority and privately owned accommodation of the old people who have been visited during the year. Throughout the survey it has been apparent that, in many cases, the old folk are distressed not by financial need, severe though it may be, but by the sense that nobody is particularly interested in their welfare. Although many of the old people are well cared for by relatives in the neighbourhood, instances do occur where the relatives shelve all filial responsibility, asserting that it is the "duty" of the state to look after "worn out" and unwanted parents. On account of the rapidity with which mental or physical deterioration may occur, frequent visiting of old people is considered to be essential. It is also helpful to make regular visits if only for the purpose of advising the old people themselves or assisting relatives to cope with the day-to-day problems of management that arise where a patient is housebound and, perhaps, incontinent. Reports are given below on representative problem cases which have been encountered during the year. (a) An old man of 82 was constantly visited over a period of eighteen months. He lived in a tiny back room and became very dirty in his habits, rarely going out mainly because of his difficulty in getting about. He rarely, if ever, used the lavatory but burned his excreta on the fire, causing great distress to other occupants of the house. Visits were made by the Administrative Officer, a male nurse from the District Nursing Association, and the Medical Officer of Health, all with the object of persuading him to enter a home where he could be cared for, but their attempts were of no avail. Subsequently, he was admitted to an institution, after a Committal Order had been made, and he died there after having been confined to bed for some weeks. (b) After a number of visits to Mr. C., aged 87, arrangements were made for him to be bathed regularly and for meals to be provided. He was also supplied with clothing and the service of a home-help was obtained. There was difficulty in getting him to pay for meals and his reluctance to put money in the gas meter or to pay for coal caused some distress to the various home-helps who called. At one stage he tore pieces off the floor covering to provide fuel for heating water. A daughter visited him occasionally but she said her father was a very difficult man and he had always been very independent. Every effort was made to persuade the old man to enter a home but without success. He later became ill and was removed to hospital where he died shortly after admittance. It was only after his death that various relatives enquired to ask what had been done for him. (c) Mr. and Mrs. P, aged 79 and 83 respectively, were rehoused under a clearance scheme and were visited regularly because it was found that their flat was only sparsely furnished and that bedding was scarce. Various pieces of second-hand furniture were supplied and a grant for extra comforts was obtained from the Mayor's Contingency Fund. The old lady seemed ailing and unhappy and it was not until she became very ill that it was learned she had not been allowed to share her husband's bed for a number of years but had had to sleep on a chair. She was visited by her doctor and the District Nurse and her last few days were made comfort- able for her before she died at home. Subsequently, the old man was admitted to a home for old people where he is quite comfortable. (d) Miss S, aged 78, continued to live in a tiny room in a condemned tenement after retiring from work. The loneliness and the small room caused her great distress and she remained in bed until noon, feeling that there was no reason for her to do otherwise. She was invited to attend the Workrooms for the Elderly and, on doing so, regained her cheerful personality and took more interest in herself. She felt, however, that she could not face another winter alone with the fear of becoming ill, and arrangements were made for her admittance to a small seaside home where she is now happy. Sick room requisites The Department is now acting as agent for the British Red Cross for the supply of sick room requisites. This appears to be a very satisfactory arrangement as immediate issues can be made from stock. During the year 122 appliances were issued. Special aids have also been obtained from the London County Council for the use of the physically handicapped. During the year wireless sets for the use of 13 homebound persons were obtained from the Society for the Provision of Wireless for the Homebound.