AC4373 Gree46 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1948 LONDON Freame, Manning & Co., Ltd. 12a, Lee High Road, S.E.I3 ERRATA Page 5 - Last para. 1st line: for 'Notification and Death' read 'Notifications and Deaths'. Page 59 - 3rd para. 3rd line: for 'bacteria' read 'bacterium'. Page 59 - Sample T.175. 3rd col. 1st line: should read 'Deficient in edible vegetable'. Index - for 'Polio-Myelitis - page 64' read 'Polio-Myelitis - page 66', Metropolitan Borough of Breenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1948 CONTENTS Page Public Health Committee 3 Introductory 4-6 Section A.—General and Vital Statistics 7-16 „ B.—General Provisions of Health Services in the Area 17-27 „ C.—Sanitary Circumstances of the Area 28-42 „ D.—Housing 43-48 „ E.—Inspection and Supervision of Food 49-61 „ F.—Prevalence of, and Control Over, Infectious Diseases 62-72 Appendix—Statistical Tables 3 PUBLIC HEALTH COMMITTEE as at 31/12/48. The Major : Councillor Mrs. J. Gollogly, J.P., L.C.C. and 13 Members. Alderman Mrs. F. Carter (Chairman) Councillor Mrs. L. Hilldrith (Vice-Chairman) Councillors : Mrs. P. M. Beacham Mrs. I. Jaggers Mrs. M. L. Bennett Mrs. A. D. A. Kennedy T. L. Dawes W. 0. Littler H. W. Gorman A. D. Patton Mrs. M. M. E. Hayter Dr. W. Smith W. H. Stevenson Powers and Duties of the Public Health Committee : 1.—There shall be referred to the Committee the powers of the Council under Acts of Parliament relating to the Public Health and sanitary condition of the Borough, the sale of food and drugs, the repair, closure and demolition of individual insanitary houses (Section 9 and 12 of the Housing Act, 1936), and the By-laws, orders and regulations made, or to be made hereafter, under the provisions of such Acts, which are not within the reference to any other Committee. 2.—All plans for drainage and redrainage of premises shall be laid before the Committee for consideration. 3.—All works of drainage of houses and premises 6hall be carried out under the direction of this Committee. 4.—The Committee shall have the control of Mortuaries, Disinfecting and Cleansing Stations erected or maintained by the Council, as the Sanitary Authority, and shall have control of the staff, apparatus and plant. 5.—The construction, maintenance and control of public sanitary conveniences, and conveniences maintained by the Council, shall be referred to this Committee. 4 STAFF. as at 31/12/48. Medical Officer of Health : F. R. Waldron, M.D., D.P.H. (Part-time as from 12th April, 1948) Public Analyst: H. A. Williams, Ph.D., A.C.G.F.C., F.R.I.C. (Part-time) Bacteriologist: G. L. Robinson, M.D. (Part-time) District Sanitary Inspectors : ac W. H. Collins (Senior) abc S. A. Radford. ab G. W. Heath. abd J. Ashmore. ab J. E. Millway. a Miss E. Arnold. a J. G. Lyons. ab A. V. Griffith. Food Inspectors : ab H. L. Bennett. (Senior) ab J. Collier. Scabies Clinic Nurse : Mrs. C. Cullen, S.R.N. CLERICAL STAFF. L. A. Westacott (Chief Clerk) Mrs. V. I. Starr. A. H. Wilcox. Mrs. H. J. Readdy. C. W. Spore. A. H. Hammond (Temporary) J. F. Vickers. E. P. Tidman (Temporary) F. B. Osborn. W. A. Pearce (Conveniences Superintendent) DISINFECTING STAFF. G. Hook (Foreman) T. Moore. T. Smith. W. Clements. A. Nash. T. Packham (Motor Driver). MORTUARY KEEPER. W. J. Lawley. a Certificated Sanitary Inspector. b „ Meat and Other Foods, etc. c „ Smoke Inspector. d „ Housing Orticer 5 Public Health Department, Town Hall, S.E.10 May, 1949 To The Mayor, Aldermen and Councillors, « Metropolitan Borough of Greenwich. I have the honour to submit the report on the health of the Borough for the year 1948. It follows the same general lines as preceding years, but owing to transfer of functions, some figures relate to the first and second quarters of the year only. The mid-year population is estimated to be 84,410, an increase of 2,180 on the previous year. The general death rate of 10.21 is less than that returned for 1947 or the recorded County or National figures. It is pleasing again to return an Infantile Mortality rate of 26. This equals the rate for 1947, itself an all time record for the Borough. The comparable figure for 1901 was 130, and the average for the five years 1917-1921 was 93. It can thus be seen that the efforts of this Council through the years in the field of Child Welfare have been well repaid. The results achieved reflect great credit on the pioneers who laid the foundations, and on those who built and extended the services between the two World Wars. The Section dealing with Infectious Disease shows that the total of notifications received greatly outnumbered the return for 1947, though it was slightly less than 1946. The main factors causing the increase were epidemics of Measles and Whooping Cough in the second and third quarters. Notification and death attributed to Tuberculosis were fewer in the year under review and indicate an unexpectedly favourable trend. It must be emphasized, however, that, while difficult housing circumstances exist and delay in arranging institutional isolation and treatment continues, the danger to the community remains grave. 6 The Rodent Control Scheme was operated successfully throughout the year, and Anti-Fly measures were again. instituted in the summer months. Both schemes have proved an integral part of environmental hygiene and the Public Health Committee have had under consideration the question of systematising these aspects of the department's activities. Great difficulties still exist in the field of sanitary surveillance as constructive results can only follow from house-to-house inspection of districts and the full operation of housing legislation. Continued effort has produced improvement and, compared with the pattern achieved in 1946 and 1947, the problem appears to be decreasing. Nevertheless overcrowding and the continued occupation of sub-standard dwellings are factors dangerous to health economy which cannot be over-emphasized. The section dealing with food inspection records in detail the attention paid by your officers to supervision of the storage, distribution and sale of foodstuffs in the Borough. The operation of the National Health Service Act, 1946, entailed a good deal of preparatory work and reorganisation within the department. Special tribute is due to those who ensured that the transfer of functions took place without dislocation of services. In conclusion, after more than twelve years' privileged association with colleagues in the Public Health Department it gives me pleasure to place on record my respect for their ungrudging loyalty and friendship. The friendly co-operation of the Town Clerk, other Chief Officers and all grades of staff, is also gratefully acknowledged, and this opportunity is taken of thanking sincerely the Chairmen of Committees and individual members of the Council for the courtesy and consideration shown to me at all times during my period of office. I have the honour to be, Your obedient Servant, F. R. Waldron, Medical Officer of Health 7 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA General Statistics Elevation.—Varies from below high-water mark up to 249 feet above sea level. Area of the Borough and Districts— East Greenwich 1,300 acres West Greenwich 453 „ St. Nicholas, Deptford 115 „ Charlton & Kidbrooke 1,990 „ 3,858 acres Population— At Census, 1931 100,924 Estimated, 1948 84,410 Density of Population 22 persons per acre Number of Inhabited Dwellings—end 1948 (according to Rate Books) 20,794 Structurally separate dwellings at Census, 1931 18,114 Number of Uninhabited Dwellings— At Census, 1931 250 At end 1948 69 Number of Families or Separate Occupiers— At Census, 1931 25,144 Rateable Value, 1948 £762,072 Sum Represented by a 1d. Rate, 1948 £3,081 8 PUBLIC OPEN SPACES. Borough Council— Charlton House and Gardens 9.25 acres R.N. College Cemetery 5.86 „ St. Alfege Recreation and Church Grounds 2.3 „ St. Nicholas Recreation Grounds 1.25 „ Hughes Fields Recreation Grounds .74 „ Batley Park .97 „ Bellot Memorial Gardens .19 „ Other Open Spaces 5.25 „ Approximately 26.00 acres H.M.Office of Works— Greenwich Park 185 acres L.C.C.— Blackheath (part of) 73 acres Maryon Park 46.70 „ Charlton Park 45.75 „ Charlton Lido 23 Sayes Court Recreation Grounds 1.43 „ Mileage of Streets Approximately 88 SOCIAL CONDITIONS. The Metropolitan Borough of Greenwich comprises three districts, viz., Greenwich, Charlton and Kidbrooke, and St. Nicholas, Deptford, all of which are now united into one civil Parish. The sub-soil of the greater portion of the Borough consists of gravel and sand, the exception being in the Kidbrooke area which is mostly clay. The altitude varies from a few feet below high-water mark on the marshes, up to 249 feet above sea-level on the Shooter's Hill Road by the Borough boundary. The Borough is well catered for in the way of parks and open spaces, the largest being the famous Greenwich Park, with its historical surroundings, covering an area of 185 acres. Blackheath forms a Southern boundary, 73 acres of which are within the Borough. There are also the excellent Recreation Grounds serving the Charlton Area, viz., Maryon Park and Charlton Park. More recently has been added the L.C.C. Play Centre and Lido with its wellequipped swimming bath. 9 The part situated near the River Thames is, generally speaking, an industrial area and is more densely populated than the upper parts of the Borough. L.C.C. Housing Estates in the Borough, comprising the Brook and Evelyn Estates, are now largely completed and occupied, whilst work on the Council's Cherry Orchard Estate has continued at a rapid rate. The majority of the industries and sources of employment in the Borough are to be found in close proximity to the River Thames which forms the Borough boundary on the north side. Chief among these are large Cable and Engineering Works, Ship Repairing Works, Gasworks, Soap and Candle Works, L.T.E. Generating Station and Tramway Car Repair Depot, The British Electricity Authority's Works, Glass Bottle Works, Rope Works, Ship Propelling Works, Merryweather's Works (Fire Engines), Cement and Stone Works, Asbestos Works, Cold Meat Storage, Pressed Tool Works, Constructional Engineering Works, Galvanising and Sheet Metal Works, Brewery, Flour Mills, Aero Parts, Wireless and Vehicle Parts and Tin Box Manufacturing Works. The numbers employed at 11 of the larger factories range between 500 and 5,000 each, whilst 17 smaller works each employ between 100 and 400. Population.—The Registrar-General has estimated the civilian population for Greenwich at mid-year 1948 as 84,410, and it is upon these figures the statistics in this report have been based. This shows that the population has increased by 2,180 since last year, and by no less than 20,610 since 1945. *EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Total M. F. Live Births Legitimate 1,586 826 760 Birth Rate 19.79 Illegitimate 79 32 47 1,665 858 807 Still Births Legitimate 36 25 11 Rate per 1,000 total Births 21.7 Illegitimate 1 1 Deaths 859 473 386 Death Rate (Crude) 10.21 10 Rate per 1000 total births. Deaths from Puerperal Causes :— Puerperal Sepsis 1 0.58 Other Puerperal Causes 1 0.58 Total 2 1.17 Death Rate of Infants under one year of age :— All Infants per 1,000 live births 26 Legitimate Infants per 1,000 legitimate live births 26 Illegitimate Infants per 1,000 illegitimate live births 38 Deaths from Tuberculosis (All forms) 60 ,, ,, Pulmonary Tuberculosis 52 Death Rate from Tuberculosis (All forms) per 1,000 0.71 ,, ,, ,, Pulmonary Tuberculosis ,, ,, 0.61 Deaths from Cancer (all ages) 145 „ „ Measles (all ages) — „ ,, Whooping Cough (all ages) 1 Diarrhoea (under 2 years of age) 2 "These figures, which are supplied by the Registrar-General, may differ sightly from those shown in other parts of the Report. MARRIAGES. Mr. F.H. Searle, the Superintendent Registrar of the Greenwich Registration District, has kindly furnished me with particulars relating to the number of marriages solemnised or registered in the Borough of Greenwich. The following table shows these particulars giving the number of marriages in the Borough for each year since 1938 :— Churches of England . Chapel and Roman Catholic Churcl.er SuperintendentRegistrar's Office Total Approximate Population Year Greenwich 1 Charlton and Kidbrooke St. Nicholas 1 1938 309 185 31 101 268 894 95,770 1939 395 218 31 128 397 1,169 94,790 1940 451 243 33 126 345 1,198 74,280 1941 277 174 7† 91 241 790 57,070 1942 257 192 3 79 198 729 60,530 1943 209 166 2 73 171 621 62,870 1944 211 136 — 74 171 592 61,800 1945 228 211 2 87 233 761 63,800 1946 258 196 1 86 235 776 76,840 1947 192 160 13 93 318 776 82,230 1948 202 152 8 104 345 811 84,410 †Parish Church destroyed by enemy action. 11 METEOROLOGICAL OBSERVATIONS. I am indebted to the Astronomer Royal, Sir Harold Spencer Jones, F.R.S., for the following meteorological data for the year ended December, 1948. The mean temperature for the year was 51.3° which is 1.6° higher than the average for 100 years 1841-1940 and brings the total of consecutive years warmer than average to six. The highest temperature in the shade was 91' 4°, registered in a Stevenson screen, on July 28th. Temperatures exceeding 90° were recorded only on three consecutive days in an unusually warm spell at the end of July. March was the second warmest on record. The lowest temperature was 21.1° which occured on February 22nd. There were 27 days on which the thermometer gave readings below freezing point, 10 in February, and the rest in January, October, November and December. The mean daily horizontal movement of the air was 250 miles. The greatest daily movement was 723 miles (January 13th); the greatest hourly movement was 38 miles (January 13th and December 9th), and the greatest wind pressure 36.2 lbs. to the square foot on March 31st. The duration of bright sunshine was 1,404.3 hours—slightly below average. The sunniest day was May 18th when 14.4 hours, representing 92 per cent of the possible total, were registered. There were 60 entirely sunless days. A sunny Spring was followed by almost the least sunny Summer on record. The total rainfall was 22.702 inches, 1.63 inches below a 100 years average. The greatest daily amount was 1.309 inches on August 6th. No measurable rain fell during the period of 22 days, February 23rd to March 15th. 12 BIRTHS The total number of births registered in the Borough during the year was 1,752, of which 1,028 occured in St. Alfege's Hospital, 125 in various Nursing Homes, and 599 in private dwellings. In 810 cases the parents resided in areas outside the Borough and the births were consequently transferred to the appropriate districts. Seven hundred and twenty-three births belonging to the Borough took place in Institutions outside the Borough area, thus the actual figure for Greenwich becomes 1,065, a decrease of 270 from the previous year. Eight hundred and fifty-eight were males and 807 females. This is equivalent to a Birth Rate of 19.79 per thousand of the population and although this rate is 3.82 lower than that for 1947, it is still 1.52 higher than the average for the previous 10 years, viz., 18.27. The Rates for the County of London and for England and Wales were 20.1 and 17.9 per thousand. Illegitimate Births numbered 79, representing 4.7 per cent of the total live births. The number of Still Births registered was 37, which is equivalent to a rate of 21.7 per 1,000 total births. DEATHS The net number of deaths registered during 1948 was 859, of which 473 were males and 386 females, as compared with 952 for last year. This gives a crude death rate for the Borough of 10.21 per thousand of the population. This rate is a decrease of 1.40 compared with the previous year and is 3.19 less than the average for the last 10 years. The Death Rates for the County of London and for England and Wales are 11.6 and 10.8 respectively. The inset table showing causes of deaths at all ages has been supplied by the Registrar-General and is included in accordance with requests contained in the Ministry of Health Circular No. 1728. No. in Short List. Sex Deaths at subjoined Ages of " Residents," whether occurring within or without the District. Causes of Death All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 45. 45 and under 65. 65 and over. All Causes M 473 29 3 5 15 129 262 F 386 15 4 5 36 90 236 i. Typhoid and Paratyphoid Fevers M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 2. Cerebro-spinal Fever M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 3. Scarlet Fever M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 4. Whooping Cough M 1 1 ... ... ... ... ... F ... ... ... ... ... ... ... 5. Diphtheria M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 6. Tuberculosis of Respiratory System M 33 ... ... ... 17 13 3 F 19 15 3 1 7. Other forms of Tuberculosis M 6 1 ... 1 3 1 ... F 2 ... ... ... ... i 8. Syphilitic Disease ... M 5 ... ...... ... ... 5 F ... ... ... ... ... ... 9. Influenrp M ... ... ... ... ... ... F ... ... ... ... ... ... JO. Measles M ... ... ... ... ... ... F ... ... ... ... ... ... 11. Ac : Poliomyelitis and Polioencephalitis M ... ... ... ... ... ... F ... ... ... ... ... ... 12. Ac : Infectious Encephalitis M ... ... ... ... ... ... F 1 ... ... 1 .... ... 13. Cancer of Bucc. Cav. and Oesoph. Uterus M 3 ... ... ... 1 2 F 6 ... ... ... 4 2 14. Cancer of Stomach and Duodenum M 12 ... ... 1 4 7 F 8 ... ... 1 2 5 15. Cancer of Breast M ... ... ... ... ... ... F 12 ... ... ... ... 7 5 10. Cancer of all other sites M 68 ... ... 3 30 35 F 36 ... ... I 14 21 17. Diabetes M 2 ... ... ... ... 2 F 2 ... ... ... ... 2 18. Intra- cranial Vascular Lesions M 35 ... ... 1 4 30 F 40 ... ... ... 13 27 19 Heart Disease M 124 ... 1 4 38 81 F 127 ... ... 4 23 100 20. Other diseases of Circulatory System M 23 ... ... ... 3 20 F 13 ... ... ... 3 10 21. Bronchitis M 41 ... ... 3 10 27 F 21 ... ... ... 3 18 22. Pneumonia M 18 5 ... ... ... 4 8 F 15 2 ... ... 1 1 10 23. Other Respiratory Diseases M 6 ... ... ... ... 4 2 F 4 ... ... ... * 2 2 k 24. Ulcer of Stomach or Duodenum M 9 ... ... ... ... 2 7 F 3 ... ... ... 1 1 1 25. I)iarrhoea (under 2 years) M 1 1 ... ... ... ... ... F 1 l ... ... ... ... 26. Appendicitis M 1 ... ... 1 ... ... F ... ... ... ... ... 27. Other Digestive Diseases M ii 2 ... ... 1 3 5 F 12 ... ... 1 0 3 5 28. Nephritis M i i ... ... ... 4 2 5 F 7 ... ... ... 1 2 4 29. Puerperal and Post-abortive Sepsis F 1 ... ... ... 1 ... ... 30. Other Maternal Causes F 1 ... ... ... 1 ... ... 31. Premature Birth M 6 6 ... ... ... ... ... F 4 4 ... ... ... ... 32. Congenital Malformations, Birth Injury, etc. M 11 10 ... ... ... 1 ... F 7 7 ... ... ... ... ... 33. Suicide M 2 ... ... ... 1 1 ... F 2 ... ... ... ... 1 1 34. Road Traffic Accidents M 5 ... 2 1 ... ... 3 F 4 ... ... 2 ... ... 2 35. Other Violent Causes M 14 1 ... 1 3 3 6 F 12 1 ... 1 1 ... 8 36. All Other Causes M 25 1 ... ... 4 5 14 F 26 ... ... 1 6 8 11 13 DEATHS IN INSTITUTIONS. The following table shows the number of deaths of Greenwich residents in Public Institutions during the last six years :— Year Total Deaths of Greenwich Residents Total Deaths of Greenwich Residents in Public Institutions. 1943 888 609 1944 978 616 1945 813 521 1946 874 585 1947 952 561 1948 862 441 Average 894 555 AGE MORTALITY. The age mortality and the distribution of the deaths between the different quarters of the year is shown by the following table :— Deaths 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Under 1 year of age 9 13 5 17 44 Between 1 and 2 years 4 — 1 1 6 Between 2 and 5 years 1 — — 1 2 Between 5 and 15 years 2 2 5 2 11 Between IS and 25 years 4 3 1 6 14 Between 25 and 45 years 29 21 9 13 72 Between 45 and 65 years 57 47 53 55 212 65 years and upwards 138 117 91 152 £01 Totals 241 203 168 247 862 INFANTILE MORTALITY. The Infantile Mortality Rate, measured by the deaths of children under 1 year of age to the number of live births registered, was 26 per thousand live births, a similar figure being returned for the previous year. For the County of London the Rate was 31 and for England and Wales 34. This Infantile Mortality Rate, identical with that for 1947, is the lowest ever recorded in the Borough. The total number of deaths during the year was 44 as compared with 51 for the previous year. 14 A further reference to the Infantile Mortality Rate will be found in the section devoted to Maternity and Child Welfare, whilst a table showing the causes of death and ages is included in the Appendix of the Report. The following Table shows the comparative Infantile Mortality Rates for the quinquennial periods since 1931, together with the Rate for the years 1946, 1947 and 1948. District Average for five years 1931-1935 Average for five years 1936-1940 Average for five years 1941-1945 Year 1940 Year 1947 Year 1948 Greenwich 75 50 40 34 26 26 London 63 56 60 41 37 31 England & Wales 62 55 50 43 41 34 REMARKS ON VARIOUS DEATH CAUSES. Classification of Deaths.—It should be borne in mind that the statistical data compiled locally relating to cause of death may not agree entirely with the figures furnished to Local Authorities. Classification of the cause of death is taken from one or more causes as stated on the medical certificate in accordance with the Rules generally adopted throughout England and Wales. The Registrar-General is able in cases where it is deemed desirable, to obtain fuller information from the certifying Practitioner. This enables his Department to modify the original classification—hence the possiblities of discrepancies in some cases between the figures prepared locally and those referred by the Registrar-General. Common Infectious Diseases.—The class known as Common Infectious Diseases, comprising Measles, Scarlet Fever, Diphtheria, Whooping Cough and Diarrhoea is credited with causing the total of 4 deaths, equalling a Death Rate of .04 per thousand. Small Pox.—There were no deaths from Small Pox, this being the 46th year since a death occurred from this cause. Measles.—There were no deaths arising from this cause during the year as compared with one for the previous year. No deaths were recorded for the years 1943, 1944 and 1945, but one was registered for the year 1946. 15 Scarlet Fever.—There were no deaths arising from this cause, the position being similar to that of 1947. None occurred in 1942 and 1943, one death in 1944, none in 1945, and one in 1946. Whooping Cough.—This disease was given as the cause of one death, with a Death Rate of 0.01 per thousand. There was one each for the years 1943 and 1944, none in 1945, two in 1946 and one in 1947. Diphtheria.—No deaths occurred during the year. Three were recorded for 1942, three in 1943, seven in 1944, one each in 1945 and 1946 and none in 1947. Enteric Fever.—No deaths have been recorded from this disease since 1941. Diarrhoea and Zymotic Enteritis.—Three deaths were stated to be due to this cause, equalling a Death Rate of 0.03 per thousand. Last year there were 4 deaths, 4 occurred in 1946, 13 in 1945, 9 in 1944, 7 in 1943 and none in 1942. Tuberculosis.—This class included 62 deaths giving a rate of 0.73. These figures compare with 64, 60, 50, 53, 75 and 69, the totals for the years 1942, 1943, 1944, 1945, 1946 and 1947 respectively, and the respective Rates of 1.05, 0.94, 0.81, 0.82, 0.97 and 0.82. Tuberculosis of the Respiratory System is, as usual, credited with the major portion of these deaths. There being 57 attributed to the cause, or a Rate of 0.67 per thousand as compared with 0.76 for the previous year. The deaths were allocated to : 21 in East Greenwich, 13 in West Greenwich, 2 in St. Nicholas, Deptford, and 21 in Charlton and Kidbrooke. The remaining forms of Tuberculosis were responsible for 5 deaths. Cancer.—This disease was responsible for a total of 152 deaths with a Death Rate of 1.80 per thousand. The number of deaths for the previous 5 years were 127, 130, 127, 137 and 142. The distribution of the deaths was as follows : 64 in East Greenwich, 25 in West Greenwich, 6 in St. Nicholas, Deptford, and 57 in Charlton and Kidbrooke. 16 The sites of the affected parts were :— Cancer of Buccal cavity and oesophagus (males only) 3 Cancer of Uterus 6 Cancer of Stomach and Duodenum 19 Cancer of Breast 12 Cancer of all other sites 112 152 infra-cranial Lesions of Vascular Origin.—This class which includes deaths arising from Cerebral Haemorrhage, Thrombosis, Hemiplegia, etc., was responsible for a total of 80 deaths. Of this number 19 died between the ages of 45-65 years and 60 from 65 years and upwards. Diseases of the Circulatory System.—Heart Disease.— As usual the deaths from this cause occupied the principal place in the classification of diseases. There were 223 deaths under this class as compared with 283 for the previous year. Seventy-five were allocated to East Greenwich, 44 to West Greenwich, 20 to St. Nicholas, Deptford, and 84 to Charlton and Kidbrooke. Diseases of the Respiratory System.—There were altogether 113 deaths from these causes. Bronchitis was responsible for 56, and Pneumonia (all forms) 44. Of the total deaths 74 were of persons aged 65 and over. The distribution of the deaths were, 56 in East Greenwich, 18 in West Greenwich, 3 in St. Nicholas, Deptford, and 36 Charlton and Kidbrooke. Deaths From Violence.—These numbered 45, including 5 from Suicide and 8 due to Road Traffic Accidents. 17 SECTION B General Provision of Health Services for the Area. Public Health Staff.—The staff of the department as at December 31st is set out on pages Following my appointment as Divisional Medical Officer in April, I was seconded part- time to the London County Council until July, after which and pending a permanent arrangement, I continued as part time Medical Officer of Health for the Borough. The resignation through ill health of Mr. H. Duck, Senior Office Clerk, in November, was received with regret. His total period of service with the Council amounted to 43 years of which 28 were spent in this department. His wide knowledge of Public Health legislation and special ability in statistical methods made him an invaluable colleague. The following changes occurred in July as a result of transfer under the National Health Service Act. (1) To the London County Council: Maternity and Child (Senior) Dr. J.M.Oldfield,M.R.C.S.,L.R.C.P. Welfare Medical (Junior) One Vacancy. Officers Sessional Four. Administrative & Foulger, F. W. (Chief Administrative Clerical Staff Garratt, R. G. Assistant) Wright, Mrs. L. E. Brooker, Mrs. P. E. Chave-Jones, Miss M. (Care Committee Secretary) Sellens, Mrs. E. R. (Foot Clinic Receptionist) Six Clinic Clerks Health Visitors Walton, Miss K. A. Fluck, Miss N.A. Hulse, Miss G. A. Coe, Mrs. D. M. Brydson, Miss J. M. Shepherd, Mrs. D. E. Morris, Miss M. E. Horton, Miss F. M. E. Wilkins, Miss D. M. (Health Visitor— Tuberculosis) Forrest, Miss H. M. (Health Visitor— Tuberculosis) Ramsay, Mrs. J. M. (Health Visitor— Tuberculosis) 18 Chiropodists Rosenstein, H. (Senior) Pratt, Miss A. F. Six Part Time. Milk Salesivoman Sibborn, Miss G. L. Light Therapy D'Oyly Watkins, Miss L. Denney, Miss M. Two Part Time Nurses Day Nursery Copp, Mrs. A. (Matron) Greening, Mrs. E. E. A. (Deputy) and a Staff of 15. Home Helps Evans, Mrs. F. M. (Full-time) and 31 Part-time Home & Domestic Helps. Cleaners & 6 Caretakers and 6 Cleaners. Caretakers (2) To the South East Metropolitan Regional Hospital Board of the Ministry of Health: Deputy Medical Officer of Health and Tuberculosis Officer: Dr. C. W. L. Jeanes, M.R.C.S., L.R.C.P. (Temporary) Tuberculosis Clerk : Miss L. M. Merricks Dispensary Caretaker: J. F. Nash. The list includes members of staff with long service and special reference is made to Mr. Foulger, Mrs. Wright and the Misses Wilkins, Walton, Merricks and Sibborn, who have worked in this department for periods varying from 16 to 32 years. Control of the following functions and premises were transferred. (1) To the London County Council: (a) 7 Welfare Centres One Day Nursery and the Tuberculosis Handicraft Hut. (b) The following functions : Health Visiting Home Nursing Domestic and Home Help Dental Clinic Foot Clinics Artificial Sunlight Treatment Vaccination and Immunisation Tuberculosis After-Care 19 (2) To the South East Metropolitan Regional Hospital Board of the Ministry of Health: The Tuberculosis Dispensary, 41 Maze Hill, S.E.10. Bacteriological Examinations.—During the year the undermentioned specimsns were submitted to the Devon port Laboratory for bacteriological investigation, the results being:— Positive Negative Total Diphtheria 8 410 418 Tuberculosis 70 172 242 Dysentery — 1 1 Whooping Cough 5 3 8 Miscellaneous 4 16 20 The figures in the following tables and records relate to the period 1st January to 4th July, 1948. Diabetes—Insulin Treatment.—Twelve cases were provided with Insulin under the special arrangement for assisting necessitous patients suffering from Diabetes at a cost of £40 8s. 8d. Foot Clinics.—Sessions were held regularly at the various centres. An extra Clinic was established at Ridgebrook Road Centre at the end of January and was functioning quite successfully by the time the London County Council assumed control. The staff consisted of two whole-time and five sessional Chiropodists, and a Clerk-Receptionist was in attendance at each Clinic. As in previous years, to avoid unnecessary waste of time, the system of advance booking was continued and the usual charge of 1/- per treatment was maintained. Whilst the number of treatments rose considerably compared with the previous year, the waiting list grew correspondingly, emphasising the increasing demand for the service. The following table gives the number of attendances at the Centres:— Shooters Hill Road 2,459 Chevening Road 3,056 Creek Road 2,063 Charlton Lane 539 Ridgebrook Road 178 Fairfield House 1,561 9,856 Arrangements were continued whereby the Senior Chiropodist attended one session weekly at St. Alfege's Hospital for the treatment of Diabetic patients, the number so treated being 170. 20 Artificial Sunlight Treatment.—Ultra-violet ray treatment was available at Chevening Road, Shooters Hill Road, Creek Road, Charlton Lane and Fairfield House Centres. Arrangements were again made for children attending Day Nurseries to receive treatment upon recommendation. Particulars relating to the number of patients treated at the various Centres up to 4th July, 1948, are given in the following table:— Daily Sessions. Under 5 5—15 Over 15 Total Number under treatment at end of previous year 300 1 18 319 Number of New Patients 539 10 34 583 Discharges 546 9 39 594 Number under treatment at 4.h July, 1948 295 2 12 309 Number of treatments given 10,981 191 557 11,729 The following table shows the type of abnormality among children up to 5 years of age, and expectant and nursing mothers, treated during the period under review. In the majority of cases marked improvement was noted. Conditions Treated Referred from Infant Welfare Centres. Rickets and prevention of Rickets 126 Bronchial Conditions 61 Underweight and Debility 109 Anaemia 16 Colds and Nasal Catarrh 32 Skin Disorders (Eczema, etc.) 13 Sore Buttocks 23 Convalescence from Infectious Disease 28 Overweight 12 Urticaria 7 Septic conditions 14 Adenitis 10 Defective circulation 4 Insomnia 4 Enlarged Tonsils 4 Other Conditions 11 Total 474 21 Referred from Ante-Natal and Post-Natal Centres. Septic Conditions 2 Rheumatic Conditions Breast Abscess 6 1 Debility 5 Mastitis 5 Anaemia 6 Other Conditions 2 Total 27 MATERNITY & CHILD WELFARE. As stated elsewhere in this Report, under the provisions of Part III of the National Health Service Act, 1946, the control of the services under the heading of Maternity and Child Welfare passed to the London County Council on 5th July, 1948. Details of the activities carried out between 1st January and 4th July, 1948, are set out below. Infant Welfare Centres.—The work at the Centres was conducted on similar lines as in previous years. Although the following figures refer to a six monthly period only, pro rata they are slightly higher than those for 1947. It is interesting to note that in 1938, when the estimated population was 95,770, the total attendances of babies was 18,558, whilst in the first half of 1948 the figure was 12,164 with a population of approximately 84,410. This increase, partly due to the higher birth rate, serves to emphasize the growing popularity and importance of the Welfare Centre in the life of the present-day mother. Particulars relating to the various Centres are given in the following tables:— Period 1st January, 1948 to 4th July, 1948. (a) Babies 0-1 vear. Centre No. of Clinics No. of Attendances New Cases Medical Consultations Chevening Road 104 3,289 206 1,232 Creek Road 49 1,381 109 286 Shooter's Hill Road 63 2,508 166 621 Bardsley Lane 50 1,053 69 227 Fairfield House 50 1,860 96 543 Rochester Way 13 381 24 108 Charlton Lane 25 982 82 380 Ridgebrook Road 26 710 43 204 Totals 380 12,164 795 3,501 22 (6) Children 1-5 years. Centre No. of Clinics No. of Attendances New Cases Medical Consultations Chevening Road 104 1,803 126 779 Creek Road 49 779 70 184 Shooter's Hill Road 63 1,130 144 358 Bardsley Lane 50 474 38 93 Fairfield House 50 1,093 54 460 Rochester Way 13 212 19 68 Charlton Lane 25 534 54 239 Ridgebrook Road 26 369 44 160 Totals 380 6,400 546 2,341 Ante-Natal and Post-Natal Clinics.—The number of new cases was 894 and attendances at the various centres were as follows: Centre No. of Clinics New Cases Total Attendances Chevening Road 125 319 1,637 Shooter's Hill Road 51 140 632 Creek Road 52 156 669 Charlton Lane 25 102 443 Fairfield House 50 111 531 Ridgobrook Road 26 66 332 Totals 329 894 4,244 *Includes 181 Post-Natal cases. Infantile Mortality.—The total number of deaths under 1 year of age was 44 as compared with 51 for the previous year. This gives an Infantile Mortality Rate of 26 per 1,000 live births, a figure considerably below those for England and Wales and the County of London, viz.: 34 and 31 respectively. The average rate for the previous ten years is 41. The Infantile Mortality Rate of 26 returned is identical with that for the previous year and therefore equals the lowest ever recorded for the Borough. The causes of the 44 deaths were:— Prematurity 12 Pneumonia and Bronchitis 10 Congenital Malformation 10 Atelectasis 4 Gastro-Enteritis 3 Violence 1 Other causes 4 23 Of the above numbers 29 were male and 15 female. Twentyfour died in St. Alfege's Hospital, 14 in other Hospitals and 6 at home. Infants dying before attaining the age of one month numbered 25, equivalent to 56.8 per cent, of the total Infantile deaths ; of this number 19 died in the first week. As usual, the principal causes were Prematurity and Congenital Malformation. Deaths of Children Between 1 and 5 Years of Age.— The number of deaths of children between the age of 1 and 2 years was 6 and between 2 and 5 years—2. The comparable figures for the previous year were 6 and 7 respectively. Of the total deaths of children between 1 and 5 years 4 were boys and 4 were girls and they occurred as follows: 1 in St. Alfege's Hospital, 2 in the Miller General Hospital, 4 in other Hospitals outside the Borough and 1 at home. Maternal Mortality.—The number of deaths from Puerperal Sepsis and other Maternal causes was 2, which gives a Maternal Death Rate of 1.17 per 1,000 total births. In the years 1947, 1946, 1945, 1944, 1943 and 1942, there was 4, 2, 2, 1, 0 and 1 deaths respectively. In accordance with the requirements of the Ministry of Health, investigations were carried out with a view to the assessment of preventable factors. It could not be said in any of the cases recorded that neglect on the part of the patient, or lack of facilities during confinement, were significant contributory factors. Dental Clinic.—The Council's Dentist, Mr. G. F. Ferris, L.D.S., R.C.S. (Eng.), attended at the Dental Clinic, Shooters Hill Road, twice weekly to deal with cases referred to him from the Welfare Centres and Clinics. The following return shows the work performed during the six months period ended 4th July, 1948:— Number of Sessions 50 Number of New Patients 186 Number of Old Patients 340 Number received Treatment 525 Number of Extractions 826 Number of Extractions (Gas) 124 Number of Dentures Supplied 28 Number of Fillings 68 Supply of Milk To Mothers and Children.—The Council's scheme for the provision of dried milk to mothers and children was continued, although since the introduction of the National Scheme the distribution has been on a much smaller scale. 24 The following table shows the amounts distributed at the various Welfare Centres during the first half of the year:— (a) Dried Milk, Virol, &c., Distributed Free Half-year ended Milk pkts. Virol lbs. Malt & Oil cartons Marmite cartons Approximate Cost £ 8. d. 4th July, 1948 344 7½ 7 — 29 0 0 (b) Dried Milk, Virol, &c., Sold at Full or Reduced Prices Half-year ended Milk pkts. Virol lbs. Malt & Oil crtns. Farex pkts. Marmite crtns. Avid. Oat Food pkts. Total Amount Received £ 8. d. 4th July, 1948 11,911 1,588 331 599 1,941 418 2,092 4 4½ Through the courtesy of the local Food Executive Officer I am also enabled to give particulars relating to milk distributed during the year under the National Scheme. Full Cream 51,613¾ lbs. Half Cream 1,903¾ lbs. Supply of Vitamins to Expectant Mothers and Children.— As in previous years, vitamin products are available at the Welfare Centres. The following quantities were distributed under the arrangements with the Ministry of Food. Cod Liver Oil 24,340 bottles Orange Juice 85,330 bottles A. & D. Tablets 6,052 packets Institutional Provision for Mothers and Children.— Cases requiring convalescent home treatment were considered by the Maternity and Child Welfare Committee. During the first six months of the year 16 children were sent to Homes arranged through the I.C.A.A. for periods varying from one to three months. There was still a long waiting list of cases awaiting admission to Convalescent Homes, but, as stated in recent Reports, until more Homes are available long delays in fixing up the necessary accommodation are unavoidable. During the same 6 months period 3 mothers were provided with Convalescent Home treatment. 25 Home Nursing.—Children attending the various Centres who were found to be in such a condition as to require special nursing at home were referred to the various Nursing Associations operating in the Borough. The Council paid 1/- a visit to the Queen's Nursing Association, and 2/2d. per visit to the Ranyard Mission in regard to such services. The total number of cases referred from the Centres was 86 at a cost to the Council of £44 17s. 2d. Home Helps Service.—This service now comprises the original Home Helps Scheme for confinement cases and Domestic Helps for providing assistance in cases of illness and the aged and infirm. The Maternity and Child Welfare Clerk acted as Organiser and was generally responsible for dealing with and interviewing applicants, collecting the fees, and arranging for the service of the Home Helps. All cases desiring financial assistance were considered by a Sub-Committee of the Maternity and Child Welfaer Committee and assessed according to the scale formulated by the Metropolitan Boroughs' Standing Joint Committee. Altogether in the first 6 months of the year Home Helps were provided in 204 cases, 111 of which were for illness or elderly and infirm cases. The duration of stay for confinement cases was two weeks except in a few instances where this was extended on medical grounds. Arrangements continued for providing regular assistance to be given to the larger of the several Almshouses in the district. One Home Help was attached to each group, putting in three or four hours two or three days a week as occasion demanded. Only a nominal charge was made in these cases. Child Life Protection.—The supervision of foster children and the homes of foster mothers was carried out by the Health Visitors who made 69 visits during the year. The number of foster mothers on the register at the end of the half year was 19 and the number of children 19. Care of Illegitimate Children.—The Council continued to assist financially Moral Welfare Associations in connection with their work for the care of illegitimate children. The Health Visitor also co-operated with the Association when called upon. Care of Premature Infants.—In accordance with the Ministry of Health Circular 20/44, doctors and nurses notifying births of children were requested to inform the Medical Officer of Health of birth weights. 26 Children designated as premature were the subject of special visits by the Health Visitors who submitted reports in respect of these infants to the Medical Officer of Health. Such reports indicated the need for a Home Help or if other special arrangements were considered necessary. The following table gives particulars in respect of the 6 months period ended 4th July, 1948:— Where Born Number Born Died during 1st 24 hrs. Died during 1st month Survived after 1st month Hospital 65 5 15 45 Home *12 Nil 2 10 Total 77 5 17 55 *Nine of these children were nursed entirely at home. The number of premature babies notified during the above period whose mothers resided in the Borough was 27. Of these 7 died ; the remainder were reported upon as progressing satisfactorily. Day Nursery.—The Council's Day Nursery at Conley Street, East Greenwich, provided places for 42 children up to the age of 2 years and the available accommodation was fully utilised. Primarily intended for babies of mothers who were engaged on full time work of National importance, cases were accepted on compassionate or hardship grounds from non-working mothers provided vacancies existed. Health Visitors.—The following tables show (A) the number of visits made by the Health Visitors during the first half of the year in connection with Births and cases if Infectious Diseases, and (B) number of Infant Consultations and Ante-Natal Clinics attended and miscellaneous visits:— Health Visitors' Visits, &c., 1948. Table A. Visits Re-visits Total Infants under 1 year 875 1,587 2,462 Children 1—5 years 61 2,691 2,752 Measles (under 5 years) 273 49 322 „ (over 5 years) 283 24 307 Whooping Cough (under 5 years) 136 3 139 „ „ (over 5 years) 105 3 108 Pneumonia 1 — 1 Puerperal Pyrexia and Fever 6 2 8 Diarrhœa 9 3 12 Ophthalmia Neonatorum 6 — 6 Inflammation of Eyes 5 1 6 Total 1,760 4,303 6,123 27 Table B. Visits Re-Visits Totals Milk Scheme 11 4 15 Dental Treatment 34 1 35 Ante-Natal Cases 415 76 491 Children Act 53 16 69 Miscellaneous 513 105 618 Infant Consultations 386 — 386 Ante-Natal Clinics 310 — 310 Dental Clinic 50 — 50 In addition to the above 187 persons were seen by the Health Visitors at the office, chiefly in connection with milk applications. Notification of Births.—The following Table gives the number and types of notifications received respecting births in the Borough up to 4th July, 1948:— Where Confined Midwives Doctors Greenwich Births Other Boroughs' Births Greenwich Births Other Boroughs' Births St. Alfege's Hospital 192 371 — — Nursing Homes — — 5 59 Other Residences — — — — At home 329 3 — — 521 374 5 59 Other Boroughs (Transfers Inwards) 352 — — — Total 873 374 5 59 From a perusal of the above Table it will be seen that 959 births actually took place in the Borough during the first six months of 1948. Of this number 433 were transferred to Other Authorities. Against this, 352 births which occurred in other areas were allocated to Greenwich, thus giving a nett figure of 878. 28 SECTION C Sanitary Circumstances of the Area. The tables on pages 41 and 42 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 21,155 houses and premises have been inspected or reinspected during the year; 2,029 intimation notices and 450 statutory notices were served. The number of registered complaints, viz., 2,178, was again greatly in excess of the pre-war average of 700. This serves to emphasise the difficulties which face the Sanitary Inspector in his task of maintaining a proper standard of housing in his district. Routine complaints mainly arise from the continued deterioration of old property despite the application of the nuisance sections of the Public Health Act. The rate of provision of new dwellings is not such as to allow of Housing Act procedure in the case of sub-standard accommodation. A good deal of effort is, therefore, spent on obtaining repairs to worn out property which, in other circumstances, would be scheduled for demolition. Factories Act, 1937.—Under this Act the principal functions are administered by the Ministry of Labour and National Service through H.M. Factory Inspectors. The Sanitary Authority is charged with the duty of enforcing the legislation as to sanitary accommodation in all factories in its area, and in those factories where mechanical power is not used the following:— Cleanliness. Ventilation. Overcrowding. Drainage of floors. All factories must have an adequate supply of drinking water from a public main or some other source approved in writing by the Council. During the year, 418 inspections were made by the Council's Inspectors in relation to the 345 registered factories. The latter figure includes 66 premises where mechanical power is not used. Defects were found in 37 instances, all of which were remedied. Outworkers.—Premises where homework is carried on were visited on 119 occasions by the Woman Inspector. In no instance was it necessary to take action because of infectious disease. 29 FACTORIES ACT 1937 Inspections for purposes of provisions as to health. Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 66 41 3 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 267 312 10 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 12 65 — — Total 345 418 13 — Cases in which defects were found. Particulars Number of cases in which defects were found Number of casas in which prosecutions were instituted Found Remedied Refe To H.M. Inspector rred By H.M. Inspector Want of cleanliness (S. 1.) 10 10 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 1 1 — — Inadequate ventilation (S.4) 3 3 — — — Ineffective drainage of floors(S.6) — — — — — Sanitary Conveniences (S.7) (a) insufficient 6 6 — 3 — (6) Unsuitable or defective 10 10 — 5 — (c) Not separate for sexes 5 5 — — — Other offences against the Act (not including offences relating to Outwork) 2 2 — 2 — Total 37 37 — 10 — 30 Outwork—(Sections 110 and 111) Nature of Work Section 110 Section 111 No. of out-workers in August list required by Sect. 110(1) (c) No. of cases of default in sending list to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel Making, etc. 47 — — — —- — Umbrellas, etc. 1 — Racquet and tennis balls 1 — — — — — Paper bags 1 — — — — — The making of boxes or other receptacles or parts thereof made wholly or partially of paper 5 — — — — Carding, etc., of buttons, etc. 1 — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 1 — — — — Lampshades . 4 — — — — — Total 61 — — — — — Smoke Abatement.—The emission of grit from local Generating Stations was again a noticeable cause of complaint from the public. In one instance special grit arresters had been fitted. It appears that the present emission of grit is due mainly to the use of inferior fuel. Representations have been made to the Ministry of Fuel and Power with a view to improving the quality of coal supplied. Smoke observations were carried out on 128 occasions, but in no instance was it necessary to serve a notice. Nuisances Arising from Bomb Damaged Buildings, E.W.S. Sites and A.R.P. Shelters.—All the public A.R.P. Shelters and many E.W.S. sites and bomb damaged buildings have been dealt with, but there is no doubt that those remaining are eyesores and potential nuisances. Many complaints have been received and although immediate dangers to health, such as rat and fly infestations, can be effectively dealt with, the real problem remains. 31 The matter was repeatedly before the Public Health Committee, and towards the end of the year, following representations to the Government Departments concerned, there were grounds for assuming that authority would be granted for dealing with some of the sites under Amenity Clearance Schemes. When the necessary authority is granted for clearance of sites, co-operation from residents in the vicinity should be sought, for without it efforts to improve conditions may be wasted. Houses Let in Lodgings.—The L.C.C. Bye-laws made under Section 6 of the Housing Act, 1936, define a house let in lodgings as one which is occupied, or is of a type suitable for occupation, by persons of the working classes and let in lodgings or occupied by members of more than one family. These dwellings are subject to registration and must comply with certain requirements as to sanitation, cleanliness, etc. The number of houses on the Register at the end of the year was 3 ; these have been visited by the Woman Inspector on 36 occasions. Defective Dwellings.—Repairs.—With regard to houses found not to be in a reasonable state of repair, the following procedure, classified under three headings, is generally adopted :— (1) Complaints from or on behalf of the occupier.—The District Sanitary Inspector makes inspection and an Intimation is sent to the owner specifying the defects and nature of nuisance found. Where necessary, the circumstances are reported to the Public Health Committee for authority to serve a Statutory Notice to enforce abatement of the nuisance. The premises are re-inspected by the Sanitary Inspector and, if work required is not executed within a reasonable period, Statutory Notice is served. In cases of non-compliance the Town Clerk is instructed to institute proceedings. (2) Sanitary defects due to depreciation of property.—Depreciation of property usually occurs as a result of the owner's inability to carry out repairs during the war period. A Notice is served on the owner by the Sanitary Inspector, and where expenditure exceeds £100 it is necessary for a licence to be obtained before the work is allowed to proceed. (3) Housing defects.—These are cases where the conditions are such that they cannot be remedied under the procedure of the Public Health (London) Act, 1936, and are dealt with under the Housing Act, 1936, as being houses unfit for human habitation. Representations are made to the Public Health Committee to 32 consider as to whether such houses can be repaired at a reasonable cost having regard to the value of the premises, or whether Closing and Demolition Orders should be made. Disinfestation Scheme—Anti-Fly And Anti-Mosquito Measures.—The Anti-Fly and Mosquito Scheme commenced on 1st April and continued throughout the summer until the end of September. By arrangement with the Borough Engineer a quantity of "Gammexane" powder was carried in each Refuse Collecting Van. The dustmen were instructed to sprinkle the powder in the dustbins after emptying and sprinkler top tins were supplied for the purpose. In addition, the vans were sprayed with D.D.T. in kerosene, this work being carried out at the Council's Depots. The scheme generally proved very successful. Pig-bins were lightly dusted with "Gammexane" and the bins were collected and returned to the Council's Depot for thorough cleansing with boiling water once every six weeks. The dust-shutes in the numerous blocks of flats in the Borough have all received fortnightly treatments of D.D.T., this work being carried out as soon as practicable after dust collection. This was most effective, only two complaints of fly maggots being received during the season. In addition, our men were at all times searching for new sources of fly breeding, and with commendable attention to detail during their travels have treated collections of dog droppings, horse droppings and food scraps thrown on the streets and open sites, preventing small infestations occurring. The nuisance arising from the collecting of barges loaded with house-refuse, off the foreshore at Blackwall Point, was very slight, possibly due to initial treatment being given by those Authorities using this method of disposal. Food shops, cafes and fish shops were particularly difficult to deal with and great care had to be taken when using either D.D.T. or "Gammexane". These premises were generally treated externally with good results. Mosquito and fly breeding in static water tanks, etc., was effectively controlled by spraying with D.D.T., or dusting with "Gammexane" Sawdust bombs "soaked with "Malariol" have been found useful in cases not readily accessible for routine treatment. Many difficulties and objectionable conditions were met and overcome with commendable ingenuity. During August and again in September requests for advice concerning insects were received from Building Contractors erecting 33 » houses on the London County Council Evelyn Estate, Kidbrooke. On investigation it was found that a non-biting beetle was infesting the straw packing of bricks. Some 60,000 bricks were sprayed with D.D.T. in kerosene with excellent results. The table given below is a brief schedule of the work carried out during the period under review:— No. OF TREATMENTS Refuse Heaps Considerable Stables 23 Ponds, Streams, etc. 4 Standings for Pig Bins 403 Private Houses 55 Shops 15 E.W.S. Dams 97 Clinics 1 Bombed Sites 119 Council Flats (Dust Shutes) 475 Factory Canteens & Offices 4 Piggeries 6 Scavenging and Refuse Disposal.—The collection of refuse in the Borough is under the control of the Borough Engineer who has kindly supplied me with the following information :— "During 1948 the amount of house refuse and street sweepings collected amounted to approximately 16,260 and 1,260 tons respectively, totalling 17,520 tons, the majority of which was disposed of via the River Thames to controlled tips. Two new totally enclosed refuse collecting vehicles together with certain other new vehicles, were, put into commission. Although during the year some adverse conditions arose (by way of failure of the Contractor to continue the barging away of the refuse and other labour difficulties) no undue disorganisation of the disposal service was encountered. An intensive effort is still being made to collect all available salvage and this is dealt with at the Council's Refuse Disposal Plant at the Tunnel Avenue Depot. During the year under review a total quantity of 1,089 tons of various types of salvage were disposed of, and 1,631 tons of kitchen waste was sent to the Concentrator plant in an adjoining Borough for processing as pig food; these two items representing an income to the Council in sales and grants of £10,770." Pig Bin Nuisance.—There were a number of complaints received during the summer months mainly in connection with the nuisances caused by foul smells and flies and the prevalence, during high winds, of the lids being blown over, allowing the contents to be strewn over the footway. 34 In the course of visits paid by the Department's Fly Squad to streets where pig bins are deposited, 403 treatments were carried out with good results. Disinfestation of Verminous Premises.—The disinfestation of verminous houses has been conducted on similar lines to that of the previous year, D.D.T. being the vermicidal agent in general use. There was a striking decrease this year in the number of cases of verminous or dirty rooms dealt with by the Sanitary Inspectors in the course of their duties. During 1948 there were only 151 instances where action was necessary, compared with 531 for the previous year. In addition, the Disinfestation Staff sprayed 614 rooms and contents with D.D.T., whilst in 32 cases bedding, etc., was removed to the Council's Disinfecting Station and treated by steam disinfection. Rent and Mortgage Interest (Restrictions) Acts, 1920.— Under the provisions of these Acts landlords are permitted to make certain increases of rent, and tenants whose houses are not in all respects reasonably fit for human habitation may apply to the Sanitary Authority for a certificate to this effect enabling them to suspend payment of the increased rent until the necessary works shall have been completed to the satisfaction of the Sanitary Authority. During the year 7 applications were received and 7 certificates were duly granted. Landlords may also apply to the Sanitary Authority for a report that the necessary works had been executed to the satisfaction of the Council. Two applications were received and reports duly granted. Shops Act, 1934.—Under the provisions of the above Act, 140 visits were made and in only seven cases was it necessary for notices to be served. Of these, six concerned the installation or alteration of W.C.s and one the improvement of ventilation. No applications for Certificates of Exemption in regard to the provision of sanitary convenience accommodation were received. Drainage and Sewerage.—Fifty-six plans of drainage and other sanitary works relating to existing and new buildings were examined and approved. A few complaints were received in this department regarding emanation from the sewers and these were referred to the Borough Engineer for necessary action. As a matter of interest, the Borough Engineer informs me that there are now only four cesspools in use in the Borough. 35 Pharmacy and Poisons Act, 1933.—This Act came into force on 1st May, 1936, and has for its object closer control of the sale of poisons and poisonous substances. Under it the Medical Officer of Health and the Sanitary Inspectors are appointed to carry out the provisions referred to in Part II of the Poisons List. These chiefly relate to the Sale of Poisons used for domestic, horticultural and sanitary purposes. During the year 9 applications to sell poisons under Part II were received and granted and 61 applied for retention in the Council's list. Water Supply.—The whole of the Borough is supplied with water by the Metropolitan Water Board which is a Statutory undertaking, and the responsibility for its purity rests with that Authority. There are 20,794 dwellings with direct connection to the Board's mains. No complaints were received during the year as to taste or possible contamination caused by insects or silt. During the year 1,009 water supply certificates were granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended in 228 cases, and extra water supply to tenement houses in 19 cases. Underground Water Supplies (Wells).—In the year 1947 the Ministry of Health requested a survey of underground water supplies in the Borough, and, in my report for that year, I appended a table giving particulars of all wells known and a map showing the positions of the borings. Of the 40 wells listed, only 2 are used for the supply of drinking water, and these are properly supervised, regular testing being carried on throughout the year. No deterioration has been detected in either of these wells for many years. Of the remainder, 13 are used for commercial purposes and 25 are disused. Rodent Control.—During the year the Rodent Scheme, as approved by the Ministry of Agriculture, lias been strictly adhered to. In all, 2,142 investigations were made and infestation found to exist in 676 dwelling houses, 32 shops, 33 factories or warehouses, and 6 bombed sites. Three infestations were of a major character, two being brown rat and one ship or black rat. The monthly average of complaints received was 62, as compared with 65 last year. It is evident that the members of the public are still 'rat conscious' as a result of the publicity given to the scheme and a knowledge of the efficiency of the service provided. 36 Allotments, bombed sites and dumps providing suitable harbourage have all been test-baited, and where found necessary, treatments have been given. The bombed sites continue to be troublesome sources of infestation, and in one particular case the house drains in a block of demolished properties were found to be open to the sewer. Arising out of the investigations 68 drainage defects were discovered. Many of these entailed much excavation and hard, laborious work, and a great deal of patience in tracing the rat runs to the ultimate drain openings. The two major infestations by brown rat were systematically dealt with and in both cases excellent results were obtained by the usual methods of treatment. (1) Badcock's Wharf, Banning Street.—A considerable amount of difficult work was encountered owing to the continuous movement of stores ; it was also suspected that rats were coming from a defective drain which, after persistent effort, was discovered and repaired. (2) Woodland Walk.—A" complaint of rat infestation in this area followed the demolition of a block of houses. Rats were coming up from the open drains buried beneath the brick rubble. With the assistance of the Borough Engineer's Department the drain connections were sealed off at the sewer. Rats which remained in the rubble were finally cleared by a system of baiting and poisoning, and the area is now clear. (3) Of three infestations, where the black or ship rat had been seen, only one proved to be of a major type ; this occurred at Messrs. Hugh Baird's, and the assistance of the Ministry of Agriculture was sought. Three treatments were given, using sausage rusk and 2½% zinc phosphide, soaked wheat and 10% arsenious oxide, and bread mash and 2½°/0 zinc phosphide. The general behaviour of the rats throughout the treatments was that typical of the ship rat. A few points remained unvisited during pre-baiting, but rats fed from them during poisoning. At other points the reverse behaviour was shown. The feeding pattern was erratic, except at a few favourite points which were regularly visited throughout the three treatments. 1st treatment 2nd treatment 3rd treatment No. of pre-baits 273 102 88 No. of poison baits 271 101 88 No. of poison baits takes 93 32 30 No. of poison baits complete takes 1 0 0 No. of post-baits 262 101 — No. of post-baits takes 18 25 — 37 (4) Unit Construction Company.—This company is engaged in the erection of a large housing estate in the Kidbrooke area for the London County Council, and have erected hutments for use as store-rooms and mess-rooms for the workmen. Rat infestation occurred at each of these sites and regular treatments were given. The infestation was fairly extensive and was caused by field rats. The housing scheme is nearing completion and arrangements have been made with the management for a month's notice to be given to this department before the hutments are demolished so that final treatment can be effectively carried out and thus prevent serious infestation in the area. An infestation at the Delta Metal Works was of a minor character and was dealt with successfully. Baiting of Sewers.—The Borough Engineer has kindly supplied me with the undermentioned information of the treatments carried out in the Council's sewers in connection with the scheme:— Details Date of Treatment 2nd to 16th Dec., 1948 31st May to 12th June, 1948 1. No. of Manholes in foul and connected systems 1,157 1,157 2. Bait base and poison used Sausage rusk and zinc phosphide 3. No. of Manholes baited 877 936 4. No. of Manholes showing prebait takes 463 540 5. No. of Manholes showing complete prebait take (on one or both days) 332 312 6. Schemes of baiting used (e.g.; consecutive days of 1st, 3rd and 5th days) Consecutive days Consecutive days 7. No. of Manholes test-baited in conjunction with this treatment and not included in No. 3 above 24 — Remarks: Prior to the above treatment, four sections (totalling 198 manholes) were test-baited. Two sections showed "no takes". Two sections (106 manholes) showed 'takes' and were included in the December treatment. It may be mentioned that the neighbouring Boroughs of Woolwich and Lewisham took action at the same time as Greenwich. 38 Public Baths and Washhouses.—The Public Baths and Washhouses situated in Trafalgar Road, Greenwich, contain three large swimming pools (one is out of order owing to enemy action), 74 ladies' and gents' slipper baths, vapour and medicated baths, and Public Laundry. The second class swimming bath is open to bathers all the year round, the first class swimming bath is floored over during the winter months (October to April) and the hall used for social functions of all kinds. The water in the swimming baths is continuously filtered, aerated and chlorinated, the whole of the bath water being passed through the pressure filters once every three and a quarter hours. Chemical tests are taken twice daily, and bacteriological tests taken periodically. I am indebted to Mr. K. L. Embley, Superintendent Engineer, for the following statistics:— Attendances.—For year ended 31st December, 1948 :— Slipper baths 97,139 Swimming baths (a) 120,907 Vapour and Medicated Baths 7,952 Public Laundry 11,511 Total 237,509 (a) includes 28,705 School-children Public Sanitary Conveniences, etc.—The Public Sanitary Conveniences of the Borough, eight in number, are situated in the main arteries of traffic. The Convenience at Charlton House, which was closed in January 1945 owing to extensive damage by enemy action, was put under repair towards the end of the year and is expected to re-open early in 1949. Negotiations have been completed for the purchase of a site for a convenience in the Woolwich Road near Anchor & Hope Lane. This will ensure full provision in the future for that important industrial area and also for the large numbers of visitors to the adjacent sports grounds. Appended is a table showing particulars of the Public Conveniences provided by the Council:— 39 Particulars of Public Sanitary Conveniences in the Borough, Convenience MEN WOMEN W.C.'s Lavatory basins Urinal stalls Hours W.C.'s Lavatory basins Hours Batley Park (Blackheath) 6 2 12 7a.m. to 11 p.m. 4 2 7a.m. to 11p.m. Blackheath Hill (foot of) 3 — 10 4 — Blackwall Lane 5 2 16 4 2 (East Greenwich) Blackwall Tunnel 3 — 6 5 — Creek Road (St. Nicholas, Deptford) 4 2 10 4 2 Greenwich South Street (near Town Hall) 4 1 10 4 2 King William Walk (near Greenwich Park) 4 2 9 7 2 Shooters Hill Road (june. Well Hall Rd.) 3 1 6 3 1 Totals 32 10 79 35 11 NOTE:—Women's Conveniences are without an Attendant between 7 a.m. and 9 a.m. On Sundays, Conveniences open at 10.30 a.m. (with the exception of Batley Park (Men) which opens at 9 a.m.), and close at 10.30 p.m. The following are the Drinking Fountains and Horse Troughs in the Borough which are cleansed daily by the attendants attached to the Department:— Drinking Fountains Armada Street, Deptford. Blackheath (Andrew Gibb Memorial) (Damaged by enemy action) Blackheath (Greenwich Park). Blackheath Hill, West Greenwich. Blackwall Lane, East Greenwich. (Damaged by enemy action) Charlton Church Lane. Westcombe Hill, Blackheath. 40 Horse Troughs Charlton Church Lane. Creek Road, Deptford. Invicta Road, Blackheath. Tunnel Avenue, East Greenwich. In addition to the above, one Council urinal and four others attached to Public Houses are cleansed daily by the attendants, responsibility for the repairs of the latter remaining with the Brewers concerned. Exhumations.—Notice was received from the Home Office of three exhumations at the Council's Cemeteries. In each case the Sanitary Inspector for the District was present to see that the usual precautions were observed. Aged, Infirm and Physically Incapacitated Persons.— Cases of infirm persons who are unable to maintain a reasonable standard of cleanliness owing to senility or ill-health are usually brought to the notice of the Department either through complaints by neighbours or through the secretaries of old people's associations and other organisations. Other cases are brought to light in the course of the Woman Sanitary Inspector's visits to almshouses, etc. During the year 201 cases were visited on 512 occasions by the Woman Sanitary Inspector. Experience has shown that these visits serve a very useful purpose, especially in the case of those individuals who for various reasons have ceased to take an interest in their own welfare. In this connection the Home Helps Scheme has been of very great assistance, and by July 5th, 1948, when this service was transferred to the London County Council, expansion was taking place to meet the growing demand. Since the transfer of functions the close liaison between the officers concerned in its administration ensures that the advantages of the scheme are available to the old and infirm in the Borough. It was not necessary for your Medical Officer to take action under section 224 of the Public Health (London) Act, 1936, during the year. 41 Summary of Work Performed by the Sanitary Inspectors during the Year 1948 Inspections— Houses inspected (House-to-House) 99 „ „ (Complaints, nuisances) 2,784 „ „ (Infectious Disease) 147 „ „ . (Overcrowding) 553 Re-inspections, calls made, etc. 14,618 Inspections of Factories 418 „ „ Shops 124 „ „ Stables and yards 62 „ „ Urinals 101 „ „ Miscellaneous 560 ,, „ Houses let in Lodgings 36 „ „ Outworkers premises 119 Inspection of Premises (Pharmacy and Poisons Act, 1933) 15 Investigations (Rats and Mice) 705 On notice from Builder 814 21,155 Drains— Drains tested—by smoke 362 „ „ —by water 290 Opened, cleansed and repaired 443 Reconstructions and additions 209 Inspection chambers constructed 146 Now covers to manholes 156 Soil and vent shafts repaired or renewed 140 Traps (gully) 255 Drains sealed off, etc. 97 Yards and forecourts drained 108 Waterclosets and Urinals— Closets erected 81 W.C.s repaired 361 Sanitary conveniences or improvements effected to Factories, Workshops and Workplaces 37 Pans or traps furnished 407 Urinals cleansed or repaired 16 Dustbins— Provided 243 Pavings— Yards and Forecourts 171 General Water Supply— Water Fittings amended 228 Extra water supply to tenement houses 19 Water supply certificates granted (Sect. 95) 1,009 42 Other Improvements— Houses generally repaired 162 Rooms cleansed and repaired 2,841 Rooms and staircases lighted and ventilated 12 Verminous rooms cleansed 151 Roofs, gutters and rainwater pipes repaired 958 Dampness abated 782 Sinks, baths and lavatory basins 216 Sink, lavatory and bath waste pipes trapped or amended 189 Stoves and fireplaces 269 Washing coppers repaired or provided 44 Floors repaired 384 Provision for storage of food 12 Miscellaneous repairs 868 Other Nuisances Abated— Illegal use of Underground rooms discontinued 2 Overcrowding abated 394 Animals kept in unfit places discontinued or removed 9 Dung receptacles provided — Accumulation of manure and other obnoxious matter removed 34 Rat infestation abated 195 Smoke Nuisances— Observations 128 Statutory Notices served (Sects. 147 and 148) — Notices, &c.— Intimations served under Public Health (London) Act, 1936 2,029 Statutory Notices served 450 Houses rendered fit by informal action 122 Legal Proceedings Premises Offence Result of Proceedings 34, Wellington Gardens, S.E.7 Non-Compliance with Statutory Notice Order made for compliance within 6 weeks. 77, Charlton Road, S.E.3 Do. Order made for compliance within 28 days. 121, Vanbrugh Hill, S.E.10 Do. Order made for compiance within 2 months. 56, Gurdon Road, S.E.7 Do. Fine of 20/- imposed with 3 guineas costs. 406, Woolwich Road, S.E.7 Do. Order made for compliance within 35 days (with costs). 43 SECTION D Housing. Repair of War Damaged Dwellings.—Reinstatement on behalf of owners continued until July when the Council were directed to end this method. At that time there were no War Damaged dwellings remaining below 'Serial 25 Standard'. Council Housing Estates.—In the development of the Cherry Orchard Estate, a further 28 houses of traditional type in Marlborough Lane were completed and occupied at the end of June whilst four blocks of flats comprising 64 dwellings in Shirley House Drive were ready for occupation in October. The 24 flats at East Mascalls, specially built for aged persons, were completed and allocated during August. In addition, the Council pressed ahead with the rebuilding of its war damaged property and by the end of the year 43 houses had been re-built on its various estates. Work on 74 flats in Victoria Way was commenced towards the end of the year and it is hoped that these may be occupied before the end of 1949. Approximately 272 flats are still to be erected on the Cherry Orchard Estate and work on these is in progress. A further 5 blocks of flats comprising 72 dwellings at Victoria Way (North) are contemplated. With regard to future housing development, the sites at Tuskar Street, Coldbath Street and Springfields have been under consideration by the Council and it is hoped that one or more of these areas will be in hand by the end of 1949. New Housing Accommodation.—The undermentioned dwellings were occupied during the year:— L.C.C. Estates (Permanent Houses) 588 „ „ („ „ rebuilt) 18 „ „ („ Flats) 88 „ „ („ „ rebuilt) 46 Borough Council (Permanent Houses) 28 „ „ („ „ rebuilt) 43 „ „ („ „ Flats) 88 Private Enterprise (Permanent Houses) 15 „ „ („ „ rebuilt) 95 1,009 44 Excluding the families accommodated in requisitioned dwellings, the total number of dwellings provided since the termination of the war is now 2,061. Council Re-Housing.—At the end of the year a total of 2,038 units of accommodation (houses and parts of houses) were requisitioned by the Council in order to provide for persons rendered homeless as a result of enemy action or who were otherwise inadequately housed. The number of housing applicants accommodated during the year in new properties was 116 and in requisitioned and pre-war Council properties 278, giving a total of 394 re-housings. New 'Points' Scheme.—The work of revising all housing applications and of applying the provisions of the new 'Points' Scheme was completed at the end of the year. Through the courtesy of the Housing Manager, Mr. Dore, the following report is quoted. "Position before Revision. When the Housing Department was set up on the 1st April, 1948, two waiting lists were in operation; one for permanent accommodation controlled by the Town Clerk's Department, and one for requisitioned premises operating through the old 'Homeless' Sub-Department. These two sections employed different methods of filing, and although the same "Points" Scheme was in use by both, it would appear there was no common basis of interpretation. Consequently, it will be appreciated the resultant position in the Lettings Section of the new Department was very far from •satisfactory. Duplications were often found on the two lists and comparison between cases appearing on these separate lists was somewhat of a problem. It was immediately obvious the old systems required complete re-organisation and therefore, when the Council approved the new "Points" Scheme, the register and filing system had to be drastically revised and brought up-to-date. Work of Revision. By the authority of the Committee, temporary clerks were employed and the first task was to weed out from 5,800 applications contained in the two old waiting lists, cases which were, really applications for transfer from existing tenants or licensees. At the same time a number of cases were found which had in fact already been rehoused by the Council, and altogether about 1,000 applications were withdrawn from the old register as a result of this preliminary survey. Circulars were then despatched to the remaining 4,800 with the request to complete and return the revised form of application 45 within fifteen days. On receipt of these new forms they were checked, indexed, "basic" points assessed, and each applicant issued with an acknowledgement card giving particulars of the registration number and the provisional "basic" points allocation. Several hundred cases had to be referred to the Medical Officer of Health before "basic" points could be awarded, since medical certificates were submitted in support of such applications, necessitating consideration for additional "basic" points being awarded to appropriate cases in accordance with the Health Clause (paragraph 21) of the new scheme. In connection with this part of the work, I should like to take this opportunity of expressing my appreciation of the valuable co-operation renderd to the Department by the Medical Officer of Health. Present Position. A large proportion of the original applicants (approximately 1,800) circularised did not reply and the position on Saturday, the 15th January, was that 3,177 applications stood on the "live" register. Of these, 1,304 stated that they were sharing accommodation with friends or relatives, and 1,873 stated that they were occupying accommodation as separate lettings. 840 applicants indicated they were registered with other local authorities, but this figure has already shown to be rather unreliable as it has been proved that a number of applicants have failed to disclose the fact that they were registered with other authorities. This is possibly due to an erroneous assumption of their part that registration with another authority would prejudice their claim with this Council. It is important to note that the initial award of points is based upon the information supplied by the applicant, and this information is, of course, subject to a careful verification later by a personal visit to the applicant's home. As indicated in Table 'B' the highest "basic" points in re.spect of families requiring one bedroomed, two bedroomed and three bedroomed accommodation are between 30 and 40, and the new scheme has the effect of spreading these applications out quite well until one gets down to 20 basic points. Referring to the lower half of this Table, it will be observed the number in each "basic" points group increases, although of course, the application of "balancing" points helps to sort out cases in each points group. The highest number of cases in any one points group is 129 having 6 "basic" points amongst those families requiring two bedroomed accommodation. Altogether, there are four "basic" points groups in which there are more than 100 applicants, and all these relate to families requiring two bedroomed accommodation. 46 The revision of the register has proved what was already known, namely that the greatest demand is for accommodation consisting of a minimum of two bedrooms and set out below are the details and percentages of the demand under the headings of the types of accommodation required and against it are set corresponding percentages of those types of existing accommodation on the Council's Estates:— TABLE "A" Accommodation Demand Accommodation on the Council's Estates Elderly Persons A.0. 77 2.4% 1.6% Elderly Persons A.l. 57 1.8% 1.3% A.0. (not E.P.) 32 1.0% Nil A.l. 693 22.0% 0.2% A.2. 1,670 53.0% 23.0% A.3. 521 16.5% 47.1 % B.3. 83 2.6% 25.8% B.4. 21 0.7% 1.0% Add "query" cases not yet pointed 3,154 100.0% 100.0% 23 These figures relate to permanent properties and E.F.M. Bungalows, but not to requisitioned properties and hutments. 3,177 It will be noted from Table "A" that, whereas 75% of the applicants are suitable for A.l. or A.2. type accommodation, i.e. they comprise either childless married couples or couples with one or two children, only 23.2% of the accommodation on the Council's permanent estates is of the one or two bedroom type, whilst 72.9% of the accommodation on the Council's estates is of the A.3. or B.3. type, and only 19.1 % of the applicants require such accommodation. The same preponderance of three bedroom accommodation is apparent in the schemes for future accommodation which have been approved. Reference to Table "B" will show that 35 families of the A.l. type, and 165 families of the A.2. type have more than 20 47 points, whilst only 39 families of the A.3. type, and 6 families of the B.3. type, fall within the same points range. This indicates that not only are the greatest number of families of the A.2. type, but also that in this particular group there is also the greatest need. In the past, the Committee has followed the general policy of endeavouring to ensure that all accommodation allocated to applicants is fully occupied, and if this policy is continued, it is clear that the types of family most needing accommodation will, in fact, receive very little attention. It is therefore urged upon the Committee that they should give very serious consideration to a change of policy, and that they should consider permitting families with one or two young children to occupy A.3. type accommodation, and for families with four children, who would hitherto have been allocated A.3. type accommodation, to be given B.3. type. Publicity. Early experience with the Committee's new policy giving maximum publicity to the operation of the points scheme, has proved very encouraging. There has, of course, been a considerable volume of correspondence resulting from this, but it is anticipated that this will gradually diminish as the initial queries are dealt with. In any case, queries which are now raised by applicants, either by correspondence or by calls at the office, can be much more satisfactorily dealt with, since there is an agreed basis for discussion. It is interesting to note that the vast majority of callers and correspondents appear to appreciate the fairness of the scheme. TABLE "B" This indicated the number of cases within various "points" ranges under the headings of minimum accommodation requirements. Basic Points EP/A0 EP/A1 A0 A1 A2 A3 B3 B4 Total 40½-45 — — — — 1 — — — 1 35½—40 — — — — — — 1 — 1 30½-35 — — — 1 7 3 — 1 12 25½-30 — — — 4 33 6 2 1 46 20½-25 2 1 — 30 124 30 3 2 192 15½-20 8 1 2 109 299 62 10 1 492 10½-15 18 19 7 218 429 122 27 4 844 5½-10 29 28 7 164 443 133 16 6 826 5 and under 17 8 16 153 290 103 18 5 610 Total 74 57 32 679 1,626 459 77l 20 3,024 The balance of cases not shown on this Table represents either Category 1 or 2A cases, or cases already approved for offer under the old Scheme. 48 Conclusion. As soon as the work in connection with the waiting list, which is at present in hand on behalf of the Ministry of Health, has been completed, a start will be made on the survey of the occupation of properties under the Council's control, in order to ascertain the degree of overcrowding and under-occupation in these dwellings. An examination of the results of this survey, in conjunction with the "live" waiting list, will enable the Committee to assess much more accurately than hitherto the realistic housing needs of the Borough on a long term basis." Overcrowding.—The number of complaints received during the year was 498. These were investigated by the Sanitary Inspectors and 162 were found to be overcrowded according to standards laid down by the Housing Act, 1936. One hundred and two of these cases were given accommodation on the L.C.C. Housing Estates. Housing Act, 1936.—Action taken during 1948 with regard to individual houses (Closing Orders made):— Section 11 1 Kendall Terrace, Weetman Street, S.E.10 3 Sigismund Street, S.E.10 21 Sigismund Street, S.E.10 23 Sigismund Street, S.E.10 21 Landsowne Lane, S.E.7 23 Lansdowne Lane, S.E.7 Marie Cottage, Floyd Road, S.E.7 118 Creek Road, S.E.8 Section 12 2 Furzefield Road, S.E.3 111 Old Dover Road, S.E.3 113 Old Dover Road, S.E.3 123 Old Dover Road, S.E.3 35a Shooter's Hill Road, S.E.3 29 Brand Street, S.E.10 70 Lassell Street, S.E.10 49 SECTION E Inspection of Food and Supervision of Food Premises. Food Inspection.—The systematic inspection of food and premises where food is handled has been continued. Relaxation of controls on building materials and equipment has facilitated an improvement in the standard of hygiene which suffered considerable deterioration during the war years. In keeping with the national effort to better the less desirable aspects of some of our canteens and restaurants special attention has been given to catering establishments generally. Imported food has called for continuous vigilance at the wharves where the Food Inspectors deal with a wide variety of meats and other vital foods. The establishment of a whale-meat packing factory has added yet another phase to the food industries of Greenwich. Here large consignments of frozen whale-meat are held in cold storage awaiting the process of cutting and packing in cartons in readiness for retail sale. The utmost cleanliness is observed in this factory where white overall-clad workers handle the meat. Facilities for frequent hand-washing are provided, and it was noted that when common washing soap failed to cleanse the hands of residual whale oil, liquid soap and hot water proved quite efficient. Ice cream has been the subject of much field work in the task of educating both manufacturers and retailers to think bacteriologically and to realise the potential dangers of careless handling. Evidence of solid progress was seen toward the latter end of the year. Milk Supply.—This is under direction of the Milk Marketing Board. The main sources of supply for this Borough are the Home Counties, with the addition of a small percentage of highly-fatted Devon and Channel Islands milk. Much of our milk is bottled at the points of production or pasteurisation, and heat treatment is general. Raw milk, when available, is from tuberculin-tested herds. Milk and Dairies (Amendment) Act, 1922.—Milk and Dairies Regulations 1926-1943.—At the commencement of the yoar there were 71 purveyors of milk on the Register of Dairies and Milkshops; no new applications have been received during the year. 50 The Food Inspectors made 115 visits of inspection, as a result of which the following defects, etc., were noted and remedied:— Action taken re dairy premises:— Roof renewed 1 Windows fitted 2 New floors laid 2 Washing facilities provided 1 Dairies cleansed and lime-washed 1 Yards repaved 1 Milk (Special Designations) Regulations, 1936-1946.—These regulations concern the issue of Licences for the sale of Milks known as Tuberculin Tested, Accredited and Pasteurised. During the year the following Licences were granted:— Principal Licences Distribution of Tuberculin Tested Milk 13 „ „ Pasteurised Milk 23 Supplementary Licences Distribution of Tuberculin Tested Milk 10 „ „ Pasteurised Milk 10 Supplementary Licences are granted in cases where licensed premises are situated outside the District and the Vendor desires to sell within the Borough. Heat Treated Milk (Prescribed Tests) Order, 1944.— The above Order prescribes the technique to be adopted in applying the Methylene Blue Test and the Phosphatase Test to milk treated by heat. Briefly the Methylene Blue Test was instituted to estimate the souring properties of milk after treatment, and the Phosphatase Test is the method of ascertaining whether the milk has been correctly pasteurised. During the year 53 samples were taken under this Order, and of these 4 failed the Methylene Blue Test and 2 the Phosphatase Test. Particulars of the unsatisfactory samples were forwarded to the Area Milk Officer of the Ministry of Food. Bacteriological Examination of Milk.—The arrangements were continued during the year whereby results of samples taken at the London County Council Schools, Hospitals, and 51 Nursery are furnished quarterly to that authority. In all cases of unsatisfactory samples reports are sent immediately both to the London County Council and the Area Milk Officer of the Ministry of Food. Analytical Examinations of Milk.—Fifty-three samples of milk were examined by the Public Analyst. Three were found to be adulterated or otherwise below the standard fixed by the Ministry of Agriculture and Fisheries. In one instance, although the sample was slightly deficient in milk-solids the addition of water was not confirmed by other tests, and further samples proved genuine. In the two unsatisfactory samples remaining, legal proceedings could not be instituted owing to lack of evidence in respect of one and in the other instance, an explanation from the vendor of the slight deficiency in milk-solids was considered adequate. Preserved Food Premises.—In accordance with the provisions of the Public Health (London) Act, 1936, Section 14, all premises with the exception of clubs, hotels or restaurants used:— (а) for the sale or manufacture for the purpose of sale of ice-cream or other similar commodity, or the storage of ice-cream or other similar commodity intended for sale; or (b) for the preparation or manufacture of sausages or potted, pressed, pickled, or preserved meat, fish, or other food intended for sale; are required to be registered by the owner or occupier with the sanitary authority. Preserved Meat, etc. Premises.—At the end of the year 111 premises were on the register and were visited on 61 occasions. Insanitary conditions were detected and remedied in 11 cases, improvements being effected on verbal instructions. Ice Cream Premises.—There were 133 premises duly registered at the end of the year and 494 visits to these premises resulted in improvements being effected and sanitary defects remedied in 6 instances. Manufacture and Sale of Ice Cream.—The Ice Cream (Heat Treatment Etc.,) Regulations 1947 and The Amendment Regulations 1948.—These regulations were introduced as a timely measure to secure a very necessary standard of hygiene in a food product that, largely by reason of sweet rationing, had gained a popularity hitherto unknown. Old and young alike developed an abiding taste for this refreshing confection. 52 As in the case of milk, heat was introduced as the agent to eliminate pathogenic organisms. The regulations further stipulated that rapid cooling must follow heat-treatment of the mixture, and that instruments be fitted to the manufacturers' plant to indicate and record the temperature to which the product had been submitted. Most important, ice cream is to be kept clean at all times. Inspectors have taken advantage of powers conferred and enforced complete reconstruction where certain factories could not be rendered adequate by less drastic means. Ice cream shops, stalls and vehicles have been constantly inspected, and means for cleansing hands and utensils introduced. Unhygienic wafer-servers have been banned and the germ-laden wooden spatula proscribed. Sites where dust and other contamination has been evident have been used for the sale of wrapped ice cream only. In the near future it may well be that a minimum nutritional standard may be set up, so that not only will our ice cream be safe, but for the first time combine a known dietetic value with palatability. Ice Cream Sampling.—With regard to ice cream, any sample containing more than 100,000 organisms per c.c. or having B.Coli present in less than 1 c.c. is considered as unsatisfactory. The virility of the organisms present is assessed by the application of the Methylene Blue Reductase Test. During 1948 one hundred and twenty-three samples of icecream were taken, thirty-seven of which were regarded as unsatisfactory or sub-standard by reason of the presence of bacillus coli in less than 1 c.c. or in that they showed a high bacterial plate count. Twenty-four of these unsatisfactory samples were manufactured outside this Borough under conditions over which we have no control and in these instances the particulars were forwarded to the Areas concerned. Food Rejected.—The amount of food rejected is shown in the following summary:— Shops, Stalls, etc. Meat— Beef 496¼ lbs. Beef trimmings 460¾ „ Meat (canned) 505¼ „ Offal 202 „ Cooked Meats 17 „ 1,681½ lbs. 53 Other Foods— Fish 2,611¾ lbs. Provisions, various 255¼ „ „ „ (canned) 1.231¾ „ Flour 375 „ „ (as dough) 14,700 „ Bread 105 „ Potatoes 448 „ Cakes 150 „ Dried Milk 112 „ Dried Fruit 94 „ Rolled Oats 68 „ Barley Flakes 27 „ Butter 39 „ Fat 26 „ 20,242¾ lbs. Slaughterhouses.—Owing to the enforcement of the Livestock (Restriction and Slaughtering) Order, 1940, the two existing slaughterhouses have not been used during the year. Public Health (Meat) Regulations, 1924-1933.—These regulations provide for the supervision of slaughterhouses, butchers' shops, stalls, and the protection of meat against contamination by dirt and flies, etc., in transport and handling. Butchers' shops and stalls are under the constant supervision of the Inspectors and proceedings are only instituted after disregard of the Officer's warning. In no case was it found necessary to caution Vendors during the year. Structural and hygienic defects were remedied in 18 instances mainly as a result of informal action. Public Health (Imported Food) Regulations.—The Metropolitan Borough of Greenwich with a river frontage of five miles, with more than 30 wharves and two of London's largest and most modern cold stores receives a considerable percentage of London's imported meat stored on behalf of the Ministry of Food. In addition, considerable quantities of fresh fruit, tinned foods and miscellaneous provisions are dealt with. Visits to wharves and cold stores are made by the Food Inspectors and imported food generally is carefully supervised. Imported Food Rejected.—The following unsound or diseased imported foods were surrendered, the meat being passed for non-edible and refining purposes, and other unsound food, with the exception of fruit pulp and juice, being processed for stock feeding. 54 The following foods were rejected at Wharves:— Meat— Lamb and Mutton Carcases 337 lbs. Mutton trimmings 23 „ Meat (canned) 248} „ Boneless Beef 48 „ 656} lbs. Other Foods— Evaporated Milk 26,955 lbs. Condensed Milk 7,292 „ Fruit Pulp 41,233} „ „ Juice 240 „ Sweetened Baking Fat 10 „ 75,730} lbs. Caseous Lymphadenitis.—During the year, the sum total of all carcases examined for this condition and the results of such examinations are given in the following table:— Mutton Carcases Landed Examined Rejected Weight 154,539 81,022 18 carcases 5,8271 lbs 323 joints 8 pieces trimmings Bags of Boneless M utton 2,416 104 — — Note: Figures given above include those in respect of the special examination of Argentine mutton and lamb. Special Examination of Argentine Mutton and Lamb.—In the early part of this year certain large consignments of frozen Argentine mutton and lamb carcases infected with Caseous Lymphadenitis entered the Port of London. In due course much of this meat found its way to the large refrigerated stores located on the wharves in the Riparian Boroughs. One such store is owned by Messrs. Palmer's Cold Air Stores (Deptford) Ltd., and here a large quantity of this meat was detained pending expert decision as to its disposal. Under the provisions of the Public Health (Imported Food) Regulations rejection of this food would have been justified if only for the reasons of inefficient pre-export examination and the absence of the customary certificates of fitness. While it is true that Caseous Lymphadenitis-infected mutton and lamb are ordinarily consumed in South America, Argentine and Australia, and there is no evidence of its causing disease in the consumer, the high standard of our food inspection has hitherto prevented such meat reaching the home market. Caseous Lymphadenitis-infected meat, while in itself innocuous, presents 55 such a repulsive picture at the seat of the lesion that a most unpleasant psychological reaction would result from a dinner-table encounter. Nevertheless, in view of the world meat shortage, and the meagreness of our own supplies, the Ministry of Food, in co-operation with the Councils concerned, resolved to permit the consumption of this meat provided that a 100% examination and the necessary condemnations could be assured. To this end a large examination shed was fitted out and your Food Inspectors trained some twenty meat trade employees to incise the carcases and detect the caseous lesions characteristic of this disease. An additional temporary inspector was also provided by the Ministry. All infected carcases, and indeed those presenting any abnormality, were set aside for expert examination by your inspectors. The lesions and a wide area of surrounding tissue were cut away i n accordance with an agreed method of inspection, based upon approved criteria. As indicated in the following table, a work of considerable national value was accomplished and a useful contribution was made to the country's meat supplies:— Examined 72,244 carcases mutton and lamb Trimmed 3,937 „ ,, „ „ Rejected 3 whole carcases Per cent, affected 5.454% Weight of meat rejected 2,929 lbs. Passed as fit for food 72,241 carcases (including those trimmed) Merchandise Marks Act, 1926.—Under the powers conferred by this Act, Orders in Council have been made prohibiting the sale or exposure for sale, of imported food stuffs unless such bear an indication of the country of origin. To secure compliance with the various Orders, 85 inspections were made but on no occasion was it found necessary to take action against vendors. Blackheath Fair.—As usual, thousands of people took the opportunity of visiting Blackheath Fair on the various Bank Holidays during the year and constant supervision of food stalls was necessary in order to ensure that a safe standard of cleanliness was maintained among the numerous vendors of light refreshments, including shellfish, stewed eels, ice cream, minerals, etc. To this end a Food Inspector was always in attendance. (A clean water supply and adequate sanitary accommodation was provided by the London County Council Parks Department). 56 Street Traders.—There were 82 Street Traders who were engaged in selling articles of food and who were licensed in accordance with the provisions of the London County Council (General Powers) Act, 1947. The premises where such articles of food were stored, were kept under regular supervision by the Food Inspectors. Supervision of Premises Including Factories Where Food is Prepared.—Included among the premises where food is prepared are flour-millers, brewers, mineral waters, pharmaceutical sundries, fruit canning and whale meat packing factories; 4,605 inspections were made of these premises and a satisfactory state of hygiene was maintained. It was found necessary to serve notices, to cleanse and lime-wash or otherwise improve premises, on 61 occasions—improvements being effected mainly on verbal instructions. Food Premises No of Visits No. of Improvements effected. Knacker's Yard 5 — Caterers' and Restaurants 984 54 Butchers' Shops 372 18 Dairies and Milkshops 115 10 Wharves and Factories 269 3 Bakehouses 201 20 Ice Cream Shops etc. 494 17 Fried Fish Shops 172 8 Other Fish Shops 123 1 Cooked Meats & Preserved Foods 61 11 Brewery 3 1 Fairs 26 — Miscellaneous Visits & Interviews 356 24 Re Rat Infestation 32 — Sampling Visits 538 — Visits Re Food & Drugs Act 155 — Re Merchandise Marks Act 85 — Re Shops Act 16 — Other Visits 463 — Food Poisoning Investigations 22 — Complaints Investigated 113 — Totals 4,605 167 Catering Establishments.—Second only to the actual provision of food are the conditions under which it is produced and 57 consumed, and for many years civic authorities, fully alive to this, have sought to remove the evils associated with the less reputable places of refreshment. With the development of communal catering the number of hotels, canteens and restaurants has risen sharply to meet the pressing public demand, and the task of supervision has, of necessity, grown proportionately. Here there had been a sense of satisfaction in the knowledge that a relatively high standard of cleanliness prevailed in the local catering establishments, and even where these lacked decorative perfection a basic degree of hygiene was maintained. Damage due to enemy action, however, and the entry into the trade of people unfamiliar with good catering practice, have brought a serious decline in the cleanly conduct of this vital business. Nevertheless, since the end of hostilities and the gradual return to normality, the need for improvement both in premises and practice was abundantly evident, and much has been done to raise standards in the food trades. Since 1947, when the National Conference on Food Infections was held in London, a campaign to awaken the public conscience to the need for cleaner food handling has been conducted on a nation-wide scale. It is unfortunate that shortages of labour and material have slowed down the tempo of reconstruction, but in spite of this local authorities have achieved a solid measure of progress towards cleaner catering. As a result of research it was clear that many deaths and much ill-health might be prevented by the adoption of a simple code of practice adaptable to the needs of every food kitchen. In Greenwich hygiene lectures have been given to all foodhandlers willing to attend, and specially prepared instructional pamphlets have been circulated to each caterer. Some of the immediate objects of the scheme have been the universal installation of permanent supplies of hot and cold water in food kitchens; the fixing of at least two sinks and the use of detergents in dishwashing. The need for clean clothing and the cultivation of clean personal habits have also been stressed. The work of educating the food-handler has been one of personal contact rather than mass exhortation. A useful part in local operations has been played by the Council's rodent operatives and fly squads, whose activities have done much to reduce the causes of rat and fly-borne infection. With their co-operation, danger from these disease-carriers can be kept at a minimum. Caterers have responded well to our endeavours toward a more hygienic meal service, and although there is much yet to be done it is felt that a future decline in food infections will justify our efforts in this direction. 58 The following table indicates the type of improvements secured in local catering establishments. Type of Improvement Effected Total No. Cleansed and painted 35 Roofa repaired 4 Ceilings repaired 6 Floors „ 2 W.C.'s „ or provided 3 Ventilation improved 2 Natural Lighting improved 3 New Sinks fitted 6 Hot and Cold water installed 3 Dustbins and Swill Bins provided 6 Food Stores provided 2 Clothes Lockers provided 2 Refrigerators installed 2 Waste Pipes fitted or amended 5 Accumulations of refuse removed 4 Miscellaneous improvements 18 Total 103 Food and Drugs Act, 1938..—Altogether 422 samples were taken and submitted to the Public Analyst for analysis under the provisions of the above Act and of these 68 were formal, 353 informal and 1 private. Twenty-three of these samples (7 formal, 16 informal) were reported as being non-genuine, the adulteration thus being equivalent to 5.4% of the total samples examined. Again Milk was the chief article sampled and out of a total of 52 samples three were found to be adulterated or below the standard fixed by the Ministry of Agriculture and Fisheries. No proceedings were instituted in respect of any of the adulterated samples although two cases were referred to the Ministry of Food for necessary action. In addition to the samples analysed for the purposes of enforcement of the Food and Drugs Act, a number of ex-naval stores, not on sale to the public, were examined to ascertain their fitness for human consumption. Public Health (Dried Milk) Regulations, 1923 and 1927.— There were no samples taken under the above regulations during the year. Public Health (Condensed Milk) Regulations, 19231927.—Six samples were taken and reported upon as genuine. The composition and labelling of one sample did not conform to the above regulations but these variations were permissible under Regulation 60 CAA of the Defence (General) Regulations, 1944, and consequently no action was necessary. 59 NOTIFICATION OF FOOD POISONING Under the provisions of the London County Council (General Powers) Act, 1932, now re-enacted in the Public Health (London) Act, 1936, every registered medical practitioner attending on any person shall, if he suspects or becomes aware that any person is suffering from food poisoning, forthwith notify such case to the Medical Officer of Health. Five cases were notified during the year, a similar number being returned for 1947. Each case was investigated thoroughly in order to ascertain the source of infection. In one instance Bact. aertryke (S. typhimurium) was considered the casual agent and in another a bacteria of the Proteus type but in no case was direct connection with food established. In all instances the infection was mild and recovery rapid and complete. Administrative Action Taken in Regard to Samples Reported to be NOT GENUINE. Sample No. Article Nature of adulteration or irregularity Action taken T. 2 Chutney Contravened Public Health (Preservatives etc., in Food) Regulations in that Sulph. Dioxide was contained to the extent of 170 parts per million. Satisfactory explanation from Manufacturer. T. 16 Chop Sauce Contravened Public Health (Preservatives etc., in Food) Regulations in that Sulph. Dioxide was contained to the extent of 135 parts per million Satisfactory explanation from Manufacturer. T. 63 Herring Tid Bits Contained tin to the extent of 5.5 grains to the pound Further sample taken. See T.85 T. 66 Pork Sausage Was deficient in meat to the extent of 8%. Formal sample proved genuine. T. 85 Herring Tid Bits Contained tin to the extent of 4.4 grains per pound. Referred to the Ministry of Food. Stock withdrawn T.147 Spirit of Sal Volatile Deficient in ammonia to the extent of 91% and carbon dioxide 89% according to British Pharmacopoeia standards. Satisfactory explanation from Wholesaler T.175 Salad Dressing D ficient in edible vegatable oils and without correct labelling. Satisfactory explanation from vendor. 60 Sample No. Article Nature of adulteration or irregularity Action taken T.218 Cake Mixture Badly infested with mites and unfit for human consumption. Stock withdrawn (Sent for animal food. T.290 Steamed Pudding Mixture Badly infested with mites and unfit for human consumption. Stock withdrawn (Sent for animal food). T.232 Gravy Powder Badly infested with mites and unfit for human consumption Stock withdrawn (Sent for animal food). T.265 Salad Cream Judged by provisions of the Food Standards (Salad Cream and Mayonnaise) Order, 1945, deficient in egg yolk solids to the extent of 55%. Referred to Ministry of Food. Stocks withdrawn. Composition amended by Manufacturer. T.293 Cakes Contained Mineral Grease— 1.8% by weight. Vendor warned. T.302 Tincture of Iodine Judged by the new British Pharmacopoeia standards the sample was deficient in Potassium Iodide to the extent of 38% Satisfactory explanation from Manufacturer T.312 Cakes Contained Mineral Grease to the extent of 7.7% by weight. Vendor warned. T.319 Scotch Broth (canned) Contained fragments of cotton material which, when dried weighed 2.3 grammes. Vendor warned T.327 "Ostomalt". Constituents contained did not accord with labelling. Satisfactory explanation from Manufacturer. T.355 Tomato Soup (Canned) Contained tin to the extent of 3.3 grains per pound. These samples were taken from Ex-Naval Stores for the purpose of ascertaining whether the food was in satisfactory condition for release for human consumption or how it could be most suitably utilised. (See Note below). T.356 Tomato Soup (Canned) Contained tin to the extent of 6.1 grains per pound T.357 Asparagus Soup Contained tin to the extent of 4.0 grains per pound. T.358 (Canned) Mulligatawny Soup (Canned) Contained tin to the extent of 2.2 grains per pound. T.360 Beef Soup (Canned) Contained tin to the extent of 2.1 grains per pound. T.362 "Marmite" Tasted stale and unpleasant. T.363 "Marmite" The sample had a very objectionable and stale taste. T.364 "Marmite" The sample was putrifying. 61 Sample No. 748 762 765 780 792 793 795 Article Milk Saccharin Tablets Milk Seed Tapioca Beef Sausage Beef Sausage Milk Nature of adulteration or irregularity Slightly deficient in Milk Solids other than Milk Fat. By the Saccharin (Controlled and Maximum Prices) Order, 1944, the sample was deficient in Saccharin to the extent of 33% Deficient in fat to the extent of 7% Consisted of Sago—two thirds and Tapioca—one third. According to the standard prescribed by the Meat Products and Canned Meat (Control and Maximum Prices) Order, 1948, deficient in meat to the extent of 5% According to the standard prescribed by the Meat Products and Canned Meat (Control and Maximum Prices) Order, 1948, deficient in meat to the extent of 40%. Milk-solids other than milk-fat7.82% indicating added water to the extent of 8%. Action taken Further formal sample proved genuine. Referred to Food Executive Officer Explanation furnished. Vendor warned. Commodity withdrawn. Vendor warned. Referred to the Ministry of Food. Vendor warned. Insufficient evidence to allow legal proceedings NOTE :—As a result of these analyses and further examinations, etc., the following stocks of canned goods were condemned. 17 tins Various foods 55 lbs. 149 tins Corned Beef 894 lbs. 251 tins, Marmite 251 lbs. 13,818 tins Soup (Various) . 11,598 lbs. 62 SECTION F Prevalence of, and Control Over, Infectious and Other Diseases. Under the Public Health (Tuberculosis) Regulations, 1930, and Section 192 of the Public Health (London) Act, 1936, with associated Orders and Regulations, 1,694 notifications were received. In 23 cases the diagnoses were not confirmed, giving a corrected total of 1,671. The following table indicates the figures for five years:— Year 1944 1945 1946 1947 1948 No. of Notifications 1397 1216 1691 1013 1671 Particulars of age groups and districts affected are shown in the tables at the end of the Report. Smallpox.—There were no cases notified during the year but a number of contacts were reported arriving in the Borough from abroad and these were kept under observation for the requisite period. Public Health (Smallpox Prevention) Regulations, 1917.—It was not necessary for your Medical Officer of Health to take any action during the year. Certificates of successful Vaccinations received during the six months ended June, 1948 565 This figure suggests that some 60% of children continue to receive a measure of protection. It is hoped that with the lapse of compulsory vaccination these figures may improve, or in any case, not lessen, in view of the ever present danger of the introduction of infection to this country. Measles.—There were 930 notifications received of which two were not confirmed. The net figure of 928 compares with 278 for the previous year and 902 for 1946. The distribution of the cases was as follows:—East Greenwich 383; West Greenwich 174; St. Nicholas, Deptford 47; Charlton and Kidbrooke 324. 63 Forty-nine eases occurred in children under one year of age, 479 between 1 and 5 years, and 388 between the ages of 5 and 15. The outbreak began in April, reached its peak in later June, finally subsiding towards the end of August. Twenty-three cases were removed to hospital. There were no fatalities. Whooping Cough.—Of 388 notifications, 3 were not confirmed, so the net total becomes 385. Of these, 206 occurred in East Greenwich, 73 in West Greenwich, 15 in St. Nicholas, Deptford, and 91 in Charlton and Kidbrooke. Forty-three cases were under 1 year of age, 221 between 1 and 5 years, and 119 between the ages of 5 and 15. Fourteen cases were removed to hospital. There was one fatality. In recent years, due to the relative mildness of these diseases and the pressure on hospital beds, removal to hospital is undertaken only where circumstances warrant it, so that the majority of Whooping Cough and Measles cases are treated at home. Diphtheria.—Nine confirmed cases occurred during the year and there were no deaths. Four of the cases were in persons over 21 years of age. Since compulsory notification was introduced the lowest recorded figure was in 1947 when the total of cases was 7. There is no doubt in my mind that the Diphtheria Inoculation Scheme sponsored by the Council has fully justified itself as shown by these figures. Antitoxin.—In accordance with the Antitoxin Order, 1910, a supply of Antitoxin is provided by the Council for the use of General Practitioners in emergency cases. Two requests were dealt with during the year. Bacteriological Examinations.—Four hundred and eighteen swabs from suspected Diphtheria cases were forwarded by Medical Practitioners for bacteriological examination. Of this number 410 were reported to have given negative or doubtful results, but 8 were of a positive character and, as such, were dealt with accordingly. Immunisation.—Up to 30th June the Diphtheria Inoculation Scheme continued under the control of the Council. In July responsibility passed to the London County Council under the National Health Service Act, 1946. 64 During the first half of the year there were 731 complete courses of inoculation, 660 in respect of children under 5 years of age, and 71 between the ages of 5 and 15 years. The total number of reinforcing doses given during the same period was 76, and 19 Schick tests were carried out. Table showing Total No. of Immunisations carried out since commencement of Scheme. Under 5 years 5-14 years *Total number of Children who have completed a full course of Inoculations at any time up to 30th June, 1948 Estimated population 3,594 8,128 5,432 10,817 *Note.—These figures relate to recorded cases. In addition it is estimated that 420 children under 5 years and 1,055 over 5 years who are now residing on the new L.C.C. Housing Estates in this Borough, have been immunised. Acute Primary Pneumonia and Acute Influenzal Pneumonia.—There were 32 cases attributed to these causes as compared with 72 for the previous year and 74 for the year 1946. Fifteen occurred in East Greenwich, 7 in West Greenwich, and 10 in Charlton and Kidbrooke. There was one death attributed to Acute Primary Pneumonia in one of ten cases removed to hospital. Typhoid Fever.—One case occurred and was removed to hospital where treatment resulted in complete recovery. Despite investigation no contact with other cases or other source of infection could be established. This is often the finding in these sporadic cases, which probably indicates the presence in the general population of intermittent carriers. Scarlet Fever.—Compared with 151 for the previous year and 108 for 1946, 74 cases were notified during 1948. In one instance the diagnosis was not confirmed, thus giving a final total of 73, and of these, 25 were treated in hospital. The distribution of the cases was: East Greenwich 22; West Greenwich 21; St. Nicholas, Deptford, 3 ; Charlton and Kidbrooke 27. There were no fatalities. 65 Erysipelas.—Twenty-two notifications, of which 3 were not confirmed, were received, as compared with 22 in 1947. There were no fatalities. Zymotic Enteritis or Epidemic Diarrhoea (Children under 5 years of age).—Originally 32 cases were notified, but this figure was modified and 23 were recorded as confirmed compared with 26 verified cases in the previous year. Of the 23 cases for 1948, 18 were under 1 and 5 between 1 and 5 years. Three deaths occurred among the 22 cases removed to hospital. Dysentery.—Five cases were notified during the year. There were 4 and 8 respectively in the years 1947 and 1946. Scabies.—The Scabies Order, 1941, and Defence Regulation 33A, which were introduced as an emergency wartime measure to combat an exceptional increase in Scabies, were rescinded by the Ministry of Health on 31st December, 1947. The disease continues to be notifiable under the County of London (Scabies) Regulations, 1943. Forty-six cases were notified during the year under review as compared with 83 in 1947 and 179 in 1946. Nineteen cases occurred in East Greenwich, 10 in West Greenwich, 7 in St. Nicholas, Deptford, and 10 in Charlton and Kidbrooke. School children receive treatment for this disease at the Tunnel Avenue Centre, whilst adults and children under school age are accommodated at St. Alfege's Hospital Centre. Puerperal Fever.—Originally notifiable under Section 304 of the Public Health (London) Act, 1936, the notification of this disease was discontinued in August, in accordance with the London County Council (General Powers) Act, 1948. Up to this time three patients were reported as suffering from this disease, all of whom received hospital treatment. There were no cases in 1947 and one for 1946. Puerperal Pyrexia.—There were 11 cases attributed to this disease as compared with 8 for the previous year and 16 for 1946. All patients received treatment in hospital. There were no deaths. 66 Ophthalmia Neonatorum.—Two notifications were received during the year : one case was admitted to the White Oak Hospital, Swanley, whilst the remaining case was treated at home. Both cases occurred in East Greenwich and were followed up by the Health Visitor and kept under observation until full recovery. Neither case proved to be of venereal type, nor were any permanent effects reported. There were five cases during 1947. Cerebro-Spinal Fever.—During 1948 four cases were notified as compared with 7 for the previous year and 5 for 1946. All the patients received hospital treatment. There were no deaths. Acute Anterior Polio-Myelitis.—Of the five confirmed cases of the disease, one notification referred to a case which occurred in the latter part of December, 1947. There were two cases in East Greenwich, 1 in West Greenwich, and 2 in Charlton and Kidbrooke. There were no deaths. In 1947 there were 16 confirmed cases with two deaths. Tuberculosis.—With the coming into effect, on 5th July, 1948, of the National Health Service Act, 1946, the main duties of the Council passed to the London County Council and the South East Metropolitan Regional Hospital Board. The responsibility for notification, disinfection, etc., remains with the Sanitary Authority. During the year 124 cases of Tuberculosis were notified in the Borough, 10 less than 1947. Of this number 109 were of the pulmonary type, ordinarily known as consumption, and 15 were non-pulmonary, i.e. tuberculosis of parts of the body other than the lungs. The following table gives the distribution :— East Greenwich West Greenwich St. Nicholas, Deptford Charlton and Kidbrooke Totals Pulmonary 41 24 5 39 109 NonPulmonary 3 3 1 8 15 Total 44 27 6 47 124 67 Disinfection was offered and carried out in 58 cases, including 111 rooms and 835 articles of bedding, etc. Where necessary, disinfectant was supplied to patients to disinfect sputum pots, etc. Up to 4th July, 1948, 242 specimens were forwarded by Medical Practitioners for bacteriological investigation, and of these, 172 were reported to be negative and 70 positive for the tubercle bacillus. Verminous Conditions.—The procedure adopted to combat infestation by lice and general verminous conditions is essentially the same. In addition to the notified cases of Scabies, all suspected cases are followed up and the homes visited by the Woman Sanitary Inspector, assisted by a qualified nurse who gives advice and instruction concerning treatment. School children are dealt with at the Council's Cleansing Station at Tunnel Avenue. Children under 5 years of age and adults are treated at the Bathing Centre attached to St. Alfege's Hospital. The following return summarises the work carried out during the year:— Attendances Vermin Scabies Adults 4 775 Children under School age 456 School Children 979 345 No. of home visits by Nurse — 229 „ „ „ re-visits by Nurse — 687 Disinfection.—This is carried out either on removal of the infectious case or termination of the illness and, on request, for conditions other than notifiable. In cases of request a charge is made according to the circumstances of the case. Bedding and wearing apparel may be removed to the Disinfecting Station, Tunnel Avenue, where they can be submitted to steam disinfection. Books may be treated with formalin. The following Return shows in detail the work carried out during the year:— 68 Rooms and Articles Disinfected, Year ended December, 1948. Diseases, etc. Premises Entered Rooms Beds Paillasses Mattresses Bolsters Pillows Blankets Sheets Cushions Quilts Odd Articles Total No. Articles Disinfected scarlet Fever 59 87 33 — 56 36 109 174 122 12 73 281 896 Diphtheria 16 27 5 — 13 8 32 54 29 — 26 67 234 Tuberculosis 58 111 24 — 46 35 127 147 96 15 50 295 835 Cancer 19 31 10 — 14 15 43 40 24 11 18 46 221 Cerebro spinal Fever 2 3 — — 2 — 2 4 4 — 2 — 16 Purposal Fever 3 2 1 — 2 2 5 4 3 — 2 10 29 Typhiod Fever 4 7 2 — 5 4 11 13 7 — 5 22 69 Polio Myelitie 6 11 3 — 8 3 17 15 12 — 7 27 92 Other Diseases 48 49 20 — 58 20 106 350 97 13 43 290 997 Verminous Premises 30 — 24 — 29 23 56 202 41 9 42 151 577 Verminous (Housing G.B.C.) 2 — — — -— — — — — — — 9 9 Total 247 328 122 — 233 146 508 1,003 435 60 268 1,200 3,975 Articles destroyed — — 22 — 83 4 29 2 3 3 2 62 210 69 TUBERCULOSIS REPORT, 1948 I am indebted to Dr. C. W. L. Jeanes, Tuberculosis Officer, (transferred to service of the Regional Hospital Board on July 5th, 1948), for the following report. Also appended is a note on Care Committee work undertaken. Owing to the difficulty of separating the work of the Dispensary into two periods, the figures relate to the full year. Despite the changes in responsibilty in the third quarter it is pleasing to record that the work of the Clinic has continued as usual and cordial relations have been maintained with the local doctors, hospitals and voluntary organisations concerned with the care of patients. During the year 263 new cases of tuberculosis of all types were notified, including 144 cases transferred from other districts. The number of transferred cases is the highest ever recorded. Notifications and deaths since 1938 are shown on the following tables:— Year. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Deaths. 1938 153 38 53 1939 93 14 60 1940 125 17 73 1941 138 32 74 1942 164 18 64 1943 117 26 60 1944 113 16 47 1945 149 16 53 1946 173 18 56 1947 171 13 67 1948 112 17 62 Of the 129 cases notified primarily, 117 came under the care of the Dispensary, and were made up as follows:— Pulmonary Tuberculosis Non-Pulmonary Adults Children Adults Children 92 11 8 6 Only 42 of the 92 new adult cases had positive sputum on diagnosis. In most cases this meant that the disease had been diagnosed in the early stage, and that the patients had not become infectious. 70 969 new patients attended the Clinic for the first time, being referred chiefly by private doctors and hospitals. Of the 144 transferred cases, a considerable number had been living under very poor housing conditions, often with a large number in family. The Housing Schemes give greatest priority to chronic infectious cases, where there is danger of infection to young children, and it is gratifying to be able to record that the incidence of tuberculosis in child contacts in these homes has been extremely low; only three children were infected out of a total of 75, of whom one died of tuberculous meningitis. Deaths.—Among patients attending the Dispensary there were 54 deaths. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Adults Male 34 — Female 17 — Children 3 — Total 54 — There were also 7 deaths from Pulmonary Tuberculosis and 1 from Non-pulmonary Tuberculosis among non-clinic patients, making the total deaths in the Borough 62. DEATHS Males Age group Females 1 0— 4 yrs. 2 - 5—14 „ — 3 15—24 „ 3 11 25—34 „ 9 6 35—44 „ 1 8 45—54 — 5 55—64 „ 2 1 over 65 „ 2 Total 35 19 = 54 71 The Pneumothorax Clinic has continued to increase in size. On the 31st December, 1948, there were 86 patients attending the Clinic, and during the year 2,500 refills were performed. Tuberculosis Dispensary.— No. of New Cases examined 969 No. of Cases of Tuberculosis notified 117 No. of X-rays reported on by Chest Physician 1,550 No. of Artificial Pneumothorax Refills 2,500 No. of patients' attendances 3,357 No. of Nurses' visits 2,583 No. of Medical Consultations in Patients' homes 416 CARE COMMITTEE The Secretary, Miss Chave-Jones, reports that in tuberculosis development there are many important factors including age, sex, heredity, and environment. There is little that can be done to affect age, sex, and heredity, but the environmental factor is one in which the skill of the trained social worker can be excerised. A detailed knowledge of social legislation brought to bear upon the circumstances can enable the patient to take advantage of facilities hitherto unknown. Financial burdens are lessened now by the provisions of the National Assistance Act, but these sometimes prove inadequate. The Care Committee funds are then able to assist, or other sources of material help can be called upon. Approximately 200 patients have been assisted in this way and a total sum of £262 4s. 4d. expended. Co-operation with other agencies is important for balanced and constructive aid. Frequently the problem is a peculiarly personal one, and professional skill and experience are needed to solve intangible difficulties or make some social adjustment, without which the patient cannot fully respond to treatment. 72 Rehabilitation is a difficult but very important factor in recovery. The demand for light work far exceeds the supply, and it is easy for a recovering patient to lose heart because there is no suitable work available. To some extent the Ministry of Labour is able to deal with this problem, but direct and personal contact with local firms is invaluable. The patient often needs help in dealing with factors at home, or at work, which may lead to a recurrence of the illness. The Handicraft Class held twice a week at the Clinic, under the supervision of a London County Council instructress, provides diversional therapy for those unable to work, and in some cases can be used as training for home work for those unable to compete in the labour market. In addition to financial help for individual patients, the Care Committee finance an annual New Year Party and summer outing to the seaside, and make periodical gifts of food to the permanent invalids. At Christmas, postal orders are sent to all patients in hospital or sanitorium and to certain patients at home. INDEX Page A Acute Anterior Poliomyelitis 66 Adoptive Acts, By-laws and Local Regulations 3 Age Mortality 13 Aged, Infirm and Physically Incapacitated Persons 40 Ante-Natal Clinics 22 Area of Borough 7 A.R.P. Shelters, Nuisances arising from 31 Articles and Rooms Disinfected 68 Articles Destroyed 68 Artificial Pneumothorax 71 Artificial Sunlight Treatment 20, 21 B Bacteriological Examinations 19,50,51,52 Baiting of Sewers 37 Baths & Wash-houses 38 Births 12 Birth Notifications 27 Blackheath Fair 55 Bomb-damaged Buildings, Nuisances arising from 31 Bronchitis 16 C Cancer 15,16 Care Committee, Tuberculosis 71, 72 Caseous Lymphadenitis 54,55 Cerebro-Spinal Fever 66 Child Life Protection 25 Circulatory System—Diseases of 16 Classification of Deaths 14 Cleansing Children 67 Clinics and Centres 19, 22 Common Infectious Diseases 14 Complaints 28, 41 Council Housing Estates 43 D Day Nursery 26 Deaths 12 Death Causes, Remarks 14-16 Deaths from Violence 16 Page Deaths in Institutions 13 Deaths, Tables showing Causes of and Ages at ... Appendix Deaths, Tables showing Causes of and Ages under 1 Appendix Defective Dwellings—Repairs 31 Density of Population 7 Dental Clinic 23 Diabetes 19 Diarrhoea and Zymotic Enteritis 15, 65 Diphtheria 15, 63 Diphtheria Immunisation 63, 64 Diseases of Circulatory System 16 Diseases of Respiratory System 16 Disinfection 67, 68 Disinfestation of Verminous Premises 34 Disinfestation Scheme 32,33 Domestic Helps 25 Drainage, New and Alterations to 34 Drinking Fountains 39. Duties and Powers of the Public Health Committee 3 Dysentery 65 E Elevation of Borough 7 Enteric Fever 15 Erysipelas 65 E.W.S. Sites, Nuisances arising from 31 Exhumations 40 Extracts from Vital Statistics 9, 10 F Factories Act, 1937 28-30 Food & Drugs Act, 1938, Samples taken under 58 Food—Inspection of 49-58 Food—Premises for Preparation of 51,56 Food Rejected 52, 53, 54 INDEX—continued Page Food & Drugs—Non-genuine Samples 59, 61 Food Poisoning, Notification of 59 Foot Clinics19 Functions transferred under National Health Service Act 18, 19 G General Statistics 7-10 H Health Centres 19-22 Health Visitors, Visits etc., 26, 27 Heart Disease 16 Heat Treated Milk (Prescribed Tests) Order, 1944 50 Home Helps 25 Home Nursing 25 Horse Troughs 40 Housing 43, 48 Housing Act, 1936 48 Houses Let in Lodgings 31 Housing Accommodation 43,44 Housing Homeless Persons 44 I Ice-cream—Bacteriological Examinations 52 Ice-Cream (Heat Treatment) Regulations, 1947 51, 52 Ice-Cream Premises 51 Illegitimate Children—Care of 25 Imported Food Rejected 53. 54 Infant Consultations 21, ?2 Infantile Mortality 13, 14, 22, 23 Infant Welfare Centres 21,22 Infectious Diseases 62-67 Inhabited Houses 7 Institution Deaths 13 Institutional Provision for Mothers and Children 24 Insulin Treatment—Diabetes 19 Intra-Cranial Lesions 16 Introductory Review 5, 6 L Laboratory Work 19 Legal Proceedings 42 Page M Marriages 10 Maternal Mortality 10. 23 Maternity & Child Welfare... 21-27 Maze Hill Clinic 21 Measles 14,62, 63 Meat Regulations 53 Meat Surrendered 52 Meteorological Observations 11 Merchandise Marks Act, 1926 55 Milk & Dairies Regulations 49 Milk, Analysis of 51 Milk—Bacteriological Examination of 50 Milk—Heat Treated 50 Milk (Special Designations) Regulations, 1936/46 50 Milk Supply 49 Milk—Supply to Mothers and Children 23, 24 N Notices, etc 28, 42 Notifications of Infectious Diseases 62-77 Notifications of Births 27 Notifications of Food Poisoning 59 Nursery 26 O Ophthalmia Neonatorum 66 Outworkers 28 Overcrowding 48 P Persons Cleansed 67 Pharmacy & Poisons Act, 1933 25 Pig Bins, Nuisances arising from 33,34 P.H. (Condensed Milk) Regs. 58 P.H. (Dried Milk) Regs 58 P.H. (Imported Food) Regs. 53 P.H. (Meat) Regs 53 P.H. (Smallpox Prevention) Regs 62 Pneumonia 16, 64 Polio-Myelitis 64 INDEX (concluded) Page Population 7,9 Post-Natal Clinics 22 Premature Infanta, Care of 25,26 Premises transferred under National Health Service Act 18,19 Preserved Food Premises 51 Public Health Committee 3 Public Open Spaces 8 Public Sanitary Conveniences 38, 39 Puerperal Fever 65 Puerperal Pyrexia 65 R Rateable Value 7 Rates, Births and Deaths 9, 10 Rat Repression 35-37 Refuse Disposal 33 Remarks on Various Death Causes 14-16 Rent & Mortgage Interest (Restrictions) Act 34 Respiratory System, Diseases of 16 Rodent Control 35-37 S Sanitary Conveniences ... 38,39 Sanitary Work—Summaries etc 41, 42 Scabies 65 Scarlet Fever 15, 64 Scavenging and Refuse Disposal 33 Services transferred under National Health Service Act 18,19 hewers—Baiting of 37 Shops Act, 1934 24 Slaughterhouses 53 Smallpox 14, 62 Smoke Abatement 30 Social Conditions of the Area 7-9 Staff transferred under National Health Service Act 17, 18 Page Staff of Public Health Department 4 Statistical Tables ... Appendix Street Traders 56 Supplies of Underground Water (Wells) 35 T Treatment Centres 19-22 Tuberculosis 15,66 Tuberculosis Care Committee 71,72 Tuberculosis Officer's Report 69-71 Typhoid Fever 15, 64 U Uninhabited Houses 7 Unsound Food 52, 54 V Vaccination 62 Various Death Causes, Remarks on 14-16 Verminous Conditions 67 Verminous Premises 34, 68 Violent Deaths 16 Vital Statistics 7-16 & Appendix Vitamins — Supply of to Expectant Mothers and Children 24 W War Damaged Dwellings 3 Water—Underground Supplies (Wells) 5 Water Supply 35 Wells 35 Whooping Cough 15,63 X X-Ray Examinations 71 Z Zymotic Diseases 65 INFANTILE MORTALITY DURING THE YEAR 1948 Deaths from stated Causes in Weeks and Months under 1 Year of Age. Cause of Death. Under 1 week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—3 Months. 3—6 Months. 6—9 Months. 9—12 Months. Total Deaths under One Year. Small-Pox ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... 1 Diphtheria—Croup ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Tubercular Meningitis ... ... ... ... ... ... ... ... ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Diseases of Trachea ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... ... ... ... Pneumonia (all forms) ... ... ... ... ... ... ... ... ... 10 Diarrhoea (all forms) ... ... ... ... ... ... ... ... ... ... Gastro-Enteritis ... ... ... ... ... ... ... ... ... 3 Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 4 ... ... ... 4 ... ... ... ... 4 Congenital Malformation 6 ... ... ... 6 ... ... ... ... 10 Premature Birth 8 ... ... ... 12 ... ... ... ... 12 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... ... ... Suffocation, Overlay ... ... ... ... ... 1 ... ... ... 1 „ Otherwise ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... ... ... 1 1 ... ... 2 Totals 19 4 2 ... 25 7 7 4 1 44 Male 29 Female 15 GASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1948. Notifiable Disease. Cases Notified in Whole District At Ages — Years Total Cases Notified in each Locality No. of Cases removed to Hospital from each Locality Total |At all Ages Under 1 1 to 5 |5 to 15 |15 to 25 25 to 45 45 to 65 65 and upwards Greenwich East Greenwich West St. Nicholas Charlton and Kidbrooke Greenwich East Greenwich West St. Nicholas Charlton and Kidbrooke Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 9 ... 2 3 3 1 ... ... 5 2 ... 2 5 2 ... 2 9 Dysentery 5 ... ... 1 ... 3 1 ... 2 1 ... 2 1 1 ... 1 3 Erysipelas 19 ... ... 1 1 ... 9 ... 4 6 2 7 2 1 2 4 9 Acute Polio-Myelitis 5 ... ... ... 1 4 ... ... 2 1 ... 2 2 1 ... 2 5 Scarlet Fever 73 ... 27 39 5 2 ... ... 22 21 3 27 5 7 1 12 25 Enteric Fever 1 ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... 1 Scabies 46 3 5 24 7 4 2 ... 19 10 7 10 ... ... ... ... ... Puerperal Fever 3 ... ... ... 1 2 ... ... 1 ... 1 1 1 ... 1 1 3 „ Pyrexia 11 ... ... ... 3 8 ... ... 5 4 ... 2 5 4 ... 2 11 Cerebro-Spinal Fever ... 4 1 3 ... ... ... ... ... 2 1 ... 1 2 1 ... 1 4 Malaria (Induced) 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... Measles 928 49 479 388 8 4 ... ... 383 174 47 324 8 7 2 6 23 Whooping Cough 385 43 221 119 1 1 ... ... 206 73 15 91 2 5 1 6 14 Diarrhoea 23 18 5 ... ... ... ... ... 9 2 5 7 9 1 5 7 22 Ophthalmia Neonatorum 2 2 ... ... ... ... ... ... 2 ... ... ... 2 ... ... ... 2 Pneumonia, Acute Primary or Acute Influenzal 32 1 4 3 2 7 12 3 15 7 ... 10 6 1 ... 3 10 Tuberculosis, Pulmonary 109 2 3 8 34 45 14 3 41 24 5 39 8 15 ... 16 39 „ Non-Pulmonary 15 1 3 4 4 1 2 ... 3 3 1 8 2 1 1 5 9 Totals 1671 120 752 590 70 87 41 11 722 330 86 533 61 47 13 68 189 NOTE :—The above Table refers to "Corrected Notifications" only, i.e. all cases in which diagnosis was not confirmed have been ignored, CAUSES OF, AND AGES AT, DEATH, during the year ended 31st December, 1948. No. in Short List Causes of Death. Deaths at Subjoined ages of "Residents" whether occuring within or without the District Deaths at all Ages of "Residents "belonging to Localities, what her occurring in or beyond the District Deaths of "Residents" in Public Institutions Total Deaths whether of "Residents" or "NonResidents" in Public Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton and Kidbrooke St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military i Hospital Brook Hospital L.C.C. Other Institutions Outside Institutions 1 Typhoid and Paratyphoid Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Whooping Cough 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 5 5 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Tuberculosis of Respiratory System 57 ... 2 ... 1 7 28 16 3 21 13 2 21 9 1 1 ... ... ... 14 46 7 Other Forms of Tuberculosis 5 1 ... ... 1 1 1 ... 1 1 1 1 2 ... ... ... ... ... ... 3 9 8 Syphilitic Disease 6 ... ... ... ... ... ... 1 5 3 ... ... 3 1 1 ... ... ... ... ... 5 9 Influenza ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... 10 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 11 Acute Poliomyelitis and Polioencephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12 Acute Infectious Encephalitis 1 ... ... ... ... ... 1 ... ... 1 ... ... ... 1 ... ...... ... ... ... ... 3 13M Cancer of buccal cavity and oesophagus (males only) 3 ... ... ... ... ... ... ... 3 1 1 ... 1 ... ... ... ... ... ... 1 5 13F Cancer of Uterus 6 ... ... ... ... ... ... 4 2 1 2 ... 3 2 ... ... ... ... ... 1 5 14 Cancer of Stomach and ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Duodenum 19 ... ... ... ... ... ... 5 12 9 5 2 3 4 ... 1 ... ... ... 3 18 15 Cancer of Breast 12 ... ... ... ... ... ... 8 4 6 1 1 4 4 ... 1 ... ... 2 8 16 Cancer of all other sites 112 ... ... ... ... ... ... 48 57 47 16 3 46 26 ... 4 ... ... ... 19 140 17 Diabetes 9 ... ... ... ... ... ... 1 8 4 2 1 2 7 ... ... ... ... ... ... 17 18 Intra-eranial Vascular Lesions 80 ... ... ... ... ... ... 19 60 38 14 2 26 23 1 2 ... ... ... 12 92 19 Heart Disease 223 ... i ... ... ... 7 58 157 75 44 20 84 46 2 6 ... ... 2 26 189 20 Other Diseases of the latory System 47 ... ... ... ... 1 .... 6 40 17 12 2 10 29 ... 1 ... ... ... 5 80 21 Bronchitis 56 ... i ... ... ... ... 13 40 26 12 2 16 14 ... ... ... 1 ... 2 42 22 Pneumonia 44 10 ... ... ... 3 1 5 25 24 4 ... 16 16 ... ... 1 ... ... 11 70 23 Other Respiratory Diseases 13 ... ... ... ... ... ... 4 9 6 2 1 4 5 ... 1 ... ... ... 1 19 24 Ulceration of the Stomach or Duodenum 11 ... ... ... ... ... 1 3 7 3 7 ... 1 6 ... ... ... ... ... ... 28 25 Diarrhoea (under 2 years of age) 3 3 ... ... ... ... ... ... ... 1 1 ... 1 1 ... ... ... 1 ... 1 12 26 Appendicitis 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 7 27 Other Digestive Diseases 21 2 i ... ... ... 3 6 9 9 5 2 5 11 1 ... ... ... 7 44 28 Nephritis 15 ... ... ... ... ... 6 3 6 8 1 ... 6 6 ... 1 ... ... ... 1 19 29 Puerperal and Post-abortive Sepsis 1 ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 30 Other Maternal Causes 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 1 1 31 Premature Birth 12 12 ... ... ... ... ... ... ... 4 1 ... 7 8 ... ... ... ... ... 4 25 32 Congenital Malformations, Birth Injury, Infantile Disease 14 14 ... ... ... ... ... 4 4 ... 6 5 ... ... ... ... ... 5 14 33 Suicide 5 ... ... ... ... ... 1 2 2 2 ... 3 1 ... ... ... ... ... 2 2 34 Road Traffic Accidents 8 ... ... 1 3 ... 1 ... 3 2 2 ... 4 5 ... 1 ... ... ... 2 12 35 Other Violent Causes 32 1 1 ... 3 2 5 3 17 16 9 1 6 21 ... ... ... ... ... 7 43 36 All Other Causes 44 ... ... 1 2 ... 3 7 31 18 10 6 10 18 ... 1 ... 1 ... 8 58 Totals 862 44 6 2 11 14 72 212 501 347 171 46 298 270 6 20 1 3 2 139 1,024 Note.—All "Transferable Deaths" of residents, i.e., persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Vales, and who died in the Borough in like manner have been excluded.