AC4B 73 1 5 B 2 Library GRE 53 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1955 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1955 Printed by Freame, Manning & Co., Ltd. Lewisham, S.E.I3 CONTENTS Page Public Health Committee 3 Introductory 6 Section A.—General and Vital Statistics 9 „ B.—General Provision of Health and Welfare Services for the Area 30 „ C.—Sanitary Circumstances of the Area 40 „ D.—Housing 73 „ E.—Inspection of Food and Supervision of Food Premises 81 „ F.—Prevalence of, and Control Over, Infectious and other Diseases 102 „ G.—Miscellaneous 123 Appendix—Statistical Tables 3 PUBLIC HEALTH COMMITTEE as at 31st December, 1955 The Mayor: Councillor B. R. Angell, J.P. and 13 Members Councillor Mrs. M. L. Wentworth (Chairman) Councillor Mrs. F. M. Kerins (Vice-Chairman) Aldermen : Mrs. C. Berry Mrs. L. Hilldrith Mrs. A. D. A. Kennedy Councillors : Mrs. M. L. Bennett P. Noble A. C. Chrisp (L.C.C.) R. Ruston D. P. Lynch Dr. W. Smith Dr. W. G. S. Neely W. F. Strong Powers and Duties of the Public Health Committee : 1.—The Committee shall consist of 13 members of the Council. 2.—There shall stand referred to the Committee all matters relating to the powers and duties of the Council under Acts of Parliament, bye-laws and regulations dealing with the public health and the sanitary condition of the Borough ; the administration of the Food and Drugs Act, 1955 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 Sections 16 and 18 of the Food and Drugs Act, 1955 (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 maintained 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, 1955 MEDICAL OFFICER OF HEALTH : John Kerr Brown, B.Sc., M.B., Ch.B., D.P.H. PUBLIC ANALYST: H. A. Williams, Ph.D., A.C.G.F.C., F.R.I.C. SANITARY INSPECTORS: ac W. H. Collins, b.e.m. (Senior). District Inspectors : abc S. A. Radford ab G. W. Heath ab B. Crowhurst* a J. G. Lyons abdef Miss B. Hatfield J. Grimston (Student)† Food Inspectors: abc G. B. Allen (Senior) ab C. W. Spore CLERICAL STAFF: L. A. Westacott (Chief Clerk) A. H. Wilcox Mrs. V. I. Starr (Senior Clerk) (Senior S/H Typist) K. Allum, d.f.m. Mrs. M. G. Simpson S. E. Thelner C. Weymouth A. G. Lyons W. A. Pearce (Conveniences Superintendent) Mrs. M. G. Janman (Temporary)‡ DISINFECTING STAFF : T. Smith (Foreman) A. Moore H. W. C. Scarff (Motor Driver) W. Clements A. Nash RODENT CONTROL, FLY DISINFESTATION, ETC : J. P. Hill—Foreman and a Team of five 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 15/8/55 † ,, ,, 11/7/55 ‡ „ „ 10/10/55 6 Public Health Department, Town Hall, Greenwich, S.E.10 July, 1956 To the Mayor, Aldermen and Councillors Metropolitan Borough of Greenwich. Ladies and Gentlemen, It is a traditional and pleasing duty to preface the Annual Report with some introductory observations. The year has seen no serious major epidemics and there has been solid progress in certain important aspects of community health, although we have had more deaths and fewer births. The Registrar General's estimate of the population at mid-year was 89,490, a decline of 1,110. Mention is made of this fact in the body of the Report. The Infantile Mortality Rate was 16.01, a reduction of 6.16 on last year and the second lowest in the history of the Borough. Analysing these figures year by year, it is obvious that Greenwich is a healthy place in which to be born, and these consistently low figures reflect great credit on the many agencies concerned both with maternal and child care. Neo-Natal deaths, however, still account for 66.6% of the total; 9 deaths out of 14 were caused by premature birth, and 3 from birth injury due to difficult labour or instrumental delivery. For the third successive year there was no maternal death. The adjusted death rate increased from 9.4 to 9.94. The cancer death rate increased from 1.83 to 1.89, and in particular, there was an increase in stomach cancer, but a decrease in cancer of the lung and bronchus for the first time for several years. This unexpectedly reversed a trend to which attention has been drawn for some time ; but no conclusions can be valid on the statistics of one particular year. Turning to infectious diseases, the year was noteworthy for the large number of measles notified: there were 1,684 cases, with 2 deaths. Tuberculosis cases declined slightly from 106 to 99, but the total number on our register, which is now kept for departmental 7 purposes and not as a statutory obligation, increased by 51, presumably due to considerable numbers of inward transfers to Greenwich. The Mass Miniature Radiography Unit visited the Borough from 15th March to 6th April, and I am pleased, as always, to include in full an analysis of the results of the survey kindly supplied by Dr. Morgan, the Director of the Unit. There were 55 cases of Poliomyelitis notified, 23 of which were of the paralytic type and 32 non-paralytic. This figure, however, does not reflect accurately the incidence of the disease in Greenwich, because some 38 were residents of neighbouring boroughs admitted to and diagnosed in the Brook Hospital. Due to inconsistencies of notification procedure for certain infectious diseases, and which is entirely beyond our control, Greenwich has to accept them for statistical purposes. The same rules apply to Puerperal Pyrexia, and boroughs with large maternity hospitals or obstetric units are heavily handicapped in having to accept puerperal pyrexias which, on logical and epidemiological grounds, should be referred to the borough of residence. Once again, we had 1 case of Diphtheria, in this instance a woman of middle age ; but Whooping Cough and Sonne Dysentery showed considerable reduction on last year. A complete survey of the Borough was undertaken by the staff, under the Housing Repairs and Rents Act, 1954, to ascertain the total number of unfit houses in the Borough. Agreement was eventually reached with the London County Council regarding totals and allocations and the joint proposals of both authorities for 195660 were submitted to the Minister for his approval. During the year the Clean Air Bill was passing through Parliament and a new Clean Air Act is expected soon. In connection with atmospheric pollution, the Department, in co-operation with the Fuel Research Station, has set up apparatus at Charlton House and the Town Hall for measuring smoke and sulphur dioxide concentrations. Our readings commenced in June and will, of course, be correlated with similar observations throughout London. Many industrial sources of pollution were investigated during the year and while most managements offered every co-operation in eliminating dust, grit or smoke emissions, there are some areas in the Borough where living conditions at times are difficult and where improvements are vitally necessary. Within the limits imposed by somewhat restricted legal powers, and the difficulties created in bygone days of industry having been sited adjacent to residential areas, I am certain the atmosphere in Greenwich is cleaner now than ever 8 before. That does not mean that we can be satisfied nor that great improvements cannot be made. In certain districts it is not the products of combustion that are the main source of complaint, but dust and grit from such processes as breeze block manufacture, the making of road surfacing materials, the discharge from the river of cement, granite chippings, limestone, sand and similar substances. All these things cause serious nuisance to nearby residents and it is no answer to them to say that these works are sited in areas scheduled in some master plan for industrial purposes. They reply and rightly, that such processes as I have mentioned should not be carried on adjacent to their homes, or alternatively, that they should be moved from a particularly unhealthy area. Nevertheless the Department has done its best, with some success, to tackle part of this difficult problem. During the year the Old People's Welfare Association expanded its services for the aged in the Borough with generous financial and practical support from the Council. The Health Department has continued to give official and unofficial help to the many services devoted to the welfare of old persons, and liaison with the hospitals, especially the Geriatric Unit at St. Alfcge's, remains close and cordial. A detailed account of these activities is included in the main report. In conclusion, I wish to thank the staff for their help throughout the year and to acknowledge the support from the Chairman and Vice-Chairman of the Public Health Committee ; likewise the Town Clerk and the other Chief Officers have shown much kindness and consideration to me throughout the year. I have the honour to be, Your obedient Servant, J. Kerr Brown Medical Officer of Health 9 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA General Statistics Elevation.—Varies from below high-water mark up to 249 feet above sea level. Area of the Borough and Districts— East Greenwich 1,300 acres West Greenwich 453 „ St. Nicholas, Deptford 115 „ Charlton & Kidbrooke 1,990 ,, 3,858 acres Population— At Census, 1951 89,846 Estimated, 1955 (mid-year) 89,490 Density of Population (persons per acre) 23.2 Number of Inhabited Dwellings—end 1955 23,277 (according to Rate Books) Structurally separate dwellings at Census, 1951 21,348 Number of Uninhabited Dwellings— At Census, 1951 364 At end 1955 131 Number of Families or Separate Occupiers— At Census, 1951 26,397 Rateable Value, 1955 £832,434 Sum Represented by a ld. Rate, 1955 £3,390 10 PUBLIC OPEN SPACES. Borough Council— Charlton House and Gardens 9.25 acres R.N. College Cemetery 5.86 „ St. Alfege Recreation and Church Grounds 2.30 „ St. Nicholas Recreation Grounds 1.25 ,, Hughes Fields Recreation Grounds .74 ,, Batley Park .97 ,, Bellot Memorial Gardens .19 ,, Other Open Spaces 5.25 „ Approximately 26.00 acres H.M.Office of Works— Greenwich Park 185 acres L.C.C.— Blackheath (part of) 89 acres Blackheath—Rangers House and Garden 2½ „ Maryon and Maryon Wilson Parks 51½ „ Charlton Park 42¾ ,, Hornfair (formerly Charlton Playing Field) 26 ,, Sayes Court Recreation Grounds 3¼ „ Approximately 215 acres Total Public Open Spaces in Borough Approx. 426 acres (representing 11.4% of the total area of the Borough) Mileage of Streets 88.6 (approx) 11 SOCIAL CONDITIONS The Metropolitan Borough of Greenwich comprises three districts, viz., Greenwich, Charlton and Kidbrooke and St. Nicholas, Deptford, all of which are now united into one civil parish. There is evidence that Greenwich has been an inhabited place for perhaps 2,000 years. In Latin it was described as Grenovicum viridis sinus a viridariis and in Saxon Grenawic, i.e., the Green Town or dwelling upon the bank of the river. 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. However, as late as the reign of Henry V Greenwich was mainly a fishing town but nevertheless the river here afforded an excellent safe road for shipping. So much so that in the time of King Ethelred (1011 A.D.) the whole Danish Fleet lay off Greenwich for three or four years whilst the army was for the most part encamped on Blackheath. This army ravaged the whole country and sacked the City of Canterbury from whence they brought Archbishop Alfege to his martyrdom at Greenwich. 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 12 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. Considerable alteration has taken place during the post-war period by the erection of modern houses and blocks of flats and the Borough Council, still pressing ahead with its new housing schemes, has behind it a record of sound achievement. The part situated near the River Thames is, generally speaking, an industrial area, and is more densely populated than the upper parts of the Borough. In recent years, however, the commencement of a gradual movement of people away from the river-side has been witnessed. The majority of the industries and sources of employment in the Borough are to be found in close proximity to the River Thames which forms the Borough boundary on the north side. Chief among these are large Cable and Engineering Works, Ship Repairing Works, Gas Works, Soap and Candle Works, L.T.E. Generating Station and Carriage Repair Depot, The British Electricity Authority's Works, Glass Bottle Works, Rope Works, Ship Propelling Works, Merryweather's Works (Fire Engines), Cement and Stone Works, Asbestos Works, Cold Meat Storage, Pressed Tool Works, Constructional Engineering Works, Galvanising and Sheet Metal Works, Brewery, Flour Mills, Aero Parts, Wireless and Vehicle Parts and Tin Box Manufacturing Works. The numbers employed at 11 of the larger factories range between 500 and 5,000 each, whilst 17 smaller works each employ between 100 and 400. 13 POPULATION The Registrar General has submitted his estimate of the population of Greenwich, computed at mid-year 1955, upon which the Statistics of this Report have been based. The figure returned is 89,490 indicating a decrease in the population of 1,110 since last year and 356 since the 1951 Census. The current figure shows an advance of 25,690 over that for 1945. The natural increase for the year, i.e., excess of births over deaths was 482. After considering a natural increase of almost 500, plus the fact that practically no slum clearance had been undertaken in the area during the year, a decrease of l¾% in the population seemed considerable and was somewhat unexpected. Correspondence with the Registrar General on this decrease elicited the information that a reduction of over 300 non-civilians stationed in the area had been reported and further, that information supplied to him by the London County Council, the New Town Development Corporations and local authorities in the Home Counties indicated a substantial movement of people out of Greenwich. 14 * EXTRACTS FROM VITAL STATISTICS OF THE YEAR. LIVE BIRTHS Legitimate Illegitimate Total Male 671 30 701 Birth Rate 14.69 (Crude) Female 580 30 610 (Comparable Rate 13.66) Total 1,251 60 1,311 STILL BIRTHS Legitimate Illegitimate Total Male 11 1 12 Rate per 1,000 total Births 20.91 Female 14 2 16 Total 25 3 28 DEATHS—All Causes Male Female Total Death Kate (Crude) 9.29 459 370 829 (Comparable Rate 9.94) DEATHS—Special Causes Puerperal Causes Nil Tuberculosis (all forms) 8 Tuberculosis, Pulmonary 7 Cancer (all ages) 169 Measles (all ages) 2 Whooping Cough (all ages) Nil Diarrhoea (under 2 years of age) Nil Influenza 1 *These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 15 DEATH RATES Infants under 1 year of age All infants per 1,000 live births 16.01 Legitimate Infants per 1,000 legitimate live births 15.18 Illegitimate Infants per 1,000 illegitimate live births 33.33 Others Puerperal Causes (per thousand total births) Nil Tuberculosis (all forms) per 1,000 population 0.08 Tuberculosis, Pulmonary per 1,000 population 0.07 Cancer per 1,000 population 1.89 Common Infectious Diseases per 1,000 population 0.02 Influenza per 1,000 population 0.01 MARRIAGES. Mr. J. Abercrombie, the Superintendent Registrar of the Greenwich Registration District, has kindly furnished me with particulars relating to the number of marriages solemnised or registered in the Borough of Greenwich during 1955. The total of 714 gives a marriage rate of 16.01 a decrease of 1.06 from that of the previous year. The following table shows these particulars giving the number of marriages in the Borough for each year since 1938:— Year Churches of England Chapels and Roman Catholic Churches SuperintendentRegistrar's Office Total Approximate Population Greenwich Charlton and Kidbrooke St. Nicholas 1938 309 185 31 101 268 894 95,770 1939 395 218 31 128 397 1.169 94,790 1040 451 243 33 126 345 1,198 74,280 1941 277 174 7† 91 241 790 67,070 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 1955 197 116 5 106 290 714 89,490 †Parish Church destroyed by enemy action. ‡ St. Peter's, Creek Road Holy Trinity, Blaekheath Hill closed. 16 METEOROLOGICAL OBSERVATIONS—1955. 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, 1955:— Temperature : The highest screen temperature was 86°F. on 22nd August. The temperature exceeded 80°F. on 12th July (81°F.) 13th „ (81°F.) 14th „ (84°F.) 15th „ (82°F.) 16th „ (81°F.) 17th „ (85°F.) 23rd„ (81°F.) 17th August (82°F.) 20th „ (84°F.) 21st„ (83°F.) 22nd „ (86°F.) 23rd „ (82°F.) 24th „ (82°F.) The lowest screen temperature was 21°F. on 12th January, 28th February and 1st March. The maximum temperatures during January, February, November and December, were:— 54°F. on 10th and 30th January 54°F. on 7th February 63°F. on 6th November 58°F. on 28th December 17 Sunshine: Total hours recorded 1519.3 The sunniest day was 30th May, when 15.0 hours of sunshine was recorded. There were 76 days when no sunshine was recorded, viz :— January 21 days February 9„ March 2,, April 1„ May 1 „ June 1 ,, July 1 „ August 2 „ September 1 „ October 9 „ November 11 ,, December 17 ,, Rainfall: Total for the year 20.10 inches Highest in 24 hours 1.25 inches on 22nd September Driest month July (0.05 inches) Wettest month May (4.21 inches) 18 BIRTHS The total number of live births registered in the Borough during the year was 1,328 and of this number 969 occurred in St. Alfege'a Hospital, and 359 in private dwellings. In 544 cases the parents resided outside the Borough and the births were consequently transferred to the appropriate districts, leaving a figure of 784. To this must be added 527 births belonging to the Borough which took place in Institutions outside the Borough, thus making a final figure for Greenwich of 1,311, a decrease of 42 from that of the previous year. Of this total 701 were males and 610 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 307 166 52 259 784 Inward Transfers:— 1st Qtr. 48 10 3 65 126 2nd Qtr. 51 15 3 76 145 3rd Qtr. 40 11 3 78 132 4th Qtr. 28 20 2 74 124 Totals 474 222 63 552 1,311 The Birth Rate for the year, calculated on the figure of 1,311 births, is 14.69 per thousand of the population, 0.29 lower than that for 1954. The average rate for the previous ten years is 17.89. The Greenwich Comparability Factor for births is 0.93 which gives an adjusted rate of 13.66. The Rates for the County of London and England and Wales are 15.1 and 15.0 respectively. Illegitimate Births which numbered 60 (representing 4.5 per cent, of the total live births) showed a decrease of 9 from those of the previous year. The number of Still Births registered was 28 (12 males - 16 females), which is equivalent to a rate of 20.91 per 1,000 total births, an increase of 2.77 over that of 1954. No. in Short List. Causes or Death Sex Deaths at subjoined Ages of " Residents," whether occurring within or without the District. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and under 75. d over. All Causes M F 459 370 13 8 4 5 5 3 4 1 23 21 144 65 121 100 145 167 Tuberculosis, Respiratory M 5 ... ... ... ... 1 3 1 ... F 2 ... ... ... ... 2 ... ... ... M 1 ... ... ... ... ... 1 ... ... F ... ... ... ... ... ... ... ... ... 4 Diphtheria ... M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 5 Whooping Cough ... M ... ... ... ::: ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 6 Meningococcal Infections M 3 ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... 7 Acute Poliomyelitis M 2 ... ... ... 1 ... ... ... ... c ... ... ... ... ... ... ... ... ... 8 Measles M 1 ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... ... ... 9 Other Infective and Parasitic M ... ... ... ... ... ... ... ... ... Diseases F 2 ... ... ... ... ... 2 ... ... 10 Malignant Neoplasm, Stomach ... M 16 ... ... ... ... ... 8 3 5 F 10 ... ... ... ... 1 2 1 6 11 Malignant Neoplasm, Lung, M 29 ... ... ... ... 2 16 5 6 Bronchus F 6 ... ... ... ... 1 3 1 1 12 Malignant Neoplasm, Breast M ... ... ... ... ... ... ... ... ... F 16 ... ... ... ... 2 5 6 3 13 Malignant Neoplasm, Uterus F 6 ... ... ... ... 1 1 3 1 14 Othei Malignant and Lymphatic M 46 ... ... ... 1 6 14 12 13 Neoplasms F 40 ... ... ... ... 1 10 17 10 16 Leukaemia, Aleukaemia ... M 1 ... ... ... ... ... ... ... 1 F 3 ... ... ... ... ... ... 1 1 16 Diabetes M 1 ... ... ... ... ... ... ... ... F 5 ... ... ... ... ... 1 2 2 17 Vascular Lesions of Nervous M 32 ... ... ... ... 1 7 12 12 System F 52 ... ... ... l 1 8 14 28 18 Coronary Disease, Angina M 77 ... ... ... ... 2 35 20 20 F 37 ... ... ... ... ... 8 12 17 19 Hypertension with Heart Disease M 8 ... ... ... ... ... 3 3 2 F 14 ... ... ... ... ... ... 5 9 20 Other Heart Disease M 57 ... ... ... ... 2 4 14 37 F 59 ... ... ... ... 3 5 13 38 21 Other Circulatory Disease M 26 ... ... ... ... 1 7 7 11 F 23 ... ... ... ... ... 4 6 13 22 Influenza ... ... ... M 1 ... ... ... ... ... 1 ... ... 23 Pneumonia F M 27 ... ... ... 1 1 8 7 8 F 17 ... ... ... ... ... 2 4 11 24 Bronohitis ... M 44 ... ... ... ... 1 12 17 13 F 15 ... ... ... ... I 1 4 9 25 Other Diseases of Respiratory ... M 7 ... ... ... ... ... 3 3 1 System ... F ... ... ... ... ... ... ... ... ... 20 Ulcer of Stomach and Duodenum M 5 ... ... ... ... ... 2 1 2 F 3 ... ... ... ... ... 1 ... 2 27 Gastritis, Enteritis and Diarrhoea M 4 ... ... ... ... ... 1 2 1 F 4 ... ... ... ... I 2 1 ... 28 Nephritis and Nephrosis M 4 ... ... ... ... I 1 ... 2 F 2 ... ... ... ... I 1 ... ... 29 Hyperplasia of Prostate ... M 10 ... ... ... ... ... 3 ? 30 Pregnancy, Childbirth, abortion F ... ... ... ... ... ... ... ... 31 Congenital Malformations M 2 1 ... ... ... ... 1 ... ... F 5 2 ... 1 ... i 1 ... 32 Other defined and ill-defined M 36 8 ... 2 ... 3 11 8 4 Diseases ... F 36 6 ... ... ... 3 7 7 12 33 Motor Vehicle Accidents ... M 5 ... ... 1 l 1 1 1 F 3 1 1 1 34 All other Accidents M 3 ... 1 I ... ... 1 F 6 ... 1 ... ... ... ... 2 3 35 Suicide M 5 ... ... ... ... ... 4 1 F 3 ... ... ... ... 2 1 ... 36 Homicide and Operations of War M ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 19 DEATHS The net number of deaths registered during 1955 was 829, of which 459 were males and 370 females, compared with last year's total of 794 comprising 418 males and 376 females. This gives a crude Death Rate for the Borough of 9.29 per thousand of the population, an increase of 0.50 as compared with that of the previous year and a rate which is 1.42 less than the average for the last ten years, viz., 10.71. The crude Death Rate figure is slightly increased to 9.94 when the comparability figure furnished by the Registrar General for adjusting Local Deaths, is taken into account. The adjusted Death Rate is in effect a ' corrected ' Death Rate. The Registrar-General has pointed out that if the population of all areas were similarly constituted as regards the proportion of their sex and age group components, their crude death rates (deaths per 1,000 population) could be accepted as valid comparative measures of the mortalities experienced by the several populations. Populations, however, are not similarly constituted and their crude Death Rates therefore fail as true comparative mortalitity indexes in that their variations are not due to mortality alone, but arise also from differences in their population constitution. For instance a town with a population consisting of aged persons would register more deaths than one composed entirely of young and vigorous adults. Again a town containing a larger number of males than females records more deaths with a consequent higher Death Rate than one in which females preponderate. To overcome this difficulty the Registrar-General has worked out for each area in the country an adjusting factor which is termed the ' Comparability Factor ' and is based on the last census population figure. The Comparability Factor for Greenwich is 1.07 and may be regarded as the population handicap to be applied which, when multiplied by the crude Death Rate for the year, modifies the latter so as to make it comparable with the country as a whole or with any similarly adjusted area. The Death Rates for the County of London and for England and Wales are 11.5 and 11.7 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. 20 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 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 1954 794 460 57.9 10-year average 897 520 57.9 1955 829 532 64.1 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 5 8 4 4 21 Between 1 and 2 years 1 — — 1 2 Between 2 and 5 years — 2 4 1 7 Between 5 and 15 years 2 3 3 — 8 Between 15 and 25 years 1 2 — 2 5 Between 25 and 45 years 16 9 7 10 42 Between 45 and 65 years 48 58 49 54 209 Between 65 and 75 years 68 51 48 52 219 75 years and upwards 99 69 71 77 316 Totals 240 202 186 201 829 21 During the year the pattern of death registrations continued normally, namely that the first quarter produced the most (28.9%) and the third quarter the least (22.4%). It will be observed from the following table that during 1955 the deaths occurring at 65 years and upwards accounted for 64.3% of the total compared with a figure of 22.8% for 1901. Deaths in the age group 0-5 years show an even more striking comparison : in 1901 the deaths in this group amounted to 37.4% whilst the figure for the current year is 3.6%. Age Group 1901 1911 1921 1931 1951 1955 Under 1 year of age 362 306 175 97 29 21 Between 1 and 5 years 187 158 80 39 7 9 Between 5 and 15 years 64 67 58 22 10 8 Between 15 and 25 years 66 60 67 65 12 5 Between 25 and 65 years 454 474 466 382 311 253 65 years and over 335 356 387 529 633 533 Totals 1,468 1,421 1,243 1,134 1,002 829 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 and for 1953. 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 16.01 per thousand live births as compared with 22.17 for the previous year. For the County of London the rate was 23.2 and for England and Wales 24.9 per 1,000 related live births. The present Borough figure of 16.01 is 7.19 lower than that for London and shows a decrease of 6.16 from that returned for the previous year and is only 1.39 greater than the rate for 1952. The actual number of infantile deaths recorded during the year 22 was 21 (a decrease of 9) and these were attributed to the following causes :— Prematurity 11 Congenital Malformations 3 Injury at Birth 3 Measles 1 Tracheo-bronchitis 1 Broncho-pneumonia 1 Meningococcal Meningitis 1 Of the above, 13 were male and 8 female ; 6 died in St. Alfege's Hospital, 12 in Hospitals and Maternity Homes outside the borough and 3 at home. This substantial decrease in infant deaths during the current year was confined wholly to the neo-natal period, a complete reversal of the trend noted in the previous year. Neo-Natal Mortality.—Neo-natal mortality, i.e., infants dying before attaining the age of one month, accounted for 14 deaths, equivalent to 66.6% of all infant deaths and giving a Neo-natal Mortality Rate of 10.67 per 1,000 live births. Thirteen 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 1955 :— District Average for five years 1931-1935 Average for five years 1936-1940 Average for five years 1941-1945 Average for live years 1946-1950 Year 1955 Greenwich 75 50 40 27 16.01 London 63 56 60 33 23.2 England & Wales 62 55 50 36 24.9 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 good index to the social circumstances of any particular area. However, Infant Mortality Rates, which are based on the number of births occurring in the same year as the infant deaths are not comparable year by year unless the birth rates remain more or less constant because approximately one-third of the infants dying in any one year will be found to have been born in the previous year. Further, it must be borne in mind that when dealing with 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 Death, 1948, should be adopted in order that local statistics can be compared with national figures and national with international. Classification of Deaths.—It should be borne in mind that the statistical data compiled locally relating to cause of death may not entirely agree with the figures furnished to Local Authorities by the Registrar-General. Classification of the cause of death is taken from one or more causes as stated on the medical certificate in accordance with the 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 2 deaths giving a rate of 0.02 for the current year. One death was registered from Common Infectious Diseases during 1954, 4 for 1953, none for 1952 and 3 for each of the years 1951 and 1950. Smallpox.—No deaths from Smallpox have been recorded during the year, this year being the 53rd since a death from this disease occurred. Measles.—There were 2 deaths arising from this cause during the year in contrast to a nil return for the previous year. Prior to this year no deaths had been registered since 1947 when there was one. Scarlet Fever.—For the ninth 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, a similar position to that obtaining during 1954. Two deaths were registered for 1953 none for 1952, and one for each of the years 1951 and 1950. Enteric Fever.—There were no deaths arising from this cause during the year and none has been recorded since 1941. Only 2 deaths from Typhoid Fever have been registered during the last twenty years. Diarrhoea and Zymotic Enteritis.—Compared with a nil return for the current year there was 1 death from this cause in 1954, 2 during 1953 and none during 1952. Diphtheria.—Again it is gratifying to report that there were no deaths from Diphtheria during the year under review and that it is now 9 years since one was recorded. Tuberculosis.—There were 8 deaths from this disease during the year giving a Death Rate of 0.08 compared with 15 deaths and a Rate of 0.16 for the previous year. This year's Rate compares extremely favourably with the average T.B. Death Rate during the previous 10 years, viz : 0.54. Again 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 sixth and the rate is one tenth of the corresponding figures for 1945 as the following table will indicate :— Year No. of Deaths Rate 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 1954 150.16 10-year Average 45 0.54 1955 8 0.08 Tuberculosis of the Respiratory System was responsible for 7 of the deaths in this category, only one death being attributed to the remaining forms of tuberculosis. At 0.07, the Pulmonary Tuberculosis rate was 0.09 less than that returned for the previous year. Locally the deaths were : 1 in East Greenwich ; 2 in West Greenwich ; and 4 in Charlton and Kidbrooke. Last year there were no deaths from other forms of Tuberculosis compared with one 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 169 deaths giving a rate of 1.89 per thousand, these figures showing increases of 3 and 0.03 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 20.4, the figure for 1955. 26 Comparing the current year's figures with those of the previous 5 years, the sites of the affected parts were :— 1950 1951 1952 1953 1954 1955 Cancer of Stomach 30 24 24 33 23 26 ,, „ Lung, Bronchus 26 51 31 27 47 35 ,, ,, Breast 12 14 11 12 18 16 „ „ Uterus 7 11 6 11 3 6 „ „ all Other Sites 92 98 89 76 75 86 Totals 167 198 161 159 166 169 Throughout the country in recent years there has been a tendency for cancer of the lung to increase and the following table has again been included in order that the trend in this Borough may be studied :— DEATHS FROM CANCER OF LUNG (including Bronchogenic Carcinoma) Year AGE GROUPS Totals Grand Totals Rate per 1,000 Pop. 25 and under 45 yrs. 45 and under 65 yrs. 65 and under 75 yrs. 75 and upwards M F M F M F M F M F 1946 2 — 12 1 1 — 1 — 16 1 17 0.22 1947 2 — 13 — 8 1 1 — 24 1 25 0.30 1948 1 — 18 1 6 1 1 — 26 2 28 0.33 1949 1 — 11 3 10 1 3 1 25 5 30 0.34 1950 1 1 14 3 5 3 1 1 21 8 29 0.32 1951 1 — 26 3 15 — 3 3 45 6 51 0.57 1952 2 — 15 2 9 1 1 1 27 4 31 0.34 1953 3 — 12 4 7 — 1 — 23 4 27 0.29 1954 — — 21 3 13 5 5 — 39 8 47 0.52 1955 2 1 16 3 5 1 6 1 29 6 35 0.39 Totals 15 2 158 23 79 13 23 7 275 45 320 Average for 10 yrs. 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 9 years of 6 to 1. In 1946, there were 17 deaths of Greenwich residents from cancer of the lung, approximately one quarter of the total registered for pulmonary tuberculosis viz. 75. During the current year, figures of 35 and 8 respectively have been recorded, showing that lung cancer is now claiming over 4 times as many victims as pulmonary tuberculosis, a complete reversal of positions within a period of 10 years. Nationally as well as locally, recent years have shown an exceptionally rapid decline in the death rate of pulmonary tuberculosis whereas that for cancer of the lung has increased, one might almost say, correspondingly. Public concern was such that early in 1956, after an investigation by the Medical Research Council, the Minister of Health in the House of Commons stated inter alia, that ' two known cancerproducing agents have been identified in tobacco smoke ' and also that ' there is, statistically, an incontrovertible association between cigarette smoking and the incidence of lung cancer.' 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. In this respect the introduction by the Government of a Clean Air Bill is to be commended. 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 introduced for the voluntary registration of all sites of cancer and that 28 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. 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 15 and 25 years ; 2 between 25 and 45 years ; 15 between 45 and 65 years ; 26 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 252 compared with a figure of 257 for 1954 and, as usual, the deaths from this class occupied the principal place in the classification of diseases. The speed and strain of modern civilization is thought to have a great bearing on diseases of the heart and circulation and it is pertinent to state here that in Greenwich almost 25% of the deaths from these so called ' stress' diseases occurred in people between the ages of 25 and 65 years, the most productive period of life. It is significant too, that males formed, by far, the larger proportion of the deaths in this age category. Social and environmental conditions are probably pre-disposing factors in hypertension and coronary disease but recent research has focussed attention on diet and, in particular, on fatty acids. Should these suspicions become substantiated then coronary artery disease becomes in part, a preventable disease. Diseases of the Respiratory System. — There were altogether 110 deaths from these diseases, Bronchitis accounting for 59 and Pneumonia (all forms) for 44. Of the total deaths 2 were children under one year of age and 77 were in respect of persons 65 years and over. Infl??? —There was one death attributed to this cause during th.??? compared with a nil return for last year. Fifteen were recorded during 1953. 29 Deaths from Violence.—These number 25 including 8 from Motor Vehicle Accidents, 8 from Suicide and the remainder being accounted for under the heading of ' All Other Accidents. Deaths from Motor Vehicle Accidents were three fewer in number to those of the previous year, while suicide showed a fall of one. Two of the remaining deaths from violence concerned children under 5 years of age. Both occurred at home and both could be considered as being preventable, one concerned a child who fell from a window and the other a child who fell down stairs. 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 1955, which will be found on the following pages in table form. NATIONAL WELFARE FOOD ITEMS Distribution Centres M. & C. W. Centres. Bardsley Lane, S.E.10 Tuesday 2 p.m.—4 p.m. Blackheath Hill S.E.10 Thursday 1.30 p.m.—4 p.m. Charlton Lane, S.E.7. Tuesday 9.30 a.m.—12 noon Thursday 1.30 p.m.—4 p.m. Chevening Road, S.E.10 Tuesday 1.30 p.m.—4 p.m. Wednesday Thursday Saturday 9.30 a.m.—12 noon Creek Road, S.E.8 Monday 9.30 a.m.—12 noon Friday 1.30 p.m.—4 p.m. Fairfield Grove, S.E.7. Tuesday 9.30 a.m.—12 noon Thursday 1.30 p.m.—4 p.m. Ridgebrook Road, S.E.3. Tuesday 1.30 p.m.—4 p.m. Shooter's Hill Road, S.E.3 Monday Tuesday Wednesday 1.30 p.m.—4 p.m. Thursday 9.30 a.m.—12 noon Friday 1.30 p.m.—4 p.m. Saturday 9.30 a.m.—12 noon Tranquil Vale, S.E.3. Wednesday 9.30 a.m.—12 noon Others W.V.S. Sub-Centre, Blackheath Park, S.E.3. Tuesday Wednesday Thursday Friday J 10.30 a.m.—4 p.m. 31 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 91 144 8 7 2 — 350 838 168 1,570 566 134 181 399 4,458 June 111 165 5 5 8 — 338 1,007 105 2,115 543 68 79 588 5,137 Sept. 82 48 4 12 5 — 268 827 63 1,724 18 4 70 550 3,675 Dec. 85 62 2 10 1 — 298 1,019 54 1,826 48 16 123 507 4,051 Totals 369 419 19 34 16 — 1,254 3.691 390 7,235 1.175 222 453 2,044 17,321 2. Infant Welfare Clinics Quarter Sessions Attendances 0-1 year 1-2 years 2-5 years 1st Total 1st Total 1st Total March 208 293 4,123 16 1,226 31 820 June 202 333 4,740 29 1,331 21 905 September 206 310 4,837 20 1,237 43 903 December 201 242 4,457 14 1,001 24 783 Totals 817 1,178 18,157 79 4,795 119 3,411 32 3. Ante and Post Natal Clinics (a) Hospital Confinements Quarter Sessions Ante Natal Post Natal 1st Attendances Total Attendances 1st Attendances Total Attendances This Year Current Pregnancy This Year Since Confinement March 104 261 172 672 38 43 67 June 94 165 165 535 43 43 46 Sept. 96 184 184 515 35 35 39 Dec. 96 129 129 433 43 43 46 Totals 390 739 650 2,155 159 164 198 (b) Domiciliary Confinements Quarter Sessions 1st Attendances Total Attendances This Year Current Pregnancy March 104 225 110 1,209 June 96 77 77 1,020 Sept. 96 81 81 1,024 Dec. 96 89 89 999 Totals 392 472 357 4,252 33 4. Toddlers Clinics Quarter Sessions Total Attendances Medically Examined Found to require Treatment March 26 162 157 25 19 234 226 30 September 19 165 164 22 December 30 157 145 32 Totals 94 718 692 109 5. Ante Natal Educational Sessions (including exercises) Quarter Sessions Total Attendances March 76 833 June 55 746 September 24 168 December 29 264 Totals 184 2,011 6. Artificial Sunlight and Children's Exercise Classes Quarter Sessions Attendances Artificial Sunlight Exercise Classes First Total First Total March 100 135 2,368 7 90 June 77 55 1,550 5 70 September 89 35 973 10 95 December 76 112 1,371 7 76 Totals 342 337 6,262 29 331 7. Chiropody Treatment Quarter Sessions Attendances First Total March 441 286 4,901 June 423 396 4,827 September 436 323 4,885 December 430 239 4,672 Totals 1,730 1,244 19,285 34 8. Dental Treatment Quarter Sessions Nursing & Expectant Mothers Children under 5 yrs. First Treatm'ts Total Attends. First Treatm'ts Total Attends. March 25 23 60 33 50 June 24 12 75 27 46 September 21 20 42 25 35 December 15 15 36 20 40 Totals 85 70 213 105 171 9. Home Help Service (a) Analysis of Cases, etc. Cases Home Helps Maternity Tuberculosis Others Total No. Part Time Whole Tim# Equivalent On live Register at: 1st Jan. '55 13 525 540 93 47.3 31st Dec. '55 5 9 484 498 102 50 Cases attended during 1955 :— 55 25 801 881 — — (b) Supervision Effective Ineffective Total Visits made by Organising Staff: 2,612 257 2,869 10. Prophylaxis Cases receiving completed prophylactic treatment during year— Diphtheria Immunisation 783 Whooping Cough Immunisation 784 Vaccination 503 11. District Nursing The staff of the Queens District Nursing Association for Charlton and Blackheath made 29,471 visits during the year. Visits carried out by the Ranyard Nurses and the Nursing Sisters of St. John the Divine were additional to those quoted above. 12. School Health Service Vision Nutrition Special Investigation Clinic No. of Attendances 666 163 164 No. of New Cases 414 24 20 No. of Glasses Ordered 137 — — 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 1.30 Chevening Road, S.E.10 Wednesday 9.30 Thursday 9.30 Friday 1.30 Creek Road, S.E.8. Monday *9.30 Friday 1.30 Fairfield House, S.E.7. Monday 9.30 Wednesday 9.30 1.30 Friday 1.30 (Toddlers) Ridgebrook Road, S.E.3. Tuesday 9.30 (Toddlers) 1.30 Shooter's Hill Road, S.E.3. Monday 1.30 Tuesday 1.30 Wednesday 9.30 Thursday 9.30 Tranquil Vale, S.E.3 Wednesday 9.30 1.30 (alt. weeks) (Toddlers) *Including Children's Exercise Class. 36 ARTIFICIAL SUNLIGHT TREATMENT DAY A.M. P.M. Chevening Road, S.E.10 Wednesday 9.30 1.30 Fairfield House, S.E.7. Monday 1.30 Wednesday 9.30 Shooter's Hill Road, S.E.3. Wednesday 1.30 Friday 9.30 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) Tuesday 9.30† Creek Road, S.E.8 Tuesday 1.30 (ab) Wednesday ((a) 1st and 3rd)l.30(b) Fairfield House, S.E.7. Thursday 1.30 (ab) Ridgebrook Road, S.E.3. Thursday 1.30 (b) ((a) alter, weeks) Shooter's Hill Road, S.E.3. Mondav 9.30† Friday 1.30 (ab)† Tranquil Vale, S.E.3 Wednesday 1.30 (ab) † Mothercraft and Exercise Class. 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. P.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 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 DENTAL CLINIC Kidbrooke Comprehensive School Tues. (alt.) School Hours Thurs. „ „ Shooter's Hill Road, S.E.3 Mon.-Weds 9.30 1.30 & 5.30 Than. & 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) 38 SPEECH THERAPY (for School Children) DAY A.M. P.M. Fairfield House, S.E.7. Wednesday 1.30 WOMEN'S SPECIAL CLINIC (Family Planning Association) Charlton Lane, S.E.7. Wednesday 12.30 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. 8.30 1.30 Saturday 8.30 OPHTHALMIC CLINIC (for School Children) Chevening Road, S.E.10 Friday 2.00 Kidbrooke Comprehensive School Daily School Hours NUTRITION & SPECIAL CONSULTATIVE CLINIC (for School Children) Chevening Road, S.E.10. Tuesday 1.30 39 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) MASS RADIOGRAPHY New Cross General Hospital, Avonley Road, S.E.14 (New Cross 1522 for appt.) NURSING ASSOCIATIONS. Queens District Nursing Association for Blackheath and Charlton, 78, Elliscombe Road, S.E.7. (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 (GRE. 0157). Citizens' Advice Bureaux, 71, Rectory Place, S.E.18 (WOOlwich 0047). 173, Walworth Road, S.E.17. (RODney 2860). Family Welfare Association, Area 6, (Deptford, Greenwich and Lewisham), 49, Rushey Green, S.E.6. (HITher Green 1630). Women's Voluntary Services, Mrs. F. Kidd, 64B, Hyde Vale, S.E.10. (TID. 3708). W.V.S. Sub Centre, Blackheath Park, S.E.3, REGISTRATION OF BIRTHS, DEATHS AND MARRIAGES. 9 a.m. to 12 noon Town Hall, S.E.10. Mon - Fri 2 p.m. to 4.30 p.m. Fri. 5 p.m. to 7 p.m. Sat. 9 a.m. to 11 a.m. 40 SECTION C Sanitary circumstances of the Area The tables on pages 70 to 72 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 13,235 houses and premises have been inspected or re-inspected during the year; 821 intimation notices and 168 statutory notices were served. Registered complaints, numbering 1,299 show an increase of 131 over those of the previous year, a total still greatly in excess of the pre-war average of 700. 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 327 inspections were made by the Council's Inspectors in relation to the 391 registered factories. The latter figure includes 67 premises where mechanical power is not used. Defects were found in 29 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 67 35 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 293 259 4 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 31 33 — — Total 391 327 4 — 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.) 15 15 — 1 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 1 1 — — — Ineffective drainage of floors (S.6) 1 1 — — — Sanitary Conveniences (S.7) (a) insufficient 1 1 — — — (b) unsuitable or defective 6 6 — — — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 5 5 — — — Total 29 29 — 1 — 42 Outwork—(Sections 110 and 111) Nature of Work Section 110 Section 111 No. of out-workers in August list required by Sect. 110 (1) (c) No. of cases of default in sending list to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecution Wearing Making, etc. 37 — — — — — apparel Cosaques, Christmas crackers, Christmas stockings, etc. 1 — — — — — Lampshades 36 — — — — — Paper Bags 1 — — — — — Cardboard Boxes 3 — — — — — Carding, etc. of Buttons, etc. 1 — — — — — Total 79 — — — — — 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 15 (b) Outworkers resident outside the Borough 18 Notifications received from firms outside the Borough of:— Outworkers resident in the Borough 108 Total number of Greenwich residents employed as outworkers (as given in August list) 79 Premises where homework is carried on were visited on 93 occasions by the Lady Sanitary Inspector. In no instance was it necessary to take action because of infectious disease. 43 River Pollution.—According to a recent London County Council statement, work at the Northern Outfall at Beckton in Essex, in connection with the improvement of sewage effluent to be discharged into the River, is expected to be completed by 1958. A general survey of the main drainage system has revealed a need for alterations in the original schemes approved by the County Council between 1946 and 1953 for the Southern Outfall at Crossness. This new programme for the Southern Outfall, which is likely to cost £93/4 million compared with £6,200,000 for the previous schemes, now provides for primary treatment of the whole of the dry weather flow plus five times this volume of storm-water and for full secondary treatment to be given to 72 million gallons of flow per day instead of the previously proposed 60 million. To achieve this aim, new primary sedimentation tanks, new detritus channels and screens will be constructed and the existing sedimentation channels modified to treat storm-water. The present pumping plant, which will be insufficient for the new scheme, will be used for dealing with storm-water and a new electric pumping station installed to deal with the dry weather flow. In addition, provision is made for new secondary biological treatment plant, a new power house, a service launch, and a new pier and jetty for sludge vessels. Under the new scheme the amount of sludge for disposal will be reduced by approximately one-half and it is anticipated that a substantial saving in costs will be effected. Completion of the programme is not expected to be delayed much beyond 1962, at which time it is hoped that the River will no longer be a source of complaint to residents of Riparian boroughs. Atmospheric Pollution.—With publicity concerning atmospheric pollution reaching greater proportions than hitherto, there is evidence that the public are becoming more " conscious " of this form of nuisance, not only in respect of smoke but in particular to the contamination of the air with dust, grit, etc., from processes in connection with stone-grinding, breeze-block making, road-making materials, etc. Complaints received concerning such nuisances have been investigated and a fair measure of success achieved rather as a result of the ready co-operation of manufacturers than by the threat of legal proceedings. In the past, control of atmospheric pollution by the existing legislation has been difficult and limited to reduction rather than to elimination, but at long last a Clean Air 44 Bill, introduced to remedy the position is now before Parliament, and is expected to become Jaw during 1956. It would appear that with the exception of processes registered under the Alkali Act, the administration of the Clean Air Act is to be in the hands of the local authorities, although in certain circumstances the Minister is to have power to transfer to the local authority the duty of exercising control over the emission of smoke, grit and dust from processes so registered. Legislation of this nature is long overdue and its effectiveness will depend upon the energy and enthusiasm with which it is enforced. The problem is no mean one for local authorities and it is clear that ultimately it will be upon the measure of co-operation of the Sanitary Inspectors with manufacturers, owners and occupiers that success will depend. Two things are necessary for the evils of air pollution to be overcome : firstly, sufficient reliable information about the kind of pollution present ; and, secondly, there must be a qualified staff to interpret this information and advise accordingly. It has been estimated that there is a deficiency of Sanitary Inspectors in the country to the extent of 10%, and re-allocation of duties resultant upon the introduction of a Clean Air Act will doubtless lead to temporary difficulties. Nevertheless, Public Health staffs can be relied upon to play their full part in a campaign to provide a cleaner and more wholesome atmosphere. Anticipating the introduction of a Clean Air Act and the necessity for more local information, the Council authorised the establishment of two stations for the measurement of atmospheric pollution : one in the Public Health Department at the Town Hall and the other at Charlton House ; and these came into operation in June of the current year. The stations, which were set up and equipped in accordance with the advice and guidance of the Fuel Research Station, measure the concentrations of smoke and sulphur dioxide in the atmosphere. Normally, readings are taken every 24 hours, but in foggy weather, at the request of the Director of the Fuel Research Station, 3-hourly readings are taken during office hours, and in the period under review there were four occasions on which this procedure was instituted, viz : 16th and 17th November, 30th November, 19th December and 4th, 5th and 6th January, 1956. 45 The following tables give the daily mean concentration of smoke and sulphur dioxide, as calculated on readings taken at the Council's two stations during 1955:— TABLE I—Daily Mean Concentration of Smoke Month Town Hall Charlton House Smoke mg/m3 Smoke mg/m3 Daily Value Daily Value Average Highest Lowest Average Highest Lowest June 1955 .2430 .6700 .0190 .1010 .5100 .0360 July „ .1958 .5099 .0619 .1330 .4690 .0260 August „ .2619 .6000 .1379 .0858 .2709 .0150 September „ .1526 .5232 .0064 .1724 .4894 .0147 October „ .4353 1.0508 .0336 .2781 .6543 .0216 November ,, .5818 1.4103 .1579 .4483 1.5944 .0642 December ,, .5318 1.4227 .1334 .4416 1.5201 .0615 January, 1956 .6370 2.7587 .1398 .4476 2.3306 .0761 February ,, .7317 2.2191 .1422 .4077 1.4447 .0781 TABLE II—Daily Mean Concentration of Sulphur Dioxide Month Town Hall Charlton House Sulphur Dioxide p.p.m. Sulphur Dioxide p.p.m. Daily Value Daily Value Average Highest Lowest Average Highest Lowest June, 1955 .0579 .1070 .0074 .0529 .0810 .009 July „ .0692 .1347 .0252 .0385 .0735 .018 August „ .0514 .1130 .0109 .0284 .0517 .0033 September ,, .0291 .0593 .0029 .0420 .0844 .0053 October „ .0722 .1729 .0074 .0893 .1999 .0194 November „ .1160 .2612 .0066 .1102 .2618 .0202 December „ .1078 .2970 .0316 .0932 .2848 .0303 Januarv, 1956 .1761 .5932 .0590 .1328 .3725 .0479 February „ .1685 .3870 .0976 .1405 .3879 .0684 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 and this is introduced in the following tables:— 46 TABLE III.—Rainfall, Monthly Deposit in Tons per Square Mile and Sulphur Dioxide by the Lead-Peroxide Method Month & Year Rainfall mm. Insoluble Deposit Soluble Deposit Total Solids SO3 mg./day/100 cm2 of Batch A Lead Peroxide tons per square mile October 1954 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 March „ 24 43.51 11.74 55.25 3.9 April „ 19 22.9 6.3 29.2 2.5 May „ 91 37.4 17.4 54.8 (a) June „ 56 28.0 13.8 41.8 2.6 July „ 1 24.8 5.8 30.6 2.1 August „ 22 39.9 8.5 48.4 3.1 September „ 58 31.3 12.6 43.9 2.8 October „ 84 31.5 16.1 47.6 4.1 November ,, 6 24.6 8.4 33.0 3.2 December „ 44 37.6 11.8 49.4 4.0 January 1956 79 31.1 12.7 43.8 5.0 February „ 21 42.6 10.2 52.8 4.4 (a) No figures available. TABLE IV.—oncentration of Smoke and Sulphur Dioxide by the Volumetric Method. Month-Year Smoke mg/100m3 Sulphur Dioxide p.p. 100 million Monthly Average Highest Daily Average Monthly Average Highest Daily Average October 1954 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 48 12 24 March „ 18 38 11 20 April „ 10 22 7 14 May „ 9 17 7 11 June „ 8 14 7 14 July „ 6 16 5 9 August „ 6 12 6 14 September „ 7 12 7 16 October „ 21 37 13 31 November „ 25 53 12 30 December „ 25 67 13 29 January 1956 31 110 16 64 February „ 30 113 13 42 47 The emission of grit from the Greenwich Power Station has been the subject of much discussion and complaint in recent years, as the result of which formal meetings from time to time have been arranged between members and officials of the Council and representatives of the London Transport Executive. It was the L.T.E.'s contention, and independent opinion supported this view, that all reasonable care was being taken to control the emission of grit from their Station at Greenwich. The gradual introduction of modern equipment has certainly brought about an improvement in the situation and there is a satisfactory measure of co-operation between the Council and the L.T.E., who regularly forward reports in respect of their own atmospheric pollution observations taken in the vicinity of the Greenwich Generating Station. A summary of their observations, compared with those of the Fuel Research Station, is given in the following table:— Station Average total deposit per month (Tons per sq. mile) 1953 1954 1955 Maze Hill 25.5 19.8 21.4 Telcon Works 40.8 23.6 23.1 Royal Naval College, or Park Row 27.8 24.0 21.2 Fuel Research Station 41.2 38.0 42.4 From the above figures it can be seen that from 1953 to 1954 there was substantial improvement and despite the fact that more coal was consumed at the Generating Station during 1955 no deterioration in the situation occurred. This is, in part, due to the fact that coal now utilised at this undertaking is 100 per cent. washed. 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. 48 (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.—Sections 11 and 12 of the Housing Repairs and Rents Act, 1954, have superseded legislation covering the Council's powers in connection with houses in multiple occupation previously contained in Sections 6 to 8 of the Housing Act, 1936, and Section 155 of the Public Health (London) Act, 1936. 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. Several Metropolitan Boroughs who are more corcerned than Greenwich with the problem of houses in multiple occupation, have indicated that certain deficiencies exist in the new legislation as compared with the old, especially with regard to periodical cleansing and redecoration of parts of buildings in common use and artificial lighting of common staircases. It is expected that the Metropolitan Boroughs Standing Joint Committee will take the matter up with the London County Council to remedy these apparent omissions. The number of houses on the Register at the end of the year was 5; these have been visited by the Sanitary Inspector on 9 occasions. Rent and Mortgage Interest (Restrictions) Acts, 1920/39. —Under the provisions of these Acts landlords are permitted to make certain increases of rent and tenants whose houses are not in all respects reasonably fit for human habitation may apply to the Sanitary Authority for a certificate to this effect enabling them to 49 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 no applications for a certificate were received and no reports were sought. Housing Repairs and Rents Act, 1954.—Part II of this Act makes provision inter alia for a 'repairs increase' in respect of controlled dwelling houses of a sufficiently good standard 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 specifically 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. Twenty-one applications for Certificates of Disrepair were received and decisions were made as under:— Certificates granted 17 Certificates refused 4 Sixteen applications were received for Revocation of Certificates of Disrepair of which 10 were granted and 6 refused. The Heating Appliances (Fireguards) Act, 1952.—In pursuance of the powers conferred upon him by section five of the above Act, the Secretary of State made 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 50 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. 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 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 2 applications for licences to sell poisons under Part II were received and 65 vendors applied for retention in the Council's List. All were duly considered and approved. Twelve 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. At the end of the year 18 exemption certificates were in operation. Routine inspections were carried out under the abovementioned Act on 234 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. 51 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. Implementation of this legislation during the current year would have added to the duties of the sanitary inspectors at a time when they were under-staffed. The Council therefore decided to defer the question of the registration of hairdressers until 1956, when it is expected that the staff situation will have improved. 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, three samples, 2 of Rag Flock and 1 of Cotton Flock were obtained and submitted for examination. All proved satisfactory. Pet Animals Act, 1951.—This Act, introduced to regulate the sale of pet animals with particular reference to their welfare prior to sale, became operative from 1st April, 1952, since when it became an offence to keep a pet shop except under licence from the Local Authority. 52 The Act defines "the keeping of a pet shop" as the carrying on at premises of any nature (including a private dwelling) of a business of selling animals as pets and as including the keeping of animals in such premises with a view to their being sold in the course of such business, whether by the keeper thereof or by any other person. The term "animal" includes any form of vertebrate. "Premises" includes any stall or barrow in a market but not any stall elsewhere or any part of a street or public place. Licences, renewable annually, are issued on payment of 10/and are valid to the 31st December of each year. When considering applications for licences, attention must be paid by the Council to the following conditions:— (a) that animals will at all times be kept in accommodation suitable as regards size, temperature, lighting, ventilation and cleanliness; (b) that animals will be adequately supplied with suitable food and drink and (so far as necessary) visited at suitable intervals. (c) that mammals will not be sold at too early an age; (d) that all reasonable precautions will be taken to prevent spreaed 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 five inspections were carried out by the Sanitary Inspectors in connection with the issuing of such licences. Land Charges Act, 1925.—Under this Act enquiries concerning 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 925 reports on such enquiries were forwarded to his department. Drainage and Sewerage.—During the year 398 drains were tested, 343 were opened, cleansed or repaired and there were 771 constructions and re-constructions, alterations and improvements effected. 53 Only two cesspools remain in use in the Borough and under the Borough Engineer's direction these are emptied on request. One hundred and twenty-six plans of drainage and other sanitary works relating to existing and new buildings were examined and approved. Discharge of Trade Effluents into Sewers.—Under the provisions of the London County Council (General Powers) Act, 1953, the Borough Engineer's Department has, during the year, consulted with various public bodies and carried out a site survey, from which a list of 330 premises has been compiled where trade effluents are discharged to the public sewer. Of these, 65 connections are directly to sewers under the control of the London County Council and will be dealt with by that authority, under the provisions of the Act. The discharges from the remaining 265 premises are now receiving investigation with a view to ascertaining whether sampling and analysis will be required. It is anticipated that the number of samples to be taken each year would be about 50 although in the early stages this figure may well be exceeded. Water Supply.—The whole of the Borough is supplied with water by the Metropolitan Water Board which is a Statutory undertaking, and the responsibility for its purity rests with that Authority. There are 23,277 dwellings with direct connections to the Board's mains. During the year 201 water supply certificates were granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended in 110 cases. 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. 54 As far as this Borough is concerned the two wells providing drinking water are properly supervised and have shown no sign of deterioration. Water from one of these wells is used by the Metropolitan Water Board to supplement the public water supply and is subjected to daily tests by that Authority for purity and palatability. Water from the other well is regularly tested by the commercial firm concerned. 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 1955 the amount of house and trade refuse collected by the Council totalled 20,790 tons, a decrease of 434 tons over the previous year. Street sweepings collected amounted to 1,945 tons, a decrease of 159 tons over the previous year. The Council continues its policy of providing for the purchase of modern vehicles for the collection of the refuse and the cleansing of roads and gullies. Arrangements continue to be made for the provision of separate refuse containers in flats and other establishments. These containers are housed in separate compartments in the vicinity of the building from which the refuse has to be collected. The refuse is deposited direct into the container and the collecting vehicle has a mechanical contrivance for picking up the container complete and depositing its contents direct into the vehicle without exposing the refuse. The matter of untidy streets is still a problem and in spite of the "Keep Britain Tidy" campaign there is still too much litter thrown on to the highway. Representations have been made—and concern expressed—from the public health point of view at the increasing amount of litter, including items of food, which were seen in the streets of the Borough, as well as on certain bombed sites. Provision has been made for additional street litter receptacles to be fixed at certain points in the Borough, with a view to mitigating this nuisance. The collection of salvage continues, the amount during the year under review representing 926 tons, which was disposed of in the best markets. The same procedure for the disposal of the refuse by the barging method still operates, and negotiations for alternative means of disposal are continuing." 55 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 3,899 investigations were made and infestation found to exist at 390 dwelling houses, 50 places of business and 17 at miscellaneous premises. There were 34 major infestations at business premises, caused by the common rat. Periodic treatments were carried out at 10 industrial premises. Throughout the year there were 10 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 48 as compared with 37 last year. This increase is explained by the fact that there appears to be a greater readiness on the part of householders to report infestations and to seek advice. Every effort is made to trace the source of infestation in each case and 28 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 22 small areas involving 451 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 again 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. 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. 56 Prevention of Damage by Peats 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 thair 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, 1956 :— 57  TYPE OF PROPERTY Non-Agricultural (5) Agricultural (1) Local Authority (2) Dwelling Houses (including Council Houses) (3) All other (includg. Business Premises) (4) Total of Cols. (1), (2) & (3) 1. Number of properties in Local Authority's District. 34 22,542 3,216 25,792 — 2. Number of properties inspected as a result of: (a) Notification 7 405 57 469 — (b) Survey under the Act 27 2,774 889 3,690 — (c) Otherwise — — — — — 3. Total inspections carried out—including re-inspections 42 3,197 961 4,200 — 4. Number of properties inspected (in Sect. II) which were found to be infested by: (a) Rats Major 2 28 5 35 — Minor 7 211 7 225 — (b) Mice Major — 2 2 4 — Minor — 167 15 182 — 5. Number of infested properties (in Sec. IV) treated by L.A. 9 407 28 444 — 6. Total treatments carried out—including re-treatments 9 425 80 514 — 7. Number of Notices served under Section 4 of the Act: (a) Treatment — — — — — (b) Structural Work (i.e. Proofing) — — — — — 8. Number of cases in which default action was taken following the issue of a Notice under Sect. 4 of the Act. — — — — — 9. Legal Proceedings — — — — — 10. Number of "Block" control schemes carried out 22 involving 451 premises. 58 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 28th Nov. to 21st Dec., 1955 6th June to 24th June, 1955 1. No. of Manholes in foul and connected systems 1,183 1,185 2. Bait base and poison used Sausage rusk and zinc phosphide Bread rusk and arsenious oxide 3. No. of Manholes baited 1,176 1,167 4. No. of Manholes showing prebait takes 707 748 5. No. of Manholes showing complete prebait take (on one or both days) 390 230 6. Schemes of baiting used (e.g.; consecutive days or 1st, 3rd and 5th days) Consecutive days Consecutive days 7. No. of Manholes test-baited in conjunction with this treatment and not included in No. 3 above Nil Nil Remarks: With regard to these treatments, the whole of the manholes were treated in the normal way—therefore no test-baiting was undertaken. It may be mentioned that the neighbouring Boroughs of Woolwich and Lewishamtook action at the same timeas 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, cafés and food shops generally. The treatment of house refuse was successfully accomplished by arrangement with the Borough Engineer, whereby at each weekly 59 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 of Verminous Premises.—DDT in kerosene continues to prove the most effective vermicidal agent in dealing with verminous houses. During the year the Sanitary Inspectors dealt with 136 cases of dirty and verminous houses compared with 66 for 1954. The Disinfestation staff sprayed 291 rooms and contents as compared with 237 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 295 houses comprising 754 rooms were treated effectively with DDT, as compared with 286 and 823 respectively 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. 60 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 bacteriological tests taken periodically. I am indebted to Mr. K. L. Embley, Superintendent Engineer, for the following statistics:— Attendances.—For the year ended 31st December, 1955:— Slipper Baths 91,465 ٭Swimming Baths 120,617 Vapour and Medicated Baths 9,956 Public Laundry 9,605 Total 231,643 *Includes 43,513 School-children. 61 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 24.1.55 10.55 a.m. 2nd Class Swimming (Mixed Bathing) 76°F. 40 Nil Nil Satisfactory 2 25.4.55 10.30 a.m. 2nd Class Swimming (Mixed Bathing) 74°F. 7 Nil Nil Satisfactory 3 27.6.55 10.30 a.m. 2nd Class Swimming (Mixed Bathing) 74°F. 48 Nil Nil Satisfactory 4 27.6.55 10.45 a.m. 1st Class Swimming (Mixed Bathing) 74°F. 16 Nil Nil Satisfactory 5 8.8.55 10.30 a.m. 2nd Class Swimming (Mixed Bathing) 74°F. 20 Nil Nil Satisfactory 6 8.8.55 10.50 a.m. 1st Class Swimming (Mixed Bathing) 73°F. 10 Nil Nil Satisfactory 7 25.10.55 11 a.m. 2nd Class Swimming (Mixed Bathing) 76°F. 126 Nil Nil Satisfactory 8 13.12.55 11 a.m. 2nd Class Swimming (Mixed Bathing) 74°F. 23 Nil Nil Satisfactory 62 Public Sanitary Conveniences, etc.—The need for public conveniences is as great as ever and the 9 Council conveniences situated in the main arteries of traffic continue to provide a most satisfactory service. No further developments can be reported with regard to the new convenience envisaged at Woolwich Road in the vicinity of Anchor and Hope Lane. Particulars of Public Sanitary Conveniences in the Borough Convenience MEN WOMEN HOURS W.C.'s Lavatory basins Urinal stalls W.C.'s Lavatory basins Batley Park (Blackheath) 6 2 12 4 2 7a.m. to 11p.m. Blackheath Hill (foot of) 3 — 10 4 — Blackwall Tunnel 3 — 6 5 — Charlton House 2 — 4 2 — Creek Road (St. Nicholas, Deptford) 4 2 10 4 2 Greenwich South Street (near Town Hall) 4 1 10 4 2 King William Walk (near Greenwich Park) 4 2 9 7 2 Rodmere Street* 5 3 12 5 3 Shooters Hill 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 convenience opens at 8.30 a.m. on Sunday. 63 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 three others attached to Public Houses are cleansed daily by two attendants, responsibility for the repairs of the Public House urinals remaining with the Brewers concerned. Free hand-washing facilities, introduced in the interests of Public Health during 1951, were continued with marked success during the year and the following table gives an indication of the growing use made of these facilities :— Convenience Men Women Total Batley Park 1,927 3,270 5,197 Creek Road 1,536 1,433 2,969 Greenwich South Street ٭ 687 687 King William Walk 1,821 3.177 4,998 Rodmere Street 1,386 1,890 3,276 Shooter's Hill Road 1,830 1,816 3,646 Totals 8,500 12,273 20,773 ٭Discontinued 6.3.54 In February of 1954 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 washing facilities at the latter convenience had to be discontinued. It was further agreed by the Council on 14th April of that year that, in future, no charge should be made for the use of the W.C.'s at the women's public conveniences. 64 Aged, Infirm and Physically Incapacitated Persons.— Since the beginning of the century the birth rate has steadily declined and, due to progress in medicine and the improvement of social amenities, the expectation of life has increased; as a result, the Royal Commission on Population stated that by 1977 there will be 10 million or more people over the age of 65 years forming approximately one-fifth of the total population, a figure almost equivalent to the estimated number of children under 15 years. This ageing of the population naturally brings its own problems and a corollary to this alteration in the constitution of the population is that there will be a greater number of persons no longer capable of fending for themselves. Aggravating the situation is the fact that in modern families, which for a number of reasons tend to be smaller and less united than before, the elderly are no longer considered to be an integral part of the family circle as is common in less civilised countries. Fortunately, there are in Greenwich a number of almshouses provided by various charities which render the problem for the aged less acute, but despite old people's clubs, associations, etc., a great deal of the responsibility for the well being of the elderly falls to the Public Health Department and, in particular, to the Lady Sanitary Inspector. Information, advice and assistance are readily available to those who take advantage of the organisations specially set up for the old people, but it is the elderly and infirm living alone in self-contained units or in sub-let rooms, and although not chronically sick are suffering from disabilities of old age, who form the core of the problem from a public health point of view. In this respect, great reliance is placed on the Lady Sanitary Inspector by the elderly of the Borough, and the following is a summary of her work during 1955:— No. of dirty premises inspected 37 No. of verminous premises inspected 13 No. of dirty rooms cleansed 60 No. of verminous rooms cleansed 40 No. of verminous persons visited 31 No. of verminous persons treated:—Heads 175 Other 66 No. of visits to scabies cases 5 No. of visits for Laundry Service:—First 46 Subsequent 57 No. of articles laundered 5,229 No. of inspections of factories:—(a) with mechanical power 54 (b) without mechanical power 3 (c) other premises 7 No. of inspections of Outworkers' premises 93 No. of inspections of Houses Let-in-Lodgings 8 65 No. of inspections of Women's Conveniences 23 No. of Bathing Centre sessions 52 No. of Home baths 38 No. of visits to Infirm Persons 1,319 No. of visits to Rest Homes, Hospitals, etc. 59 No. of visits, re: housing 21 No. of visits to Food Premises re: Meals for O.A.Ps. 118 No. of Miscellaneous visits 242 No. of re-inspections, calls made, etc. 268 No. of interviews for Holidays 60 No. of interviews at offices 166 No. of complaints received 56 No. of Intimation Notices served Nil Cleansing of Old People.—Section 43 of the London County Council (General Powers) Act, 1953, provides for the cleansing 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 authority under any enactment or to cleanse himself properly. In this respect, during the current year, 20 baths were given to dirty or verminous elderly persons at the Cleansing Station and 38 home baths were effected. In addition, arrangements were made for the living accommodation and household effects of 40 elderly persons to be generally cleansed and, where necessary, disinfected. 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. Cases in need of such assistance are brought to the notice of the department by Hospitals, District Nurses, Doctors and by ordinary routine investigation of complaints. 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 cooperation with voluntary organisations often results in the repair or replacement of outworn articles. 66 By the end of the year the laundry service, supervised by the Lady Sanitary Inspector, had been extended to 59 separate individuals. In one instance collection and delivery was made daily, in 6 cases 3 times per week, in 12 cases twice a week and in 10 cases once a week. During the current year, the staff at the Cleansing Station have dealt with the following articles:— Blankets 91 Quilts 70 Sheets 783 Mattress Covers 15 Dressing Gowns 12 Draw Sheets 580 Towels 302 Night Attire 525 Pillowcases 426 Underclothes 1,514 Miscellaneous 753 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, arc 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. 67 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:— 12 Old Persons moved to Hospital 23 Old Persons admitted to L.C.C. Homes Transported Meals for Old People.—The "Meals on Wheels" service has 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 makes monetary grants towards the cost of transporting meals to the old people who are home-bound and to certain of the Old People's Clubs in the borough. The meals had been prepared at a London County Council kitchen but this arrangement ceased on the 14th January when the County Council kitchen closed. In anticipation of this event, arrangements had been made with a local restaurateur from which the meals have been obtained since the following Monday, 17th January. The cost of the meals continues to be subsidised by the London County Council to the extent of 8d., the old people paying 10d. each. A good quality meal was produced for l/6d. but with prices and wages rising generally, the restaurateur intimated in the month of May that the price would have to rise. The London County Council subsidy mentioned above is granted only on condition that the meal does not cost more than l/6d. In order, therefore, not to jeopardize this subsidy, the Greenwich Old People's Welfare Association decided to make a grant to the restaurateur of a sum equal to 2d. per meal. During the year, an average of 42 home-bound persons had meals delivered twice weekly and in about 15 cases meals were delivered three or four times per week. The average number of meals brought to the home-bound was 137, another 95 were delivered weekly to the various Old People's Clubs in the borough. The figures given indicate the popularity of the service and, not unnaturally, demand is increasing. Ways and means are being explored to supplement the existing service and these will almost certainly involve the introduction or purchase of another delivery van. 68 Greenwich Old People's Welfare Association.—This association, set up in July 1954, co-ordinates the activities of 10 Old People's Clubs in the Borough which provide for the physical and mental recreation of their members. During the year, grants were made by the Council to the Greenwich Old People's Welfare Association for distribution, as under:— £300 British Red Cross Society for "Meals on Wheels" scheme. £50 Greenwich Old People's Welfare Association for washing up "Meals on Wheels" utensils. £112 Women's Voluntary Services for six Darby and 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. Holidays.—A sum of £1,550 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 163 old people to spend a fortnight's holiday at Margate in May and a further 188 in September. It is gratifying to record that, while prices are rising generally, the supply of transport by a local coach firm was not only at reasonable cost but that the service given by the drivers and staff enabled the holiday-makers to enjoy a most comfortable journey to and from the booked accommodation. Food Parcels.—The distribution of some 400 parcels containing sugar, tea, milk, biscuits, sweets and chocolate by willing helpers during Christmas week was made possible by a grant of £100 by the Council for this purpose. Needless to say the joy given to the old folks by this gesture was sufficient thanks to those who had given so much time to ensure the success of this scheme. Entertainments.—In order to cater for the old persons who were either homebound or for various reasons were unable to take advantage of other organised functions, two garden parties were held during September. These people were, in the main, transported 69 by private cars to Charlton House where they sat down to an extra special tea and were afterwards suitably entertained. During the early part of December an excellent concert was given at the Borough Hall for the benefit of 700 old people by the Concert Party consisting of members of the Wire Room of Siemen's (Brothers) Ltd. Resulting from an invitation extended by the Vicar of Christ Church, arrangements were made whereby a large number of old people were enabled to participate in a Carol Service with tea and biscuits following. S.O.S. Scheme.—At the close of the current period, the Executive Committee of the Greenwich Old People's Welfare Association were considering a scheme whereby old people living alone and unable to call upon immediate local help would be able to indicate their need for assistance. Appropriate old people will be given to display in their window a card which will bear a prominently printed S.O.S. on one side and sources from which help can be obtained printed on the other. Co-operation for the scheme is to be sought from the various organisations and from the local police. 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. During 1955 arrangements were made under the above Act for the burial of 6 bodies. The total expenses of these burials amounted to 35 15s. 0d., of which the sum of £13 17s. 10d. was recovered, making the nett cost to the Council of £21 17s. 2d. Exhumations.—In addition to one ordinary exhumation and re-internment at the Greenwich Cemetery, the bodies of 5 'Free Norwegians' who died during the war period were exhumed for the purposes of cremation and the return of their ashes to Norway. In each case the Sanitary Inspector for the district was present to see that the usual precautions were observed. 70 Summary of Work Performed by the Sanitary Inspectors during the Year 1955 Inspections— Houses inspected (House-to-House) 17 ,, „ (Complaints, nuisances) 1,502 „ „ (Infectious Disease) 149 „ „ (Overcrowding) 75 Re-inspections, calls made, etc. 8,607 Inspections of Factories 308 „ „ Shops 31 „ „ Piggeries 16 „ „ Caravans 16 „ „ Pet Shops 5 „ ,, Stables and yards 27 „ „ Urinals 250 „ „ Houses let in Lodgings 9 ,, ,, Outworkers premises 93 „ ,, Miscellaneous 1,106 Inspection of Premises (Pharmacy and Poisons Act, 1933) 12 „ ,, „ (Housing Repairs and Rents Act, 1954) 37 Investigations (Rats and Mice) 309 On notice from Builder 666 13,235 Drains— Drains tested—by smoke 108 ,, ,, —by water 290 Opened, cleansed and repaired 343 Reconstructions and additions 137 Inspection chambers constructed 103 New covers to manholes 105 Soil and vent shafts repaired or renewed 163 Traps (gully) 178 Drains sealed off, etc. 27 Yards and forecourts drained 58 Watbrclosets and Urinals— Closets erected 60 W.C.s repaired 135 Sanitary conveniences or improvements effected to Factories, Workshops and Workplaces 7 W.C. pedestals installed 219 Urinals cleansed or repaired 24 71 Dustbins— Provided 241 Pavings— Yards and Forecourts 90 General Water Supply— Water Fittings amended 110 Extra water supply to tenement houses — Water supply certificates granted (Sect. 95) 201 Other Improvements— Houses generally repaired 143 Rooms cleansed and repaired 866 Rooms and staircases lighted and ventilated 30 Verminous rooms cleansed 202 Roofs, gutters and rainwater pipes repaired 571 Dampness abated 578 Sinks, baths and lavatory basins 238 Sink, lavatory and bath waste pipes trapped or amended 257 Stoves and fireplaces 179 Washing coppers repaired or provided 24 Floors repaired 280 Provision for storage of food 23 Miscellaneous repairs 909 Other Nuisances Abated— Illegal use of Underground rooms discontinued — Overcrowding abated 79 Animals kept in unfit places discontinued or removed 1 Dung receptacles provided — Accumulation of manure and other obnoxious matter removed 31 Rat infestation abated 158 Smoke Nuisances— Observations... 95 Statutory Notices served (Sects. 147 and 148) — Notices, &c.— Intimations served under Public Health (London) Act, 1936 821 Statutory Notices served 168 Houses rendered fit by informal action 226 72 Legal Proceedings Premises Offence Result of Proceedings 105, Creek Road Non-compliance with Statutory Notice Summons withdrawn on payment of 6/- costs. 24, Aldeburgh Street do. Order for work to be executed within 7 days. £1 1s. costs. 24, Herringham Road do. Order for abatement of Nuisance within 6 weeks 10/6d. costs. 16, Caletock Street do. Summons withdrawn on payment of 6/- costs. 19, Collerston Road do. Order for abatement of Nuisance within 14 days £1 costs. 109, Creek Road do. Summons withdrawn on payment of 4/- costs. 10, Maidenstone Hill do. Summons withdrawn on payment of 6/- costs. 24, Armitage Road do. Summons withdrawn. do. do. £5 fine and £1 1s. costs. 21, Caletock Street do. Adjourned sine die. 21 & 23, Caletock Street do. Adjourned sine die* 16, Armitage Road do. Order for abatement of Nuisance within 14 days £1 1s. costs. 75, Glenister Road do. do. do. do. £5 fine and £1 1s. costs. 51, Burney Street do. Summons withdrawn on payment of 2/- costs. *Work subsequently completed. 73 SECTION D Housing The problem of an acute shortage of living accommodation, due to bomb damage and the cessation of building during the war, is still with us. It has been tackled very vigorously by the Council although progress may not have been as rapid as one could have wished. Since the war, new building in the Borough has been unable to keep pace with the creation of new households, as instanced by the following table:— (a) New units of accommodation erected since 1945 up to:— (b) Marriages since 1945 (c) Difference between (a) and (b) 31st Dec. 1946 517 776 259 „ „ 1947 1,052 1,552 500 ,, „ 1948 2,061 2,363 302 ,, „ 1949 2,578 3,048 470 ,, ,, 1950 2,704 3,700 996 ,, ,, 1951 3,172 4,370 1,198 ,, ,, 1952 3,635 5,090 1,455 ,, ,, 1953 4,017 5,869 1,852 ,, ,, 1954 4,088 6,640 2,552 ,, ,, 1955 4,289 7,354 3,065 Although for various reasons this is not a strictly accurate picture, it does serve to indicate a general trend. Now that the major proportion of land available for housing purposes has either been taken or is already earmarked, it is possible for the situation to deteriorate. In previous Reports emphasis has been given to this lack of 'housing space' and to the fact that such a situation in the urban areas can only be alleviated (a) by alteration and conversion of existing dwellings and (b) by slum clearance. Prior to 1954, Government policy had concentrated largely on the building of new houses for families without a separate home of their own ; but it was recognised that no progress is made if every new dwelling erected is cancelled out by the dilapidation of an old one. In his Circulars 36/54 and 50/54, the Minister of Housing and Local Government stressed that every encouragement should be given by local authorities to owners to convert, improve and modernise 74 existing dwellings under the Housing Act, 1949, and that more attention should be directed to Parts II and III of the Housing Act, 1936, regarding unfit houses and clearance areas. Housing Act, 1949—Improvement Grants.—Section 20 of the Housing Act, 1949, empowered local authorities to make grants to private owners for improvements and conversions involving a maximum cost of £800 where it could be shown that the dwellings would provide satisfactory accommodation for at least 30 years. By Section 16 of the Housing Repairs and Rents Act, 1954, this period was modified to 'more than fifteen years' where circumstances made it a matter of expediency and the clause stipulating a maximum cost of £800 was substituted by a provision granting a maximum of half the cost or £400, whichever is the less. Nevertheless, where conditions justify it, the local authority may, with the Minister's approval, pay higher improvement grants. In April of the current year, the Council decided to implement this part of the above Act and 2 grants were so made. Procedure under Housing Act, 1936.—The following representations were made under Part II of the above Act during 1955:— 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. 3, Royal Place, S.E.10. 37, Albury Street, S.E.8. Slum Clearance.—The following two areas which had been represented by the Council under Part III of the above Act were confirmed by the Minister during the year:— Area No. of Persons to be Confirmation Properties Displaced Date Roan Street 4 11 Children 10th Feb. 1955 Haddo Street No.l Haddo Street No.2 173 Adults Haddo Street No.3 56 37 Children 18th Nov. 1955 Haddo Street No.4 Joint proposals by the London County Council and the Greenwich Borough Council for action under Parts II and III of the Housing Act, 1936, in accordance with Section 1 of the Housing Repairs and Rents Act, 1954, were submitted to the Minister of Housing and Local Government in the form prescribed as follows:— 75 Total number of permanent dwellings in the borough 23,408 Total Problem (1) Estimated number of houses unfit for human habitation within the meaning of section 9 of the Housing Repairs and Rents Act, 1954, and suitable for action under section 11 or 25 of the Housing Act, 1936 612 (2) Period in years which the Councils think necessary for securing demolition of all the houses in (1) 5 By By Orders already made, etc. L.C.C. G.B.C. (3) Number of houses in (1) in clearance areas and already covered by operative clearance or compulsory purchase orders or owned by local authority. 82 21 (4) Number of houses already in clearance areas for which clearance or compulsory purchase orders have been submitted to the Minister but have not yet become operative. Nil 56 Action in the first five years— (5) Number of houses already in clearance areas for which clearance or compulsory purchase orders are to be made or which arc to be purchased by agreement within 5 years. Nil Nil (6) Number of houses to be included in clearance areas still to be declared and which within 5 years will be owned by the local authority or will have been included in a clearance order or a compulsory purchase order submitted to the Minister. 335 118 (7) Number of houses under (3), (4), (5) and (6) to be patched if necessary and retained within the 5 years under section 2 of the Housing Repairs and Rents Act, 1954 for temporary accommodation. Nil Nil (8) Number of houses under (3), (4), (5) and (6) to be demolished in 5 years. 417 195 (9) Number of houses, including those already comprised in operative demolition orders, to be demolished in the 5 years as a result of action under section 11 of the Housing Act, 1936. Nil 3 76 Re-Housing.— (a) Borough Council.—There were 114 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 312. Of this number, 9 were in respect of overcrowded cases and 28 families re-housed from outside the Borough. The Housing Department now has control of 3,047 Councilowned units of accommodation, an increase of 13 over that of the previous year. At the end of the year, in addition to 73 occupied hutments, a total of 868 properties giving 1,548 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, 1955, the L.C.C. had provided alternative accommodation for a total of 242 Greenwich families of which 6 had been certified as overcrowded cases. Of this figure, 111 were housed on L.C.C. housing estates outside the Borough. One family from outside Greenwich was rehoused in the Borough under the L.C.C. scheme. (c) Other.—A further 64 families were rehoused by other means. Overcrowding.—As a direct result of rehousing carried out under (a), (6) and (c) above 79 cases of overcrowding were abated during the year under review. The number of unabated certified cases of overcrowding in the Borough now amounts to 185. During 1955 the number of complaints received concerning overcrowding continued its downward trend, the year's figure of 61 showing a decrease of 7 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:— 77 Year No. of cases of overcrowding reported 1946 261 1947 128 1948 162 1949 168 1950 148 1951 56 1952 52 1953 53 1954 39 9-year average 118 1955 39 New Housing Accommodation.—The following table lists the new dwellings erected in the Borough during 1955:— Type of Dwelling G.B.C. L.C.C Private Total Permanent Homes 6 1 31 38 Permanent Houses (rebuilt) 8 - 3 11 Flats 100 — 40 140 Flats (rebuilt) — — 12 12 Total No. of Dwellines 114 1 86 201 Excluding the families accommodated in requisitioned property, the total number of dwellings provided in the Borough since the termination of the war is now 4,289. Council Housing Schemes. (a) Schemes completed during the year under review. Site Dwellings Pond Road 78 Woolwich Road/Tuskar Street 12 26 Kidbrooke Grove 18 Ormiston Road 8 78 (b) Schemes in progress at the end of the current year. Site Dwellings Little Heath 24 Coldbath Street 88 Humber/Ruthin Roads 16 Blackheath Hill 22 (c) Whilst not confirmed the following suggested list of additions and extensions envisaged by the Council for 1956 et seq has been supplied by the Borough Engineer. Site Dwellings Merriman Road 12 Sunfields 40 Roan Street 13 Haddo Street 192 Lansdowne Lane 47 Little Heath 12 Ormiston/Halstow Roads 11 Coleraine Road (Orchard) 9 Coleraine Road (Vicarage) 9 Vanbrugh Park 36 Tunnel Avenue 40 (approx) Troughton/Woolwich Roads 32 Westcombe Hill 2 Westcombe Hill/Wcstcombe Park 12 Road Hardy Road 6 Greenwich High Road 38 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 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. 79 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 1955 :— " Undoubtedly, the most important factor affecting the Councils housing activities during this year was the coming into force on the 6th June of the Requisitioned Houses and Housing (Amendment) Act, 1955. The purpose of the Act is to bring requisitioning to an end by March 31st, 1960 and a provision which came into effect immediately was the prohibition against using requisitioned accommodation to house families off the general register. Since a large proportion of allocations of accommodation to housing applicants are in properties vacated by previous tenants, this had an immediate effect on the rate of letting by reason of the fact that hitherto many such vacancies had arisen in requisitioned accommodation. Fortunately, this loss was offset, as far as 1955 was concerned, by the fact that more than three times as many new dwellings were handed over for letting during the year. One hundred and seven new dwellings at Pond Road, Woolwich Road, Tuskar Street, Ormiston Road, Westbrook Court and Coldbath Street were completed and occupied. The completion of the Pond Road estate and the near completion of the Coldbath Street Estate during the year meant that all the sizeable housing sites have now been used up and, towards the end of the period under review, a start had to be made on clearing some of the sites occupied by temporary bungalows so as to make land available for redevelopment. Since the families in these bungalows had to be transferred elsewhere, this again reduced the proportion of accommodation available for general letting. Despite these demands on the Council's housing resources, 133 families were rehoused from the housing register during the year, only 7 less than in 1954. The number of transfers was 129 as against 102 in 1954, the increase being due partly to the need to transfer families from the temporary bungalows as already referred to. Mutual exchanges between tenants have still been encouraged and 46 such exchanges were effected as against 52 in the preceding 12 months. It is interesting to note that, despite the fact that the number of housing applicants fixed up during the year was only 133, the number on the register fell from 2,861 on the 1st January, 1955 to 2,647 on the 31st December and this drop occurred notwithstanding the fact that, during the year, 511 new applications were registered. It is known that at least 45 of the families were rehoused by the 80 L.C.C. and 12 went to New Towns but 535 were cancelled by reason of the applicants' failure to make annual renewals of their applications, even after reminders had been sent. It is reasonable to assume that the vast majority of these families have found satisfactory accommodation, either through other local authorities or privately. Looking ahead, it is clear that the derequisitioning of properties under the provisions of the Requisitioned Houses & Housing (Amendment) Act, 1955, the clearing of temporary bungalow sites for redevelopment and the rehousing of families from slum clearance areas is bound to have an adverse effect on the rate of rehousing from the general Housing Register. However, this may be mitigated to some extent by the purchase of requisitioned properties by the Council, but the extent of this cannot at present be foreseen." 81 SECTION E Inspection of Food and Supervision of Food Premises After the death of the Senior Food Inspector in July, 1954, there was an inevitable curtailment of the less essential work under this section until his replacement in November of the same year. With the full complement of Food Inspectors, 1955 has seen a return to more normal duties and working conditions. Legislation.—Contrary to expectations, the Food & Drugs Amendment Act, 1954, was not implemented during 1955, but the current year witnessed the introduction of the new Food & Drugs Act, 1955, and the Food Hygiene Regulations, 1955, both of which had been eagerly awaited and which are to operate from the 1st January, 1956. Food & Drugs Act, 1955.—This Act consolidates the Food & Drugs Act, 1938, the Food & Drugs (Milk, Dairies & Artificial Cream) Act, 1950, and the Food & Drugs Amendment Act, 1954, together with certain other enactments amending and supplementing Part V of the said Act of 1938 in relation to Slaughterhouses and Knackers' Yards. The following notes indicate the more important changes brought about by the new Act:— (1) Account is now to be taken of probable cumulative effects of consuming food injurious to health over a period. (2) Removal of defences relating to patent and proprietary medicines. (3) Power is given to Inspectors to examine and detain containers and vehicles, certain transport undertakings being excepted. (4) Disqualification for a period up to two years of caterer convicted for serious contravention of Food Hygiene Regulations. (5) Modifications to procedure for registration of food premises, including dairies. (6) New definition of substitute creams. (7) Changes in procedure for sampling and analysis. 82 (8) Powers to enter ships, aircraft and vehicles and to restrict movement of imported food into the district. (9) Similar penalties for first and subsequent offences. (10) In connection with food other than milk, an increase in time limit within which prosecutions must be made. (11) Changes in conditions for acceptance of warranty. (12) Temporary continuance of licence or registration by personal representative as well as widow or any other member of family on death of holder. (13) Extension of the meaning of "sale" of food and revised definitions of "analysis," "business," "Council," "food," "premises," and "preparation." (14) Withdrawal of the necessity for registration of butter and margarine factories and premises for the sale of artificial cream. Food Hygiene Regulations, 1955.—These regulations replace Section 13 of the Food & Drugs Act, 1938, and Sections 19, 20 and 21 of the Public Health (Meat) Regulations, 1924, and add a number of new provisions in respect of the hygienic handling of food and the construction and maintenance of premises, stalls, vehicles, etc., where food is handled. Most of the regulations come into operation on the 1st January, 1956, but certain provisions involving alterations to premises or equipment, etc., will be deferred until the 1st July, 1956. Previously, Section 13 of the Food & Drugs Act, 1938 covered premises, yards and forecourts, and related to sales whether actual or intended, but the new regulations affect stalls and vehicles and provide for certain general requirements wherever food is handled whether or not there is any question of sale. The regulations apply to the supply of food in the course of a business, and this is defined so as to include canteens, clubs, schools and other institutions, as well as undertakings carried on by public and local authorities. The principal extensions of the previous law relate to:— (i) specific requirements designed to prevent the contamination of food; (ii) provision of sinks or other facilities for washing food and equipment; (iii) the provision of a constant supply of hot water for sinks, wash basins, etc., in food premises and of a supply of hot water on stalls and vehicles; 83 (iv) restrictions on the preparation and packing of food in or about domestic premises; (v) the conditions under which certain foods that provide a particularly favourable medium for food poisoning organisms are to be kept in food premises; (vi) a requirement to provide vehicles used for the transport of meat with duckboards and separate receptacles for offal, and, where the vehicles are not enclosed, a covering supported by a frame or poles ; (vii) the circumstances in which persons carrying meat are required to wear overalls and head coverings. Separate regulations are under consideration with regard to the handling of food at docks, wharves, public warehouses and cold stores, carriers' and wholesale vegetable merchants' premises, storehouses and slaughterhouses. Although, by themselves, regulations can never effect a substantial reduction in the incidence of food-borne disease, the application of the new legislation and the co-operation of the caterers and food-handlers will doubtless achieve a great measure of success. 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. 84 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 108 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 110 which total includes 7 dairy premises. On 69 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, 1955 :— Licences In Operation Principal Licences issued 31.12.55 Distribution of Sterilised Milk ... 89 83 ,, „ Pasteurised Milk... 46 45 „ ,, Tuberculin Tested 36 34 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 efficiency of pasteurisation. In addition, a Turbidity test is also 85 prescribed for ascertaining the effectiveness of the heat treatment of Sterilised milk. During the year 55 samples of milk consisting of 39 Pasteurised milks, 7 Sterilised, 9 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. A total of 43 samples, 12 formal and 31 informal, were submitted to chemical analysis and all proved to be genuine. Three samples of cream and one of Canned Imitation Cream were sampled and found to be genuine. Summaries of samples taken from L.C.C. Schools and Nurseries for chemical and bacteriological examination continued to be furnished regularly 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.).—One application for registration was received during the year and the total number of premises remaining on the register at 31st December was 112. One hundred and fourteen 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 8 to a total of 252. Visits to these premises were made on 144 occasions and 2 improvements effected. 80 Manufacture and Sale of Ice Cream.—Consumption of icecream continues to rise as instanced by the increase in the number of premises registered for its sale, but as yet, no legal bacteriological standard exists and the methylene blue reductase test is certainly not selective enough to justify its adoption as a statutory measure. 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. 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 55 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 Provisional Observations Methylene Blue Grade 40 4£ hours or more 1 Satisfactory 6 2^ to 4 hours 2 Sub-standard 4 j to 2 hours 3 Unsatisfactory 1 0 hours 4 Most Unsatisfactory 4 Ice-lollies Plate count and bacteria reports showed these samples to be Satisfactory On receipt of a Grade 3 or 4 report it is the practice in this Borough to obtain further samples from a vendor before administrative action is taken. It was not necessary during the year to have recourse to 'administrative action.' 87 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 16 samples of icecream and 2 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. 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 5,859 lbs. Beef Trimmings 84,916 „ Mutton 91 „ Turkey 17 „ Pigs Livers 22 „ „ Tongues 118 ,, „ Kidneys 106 „ „ Heads 9 „ 91,138 lbs. Other Foods— Cheese Trimmings 177 lbs Skate Wings 140 „ Cod Roes 42 „ Whiting 84 „ Mackerel 28 „ Sultanas 600 „ Various Foods (Tinned) 1,235 „ Cooked Meats (Tinned) 1,591 „ Margarine 121 „ Marmalade 40 „ Sweets 14 „ Flour 44 „ Tomato and Mango Chutney 1½ „ 4,008¾ lbs. Total Food Rejected 95,146¾ lbs. Public Health (Meat) Regulations, 1924/52.—These regulations provide for the supervision of slaughterhouses, butchers' shops, stalls and the protection of meat against contamination by dirt and flies, etc., in transport and handling. 88 Butchers' Shops and Stalls.—These are under the constant supervision of the Food Inspectors who made 91 visits of inspection and arranged for the correction of insanitary defects at 7 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 various importers. 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. Three circulars were received from the Ministry during the year, illustrating official certificates approved for Hungary, Portugal and Yugoslavia. Imported Food Rejected.—The following unsound or diseased imported foods were surrendered, the meat being passed for nonedible and refining purposes, and other unsound food, with the exception of fruit pulp and juice, being processed for stock feeding. 89 The following foods were rejected at the wharves :— Meat— Beef 39,274 lbs. Pork 35 „ Sheep 25,895 „ Trimmings 44,847 „ Corned Beef with Cereals 10,765 „ Pigs Heads 431 „ Ox Tails 369 „ Sheep Livers 60 „ Hearts 58 „ Ham (Tinned) 59 „ 121,793 lbs. Other Foods Liquid frozen Whole Eggs 28 lbs. Fruit (Canned) 114 „ Tomato Purée 594 „ Tomato Juice 518 „ Natural Lemon Juice 560 „ Grapefruit Juice (Canned) 61 „ Apricot Nectar (Concentrate) 74 „ 1,949 lbs. Total Imported Food Rejected 123,742 lbs. Caseus 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 92,961 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 80,187 922 - - Australian sheep 6,859 83 — — New Zealand sheep 5,915 67 — — Merchandise Marks Act, 1926.—Under the powers conferred by this Act, Orders in Council have been made prohibiting the sale or exposure for sale of imported foodstuffs unless bearing an indication of the country of origin. One hundred and forty-eight inspections were made to secure compliance with the various Orders but on no occasion was it found necessary to take action against Vendors. 90 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 45 applications were made and licences granted to street traders engaged in the retailing of articles of food. Two licences lapsed (one, the outcome of a coffee stall being destroyed by fire and the other the result of the death of the licensee) and there were 43 licenses in operation at the end of 1955. No contraventions of Section 16 of the Food and Drugs Act, 1938 were observed. Premises used for the purpose of storing articles of food intended for sale by street traders, were kept under regular supervision by the Food Inspectors. 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 food is provided, the Borough has numerous other premises at which food and drugs are prepared. Such premises include those of the manufacturers of pharmaceutical sundries, mineral waters and icecream as well as fruit-canning factories, flour millers and brewers. To these establishments the Food Inspectors made 2,579 visits, as a result of which 60 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. 91 The following table is a statistical record of the major portion of the duties performed and inspections undertaken during the year by the Food Inspectors. Premises Inspected or Visits Made. No. of Visits No. of Premises at which Improvements were effected Caterers', Restaurants, etc. 205 19 Grocers 197 19 Butchers' Shops 91 7 Dairies, milk shops 69 2 Licensed Victuallers 34 4 Wharves and Factories 179 — Bakehouses 52 7 Ice-Cream Shops, etc. 144 2 Fried Fish Shops 42 — Other Fish Shops 39 — Cooked Meat & Preserved Foods 72 - Visits Re. Shops Act 203 — „ „ Rat Infestation 8 — „ „ Food and Drugs Act 193 — „ „ Merchandise Marks Act & Markets 148 - „ „ Food Poisoning 15 - Sampling Visits 336 - Fair Visits 12 - School Visits 37 - Miscellaneous Visits (including Flour MillsCyanide Fumigation) 357 - Interviews * 35 - Complaints Investigated 111 - Totals 2,579 60 *Included under Grocers' and Butchers' Shops. Bakehouses.—Basement bakehouses at 412, Woolwich Road, S.E.7., and 2, Delacourt Road, S.E.3., were closed in August and September, respectively of the current year. In addition 3 occupiers ceased to bake and obtained their supplies from other bakehouses. At the end of the year, 11 premises in the Borough were being used as bakehouses, none of which was underground. Bakehouses and bakers' shops were visited on 52 occasions and, as a result of the inspections 7 improvements were realised. These alterations were effected solely by informal action. 92 Catering Establishments.—Public demand for communal catering continues and as a result of this practice of 'eating out' the inspection and supervision of cafes, restaurants, works' canteens etc., remains one of the most important duties of the Food Inspectors. Disregard of normal hygiene in the handling and preparation of food at such establishments can lead to an outbreak of food poisoning on a large scale and it is a tribute to the Inspectors' vigilance that no such outbreaks have occurred. As a result of 239 visits of inspection to the catering establishments insanitary conditions were remedied and improvements effected at 27 premises. The following is a summary of the improvements carried out:— Type of Improvement Effected Total No. Cleaned and Painted 17 W.C. Wallplaster Renewed 2 New sink fitted 1 Refrigerator installed 1 Dampness in Basement walls remedied 1 Rainwater pipe fixed 1 Dustbin renewed 1 Asphalted throughout 1 Hot water supply installed in Staff W.C. 1 W.C. sealed 1 Total Improvements Effected 27 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 4 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, 439 were obtained under the provisions of the above Act and presented for examination. Of this total, 24 samples were formal and 415 informal of which 10 (all informal) were reported to be non-genuine. The adulteration figure at 2.2% shows a reduction of 0.4 from that of last year. Milk was again the main food sampled and not one of the 43 samples submitted for analysis was unsatisfactory. 93 Sixteen ice-cream samples were obtained and submitted to the Public Analyst for examination together with 2 ice-lollies. All proved to be genuine and the ice-creams more than fulfilled the requirements of the Food Standards (Ice Cream) Order, 1953 with an average fat content of 12.07%. 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. 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 :— Article How Obtained Examination Action Taken Bact. or Chem. Result 6 tins Corned Beef with cereal Taken from a Cold Storage plant in the Borough. Part of a consignment with an unusual number of blown tins. Bact. After an incubation period of 3 days at a temp. 37°C. one tin developed pin-holes through which the contents leaked. This can gave a mixed growth of 'gran positive' cocci and anaerobic sporebearers. Of the remaining 5 cans, 2 remained sterile, 2 others gave growths of anaerobic spore bearers and one of a 'gram positive' coccus. The Importers were notified accordingly 94 Article How Obtained Examination Action Taken Bact. or Chem. Result Portion of loaf of Bread Submitted by a member of the Public. Chem. Composition of specimen not consistent with rodent excrement, but suggests rather the agglomeration of particles of dust in the bakery, possibly by rubbing together under a bread tin. Complainant notified accordingly. 2 .Samples of Natural Lemon Juice Extract Taken from different casks at a large Cold Storage plant in the Borough. Chem. One sample proved fit for immediate consumption but the other was fermenting actively and in the opinion of the Public Analyst was not fit for this purpose Company notified accordingly. 3 tins Sheep Tongues. Purchased locally after Public Analyst's report on routine sample indicated an unpleasant taste and traces of mould. Bact. After incubation of 4 days at 37°C. the cans remained sound and the contents good. Microscopically, no bacteria were seen. Cultures from the contents of the cans have yielded in the two cases, a very scanty growth of Staph. Albus and in the other case an aerobic sporebearer. No action. Crown Corks approx. 12 and a sample of glue. Submitted by a local firm, as the result of information that some Flaked Hen Egg Albumen had been found to be positive for a Salmonella organism, the albumen being a constituent of the glue used in the fixing of the corks. Bact. Reports from the Laboratory indicated that both samples were satisfactory. Company notified accordingly. 95 Article How Obtained Examination Action Taken Bact. or Chem. Result 3 tins of Sweetened Condensed MachineSkimmed Milk. Taken from a large Cold Storage plant in the Borough. Thickening and discolouration alleged. Chem. The samples were darker and thicker than usual for condensed Milk, but no rancidity or other objectionable taint was observed and their composition and labelling conformed to the requirements of the Public Health (Condensed Milk) Regs. The thickening which often occurs on prolonged storing of condensed milk is due to the phenomena of thixotrophy and disappears if the product is well stirred Sample was rancid and in the opinion of the Public Analyst, unfit for human consumption. The analysis indicated that the rancidity was excessive and of the type known as " Ketonic." Company notified accordingly. Dutch Margarine with 25% Fresh Dairy Cream Submitted by local trader after complaints from customer. Chem. All stocks withdrawn from sale. Peeled Shrimps Obtained from local trader following complaints regarding discolouration. Chem. Excessive proportion of tin present (2.9 grains). Interior of cans badly corroded shrimps black and inedible owing to metallic contamination. Entire stock (73 tins) withdrawn from sale. 96 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. No samples of dried milk were obtained during the current year. 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. Six samples of condensed Milk were taken in the normal course of sampling and all were declared genuine. One sample, although not complying with the 1923 Regulations, was covered by the Amendment Regulations of 1953, i.e., condensed milk imported by the Minister prior to 31st December, 1954, and sold before 31st December, 1955. 97 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 14 notifications received during the year compared with 12 in 1954, 9 in 1953, 10 in 1952, 4 in 1951 and 12 in 1950. All cases were of the sporadic type and in 6 instances Salmonella typhimurium was identified as the specific agent involved. Tinned peas was the suspected source of infection in three other cases (all soldiers) but only in one instance was any causal organism identified and this was of the Staphylococcal group. A further case concerned a child of 2 years who was attending the Miller General Hospital as an outpatient. It would appear that after leaving a residential nursery in April 1954, he had diarrhoea and vomiting and since then he has had recurrent attacks, usually about once a month. One specimen only revealed the presence of Salmonella Worthington and it was presumed that the patient was a chronic carrier. The child was admitted to the Park Hospital where the laboratory staff were unable to isolate this organism and rediagnosed the case as one of non-specific enteritis. In the remaining cases the suspected food was unobtainable and the cause was unascertainable. A complete recovery was made by all patients. 98 FOOD AND DRUGS ACT, 1938 Number and Description of Samples Submitted for Analysis under the above Act during the year 1955 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Almonds 1 1 Arrowroot — 1 1 — — — Aspirin Tablets — 1 1 — — — Baking Powder — 1 1 — — — Barley, Pearl — 1 1 — — — Beans, Butter — 1 1 — — — Beverage, Chocolate — 2 2 — — — Biscuits — 2 2 — — — Borax & Honey — 1 1 — — — Brandy 3 — 3 — — — Butter — 5 5 — — — Cake & Pudding Mixture - 4 4 - - - Camphorated Oil — 1 1 — — — Capers — 2 2 — — — Cascara Tablets — 1 1 — — — Castor Oil — 1 1 — — — Cheese — 1 1 — — — Cheese Spread with Ham - 1 1 - - - Chocolate Spread — 1 1 — — — Cloves — 1 1 — — — Cocoa — 1 1 — — — Coconut, Desiccated — 2 2 —. — — Codeine Tablets — 1 1 — — — Cod Liver Oil — 1 1 — — — Coffee — 1 1 — — — Coffee Beans — 1 1 — — — Coffee & Chicory — 2 2 — — — Coffee Extract, Dried - 1 1 - - - Colouring Matter — 1 1 — — — Confectionery, Flour - 6 6 — — — Confectionery, Sugar — 10 10 — — — Cooking Fat — 1 1 — — — Corn, Canned — 1 1 — — — Cornflour — 1 1 — — — Cough Mixture — 2 2 — 1 1 Cream — 3 3 — — — Cream, Imitation Canned - 1 1 - - - Cream of Tartar — 1 1 — — — Curry Powder — 1 1 — — — Custard Powder — 2 2 — — — Dessert Powder — 1 1 — — — Drinks, Soft — 9 9 — — — Dripping — 1 1 — — — Fish, Various, Canned - 16 16 1 1 Fish Paste — 6 6 - — — Flavouring Essence — 6 6 - — — 99 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Flour 5 5 Fruit, Various, Canned - 24 24 - 1 1 Fruit, Various, Dried - 12 12 - 1 1 Fruit Pudding — 1 1 - — — Fruit Curd, Lemon — 1 1 - — — Fruit, Crystallised — 1 1 - — — Fruit Pie, Apricot — 1 1 - — — Fruit Juice, Canned — 2 2 - — — Fruit Syrup — 3 3 - 1 1 Fruit Glace, Cherry — 1 1 - — — Gee's Linctus — 1 1 - — — Gin 3 — - — — Glycerine of Thymol — 1 1 - — — Golden Raising Powder - 1 1 - Gravy Preparation - 1 1 - — — Herbs - 2 2 - — — Honey — 3 3 - — — Ice Cream — 16 16 - — — Ice Lolly — 2 2 - — — Ice Cream Powder — 1 1 - — — Iodine, Tincture of — 1 1 - — — Jam, Various — 7 7 - — — Jelly, Tablets and Compounds 5 5 - Lard — 3 3 - — — Lemonade Powder — 3 3 - — — Lentils — 1 1 - — — Macaroni — 1 1 - — — Magnesia, Bisurated — 1 1 - — — Margarine — 4 4 - — — Marmalade — 3 3 - 1 1 Marzipan — 1 1 - — — Meat Products — 17 17 - — — Meat Products, - Canned — 18 18 - — — Meat Paste — 2 2 - — — Medicated Lozenges — 3 3 - 1 1 Milk, Sterilised, T.T. Pasteurised and Pasteurised 12 31 43 - - - Milk, Condensed Full Cream and Unsweetened - 6 6 - - - Mincemeat — 3 3 - — — Mushrooms, Canned — 1 1 - — — Mustard — 1 1 - — — Oatmeal — 1 1 - — — Olive Oil — 1 1 - — — Paraffin, Medicinal — 1 1 - — — Pastry, Uncooked — 1 1 - — — Peanut Butter — 2 2 - — — Pea Flour — 1 1 - — — 100 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Peel, Candied — 1 1 Pepper — 2 2 — — — Pickles, Various — 8 8 — — — Potato Crisps — 1 1 — — — Proprietary Foods — 6 6 — — — Puddings — 3 3 — — — Pudding Mixture — 1 1 — — — Rennet, Essence of — 2 2 — — — Rice — 2 2 — — Rum 2 — 2 — — Saccharin Tablets — 1 1 — — — Sago — 1 1 — — — Salad Cream — 1 1 — — — Sauce — 12 12 — 1 1 Sausages — 6 6 — 1 1 Savoury Mixture - 1 1 — — — Semolina — 1 1 — — — Soda, Bicarbonate — 1 1 — — — Soup, Canned — 4 4 — — — Soup, Powder — 2 2 — — — Spaghetti — 1 1 — — — Spaghetti in Tomato Sauce with Cheese, Canned - 1 1 - - - Spice - 8 8 — — — Stout - 1 1 — — — Stuffing Mixture — 1 1 — — — Suit, Shredded — 2 2 — 1 1 Sugar — 5 5 — — — Sulphur Tablets — 1 1 — — — Surgical Spirit — 1 1 — — — Syrup, Golden — 1 1 — — — Tapioca — 1 1 — — — Tea — 3 3 — — — Tomato Juice — 2 2 — — — Tomato Puree — 1 1 — — — Vegetables, Canned — 12 12 — — — Vegetables, Dehydrated 1 1 - Vinegar, Malt — 1 1 - — — Vinegar, Imitation — 1 1 - — — Welsh Rarebit Mixture - 1 1 - - - Whisky 4 — 4 - — — Wine, Alcoholic — 3 3 - — — Witch Hazel, Distilled - 1 1 - - - Yeast Tablets — 1 1 - — — Yoghurt — 1 1 - — — Zinc and Castor Oil Cream — 1 1 — — — Totals 24 415 439 0 10 10 101 Administrative Action Taken in Respect to Samples Reported to be NOT GENUINE Sample No. Article Nature of adulteration and/or irregularity Action taken T. 84 Shredded Beef Suet Contained Suet Fat 81.6% and Wheat Flour 18.4% by weight. The Food Standards (General Provisions) Order, 1944, and the Food Standards (Suet) Order, 1952, prescribe a content of not less than 83% by weight of Beef Fat. The article was also stated to contain rice flour, but none was found. Letter to manufacturer. Satisfactory explanation received. Existing stocks withdrawn from sale. T. 150 Soft Roes Canned Interior of can badly corroded. Contents contained tin 2.7 grains per pound. Stock withdrawn T. 234 Iodised Throat Lozenges Analysis indicated a deficiency of 58% of Iodine. Stock withdrawn. T. 259 Sliced Bananas in Light Syrup (Canned) Tin content (3.3 grains per pound) was considered excessive. Stock withdrawn and destroyed. T. 270 Blackcurrant Syrup Contained sulphur dioxide preservative, 370 parts per million—permissible amount 350p.p.m. Letter to manufacturer. T. 324 Pork Sausages Contained preservative—230 parts per million by weight of S02. (Sausages should not contain preservative unless its presence is declared). Warning letter to manufacturer. T. 327 Dried Apricots Sample contained 2,500 parts per million by weight of S02. By the provisions of the Public Health (Preservatives etc. in Food) Regulations, 1925/53, Dried Apricots may contain S02 in a proportion not exceeding 2,000 parts per million No Action. T. 335 Glycerin, Honey & Lemon with Ipecacuanha. Deficient in Chloroform. Stock withdrawn. T. 349 Sweet Orange Marmalade, Canned. Contained excessive tin (2.2 grains per pound). Stock withdrawn. T. 351 Tomato & Mango Relish. An excessive amount of fungus present. Stock withdrawn. 102 SECTION F Prevalence of, and control over, infectious and other Diseases During the current year, no new Statutory Instruments were issued in respect of Infectious Diseases. However, at various times since 1949 legislation has been introduced concerning the notification of poliomyelitis, encephalitis, meningococcal meningitis, puerperal pyrexia, etc., in accordance with Section 144 of the Public Health Act, 1936. In effect, this has meant the allocation to Greenwich of notifications in respect of nonresidents merely as a result of the accidental location of hospitals in the vicinity. Statistics in connection with these diseases, therefore, have no specific relevance to the population of the Borough and, with the uninitiated, could even be misleading. (For example a situation can and does arise whereby Greenwich may show a death from poliomyelitis and yet have no notification for the case). Irrespective of the area of occurrence, births and deaths are always referred to the area of residence for statistical purposes and it would be logical if notifications of infectious diseases were similarly treated. 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 2,030. Under the Public Health (Tuberculosis) Regulations, 1952, there were 99 notifications, giving a consolidated total of 2,129 cases notified during the year. In 9 of these cases the diagnoses were not confirmed, thus giving a corrected figure of 2,120. The following table indicates the figures for the previous nine years:— 103 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 1954 569 9-year A verage 1,444 1955 2,120 Particulars of age groups and districts affected are shown in the table at the end of this Report. 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 eight certificates were so issued, all in respect of poliomyelitis. 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. 104 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 1955 was 503. This is a decrease of 97 from the previous year and 812 less than the figure returned for 1951. In Greenwich during the last 5 years 6,695 births have been registered and for the same period only 3,622 vaccinations have been effected, a figure equivalent to 54.1%. In 1951 the births numbered 1,351 and the vaccinations 1,315 (97.3%), but during the current year the figures were 1,311 and 503 (38.3%) respectively. 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 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 Internat ional 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. 105 During the year some 319 certificates of persons proceeding abroad were so authenticated, of these 225 were in respect of Smallpox, 69 for Cholera and 25 for Typhoid. Five vaccinations and 1 inoculation for T.A.B. were actually carried out by your Medical Officer of Health. Measles.—The normal biennial fluctuation was evident in the sharp increase in the number of notified cases from a figure of 28 confirmed in 1954 to 1,684 for the current year. Fifty cases occurred in children under one year of age and 1,605 between one and ten years. Of the 41 patients removed to hospital 2 males, one aged 10 months and the other 3 years, died. The distribution of the cases was as follows:—East Greenwich 543; West Greenwich 284; St. Nicholas, Deptford 98; Charlton and Kidbrooke 759. During 1953, 560 cases were recorded and in 1952 there were 918. Whooping Cough.—Altogether 165 notifications were received in 1955, a decrease of 58 from the previous year. The year 1953 produced 236 and there were 190, 384 and 309 respectively for the years 1952, 1951 and 1950. Area distribution for the present period was:—East Greenwich 55; West Greenwich 26; St. Nicholas, Deptford 2; Charlton and Kidbrooke 82. Nine cases were admitted to hospital but there were no fatalities. Diphtheria.—There was only one notified case of Diphtheria during the year and this occurred in a woman of 52 years. She received hospital treatment and was discharged free from infection. Bacteriological investigation of a throat swab revealed the presence of "a rather degenerate strain of C. Diphtheria gravis with a slight but definite virulence for guinea-pig." On request, this information was forwarded to the Ministry of Health. One case was confirmed in 1954; there was none in 1953; 4 in 1952; and a nil return was recorded for 1951. Since 1945, diphtheria notifications for England and Wales have fallen from 18,596 to 161, the figure for the current year. Over the same period deaths have decreased from 722 to 11. 106 While present progress 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 recrudescence. A warning against any relaxation of effort was made by the Minister of Health when asking that the Diphtheria Publicity Campaign should be continued by the various health organisations. Diphtheria immunisation is a County Council service and during the year there were 783 completed immunisations carried out in the Borough. This is a decrease of 121 from that of the previous year and a reduction of no less than 853 from the figure returned for 1950. County Council publicity in support of the Minister's campaign stressed the fact that there is now a generation of parents growing up that, having no knowledge of the dire effects of diphtheria, has no fear of the disease, yet retaining almost a hypochondriacal attitude to poliomyelitis. In London there were 12 notifications and 2 deaths registered in 1955, compared with 4 and nil respectively for 1954, and these deaths were the first recorded since 1952. The figures are small and, therefore, may be of little significance, but they do occasion anxieties as to whether recent advances are likely to be reversed. Antitoxin.—Since January, 1949 arrangements have been made for a small stock of diphtheria antitoxin to be held at St. Alfege's Hospital for use by general practitioners in emergencies. Acute Primary Pneumonia and Acute Influenzal Pneumonia.—There were 14 cases attributed to these causes, as compared with 23 and 16 for the years 1953 and 1954 respectively. Five occurred in East Greenwich, 1 in West Greenwich, 2 in St. Nicholas, Deptford, and 6 in Charlton and Kidbrooke. There were no deaths. Typhoid.—Two cases were notified as paratyphoid fever, but these were subsequently diagnosed as enteritis. There was one case last year and a nil return for 1953. Scarlet Fever.—Sixty cases were notified during the year and 3 corrections were received, and the final total of 57 compares favourably with 69 cases for 1954. Fourteen occurred in East Greenwich, 6 in West Greenwich, 2 in St. Nicholas, Deptford, and 35 in Charlton and Kidbrooke. 107 Eight cases were removed to hospital and no fatalities were recorded. Erysipelas.—Six cases were notified compared with 5 last year and 11 for 1953. Two cases received hospital treatment. Zymotic Enteritis or Epidemic Diarrhoea (Children under 5 years of age).—Originally 8 cases were notified but this figure was modified and 7 were eventually recorded as confirmed compared with 15 for the previous year. Of these, 4 were under one year and 3 between 1 and 5 years. Unfortunately it is necessary to record the death of a child of 3½ months, one of the 7 admitted to hospital. Sonne 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 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 70 for 1954, during the current year some 17 cases were confirmed after the receipt of 18 notifications, one case being re-diagnosed as food poisoning. Six patients were removed to hospital. Area distribution was as follows :—East Greenwich 7 and Charlton and Kidbrooke 10. 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.—Four cases were so notified compared with 5 for the previous year. Treatment of all cases of scabies is carried out at the Tunnel Avenue Centre. 108 Puerperal Pyrexia.—During the year one notification was received in accordance with the 1951 Regulations which was in respect of a Deptford resident, but from other sources 14 cases concerning Greenwich residents were brought to the notice of the department. All patients received hospital treatment. There were no fatalities. Meningococcal Infection.—There were 5 notifications received compared with 4 last year and 3 in each of the previous two years. All cases received hospital treatment. There were three deaths from meningococcal infection recorded the ages being 1 month, 21 months and 2 years respectively. Acute Encephalitis. (Infective or Post-Infectious).—A NIL return is recorded for the current year, a similar return to that for 1954. Ophthalmia Neonatorum.—In respect of this disease, one notification was received. The case was removed to hospital for treatment and was kept under observation by the Health Visitor at home. The child made a full recovery. Poliomyelitis.—It has already been pointed out at the commencement of this Section that the vagaries of notification procedure have led to misleading statistics concerning specified administrative areas and this is emphasised by the notifications received in respect of poliomyelitis. During the year, 59 notifications were received of which 4 were re-diagnosed. Of the 55 confirmed cases, only 17 were in respect of Greenwich residents and a further 4 cases concerning residents notified to Lewisham gave a final total of 21 for the Borough. Of these, 8 were of the paralytic type and 13 non-paralytic. Two deaths were recorded, one of which concerned a male of 31 years who died in Lewisham and for whom no notification was received and the other was in respect of a boy of 16 years who succumbed to the ' bulbar ' type. 109 Malaria.—Four notifications were received, three from the Royal Herbert Hospital in connection with military personnel and one concerned a civilian returning from overseas. Each case was of the benign tertian type believed to have been contracted abroad. Tuberculosis.—During the year 99 notifications in respect of confirmed casts of tuberculosis were received compared with 106 for 1954. Of these, 91 were of the pulmonary type and 8 nonpulmonary, i.e., tuberculosis of parts of the body other than the lungs. The slight decrease in the figure for the current year appears to be contrary to the general trend throughout the Country. The following table gives the distribution :— District Pulmonary Non-Pulmonary Total East Greenwich 18 1 19 West Greenwich 20 2 22 St. Nicholas, Deptford 4 — 4 Charlton and Kidbrooke 49 6 54 Totals 91 8 99 Disinfection was offered and carried out in 22 cases including 63 rooms and 485 articles of clothing and bedding, etc. The number of notified cases of Tuberculosis remaining on the Register at 31st December, 1955, was as follows :— PULMONARY NON-PULMONARY Men Women Children Total Men Women Children Total M F M F 515 449 27 30 1,021 24 44 12 7 87 For further clarification I append herewith copy of Form T.137 (revised) for the year under review as forwarded to the County Medical Officer of Health. 110 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 Part I.—Summary of notifications of Tuberculosis during the period from the 1st January, 1955, to the 31st December, 1955. 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 — 4 7 12 9 6 4 3 — 47 Respiratory, Females — — — 2 2 5 10 17 3 2 1 — — 42 Non-Respiratory, Males — — — — 2 2 1 - - - - - - 5 Non-Respiratory, Females - - - - - - 1 1 - - - - - 2 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 or Intormation 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 RegistrarGeneral (Transferable deaths) Respiratory M - - - - - - - - - - - - - - (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) Respiratory M - - - - - - - - 1 1 - — 2 (A) Posthumous Notifications F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (0) F - - - - - - - - - - 1 - - 1 (D) N.B. Where notification of one form of Tuberculosis is subsequently followed by a notification Totals (A) 2 (B) — of the other, only the first notification is taken into account for the purpose of this return. (C) — (D) 1 111 Mass Radiography.—In London, Mass Radiography was originally carried out under the direction of the London County Council, but since January 1948 the responsibility for this service has rested with the South East Metropolitan Regional Hospital Board. Introduced primarily for the early detection of Tuberculosis, the Mass Radiography service is responsible for revealing many other chest malformations and disabilities which would doubtless have remained undetected perhaps for years. As a direct consequence of the diagnosis of these ailments treatment is made possible at a very early stage, thereby enabling a much more favourable prognosis to be entertained. The South East London Mass Radiography Unit carried out a public sunvey in Greenwich during March and April and every assistance was given by the Health Department in order to make the unit's visit a success. I am indebted to Dr. J. M. Morgan the Director, for the following analysis of the results:— Survey Carried Out in Respect of the General Public at Public Baths, Trafalgar Road, Greenwich from 15th March to 6 th April, 1955. PART I.—General Analysis Men Women Total (a) Total X-rayed 2,662 2,645 5,307 (b) Total previously X-rayed 1,301 1,246 2,547 (c) Total recalled for large film 91 86 177 (d) Number normal on large film 23 39 62 (e) Number abnormal on large film 68 47 115 (f) Not yet attended for large film — — — PART II.—Analysis of Abnormal Large Films (1) Cases considered tuberculous and referred elsewhere: Men Women Total[/##] (a) No further action required - — — (b) Occasional supervision only 5 4 9 (c) Requiring treatment 11 8 19 (d) Still under investigation 2 — 2 112 (2) Non-tuberculous cases: (a) investigated Men Women Tota Sarcoidosis 1 — 1 Bronchiectasis 1 1 2 Pneumonitis 1 — 1 Eventration of Diaphragm 1 — 1 Carcinoma of bronchus 1 1 2 (b) still under investigation — — — (3) Cardio vascular lesions 1 4 5 (4) Previously kno n tuberculous cases 3 4 7 (5) Abnormalities requiring no action 41 25 66 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 120 6 Children under school age 62 — School children 446 30 No. of home visits by Lady Sanitary Inspector 18 No. of home revisits by Lady Sanitary Inspector 55 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:— 113 Rooms and Articles Disinfected, Year ended 31st December, 1955 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 42 84 19 39 39 99 83 157 20 26 33 272 216 - 36 1,039 Diphtheria 1 2 — 1 1 2 3 3 — 2 — — — - — 12 Tuberculosis 22 63 9 15 13 41 40 57 9 18 12 149 102 2 18 485 Cancer 8 17 3 2 2 5 5 19 1 10 1 66 10 — 2 126 Meningococcal Infection 5 10 2 5 3 8 5 13 3 7 2 26 10 — 4 88 Puerperal Pyrexia - - - - - - - - - - - - - - - - Typhoid Fever 1 3 — 1 1 3 2 3 1 — — 10 10 — 1 32 Polio-Myelitis 50 112 15 44 37 107 107 143 32 59 36 284 281 — 45 1,190 Erysipelas 2 2 — 2 1 8 7 6 3 — 1 5 6 1 2 42 Acute Encephalitis 1 2 1 1 1 2 2 3 1 — 1 5 8 — 1 26 Measles - - - - - - - - - - - - - - - - Scabies — — — — — — — — Other Diseases 109 70 18 40 12 92 17 129 4 28 5 877 57 3 11 1,293 Verminous Premises 3 3 4 5 - 14 4 11 2 23 - 20 10 - 2 95 Total. 244 368 71 155 110 381 275 544 76 173 91 1,714 710 6 122 4,428 Articles destroyed 31 138 2 23 10 11 7 725 60 6 5 1,018 Library Books Disinfected 65 114 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 Physicians Dr. C. W. L. Jeanes Dr. Joyce Brown Tuberculosis Health Visitors Miss D. M. Noakes Mrs. L. M. Smith Miss E. Wells Clinic Nurse Mrs. M. Hawkins Radiographer Mr. P. Evans Tuberculosis Care Organiser Miss H. Fischer Occupational Therapists Miss M. Moncur Miss E. Collings Dressmaking Instructress Mrs. J. Wilkins Clerical & Administrative Staff Mrs. E. M. Brown Mrs. M. Shackleton Mrs. P. Fraser (Part-time) Mrs. K. Hicks ( ,, „ ) Greenwich is a busy industrial Thames-side borough with a population of 89,490. In its lower part alongside the river are the majority of the industries. Chief among these are large Cable and Engineering Works, Ship repairing works, Gas Works, Electricity 115 Generating Stations, Glass Bottle Works, Rope Works, Ship propelling works, Cement and Stone works, Cold Meat Storage, Merryweather's Fire Engine factory, constructional engineering works, Galvanising and sheet metal works, Brewery and Flour Mills. The numbers employed at these factories range between 500 and 5,000 each while 17 smaller works each employ between 100 and 400. The upper part of the Borough away from the river surrounds the famous Greenwich Park and Blackheath, which together cover 275 acres. This is the main residential area of Greenwich and comprises several large Council Estates of modern houses and flats and numerous private dwelling houses in Blackheath, Charlton and Kidbrooke. The Greenwich Chest Clinic is a very well equipped modern building with adequate accommodation. Under a re-organisation scheme completed at the end of 1955 there are now two medical consulting rooms, a Nurses' reception room, Almoner's office and patients' waiting room, and a modern X-ray Department with a 4 valve 400 m.a. X-ray apparatus including tomograph and an Odelca 70 mm. camera unit. A centralised and compact X-ray and note filing room has now been arranged and more office accommodation has been made available for the clerical staff. As will be stated later in this report a domiciliary Occupational Therapist has now been appointed and a room in the Clinic has been allocated to her to serve as her headquarters. This is in addition to the ordinary outpatients Occupational Therapy department which is continuing as before. Tuberculosis At the end of 1955 there were 1,003 patients on the Chest Clinic register, consisting of :— Pulmonary Tuberculosis. Non-pulmonary Tuberculosis Men Women Children Men Women Children 477 423 53 14 23 13 During the year there were 86 new notifications of pulmonary Tuberculosis and 5 of non-pulmonary Tuberculosis. There were 18 deaths of patients on the register but of these only 9 were due to tuberculosis, as will be explained later. Comparative figures for recent years are set out in the following table:— 116 Chest Clinic Statistics Year Population of Borough Notifications Incidence per 1,000 of population Deaths Pulm. Tub. NonPulm. Tub. Pulm. Tub. NonPulm. Tub. Total Rate per 1,000 1938 95,770 153 38 1.59 0.39 53 0.55 1939 94,790 93 14 0.98 0.14 60 0.67 1940 74,280 125 17 1.68 0.23 73 0.97 1941 57,070 138 32 2.42 0.56 74 1.30 1942 60,530 164 18 2.70 0.29 64 1.06 1943 62,870 117 26 1.86 0.41 60 0.96 1944 61,800 113 16 1.82 0.26 47 0.76 1946 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 60 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 1955 89.490 86 5 0.96 0.05 18* 0.20 *Deaths from all causes of Tuberculous patients on register. The number of cases on the Tuberculosis register does not diminish and has remained about 1,000 for many years. There is now a very great tendency not to discharge patients after 5 years but to advise them to continue to come for an annual check-up, and this although very much to the benefit of the patient does keep up the numbers on the register. The new notifications in 1955 totalling 91 were 8 less than in the previous year. The age and sex distribution of these 91 new notifications was as follows :— Male Age Female 1 0—5 years 0 2 6—15 years 4 15 16—25 years 18 11 26—35 years 13 9 36—45 years 4 6 46—55 years 1 4 56—65 years 1 2 66—75 years 0 0 76 years and over 0 50 cases 41 cases 117 This table illustrates how tuberculosis is most prevalent in the young adult male and female between the ages of 16 and 35 years. In men the incidence is still high in later decades but in women over the age of 35 years and in young children, tuberculosis is now quite rare. The sources of these new cases were— Referred by own Doctor 51 cases Referred by Mass X-ray units 23 ,, Referred by National Service Medical Board 2 ,, Discovered on routine contact 40 cases examination 11 „ Discovered on routine ante-natal Clinic X-rays 4 ,, It will be seen that 40 of the new cases were discovered by case finding methods. This emphasises the importance of adequate and convenient X-ray facilities for patients, including the occasional evening session for workers. For the past two years a special session has been set aside for ante-natal clinic X-rays. This arrangement has been most successful. During the year 645 patients attended, of whom 4 were found to have active pulmonary tuberculosis. This early diagnosis meant that these four patients were able to have adequate treatment during pregnancy. Each now has quiescent disease and a healthy baby, which would certainly not have been the case if diagnosis had been delayed. The 51 patients who had consulted their own doctors on account of symptons tended to have much worse disease on diagnosis than the 40 picked up by routine radiography. Treatment There have been no great changes in treatment during the year. There has been no wait for admission to hospital or sanatorium for treatment and no patient has had to wait for thoracic surgery. The combined hospital-home treatment schemes have continued most successfully in conjunction with Kettlewell (now Joyce Green) and Bow Arrow Hospitals at Dartford. A very much smaller number of patients are now being sent away to distant sanatoria for treatment, and much greater use is now being made of the Chest Physician's beds in St. Alfege's Hospital to treat local patients. 118 Streptomycin, P.A.S. and Isoniazid continue to be the drugs of initial choice for treatment but there are now several other very effective anti-tuberculous drugs which are used in complicated cases. The tendency now is to give anti-tuberculous chemotherapy for longer and longer periods. No patient has this treatment for less than about a year, and it is continued in many cases for several months after the patient has returned to work. In some cases, particularly those with extensive disease, this treatment has been carried on for two or three years and the results of this have been dramatic. There follows a special note on this treatment in chronic sputum positive cases later in this report. Artificial pneumothorax has now been almost completely superseded by other methods of treatment. Pneumoperitoneum in conjunction with chemotherapy is still a very effective form of treatment in many cases and produces excellent results. Major thoracic surgery has played a large part in treatment of pulmonary tuberculosis but the number of patients who need major surgery is diminishing. In 1954, 39 patients had major chest surgery but in 1955 only 29 were operated on as follows— Men Women Thoracoplasty 3 0 Lobectomy 9 9 Segmental Resection 3 1 Pneumonectomy 0 1 Decortication 1 0 Bilateral Plombage 0 1 Lobectomy and corrective thoracoplasty 0 1 The average age of the men was 30 years with extremes ranging from 15 years to 59 years and in the women the average age was 31 years with extremes from 22 years to 55 years. There was one postoperative death, a woman aged 29 years with extensive Tuberculosis who died 8 weeks after the operation. There are now under the Chest Physicians' care 184 patients who have had major thoracic surgery for tuberculosis. Of these, four still have active disease and are unable to work and two, although their tuberculosis has been controlled have suffered so much lung damage that they are respiratory cripples and able to lead only very restricted lives. The remaining 178 patients are well and leading normal lives. Their operations were— 119 Men Women Thoracoplasty 60 32 Lobectomy 17 24 Segmental resection 9 5 Pneumonectomy 7 6 Decortication of lung 1 1 Plombage 2 2 Lobectomy and thoracoplasty 1 5 Pericardectomy 1 1 Extra Pleural Pneumothorax 0 1 Bilateral resection 1 2 Bilateral plombage 0 3 Bilateral thoracoplasty 3 0 With modern methods of treatment, including chemotherapy and earlier diagnosis, the time that a patient needs to be in hospital has been very much diminished. For patients not needing surgical treatment the average time is now about four months, and for those needing surgery 9—12 months. There are a small number of patients, specially selected because of their limited disease and non-infectivity, who are being treated by chemotherapy without rest; that is they are being allowed to continue working. The results so far are very promising. Chronic Pulmonary Tuberculosis This condition used to be the greatest problem of the Chest Physician, both from the point of view of managing the patient and secondly preventing his spreading infection. Six years ago, that is before the days of chemotherapy, there were never less than 100 chronic sputum positive cases attending the Clinic. In 1955 there were only 68 chronic cases of whom only 24 were sputum positive. Most of these chronic cases are on long term chemotherapy. Some heal up remarkably well and then cease to be called chronic cases which accounts for the fall from 100 to 68. Of these latter 68, 24 although still sputum positive are very much better in themselves and because the amount of sputum they produce is considerably diminished their infectivity is much less. The 44 remaining sputum negative chronic cases are an interesting end result of chemotherapy in that although the patient may continue to have cavities in his lungs these have apparently been sterilised. Whether they will remain so can only be determined by several years of careful observation. 120 Deaths There were 18 deaths of patients on the tuberculosis register. Of these, 15 were men of average age 52 years with extremes 34—77 years, 7 of these deaths were definitely due to tuberculosis. Of the remaining 8 deaths 5 were due to heart disease, one to silicosis, one to carcinoma of the bronchus and one to carcinoma of the prostate. Three women on the tuberculosis register died. One aged 56 with quiescent disease was killed by falling off a bus. Of the two who died from tubercle one aged 41 years had been diagnosed 11 years previously and had much hospital treatment and chemotherapy. The other aged 29 years had extensive disease on diagnosis in 1953. After thoracoplasty in August 1955 she had persistent bronchitis from which she died 8 weeks later. Thus it will be seen that out of a population of 89,490 there were only 9 deaths attributable to tuberculosis, 7 men and 2 women. So much for the treatment side of tuberculosis. It has been said that no infectious disease can ever be eradicated merely by treating the victims of that disease and that maxim certainly applies to tuberculosis. Prevention is an extremely important part of our work. By an active campaign of health education among the families of known cases of tuberculosis the Health Visitors have continued their invaluable work. Routine contact investigation as has been shown earlier in this report is a very fruitful source of new cases of tuberculosis, and it is only by constant visits and persuasion by the nurses that many contacts can be induced to attend. The adequate X-ray facilities available at the Clinic make it possible to keep up the very high average of 5 contacts X-rayed per new notification, which is much higher than the national average of just over 2. It might be said that, by making full use of the 70 mm. Odelca camera, the cost of X-ray films here is a fraction of departments using only full-size X-rays. The efficacy of B.C.G. vaccination has now been generally accepted and the Medical Research Council's report published early in 1956 adds authority to this opinion. B.C.G. vaccination has been offered to all contacts and nurses and other hospital staff and since 1950 when this work commenced some 600 individuals have been vaccinated. Not one of these has been known subsequently 121 to have developed tuberculosis. In 1955 there was an extension of this scheme by the London County Council to include school leavers and the Chest Physician does assist in certain small ways with this work. Occupational therapy classes have been continued for outpatients attending the Clinic. In 1955 a new scheme was started to provide for patients being treated in their homes. Miss M. Moncur came to start this scheme which is working most successfully and much to the benefit of patients. The Clinic is fortunate in having an active Care Committee with voluntary funds, raised largely by the sale of Christmas Seals and donations, at its disposal. These funds are dispersed by the Committee for the benefit of patients. It is possible in this way either to supplement official sources of help, or to provide assistance where no statutory aid is available. The Committee has provided holidays for needy patients and their families, bought food, clothing and furnishing in necessitous cases, and also helped with a wide variety of patients' financial problems. A summer outing to the seaside was arranged for patients and numerous fares for relatives to visit patients in distant Sanatoria have been provided. Patients on resettlement and retraining courses often require assistance over and above that given by the Ministry of Labour and here the Care Committee helps again The Tuberculosis Care Organiser besides acting as Secretary to the Care Committee, deals with all the routine investigation of patients' social, domestic and financial affairs and where necessary arranges for the appropriate National Health Insurance and National Assistance grants. Apart from these duties, there are innumerable problems about which patients consult her and where her advice and encouragement to the patient is invaluable. Non-tuberculous Chest Diseases The Chest Clinic has for 10 years dealt with non-tuberculous chest diseases. Bronchitis is a very great problem in this country. There are about 36,000 deaths per year from bronchitis compared with under 8,000 from tuberculosis. It has been estimated that nearly 27 million working days are lost annually in this country on account of bronchitis. There is undoubtedly a connection between atmospheric pollution and cigarette smoking and bronchitis, and in a district such as Greenwich with its heavy air pollution the incidence of bronchitis is much higher than in a non-industrial area. 122 Certain promising lines of treatment are being investigated at the Clinic. Besides routine breathing exercises and measures to promote bronchial drainage, long term antibiotic treatment has been very successful in a few patients. This work is continuing. There is definite statistical evidence that the incidence of carcinoma of the lung is increasing. Of 24 new cases diagnosed at the Greenwich Chest Clinic in 1955, 13 were after investigation considered operable and 8 of these eventually had the growth resected. At the end of the year of the original 24 cases only 15 were still alive. Recent figures suggest that of operable cases only 25—30% survive five years. Of the inoperable ones the survival time can usually be measured only in months. General Statistics. Number of new out-patients 2,107 Total number of out-patient attendances 11,082 Total number of Radiological examinations 10,140 No. of Home consultations by Chest Physician 154 No. of B.C.G. Vaccinations 190 No. of Home visits by Health Visitors 3,442 No. of contacts examined for first time 470 123 SECTION G Miscellaneous Guild of Hygiene.—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. Allowing for additions and deletions, the number of certificates earned and displayed by traders in the Borough has now reached a total of 88. Medical Inspection— Superannuation.—All medical examinations of the staff for Superannuation purposes are undertaken by the Medical Officer of Health and during the current year 58 examinations were so made. Sick Persons.—In addition, the Medical Officer of Health carried out 47 medical examinations of Council's employees (one at home), who for medical reasons had been absent for 4 weeks from their employment. In consequence, the Council was advised that nine of their servants were no longer capable of discharging their duties efficiently by reason of permanent infirmity. 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 60 interviews during the year, 4 of which were carried out in the applicants' own homes. INDEX A Page Acute Encephalitis 108 Acute Influenzal Pneumonia 106 Acute Poliomyelitis 108 Acute Primary Pneumonia 106 Adoptive Acts, Bye-laws and Local Regulations 3, 4 Age Mortality 20, 21 Aged, Infirm and Physically Incapacitated Persons 64-69 Analytical Examination of Milk 85,92,96 Ante and Post Natal Clinics 36 Ante and Post Natal Clinics, Attendances 32, 33 Anti-Fly and Anti-Mosquito Campaign 58, 59 Antitoxin, Diphtheria 106 Area of Borough 9 Articles and Rooms Disinfected 113 Articles Destroyed 113 Artificial Sunlight Centres, Attendances 33 Artificial Sunlight Treatment 36 Atmospheric Pollution 43-47 B Bacteriological Examinations 61, 84 86, 93, 94 Baiting of Sewers 58 Bakehouses 91 Baths and Wash-houses 60,61 B.C.G. Vaccinations 120,122 Births 14, 18 Birth Registrations 18 Blackheath Fair 90 British Red Cross Society 39, 67 Bronchitis 28 Burial and Cremation of the Dead 69 C Cancer 14, 15, 25-28 Caseous Lymphadenitis 89 Catering Establishments 92 Cerebral Embolism 28 Cerebral Haemorrhage 28 Cerebral Thrombosis 28 Certificates of Guild of Hygiene 123 Chest Clinic 37, 114 Chest Physicians' Report 114-122 Children's Exercise Classes 33 Page Chiropody Clinics, Attendances 33 Chiropody Treatment (Old People) 66 Citizens Advice Bureaux 39 Classification of Deaths 23 Clean Air Act 44 Cleansing and Scabies Clinic 37, 112 Cleansing of Children 112 Cleansing of Old People 65 Clinics and Centres 30-38 Common Infectious Diseases 15,24 Complaints 40, 70 Conveniences, Public 62-63 Coronary Disease 28 Council Housing Schemes 77, 78 Council Rehousing 76 Cremation or Burial of the Dead 69 D Death Causes, Remarks 23-29 Death Rates 15 Death Registrations 19 Death, Table showing Causes of and Ages at Appendix Deaths 14, 19 Deaths, Table showing Causes of and Ages under 1 yr. Appendix Deaths from Violence 29 Deaths in Institutions 20 Defective Dwellings—Repairs 47 Density of Population 9 Dental Clinic 37 Dental Treatment 34 Diarrhoea and Zymotic Enteritis 14, 24, 107 Diphtheria 24, 105, 106 Diphtheria Antitoxin 106 Diphtheria Immunisation Clinics 36 Diphtheria Prophylaxis Cases 34, 106 Discharge of Effluents into Sewers 53 Diseases of Respiratory System 28 Disinfecting Station 39 Disinfection 112,113 Disinfestation of Verminous Premises 59 Distribution Centres—National Welfare Foods 30 District Nursing 34 Domestic Helps 34, 39 Domiciliary Confinements 32 INDEX (continued) Page Drainage and Sewerage 52, 53 Drainage, New and Alterations to 52 Drinking Fountains 63 Duties and Powers of the Public Health Committee 3,4 Dwellings 9 Dysentery 107 E Elevation of Borough 9,11 Emission of Grit 43-47 Encephalitis 108 Enteric Fever 24 Entertainment (Old People) 68 Erysipelas 107 Exercise Classes, Ante Natal 33 Exercises Classes, Children's 33 Exhumations 69 Extracts from Vital Statistics 14, 15 F Factories Acts, 1937/48 40-42 Fair, on Blackheath 90 Family Planning Association, Sessions 38 Family Welfare Association 39 Food Hygiene Regs, 1955 82 Food, Inspection of 81-101 Food Parcels (Old People) 68 Food Poisoning 97 Food—Premises for Preparation of 85, 90-92 Food Rejected 87, 89 Food and Drugs Act, 1955 81 Food and Drugs Amendment Act, 1954 81 Food and Drugs—Non-genuine Samples 101 Food and Drugs Act, 1938 Samples taken under 92, 93, 98-101 Food Standards Orders 101 Foot Clinics 37 Foot Clinics, Attendances 33 G General and Vital Statistics 9-29 General Provision of Health & Welfare Services in the Area 30-39 Page Grants to Voluntary Organisations 68 Greenwich Guild of Hygiene 123 Grit Emission 43-47 Guild of Hygiene 123 H Habitation Certificates (Water Supply) 53 Hairdressers and Barbers 50, 51 Handicraft Centre 37 Handwashing Facilities 63 Health Centres 35-38 Health Visiting 31, 122 Heart Disease 28 Heating Appliances (Fireguards) Act, 1952 49, 50 Holidays (Old People) 68 Home Help Statistics 34 Home Help Service, Applications for 39 Horse Trough 63 Hospitals 39 Hospital Confinements 32 Houses, No. in Borough 9 Houses Let in Lodgings 48 Housing 73-80 Housing Act, 1936, Procedure under 74 Housing Act, 1949 74 Housing Accommodation 73-78 Housing Homeless Persons 76 Housing Register 79 Housing Repairs and Rents Act, 1954 48, 49, 74 Housing Schemes, Council's 77, 78 Housing Survey 79 Hygiene, Guild of 123 I Ice-Cream — Bacteriological examinations 86 Ice-Cream (Heat Treatment, etc.) Regulations 86 Ice-Cream Premises 85 Ice-Cream Quantitative Analysis 87, 93 Ice-Cream Sampling 86, 93 Illegitimate Births 14,18 Immunisation and Vaccination Clinics 36 INDEX (continued) Page Immunisation and V accina- tion Clinics, Attendances 34 Imported Food Rejected 88, 89 Infantile Mortality 15, 21-23 Infant Welfare Centres 35 Infant Welfare Clinics, Attend- dances 31-33 Infectious Diseases 14, 15, 24, 102-122 Infirm Persons 64-69 Influenza 14, 15, 28 Inhabited Houses 9 Inspection of Food and Supervision of Food Premises 81-101 Institution Deaths 20 International Certificates 104 International Statistical Classification of Diseases, Injuries, and Causes of Death, 1948 23 Interviews, (Rehousing) by M.O. 123 Introductory Review 6-8 L Laboratory Work 51, 61, 84, 86, 87 92-101 Land Charges Act, 1925 52 Laundry Service 65 L.C.C. (Gen. Powers) Act, 1953 53 L.C.C. (Gen. Powers) Act, 1954 50 Legal Proceedings 72 Legislation, New 79, 81, 82 Leptospirosis 56 Lettings (Housing) 79 M Malaria 109 Manufacture and Sale of Ice- Cream 86 Marriages 15, 73 Marriage Guidance Centre 38 Mass Radiography Ill Maternal Mortality 14, 16, 21 Maternal and Child Welfare 30-39 Maze Hill Clinic (Tuberculosis) 37 114-122 " Meals on Wheels " 67 Measles 14, 24, 105 Meat Regulations 87 Meat Surrendered 87,89 Medical Inspections (Superannuation) 123 Page Medical Inspections (Sick Persons) 123 Medical Officer of Health's Review 6-8 Medical Statistics (Schools) 34 Meningococcal Infection 108 Merchandise Marks Act 89 Meteorological Observations 16, 17 Mileage of Streets 10 Milk, Analysis of 84, 85, 92 Milk and Dairies Regulations 84 Milk Licences 84 Milk (Special Designation) (Pasteurised & Sterilised Milk) Regulations 84 Milk (Special Designation) (Raw Milk) Regulations 84 Milk Supply 83 Minor Ailments Centres (for School Children) 38 Motor Vehicle Accidents 29 Mutual Exchanges (Housing) 79 N National Assistance Act 66 National Insurance Act (Medical Certificates) 103 National Welfare Foods — Distribution Centres 30 Natural Increase 13 Neo-Natal Mortality 22, 23 & Appendix New Housing Accommodation 77 New Legislation 79, 81, 82 Nomenclature Regulations, 1948 23 Non-Genuine Samples 101 Notices, etc. 40, 71 Notifications of Infectious Diseases 102-122 & Appendix Notifications of Food Poisoning 97 Nursing Associations 39 Nutrition Clinic 380 Old People's Welfare Association 68 Open Spaces 10 Ophthalmia Neonatorum 108 Ophthalmic Clinic (Children) 38 Outworkers 42 Overcrowding 76 INDEX (continued,) P Page Personal Health Services 30-39 Persons Cleansed 64, 65 Pet Animals Act 51 Pharmacy & Poisons Act 50 P.H. (Condensed Milk) Regulations 96 P.H. (Dried Milk) Regulations 96 P.H. (Imported Food) Regulations) 88 P.H. (Meat) Regulations 87 P.H. (Preservatives, etc., in Food) Regulations 101 P.H. (Smallpox Prevention) Regulations 104 Physically Incapacitated Persons 64-69 Pneumonia 28, 106 Poliomyelitis 108 Pollution, Atmospheric 43-47 Pollution, River 43 Population 9, 13 Post-Natal Attendances 32 Powers & Duties of the Public Health Committee 3, 4 Preserved Food Premises 85 Prevalence of, and Control over Infectious Diseases 102-122 Prevention of Damage by Pests Act 56 Procedure under the Housing Act, 1936 74 Prophylaxis Cases 34 Prophylaxis Clinics 36 Public Baths & Washhouses 60, 61 Public Health Committee 3 Public Health Department Staff 5 Public Health Laboratory Service 84, 86, 93, 94 Public Open Spaces 10 Public Sanitary Conveniences 62-63 Puerperal Pyrexia 108 Q Quantitative Analysis of Ice- Cream 87, 93 Queen's District Nursing Association 34, 39 R Radiography, Mass 111 Page Rag Flock Act 51 Ranyard Mission 34, 39 Rateable Value 9 Rates, Births and Deaths, etc. 14,15 Rat Repression 55-58 Refuse Disposal 54 Registered Births 14, 18 Registered Deaths 14, 19 Registrar—Office Hours 39 Registration of Preserved Food Premises 85 Rehousing 76 Rehousing Interviews (by M.O.H.) 123 Rejected Food 87, 89 Remarks on Various Death Causes 23-29 Rent & Mortgage Interest (Restrictions) Acts 48 Requisitioned Accommodation 76 Requisitioned Houses & Housing (Amendment) Act, 1955 79, 80 Respiratory System—Diseases of 28 Review by M.O.H. 6-8 River Pollution 43 River Smells 43 Rodent Control 55-57 S Sampling of Ice-Cream 86 Sampling of Milk 84, 85, 92 Sampling under Food & Drugs Act 92,98-101 Sanitary Circumstances of the Area 40-72 Sanitary Conveniences, etc. 62-63 Sanitary Work — Summaries etc. 70-72 Scabies 107 Scabies & Cleansing Clinics 37 Scarlet Fever 24, 106 Scavenging and Refuse Disposal 54 Schools (Medical Statistics) 34 Sewerage and Drainage 52, 53 Sewers—Baiting of 58 Shops Act 50 Slaughterhouses 88 Slum Clearance 74 Smallpox 24, 103 Smells from River 43 Smoke and Grit Emission 43-47 INDEX (continued) Page Social Conditions of the Area 11-12 Sonne Dysentery 107 S.O.S. Scheme 69 Special Consultative Clinic (Children) 38 Speech Therapy (Children) 38 Staff of Public Health Department 5 Statistical Tables Appendix Statistics General 9,10 Still Births 14, 18 Streets, Mileage of 10 Street Traders 90 Suicide 29 Summary of Sanitary Work 70-72 Sunlight Treatment 33 Supervision of Food Premises 90 Supplies of Underground Water (Wells) 53 Swimming Baths 60, 61 T Therapy, Speech (Children) 38 Toddlers Clinic Attendances 33 Town & Country Planning Act, 1947 78 Transfers (Housing) 79 Transported Meals for Old People 67 Treatment Centres and Clinics 35-38 Tuberculosis 14, 15, 24, 25, 109, 110 111, 114-122 Tuberculosis — Handicrafts Centre Sessions 37 Tuberculosis Officer's Report 114-122 Typhoid Fever 24, 106 U Underground Water Supplies (Wells) 53 Uninhabited Houses 9 Unsound Food 87, 89 V Page Vaccination Cases 34, 104 Vaccination and Immunisation Clinics 36 Vaccination, International Certificates 104 Various Death Causes, Remarks on 23-29 Vascular Lesions of Nervous System 28 Verminous Conditions 64, 65, 112 Verminous Premises 59, 64, 65 Violent Deaths 29 Vital Statistics 9-29 & Appendix Voluntary Organisations 39 Voluntary Organisations, Grants to 68 W Wash-houses & Public Baths 60, 61 Washing Facilities (Hand) 63 Water—Underground Supplies (Wells) 53 Water Supply 53 Water Supply Certificates 53 Weil's Disease 56 Welfare Clinics 35-38 Welfare Foods, National— Distribution Centres 30 Wells 53 Whooping Cough 14, 24, 105 Whooping Cough Prophylaxis Cases 34 Whooping Cough Prophylaxis Clinics 36 Women's Special Clinic 38 Women's Voluntary Services 39 X X-Ray Examinations 122 X-Ray, Mass 111 Z Zymotic Diseases 24, 107 Zymotic Enteritis 24, 107 INFANTILE MORTALITY DURING THE YEAR 1955 Deaths from stated Causes in Weeks and Months under 1 Year of Age. Cause of Death. Under 1 week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—3 Months. 3—6 Months. 6—9 Months. 9—12 Months. Total Deaths under One Year. Small-Fox ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Tubercular Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... 1 ... ... ... 1 Tracheo Bronchitis ... ... ... ... ... 1 ... ... ... 1 Broncho Pneumonia ... ... 1 ... 1 ... ... ... ... 1 Gastro-Enteritis ... ... ... ... ... ... ... ... ... ... Injury at Birth 3 ... ... ... 3 ... ... ... ... 3 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformation 1 ... ... ... 1 1 ... ... ... 3 Premature Birth 9 ... ... ... 9 1 1 ... ... 11 Atrophy, Debility and Marasmus ... ... ... ... ... ... ... ... ... ... Hepatic Failure ... ... ... ... ... ... ... ... ... ... Inattention at Birth ... ... ... ... ... ... ... ... ... ... Other Causes ... ... ... ... ... ... ... ... ... ... Unascertainable ... ... ... ... 1 ... ... ... ... ... Totals 13 ... 1 ... 14 4 1 1 1 21 Male 13 Female 8 CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1955. Notifiable Disease Cases Notified in Whole District Age & Sex Group Total Cases Notified in each Locality No. of Cases removed to Hospital from each Locality Total At all Ages 0 to 1 1 to 3 3 to 5 5 to 10 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 ... 1 ... 1 ... ... ... 1 ... ... 3 1 ... ... 3 4 Small-Pox ... ... ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Encephalitis Infectious ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Post-Infectious ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 1 Dysentery 8 9 ... 1 4 2 1 ... ... 2 1 ... 1 1 1 2 ... 1 ... ... 7 ... ... 10 2 ... ... 4 6 Erysipelas 2 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 ... ... 3 ... ... 3 1 ... ... 1 2 Acute Polio-Myelitis P. 17 6 1 ... 1 ... 1 1 7 3 ... ... 3 1 4 1 ... ... ... ... 2 2 ... 19 2 2 ... 19 23 N.P. 20 12 1 ... 3 ... 3 1 7 8 2 1 4 ... ... 2 ... ... .... ... 7 ... ... 25 7 ... ... 25 32 Scarlet Fever 31 20 ... ... 3 1 9 7 18 15 ... 2 1 ...... ...... ... ... 1 ... ... 14 6 2 35 3 ... 1 4 8 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scabies 1 3 ... ... ... ... ... ... ... ... 1 3 ... ... ... ... ... ... ... ... 2 ... 1 1 ... ... ... ... ... Puerperal Pyrexia ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 1 ... ... ... 1 Meningococcal Infection 4 1 1 ... 2 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 2 ... 2 1 2 ... 2 5 Measles 857 827 22 28 171 158 253 217 394 412 14 7 2 1 1 2 ... 2 ... ... 543 284 98 759 20 7 7 7 41 Whooping Cough 92 73 7 5 18 13 19 18 48 33 ... 1 ... ... ... 3 ... ... ... ... 55 26 2 82 1 1 2 5 9 Diarrhoea 2 5 ... 4 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 4 1 1 1 4 1 1 1 7 Ophthalmia Neonatorum ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 Pneumonia, Acute Primary or Acute Influenzal 8 6 ... ... ... ... ... ... ... 1 ... ... ... 1 2 2 2 2 4 ... 5 1 2 6 ... ... 1 1 2 Tuberculosis, Pulmonary 49 42 ... .... 1 ... ... ... 1 2 ... 2 11 15 22 20 11 3 3 ... 18 20 4 49 2 1 ... 4 7 „ Non Pulmonary 5 3 ... ... ... ... ... ... ... ... 2 ... 3 1 ... 1 ... 1 ... ... 1 2 ... 5 1 1 ... 3 5 Totals 1,100 1,020 32 39 204 175 287 245 475 476 20 16 27 20 32 35 16 12 7 2 665 344 110 1,001 47 15 12 80 154 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, 1955. No. in Short List 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 Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton and Kidbrooke St. Alfeee's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital Other Institutions Outside Institutions Under 4 mths. 4 mths. and undter 1 yr. 1 Tuberculosis, Respiratory 7 ... ... ... ... ... ... 3 3 1 ... 1 2 ... 4 3 ... 1 ... ... ... ... 33 2 Tuberculosis, Other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 3 Syphilitic Disease 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... 5 4 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Meningococcal Infections 3 1 ... 1 1 ... ... ... ... ... ... 1 1 ... 1 1 ... ... ... 1 ... 1 2 7 Acute Poliomyelitis 2 ... ... ... ... ... ... 1 ... ... ... 2 ... ... ... ... ... ... ... 1 ... 1 4 8 Measles 2 ... ... ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... ... ... 1 2 9 Other Infective and Parasitic Diseases 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 2 10 Malignant Neoplasm, Stomach 25 ... ... ... ... ... ... 1 10 4 10 9 5 1 10 8 ... 2 ... 4 ... 2 36 11 Malignant, Neoplasm, Lung, Bronchus 35 ... ... ... ... ... ... 3 19 6 7 11 8 1 15 14 ... 4 ... 1 ... 9 90 12 Malignant Neoplasm, Breast 15 ... ... ... ... ... 1 5 6 3 9 3 ... 3 6 ... 2 ... ... ... 5 25 13 Malignant Neoplasm, Uterus 7 ... ... ... ... ... ... 1 1 4 1 2 1 ... 4 2 ... ... ... 1 ... 1 7 14 Other Malignant and Lymphatic Neoplasms 84 ... ... ... ... 2 1 8 24 26 23 34 17 2 31 31 3 6 ... 1 ... 19 143 15 Leukaemia, Aleukaemia 4 ... ... ... 1 ... ... ... ... 1 2 3 1 ... ... 1 ... ... ... ... ... 3 9 16 Diabetes 6 ... ... ... ... 1 ... ... 1 2 2 2 2 ... 2 3 ... ... ... 1 ... 1 18 17 Vascular Lesions of Nervous System 92 ... ... ... ... ... 1 2 19 27 43 39 15 4 34 44 2 5 ... ... ... 12 169 18 Coronary Disease, Angina 107 ... ... ... ... ... ... 3 39 27 38 52 14 4 37 24 1 10 ... 1 ... 12 107 19 Hypertension with Heart Disease 12 ... ... ... ... ... ... ... 2 5 5 6 3 ... 3 2 1 1 ... ... ... 1 13 20 Other Heart Disease 128 ... ... ... ... 1 ... 5 9 35 78 47 27 6 48 63 3 3 ... 2 2 2 180 21 Other Circulatory Disease 59 ... ... ... ... ... ... 1 13 16 29 21 12 4 22 28 2 2 ... 1 ... 6 101 22 Influenza 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 1 ... ... 2 23 Pneumonia 42 1 ... 1 ... ... 1 ... 9 11 19 20 6 2 14 25 4 1 ... 1 ... 4 114 24 Bronchitis 56 1 ... ... ... ... ... 2 11 19 23 15 15 1 25 12 3 2 ... 1 1 2 75 25 Other Diseases of Respiratory System 12 ... ... ... ... ... ... ... 7 4 1 5 1 ... 6 2 ... 1 ... 1 ... 1 15 26 Ulcer of Stomach and Duodenum 8 ... ... ... ... ... ... ... 3 1 4 3 1 ... 4 5 ... 1 ... 1 ... ... 30 27 Gastritis, Enteritis and Diarrhoea 8 ... ... ... ... ... ... 1 3 3 1 3 3 ... 2 3 ... 3 ... ... ... 2 12 28 Nephritis and Nephrosis 6 ... ... ... ... ... ... 2 2 1 1 4 ... 1 1 4 ... ... ... ... ... ... 14 29 Hyperplasia of Prostate 10 ... ... ... ... ... ... ... ... 3 7 5 ... ... 5 7 1 1 ... ... ... 1 14 30 Pregnancy, Childbirth, abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 31 Congenital Malformations 7 4 ... ... ... ... ... 1 2 ... ... 3 ... ... 4 1 ... ... ... ... ... 4 8 32 Other defined and ill-defined Diseases 62 12 1 ... 1 2 ... 7 15 11 13 16 7 5 34 10 1 3 ... 6 ... 18 127 33 Motor Vehicle Accidents 7 ... ... ... 1 1 1 1 1 1 1 5 ... ... 2 4 ... ... ... ... ... 2 20 34 All other Accidents 10 ... ... ... 2 1 ... ... 3 2 2 5 ... ... 5 6 ... ... ... ... ... 2 26 35 Suicide 8 ... ... ... ... ... ... 1 4 2 1 2 2 ... 4 2 1 ... ... ... ... ... 11 36 Homicide and Operations of War ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 827 19 2 2 7 8 5 44 207 219 314 328 147 32 320 320 23 49 ... 25 3 112 1,420 Note.—All " Transferable Deaths " of residents, i.e., persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e.. of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded.