??? Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1956 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1956 Printed, by Freame, Manning & Co., Ltd. Lewisham, S.E.I3 CONTENTS Page Public Health Committee 3 Introductory 6 Section A.—General and Vital Statistics 8 „ B.—General Provision of Health and Weltare Services for the Area 27 „ C.—Sanitary Circumstances of the Area 35 „ D.—Housing 73 „ E.—Inspection of Food and Supervision of Food Premises 80 „ F.—Prevalence of, and Control Over, Infectious and other Diseases 102 „ G.—Miscellaneous 127 Appendix—Statistical Tables 3 PUBLIC HEALTH COMMITTEE as at 31st December, 1956 The Mayor: Councillor Mrs. M. L. Bennett, J.p. and 13 Members Councillor Mrs. M. L. Wentworth (Chairman) Councillor A. C. Chrisp, L.C.C. (Vice-Chairman) Aldermen : Mrs. L. Hilldrith P. Noble Councillors : Mrs. L. Berry D. P. Lynch Mrs. K. P. Bullard W. S. Manners J. B. Gillard R. Ruston R. G. Ingrey Dr. W. Smith Mrs. A. D. A. Kennedy Powers arid 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 apecified in Part I of the First Schedule to such Acts, the functions of the Council under Sections 16 and 18 of the Food and 4 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.—(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. 7.—The functions of the Council under the Clean Air Act, 1956, shall stand referied to the Committee. 8.—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. 9.—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. 10.—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. 5 STAFF as at 31st December, 1956 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. PUBLIC HEALTH INSPECTORS: ac W. H. Collins, b.e.m. (Senior). District Inspectors : abc S. A. Radford ab W. C. Scales† a H. D. Dawes* 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 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 Public Health Inspector. b „ Meat and Other Foods c „ Smoke Inspector. d „ Health Visitor. e „ State Registered Nurse. f „ State Certified Midwife. * Commenced duties 1 /3/56 † „ „ 9/4/56 6 Public Health Department, Town Hall, Greenwich, S.E.10. August, 1957. To the Mayor, Aldermen and Councillors, Metropolitan Borough of Greenwich. Ladies and Gentlemen, I have pleasure in presenting the Annual Report for 1956. Once again the population has continued to decline, the estimated figure of 88,780 being 710 lower than last year. The adjusted death rate was 1.41 greater, but again, at 15.07, Infantile Mortality Rate continued to be lower than most boroughs and considerably lower than the average for London. There were 13 Neo-natal Deaths, corresponding to 65% of all Infant Deaths under one year. I am glad to report that no mother died as a result of childbirth. The Cancer death rate continues to increase and is now 2.11 as against 1.89 last year. Cancer of Lung and Bronchus showed marked increase but there was a slight decline in intestinal malignancy. There was a slight increase in deaths from Pulmonary Tuberculosis, but no deaths were recorded as due to any of the other common infectious diseases. The Borough was free from Diphtheria and there were only 44 cases of Measles as against 1,684 in 1955. Whooping Cough declined by 43 and Poliomyelitis by 15. There were 9 notifications of Poliomyelitis, 5 being in respect of residents ; one Greenwich case was notified to Lewisham, giving a total of 6 Borough cases. Four were of the paralytic type and 2 non-paralytic. The most notable feature of the year in regard to infectious diseases was the high incidence of Sonne Dysentery, a comparatively mild but troublesome intestinal infection. There were 480 notified cases and in the body of the Report I have included a comprehensive analysis of the cases, together with an assessment of environmental factors. The Chest Physician, Dr. Jeanes, has kindly supplied me with information about the year's work at the Chest Clinic, and it is gratifying to record the satisfactory progress which is being made in Greenwich in regard to Tuberculosis treatment and control. 7 The Old People's Welfare Committee is now well established and I have included details of welfare work undertaken for the old people in the Borough. The Food and Drugs Act became law at the beginning of the year, together with the Food Hygiene Regulations, although the implementation of some of the provisions of the Regulations was delayed until July. The Clean Air Act passed through Parliament and became law on the 31st December, and I have detailed the main provisions in so far as they affect the Health Department. Meanwhile, the Department continues to measure smoke and sulphur dioxide concentration at Charlton House and the Town Hall as part of a research project covering the whole of the country. With the Clean Air Act, now law, serious attention will have to be given to the creation of smoke control areas. This will necessitate major policy decisions by the Council together with close co-operation with adjacent boroughs, in order to ensure uniformity of practice. In conclusion, I wish to thank the staff for help and loyalty throughout the year, and I am glad to record the support which I have received from the Chairman and Vice-Chairman of the Public Health Committee. I am also pleased to acknowledge the kindness and consideration of the Town Clerk and other Chief Officers to me personally. I have the honour to be, Your obedient Servant, J. Kerr Brown. Medical Officer of Health 8 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. Abba of the Bobough and Disteicts— East Greenwich 1,300 aores West Greenwich 453 „ St. Nicholas, Deptford 115 „ Charlton & Kidbrooke 1,990 „ 3,858 aores Population— At Census, 1951 89,846 Estimated, 1956 (mid-year) 88,780 Density of Population (persons per acre) 23.0 Numbee of Inhabited Dwellings—end 1956 23,759 (according to Rate Books) Structurally separate dwellings at Census, 1951 21,348 Numbeb of Uninhabited Dwellings— At Census, 1951 364 At end 1956 136 Numbeb of Families ob Sep abate Ocoupiebs— At Census, 1951 26,397 Rateable Value, 1956 £1,402,911 Sum Rbpbesented by a Id. Rate, 1956 £5,755 9 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— Greenwioh Park 185 acres L.C.C.— Blackheath (part of) 89 acres Blackheath—Rangers House and Garden 2½ ,, Mar yon and Mary on 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) 10 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 wliich 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. In all, public open spaces amount to 11.4% of the total area of the Borough, equivalent to approximately 5 acres per 1,000 of its population. 11 Excellent recreation grounds serve the Charlton area for, in addition to the Maryon and Charlton Parks, there is the L.C.C. Play Centre and Lido with its well-equipped swimming bath, tennis courts and bowling greens. More recently, social centres catering for all shades of cultural and educational tastes have been established at Charlton House, Kidbrooke House, the Town Hall and the Old 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, Merry weather's Works (Fire Engines), Cement and Stone Works, Asbestos Works, Cold Meat Storage, Pressed Tool Works, Constructional Engineering Works, Galvanising and Sheet Metal Works, Brewery, Flour Mills, Aero Parts, Wireless and Vehicle Parts and Tin Box Manufacturing Works. The numbers employed at 11 of the larger factories range lietween 500 and 5,000 each, whilst 17 smaller works each employ l>otween 100 and 400. 12 POPULATION The Registrar General has submitted his estimate of the population of Greenwich, computed at mid-year 1956, upon which the Statistics of this Report have been based. The figure returned is 88,780 indicating a decrease in the population of 710 since last year and 1,066 since the 1951 Census. The current figure shows an advance of 24,980 over that for 1945. The natural increase for the year, i.e., excess of births over deaths was 453. The Child Population at mid-year 1956, as estimated by the Registrar General was :— Age No. Approx. per cent, of Total Population Under 1 year 1,330 1.5 1 to 4 years inclusive 5,470 6.2 5 to 14 years inclusive 14,300 16.1 Total 21,100 23.8 13 * EXTRACTS FROM VITAL STATISTICS OF THE YEAR. LIVE BIRTHS Legitimate Illegitimate Total Male 638 37 675 Birth Rate (Crude) 14.99 Female 626 26 652 1 (Comparable Rate J 14.09) Total 1,264 63 1,327 STILL BIRTHS Legitimate Illegitimate Total Male 12 1 13 Rate per 1,000 total Births Female Total 17 29 3 4 20 33 24.26 DEATHS—All Causes Male Female Total Death Rate (Crude) 9.87 494 380 874 (Comparable Rate 11.35) DEATHS—Special Causes Puerperal Causes Nil Tuberculosis (all forms) 13 Tuberculosis, Pulmonary 12 Cancer (all ages) 187 Measles (all ages) Nil Whooping Cough (all ages) Nil Diarrhoea (under 2 years of age) Nil Influenza 3 'These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 14 DEATH RATES Infants under 1 year of age All infants per 1,000 live births 15.07 Legitimate Infants per 1,000 legitimate live births 15.03 Illegitimate Infants per 1,000 illegitimate live births 15.87 Others Puerperal Causes (per thousand total births) Nil Tuberculosis (all forms) per 1,000 population 0.14 Tuberculosis, Pulmonary per 1,000 population 0.13 Cancer per 1,000 population 2.11 Common Infectious Diseases per 1,000 population Nil Influenza per 1,000 population 0.03 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 1956. The total of 723 gives a marriage rate of 16.34 an increase of 0.33 over that of the previous year. The following table shows these particulars giving the number of marriages in the Borough for each year since 1946 :— Churches of England Chapels and Roman Catholic Churches SuperintendentRe^iatrar's Office Total Approximate Population Year Greenwich Charlton and Kidbrooke St. Nicholas 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 1956 194 169 6 133 221 723 88,780 18t. Peter's, Creek Road )closed. Holy Trinity. Blackheath Hill ) 15 METEOROLOGICAL OBSERVATIONS—1956. 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,1956 : — Temperature : The highest screen temperature was 84°F. on 26th July. The temperature exceeded 80°F. on 8th July (82°F.) 25th July (82°F.) 26th July (84°F.) The lowest screen temperature was 16°F. on 21st February. The extreme maximum temperatures during January, February, November and December, were :— 55°F. on 29th January 55°F. on 29th February 57°F. on 8th and 9th November 57 °F. on 12th December Sunshine: Total hours recorded 1323.0 The sunniest day was 25th July, when 14.4 hours of sunshine was recorded. There were 94 days when no sunshine was recorded, viz:— January ... 17 days February ... 11 „ March ... 5 ,, April ... 3 „ May ... Nil June ... 4 days July ... 5 „ August ... 3 ,, September ... 2 ,, October ... 6 „ November ... 13 ,, December ... 25 „ Rainfall : Total for the year ... 21.30 inches Highest in 24 hours ... 1.18 inches on 11th June Driest Month ... February (0.16 inches) Wettest Month ... July (3.38 inches) 16 BIRTHS The total number of live births registered in the Borough during the year was 1,386 and of this number 1,013 occurred in St. Alfege's Hospital, and 373 in private dwellings. In 560 cases the parents resided outside the Borough and the births were consequently transferred to the appropriate districts, leaving a figure of 826. To this must be added 501 births belonging to the Borough which took place in Institutions outside the Borough, thus making a final figure for Greenwich of 1,327, an increase of 16 over that of the previous year. Of this total 675 were males and 652 females. The following table gives by districts the number of registrations of Greenwich Births during the current year :— Source of Information DISTRICT Total Greenwioh Births East West St. Nicholas Charlton & Kidbrooke Greenwich Registrar's Returns:— 303 169 72 282 826 Inward Transfers:— 1st Qtr. 42 15 — 73 130 2nd Qtr. 44 14 1 73 132 3rd Qtr. 40 17 — 70 127 4th Qtr. 33 17 — 62 112 Totals 462 232 73 560 1,327 The Birth Rate for the year, calculated on the figure of 1,327 births, is 14.99 per thousand of the population, 0.30 higher than that for 1955. The average rate for the previous ten years is 17.50. The Greenwich Comparability Factor for births is 0.94 which gives an adjusted rate of 14.09. The Rates for the County of London and England and Wales are 15.9 and 15.6 respectively. Illegitimate Births which numbered 63 (representing 4.7 per cent, of the total live births) showed an increase of 3 over those of the previous year. The number of Still Births registered was 33 (13 males 20 females), which is equivalent to a rate of 24.26 per 1,000 total births, an increase of 3.35 over that of 1955. No. in Short List. Causes OF Death Sex Deaths at subjoined Ages of " Residents," whether occurring within or without the District. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 6") and under 75. 75 and over. All Causes M 494 10 4 4 3 22 42 146 163 F 380 10 1 3 1 21 72 86 186 1 Tuberculosis, Respiratory M 9 ... ... ... ... 3 ... 5 1 F 3 ... ... ... ... 1 ... 1 1 2 Tuberculosis, Other M ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... ... 1 3 Syphilitic Disease M 4 ... ... ... ... ... 2 2 ... F ... ... ... ... ... ... ... ... ... 4 Diphtheria M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 5 Whooping Cough M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 6 Meningococcal Infections M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 7 Acute Poliomyelitis M ... ... ... ... ... ... ... ... ... 8 Measles F ... ... ... ... ... ... ... ... ... M ... ... ... ... ... ... ... ... ... 9 Other Infective and Parasitic F ... ... ... ... ... ... ... ... ... M i ... ... ... ... ... 1 ... ... 10 Diseases Malignant Neoplasm. Stomach F ... ... ... ... ... ... ... ... ... M 12 ... ... ... ... ... 6 6 ... 11 Malignant Neoplasm, Lung, F 8 ... ... ... ... ... 2 2 4 M 54 ... ... ... ... 1 29 16 8 Bronchus F 4 ... ... ... ... ... 3 1 ... 12 Malignant Neoplasm, Breast M ... ... ... ... ... ... ... ... ... F 13 ... ... ... ... 2 4 5 2 13 Malignant Neoplasm, Uterus F 6 ... ... ... ... 1 4 ... 1 14 Othei Malignant and Lymphatic M 52 ... ... ... ... 5 18 18 9 Neoplasms F 38 1 ... ... ... 1 14 8 14 15 Leukaemia, Aleukaemia M 1 ... ... ... ... ... ... ... 1 F 3 ... ... 2 ... 1 ... ... ... 16 Diabetes M 3 ... ... ... ... ... 2 ... 1 F 7 ... ... ... ... ... 2 2 3 17 Vascular Lesions of Nervous M 36 ... ... ... ... 1 13 8 14 System F 49 ... ... ... ... 2 11 12 24 18 Coronary Disease, Angina M 80 ... ... ... ... 3 22 30 25 F 51 ... ... ... ... 1 6 19 25 19 Hypertension with Heart Disease M 14 ... ... ... ... ... 4 3 7 F 11 ... ... ... ... ... 2 4 5 20 Other Heart Disease M 49 ... ... 1 ... ... 5 11 32 F 54 ... ... ... ... 4 6 10 34 21 Other Circulatory Disease M 15 ... ... ... ... ... 6 2 7 F 15 ... ... ... ... ... 2 2 11 22 Influenza M F 3 ... ... ... ... ... 2 ... 1 23 Pneumonia M 37 2 1 1 ... ... 3 12 8 F 42 ... ... ... ... 1 3 7 31 24 Bronohitis .. M 48 2 ... ... ... ... 12 17 17 F 24 1 ... ... ... ... 4 6 13 25 Other Diseases of Respiratory M 6 ... ... ... ... ... 4 1 1 System F 1 ... ... ... ... ... 1 ... ... 26 Ulcer of Stomach and Duodenum M 5 ... ... ... ... ... 2 2 1 F 3 ... ... ... ... ... ... 1 2 27 Gastritis, Enteritis and Diarrhoea M 1 ... ... ... ... ... ... ... 1 F 1 ... ... ... ... ... 1 ... ... 28 Nephritis and Nephrosis M 9 ... ... 1 ... 2 2 ... 4 F 2 ... ... ... ... 1 ... 1 ... 29 Hyperplasia of Prostate M 9 ... ... ... ... ... ... 4 5 30 Pregnancy, Childbirth, abortion F ... ... ... ... ... ... ... ... ... 31 Congenital Malformations M 4 2 1 ... ... 1 ... ... ... F 5 4 ... ... ... l ... ... ... 32 Other defined and ill-defined M 28 4 ... ... ... 3 7 4 10 Diseases F 23 4 ... 1 ... 1 5 4 8 33 Motor Vehicle Accidents M 3 ... ... 1 2 ... ... ... ... F 3 ... 1 ... ... 1 ... ... 1 34 All other Accidents M 8 ... ... ... 1 3 1 3 ... F 7 ... ... ... ... 1 ... 1 5 35 Suicide M 3 ... ... ... ... ... 1 2 ... F 5 ... ... ... 1 1 2 ... 1 36 Homicide and Operations of War M ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... 1 ... ... ... 17 DEATHS The net number of deaths registered during 1956 was 874, of which 494 were males and 380 females, compared with last year's total of 829 comprising 459 males and 370 females. This gives a crude Death Rate for the Borough of 9.87 per thousand of the population, an increase of 0.58 as compared with that of the previous year and a rate which is 0.49 less than the average for the last ten years, viz., 10.36. The crude Death Rate figure is increased to 11.35 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 nlore 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 1.15 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 identical viz: 11.7. The inset table showing the causes of deaths at all ages has been supplied by the Registrar-General and is included in accordance with the Ministry of Health's request. In the Appendix to the Report will be found a table giving by districts, the causes of, and ages at death of residents whilst indicating the numbers actually dying in Public Institutions. 18 DEATHS IN INSTITUTIONS. The following table compares the average number of deaths of Greenwich residents in Public Institutions during the previous ten years with those of the current year :— Deaths of Greenwich Residents Year Total In Public Institutions No. % of Total Deaths 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 1955 829 532 64.1 10-year average 898 521 57.9 1956 874 574 65.6 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 5 4 6 20 Between 1 and 2 years 1 — — — 1 Between 2 and 5 years — 2 1 1 4 Between 5 and 15 years 1 4 1 1 7 Between 15 and 25 years — 1 o 1 4 Between 25 and 45 years 15 11 9 8 43 Between 45 and 65 years 67 53 40 54 214 Between 65 and 75 years 85 57 47 43 232 75 years and upwards 120 79 69 81 349 Totals 294 212 173 195 874 19 During the year the pattern of death registrations continued normally, namely that the first quarter produced the most (33.6%) and the third quarter the least (19.8%). It will be observed from the following table that during 1956 the deaths occurring at 65 years and upwards accounted for 66.5% 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 2.9%. Age Group 1901 1911 1921 1931 1951 1956 Under 1 year of age 362 306 175 97 29 20 Between 1 and 5 years 187 158 80 39 7 5 Between 5 and 15 years 64 67 58 22 10 7 Between 15 and 25 years 66 60 67 65 12 4 Between 25 and 65 years 454 474 466 382 311 257 65 years and over 335 356 387 529 633 581 Totals 1,468 1,421 1,243 1,134 1,002 874 MATERNAL MORTALITY There were no deaths from Puerperal Sepsis or other Maternal causes during the current year, a similar position to that recorded for each of the previous three years. 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 15.07 per thousand live births as compared with 16.01 for last year and 22.79, the average for the previous ten years, For the County of London the rate was 21.4 and for England and WaJcs 23.8 per 1,000 related live births. The present Borough figure of 15.07 is 6.33 lower than that for London and shows a decrease of 0.94 from that returned for the previous year and is only 0.45 greater than the rate for 1952, viz. 14.62, the lowest figure ever recorded for Greenwich. 20 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 1956 :— Average for Quinquennial Periods Year 1956 District 1931 to 1935 1936 to 1940 1941 to 1945 1946 to 1950 1951 to 1955 Greenwich 75 50 40 27 18.4 15.07 London 63 56 60 33 23.8 21.4 England & Wales 62 55 50 36 26.9 23.8 The actual number of infantile deaths recorded during the year was 20 (one less than last year) and these were attributed to the following causes :— Congenital Inhalation 1 Malformations 7 Pulmonary Atelectasis 1 Prematurity 4 Pancreatic Atrophy Tracheo-bronchitis 3 and Fibrosis 1 Broncho-pneumonia 2 Sarcoma of Vulva 1 Of the above, 10 were ma'e and 10 female; 9 died in St. Alfege's Hospital, 9 in Hospitals and Maternity Homes outside the borough and 2 at home. Neo-Natal Mortality.—Neo-natal mortality, i.e., infants dying before attaining the age of one month, accounted for 13 deaths, equivalent to 65% of all infant deaths and giving a Neo-natal Mortality Rate of 9.79 per 1,000 live births. This compares very favourably with the figure of 16.9 for England & Wales. Twelve of these neo-natal deaths occurred within the first week of birth, the main causes being Congenital Malformation and Prematurity. Perinatal Mortality.—The Perinatal Mortality Rate, calculated from a total of 45 stillbirths and deaths of infants under 1 week, was 33.1 per 1,000 total births. Reproductive Wastage.—A sum total of 53 Stillbirths and Infantile deaths gives a reproductive wastage rate of 38.9 per 1,000 total births. 21 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. 22 Common Infectious Diseases.—Under this classification comprising Measles, Scarlet Fever, Diphtheria, Whooping Cough and Diarrhoea no deaths were registered for the current year. There were 2 deaths during 1955, one for 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 54th since a death from this disease occurred. Measles.—There were no deaths arising from this cause during the year compared with 2 for the previous year. Prior to 1955 no deaths had been registered since the year 1947 when there was one. Scarlet Fever.—For the tenth 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 each of the previous 2 years. 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 and for 1955, 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 10 years since one was recorded. Tuberculosis.—There were 13 deaths from this disease during the year giving a Death Rate of 0.14 compared with 8 deaths and a Rate of 0.08 for the previous year. This year's Rate, although some 0.06 higher than that for 1955, still compares favourably with the average T.B. Death Rate during the previous 10 years, viz : 0.47 Again current figures throw into relief the remarkable improvement in the Tuberculosis situation in the Borough during recent 23 years. Actual deaths from Tuberculosis have been reduced to approximately one sixth and the rate to one seventh of the corresponding figures for 1946 as the following table will indicate:— Year No. of Deaths Rate 1946 75 0.97 1947 69 0.82 1948 62 0.73 1949 46 0.53 1950 44 0.49 1951 35 0M 1952 32 0.35 1953 18 0.19 1954 15 0.16 1955 8 0.08 10-year Average 40 0.49 1956 13 0.14 Tuberculosis of the Respiratory System was responsible for 12 of the deaths in this category, only one death being attributed to the remaining forms of tuberculosis. At 0.13, the Pulmonary Tuberculosis rate was 0.06 higher than that returned for the previous 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 deathsi An increase in numbers therefore, is not, per se, necessarily an indication of increased morbidity. Cancer was responsible for a total of 187 deaths giving a rate of 2.11 per thousand, these figures showing increases of 18 and 0.22 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 21.4, the figure for 1956. 24 Comparing the current year's figures with those of the previous 5 years, the sites of the affected parts were — 1951 1952 1953 1954 1955 1956 Cancer of Stomach 24 24 33 23 26 20 „ „ Lung, Bronchus 51 31 27 47 35 58 „ „ Breast 14 11 12 18 16 13 „ „ Uterus 11 6 11 3 6 6 „ „ all Other Sites 98 89 76 75 86 90 Totals 198 161 159 166 169 187 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 1956 1 — 29 3 16 1 8 — 54 4 58 0.65 Totals 16 2 187 26 95 14 31 7 329 49 378 Average for 11 yre. 0.39 25 From the preceding table it can be seen that the age group 45 to 65 years is still the period of greatest mortality and is twice that of the next age group viz. 65 to 75 years, a category in which the reverse would have been a more normal pattern. In 1946, there were 17 deaths of Gieenwich residents from cancer of the lung, approximately one quarter of the total registered for pulmonary tuberculosis viz. 75. During the current year, figures of 58 and 12 respectively have been recorded, showing that lung cancer is now claiming nearly 5 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 Jung has increased, one might almost say, correspondingly. 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 Act 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. So far, no such scheme for notification has yet been formulated. Vascular Lesions of Nervous System.—This class, which includes deaths arising from Cerebral Haemorrhage, Embolism and Thrombosis was responsible for a total of 85 deaths. The age distribution was as follows:—3 between 25 and 45 years; 24 between , 45 and 65 years ; 20 between 65 and 75 years and 38 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 Diseaso. The total deaths occasioned by such maladies amounted to 259 compared with a figure of 252 for 1955 and, as usual, the deaths from this category occupied the principal place in the classification of diseases in that they formed 29.6% of the total of deaths from all causes. 26 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 a quarter 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, viz. 64%. 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 158 deaths from these diseases, Bronchitis accounting for 72 and Pneumonia (all forms) for 79. These figures show increases of 48, 13 and 25 respectively over those of the previous year. Of the total deaths 5 were children under one year of age and 123 were in respect of persons 65 years and over. Influenza.—There were 3 deaths attributed to this cause during the year compared with one returned for last year. None was registered in 1954 but fifteen were recorded during 1953. Deaths from Violence.—These numbered 29 including 6 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 two fewer in number to those of the previous year, while the figure for suicide showed no change. 27 SECTION B General Provision of Health and Welfare Services for the Area Since July, 1948, the Personal Health Services available to residents of the Borough have been under the control of the London County Council and Dr. Waldron, the Divisional Medical Officer, has kindly supplied me with information and statistics relating to Health Visitors' records, attendances at Infant Welfare Centres, Prophylaxis figures, etc., for 1956, 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.—1 p.m. Chevening Road, S.E.10 Tuesday 1.30 p.m.—1 p.m. Wednesday 9.30 a.m.—12 noon Friday 1.30 p.m.—4 p.m. 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 9.30 a.m.—12 noon 1.30 p.m.—4 p.m. Shooter's Hill Road, S.E.3 Monday Tuesday 1.30 p.m.—4 p.m. Wednesday 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 28 Health Visitors' Records, Attendances at Infant Welfare Sessions, Prophylaxis figures, etc. 1. Health Visiting Quarter Expectant Mothers Premature Babies StillBirths Infanta (under 1 year) Chldren 1—5 years S hool Children Care of Feop e Miscellaneous Unsuc cessful Total Visits 1st visit Revisit 1st visit Re- visit Old Others March 116 05 19 11 330 1,016 1,733 158 89 17 182 550 4,316 June 76 107 19 37 375 1,305 2,875 167 69 31 £95 646 6,002 Sept. 106 85 16 8 396 1,221 2,530 184 92 30 253 540 5,461 Dec. 132 107 21 6 299 1,422 2,946 213 96 55 160 523 5,980 Totals 430 | 394 75 62 1,400 4,964 10,084 722 346 133 890 2,259 21,759 2. Infant Welfare Clinics Quarter Sessions Attendances 0-1 year 1-2 years 2-5 years 1st Total 1st Total 1st Total March 206 307 4,035 16 1,025 27 768 June 203 320 4,686 17 1,172 42 859 September 208 324 5,233 19 1,152 40 917 December 213 £41 4,703 7 1,002 16 768 Totals 830 1,192 18,657 59 4,351 125 3,312 29 3. Ante and Post Natal Clinics (a) Ante Natal Quarter Hospital Confinements Domiciliary Confinements Sessions 1st Attendances Total Attendances Sessions 1st Attendances Total Attendances This Year Current Pregnancy This Year Current Pregnant y March 185 217 158 478 185 194 113 1,010 J une 180 150 150 471 180 80 80 926 Sept. 199 129 129 478 199 90 90 1,018 Dec. 191 144 144 528 194 68 68 823 Totals 758 640 581 1,955 758 432 351 3,777 (b) Post Natal (cases seen at Ante-Natal Clinics) Quarter 1st Attendances Total Attendances This Year Since Confinement March 34 34 36 June 34 34 40 Sept. 44 44 48 Dec. 44 44 58 Totals 156 156 182 30 4. Toddlers Clinics Quarter Sessions Total Attendances Medically Examined Found to require Treatment M arch 27 187 183 18 June 20 141 141 7 September 11 54 53 9 December 8 125 125 13 Totals 66 507 502 47 5. Ante Natal Educational Sessions (including exercises) Quarter Sessions Total Attendances March 36 413 June 30 379 September 33 343 December 30 363 Totals 129 1,498 6. Artificial Sunlight and Children's Exercise Classes Quarter Sessions Attendances Artificial Sunlight Exercisi Classes First Total First Total March 69 75 1,578 8 36 June 50 30 966 1 33 September 68 40 852 5 37 December 76 65 1,100 4 88 Totals 263 210 4,496 18 194 7. Chiropody Treatment Quarter Sessions Attendances First Total March 434 262 4,642 June 431 354 4,507 September 436 256 4,172 Drcember 288 129 3,563 Totals 1,589 1,001 16,884 31 J. Home Help Service (a) Analysis of Cases, etc. Cases Home Helps Maternity Tuberculosis Chronii Sick, Aged & Infirm Others Total No. Part Time Whole Time Equivalent On live Register at: 1st Jan. '56 5 9 476 8 498 84 38 31st Deo. '56 Cases attended 2 13 513 3 531 79 36.84 during 1956 :— 53 19 651 29 752 — — (b) Supervision Effective Ineffective Total Visits made by Organising Staff: 2,221 387 2,608 9. Prophylaxis (a) Immunisation and Vaccination (Children under 5 years) Diphtheria immunisation (completed cases) 807 Whooping Cough immunisation (completed cases) 761 Vaccinated 59 7 (b) B.C.G. Vaccination (Children 13 years old at Greenwich Schools) No. of Children 13 years old 1,414 No. for whom parental consent was obtained 1,065 No. of negative reactors vaccinated 868 No. of positive reactors X-rayed 113 (c) Poliomyelitis Inoculation (Childrn born 1947-54 attending Greenwich Schools) No. of completed cases 655 10. District Nursing The staff of the Queens District Nursing Association for Charlton and Blackheath made 28,586 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. 11. School Health Service Vision Minor Ailments Clinics Special Investigation Clinic No. of Attendances 779 4,616 345 No. of New Cases 471 46 No. of Glasses Ordered 162 — — Note : As appropriate children from Greenwich also attend special clinics in Deptford and Woolwich. 32 TREATMENT CENTRES AND CLINICS Particulars relating to the local Health Services throughout the Borough are given below :— INFANT WELFARE CLTNICS ANTE & POST NATAL CLINICS Bardsley Lane, S.E.10 Blackheath Hill, S.E.10. (St. Alfege's Parochial Hall). Charlton Lane, S.E.7. Blackheath Hill, S.E.10 Chevening Road, S.E.10. Charlton Lane, S.E.7. Creek Road, S.E.8. ... Chevening Road, S.E.10 Fairfield House, S.E.7. Creek Road, S.E.8. Ridgebrook Road, S.E.3. Fairfield House, S.E.7. Shooter's Hill Road, S.E.3. Ridgebrook Road, S.E.3. Tranquil Vale, S.E.3 Shooter's Hill Road, S.E.3. Tranquil Vale, S.E.3 ARTIFICIAL SUNLIGHT TREATMENT FOOT CLINICS Chevening Road, S.E.10 Chevening Road, S.E.10 Fairfield House, S.E.7. Shooter's Hill Road, S.E.! Shooter's Hill Road, S.E.3. 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 MINOR AILMENTS CENTRES (for School Children) Chevening Road, S.E.10. Maryon Park School Treatment Centre, S.E.7. Halstow School, S.E.10. Sherington Road Kidbrooke Park School, S.E.3. Treatment Centre, S.E.7. LONDON COUNTY COUNCIL HEALTH SERVICES Enquiries :—Divisional Medical Officer, Division 6, St. Paul's House, Deptford High Street, S.E.8. (TID. 4621). 33 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 SCABIES & CLEANSING CLINICS Daily 9-12 2-4 Tunnel Avenue (Saturdays (School (Adults and excepted) Children) Children under school age) WOMEN'S SPECIAL CLINIC (Family Planning Association) Charlton Lane, S.E.7. Wednesday 12.30 HOME HELP SERVICE Applications for this service to be addressed to:— Divisional Medical Officer London County Council, Greenwich Sub-Office, 105, Shooter's Hill Road, S.E.3. DISINFECTING STATION Applications to:—Medical Officer of Health, Public Health Department, Town Hall, S.E.10. HOSPITALS Brook Hospital (Woolwich 1172) Miller Hospital (TIDeway 1136) Royal Herbert Hospital (Woolwich 1166) St. Alfege's Hospital (GREenwich 2655) Seamen's Hospital (GREenwich 3433) 34 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. 1075).. 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.I7. (RODney 2860). Family Welfare Association, Area 6, (Deptford, Greenwich and Lowisham), 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 p.m. to 4.30 p.m. Fri. 6 p.m. to 7 p.m. Sat. 9 a.m. to 11 a.m. 35 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 see n that a total of 13,614 houses and premises have been inspected or re-inspected during the year; 808 intimation notices and 147 statutory notices were served. Registered complaints, numbering 1,481 show an increase of 182 over those of the previous year, a total more than twice the pre-war average of 700. Legislation.—Sanitary Inspectors (Change of Designation) Act, 1956.—In accordance with this Act, from 2nd August onwards the Sanitary Inspectors are to be known as Public Health Inspectors, a designation more in keeping with their present-day duties. 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 441 inspections were made by the Council's Inspectors in relation to the 454 registered factories. The latter figure includes 81 premises where mechanical power is not used. Defects were found in 24 instances, all of which were remedied. 36 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 81 55 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 352 341 2 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 21 45 — — Total 454 441 2 - 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.l.) 7 7 — 1 Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors(S.6) 3 3 — — — Sanitary Conveniences (S.7) (o) insufficient — — — — — (b) unsuitable or defective 9 9 — 1 — (c) not separate for sexes 1 1 — — — Other offences against the Act (not including offences relating to Outwork) 4 4 - — — Total 24 24 — 2 — 37 Outwork—(Sections 110 and 111) Nature of Work Section 110 Section 111 No. of out-workers in August list required by Sect. 110(1) (c) No. of cases of default in sending list to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel}Making, etc. 50 — — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 1 - - - - - Lampshades 49 — — — — — Brass & Bras i articles 1 — — — — — Lace 1 — — — — — Cardboard Boxes 1 — — — — — Carding, etc. of Buttons, etc. 8 — - — — — Total 111 — — — — — 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 36 (b) Outworkers resident outside the Borough 57 Notifications received from firms outside the Borough of:— Outworkers resident in the Borough 125 Total number of Greenwich residents employed as outworkers (as given in August list) III Premises where homework is carried on were visited on 86 occasions by the Lady Public Health Inspector. In no instance was it necessary to take action because of infectious disease. 38 Pigeon Nuisance.—A local authority is enabled by Section 121 of the Public Health (London) Act, 1936, to deal with a nuisance arising from the congregation of pigeons believed to be ownerless and it has been the practice of this Council to authorise a pigeoncatcher to deal with pigeons on the highway and other public places. During the year several complaints were received and arrangements were made to reduce the pigeons to a reasonable number. In one instance, that concerning a school, special trapping methods had to be devised to deal with pigeons congregating in the roof space. River Pollution.—A probable explanation for the fact that no complaints regarding smells emanating from the River were registered during the current year was the increased rainfull, less sunshine and lower average temperatures, and the completion of certain works by the London County Council at their Northern Outfall at Beckton. Suspended solids and oxygsn demand on the river an important criteria in determining the quality of an ifHuent and the L.C.C. have reported, in connection with their plans to improve the sewage effluent discharged into the river at their Northern and Southern Outfalls, that the scheme for the Northern Outfall although not yet complete has already effected considerable improvement. The removal of suspended solids has risen from 61% in 1954/55 to 75% in 1955/56, and oxygen demand reduced from 61% to 51% respectively. This is an encouraging beginning to a project designed to restore, even if only partially, the former wholesomeness of the Thames. Atmospheric Pollution.—Pollution Recording.—Two atmospheric pollution measuring stations are maintained by the Council, one at the Town Hall and the other at Charlton House and 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 1956 :— 39 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 November 1955 .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 March »» .4601 .9788 .0863 .3479 .7113 .0837 April »» .5167 1.1035 .1789 .2005 .6800 .0445 May »» .1772 .3542 .us:w .1564 .4203 .0213 June »» .1475 .2809 .0273 .0706 .2487 .0108 July »» .1131 .2408 .0192 .0692 .1895 .0053 August »» .1370 .3372 .0160 .0550 .1616 .0101 September »» .2565 .5632 .0901 .0996 .3616 .0129 October >» .3642 .7056 .1780 .2175 .4480 .0700 November »» .3.1 .5900 .2370 .3411 .5800 .1445 December »» .5977 2.0399 .0850 .5110 1.4450 .0380 January, 1957 .5911 1.0624 .2627 .3844 .9058 .0466 February » .6601 1.1101 .2890 .3952 .9058 .1204 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 H ighest Lowest Average Highest Lowest November 1955 .1160 .2612 .0066 .1102 .2618 .0202 December „ .1078 .2970 .0316 .0932 .2848 .0303 January 1956 .1761 .5932 .0590 .1328 .3725 .0479 February „ .1685 .3870 .0976 .1405 .3879 .0684 March „ .0818 .1263 .0361 .0684 .1144 .0206 April „ .1009 . 1793 .0596 .0752 .1582 .0272 May „ .0576 .1313 .0257 .0576 .1055 .0158 June „ .0449 .0875 .0138 .0439 .0860 .0072 July „ .0375 .0659 .0109 .0338 .0755 .0071 August „ .0290 .0519 .0123 .0306 .0587 .0106 September „ .0440 .0950 .0160 .0310 .0640 .0080 October „ .0750 .1390 .0170 .0770 .1490 .0170 November „ .1170 .1950 .0390 .1180 .2330 .0350 December „ .1260 .3620 .0350 .0970 .3730 .0130 J anuary 1957 .0970 .2120 .0440 .0740 .1970 .0250 February „ .0930 .2000 .0350 .0780 .1580 .0200 40 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 :— TABLE III.—Rainfall, Monthly Deposit in Tons per Square Mile and Sulphur Dioxide by the Lead-Peroxide Method. Month Rainfall mm. Insoluble Deposit Soluble Deposit Total Solids SOs mg./day/lOO cm! of Batch A Lead Peroxide tons per square mile November 1955 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 March „ 7 35.0 10.3 45.3 3.9 April „ 26 30.7 8.8 39.5 2.3 May „ 11 29.2 9.1 38.3 1.4 June „ 69 40.4 17.2 57.6 1.4 July „ 70 28.5 10.3 38.8 1.2 August „ 111 29.0 10.0 39.0 0.7 September „ 65 32.0 12.3 44.3 0.9 October „ 20 35.1 10.0 45.1 2.4 November „ 10 37.9 9.7 47.6 3.4 December „ (a) (a) (a) (a) 2.8 January 1957 44 35.0 (a) (b) 2.4 February „ 66 29.4 9.6 39.0 2.3 (a) No figures available. (b) Not a certainable. TABLE IV.—Concentration of Smoke and Sulphur Dioxide by the Volumetric Method. Month Smoke mg/100mS Sulphur Dioxide p.p. 100 million Monthly Average Highest Daily Average Monthly Average Highest Daily Average November 1955 25 53 12 30 December „ 25 67 13 29 January 1956 31 110 16 64 February „ 30 113 13 42 March ,, 17 31 7 16 April „ 17 32 6 20 May „ 8 13 5 11 June ,, 6 10 5 15 July „ 5 10 5 8 August ,, 6 13 6 12 September „ 7 16 6 14 October „ 18 47 12 19 November „ 25 54 13 29 December „ 23 54 H 34 January 1957 17 38 9 29 February „ 21 39 10 20 41 Legislation.—Clean Air Act, 1956.—The main purposes of this Act, which was given the Royal Assent on 5th July, 1956, are :— (i) To prohibit the emission of dark smoke from chimneys, railway engines and vessels,subject to certain qualifications; (ii) To prohibit the installation of new industrial furnaces unless they are capable, as far as practicable, of being operated without emitting smoke ; (iii) To require that the emission of grit and dust from existing industrial furnaces shall be minimised, and that new industrial furnaces burning pulverised fuel or substantial quantities of other solid fuel shall be provided with grit arresting equipment ; and (iv) To empower local authorities by order, and subject to confirmation by the Minister concerned, to declare " smoke control areas " in which the emission of smoke from chimneys will constitute an offence. " Local Authority," so far as London is concerned, is defined in Part II of the Third Schedule to the Act as the sanitary authority and not the County Council, provided that (a) both the County Council and the Sanitary Authorities shall be Local Authorities for the purposes of powers relating to research and publicity (Section 25) ; (b) if in a special instance the sanitary authority so requests, the County Council may enforce any of the provisions of the Act in lieu of the sanitary authority ; (c) the duty of enforcing the provisions of the Act in relation to any such premises not beir.g premises within the Port of London as are occupied by a sanitary authority, shall be performed by the County Council, and for the purposes of performing their duties under this proviso the County Council may act as if they were the Local Authority and the county were their district. Section 1. (The prohibition of dark smoke from chimneys). This makes emission of dark smoke from a chimney, including domestic chimneys, an offence. The emission itself is an offence and there is no necessity to prove that a nuisance is being caused. Defence : (a) Lighting up from a cold furnace ; (b) some unavoidable or unforseeable failure of the furnace or equipment; (c) use of unsuitable fuel, suitable fuel being unobtainable. Departmental duties. Regular and frequent observation of all chimneys in the Borough. 42 Section 2. (Temporary exemptions from Section 1.) Over a period of not more than 7 years from the passing of the Act it will be a defence to prove :— (a) that the contravention was due to the nature of the building or equipment and not to failure in use or maintenance ; and (b) that it had not been practicable to make the necessary alterations to prevent the emission of dark smoke. On application, the Local Authority may at any time during the 7 years issue a certificate, renewable annually, stating that they are satisfied that it had not been practicable to make the necessary alterations. This certificate can be limited to particular chimneys of the building. Departmental duties. (a) The inspection by a suitably qualified officer of all premises from which the emission of dark smoke is observed ; (b) dealing with applications for certificates of exemption. Section 3. (Requirement that new furnaces shall be, so far as is practicable, smokeless). This section requires all new furnaces (including domestic installations) with a heating capacity of 55,000 or more B.T.Us. per hour to be capable of being operated continuously without emitting smoke when burning fuel of a type for which they were designed. The installation of a new furnace must be notified to the Local Authority. Plans and specifications for a new furnace may be submitted to the Local Authority for their approval. Departmental duties. Advice and assistance when plans for installation of new furnaces are submitted for approval. Section 5. (Requirement that grit and dust from furnaces shall be minimised). Failure to use any practicable means there may be for minimising emission of grit or dust from any furnace used to burn solid fuel or solid waste constitutes an offence. Departmental duties. Advice regarding minimising grit and dust emission. Section 6. (Requirement that new furnaces shall be fitted with plant to arrest grit and dust). This provides that all new 43 furnaces burning pulverised fuel, or burning 1 ton an hour or more of solid fuel in any other form, must have grit arresting plant installed in accordance with the plans and specifications submitted to and approved by the Local Authority. The applicant may appeal to the Minister against a refusal to approve plans. Departmental duties. Receiving and examination of plans, consulting with technicians constructing the furnace, and ensuring that construction is carried out in accordance with approved plans. Section 8. (Information about furnaces and fuel consumed). The Local Authority may, by notice in writing, require the occupier of any building or land to furnish to them, within 14 days or such longer time as may be specified in the notice, information as to the furnaces or ovens in the building or on the land, and the fuel or waste burned in those furnaces or subjected to any process in those ovens as they may reasonably require for that purpose. Section 11. (Smoke Control areas). Any Local Authority may make an order, subject to confirmation by the Minister, declaring the whole or any part of its district a " smoke control area." Subject to any stated exceptions and limitations the emission of smoke in such an area on any day is an offence unless the emission was caused by the burning of an authorised fuel. The terms and conditions of the order may be subject to considerable variations ; the provisions may differ for different parts of the area ; and the order may limit the specified classes of buildings or may exempt specified buildings or classes of buildings. Certain types of fireplaces and classes of fireplaces may also be exempted. A smoke controlled area may, therefore, be a smokeless zone in the generally accepted sense of that term, or may be an area in which certain defined emissions of smoke are permitted. The Minister may also make orders exempting any class of fireplace if he has specified that such fireplaces can be used for burning fuel other than an authorised fuel " without producing smoke or any substantial quantity of smoke." The Minister also has the power to suspend or relax the operation of a smoke control area order, although he must, except in cases of emergency, consult with the Local Authority. Departmental duties. If the principle was approved by the Council, careful preliminary planning of the area would be vital. The area would have to be surveyed and its boundaries defined, with the possibility of subsequent extensions. A detailed house-to-house inspection of the proposed area would be necessary to ascertain :— 44 (a) the number and different types of premises ; (b) the number and types of fireplaces to be converted or adapted ; and (c) the pattern of fuel utilisation. Estimates would have to be made of:— (i) the cost of conversion ; (ii) the necessary increase in the supply of smokeless fuels ; (Hi) the cost to occupiers of the premises in the area of change to the use of smokeless fuels. It would also be necessary to ascertain the production and distribution of appliances and the availability of labour force, to carry out the necessary conversion or adaptions. There would have to be discussions with Gas and Electricity Boards; consultations with fuel distributors and manufacturers and distributors of appliances, on the question of supplies. Discussions would be necessary with occupiers of non-domestic premises regarding conversion or adaptations. Section 12. (Adaptation of fireplaces in private dwellings). If the owner or occupier cf a private dwelling, not being a new dwelling, which is in or will be in a smoke control area, has to incur expenditure in adapting his heating requirements, the Local Authority shall repay to him at least 7/10ths of the expenditure. If it thinks fit it may in any case pay the whole or any further part of the remainder. The repayment is contingent on the work being done to the satisfaction of the Authority and that it is done either before the order comes into operation or is reasonably incurred as a result of a notice served by the Local Authority requiring it to be done. A further requirement concerns adaptations made by an occupier who is not the owner of the house and who instals equipment that can be readily removed. In such cases not more than half the amount due, i.e. 7/20ths of the cost shall be repaid until after 2 years from an order coming into operation. The remainder shall then be paid only if the equipment has not been removed, and it is paid to the person then occupying the dwelling. If adaptations are not made as required in the smoke controlled area, the Local Authority may serve a notice calling for the work to be done or may execute it themselves under the provisions of Suction 286 of the Public Health (London) Act, 1936, and may demand a payment of 3/10ths or less of the expenses incurred. 45 Departmental duties. (a) Inspection and re-inspection of premises; (b) service of notices; (c) legal proceedings; (d) arrangements for carrying out work in default. Section 13. (Exchequer contributions). The Exchequer may pay 2/5ths of the cost of adapting fireplaces in all houses, whether privately owned or controlled by the Local Authority. The Local Authority's contribution will be 3/lOths in the case of the privately owned house and 6/l0ths in the case of their own houses. Section 14. (Interpretation of two last preceding Sections). Only work reasonably necessary to avoid contravention of a smoke control area order qualifies for grant, but this work may include adapting or converting a fireplace, replacing it by other means of heating or cooking, altering flues and carrying out any consequential operations. Expenses include the cost of fixing appliances, even though they may be easily removed without damage to the fabric of the building. Appliances purchased under a hire-purchase agreement will qualify for payment as if the cash price of the appliance had been paid on the day of the agreement. Section 15. (Power of Local Authority to make grants towards adaptations to fireplaces in churches, chapels, buildings used by charities, etc.) Local Authorities are given power under Section 11 of the Act to make grants towards the cost of adaptations as in the case of dwellings, to owners or occupiers of churches, chapels, other places of worship, and other premises used by nonprofit making organisations, whose main objects are charitable or concerned with the advancement of religion, education or social welfare. Section 16. (Abatement of smoke nuisances). This is concerned with smoke other than that from a domestic or industrial chimney which shall, if it is a nuisance to the inhabitants of the neighbourhood, be deemed to be a nuisance, which may be dealt with summarily under Section 282 of the Public Health (London) Act, 1930, and the Fifth Schedule thereto. Departmental duties. (a) Observations; (b) service of notices; (c) legal proceedings. 46 Section 19. (Railway engines). The emission of dark smoke from railway locomotives is an offence under Section 1 of the Act. Section 21. (Exemption for purposes of investigation and research). A Local Authority, on application by an interested person, may give exemption from the operation of the various sections of the Act for the purpose of enabling investigations or research relevant to the problem of air pollution to be carried out. Exemption may be wholly or to a limited extent for a specified period and subject to conditions. Provision is made for appeal by interested persons to the Minister against the Local Authority's decision. Section 22. (Crown premises, etc.) This requires a Local Authority to report emission of smoke, grit or dust from Crown premises to the responsible Minister who shall then make an enquiry into the circumstances, and if the cause for complaint is justified, employ all practicable means to prevent or minimise the emission or to abate the nuisance and prevent its recurrence. Departmental duties. Observations and notifications to appropriate Ministry. Section 25. (Powers of Local Authorities as to research and publicity). Local Authorities are given powers to undertake or contribute towards the cost of relevant investigations and research. It also empowers them to conduct publicity and educational work by lectures, exhibitions, films, etc., and to prepare or contribute towards the cost of preparation of the material required for this work. Departmental duties. If considered appropriate and useful, an extensive and continuous campaign of education. Section 30. (Duty to notify occupiers of offences). If an authorised officer of an Authority considers than an offence is being or has been committed with respect to dark smoke (Section 1), smoke in a smoke control area (Section 11) or smoke which is a nuisance (Section 16) he must, as soon as may be, notify the occupier of the premises (which includes the owner of a railway locomotive or person in charge of a vessel). If this notification is not in writing, it must be confirmed in writing within 48 hours. Section 34. (Interpretation). This section gives a precise legal definition of certain terms included in the Act. 47 Regulations The Minister of Housing and Local Government is empowered to make regulations dealing with, among other things :— Section 4. (Density meters, etc.) This section refers to the installation of apparatus to indicate and/or record smoke density or to facilitate the observation of smoke. Requirements may be imposed about the adaptation of chimneys, the use and maintenance of the apparatus, and the making of records available to the Local Authority. Section 7. (Measurement of grit and dust emitted from furnaces). This refers to the making and recording of measurements of grit and dust emission, including the adaptation of the chimney, providing and maintaining the necessary apparatus, and informing the Local Authority of the results. The Regulations may vary according to the types of furnaces and will apply to furnaces burning pulverised fuel and those burning more than 1 ton of fuel per hour, provided that the Local Authority serves notices in writing to that effect. Departmental duties. The inspection of apparatus ; the service of notices ; and possible legal proceedings. 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 Public Health 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 Public Health Inspector, and, if work required is not executed within a reasonable period, Statutory Notice is served. In cases of noncompliance the Town Clerk is instructed to institute proceedings. (2) Housing Defects.—These are cases where the conditions are such that they cannot be remedied under the procedure of the Public Health (London) Act, 1936, and are dealt with under the Housing Act, 1936, as being houses unfit for human habitation. Representations are made to the Public Health Committee to consider as to whether such houses can be repaired at a reasonable cost having regard to the value of the premises, or whether Closing and Demolition Orders should be made. 48 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 securc 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. Deficiencies in the 1954 Act concerning artificial lighting of common staircases and the periodical cleansing and redecoration of parts of buildings in common use were taken up by the Metropolitan Boroughs' Standing Joint Committee with the London County Council. The omission regarding artificial lighting to common staircases was rectified by Section 63 of the L.C.C. (General Powers) Act, 1956, which enables the Borough Councils to make byelaws with respect to tenement houses and flats. Further consultations between the two bodies are contemplated with a view to securing similar action relating to periodical cleansing and redecoration. The number of houses on the Register at the end of the year was 5 ; these have been visited by the Public Health Inspector on 17 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 suspend the payment of increased rent until the necessary works shall have been completed to the satisfaction of the Sanitary Authority. Landlords may als apply to the Sanitary Authority for a report to the effect that necessary works have been executed to the satisfaction of the Council. 49 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 subjcct to a ' repairs increase ' under the 1954 Act. Three applications for Certificates of Disrepair were received and in each case a Certificate was issued. Five applications were received for Revocation of Certificates of Disrepair all of which were granted. Very little use is being made of Section 26 of the Act presumably because landlords are finding that increased rents obtainable do not cover the cost of repairs involved. 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 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 Public Health Inspectors. 50 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 Public Health 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 7 applications for licences to sell poisons under Part II were received and 64 vendors applied for retention in the Council's List. All were duly considered and approved. Seventy 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, in every part of a shop in which persons are employed about the business of that shop : (a) suitable and sufficient ventilation is provided and maintained, (b) suitable and sufficient temperature is provided and maintained, and (c) suitable and sufficient sanitary conveniences are provided and maintained. In the event of satisfactory sanitary arrangements 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 316 occasions. Hairdressers and Barbers.—Under Section 18 of the London County Council (General Powers) Act, 1954, 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. Byelaws made by the Council under Sub-section 4 of Section 18, were confirmed by the Minister of Housing and Local Government 51 on 21st August and became operative on 1st October of the curent year. Premises registered at 31st December, 1956 ... ... 55 Persons registered at 31st December, 1956 ... ... 60 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 Public Health 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, five samples, 2 of Rag Flock, 1 each of Kapok, Kapok mixture and Coir Fibre were obtained and submitted for examination. All proved satisfactory. Pet Animals Act, 1951.—This Act, introduced to regulate the sale cf pet animals with particular reference to their welfare prior to sale, became operative from 1st April, 1952, since when it became an offence to keep a pet shop except under licence from the Local Authority. The Act defines " the keeping of a pet shop " as the carrying on at premises of any nature (including a private dwelling) of a business of selling animals as pets and as including the keeping of animals in such premises with a view to their being sold in the course of such business, whether by the keeper thereof or by any other person. The term "animal" includes any form of vertebrate. " Premises " includes any stall or barrow in a market but not any stall elsewhere or any part of a street or public place. Licences, renewable annually, are issued on payment of 10/and are valid to the 31st December of each year. 52 At the end of the year five licences were in operation and 14 inspections were carried out by the Public Health 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 893 reports on such enquiries were forwarded to his department. Drainage and Sewerage.—During the year 430 drains were tested, 328 were opened, cleansed or repaired and there were 601 constructions and re-constructions, alterations and improvements effected. Only two cesspools remain in use in the Borough and under the Borough Engineer's direction these arc emptied on request. One hundred and eighteen 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 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 sower. 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. In connection with this matter the Borough Engineer has kindly supplied the following information :— " During the year, the survey work at existing premises was completed and the register prepared of trade effluents under the London County Council (General Powers) Act, 1953. A start was made upon the sampling of trade effluents, informal samples being taken and analysed from the discharges of thirteen industrial concerns. Of these, five were found to bo unsatisfactory and the firms concerned are now taking steps to rectify the matter. During the year, the first application was made under the new Act for the discharge of a new trade effluent to the Council's sewerage system and conditions were laid down in conjunction with the London County Council, both for the protection of sewers from damage and for the protection of treatment at the Southern Outfall Works." 53 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 23,759 dwellings with direct connections to the Board's mains. During the year 311 water supply certificates were granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended in 170 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. 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 1956 the amount of house and trade refuse collected by the Council totalled 21,426 tons, an increase of 736 tons over the previous yeai. Street sweepings collected amounted to 1,991 tons, an increase of 16 tons over the previous year. As mentioned in previous reports 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. 54 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 968 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." 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 5,209 investigations were made and infestation found to exist at 428 dwelling houses, and 86 at miscellaneous premises and places of business. There were 3 major infestations at business premises, caused by the common rat. Periodic treatments were carried out at 7 industrial premises and throughout the year thera were 15 instances only of re-infc station in private dwelling houses after treatment. The monthly average of complaints from occupiers, coupled with infestations reported as a result of routine investigation, was 46 compared with 48 last year. Occupiers of business premises and also householders readily report any known or suspected infestation and the value of routine investigation made in these properties is emphasised by the fact that 55 it is rare to find occupiers tolerating infestation after being made aware of the service available under the Rodent Control Scheme. Following the policy of tracing the source of infestation in each case, 31 defective drainage systems were discoveied. Intimation notices were served under the Public Health (London) Act, 1936, and the drainage defects made good by the owners of the properties. Bombed sites and dumps were test baited resulting in 7 infestations being found and treated, and block treatments were carried out in 15 small areas. The Blue Cross Kennels premises in Shooters' Hill Road, although subject to regular inspection were found to be free from infestation. Contributing to this satisfactory condition has been the removal of the remaining wooden kennels and harbourage. Calls were made on the services of the Borough Engineer's staff to enter the sewers during colour tests or in the tracing of disused drains and also to the lifting of paving to locate sources of infestation. These services were readily available. The Rodent Control personnel have performed their duties with diligence throughout the year and have given the Department good service. Prevention of Damage by Pests Act, 1949.—Under previous legislation responsibility for the eradication of rats and mice rested with each individual occupier, but the introduction of the Prevention of Damage by Pests Act, 1949, whilst repealing the Rats and Mice (Destruction) Act, 1919, and the Infestation Order, 1943 places the onus for the destruction of these pests on Local Authorities. The 1949 Act also makes it obligatory for occupiers to notify the Local Authority of any rodent infestation. Rats and mice are notorious not only for the wholesale destruction and fouling of foodstuffs and for the structural damage they cause to buildings, but also for their part in the spread of disease. Leptospirosis (Weil's disease) is primarily a disease of rats and is one which can be fatal to man. The disease is transmitted by means of food, dust, mud, slime and water which has been contaminated by urine or faeces from infected rats. Efficient rodent control is the first and most important defence against this type of disease. The following report was submitted to the Ministry of Agriculture and Fisheries for the 12 months ended 31st March, 1957 :— 56  TYPE OF PROPERTY Non-Agricultural (1) Local Authority (2) Dwelling Houses (including Council Houses) (3) All other (includg. Business Premises) (4) Total of Cols. (1), (2) & (3) (5) Agricultural 1. Number of properties in Local Authority's District. 34 22,591 3,232 25,857 2. Number of properties inspected as a result of: (a) Notification 4 383 57 444 - (b) Survey under the Act 24 3,463 927 4,414 - (c) Otherwise — — — — - 3. Total inspections carried out — including re-inspections 28 3,874 1,029 4,931 4. Number of properties inspected (in Sect. II) which were found to be infested by: (a) Rats Major 23 5 28 - Minor 1 182 26 209 — (b) Mice Major — 3 3 6 - Minor 1 179 18 198 - 5. Number of infested properties (in Sec. IV) treated by L.A. 2 367 46 415 - 6. Total treatments carried out — including re-treatments 4 450 101 555 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 18 57 Baiting of Sewers.—The Borough Engineer has kindly supplied me with the undermentioned information of the treatments carried out in the Council's sewers in connection with the scheme:— Details Date of Treatment 3rd Dec. to 21st Dec., 1956 4th June to 23rd June, 1956 1. No. of Manholes in foul and connected systems 1,186 1,183 2. Bait base and poison used Sausage rusk and zinc phosphide Bread rusk and arsenious oxide 3. No. of Manholes baited 1,179 1,159 4. No. of Manholes showing prebait takes 790 756 5. No. of Manholes showing complete prebait take (on one or both days) 343 350 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: During the December treatment 21 manholes were che ked for poison " takes '' Result—12 'no takes ' 9 partial It may be mentioned that the neighbouring Boroughs of Woolwich and Lewisham took action at the same time aa Greenwich. Anti-Fly and Anti-Mosquito Campaign.—During the summer period, April to September, the campaign has continued on similar lines to previous years. Three men ar-e employed in this important preventive aspect of the Department's work consisting of dealing with complaints and carrying out routino inspection and treatment of sites where breeding may occur. A motor cycle with a box sidecar is used to convey personnel and the necessary appliances and materials. The major factors to be controlled include house refuse contained in the dust chutes and dustbins, food shops, cafes and canteens, static water sites, ponds and ditches, etc. 58 The treatment of house refuse in the dustbins was carried out by arrangement with the Borough Engineer, a small quantity of 'Gammexane' powder being sprinkled into the dustbins at each weekly collection. The dust chutes in the numerous blocks of flats received weekly treatment with 'Gammexane' powder by anti-fly personnel, as soon as possible after dust collection. Static water sites, ditches, etc., were sprayed with either D.D.T. in Kerosene or Malariol, and in certain instances dusted with ' Gammexane ' powder. Vacant and bombed sites are regularly inspected for offensive deposits in the nature of dead animals and food waste. It is found that these items are generally placed away from the public view and can become a potent source of fly breeding if not detected. Other deposits include mattresses, discarded clothing and sundry items of furniture, etc. Deposits which by reason of organic substance allow fly breeding are sprayed and removed for destruction centrally and the immediate area sprayed and subjected to follow up inspection. Other items are either treated and disposed of centrally, or burned on the spot. During the year, 78 requests were received for the collection and disposal of unwanted bedding, furniture and miscellaneous household effects. In each instance the items were sprayed as a precautionary measure prior to removal. Disinfestation of Verminous Premises.—D.D.T. in kerosene continues to prove the most effective vermicidal agent in dealing with verminous premises. During the year the Public Health Inspectors dealt with 144 cases of dirty and verminous premises compared with 136 in 1955. The disinfestation staff sprayed 270 rooms and contents as compared with 291 last year. In 11 cases the bedding and effects were removed to the Council's disinfecting station for treatment by steam or formaldehyde. Other pests such as wasps, ants, earwigs, silverfish, moths, etc. were again troublesome, and 322 houses comprising 887 rooms were treated effectively with D.D.T. as compared with 295 and 754 respectively last year. Cockroaches.—(Blatta orientalis).—Most of the complaints received concerning this pest came from the 3 large Hospitals in the Borough. The construction of such premises affords ideal breeding 59 sites in concealed and almost inaccessible places. Thorough investigation and treatment has resulted in the infestations being considerably reduced after treatment with D.D.T. Very few complaints were received from occupiers of dwelling houses. Clover or Gooseberry Mite (Bryobia praetiosa).—Complaints were received from tenants in blocks of flats situated in various parts of the Borough concerning small red insects found moving over the walls and windows. After investigation these insects were identified as Clover or Gooseberry Mites, the life history of which is not completely known although it is common knowledge that they breed on fruit trees, gooseberry bushes, raspberry canes and certain fodder plants. They are not considered as being harmful to humans or to household property but can cause some concern when, during the spring season they migrate from their natural environment into nearby buildings. Some infestations were reported from houses and flats where natural breeding conditions were non-existent but where the recent laying of turves had occurred. After spraying interior and exterior surfaces of such buildings with D.D.T. in kerosene no further complaints were received. Such treatments must extend to the examination and spraying of all trees and plants which form the natural habitat of these insects and which are in close proximity to the source of complaint . Golden Spider Beetle (Niptus hololeucus).—This insect, which normally feeds on animal matter, especially dead insects, was the subject of several complaints during the current year. In large numbers they attack woollen articles, clothes, linen and silks and are most plentiful in June/July and again in Oct./Nov. No further complaints arose after a spraying with D.D.T. in kerosene had been carried out. 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 60 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 ohemical 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, 1956:— Slipper Baths 89,133 * Swimming Baths 129,878 Vapour and Medicated Baths 10,894 Public Laundry 9,566 Total 239,471 *Includes 48,878 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 2.2.56 2.40 p.m. 2nd Class Swimming (Mixed Bathing) 78°F. 23 Nil Nil Satisfactory 2 26.3.56 11.20 a.m. 2nd Class Swimming (Mixed Bathing) 75°F. 54 Nil Nil Satisfactory 3 23.5.56 2.30 p.m. 2nd Class Swimming (Mixed Bathing) 76°F. 64 Nil Nil Satisfactory 4 23.5.56 2.25 p.m. 1st Class Swimming (Mixed Bathing) 74°F. 72 Nil Nil Satisfactory 5 1.8.56 2.25 p.m. 2nd Class Swimming (Mixed Bathing) 74•5°F. 18 Nil Nil Satisfactory 6 1.8.56 2.35 p.m. 1st Class Swimming (Mixed Bathing) 74°F. 14 Nil Nil Satisfactory 7 1.10.56 2.15 p.m. 2nd Class Swimming (Mixed Bathing) 74°F. 22 Nil Nil Satisfactory 8 26.11.56 12.10 p.m. 2nd Class Swimming (Mixed Bathing) 76°F. — 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. The Government's "credit squeeze" prevented any progress during the year in connection with 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 7 a.m. to 11 p.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 (june. Well Hall Rd.) 3 1 6 3 1 Totals 34 11 79 38 12 NOTE :—Women's Conveniences are without an Attendant between 7 a.m. and 8 a.m. On Sundays, Conveniences open at 10.30 a.m. and close at 10.30 p.m. *During Summer Period this convenience opens at 8.30 a.m. 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 (Greenwioh Park). Blackheath Hill, West Greenwich. Charlton Church Lane. Westcombe Hill, Blaokheath. Horse Troughs Charlton Churoh Lane. Creek Road, Deptford. Invicta Road, Blackheath. Tunnel Avenue, East Greenwioh. 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 Publio House urinals remaining with the Brewers concerned. Free hand-washing facilities, introduced in the interests of Publio Health during 1951, were continued with marked success during the year and the following table gives an indication of the growing use made of these facilities:— Convenience Men Women Total Batley Park 2,501 3,124 5,625 Creek Road 1,321 2,867 4,188 Greenwich South Street 839* 2,362 3,201 King William Walk 1,645 4,038 5,683 Rodmere Street 1,883 2,847 4,730 Shooter's Hill Road 1,785 1,953 3,738 Totals 9,974 17,191 27,165 * Recommenced 8.2.56 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. However, on 8th February of the current year, the Council rescinded this decision and reinstated full time attendants at both conveniences, and the free washing facilities discontinued at Greenwich South Street convenience were recommenced. 64 Aged and Physically Handicapped Persons.—Problems connected with old age continued to increase because more of our population are reaching advanced years. It is important that apart from the "welfare" and "first aid" services provided by local authorities old people should be made to realise that they are still an integral element in the community. Nothing is more demoralizing than to feel that with waning physical powers an old person is unwanted and considered an irksome burden. Too many elderly people find difficulty in filling their days when they retire and part of their lives if possible, on retirement, should be devoted to some form of creative activity. Loneliness is another difficulty but in this borough no reasonably active old person need be lonely for there are numerous clubs devoted to their interests. These clubs can be an important clement in their lives and are in a unqiue position to influence and guide people of advancing and advanced years in the " philosophy of old age." Great reliance is placed on the Lady Public Health Inspector by the elderly of the Borough and the following is a summary of her work during 1956:— No. of dirty premises inspected 28 No. of verminous premises inspected 9 No. of dirty rooms cleansed 48 No. of verminous rooms cleansed 27 No. of verminous persons visited 19 No. of verminous persons treated :— Heads 139 Other 61 No. of visits to scabies cases 12 No. of visits for Cleansing Service:— First 46 Subsequent 58 No. of articles cleansed 7,676 No. of inspections of factories :— (a) with mechanical power 49 (b) without mechanical power 4 (c) other premises 3 No. of inspections of Outworkers' premises 86 No. of inspections of Houses Let-in-Lodgings 12 No. of inspections of Women's Conveniences 16 No. of Bathing Centre sessions 41 No. of Home baths 69 No. of visits to Infirm Persons 1,360 No. of visits to Rest Homes, Hospitals, etc. 29 No. of visits, re: housing 22 No. of visits to Food Premises re: Meals for O.A.Ps. 29 No. of Miscellaneous visits 203 No. of re-inspections, calls made, etc. 285 No. of interviews for Holidays 70 No. of interviews at offices 99 No. of complaints received 41 No. of Intimation Notices served Nil 65 The services provided by the Borough Council expanded satisfactorily. Generous grants were made to the Greenwich Old People's Welfare Association for the provision of holidays and recreational facilities and an account of the activities of the Committee is included in this report. The hospital bed situation for geriatric cases remains satisfactory and no old person has had to wait for admission to hospital. Although admission to an institution is more difficult the position is much better than in the country as a whole. During the year no cases occurred where the provisions of the National Assistance Act, 1948, for compulsory removal had to be enforced. Experience shows that friendly persuasion is the best method and if the situation is explained carefudly to old people that the Health Department is here to serve their best interests. In 1956, 11 people were admitted to the Geriatric Wards of St. Alfege's Hospital and 16 to London County Council Homes. Laundry facilities provided by the Council for aged bed-ridden were expanded by the provision of a new washing machine at the Cleansing Station and during the year 7,676 individual articles were collected, laundered and delivered. Meals on Wheels.—During the year this service was augmented by the purchase of a new van fitted with hotlock food containers. The British Red Cross van was also fitted with hotlock containers and this has led to great improvement in the service since individual portions arc now being delivered to the homebound. Some bulk meals howevor continue to be delivered to the Darby and Joan Clubs. During the year an average of 35 homebound persons had meals delivered twice weekly and in over 40 cases meals were delivered three or four times per week. Towards the end of the year a few people were receiving these meals five days per week. The average number of meals brought to the homebound was 247 and another 84 were delivered weekly to the various Old People's Clubs in the Borough. The following extracts are from the third Annual Report of the Old People's Welfare Association. "Old People's Clubs.—The Darby and Joan Clubs, Federation Clubs and Church Clubs are our greatest source of contact amongst old people. They are able to bring much happiness to a very large 66 number of the elderly population of the Borough, and apart from the small grant made each year by the Borough Council and in many cases the facilities provided for holding their Clubs, they are selfsupporting, and this, we feel, is a fine achievement, due, to a large extent, to the untiring efforts of the persons who organise the Clubs and the helpers encouraged no doubt by the gratitude of those who attend them. On behalf of the old people we would like to extend our sincere thanks to the leaders of these clubs and their assistants, and also for the grants and facilities mentioned above. For the third consecutive year we are able to report that an additional Club has been opened. This time it is the turn of the National Federation of Old Age Pensioners Associations, who found that there was sufficient demand in the West Greenwich area for a branch to be formed, and we are pleased to report that here again the Borough Council kindly granted the Branch facilities in the Minor Hall on Tuesday afternoons. This now means that there are eleven clubs in the Borough meeting each week, which provide an opportunity for their members to meet for social intercourse, entertainment and fellowship. They are held at:— Oakland House, Shooter's Hill Road. 560, Woolwich Road. The Town Hall, S.E.10. The Co-operative Hall, Park Vista. The Parish Hall, Swallowfield Road, Charlton. St. John's Hall, Furzefield Road, Charlton. The Albany Institute, Creek Road. Heathside Social Club, Blackheath Hill. Central Library, and Two Clubs at Charlton House. Day Rooms at Community Centres.—Since submitting our re port to you at the last Annual Meeting the Executive Committee has given lengthy and detailed consideration to the supplementation of the Old People's Clubs. These Clubs do, of course, meet once a week and in some instances are limited in space and therefore the number of persons who can attend is also limited. 67 The Committee felt, therefore, that Day Rooms provided at various parts of the Borough would fill a much needed gap, particularly in the winter months. Again the Borough Council was very receptive to the Committee's suggestions and provided a room at each of the three Community Centres for Day Rooms to be set up. The Committee felt that the rooms should be well furnished, comfortable and yet homely, and this was effected, with the aid of a grant from "The Mayor of Greenwich Old People's Welfare Fund" which was a fund received by the then Mayor of Greenwich upon the winding up of the Lord Mayor's National Air Raid Distress Fund. The room at Charlton House was opened on Monday, 5th November, 1956, by the Worshipful the Mayor of Greenwich (Councillar Mrs. M. L. Bennett, J.P.) accompanied by the Mayoress and the Chairman of the Association, Alderman Mrs. L. Hilldrith. The second room is due to be opened at Kidbrooke House Community Centre, also by the Mayor in February, 1957. Again we are indebted to those voluntary helpers who go along each day to supervise the running of the Day Room and to provide those attending with light refreshments. Holidays for elderly persons.—Since the Annual Meeting last year we have again been able to send away two parties to Margate for a fortnight's holiday. The party which went in May numbered 105, and another party in September 1956 also numbered 105. In addition, holidays were arranged for six invalids who required special care and attention. We would like to thank the Women's Voluntary Service helpers who travel to Margate and back for taking care of the old people so well, and also to the drivers of Lewis (Greenwich) Ltd., for the way in which they assist our old people in having a comfortable and enjoyable journey. Distribution of Christmas Food Parcels.—We are most grateful to the Greenwich Borough Council for again making us a grant this year of £150, so that we were able to distribute food parcels to homebound elderly persons at Christmas. The grant enabled us to obtain provisions to make up 460 parcels containing sugar, tea, milk, biscuits, sweets and chocolate. The parcels into which were slipped a Christmas Greetings Card were packed in attractive paper by members of the Association and distributed by very willing helpers during 68 Christmas week. We know that the joy which these parcels gave to the recipients was sufficient thanks to the helpers who gave up so much of their time in ensuring the success of the scheme. Carol Service.—The Annual Carol Service held this year in the Parish Church of St. Alfege on the 6th December was very successful in that over 300 elderly persons were present. We are sure that those who attended enjoyed the Service very much indeed. We appreciate very much the work of those helpers who came along and assisted in giving those attending some light refreshment after the Service. Welfare Scheme for Old People.—We are pleased to report that the Executive Committee has been able to increase the scheme whereby elderly persons can obtain Welfare Foods at reduced prices, and also the cheap launderette facilities. We are sure that the old people have again benefited from these schemes and we are indebted and most grateful to the Women's Voluntary Service for carrying out the distribution of the Welfare Foods. Quarterly Meeting.—The Quarterly Meetings of the Association have been very well attended and we are most grateful to the speakers who have come along to address the members present on the various aspects of old people's welfare. Acknowledgments.—It is not possible to mention individually all who have helped with the work amongst the old people during the year and we would therefore like to say a sincere " thank you " to all the voluntary workers who have given up their time so willingly in this work. We feel, however, that we must make special mention of the Greenwich Borough Council for the many facilities offered to us and the financial grants which have totalled a considerable sum ; to the Town Clerk, the Medical Officer of Health, the Borough Treasurer and the Area Officer of the National Assistance Board and their staffs. We, the Executive Committee are inspired by the willing co-operation of all the voluntary helpers and friends and not least by the appreciation shown by the old people themselves. We feel that it is a privilege to engage in this work and we shall endeavour to extend the scope and influence of it to every old person within the Metropolitan Borough of Greenwich." 69 Executive Committee, 1956/57. Council Representatives Alderman Mrs. L. Hilldrith (Chairman) Alderman H. W. H. Icough Councillor Mrs. C. Berry Councillor Mrs. A. D. A. Kennedy Councillor W. S. Manners Councillor T. E. Smith Councillor Mrs. M. L. Wentworth Elected Representatives Mrs. P. M. Beacham, (Greenwich & Deptford Hospital Management Committee) Miss E. Bertrand (The Albany Institute) Mr. T. Essex (Federation of Old Age Pensioners' Association, Greenwich Branch) Mrs. M. E. Kidd (Vice-Chairman) (Women's Voluntary Service) Mrs. N. C. Lewis (Inner Wheel Club of Greenwich) Miss L. M. Scott (Resigned on removal to another area) (Family Welfare Association) Mrs. E. M. Wigley (Honorary General Secretary) (British Red Cross Society) 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 bis death. During 1956, arrangements were made under the above Act for the burial of 3 bodies. In 2 instances expenses were recovered from death grants and from relatives but in the remaining case the burial was arranged at a cost to the Council of £7 15s. Od. Exhumations.—No exhumations were carried out during the year. 70 Summary of Work Performed by the Public Health Inspectors during the Year 1956 Inspections— Houses inspected (House-to-House) — „ „ (Complaints, nuisances) 1,605 „ „ (Infectious Disease) 529 „ „ (Overcrowding) 115 Re-inspections, calls made, etc. 8,704 Inspections of Factories 441 „ „ Shops 41 „ „ Piggeries 8 „ „ Caravans 8 „ „ Licensed Victuallers 85 „ ,, Pet Shops 14 „ ,, Stables and yards 12 „ „ Urinals 113 „ „ Houses let in Lodgings 17 „ „ Outworkers premises 86 „ „ Miscellaneous 897 Inspection of Premises (Pharmacy and Poisons Act, 1933) 70 „ „ „ (Housing Repairs and Rents Act, 1954) 8 Investigations (Rats and Mice) 369 On notice from Builder 492 13,614 Drains— Drains tested—by smoke 162 „ „ —by water 268 Opened, cleansed and repaired 328 Reconstructions and additions 147 Inspection chambers constructed 76 New covers to manholes 66 Soil and vent shafts repaired or renewed 99 Traps (gully) 153 Drains sealed off, etc. 20 Yards and forecourts drained 40 Waterclosets and Urinals— Closets erected 76 W.C.s repaired 202 Sanitary conveniences or improvements effected to Factories, Workshops and Workplaces 29 W.C. pedestals installed 229 Urinals cleansed or repaired 38 71 Dustbins— Provided 191 Payings— Yards and Forecourts 59 General Water Supply— Water Fittings amended 170 Extra water supply to tenement houses — Water supply certificates granted (Sect. 95) 291 Other Improvements— Houses generally repaired 125 Rooms cleansed and repaired 511 Rooms and staircases lighted and ventilated 8 Verminous rooms cleansed 83 Roofs, gutters and rainwater pipes repaired 450 Dampness abated 474 Sinks, baths and lavatory basins 236 Sink, lavatory and bath waste pipes trapped or amended 237 Stoves and fireplaces 167 Washing coppers repaired or provided 10 Floors repaired 206 Provision for storage of food 14 Miscellaneous repairs 519 Other Nuisances Abated— Illegal use of Underground rooms discontinued — Overcrowding abated 70 Animals kept in unfit places discontinued or removed 2 Dung receptacles provided — Accumulation of manure and other obnoxious matter removed 33 Rat infestation abated 134 Smoke Nuisances— Observations 137 Statutory Notices served (Sects. 147 and 148) — Notices, &c.— Intimations served under Public Health (London) Act, 1936 808 Statutory Notices served 147 Houses rendered fit by informal action 148 72 Legal Proceedings Premises Offence Result of Proceedings 22, Armitage Road Non-compliance with Statutory Notice Order for work to be executed within 7 days. £1 1s. costs. 26, Armitage Road do. Order for work to be executed within 21 days. £1 1s. costs. 109, Creek Road do. Summons withdrawn on payment of 6/- costs. 11, Ashburnham Grove do. Summons withdrawn on payment of 3/- costs. 24, Armitage Road do. Summons withdrawn on payment of 6/- costs. 103, Creek Road do. do. 107, Creek Road do. do. 117, Creek Road do. do. 101, Creek Road do. do. 105, Creek Road do. do. 113, Creek Road do. do. 29, Lenthorp Road do. Summons withdrawn on payment of 3/- costs. 15, Collerston Road do. do. 43, Collerston Road do. do. 73 SECTION D Housing 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 „ „ 1956 4,580 8,077 3,497 This is not, strictly speaking, an accurate picture although it does indicate a general trend and, now that the greater portion of land available for housing purposes has either been taken or is already earmarked, under present conditions the position can hardly improve. This lack of 'housing space,' especially in urban areas, prompted government policy to be directed at giving encouragement to local authorities not only to consider favourably the making of grants to 74 owners under the 1949 Act for the conversion, improvement and modernisation of existing dwellings but also to concentrate on implementing Part 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, as modified by Section 16 of the Housing Repairs and Rents Act, 1954, empowers local authorities to make grants to private owners for improvements and conversions of sums up to £400 or half the cost whichever is the less where the dwellings would provide satisfactory accommodation for ' more than fifteen years.' During the year, eleven grants were so made. Procedure under Housing Act, 1936.—The following representations were made under Part II of the above Act during 1956 :— Section 11.—Houses unfit for human habitation and not capable at reasonable expense of being rendered so fit. 41, King George Street, S.E.10. 11a, Morden Mews, S.E.3. 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. 80, Beaconsfield Road, S.E.3. 6, Egerton Drive, S.E.10. 1, Egerton Drive, S.E.10. 211, Greenwich High Road, S.E.10. 1, West Grove Lane, S.E.10. Slum Clearance.—A report on the following area is being prepared with a view to its representation by the Council under Part III of the above Act: Area No. of Persons to be Properties Displaced 70 Adult Families Norman Road 24 75 5 Children 24 Slum Clearance.—A report on the following area is being prepared with a view to its representation by the Council under Part III of the above Act: Area No. of Properties Persons to be Displaced Families Norman Road 24 75 70 Adults 24 5 Children 75 Re-Housing.— (a) Borough Council.—There were 169 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 306. Of this number, 21 were in respect of overcrowded cases and 23 families re-housed from outside the Borough. The Housing Department now has control of 3,201 Councilowned units of accommodation, an increase of 54 over that of the previous year. At the end of the year, in addition to 65 occupied hutments, a total of 576 properties giving 1,085 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, 1956, the L.C.C. had provided alternative accommodation for a total of 222 Greenwich families of which 3 had been certified as overcrowded cases. Of this figure, 135 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 46 families were rehoused by other means. Overcrowding.—As a direct result of rehousing carried out under (a), (b) and (c) above 70 cases of overcrowding were abated during the year under review. The number of unabated certified cases of overcrowding in the Borough now amounts to 153. During 1956 there was a rise in the number of complaints received concerning overcrowding, the year's figure of 97 showing an increase of 36 over that of the previous year. Each complaint was investigated by the Public Health Inspector concerned and as a result of these investigations 38 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 :— 76 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 1955 39 10-year average 110 1956 38 New Housing Accommodation.—The following table lists the new dwellings erected in the Borough during 1956:— Type of Dwelling G.B.C. L.C.C Private Total Permanent Houses 13 9 16 38 Permanent Houses (rebu.lt) — - 17 17 Flats 156 6 74 236 Flats (rebuilt) — — — — Total No. of Dwellings 169 15 107 291 Excluding the families accommodated in requisitioned property, the total number of dwellings provided in the Borough since the termination of the war is now 4,580. Council Housing Schemes. (а) Schemes completed during the year under review. Site Dwellings Little Heath 36 Cold bath Street 88 Humber/Ruthin Roads 16 Blackheath Hill 22 Ormiston/Halstow Roads 11 (б) Schemes in progress at the end of the current year. Nil. 77 (c) Whilst not confirmed the following suggested list of additions and extensions envisaged by the Council for 1957 et seq has been supplied by the Borough Engineer. Site No. of Dwellings where known *Woolwich Road/Troughton Road 32 *Devonshire Drive 32 *Coleraine Road 32 *Hardy Road 6 *Greenwich High Road 40 *Sunfields 46 *Roan Street 13 Westcombe Park Road, corner site 16 West com be Hill 2 Lansdowne Lane — Heathway — Coldbath Arches 8 Dutton Street 8 Tunnel Avenue Sites 43 Annandale Road 3 Vanbrugh Park — Shooter's Hill Road (84, 86) — Burney Street/Gloucester Circus Clinic and flats Central Area Shops, Offices and Flats. Haddo Street Clearance Area Nadine Street and Wellington Gardens *Should start 1957. 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. 78 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. 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 1956 :— " In my observations last year I referred to the coming into force of the Requisioned Houses and Housing (Amendment) Act, 1955. The full impact of this measure was felt in 1956 and altogether 463 dwellings were derequisitioned during the year. A high proportion of these were released to the owners with the occupiers still in residence under a provision in the Act whereby these licensees became the owners' statutory tenants. Whilst derequisitioning is the aim of the Act there is a proviso that parts of requisitioned houses falling vacant cannot be released without the consent of the owners if they did not constitute separate dwellings prior to requisitioning. The result of this is that in many cases parts of houses have to stand empty pending the vacation of the rest of the premises, and at the end of the year there were 35 such dwellings unoccupied. Reference was also made last year to the need for clearing temporary bungalow sites so as to make land available for redevelopment. During the year 28 bungalows were vacated and demolished so as to clear sites in Greenwich High Road, Woolwich Road and Sunfields Place. The effect of these losses of accommodation under the control of this Council meant that, notwithstanding the fact that 177 new dwellings were completed during the year, the total number of lettings under management fell from 4,668 at the end of 1955 to 4,351 at the end of 1956. Although the number of new properties handed over was more than in the previous year, fewer families were rehoused from the Housing Register, 118 against 133 in 1955. This was of course due to the loss of requisitioned accommodation and the need to rehouse families from the prefabricated bungalows subsequently demolished. 79 There was also a drop in the number of transfers effected, i.e., 110 as against 129 in 1955, whilst the number of mutual exchanges was 33 as against 46 in the preceding twelve months. Despite the reduction in lettings activities during the year, the number on the Housing Register has continued to fall, from 2,647 on the 1st December, 1955, to 2,555 on the 1st December, 1956, largely due to the failure of applicants to renew their applications even after the issue to them of reminder letters. The outlook at the end of the year for rehousing from the general register in the immediate future is not so good. Very little accommodation from new building can be expected during 1957 since, although several schemes are due to be commenced, it is unlikely that many will be completed by the end of the year. The main source of supply will be casual relets, a proportion of which will be needed for slum clearance rehousing, and rehousing in connection with derequisitioning." 80 SECTION E Inspection of Food and Supervision of Food Premises From 1st January of this year the systematic inspection of food and premises where food is handled was carried out for the first time under the new Food and Drugs Act, 1955, and the Food Hygiene Regulations, 1955, which exercise control over the hygienic handling, etc., of food, became fully operative from 1st July of the current year. Both the Act and the Regulations were reviewed in the Report for 1955. Legislation.—Little fresh legislation was introduced during the year, the most important being the Flour (Composition) Regulations, 1956, which states that all flour, other than 100 per cent. extraction flour must contain not less than 235 nor more than 390 milligrams of creta praeparata per 100 grams, and all flour must contain the undermentioned nutrients in amounts not less than stated :— Iron Not less than 1.65 mgm. per 100 gms of flour Vitamin B1 „ „ „ 0.24 mgm. „ „ „ „ ,, Nicotinic acid, or Nicotinamide „ „ „ 1.60 mgm. „ „ „ „ ,, Other Statutory Instruments introduced during 1956 included Regulations amending the amounts of metals to be contained in Tomato Ketchup and Curry Powder, and the Milk and Dairies (Channel Islands and South Devon Milk) Regulations, 1956, which fix at 4 per cent, by weight, the fat content of milk sold as Channel Island, Jersey, Guernsey or South Devon milk. The Food Hygiene (Amendment) (No. 1) Regulations, 1956, exempts the giving out of shrimps, prawns and onions from the provisions of regulation 7, para. (1) of the 1955 Regulations until 1st January, 1957. 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. It is, therefore, to be expected that this commodity formed the largest class of food sampled during the year. 81 Milk Supply.—The supply of milk continues to be under the direction of the Milk Marketing Board, who, in this connection, act as agents to the Ministry of Food. The greater proportion of the milk which enters the Borough originates from the Home Counties and the remainder which is of a higher fat content, arrives from Devon and the Channel Islands. Milk and Dairies Regulations 1949/54.—Under the provisions of the principal Regulations each person retailing milk in the Borough must be registered as a Distributor. The number of Distributors registered at the end of the year was 110 which total includes 7 dairy premises. On 101 occasions the premises of distributors and dairies were visited other than for sampling purposes, and defects, when detected were 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, 1956 :— Licences In Operation Principal Licences issued 31.12.56 Distribution of Sterilised Milk 96 90 „ „ Pasteurised Milk 47 45 „ ,, Tuberculin Tested 34 32 Supplementary Licences Distribution of Sterilised Milk 20 20 „ „ Pasteurised Milk 16 16 „ ,, Tuberculin Tested 16 16 82 Sampling.—Under provisions of the Third Schedule to the first of the above-mentioned Regulations, Methylene Blue and Phosphates tests have been prescribed, the former for assessing the " keeping " qualities of milk, and the latter for estimating the efficiency of pasteurisation. In addition, a Turbidity test is also prescribed for ascertaining the effectiveness of the heat treatment of Sterilised milk. During the year 56 samples of milk consisting of 41 Pasteurised milks, 2 Sterilised and 13 T.T. Pasteurised were examined in accordance with the prescribed tests and, with the exception of one sample of pasteurised milk, all proved to be satisfactory. In connection with the unsatisfactory sample, consultations with the processing manager were arranged and the producers warned. 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 61 samples, 24 formal and 37 informal, were submitted to chemical analysis and all proved to be genuine. There was, however, a slight deficiency of milk fat in a sample of Channel Island milk and a slight deficiency of fat and other milk solids in a South Devon milk. Investigation revealed that the deficiencies were due to insufficient mixing at the dairy, a fault which the producer was instructed to remedy. Six samples of 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, 1955, Section 16, all premises with the exception of schools, clubs, hotels or restaurants used :— (a) for the sale, or manufacture for the purpose of sale, of ice-cream, or storage of ice-cream intended for sale ; or (b) for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale ; are required to be registered by the owner or occupier with the Local Authority. 83 With the introduction of the new Food and Drugs Act, opportunity was taken to review the lists of all premises registered for the sale and storage of ice-cream and for the sale or preparation of preserved foods. Preserved Food Premises (meat, fish, etc.).—The total number of premises on the register at 31st December, was 87. One hundred and forty visits of inspection were made to Preserved Food premises and Fried Fish shops as a result of which two improvements were made and several sanitary defects remedied. Ice Cream Premises.—By the end of the year the total number of registered Ice Cream premises stood at 186. Visits to these premises were made on 235 occasions and 9 improvements effected. Manufacture and Sale of Ice Cream.—As the public's appreciation of the food value of ice-cream increases, so consumption rises, 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 61 samples were submitted for examination and grading according to the Ministry's provisional Grading Scheme. 84 The grading is based on the results of the Methylene Blue Reductase Test and a summary of this year's reports is given below:— Samples taken Time taken to Reduce Methylene Blue Provisional Grade Observations 34 4½ hours or more 1 Satisfactory 22 2½ to 4 hours 2 Sub-standard 3 ½ to 2 hours 3 Unsatisfactory 2 0 hours 4 Most Unsatisfactory 6 Ice-lollies Plate count and bacteria reports showed these samples to be Satisfactory On receipt of a Grade 3 or 4 report it is the practice in this Borough to obtain further samples from a vendor before administrative action is taken. It was not necessary during the year to have recourse to ' administrative action.' Quantitative Analysis.—Standards for the composition of ice cream were first laid down in the Food Standards (Ice Cream) Order, 1951. However, on 7th July, 1952, the legal minimum quantity of fat and milk solids other than fat required to be contained in ice cream were reduced by the introduction of the Amendment Order of 1952. The original standards were re-introduced with effect from 1st June, by the Food Standards (Ice Cream) Order, 1953. In connection with quantitative analysis, 9 samples of ice-cream and 2 ice-lollies were examined in the normal course of food sampling. All samples proved to be satisfactory and reference to the Analyses will be found under the heading of Food and Drugs Act, 1955. 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, 193(1, Section 180(8) most of which was processed and used for animal feeding :— Shops, Stalls, etc.:— Meal— Beef 11,979 lbs. Sheep Casings 1,333 „ Ox Livers 137 „ Lamb 76 „ Cut Poultry 46 „ Figs' Kidneys 33} „ Rabbit 30 „ Pork 7 13,641¾ lbs. 85 Other Foods— Potatoes 102,032 lbs. Fruit Juices & Pulp 6,219 „ Foods, Various 1,268½ „ Cooked Meats 1,150 „ Dog Fish 224 „ Raisins 150 „ Apricots (Canned) 124 „ Cheese Trimmings 94 „ Skate Wings 89 „ Flour 70 „ Butter 50 „ Skate Knobs 49 „ Bacon 44 „ Lard 17 „ Sausage Meal 11 „ Margarine 3½ „ Cooked Ham (Boneless) 2¾ „ Soya Flour 2 „ Nougat Bar 1 ,, 111,600¾ lbs. Total Food Rejected 125,242½ lbs. Compared with the previous year, the amount of meat rejected fell by 77,496¼ lbs. during 1956, but the total of all food rejected rose by 30,095¼ lbs. This was mainly the result of the condemnation of approximately 45 tons of potatoes originally introduced by the government from the continent at a time when a shortage of potatoes in this country appeared imminent. The stock in store was never drawn upon, it subsequently deteriorated and was finally surrendered. 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. Butchers' Shops and Stalls.—These are under the constant supervision of the Food Inspectors who made 119 visits of inspection and arranged for the correction of insanitary defects at 15 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. 86 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 Ministiy 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. 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 iuice. beinir prows:-ed for stock feeding. The following foods were rejected at the wharves :— Meat— Beef 626 lbs. Lamb & Mutton 374 „ Pork 5½ „ Meat Trimmings 120 „ Ox Kidneys 80 „ Ox Livers 4 „ Sheeps Liver 173 „ Lambs Tongue ¾ „ Stewed Steak (Canned) 389 „ Corned Beef 45¾ ,, Bacon (Uncured) 12 „ Cooked Meats (Canned) 120 „ 1,950 lbs. Other Foods— Fruits (Canned) 771¾lbs. Fruit Juices 2,258½ „ Tomato Juice 44 „ Tomato Puree 99½ „ Peeled Tomatoes 70¼ ,, Fish 179½ .. Cheese Trimmings 24 „ Sausage Meal 11 „ Foods, Various 72 „ 3.530½ lbs. Total Imported Food Rejected 5,480½ lbs. 87 Caseous Lymphadenitis.—This disease, sometimes called "pseudo-tuberculosis" occurs mainly in sheep although it is occasionally found in cattle, rabbits and chickens. It is met usually in imported sheep carcases and is often the cause of meat being rejected as unfit for human consumption. It follows, therefore that much time and attention is given by the Food Inspectors to this disease during their inspections at the wharves and cold storage plants in the Borough. Results of examinations for caseous lymphadenitis are given below. Landed Examined Rejected Weight Australian Sheep, Ewes & 1 pr. short Wethers 29,642 342 forequarters 18 lbs. New Zealand sheep65,453 671 1 leg 5½lbs. Imported, Egg Albumen.—In 1956 there were greatly increased landings in this country of Chinese Dried Egg Albumen and from June until December, Greenwich received over 100 tons. This commodity in the previous year had contained salmonella organisms of various strains and some batches contained paratyphoid B. Extensive sampling in Greenwich confirmed these general findings. Because of the urgency of the problem a National Albumen Advisory Committee was set up consisting of representatives of the Importers, the Ministry of Health, the Public Health Laboratory Service and Food Research Organisations to consider methods of processing to render the product bacteriologically safe. Heat treatment eventually was considered to be the only effective solution and after many experiments it was decided that the albumen should be heated to a temperature of between 127° and 128°F. in specially constructed heat treatment chambers. Accordingly, several Heat Treatment Centres were set up throughout the country and a storeroom at Palmer's Cold Stores, Deptford, was adapted for this purpose. This room, which is capable of holding 40 tons at a time was heavily insulated and appropriate electrical heating equipment was installed to maintain the required temperature within very fine limits. The egg albumen was subjected in the first instance to 100 per cent. bacteriological examination by the Health Department, before being loaded into the heat treatment chamber. The temperature was then raised to between 127° and 128°F. and held at that level for at least six days before being allowed to cool gradually. The complete process takes about ten days. Batches found to be positive before heating were again subjected to bacteriological examination and in every case positive tins were found to be negative after treatment. 88 With increasing experience of the heat treatment method the sampling rate has now been reduced to 33⅓ per cent. which gives us sufficient "tracer" positives to keep a check on the effectiveness of the process. It has been found desirable to subject all dried albumen, from whatever source, to heat treatment and this has become routine. The following table gives the results obtained from the sampling of all types of egg albumen during the year ended 31st December, 1956 :— Imported Egg Albumen—Summary of Findings Chinese Dried Hen Eoo Albumen :— Imported Egg Albumen—Summary of Findings Chinese Dried Hen Egg Albumen :— Batch No. No. of Tins of 100 lbs. Control Samples Bact. Results of Positives after Heat Treatment Positive Negative Postive Negative Percentage rate of Control Sampling: 100% 1 81 24 57 Nil 24 2 268 23 245 Nil 23 3 323 26 297 Nil 26 4 186 4 182 Nil 4 5 232 10 222 Nil 10 6 231 10 221 Nil 10 7 238 Nil 238 — — 8 168 Nil 168 — — Percentage rate of Control Sampling : 33⅓% 9 157 Nil 55 — — 10 190 1 74 Nil 1 11 112 Nil 40 — — 12 112 Nil 40 - - Heat treatment is carried out in accordance with the recommendations of the Albumen Advisory Committee. Incidence of Salmonellae : Salmonella aberdeen 6 tins „ anatum 1 tin „ neivport 1 tin „ potsdam 9 tins „ thompson 83 tins „ typhi-murium 1 tin Norwegian Dried Eoo Albumen :— Occasional importations of 2 cwts. drums. Samples for bacteriological examination extracted from each drum. 2 drums imported in October, 1956 All negative for 2 drums „ „ November, 1956 Salmonellae Danish Pasteurised Flake Hen Ego Albumen :— 40 X 1 cwt. wooden casks arrived recently at Heat Treatment Centre. 100% sampling carried out for bacteriological findings. Salmonella typhi-murium isolated from 36 casks. 4 samples negative. Heat treatment of this albumen still in experimental stage. 89 Canned Stewed Steak.—In September, a consignment of 1,854 tins, each 6| lbs., of Stewed Steak was landed, ex s.s. "City of Hull" at Palmer's Wharf from South Africa. On examination approximately three per cent of the tins were found to be blown or in a state of advanced decomposition, or otherwise unfit. Six samples, apparently sound tins, were submitted for bacteriological examination and three produced anaerobic spore-bearing organisms of the Clostridium group ; two cans were sterile and one can produced Bac. cereus. These results suggested that the steak had been underprocessed and accordingly they were held under " Stop Notice " for further investigation. The Senior Trade Commissioner for South Africa, on his own behalf, arranged for bacteriological examination of a representative sample, and a further 12 tins were examined for the Health Department by an independent laboratory. The South African samplings were reported as negative but one of our further samples had a slight growth of Clostridium. After careful consultation with the Bacteriologists and considerable correspondence between South Africa and this department we decided to release the consignment but impressed upon the South African Bureau of Standards our concern about the matter. No complaints were subsequently received about the tins. 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. Two hundred and fifty-four inspections were made to secure compliance with the various Orders but on no occasion was it found necessary to take action against Vendors. Blackheath Fair.—At Easter, Whitsun and the August Bank Holiday, many thousands of Londoners from this and adjacent Boroughs once again availed themselves of the opportunity of making a visit to this source of entertainment. Constant supervision of refreshment stalls, etc., was necessary to ensure that a safe standard of cleanliness was maintained by the vendors and to this end a Food Inspector was always in attendance. Section 16 of the Food and Drugs Act, 1938, which previously had required the stallholder's name and address to be clearly displayed on his stall has now been replaced by Regulation 26 of the 90 Food Hygiene Regulations, 1955. In the past it had been necessary on occasions to warn vendors but during the current year such action was not required. 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 43 applications were made and licences granted to street traders engaged in the retailing of articles of food. No contraventions of Regulation 26 of the Food Hygiene Regulations, 1955, 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 3,747 visits, as a result of which 160 premises were improved. It is pleasing to record that of the improvements obtained only one was prompted by the issue of a Notice, the remainder being accomplished on verbal instructions. The following table is a statistical record of the major portion of the duties performed and inspections undertaken during the year by the Food Inspectors. 91 Premises Inspected or Visits Made No. of Visits No. of Premises at which Improvements were effected Caterers', Restaurants, etc. 392 32 Grocers 396 39 Butchers' Shops 119 15 Dairies, milk shops 101 1 Licensed Victuallers 34 1 Wharves and Factories 355 — Bakehouses 57 4 Ice-Cream Shops, etc. 235 9 Fried Fish Shops 53 2 Other Fish Shops 53 6 Cooked Meat & Preserved Foods 87 * Visits Re. Shops Act 275 — „ „ Rat Infestation 9 — „ „ Food and Drugs Act 201 — ,, ,, Merchandise Marks Act & Markets 254 - „ „ Food Poisoning 34 - Sampling Visits 346 - Fair Visits 14 - School Visits 37 - Miscellaneous Visits (including Flour MillsCyanide Fumigation) 478 7 Interviews 26 — Complaints Investigated 75 — Totals 3,747 116 Bakehouses.—At the end of the year, 12 premises in the Borough were being used as bakehouses, none of which was underground. Bakehouses and bakers' shops were visited on 57 occasions and, as a result of the inspections 4 improvements were realised. Thes< alterations were effected solely by informal action. Catering Establishments.—Public demand for communal catering continues and as a result of this practice of ' eating out ' the inspection and supervision of cafes, restaurants, works' canteens etc.,remains one of the most important duties of the Food Inspectors. Disregard of normal hygiene in the handling and preparation of food at such establishments can lead to an outbreak of food poisoning on a large scale and it is a tribute to the Inspectors' vigilance that no such outbreaks have occurred. 92 As a result of 426 visits of inspection to the catering establishments insanitary conditions were remedied and improvements effected at 49 premises. The following is a summary of the improvements carried out:— Type of Improvement Effected Total No. Cleaned and Painted 25 Wash-hand Basins installed 5 Heaters installed 2 Dustbins renewed 2 Institution of Nailbrushes 1 Ovens cleaned 1 Floors cleaned 1 Roof Gutters and Flashings repaired, 3 Sink waste pipe repaired 1 Yard paving repaired 1 Walls & Ceilings repaired 2 Floors repaired 1 W.C. Seat repaired 1 External W.C. repaired 1 Staircase repaired 1 Window repaired 1 Total Improvements Effected 49 Many licensed 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. One improvement was carried out at a public house as a result of informal action. Food and Drugs Act, 1955.—In accordance with the Council's contract with the Public Analyst, 387 samples were obtained under the provisions of the above Act and presented for examination. Of this total, 37 samples were formal and 350 informal of which 16 (all informal) were reported to be non-genuine. Five of the unsatisfactory samples were only incorrectly labelled and have therefore been excluded in the calculation of the adulteration figure. The adulteration figure at 2.8% shows an increase of 0.6 over that of ast year. Milk was again the main food sampled and not one of the 61 samples submitted for analysis was unsatisfactory. 93 Nine 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 11.6%. 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. Pharmacy and Medicines Act, 1941.—Four samples were taken for analysis, one each of Slimming Tablets, Asthma and Bronchitis Tablets, Blood Purifier and Nerve Tonic (complex formula), all of which complied with the provisions of the above Act. 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. Four samples of dried milk were obtained during the current year, all of which were satisfactory. 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. Three samples of condensed Milk were taken in the norma course of sampling and all were declared genuine. 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. 94 Information concerning the analyses of these samples is given in the following table:— Article How Obtained Examination Action Taken Bact. or Chem. Result Slices of White Bread Submitted by a member of the public—complaint of foreign bodies. Chem. Small black bodies identified as roasted poppy and maw seeds used by bakers for flavouring. Complainant notified accordingly. Sausage Meat (11 Samples) Taken from Cold Store in Borough. Bact. 2 Samples contained Salmonella typhi-murium and Staph, aureus. Undertaking given that, before disposal, consignment would receive heat treatment to render it fit for human consumption. Gravy Powder (2 Samples) Submitted by a member of the public—complaint of discolouration when used for dishes 'en casserole.' Chem. When used as directed, powder was satisfactory. Prolonged boiling with other ingredients broke down the colouring components. Complainant informed. Suggestions to the manufacturer that the composition be changed. Apricots (Canned) From an Admirralty Canteen. Part of a stock of doubtful tins. Chem. Edible—free from excesisve corrosion. Canteen notified of result. Dried Skimmed Milk (4 Samples) Complaint from local Hospital regarding taste. Chem. Sound and edible though not of highest quality. Hospital notified of result. Portion of Iced Birthday Cake. Suspected food from a paratyphoid case. Bact. No Salmonella organisms found. No further action. Sliced Applies (Canned) Part of consignment delivered to local Hospital —suspected of excessive internal corrosion. Chem. Satisfactory—fit for human consumption. Hospital notified of results of examination. Apple Purée (Canned) From stock of local tradesman —age of stock unknown. Chem. Satisfactory. Tradesman notified accordingly. 95 Article How Obtained Examination Action Taken Bact. or Chem. Result Quick Frozen Prawns (4 Samples) Taken from Cold Store in Boro'. Bact. Satisfactory Importer informed. Meat Balls Paté de Foie Luncheon Meat (1 sample of each). do. Bact. Sterile do. Corned Beef (Canned) do. Bact. Sterile do. Soft Herring Roes, (canned) potatoes and carrots. Portion of a meal—rejected by children on account of unpleasant odour. Chem. No injurious constituents detected Complainant notified of results of examination. Lemonade Aerated (Bottled) Complaint from a member of the public regarding an unpleasant smell. Bact. No pathogens isolated but smelt strongly of H2S. Bacteria—1,500 per ml. Manufacturer advised to introduce more effective means of coding. do. do. Chem. Incipient decomposition. do. 96 NOTIFICATION OF FOOD POISONING Under the provisions of Section 26 of the Food and Drugs Act, 1955, 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 23 notifications received during the year compared with 14 for the previous year, 12 for 1954, 9 for 1953, 10 for 1952, 4 for 1951 and 12 for 1950. All cases, which were of the sporadic type, were investigated with the following results:— Unknown Cause 13 Salmonella typhimurium 7 Salmonella enteritidis 1 Salmonella infection 1 Paracolon bacilli 1 In no instance was any direct connection with any specific food established. In no case was hospital treatment necessary and each patient made a complete recovery. 97 FOOD AND DRUGS ACT, 1955 Number and Description of Samples Submitted for Analysis under the above Act during the year 1956 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Ale — 1 1 — — — Almonds, Ground — 1 1 — — — Angelica — 1 1 — — — Aniseed, Balsam of — 1 1 — — — Arrowroot — 1 1 — — — Baby Foods, Canned — 2 2 — — — Baking & Golden Raising Powder — 4 4 — — — Barley, Pearl — 1 1 — — — Bay Leaves — 1 1 — — — Beverage, (Vitacup) — 1 1 — — — Biscuits — 2 2 — — — Blancmange Powder — 2 2 — — — Brandy 1 — 1 — — — Bread — 2 2 — — — Butter — 5 5 — — — Cake & Pudding Mixture — 3 3 — — — Cheese & Cheese Spread — 3 3 — — — Cocoa — 1 1 — — — Coconut, Desiccated — 1 1 — — — Coffee & Chicory Essences — 5 5 — — — Confectionery, Flour — 4 4 — — — Confectionery, Sugar — 11 11 — 1 1 Cooking Fat — 1 1 — — — Cough Mixture — 1 1 — — — Cream — 6 6 — — — Curry Powder — 2 2 — — — Custard Powder — 2 2 — — — Drinks, Soft — 4 4 — — — Dripping — 3 3 — 1 1 Epsom Salts — 2 2 — — — Fish, Various (Canned) — 26 26 — 7 7 Fish, (Frozen Prawns) — 1 1 — — — Fish Cakes — 2 2 — — — Fish Paste — 3 3 — — — Flavouring Essences — 4 4 — 1 1 Flour — 4 4 — — — Fruit (Canned) — 17 17 — — — Fruit (Dried) — 7 7 — — — Fruit Curd (Lemon) — 2 2 — — — Fruit Glace (Cherry) — 1 1 — — — Fruit Juice (Lemon) — 1 1 — — — 98 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Fruit Pudding (Canned) — 1 1 — — — Fruit Pie — 1 1 — — — Gelatine — 1 1 — — — Gin 2 — 2 — — — Glycerine, (Flavoured) — 1 1 — — — Gravy Preparation, with Browning — 2 2 — — — Herbs (Dried) — 1 1 — — — Honey — 1 1 — — — Horseradish (Dried) — 1 1 — 1 1 Ice Cream — 9 9 — — — Ice Lolly — 2 2 — — — Icing Compound — 1 1 — — — Jam, Various — 5 5 — — — Jelly Tablets — 3 3 — — — Lard — 2 2 — — — Laxative — 1 1 — — — Lemonade Crystals — 1 1 — — — Macaroni with Cheese Sauce — 1 1 — — — Margarine — 6 6 — — — Marmalade — 3 3 — — — Marzipan — 1 1 — — — Meat Products — 10 10 — 1 1 Meat Products, (Canned) — 30 30 — — — Meat Paste — 2 2 — — — Meat, Minced — 1 1 — — — Medicated Tablets — 2 2 — — — Menthol & Wintergreen Cream — 1 1 — — — Meringue Mixture — 1 1 — 1 1 Milk 24 37 61 — — — Milk (Condensed) — 3 3 — — — Milk Pudding (Canned) — 2 2 — — — Mustard — 1 1 — — — Nut Meat Curried, (Canned) — 1 1 — — — Nutmeg, Ground — 1 1 — — — Oatmeal — 1 1 — — — Orangeade Powder — 1 1 — — — Pea Flour — 1 1 — — — Pease Pudding — — 1 — — — Peel, Candied — 1 1 — — — Pepper — 1 1 — — — Pickles, Various — 7 7 — — — Potato Powder — 1 1 — — — Pudding, Xmas — 1 1 — — — 99 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Rice — 3 3 — — — Rum 3 — 3 — — — — Salad Cream — 1 1 — — — Salmon Mayonnaise — 1 1 — — — Salmon Salad with Mayonnaise, (Canned) — 1 1 — — — Salt — 1 1 — — — Sauce, Various — 6 6 — 1 1 Sausages — 5 5 — — — Sausage Meal — 1 1 — 1 1 Soup (Canned) — 5 5 — — — Soup Preparation — 2 2 — — — Soya Flour — 2 2 — 1 1 Spice, Cinnamon — 1 1 — — — Suet, Shredded — 2 2 — — — Sugar — 2 2 — — — Tapioca Flakes — 1 1 — — — Tea — 2 2 — — — Teaseed Oil — 1 1 — — — Tomato Juice, (Canned) — 3 3 — — — Vegetables, Various, (Canned) — 11 11 — — — Vinegar, Malt — 2 2 — — — Whiskey 7 — 7 — — — Wine, Alcoholic & Barley — 2 2 — — — Yeast Extract, (Marmite) — 1 1 — — — Zinc & Castor Oil — 1 1 — — — Totals 37 350 387 — 16 16 100 Administrative Action Taken in Respect to Samples Reported to be NOT GENUINE Sample No. Article Nature of adulteration and/or irregularity Action taken T.1 Soya Flour Contaminated by insects. Stocks withdrawn and destroyed. T.144 Chocolate Flavouring Contained benzoic acid 500 parts per million by weight. It would seem that this article is not covered by the P.H. (Preservatives, etc. in Food) Regulations, 1925/53. Letter to manufacturer suggesting alteration of label. T.170 Dripping Contained 2.5 %free fatty acids. Standard for this commodity is 1.5% Letter to manufacturer. Further samples to be obtained. T.171 Horseradish Deficient in aroma due to loss of enzyme activity and of little use as a condiment. Remaining stocks withdrawn. T.175 Meringue Mixture Article contained neither sugar nor albumen. Stock withdrawn. T.221 Brisling in Edible Oil (Canned) Contained an excessive proportion of tin, viz: 3.4 grains per pound. Stock withdrawn. T.233 Canned Salmon Label pictured bright red section of salmon on plate. Sample consisted of pink salmon. Label calculated to mislead purchaser as to quality of article. Letter to Canners. T.289 Vegetarian Sausage Meal Carcase of small fly and a quantity of insect webbing and droppings were found in the sample. Existing stocks withdrawn and destroyed. T.305 Chocolate Cigarettes Chocolate paper covering made from wood pulp and was indigestible (presence not mentioned in list of ingredients). Rice paper is customarily used in this connection. Matter taken up with Importers. T.312 Herring Tid-bits in Wine Sauce (Canned) Alcohol virtually absent. Description "Wine Sauce" is therefore liable to be misleading. Importers have agreed to the reexport of the consignment. T.316 Minced Turkey Label was such as to bo liable to mislead. Manufacturer has introduced new label. T.318 Peeled Shrimps in Salt Water (Canned) Shrimps had obtectionable metallic taste due to an excessive proportion of iron. Stock withdrawn. 101 Sample No. Article Nature of adulteration and/or irregularity Action taken T.331 Dressed Crab (Canned) Contained iron 150 parts per million. Condition of contents of tin were rendered unfit for human consumption. Stock withdrawn. T.349 Sauce Contained a small number of dead mites (probably introduced through one of the ingredients). Warning letter sent. T.352 Herring Tid-bits in Wine Sauce (Canned) Absence of alcohol, label therefore liable to be misleading. Matter taken up with Importers. T.353 Smoked Sliced Saithe in Soya bean Oil (Canned) Presence of added salt and colouring matter not disclosed on label. Matter taken up with Importers. 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. Legislation introduced since 1949 in accordance with Section 144 of the Public Health Act, 1936, concerning the notification of poliomyelitis, encephalitis, meningococcal meningitis, puerperal pyrexia, etc., has in common with other London boroughs, led to the allocation to Greenwich of notifications in respect of non-residents merely as the 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 Sectio 144 of the Public Health Act, 1936, Section 192 of the Pub lic Health (London) Act, 1936, and associated Orders and Regulations was 762. Under the Public Health (Tuberculosis) Regulations, 1952, there were 86 notifications, giving a consolidated total of 848 cases notified during the year. In 4 of these cases the diagnoses were not confirmed, thus giving a corrected figure of 844. The following table indicates the figures for the previous ten 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 1955 2,120 10-year Average 1,511 1956 844 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 seven certificates were so issued, all in respect of dysentery. 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 at the County Council clinics during 1956 was 597. This is an increase of 94 over the previous year but 718 less than the figure returned for 1951. In Greenwich during the last 6 years 8022 births have been registered, and for the same period only 4,219 vaccinations have been effected, a figure equivalent to 52.6%. In 1951 the births numbered 1,351 and the vaccinations 1,315 (97.3%), but during the current year the figures were 1,327 and 597 (44.9%) 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 International Certificates of vaccination has now been settled by the adoption of the International Sanitary Regulations (W.H.O. Regulations No. 2) which replaced the International Sanitary Conventions on 1st October, 1952. The Regulations prescribe inter alia, new forms of International Certificates of vaccination against Cholera and Smallpox and, to be valid, the certificate must bear an approved stamp which certifies that the signature of the Vaccinator is that of a practising medical practitioner. 105 During the year some 352 certificates of persons proceeding abroad were so authenticated, of these 301 were in respect of Smallpox, 25 for Cholera, 25 for Typhoid and 1 for Typhus. Six vaccinations and 1 inoculation for T.A.B. and 1 for Typhus were actually carried out by your Medical Officer of Health. Measles.—The normal biennial fluctuation was evident in the sharp decrease in the number of notified cases from a figure of 1,684 confirmed in 1955 to 44 for the current year. Five cases occurred in children under one year of age, 37 between one and ten years and 2 between 15 and 25 years. One case was removed to hospital and there were no deaths. The distribution of the cases was as follows :—East Greenwich 19 ; West Greenwich 2 ; Charlton and Kidbrooke 23. During 1954 28 cases were recorded and in 1953 there were 560. Whooping Cough.—Altogether 122 notifications were received in 1956, a decrease of 43 from the previous year. The year 1954 produced 223 and there were 235, 190, and 384, respectively for the years 1953, 1952 and 1951. Area distribution for the present period was :—East Greenwich 38 ; West Greenwich 15 ; St. Nicholas, Deptford, 3 ; Charlton and Kidbrooke 66. One case was admitted to hospital and there were no fatalities. During the year, 761 children under 5 years were immunised against Whooping Cough at the County Council's clinics. Diphtheria.—There was a Nil return recorded for the current year compared with one for 1955. 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 63, the figure for the current year. Over the same period deaths have decreased from 722 to 8. 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. 106 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 807 completed immunisations carried out in the Borough. This is an increase of 24 over that of the previous year but a reduction of no less than 829 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 11 notifications and 3 deaths registered in 1956 compared with 12 and 2 respectively for 1955. The deaths registered for the years 1955 and 1956 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 16 and 14 for the years 1954 and 1955, respectively. Six occurred in East Greenwich, 1 in St. Nicholas, Deptford, and 7 in Charlton and Kidbrooke. One case, a woman of 67 years, was removed to hospital where she died. Typhoid.—There was one case of paratyphoid fever notified last year, a similar return to that of 1955. This case was removed to hospital and eventually made a satisfactory recovery. Scarlet Fever.—A total of 58 notifications for the year shows an increase of 1 over 1955 and compares favourably with 69 cases for 1954. Twenty-one occurred in East Greenwich, 13 in West Greenwich, 3 in St. Nicholas Deptford, and 21 in Charlton and Kidbrooke. Twelve cases were removed to hospital and no fatalities were recorded. 107 Erysipelas.—Four cases were notified compared with 6 last year and 5 for 1954. One case received hospital treatment. Zymotic Enteritis or Epidemic Diarrhoea (Children under 5 years of age).—Originally 18 cases were notified but this figure was modified and 17 were eventually recorded as confirmed compared with 7 for the previous year. Three cases were admitted to hospital but there were no deaths. Sonne Dysentery.—This disease is usually characterised by diarrhoea, fever and, to a lesser extent, vomiting. Although modern methods of treatment are effective and usually fairly rapid, nevertheless the disease has become a serious nuisance and difficult to control. It is normally mild but in infants and young children it can produce serious illness and debility, especially if the patients are already slightly below normal health. In adults it is an irksome inconvenience and, if they work in the food trade, it can cause economic hardship. Notifications of this illness are increasing and have increased alarmingly since the war, e.g. in 1940, 2,860 cases of Dysentery were notified in England and Wales and in 1954 there were 31,833. Undoubtedly these figures represent only a fraction of the true incidence, because in Greenwich we have found many cases with symptoms too mild to seek serious medical attention, and yet these untreated cases can become a potent source of spread. Since the war the incidence in Greenwich has paralleled national experience ; e.g., in 1946 notifications totalled 8 and in 1954 70. The problem is to decide whether this type of Sonne Dysentery which is now so prevalent is of exactly the same type as previously existed. Some workers believe that new strains of Sonne organisms of increased infectivity and antigenically indistinguishable from the old organism were imported into the country during the war. On the other hand this " new " Dysentery may be a true variant of the old strains—laboratories are apparently unable to help us in this matter. The difficulties of preventing outbreaks or controlling them when they occur have been magnified by the lack of knowledge of the precise methods of spread of the illness. Some years ago it was confidently assumed that the spread was predominantly by food and drink, and that, indeed, may have been true. Recently, however, it has been suggested that this method is no longer of primary importance and that case-to-case contact is the method of choice. It is significant in support of change of method of spread from food to direct contact that the most vulnerable groups in respect of food 108 109 spread, namely, the 0-1 year and the 1-3 years groups, constituted only 13% of the total cases notified. Certainly experience in Greenwich over the past 5 years seems to confirm this view, for in no outbreak investigated during that time has food or drink been seriously indicted. If, in fact, it is true that the disease has undergone a fundamental change in natural history, the method of control will have to be varied. With this apparent change in mode of spread seems to have come an increase in infectivity and the new method of spread is more effective. This would account to some extent for the remarkable increase in incidence. It was with these thoughts in mind that we decided to try to analyse the information which we have collected in our investigations ; in particular we have classified the primary and secondary cases according to age and sex, and we have tried to relate the secondary spread to environmental and social factors in respect of occupation, density, size of family and ablutionary facilities. In regard to the latter, in some cases we have had to draw certain inferences from the collective knowledge of the Borough of members of the staff. The outbreak began explosively in February and increased in incidence through March with peaks in April, May and June; thereafter, as will be seen from the accompanying graph, there was a gradual defervescence and there was no autumnal recrudescence. The procedure of investigation was as follows : all notified cases were visited and faecal specimens taken from the patient and all other members of the family. Positive cases were referred to their private practitioners for treatment and faecal specimens taken at weekly intervals until two consecutive negatives were obtained. Time and shortage of staff precluded our insisting on three consecutive negatives. Positive excretors were excluded from school and from work involving handling or preparation of food, until two consecutive negatives were obtained. Refractory cases were given special attention and single drugs and combination of drugs were tried. Talble I shows the number of primary and secondary cases classified according to age and sex. It will be seen that in accordance with general experience in the country, the 5-15 age group predominates, accounting for 48% of total notifications. This contrasts with our experience of 1951 when this same age group accounted for 25%. With the apparent change in method of spread there has been a change in age group incidence. It may be that this can be accounted for by the greater mobility and more diverse activity of this group. Undoubtedly, the schools seemed to be the main source of primary infection, for school children accounted for 53% of the total number of primary 110 cases. It was also significant that during the Easter and summer vacations notifications dropped considerably. Table II relates the number of persons in family to the total number of primary notifications and their secondary cases. The secondary attack rate has been calculated by dividing the number of secondary cases by the number of persons at risk and multiplied by 100. It will be seen that generally, the larger the number of persons per family the greater the secondary attack rate, viz., the secondary attack rate was greatest in families of five, six and seven persons per family. The next table, Table III, attempts to relate housing density to incidence of primary and secondary cases and it will be seen that whereas according to the 1951 census the average density in Greenwich was 0.83 persons per room, the average density of the 218 families of which we have reliable details was 1.3 persons per room In actual fact, 88.5% of dysentery families were living in more overcrowded conditions than the Borough average. More detailed analysis shows that 80% of dysentery families live in densities of between one and two persons per room, whereas in Greenwich generally the figure is 45.2%. A surprising feature of the outbreak is that lack of sanitary and ablutionary facilities do not appear to be as potent a source of spread as one might imagine, because 148 out of 250 families under analysis were living in modern, self-contained properties. Of the remainder, a substantial proportion had apparently satisfactory standards of hygiene. Table IV indicates the duration of the illness in weeks after the institution of treatment by the family doctor and it will be seen that a substantial proportion of cases took from four to eight weeks before two consecutive negatives were obtained, and in one case it took 31 months to obtain negative stools. Our general experience has been that appropriate sulphonamide drugs were satisfactory after two to three weeks in about 55% of cases, but approximately 15% required chloramphenicol or other suitable antibiotic before treatment was considered complete. Generally speaking, the antibiotic seemed to be more effective and more rapid in action than any of the sulphonamide drugs. In all, a total of 2,747 faecal specimens were taken for examination which figure includes 373 taken from ' suspects ' at the request of local practitioners. In 2,033 cases the results were negative but in 713 instances the causal organism was identified as Shigella sonnei and in one as Shigella flexneri. (In the latter case the patient had recently returned from a holiday in Spain). 111 TABLE I. Type & Sex of Case Cases of Dysentery Notified Ages (in years) Totals 0-1 1-3 3-5 5-10 10-15 15-25 25-45 45-65 65 yrs & Over Primary Cases: Male 6 20 74 65 15 6 13 13 - 162 Female 4 17 19 57 27 10 32 7 1 174 Total 10 37 43 122 42 16 45 20 1 336 Secondary Cases: Male 2 3 8 23 8 2 14 1 1 62 Female 2 9 2 24 10 7 25 2 1 82 Total 4 12 10 47 18 9 39 3 2 144 Total of Secondary and Primary Cases 14 49 53 169 60 25 84 23 3 480 112 TABLE II No Persons in Family No. of Families Notifications Primary Secondary Attack Rate* Pos. Neg. Total Pos. Neg. Total 1 2 - 2 2 - - - - 2 7 4 3 7 - - - - 3 41 16 28 44 6 - 6 7.6% 4 72 51 40 91 24 4 28 14.2% 5 60 52 28 80 31 3 34 15.4% 6 40 41 13 54 39 2 41 22.0% 7 16 18 4 22 24 1 25 27.7% 8 6 20 1 21 1 - 1 3.7% 9 4 2 2 4 5 - 5 15.6% 10 2 1 2 3 2 - 2 11.8% Totals 250 205 123 328 132 10 142 16.6% * Notifications as a percentage of persons at risk. 113 TABLE III Density (Persons per Room) Number of Families Totals Persons per Family Actual As %of Families Involved 1 2 3 4 5 6 7 8 9 10 8 — — — — — — — 1 — — 1 0.4 4 — — — 2 — — — — — — 2 0.9 3 — — 4 —- — 2 — — — — 6 2.7 2.75 — — — — — — — 1 — — 1 0.4 2.50 — — — — 4 — — — — — 4 1.8 2.25 — — — — — — 2 — 2 — 4 1.8 2.00 — — — 17 — 9 — 4 — — 30 13.7 1.75 — — — — 20 — 4 — 1 1 26 12.0 1.50 — 1 7 — — 6 7 1 — — 22 10.1 1.25 — — — 28 14 8 — — 1 — 51 23.4 1.00 — 5 9 18 9 5 — — — — 46 21.0 0.75 — — 5 7 2 — — — — — 14 6.4 0.50 — — 6 4 — — — — — — 10 4.5 0.25 1 — — — — — — — — — 1 0.4 Totals 1 6 31 76 49 30 13 7 4 1 218 100 Average Density Whole Borough (1951 Census)— 0.83 persons per room Dysentery Families (1956)— 1.3 „ „ „ (88.5% of Dysentery Families living in conditions more overcrowded than average) 114 TABLE IV Age Duration of Illness in weeks after the institution of Treatment Totals 2 3 4 5 6 7 8 9 10 12 14 P S. P. S. P. S. P. S. P. S. P. S. P. S. P. S. p. S. P. S. P. S. P. S. 0—1 year 3 — 2 2 — 1 3 1 — — — — — 1 1 — — — — — — — 9 5 1—3 years 11 1 8 3 6 5 2 1 2 1 3 1 3 — — — — — — — — — 35 12 3—5 years 11 1 9 1 4 3 6 — 6 — 3 1 1 — — — — 1 1 — — 1 41 8 5—10 years 33 2 30 14 21 11 14 8 11 6 4 2 2 2 2 1 — — 1 — — — 118 46 10—15 years 17 1 10 8 5 5 2 2 3 — 1 1 1 1 — — — — — — — — 39 18 15—25 years 7 — 4 6 1 1 1 1 1 1 — — — — — — 1 — — — — — 15 9 25—45 years 21 6 14 20 6 6 2 3 1 2 — — — — — — — — — — — — 44 38 45—65 years 13 — 5 2 2 1 — — — — — — — — — — — — — — — — 20 3 65 years and over 1 1 — — — 1 — — — — — — — — — — — — — — — — 1 2 117 12 82 56 45 34 30 16 24 10 11 5 7 5 3 1 1 1 2 — — 1 322 141 129 138 79 46 34 16 12 4 2 2 1 463 P=Primary. S.=Secondary 115 The distribution of the positive cases was: 57 in East Greenwich, 124 in West Greenwich; 61 in St. Nicholas, Deptford and 238 in Charlton and Kidbrooke. Of these, twelve received hospital treatment. Where possible, in order to prevent financial hardship, arrangements were made with employers for 'food handlers' temporarily to be transferred to alternative duties. Nevertheless, it was necessary for 7 National Health Certificates to be issued to exclude workers for whom alternative work could not be found. With the co-operation of the School Medical Officer, children excluded from school on account of dysentery were allowed to return only on the production of a clearance certificate issued by the Medical Officer of Health. School children who were contacts of dysentery in their homes were excluded from school until a satisfactory result had been obtained from a faecal specimen. Scabies.—Six cases were so notified compared with 4 for the previous year and 5 for 1954. Treatment of all cases of scabies is carried out at the Tunnel Avenue Centre. Puerperal Pyrexia.—During the year there were no notifications received in accordance with the 1951 Regulations, but from other sources 19 cases concerning Greenwich residents were brought to the notice of the department, compared with 14 for 1955. All patients received hospital treatment. There were no fatalities. Meningococcal Infection.—There were no notifications received compared with 5 last year and 4 for 1954. Acute Encephalitis. (Infective or Post-Infectious).—A NIL return is recorded for the current year, a similar return to those for the years 1955 and 1954. Ophthalmia Neonatorum.—In respect of this disease, two notifications were received. One case was removed to hospital for treatment and the other was kept under observation by the Health Visitor at home. Each child made a full recovery. Poliomyelitis.—It has already been pointed out at the commencement of this Section that the vagaries of notification 116 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, 10 notifications were received of which 1 was re-diagnosed. Of the 9 confirmed cases, only 5 were in respect of Greenwich residents and a further case concerning a resident notified to Lewisham gave a final total of 6 for the Borough. Of these 4 were of the paralytic type and 2 non-paralytic, and all were children of 8 years or under. The grandparents of one case refused hospital treatment but no deaths were recorded. Malaria.—One notification of benign tertian believed to have been contracted abroad was received from the Royal Herbert Hospital in connection with a serviceman of 20 years. Tuberculosis.—During the year 86 notifications in respect of confirmed cases of tuberculosis were received compared with 99 for 1955. Of these, 77 were of the pulmonary type and 9 nonpulmonary, i.e., tuberculosis of parts of the body other than the lunes. The following table gives the distribution:— District Pulmonary Non-Pulmonary Total East Greenwich 28 3 31 West Greenwich 12 1 13 St. Nicholas, Deptford 6 — 6 Charlton and Kidbrooke 31 5 36 Totals 77 9 86 Disinfection was offered and carried out in 23 cases including 56 rooms and 241 articles of clothing and bedding, etc. The number of notified cases of Tuberculosis remaining on the Register at 31st December, 1956, was as follows:— PULMONARY NON-PULMONARY Men Women Children Total Men Women Children Total M F M F 537 461 24 21 1,043 26 41 12 6 85 For further clarification I append herewith copy of Form T.137 (revised) for the year under review as forwarded to the County Medical Officer of Health. 117 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 Part I.—Summary of notifications of Tuberculosis during the period from the 1st January, 1956, to the 31st December, 1956. 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 — — — 4 4 9 7 14 2 5 1 47 Respiratory, Females — — — — — 4 6 7 4 1 2 — 1 25 Non-Respiratory, Males — — 1 1 — 2 1 1 — — — — 6 Non-Respiratory, Females — — — — — — — 1 1 — — 1 3 Part II.—New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Source of Information Number of cases in age Groups Respiratory 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total M — — — — — — — — — — — — — — (A) Death Returns from Local Registrars Non-Respiratory F — — — — — — — — — — — — — — (B) M — — — — — — — — — — — — — — (C) Respiratory F — — — — — — — — — — — — — — (D) Death Returns from RegistrarGeneral (Transferable deaths) M — — — — — — — — — — — — — — (A) Non - Respiratory F — — — — — — — — — — — — — — (B) M — — — — — — — — — — — — — — (C) Respiratory F — — — — — — — — — — — — — (D) Posthumous Notifications M — — — — — — — — — — — 4 1 5 (A) Non-Respiratory F — — — — — — — — — — — — — — (B) M — — — — — — — — — — — — — — (C) F — — — — — — — — — — — — — — (D) N.B. Where notification of one form of Tuberculosis is subsequently followed by a notification of the other, only the first notification is taken into account for the purpose of this return. Totals (a (C) 5 (B) — — (D) — 118 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. Two surveys by the South East London Mass Radiography Unit were carried out during the year. The first, on 3rd August, was in respect of the Operators at Blackheath Fair and the second on 12th and 13th November, was in connection with a large factory in the area. I am indebted to Dr. J. M. Morgan the Director, for the following analysis of the results :— PART I.—General Analysis Men Women Total (a) Total X-rayed 1,354 57 1,411 (b) Total previously X-rayed 1,014 19 1,033 (c) Total recalled for large film 69 5 74 (d) Number normal on large film 16 2 18 (e) Number abnormal on large film 51 3 54 (f) Not yet attended for large film 2 — 2 PART II.—Analysis of Abnormal Large Films (1) Cases considered tuberculous and referred elsewhere : Men Women Total (a) No further action required — 11 (b) Occasional supervision only — — — (c) Requiring treatment 8 — 8 (d) Still under investigation 1 — 1 (e) Refused further investigation 1 — 1 (2) Non-tuberculous cases: (a) investigated Men Women Total Emphysema 1 — 1 Pneumonitis 1 1 2 Sarcoidosis 1 — 1 119 Post pneumonic fibrosis 1 — 1 Fractured Ribs (1th, 8th & 9th) 1 — 1 Secondary deposits in chest from carcinoma of tongue 1 — 1 (b) still under investigation — — — (3) Cardio vascular lesions — — — (4) Previously known tuberculous cases 1 — 1 (5) Abnormalities requiring no action 32 1 33 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 Public Health 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 97 10 Children under school age 34 4 School children 395 61 No. of home visits by Lady Public Health Inspector 19 No. of home revisits by Lady Public Health Inspector 57 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 :— 120 Rooms and Articles Disinfected, Year ended 31st December, 1956 Diseases, etc. Premises Entered Rooms Beds Mattresses Bolsters Pillows Sheets Blankets Eiderdowns Cushions Quilts Odd Articles Wearing Apparel Rugs and Mats Covers Total No. of Articles Disinfected. Scarlet Fever 59 117 14 57 44 150 126 219 41 70 53 241 310 — 53 1,378 Diphtheria 1 2 — 1 1 2 2 2 1 — 1 3 5 — 1 19 Tuberculosis 23 56 1 11 7 25 23 54 6 13 6 52 32 — 11 241 Cancer 11 18 3 7 7 21 12 26 10 9 5 45 30 1 7 183 Meningococcal Infection 8 24 4 7 4 22 22 31 5 9 9 65 68 1 8 255 Puerperal Pyrexia — — — — — — — — — — — — — — — — Typhoid Fever — — — — — — — — — — — — — — — — Polio-Myelitis 16 31 4 14 10 33 31 53 13 16 13 172 75 — 15 449 Erysipelas 4 7 1 2 — 4 5 4 — 3 — 13 5 — 2 39 Acute Encephalitis 1 2 — 1 1 2 2 5 1 2 1 5 — — 1 21 Measles " — — — — — — — — — — — — — — — — Scabies 1 4 1 1 2 7 6 12 1 3 1 5 20 — 1 60 Other Diseases 191 75 19 53 9 89 23 214 5 4 7 66 53 — 17 559 Verminous Premises 11 10 5 12 9 25 15 26 2 15 6 20 28 — 16 179 Tot at. 326 346 52 166 94 380 267 646 85 144 102 687 626 2 132 3,383 Articles destroyed 51 288 11 25 8 7 1 8 — 1,314 54 3 — 1,770 Library Books Disinfected 77 121 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. 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. In addition there are two small adjoining buildings which are used for occupational therapy and dressmaking classes for patients. The Clinic is part of the Miller, St. Alfege's Hospital Group and deals with all forms of chest disease from the diagnostic, therapeutic, social and preventive aspects. The Physicians admit some of their patients requiring in-patient treatment to their beds in St. Alfege's Hospital and also have access through the Regional Hospital Board to beds in specialised chest units and Sanatoria, principally Joyce Green and Bow Arrow Hospitals at Dartford, for short term treatment, the Eversfield Hospital, St. Leonards-on-Sea for long-term treatment, Grove Park and the Brook Hospitals for thoracic surgery—both tuberculous and non-tuberculous—and the Royal Sea Bathing Hospital, Margate, for orthopaedic and renal tuberculosis. During the year a number of visitors, some from overseas, came to study the work of the Clinic. These included Mr. B. P. Pathak, Secretary to the Government of Madhyer Pradesh, Nagpur, India, Overseas visitors from Finland, Spain, France, Germany and Venezuela, Colonial Scholars from Ghana, British Guiana and Brunei and students from King's College Hospital, Battersea Polytechnic and London University Institute of Education. Dr. Jeanes had the privilege of being awarded a Travelling Fellowship by the National Association for the Prevention of Tuberculosis and visited Canada for three months as guest of the Canadian Tuberculosis Association and also spent a month in the United States. A report has already been presented to the Management Committee on this 18,000 mile medical tour in which all the principal cities in Canada and fifteen major cities in the United States were visited. 122 Tuberculosis. At the end of 1956 there were 1,011 patients on the Chest Clinic register, consisting of:— Pulmonary Tuberculosis Non-pulmonary Tuberculosis Men Women Children Men Women Children 495 431 41 15 19 10 During the year there were 69 new notifications of Pulmonary Tuberculosis and 9 of non-pulmonary Tuberculosis, plus 5 posthumous notifications. There were 10 deaths of patients on the Tuberculosis register and 5 posthumous notifications. Of these 15 deaths only 10 were due to tuberculosis as will be outlined later in this report. Comparative figures for recent years are set out in the following table:— 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 1940 74,280 125 17 1.68 0.23 73 0.97 1942 60,530 164 18 2.70 0.29 64 1.06 1944 61,800 113 16 1.82 0.26 47 0.76 1946 76,840 173 18 2.25 0.23 56 0.73 1948 84,410 112 17 1.32 0.20 62 0.73 1950 89,570 126 18 1.41 0.20 50 0.56 1952 90,880 101 18 1.11 0.19 42 0.46 1954 90,600 86 13 0.95 0.14 22 0.24 1955 90.600 86 5 0.95 0.05 18 0.19 1956 88,780 69 9 0.78 0.10 10 0.11 The number of cases on the Tuberculosis Register does not diminish and has remained at about 1,000 for many years. There is now a very great tendency not to discharge patients after five years of quiescence, 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 clinic register. From this table it will now be seen that the incidence rate of tuberculosis, after remaining high after the war, is now diminishing 123 appreciably and the death rate even more rapidly. It is noteworthy that Greenwich has one of the lowest tuberculosis death rates of any London borough. The new notifications in 1956 totalling 78 were 13 less than in the previous year. The age and sex distribution of these 78 new notifications was as follows :— Age Male Female 0— 5 years 2 — 6—15 years 2 — 16—25 years 7 10 26—35 years 9 5 36—45 years 10 4 46—55 years 12 2 56—65 years 3 1 66—75 years 8 1 76 years and over 1 1 54 cases 24 cases This table illustrates that tuberculosis is a disease of young adults and middle aged and elderly men. The sources of these new cases were :— Referred by own doctor 43 cases Referred by Mass X-ray Units 23 „ Referred by National Service Medical Board 1 „ Discovered on routine contact 35 cases examination 10 „ Discovered on routine ante-natal Clinic X-rays 1 ,, It will be seen that 35 cases were discovered by case finding method. This emphasises the importance of adequate and convenient X-ray facilities for patients and their relatives and friends, including the occasional evening session for workers. In addition close co-operation with the local Mass X-ray Unit is maintained in order to follow up the patients who are found to have abnormal X-rays by these units. The special sessions for Ante-Natal Clinic X-rays started in 1953 has been continued and has been much used by the various Hospitals, clinics and private doctors concerned with ante-natal care. 594 women were X-rayed of whom only one was found to have tuberculosis requiring treatment. 124 The 43 patients who had consulted their doctors on account of symptoms tended to have much worse disease on diagnosis than the 35 picked up by routine radiography. Treatment. There have been no great changes in treatment during the year, and at no time has any patient had to wait for admission to hospital, sanatorium or thoracic surgery. The combined hospital-home treatment schemes have continued most successfully and half the 78 new cases seen were treated in this way, being in hospital for 3-4 months only until their disease was under control, and then continuing rest, chemotherapy and upgrading at home. There are, of course, critics of these methods of management of tuberculosis who say that by by-passing full long-term sanatorium treatment one's treatment of the individual patient is bound to fail. The experience of the past 5 years at the Greenwich Chest Clinic has clearly demonstrated that by careful selection of patients and their home background, fully 50% of the new cases seen can be treated entirely successfully in this way. Streptomycin, P.A.S. and Isoniazid continue to be the drugs of initial choice in the treatment of tuberculosis, and the tendency is to give longer and longer courses of these drugs, a year being about the minimum time. Artificial Pneumothorax has now been entirely abandoned as a method of treatment, but a few patients still have pneumoperitoneum, a useful method in a few cases. Twelve patients had major chest surgery during the year—all resections. With modern methods of treatment, including chemotherapy, the time a patient needs to be in Hospital has been very much diminished. For patients not requiring surgical treatment the average time is now about four months and for those needing surgery 9-12 months. In 1955 it was reported that a small number of patients, specially selected because of their limited disease and non-infectivity, were being treated by chemotherapy without rest. In 1956, 28 new cases of minimal tuberculosis were treated in this way by being given chemotherapy and allowed to continue at work, with entirely satisfactory results so far. In addition 21 old cases who had small reactivations of disease were treated with ambulant chemotherapy, again with very satisfactory results. It is realised that this is a revolutionary idea but results so far have quite justified ambulant chemotherapy as a method of treatment of some cases of tuberculosis. 125 Deaths. There were 15 deaths of patients on the tuberculosis register, but of these only 10 died from Tuberculosis, 8 men, the youngest aged 30 and the oldest aged 79 with 4 over the age of 65 years, and 2 women aged 68 and 84 years. Prevention is an extremely important part of the management of any disease, and this particularly applies to tuberculosis. By an active campaign of 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 persuaded 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 here be said that by making full use of the 70 mm. Odelca camera, the cost of X-ray films here is a fraction of that 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 700 individuals have been vaccinated. Not one of these has been known subsequently 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. The new scheme of occupational therapy provided in patients' homes, which was started in 1955, has continued to work most successfully, much to the benefit of patients. Social Work. The Clinic is fortunate in having an active Care Committee with voluntary funds, largely raised 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 126 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 Clinic has continued to deal with a large number of nontuberculous chest cases including bronchitis, asthma, bronchiectasis, lung abscess, industrial lung diseases and carcinoma of the lung. General Statistics : Number of new out-patients 2,341 Total number of out-patient attendances 9,373 Total number of Radiological examinations 9,169 Attendances for Artificial Pneumothorax Refills 2,361 Visits by Chest Physician to patients in their houses 100 Number of B.C.G. Vaccinations 159 Number of Home visits by Health Visitors 3,816 Number of contacts examined for first time 498 127 SECTION G Miscellaneous Guild of Hygiene.—The new Food Hygiene Regulations have to a very large extent superseded the Codes of Practice which were drawn up by this Department some years ago as a qualification for membership of the Guild. The standard demanded of members of the Guild is still a little higher than that which is legally enforceable, and it has been found that enlightened food traders still value the membership certificates of the Guild which acts as a safeguard to the public that the premises and the conduct of the business from hygienic aspects have official approval. During the course of the year there were three new certificates issued, and 81 were renewed on application by the members. As the result of the closing down of businesses 7 certificates were withdrawn leaving a final total of 84 certificates in operation at the end of the year. 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 146 examinations were so made. Sick Persons.—In addition, the Medical Officer of Health carried out 40 medical examinations of Council's employees 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 41 interviews during the year, 3 of which were carried out in the applicants' own homes. INDEX A Page Acute Encephalitis 115 Acute Influenzal Pneumonia 106 Acute Poliomyelitis 115 Acute Primary Pneumonia 106 Adoptive Acts, Bye-laws and Local Regulations 3, 4 Age Mortality 18, 19 Aged, Infirm and Physically Incapacitated Persons 64-69 Analytical Examination of Milk 82, 92, 93 Ante and Post Natal Clinics 32 Ante and Post Natal Clinics, Attendances 29 Anti-Fly and Anti-Mosquito Campaign 57, 58 Antitoxin, Diphtheria 106 Area of Borough 8 Articles and Rooms Disinfected 120 Articles Destroyed 120 Artificial Sunlight Centres, Attendances 30 Artificial Sunlight Treatment 32 Atmospheric Pollution 38-47 B Bacteriological Examinations 61, 82 83, 87-89, 94, 95, 110 Baiting of Sewers 57 Bakehouses 91 Baths and Wash-houses 59-61 B.C.G. Vaccinations 31, 125, 126 Births 13, 16 Birth Registrations 16 Blackheath Fair 89 British Red Cross Society 34, 65 Bronchitis 26 Burial and Cremation of the Dead 69 C Cancer 13, 14, 23-25 Caseous Lymphadenitis 87 Catering Establishments 91 Cerebral Embolism 25 Cerebral Haemorrhage 25 Cerebral Thrombosis 25 Certificates of Guild of Hygiene 127 Chest Clinic 33, 121 Chest Physician's Report 121-126 Children's Exercise Classes 30 Page Chiropody Clinics, Attendances 30 Chiropody Treatment 32 Citizens Advice Bureaux 34 Classification of Deaths ... 21 Clean Air Act 41-47 Cleansing and Scabies Clinic 33, 119 Cleansing of Children 119 Cleansing of Old People 69 Clinics and Centres 32 Clover Mite 59 Cockroaches 58 Common Infectious Diseases 14, 22 Complaints 35, 70, 75 Conveniences, Public 62-63 Coronary Disease 25 Council Housing Schemes 76 Council Rehousing 75 Cremation or Burial of the Dead 69 D Day Rooms (for Old People) 66,67 Death Causes, Remarks 21-26 Death Rates 14 Death Registrations 17 Death, Table showing Causes of and Ages at Appendix Deaths 13, 17 Deaths, Table showing Causes of and Ages under 1 yr. Appendix Deaths from Violence 26 Deaths in Institutions 18 Defective Dwellings—Repairs 47 Density of Population 8 Diarrhoea and Zymotic Enteritis 13, 22, 107 Diphtheria 22, 105, 106 Diphtheria Antitoxin 106 Diphtheria Immunisation Clinics 32 Diphtheria Prophylaxis Cases 31, 106 Discharge of Effluents into Sewers 52 Diseases of Respiratory System 26 Disinfecting Station 33 Disinfection 119, 120 Disinfestation of Verminous Premises 58, 59 Distribution Centres—National Welfare Foods 27 District Nursing 31 Domestic Helps 31, 33 Domiciliary Confinements 29 Drainage and Sewerage 52 INDEX (continued) Page Drainage, New and Alterations to 52 Drinking Fountains 63 Duties and Powers of the Public Health Committee 3, 4 Dwellings 8 Dysentery 107-115 E Egg Albumen, Imported 87-88 Elevation of Borough 8,10 Emission of Grit 38 Encephalitis 115 Enteric Fever 22, 106 Erysipelas 107 Exercise Classes, Ante Natal 30 Exercises Classes, Children's 30 Exhumations 69 Extracts from Vital Statistics 13, 14 F Factories Acts, 1937/48 36, 37 Fair on Blackheath 89 Family Planning Association, Sessions 33 Family Welfare Association 34 Flour (Composition) Regs., 1956 80 Food Hygiene Regs, 1955 80 Food, Inspection of 80-101 Food Parcels (Old People) 67 Food Poisoning 96 Food—Premises for Preparation of 83, 90 Food Rejected 84, 86-87 Food and Drugs Act, 1955 80, 92 Food and Drugs—Non-genuine Samples 100 Food and Drugs Act, 1955, Samples taken under 92, 97 Foot Clinics 32 Foot Clinics, Attendances 30 G General and Vital Statistics 8-26 General Provision of Health & Welfare Services in the Area 27-34 Golden Spider Beetle 59 Gooseberry Mite 59 Page Grants to Voluntary Organisations 65, 68 Greenwich Guild of Hygiene 127 Grit Emission 38-47 Guild of Hygiene 127 H Habitation Certificates (Water Supply) 53 Hairdressers and Barbers 50 Handicraft Centre 33 Handwashing Facilities 63 Health Centres 32 Health Visiting 28, 125, 126 Heart Disease 25 Heating Appliances (Fireguards) Act, 1952 49 Holidays (Old People) 67 Home Help Statistics 31 Home Help Service, Applications for 33 Horse Troughs 63 Hospitals 33 Hospital Confinements 29 Houses, No. in Borough 8 Houses Let in Lodgings 48 Housing 73-79 Housing Act, 1936, Procodure under 74 Housing Act, 1949 74 Housing Accommodation 73-78 Housing Homeless Persons 75 Housing Register 79 Housing Repairs and Rents Act, 1954 49 Housing Schemes, Council's 76-77 Housing Survey 78 Hygiene, Guild of 127 I Ice-Cream — Bacteriological examinations 83 Ice-Cream (Heat Treatment, etc.) Regulations 83 Ice-Cream Premises 82-83 Ice-Cream Quantitative Analysis 84 Ice-Cream Sampling 83, 84, 93 Illegitimate Births 13, 16 Immunisation and Vaccination Clinics 32 INDEX (continued) Page Immunisation and Vaccination Clinics, Attendances 31 Imported Food Rejected 86 Infantile Mortality 14, 19-21 Infant Welfare Centres 32 Infants Welfare Clinics, Attendances 28-30 Infectious Diseases 14, 22, 102-126 Infirm Persons 64-69 Influenza 13, 14, 26 Inhabited Houses 8 Inoculations, Poliomyelitis 31 Inspection of Food and Supervision of Food Premises 80-101 Institution Deaths 18 International Certificates 104 International Statistical Classification of Diseases, Injuries, and Causes of Death, 1948 21 Interviews, (Re-housing) by M.O.H. 127 Introductory Review 6-7 L Laboratory Work 51, 61, 82, 83, 8789, 92-101 Land Charges Act, 1925 52 Laundry Service 64, 65 L.C.C. (Gen. Powers) Act, 1953 52 L.C.C. (Gen. Powers) Act, 1954 50 Legal Proceedings 72 Legislation, New 35, 41-47, 80 Leptospirosis 55 Lettings (Housing) 79 M Malaria 116 Manufacture and Sale of Ice- Cream 83 Marriages 14 Mass Radiography 34,118 Maternal Mortality 13, 14, 19 Maternal and Child Welfare 27-34 Maze Hill Clinic (Tuberculosis) 33 121-126 " Meals on Wheels " 65 Measles 13, 22, 105 Meat Regulations 85 Meat Surrendered 84, 86 Medical Inspections (Superannuation) 127 Page Medical Inspections (Sick Persons) 127 Medical Officer of Health's Review 6-7 Medical Statistics (Schools) 31 Meningococcal Infection 115 Merchandise Marks Act 89 Meteorological Observations 15 Mileage of Streets 9 Milk, Alalysis of 82, 92 Milk and Dairies Regulations 81 Milk Licences 81 Milk (Special Designation) (Pasteurised & Sterilised Milk) Regulations 81 Milk (Special Designation) (Raw Milk) Regulations 81 Milk Supply 81 Minor Ailments Centres (for School Children) 32 Motor Vehicle Accidents 26 Mutual Exchanges (Housing) 79 N National Assistance Act 65 National Insurance Act (Medical Certificates) 103 National Welfare Foods—Distribution Centres 27 Natural Increase 12 Neo-Natal Mortality 20 & Appendix New Housing Accommodation 76 New Legislation 35, 41-47, 80 Nomenclature Regulations, 1948 21 Non-Genuine Samples 100 Notices, etc. 35, 71 Notifications of Infectious Diseases 102-126 & Appendix Notifications of Food Poisoning 96 Nursing Associations 34 O Old People's Clubs 65-66 Old People's Welfare Association 65 Open Spaces 9 Ophthalmia Neonatorum 115 Outworkers 37 Overcrowding 75 INDEX (continued) P Page Perinatal Mortality 20 Personal Health Services 27-34 Persons Cleansed 64,119 Pet Animals Act 51 Pharmacy & Medicines Act 93 Pharmacy <fe Poisons Act 50 P.H. (Condensed Milk) Regulations 93 P.H. (Dried Milk) Regulations 93 P.H. (Imported Food) Regulations 86 P.H. (Meat) Regulations 85 P.H. (Preservatives, etc., in Food) Regulations 100 P.H. (Smallpox Prevention) Regulations 104 Physically Incapacitated Persons 64-69 Pigeon Nuisance 38 Pneumonia 26, 106 Poliomyelitis 115 Poliomyelitis Inoculations 31 Pollution, Atmospheric 38-47 Pollution, River 38 Population 8, 12 Post-Natal Attendances 29 Powers & Duties of the Public Health Committee 3, 4 Preserved Food Premises 82, 83 Prevalence of, and Control over Infectious Diseases 102-126 Prevention of Damage by Posts Act 55 Procedure under the Housing Act, 1936 74 Prophylaxis Cases 31 Prophylaxis Clinics 32 Public Baths & Washhouses 59-61 Public Health Committee 3 Public Health Department Staff 5 Public Health Laboratory Service 82, 83, 87-89, 94-95, 96 Public Open Spaces 9 Public Sanitary Conveniences 62-63 Puerperal Pyrexia 115 Q Quantitative Analysis of Ice- Cream 84 Queen's District Nursing Association 31, 34 R Page Radiography, Mass 34, 118, 123 Rag Flock Act 51 Ranyard Mission 31, 34 Rateable Value 8 Rates, Births and Deaths, etc 13, 14 Rat Repression 54-57 Refuse Disposal 53 Registered Births 13, 16 Registered Deaths 13, 17 Registrar—Office Hours 34 Registration of Preserved Food Premises 82, 83 Rehousing 75 Rehousing Interviews (by M.O.H.) 127 Rejected Food 84,86-87 Remarks on Various Death Causes 21-26 Rent & Mortgage Interest (Restrictions) Acts 48 Reproductive Wastage 20 Requisitioned Accommodation 75 Requisitioned Houses & Housing (Amendment) Act, 1955 78 Respiratory System—Diseases of 26 Review by M.O.H. 6-7 River Pollution 38 River Smells 38 Rodent Control 54-57 S Sampling of Ice-Cream 83 Sampling of Milk 82,92 Sampling under Food & Drugs Act 92, 97-101 Sanitary Circumstances of the Area 35-72 Sanitary Conveniences, etc. 62-63 Sanitary Inspectors (Change of Designation) Act, 1956 35 Sanitary Work—Summaries etc 70-72 Scabies 115 Scabies & Cleansing Clinics 119 Scarlet Fever 22, 106 Scavenging and Refuse Disposal 53 Schools (Medical Statistics) 31 Sewerage and Drainage 52 Sewers—Baiting of 57 Shops Act 50 Slaughterhouses 85 Slum Clearance 74 INDEX (continued) Page Smallpox 22, 103-104 Smells from River 38 Smoke and Grit Emission 38-47 Social Conditions of the Area 10-11 Sonne Dystentery 107-115 Staff of Public Health Department 5 Statistical Tables Appendix Statistics, General 8, 9 Stewed Steak (Canned) (Special Examination) 89 Still Births 13, 16 Streets, Mileage of 9 Street Traders 90 Suicide 26 Summary of Sanitary Work 70-72 Sunlight Treatment 30 Supervision of Food Premises 90 Supplies of Underground Water (Wells) 53 Swimming Baths 60, 61 T Toddlers Clinic Attendances 30 Town & Country Planning Act, 1947 77 Transfers (Housing) 79 Transported Meals for Old People 65 Treatment Centres and Clinics 32 Tuberculosis, 13, 14, 22, 116, 117, 118 121-126 Tuberculosis — Handicrafts Centre Sessions 33 Tuberculosis Officer's Report 121-126 Typhoid Fever 22, 106 U Underground Water Supplies (Wells) 53 Uninhabited Houses 8 Unsound Food 84, 86, 87 V Page Vaccination Cases 31,104 Vaccination and Immunisation Clinics 32 Vaccination International Certificates 104 Various Death Causes, Remarks on 21-26 Vascular Losions of Nervous System 25 Verminous Conditions 64, 119 Verminous Premises 58, 59, 64 Violent Deaths 26 Vital Statistics 8-26 & Appendix Voluntary Organisations 34 Voluntary Organisations, Grants to 65 W Wash-houses & Public Baths 59-61 Washing Facilities (Hand) 63 Water—Underground Supplies (Wells) 53 Water Supply 53 Water Supply Certificates 53 Weil's Disease 55 Welfare Clinics 32 Welfare Foods, National — Distribution Centres 27 Welfare Scheme for Old People 68 Wells 53 Wooping Cough 13,22, 105 Whooping Cough Prophylaxis Cases 31,105 Whooping Cough Prophylaxis Clinics 32 Women's Special Clinic 33 Women's Voluntary Services 34 X X-Ray Examinations 123, 125 X-Ray, Mass 34, 118 Z Zymotic Diseases 22, 107 Zymotic Enteritis 22, 107 INFANTILE MORTALITY DURING THE YEAR 1956 Deaths from stated Causes in Weeks and Months under 1 Year of Age. Cause or 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 ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Tubercular Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningococcal Moningitis ... ... ... ... ... ... ... ... ... ... Tracheo Bronchitis ... ... ... ... ... 3 ... ... ... 3 Broncho Pneumonia ... ... ... 1 1 1 ... ... ... 2 Castro-Enteritis ... ... ... ... ... ... ... ... ... ... Pulmonary Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformation 6 ... ... ... 6 ... 1 ... ... 7 Premature Birth 4 ... ... ... 4 ... ... ... ... 4 Pancreatic Atrophy and Fibrosis ... ... ... ... ... 1 ... ... ... 1 Sarcoma of Vulva ... ... ... ... ... ... ... ... 1 1 Inhalation 1 ... ... ... 1 ... ... ... ... 1 Other Causes ... ... ... ... ... ... ... ... ... ... Totals 12 ... ... 1 13 5 1 ... 1 20 Male 10 Female 10 CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1956. Notifiable Disease Cases Notified in Whole District Total Cases Notified in each Locality No. of Cases removed to Hospital from each Locality Total Age & Sex Group At all Ages 0 to 1 I 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 Kldbrooke Greenwich East Greenwich West St. Nicholas Charlton and Kldbrooke m f m F M f M f m f M f m F m f M f m f Malaria 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Encephalitis Infectious ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Post-Infectious ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 224 256 8 6 23 26 32 21 88 81 23 37 8 17 27 57 14 9 1 2 57 124 61 238 3 4 1 4 12 Erysipelas 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... 1 2 1 ... 1 ... ... ... 1 1 Acute Polio-Myelitis P 3 2 ... ... 1 1 ... 1 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 5 ... ... ... 4 4 N.P 2 2 ... ... ... ... ... ... 1 2 ... ... 1 ... ... ... ... ... ... ... 2 1 ... 1 1 1 ... 1 3 Scarlet Fever 32 26 1 ... 2 1 4 4 21 17 3 4 ... ... 1 ... ... ... ... ... 21 13 3 21 5 3 3 1 12 Paratyphoid Fever ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Scabies 3 3 ... ... ... ... 1 ... ... 2 1 ... ... 1 1 ... ... ... ... ... 4 1 1 ... 1 ... ... ... 1 Puerperal Pyrexia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Infection ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 24 20 4 1 5 3 3 6 12 8 ... ... ... 2 ... ... ... ... ... ... 19 2 ... 23 ... ... ... 1 1 Whooping Cough 48 74 5 4 8 15 15 20 20 33 ... 1 ... ... ... ... ... ... ... 1 38 15 3 66 ... ... ... 1 1 Diarrhoea 7 10 2 3 4 2 1 5 ... ... ... ... ... ... ... ... ... ... ... ... 4 1 2 10 ... ... 2 1 3 Ophthalmia Neonatorum 1 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... Pneumonia, Acute Primary or Acute Influenzal 10 4 ... ... 2 1 1 ... 1 ... ... ... 1 1 2 1 1 ... 2 1 6 ... 1 7 1 ... 1 1 3 Tuberculosis, Pulmonary 52 25 ... ... 1 ... ... ... ... ... ... ... 8 10 16 11 16 3 11 1 28 12 6 31 3 1 1 2 7 „ Non Pulmonary 6 3 ... ... ... ... 1 ... 1 ... ... ... 2 ... 2 1 ... 1 ... 1 3 1 ... 5 2 ... ... 2 4 Totals 415 429 21 15 46 49 58 57 144 143 27 42 21 32 51 70 33 14 14 7 185 171 77 411 16 9 8 21 54 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, 1956. 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 £5 and under 75 75 and upwards Greenwich East I Greenwich West 1 St. Nicholas, Deptford Chariton and Kidbrooke St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital Other Institutions Outside Institutions Under 4 mths. 4 mths. and undtr 1 yr. 1 Tuberculosis, Respiratory 12 ... ... ... ... ... ... 4 ... 6 2 3 3 2 4 1 ... 2 ... ... ... 4 26 2 Tuberculosis, Other 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... 1 3 3 Syphilitic Disease 4 ... ... ... ... ... ... ... 2 2 ... ... 1 ... 3 2 ... 1 ... ... ... 1 5 4 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Meningococcal Infections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7 Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 8 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Other Infective and Parasitic Diseases 1 ... ... ... ... ... ... ... 1 ... ... ... l ... ... ... 1 ... ... ... ... ... 4 10 Malignant Neoplasm, Stomach 21 ... ... ... ... ... ... ... 8 9 4 12 2 ... 7 8 i 2 ... ... ... 4 30 11 Malignant, Neoplasm, Lung, Bronchus 61 ... ... ... ... ... ... 1 33 17 10 19 8 6 28 24 3 1 ... 4 ... 10 89 12 Malignant Neoplasm, Breast 12 ... ... ... ... ... ... 3 3 4 2 4 1 ... 7 3 ... ... ... ... ... 3 17 13 Malignant Neoplasm, Uterus 4 ... ... ... ... ... ... 1 2 ... 1 1 ... ... 3 1 ... ... ... ... ... 2 3 14 Other Malignant and Lymphatic Neoplasms 92 ... 1 ... 2 ... ... 6 35 24 24 32 17 3 40 36 4 5 ... ... 1 20 165 15 Leukaemia, Aleukaemia 4 ... ... ... ... 2 ... 1 ... ... 1 ... ... ... 4 ... ... ... ... ... ... 3 7 16 Diabetes 11 ... ... ... ... ... ... ... 4 3 4 3 4 1 3 3 ... 1 ... ... 1 2 13 17 Vascular Lesions of Nervous System 88 ... ... ... ... ... ... 3 25 19 41 38 9 3 38 39 2 5 ... 2 2 10 178 18 Coronary Disease, Angina 115 ... ... ... ... ... ... 3 22 45 45 41 18 3 53 19 3 10 ... 1 2 12 113 19 Hypertension with Heart Disease 6 ... ... ... ... ... ... ... 1 2 3 2 1 1 2 ... ... ... ... ... ... ... 3 20 Other Heart Disease 112 ... ... ... ... 1 ... 6 19 21 65 46 21 9 36 54 2 4 ... 2 ... 6 225 21 Other Circulatory Disease 46 ... ... ... ... ... ... ... 12 13 21 16 11 3 16 15 1 5 ... 3 1 3 85 22 Influenza 3 ... ... ... ... ... ... ... 2 ... 1 ... 1 ... 2 ... ... ... ... ... ... ... ... 23 Pneumonia 79 3 ... ... ... 1 ... ... 5 19 50 32 18 5 24 56 1 6 ... 2 ... 4 187 24 Bronchitis 70 3 ... ... ... ... ... ... 13 25 29 25 11 5 29 23 1 3 ... 1 ... 4 68 25 Other Diseases of Respiratory System 8 ... ... ... ... ... ... ... 5 1 2 7 ... ... 1 2 1 ... ... ... 2 1 38 26 Ulcer of Stomach and Duodenum 9 ... ... ... ... ... ... ... 2 4 3 5 1 1 2 2 1 4 ... ... ... 2 24 27 Gastritis, Enteritis and Diarrhoea 2 ... ... ... ... ... ... ... 1 ... 1 2 ... ... ... 1 ... 1 ... ... ... ... 11 28 Nephritis and Nephrosis 11 ... ... ... ... 1 ... 3 2 1 4 3 2 ... 6 6 ... 1 ... ... ... 1 22 29 Hyperplasia of Prostate 7 ... ... ... ... ... ... ... ... 4 3 2 4 ... 1 6 ... ... ... ... ... 1 14 30 Pro tenancy, Childbirth, abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 Congenital Malformations 12 7 ... ... 1 ... ... 3 1 ... . . . 5 2 ... 5 3 ... 2 ... 1 ... 6 19 32 Other defined find ill-defined Diseases 54 6 ... ... ... l ... 3 10 9 25 17 11 4 22 23 1 9 ... ... 1 10 138 33 Motor Vehicle Accidents 6 ... ... ... 1 l 2 1 ... ... 1 ... 3 ... 3 2 ... 2 ... ... ... 2 21 34 All other Accidents 14 ... ... ... ... ... 1 3 1 4 5 7 1 1 5 6 ... 1 ... ... 1 5 25 35 Suioide 8 ... ... ... ... ... 1 1 3 2 1 2 1 ... 5 2 ... 1 ... ... 1 2 10 36 Homicide and Operations of War 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Totals 874 19 1 1 4 7 4 43 212 234 349 325 152 47 350 337 22 66 ... 16 12 119 1,544 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