AC4373 1 Mr Cmara d w 5 B 2 library Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1954 Metropolitan Borough of greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1954 Printed by Freame, Manning & Co., Ltd. Lewisham, S.E. 13 CONTENTS Paoe Public Health Committee 3 Introductory 6 Section A.—General and Vital Statistics 10 „ B.—General Provision of Health and Welfare Services for the Area 30 „ C.—Sanitary Circumstances of the Area 39 „ D.—Housing ... _ 72 „ E.—Inspection of Food and Supervision of Food Premises 78 „ F.—Prevalence of, and Control Over, Infectious and other Diseases 99 „ G.—Miscellaneous 115 Appendix—Statistical Tables 3 PUBLIC HEALTH COMMITTEE as at 31st December, 1954 The Mayor: Councillor T. L. Dawes, J.P. and 13 Members Councillor H. W. Gorman (Chairman) Councillor Mrs. M. L. Wentworth (Vice-Chairman) Aldermen: Mrs. C. Berry Mrs. L. Hilldrith Mrs. A. D. A. Kennedy Councillors : Mrs. M. Bennett P. Noble A. C. Chrisp (L.C.C.) Dr. W. Smith Mrs. F. M. Kerins W. F. Strong D. F. Lynch 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 Parlia— ment, bye-laws and regulations dealing with the public health and the sanitary condition of the Borough ; the adminis— tration 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.—The powers and duties of the Council conferred by Section 47 of the National Assistance Act, 1948, shall be delegated to the Committee. 5.—The powers and duties conferred upon the Council by the Pet Animals Act, 1951, the Rag Flock and Other Filling Materials Act, 1951, and by the Heating Appliances (Fireguards) Act, 1952, be delegated to the Committee. 6.—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. 7.—The Committee shall have the control of any Mortuary and of any disinfecting apparatus and plant provided and main– tained by the Council, as well as public sanitary conveniences and conveniences maintained by the Council. 8.—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. 9.—(a) 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. (b) The powers and duties of the Council conferred by Section 26 of the Housing Repairs and Rents Act, 1954, to issue and revoke certificates as to dwelling-houses being in good repair and reasonably suitable for occupation, be delegated to the Committee. 5 STAFF, as at 31st December, 1954 MEDICAL OFFICER OF HEATH : John Kerb 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 C. W. Spore. a J. G. Lyons. abdef Miss B. Hatfield Food Inspectors: ab G. B. Allen* (Senior) ab (vacant) CLERICAL STAFF : L. A. Westacott (Chief Clerk) A. H. Wilcox Mrs. V. I. Starr (Senior Clerk). (Senior S/H Typist). J. F. Vickers. Mrs. M. G. simpsonf k. Allum, d.f.m. A. H. Hammond (Temporary). s. E. Thelner. W. A. Pearce (Conveniences A. G. Lyons 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 seven 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 17/11/54 t 3/8/54 6 Public Health Department, Town Hall, Greenwich, S.E.10. July, 1955 To the Mayor, Aldermen and Councillors, Metropolitan Borough of Greenwich. Ladies and Gentlemen, It is my agreeable duty to present this account of the health and environmental ciroumstances of our Borough for 1954. The population has increased and is now well over 90,000. The death rate has declined to the new low figure of 8.79 and still births have decreased by 7. This year has seen a further increase in the Infantile Mortality rate from 18.1 to 22.17. This is the second consecutive year that this rate has increased, and while it would be unfair and unwise to draw any definite conclusions from this, a more disturbing feature is that neo-natal deaths (deaths within the first 4 weeks of birth) constituted 76.6% of all infant deaths under one year, as against the usual figure of 45% to 55%. It is recognised that the first four weeks of life are the most vulnerable and it is in these early days that the value of effective ante- and post-natal care becomes apparent. Mothercraft also plays an important part at this time. I have analysed the causes of each neo-natal death and I find that 50% were attributable to premature birth. Many factors involved in prematurity are obscure and little understood, but high on the list of preventive measures must be good ante-natal supervision, which can reduce to an absolute minimum the incidence of premature birth and at the same time ensure that if a child is born early it is born healthy with every chance of survival. I think it is also clear that much has yet to be learned about the care and management of these small infants, clinging so precariously to life. Twenty-five per cent, of deaths were attributable to con— genital defects, none apparently related to pre-natal virus infection of the mother, and in the present state of knowledge of eugenics and heredity nothing can be done about preventing these embryological abnormalities. Four of the infants died of broncho— pneumonia and it always seems tragic in these days of chemotherapeutic and anti-biotic drugs that lives should be lost to 7 infection. It is surely an indication that infection still lurks and its control requires constant vigilance. Once again I am glad to report no maternal deaths. Infectious diseases continue to decline significantly. Total notifications were only 569, a reduction on last year of 673, due in large proportion to the low incidence of Measles, but there were also considerable reductions in Scarlet Fever and Sonne Dysentery. Once again the Borough was comparatively free from Poliomyelitis, having only 3 paralytic and 2 non-paralytic cases. Unfortunately, there was one death. A case of Nasal Diphtheria of a mild type was our first for some years. The hard core of Pulmonary Tuberculosis remains, for while deaths declined slightly, notifications were above last year's figure and the number of patients on the Pulmonary Tuberculosis Register increased by 67 to 972. It would appear that a case can be made out for a more intensive campaign of BCG vaccination among vulnerable classes. The efficacy of this vaccine is I think generally accepted and Tuberculosis may have to be tackled now using BCG with the same determination and resolution as Diphtheria was attacked between the wars. Already Mass Miniature Radiography throughout the country has yielded valuable results, but perhaps the use of this diagnostic facility as a general screening method for casefinding in the community at large should be reviewed in the light of experience. Some physicians and hygienists criticise Mass Miniature Radiography on economic and indeed on epidemiological grounds and the fact remains that there are many people who, suspecting that they may suffer from Pulmonary Tuberculosis, prefer to remain in ignorance of the fact. On the other hand, many who are not open to any apparent risk and who remain continually in good health, are screened over and over again and are pronounced clear with monotonous regularity. It is thus argued that too often Mass Miniature Radiography is reaching and screening the wrong people. Short of compulsion, which is always unacceptable, it is difficult to see how this objection can be overcome and in any case it is not a valid criticism of Mass Miniature Radiography as a principle ; but more and more I am tending to the view that Mass Miniature Radiography might with advantage be re-deployed and be reserved for the investigation of specific community groups, for ' black spots ' where incidence is high and risk of infection greater or, for workers engaged on certain manufacturing processes known 8 to be associated with high Tuberculosis rates. Cases and contacts could, as at present, continue to be dealt with by routine procedure at Chest Clinics and by the general practitioners ; thus, the resources of this pioneer service would be concentrated where most required and not as at present sometimes overwhelmed and diluted in a flood of normality. Deaths from Cancer continue to rise and it is lung and bronchus carcinomata that show the greatest increase. Possible relationships between smoking, atmospheric pollutants and lung cancer incidence are being studied throughout the world and most experts are agreed that some sort of correlation has been established between them. Lung irritants in the form of smoking, pungent gases in the atmos— phere or fumes from internal combustion engines may provoke cancer action directly or act as catalysts in an already established pre-cancerous condition of the tissue cells. In relation to Greenwich I will make only one observation about our own figures, which are too small for any dogmatic assertions. Since 1945 the lung cancer rate in females has increased absolutely and also relatively to male incidence. The fact that smoking is now much more prevalent among women than before the war may not be without statistical significance. The figures are being assessed year by year and may yield useful results in the future. The Beaver Report on Atmospheric Pollution has now been published and we await its translation into some workable legal code. The Health Department have caused grit-measuring trays to be placed at strategic points in the Borough and, in collaboration with the Fuel Research Station, we are now measuring atmospheric smoke and sulphur dioxide concentrations at the Town Hall and at Charlton House. This information will be correlated with similar stations situated throughout London and should give an authentic and accurate picture of atmospheric pollution over a wide area of the Metropolis. During the year the Ministry of Housing and Local Government confirmed the Little Heath Clearance Area representation. A small area in Roan Street awaits confirmation and a large area in the vicinity of Haddo Street is being surveyed for presentation to the Council early in 1955. The Old People's Welfare Committee is now well established and in addition to the valuable " Meals on Wheels " Service run by the British Red Cross Society the Committee extended considerably the holiday scheme for Old People and details are included in the body of the Report. In addition, the Council have installed a 9 washing-machine at the Cleansing Station for dealing with foul and contaminated linen and personal clothing prior to disinfection and this service is proving of great value to old, helpless and bedridden persons. Once again relations with the St. Alfege Hospital Geriatric Unit and L.C.C. Institutions remain cordial and mutually advan— tageous, and there must be few Boroughs in London where oJd people in urgent need receive more prompt or sympathetic con— sideration in hospitals or in Old People's Homes. This year brought staff shortages, particularly of Sanitary Inspectors, and the Department sustained a great loss with the death of Mr. H. L. Bennett, the Senior Food Inspector. Mr. Bennett was recognised as an expert on food matters and it was due largely to his efforts that the Greenwich Guild of Hygiene was formed. The multifarious improvements and the high standards of hygienic practice attained in the handling, sale and distribution of food in this Borough during his tenure of office are a lasting tribute to his memory. He applied himself to his duties with diligence and with enthusiasm and the Council, and indeed the Borough as a whole, have lost a valuable public servant. For my part I lost a personal friend whom I held in the highest esteem. In conclusion, I wish to thank the staff for their help throughout the year and to acknowledge the support which I have received from the Chairman and Vice-Chairman of the Public Health Committee ; likewise the Chief Officers have shown much kindness and consideration throughout the year. I have the honour to be, Your obedient Servant, J. Kerb Brown Medical Officer of Health 10 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, 1954 (mid-year) 90,600 Density of Population (persons per acre) 23.4 Number of Inhabited Dwellings—end 1954 23,062 (according to Rate Books) Structurally separate dwellings at Census, 1951 21,348 Number of Uninhabited Dwellings— At Census, 1951 364 At end 1954 123 Number of Families or Separate Occupiers— At Census, 1951 26,397 Rateable Value, 1954 £822,774 Sum Represented by a Id. Rate, 1954 £3,330 11 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.Offioe of Works— Greenwioh Park 185 acres L.C.C.— Blackheath (part of) 89 acres Blackheath—Rangers House and Garden „ Maryon and Maryon Wilson Parks 51$ „ Charlton Park 42£ „ Hornfair (formerly Charlton Playing Field) 26 „ Say es Court Recreation Grounds 3£ „ 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) 12 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. 13 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, Merry weather'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. 14 POPULATION The Registrar General has submitted his estimate of the popula— tion of Greenwich, computed at mid-year 1954, upon which the Statistics of this Report have been based. The figure returned is 90,600, indicating an increase in the population of 160 since last year and 754 since the 1951 Census. The current figure shows an advance of 26,800 over that for 1945. The natural increase for the year, i.e., excess of births over deaths was 559. Generally speaking it would appear that births have settled at a level sufficient for each generation to replace itself and the popula— tion should therefore remain comparatively stable. In recent years much has been made of the fact that the popula— tion is ageing and this has led to a popular misconception that people nowadays live to a greater age than before. Although it is true to say that many more people are reaching the age of 65 years today than formerly, the chances of these people becoming centenar— ians is little better now than it was some 100 or so years ago. Perusal of the following data will make the position more readily under— stood :— Expectation of Life at Birth Males Females In 1841 it was 39.9 yrs. 41.9 yrs. In 1952 it was 67.1 yrs. 72.4 yrs, Expectation of Life at 65 years of age. In 1841 it was 10.8 yrs. 11.5 yrs In 1952 it was 12.0 yrs. 14.8 yrs. Thus, although the expectation of life at birth for the male has risen some 27 years since 1841, over the same period his expectation of life at the age of 65 has increased by a mere 1.2 years. Even for females who normally experience greater longevity the increase at 65 years is only 3 years. 15 * EXTRACTS FROM VITAL STATISTICS OF THE YEAR. LIVE BIRTHS Male Legitimate Illegitimate Total Birth Rate 14.98 (Crude) 634 34 668 Female 650 35 685 (Comparable Rate 13.93) Total 1,284 69 1,353 STILL BIRTHS Male Legitimate Illegitimate Total 13 1 14 Rate per 1,000 18.14 total Births  Female 11 — 11 Total 24 1 25 DEATHS—All Causes Male Female Total Death Rate (Crude) 8.79 418 376 794 (Comparable Rate 9.40) DEATHS—Special Causes Puerperal Causes Nil Tuberculosis (all forms) 15 Tuberculosis, Pulmonary 15 Cancer (all ages) 166 Measles (all ages) Nil Whooping Cough (all ages) Nil Diarrhoea (under 2 years of age) 1 Influenza Nil •These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 16 DEATH RATES Infanta under 1 year of age All infants per 1,000 live births 22.17 Legitimate Infants per 1,000 legitimate live births 19.47 Illegitimate Infants per 1,000 illegitimate live births 57.97 Others Puerperal Causes (per thousand total births) Nil Tuberculosis (all forms) per 1,000 population 0.16 Tuberculosis, Pulmonary per 1,000 population 0.16 Cancer per 1,000 population 1.83 Common Infectious Diseases per 1,000 population 0.01 Influenza per 1,000 population Nil MARRIAGES. Mr. J. Abercrombie, the Superintendent Registrar of the Green— wich Registration District, has kindly furnished me with particulars relating to the number of marriages solemnised or registered in the Borough of Greenwich during 1954. The total of 771 gives a marriage rate of 17.07 a decrease of 0.13 from that of the previous vear. 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 Kidbrooke St. Nicholas j 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 n 91 241 790 57,070 1942 257 192 3 79 198 729 60,530 1943 209 166 2 73 171 621 62,870 1944 211 136 — 74 171 592 61,800 1945 228 211 2 87 233 761 63,800 1946 258 196 1 86 235 776 76,840 1947 192 160 13 93 318 776 82,230 1948 202 152 8 104 345 811 84,410 1949 184 129 10 . 90 272 685 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 1954 200 . 155 ... 5 . 86 325 771 90,600 ♦Parish Church destroyed by enemy action. tSt. Peter's, Creek Road Holy Trinity, Blackheath Hill closed 17 METEOROLOGICAL OBSERVATIONS—1954. 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, 1954 :— Temperature: The highest screen temperature 83°F. on 1st September. The temperature exceeded 80°F. on 27th May (81 °F.) 1st Sept. (83°F.) The lowest screen temperature was 17°F. on 28th January. The maximum temperatures during January, February, November and December were : 57°F. on 15th January 54°F. on 22nd February 61 °F. on 6th November 59°F. on 2nd December Sunshine : Total hours recorded 1,248.9 The sunniest day was 26th May, when 13.1 hours of sunshine were recorded. There were 65 days when no sunshine was recorded, viz :— January 12 days February 12 „ March 7 „ April 0 „ May 1 „ June 2 „ July 2 „ August 2 „ September 1 „ October 4 „ November 8 „ December 14 ,, Rainfall: Total for the year 25.80 ins. Highest in 24 hours 92 ins. on 25th July Driest month April (0.31 inches) Wettest month August (4.48 ,, ) 18 BIRTHS The total number of live births registered in the Borough during the year was 1,318 and of this number 915 occurred in St. Alfege's Hospital, 27 in various Nursing Homes and 376 in private dwellings. In 484 cases the parents resided outside the Borough and the births were consequently transferred to the appropriate districts, leaving a figure of 834. To this must be added 519 births belonging to the Borough which took place in Institutions outside the Borough, thus making a final figure for Greenwich of 1,353, a decrease of 28 from that of the previous year. Of this total 668 were males and 685 females. The following table gives by districts the number of registrations of Greenwich Births during the current year :— Source of Information DISTRICT Total Greenwich Births East West St. Nicholas Charlton & Kidbrooke Greenwich Registrar's Returns :— 289 216 63 266 834 Inward Transfers :— 1st Qtr. 43 14 7 70 134 2nd Qtr. 45 10 2 64 121 3rd Qtr. 42 15 — 72 129 4th Qtr. 34 17 2 82 135 Totals 453 272 74 554 1,353 The Birth Rate for the year, calculated on the figure of 1,353 births, is 14.98 per thousand of the population, 0.34 lower than that for 1953. The average rate for the previous ten years is 18.29. The Greenwich Comparability Factor for births is 0.93 which gives an adjusted rate of 13.93. The Rates for the County of London and England and Wales are identical, viz : 15.2. Illegitimate Births which numbered 69 (representing 5.1 per cent, of the total live births) showed an increase of 13 over those of the previous vear. The number of Still Births registered was 25 (14 males - 11 females), which is equivalent to a rate of 18.14 per 1,000 total births, a decrease of 4.50 from that of the previous year. No. in Short List. 1 Causes of Death Deaths at subjoined Ages of " Residents," whether occurring within or without the District. 1 Sex 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 5. 75 and over. All Causes M 418 19 2 4 3 31 108 119 132 F 376 11 4 ... ... 14 85 89 173 1 Tuberculosis, Respiratory M 12 ... ... ... 1 3 5 1 2 F 3 ... ... ... ... 2 ... ... ... 2 Tuberculosis, Other M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 3 Syphilitic Disease M 3 ... ... ... ... 1 ... 2 ... F 2 ... ... ... ... ... ... 1 1 4 Diphtheria M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 5 Whooping Cough M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 6 Meningococcal Infections M 3 1 1 1 ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 7 Acute Poliomyelitis M 1 ... ... 1 ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 8 Measles M ... ... F ... ... ... ... ... ... ... 9 Other Infective and Parasitic Diseases M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 10 Malignant Neoplasm, Stomach M 14 ... ... ... ... 1 6 6 1 F 9 ... ... ... ... ... 3 1 5 11 Malignant Neoplasm, Lung, Bronchus M 39 ... ... ... ... ... 21 13 5 F 8 ... ... ... ... ... 3 5 ... 12 Malignant Neoplasm, Breast M ... 18 ... ... ... ... ... ... ... ... F ... ... ... ... 3 8 4 3 13 14 Malignant Neoplasm, Uterus Othei Malignant and Lymphatic F 3 ... ... ... ... ... 1 ... 2 M 36 ... ... ... ... 2 10 9 15 15 Neoplasms Leukaemia, Aleukaemia F 39 ... ... ... ... 1 16 15 7 M 6 ... ... ... ... 5 ... 1 ... 16 Diabetes F M 3 2 ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 1 1 F 1 ... ... ... ... ... ... ... 1 17 Vascular Lesions of Nervous M 27 ... ... ... ... 1 9 5 12 System F 57 ... ... ... ... ... 10 19 28 18 Coronary Disease, Angina M 67 ... ... ... ... 3 2 28 12 F 44 ... ... ... ... 1 12 10 21 19 Hypertension with Heart Disease M 10 ... ... ... ... ... 1 5 4 F 22 ... ... ... ... ... 3 8 11 20 Other Heart Disease M 49 ... ... ... ... ... 4 10 32 F 65 ... ... ... ... ... 10 7 46 21 Other Circulatory Disease M 18 ... ... ... ... ... 2 5 8 F 28 ... ... ... ... ... 2 8 18 22 Influenza M p ... ... ... ... ... ... ... ... ... 23 Pneumonia M 19 4 ... ... ... ... 3 5 7 F 8 ... ... ... ... ... 1 2 5 24 Bronchitis M 31 1 ... ... ... ... 6 8 15 F 16 ... ... ... ... ... 5 3 8 25 Other Diseases of Respiratory M ... ... ... ... ... ... ... ... ... System ... F 1 ... ... ... ... ... ... 1 ... 26 Ulcer of Stomach and Duodenum M 9 ... ... ... ... ... 1 6 2 F 2 ... ... ... ... ... ... 1 1 27 Gastritis, Enteritis and Diarrhoea M 2 1 ... ... ... ... 1 ... ... 28 Nephritis and Nephrosis F 1 ... ... ... ... ... ... ... 1 M 5 ... ... ... ... ... 3 ... 1 F 1 ... ... ... ... ... ... ... 1 2!l Hyperplasia of Prostate .. M 5 ... ... ... ... ... 1 1 3 :i(i Pregnancy, Childbirth, abortion F ... ... ... ... ... ... ... ... ... 91 Congenital Malformations M 4 4 ... ... ... ... ... ... ... 32 Other defined and ill-defined F 3 3 ... ... M 35 7 ... 2 1 1 7 11 6 Diseases F 26 7 2 ... ... 2 7 1 7 33 Motor Vehicle Accidents M 10 ... ... ... 1 4 2 1 2 F 1 ... ... ... ... ... ... ... 1 34 All other Accidents M 7 ... 1 ... ... 3 1 1 1 35 Suicide F 10 1 1 ... ... ... ... 3 5 M 4 ... ... ... ... ... 1 ... 3 36 Homicide and Operations of War F 5 ... ... ... ... 2 3 ... ... M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 19 DEATHS The net number of deaths registered during 1954 was 794, of which 418 were males and 376 females, compared with last year's total of 848 comprising 426 males and 422 females. This gives a crude Death Rate for the Borough of 8.79 per thousand of the population, a decrease of 0.61 as compared with that of the previous year and a rate which is 2.63 less than the average for the last ten years, viz., 11.42. The crude Death Rate figure is slightly increased to 9.40 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 popula— tion 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 10.7 and 11.3 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. 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 :— Deaths of Greenwich Residents Year Total In Public Institutions No. % of Total Deaths 1944 978 616 62.9 1945 813 521 64.0 1946 874 585 66.9 1947 952 561 58.9 1948 862 441 51.1 1949 942 484 51.3 1950 926 540 58.3 1951 1,002 574 57.2 1952 958 551 57.5 1953 847 489 56.5 10-year average 915 536 58.5 1954 794 460 57.9 AGE MORTALITY. The age mortality and the distribution of the deaths between the 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 8 10 5 7 30 Between 1 and 2 years 1 — — — 1 Between 2 and 5 years — 1 — 4 5 Between 5 and 15 years — 3 — 1 4 Between 15 and 25 years — 1 — 2 3 Between 25 and 45 years 14 12 11 8 45 Between 45 and 65 years 55 44 43 51 193 Between 65 and 75 years 55 49 40 65 209 75 years and upwards 102 70 58 74 304 Totals 235 190 157 212 794 21 During the year the pattern of death registrations continued normally, namely that the first quarter produced the most (29.6%) and the third quarter the least (19.7%). It will be observed from the following table that during 1954 the deaths occurring at 65 years and upwards accounted for 64.6% 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 4.5%. Age Group 1901 1911 1921 1931 1951 1954 Under 1 year of age 362 306 175 97 29 30 Between 1 and 5 years 187 158 80 39 7 6 Between 5 and 15 years 64 67 58 22 10 4 Between 15 and 25 years 66 60 67 65 12 3 Between 25 and 65 years 454 474 466 382 311 238 65 years and over 335 356 387 529 633 513 Totals 1,468 1,421 1,243 1,134 1,002 794 MATERNAL MORTALITY There were no deaths from Puerperal Sepsis or other Maternal causes during the current year, a similar position to that recorded last year. Three deaths were registered for the year 1952 and the corresponding figures for 1951, 1950, 1949 and 1948 were 4, 0, 1 and 2 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 22.17 per thousand live births as compared with 18.10 for the previous year. For the County of London the rate was 20.7 and for England and Wales 25.5 per 1,000 related live births. The present Borough figure of 22.17 is 1.47 higher than that for London and shows an increase of 4.07 over that returned for the previous year and is no less than 7.57 greater than the rate for 1952. The actual number of infantile deaths recorded during the year 22 was 30 (an increase of 6) and these were attributed to the following causes:— Prematurity 12 Acute Meningococcal Congenital Meningitis 1 Malformations 6 Hypertrophy of Heart Broncho-pneumonia 5 (idiopathic) 1 Bronchitis 1 Inattention 1 Gastro-enteritis 1 Unascertainable 1 Hepatic Failure 1 Of the above, 19 were male and 11 female ; 5 died in St. Alfege's Hospital, 3 in Brook Hospital, 2 in Miller Hospital, 14 in other Hospitals and 4 at home. Of the remaining 2 deaths, one body was recovered from the river foreshore and one from waste ground in the Borough. Significantly perhaps, this substantial increase in infant deaths during the current year was confined wholly to the neo-natal period, deaths occurring after the first 4 weeks from birth actually showing a decline. Neo-Natal Mortality.—Neo-natal mortality, i.e., infants dying before attaining the age of one month, accounted for 23 deaths, equivalent to 76.6% of all infant deaths and giving a Neonatal Mortality Rate of 17.00 per 1,000 live births. Seventeen 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 1954 :— 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 1954 Greenwich 75 50 40 27 22.17 London 63 56 60 33 20.7 England & Wales 62 55 50 36 25.5 23 Bad housing, overcrowding, poor sanitation, low standards of education, all tend to produce higher Infant Mortality Rates. It follows therefore, that the Infant Mortality Rate should provide a gcod 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 small 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 Doath, 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 rules generally adopted throughout England and Wales. The Registrar-General is able, in cases where it is deemed desirable, to obtain fuller information from the certifying practitioner. This enables his department to modify the original classification—hence the possibilities of discrepancies in some cases between the figures prepared locally and those referred by the Registrar-General. 24 Common Infectious Diseases.—This classification comprising Measles, Scarlet Fever, Diphtheria, Whooping Cough and Diarrhoea was responsible for one death giving a rate of 0.01 for the current year. There were 4 deaths from Common Infectious Diseases during 1953 but none was recorded for 1952, 3 for 1951, 3 for 1950 and 2 for 1949. Smallpox.—No deaths from Smallpox have been recorded during the year, this year being the 52nd since a death from this disease occurred. Measles.—There were no deaths arising from this cause during 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 eighth 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.—No deaths were credited to this cause during the current year in comparison with two for the previous year. One death was registered for each of the years 1947,1948,1949, 1950 and 1951 and none for 1952. 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.—One death was stated as being due to this cause, equalling a Death Rate of 0.01 per thousand. Last year 2 deaths were recorded from this cause and none for 1952. Two 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 8 years since one was recorded. Tuberculosis.—There were 15 deaths from this disease during the year giving a Death Rate of 0.16 compared with 18 deaths and a Rate of 0.19 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 : 0.61. Current figures throw into relief the remarkable improvement in the Tuberculosis situation in the Borough during the past 10 25 years. Actual deaths from Tuberculosis are less than one third and the rate is one fifth of the corresponding figures for 1944 as the following table will indicate :— Year No. of Deaths Rate 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 1953 18 0.19 10-year Average 48 0.61 1954 15 0.16 Tuberculosis of the Respiratory System was responsible for all the deaths in this category, not a single death being attributed to the remaining forms of tuberculosis. At 0.16, the Pulmonary Tuberculosis rate was 0.01 less than that returned for the previous year. Locally the deaths were : 3 in East Greenwich ; 1 in West Greenwich ; 2 in St. Nicholas, Deptford ; and 9 in Charlton and Kidbrooke. Last year there were 2 deaths from other forms of Tuberculosis compared with NIL for the current year. 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 166 deaths giving a rate of 1.83 per thousand, these figures showing increases of 7 and 0.07 respectively over 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 20.9, the figure for 1954. 26 Comparing the current year's figures with those of the previous 4 years, the sites of the affected parts were :— 1950 1951 1952 1953 1954 Cancer of Stomach 30 24 24 33 23 ,, „ Lung, Bronchus 26 51 31 27 47 „ Breast 12 14 11 12 18 ,, ,, Uterus 7 11 6 11 3 „ „ all Other Sites 92 98 89 76 75 Totals 167 198 161 159 166 Tliroughout 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 Bronchogenic Carcinoma) Year AGE GROUPS Rate per 1,000 Pop. 25 and under 45 yrs. 45 and under 65 yrs. 65 and under 75 yrs. 75 and upwards Totals Grand Totals 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 — 23 4 27 0.29 1954 — — 21 3 13 5 5 — 39 8 47 0.52 Totals 13 1 142 20 74 12 17 6 246 39 285 Average for 9yrs. 0.36 27 From the preceding table it can be seen that the age group 45 to 65 years is still the period of greatest mortality and it may well be that some significant relationship exists between the increase in female deaths from lung cancer and the increase in female cigarette consumption. Current figures give a ratio of approximately 5 males to every female death from this cause compared with an average of the previous 8 years of 6 to 1. Despite intensive research, causes of cancer have still to be determined and atmospheric pollution may yet be proved to be a potent factor in promoting lung cancer. Consideration has been given at various times to the question of making malignant diseases notifiable, as in present circumstances the only information available to a Medical Officer of Health is that obtained from the death returns ; he, therefore, gains no knowledge of the incidence of the disease, effect of treatment, recovery rates or possible pre-disposing factors. As the result of an investigation by a Sub-Committee set up in 1952 by the Registrar General's Advisory Committee on Medical Nomenclature and Statistics, the whole question of the future of cancer registration was referred to the Ministry of Health's Standing Advisory Committee on Cancer and Radiotherapy. The outcome was a recommendation to the effect that a simplified card be intro— duced for the voluntary registration of all sites of cancer and that a concentrated effort be made to achieve complete registration in a few selected regions. In February 1954 the Minister of Health requested reports on this suggestion from Regional Hospital Boards and Boards of Governors and it seems likely that a number of regions will be operating full regional schemes in the near future. 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. However, at the moment the most important factor is time, but unfortunately, many cases are beyond cure before advice is taken. At the risk of pro— ducing a few hypochondriacs it is obvious that greater efforts must be made to educate the public because the latest available informa— tion supports the fact that delay in seeking medical advice is becom— ing more prolonged. 28 Vascular Lesions of Nervous System.—This class, which includes deaths arising from Cerebral Haemorrhage, Embolism and Thrombosis was responsible for a total of 84 deaths. The age distribution was as follows :—1 between 25 and 45 years ; 19 between 45 and 65 years ; 24 between 65 and 75 years and 40 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 257 compared with a figure of 246 for 1953, and, as usual, the deaths from this class occupied the principal place in the classification of diseases. Diseases op the Respiratory System. — There were altogether 75 deaths from these diseases, Bronchitis accounting for 47 and Pneumonia (all forms) for 27. Of the total deaths, 4 were of children under one year of age and 54 were in respect of persons 65 years and over. Influenza.—There were no deaths attributed to this cause during the year. Fifteen were recorded during 1953. Deaths from Violence.—These number 37 including 11 from Motor Vehicle Accidents, 9 from Suicide and the remainder being accounted for under the heading of 'All Other Accidents.' Deaths from Motor Vehicle Accidents were similar in number to those of the previous year, while suicide showed a fall of two. Three of the remaining deaths from violence concerned children under 5 years of age. Two, which may be regarded as preventable, were caused by asphyxia (one as the result of the child swallowing a metal stud and the other resulting from the inhalation of coal gas) and the third concerned a newly born female child found on waste ground, the cause of whose death was unascertainable. 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. 29 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. 30 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 1954, which will be found on the following pages in table form. 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 Infectious 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 101 126 13 47 5 — 292 884 63 1,354 44 16 117 391 3,453 June 111 151 13 28 — 1 335 1,008 68 1,728 86 19 151 495 4,194 Sept. 107 131 13 35 3 — 276 853 66 1,463 51 3 69 477 3,547 Dec. 100 191 7 10 1 — 324 1,148 55 1,744 30 9 53 524 4,196 Totals 419 599 46 | 120 9 | 1 1,227 3,893 252 6,289 211 47 390 1,887 15,390 2. Infant Welfare Clinics Quarter Sessions Attendances 0-1 year 1-2 years 2-5 years 1st Total 1st Total 1st Total Mart-h 209 332 4,792 15 1,149 27 950 June 202 316 4,999 9 1.329 35 1,068 September ... 206 299 4,950 10 1,314 24 1,001 December ... 203 255 4,498 12 1,311 24 1,010 Totals 820 1,202 19,239 46 5,103 110 4,029 IE 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 108 307 241 239 702 427 40 40 42 42 J line 95 185 184 180 563 376 47 47 48 48 Sept. 92 178 178 177 532 336 62 62 63 62 Dee. 99 153 120 154 486 357 28 28 30 30 Totals 394 823 | 723 750 2,283 1,496 177 177 183 182 (b) Domiciliary Confinements 1st Attendances 1st Med. Examinations Total Attendances Subs. Quarter Sessions This Year Current Pregnancy Med. Exams March 99 226 127 107 1,076 256 June 96 105 104 84 1,100 197 Sept. 99 115 114 98 999 203 Deo. 97 74 87 82 1,007 212 Totals 391 520 432 371 4,182 868 se C3 4. Toddlers Clinics Quarter Sessions Total Attendances Medically Examined Found to require Treatment March 26 204 203 28 June 14 116 116 8 September 13 130 130 16 December 13 81 81 12 Totals 66 531 530 64 5. Ante Natal Educational Sessions (including exercises) Quarter Sessions Total Attendances March ... 13 105 June ... 11 106 September 13 113 December 19 129 Totals 56 453 6. Artificial Sunlight and Children's Exercise Classes Attendances Quarter Sessions Artificial Sunlight Exercise Classes First Total First Total March 101 117 2,089 11 55 June 77 65 1,446 4 47 September 91 102 1,395 1 48 December 97 125 2,334 6 52 Totals 366 409 7,264 22 202 7. Chiropody Treatment Quarter Sessions Attendances First Total March ... 440 332 5,010 June ... 422 409 5,014 September 436 321 4,824 December 428 272 4,811 Totals 1,726 1,334 19,659 34 8. Dental Treatment Quarter Sessions Nursing & Expectant Mothers Children under 6 yra. First Treatm'ts Total Attends. First Treatm'ts Total Attends. March 14 12 68 9 103 June 13 10 51 18 60 September 10 14 51 16 59 December 20 15 61 25 92 Totals 57 51 231 68 314 9. Home Help Service (a) Analysis of Cases, etc. Cases Home Helps Maternity Tuber— culosis Others Total No. Part Time Whole Time Equiva— lent On live Register at: 1st Jan. '54 7 24 443 474 100 49 31st Dec. '54 2 13 525 540 93 47 Cases attended during 1954 :— 54 37 812 903 (b) Supervision Effective Ineffective Total Visits made by Organising Staff: 2,089 352 2,441 10. Prophylaxis Cases receiving completed prophylactic treatment during year i— Diphtheria Immunisation 904 Whooping Cough Immunisation 959 Vaccination 600 11. District Nursing The staff of the Queens District Nursing Association for Charlton and Blackheath made 27,924 visits during the year. Visits carried out by the Ranyard Nurses and the Nu sing Sisters of St. John the Divine were additional to those quoted above. 12. School Health Service Vision Nutri— tion Special Investi— gation Clinic No. of Attendances 728 115 165 No. of New Pases 338 29 25 No. of Glasses Ordered 203 — Note : As appropriate children from Greenwich also attend special clinics in Deptford and Woolwich. 35 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 1.80 Chevening Road, S.E.10 Wednesday 0.30 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 (Toddlers) 1.30 Shooter's Hill Road, S.E.3. ... Monday 1.30 Tuesday 1.30 Wednesday 9.30 Thursday 9.30 *Including Children's Exeroise Claaa. 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)1.30(b) Fairfield House, S.E.7. Thursday 1.30 (ab) Ridgebrook Road, S.E.3. Thursday 1 1.30 (b) ((a) alter, weeks) Shooter's Hill Road, S.E.3. ... Monday 9.30† Friday 1.30 (ab)† †Motheroraft and Exercise Class. 36 ARTIFICIAL SUNLIGHT TREATMENT Chevening Road, S.E.10 DAY A.M. P.M. 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. (Diabetic Patients) Monday 2 - 5 Wednesday 10 - 1 Friday 2 - 5 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 37 CHEST CLINICS (By appointment only). DAY A.M.  Maze Hill, S.E.10 Monday 2.00 Tuesday 9.30 2.00 Wednesday 10.00 (men) [ 2.00 (women) (Special A.P. Clinics) Thursday 9.30 5 - 6.30 (workers only) Handicraft Centre Wednesday 2.15 - 4.15 Friday 2.00 - 4.00 DENTAL CLINIC Kidbrooke Comprehensive Tues. (alt.) School Hours School Thurs. " " 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 Kidbrooke Comprehensive School Daily Sohool Hours 38 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 Nurses, 110, Kennington Road, S.E.ll. (RELiance 4671). Nursing Sisters of St. John the Divine, Watson Street, S.E.8. (TIDeway 3028). OTHER ORGANISATIONS. British Red Cross Society, Mrs. E. M. Wigley, Divisional Director, 46, Vanbrugh Park, S.E.3 (Tel. GRE; 0157). Citizens' Adtice 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, W.V.S. Sub-Centre, 64B, Hyde Vale, S.E.I0. (Tel. TID. 3708). Blackheath Park, S.E.3. 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. 39 SECTION C Sanitary circumstances of the Area The tables on pages 69 to 71 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 18,401 houses and premises have been inspected or re-inspected during the year; 956 intimation notices and 184 statutory notices were served. Registered complaints, numbering 1,168 show a fall of 35 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 satisfactory standards. Representations on these lines had 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. The outcome of this and other agitation was the Housing Repairs and Rents Act, 1954, which became effective from 30th August of this year. Part I provides the statutory powers needed to implement the proposals made in the Government's White Paper ' Houses— the Next Step ' and as such is intended to widen the scope of housing policy. Since the war, emphasis has been on the erection of new houses for families without a home of their own. Parliament has now 40 decided that more attention shall be given to existing property with particular stress not only on the clearance of slums and their replace— ment but also on essential repairs and the encouragement of improve— ments and conversions. Part II of the new Act allows a ' repairs increase ' in rent subject to certain conditions. Briefly stated, these conditions cover the production by the landlord of evidence that work of a specified value has been carried out and that the dwelling is in good repair and reasonably suitable for human habitation, the term ' good repair ' being defined in the Act for this purpose. A tenant, if dissatisfied with the evidence presented by the landlord, can apply to the Local Authority for a Certificate of Dis— repair. In the event of a Certificate of Disrepair being issued, then, subject to satisfactory proof being provided by the landlord that such work as required by the Local Authority to bring the dwelling house up to the required standard has been executed, by suitable application he can obtain the revocation of the Certificate of Dis— repair. Factories Acts, 1937/48. Under these Acts the principal functions are administered by the Ministry of Labour and National Service through H.M. Factory Inspectors. The Sanitary Authority is charged with the duty of enforcing the legislation as to sanitary accommodation in all factories in its area and in those factories where mechanical power is not used, the following :— Cleanliness Ventilation. Overcrowding. Drainage of floors. All factories must have an adequate supply of drinking water from a public main or some other source approved in writing by the Council. During the year 398 inspections were made by the Council's Inspectors in relation to the 361 registered factories. The latter figure includes 66 premises where mechanical power is not used. Defects were found in 31 instances, all of which were remedied. 41 FACTORIES ACTS 1937 & 1948 Inspections for purposes of provisions as to health. Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 66 26 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 283 355 7 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 12 17 — — Total 361 398 7 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 Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S. 1.) 18 18 — 1 — Overcrowding (S.2) — — — — — Unreasonable temperature (8.3) — — — — _ Inadequate ventilation (S.4) Ineffective drainage of 1 1 — i — floors(S. 6) Sanitary Conveniences (S.7) 2 2 — — — (a) insufficient — — — — — (b) unsuitable or defective 5 5 — — — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 5 5 — — — Total 31 31 — 2 — 42 Outwork—(Sections 110 and 111) Section 110 Section 111 Nature of Work 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 prosecu— tions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prose— cution* 62 — — — — — Lace ... 3 — — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 1 — — — — — Lampshades ... 36 — — — — — Artificial Flowers 1 — — — — — Paper Bags ... 1 — — — — — Cardboard Boxes 1 — — — — — Carding, etc. of Buttons, etc. 3 — — — — — Total 108 — — — — — Outworkers.—Twice yearly, February and August, the Factory Act requires all employers of outworkers to forward to the 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 19 (b) Outworkers resident outside the Borough 30 Notifications received from firms outside the Borough of:— Outworkers resident in the Borough 141 Total number of Greenwich residents employed as outworkers (as given in August list) 108 Premises where homework is carried on were visited on 140 occasions by the Lady Sanitary Inspector. In no instance was it necessary to take action because of infectious disease. 43 River Pollution.—Complaints continue to be received from time to time in connection with smells emanating from the River. The smells arise mainly from the movement up and down 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. Work costing approximately £5½ million on the diffused air and sludge digestion plant at the Northern Outfall works has now commenced, and when this and similar works at the Southern Out— fall, (as itemised in the 1952 Report) have been completed, in the opinion of the London County Council, this will render the River inoffensive from this source of pollution. A certain amount of river pollution also arises from the dis— charge of trade effluent into sewers and further control of this aspect of pollution is expected to result from the application of Part II of the London County Council (General Powers) Act, 1953, which came into operation on the 1st April of the current year. Atmospheric Pollution.—" Smog " consciousness appears very difficult to generate in the minds of the public at large and perhaps more difficult still to bring home to them the fact that occasional " smog," serious though it may be, is less of a menace to health (and less costly) than the results of the perpetual day-to-day pollution of our air. In an appendix to the Beaver Report presented to Parliament in November, 1954, it was stated that even a very modest estimate of the direct economic cost under the headings of laundry, painting and decorating, cleaning and depreciation of buildings other than houses, corrosion of metals, damage to textiles and other goods, amounts to some £150 million, and the loss of efficiency, e.g., effects on agriculture, damage to soil, crops and animals, interference with transport and reduced human efficiency due to illness, amounts to a further £100 million per year. At this rate, air pollution is costing the nation some £250 million a year in terms only of losses that can be given a monetary value, and even this figure does not include the value of the lost fuel through incomplete combustion estimated at between £25 million and £50 million each year. It is stated in the Beaver Report that a clear association exists between pollution and the incidence of bronchitis and other respira— tory diseases and that ' air pollution is a social and economic evil which should no longer be tolerated and that it needs to be combated with the same conviction and energy as were applied 100 years ago in securing pure water.' 44 Causes of cancer have still to be fully determined and while uncertainty exists, action to minimise potential risks is vital. Atmospheric pollution may yet be proved to be a potential factor in lung cancer as is suggested by the comparative rates for urban and rural areas. The Beaver Report is so comprehensive that a brief summary of its contents is impracticable. The Committee stated that the securing of clean air should be a declared national policy and that their recommendations for this policy (after the ' immediate action' recommended in their interim report has been implemented) briefly covered the following :— Legislation—Prohibition of dark smoke. Obligation for new industrial plants to instal efficient grit and dust-arresting plant. Special industrial processes presenting technical diffi— culty concerning emission of harmful gases to be covered by an amended Alkali Act. General legislation regulating design of new industrial furnaces. Local Authority to be made responsible for stricter control of smoke from railways, etc. Power for Local Authorities to establish smokeless zones and areas in which domestic use of bitumin— ous coal would be restricted. Financial assistance by Local Authorities and Ex— chequer towards costs of conversion of appliances in smoke controlled areas. Domestic heating appliances to be of approved types. Purchase Tax to be removed from gas and electric heaters. With certain exceptions, responsibility for enforcing the law to be a statutory duty of Local Authorities. Local Authorities to submit to the appropriate Minister annual reports on progress regarding smoke abate— ment. Other Recommendations— Codes of practice and standard specifications for smoke indicators and recorders, etc. 45 Simpler apparatus for sampling flue gases and determin— ing grit emission. Recognition of stoking as a skilled occupation. Government Loan Scheme to be extended to cover installation of pollution-reducing equipment. Tax exemption on cost of new equipment designed to prevent smoke and grit emission. Efficient methods to be adopted to remove sulphur from flue gases at power stations. Change over from steam to diesel locomotives to be accelerated. Control of pollution by motor vehicles. Progressive extension of smokeless areas and the increase of supplies of smokeless fuels. Standards for solid domestic fuels. Employment by Local Authorities of adequate and well-trained smoke-control staff. Co-ordination of Local Authorities in smoke prevention. &c. The Government have already announced that it accepts the principles embodied in the Beaver Report and legislation to deal with the matter is now before Parliament in the form of a Clean Air Bill, the terms of which are eagerly awaited. In common with other Metropolitan Boroughs and as a means of obtaining more local information, the Council authorised the estab— lishment of two stations for the measurement of atmospheric pollution ; one at the Town Hall and the other at Charlton House. Due to delay in the delivery of apparatus, neither station will be able to function until next year. As in previous years I am indebted to Dr. Wilkins, Officer inCharge of the Atmospheric Pollution Section of the Government Fuel Research Station at Blackwall Lane, for permission to make use of data compiled at the Station. It would appear from the following tables that pollution of the atmosphere by smoke, grit and sulphur dioxide during 1954 was somewhat less than the two preceding years—a favourable trend which perhaps indicates the value and effect of the publicity afforded to this vital problem :— 46 TABLE I.—Rainfall, Monthly Deposit in Tons per Square Mile and Sulphur Dioxide by the Lead-Peroxide Method. Month & Year Rain— fall mm. Insoluble Deposit tons Soluble Deposit per square Total Solids mile SOs mg./day/lOO cm2 of Batch A Lead Peroxide October 1953 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 Maroh „ 45 30.65 8.04 38.69 3.60 April „ May „ June ,, 8 18.59 6.44 25.03 3.05 56 36.20 15.26 51.46 3.38 76 19.34 6.01 25.35 2.29 July „ 69 28.98 6.36 35.34 2.30 August „ 129 13.50 18.21 31.71 2..35* September „ 53 31.33 11.58 42.91 October „ 36 16.02 6.86 22.88 2.93 November „ 87 26.52 13.78 40.30 3.56 December „ 46 24.78 13.19 37.97 3.02 January 1955 56 34.19 14.17 48.36 3.76 February „ 33 13.09 13.32 26.41 4.50 * Figure for August and September TABLE II —Concentration of Smoke and Sulphur Dioxide by the Volumetric Method. Month - Year Smoke mg/lOOm Sulphur Dioxide p.p 100 million Monthly Average Highest Daily Average Monthly Average Highest Daily Average October 1953 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 March „ 13.8 29.7 11.7 18.4 April „ 12.4 23.7(b) 9.9 18.5 May „ 9.4 17.8 8.4 14.2 June „ 9.6 23.6 5.9 9.3 July „ 3.9 6.9 4.4 9.7 August „ 6.5 14.0 4.9 9.8 September „ 6.7 16.9 4.2 7.4 October (c) „ 9.2 29.3 5.6 10.0 November „ 17.3 65.7 12.4 38.9 December „ 16.7 61.5 11.9 28.6 January 1955 24.0 75.0 13.0 37.0 February „ 18.0 48.0 12.0 24.0 (a) SO2. No observation? 1st, 4th and 5th October. (b) Smoke „ „ 29th and 30th April. (c) No observations 2nd, 5th, 10th, 11th, 13th and 17th October. 47 Defective Dwellings.—Repairs.—With regard to houses found not to be in a reasonable state of repair, the following procedure, classified under two headings, is generally adopted :— (1) Complaints from or on behalf of the occupier.—The District Sanitary Inspector makes inspection and an intimation is sent to the owner specifying the 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) 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, defined a house let in lodgings as one which was occupied or was 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 were subject to registration and had to comply with certain requirements as to sanitation, cleanliness, etc. However, Sections 6 to 8 of the Housing Act, 1936, and Section 155 of the Public Health (London) Act, 1936, were superseded during the year by Sections 11 and 12 of the Housing Repairs and Rents Act, 1954. Under these Sections of the new Act, general powers have now been given to the Council to secure the provision of the following :— 1. Natural Lighting 2. Ventilation. 3. Water Supply. 4. Drainage and Sanitary Conveniences. 5. Facilities for storage, preparation and cooking of food and for the disposal of waste water. 6. Prevention of Overcrowding of sleeping rooms. 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 16 occasions. 48 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 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 the one application made for a certi— ficate was refused and no reports were sought. From 30th August of this year, however, the Housing Repairs and Rents Act, 1954, came into operation and Part II of this Act makes provision inter alia for a ' repairs increase ' in respect of controlled dwelling houses and makes certain amendments to the Rents Acts, 1920/39. In order that the landlord shall be aware of the extent to which his property falls short of the necessary standards and therefore to be able to determine the work required to be effected in order to obtain the revocation of a certificate of disrepair, it is now necessary for the Council to issue a Certificate of Disrepair in the form speci— fically prescribed by the Minister of Housing and Local Government stating the defects in respect of which it is issued. Further, the standards laid down in the new Act must be adopted in respect of an application for a Certificate of Disrepair made under the previous Rents Acts, i.e., where a tenant is not subject to a ' repairs increase ' under the 1954 Act. Under the recent Act 27 applications for Certificates of Disrepair were received but in 2 instances were withdrawn. Decisions made in respect of the remaining 25 were :— Certificates granted 8 Certificates refused 17 Two applications were received for Revocation of Certificates of Disrepair and both were granted. 49 The Heating Applicances (Fireguards) Act, 1952.—In pursuance of the powers conferred upon him by section five of the above Act, the Secretary of State made Regulations to come into operation on the 1st October, 1953. 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 chiefly relate to the Sale of Poisons used for domestic, horticultural and sanitary purposes. During the year 4 applications for licences to sell poisons under Part II were received, 67 vendors applied for retention in the Council's List and one vendor requested a substitution of registered deputy. All were duly considered and approved. Eleven inspections were carried out in accordance with the above Act. Shops Act, 1950.—Under this Act, which became effective from 1st October, 1950, the Council is responsible 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 no exemption certificates were sought, but 50 owing to demolition of a property it was necessary to cancel one certificate. At the end of the year 16 exemption certificates were in operation. Routine inspections were carried out under the abovementioned Act on 197 occasions. Hairdressers and Barbers.—Under Section 18 of the London County Council (General Powers) Act, 1954, from a day to be appointed and with certain exceptions, no person shall carry on the business of a hairdresser or barber on any premises in the Borough unless he and those premises are registered by this Council. The Council is empowered to make if it so desires, byelaws for the purpose of securing the cleanliness of premises, utensils and employees, such byelaws shall be confirmed by the Minister of Housing and Local Government. The day on which registration shall become compulsory shall be fixed by resolution of the Council, being not less than one month after public notice has been given. Rag Flock and Other Filling Materials Act, 1951.—The introduction of this 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, 3 of Rag Flock and 1 of Cotton Flock were obtained and submitted for examination. All proved satisfactory. 51 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. 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 :— (а) that animals will at all times be kept in accommodation suitable as regards size, temperature, lighting, ventilation and cleanliness ; (б) 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. At the end of the year five licences were in operation and four inspections were carried out by the Sanitary Inspectors in connection with the issuing of such licences. Land Charges Act, 1925.—Under this Act enquiries concern— ing outstanding notices under the Public Health and Housing Acts on properties in the Borough are received from time to time by the Town Clerk. During the year 897 reports on such enquiries were forwarded to his department. 52 Drainage and Sewerage.—During the year 480 drains were tested, 440 were opened, cleansed or repaired and there were 1,123 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. One hundred and fifty-four plans of drainage and other sanitary works relating to existing and new buildings were examined and approved. Discharge of Trade Effluents into Sewers.—On the 1st April, 1954, the provisions of the London County Council (General Powers) Act, 1953, relating to the discharge of trade effluents, etc., into sewers, came into operation. Section 4(2) of the Act provides that the " sewer authority " in relation to the discharge or proposed discharge of any trade effluent into the London Sewerage system shall be the London County Council or the local sewer authority (i.e., the City Corpora— tion or the Metropolitan Borough Council) in whom is vested the sewer into which the effluent first enters or will enter ; but this provision is subject to the provisions of section 13 by which the local sewer authority may, with the agreement of the London County Council, authorise that Council to perform on its behalf any of its functions under sections 9 to 12 (relating to requests to traders for information, imposition of conditions with respect to discharge of trade effluents, agreements with traders and provision of inspection chambers at trade premises). Such an authorisation may be subject to such conditions as may be agreed between the two authorities. By far the largest proportion of the trade effluents in London are drained first into sewers vested in the Metropolitan Borough Councils. The London County Council enquired whether this Council intended to ask them to perform its functions under the sections of the Act mentioned above. They were informed that this Council itself intended to discharge its responsibilities under Sections 9 to 12 of the London County Council (General Powers) Act, 1953. Water Supply.—The whole of the Borough is supplied with water by the Metropolitan Water Board which is a Statutory under— taking, and the responsibility for its purity rests with that Authority. There are 23,062 dwellings with direct connections to the Board's mains. 53 During the year 71 water supply certificates were granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended in 161 cases and extra water supply to 9 tenement houses 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. During September of 1953, 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 and bringing the total of wells in the Borough to 41. This new well is to be used for industrial purposes only. 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 firrm concerned. 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 1954 the amount of house and trade refuse collected totalled 212,224 tons, an increase of 579 tons (0.27%) over the previous year. The street sweepings collected amounted to 2,104 tons, an increase of 390 tons (18.5%) over the previous year. The continued scattering of litter is most disappointing, particularly in view of the propaganda that has been promulgated in an endea— vour to educate the public to keep the streets tidy and the erection by the Council of bins in various parts of the Borough for the recep— tion of this. The collection of salvage was continued on an intensive scale and the amount collected was 840 tons, an improvement on the previous year's total of 708 tons. The best markets were found for 54 the disposal of useful material and the Council derived some revenue on this account. The waste food collection was continued, but the availability of alternative animal feeding stuffs made this a somewhat expensive item. The Government realised that it was uneconomical for local authorities to continue this service and revoked the compulsory order with the result that the Scheme was discontinued by the Council as from September, 1954. The Council continued its policy of purchasing up to date refuse collection vehicles ensuring that the material collected was after collection totally enclosed, and also had carried out alterations to its vehicles to further this improvement. The refuse collected continued to be barged away from the Tunnel Avenue Depot to controlled tips in the Thames Estuary, and the negotiations for alternative means of disposal (mentioned in the previous report on this subject) were continued. During the latter part of the year a strike of watermen on the river suspended the operation of the river as a means of transport, but with the co— operation of other local authorities, who accepted the Greenwich refuse, no undue disorganisation took place, and the thanks of the Council were extended to these authorities for their helpful co— operation." 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 2,075 investigations were made and infesta— tion found to exist at 401 dwelling houses and 41 places of business. There were 14 major infestations at business premises, 2 of them caused by ship rat and 12 by common rat. Periodic treatments were carried out at 14 of the large industrial premises. Throughout the year there were 3 instances only of re-infestation in private dwelling houses after treatment and this low figure reflects credit on the staff carrying out these duties. The monthly average of complaints received was 37 as compared with 38 last year. Although the average is maintained the difficul— ties encountered are easier to overcome, probably due to early notification of the presence of rodents and as a result of drainage repair work carried out over the past few years. 55 Every effort is made to trace the source of infestation in each case and 35 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 20 small areas involving 367 premises. Bombed sites and dumps were test baited but in only 2 cases was it found necessary to carry out treatment. 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. This reconstruction is shortly to be put in hand. 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. Owners and occupiers still continue to take advantage of the Rodent Control Service : 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 destruction 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 been 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 12 months ended 31st March, 1955 :— 56  TYPE OF PROPERTY Non-Agricultural (1) Local Authority (2) Dwelling Houses (including Council Houses) (3) All other (inoludg. Business Premises) (4) Total of Cols. (1), (2) & (3) (5) Agricultural 1. Number of properties in Local Authority's District. 33 22,317 3,188 25,538 — 2. Number of properties inspected as a result of: (a) Notification 1 650 63 714 — (b) Survey under the Act 6 2,205 1,086 3,297 _ (o) Otherwise — — — — — 3. Number of properties inspected (in Sect. II) which were found to be infested by: (a)Rate{Major Minor 1 49 6 56 — 3 239 30 272 — (b) Mice {Major Minor — 5 4 9 — — 163 20 173 — 4. Number of injeited properties (in Sec. IV) treated by L.A. 4 421 56 481 — 5. Total treatments carried out — including re-treatments — — — — — 6. Number of Notices served under Section 4 of the Act: (a) Treatment — — — — — (b) Structural Work (i.e. Proofing) — — — — — 7. Number of cases in which default action was taken following the issue of a Notice under Sect. 4 of the Act. — — — — — 8. Legal Proceedings — — — — — 9. Number of "Block" control schemes carried out 28 involving 528 premises. 57 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 29th Nov. to 17th Dec., 1954 14th June to 9th July, 1954 1. No. of Manholes in foul and connected systems 1,185 1,175 2. Bait base and poison used Sausage rusk and zinc phosphide Bread rusk and arsenious oxide 3. No. of Manholes baited 1,183 1,175 4. No. of Manholes showing prebait takes 571 483 5. No. of Manholes showing complete prebait take (on one or both days) 316 237 8. Schemes of baiting used (e.g.; consecutive days or 1st, 3rd and 5th days) Consecutive days Consecutive days (Poison check on 4th day) 7. No. of Manholes test-baited in conjunction with this treat— ment 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. One additional day was employed in checking poison takes dur.ng the Juno treatment. 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, caf6s and food shops generally. 58 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. 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 good results. Disinfestation or Verminous Premises.—DDT in kerosene oontinues to prove the most effective vermicidal agent in dealing with verminous houses. During the year the Sanitary Inspectors dealt with 66 cases of dirty and verminous houses compared with 127 for 1953. The Disinfestation staff sprayed 237 rooms and contents as compared with 380 last year. In 3 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 286 houses comprising 823 rooms were treated effectively with DDT, as compared with 840 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 one of the large hospitals in the Borough. Regular spraying with D.D.T. has kept the infestation down to a minimum. 59 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 1¼ acres. Originally there were 3 large swimming baths, 74 ladies and gents' slipper baths, medicated vapour and foam baths, washhouses and laundry, etc. 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 bacterio— logical tests taken periodically. I am indebted to Mr. K. L. Embley, Superintendent Engineer, for the following statistics :— Attendances.—For the year ended 31st December, 1954 :— Slipper Baths 90,698 *Swimming Baths 120,645 Vapour and Medicated Baths 10,196 Public Laundry 10,719 Total 232,258 *Includes 43,112 School-children. 60 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 :— 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 6.4.54 10.15 a.m. 2nd Class Swimming (Mixed Bathing) 76°F. 60 Nil Nil Satisfactory a 6.7.54 10.05 a.m. 1st Class Swimming (Mixed Bathing) 75°F. 70 Nil Nil Satisfactory s 6.7.54 10.15 a.m. 2nd Class Swimming (Mixed Bathing) °75F. 68 Nil Nil Satisfactory 4 29.11.54 10.10 a.m. 2nd Class Swimming (Mixed Bathing) 76°F. Nil Nil Nil Satisfactory 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. 61 Particulars of Public Sanitary Conveniences in the Borough Convenience MEN WOMEN W.C.'s Lavatory basins Urinal stalls W.C.'s Lavatory basins HOURS Batley Park (Blackheath) 6 2 12 4 2 Blackheath Hill (foot of) 3 10 4 _ Blackwall Tunnel 3 — 6 6 — 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 7a.m. to 11p.m. King William Walk (near Greenwich Park) 4 2 9 7 t Rodmpre Street* Shooters Hill 5 3 12 5 3 Road (junc. 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 oonvenienoe opens at 8.30 a.m. on Sunday. 62 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 Publio Health during 1951, were continued with marked success during the year and the following table gives an indication of the growing use made of these facilities :— Convenience Men Women Total Batley Park 1,610 1,500 3,110 Creek Road 1,119 1,305 2,424 Greenwich South Street 164* 779 943 King William Walk 1,253 2,196 3,449 Rodmere Street 1,017 912 1,929 Shooter's Hill Road 1,919 1,749 3,668 Totals 7,082 8,441 15,523 •Discontinued 6.3.54 In February of the current year the Council decided to utilise only one attendant to serve the Blackheath Hill and Greenwich South Street men's conveniences, as a result of which the free wash— ing facilities at the latter convenience had to be discontinued. It was further agreed by the Council on 14th April that, in future, no charge should be made for the use of the W.C.'s at the women's public conveniences. 63 Aged, Infirm and Physically Incapacitated Persons.— Public Health Departments are in constant contact with problems of old age, many of which are either difficult to overcome or incap— able of permanent solution. In 1949 the percentage of the population of pensionable age was 13.5 and it has been estimated that this will rise to 18.8% in 1979—a proportion which will almost equal that of children under 15 years. It is to be expected, therefore, that there will be a consequent rise in the number of persons who are no longer capable of fending for themselves, especially where no practical help is forthcoming from relatives. Questions of retirement age, size of pensions, etc., have received nation-wide publicity : not only do these fall outside the scope of local administration but the publicity has tended to focus attention on those elderly persons who are able to lead fairly normal lives. It is the health and well-being, however, of the infirm, decrepit and incapacitated which are the greatest concern to a Medical Officer of Health and his Department. In a general way, the aged can be classified as follows :— (a) The Elderly—those who are sufficiently healthy and active to manage small homes of their own. (b) The Elderly and Infirm—those who suffer from the disabilities of age but not from extreme frailty or chronic disease. (c) The Elderly Sick :— (i) Acute sick—those for whose treatment the normal hospitals will provide. (ii) Long-term sick Those whose treatment (potentially and prospects of recovery remediable) are the responsibility of (iii) Irremediable— the Geriatric Unit. In normal circumstances the local Geriatric Unit is called upon to deal with persons in Category (c). In sub-divisions (i) and (ii), the aim is to investigate, treat and rehabilitate so that in due course these persons may be discharged, either to their own homes or, after consideration, to other appropriate accommodation. Regarding those classified under (iii) of (c) above, it is necessary, in order to avoid blocked hospital beds, to see that the persons finally classified as ' irremediable ' (subject to periodical review) should be passed to long-stay annexes but still under the direct supervision of the Geriatrician. Relations between Dr. A. J. Mester, (Geriatrician of the Greenwich and Deptford Hospital Group) and this Department are 64 excellent and admirable arrangements are in existence for the treatment of elderly residents of this Borough. The success of Dr. Mester's supervision is evidenced by the regular flow of patients to and from his Geriatric Unit at St. Alfege's Hospital, where, after discharge patients are seen and followed up at his out-patient clinic. If found necessary, arrangements are made either for further domestic help or in certain eventualities for re-admittance. Problems for the Health Department arise mainly from persons in Categories (a) and (b) and even here, apart from advice and incidental help in the social sphere, the Department is little troubled by those in the former group. It is mainly the elderly and infirm in group (b) to whom the Lady Sanitary Inspector is compelled to direct her efforts and attention. These are the people who either live alone in self-contained units or in sub-let rooms. Such people are often no more than aged, in need perhaps of a little attention but outside the scope of the National Assistance Act. Information regarding their circumstances often reaches the Department via interested neighbours or from sons or daughters living away from home who are unable or unwilling to accept further responsibilities. 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 1954 :— No. of dirty premises inspected 40 No. of verminous premises inspected 21 No. of dirty rooms cleansed 60 No. of verminous rooms cleansed 59 No. of verminous persons visited 48 No. of verminous persons treated :—Heads 280 Other 65 No. of visits to scabies cases 17 No. of visits for Laundry Service :—First 20 Subsequent 18 No. of articles laundered (commenced 1.9.1954) 1,229 No. of inspections of factories :—(o) with mechanical power 44 (6) without mechanical power 6 (e) other premises 1 No. of inspections of Outworkers' premises 140 No. of inspections of Houses Let-in-Lodgings 16 No. of inspections of Women's Conveniences 21 No. of Bathing Centre sessions 39 No. of Home baths 28 No. of visits to Infirm Persons 1,619 No. of visits to Rest Homes, Hospitals, etc. 45 No. of Miscellaneous visits 333 No. of re-inspections, calls made, etc. 306 No. of visits, re: housing 27 No. of interviews at offices. 87 No. of complaints received 66 No. of Intimation Notices served Nil 65 Cleansing of Old People.—Section 43 of the London County Council (General Powers) Act, 1953, provides for the cleansing in their own homes or other suitable place by the Sanitary Authority of any aged person in the district who : (a) is verminous or for any other reason in need of cleansing in order to prevent injury or the danger of injury to health ; and (b) is so enfeebled that he is unable to avail himself of any facilities for cleansing himself provided by the author— ity under any enactment or to cleanse himself properly. In this respect, during the current year, 88 baths were given to dirty or verminous elderly persons at the Cleansing Station and 25 home baths were effected. Laundry Service.—Under Section 122 of the Public Health (London) Act, 1936, the Council is empowered to cause to be cleansed " any articles which are filthy, dangerous or unwholesome and liable to affect or endanger health." Advantage has been taken not only of this section but also Sections 124 and 194 by your Medical Officer of Health to introduce a laundry service in order that his department can suitably deal with what has always been a major problem, namely, the treatment of badly soiled clothes, bedlinen, etc., from the homes of elderly people. From the Council's limited stocks of bedding and clothing it is possible in certain circumstances for temporary supplies of linen, etc., to be made to people whose own is being laundered, and co— operation with voluntary organisations often results in the repair or replacement of outworn articles. By the end of the year the laundry service, supervised by the Lady Sanitary Inspector, had been extended to 24 separate indviduals, and in 3 instances collections and deliveries were made 3 times a week, in 10 cases twice a week, and in 11 once a week. Since the inception of the service on the 1st September to the 31st December of the current year, the staff at the Cleansing Station have dealt with the following articles:— Sheets 326 Draw Sheets 108 Blankets 43 Quilts 29 Pillowcases 87 Towels 76 Mattress Covers 4 Dressing Gowns 5 Pyjamas 46 Miscellaneous articles 505 66 Chiropody Treatment.—Facilities for foot treatment for the aged are provided by the London County Council and, depending upon personal income, the charge varies from nil to 2/6d. Elderly persons receiving nothing more than the Old Age Pension and/or National Assistance automatically receive treatment free of charge. On production of a doctor's certificate, arrangements are made for transport of the elderly who, for reasons of infirmity, are unable to make their own way to the Clinic. 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. Where delay of even a few hours may prove decisive, under the Amendment Act of 1951, the Local Authority or the Medical Officer of Health, if so authorised by the Council is enabled to remove urgent cases 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 :— 8 Old Persons moved to Hospital 20 Old Persons admitted to L.C.C. Homes 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 67 cost is subsidised by that authority. During the year an average of about 30 homebound persons had meals delivered twice weekly and in about 6 cases, meals were delivered three or four times per week. The average number of meals brought to the homebound was 108. Another 60 were delivered weekly to the various Old People's Clubs in the Borough. The London County Council have intimated that their local kitchen from which the meals are obtained will be closing in January and negotiations are in hand with a local restaurant for the supply of the meals. It has long been realised that the standard meal prepared at the London County Council kitchens for the general public is not the best diet for all old people and it is hoped that the anticipated new arrangements will allow more suitable and varied menus. Provided that a meal can be obtained for l/6d. the London County Council will be prepared to continue to subsidize the cost and it is not intended that the old people will have to pay any more than their present contribution of lOd. per meal. Old People's Welfare Association.—Briefly, the purpose of the National Old People's Welfare Committee is " to study the needs of old people and to promote measures for their wellbeing," and the Greenwich Old People's Welfare Association which was set up in July of this year has for its object the implementation of these aims. In general, this new Association co-ordinates the activities of 9 Old People's Clubs in the Borough which provide for the physical and mental recreation of their members by arranging coach-outings, garden parties, Christmas, New Year and anniversary parties, etc. In one instance, with the co-operation of the " Nightmares' Concert Party " from Siemens Brothers, Charlton, a concert was staged for the entertainment of some 700 old people. During the year, grants were made by the Council to voluntary organisations as under :— £250 ... British Red Cross Society for " Meals on Wheels " scheme. £101 ... Women's Voluntary Services in respect of six Darby & Joan Clubs. £10 ... Old Age Pensioners' Association, Parish Hall, Swallowfield Road, S.E.7. £10 ... Old Age Pensioners' Association, Park Vista, S.E.10. £10 ... St. John's Old Folks' Club, Furzefield Road, S.E.3. 68 Holidays.—A sum of £1,675 was made available to the Greenwich Old People's Welfare Association for providing recreation and holidays for old people. Under the Pensioners' Holiday Scheme and in conjunction with the Margate Hotel and Boarding Association arrangements were made for 229 old people to spend a fortnight's holiday at Margate in September. Admirable and diverse 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. At various times in this Report I have 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 achieved 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. 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. 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 for 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. 69 During 1954 arrangements were made under the above Act for the burial of 7 bodies. The total expenses of these burials amounted to £52 8s. 6d., of which the sum of £25 1s. 9d. was recovered, making the nett cost to the Council of £27 6s. 9d. Exhumations.—At the Greenwich Cemetery the bodies of 19 ' Free Norwegians ' who died during the war period were exhumed for the purposes of cremation and the return of their ashes to Norway. 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 1954 Inspections- Houses inspected (House-to-House) 239 „ „ (Complaints, nuisances)... 1,650 „ „ (Infectious Disease) 208 „ „ (Overcrowding) 164 Re-inspeotions, calls made, eto. 12,752 Inspections of Factories 398 „ „ Shops 98 » >. Piggeries 21 „ „ Caravans 21 „ „ Pet Shops 4 „ „ Stables and yards 24 „ ,, Urinals 160 „ ,, Houses let in Lodgings 16 „ „ Outworkers premises 141 „ „ Miscellaneous 1,331 Inspection of Premises (Pharmacy and Poisons Act, 1933) 11 „ ,, „ (Housing Repairs and Rents Act, 1954) 29 Investigations (Rats and Mice) 365 On notioe from Builder 769 18,401 70 Drains— Drains tested—by smoke 127 " " —by water 353 Opened, cleansed and repaired 440 Reconstructions and additions 209 Inspection chambers constructed 175 New covers to manholes 151 Soil and vent shafts repaired or renewed 174 Traps (gully) 318 Drains sealed off, etc. 38 Yards and forecourts drained 58 waTERCLOSETS and urinals— Closets erected 141 W.C.s repaired 204 Sanitary conveniences or improvements effected to Factories, Workshops and Workplaces 5 W.C. pedestals installed 334 Urinals cleansed or repaired 39 Dustbins— Provided 243 Pavings— Yards and Forecourts 128 General Water Supply— Water Fittings amended 161 Extra water supply to tenement houses 9 Water supply certificates granted (Sect. 95) 71 Other Improvements— Houses generally repaired 203 Rooms cleansed and repaired 1,326 Rooms and staircases lighted and ventilated 23 Verminous rooms cleansed 231 Roofs, gutters and rainwater pipes repaired 551 Dampness abated 605 Sinks, baths and lavatory basins 268 Sink, lavatory and bath waste pipes trapped or amended 244 Stoves and fireplaces 205 Washing coppers repaired or provided 20 Floors repaired 278 Provision for storage of food 21 Miscellaneous repairs 932 71 Other Nuisances Abated— Illegal use of Underground rooms discontinued 1 Overcrowding abated 103 Animals kept in unfit places discontinued or removed 2 Dung receptacles provided — Accumulation of manure and other obnoxious matter removed 37 Rat infestation abated 138 Smoke Nuisances— Observations 129 Statutory Notices served (Sects. 147 and 148) — Notices, &c.— Intimations served under Public Health (London) Act, 1936 956 Statutory Notices served 184 Houses rendered fit by informal action 240 Legal Proceedings Premises Offence Result of Proceedings 16, Caletock Street Non-compliance of Statutory Notice Adjourned Sine Die 6/costs. 27, Caletock Street do. Summons withdrawn on payment of 6/- costs. 26, Armitage Road do. Summons withdrawn on payment of 6/- costs. 124, Creek Road do. Summons withdrawn on payment of 6/- costs. 1, Sundorne Road do. Summons withdrawn on payment of 6/- costs. 20, Aldeburgh Street do. Summons withdrawn on payment of 3/- costs. 23, Fingal Street do. Summons withdrawn on payment of 3/- costs. 36, Fingal Street do. *Adjourned Sine Die 3/costs. 38, Fingal Street do. *Adjourned Sine Die 3/costs. 51, Fingal Street do. Summons withdrawn on payment of 6/- costs. 272, Creek Road do. Summons withdrawn on payment of 3/- costs. 28, Banchory Road do. Summons withdrawn on payment of 3/- costs. 32, Armitage Road do. Summons withdrawn on payment of 6/- costs. *Work subsequently completed. 72 SECTION D Housing The greater the population the more extensive are the areas of land necessary to house it, and as intimated in earlier reports, the Councils of urban areas are finding it increasingly difficult to obtain " housing space " in order to accommodate all the families on their housing lists. If it is conceded that encroachment on the " green belt " or upon agricultural land, is to be prohibited, then in urban districts, the problem resolves itself almost entirely into one of " slum clearance." Until recently, in order not to dissipate the available labour and materials, Government policy has concentrated on the erection of new houses for families without a separate home of their own. This year, however, has seen a change in this policy for, in accordance with Circular 36/54 issued by the Ministry of Housing and Local Government, every encouragement and consideration is to be given by local authorities to owners to convert, improve and modernise existing dwelling houses under the Housing Act, 1949, as modified by Section 16 of the Housing Repairs and Rents Act, 1954. A further Circular (50/54) directed that more attention be afforded to unfit houses and clearance areas in Parts II and III respectively of the Housing Act, 1936, until proposals made under Section 1 of the Housing Repairs and Rents Act, 1954, have been approved. In this respect every Metropolitan Borough, jointly with the London County Council, is required to submit such proposals to the Minister by the end of August, 1955. The fact that no progress is made if every new house is cancelled out by the falling down of an old one has doubtless had its effect in the formulation of this new policy which now emphasises the need for preserving and improving existing accommodation. Households, as revealed by the 1951 Census, outnumber dwellings to the extent of 1J millions due in the main to ageing population, smaller families, better living conditions and perhaps to earlier marriages. That new building has been unable to keep pace with the creation of new households in this Borough is exemplified in the following table which compares the number of dwellings erected in the Borough since 1945 with the marriages solemnised during the same period :— 73 (a) New units of accommodation erected since 1945 up to:— (b) Marriages since 1945 (c) Difference en (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 „ „ 1954 4,088 6,640 2,552 One cannot pretend that this table represents an accurate picture of the housing position because in fairness it must be said that many couples married in the area obviously take up residence out— side 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. 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 21 properties in Little Heath, which was represented for slum clearance by the Council during the latter half of 1953 was confirmed by the Minister for Housing and Local Government on 27th May of the current year. Further areas in Roan Street and Haddo Street have been represented and are awaiting official confirmation. Surveys of areas which might be represented for clearance are in hand in accordance with Part I of the Housing Repairs and Rents Act, 1964. Re-Housing.— (a) Borough Council.—There were 32 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 291. Of this number 9 were in respect of overcrowded cases and 4 in respect of closures under the Housing Act. 74 The Housing Department now has control of 3,034 Councilowned units of accommodation, an increase of 126 over that of the previous year. At the end of the year, in addition to 79 occupied hutments, a total of 888 properties giving 1,574 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.—During the year ended 31st December, 1954, the L.C.C. had provided alternative accommodation for a total of 302 Greenwich families of which 17 had been certified as overcrowded cases. Of this figure, 155 were housed on L.C.C. housing estates outside the Borough. Four families from outside Greenwich were rehoused in the Borough under the L.C.C. scheme. (c) Other.—A further 77 families were rehoused by other means. Overcrowding.—As a direct result of rehousing carried out under (a), (6) and (c) above, 103 cases of overcrowding were abated during the year under review. The number of unabated certified cases of overcrowding in the Borough now amounts to 225. During 1954 there was a considerable decrease in the number of complaints received concerning overcrowding, the year's figure of 68 showed a decrease of 78 from that of the previous year. Each complaint was investigated by the Sanitary Inspector concerned and as a result of these investigations 39 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 :— Year No. of cases of overcrowding reported 1946 261 1947 128 1948 162 1949 168 1950 148 1951 56 1952 52 1953 53 8-year average 128 1954 39 75 New Housing Accommodation.—The following table lists the new dwellings erected in the Borough during 1954 :— Type of Dwelling G.b.C. l.C.C Private Total Permanent Houses 6 4 17 27 Permanent Houses (rebuilt) — — 17 17 Flats 26 — 1 27 Flats (rebuilt) — — — — Total No. of Dwellings 32 4 35 71 Excluding the families accommodated in requisitioned property, the total number of dwellings provided in the Borough since the termination of the war is now 4,088. Council Housing Schemes. (a) Dwellings completed during the year under review. Site Dwellings Bramhope Lane ... ... ... 2 Charlton Village (Earl House) ... 3 (and 3 shops) Pond Road (Fulthorpe Road) ... 27 (b) Dwellings in the course of construction at the end of the current year. Site Dwellings Pond Road 78 Woolwich Road/Tuskar Street 12 26 Kidbrooke Grove 18 Ormiston Road 8 Total 116 (c) Whilst not confirmed the following list of suggested addi— tions and extensions envisaged by the Council has been supplied by the Borough Engineer. Site Dwellings, 1955 Coldbath Street 88 Humber/Ruthin Roads 16 Blackheath Hill 22 Little Heath 24 Merriman Road 14 Ormiston Road North and Halstow Road 11 Greenwich High Road 24 (say) if obtained Troughton/Woolwich Roads 20-24 Annandale Road 6 76 Site Dwellings 1956 Sunfields 42 Vanbrugh Park (80-83) 38 Devonshire Drive 12 (say) Coleraine Road (Orchard) 9 Glenforth Street 5 Maze Hill 12 Westcombe Hill 2 Vanbrugh Park (20) 32 Site Not programmed Lansdowne Lane 44 Ingleside Grove 12 Brook Lane 13 (say) if obtained Broad Walk 2 Haddo Street and Roan Street 192 Sundry small bungalow sites 12 (say) Total 652 Procedure under Housing Act, 1936.—The following representations were made under Part II of the above Act during 1954 :— Section 11.—Houses unfit for human habitation and not capable at reasonable expense of being rendered so fit. 63, Roan Street, 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 Regulations. 115, Victoria Way, S.E.7. Town and Country Planning Act, 1947.—In exercise of powers under Section 15 of this Act and para. 3 of article 9 of the Town and Country Planning General Development Order, 1950, the Minister of Housing and Local Government has issued the Town and Country Planning (Housing Accommodation) Direction, 1952. Consequent upon the issue of this Direction, the Borough Council is consulted by the London County Council (the Planning 77 Authority) before any application for planning permission involving change of use of premises from use as a dwelling, is determined. Such consultations are designed to prevent any unnecessary aggravation of the housing situation by the encroachment of business premises into residential property. 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 1954 :— " Last year, I referred to the effect of the shortage of further sites for housing development which resulted in a marked drop in the rate of rehousing of families from the waiting list. The trend has continued and this year only 140 families were rehoused compared with 184 in 1953. The number of transfers as between the various types of properties controlled by the Council also dropped and was only 102 compared with 183 in 1953. The reason for this reduction in lettings activity is the fact that only 38 new properties were handed over for letting during the year and 39 dwellings were lost, due to either derequisitioning or the demolition of the curved type hutments, the net result being that at the end of the year the Council controlled almost the same number of dwellings as at the 1st January, 1953. In view of this difficult position, continued encouragement has been given to tenants to try to solve their problems by way of mutual exchanges, and it is gratifying to know that 52 exchanges were arranged during the year against 37 in 1953. This meant that at least 104 families solved their housing problems in this way. The number of families on the waiting list increased during the year from 2,539 to 2,861. In my notes last year, I referred to the introduction of the Industrial Selection Scheme for the transfer of families from London to the new and expanded towns. This scheme has now been in operation for a full year, and during that period I have been notified of the moves of 32 families from Greenwich to these other towns. Of these, 13 were applicants registered with this Council, and one was an occupier of a requisitioned property. It is to be hoped that further progress will be made in the operation of this Scheme since the rehousing of families in these towns is a real contribution in dealing with the housing problem." 78 SECTION E Inspection of Food and Supervision of Food Premises Duties of the Department under this Section were severely handicapped by the sudden and premature death in July of the Senior Food Inspector and, due to the shortage of qualified Sanitary Inspectors, some difficulty was experienced in appointing a successor. Legislation.—During the year legislation affecting the department was confined mainly to minor Statutory Instruments. It had been hoped that the current year would have seen the implementation of the new Food and Drugs Amendment Act, 1954, but although it was given Royal Assent on 25th November, with the exception of Section 28 which deals with further provisions as to restriction of private slaughter-houses, the Act will not become operative until such date as may be appointed by order of the Minister. 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. 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 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 food 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. 79 Milk and Dairies Regulations 1949/54.—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 111 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 108 which total includes 7 dairy premises. On 106 occasions the premises of distributors and dairies were visited other than for sampling purposes, and defects were detected and remedied as and when necessary. The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949-1953 and The Milk (Special Designation) (Raw Milk) Regulations, 1949/54.—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. 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, 1954 :— Licences issued In Operation Principal Licences 31.12.54 Distribution of Sterilised Milk 95 85 ,, ,, Pasteurised Milk 48 45 ,, ,, Tuberculin Tested 32 29 Supplementary Licences Distribution of Sterilised Milk 19 19 „ ,, Pasteurised Milk 16 16 ,, ,, Tuberculin Tested 16 16 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 80 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 42 samples of milk consisting of 31 Pasteurised milks, 4 Sterilised, 7 T.T. Pasteurised were examined in accordance with the prescribed tests and, with the exception of one sample declared to be void due to a high laboratory temperature, all proved to be satisfactory. Analytical Examination of Milk.—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 3 (all informal) of the 6 formal and 36 informal samples submitted to chemical analysis proved non-genuine. Although in the case of two non-genuine reports the presence of up to 1 % water was indicated, the deficiency of milk solids was considered insufficient to justify action other than a warning letter to the Distributor. In the case of the third non-genuine sample, the report indicated abstraction of 56% of the milk fat. It subsequently transpired that this sample had been obtained from a part-used churn at a hospital store and the result was due to the milk not being plunged before use by the hospital staff. The Superintendent of the hospital was notified accordingly. Seven samples of cream and one each of Canned Imitation Cream and Powdered Imitation Cream were sampled and found to be genuine. Subsequent to a complaint in Birmingham that a tin of Cream had a bitter taste, Salmonella typhimurium was recovered from a sample tin of this cream. Resulting from this discovery, a national warning against consumption of this commodity was promulgated by means of Press and radio. Further, a circular letter from the Ministry of Health was received on the subject stating, inter alia, that " Medical Officers of Health will wish to seek the co-operation of the local trade organisations so that tins of this brand of cream do not pass into consumption." Four tins of this cream were subsequently obtained and submitted for examination : one was submitted by a member of the public and the others were obtained from vendors in the Borough who had reported that they held stocks of the cream. In no case was Salmonella typhimurium discovered and the Ministry of Health were notified accordingly. 81 The sole importing agents in England and Wales informed the Ministry of Health that they were recalling distributed stocks through the wholesalers involved. 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.).—Three applications for registration were received during the year and the total number of premises remaining on the register at 31st December was 111. Eighty-one 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. Ice Cream Premises.—By the end of the year the number of registered Ice Cream premises had increased by 14 to a total of 244 after allowance had been made for 2 deletions. Visits to these premises were made on 247 occasions and 7 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.' Factories in the area which produce 'Ice Lollies' or 'Lolly' syrup are regularly and carefully supervised. 82 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. 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 50 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 24 4½hours or more 1 Satisfactory 12 2½| to 4 hours 2 Sub-standard 6 ½to 2 hours 3 Unsatisfactory 2 0 hours 4 Most Unsatisfactory 4 Ice-lollies Plate count and bacteria reports showed these samples to be Satisfactory 1 Sample—Methelene Blue lest was obscured by the colour in the sample. 1 Sample—Sampling jar broken in the Laboratory. 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 not necessary during the year to have recourse to ' administrative action.' 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 (Ice Cream) Order, 1953. In connection with quantitative analysis 25 samples of icecream and 8 ice-lollies 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. One sample of Ice Cream Powder taken was also found to be genuine. 83 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 1,678 lbs. Mutton 15 „ Pork 47 „ Veal 8 Calves 472 „ Ox Sweetbread 4¾„ Ox Head 38 „ Livers 196 „ Kidneys 117 „ Pork Sausages 14½„ Corned Meat 449½ „ 3,039¾ lbs. Other Foods— Cheese Trimmings 251¾ „ Skate Wings 168 „ Dog Fish 84 „ Herrings 112 „ Provisions, Various (Canned) 1,657¾ „ Raisins 42 „ Sultanas 240 „ Fruit (Canned) 8,479 „ Ground Rice 68 „ Flour 27½ .. Tomato Soup (Canned) 39 „ Coconut Ice 53½ ., Marzipan 17 „ Ground Almonds 3 „ Curry Powder ¾ 11,242¾lbs. Total Food Rejected 14,282½ lbs. Public Health (Meat) Regulations, 1924/52.—These regu— lations 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. 84 Butchers' Shops and Stalls.—These are under the constant supervision of the Food Inspectors who made 180 visits of inspection and arranged for the correction of insanitary defects at 14 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. Two circulars were received from the Ministry during the year, illustrating official certificates approved for Hong Kong and Spain. 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 :— 85 Meat— Beef 26,664 lbs. Beef Trimmings and Offal 13,276 " Lamb, Mutton, Sheep & Trimmings 22,565 " Lambs' & Sheeps' Hearts 3,776 " Pork, Bellies &Trimmings 11,318 " Reindeer & Trimmings 907 " Hog casings 2,268 " Ox tongues & Cheeks 1,040 " Rabbits 52 " Corned Beef 20.771½ " Stewed Steak & Kidney (Canned) 1,374 " Ham (Canned) 41 " 104.052½ lbs. Other Foods— Cheese 144 lbs. Cucumbers 5,830 " Gherkins 112 " Ground Nuts 3.66S " Fruit (Canned) 631½ " Fruit Juice (Canned) 752 " Natural Orange Juice (casked) 8,960 " Tomato Juice & Puree 1,170 " 21.267½ lbs. Total Imported Food Reje cted 125,320 lbs. 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 usually 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 71,000 carcases, etc., of meat were landed none was rejected as a result of Caseous Lymphadenitis. Landed. Examined Rejected Weight Australian & New Zealand Ewes, Lambs & Wethers 63,095 681 — — Australian sheep 8,447 92 — — 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 indi— cation of the country of origin. Ninety-nine inspections were made to secure compliance with the various Orders but on no occasion was it found necessary to take action against Vendors. 86 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 47 applications were made and licences granted to street traders engaged in the retailing of articles of food, and there were no revocations. No contraventions of Section 16 of the Food and Drugs Aot, 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. Supervision of Premises Including Factories where Food is Prepared.—In addition to the more general type of premises, such as restaurants, cafes, bakehouses, fish shops, etc., where focd 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, floor millers and brewers. To these establishments the Food Inspectors made 2,896 visits, as a result of which 82 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 proportion of the duties performed and inspection undertaken during the year by the food Inspector. 87 Premises Inspected or Visits Made. No. of Visits No. of Premises at which Improve— ments were effected Caterers', Restaurants, etc. 269 18 Grocers 249 16 Butchers' Shops 180 14 Dairies, milk shops 106 1 Licensed Victuallers 91 7 Wharves and Factories 240 — Bakehouses 68 8 Ice-Cream Shops, etc. 247 7 Fried Fish Shops 50 2 Other Fish Shops 53 4 Cooked Meat & Preserved Foods 81 * Visits Re. Shops Act 99 — „ „ Diseases of Animals Act 2 — „ „ Rat Infestation 4 — „ „ Food and Drugs Act 266 — „ „ Merchandise Marks Act & Markets 255 — „ „ Public Health (London) Act. 17 — „ „ Food Poisoning 20 — Sampling Visits 250 — Fair Visits 22 — School Visits... 27 — Miscellaneous Visits (including Flour MillsCyanide Fumigation) 214 5 Interviews 33 — Complaints Investigated 63 — Totals 2,896 82 'Included under Grocer* and Butchers' Shops. Bakehouses.—Of the 16 premises in the Borough being used as bakehouses at the end of the year, 2 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 basement premises were subjected to their quinquennial inspection in 1953 and in two cases the bakehouses were found to be satis— factory for continuance of their respective Certificates of Suitability. Suitability certificates in respect of the two other basement bake— houses, 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. These alternative premises became available and the Certificates of Suit— 88 ability were consequently revoked by the Council in September of the current year. Bakehouses and bakers' shops were visited on 68 occasions and, as a result of the inspections, 8 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 poison— ing on a large scale and it is a tribute to the Inspectors' vigilance that no such outbreaks have occurred. As a result of 269 visits of inspection to the catering establish— ments insanitary conditions were remedied and improvements effected at 18 premises. The following is a summary of the improve— ments carried out:— Type of Improvement Effected. Total No. Cleaned and painted 16 New sink fitted 3 Refrigerator installed 2 Extractor fan installed 1 Lavatory Basin installed 1 Floor recovered 2 Ventilation improved 2 Hoods fitted to Gas Stoves 1 Walls refaced 1 Shop front tiled 1 Total Improvements Effected 30 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 cooked 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, 416 were obtained under the provisions of the above Act and presented for examination. Of this total, 6 samples were formal and 410 informal of which 11 (all informal) were reported to be non-genuine. Four other samples were reported upon as contravening various regulations concerning labelling, etc., but being genuine in composition have not been included in the calculation of 89 the adulteration figure which at 2.6% shows a reduction of 0.4 from that of last year. Milk was again the main feed trampled and of the 42 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. A third sample, taken from a part-used churn at a hospital, was reported upon as not being genuine by reason of the abstraction of 56 % of milk fat. This deficiency was due to the non-plunging of the milk before use and the Superintendent was notified accordingly. Ice-cream was also sampled fairly heavily and during the year 25 samples were obtained and submitted to the Public Analyst for examination together with 8 ice-lollies. All samples proved to be genuine and the ice-creams more than fulfilled the requirements of the Food Standards (Ice-Cream) Order, 1953, which governed from 1st June, 1953, the minimum content of fat and milk solids other than fat in relation to ice-cream. One sample of Ice-cream powder also proved to be genuine. 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. Legal Proceedings.—Legal proceedings instituted against a retail vendor of sweets for continuing, after previous warning, to store his commodities in a W.C. compartment had to be abandoned on account of the death of the Senior Food Inspector, the principal witness. Costs for the defendant were refused by the Magistrate in view of the fact that the Council had been ready to prove its case prior to the demise of the Food Inspector and had postponed its action only at the defendant's request. Other Food Examinations.—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 *1 tin, Pure Homogenised and Sterilised Cream. Submitted by a member of the Public. Bact. Salmonella Typhi, and other pathogens not isolated. Ministry of Health notified accordingly *3 tins Pure Homogenised and Sterilised Cream. Submitted by vendors in the Borough. Bact. Salmonella Typhi, and other pathogens not isolated. Ministry of Health notified accordingly 1 tin Shrimps. Complaint that the shrimps caused diarrhoea in the case of three people eating shrimp Bact. All cultures sterile after 24 hours incubation. Complainant notified accordingly. 1 tin Soup omelet. Complaint by a member of the Public that the Soup tasted tinny. Chem. Contained an excessive quantity of tin (2.5 grains per pound). Complete stock held by vendor destroyed. Sample of ' Frozen Water.' Found in some bags and car— cases of Ewe Mutton. Chem. Contaminated by arsenical sheep dip and bacterial liquid. Quantity of trimmings and pieces from 89 lambs rejected. Sample of Powdered Milk. Taken from a school following several cases of diarrhoea. Bact. Low plate count, with no B. Coli and no pathogenic organisms being isolated. Head Teacher acquainted with result. 2 Samples from a bottle of milk. Complaint by a member of the Public regarding foreign bodies at the bottom of the bottle. Bact. & Chem. Eleven gummy particles, swollen with liquid, consisting mostly of gum arabic were isolated. Conformed to the standard of pasteurised milk. Complainant notified accordingly. The milk bottlers were acquainted with the position and their explanation accepted. Pieces of Bread. Complaint by a member of the Public regarding alleged rat dirt contained in sample. Chem. Foreign body consisted of rust and dough. No faecal matter. Complainant notified accordingly. Bakers equipment inspected and the baker warned. 91 Article How Obtained Examination Action Taken Bact. or Chem. Result 6 tins of Corned Beef with Cereal. Taken from a large Cold Stor— age plant in the Borough as apparently sound but part of a consignment showing high percentage of blown tins. Bact. After 6 days incubation at 37 %C. all tins remained sound and all cultures from the contents remained sterile. The Company notified accordingly. Sample of Orange Juice Taken from Cask Taken from a cask stored at a large Cold Stor— age plant in the Borough. Alleged to be fermented. Chem. Report indicated absence of fermentation. Large amount of sulphur dioxide present would be calulated to inhibit any biological decomposition. Due to the large sulphur dioxide content the commodity would have to be treated prior to retail sale in order to comply with the Preserva—¬tives Regulations. Otherwise fit for human consumption. *Samples of Irish Cream taken in response to a Ministry request. Full report given under Analytical Examination of Milk on page 80. 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. Following upon several cases of diarrhoea arising from a local school, a ' special sample ' of powdered milk was taken, the report on which showed a low plate count and no pathogenic organisms were isolated. 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 milk 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. 92 Ten samples of condensed milk taken in the normal course of sampling were declared genuine but 2 samples contravened the above Regulations in that the size of type used for the prescribed declaration of equivalent pints of milk was smaller than required. In one case a warning letter was sent to the manufacturer but in the other the milk had been purchased in bulk under licence by the now disbanded Condensed Milk Pool of the Ministry of Food. No further action was taken. 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 12 notifications received during the year compared with 9 in 1953, 10 in 1952, 4 in 1951 and 12 in 1950. In one instance only was the specific agent identified and this case concerned an elderly lady of 72 years already a patient in a local hospital. Salmonella typhimurium was isolated but despite rectal swabbing of patients in the same ward and investigation of her home contacts no further cases were discovered. In this particular instance there had been a history of diarrhoea prior to her admission into hospital. In the remaining sporadic cases the suspected food was unobtainable and the cause was unascertainable. A complete recovery was made by all patients. 93 FOOD AND DRUGS ACT, 1938 Number and Description of Samples Submitted for Analysis under the above Act during the year 1954 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Ale 1 1 Almonds, Ground — 4 4 1 1 Angelica — 1 1 — — — Aspirin Tablets — 1 1 — — — Baking Powder — 3 3 — — — Barley, Pearl — 1 1 — — — Beverage, Chocolate Milk — 1 1 — — — Borax & Honey — 3 3 — — — Bread — 1 1 — — — Butter — 3 3 — — — Cake Decorations — 2 2 — — — Cake-Pudding Mixtures — 8 8 — — — Cascara Sagrada Tablets — 1 1 — — — Castor Oil — 1 1 — — — Cheese — — — — Cheese Spread — 1 1 — — — Chemical Food Parish's — 1 1 — — _ Cocoa — 1 1 — — Coconut Shredded, Canned — 1 1 — — — Coffee & Chicory Essence — 1 1 — — — Confectionery, Flour — 1 1 — — — Confectionery, Sugar — 11 11 — — — Cooking Fat — — — — Cornflour — 1 1 — — — Cream — 7 7 — — — Cream, Imitation, Canned — 1 1 — — — Cream, Imitation, Powder — 1 1 — — — Cream of Tartar — 1 1 — — — Curry Powder — 3 3 — 1 1 Custard Powder — 3 3 — — — Dessert Powder — 1 1 — — — Drinks, Soft — 3 3 — — — Dripping — 6 6 — 1 1 Fish, Canned (Dressed Crab 1 Sild 1 Pilchards 2) — 4 4 — — — Fish Cakes — 2 2 — — — Fishpaste — 3 3 — — — Flavouring Essence — 1 1 — — — 94 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Flour — 5 5 — Friars Balsam — 1 1 — — — Friut, canned (Various) — 15 15 — — — Fruit Curd (Lemon) — 2 2 — — — Fruit, Dried — 6 6 — — — Fruit, Fresh — 6 6 — 1 1 Fruit Glace (Cherries) — 4 4 — — — Fruit Pie — 1 1 — — — Gee's Linctus — 1 1 — — — Ginger, Ground — 1 1 — — — Ginger Preserve — I 1 — — — Glucose, Medicinal — 1 1 — — — Glycerine of Borax — 1 1 — — — Honey — 3 3 — — — Hydrogen Peroxide — I 1 — — — Ice Cream — 25 25 — — — Ice Cream Powder — 1 1 — — — Ice Lolly — 8 8 — — — Iodine, Paint — 1 1 — 1 1 Iodine, Tincture — 2 2 — 1 1 Jam — 12 12 — — — Jelly Tablets — 5 5 — 1 1 Lard — 1 1 — — — Laxative Chocolate — 2 2 — — — Lemon, Glycerine & Honey Mixture — 1 1 — — — Lemonade Powder — 2 2 — — — Lemonade Tablets — 1 1 — — — Macaroni — 1 1 — — — Margarine — 5 5 — — — Marmalade — 4 4 — — — Marzipan — 1 1 — 1 1 Meat Paste — 2 2 — — — Meat Pie — 7 7 — — — Meat Products (Brawn, Liver Sausage, etc. including canned meat products, meat roll, stewed steak, etc.) — 26 26 — — — Milk (including Channel Island & Sterilised) 6 36 42 — 3 8 Milk, Condensed full cream (sweetened 3 ; unsweetened 2 ; machine skimmed sweetened 5) — 10 10 — 2 2 Mincemeat — 4 4 — — — 95 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Mussels, Bottled 1 1 — __ - Mustard — 3 3 — — - Olive Oil — 2 2 — — — Orangeade Powder — 1 1 — — — Paraffin, Medicinal — 1 1 — — Pease Pudding, Canned 2 2 — Peas, Dried — 1 1 — — — Pepper — 3 3 — — — Pickles — 5 5 — — — Potatoes, Frozen — 1 1 — — — — Pudding, Canned — 2 2 — — Pudding, Christmas — 3 3 — — — — Rice — 2 2 — — — Salad Cream — 5 5 — — — Salt, Celery — 1 1 — — — Sandwich Spread — 1 1 — — — Sauce — 11 11 — — — Sausages — 6 6 — — — Soup, Canned — 5 5 — — — Soup, Powder — l 1 — — — Soya Flour — l 1 — — — Spaghetti, Canned — l 1 — — — Spice — 6 6 — — — Suet, Shredded — 5 5 — — — Sugar — 1 1 — — — Syrup, Golden — 1 1 — — — Tapioca — 1 1 — — — Tea — 5 5 — — — Teaseed Oil — 1 1 — — — Tea, Siftings — 1 1 — — — Throat Lozenges — 2 2 — — 1 Tomato Juice, Canned — 3 3 — — — Tomato Paste, Canned — 1 1 — — — Tomato Puree, Canned — 1 1 — — — Treacle — 1 1 — — — Vegetables, Canned — 13 13 — — — Vermicelli — 1 1 — — — Vinegar (Malt 3 ; —— — Imitation 2 ; — — Taragon 1) — 6 6 — — — Welsh Rarebit Mixture 1 1 — — Wine, Alcoholic — 2 2 — — — Zinc—Castor Oil Ointment — 2 2 — — — Totals 6 410 416 — 14 14 96 Administrations Action Taken in Regard to Samples Reported to be NOT GENUINE Sample No. Article Nature of adulteration and/or irregularity Action taken T. 12 Dripping Contained an excess of free fatty acids. Warning letter to manufacturer. All stock held ' Written off.' T. 69 Iodine Paint Contained an excessive proportion of Iodine and Potassium Iodide compared with the formula given on the label. Being old stock concentration due to evaporation. Remaining stock destroyed. T. 70 Curry Powder Had caked and been attacked by mildew. Had also been contaminated at the point of contact with the metal ends. Remainder of stock destroyed. T. 90 Iodised Throat Tablets Deficient in Methyl Salicylate. Old Stock. Deficiency due to overlong storage. Letter to manufacturer. T. 115 Tangerines Contained Thiourea, 40 parts per million, by weight. Thiourea is a preservative and its presence in food is not permitted by the Public Health (Preservatives, etc., in Food) Regulations, 1925/.53 Information passed to Ministry of Food. T. 137 Milk Contained Fat, 3.46%, Solids— not—fat, 8.35%, corresponding to the presence of one per cent added water. Satisfactory reply received to letter to Distributor. T. 142 Milk Contained Fat, 3.44%, Solids— not—fat, 8.40% corresponding to the presence of one per cent added water. Warning letter to Distributor. T. 145 Milk Contained Fat 1.30%, Solids— not—fat, 8.68% corresponding to the abstraction of 56% of the milk—fat. Sample taken from part—used churn at a hospital store. Result due to milk not being plunged before use by hospital staff. Hospital Superintendent notified. 97 Sample Article No. Nature of adulteration and/or irregularity Action taken T. 179 Tincture of Iodine, B.P. Failed to comply with the standard of the British Pharmacopoeia—the proportion of Iodine in the sample being 66% excessive and the proportion of Potassium Iodide, 74% excessive. Letter to manufacturer who replied that stock had been held a long time with evaporation of alcohol causing increased strength. No T. 325 Ground Almonds Contained free fatty acids, calculated on the almond oil, 12.8 per cent., and was rancid and unfit for human consumption. Remaining stock destroyed. T. 374 Marzipan The surface of the block of marzipan was contaminated by growths of fungus and had become sticky owing to decomposition. Stock withdrawn from sale. 98 Administrative Action Taken in Regard to Samples that were Found to be GENUINE but failed to meet the Requirements of The Labelling of Food Order, 1953, The Food Standards (Table Jellies) Order, 1949 and The Public Health (Condensed Milk) Regulations, 1923—1943. Sample No. Article Nature of Adulteration and/or Irregularity Action taken T. 74 Sweetened Sponge Mixture Contravened the Labelling of Food Order, 1953, in that the statement of ingredients did not appear prominently and in a conspicuous position on the label. Letter to manufacturer produced reply that correctly labelled cartons were now being used. T. 117 Table Jelly When made up with water the sample failed to set satisfactorily and did not comply with the Setting Test specified in the Schedule to the Food Standards (Table Jellies) Order, 1949. Letter to manufacturer. Gone out of business— manufacture of this jelly discontinued. T. 267 Condensed Full Cream Milk, Sweetened The size of type used for the prescribed declaration of equivalent pints of milk was smaller than that required by the Public Health (Condensed Milk) Regulations, 1923—1953 Purchased in bulk under licence by the now disbanded Condensed Milk Pool of the Ministry of Food — no further action was taken. T. 404 Condensed machine skimmed milk. Sweetened The size of type used for the prescribed declaration of equivalent pints of milk was smaller than that required by the Public Health (Condensed Milk) Regulations, 1923—1953 Warning letter to manufacturer. 99 SECTION F Prevalence of, and control over, infectious and other Diseases During the year the Puerperal Pyrexia (Amendment) Regulations, 1954, were introduced amending the 1951 Regulations in that they prescribe a new form of notification certificate for puerperal pyrexia requiring the cause, if known, to be stated. The new Regulations become effective from 1st March, 1955. The total number of Infectious Diseases notified under Section 144 of the Public Health Act, 1936, Section 192 of the Public Health (London) Act, 1936, and associated Orders and Regulations was 472. Under the Public Health (Tuberculosis) Regulations, 1952, there were 107 notifications, giving a consolidated total of 579 cases notified during the year. In 10 of these cases the diagnoses were not confirmed, thus giving a corrected figure of 569. 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 1953 1,242 8—year Average 1,553 1954 569 Particulars of age groups and districts affected are shown in the table at the end of this Report. 100 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 1954 was 600. This is a decrease of 63 from the previous year and 715 less than the figure returned 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 101 comparative immunity of the country has hitherto been due mainly to its high vaccination state. With the fall in the number of 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 251 certificates of persons proceeding abroad were so authenticated, of these 223 were in respect of Smallpox, 14 for Cholera and 14 for Typhoid ; in 2 instances the necessary vaccinations were actually carried out by your Medical Officer of Health. Measles.—Only 28 notifications were received throughout the year compared with 560 in 1953 and 918 in 1952. Indeed, this present figure is the lowest recorded in the Borough since the introduction of notification. The distribution of the cases was as follows :—East Greenwich 6 ; West Greeenwich 10 ; St. Nicholas, Deptford 2 ; Charlton and Kidbrooke 10. One case occurred in a child under one year of age and 27 cases between 1 and 10 years. One was removed to hospital. No fatalities were recorded. Whooping Cough.—Altogether 225 notifications of this disease were notified but in 2 instances the diagnosis was not upheld. The final figure of 223 is a decrease of 13 from that of the previous year but 33 higher than for 1952. In 1950 and 1951 the figures were 309 and 384 respectively. Area distribution was as follows :—East Greenwich 113 ; West Greenwich 37 ; St. Nicholas, Deptford 10 ; Charlton and Kidbrooke 63. Fifteen cases were removed to hospital but there were no fatalities. Diphtheria. Two notifications were received one of which was subsequently re—diagnosed as tonsillitis. There were no cases last year, four were registered during 1952 and a NIL return was recorded for 1951. 102 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. In his Circular 8/53 inaugurating a special Diphtheria Publicity Campaign the Minister of Health stated 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. A satisfactory level is only to be secured by the persuading of each generation of new mothers of the necessity of immunisation and 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. Complete immunisations in the Borough during the current year numbered 904. This is an increase of 15 over the figure for 1953 but 175 less than that for 1952. Only 176 cases of diphtheria were notified throughout England and Wales during the year and as the Minister of Health has shown some concern over the question of the incidence of diphtheria and the fall in immunisations effected, investigation was made into sporadic cases. In connection with the Greenwich case, which was of anterior nasal type in an immunised child of 9 years, C. Diphtheria miiia was isolated but this was avirulent by the Elik plate test. Guinea pig inoculation, however, gave the reaction of a weakly virulent strain. The remainder of the family and all his school contacts were swabbed with negative results. On request, this information was forwarded to the Ministry of Health. 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 Primary Pneumonia and Acute Influenzal Pneumonia.—There were 16 cases attributed to these causes as compared with 18 and 23 for 1952 and 1953 respectively. Seven occurred in East Greenwich ; 1 in St. Nicholas, Deptford and 8 in (Carlton and Kidbrooke. There was one death—a man of 69 years. 103 Typhoid Fever.—Compared with a NIL return for 1953, one case was notified during the current year concerning a 13 year old boy who was removed t.o hospital. Despite thorough investigation, the source of the infection remained undiscovered. Faecal specimens were taken from the remainder of the family for bacteriological examination and the water supply at and to the house was tested by this department and the Metropolitan Water Board respectively, all without success. It was ascertained that the patient was in the habit of purchasing unwrapped ice—cream and ice lollies from a local shop and samples of these were taken without result. Faecal specimens were taken from 5 people who served these unwrapped products and no pathogenic organisms were isolated. The only other information obtained was elicited from enquiries made at the hospital by the Physician Superintendent. It was to the effect that the patient had eaten winkles some 2 months before the onset of his illness. Scarlet Fever. Sixty—nine cases were notified during the year and this figure shows a very satisfactory reduction of 77 from that of 1953. Eight cases were removed to hospital but no fatalities were recorded. Area distribution was as follows :—East Greenwich 18 ; West Greenwich 15 ; St. Nicholas, Deptford 2 ; Charlton and Kidbrooke 34. Erysipelas.—Five cases were notified compared with 11 for the previous year. Two cases received hospital treatment. Zymotic Enteritis or Epidemic Diarrhoea (Children under 5 years of age).—Orignally 17 cases were notified but this figure was modified and 15 were eventually recorded as confirmed compared with 16 for the previous year. Of these, 8 were under one year and 7 between 1 and 5 years. Unfortunately it is necessary to record the death of a child of 2 months, one of the 10 admitted to hospital. Dysentery.—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 usual means of spread is by food 104 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. Compared with a figure of 100 for 1953, during the current year some 70 cases were confirmed after the receipt 71 notifications, one case being re—diagnosed as a ' gastric disturbance.' Eighteen patients were removed to hospital. Area distribution was as follows :—East Greenwich 22 ; West Greenwich 22 ; St. Nicholas, Deptford 1 and Charlton and Kidbrooke 25. 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 this service and called for faecal samples from suspects. Treatment of all positive cases was continued until two consecutive specimens proved bacteriologically negative. Scabies.—Five cases were so notified compared with 12 for the previous year. Treatment of all cases of scabies is carried out at the Tunnel Avenue Centre. Puerperal Pyrexia.—During the year 3 notifications were received in accordance with the 1951 Regulations, 2 of which were in respect of Deptford residents, but from other sources a further 8 cases concerning Greenwich residents were brought to the notice of the department. All patients received hospital treatment. There were no fatalities. Meningococcal Infection.—Diagnosis of one of 5 notifications received was not upheld, giving a final total of 4 which compares with 3 cases in each of the previous 2 years. All cases received hospital treatment. There were 3 deaths from meningococcal infection recorded and all were notified posthumously after post mortem. Acute Encephalitis. (Infective or Post—Infectious).—A NIL return is recorded for the current year. One notification was received in respect of a ' post—infectious ' case but on removal of the patient to hospital the complaint was re—diagnosed as mumps. 105 Ophthalmia Neonatorum.—In respect of this disease 2 notifications were received. One case was removed to the Royal Eye Hospital for treatment and the other was kept under observation by the Health Visitor at home. Both made a full recovery. Poliomyelitis.—Six notifications were received and of this total only 5 were finally confirmed, 3 being of the paralytic type and 2 non—paralytic. Figures for the year 1953 and 1952 were 11 and 10 respectively. The one death registered as being from this disease concerned a 10 year old boy who had been admitted to hospital as a suspected meningitis case. Subsequently the autopsy revealed that death was due to bulbo—spinal poliomyelitis and a notification to this effect was received and is included in the total of 5 confirmed cases. No determinable relationship was established between the cases which were distributed throughout the area thus :—West Greenwich 1 ; Charlton and Kidbrooke 4. All notified cases were treated in hospital. In virus diseases such as measles and smallpox where a vir— aemia is present, immunity is so prolonged that it is the opinion of many that the virus persists in the tissues throughout life. There is a growing feeling in some circles that Poliomyelitis conforms in like manner to behaviour observed in other virus infections, namely, that it is a life—long occupant of the body in a large proportion of the population and becomes evident and destructive only in response to certain stimuli or perhaps after change of environment. Seventy years after an attack of Yellow Fever a high titre of antibody has been found ; a feature almost certainly indicating the persistence of the virus in the body. The herpes virus is acquired early and persists throughout life in about 60% of the population. As a result, such people possess a high titre of antibody and the virus shows itself only after a cold or other seemingly small upset. So it may be with Poliomyelitis. The possible connection of bulbar paralysis following tonsillectomy or paralysis of the muscles of a limb recently subjected to inoculation for diphtheria or whooping—cough immunisation, and more especially in regard to the combined injection, have been the subject of intensive research and there is much support for the theory that the recrudescence of a latent virus will sometimes occur when it gains access to a new type of tissue in the same host. 106 So far this fact has not been established or confirmed from the polio cases in this area. Some forms of virus exclude and prevent colonisation of a host's cells by a related fiercer strain—this is, of course, the basis of vaccination—and it is possible that the future may reveal that the odd 1 % of polio sufferers who progress to the paralytic stage have not an inherent ' interfering ' virus. Malaria.—Four 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 106 notifications in respect of confirmed cases of tuberculosis were received compared with 101 for 1953. Of these, 93 were of the pulmonary type and 13 non— pulmonary, i.e., tuberculosis of parts of the body other than the lungs. The slight increase in the figure for the current year follows the general trend obvious throughout the country. The following table gives the distribution :— District Pulmonary Non—Pulmonary Total East Greenwioh 32 6 38 West Greenwich 14 2 16 St. Nicholas, Deptford 6 — 6 Charlton and Kidbrooke 41 5 46 Totals 93 13 106 Disinfection was offered and carried out in 39 cases including 64 rooms and 348 articles of clothing and bedding, etc. The number of notified cases of Tuberculosis remaining on the Register at 31st December, 1954, was as follows :— PULMONARY NON—PULMONARY Men Women Children Total Men Women Children Total M F M F 505 412 29 26 972 21 46 12 6 85 For further clarification I append herewith copy of Form T.137 (revised) for the year under review as forwarded to the County Mcdical Officer of Health. 107 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 Part I.—Summary of notifications of Tuberculosis during the period from the 1st January, 1954, to the 31st December, 1954. 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 — — 1 1 2 4 2 14 7 7 8 — 1 47 Respiratory, Females — — — 2 2 2 6 10 12 5 2 2 — 43 Non—Respiratory, Males 1 — 1 2 — — 1 — 1 — 1 — — 7 Non—Respiratory, Females — — — 1 — 2 2 1 — — 6 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 cases 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 Registrar— General (Transferable deaths) Respiratory M — — — — — — — — — — — — — — (A) F — — — — — — — — — — — — — (B) Non—Respiratory M — — — — — — — — — — — — — — (C) F — — — — — — — — — — — — — — (D) Posthumous Notifications Respiratory M — — — — — — — — — 1 1 1 — 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 of the other, only the first notification is taken into account for the purpose of this return. Totals (A' (C) 3 (B) — (D) — 108 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. No public survey was carried out during the current year but arrangements are being made for one to be effected during March and April of the coming year. 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 178 4 Children under school age 103 4 School children 486 25 No. of home visits by Lady Sanitary Inspector 38 No. of home revisits by Lady Sanitary Inspector 116 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 :— 109 Rooms and Articles Disinfected, Year ended 31st December, 1954 Diseases, etc. Premises Entered |Rooms Beds Mattresses Bolsters Pillows Sheets Blankets Eiderdowns Cushions Quilts Odd Articles Wearing Apparel Rugs and Mats Covers Total No. of Articles Disinfected Scarlet Fever 59 98 11 48 37 91 97 191 11 31 24 185 133 1 44 904 Diphtheria 3 6 1 2 2 3 6 10 1 1 5 8 4 43 Tuberculosis 39 64 7 25 8 40 29 76 6 23 7 67 33 6 21 348 Cancer 15 18 7 12 6 27 17 37 5 14 3 40 10 6 184 Meningococcal Infection 11 18 5 12 7 25 19 41 2 4 4 21 61 1 8 210 Puerperal Pyrexia Typhoid Fever 1 2 1 2 3 1 _ 1 __ 1 9 Polio—Myelitis 9 17 10 3 25 17 24 3 9 2 20 26 6 145 Erysipelas — — — — — — Acute Encephalitis Measles Scabies 1 2 3 10 14 ___ 2 1 30 Other Diseases 111 57 25 50 8 54 3 74 6 5 3 101 50 9 24 412 Verminous Premises 3 3 4 5 2 6 6 13 6 33 6 81 TOTAL. 252 285 60 168 73 283 194 483 35 92 44 473 323 18 120 2,366 Articles destroyed — — 34 103 10 26 2 9 2 6 — 605 30 — 3 830 Library Books Disinfected 83 110 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. "Staff.—Dr. V. H. Springett who had worked at the Clinic since 1950, resigned on his appointment as Medical Director of the Birmingham Chest Clinic. We were very sorry to lose his most valuable services and offer our congratulations to him on obtaining this important appointment. Dr. Joyce Brown came to replace him and we are very pleased to welcome her. Miss A. Derry, who had been Care Secretary at the Clinic for three years, left to take up another appointment, and her place as Almoner was taken by Mrs. B. M. Campbell. The year 1954 was a very busy one at the Greenwich Chest Clinio, and, as far as progress and advances in methods of treatment were concerned, a highly successful one. At the end of the year there were 993 patients on the Chest Clinic Register consisting of:— Pulmonary Tuberculosis. Non—pulmonary Tuberculosis Men Women Children Men Women Children 479 395 53 14 35 17 Of these 86 were new notifications of Pulmonary Tuberculosis and 13 of Non—pulmonary Tuberculosis. The number of new notifications was two less than last year. These figures are very gratifying and instructive as there now seems to be a very definite drop in the incidence rate of Tuberculosis, in spite of intensive case finding methods including several visits of the Mass X—ray Unit to Greenwich. There was a further marked fall in the number of deaths; 22 patients on the Clinic register, 18 men and 4 women died during the year. In a population of 90,600 these figures are extremely small and in relation to other causes of death Tuberculosis is now well down the list. The average age of the 18 male patients who died was 52 years with a variation from 18 to 80 years. Two of these deaths were immediate post operative in patients undergoing major chest surgery; 11 deaths were directly due to Pulmonary Tuberculosis and the remaining 5 were not related to Tuberculosis in any way, 111 one being due to diabetic arteriosclerosis, one to carcinoma of the lung, one to accidental drowning in the River Thames, and the remaining 2 eighty year old men both died from heart failure. The four women who died were aged 26, 31, 49 and 45 years. The first three were deaths due to Tuberculosis while the last was from a cerebral tumour. It will be seen, therefore, that of the total of 22 deaths on the Tuberculosis Register only 17 were actually due to Pulmonarv Tuberculosis. Chest Clinic Statistics Year Population of Borough Notifications Incidence per 1,000 of population Deaths* Pulm. Tub. Non— Pulm. Tub. Pulm. Tub. Non— Pulm. Tub. Total Kate 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 1954 90,600 86 13 0.95 0.14 22 0.24 *Deaths of Tuberculous patients from all causes. In the Report of 1953 reference was made to the combined Hospital—home treatment scheme run in conjunction with Kettle well Hospital, Swanley. This scheme has so altered the situation regarding the treatment of Tuberculosis that whereas in 1951 there was a waiting list of one year for admission to Hospital there was at the end of 1954 no waiting list at all. I am indebted to Dr. Forgacs, Physician Superintendent, Kettlewell Hospital, Swanley, for much of the report which follows on short term treatment. 112 The principle behind this scheme was to admit selected patients without delay to this special unit for active treatment. The patients were selected as having firstly good home conditions where further treatment could be continued and secondly, reasonably limited disease. On an average these patients were in Hospital 3—4 months only, the rest of their treatment being carried out at home under the guidance of the Chest Physician and Health Visitors. The methods of treatment adopted do not depart in essentials from those in use in other Chest Hospitals. During the first six to twelve weeks most patients are kept in bed and are given chemotherapy. The effect of this regime, as judged by comparison of radiographs at the end of the second month, is regarded as an important guide to prognosis. The principle of observing a patient's progress while at rest, before planning further treatment is not new, but with the more speedy action of drugs this important assessment can be made much earlier and the time spent in hospital correspondingly shortened. The decline of artificial pneumothorax treatment is another reason why a prolonged stay in a sanatorium is no longer necessary for many patients. The present forms of medical treatment of tuberculosis are safe enough to be continued at home after starting in hospital. By the end of the third month most patients are allowed to get up for four hours daily. At this point their care need throw no additional burden on the rest of the family and they can continue their treatment at home. Their activities during the following months are increased under the guidance of the Physician at the Chest Clinic. The need for surgical measures is in many cases obvious from the start, but in others it is difficult to foretell at this early stage how far the disease will heal on medical treatment alone. Such patients are re—admitted six to twelve months later. After a review of their progress, which can be completed in a few days, it is generally possible to decide whether an operation will be necessary. The only important difference between this plan of treatment and that adopted by many other sanatoria is that the graded return to full activity under close supervision is omitted. Greenwich patients admitted to Kettle well in 1953 were 49 in all and it is convenient here to review their progress as they have now all been out of Hospital for at least one year, and some nearly two years. They comprise 26 men of average age 29 years and 23 women average age 25 years with extremes of 16—42 years. All these patients had bed rest and chemotherapy. Their treatment can be summarised as follows :— 113 Chemotherapy alone 10 patients Chemotherapy + Pneumoperitoneum 21 ,, Chemotherapy + Artificial pneumothorax 4 ,, Chemotherapy + Pneumoperitoneum and surgery 2 Chemotherapy + Surgery 12 „ At the beginning of 1955 all these patients were well and their treatment can be said to have gone completely according to plan. The critics of this scheme of treatment say that by cutting out full sanatorium treatment, the patients are being incompletely treated. The above figures, although covering only a two year follow up, do illustrate that this is not true. One must emphasize that only a selected group of patients fit into this scheme by virtue of their limited disease and good home conditions. In 1953, out of 110 new cases seen, 49 only were admitted to Kettlewell, while in 1954, out of 99 new notifications, 34 only were admitted under this scheme. Although these figures represent only about 40% of the new cases seen, their treatment in this way has made it possible for the remaining 60% to be admitted to appropriate Chest Hospitals or Sanatoria without any delay. The surgical treatment of Pulmonary Tuberculosis has advanced considerably in the past few years, especially since the advent of chemotherapy. 39 cases from the Greenwich Chest Clinic were operated on in 1954. There were 2 immediate post—operative deaths, but the remaining 37 patients are well. The operations done were : Thoracoplasty 11 cases Segmental resection 3 Lobectomy 11 Pneumonectomy 6 Lobectomy and thoracoplasty 6 Bilateral polythene plombage 1 case Right upper lobectomy and left thoracoplasty 1 39 114 On the preventive side the Health Visitors have continued an active campaign of health education among the families of known cases of tuberculosis. Routine contact investigation is an important part of their work and it is very gratifying to note that an average of 5 contacts of every new case of tuberculosis were X—rayed at the Clinic. This is by far the highest of any clinic in London and has been made possible by the Odelca Camera Unit at the Chest Clinic. B.C.G. vaccine has again been given to all known contacts, nurses and hospital staff, who need it, and there has now been an extension of the scheme to include school leavers. Oeneral Statistics. No. of X—rays taken 10,475 Total Patients' attendances 11,126 No. of new patients examined 1,449 No. of contacts examined for 1st time 437 No. of Home VisitB by Health Visitors 3,572 No. of Home Consultations by Chest Physician 240 No. of B.C.G. vaccinations 40 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." 115 SECTION G Miscellaneous Guild of Hygiene.—Owing to the sudden death of the Senior Food Inspector during the year, activities carried on under this heading were confined mainly to inspections of premises for the issue of further certificates and to the re—inspection of premises already issued with a certificate in order to ascertain that standards were being maintained in accordance with the Guild's constitution. The number of certificates earned and displayed by traders in the Borough has now reached a total of 92. Medical Inspection— Superannuation.—All medical examinations of the staff for Superannuation purposes are undertaken by the Medical Officer of Health. Dining the current year, 61 examinations were so made, one of which was in accordance with Section 106 of the L.C.C. (General Powers) Act, 1937, as amended by the 1951 Act (Widows' Pensions). Sick Persons.—In addition, the Medical Officer of Health carried out 42 medical examinations of Council's employees (one at home), who for medical reasons had been absent for 4 weeks from their employment. Interviews. Rehousing.—Under the Council's Rehousing Scheme, additional points are attracted if an applicant's case is supported on medical grounds. In order to ascertain from a medical point of view, the degree of priority to be allocated to the housing applicants in the Borough, the Medical Officer of Health gave 53 interviews during the year. INDEX A Page Page Acute Encephalitis 104 Chiropody Clinics, Attendances 33 Acute Influenzal Pneumonia.102 Chiropody Treatment (Old Acute Poliomyelitis105 People) 66 Acute Primary Pneumonia 102 Citizens Advice Bureaux 38 Adoptive Acts, Bye—laws and Classification of Deaths 23 Local Regulations3,4 Cleansing and Scabies Clinic 37,108 Age Mortality 20, 21 Cleansing of Children 108 Aged, Infirm and Physically Cleansing of Old People 66 Incapacitated Persons63—68 Clinics and Centres 31—38 Analytical Examination of Common Infectious Diseases 16, 24 Milk80, 89 Complaints 39, 69 Ante and Post Natal Clinics.35 Conveniences, Public 60—62 Ante and Post Natal Clinics, Coronary Disease 28 Attendances 32, 33 Council Housing Schemes 75, 76 Anti—Fly and Anti—Mosquito Council Rehousing 73 Campaign 57, 58 Cremation or Burial of the Antitoxin, Diphtheria102 Dead 68, 69 Area of Borough 10 Articles and Rooms Disinfected 109 Articles Destroyed 109 D Artificial Sunlight Centres, Attendances 33 Death Causes, Remarks 23—29 Artificial Sunlight Treatment 36 Death Rates 16 Atmospheric Pollution 43—46 Death Registrations 19 Death, Table showing Causes of and Ages at Appendix Deaths 15, 19 Deaths, Table showing Causes Bacteriological Examinations 60, 79 Deaths from Violence 28 Baiting of Sewers 57 Deaths in Institutions 20 Bakehouses Defective Dwellings—Repairs 47 Baths and Wash—houses ... 59 60 Density of Population 10 B.C.G. Vaccinations 114 Dental Clinic 37 Beaver Report 44,45 Dental Treatment34 Birth 18 Diarrhoea and Zymotic BirthRegistrations 11 Enteritis 15,24,103 BlackheathFair ... ... 86 Diphteria 24,101,102 British Red Cross Society ... 38, 66 Diphtheria Antitoxin 102 Bronchitis Diphtheria Immunisation Burial and Cremation of the Clinics 36 Dead Diphtheria Prophylaxis Cases 34 Discharge of Effluents into C Sewers 52 Diseases of Respiratory System 28 Cancer 15, 16,25—27 Disinfecting Station 38 Caseous Lymphadenitis 85 Disinfection 108, 109 Catering Establishments 88 Disinfestation of Verminous Cerebral Embolism28 Premises 58 Cerebral Haemorrhage 28 District Nursing 34 Cerebral Thrombosis 28 Domestic Helps 34, 38 Certificates of Guild of Hygiene 115 Domiciliary Confinements 32 Chest Clinic 37,111 Drainage and Sewerage 52 Chest Physicians'Report110—114 Drainage, New and Alterations Children's Exercise Classes 33 to 52 INDEX (continued) Page H Page Drinking Fountains 62 Habitation Certificates (Water Duties and Powers of the Supply) 52, 53 Public Health Committee 3,4 Hairdressers & Barbers 50 Dwellings 10 Handicraft Centre 37 Dysentery103, 104 Handwashing Facilities 62 Health Centres 35—38 Health Visiting 31 E Page Heart Disease 28 Heating Appliances (Fire— Elevation of Borough10,12 guards) Act, 1952 49 Emission of Grit 43—46 Holidays (Old People) 68 Encephalitis 104 Home Help Statistics 34 Enteric Fever 24 Home Help Service, Applica— Erysipelas 103 tions for 38 Exercise Classes, Ante Nata 33 Horse Troughs 62 Exercise Classes, Children's 33 Hospitals 38 Exhumations 69 Hospital Confinements, 32 Expectation of Life 14 Houses, No. in Borough 10 Extracts from Vital Statistics 15, 16 Houses Let in Lodgings 47 Housing 72—77 Housing Act, 1936, Procedure F under 76 Housing Act, 1949 72 Factories Acts, 1937/4840—42 Housing Accommodation 73, 75 Fair, on Blackheath 86 Housing Homeless Persons 74 Family Planning Association, Housing Register 77 Sessions 37 Housing Repairs & Rents Act, Family Welfare Association38 1954 39,40, 47,48,72 Food—Inspection of. 78—98 Housing Schemes, Council's 75, 76 Food Poisoning 92 Housing Survey 77 Food—Premises for Prepara— Hygiene, Guild of 115 tion of 81, 86, 87 Food Rejected 83, 85 Food and Drugs Amendment I Act, 1954 78 Food & Drugs—Non—genuine Ice—Cream — Bacteriological Samples 96, 97 examinations 82 Food & Drugs Act, 1938 Ice—Cream (Heat Treatment, Samples taken under 88, 89, 93—97 etc.) Regulations 82 Food Standards Orders 98 Ice—Cream Premises 81 Foot Clinics 36 Ice—Cream Quantitative Foot Clinics, Attendances 33 Analysis 82,89 Ice—Cream Sampling 82 Illegitimate Births 15, 18 G Immunisation and Vaccination Clinics 36 General and Vital Statistics10—29 Immunisation and Vaccina— General Provision of Health & tion Clinics, Attendances 34 Welfare Services in the Area 30—38 Imported Food Rejected 84, 85 Geriatrics 63, 64 Infantile Mortality ... 16, 21—23 Grants to Voluntary Organisa— i Infant Welfare Centres 35 tions 67 Infant Welfare Clinics, Atten— Greenwich Guild of Hygiene... 115 dances . 31—33 Grit Emission 43—46 Infectious Diseases 15,16, 24,99—114 Guild of Hygiene 115 Infirm Persons. 63—68 INDEX (continued) Page Page Influenza 15, 16, 28 ' Milk, Analysis of ... 79, 80, 89 Inhabited Houses 10 Milk and Dairies Regulations79 Inspection of Food and Super— Milk Licences 79 vision of Food Premises 78—98 Milk (Special Designation) Institution Deaths 20 (Pasteurised & Sterilised International Certificates 101 Milk) Regulations 79 International Statistical Classi— Milk (Special Designation) fication of Diseases, Injuries, (Raw Milk) Regulations 79 and Causes of Death, 1948 23 Milk Supply 78 Interviews, (Rehousing) by Minor Ailments Centres (for M.O.H 115 Schoolchildren) 37 Introductory Review 6—9 Motor Vehicle Accidents 28 Mutual Exchanges (Housing) 77 L N Labelling of Food Order 98 Laboratory Work 50, 60, 79, 80, 82 National Assistance Act 66 88—98 National Insurance Act Land Charges Act, 1925 51 (Medical Certificates) 100 Laundry Service 65 Neo—Natal Mortality 22, 23 & L.C.C. (Gen. Powers) Act, 1953 52 Appendix L.C.C. (Gen. Powers) Act, 1954 50 New Housing Accommodation 75 Legal Proceedings 71, 89 New Legislation 39, 47, 50, 78 Legislation, New 39, 47, 50, 78 Nomenclature Regulations, Leptospirosis 55 1948 23 Lettings (Housing) 77 Non—Genuine Samples 96, 97 Notices, etc. 39, 71 Notifications of Infectious M Diseases 99—114 & Appendix Notifications of Food Poisoning 92 Malaria 106 Nursing Associations 38 Manufacture and Sale of Ice— Nutrition Clinic 38 Cream 81 Marriages 16, 73 Marriage Guidance Centre 37 O Mass Radiography 108 Maternal Mortality 15, 16, 21 Old People's Welfare Associa— Maternal and Child Welfare 30—38 tion 67 Maze Hill Clinic (Tuberculosis) 37 Open Spaces 11 110—114 Ophthalmia Neonatorum 105 Meals on Wheels 66, 67 Ophthalmic Clinic (Children 37 Measles 15, 24, 101 Outworkers 42 Meat Regulations 83, 84 Overcrowding 74 Meat Surrendered 83, 85 Medical Inspections (Superannuation)115 P Medical Inspections (Sick Persons) 115 Personal Health Services 30—38 Medical Officer of Health's Persons Cleansed 64, 65, 108 Review6—9 Pet Animals Act 51 Medical Statistics (Schools) 34 Pharmacy & Poisons Act 49 Meningococcal Infection 104 P.H. (Condensed Milk) Regu— Merchandise Marks Act 85 lations 91,98 Meteorological Observations 17 P.H. (Dried Milk) Regulations 91 INDEX (continued) Page Page P.H. (Imported Food) Regu— Registered Deaths 16,19 lations 84 Registrar—Office Hours 38 P.H. (Meat) Regulations 83 Registration of Preserved Food P.H. (Preservatives, etc., in Premises 73, 74 P.H. (Smallpox Prevention) Rehousing Interviews (by Regulations 100 M.O.H.) 115 Physically Incapacitated Rejected Food 83, 85 Persons 63—68 Remarks on Various Death Pneumonia 28, 102 Causes Pollution, Atmospheric 43—46 (Restrictions) Acts. 48 Pollution, River 43 Requisitioned Accommodation 74 Population 10, 14 Respiratory System—Diseases Post—Natal Attendances 32 of 28 Powers & Duties of the Public Review by M.O.H 6—9 Health Committee 3, 4 River Pollution 43 Preserved Food Premises 81 River Smells 43 Prevalence of, and Control Rodent Control 54—57 over Infectious Diseases 99—114 Prevention of Damage by Pests Act 55,56 S Procedure under the Housing Act, 1936 76 Sampling of Ice—Cream 82 Prophylaxis Cases 34 Sampling of Milk79,80, 89 Prophylaxis Clinics 36 Sampling under Food & Public Baths & Wash—houses 59, 60 Drugs Act 88, 93—98 Public Health Committee3 Sanitary Circumstances of the Public Health Department Area 39—71 Staff 5 Sanitary Conveniences, etc 60—62 Public Health Laboratory Sanitary Work — Summaries Service 60, 82, 90, 91 etc 69—71 Public Open Spaces 11 Scabies 104 Public Sanitary Conveniences 60—62 Scabies & Cleansing Clinics 37 Puerperal Pyrexia 104 Scarlet Fever 24, 103 Scavenging and Refuse Disposal 53, 54 Q Schools (Medical Statistics) 34 Sewerage and Drainage 52 Quantitative Analysis of Ice— Sewers—Baiting of 57 Cream 82, 89 Shops Act 49 Queen's District Nursing Slaughterhouses 84 Association34, 38 Slum Clearance 73 Smallpox 24, 100 Smells from River 43 R Smoke and Grit Emission 43—46 Social Conditions of the Area 12,13 Radiography, Mass 108 Sonne Dysentery 103 Rag Flock Act 50 Special Consultative Clinio Ranyard Mission 34, 38 (Children) 38 Rateable Value10 Speech Therapy (Children) 38 Rates, Births and Deaths, etc. 15, 16 Staff of Public Health Depart— Rat Repression 54—57 ment 5 Refuse Disposal 53—54 Statistical Tables Appendix Registered Births 15,18 Statistics General 10,11 INDEX (continued) Page Still Births 15, 18 Street Traders 86 Suicide 28 Summary of Sanitary Work 69-71 Sunlight Treatment 33 Supervision of Food Premises 86 Supplies of Underground Water (Wells) 53 Swimming Baths 59, 60 T Therapy, Speech (Children) 38 Toddlers Clinic, Attendances 33 Town & Country Planning Act, 1947 76 Transfers (Housing) 77 Transported Meals for Old People 66, 67 Treatment Centres and Clinics 35-38 Tuberculosis 15, 16, 24, 25, 106, 107 110-114 Tuberculosis — Handicrafts Centre Sessions 37 Tuberculosis Officer's Report 110-114 Typhoid Fever ... ... 24, 103 U Underground Water Supplies (Wells) 53 Uninhabited Houses 10 Unsound Food 83, 85 V Vaccination Cases 34 Vaccination and Immunisation Clinics 36 Vaccination, International Certificates 101 Page Various Death Causes, Remarks on 23-29 Vascular Lesions of Nervous System 28 Verminous Conditions 65, 108 Verminous Premises 58, 64, 65 Violent Deaths 28 Vital Statistics 10-29 & Appendix Voluntary Organisations 38 Voluntary Organisations, Grants to 67 W Wash-houses & Public Baths 59, 60 Washing Facilities (Hand) ... 62 Water—Underground Supplies (Wells) 53 Water Supply 52, 53 Water Supply Certificates 53 Weil's Disease 55 Welfare Clinics 35-38 Wells 53 Whooping Cough 15, 24, 101 Whooping Cough Prophylaxis Cases 34 Whooping Cough Prophylaxis Clinics 36 Women's Special Clinic 37 Women's Voluntary Services 38 X X-Ray Examinations 114 X-Ray, Mass 108 Z Zymotic Diseases 24, 103 Zymotic Enteritis 24, 103 INFANTILE MORTALITY DURING THE YEAR 1954 Deaths from stated Causes in Weeks and Months under 1 Year of Age. Cause of Death. Under 1 week. 1—2 Weeks. 2— 3 Weeks. 3—4 Weeks. Total under 1 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 ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ...... ... ... ... ... ... ... ... Tubercular Meningitis ... ... ... ... ...... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... 1 1 Bronchitis ... ... ... ... ... ... ... ............ ... 1 Pneumonia (all forms) ... ... ... 3 ... ... ... 1 4 Gastro-Enteritis ... ... ... ... ... ... ... ... ... I Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformation 3 ... ... ... 8 ... ... ... 1 8 Premature Birth 12 ... ... ... 12 ... ... ... ... 12 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... ... Hepatic Failure ... ... ... ... ... ... ... ... ... 1 Inattention at Birth 1 ... ... ... 1 ... ... ... ... 1 Other Causes ... ... ... ... ... ... ... ... ... ... Unascertainable 1 ... ... ... 1 ... ... ... ... 1 Totals 17 5 ... ... 23 3 1 ... 3 30 Male 19 Female 11 CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1954. Notifiable Disease Cases Notified in Whole District Total Cases Notified in each Locality No. of Cases removed to Hospital from each Locality Total Age & Sex Group At all Ages 0 to 1 1 to 3 3 to 6 a to io 10 to 15 15 to 25 25 to 45 45 to 65 65 and over Greenwich East Greenwich West St. Nicholas Charlton and Kidbrooke Greenwich East Greenwich West St. Nicholas Charlton and Kidbrooke M f M f M f M F M f M f M F M f M f M f Malaria 4 2 2 4 4 4 Small-Fox ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Encephalitis j Infectious Post-Infectious ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... Diphtheria 1 ... ... ... ... ... ... ... 1 ... ... ...... ... ... ... ...... ... ... ... ... ... ... 1 1 1 Dysentery 27 43 1 ... ... 2 10 13 3 ... io 4 22 22 1 25 5 ... 1 9 18 Erysipelas 1 4 ... ... ... ... ... ... ...... ... ... ... ... 3 2 3 1 ... ... 1 2 Acute Polio-Myelitis P 1 ? ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 2 ... ... 2 3 N.P 2 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 ... ... 2 2 Scarlet Fever 37 32 ... ... ... ... ... 5 21 25 4 ... ...... ... ... ... ... ... ... 18 15 2 34 3 ... 1 2 8 Enteric Fever 1 ... ... ... ... ... ... ... ... 1 ... ... ... ...... ... ... ... ... 1 1 ... ... ... 1 Scabies 3 2 ... ... ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... ... 3 l 1 ... ... ... Puerperal Pyrexia 3 ... ... ... ... ... ... ... ... ... ...... ... 1 ... ... ... ... ... ... 2 2 ... ... ... 3 Meningococcal Infection 4 1 ... ... ... 1 ...... 2 ... ... ... ... ... ... ...... ... ... ... 3 1 3 ... 1 ... 4 Measles .. 15 13 1 ... 3 4 2 5 9 4 ... ... ... ... ... ... ... ... 6 10 2 10 1 ... ... ... i Whooping Cough 114 109 7 9 26 29 34 28 41 40 5 ... ... ... ... ... ... ... ... ... 113 a \j 37 10 63 3 ... 3 4 13 Diarrhoea 6 9 3 5 2 3 1 1 ... ... ... ... ... ... ... ... ... 7 6 2 3 ... 6 1 10 Ophthalmia Neonatorum 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 Pneumonia, Acute Primary or Acute Influenzal 8 8 ... ... ... 1 ... 1 1 ... 2 ... 2 ... 1 4 1 1 1 1 7 1 8 ... ... ... ... Tuberculosis, Pulmonary 50 43 ... ... ... 1 ...... 1 1 2 2 ... 7 15 20 18 17 4 2 32 14 6 41 6 4 ... 8 19 Non Pulmonary 7 6 ... ... 2 1 ... ... 2 ... ... ... 1 2 1 3 1 6 2 5 5 1 5 11 Totals 280 277 14 15 39 42 53 44 88 86 19 8 16 30 24 37 23 13 4 2 222 104 29 202 33 15 13 40 101 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, 1954. No. in Short Lit 1 Causes of Death. Deaths at Subjoined ages of " Residents " whether occurring within or without the District Deaths at all 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 Infttitutions in the Digtxict- 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 | Greenwich West St. Nicholas, Deptford Charlton and Kldbrooke St. Alfeee's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital Other Institutions Outside Institutions Under 4 mths. 4 mths. and UDder 1 yr. i Tuberculosis, Respiratory 15 ... ... ... ... ... 1 5 6 1 2 3 1 2 9 3 ... ... ... ... 5 32 2 Tuberculosis, Other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Syphilitic Disease 3 ... ... ... ... ... ... 1 ... 2 ... 1 1 ... 1 ... ... ... ... 1 8 4 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Meningococcal Infections 3 ... 1 ... ... 1 ... ... ... ... ... 2 ... 1 1 ... ... ... 2 ... 4 7 Acute Poliomyelitis 1 ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... 1 8 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Other Infective and Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... 10 Malignant Neoplasm, Stomach 23 ... ... ... ... ... ... l 9 7 6 10 4 ... 9 13 ... 3 ... ... ... 1 46 11 Malignant, Neoplasm, Lung, Bronchus 46 ... ... ... ... ... ... 24 18 4 14 9 1 22 20 ... 4 ... ... ... 2 84 12 Malignant Neoplasm, Breast 18 ... ... ... ... ... ... 3 8 4 3 1 6 ... 11 7 ... ... ... ... ... 6 14 13 Malignant Neoplasm, Uterus 3 ... ... ... ... ... ... 1 2 ... ... 3 ... ... ... ... ... 1 3 14 Other Malignant and Lymphatic Neoplasms 73 ... ... ... ... ... ... 3 26 22 22 24 17 1 31 28 3 9 ... ... ... 5 136 16 Leukaemin, Aleukaemia 9 ... ... ... ... ... ... 6 ... 1 1 1 3 ... 5 2 ... 1 ... 1 ... 1 15 16 Diabetes 3 ... ... ... ... ... ... ... ... 1 2 1 1 ... 1 ... ......... ... ... ... ... 1 7 17 Vascular Lesions of Nervous System 83 ... ... ... ... ... ... 1 18 25 39 24 18 3 38 24 1 1 6 ... 4 171 18 Coronary 1 disease, Angina 105 ... ... ... ... ... ... 4 34 38 29 43 20 1 41 21 4 6 1 3 15 107 19 Hypertension with Heart Disease 20 ... ... ... ... ... ... 6 5 9 5 4 2 9 7 ... ... ... ... ... 2 21 20 Other Heart Disease 125 ... ... ... ... 1 ... 6 13 23 82 57 19 7 42 43 6 ... ... 13 110 21 Other Circulatory Disease 53 ... ... ... ... ... ... 3 8 14 28 20 15 2 16 24 3 2 ... ... 9 178 22 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 23 Pneumonia 31 3 1 ... ... ... ... ... 4 9 14 8 11 ... 11 12 1 2 ... ... 5 84 24 Bronchitis 45 1 ... ... ... ... ... 10 11 23 10 12 ... 20 9 1 1 ... 1 ... 2 64 26 Other Diseases of Respiratory System 4 ... ... ... ... ... 1 1 2 ... ... ... ... 4 ... ... ... ... ... ... 2 8 26 Ulcer of Stomach and Duodenum 12 ... ... ... ... ... ... ... 2 7 3 6 3 ... 3 7 ... 2 ... ... ...... 2 22 27 Gastrit s, Enteritis and Diarrhoea 4 1 ... ... ... ... ... ... 1 2 2 1 1 ... 1 ... 1 ... 2 6 28 Nephritis und Nephrosis 8 ... ... ... ... ... ... 1 4 1 2 5 2 1 3 ... ... 2 15 29 Hyperplasia of Prostate 5 ... ... ... ... ... ... 1 1 3 2 1 ... 2 4 ... ... 1 6 30 Pregnancy, Childbirth, abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 Congenital Malformations 9 7 1 ... ... ... ... 1 ... ... 1 5 ... 3 2 2 ... 1 ... 4 16 32 Other defined and ill-defined Diseases 59 15 ... ... ... l ... l 10 14 15 16 12 2 29 21 3 6 ... 4 ... 13 7 139 oo 33 Motor Vehicle Accidents 11 ... ... ... ... ... ... 4 2 1 3 1 3 7 1 1 ... 2 ... / q 22 34 All other Accidents 14 ... ... ... ... ... ... 3 1 2 6 3 4 1 6 5 2 2 ... 0 1 13 35 Suicide 9 ... ... ... ... 2 4 ... 3 4 1 l 3 3 ... 1 36 Homieide and Operations of War ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 794 27 3 1 5 4 3 45 193 210 303 264 173 29 328 257 21 49 1 22 110 1,355 Note.—All " Transferable Deaths " of residents, t.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 11