AC 4373 cal GRE51 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1953 65873 19/11/54 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1953 Printed by Freame, Manning & Co., Ltd. Lewisham, S.E. 13 CONTENTS Page Public Health Committee 3 Introductory 6 Section A.—General and Vital Statistics 9 „ B.—General Provision of Health and Welfare Services for the Area 27 „ C.—Sanitary Circumstances of the Area 37 „ D.—Housing 65 „ E.—Inspection of Food and Supervision of Food Premises 72 „ F.—Prevalence of, and Control Over, Infectious and other Diseases 100 „ G.—Greenwich Guild of Hygiene 114 Census, 1951 117 Appendix—Statistical Tables 3 PUBLIC HEALTH COMMITTEE as at 31st December, 1953 The Mayor: Alderman Mrs. L. Hilldrith, J.P. and 13 Members Councillor H. W. Gorman (Chairman) Councillor Mrs. M. L. Wentworth (Vice-Chairman) Alderman : Mrs. C. Berry Councillors : Mrs. M. Bennett D. F. Lynch A. C. Chrisp (L.C.C.) P. Noble T. L. Dawes Dr. W. Smith Mrs. A. D. A. Kennedy W. F. Strong Mrs. F. M. Kerins E. Yates Powers and Duties of the Public Health Committee : 1.—The Committee shall consist of 13 members of the Council. 2.—There shall stand referred to the Committee all matters relating to the powers and duties of the Council under Acts of Parliament, bye-laws and regulations dealing with the public health and the sanitary condition of the Borough ; the administration of the Food and Drugs Act, 1938 and any regulations dealing with the preparation, storage and sale of Food and Drugs ; the powers and duties of the Council under enactment relating to milk and dairies. 3.—Without prejudice to the generality of the provisions of the preceding paragraph, the powers and duties of the Council to serve and receive Notices, take proceedings and empower officers to make complaints and take proceedings on the Council's behalf and otherwise to enforce the provisions of the Public Health (London) Act, 1936, other than those 4 specified in Part I of the First Schedule to such Acts, the functions of the Council under Section 14 of the Food and Drugs Act, 1938 (registration of premises used in connection with manufacture or sale of ice-cream, preserved food, etc.), the Food and Drugs (Milk and Dairies) Act, 1944 and the Milk (Special Designations) Act, 1949 and all Regulations made or to be made under such last mentioned statutes, and under the Slaughter of Animals Act, 1933 (licensing of slaughtermen) and also the functions of the Council under the Bye-law dealing with the deposit of rubbish on vacant sites in the Borough, shall be delegated to the Committee. 4.—All plans for the drainage and re-drainage of buildings in the Borough shall be considered by the Committee, and all works of drainage and re-drainage of buildings shall be carried out under their jurisdiction. 5.—The Committee shall have the control of any Mortuary and of any disinfecting apparatus and plant provided and maintained by the Council, as well as public sanitary conveniences and conveniences maintained by the Council. 6.—The Committee shall have the control of all public drinking fountains other than those provided in any open space or other property belonging to the Council and coming within the jurisdiction of any other Committee. 7.—The powers and duties of the Council in connection with the repair, closure or demolition of individual insanitary dwellings and the duty of the Council to issue certificates under Section 5 (1) of the Rent and Mortgage Interest Restrictions Act, 1923 and Section 12 of the Rent and Mortgage Interest Restrictions (Amendment) Act, 1933 and the issue of reports under Section 5 (2) of the former Act, shall stand referred to the Committee. 5 STAFF. as at 31st December, 1953. MEDICAL OFFICER OF HEATH : John Kerr Brown, B.Sc., M.B., Ch.B., D.P.H. PUBLIC ANALYST: H. A. Williams, Ph.D., A.C.G.F.C., F.R.I.C. SANITARY INSPECTORS : ac W. H. Collins, b.e.m. (Senior). District Inspectors : abc S. A. Radford. ab G. W. Heath. ab J. E. Millway. a J. G. Lyons. a C. W. Spore. a F. Valentine * abdef Miss B. Hatfield. Food Inspectors: ab H. L. Bennett (Senior) ab F. A. Saunders CLERICAL STAFF : L. A. Westacott (Chief Clerk). A. H. Wilcox Mrs. V. I. Starr (Senior Clerk). (Senior S/H Typist). J. F. Vickers. Miss J. D. Vanner. K. Allum, d.f.m. A. H. Hammond (Temporary). S. E. Thelner. W. A. Pearce (Conveniences Superintendent). DISINFECTING STAFF : T. Smith (Foreman) A. Moore. H. W. C. Scarff (Motor Driver). W. Clements. A. Nash. RODENT CONTROL, FLY DISINFESTATION, ETC : C. Weymouth — Investigator and a Team of eight men. a Certificated Sanitary Inspector. b „ Meat and Other Foods c „ Smoke Inspector. d „ Health Visitor. e ,, State Registered Nurse. f „ State Certified Midwife. * Commenced duties 9/11/53 6 Public Health Department, Town Hall, Greenwich, S.E.10 To the Mayor, Aldermen and Councillors, Metropolitan Borough of Greenwich. Ladies and Gentlemen, I beg to present the annual report on the health and environmental circumstances of our Borough for 1953. The population has declined slightly by 440 ; the death rate has decreased from 10.57 to 9.40 and the birth rate has improved from 14.34 to 15.32. For the year under review a comprehensive Census was made and an opportunity has been taken to summarise the main factors. Last year the Infant Mortality rate was the lowest ever for the Borough and it is gratifying to record another low figure of 18.10 which, although 3.48 greater than last year, is sufficiently low to afford satisfaction. The neo-natal death rate also increased slightly by 0.98 and accounted for 50% of all infant deaths. No maternal deaths were recorded. Infectious Diseases continue to decline and the total notifications of 1,242 is 323 below the 1952 figure. This was due mainly to a rapid decline in Measles which showed the lowest incidence since 1947. Scarlet Fever also declined by 31%. For the second time in the history of the Borough no case of Diphtheria was recorded. Nevertheless, I note that the number of Diphtheria immunisations carried out during the year has fallen by 190. If this trend continues, it will mean that in five or six years time the immunity state for the more susceptible age groups will fall to a dangerous level. It cannot be stressed too emphatically to parents and responsible citizens the value of Diphtheria immunisation as a necessary safeguard to the growing infant. Unlike the general trend in the country, notifications of Pulmonary Tuberculosis fell by 15 and the death rate was almost halved. In recent years it has been usual for the death rate to diminish but the incidence of the disease to remain more or less constant. This is disturbing for it means that little, if any, apparent progress is being made towards the eradication of the disease from the community, although it is perhaps too early yet for definite conclusions to be drawn. 7 The Mass Miniature Radiography schemes and the excellent follow up work of Chest Clinics undoubtedly are discovering more cases of Pulmonary Tuberculosis than formerly, but the use of modern drug therapy may be encouraging the formation of a pool of infection with organisms resistant to many of the new anti-biotic drugs. The extension of B.C.G. vaccination to some vulnerable groups being organised by the County seems to me to be a valuable effort but it will be some time before the results of the scheme can be assessed. The whole subject is a highly technical one and there are many epidemiological and immunological problems associated with Tuberculosis which, as yet, are not clearly understood. Poliomyelitis increased slightly but there was no apparent relationship between the cases and no connection between immunisation or trauma and the site of paralysis was established. There was a drastic increase in Sonne Dysentery but the measures taken to render all cases and carriers bacteriologically negative undoubtedly kept the incidence within manageable proportions. The thanks of the Department are due to the general practitioners who co-operate with us and who supervise the treatment of their patients and contacts. At the beginning of the year deaths in the higher age groups from respiratory and circulatory disturbances increased and were almost certainly a legacy from the fog period of the previous December which was studied in some detail in last year's report. Old people continue to receive much advice and help from the Department. At short notice a holiday scheme was arranged by the Council and many old people enjoyed a week at the seaside in the late summer. With the formation of an Old Peoples' Welfare Association more ambitious schemes are planned for next year and the Council may be able to make available a larger sum for an expansion of the services. Once again the Geriatric Unit at St. Alfege's Hospital satisfied the many formidable demands made on it by us and the local institutions helped to place many old persons living in difficult and distressing circumstances. The repair of old and worn out premises continued to occupy the attentions of the Sanitary Inspectors. The main efforts have been directed to minimising the hardships occasioned to tenants living in sub-standard properties who may have to wait for considerable periods before they can be rehoused. Nevertheless, in some areas it has been possible for the Sanitary Inspectors to persuade and encourage Agents and Owners to renovate much of their 8 property and although a lot remains to be done this aspect of the Department's work should not go unrecognised. The Slum Clearance programme was continued and in December the Ministerial enquiry into the Little Heath area representation was held and the Minister's decision is awaited. Other areas were surveyed in detail in preparation for submission to the Council next year. An account of the floods as they affected Greenwich is included in the body of the report and some observations are made on the problems of atmospheric pollution. After the initial shock caused by the tragedy last December the usual state of apathy has developed and one waits for the report of the Beaver Committee with considerable apprehension. At the moment there is no indication that the drastic measures necessary for tackling the problems will be taken and we must anticipate each succeeding winter with increasing mis-givings. Of course, the remedies will require heavy expenditure and may cause considerable inconvenience and temporary dislocation to many undertakings but it cannot be stressed sufficiently that without the full backing of the law and without a well planned smoke abatement and national fuel policy Health Departments are restricted to very limited preventive action. Once again it is a pleasure to thank my Chairman and ViceChairman for their support and encouragement. My thanks are also due to the Town Clerk, his Deputy and my other chief Officer colleagues for many kindnesses and much advice on diverse matters. In conclusion I am grateful to the staff of the Department for their loyalty and work done. I have the honour to be, Your obedient Servant, J. Kerr Brown Medical Officer of Health 9 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, 1951 89,846 Estimated, 1953 (mid-year) 90,440 Density of Population 23 persons per acre Number of Inhabited Dwellings—end 1953 22,685 (according to Rate Books) Structurally separate dwellings at Census, 1951 21,348 Number of Uninhabited Dwellings— At Census, 1951 364 At end 1953 159 Number of Families or Separate Occupiers— At Census, 1951 26,397 Rateable Value, 1953 £814,313 Sum Represented by a 1d. Rate, 1953 £3,291 10 PUBLIC OPEN SPACES. Borough Council— Charlton House and Gardens 9.25 acres R.N. College Cemetery 5.86 „ St. Alfege Recreation and Church Grounds 2.30 ,, 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) 89 acres Blackhoath—Rangers House and Garden 2½ „ Maryon and Maryon Wilson Parks 51½ ,, Charlton Park 42¾ „ Hornfair (formerly Charlton Playing Field) 26 „ Sayes Court Recreation Grounds 3¼ „ Approximately 215 acres Total Public Open Spaces in Borough Approx. 426 acres (representing 11.4% of the total area of the Borough) Mileage of Streets 88 (approx) 11 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. There is evidence that Greenwich has been an inhabited place for perhaps 2,000 years. Saxon burial mounds and barrows dating from the 6th century are still to be seen in Greenwich Park and coins and fragments of pottery deposited at Charlton House show an almost continuous Roman settlement from 41 B.C. to 423 A.D. In 1738, in a road book of the British Isles, this description was given : " Greenwich on the Thames, 4 miles east of London Bridge, a very delightful place." It can still lay claim to that title. Greenwich lies mainly on a natural slope from the Thames to Blackheath and it thereby affords extensive views of London and the River and it is to this fact, coupled with its historic connection with Royalty, that it owes its fascination. The sub-soil of the greater portion of the Borough consists of gravel and sand, the exception being in the Kidbrooke area which is mainly clay. The altitude varies from a few feet below high-water mark on the Marshes up to 249 ft. 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 the southern boundary, 89 acres of which are within the Borough, providing unsurpassed facilities for games, sports and amusements. There are also excellent recreation grounds serving the Charlton area. In addition to the Maryon and Charlton Parks there is the L.C.C. Play Centre and Lido with its well-equipped swimming bath, tennis courts and bowling greens. More recently, social centres catering for all shades of cultural and educational tastes have been established at Charlton House, Kidbrooke House and the Town Hall under the auspices of the Greenwich Community Council in conjunction with the L.C.C. In addition to the normal Health Services, Greenwich has always been well furnished with schools and hospitals and it can boast of modern baths and excellent library facilities. 12 Considerable alteration has taken place during the post-war period by the erection of modern houses and blocks of flats and the Borough Council, still pressing ahead with its new housing schemes, has behind it a record of sound achievement. 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. In recent years, however, the commencement of a gradual movement of people away from the river-side has been witnessed. 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, Gas Works, Soap and Candle Works, L.T.E. Generating Station and Carriage 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 submitted his estimate of the population of Greenwich, computed at mid-year 1953, upon which the Statistics of this Report have been based. The figure returned is 90,440 indicating a decrease in the population of 440 since last year but nevertheless showing an advance of 26,640 since 1945. The natural increase for the year, i.e., excess of births over deaths, was 533. 13 * EXTRACTS FROM VITAL STATISTICS OF THE YEAR. LIVE BIRTHS Legitimate Illegitimate Total Male 711 30 741 Birth Rate 15.32 Female 614 26 640 (Comparable Rate 14.25) Total 1,325 56 1,381 STILL BIRTHS Legitimate Illegitimate Total Male 14 — 14 Rate per 1,000 total Births 22.64 Female 18 — 18 Total 32 — 32 DEATHS—All Causes Male Female Total Death Rate (Crude) 9.40 426 422 848 (Comparable Rate 10.05) DEATHS—Special Causes Puerperal Causes Nil Tuberculosis (all forms)18 Tuberculosis, Pulmonary 16 Cancer (all ages) 159 Measles (all ages) Nil Whooping Cough (all ages) 2 Diarrhoea (under 2 years of age) 2 Influenza 15 "These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 14 DEATH RATES Infanta under 1 year of age All infants per 1,000 live births 18.10 Legitimate Infants per 1,000 legitimate live births 16.60 Illegitimate Infants per 1,000 illegitimate live births 53.50 Others Puerperal Causes (per thousand total births) Nil Tuberculosis (all forms) per 1,000 population 0.19 Tuberculosis, Pulmonary per 1,000 population 0.17 Cancer per 1,000 population 1.76 Common Infectious Diseases per 1,000 population 0.04 Influenza per 1,000 population 0.16 MARRIAGES. Mr. J. Abercrombie, 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 during 1953. The total of 779 gives a marriage rate of 17.20, an increase of 1.4 over the previous year. The following table shows these particulars giving the number of marriages in the Borough for each year since 1938 :— Year Churches of England Chapels and Roman Catholic Churches SuperintendentRegistrar's Office Total Approximate Population Greenwich Charlton and Kldbrooke St. Nicholas 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 1047 192 160 13 93 318 776 82,230 1948 202 152 8 104 345 811 84,410 1949 184 129 10 no 272 685 87,680 1950 206‡ 121 6 74 245 652 89,570 1951 210 133 3 60 264 670 89,390 1952 191 144 4 102 279 720 90,880 1953 221 136 4 113 305 779 90,440 t Parish Church destroyed by enemy action. St. Peter's, Creek Road 1 Holy Trinity, Blackheath HILL Closed 15 METEOROLOGICAL OBSERVATIONS—1953 I am indebted to the Director of the National Maritime Museum and, in particular, to Eng. Commander H. O. Hill, R.N., for the following meteorological data for the year ended December, 1953 :— Temperature : The highest screen temperature 89°F. on 12th August. The temperature exceeded 80°F. on 25th May (84°F.) 11th Aug. (81 °F.) 12th Aug. (89°F.) The lowest screen temperature was 23°F. on 7th February (but no observations were taken from 17th-30th Nov.) The maximum temperatures during January, February, November and December were : 53°F. on 28th January 58°F. on 25th February 58°F. on 8th, 9th, 13th & 14th November (but no observations were taken from 17th-30th November) 60°F. on 4th December Sunshine : Total hours recorded 1,442.4 The sunniest day was 24th July, when 14.1 hours of sunshine were recorded. There were 95 days when no sunshine was recorded, viz :— January 24 days February 8 ,, March 5 „ April 3 „ May 1 June 3 „ July 2 „ August 0 „ September 0 ,, October 16 ,, November 12 „ December 21 ,, Rainfall: Total for the year 20.77 ins. Highest in 24 hours 1.30 ins. on 12th October Driest month March (0.50 inches) Wettest month July (4.51 „ ) 16 BIRTHS The total number of live births registered in the Borough during the year was 1,426 and of this number, 1,001 occurred in St. Alfege's Hospital, 76 in various Nursing Homes and 349 in private dwellings. In 593 cases the parents resided outside the Borough and the births were consequently transferred to the appropriate districts, leaving a figure of 833. To this must be added 548 births belonging to the Borough which took place in Institutions outside the Borough, thus making a final figure for Greenwich of 1,381, an increase of 82 over that of the previous year. Of this total 741 were males and 640 females. The following table gives, by districts, the number of registrations of Greenwich Births during the current year :— of Information DISTRICT Total Greenwich Births East West St. Nicholas Charlton & Kidbrooke Greenwich Registrar's Returns :— 287 183 67 296 833 Inward Transfers :— 1st Qtr. 45 9 — 81 135 2nd Qtr. 50 14 1 74 139 3rd Qtr. 41 17 — 78 136 4th Qtr. 48 14 1 75 138 Totals 471 237 60 604 1,381 The Birth Rate for the year, calculated on the figure of 1,381 births, is 15.32 per thousand of the population, 0.98 higher than that for 1952. The average rate for the previous ten years is 18.65. The Greenwich Comparability Factor for births is 0.93 which gives an adjusted rate of 14.25. The Rates for the County of London and England and Wales are 17.5 and 15.5 respectively. Illegitimate Births numbered 56 (representing 4.0 per cent, of the total live births) thus showing a decrease of 7 from those of the previous year. The number of Still Births registered was 32 (14 males - 18 females), which is equivalent to a rate of 22.64 per 1,000 total births, an increase of 5.25 over that of the previous year. No. in Short List. Causes of Death Sex Deaths at subjoined Ages of " Residents," whether occurring within or without the District. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and under 75. 75 and over. All Causes M 426 14 6 4 4 26 127 128 117 F 422 11 2 2 3 15 83 113 193 1 Tuberculosis, Respiratory M 14 ... ... ... ... 2 8 3 1 F 2 ... ... ... ... 1 ... 1 ... 2 Tuberculosis, Other M 1 ... ... ... ... 1 ... .... ... F 1 ... ... ... ... 1 ... ... ... 3 Syphilitic Disease M 3 ... ... ... ... ... 1 2 ... F ... ... ... ... ... ... ... ... ... 4 Diphtheria M ... ... ... ... ... .... ... ... ... F ... ... ... ... ... ... ... ... ... 5 Whooping Cough M ... ... ... ... ... ... ... ... ... F 2 2 ... ... ... ... ... ... ... 6 Meningococcal Infections M 1 ... 1 ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 7 Acute Poliomyelitis M 1 ... ... 1 ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 8 Measles M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 9 Other Infective and Parasitic Diseases M 2 ... 1 ... ... ... 1 ... ... F ... ... ... ... ... ... ... ... ... 10 Malignant Neoplasm, Stomach M 18 ... ... ... ... 1 8 7 2 F 15 ... ... ... ... ... 6 2 7 11 Malignant Neoplasm, Lung, Bronchus M 23 ... ... ... ... 3 12 7 1 F 4 ... ... ... ... ... 4 ... ... 12 Malignant Neoplasm, Breast M ... ... ... ... ... ... ... ... ... F 12 ... ... ... ... 3 1 4 4 13 Malignant Neoplasm, Uterus ... F 11 ... ... ... ... 1 7 2 1 14 Other Malignant and Lymphatic Neoplasms M 34 ... ... ... ... ... 17 6 11 F 42 ... ... ... ... 1 14 18 9 16 Leukaemia, Aleukaemia M 5 ... 1 ... ... 1 2 1 ... F 4 ... 1 ... ... ... ... 2 1 16 Diabetes M 1 ... ... ... ... ... ... 1 ... F 2 ... ... ... ... ... 1 ... 1 17 Vascular Lesions of Nervous System M 31 ... ... ... 1 ... 8 11 11 F 55 ... ... ... ... ... 7 15 33 18 Coronary Disease, Angina M 60 ... ... ... ... 3 20 23 14 F 44 ... ... ... ... ... 9 14 21 10 Hypertension with Heart Disease M 13 ... ... ... ... 1 1 3 8 F 15 ... ... ... ... ... 2 4 9 20 Other Heart Disease M 46 ... ... ... ... 1 7 15 23 F 68 ... ... ... 1 1 7 17 42 21 Other Circulatory Disease M 24 ... ... ... ... ... 7 10 7 F 28 ... ... ... l 1 3 7 16 22 Influenza M 6 ... ... ... ... 1 ... 2 3 F 9 ... ... ... ... ... 1 1 7 23 Pneumonia M 21 4 ... ... ... 1 4 6 6 F 12 1 ... ... ... ... 3 3 5 24 Bronchitis M 46 ... ... ... ... 1 16 15 14 F 36 1 ... ... ... 1 2 10 22 25 Other Diseases of Respiratory System M 4 ... ... ... ... ... 3 ... 1 F 4 1 ... ... ... 1 ... 2 ... 26 Ulcer of Stomach and Duodenum M 8 ... ... ... ... ... 2 5 1 F 6 ... ... ... ... ... 3 2 1 27 Gastritis, Enteritis and Diarrhoea M 3 .. 1 ... ... ... 1 1 ... F 2 1 ... ... ... ... 1 ... ... 28 Nephritis and Nephrosis M 3 ... ... ... 1 1 1 ... ... F 8 ... ... ... ... 3 4 ... 1 29 Hyperplasia of Prostate M 8 ... ... ... ... ... 1 2 5 30 Pregnancy, Childbirth, abortion F ... ... ... ... ... ... ... ... ... 31 Congenital Malformations M 6 3 2 ... ... 1 ... ... F 1 1 ... ... ... ... ... ... ... 32 Other defined and ill-defined Diseases M 21 7 ... 1 1 l 4 1 7 F 28 4 1 ... 1 ... 4 8 10 33 Motor Vehicle Accidents M 8 ... ... 1 l 2 1 2 1 F 3 ... ... 1 ... 1 1 ... 34 All other Accidents M 9 ... ... 1 1 2 1 3 1 F 3 ... ... ... ... ... ... ... 3 35 Suicide M 6 ... ... ... ... 3 1 2 F 5 ... ... 1 ... ... 3 1 ... 36 Homicide and Operations of War M ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 17 DEATHS The net number of deaths registered during 1953 was 848, of which 426 were males and 422 females, compared with last year's total of 958 comprising 534 males and 424 females. This gives a crude Death Rate for the Borough of 9.40 per thousand of the population, a decrease of 1.17 as compared with that of the previous year and a rate which is 2.50 less than the average for the last ten years, viz., 11.90. The crude Death Rate figure is slightly increased to 10.05 when the comparability figure furnished by the Registrar General for adjusting Local Deaths, is taken into account. The adjusted Death Rate is in effect a ' corrected ' Death Rate. The Registrar-General has pointed out that if the population of all areas were similarly constituted as regards the proportion of their sex and age group components, their crude death rates (deaths per 1,000 population) could be accepted as valid comparative measures of the mortalities experienced by the several populations. Populations, however, are not similarly constituted and their crude Death Rates therefore fail as true comparative mortalitity indexes in that their variations are not due to mortality alone, but arise also from differences in their population constitution. For instance a town with a population consisting of aged persons would register more deaths than one composed entirely of young and vigorous adults. Again a town containing a larger number of males than females records more deaths with a consequent higher Death Rate than one in which females preponderate. To overcome this difficulty the Registrar-General has worked out for each area in the country an adjusting factor which is termed the 'Comparability Factor' and is based on the last census population figure. The Comparability Factor for Greenwich is 1.07 and may be regarded as the population handicap to be applied which, when multiplied by the crude Death Rate for the year, modifies the latter so as to make it comparable with the country as a whole or with any similarly adjusted area. The Death Rates for the County of London and for England and Wales are 12.5 and 11.4 respectively. The inset table showing the causes of deaths at all ages has been supplied by the Registrar-General and is included in accordance with the Ministry of Health's request. In the Appendix to the Report will be found a table giving by districts, the causes of, and ages at death of residents whilst indicating the numbers actually dying in Public Institutions. 18 DEATHS IN INSTITUTIONS. The following table compares the average number of deaths of Greenwich residents in Public Institutions during the previous ten years with those of the current year :— 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 1949 942 484 1950 926 540 1951 1,002 574 1952 958 551 10 year Average 919 548 1953 847 489 AGE MORTALITY. The age mortality and the distribution of the deaths between tho different quarters of the year are shown by the following table:— Deaths 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Under 1 year of age 5 9 7 3 24 Between 1 and 2 years 2 — 1 — 3 Between 2 and 5 years 2 — 1 2 5 Between 5 and 15 years — — 4 2 6 Between 15 and 25 years — 1 2 4 7 Between 25 and 45 years 14 11 10 7 42 Between 45 and 65 years 70 47 41 52 210 Between 65 and 75 years 91 47 45 59 242 75 years and upwards 122 68 53 65 308 Totals 306 183 164 194 847 The first quarter of the current year produced over 36% of the year's total deaths and although a trend of this nature is normal there was an exceptional increase in deaths from respiratory and circulatory diseases especially among the older people. This was in all probability an aftermath of the December ' smog ' of 1952. 19 The 1949 Report of the Royal Commission on Population indicated inter alia the trend during recent years towards an ageing population and, as one would expect, the number of deaths in the older groups increases at approximately a similar rate. Conversely, the deaths in the lower age groups show a remarkable decline since the beginning of the century. It will be observed from the following table that during 1953 the deaths occurring at 65 years and upwards accounted for 64.9% of the total compared with a figure of 22.8% for 1901. Deaths in the age group 0-5 years show an even more striking comparison: in 1901 the deaths in this group amounted to 37.4% whilst the figure for the current year is 3.7%. Age Group 1901 1911 1921 1931 1951 1953 Under 1 year of age 362 306 175 97 29 24 Between 1 and 5 years 187 158 80 39 7 8 Between 5 and 15 years 64 67 58 22 10 6 Between 15 and 25 years 66 60 67 65 12 7 Between 25 and 65 years 454 474 466 382 311 252 65 years and over 335 356 387 529 633 550 Totals 1,468 1,421 1,243 1,134 1,002 847 MATERNAL MORTALITY There were no deaths from Puerperal Sepsis or other Maternal causes during the current year compared with 3 recorded for 1952. Four deaths were registered for the year 1951 and the corresponding figures for 1950, 1949, 1948 and 1947 were 0, 1, 2, and 4 respectively. INFANTILE MORTALITY The Infantile Mortality Rate, measured by the deaths of children under one year of age to the number of live births registered was 18.10 per thousand live births as compared with 14.62 for the previous year. For the County of London the rate was 24.8 and for England and Wales 26.8 per 1,000 related live births. The present rate of 18.10 although very satisfactory, shows an increase of 3.48 over that of 1952. Nevertheless the current year is the second in the history of the Borough to yield a rate below 20, a figure once considered an irreducible minimum. The total number of deaths during the year was 24, an increase of 5 over that of 1952. Due to a mechanical error in computation 20 the Registrar General has allocated to this Borough a total of 25 infant deaths, one more than actually occurred. The error was revealed too late to allow of alteration in the official figure but timelv correction would have produced an Infantile Mortality Rate of 17 33. The deaths of the 24 infants were attributed to the following causes:— Prematurity 5 Gastro-enteritis 1 Broncho-pneumonia 5 Emphysema (staphylococcal) 1 Congenital Malformation 4 Intussusception 1 Whooping Cough 2 Kernicterus 1 Meningitis 1 Birth Injury 1 Bronchitis 1 Other Causes 1 Of the above, 13 were male and 11 female : 9 died in St. Alfege's Hospital, 3 in Brook Hospital, 8 in other Hospitals and 4 at home. Neo-Natal Mortality.—Neo-natal mortality, i.e., infants dying before attaining the age of one month, accounted for 12 deaths, equivalent to 50% of all infant deaths and giving a Neonatal Mortality Rate of 8.68 per 1,000 live births. Nine of these neo-natal deaths occurred within the first week of birth, the main cause being Prematurity. A table showing the causes of and ages at death is included in the Appendix to the Report. The following table shows the comparative Infantile Mortality Rate for the quinquennial periods since 1931, together with the Rate for 1953 :— District Average for five years 1931-1935 Average for five years 1936-1940 Average for five years 1941-1945 Average for five years 1946-1950 Year 1953 Greenwioh 75 50 40 27 18.1 London 63 56 60 33 24.8 England & Wales 62 55 50 36 26.8 Bad housing, overcrowding, poor sanitation, low standards of education, all tend to produce higher Infant Mortality Rates. It 21 follows therefore, that the Infant Mortality Rate should provide a good index to the social circumstances of any particular area. However, Infant Mortality Rates, which are based on the number of births occurring in the same year as the infant deaths are not comparable year by year unless the birth rates remain more or less constant because approximately one-third of the infants dying in any one year will be found to have been born in the previous year. Further, it must be borne in mind that when dealing with 6mall figures the slightest deviation in the number of deaths tends to misleading fluctuations in the rate. Consequently care must be exercised when drawing conclusions from any rise or fall in Infant Mortality Rates. REMARKS ON VARIOUS DEATH CAUSES. Recognising the importance of ensuring as far as possible the uniformity and comparability of statistics in relation to diseases and causes of death, the Registrar-General has, from 1st January, 1950, implemented the Nomenclature Regulations, 1948, as suggested by the World Health Organisation. Although these regulations are not binding on Medical Officers of Health, it is essential that the International Statistical Classification of Diseases, Injuries and Causes of Death, 1948, should be adopted in order that local statistics can be compared with national figures and national with international. Classification of Deaths.—It should be borne in mind that the statistical data compiled locally relating to cause of death may not entirely agree with the figures furnished to Local Authorities by the Registrar-General. Classification of the cause of death is taken from one or more causes as stated on the medical certificate in accordance with the rulos 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 possibilities of discrepancies in some cases botween the figures prepared locally and those referred by the Registrar-General. Common Infectious Diseases.—This classification comprising Measles, Scarlet Fever, Diphtheria, Whooping Cough and Diarrhoea was responsible for 4 deaths giving a rate of 0.04 for the current year. 22 There were no deaths from Common Infectious Diseases during 1952 but 3 were recorded for 1951, 3 for 1950, 2 for 1949 and 4 for 1948. Smallpox.—No deaths from Smallpox have been recorded during the year, this year being the 51st since a death from this disease occurred. Measles.—There were no deaths arising from this cause dining the year—a similar return to that of the previous year. No deaths have been recorded since 1947 when there was one. Scarlet Fever.—For the seventh year in succession there were no deaths attributed to this cause. One was recorded in 1946, none in 1945 and one in 1944. Whooping Cough.—Two deaths were credited to this cause during the current year in comparison with none for the previous year. One death was registered for each of the years 1947,1948,1949, 1950 and 1951. Enteric Fever.—There were no deaths arising from this cause during the year and none has been recorded since 1941. Only 3 deaths from Typhoid Fever have been registered during the last twenty years. Diarrhoea and Zymotic Enteritis.—Two deaths were stated as being due to this cause, equalling a Death Rate of 0.02 per thousand. Last year there were no deaths recorded from this cause, although 2 were registered during 1951 and also during 1950. Diphtheria.—Again it is gratifying to report that there were no deaths from Diphtheria during the year under review and that it is now 7 years since one was recorded. Tuberculosis.—There were 18 deaths from this disease during the year giving a Death Rate of 0.19 compared with 32 deaths and a Rate of 0.35 for the previous year. Again this year's Rate compares very favourably with the average T.B. Death Rate during the previous 10 years, viz : 0.75. Current figures throw into relief the remarkable improvement in the Tuberculosis situation in the Borough during the past 10 years. Actual deaths from Tuberculosis are less than one third 23 and the rate is one fifth of the corresponding figures for 1943 as the following table will indicate :— Year No. of Deaths Rate 1943 60 0.94 1944 50 0.81 1945 53 0.82 1946 75 0.97 1947 69 0.82 1948 62 0.73 1949 46 0.53 1950 44 0.49 1951 35 0.39 1952 32 0.35 10-year Average 52 0.68 1953 18 0.19 Tuberculosis of the Respiratory System is, as usual, credited with the major portion of these deaths, there being 16 attributed to the cause, equalling a Rate of 0.17 as compared with 0.32 for the previous year. Locally the deaths were : 3 in East Greenwich ; 4 in West Greenwich ; 3 in St. Nicholas, Deptford ; and 6 in Charlton and Kidbrooke. The remaining forms of Tuberculosis were responsible for 2 deaths, 1 of which occurred in East Greenwich and 1 in West Greenwich. Cancer.—Cancer is generally considered to be a disease of middle and old age and, as indicated in my Annual Report for 1950, as the proportion of middle-aged and elderly persons in the population becomes greater, one would normally expect a rise in the incidence of this disease. In addition, improved diagnosis and more accurate certification will effect an apparent rise in the number of cancer deaths. An increase in numbers therefore, is not, per se, necessarily an indication of increased morbidity. Cancer was responsible for a total of 159 deaths giving a rate of 1.76 per thousand, these figures showing a decline of 2 and 0.01 respectively from those of the previous year. The total indicates that approximately one in every five deaths resulted from cancer of one form or another. Since 1901 the yearly percentage of cancer deaths has risen from 4.2 to 18.8, the figure for 1953. 24 The distribution of the 1953 deaths was as follows : 55 in East Greenwich, 30 in West Greenwich, 9 in St. Nicholas, Deptford and 65 in Charlton and Kidbrooke. Comparing the current year's figures with those of the previous 3 years, the sites of the affected parts were :— 1950 1951 1952 1953 Cancer of Stomach 30 24 24 33 „ „ Lung, Bronchus 26 51 31 27 „ „ Breast 12 14 11 12 ,, „ Uterus 7 11 6 11 „ ,, all Other Sites 92 98 89 76 Totals 167 198 161 159 Throughout the country in recent years there has been a tendency for cancer of the lung to increase and the following table has again been included in order that the trend in this Borough may be studied :— DEATHS FROM CANCER OF LUNG (including Bronchiogenic Carcinoma) Year AGE GROUPS Totals Grand Totals Rate per 1,000 Pop. 25 and under 45 yrs. 45 and under 65 yrs. 65 and under 75 yrs. 75 and upwards M F M F M F M F M F 1946 2 — 12 1 1 — 1 — 16 1 17 0.22 1947 2 — 13 — 8 1 1 — 24 1 25 0.30 1948 1 — 18 1 6 1 1 — 26 2 28 0.33 1949 1 — 11 3 10 1 3 1 25 5 30 0.34 1950 1 1 14 3 5 3 1 1 21 8 29 0.32 1951 1 — 26 3 15 — 3 3 45 6 51 0.57 1952 2 — 15 2 9 1 1 1 27 4 31 0.34 1953 3 — 12 4 7 — 1 — 22 5 27 0.29 Totals 13 1 121 17 61 7 12 6 206 32 238 Average for 8 yrs. 0.27 26 The age group 45 to 65 years still proves to be the period of greatest mortality and it is relevant to point out that the proportion of female to male deaths from this cause is rising in the Borough. In 1946 the ratio was 1 female death for every 16 males ; the corresponding figures for the current year are 1 female for every 4 males. Once again I must reiterate that many misconceptions regarding Cancer exist in the minds of the public, e.g., that Cancer is an hereditary disease ; that it is infectious or contagious ; or that chronic irritation or inflammation causes Cancer. Not one of these assumptions has been proved scientifically. Moreover, it is becoming more evident that under certain conditions Cancer is a curable disease but at the moment the most important factor is time. Unfortunately, many cases are beyond cure before advice is taken. At the risk of producing a few hypochondriacs it is obvious that greater efforts must be made to educate the public because the latest available information supports the fact that delay in seeking medical advice is becoming more prolonged. Vascular Lesions of Nervous System.—This class, which includes deaths arising from Cerebral Haemorrhage, Embolism and Thrombosis, was responsible for a total of 86 deaths. The age distribution was as follows:—1 between 15 and 25years; 15 between 45 and 65 years ; 26 between 65 and 75 years and 44 from 75 years upwards. Heart Disease.—Under the new classifications this disease has been divided into three sub-headings: (a) Coronary Disease, Angina, (b) Hypertension with Heart Disease, and (c) Other Heart Disease. The total deaths occasioned by these amounted to 246 compared with a figure of 287 for 1952 and, as usual, the deaths from this class occupied the principal place in the classification of diseases Diseases of the Respiratory System.—There were altogether 123 deaths from these diseases, Bronchitis accounting for 82 and Pneumonia (all forms) for 33. Of the total deaths, 7 were of children under one year of age and 84 were in respect of persons 65 years and over. Influenza.—Fifteen deaths were attributed to this cause during the year, thus showing an increase of 14 from that of the previous year. Thirteen of these deaths occurred in people over the age of 65 years. 26 Deaths feom Violence.—These numbered 34 including 11 from Motor Vehicle Accidents, 11 from Suicide and the remainder being accounted for under the heading of 'All Other Accidents.' Deaths from Motor Vehicle Accidents show an increase of 5 over those of the previous year, while suicide shows an advance of two. Much has been made, in recent times, of the serious nature of the increase in deaths due to cancer and heart disease but there has often been a tendency for the case, important though it undoubtedly is, to be overstated. From a national and economic standpoint the child who is killed in a road accident is a greater potential loss to the community than a person of over 65 years of age who dies from cancer or a heart disability. Recently, Dr. D. J. R. Snow, Epidemiologist to the Department of Public Health for Western Australia analysed vital statistics with a view to determining the number of 'useful years lost' for each of the major causes of death and his investigations revealed that on this basis 'automobile and other accidents' head the list as the primary cause of premature death with cancer and coronary disease in 3rd and 5th places respectively ; suicide occupies 7th position in this new form of classification. Observations of this nature only emphasise the necessity for even greater attention on accident prevention measures. 27 SECTION B General Provision of Health and Welfare Services for the Area. Since July, 1948, the Personal Health Services available to residents of the Borough have been under the control of the London County Council and Dr. Waldron, the Divisional Medical Officer, has kindly supplied me with information and statistics relating to Health Visitors' records, attendances at Infant Welfare Centres, Prophylaxis figures, etc., for 1953, which will be found on the following pages in table form. In addition, the following details of vitamin products distributed throughout the Borough from the Food Office and Welfare Centres during the first half of 1953 have been obtained from the returns issued by the London and South East Regional Food Office:— Vitamin Product 1st Qtr, 2nd Qtr 3rd Qtr 4th Qtr Whole Year Orange Juice (Bottles) Average weekly Issues 1,098 1,143 % of Potential 26.2% 27.5% God Liver Oil (Bottles) No longer available. Average weekly Issues 291 265 % of Potential 24.0% 21.9% See Note below. A & D Tablets (Packets) Average weekly Issues 81 88 % of Potential 33.2% 37.8% Note :—The Government's policy of concentrating the Ministry of Food offices and staff has made it impossible for quarterly statements concerning vitamin products to be prepared. As a consequence, after the second quarter of the current year, details of the average weekly issues of Orange Juice, Cod Liver Oil and A & D Tablets and their percentage of potential were discontinued. 28 Health Visitors' Records. Attendances at Infant Welfare Sessions, Prophylaxis figures, etc. 1. Health Visiting Quarter Expectant Mothers Premature Babies Still-Births Infants (under 1 year) Children 1—5 years Infantile Diseases Miscellaneous Unsuc cessful Total Visits 1st visit Revisit 1st visit Revisit 1st visit Revisit 1st visit Revisit 1st visit Revisit 1st visit Revisit March 103 210 17 24 6 - 294 837 85 1,812 320 38 335 478 4,559 June 79 122 13 18 8 1 344 837 72 1,618 133 15 424 489 4,173 Sept. 93 93 11 27 4 1 264 826 74 1,057 66 13 370 419 3,318 Dec. 94 196 12 24 5 — 300 928 53 1,304 55 23 417 504 3,915 Totals 369 621 53 93 23 2 1,202 3.428 284 5,791 574 89 1,546 1,890 15,965 2. Infant Welfare Clinics Quarter Sessions Attendances 0-1 year 1-2 years 2-5 years 1st Total 1st Total 1st Total March 204 326 4,586 12 1,180 17 1,213 June 197 329 4,998 31 1,319 32 1,148 September 208 343 5,327 11 1,307 36 1,179 December 206 271 4,851 8 1,311 11 1,022 Totals 815 1,269 19,762 62 5,117 96 4,562 29 3. Ante and Post Natal Clinics (a) Hospital Confinements Quarter Sessions Ante Natal Post Natal 1st Attendances 1st Med. Exams Total Attendances Subs. Med. Exams 1st Attendances Total Attendances Med. Exams This Year Current Pregnancy This Year Since Confinement March 101 323 244 244 674 430 46 46 47 44 June 97 210 211 211 702 482 32 32 37 33 Sept. 103 190 193 182 682 478 46 46 49 39 Dec. 101 227 226 224 725 473 37 37 37 34 Totals 402 950 874 861 2,783 1,863 161 161 170 150 (b) Domiciliary Confinements Quarter Sessions 1st Attendances 1st Med. Examinations Total Attendances Subs. Med. Exams This Year Current Pregnancy March 98 247 178 115 841 163 June 93 110 102 80 928 243 Sept. 103 141 138 103 1,060 206 Dec. 100 131 131 110 1,085 272 Totals 394 629 549 408 3,914 884 30 4. Toddlers Clinics Quarter Sessions Total Attendances Medically Examined Found to require Treatment March 24 224 220 22 June 29 266 266 36 September 32 212 193 31 December 30 200 196 33 Totals 115 902 875 122 5. Ante and Post Natal Exercise Classes Quarter Sessions Attendances First Total March 13 18 124 June 12 21 111 September 12 7 71 December 11 – 74 Totals 48 46 380 6. Children's Exercise Classes Quarter Sessions Attendances First Total March 13 1 37 June 13 5 33 September 6 2 76 December — 4 75 Totals 31 12 221 7. Sunlight Treatment Quarter Sessions Attendances First Total March 178 146 2,945 June 172 81 1,897 September 146 61 1,112 December 141 172 1,741 Totals 637 460 7,695 31 8. Chiropody Treatment Quarter Sessions Attendances First Total March 415 341 4,934 June 421 481 5,202 September 438 311 4,947 December 432 236 4,892 Totals 1,706 1,369 19,975 9. Dental Treatment Quarter Sessions Nursing & Expectant Mothers Children under 5 yrs. First Treatm'ts Total Attends. First Treatm'ts Total Attends. March 8 – 15 25 56 June 13 5 16 9 33 September 16 15 55 20 108 December 13 6 50 15 94 Total 50 26 136 69 291 10. Home Help Service (a) Analysis of Cases, etc. Cases Home Helps Maternity Tuberculosis Others Total No. Part Time Whole Time Equivalent On live Register at: 1st Jan. '53 4 27 385 416 110 50 31st Dec. '53 7 24 443 474 100 49 Cases attended during 1953:- 67 49 689 805 — — (b) Supervision Effective Ineffective Total Visits made by Organising Staff: 1,710 270 1,880 11. Prophylaxis Cases receiving completed prophylactic treatment during year:— Diphtheria Immunisation 889 Whooping Cough Immunisation 501 Vaccination 663 32 12. District Nursing The staff of the Queens District Nursing Association for Charlton and Blackheath made 18,434 visits during the year. Visits carried out by the Ranyard Nurses were additional to those quoted above. 13. School Health Service Vision Nutrition Special Investigation Clinic No. of Attendances 733 154 121 No. of New Cases 496 17 25 No. of Glasses Ordered 197 - - Note : As appropriate children from Greenwich also attend special clinics in Deptford and Woolwich. 33 TREATMENT CENTRES AND CLINICS Particulars relating to the local Health Services throughout the Borough are given below:— INFANT WELFARE CLINICS DAY A.M. P.M. Bardsley Lane, S.E.10. Thursday 1.30 Blackheath Hill, S.E.10 Thursday 1.30 Charlton Lane, S.E.7. Tuesday 9.30 Thursday 1.30 Chevening Road, S.E.10 Wednesday 9.30 Thursday 9.30 Friday 1.30 Creek Road, S.E.8. Monday *9.30 Friday 1.30 Fairfield House, S.E.7. Monday 9.30 Wednesday 9.30 1.30 Friday 1.30 (Toddlers) Ridgebrook Road, S.E.3. Tuesday 9.30 1.30 (Toddlers) Shooter's Hill Road, S.E.3. Monday 1.30 Tuesday 1.30 Wednesday 9.30 Thursday 1.30 *Including Children's Exercise Class. ANTE & POST NATAL CLINICS Note : (a) Doctor in attendance (b) Midwife in attendance Blackheath Hill, S.E.10. Monday 1.30 (ab) Charlton Lane, S.E.7. Friday 1.30 (ab) Chevening Road, S.E.10. Monday 1.30 (ab) Creek Road, S.E.8. Tuesday 1.30 (ab) Wednesday ((a) 1st and 3rd) l.30(b) Fairfield House, S.E.7. Thursday 1.30 (ab) Ridgebrook Road, S.E.3. Thursday ((a) alter, weeks) 1.30 (b) 1.30 (b) Shooter's Hill Road, S.E.3. Friday 1.30 (ab) 34 ARTIFICIAL SUNLIGHT TREATMENT DAY A.M. P.M. Chevening Road, S.E.10 Wednesday 9.30 1.30 Creek Road, S.E.8. Tuesday 9.30 Thursday 9.30 Fairfield House, S.E.7. Monday 1.30 Wednesday 1.30 Shooter's Hill Road, S.E.3. Tuesday 9.30 Thursday 1.30 FOOT CLINICS (2/6 per treatment—by appointment only) Chevening Road, S.E.10 Monday 9.30-12.30 1.30-4.30 Tuesday 9.30-12.30 Wednesday 9.30-12.30 1.30-8.00 Thursday 1.30-8.00 Friday 9.30-12.30 1.30-4.30 Saturday 9.30-12.30 Fairfield House, S.E.7. Monday 9.30-12.30 1.30-4.30 Tuesday 1.30-8.00 Wednesday 9.30-12.30 1.30-4.30 Thursday 1.30-8.00 Friday 9.30-12.30 Saturday 9.30-12.30 Shooter's Hill Road, S.E.3. Monday 1.30-8.00 Tuesday 9.30-12.30 1.30-4.30 Wednesday 9.30-12.30 1.30-4.30 Thursday 1.30-8.00 Friday 9.30-12.30 1.30-4.30 Saturday 9.30-12.30 St. Alfege's Hospital S.E.10... Wednesday 10 - 1 Friday 2 - 5 (Diabetic Patients) IMMUNISATION AND VACCINATION CLINICS Chevening Road, S.E.10 Friday 9.30 Fairfield House, S.E.7. Monday 1.30 Shooter's Hill Road, S.E.3. Wednesday 1.30 35 CHEST CLINICS (By appointment only). DAY A.M. P.M. Maze Hill, S.E.10. Monday 2.00 Tuesday 10.00 2.00 Wednesday 10.00 (men) (Special A.P. 2.00 (women) Clinics) Thursday 10.00 5 - 8.30 (workers only) Handicraft Centre Wednesday 2.15 - 4.15 Friday 2.00 - 4.00 DENTAL CLINIC Shooter's Hill Road, S.E.3 Mon.-Fri 9.30 1.30 Saturday 9.30 SCABIES & CLEANSING CLINICS Tunnel Avenue Daily (Saturdays excepted) 9 - 12 (School Children) 2 - 4 (Adults and Children under school age) WOMEN'S SPECIAL CLINIC (Family Planning Association) Charlton Lane, S.E.7. Wednesday 2.00 MARRIAGE GUIDANCE CENTRE (Temporarily Suspended) Shooter's Hill Road, S.E.3 Friday 7.30 MINOR AILMENTS CENTRES (for School Children) Chevening Road, S.E.10. Mon-Fri 1.30 Saturday 8.30 Kidbrooke Park School, S.E.3. Mon-Fri 8.30 1.30 Saturday 8.30 Maryon Park School Treatment Centre, S.E.7. Mon-Fri 8.30 Saturday 8.30 Sherington Road Treatment Centre, S.E.7. Mon-Fri 8.30 1.30 Saturday 8.30 OPHTHALMIC CLINIC (for School Children) Chevening Road, S.E.10 Friday 2.00 36 SPEECH THERAPY (for School Children) Fairfield House, S.E.7. DAY A.M. P.M. Wednesday 1.30 NUTRITION & SPECIAL CONSULTATIVE CLINIC (for School Children Chevening Road, S.E.10. Tuesday 1.30 HOME HELP SERVICE Applications for this service to be addressed to:— Divisional Medical Officer London County Council, Greenwich Sub-Office, 105, Shooter's Hill Road, S.E.3. DISINFECTING STATION Applications to Medical Officer of Health, Public Health Department, Town Hall, S.E.10. HOSPITALS Brook Hospital (WOOlwich 1172) Miller Hospital (TIDeway 1136) Royal Herbert Hospital (WOOlwich 1166) St. Alfege's Hospital (GREenwich 2655) Seamen's Hospital (GREenwich 3433) NURSING ASSOCIATIONS. Queens District Nursing Association for Blackheath & Charlton, 78, Elliscombe Road, S.E.7. (Tel. GRE. 1675). Ranyard Mission, Ranyard House, 11, Taviton Street, W.C.I. (Tel. EUSton 5507). Nursing Sisters of St. John the Divine, Watson Street, S.E.8. OTHER ORGANISATIONS. British Rod Cross Society, Mrs. E. M. Wigley, Divisional Director, 46, Vanbrugh Park, S.E.3 (Tel. GRE. 0157). Citizens' Advice Bureaux, 71, Rectory Place, S.E.18 (WOOlwich 0047). 173, Walworth Road, S.E.17. (RODney 2860). Family Welfare Association. Area 6, (Deptford, Greenwich and Lewisham), 49, Rushey Green, S.E.6. (HITther Green 1630). Women's Voluntary Services, Mrs. F. Kidd, 64B, Hyde Vale, S.E.10. (Tel. TID. 3708). REGISTRATION OF BIRTHS, DEATHS AND MARRIAGES. 9 a.m. to 12 noon Town Hall, S.E.10. Mon - Fri 2p.m. to 4.30 p.m. Fri. 5 p.m. to 7 p.m. Sat. 9 a.m. to 11 a.m. 37 SECTION C Sanitary circumstances of the Area The tables on pages 62 to 64 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 16,443 houses and premises have been inspected or re-inspected during the year; 918 intimation notices and 149 statutory notices were served. Registered complaints, numbering 1,203, show a fall of 29 from those of the previous year, but again this total is greatly in excess of the pre-war average of 700. Repeatedly in the post war years it has been pointed out in this Report that, as a means of improving sub-standard houses, the use of Section 9 of the Housing Act, 1936, has virtually been prohibited by the rising costs of labour and materials and that although insanitary conditions are remedied, mainly by the application of the Nuisance sections of the Public Health Act, this seldom provides adequate or complete repair. Representations on these lines have been made from time to time by Local Authorities to the Minister of Housing and Local Government emphasising also the need for legislation in order to overcome obstruction to the satisfactory repair of dwelling houses occasioned by the Rent Restrictions Acts. Presumably as a result of these official expostulations the Government, at the close of the current year, produced a white paper ' Houses, the Next Step ' which will shortly be translated into some tangible form of legislation affording, it is hoped, means whereby Local Authorities may be enabled to alleviate the extremely serious and difficult housing situation. 38 Should this enactment prove efficacious then the district Sanitary Inspector's time will no longer be spent primarily in routine complaints and re-visits but rather in the more necessary preventive functions. 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 these 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 433 inspections were made by the Council's Inspectors in relation to the 379 registered factories. The latter figure includes 67 premises where mechanical power is not used. Defects were found in 39 instances, all of which were remeelied. 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 67 59 2 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 300 325 4 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 12 49 — — Total 379 433 6 — 39 Cases in which defects were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Reforred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l.) 17 17 1 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) 4 4 — — — Ineffective drainage of floors(S.6) 2 2 — — — Sanitary Conveniences (S.7) (a) insufficient (6) unsuitable or defective 8 8 — — — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 8 8 1 — Total 39 39 2 — — 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. 57 — — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 2 — — — — — Lampshades 36 — — — — — Flower Mounting (Art Shop) 1 — — — — — Total 96 — — — — — Outworkers. Twice yearly, February and August, the Factory Act requires all employers of outworkers to forward to the 40 Local Authority a list giving the names and addresses of all employed in homework during the previous six months. Notifications received from Greenwich firms of:— (a) Outworkers resident in the Borough 12 (b) Outworkers resident outside the Borough 32 Notifications received from firms outside the Borough of:— Outworkers resident in the Borough 227 Total number of Greenwich residents employed as outworkers (as given in August list) 96 Premises where homework is carried on were visited on 164 occasions by the Lady Sanitary Inspector. In no instance was it necessary to take action because of infectious disease. Thames Flooding.—A high tide in the early hours of Sunday, 1st February, caused the North Sea to break through the coast defences and to inundate parts of the East Coast bringing about much damage and loss of life. This same tide caused the Thames to overflow at various places and damage to property and personal effects was sustained by some riverside areas of this Borough. Damage was largely confined to industrial premises but in the Creek Road area the waters broke through the General Steam Navigation Co's berth at the Stowage, overflowed across the vacant site adjacent to No. 105 The Stowage, found their way into the gardens of Creek Road where their force broke down garden walls, sheds, back doors and windows and finally flowed through the passages flooding basement rooms, putting out of action the gas and electricity services. This latter eventuality necessitated the introduction of emergency feeding services which were put into operation on the same day. Minor damage was reported from Kirkland Place ; Wardell House, Thames Street; Skinner's Row, and cellars in the Crane Street area. Dwellings in the Stowage were flooded to a depth of from 1 to 3 feet but in the Creek Road area, which suffered most of all, the waters rose to a height of 5 feet in the basements and when the L.C.C. Fire Brigade had pumped away the water a film of slime covered the debris, rooms and furniture. On the following morning (Monday) the Public Health Depart0ment concentrated on the urgent task of collecting the various soiled articles such as blankets, sheets, beds, cushions, etc., which were washed and dried at the Greenwich and Deptford Councils' Baths. Arrangements were also made by the Public Health Department for householders to have their soiled linen washed free of charge at the 41 Greenwich Public Baths and appreciation was expressed by the persons availing themselves of this service. In two cases of exceptional circumstances permission was given for the washing to be carried out by a Laundry, the cost being borne by the Mayor's Flood Relief Fund. Three mattresses were loaned to persons in need, while the offer of a double bedstead, spring and mattress was accepted and the articles given to a local victim. Emergency repairs were carried out to doors and windows and all premises and debris contaminated by mud from the Thames were immediately sprayed with a germicide, the spraying being repeated every other day. Later floorboards were lifted and sites were sprinkled with hydrated lime as often as proved necessary. Further treatment was given by the means of an R.A.F. Ground Heater which was obtained from the Minister of Housing and Local Government who, at that time, had been given temporary command of such apparatus. The Ground Heater consisted of a container heated by petrol pressure burners over which air was drawn by induction fans. When heated to approximately 400°F. the air was then pumped through large asbestos ducts into the rooms and basements of premises and each affected house was treated for a half day or more according to necessity. Finally arrangements were made for the rubble and debris to be cleared from the gardens. River Pollution.—From time to time over the past few years and in common with other Riparian Authorities, complaints have been received in connection with offensive smells emanating from the River. It has been confirmed that by far the greatest cause of this nuisance arises from the continual movement, up and down stream with the tides, of a permanent concentration of inadequately treated sewage effluents discharged at the Northern and Southern Outfalls situated at Beckton and Crossness respectively. In the 1952 Report a detailed list was given of the fairly extensive work contemplated by the London County Council which, in their opinion, would enable the sewage at both outfalls to receive efficient sedimentation and for two-thirds of the effluents to be further purified by the activated sludge process in order to render the River inoffensive from this source of pollution. Before the new scheme for diffused air and sludge digestion plant could be commenced it was necessary for 16 new sedimentation tanks to be completed, but owing to the steel shortage work on these 42 tanks was delayed and completion, originally planned for 1953, is now not expected until 1954. However, the Minister of Housing and Local Government has intimated that in order to minimise delay he would be prepared to authorise the commencement of the new scheme during 1954. Atmospheric Pollution.—As an outcome of the four-day smoke fog of 1952 the Beaver Committee, a Government Committee on Air Pollution, was set up and is now in process of sifting information and evidence obtained from various interested organisations. It is all too obvious that despite the catastophe of 1952, when some 4,000 people in the London area died as a result of " smog," the public's outlook regarding smoke abatement has not materially changed and it is clear that neither publicity nor the threat of illhealth has served to improve the situation. Inducement and cajolery having failed to mitigate this smoke nuisance, the indications are that amelioration is only to be achieved by some measure of legislative discipline. Existing smcke-abatcment legislation is rapidly becoming known as " stable-dcor control " in that action can only be taken after the nuisance has been committed, whereas fundamentally the aim should be elimination. In other spheres of environmental hygiene, such as factories, housing, food, etc., a substantial improvement can be noted in the standard of legislative control, with which the present position concerning anti-pollution of the atmosphere compares most unfavourably. Certain authorities with sufficient financial resources have managed to negotiate private Acts, but these are in the minority and in the main, reliance has to be on bye-laws which are notable not only for their brevity but also for the fact that they are concerned merely with the limiting of smoke and not at all with the domestic fire. This method of cont rolling or eliminating atmospheric pollution is in direct contrast with that prevalent in parts of the United States, where municipalities are free to legislate for their own particular problems including those arising from domestic smoke. In many instances the installation of fuel-burning appliances is permitted only in accordance with stringent "prior approval" conditions, offences against which can lead to the " sealing " of the offending plant. While not claiming that these methods are ideal, the American system does give effective control of air pollution at source, which, after all, is the essence of the problem. 43 In England some efforts have been made to control atmospheric pollution by the setting up of " smokeless zones " and in certain areas some authorities are in favour of letting their flats and houses only on condition that tenants use nothing but smokeless fuel. However, the control or elimination of smoke will not completely solve the problem, for much of the damage to health and property is probably due to concentrations of transparent or odourless gases which in themselves may constitute a much more difficult obstacle to surmount. From the very considerable mass of evidence obtained in response to its questionnaire the Beaver Committee may be able to produce a document upon which legislation of a sort that will be both practicable and expeditious may be based, but this would appear to be a rather optimistic view. Everyone is agreed that this atmospheric pollution is a threat to health and destructive to property, but sufficient data which can stand the test of legal investigation has yet to be obtained. Greenwich is fortunate in that a Government Fuel Research Station comprising a section dealing with atmospheric pollution is established in the area and I am indebted to Dr. Wilkins, Officerin-Charge of the latter department for permission to make use of data compiled at the Station. Observations concerning rainfall, deposited matter and sulphur dioxide are given in Table I. The deposited matter, expressed in tons per square mile, is divided into total soluble and total insoluble deposit. The sulphur dioxide figures give a rate of sulphation as measured by the lead-peroxide instrument and are expressed in milligrammes of SO3 per day per 100 cm2. In Table II, smoke is expressed as milligrammes per 100 cubic metres and sulphur dioxide as parts per 100 million parts of air. One part of SO2 per 100 million parts of air is equivalent to approximately 2.86 milligrammes of SO2 per 100 cubic metres. TABLE I.—Rainfall, Monthly Deposit in Tons per Square Mile and Sulphur Dioxide by the Lead-Peroxide Method. Month & Year Rainfall mm. Insoluble Deposit tons Soluble Deposit per square Total Solids mile SO3 mg./day/lOO cm2 of Batch A Lead Peroxide October 1952 68 35.30 11.24 46.54 2.20 November ” 88 61.62 16.32 77.94 * December ” 66 41.83 16.18 58.01 3.02 January 1953 10 19.43 5.21 24.64 2.08 February ” 40 40.74 9.92 50.66 1.88 March ” 14 19.43 16.16 35.59 4.69 April ” 67 29.24 12.16 41.40 3.14 May ” 28 27.06 7.03 34.09 2.81 June ” 31 26.84 20.86 47.70 2.79 July ” 91 21.35 9.53 30.88 2.51 August ” 69 30.65 11.15 41.80 * September ” 52 26.49 10.02 36.51 2.98 October ” 74 35.89 11.84 47.73 3.77 November ” 48 25.96 7.40 33.36 3.41 December ” 15 36.19 16.44 52.63 4.01 January 1954 28 41.04 12.04 53.08 5.30 February „ 56 41.30 9.59 50.89 3.52 * No figures available. TABLE II.—Concentration of Smoke and Sulphur Dioxide by the Volumetric Method. Month - Year Smoke mg/100m3 Sulphur Dioxide p.p 100 million Monthly Average Highest Daily Average Monthly Average Highest Daily Average October 1952 21.4 80.3 7.8 21.4 November ,, 23.1 45.6 11.4 23.1 December „ 43.0 206.0 16.2 71.5 January 1953 35.2 107.6 13.8 46.8 February „ 22.6 77.4 11.0 26.4 March „ 24.0 78.0 15.0 50.2 April „ 8.4 17.0 7.5 17.8 May „ 5.7 12.7 3.6 6.4 June „ 4.3 7.8 2.9 6.7 July „ 2.7 4.8 1.2 2.4 August „ 3.9 6.9 2.3 7.1 September „ 6.6 13.4 5.2 8.7 October „ 14.5 27.8 10.6 12.7(a) November ,, 20.2 88.5 3.1 12.5 December „ 20.8 36.5 8.5 13.3 January 1954 18.8 41.0 10.6 17.8 February „ 16.9 35.9 11.0 19.9 (a) SO2. No observations 1st, 4th and 5th October. 44 45 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 specifiying the defect 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 noncompliance the Town Clerk is instructed to institute proceedings. (2) Sanitary defects due to depreciation of property.—Nowadays, depreciation of property can usually be traced to the owners' inability to carry out repairs during the war period. A Notice is served on the owner by the Sanitary Inspector for the defects to be remedied. Expenditure to the extent of £1,000 is allowed per house or unit but over and above this amount a licence is required. (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 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. 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 8 ; these have been visited by the Lady Sanitary Inspector on 25 occasions. Rent and Mortgage Interest (Restrictions) Acts, 1920/39. —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 46 suspend the payment of increased rent until the necessary works shall have been completed to the satisfaction of the Sanitary Authority. Landlords may also apply to the Sanitary Authority for a report to the effect that necessary works have been executed to the satisfaction of the Council. All applications whether for certificates or reports must be accompanied by the statutory fee of one shilling. During the current year there were no applications either for certificates or reports. The Heating Appliances (Fireguards) Act, 1952.—In pursuance of the powers conferred upon him by section five of the above Act, the Secretary of State made the Heating Appliances (Fireguards) Regulations, 1953, to come into operation on the 1st October. These Regulations require fireguards to be fitted to gas fires, electric fires and oil heaters which are so designed that they are suitable for use in residential premises and are of such a type that, without a guard there is a likelihood of injury by burning. The standards of construction and fitting for guards and the tests to be employed in ascertaining whether guards comply with those standards, are set out in the Schedule. Regulation 4 gives an exemption from the Regulations in the cases of sales for scrap. Under Regulation 5, heating appliances, other than imported appliances, manufactured before the date of the coming into operation of the Regulations and not fitted with the requisite guard may be sold or let until the end of September, 1954. Powers and duties of the Council under this Act have been delegated to the Public Health Committee and inspections are carried out by the Sanitary Inspectors. 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 chicfly relate to the Sale of Poisons used for domestic, horticultural and sanitary purposes. During the year 5 applications for licences to sell poisons under Part II were received, 66 vendors applied for retention in the Council's List and one vendor requested a substitution of registered deputy. All were duly considered and approved. Twenty inspections were carried out in accordance with the above Act. 47 Shops Act, 1950.—Under this Act, which became effective from 1st October, 1950, the Council is responsible, inter alia, for ensuring that adequate and proper sanitary accommodation and washing facilities are available at each shop in the Borough. In the event of such accommodation not being available at the premises the Council is empowered under Section 38 of the Act to grant exemption from this provision if it is satisfied that suitable facilities are readily accessible elsewhere. During the year 2 exemption certificates were granted, both in respect of sanitary accommodation. At the end of the year 17 exemption certificates were in operation. Routine inspections were carried out under the abovementioned Act on 463 occasions. Rag Flock and Other Filling Materials Act, 1951.—The introduction of tliis Act, which became operative on the 1st November, 1951, brought about the repeal of the previous Rag and Flock Acts of 1911 and 1928 as well as Section 136 of the Public Health (London) Act, 1936. This Act seeks to secure the use of clean filling materials in upholstered or other articles which are stuffed or lined and it can be said to be a consolidation of the previous Acts of 1911 and 1928. It is the duty of the Local Authority to enforce the Act and the Medical Officer of Health and the Sanitary Inspectors, being duly authorised officers of the Council, have the right at all reasonable times and on production of their ' authority ' to enter and inspect premises and take samples for the purposes of the Act. Three premises, at which filling and upholstering with new materials is carried out, remained on the register at the end of the year and one licence in respect of the manufacture of Rag Flock was renewed. Regulations prescribe the standards of cleanliness for each type of filling material to which the Act applies and under the Rag Flock and Other Filling Materials Regulations, 1951, four samples, 2 of Woollen Mixture Felt, 1 of Rag Flock and 1 of Jute Wadding were obtained and submitted for examination. All proved satisfactory. Pet Animals Act, 1951.—This Act, introduced to regulate the sale of pet animals with particular reference to their welfare prior to sale, became operative from 1st April, 1952, since when it became an offence to keep a pet shop except under licence from the Local Authority. 48 The Act defines " the keeping of a pet shop " as the carrying on at premises of any nature (including a private dwelling) of a business of selling animals as pets and as including the keeping of animals in such premises with a view to their being sold in the course of such business, whether by the keeper thereof or by any other person. The term " animal " includes any form of vertebrate. " Premises " includes any stall or barrow in a market but not any stall elsewhere or any part of a street or public place. Licences, renewable annually, are issued on payment of 10/and are valid to the 31st December of each year. When considering applications for licences, attention must be paid by the Council to the following conditions :— (a) that animals will at all times be kept in accommodation suitable as regards size, temperature, lighting, ventilation and cleanliness ; (b) that animals will be adequately supplied with suitable food and drink and (so far as necessary) visited at suitable intervals. (c) that mammals will not be sold at too early an age ; (d) that all reasonable precautions will be taken to prevent spread of infectious disease among animals ; (e) that appropriate steps will be taken in case of fire or other emergency. In this connection a schedule concerning the method of securing these conditions was drawn up by the Metropolitan Boroughs' Standing Joint Committee and was adopted by the Council in its entirety. During the year four applications for renewal of licences were received and approved. Nine inspections were carried out by the Sanitary Inspectors in connection with the issuing of such licences. Drainage and Sewerage.—During the year 425 drains were tested, 322 were opened, cleansed or repaired and there were 885 constructions and re-constructions, alterations and improvements effected. Only two cesspools remain in use in the Borough and under the Borough Engineer's direction these are emptied on request. Eighty-four plans of drainage and other sanitary works relating to existing and new buildings were examined and approved. 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. 49 There are 22,685 dwellings with direct connection to the Board's mains. A newly installed water supply to a ward in St. Alfege's Hospital was sampled on request. The water, drawn from a supply pipe joined to a 4" rising main which had not been in use for a number of years, was some few degrees warmer than the main cold water supply. The Public Analyst reported that apart from a small amount of dissolved iron which would appear to have been brought about by contact with warm iron pipes, the water was of normal composition. The Group Engineer at the hospital was advised that the water would regain the normal characteristics of a wholesome mains supply if sufficient water were drawn off daily to keep the supply cool and aerated. During the year 382 water supply certificates were granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended in 69 cases and extra water supply to a tenement house was provided. Underground Water Supplies (Wells).—In August, 1947 at the request of the Ministry of Health, a survey of underground water supplies was made and full particulars were given in the Report for that year. In all, 40 wells are listed, only 2 of which are used for the supply of water for drinking purposes. Of the remaining 38 wells, 13 are used for commercial purposes and 25 disused. As far as this Borough is concerned the two wells providing drinking water are properly supervised and have shown no sign of deterioration. Water from one of these wells is used by the Metropolitan Water Board to supplement the public water supply and is subjected to daily tests by that Authority for purity and palatability. Water from the other well is regularly tested by the commercial firm concerned. During September of this year a further shallow well was sunk on the premises of the Tunnel Glucose Refineries Ltd., at Tunnel Avenue, thus making 3 wells in all on this property. The new well is 25 ft. deep and some 150 yards from the river and the water, which is to be used for industrial cooling purposes only, is extremely hard containing iron and excessive amounts of dissolved solids and chlorides. 50 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 1953 the amount of house and trade refuse collected totalled 20,645 tons, showing an increase of 6% over the previous year. The street sweepings collected amounted to 1,714 tons and the percentage increase over the previous year was more than double that shown on the refuse collecting service. This increase in the tonnage of litter in the streets is most disappointing as the year 1953 was one of special propaganda effort on a national scale designed to discourage the public from depositing litter in the streets and open spaces. The organisation for the supervision and marketing of salvage continued and the quantity collected totalling 708 tons was very little different from that collected in 1952. Unfortunately the adverse movement in waste paper prices continued, the price falling to a little more than a third of the high price obtainable in 1951. The scheme continued, however, to show a small profit and is likely to continue. The waste food collected totalling 1,338 tons was also similar in amount to 1952 but towards the end of the year the effect of the availability of alternative animal feeding stuffs was apparent in the increasing difficulty in the disposal of this salvaged material. The practice of disposing of refuse by barging to refuse tips in the Thames Estuary continued, the Council using its Tunnel Avenue jetties for loading the barges. Negotiations have continued with representatives of adjoining Boroughs for a Group Refuse Disposal Scheme and attention has been directed towards exploring the possibility of using pits in North Kent for the controlled tipping of refuse." RODENT CONTROL General.—During the year the Rodent Control scheme, as approved by the Ministry of Agriculture and Fisheries, has been continued. A total of 2,278 investigations were made and infestation found to exist at 397 dwelling houses and 60 places of business. There were 8 major infestations at business premises, 6 of them caused by ship rat and 2 by common rat. Periodical treatments were carried out at 12 of the large industrial premises. Throughout the year there were 9 instances only of re-infestation after treatment. This is a remarkably low figure and reflects credit on the staff carrying out these duties. 51 The monthly average of complaints received was 38 as compared with 43 last year. The number of infestations continue to show a steady annual decrease. Every effort is made to trace the source of infestation in each case and 29 defective drainage systems were discovered. Intimation Notices were served under the Public Health (London) Act, 1936 and the drainage defects made good by the owners of the properties. Block treatments were carried out in 26 small areas, involving 438 premises. Bombed sites and dumps were test-baited but in orly 1 instance was it found necessary to carry out treatment. Frequent calls were made on the services of the Borough Engineer's staff to open up paving to trace the source of infestation and this service was readily available. The Blue Cross Kennels, Shooter's Hill Road, were given 2 treatments with excellent results. A small section of old wooden kennels still remain and until this is replaced by brick-built kennels with concrete runs, re-infestation is always possible. Owners and occupiers still continue to take advantage of the Rodent Control service which has resulted in the early notification of the presence of rate. Only rarely are rats discovered during routine investigation. The Rodent Control personnel have performed their duties with diligence throughout the year and have given the Department good service. Prevention of Damage by Pests Act, 1949.—Under previous legislation responsibility for the eradication of rats and mice rested with each individual occupier, but the introduction of the Prevention of Damage by Pests Act, 1949, whilst repealing the Rats and Mice (Destruction) Act, 1919, and the Infestation Order, 1943, places the onus for the destruction of these pests on Local Authorities. The 1949 Act also makes it obligatory for occupiers to notify the Local Authority of any rodent infestation. Rats and mice are notorious not only for the wholesale destruc tion and fouling of foodstuffs and for the structural damage they cause to buildings, but also for their part in the spread of disease. Leptospirosis (Weil's disease) is primarily a disease of rats and is one which can be fatal to man. The disease is transmitted by means of food, dust, mud, slime and water which has become contaminated by urine or faeces from infected rats. Efficient rodent control is the first and most important defence against this type of disease. The following report was submitted to the Ministry of Agriculture and Fisheries for the 15 months ended 31st March, 1954 :— 52  Type of Property Local Authority Dwelling Houses Agricultural All other (includg. Business & Industrial) Total 1. Total number of properties in Local Authority's District 31 21,973 — 3,215 25,219 2. Number of properties inspected by the Local Authority during the 15 months ended 31st March, 1954, as a result of (a) notification or (b) otherwise (a) 15 600 — 68 683 (b) 13 2,175 — 1,074 3,262 3. Number of properties (under 2) found to be infested by rats Major — 58 — 12 70 Minor 2 305 — 52 359 4. Number of properties (under 2) found to be seriously infested by mice 13 237 — 4 254 5. Number of infested properties (under 3 & 4) treated by the Local Authority 16 600 — 68 683 6. Number of Notices served under Sec. 4:— (1) Treatment — — — (2) Structural Works (i.e. Proofing) — — 7. Number of cases in which default action was taken by Local Authority following issue of Notice under Section 4 - - - - - 8. Legal Proceedings — — — — — 9. Number of " block " control schemes carried out 30 (involving 510 premises). 53 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 30th Nov. to 18th Dec., 1953 15th June to 3rd July, 1953 I. No. of Manholes in foul and connected systems 1,175 1,175 2. Bait base and poison used Sausage rusk and zinc phosphide Bread rusk and arsenious oxide 3. No. of Manholes baited 1.175 1,175 4. No. of Manholes showing prebait takes 578 688 6. No. of Manholes showing complete prebait take (on one or both days) 386 447 6. Schemes of baiting used (e.g.; consecutive days or 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 Nil Nil Remarks: With regard to these treatments, the whole of the manholes were treated in the normal way — therefore no test-baiting was undertaken. It may be mentioned that the neighbouring Boroughs of Woolwioh and Lewisham took action at the same time as Greenwich. Anti-Fly and Anti-Mosquito Campaign.—During the summer period, April to September, the campaign was continued on similar lines to those of previous years, 4 men with the use of 2 motor-cycles and sidecars being employed in this important preventive aspect of the Department's work. The major factors to be controlled include house refuse, static water sites, ponds, ditches, caftis and food shops generally. The treatment of house refuse was successfully accomplished by arrangement with the Borough Engineer, whereby at each weekly collection a small quantity of' Gammexane ' powder was introduced to each refuse bin by means of sprinkler-top tins. The collecting vans were periodically sprayed with DDT in kerosene. The dust-chutes in the numerous blocks of flats all receive fortnightly treatment with ' Gammexane ' powder as soon as possible after the dust collection. 54 Static water sites, ponds, ditches, etc., were sprayed with DDT and in certain instances ' Gammexane ' powder was used. Offensive deposits, such as old mattresses, dead animals, food waste, etc., deposited on vacant and bombed sites are an occasional source of nuisance, in these cases the articles are sprayed with DDT and either burned on the site or removed and destroyed centrally. The site is again sprayed. Food shops and cafes are difficult subjects to deal with and great care has to be exercised in the use of DDT and ' Gammexane ' but these premises were treated with gocd results. Disinfestation of Verminous Premises.—DDT in kerosene continues to prove the most effective vermicidal agent in dealing with verminous houses. During the year the Sanitary Inspectors dealt with 127 cases of dirty and verminous houses compared with 176 for 1952. The Disinfestation staff sprayed 380 rooms and contents as compared with 398 last year. In 6 cases the bedding and effects were removed to the Council's Disinfecting Station for steam disinfection. Other pests, such as cockroaches, ants, moths, earwigs and wasps, were again troublesome and 313 houses comprising 840 rooms were treated effectively with DDT, as compared with 615 last year. This service is more and more appreciated by residents of the Borough. Pharaoh's Ants.—This pest has given rise to a number of complaints being received from two of the large hospitals in the Borough. The sources of infestation in each case were never found and this resulted in a great deal of work being carried out in almost inaccessible places. Spraying DDT was found to be only partially effective. The pipe ducts under the flooring in the corridors were treated and also the cellars and similar underground areas. During the cam paign Steam Flies were discovered and much good resulted from the effort. Frequent similar treatments have been carried out with success. Public Baths and Washhouses.—Greenwich is in the happy position of having a modern establishment for its Public Baths and Washhouses, situated in Trafalgar Road, and covering an area of 1J acres. Originally there were 3 large swimming baths, 74 ladies and gents' slipper baths, medicated vapour and foam baths, washhouses and laundry, etc. 55 During the war the Ladies 2nd Class Swimming Bath was demolished by enemy action and it has been decided that when Ministry permission is obtained for reinstatement the bath will in future be utilised not for swimming but for Turkish Vapour Baths. In this respect the Adoptive Acts Committee have agreed upon a scheme and plans are now being drawn up with a view to an early start being made. In connection with these baths there has been provided a most up-to-date filtration, aeration and chlorination plant capable of purifying the contents of each bath every 3½ hours, thus enabling bathers to use the baths with every confidence. Regular 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 the year ended 31st December, 1953 :— Slipper Baths 90,206 *Swimming Baths 117,006 Vapour and Medicated Baths 8,829 Public Laundry 9,835 Total 225,876 *lncludes 34,962 School-children. A Summary of Bacteriological Samples taken during the year, with the results of the examinations, is given in the following table, particulars of which were communicated to the Adoptive Acts Committee and the Baths Superintendent at the time of receipt of the Reports :— 56 Sample No. Date & Time Nature & Temperature No. of Bathers Plate Count per ml. Yeastral Agar 2 days 37°C. Probable No. of Coliform bacilli. MacConkey 2 days 37°C. Result 1 4.2.53 10.05 a.m. 2nd Class Swimming (Mixed Bathing) 76°F. 35 4 Nil Satisfactory 2 27.5.53 11.35 a.m. 1st Class Swimming (Mixed Bathing) 74°F. 50 18 Nil Satisfactory 3 27.5.53 11.40 a.m. 2nd Class Swimming (Mixed Bathing) 76°F. 70 2 Nil Satisfactory 4 23.6.53 11.05 a.m. 2nd Class Swimming (Mixed Bathing) 76°F. 70 80 Nil Satisfactory 5 23.6.53 11.10 a.m. 1st Class Swimming (Mixed Bathing) 74°F. 42 10 Nil Satisfactory 6 24.8.53 10.50 a.m. 2nd Class Swimming (Mixed Bathing) 75°F. 50 — Nil Satisfactory 7 24.8.53 10.55 a.m. 1st Class Swimming (Mixed Bathing) 75°F. 40 — Nil Satisfactory 8 12.11.53 10.00 a.m. 2nd Class Swimming (Mixed Bathing) 76°F 46 — Nil Satisfactory 57 Public Sanitary Conveniences, etc.—The need for public conveniences is as great as ever and the 9 Council conveniences situated in the main arteries of traffic continue to provide a most satisfactory service. No further developments can be reported with regard to the new convenience envisaged at Woolwich Road in the vicinity of Anchor and Hope Lane. Particulars of Public Sanitary Conveniences In the Borough Convenience MEN WOMEN HOURS W.C.'s Lavatory basins Urinal stalls W.C.'s Lavatory basins Batley Park (Blackheath) 6 2 12 4 2 7a.m. to 11p.m. Blackheath Hill (foot of) 3 _ 10 4 _ Blackwall Tunnel 3 _ 6 5 _ Charlton House 2 _ 4 2 _ 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 Rodmer Street* 5 3 12 5 3 Shooters Hill Road (june Well Hall Rd.) 3 1 6 3 1 Totals 34 11 79 38 12 NOTE :—Women's Conveniences are without an Attendant between 7 a.m. and 8 a.m. On Sundays, Conveniences open at 10.30 a.m. and close at 10.30 p.m. •During Summer Period this convenience opens at 8.30 a.m. 58 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). Blackheath (Greenwich Park). Blackheath Hill, West Greenwich. Blackwall Lane, East Greenwich. (Damaged by enemy action). Charlton Church Lane. Westcombe Hill, Blackheath. Horse Troughs Charlton Church Lane. Creek Road, Deptford. Invicta Road, Blackheath. Tunnel Avenue, East Greenwich. In addition to the above-mentioned Drinking Fountains and Horse Troughs one Council urinal and four others attached to Public Houses are cleansed daily by two attendants, responsibility for the repairs of the Public House urinals remaining with the Brewers concerned. Free hand-washing facilities, introduced in the interests of Public Health during 1951, were continued with marked success during the year and the following table gives an indication of the use made of these facilities :— Convenience Men Women Total Batley Park 562 1,141 1,703 Creek Road 1,196 443 1,639 Greenwich South Street 344 650 994 King William Walk 1,094 485 1,579 Rodmere Street 1,121 1,191 2,312 Shooter's Hill Road 1,892 1,195 3,087 Totals 6,209 5,105 11,314 Aged, Infirm and Physically Incapacitated Persons.— Social and economic problems associated with the rapid increase in the numbers and proportion of the elderly in our population are patent to everyone and they continue to engage the attention of all local authorities. 59 Questions of retirement age, size of pensions, etc., fall outside the scope of local administration but the health and well-being of the aged is a matter of great concern to a Medical Officer of Health and his department. Voluntary organisations perform much good work unobtrusively and unsolicited but among these bodies there is often overlapping. Individually they suffer from lack of funds and collectively from a lack of cohesion. In my Report last year I pointed out the multiplicity of agencies concerned directly and indirectly with the welfare of the aged and infirm and that some co-ordination of them was not only desirable but essential if maximum benefits were to be made available to all the elderly. I am more than ever convinced that the general improvement in the health and welfare of the elderly is to be gained not by the casual, haphazard and sporadic approach, but only by a joint or team effort with some form of central co-ordination and direction. That this can be acliieved solely by voluntary organisation is rather problematical and here it is inevitable that one is drawn to an analogy between Old Age Welfare and Child Welfare ; the latter service as we know it to-day was founded on the pioneer work of voluntary bodies, but eventually national recognition was effected and Local Government control instituted. It appears to me that, provided no reduction in the moral obligation of people to care for their own parents results, then similar action in respect of the welfare of the aged and infirm is not only justifiable but is probably the only method likely to produce a satisfactory solution to the growing problem. At the moment, however, by virtue of the present legal position the Council is precluded from taking any direct part in this work and is limited to giving financial aid to Old People's voluntary organisations. During the year grants were made by the Council to voluntary organisations as under :— £250 British Red Cross Society for the ' Meals on Wheels' scheme. £40 Women's Voluntary Services in respect of the four ' Darby and Joan ' Clubs. £10 Old Age Pensioners'Association, Parish Hall, Swallowfield Road, S.E.7. £10 St. John's Old Folks' Club at Furzefield Road, S.E.3. In addition, a sum of £674 18s. lid. was made available by the Council to the Greenwich Old People's Welfare Committee for the specific purpose of providing holidays for old people. 60 Plans were made for 114 elderly persons each to spend a fortnight's holiday at Margate and in this connection mention may be made of the special arrangements effected for dealing with a cripple and her husband as well as a diabetic patient. Catering for two groups of people unsuitable for this type of holiday took the form of (a) a coach drive into Kent with tea ' en route ' and (b) a tea party and entertainment at Kidbrooke House. Admirable though these schemes are in satisfying certain needs of the aged, it is my conviction that the answer to our problem lies not wholly in the provision of these kinds of amenities but also in creating contentment in the elderly by stimulating activity of the hands and minds in order to impart a purpose to life and so to produce a feeling of self-reliance. Spending, however lavish, on the provision of diversions and entertainments is merely palliative ; the secret, I feel sure, is in making the elderly feel ' wanted ' and that they are an integral part of the community and its life. Great reliance is placed on the Lady Sanitary Inspector by the elderly of the Borough and the following is a summary of the work performed by her during the year 1953 :— No. of dirty and verminous premises inspected 61 No. of verminous rooms cleansed 113 No. of verminous persons treated :—Heads 193 Other 103 No. of visits to scabies cases 25 No. of inspections of factories (a) with mechanical power 65 (6) without mechanical power 10 (c) other premises 8 No. of inspections of Outworkers'premises 164 No. of inspections of Houses Let-in-Lodgings 25 No. of inspections of Women's Conveniences 35 No. of Bathing Centre sessions 25 No. of visits to Infirm Persons 1,134 No. of visits to Rest Homes, Hospitals, etc. 22 No. of Miscellaneous visits 215 No. of re-inspections, calls made, etc. 294 No. of visits re: housing 42 No. of complaints received 70 No. of Intimation Notices served 4 National Assistance Act, 1948. No action under Section 47 of the above Act has been required in respect of compulsory removal of aged and infirm persons unable adequately to care for themselves. It had long been considered that the provisions of Section 47 failed to cover really urgent cases of this nature and in order to 61 meet the situation the National Assistance (Amendment) Act, 1951 was introduced and put into operation on 1st September of that year. This alternative procedure enables the Local Authority or the Medical Officer of Health, if so authorised by the Council, to remove urgent cases where delay of even a few hours may prove decisive, without the necessity of giving 7 days' notice. Orders for removal can be made by a Court of Summary Jurisdiction or a single Justice on an application certified by the Medical Officer of Health and another registered general medical practitioner and where agreement to receive such patients has been reached with the Hospital or Institution authorities. If necessary, the court or justice may act ex parte. Orders so made under the Amendment Act are limited to a period not exceeding 3 weeks and applications for extension of this period must be made in accordance with the procedure laid down in Section 47. Persuasion rather than compulsion has always been the aim of the Health department and although no advantage was taken of Section 47 of the National Assistance Act, 1948, the following procedures were adopted on the advice and under the direction of your Medical Officer :— 19 Old Persons moved to Hospital 22 Old Persons admitted to L.C.C. Homes 63 Dirty or verminous Old Persons taken or attended for Baths. 3 Home baths effected (commenced November) Transported Meals for Old People. The " Meals on Wheels " service has now been in operation for a number of years by the local branch of The British Red Cross Society under the direction of Mrs. Wigley. The Council has continued to make monetary grants towards the cost of transporting the meals to the homes of old people. The meals are prepared at a London County Council kitchen and the cost is subsidised by that authority. During the year an average of 37 homebound persons had meals delivered twice weekly. The average number of meals brought to the homebound was 129. Another 73 were delivered weekly to the various Old Peoples' Clubs in the Borough. Although this service is much appreciated by those receiving the meals, the standard meal which is prepared at the kitchen for the general public is not the best diet for all old people. I think that at sometime in the future attention may have to be given to the preparation of specially designed diets. 62 Burial or Cremation of the Dead.—Under Section 50 of the National Assistance Act, 1948, the Council is required to arrange for the burial or cremation of any person who has died or has been found dead in the Borough if in such cases it appears to the Council that no suitable funeral arrangements have been or are being made. The Council is empowered, if it so desires, to recover expenses f or the burial or cremation from the estate of the deceased person or from any person who, for the purposes of this Act, was liable to maintain the deceased person immediately prior to his death. During 1953 arrangements were made under the above Act for the burial of 4 bodies (3 males and 1 female). The total expenses of these burials amounted to £34 3s. 6d., of which the sum of £17 Is. Id. was recovered, making the nett cost to the Council of £17 2s. 5d. Exhumation.—During the year there were two exhumations at the Greenwich Cemetery, one concerning the removal of a body from a common to a private grave, the other in respect of a body removed to another area. The Sanitary Inspector for the district was present to see that the usual precautions were observed. Summary of Work Performed by the Sanitary Inspectors during the Year 1953 Inspections— Houses inspected (House-to-House) 219 ,, ,, (Complaints, nuisances) 1,490 „ „ (Infectious Disease) 301 „ „ (Overcrowding) 239 Re-inspections, calls made, etc. 10,901 Inspections of Factories 433 ,, ,, Shops 98 „ „ Piggeries 33 „ „ Caravans 32 „ „ Pet Shops 9 ,, ,, Stables and yards 42 „ „ Urinals 131 „ „ Houses let in Lodgings 25 „ „ Outworkers premises 164 ,, ,, Miscellaneous 1,248 Inspection of Premises (Pharmacy and Poisons Act, 1933) 20 Investigations (Rats and Mice) 375 On notice from Builder 683 16,443 63 Drains— Drains tested—by smoke 125 „ „ —by water 300 Opened, cleansed and repaired 322 Reconstructions and additions 183 Inspection chambers constructed 123 New covers to manholes 131 Soil and vent shafts repaired or renewed 111 Traps (gully) 224 Drains sealed off, etc. 34 Yards and forecourts drained 79 Waterclosets and Urinals— Closets erected 72 W.C.s repaired 183 Sanitary conveniences or improvements effected to Factories, Workshops and Workplaces 8 W.C. pedestals installed 235 Urinals cleansed or repaired 39 Dustbins— Provided 190 Pavings— Yards and Forecourts 98 General Water Supply— Water Fittings amended 69 Extra water supply to tenement houses 1 Water supply certificates granted (Sect. 95) 382 Other Improvements— Houses generally repaired 186 Rooms cleansed and repaired 1,290 Rooms and staircases lighted and ventilated 23 Verminous rooms cleansed 272 Roofs, gutters and rainwater pipes repaired 689 Dampness abated 558 Sinks, baths and lavatory basins 242 Sink, lavatory and bath waste pipes trapped or amended 234 Stoves and fireplaces 229 Washing coppers repaired or provided 24 Floors repaired 250 Provision for storage of food 7 Miscellaneous repairs 741 64 Other Nuisances Abated— Illegal use of Underground rooms discontinued 1 Overcrowding abated 57 Animals kept in unfit places discontinued or removed 4 Dung receptacles provided — Accumulation of manure and other obnoxious matter removed 51 Rat infestation abated 154 Smoke Nuisances— Observations 123 Statutory Notices served (Sects. 147 and 148) — Notices, &c.— Intimations served under Public Health (London) Act, 1936 918 Statutory Notices served 149 Houses rendered fit by informal action 235 Legal Proceedings Premises Offence Result of Proceedings 17, Collerston Road Non-compl iance with Statutory Notice Summons withdrawn on payment of 6/- costs. 107, Creek Road do. Summons withdrawn on payment of 6/- costs. 28, Armitage Road do. Summons withdrawn on payment of 6/- costs. 30, Armitage Road do. Summons withdrawn on payment of 6/- costs. 27, Caletock Street do. Order for work to be completed in 28 days. 20/- costs. 103, Creek Road do. Summons withdrawn on payment of 6/- costs. 107, Creek Road do. Summons withdrawn on payment of 6/- costs. 25, Caletock Street do. Summons withdrawn on payment of 6/- costs. 65 SECTION D Housing Many times in previous Reports the importance of reasonable housing conditions in the field of preventive medicine has been stressed, as have the various factors which militate to impede efforts to improve the present situation. There is one aspect of the problem which has not received as much publicity as it warrants, and that is the underlying reasons for the housing shortage as opposed to actual housing conditions. Part of the answer is provided by the 1951 Census, according to which, the number of rooms is in excess of the number of people ; indeed, there were 1.37 rooms per person. From this it would appear the accommodation is there but that the population does not fit tidily into the available space. Nevertheless, the Census reveals also that households outnumber dwellings to fhe extent of almost 1J millions. Four reasons spring to mind for this increase : they are (1) ageing population, (2) smaller families, (3) a trend towards earlier marriages, (4) better living standards. With regard to marriages, the following table compares the number of dwellings erected in the Borough since 1945 with the marriages solemnised during the same period :— (a) (b) (c) New units of accommodation erected since 1945 up to :— Marriages since 1945 Difference between (a) and (b) 31st Dec. 1946 517 776 259 „ „ 1947 1,052 1,552 500 .. „ 1948 2,061 2,363 302 „ „ 1949 2,578 3,048 470 „ „ 1950 2,704 3,700 996 „ „ 1951 3,172 4,370 1,198 „ „ 1952 3,635 5,090 1,455 „ „ 1953 4,017 5,869 1,852 One cannot pretend that this table represents an accurate picture of the housing position because in fairness it must be said that 66 many couples married in the area obviously take up residence outside the Borough ; but this exodus is partially offset by the fact that new dwellings built in the Borough by the L.C.C. are often allocated to non-residents and the status quo therefore largely remains. As new accommodation is seldom assigned to the recently married, the inference is that they take ' rooms ' often with parents or relations. This is a disturbing feature because psychologically it is unsound and frequently leads to disharmony in the home. Perhaps another point is worthy of note. Housing standards are constantly improving with the result that for a given sum of money less dwellings can now be completed compared with what was possible in the immediate post-war years. Difficulties confronting local authorities in their search for further " housing space " are obvious and in urban areas the problem is reduced to a matter of " slum clearance." This fact, together with the recent disclosures of the Census, serve, merely to emphasise the necessity for local authorities to utilise to the full their present powers under the Housing Acts, 1936 and 1949 and the Town and Country Planning Act, 1947, in order to acquire, to improve, to repair, and where possible, to convert existing properties. Slum Clearance.—As intimated earlier in this section, slum clearance remains the only practical method left for urban authorities to obtain space for new housing. In common with other Metropolitan Boroughs, slum clearance becomes a joint responsibility between the Borough Council and the County Council and arrangements usually cover periods of 5 years. During the year an area, comprising 20 properties in Little Heath, was represented for slum clearance by the Council and confirmation by the Minister for Housing and Local Government is awaited. Preliminary surveys of areas which might be represented for clearance during 1956/60 are in hand and, with the approval of the Housing Committee, lists will eventually be forwarded to the County Council for consideration. Re-Housing.— (a) Borough Council.—There were 131 new dwellings provided by the Council during the year and the number of families housed and re-housed including transfers, casual voids, etc., amounted to 403. Of this number 15 were in respect of overcrowded cases and 8 in respect of closures under the Housing Act. 67 The Housing Department now has control of 2,908 Councilowned units of accommodation, an increase of 133 over that of the previous year. At the end of the year, in addition to 89 occupied hutments, a total of 930 properties giving 1,634 units of accommodation 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. (b) London County Council.—By 31st December, 1953, the L.C.C. had provided alternative accommodation for a total of 352 Greenwich families of which 31 had been certified as overcrowded cases. Of this figure, 176 were housed on L.C.C. housing estates outside the Borough. Overcrowding.—As a direct result of rehousing carried out by the Housing departments of the Council and the County Council, 57 cases of overcrowding were abated during the year under review. The number of unabated certified cases of overcrowding in the Borough now amounts to 289. During 1953 there was a rise in the number of complaints received concerning overcrowding, the year's figure of 146 shows an increase of 41 over that of the previous year. Each complaint was investigated by the Sanitary Inspector concerned and as a result of these investigations, 53 families were found to be overcrowded according to the standards laid down by the Housing Act, 1936, and were subsequently certified as such. It can be seen by the figures in the following table that there has been a definite decline since 1945 in the number of families found to be living in overcrowded conditions in the Borough :— It can be seen by the figures in the following table that there has been a definite decline since 1945 in the number of families found to be living in overcrowded conditions in the Borough:— Year No. of cases of overcrowding reported 1946 261 1947 128 1948 162 1949 168 1950 148 1951 56 1952 52 7-year Average 139 1953 53 68 New Housing Accommodation.—The following table lists the new dwellings erected in the Borough during 1953:— Type of Dwelling G.B.C. L.C.C Private Total Permanent Houses 64 9 73 Permanent Houses (rebuilt) — — 16 16 Flats 131 160 2 293 Flats (rebuilt) — — — — Total No. of Dwellings 131 224 27 382 (c) Whilst perhaps not finally confirmed, the following additions and extensions have been envisaged by the Council:— Excluding the families accommodated in requisitioned property, the total number of dwellings provided in the Borough since the termination of the war is now 4,017. Council Housing Schemes. Determined efforts by the Council to overcome the lack oi housing accommodation in the Borough is shown by the following tables :— (a) Dwellings completed during the year under review. Site Dwellings Ashburnham Place 12 Beaconsfield Road 60 Charlton Village ... 6 (and 4 shops) Elliscombe Road 12 Invicta Road 18 Kinveachy Gardens 16 Plumbridge Street 13 (and 9 shops) (b) Dwellings in the course of construction at the end of the current year. Site Dwellings Bramhope Lane ... 2 Charlton Village ... 3 (and 3 shops) Pond Road 44 69 Site Dwellings Blackheath Hill 22 Coldbath Street 88 Humber Road/Ruthin Road Not yet determined Kidbrooke Grove „ „ „ Littleheath „ „ „ Ormiston Road 8 Pond Road 57 Roan Street Not yet determined Tuskar Street 4 Woolwich Road 8 Procedure under Housing Act, 1936.—The following representations were made under Part II of the above Act during 1953 :— Section 11.—Houses unfit for human habitation and not capable at reasonable expense of being rendered so fit. 1, Topham Place, S.E.10. 10, Kirkland Place, S.E.10. Section 12.—Parts of buildings unfit for human habitation, i.e., rooms being more than 3 ft. below the surface of adjoining ground and not complying with the Local Authority's Regulatio7is. 64, Lewisham Road, S.E.13. Local Government (Miscellaneous Provisions) Act, 1953.— Local authorities have often experienced difficulties while enforcing Demolition Orders made under the Housing Act, 1936, when such Orders have been in respect of houses situated within a terrace. Demolition in these instances entails protection and support of the properties on either side. Under Section 10 of the above-mentioned Act, a local authority is empowered to make a Closing Order in respect of a whole house where enforcement of a Demolition Order would adversely affect adjoining property. At any time, such a Closing Order may be revoked and a Demolition Order substituted. 70 Section 11 extends the time in which an owner of a house may apply to have quashed a Demolition Order made to operate prior to 1st January, 1946, if subsequent works have made the premises fit for human habitation. Further, the local authority is empowered to revoke a Demolition Order made before 14th July, 1953, and substitute a Closing Order, if as a result of demolition, adjoining properties would be affected. Housing Survey.—Through the courtesy of Mr. F. H. Dore, the Housing Manager, the following extracts are quoted from his observations on the housing position in 1953 :— " During this year the result of the shortage of further large sites for development became most apparent. Whereas in 1952 nearly 340 families were rehoused from the waiting list, in 1953, only 184 could be dealt with. The slowing down of the rate of rehousing prompted the Housing Committee to re-examine the working of the points scheme and a number of amendments were introduced during this year. This involved the circularisation of applicants for further detailed information regarding their housing circumstances and, in connection with this, applicants were informed that if they did not send in a return of the required information within 2 weeks, it would be assumed that they were no longer in need of accommodation from the Council. This had the effect of considerably reducing the number of cases on the register, and, whereas the year opened with 3,615 applicants registered, at the end of the year the number was 2,539. At the time of the amendment of the points scheme, the decision was also made to deal with applications for transfer on the same basis so that applications from persons on the housing register and from occupiers of properties under the Council's control are now dealt with in the same way. What effect this would have on the rate of transfer from one property to another was not apparent during the year since the pointing of transfer applicants was not carried out until the closing months of 1953. During the year, the number of transfers effected from one Council property to another, including both requisitioned and permanent accommodation, was 183. A number of housing problems were solved by mutual exchange between occupiers of Council-controlled properties and also between Council tenants and tenants of other landlords and Councils, and during 1953, 37 such exchanges were effected. This means, of course, that at least 74 problems were solved in that way. 71 During the year, negotiations were carried out between the Metropolitan Boroughs' Standing Joint Committee and the London County Council regarding the transfer of families from London to New Towns under the Industrial Selection Scheme, whereby liaison is established between the Ministry of Labour and National Service, the New Towns Corporations and the exporting Local Authorities to tie up the allocation of accommodation in New Towns with the question of new employment in industry there. These negotiations resulted in agreement being reached whereby the London County Council act as a central clearing house for the London County Area, and when the revision of the points scheme was carried out, the opportunity was taken to find out which applicants were interested in moving to New Towns. The scheme came into operation too [ate in the year for any opinion to be formed as to what effect it will have on the housing problem in this Borough." 72 SECTION E Inspection of Food and Supervision of Food Premises Systematic inspection of food and the supervision of food premises continued at a high level during the current year which was the first full year of operation of the new London County Council Food Byelaws. These were based on the Ministry of Food's Model Byelaws of J 949 and were made under Section 15 of the Food and Drugs Act, 1938, " to secure the observance of sanitary and cleanly conditions and practices in connection with the handling, wrapping and delivery of food sold or intended for sale for human consumption and in connection with the sale or exposure for sale in the open air of food intended for human consumption." A copy of these byelaws, which were operative from 3rd November, 1952, was forwarded to the occupiers of all premises concerned with the sale, storage for sale or handling of any food commodity. This year witnessed official support of the Clean Food Campaign in the shape of an issue by the Ministry of Health of a coloured poster indicating the various ways by which food can become contaminated by the lack of ' hand hygiene.' In previous Reports emphasis has been made on the fact that hygiene, especially with regard to food, is now rapidly becoming more of an individual responsibility and it is regrettable that it should be necessary to reiterate this truism. All the efforts of the Food Inspectors can be brought to nought by irresponsible persons apathetic to hygiene. As an additional aid to the production, preparation and distribution of clean food it had been hoped that by the beginning of 1954 the Food and Drugs (Amendment) Act would have been on the Statute book but it is a great disappointment to report that the new enactment has reached only the Bill stage. Legislation During this year legislation was confined to minor Statutory Instruments dealing in the main with milk and milk products and causing little variation in the administrative duties of the Food section of the department. 73 Milk The Milk (Special Designations) (Specified Areas) Order, 1953, operative from 1st May, extended to a further four areas, the compulsory use of special designations in relation to the retail sale of milk. The Milk (Special Designations) (Specified Areas) (No. 2) Order, 1953, increased by a further four areas the section of the country now to use such special designations and came into force on 2nd December. The Milk (Special Designation) (Pasteurisedand Sterilised Milk) (Amendment) Regulations, 1953, which came into operation on 20th December, appoints 1st October, 1954 as the date from which it shall be compulsory to use overlapping caps on containers of pasteurised milk. The Regulations also allow milk to be sterilised in cans or other suitable containers as well as in bottles. The Milk and Dairies (Amendment) Regulations, 1953, effective from 27th December, excludes from registration requirements of the principal Regulations persons who sell cream in hermetically sealed containers in which it is delivered to the premises and who are not otherwise distributors of milk. The Public Health (Condensed Milk) (Amendment) Regulations, 1953, introduced on 11th November, permit, for a limited period, the sale of full cream unsweetened condensed milk imported by the Minister of Food containing not less than 7.8% milk-fat and not less than 25.5 % of all milk-solids including fat. The Cream and Use of Milk (Revocation) Order, 1953, came into force on 1st April and revoked the amended Cream Order, 1951, thereby removing control over the manufacture and sale of cream. It also revoked the Use of Milk (Restriction) Order, 1945, and the Use of Milk (Suspension of Restriction) Order, 1951, thereby removing the prohibition on the use of milk in the manufacture of biscuits, bread, buns, pastries, cakes, rolls, scones and other similar products, ice-cream, sweetmeats (including sugar confectionery and chocolates) and synthetic cream. Several Statutory Instruments were introduced concerning the price of Milk and a number of amendments to the Milk and Dairies Regulations were received regarding approved oxidising agents. 74 Meat The Meat Products Order (No. 3), 1952, came into operation on 1st January and replaced, the No. 2 Order. The Offals in Meat Products Order, 1953, which became effective from 1st March, prohibits the use of certain offal in the composition or preparation of uncooked open meat products intended for sale or sold for human consumption. Slaughter of Animals (Pigs) Act, 1953, provided, from 7th July, for the humane slaughter of pigs in places other than slaughterhouses or knacker's yards to which the Slaughter of Animals Act, 1933, applies. Flour The Flour Order, 1953, came into operation on 30th August and replaced the amended Order of 1952. The control of production and packing was abolished as were the controls on distribution, use and price. The addition of creta praeparata to all flour is now required unless it is flour which contains the whole product of the milling of wheat and no additions whatsoever. The restoration of certain specified nutrients is required to be made to all flours of an extraction rate of less than 80% and containers of National Flour or National Brown Flour for sale otherwise than by retail must be marked or labelled to show their contents. Ice-cream The Food Standards (Ice-Cream) Order, 1953, enforcible from 1st June, restored the higher standard for icecream in relation to the minimum quantity of fat and milk solids other than fat which was in operation prior to July 1952. Food The Food Standards (Saccharin Tablets) Order, 1953, Standards revises the standard for saccharin tablets previously laid down in the Saccharin Order, 1949, and applies it from 1st September to all sweetening tablets containing saccharin. The Artificial Sweeteners in Food Order, 1953, which came into operation on the same day, prohibits the use of artificial sweeteners, other than saccharin, in the composition or preparation of any food sold or intended for sale for human consumption. The Food Standards (Soft Drinks) Order, 1953, ieplaces, with certain modifications the standard for soft drinks as laid down in the Soft Drinks Order, 1947. 75 Preserva- The Public Health (Preservatives, etc., in Food) (Amend tives in ment) Regulations, 1953, provide for the sale and Food importation of certain specified dehydrated vegetables which contain sulphur dioxide within prescribed limits, increase the maximum permitted sulphur dioxide content of jam, permit the presence of diphenyl in citrus fruit imported in wrappers treated with diphenyl and, for a limited period, the addition of borax to margarine. These amending Regulations became operative from 11th November of this year. The Public Health (Preservatives, etc., in Food) (Amendment) (No. 2) Regulations, 1953, re-enact the first mentioned Regulations and include, as required by law, an expression of the Minister's opinion that certain provisions are necessary for preventing danger to health or otherwise for protecting purchasers. Labelling The Labelling of Food Order, 1953, was introduced to of Food take effect from 1st April, except where otherwise mentioned. This Order substantially re-enacts in a consolidated and revised form the Labelling of Food Order, 1950, as amended. Certain new provisions have been introduced and the following list gives those of principal import:— (a) to define biscuits and flour confectionery for the purposes of the exemption in the First Schedule ; (b) to require retailers, who pre-pack food consisting of two or more ingredients on the premises where it is to be sold to declare on and after 1st July, 1953, the ingredients on labels ; (c) to permit the declaration on labels for intoxicating liquors to be printed in light block type on a dark ground or in dark block type on a light ground ; (d) to impose requirements as to the labelling of French coffee and Viennese coffee, such requirements to come into effect by stages on the dates in the Fourth Schedule ; (e) to permit emulsifying salts (as defined) and edible starch to be designated as such when forming an ingredient of some other food ; 76 (f) to exempt from the requirements to disclose ingredients those preparations specified in the 1948 British Pharmacopoeia and the 1949 British Pharmaceutical Codex, such exemption to come into effect on 1st December, 1953 ; (g) the exemption from the requirement to specify the ingredients of beef and pork sausages and sausage-meat and home-canned fruit and vegetables now included. The Labelling of Food (Amendment) Order, 1953, effective from 1st January, 1954, permits, among other things, National and National Brown Flour to be sold without a declaration of ingredients in so far as they comply as regards composition with the requirements of the Flour Order, 1953, and removes from the appropriate table in the principal Order, specific reference to soft drinks, saccharin and sweetening tablets which are now the subject of Standards Orders. Imported The Public Health (Imported Food) Regulations, 1937 Food and 1948. ' Official Certificates' for the Falkland Islands, Sudan, Eritrea, Greece and Bechuanaland were approved and notified to all Authorities concerned. A number of other minor enactments were introduced during the year but these were considered not to be of sufficient general importance to warrant inclusion in this survey. Milk Milk consists of approximately 87% of water holding proteins, sugar and certain salts in solution and having suspended in it finely divided globules of fat to which the milk owes its whiteness. This most important food is used in many familiar ways. It is encountered in many beverages, hot and cold, and is a staple constituent in numerous food preparations. Milk, as drawn aseptically from a healthy cow, contains few bacteria but as it forms an excellent medium for the growth of organisms every precaution should be taken to prevent its contamination. Wise application of many branches of science is required for the production and distribution of a pure milk supply. The 77 hygienic handling of milk is of vital importance to the health and well-being of the nation and the eradication of bovine Tuberculosis, Typhoid and Undulant Fever, Diarrhoea and many other diseases is largely dependent on this factor. It is, therefore, to be expected that this commodity formed the largest class of focd sampled during the year. Milk Supply.—The supply of milk continues to be under the direction of the Milk Marketing Board, who, in this connection, act as agents to the Ministry of Food. The greater proportion of the milk which enters the Borough originates from the Home Counties and the remainder which is of a higher fat content, arrives from Devon and the Channel Islands. Milk and Dairies Regulations 1949 and 1953.—Under the provisions of the principal Regulations each person retailing milk in the Borough must be registered as a Distributor. At the commencement of the year 109 persons were so registered and, allowing for additions to and deletions from this list the number of Distributors registered at the end of the year was 111 which total includes 7 dairy premises. On 201 occasions the premises of distributors and dairies were visited, other than for sampling purposes, and defects were detected and remedied as and when necessary. Only one Intimation Notice was required and this was served in respect of a defective drain. The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949-1953 and The Milk (Special Designation) (Raw Milk) Regulations, 1949 and 1950.—All milk now sold in the Borough has been Sterilised, Pasteurised or Tuberculin Tested and the use of these Special Designations in relation to the sale of milk is prohibited under the above Regulations unless the distributor is licensed for the use of same. The special designation " Accredited " is coupled with " Tuberculin Tested" in the Milk (Special Designation) (Raw Milk) Regulations, 1949, in order to obtain absolute control of the sale of milk so designated. Licences issued in accordance with the above Regulations are operative for one year from 1st January and are required to be renewed annually. Principal Licences are granted to Distributors in respect of premises within the Borough and Supplementary Licences to Distributors who sell within the Borough but whose premises are outside. The following licences had been granted and were in force on the 31st December, 1953 :— 78 Licences Sampling.—Under provisions of the third Schedule to the first of the above-mentioned Regulations, Methylene Blue and Phosphatase tests have been prescribed, the former for assessing the " keeping " qualities of milk and the latter for estimating the efficiency of pasteurisation. In addition, a Turbidity test is also prescribed for ascertaining the effectiveness of the heat treatment of Sterilised milk. During the year 58 samples of milk consisting of 51 Pasteurised milks, 5 Sterilised, 1 T.T. Pasteurised and 1 T.T. Farm-bottled were examined in accordance with the prescribed tests and, in addition, the latter sample was appropriately tested and found to be free from tuberculosis. With regard to the pasteurised samples, in 4 cases the nocturnal temperature in the laboratory rose 3 degrees above the limit prescribed by the Regulations and were consequently considered void. Two further samples failed to satisfy the tests completely. In one instance failure to pass the Methylene Blue test was notified to the Distributor and the Medical Officer of Health of the Borough concerned as well as to the Area Milk Officer while in the case of the other unsatisfactory sample which failed the Phosphatase test similar action was taken. Analytical Examination of Milk.—Two (both informal) of the 46 formal and 18 informal milk samples submitted to chemical analysis proved non-genuine. Although in the case of each nongenuine report the presence of up to 1 % water was indicated, the deficiency of milk solids was considered insufficient to justify further action. All designated milks being sold in the Borough were sampled, including those of the super-fatted variety, viz. Channel Island, Jersey, South Devon, etc., and in this latter group 2 samples, although genuine milks in that the fat content was more than that legally required, were considered to have contravened the Milk (Control and Maximum Prices) (Great Britain) Order, 1947, as the In Operation Principal Licences issued 31.12.53. Distribution of Sterilised Milk 93 90 ,, ,, Pasteurised Milk 44 43 ,, „ Tuberculin Tested 33 32 Supplementary Licences Distribution of Sterilised Milk 18 18 „ ,, Pasteurised Milk 17 17 „ ,, Tuberculin Tested 21 21 79 fat content did not equal 4%. The Minister of Food was notified accordingly. Sixteen samples of cream and one ' special sample ' of evaporated milk were also examined and found to be genuine. Reports on samples taken from L.C.C. Schools and Nurseries for chemical and bacteriological examination continued to be furnished quarterly to that authority. Preserved Food and Ice Cream Premises.—In accordance with the provisions of the Food and Drugs Act, 1938, Section 14, all premises with the exception of clubs, hotels or restaurants used :— (a) for the sale or manufacture for the purpose of sale of ice-cream or other similar commodity or 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 Food Premises (meat, fish, etc.).—No applications for registration were received during the year and, allowing for deletions, the total number of premises remaining on the register at 31st December was 108. Three hundred and nine visits of inspection were made to Preserved Food premises and Fried Fish shops as a result of which a number of improvements were made and sanitary defects remedied. In one instance a notice was issued requiring the repair of a W.C. compartment. The work was completed without undue delay. Ice Cream Premises.—By the end of the year the number of registered Ice Cream premises had increased by 14 to a total of 230. Visits to these premises were made on 422 occasions and 8 defects were remedied without recourse to notices. Manufacture and Sale of Ice Cream.—Whilst in operation, sweet rationing undoubtedly stimulated the demand for ice cream and, as evidenced by the increase in the number of premises registered, the consumption of this commodity is still rising. However, in order to minimise the risk of contamination and the spread of infection, the policy in Greenwich has been to encourage the sale of' wrapped ' or ' carton ' ice-cream in preference to the manufacture and sale of it 'loose." 80 Factories in the area which produce ' Ice Lollies ' or ' Lolly ' syrup are regularly and carefully supervised. The Ice Cream (Heat Treatment, etc.) Regulations, 1947 to 1952.— The above Regulations were introduced to secure the elimination of pathogenic organisms by a heat-treatment process similar to that used in the pasteurisation of milk and, generally speaking, this has been accomplished. The Amendment Regulations, introduced on 5th May, 1952, served to provide a third method of heat treatment for ice-cream. IceCream Sampling. (Bacteriological Examination).—As in the previous year the Council continued to make use of the Public Health Laboratory Service as provided for under the National Health Act and 98 samples were submitted for examination and grading according to the Ministry's provisional Grading Scheme. The grading is based on the results of the Methylene Blue Reductase Test and a summary of this year's reports is given below :— Ice Cream Sampling. (Bacteriological Examination).—As in the previous year the Council continued to make use of the Public Health Laboratory Service as provided for under the National Health Act and 98 samples were submitted for examination and grading according to the Ministry's provisional Grading Scheme. The grading is based on the results of the Methylene Blue Reductase Test and a summary of this year's reports is given below :— Samples taken Time taken to Reduce Methylene Blue Provisional Grade Observations 40 4½ hours or more 1 Satisfactory 32 2½ to 4 hours 2 Sub-standard 17 ½ to 2 hours 3 Unsatisfactory 3 0 hours 4 Most Unsatisfactory 6 Ice-lollies Plate count and bacteria reports showed these samples to be Satisfactory On receipt of a Grade 3 or 4 report it is the practice in this Borough to obtain further samples from a vendor before administrative action is taken. It was necessary on 2 occasions during the year to have recourse to ' administrative action.' In the first instance, six of the nine samples obtained during September proved unsatisfactory. The vendors and manufacturers were notified of the result and the relevant information passed to the M.O's.H. of the Boroughs in which the commodity was manufactured. In the second instance, three of eight samples obtained during October proved unsatisfactory and, of these, two were obtained from the same vendor. It transpired that, of the last eleven samples obtained from this vendor, six had proved unsatisfactory and that his supplies were obtained from a manufacturer outside the Borough. The Medical Officer of Health of the area concerned, when acquainted with this undesirable situation, indicated that a full investigation would be carried out. 81 Quantitative Analysis.—Standards for the composition of ice cream were first laid down in the Food Standards (Ice Cream) Order, 1951. However, on 7th July, 1952, the legal minimum quantity of fat and milk solids other than fat required to be contained in ice cream were reduced by the introduction of the Amendment Order of 1952. The original standards were re-introduced with effect from 1st June, by the Food Standards (IceCream) Order, 1953. In connection with quantitative analysis 26 samples of icecream and one ice-lolly were examined in the normal course of sampling. All were satisfactory and full reference to the Analyses will be found under the heading of Food and Drugs Act, 1938. Food Rejected.—The following table is a summary of unsound food voluntarily surrendered during the year under the provisions of the Public Health (London) Act, 1936, Section 180 (8), most of which was processed and used for animal feeding :— Food Rejected.—The following table is a summary of unsound food voluntarily surrendered during the year under the provisions of the Public Health (London) Act, 1936, Section 180 (8), most of which was processed and used for animal feeding :— Shops, Stalls, etc.— Meat— Beef and Mutton pieces and trimmings 1,179 lbs. 99,142 lbs. Beef sausages 116 „ Ham 99½ „ Ox Cheek 26 „ Ox Heads 964 „ Ox Tongues 89 Pigs' Heads 40½ „ Pork 94,321¾ „ Stewed Steak (Canned) 2,304 „ Veal pieces 2¼ „ Other Foods— Bacon 8½ lbs. 45,394 lbs. Beetroot, dried 41 „ Cake Flour 10½ „ Cherries in Syrup 39,335 „ Cheese trimmings 42 „ Dogfish, skinned 126 „ Flour 47 „ Hake 14 „ Provisions, Various (Canned) 3,165 „ Milk, Condensed 84 „ Sultanas 35 Sherbert Dabs & Suckers 784 Sweets 108 „ Skate wings 294 „ Tomato Puree 1,300 „ Total Food Rejected 144,536 lbs. 82 Food rejected during the current year was some 4 times that of the previous year and it will be observed that of the total goods found to be unsound and unfit for human consumption the largest proportion consisted of:— (a) Pork Condemned at a large cold storage plant on account of advanced and excessive rancidity. Consisted mainly of sow and boar fore and hind-quarters, sides and middle cuts. (b) Stewed A consignment of canned Army stores, the warrant Steak of which had expired and the contents were suspect. (canned) (c) Cherries Contents of cans found to be blown, leaky, perforated, in Syrup etc., at a Charlton warehouse were used for pig food. (canned) Others found to be slightly blown with hydrogen were reported on as being free from pathogenic bacteria and suitable for human consumption if used for manufac turing or catering purposes only. Medical Officers of Health of Boroughs in which the purchasers of these hydrogen swells' operated were furnished with full particulars in order that they could take appropriate steps to ensure that the fruit was disposed of in accordance with the Analyst's report. Included in the food rejected was an item of fruit flavoured sherbert and liquorice ' amounting to some 784 lbs. in all and this rejection warrants special mention. On receipt of a letter from the Medical Officer of Health of Dudley alleging adulteration of a packet of sherbert which had been supplied by a manufacturer in this Borough, a formal sample was obtained and this was found to be grossly adulterated with French chalk (24%). As a result, the complete stock was surrendered to the Senior Food Inspector and disposed of in such a manner as to prevent its use in food for human consumption. The supplier claimed that he only packed and distributed the commodity and that his stock was acquired from 2 manufacturers from outside the Borough. The M.Os. H. of the Boroughs concerned were advised of the position in order that appropriate action could be taken. Public Health (Meat) Regulations, 1924/52.—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. 83 Butchers' Shops and Stalls.—These are under the constant supervision of the Food Inspectors who made 308 visits of inspection and arranged for the correction of insanitary defects at 18 premises. As with other premises, legal proceedings are instituted only after disregard of the Officer's warning and in no instance was it necessary to resort to this procedure. Slaughterhouses.—Two premises in the Borough originally licensed as slaughterhouses have not been used as such since the introduction of the Livestock (Restriction of Slaughtering) Order 1940. In both instances the premises are no longer to be used as slaughterhouses and the issue of the appropriate licences has therefore been discontinued. Public Health (Imported Food) Regulations, 1937 and 1948.—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. Inevitably meat is the commodity to which Food Inspectors must devote most of their time and it is their responsibility to see that each consignment landed is accompanied by an " official " certificate. This may be in the form of a certificate, label, mark, stamp or voucher which is recognised by the Ministry of Food, as a guarantee that the accompanying product was inspected ante and post mortem and passed as fit in accordance with criteria satisfactory to the Minister and that any necessary packing or preparation had been executed under hygienic conditions. A number of circulars were received from the Ministry during the year illustrating official certificates approved for the Falkland Islands, Sudan, Eritrea, Greece and Bechuanaland. 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. The following foods were rejected at the wharves :— 84 Meat:— Beef 560 lbs. 2,215¾ lbs. Ham 1 ,, Lamb pieces and trimmings 81 ,, Ox tongues 819 ,, Pigs' heads 23 ,, Pork 391 ,, Rabbit 195 ,, Stewed Steak (Canned) 134 ,, Turkey 11¾ ,, Other Foods — Apricots (Canned) 133½ lbs. 12,747 lbs. Bacon Rinds 2,570 ,, Beans 55 ,, Cherries (Canned) 364 ,, Fruit and Tomato Juice 4,164 ,, Milk, Condensed 96 ,, Milk, Powder 56 ,, Mincemeat 216 ,, Molasses 3,724 ,, Peaches (Canned) 320 ,, Pears (Canned) 314 ,, Provisions, Canned (Various) 456 ,, Pinapple slices (Canned) 201 ,, Tomato Puree 77 ,, Total Imported Food Rejected 14,962½ lbs- The amount of meat rejected was appioximately the same as ast year but the overall total shows a reduction of some 6%. It is interesting to note that 363 bags r f Irish Tripe and 98 bags of Irish Beef were rendered free from oil vt.pt ur taint by treatment with Ozone and further to report that 2,318 cai cases of Reindeer were landed during the year and passed as fit after examination by che Food Inspectors. Caseous Lymphadenitis.—This disease, sometimes called " pseudo-tuberculosis" occurs mainly in sheep although it is occasionally found in cattle, rabbits and chickens. It is met i sually in imported sheep carcases and is often the cause of meat being rejected as unfit for human consumption. It follows, therefore, that much time and attention is given by the Food Inspectors to this disease during their inspections at the wharves and cold storage plants in the Borough. It is worthy of note that although more than 150,000 carcases, etc., of meat were landed none was rejected as a result of Caseous Lymphadenitis and only 3 minor lesions removed. 85 Landed 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 foodstuffs unless bearing an indication of the country of origin. Five hundred and ninety inspections were made to secure compliance with the various Orders but on no occasion was it found necessary to take action against Vendors. Blackheath Fair.—At Easter, Whitsun and the August Bank Holiday, many thousands of Londoners from this and adjacent Boroughs, once again availed themselves of the opportunity of making a visit to this source of entertainment. Constant supervision of refreshment stalls, etc., was necessary to ensure that a safe standard of cleanliness was maintained by the vendors and to this end a Food Inspector was always in attendance. On occasions it has been necessary in previous years to warn vendors that Section 16 of the Food and Drugs Act, 1938, requires the stallholder's name and address to be clearly displayed on the stall. During the current year such action was unnecessary. The observance of hygiene during these holiday periods was assisted by the provision of a clean water supply and adequate sanitary accommodation by the London County Council's Parks Department. Street Traders.—Under Part IV of the London County Council (General Powers) Act, 1947, registration with the local Council is compulsory for all street traders. During the year 52 applications were made and licences granted to street traders engaged in the retailing of articles of food. Four licences were revoked, reducing the total number of licences in force on 31st December to 48. No contraventions of Section 16 of the Food and Drugs Act, 1938 were observed. Premises used for the purpose of storing articles of food intended for sale by street traders, were kept under regular supervision by the Food Inspectors. Examined Rejected Weight Australian & New Zealand Ewes, Lambs & Wethers 144,062 1,575 *— — Australian sheep 382 8 — — Bags Australian Mutton 52 1 — — Uraguayan Ewes & Wethers 4,450 90 — — *Three minor lesions removed. 86 Supervision of Premises Including Factories where Food is Prepared.—In addition to the more general type of premises, such as restaurants, cafés, bakehouses, fish shops, etc., where food is provided, the Borough has numerous other premises at which food and drugs are prepared. Such premises include those of the manufacturers of pharmaceutical sundries, mineral waters and icecream as well as fruit-canning factories, flour millers and brewers. To these establishments the Food Inspectors made 5,437 visits, as a result of which 126 premises were improved. It is pleasing to record that of the improvements obtained only two were prompted by the issue of a Notice, the remainder being accomplished on verbal instructions. The following table is a statistical record of the major portion of the duties performed and inspections undertaken during the year by the Food Inspectors. Premises Inspected or Visits Made. No. of V isits No. of Premises at which Improvements were effected Caterers', Restaurants, etc. 502 32 Grocers 430 22 Butchers' Shops 308 18 Dairies, milk shops 201 1 Licensed Victuallers 133 7 Wharves and Factories 208 1 Bakehouses 175 15 Ice-Cream Shops, etc. 422 8 Fried Fish Shops 116 6 Other Fish Shops 83 1 Cooked Meat & Preserved Foods 193 * Visits Re. Shops Act 365 — „ „ Diseases of Animals Act 1 — „ „ Rat Infestation 19 — „ „ Food and Drugs Act 485 — ,, „ Merchandise Marks Act & Markets 590 — „ „ Public Health (London) Act 14 — „ „ Food Poisoning 9 — Sampling Visits 570 — Fair Visits 25 — School Visits 28 — Miscellaneous Visits (including Flour Mills- Cyanide Fumigation-2) 423 15 Interviews 29 — Complaints Investigated 108 — Totals 5,437 126 *Included under Grocers' and Butchers' Shops. 87 Bakehouses.—Of the 16 premises in the Borough being used as bakehouses at the end of the year, 4 were of the basement type in respect of which Suitability Certificates were in operation. Under the provisions of Section 54 of the Factories Act, 1937, all four basement premises were subjected to their quinquennial inspection and in two cases the bakehouses were found to be satisfactory for continuance of their respective Certificates of Suitability. Suitability certificates in respect of the other two basement bakehouses, viz : 29, Blackheath Hill, S.E.10 and 115, Trafalgar Road, S.E.10., were temporarily extended until such time as the alternative premises at Plumbridge Street, S.E.10 were completed. Bakehouses and bakers' shops were visited on 175 occasions and, as a result of the inspections, 15 improvements were realised. These alterations were effected solely by informal action. Catering Establishments.—Public demand for communal catering continues and as a result of this practice of ' eating out' the inspection and supervision of cafes, restaurants, works' canteens etc., remains one of the most important duties of the Food Inspectors. Disregard of normal hygiene in the handling and preparation of food at such establishments can lead to an outbreak of food poisoning on a large scale and it is a tribute to the Inspectors' vigilance that no such outbreaks have occurred. A publication entitled' Clean Catering ' was prepared and issued by the Ministry of Food towards the end of the current year. In this booklet advice is given on the most practical ways for achieving a high standard of hygiene and is intended not only for existing focd caterers but also for those entering this field for the first time. The Food Inspectors found this a useful publication to recommend to proprietors in respect of their premises and with the assistance of the Greenwich Guild of Hygiene, a fair measure of success in improving the standards of food preparation and handling in the Borough can be claimed. As a result of 502 visits of inspection to the catering establishments insanitary conditions were remedied and improvements effected at 32 premises. The following is a summary of the improvements carried out:— 88 Type of Improvement Effected Total No. Cleaned and painted 30 New Counter installed 1 New Floor 2 New Sink fitted 1 Refrigerator installed 2 Refrigerator overhauled 1 Dust extractor fan installed 3 Hygienic show case installed 1 Rooms tiled 2 Sink surround tiled 1 Rooms ventilated 2 Light improved 1 Floor repainted 1 Ceiling repaired 1 Premises overhauled 1 Total Improvements Effected 50 Many licenced victuallers have instituted a catering service during the last few years, some providing prepared food to be consumed at the bar counter and others supplying a cookcd lunch in a separate dining room. Improvements were carried out at 7 public houses as a result of informal action. Food and Drugs Act, 1938.—In accordance with the Council's contract with the Public Analyst to submit between four and five hundred samples per year, 423 were obtained under the provisions of the above Act and presented for examination. Of this total, 31 samples were formal and 392 informal of which 17(1 formal and 16 informal) were reported to be non-genuine. The unsatisfactory formal sample was taken not in the normal course of sampling but as the result of information received fro m the Medical Officer of Health of Dudley (a full report on which is given under the heading ' Food Rejected ') and consequently for the purpose of calculating the adulteration figure this sample has been disregarded. A further three informal samples reported upon as being unsatisfactory were disregarded when computing the adulteration figure ; these were all samples of canned soup which although genuine as regards the Act, failed to comply with the agreed Code of Practice set up between the Ministry of Food and manufacturers. As the soups had been imported prior to the setting up of this code they h ave been regarded as genuine and have been included in a separate list together with other samples contravening the Labelling of Food Order, 1953. 89 After due allowance has been made for these adjustments the resultant adulteration figure at 3.0% shows a reduction of 0.9 from that of last year. Milk was again the main food sampled and of the 64 samples submitted for analysis only 2 proved to be non-genuine by reason of the presumed presence of water to the extent of up to 1%. It was considered that the percentage was insufficient to warrant further action especially as repetitive samples proved satisfactory. Ice-cream was also sampled fairly heavily and during the year 26 samples were obtained and submitted to the Public Analyst for examination together with 1 ice-lolly. All samples proved to be genuine and the ice-creams more than fulfilled the requirements of the Food Standards (Ice-Cream) (Amendment) Orders, 1952 and 1953, which governed, up to 31st May and from 1st June respectively the minimum content of fat and milk solids other than fat in relation to ice-cream. Appended at the end of this Food Section is a table listing all the samples reported upon as being " non-genuine " and giving the administrative action taken in respect of each unsatisfactory sample. No legal proceedings were instituted during the current year. In addition to those obtained under the Food & Drugs Act, other articles not procured in the normal course of sampling were examined either by the Public Analyst or at the Public Health Service Laboratory. These examinations were the outcome of complaints from members of the public or as a result of special investigations into certain foods carried out by the Food Inspectors or as the " follow-up " to reported food poisoning cases. Information concerning the analyses of these samples is given in the following table :— 90 Article How Obtained Examination Action Taken Bact. or Chem. Result 2 tins of Italian Red Cherries. Special Investigation at Warehouse. Chem. Contained quantity of compressed hydrogen, but metal content not excessive. Considered as satisfactory. 6 tins of Italian Red Cherries. Special Investigation at Warehouse. Chem. Five of the samples proved to be in a satisfactory condition for catering and manufacturing purposes but the remaining sample was regarded as unfit for human consumption. See report under heading of ' Food Rejected.' 2 tins of Italian Red Cherries. Special Investigation at Warehouse. Bact. No pathogenic bacteria present. No action necessary. 4 bottles of Synthetic Cream. ' Follow up ' to investigation carried out on this commodity last year. Bact. Each proved to have a high plate count but no B. Coli was cultured. To be re-sampled after a short period. 4 bottles of Synthetic Cream ' Follow up ' to investigation carried out on this commodity last year. Bact. In each case the number of viable organisms found to be excessively high. Reported to Ministry of Food. 1 tin Evaporated Milk. Complaint that it curdled on exposure to atmosphere. Chem. Genuine. No action. 1 tin Condensed Full Cream Milk Unsweetened. Taken from a case of condensed milk (in stock for some months) and on opening found to be coagulated and curdled. Chem. Found to be curdled and unsuitable for ordinary use. Stock destroyed. Mincemeat. Taken from a barrel at Cold Storage Plant. Chem. Had a sour taste and smell and contained a considerable amount of fungus and other microorganisms. Unfit for human consumption— sent for pig food. 91 Article How Obtained Examination Action Taken Bact. or Chem. Result 1 tin of Australian canned Stewed Steak. Stock held at Cold Storage plant. Canned in 1944. Tested for suitability for human consumption. Chem. Rather stale but not inedible or objectionable. To be used immediately. 2 tins Brazilian canned Stewed Steak. Stock held at Cold Storage plant. Canned in 1944. Tested for suitability for human consumption. Chem. Interior of tin badly corroded. Contents discoloured. Objectionable metallic taste. Tin-1 grain per lb. Unfit for human consumption. Senl for pig food. Piece of cooked Loin of Beef. Gift from U.S.A to sufferer from food poisoning. Suspected food. Baot. No pathogens isolated. Information " passed to patient. Chocolate sauce. Investigated as being cause of food poisoning. Bact. No pathogens isolated. Beef Sausage Meat, frozen. Special Investigation at Warehouse. Chem. Genuine sample. Details passed to Warehouse - Manager. Fork and Veal Sausage Meat. Special Investigation at Warehouse. Chem. Genuine sample. 4 samples of Mincemeat. Taken from different casks at cold storage plant to ascertain if fit for human consumption. Chem. Was a high grade mincemeat. Somewhat stale and fermenting smell and taste. Mince pies made from the samples considered edible. Should be used in moderation for catering purposes and cooked well. Company notified. 2 tins of Pork Sausages. Taken from cold storage plant to test regarding suitability for human consumption. Chem. Fit for human conconsumption. Company notified accordingly. 1 tin Diced Beetroot. Taken from the Dreadnought School, Tunnel Avenue. Complaint of discolourisation and bitterness. Chem. Had unpleasant taste and turned dark brown on opening due to oxidation of ferrous iron to dark ferric compounds. Stock destroyed. 92 ###]Article How obtained Examination Action taken Bact. or Chem. Result Jellied Sweets. Taken from cinema as the result of a complaint that they tasted and smelled musty. Chem. Stale and attacked by mildew. Unpleasant musty taste. Stock destroyed. Full Cream Dried Milk. Supplied by complainant who submitted that the sample may be rancid. Chem. Free from rancidity and other taint. Complainant notified accordingly. Public Health (Dried Milk) Regulations, 1923 to 1948.— These Regulations control the minimum milk-fat content of dried milk and the labelling of tins or other receptacles in which this commodity is contained. As the result of a complaint that a child would not take a full cream milk food which had been obtained from a Child Welfare Clinic, a ' special sample ' suspected of rancidity was submitted to the Public Analyst who declared the milk powder free from taint and rancidity and in conformity with the requirements of the above Regulations. Public Health (Condensed Milk) Regulations, 1923 to 1948.—Minimum percentages of milk-fat and milk-solids of condensed milk as well as the standards of labelling of receptacles are covered under the provisions of these Regulations. The Amendment Regulations of 1953, permit, for a limited period, the sale of full cream unsweetened condensed mdk containing not less than 7.8% milk-fat and not less than 25.5% of all milk-solids including fat, previously imported by the Minister of Food. Three samples of unsweetened and 2 of condensed, full cream sweetened milk taken in the ncrmal course of sampling were declared genuine and in conformity with the requirements of the Regulations. A further ' special sample ' from a shop keeper in the Borough was forwarded to the Public Analyst for examination. It was one of a case of condensed milk, imported from Holland, which had been in stock for some months. On opening the tin the contents were found to be curdled and unsuitable for ordinary use. The remaining stock was therefore destroyed. 93 NOTIFICATION OF FOOD POISONING Under the provisions of Section 17 of the Food and Drugs Act, 1938, 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. There were 9 confirmed notifications received during the year compared with 10 in 1952, 4 in 1951 and 12 in 1950. In 3 instances the specific agent was identified ; 2 proved to be Salmonella typhimurium and 1 Staphylococcus Aureus. In the remaining cases samples of suspected food were unobtainable and it was therefore impossible to ascertain the cause. The following is a short summary of the three ' typed ' cases, all of which occurred outside the Borough :— (1) Salmonella typhimurium—a serviceman became infected while in attendance at the Royal Tournament at Earl's Court. Treatment was carried out at the Royal Herbert Hospital. (2) Salmonella typhimurium— a woman became ill after partaking of tea and ham sandwiches at a funeral in the Bermondsey area. Park Hospital informed this department that, on discharge, the case was a persistent carrier. Further treatment at home rendered her negative. (3) Staphylococcus Aureus—patient admitted to Acton Hospital after being infected at wedding in that area. Suspected food was tongue. A complete recovery was made by all patients. 94 FOOD AND DRUGS ACT, 1938 Number and Description of Samples Submitted for Analysis under the above Act during the year 1953 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Ale — 2 2 — — — Almonds, Ground — 2 2 — — — Aspirin Tablets — 4 4 — — — Baking Powder — 2 2 — — — Barley, Pearl — 2 2 — — — Beetroot, Pickled — 1 1 — — — Beverages (Chocolate 2 : Milk Compound 1.) 3 3 Biscuits — 1 1 — — — Borax — 1 1 — — — Boric Acid — 2 2 — — — Butter — 3 3 — — — Cake — 1 1 — — — Cake Decorations — 2 2 — — — Cake-Pudding Mixtures 5 5 Calamine Lotion — 2 2 — 1 1 Camphorated Oil — 2 2 — — — Castor Oil — 2 2 — — — Cheese — 1 1 — — — Cheese Spread — 2 2 — — — Chlorodyne — 1 1 — — — Chocolate Spread, Canned — 1 1 1 1 Cod-Liver Oil — 2 2 — — — Coffee — 1 1 — — — Coffee Extracts (Dry 4 ; Liquid 5) 9 9 Confectionery, Flour — 1 1 — — — Confectionery, Sugar 1 7 8 1 1 2 Cooking Fat — 1 1 — — — Cornflour — 2 2 — — — Cough Mixture — 1 1 — — — Cream — 16 16 — — — Cream Powder, Imitation 1 1 Curry Powder — 2 2 — — — Dessert Powder — 1 1 — — — Drinks, Soft — 7 7 — 1 1 Dripping — 1 1 — 1 1 Epsom Salts — 2 2 — — — Eucalyptus, Oil of — 1 1 — — — Fish, Bottled (Cockles 1 ; Mussels 2) — 3 3 — — — Fish Canned (Sardines, Sild, Pilchards, etc.) — 9 9 — — — 95 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Fishpaste — 3 3 — — — Flour — 5 5 — — — Friars Balsam — 1 1 — — — Fruit Canned (Plums, Cherries, etc.) — 11 11 — 1 1 Fruit Curd — 2 2 Fruit, Dried — 7 7 Fruit Juice-Purée (Apple Juice 1 ; Blackcurrant Purée 1.) — 2 2 — — — Fruit Pie — 1 1 — __ — Gee's Linctus Pastilles — 1 1 — — — Gin 3 — 3 — __ — Ginger, Ground — 1 1 — — — Ginger in Syrup — 1 1 — — — Glauber's Salt — 3 3 — 3 3 Glycerine of Borax — 1 1 — — — Glycerine of Thymol Compound — 2 2 — — — Golden Raising Powder — 1 1 — — — Gravy Browning — 1 1 — — — Gravy Preparation — 1 1 — — — Herbs, Dried — 4 4 — — — Honey — 2 2 — — — Horseradish, Grated — 1 1 — — — Hydrogen Peroxide Solution — 1 1 — — — Ice Cream — 26 26 — — — Ice Lolly — 1 1 — — — Jam (including Diabetic Apricot 1.) — 8 8 — 1 1 Jelly, Bottled — 2 2 — — — Jelly Tablets — 2 2 — — — Junket Preparation — 1 1 — — — Lard — 1 1 — — — Lemonade Crystals — 1 1 — — — Lemonade Powder — 2 2 — — — Lemonade Tablets — 1 1 — — — Lentils — 1 1 — — — Margarine — 3 3 — — — Marmalade — 2 2 — — — Marzipan — 1 1 — — — Meat Pie — 1 1 — — — Meat Products (Brawn, Liver Sausage, etc. including canned meat products, meat roll, stewed steak, etc.) — 16 16 — — — 96 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Milk (including Channel Island & Sterilised) 18 46 64 — 2 2 Milk, Condensed full cream (sweetened 2 ; unsweetened 3) — 5 5 — — — Milk Pudding, canned 1 1 Mincemeat — 4 4 — — — Olive Oil — 2 2 — — — Paraffin, Medicinal — 1 1 — — — Parrish's Food — 1 1 — — — Peanut Butter — 2 2 — — — Pepper — 1 1 — — — Peppermint Tablets — 1 1 — — — Pickles — 5 5 — — — Pudding, Christmas — 1 1 — — — Rennet, Essence of — 1 1 — — — Kice — 4 4 — — — Rum 2 — 2 — — — Saccharin Tablets — 1 1 — — — Sago — 1 1 — — — Salad Cream — 3 3 — — — Sandwich Spread — 1 1 — — — Sauce — 7 7 — 1 1 Sausages — 7 7 — — — Sausages, Canned — 1 1 — — — Semolina — 1 1 — — — Soda, Bicarbonate of — 4 4 — — — Soup, Canned — 8 8 — 3 3 Soup preparations — 3 3 — — — Spaghetti, Canned — I 1 — — — Spice — 2 2 — — — Suet, Shredded — 3 3 — — — Sugar — 1 1 — — — Surgical Spirit — 1 1 — — — Syrup, Golden — 1 1 — — — Tea — 5 5 — — — Vegetables, Canned — 16 16 — — — Vegetables, Dried — 2 2 — — — Vegetarian Mixtures — 2 2 — — — Vinegar (Malt 5 ; Imitation 3.) — 8 8 — — — Welsh Rarebit Mixtures — 2 2 — — — Whiskey 7 — 7 — — — Wine, Alcoholic — 2 2 — — — Wine, Cocktails — 2 2 — — — Wine, Non-alcoholic — 1 1 — — — Zinc-Castor Oil Ointment — 1 1 — — — Totals 31 392 423 1 16 17 97 Administrative Action Taken in Regard to Samples Reported to be NOT GENUINE Sample No. Article Nature of adulteration and/or irregularity Action taken T. 101 Milk Judged by the recognised standard the sample was deficient in milk-solids other than milk-fat to the equivalent of 1 % of added water. The deficiency was insufficient to justify any further action. T. 102 Milk Judged by the recognised standard the sample was deficient in milk-solids other than milk-fat to the equivalent of 1 % of added water. The deficiency was insufficient to justify any further action. T. 146 Blackcurrants in Syrup, Canned. The proportion of tin in the sample excessive. Remainder of stock surrendered and destroyed. T. 156 Chocolate Spread. Rendered unsuitable as a spread owing to the crystallization of the sugar during storage. Stock withdrawn from sale. T. 220 Glauber's Salt, B.P. The sample had lost its ' water of crystallization ' and was in fact exsiccated sodium Sulphate—the potency of which was equal to 2 ¾ times that of Glauber's Salt. Remainder of old stock destroyed. T. 254 Tomato Ketchup Judged by the recognised standard the proportion of tomato in the sample was not less than 33% deficient. Remaining stock destroyed. T. 272 Dripping Contained an excess of free fatty acids. Vendor warned. T. 284 Calamine Lotion, B.P. Did not conform to the current British Pharmacopoeia standard. A revised British Pharmacopoeia came into operation on the 1st Sept., 1953. This sample complied with the B.P. standard operative at the date of manufacture. T. 344 Glaubor's Salt, B.P. Irregularity as shown for T. 220 Remaining stock withdrawn from sale. 98 Sample No, Article Nature of adulteration and/or irregularity Action taken T. 358 Sweet Cigarettes Contained an excessive proportion of mineral matter which was chiefly calcium phosphate and carbonate. Explanation received from manufacturers. The carbonate which is used for dusting purposes to be replaced by cornflour and the phosphate which is v 83d for extrusion to be reduced. M.O.H. of Borough concerned to re-sample. T. 369 Strawberry Jam. Contained soluble solids 67.6%. Food Standards (Preserves) Order, 1953 and Food Standards (General Provisions) Order, 1944 require jams to contain not less than 68.5% soluble solids. Warning letter to manufacturer. Explanation received. T. 373 Lemon Squash Had unpleasant, mouldy taste. The bottle contained a growth of fungus under the cap and a further quantity dispersed throughout contents. Manufacturer acquainted with position. Incorrect seal had been used. To be replaced immediately. T. 375 Glauber's Salt, B.P. Irregularity as shown for T.220 Stock withdrawn from sale. *41 Fruit Flavoured Sherbert Packet Grossly adulterated with French Chalk (24%). Complete stock of 784 lbs. surrendered to the Senior Food Inspector for disposal in such a manner as to prevent its use for human consumption. •This sample has been reported upon fully under the ' Food Rejected' heading and is not used in the calculation of the adulteration figure. 99 Administrative Action Taken in Regard to Samples that were Found to be GENUINE but failed to meet the Requirements of a Code of Practice or the Labelling of Food Order, 1953. Sample No. Article Nature of adulteration and/or irregularity Action taken T. 131 Lemonade Crystals Contravened the Labelling of Food Order, 1953, in that the presence of Tartaric Acid was not included in the statement of ingredients on the label. Warning letter to manufacturer. Matter has been rectified. T. 192 Fruit Flavoured Junket Tablets. Contravened the Labelling of Food Order, 1953, in that the statement of ingredients on the label was incomplete. Part of old stock. To be replaced by manufacturers. T. 242 Cream of Tomato Soup Canned. Contained edible oil and fat 0.9% by weight. In accordance with the Code of Practice agreed between the Ministry of Food and manufacturers, Cream Soups should contain not less than 3.5% of edible oil and fat. Satisfactory explanation from Manufacturers. Soup of this low edible oil and fat content discontinued. T. 370 Cream of Tomato Soup Canned. Contained edible oil and fat 0.9% by weight. In accordance with the Code of Practice agreed between the Ministry of Food and manufacturers, Cream Soups should contain not less than 3.5% of edible oil and fat. Imported produce brought into the Country before Code of Practice had been agreed. T. 391 Cream of Tomato Soup, Canned. Contained edible oil and fat 2.9%. Not in accord with Code of Practice. Warning letter to manufacturer. Explanation received considered satisfactory. 100 SECTION F Prevalence of, and control over, infectious and other Diseases During the year under review, the only addition to legislation in respect of Infectious Diseases was provided by the Public Health (Infectious Diseases) Regulations, 1953, which, revoking the 1927 Regulations, operated from 1st April. These new Regulations modify Section 144 of the Public Health Act, 1936, in respect to the notification of malaria, dysentery, acute primary or acute influenzal pneumonia, and prescribe action in relation to malaria, typhus and relapsing fever. In addition they give wider powers to the Medical Officer of Health in regard to the prevention and spread of food poisoning and extend the authority of control in the food and drink trades to cases and presumptive carriers of specially defined infections. The total number of Infectious Diseases notified under Section 192 of the Public Health (London) Act, 1936, and associated Orders and Regulations was 1,158. Under the Public Health (Tuberculosis) Regulations, 1952, there were 103 notifications, giving a consolidated total of 1,261 cases notified during the year. In 19 of these cases the diagnoses were not confirmed, thus giving a corrected figure of 1,242. The following table indicates the figures for seven years :— Year No. of corrected notifications 1946 1,691 1947 1,013 1948 1,671 1949 1,335 1950 1,644 1951 2,266 1952 1,565 1-year Average 1,598 1953 1,242 Particulars of age groups and districts affected are shown in the table at the end of this Report. 101 National Insurance Act, 1946.—From time to time it is necessary for the Medical Officer of Health to insist that a suspected ' carrier ' of, or a person in contact with, an infectious disease should be precluded from working in order that the risk of transmission of the disease is minimised. This is especially necessary when the person concerned is a ' food handler.' Regulation 3(b) of the National Insurance (Unemployment and Sickness Benefit) Regulations, 1948, made under the above Act, enables any person so excluded to claim sickness benefit on production of a certificate issued by the Medical Officer of Health. In the Ministry of Health Circular 115/48 it has been suggested that the Medical Officer of Health should be prepared to furnish such a certificate if, in his opinion, circumstances are such that this action becomes necessary. During the current year it was unnecessary to issue any certificates. 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.—These Regulations give a Medical Officer of Health power to vaccinate or re-vaccinate without charge, any contacts of Smallpox cases willing to submit themselves for treatment. Vaccination.—Smallpox is a very dangerous and disfiguring disease and prior to the introduction of compulsory vaccination in 1853, nine-tenths of smallpox victims were children under 5 years of age. Subsequent to this period children, by and large, escaped. However, since 1898, when the ' conscientious objection ' clause made its appearance, vaccinations have declined steeply and the position deteriorated still further from 1948 when vaccination became optional. Glycerinated calf lymph is the standard vaccine used in this country and the number of vaccinations carried out in the Borough during 1953 was 663. Although this is a rise of 122 over the previous year it is still 652 less than that for 1951. Occasionally a smallpox scare in the country results in a jump in the number of vaccinations effected but generally the trend is downwards. Today, although every precaution is taken at seaports and airports, infected persons do occasionally slip through but the 102 comparative immunity of the country has hitherto been due mainly to its high vaccination state. With the fall in vaccinations this fortunate state of affairs cannot be expected to continue. International Certificates (Ministry of Health Circular 20/52).—The question of authentication of International Certificates of vaccination has now been settled by the adoption of the International Sanitary Regulations (W.H.O. Regulations No. 2) which replaced the International Sanitary Conventions on 1st October, 1952. The Regulations prescribe, inter alia, new forms of International Certificates of vaccination against Cholera and Smallpox and, to be valid, the certificate must bear an approved stamp which certifies that the signature of the Vaccinator is that of a practising medical practitioner. During the year some 224 certificates of persons proceeding abroad were so authenticated, of these 199 were in respect of Smallpox and 25 for Cholera ; in 4 instances the necessary vaccinations were actually carried out by your Medical Officer of Health. In addition to the above, 9 certificates in respect of inoculation against Typhoid were similarly verified. Measles.—The customary ' rhythm ' of the biennial fluctuation in the incidence of measles reasserted itself in the last Quarter of 1952 and the outbreak continued into the first Quarter of the following year. In fact 86% of the current year's total of notifications for this disease were received in the first three months. There were 560 notifications received throughout the year as compared with 918 and 1,482 for 1952 and 1951 respectively. Indeed, this present figure is the lowest since 1947 when 273 notifications were received. The distribution of the cases was as follows :—East Greenwich 125 ; West Greenwich 51 ; St. Nicholas, Deptford 13 ; Charlton and Kidbrooke 371. Seventeen cases occurred in children under one year of age, 273 between 1 and 5 years, 260 between 5 and 15 years and 10 were reported in persons of 15 years and over. Of the total, seventeen cases were removed to hospital but there were no fatalities. Whooping Cough.—Altogether 236 notifications of this disease were received but in one instance the diagnosis was not upheld. The final figure of 235, although 45 higher than 1952, compares very favourably with the 384 for 1951 and 309 for 1950. It is regrettable that 2 of the six cases removed to hospital died. Both of these cases were notified posthumously and were in respect of infants aged 4 months and 9 months respectively. 103 Area distribution was as follows :—East Greenwich 93 ; West Greenwich 17; St. Nicholas, Deptford 7; Charlton and Kidbrooke 118. Diphtheria.—One notification only was received in respect of diphtheria and this was subsequently re-diagnosed as tonsillitis. This is the second year since the introduction of compulsory notification that a NIL return has been recorded, the previous year being 1951. While this affords reason for satisfaction to all who have worked unremittingly to bring about the elimination of diphtheria it must again be emphasised that there is an inherent danger in that freedom from this disease may lead to apathy towards immunisation, which, in turn, could give rise to a recrudescence. Births in the Borough rose slightly this year but, contrary to what one might have expected, the number of completed immunisations, viz. 889, carried out during the current year indicates a fall of 190 from that of 1952. This is a trend which would appear to be general throughout the country and the Minister of Health has shown some concern over the situation. In his Circular 8/53 inaugurating a special Diphtheria Publicity Campaign he states that it cannot be said too often by Medical Officers of Health in their Annual Reports and in public utterances that " diphtheria still kills " and that elimination is conditional upon the maintenance of an adequate level of immunisation, and a satisfactory level is only to be secured by the persuading of each generation of new mothers of the necessity of immunisation. Great as the effect may be of advertisements, posters, cinema slides, etc., it is the sustained effort of personal persuasion by doctors, health visitors, sanitary inspectors and other welfare workers which is likely to prove most successful. Antitoxin.—Since January 1949 a small stock of Diphtheria Antitoxin has been held at St. Alfege's Hospital for use by General Practitioners in emergencies. Acute Primaby Pneumonia and Acute Influenzal Pneumonia.—There were 23 cases attributed to these causes as compared with 29 and 18 for 1951 and 1952 respectively. Seven occurred in East Greenwich ; 3 in West Greenwich ; 2 in St. Nicholas, Deptford and 11 in Charlton and Kidbrooke. Three cases were removed to hospital but there were no fatalities. Typhoid Fever.—No confirmed case in respect of this disease was received during the year. 104 Scarlet Fever.—Of the 149 notifications received 3 were not confirmed and the final figure of 146 shows a very satisfactoryreduction of 66 from that of 1952. Twenty-six cases were removed to hospital but no fatalities were recorded. Area distribution was as follows :—East Greenwich 43 ; West Greenwich 19 ; St. Nicholas, Deptford 3 ; Charlton and Kidbrooke 81. Erysipelas.—Eleven cases were notified compared with 16 for the previous year. Seven cases received hospital treatment and there were no fatalities. Zymotic Enteritis or Epidemic Diarrhoea (Children under 5 years of age).—Originally 18 cases were notified but this figure was modified and 16 were eventually recorded as confirmed compared with 8 for the previous year. Of these 10 were under one year and 6 between 1 and 5 years. Unfortunately it is necessary to record 2 deaths, one from the 2 cases nursed at home and one of the 14 admitted to hospital. Dysentery.—The current year saw a resurgence of Sonne Dysentery similar to the rise observed during 1951. This disease, although comparatively mild is highly infectious and troublesome to eradicate and it is the very fact that many of the cases appear trivial and symptomless that makes its detection so elusive. The most important means of spread is by food contaminated by the unwashed hands of persons excreting pathogenic bacteria. Rigorous attention to this one principle of hygiene would go a long way towards reducing those ' explosive ' outbreaks which can be so very difficult to track down. Some 105 cases of sonne dysentery were originally notified but after allowances for rediagnoses the final corrected figure was 100. The cases occurred mostly in private families and there were no major outbreaks involving hospitals, schools, nurseries, canteens or food premises. In order to limit the spread of infection every case was diligently investigated by the Sanitary Inspector and arrangements were made by the department for the collection of faecal specimens from all cases and contacts. Many local practitioners took advantage of 103 this service and called for faecal samples from suspects, as a result of which a number of carriers were revealed. Altogether investigations were carried out in respect of 277 persons which necessitated the taking of 483 specimens, the writing of 270 letters to doctors, families and other interested parties and the return of 80 completed forms to the London County Council for research purposes. AGE GROUPS M F Total 100 NOTIFIED CASES 16 proved negative 0— 1 yr. 5 — 5 1— 5 yrs. 10 16 26 2 military personnel (treated at the Royal Herbert Hospital) 5—15 yrs. 18 16 34 15—25 yrs. 5 2 7 25—45 yrs. 6 14 20 45—65 yrs. 4 2 6 20 Cases treated at Hospital 65 yrs and over 1 1 2 62 Cases treated at Home Total 49 51 100 Treatment of all positive cases was continued until two consecutive specimens proved bacteriologically negative. Of the 62 cases treated at home, 48 were completely tractable and cleared up immediately on the institution of treatment. The remainder, with the exception of one case which removed to Great Yarmouth, although proving somewhat difficult were finally freed from infection. Area distribution was as follows :—East Greenwich 16 ; West Greenwich 2 ; St. Nicholas, Deptford 44 and Charlton and Kidbrooke 38. Scabies.—Twelve cases were so notified compared with 10 for the previous year. Treatment of all cases of scabies is carried out at the Tunnel Avenue Centre. Puerperal Pyrexia.—During the year 10 notifications were received in accordance with the 1951 Regulations but from other sources a further 24 cases concerning residents were brought to the notice of the department. All patients received hospital treatment. There were no fatalities. 106 Ophthalmia Neonatorum.—For the second successive year no notifications of this disease were received. Meningococcal Infection.—Diagnoses of two of the 5 notifications received were not upheld, giving a final total of 3. There were 3 cases in the previous year but none in 1951. Two cases were removed to hospital and recovered but the third died prior to the arrival of the ambulance. Acute Encephalitis. (Infective or Post-Infectious).—Two cases attributed to this cause were received during the year under review, both being of the ' Post-Infectious ' type. In the first case, which followed an attack of Rubella, the recovery was complete but in the second instance which followed a chicken-pox infection the patient, a boy of 4 years, died. Each case received hospital treatment. Poliomyelitis.—Following investigations into 24 suspects 16 notifications were received. Of this total only 11 were finally confirmed, 10 being of the paralytic type and 1 non-paralytic. Figures for the years 1952 and 1951 were 10 and Nil respectively. The one death registered as being from this disease concerned a 6 year old boy who had been admitted to hospital as a meningococcal case. Subsequently the autopsy revealed that death was due to poliomyelitis and a notification to this effect was received and is included in the total of 11 confirmed cases. Once again it must be recorded that no determinable relationship was established between the cases which were distributed throughout the area thus :—East Greenwich 4 ; West Greenwich 2 ; St. Nicholas, Deptford, 1 ; Charlton and Kidbrooke 4. All notified cases were treated in hospital. The possible connection of paralytic cases with recent inoculation for diphtheria or whooping cough immunisation and more especially in regard to the combined antigen has been the subject of much research. This fact has not been established or confirmed from the cases in this area. In one case where the patient was so inoculated less than six months prior to contracting poliomyelitis the site of the injection was the left arm and the area of paralysis the lower right leg. 107 Continued Fever.—As in the case of the previous year no notifications were received in respect of this disease. Malaria.—Ten notifications were received, all from the Royal Herbert Hospital and all in connection with military personnel. Each case was of the benign tertian type believed to have been contracted abroad. Tuberculosis.—During the year 103 notifications in respect of tuberculosis were received compared with 119 for 1952. In two instances, however, patients were registered for both pulmonary and non-pulmonary and the actual number of new cases recorded was 101. Of these, 86 were of the pulmonary type and 15 nonpulmonary, i.e., tuberculosis of parts of the body other than the lungs. The figure for the current year shows a reduction of some 15% and as such is contrary to the general trend obvious throughout the country. The following table gives the distribution :— District Pulmonary Non-Pulmonar Total East Greenwich 29 4 33 West Greenwich 17 2 19 St. Nicholas, Deptford 5 5 Charlton and Kidbrooke 35 9 44 Totals 86 16 101 Disinfection was offered and carried out in 55 cases including 93 rooms and 364 articles of clothing and bedding, etc. The number of notified cases of Tuberculosis remaining on the Register at 31st December, 1953, was as follows :— PULMONARY NON-PULMONARY Men Women Children Total Men Women Children Total M F M F 474 364 34 33 905 22 41 9 10 82 For further clarification I append herewith copy of Form T.137 (revised) for the year under review as forwarded to the County Medical Officer of Health. 108 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 Part I.—Summary of notifications of Tuberculosis during the period from the 1st January, 1953, to the 31st December, 1953. Age Periods Formal Notifications Number of Primary Notifications of new cases of tuberculosis 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total (all ages Respiratory, Males — — — 0 1 5 9 7 8 11 6 2 — 51 Respiratory, Females — — — — 1 7 6 11 3 — 1 2 — 31 Non-Respiratory, Males — — — — 1 1 — — — — — — 2 Non-Respiratory, Females — — — 1 1 — 4 2 1 3 1 1 — 14 Part II.—New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Source of Information Number of oases in age Groups 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total Death Returns from Local Registrars Respiratory M — — — — — — — — — — — — — — (A) F — — — — — — — — — — — — — — (B) Non-Respiratory M — — — — — — — — — — — — — — (C) F — — — — — — — — — — — — — — (D) Death Returns from RegistrarGeneral (Transferable deaths) Respiratory M — — — — — — — — — — — — — — (A) F — — — — — — — — — — — — — — (B) Non-Respiratory M — — — — — — — — — — — — — — (C) F — — — — — — — — — — — — — — (D) Posthumous Notifications Respiratory M — — — — — — — 1 — — — 2 — 3 (A) F — — — — — — — — — — — — — — (B) Non-Respiratory M — — — — — — — — — — — — — — (C) F — — — — — — — — — — — — — — (D) N.B. Where notification of one form of Tuberculosis is subsequently followed by a notification Totals (A) 3 (B) — of the other, only the first notification is taken into account for the purpose of this return. (C) — (D) — 109 Mass Radiography.—In London, Mass Radiography was originally carried out under the direction of the London County Council, but since January 1948 the responsibility for this service has rested with the South East Metropolitan Regional Hospital Board. Introduced primarily for the early detection of Tuberculosis, the Mass Radiography service is responsible for revealing many other chest malformations and disabilities which would doubtless have remained undetected perhaps for years. As a direct consequence of the diagnosis of these ailments treatment is made possible at a very early stage, thereby enabling a much more favourable prognosis to be entertained. The South East London Mass Radiography Unit carried out a public survey in Greenwich during March and April. Information was supplied, appointments made, local firms informed and every assistance was given by the Health Department in order to make the unit's visit a success and I am indebted to Dr. J. M. Morgan, the Director, for the following analysis of the results :— Survey Carried Out in Respect of the General Public at Public Baths, Trafalgar Road, Greenwich, and at Our Lady of Grace School, Charlton. From 4th March to 14th April, 1953 (incl.) PART I.—Stages of Procedure MEN WOMEN TOTAL Total radiographed 2,681 3,062 5,743 Total large films 136 152 288 Number normal on large film 40 46 86 Number abnormal on large film 96 106 202 Not yet attended for large film — — — PART II.—Analysis of Abnormal Large Films MEN WOMEN TOTAL Probably significant new cases of pulmonary tuberculosis for further investigation 27 33 60 Probably significant non-tuberculous cases for further investigation 3 5 8 Previously known tuberculous cases 4 1 5 Cardio vascular lesions 4 18 22 Abnormalities requiring no action 55 46 101 Examination not yet completed 3 3 6 110 In 1951 I commented on the poor response afforded the Mass Radiography Unit on its previous visit to the Borough and again I find it necessary to point out that far too small a proportion of the residents avail themselves of this service. Routine chest examination as exemplified by the Unit is probably the most effective method for the discovery of incipient tuberculosis and as such should be one of the cardinal items in preventive medicine. 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 Lady Sanitary Inspector who gives advice and instruction concerning treatment. Treatment for all cases is carried out at the Tunnel Avenue Cleansing Station and the following Return summarises the work carried out during the year :— Attendances Vermin Scabies Adults 121 26 Children under school age 89 4 School children 476 58 No. of home visits by Lady Sanitary Inspector 61 No. of home revisits by Lady Sanitary Inspector 147 Disinfection.—The disinfection of rooms is effected by the formaldehyde spray. This is carried out 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 can 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 :— Ill Rooms and Articles Disinfected, Year ended December, 1953 Diseases, etc. Premises Entered Booms Beds Mattresses Bolsters Pillows Sheets Blankets Eiderdowns Cushions Quilts Odd Articles Wearing Apparel Rugs and Mats Covers Total No. of Articles Disinfected Scarlet Fever 116 161 40 76 71 187 181 328 14 51 35 171 174 — 80 1,408 Diphtheria 3 7 3 — 3 7 6 6 1 1 9 2 — 2 40 Tuberculosis 55 93 12 19 14 49 39 100 2 10 7 54 28 1 29 364 Cancer 11 10 4 6 6 21 10 20 1 3 4 18 4 — 3 100 Meningococcal Infection 12 19 5 7 5 25 19 37 2 7 — 22 27 — 9 165 Puerperal Pyrexia — — — — — — — — — — — — — — — — Typhoid Fever — — — — — — — — — — — — — — — — Polio-Myelitis 26 61 7 9 3 39 34 53 1 9 3 41 35 — 14 248 Erysipelas — — — — — — — — — — — — — — — — Acute Encephalitis 2 5 — 1 1 1 3 4 — — — — — — 1 11 Measles 12 13 1 3 — 4 3 51 — — — — — — 3 65 Scabies 1 1 — 1 — 2 — 2 — — 1 — — — — 6 Other Diseases 87 52 21 128 9 160 40 40 1 38 4 67 77 — 7 592 Verminous Premises 6 — 5 7 2 5 4 16 — 8 1 9 5 — 3 65 Total. 331 422 98 257 114 500 339 657 22 126 56 391 352 1 151 3,064 Articles destroyed — — 30 76 8 41 3 24 — 7 — 154 8 — 12 363 Library Books Disinfected 90 112 CHEST CLINIC REPORT I am indebted to Dr. C. W. L. Jeanes, Chest Physician at the Greenwich Chest Clinic for the following Report on Tuberculosis in the Borough. At the end of 1953 there were 932 patients on the Chest Clinic Register consisting of:— Pulmonary Tuberculosis Non-pulmonary Tuberculosis Men Women Children Men Women Children 453 351 65 15 31 17 Of these, 81 were new notifications of Pulmonary Tuberculosis and 14 of Non-pulmonary Tuberculosis. Twenty nine patients on the Notification Register died during the year, 24 men and 5 women. Of the 24 men, 7 were over the age of 65 years, the oldest being 74. The youngest man to die was aged 30 years. In 6 of these 24 cases death was due to diseases other than tuberculosis, e.g., the 74 year old patient died from coronary thrombosis and the 30 year old from leukaemia. Of the 5 women who died, the youngest was 39 and the oldest 66 years. In 2 of the cases tuberculosis was not the cause of death, one being due to cancer of the bladder and the other to ulcerative colitis. Bearing these facts in mind, the actual death rate from Tuberculosis was 0.19 per 1,000 population. It is most remarkable in studying the following table to note how the death rate has fallen during the past 10 years. 113 ###]Year Population of Borough Notifications Incidence per 1,000 of population Deaths Pulm. Tub. NonPulm. ' Tub. Pulm. Tub. NonPulm. Tub. Total Rate per 1,000 1938 95,770 153 38 1.59 0.39 53 0.55 1939 94,790 93 14 0.98 0.14 60 0.67 1940 74,280 125 17 1.68 0.23 73 0.97 1941 57,070 138 32 2.42 0.56 74 1.30 1942 60,530 164 18 2.70 0.29 64 1.06 1943 62,870 117 26 1.86 0.41 60 0.96 1944 61,800 113 16 1.82 0.26 47 0.76 1945 63,800 149 16 2.33 0.25 53 0.83 1946 76,840 173 18 2.25 0.23 56 0.73 1947 82,230 171 13 2.08 0.16 67 0.82 1948 84,410 112 17 1.32 0.20 62 0.73 1949 87,680 118 10 1.35 0.11 53 0.61 1950 89,570 126 18 1.41 0.20 50 0.56 1951 89,390 124 22 1.39 0.24 40 0.44 1952 90,880 101 18 1.11 0.19 42 0.46 1953 90,440 86 15 0.95 0.15 29* 0.32 *Deaths of Tuberculous patients from all causes. The continued use of the drugs Streptomycin, P.A.S. and Isoniazid have made the treatment and cure of Tuberculosis much more rapid and certain. Hospital and Sanatorium care is still, however, the most important basis of treatment. There is now no appreciable waiting list for admission to hospitals or sanatoria, but there is unfortunately still some delay in obtaining thoracic surgery, although this is much less than it was. General Statistics. No. of X-rays taken 10,123 Total Patients' attendances 10,578 No. of new patients examined 1,497 No. of contacts examined for 1st time 532 No. of Home Visits by Health Visitors 3,421 No. of Home Consultations by Chest Physician 216 No. of B.C.G. vaccinations 65 The above report refers only to the work in connection with tuberculosis. The Chest Clinic is of course, concerned with the diagnosis, treatment and management of all forms of chest disease including asthma, bronchitis, cancer of the lung, industrial lung diseases, and the various forms of pneumonia. 114 SECTION G Greenwich Guild of Hygiene During the year the support and encouragement of the Council and the Health Department continued to be extended to food traders who were willing to improve their premises and their methods of preparing, handling and selling of food. At most meetings of the Public Health Committee there were one or two traders presented with the Certificate of Hygiene as official recognition of the high standards of hygiene attained by them. It is true that with the adoption of the new Food Byelaws Health Departments can now demand higher standards of practice and there may be some who feel that such legally enforcible standards render the Guild of Hygiene redundant. Such people fail to recognise that the primary purpose of the Guild is to encourage traders voluntarily to reach the highest standards of hygiene. The display of a certificate endorsed by the Council is a guarantee to the public that such standards will be maintained. It must be admitted that the educational and social activities of the Guild have had disappointing support, but although desirable, these were not the primary functions. The number of certificates earned and displayed by traders is the primary purpose of the Guild's existence and these certificates now total 89. If members of the public continue to show their appreciation of such enlightened traders the Guild will continue to flourish. On the other hand, if the general public are prepared to accept willingly second-hand service, certificate holders may become discouraged and the good work of the Guild will be nullified. To my mind this would be a misfortune. Irrespective of how high legal standards are set there will always be the need to recognise officially the efforts of traders who are prepared to go beyond bare legal requirements. The future of the Guild of Hygiene is undoubtedly in the hands of the general public. The Health Department must depend to a large extent on their vigilance as there is a limit to the time the Food Inspectors can spend on this aspect of their work. 115 It is the duty of every citizen to report to us all cases of indifferent service, dirty premises or unclean food. If the public will take the trouble to patronise only those traders who aspire to the highest standards, our job will be the easier. The standards of hygiene in Greenwich are as high as in any other comparable Borough in the country, but there is still room for improvement. Progress in this direction has been steady for several years due to many factors, but the Guild of Hygiene and the Health Department can take mcdcst pride in claiming some credit for that achievement. 117 CENSUS 1951 118 The following figures and tables are abstracted from the Census Statistics and are in respect of the living population enumerated as at midnight 8th/9th April, 1951. General.—As on previous occasions, the census population which forms the basis of the statistics was the de facto population, whether of British or non-British nationality, actually enumerated within the area on census night. The population so enumerated excluded, in particular, members of the Armed Forces and Mercantile Marine outside the country and, in this respect, omitted a number of persons who might otherwise have been in the area. It must also be remembered that, at the time of the census, many children in boarding schools and students in residential colleges were on vacation and, therefore, the population enumerated for these areas was probably appreciably less than normal. Despite the fact that there was a natural increase, i.e., excess of births over deaths, of some 3.9%, the total population in the City and County of London showed a decline of 1,049,021 for the whole period since 1931, indicating that migration movements were almost entirely responsible for the changes. The greater part of the decline took place after 1939 and, in respect of the central and dockside areas, this must be attributed to (a) the destruction of property and large scale evacuation of people which took place during the war years, and to (b) the post-war planning policies, i.e., the " decanting " of population to areas outside the County. In respect of (a) above, it is obvious that an appreciable proportion of the people who were driven out during the war did not return to their previous places of residence. GREENWICH STATISTICS Population.—Population in Greenwich, amounting to 89,846, showed a decrease of 11,078 from the previous Census figure of 1931 which itself was a slight increase over that for 1921; whereas in 1931 there were 7 Metropolitan Boroughs showing advances, in 1951 only in Hampstead, Lewisham and Woolwich were increases recorded. With the exception of two, namely, Kidbrooke and the SouthEast, all ward populations showed substantial decreases. In the case of Kidbrooke an increase was recorded of approximately 175%, while the South-East Ward showed practically no change. 119 Ages.—In the age groups, comparison with the 1931 Census reveals that of the first thirteen quinquennial groups only one (0-4 years) showed an increase, thus reflecting the higher number of births occurring during the years 1946-1947. From the age of 65 years and upwards the increase in the present Census figures indicate the general trend towards an ageing population, and the following table compares the 1951 composition of the three main age groups with that of 1931 :— Age Group 1931 1951 Persons % of Pop. Persons % of Pop. Under 15 years 24,997 24.8%20,896 23.3% (School children) 15-64 years 68,817 68.2% 60,111 66.9% (Working population) Over 65 years 7,110 7.0% 8,839 9.8% (Retired persons) Taken as a whole, although there was only a slight decrease in the proportions in the working-age group, 15-64 years, there were relatively fewer persons in the younger section and more in the older section of it; viz , in 1931 there were 34.6% aged 15-34 years and 33.5% at 35-64 years, compared with 29.7% and 37.0% respectively in 1951. Excess of Females —There was an excess of 2,264 females over males, which compares with the figure of 1,828 for 1931, and the female content of the population rose from 50.9% in the previous Census to 51.3% in 1951. Compared with the London figure of 1,138, the sex ratio in Greenwich, i.e., the number of females per thousand males, was 1,052 a rise of 15 over that for 1931. Despite this overall preponderance of females, collectively there was a slight excess of males up to the age of 54 years, although this excess was not regular throughout the intervening quinquennial groups. An excess of males was evident up to the age of 10 years but for the next 20 years (up to the age of 30), the balance was reversed and it moved in favour of the females. From 30 years up to the age of 50, the males were again in excess but from this period upwards the numbers of females outweighed those of the males. Marital Condition.—Considering only persons of 15 years and over, some 65.3% were married, 25.5% were single, 8.6% were widowed and 0.6% were divorced. The ratio of the widowed 120 (3 females to each male) reflects the normal higher mortality rate of the males and probably the effect of the 1914-1918 war as well. Table I gives the composition of the population of the Borough by age, sex and marital condition in quinary age groups. Density.—In addition to the density of population by wards and an indication of the accommodation occupied therein, it will be observed in Table II that, for the Borough as a whole, the number of persons per acre was 23.3 a reduction of 2.9 from the 1931 figure. With exception of the South East, all wards showed a reduction in density as well as an increase in the dwelling tpace available per person. The total dwellings in the Borough numbered 21,712 as compared with 18,364 in 1931, so that the net effect of all new building, structural alteration, demolition, war damage and conversion to other uses during the past twenty years has resulted in an increase of 3,348 dwellings ; this is equivalent to a rise of 18.2%. The average number of rooms per structurally separate dwelling was 4.84 as compared with 5.51 in 1931, a reduction partially accounted for by the conversion into flats of the larger types of properties. Actual households increased by 4.7% from 25,144 to 26,397 and this was due in the main to an advance in the number of 2 and 3-person families. Housing pressure, measured by the proportion of households to dwellings, showed that in Greenwich, there was an average of 1.2 families per dwelling each consisting of 3.23 persons. Comparable figures for 1931 were 1.39 and 3.74 respectively. Taking into account only private households, there were 1.2 rooms per person, or alternatively 0.83 persons per room, a sign that sufficient accommodation is available but that it is unevenly distributed. Assuming the standard of measuring the state of overcrowding as being more than 2 persons per roim then the population under this category has been reduced from 10,428 (11.1%) in 1931, to 1,576 (1.85%) in 1951. Tables III and IV are designed to show the more direct features of the housing situation, the actual dwellings available, the number of rooms therein, the households occupying them and the size of the households in relation to the rooms occupied. 121 TABLE I.—Population of Greenwich—Age, Sex and Marital Condition Age last Birthday Persons Maizes Females Total Single Married Widowed Divorced Total Single Married Widowed Divorced 0- 4 8,283 4,290 4,290 — — — 3,993 3,993 — — — 5- 9 6,839 3,487 3,487 — — — 3,352 3,352 — — — 10-14 5,774 2,865 2,865 — — — 2,909 2,909 — — — 15-19 5,525 2,761 2,750 11 — — 2,764 2,639 125 — — 20-24 6,493 3,215 2,470 744 1 — 3,278 1,711 1,562 3 2 25-29 7,436 3,644 1,282 2,339 7 16 3,792 778 2,969 25 20 30-34 7,238 3,625 655 2,930 12 28 3,613 479 3,022 73 39 35-39 7,008 3,594 452 3,081 17 44 3,414 443 2,855 78 38 40-44 6,684 3,388 350 2,975 34 29 3,296 470 2,657 131 38 45-49 5,856 2,972 309 2,581 62 20 2,884 404 2,304 153 23 50-54 5,314 2,485 224 2,180 65 16 2,829 388 2,114 300 27 55-59 4,578 2,078 130 1,850 91 7 2,500 302 1,723 467 8 60-64 3,979 1,755 125 1,470 152 8 2,224 290 1,286 635 13 65-69 3,384 1,506 97 1,214 190 5 1,878 229 916 731 2 70-74 2,555 1,050 83 732 232 3 1,505 183 523 799 — 75-79 1,644 625 59 337 229 — 1,019 141 245 633 — 80-84 862 322 20 162 140 — 540 64 91 385 — 85-89 304 97 6 29 62 — 207 25 16 166 — 90-94 77 30 3 6 21 — 47 4 3 40 — 95 & over 13 2 — — 2 — 11 2 2 7 — AU ages 89,846 43,791 19,657 22,641 1,317 176 46,055 18,806 22,413 4,626 210 122 TABLE II.—Acreage, Population, Density, Private Households and Dwellings by Wards Administrative Area Acreage (Land and Inland Water) Population Private Households and Dwellings, 1951 1931 1951 Private Households Population in Private Households Structurally Separate Dwellings Occupied Rooms Occupied Density of Occupation Persons Persons Males Females Persons per Acre Persons per Room Percentage of Persons at more than 2 per room 1931 1951 Civil Parish :— Borough of Greenwich 3,858 100,924 89,846 43,791 46,055 23.3 25,144 26,397 85,184 21,348 103,329 0.82 1.9 Wards :— Charlton 636 18,595 15,443 7,546 7,897 24.3 J 6,5881 4,743 15,227 3,612 18,689 0.81 1.7 Kidbrooke 1,354 9,092 25,001 12,423 12,578 18.5 6,332 22,900 5,808 26,642 0.86 1.2 Marsh 582 15,304 9,814 4,756 5,058 16.9 3,623 2,930 9,036 2,165 11,116 0.81 1.9 North 170 12,457 7,298 3,629 3,669 42.9 3,300 2,303 7,217 1,981 8,745 0.83 2.3 North West 114 8,704 4,765 2,399 2,366 41.8 1,739 1,290 4,445 1,213 4,447 1.00 3.7 South 217 7,677 4,984 2,362 2,622 23.0 2,098 1,659 4,908 1,228 6,442 0.76 1.7 South East 548 13,936 13,819 6,380 7,439 25.2 3,809 4,483 13,293 3,307 18,234 0.73 0.8 West 122 8,586 5,378 2,561 2,817 44.1 2,415 1,689 5,025 1,209 6,030 0.83 2.3 St. Nicholas Deptford 115 6,573 3,344 1,735 1,609 29.1 1,572 968 3,133 825 2,984 1.05 5.8 123 TABLE III.—Dwellings, Rooms and Households Structurally Separate Dwellings Number of Rooms 1 room 2 rooms 3 rooms 4 rooms 5 rooms 6 rooms 7 rooms 8 or 9 rooms 10 or more rooms All Sizes Occupied Vacant Total Furn. Others Dwellings occupied By 1 Private Household(s) 186 1,008 3,468 4,993 4,195 2,311 662 359 82 17,264 75,497 291 161 75,949 „ 2 „ „ — 2 20 230 373 1,546 603 521 92 3,387 21,483 82 53 21,618 „ 3 or more „ — — — 6 23 70 78 268 252 697 6,349 60 18 6,427 Total dwellings occupied Dwellings wholly vacant 186 1,010 3,488 5,229 4,591 3,927 1,343 1,148 426 21,348 103,329 433 232 103,994 furnished 7 31 41 37 37 27 7 6 1 194 794 794 others 5 35 18 42 33 18 7 10 2 170 — — 722 722 Total dwellings occupied and vacant 198 1,076 3,547 5,308 4,661 3,972 1,357 1,164 429 21,712 103,329 1,227 954 105,510 Number of private households therein 186 1,012 3,508 5,472 5,012 5,622 2,114 2,258 1,213 26,397 Miscellaneous habitations and institutions housing non-private households 95 N.B.—The above section includes 3 caravans comprising 3 rooms occupied by 3 households 124 TABLE IV—Private Households by Size, Rooms Occupied and Density of Occupation Number of Persons in Household Number of Households occupying the following number of rooms Total Households Total Persons in Households Total Rooms Occupied Average Number of Persons per Room 1 Room 2 Rooms 3 Rooms 4 Rooms 5 Rooms 6 Rooms 7 Rooms 8 or 9 Rooms 10 or more Rooms 1 546 911 834 365 147 90 21 9 2,923 2,923 7,824 0.37 2 145 1,286 2,302 1,570 931 438 116 61 14 6,863 13,726 24,653 0.56 3 83 634 2,035 1,755 1,186 589 150 68 23 6,523 19,569 25,806 0.76 4 33 238 1,450 1,613 1,115 576 156 67 14 5,262 21,048 22,136 0.95 5 7 32 508 905 688 380 119 70 7 2,716 13,580 12,433 1.09 6 1 12 147 429 338 168 54 37 4 1,190 7,140 5,606 1.27 7 — — 43 164 149 97 37 24 3 517 3,619 2,601 1.39 8 1 9 66 69 28 19 11 1 204 1,632 1,041 1.57 9 3 16 44 30 7 7 4 111 999 623 1.60 10 or more — — 1 14 39 20 7 6 1 88 948 481 1.97 Total households 815 3,114 7,332 6,897 4,706 2,416 686 360 71 26,397 Total persons 1,258 6,577 21,178 24,284 17,902 9,332 2,804 1,560 289 — 85,184 — 0.83 Rooms occupied 815 6,228 21,996 27,588 23,530 14,496 4,802 2,967 782 — — 103,204 — Distribution per 1,000 households by rooms occupied, 1951 31 118 278 261 178 91 26 14 3 1,000 — — INDEX A Page Acuto Encephalitis 106 Acute Influenzal Pneumonia 103 Acute Poliomyelitis 106 Acute Primary Pneumonia 103 Adoptive Acts, Bye-laws and Local Regulations 3, 4 Age Mortality 18, 19 Aged, Infirm and Physically Incapacitated Persons 58-61 Analytical Examination of Milk 78, 89 Ante and Post Natal Clinics 33 Ante and Post Natal Clinics, Attendances 29, 30 Anti-Fly and Anti-Mosquito Campaign 53, 54 Antitoxin, Diphtheria 103 Area of Borough 9 Articles and Rooms Disinfected 111 Articles Destroyed 111 Artificial Sunlight Centres, Attendances 30 Artificial Sunlight Treatment 34 Artificial Sweeteners in Food Order 74 Atmospheric Pollution 42-44 B Bacteriological Examinations 56, 78 80, 90-92 Baiting of Sewers 53 Bakehouses 87 Baths and Wash-houses 54-56 B.C.G. Vaccinations 113 Births 13, 16 Birth Registrations 16 Blackheath Fair 85 British Red Cross Society 36,61 Bronchitis 25 Burial and Cremation of the Dead 62 C Cancer 13, 14, 23-25 Caseous Lymphadenitis 84-85 Catering Establishments 87, 88 Census of Population, 1951 117-124 Cerebral Embolism 25 Cerebral Haemorrhage 25 Cerebral Thrombosis 25 Certificates of Guild of Hygiene 114 Page Chest Clinic 35, 112, 113 Chest Physician's Report 112, 113 Children's Exercise Classes 30 Chiropody Clinics 34 Chiropody Clinics, Attendances 31 Citizens Advice Bureaux 36 Classification of Deaths 21 Cleansing and Scabies Clinic 35, 110 Cleansing of Children 110 Clinics and Centres 28-36 Common Infectious Diseases 14,21 Complaints 37, 62 Continued Fever 107 Conveniences, Public 57, 58 Coronary Disease 25 Council Housing Schemes 68, 69 Council Rehousing 66 Cream and Use of Milk (Revocation) Order 73 Cremation or Burial of the Dead 62 D Death Causes, Remarks 21-26 Death Rates 14 Death Registrations 17 Death, Table showing Causes of and Ages at Appendix Deaths 13, 17 Deaths, Table showing Causes of and Ages under 1 yr. Appendix Deaths from Violence 26 Deaths in Institutions 18 Defective Dwellings—Repairs 45 Density of Population 9 Dental Clinic 35 Dental Treatment 31 Diarrhoea and Zymotic Enteritis 13,22,104 Diphtheria 22, 103 Diphtheria Antitoxin 103 Diphtheria Immunisation Clinics 34 Diphtheria Prophylaxis Cases 31 Diseases of Respiratory System 25 Disinfecting Station 36 Disinfection 110, 111 Disinfestation of Verminous Promises 54 Distribution of Vitamin Products 27 District Nursing 32 Domestic Helps 31, 36 INDEX (continued) Page Domiciliary Confinements 29 Drainage and Sewerage 48 Drainage, New and Alterations to 48 Drinking Fountains 58 Duties and Powers of the Public Health Committee 3, 4 Dwellings 9 Dysentery 104, 105 E Elevation of Borough 9,11 Emission of Grit 42-44 Encephalitis 106 Enteric Fever 22 Erysipelas 104 Exercise Classes, Ante & Post Natal 30 Exercise Classes, Children's 30 Exhumations 62 Extracts from Vital Statistics 13, 14 F Factories Act, 1937 38, 39 Fair, on Blackheath 85 Family Planning Association, Sessions 35 Family Welfare Association 36 Flooding of Thames 40,41 Flour Order 74 Food—Inspection of 72-99 Food Poisoning 93 Food—Premises for Prepara- tion of 79,86 Food Rejected 81, 84, 85 Food & Drugs—Non-genuine Samples 97, 98 Food & Drugs Act, 1938, Samples taken under 88, 89, 94-98 Food Standards Orders 74 Foot Clinics 34 Foot Clinics, Attendances 31 G General and Vital Statistics 9-26 General Provision of Health & Welfare Services in the Area 27-36 Geriatrics 58, 59 Greenwich Guild of Hygiene 114, 115 Grit Emission 42-44 Guild of Hygiene 114-115 H Page Habitation Certificates (Water Supply) 49 Handicraft Centre 35 Handwashing Facilities 58 Health Centres 28-36 Health Visiting 28 Heart Disease 25 Heating Appliances (Fire- guards) Act, 1952 46 Home Help Statistics 31 Home Help Service, Applica- tions for 36 Horse Troughs 58 Hospitals 36 Hospital Confinements 29 Houses, No. in Borough 9 Houses Let in Lodgings 45 Housing 65-71 Housing Act, 1936, Procedure under 69, 70 Housing Act, 1949 66 Housing Accommodation 65,68 Housing Homeless Persons 67 Housing Register 70 Housing Schemes, Council's 68, 69 Housing Survey 70, 71 Hygiene, Guild of 114, 115 I Ice-Cream—Bacteriological examinations 80 Ice-Cream (Heat Treatment, etc.) Regulations 80 Ice-Cream Premises 79 Ice-Cream, Quantitative Analysis 81, 89 Ice-Cream Sampling 80, 81 Illegitimate Births 13, 16 Immunisation and Vaccination Clinics 34 Immunisation and Vaccination Clinics, Attendances 31 Imported Food Rejected 83-85 Infantile Mortality 14, 19-21 Infant Welfare Centres 33 Infant Welfare Clinics, Attendances 28-31 Infectious Diseases 13, 14, 21, 22 100-113 Infirm Persons 58-61 Influenza 13, 14, 25 Inhabited Houses 9 INDEX (continued) Page Inspection of Food and Supervision of Food Premises 72-99 Institution Deaths 18 International Certificates 102 International Statistical Classification of Diseases, Injuries and Causes of Death, 1948 21 Introductory Review 6-8 L Labelling of Food Order 75 Laboratory Work 47, 56, 78, 80, 81 88, 89 Legal Proceedings 64 Legislation, New 46, 73-76, 100 Leptospirosis 51 Lettings (Housing) 70 Local Government (Miscellaneous Provisions) Act 69 M Malaria 100, 107 Manufacture and Sale of Ice- Cream 79 Marriages 14, 65 Marriage Guidance Centre 35 Mass Radiography 109,110 Maternal Mortality 13, 14, 19 Maternity and Child Welfare 27-36 Maze Hill Clinic (Tuberculosis) 35 112, 113 " Meals on Wheels " 61 Measles 13, 22, 102 Meat Products Orders 74 Meat Regulations 82, 83 Meat Surrendered 81,84 Medical Officer of Health's Review 6-8 Medical Statistics (Schools) 32 Meningococcal Infection 106 Merchandise Marks Act 85 Meteorological Observations 15 Milk, Analysis of 78,89 Milk and Dairies Regulations 73, 77 Milk Licences 78 Milk (Special Designation) (Pasteurised & Sterilised Milk) Regulations 73, 77 Milk (Special Designation) (Raw Milk) Regulations 77 Page Milk (Special Designations) (Specified Areas) Order 73 Milk Supply 77 Minor Ailments Centres (for School Children) 35 Motor Vehicle Accidents 26 Mutual Exchanges (Housing) 70 N National Assistance Act 60 National Insurance Act (Medical Certificates) 101 Neo-Natal Mortality 20, 21 & Appendix New Housing Accommodation 68 New Legislation 73-76, 100 Nomenclature Regulations, 1948 21 Non-Genuine Samples 97, 98 Notices, etc. 37, 64 Notifications of Infectious Diseases 100-113 & Appendix Notifications of Food Poisoning 93 Nursing Associations 36 Nutrition Clinic 36 O Offals in Meat Products Order 74 Open Spaces 10 Ophthalmia Neonatorum 106 Ophthalmic Clinic (Children) 35 Outworkers 39, 40 Overcrowding 67 P Personal Health Services 27-36 Persons Cleansed 110 Pet Animals Act 47,48 Pharmacy & Poisons Act 46 P.H. (Condensed Milk) Regulations 73, 92 P.H. (Dried Milk) Regulations 92 P.H. (Imported Food) Regulations 76, 83 P.H. (Infectious Diseases) Regulations 100 P.H. (Meat) Regulations 82 P.H. (Preservatives, etc., in Food) Regulations 75 INDEX (continued) Page P.H. (Smallpox Prevention) Regulations 101 Physically Incapacitated Persons 58-61 Pneumonia 25, 103 Points Scheme (Housing) 70 Poliomyelitis 106 Pollution, Atmospheric 42-44 Pollution, River 41 Population 9, 12 Population Census, 1951 117-124 Post-Natal Attendances 29 Powers & Duties of the Public Health Committee 3, 4 Preserved Food Premises 79 Prevalence of, and Control over Infectious Diseases 100-113 Prevention of Damage by Pests Act 51,52 Procedure under the Housing Act, 1936 69, 70 Prophylaxis Cases 31 Prophylaxis Clinics 34 Public Baths & Wash-houses 54-56 Public Health Committee 3 Public Health Department Staff 5 Public Health Laboratory Service 80, 89 Public Open Spaces 10 Public Sanitary Conveniences 57, 58 Puerperal Pyrexia 105 Q Quantitative Analysis of Ice- Cream 81, 89 Queen's District Nursing Association 32, 36 R Radiography, Mass 109, 110 Rag Flock Act 47 lianyard Mission 32, 36 Rateable Value 9 Rates, Births and Deaths, etc. 13, 14 Rat Repression 50-53 Refuse Disposal 50 Registered Births 13, 16 Registered Deaths 13, 17 Registrar—Office Hours 36 Registration of Preserved Food Premises 79 Page Rehousing 66, 67 Rejected Food 81, 84 Remarks on Various Death Causes 21-26 Rent & Mortgage Interest (Restrictions) Acts 45, 46 Requisitioned Accommodation 67 Respiratory System—Diseases of 25 Review by M.O.H. 6-8 River Flooding 40, 41 River Pollution 41 River Smells 41 Rodent Control 50-53 S Sampling of Ice-Cream 80-81 Sampling of Milk 78,89 Sampling under Food & Drugs Act 88, 94-98 Sanitary Circumstances of the Area 37-64 Sanitary Conveniences, etc. 57, 58 Sanitary Work—Summaries etc. 62-64 Scabies 105 Scabies & Cleansing Clinics 35 Scarlet Fever 22, 104 Scavenging and Refuse Disposal 50 Schools (Medical Statistics) 32 Sewerage and Drainage 48 Sewers—Baiting of 53 Shops Act 47 Slaughter of Animals (Pigs) Act 74 Slaughterhouses 83 Slum Clearance 66 Smallpox 22, 101 Smells from River 41 Smoke and Grit Emission 42-44 Social Conditions of the Area 11,12 Sonne Dysentery 104, 105 Special Consultative Clinic (Children) 36 Speech Therapy (Children) 36 Staff of Public Health Department 6 Statistical Tables Appendix Statistics General 9,10 Still Births 13, 16 Street Traders Suicide 26 INDEX (continued) Page Summary of Sanitary Work 62-64 Sunlight Treatment 30 Supervision of Food Premises 86 Supplies of Underground Water (Wells) 49 Swimming Baths 54-56 T Therapy, Speech (Children) 36 Thames Flooding 40, 41 Toddlers Clinic, Attendances 30 Town & Country Planning Act, 1947 66 Transfers (Housing) 70 Transported Meals for Old People 61 Treatment Centres and Clinics 33-36 Tuberculosis 13, 14, 22, 23, 107-109 112, 113 Tuberculosis—Handicrafts Centre Sessions 35 Tuberculosis Officer's Report 112,113 Typhoid Fever 22, 103 U Underground Wator Supplies (Wells) 49 Uninhabited Houses 9 Unsound Food 81, 84 V Vaccination Cases 31 Vaccination and Immunisation Clinics 34 Vaccination, International Certificates 102 Page Various Death Causes, Remarks on 21-26 Vascular Lesions of Nervous System 25 Verminous Conditions 110 Verminous Premises 54 Violent Deaths 26 Vital Statistics 9-26 & Appendix Vitamin Products, Distribution of 27 W Wash-houses & Public Baths 54-56 Washing Facilities (Hand) 58 Water—Underground Supplies (Wells) 49 Water Supply 48,49 Water Supply Certificates 49 Weil's Disease 51 Welfare Clinics 33-36 Wells 49 Whooping Cough 13, 22, 102 Whooping Cough Prophylaxis Cases 31 Whooping Cough Prophylaxis Clinics 34 Women's Special Clinic 35 Women's Voluntary Services 36 X X-Ray Examinations 109, 113 Z Zymotic Diseases 22, 104 Zymotic Enteritis 22, 104 INFANTILE MORTALITY DURING THE YEAR 1953 Deaths from stated Causes in Weeks and Months under 1 Year of Age. Cause of Death. Under 1 week. 1—2 Weeks. 2—3 W%eks. 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 ... 1 2 Diphtheria ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Tubercular Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... 1 ... ... ... 1 Meningococcal Infection ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... ... ... 1 Pneumonia (all forms) 1 ... ... ... 1 2 1 ... 1 5 Emphysema {Staphylococcal) ... ... ... ... ... ... 1 ... ... 1 Gastro-Enteritis ... ... ... ... ... ... 1 ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformation 1 3 ... ... 4 ... ... ... ... 4 Premature Birth 5 ... ... ... 5 ... ... ... ... 5 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... ... ... Intussusception ... ... ... ... ... ... ... 1 ... 1 Kernicterus 1 ... ... ... 1 ... ... ... ... 1 Other Causes ... ... ... ... ... ... ... 1 ... 1 Totals 9 3 ... ... 12 4 4 2 2 24 Male 13 Female 11 GASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1953. Notifiable Disease Cases Notified in Whole District Total Cases Notified in each Locality No. of Cases removed to Hospital from each Locality Total Axe & Sex Group • Greenwich East Greenwich West St. Nicholas Charlton and Kidbrooke Greenwich East Greenwich West St. Nicholas Charlton and Kidbrooke At all Ages 0 to 1 l to 3 3 to 5 5 to 10 10 to 15 15 to 25 25 to 45 45 to 65 65 and over M F M F M F m F m f m F m F m f m f M F Malaria 10 ... ... ... ... ... ... ... ... ... ... ... 6 ... 4 ... ... ... ... ... ... ... ... 10 ... ... ... 10 10 Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Encephalitis Infectious ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Post-Infectious 2 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 1 2 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 49 51 5 ... 2 9 8 7 12 11 6 5 5 2 6 14 4 2 1 1 16 2 44 38 3 2 4 10 19 Erysipelas 3 8 ... 1 ... ... ... ... ... ... ... ... 1 ... ... 2 2 3 1 1 4 l 1 5 2 l ... 4 7 Acute Polio-Myelitis P. 5 5 ... ... 1 2 ... 1 1 1 ... ... ... 1 3 ... ... ... ... ... 4 1 1 4 4 l 1 4 10 N.P. 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 1 Scarlet Fever 73 73 ... 2 5 5 11 10 45 45 8 9 3 2 1 ... ... ... ... ... 43 19 3 81 17 2 1 6 26 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scabies 8 4 ... ... ... ... ... 1 ... ... 2 ... 2 1 4 ...1 ... 1 ... ... 6 1 ... 5 ... ... ... ... ... Puerperal Pyrexia ... 10 ... ... ... ... ... ... ... ... ... ... ... 2 ... 8 ... ... ... ... 1 1 ... 8 1 1 ... 8 10 Meningococcal Infect on 2 1 ... 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 1 ... 1 2 Measles 295 265 10 7 57 63 87 66 130 123 6 1 3 3 2 2 ... ... ... ... 125 51 13 371 1 2 ... 14 17 Whooping Cough 107 128 9 8 28 25 28 30 39 64 1 ... 1 ... 1 1 ... ... ... ... 93 17 7 118 ... 1 2 2 5 Diarrhoea 8 8 5 5 3 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 6 3 4 3 5 2 4 3 14 Ophthalmia Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia, Acute Primary or Acute Influenzal 11 12 ... 1 1 1 2 1 ... ... 1 ... ... ... 2 3 3 3 2 3 7 3 2 11 1 ... ... 2 3 Tuberculosis, Pulmonary 54 32 ... ... ... ... ... ... 2 ... 1 1 15 13 16 14 16 2 4 2 29 17 5 35 6 5 1 9 21 „ Non Pulmonary 2 15 ... ... ... ... ... ... ... 1 ... 1 2 4 ... 4 ... 4 ... 1 4 2 1 10 2 1 1 7 11 Totals 630 612 29 25 98 106 138 118 230 245 26 17 38 28 39 49 25 15 8 8 338 121 81 702 42 21 14 81 158 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, 1953. No. in Short List Causes of Death. Deaths at Subjoined ages of " Residents " whether occurring witliin or without the District Deaths at ail Ages of " Residents " belonging to Localities, whether 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 under 75 75 and upwards Greenwich East j Greenwich West St. Nicholas, Deptford Charlton and Kidbrooke 1 St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital Other Institutions Outside Institutions Under 4 mths. 4 mths. and under 1 yr. 1 Tuberculosis, Respiratory 16 ... ... ... ... ... ... 3 8 4 1 3 4 3 6 3 2 ... ... ... ... 7 46 2 Tuberculosis, Other 2 ... ... ... ... ... ... 2 ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... 6 3 Syphilitic Disease 3 ... ... ... ... ... ... ... ... 2 ... 1 ... ... 2 1 ... ......... ... ... ... 1 3 4 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Whooping Cough 2 ... 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... 3 6 Meningococcal Infections 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 7 Acute Poliomyolitis 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 3 8 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Other Infective and Parasitic Diseases 2 ... ... ... 1 ... ... ... 1 ... ... ... 1 ... 1 1 ... ... ... 1 ... ... 6 10 Malignant Neoplasm, Stomach 33 ... ... ... ... ... ... 1 14 9 9 12 5 2 14 12 1 ... ... 1 ... ... 43 11 Malignant, Neoplasm, Lung, Bronchus 27 ... ... ... ... ... ... 3 16 7 1 10 5 1 11 6 4 2 ... 2 ... 3 58 12 Malignant Neoplasm, Breast 12 ... ... ... ... ... ... 3 1 4 4 3 2 ... 7 4 ... ... ... ... ... 4 18 13 Malignant Neoplasm, Uterus 11 ... ... ... ... ... ... 1 7 2 1 5 1 1 4 2 ... 2 ... ... ... 2 8 14 Other Malignant and Lymphatic Neoplasms 76 ... ... ... ... ... ... 2 32 24 18 25 17 5 29 20 5 6 ... 1 ... 21 128 15 Leukaemia, Aleukaemia 10 ... ... ... 2 ... ... 1 2 4 1 3 1 ... 6 5 ... 1 ... 3 ... ... 15 16 Diabetes 2 ... ... ... ... ... ... ... ... 1 1 2 ... ... ... 1 ... ... ... ... ... ... 7 17 Vascular Lesions of Nervous Svstem 88 ... ... ... ... ... 1 ... 17 25 45 28 24 4 32 28 2 3 ... 4 3 10 173 18 Coronary Disease, Angina 96 ... ... ... ... ... ... 4 26 36 30 38 18 4 36 13 1 2 ... 2 1 13 104 19 Hypertension with Heart Disease 28 ... ... ... ... ... ... 1 3 5 19 11 8 1 8 11 ... 1 ... ... ... 1 41 20 Other Heart Disease 113 ... ... ... ... ... 1 2 17 28 65 51 17 8 37 45 2 3 ... 1 1 10 157 21 Other Circulatory Disease 63 ... ... ... ... ... 1 2 9 22 29 24 14 4 21 32 1 1 ... ... 1 14 137 22 Influenza 15 ... ... ... ... ... ... 1 1 4 9 5 5 ... 5 1 ... ... ... ... ... 1 3 23 Pneumonia 32 2 2 ... ... ... ... ... 7 11 10 10 4 2 16 18 3 2 ... ... ... 2 86 24 Bronchitis 79 1 ... ... ... ... ... 2 16 26 34 33 16 1 29 15 ... 2 ... ... l 5 86 25 Other Diseases of Respiratory System 8 ... 1 ... ... ... ... 1 3 2 1 2 ... 1 5 4 ... ... ... 1 ... 2 13 26 Ulcer of Stomach and Duodenum 14 ... ... ... ... ... ... ... 6 6 2 7 1 ... 6 7 1 3 ... ... ... 2 34 27 Gastritis, Enteritis and Diarrhoea 5 1 ... 1 ... ... ... ... 2 1 ... 1 2 ... 2 2 ... ... ... 1 ... ... 12 28 Nephritis and Nephrosis 10 ... ... ... ... ... 1 3 5 ... 1 4 1 ... 5 3 1 ... ... 1 ... 1 1 6 29 Hyperplasia of Prostate 8 ... ... ... ... ... ... ... 1 2 5 3 ... ... 5 7 ... ... ... ... ... 1 20 30 Pregnancy, Childbirth, abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 31 Congenital Malformations 7 4 ... ... ... ... ... 1 ... ... 3 ... ... 4 4 ... ... ... ... ... 3 13 32 Other defined and ill-defined Diseases 49 9 2 1 ... 1 1 1 8 9 17 20 6 1 22 16 2 1 ... 1 ... 14 146 33 Motor Vehicle Accidents 11 ... ... ... ... 2 1 3 2 2 1 1 3 2 5 1 ... ... ... 2 ... 8 26 34 All other Accidents 12 ... ... ... ... 1 1 2 1 3 4 3 2 ... 7 7 ... ... ... 1 ... 3 25 35 Suicide 11 ... ... ... ... 1 ... 3 4 3 ... 3 3 ... 5 ... 2 ... ... ... 3 8 36 Homicide and Operations of War ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 847 17 7 3 5 6 7 42 210 242 308 312 162 40 333 269 26 31 ... 24 7 131 1,446 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 Wales, and who died in the Borough in like manner have been excluded.