Metropolitan JBorongb of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1957 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1957 Printed, by Freame, Manning &• Co., Ltd. Lewisham, S.E.13 CONTENTS Paob Public Health Committee 3 Introductory 6 Section A.—General and Vital Statistics 9 „ B.—General Provision of Health and Welfare Services for the Area 29 „ C.—Sanitary Circumstances of the Area 37 „ D.—Housing 77 „ E.—Inspection of Food and Supervision of Food Premises 83 „ F.—Prevalence of, and Control Over, Infectious and other Diseases 104 „ G.—Miscellaneous 118 Appendix—Statistical Tables 3 PUBLIC HEALTH COMMITTEE as at 31st December, 1957 The Mayor: Councillor Mrs. M. L. Wentworth, J.P. and 13 Members Councillor A. C. Chrisp, L.C.C. (Chairman) Councillor Mrs. M. L. Bennett (Vice-Chairman) Aldermen : Mrs. L. Hilldrith Mrs. J. Gollogly P. Noble Councillors : Mrs. L. Berry D. P. Lynch J. B. Gillard W. S. Manners Mrs. A. D. A. Kennedy R. Ruston Dr. W. Smith Powers and Duties of the Public Health Committee : 1.—The Committee shall consist of 13 members of the Council. 2.—There shall stand referred to the Committee all matters relating to the powers and duties of the Council under Acts of Parliament, by-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 enactments 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 specified in Part I of the First Schedule to such Acts, the functions of the Council under Sections 16 and 18 of the Food and Drugs Act, 1955, (registration of premises used in connection with 4 manufacture or sale of ice cream, preserved food, etc.) the Food and Drugs (Milk and Dairies) Act, 1944, and the Milk (Special Designation) 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 for deal ing 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 (as amended) 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, shall be delegated to the Committee. 6.—The powers and duties of the Council conferred by sub-section 1 of Section 18 of the London County Council (General Powers) Act, 1954, to register hairdressers and barbers and their places of business shall be delegated to the Committee. 7.—The functions of the Council under the Clean Air Act, 1956, shall stand referred to the Committee. 8.—The powers and duties of the Council in connection with the repair, closure or demolition of individual insanitary dwellings under the Housing Act, 1957, and the powers and duties of the Council under the Rent Act, 1957, to issue Certificates of Disrepair shall be delegated to the Committee. 9.—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. 10.—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. 11.—The Committee shall have the control of all public drinking fountains other than those provided in any open space or property belonging to the Council and coming within the jurisdiction of any other Committee. 12.—All matters arising out of the powers of the Council under Section 82 of the London County Council (General Powers) Act, 1957, shall stand referred to the Public Health Com-mittee. 5 STAFF as at 31st December, 1957 MEDICAL OFFICER OF HEALTH : John Kerr Brown, B.Sc., M.B., Ch.B., D.P.H. PUBLIC ANALYSTS : H. A. Williams, Ph.D., A.C.G.F.C., F.R.I.C. D. G. Allen, B.Sc., F.R.I.C. PUBLIC HEALTH INSPECTORS : oc 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 abefg Miss B. Hatfield abd J. Grimston 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 F. C. Smart* (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 Certificate of Sanitary Science. e Certificated Health Visitor. f „ State Certified Midwife. g „ State Registered Nurse. * Commenced duties 22/3/57 6 Public Health Department Town Hall, Greenwich, S.E.10. August, 1958. To the Mayor, Aldermen and Councillors, Metropolitan Borough of Greenwich. Ladies and Gentlemen, I have pleasure in presenting the Annual Report on the health and environmental circumstances of Greenwich for 1957. There was an increase in the population of 130, which reversed a trend which had been apparent for the last few years. The birth rate was down and there was a decrease also in the death rate. The Infantile Mortality rate of 36 is an increase of 16 over last year and is the highest for some time. It is accounted for primarily by a preponderance of neo-natal deaths, the majority of which occurred in the first week and were due to prematurity. I have stressed in past reports the unreliability of placing too much emphasis on yearly statistical variations when comparatively small numbers are involved, but the very large number of deaths due to prematurity emphasizes once again the prime importance of adequate ante-natal care and supervision. Until the precise cause or causes of premature birth are completely understood, strict attention to the routine management of the pregnant woman remains the best preventive measure against prematurity. For the first time for four years there was a maternal death, which was the subject of a Coroner's inquest, but the circumstances were so unusual that it had no public health significance. Turning to causes of death, tuberculosis deaths are down by 6, but cancer deaths remain the same although lung cancer decreased by 12. Stomach cancer and other forms increased by a similar amount. Deaths from acute primary and influenzal pneumonia increased by 14, a result of the minor influenza epidemic which affected the whole country in the latter part of the year. There was very little dysentery in the Borough and this saved the Department much laborious routine work ; on the other hand, measles was very prevalent with 1,194 notifications. 7 The Borough had 8 cases of poliomyelitis, but there were only 17 cases of food poisoning notified to us. I am glad to include some observations by Dr. Morgan, Director of the Mass Miniature Radiography Unit for this area. The results of these surveys suggest to Dr. Morgan that random and selective examination of the public in South-east London are revealing numbers of active pulmonary tuberculosis slightly in excess of the national average at similar surveys. It is true that notifications are again down, this time by 6, but as Dr. Morgan points out, these are cases who normally have sought medical advice, and he advocates all adults who have not been previously x-rayed to make use of the facilities of mass miniature radiography. This advice I would heartily endorse and applies not only to the adolescent and the working adult but also to the elderly who can be a fertile source of latent infection in the community. It behoves all public-spirited citizens to visit the Mass Miniature Radiography Unit when it is in their area in order to satisfy themselves at least once that they are not suffering from pulmonary tuberculosis or other serious chest ailment, and to avail themselves of all treatment facilities and preventive measures if found to be necessary. This seems to me to be the only effective way that the residuum of infection can be eliminated from the community and the last great infectious epidemic disease in the country be conquered. This is written in no spirit of alarm, for the position of pulmonary tuberculosis in Greenwich continues to be satisfactory, if we can judge by our notification rates and death rates, which have been falling steadily during the last decade. These results are due in large measure to the vigilance of local practitioners and to the excellent work of the Chest Clinic in treatment of cases, tracing of contacts, administration of BCG, and to the multifarious sociomedical work done on a voluntary basis by the After-Care Committee. The general raising of the standard of living of the community and the improvement of housing environment provided by the Slum Clearance programmes of this Council and the London County Council, and the building programme of both authorities, are all having and will continue to have a cumulative effect not only in the eradication of this disease but of other disabilities which have their roots in deprivation and unhealthy living conditions. The Rent Act came into force during the year and has presented this Department with difficulties both of administration and of interpretation. The main provisions are detailed in the body of the Report. 8 The Housing Act, 1957, was a consolidating measure embracing enactments relative to housing legislation passed during the last few years. Services relating to old persons continue to expand and are fulfilling a great need, particularly the laundry service and the home baths. The Geriatric Unit at St. Alfege's Hospital continues to give priority to our cases on medical and social grounds and the Department is grateful for the consideration we receive from Dr. Mester. Similarly, the institution accommodation of the L.C.C. serves a very useful purpose and we are glad of the co-operation we receive. An account of the work of the Old People's Association is also included and mention must be made of the work done by the Red Cross, the W.V.S. and the Association in connection with Meals-on-Wheels, holidays, outings, Christmas parcels, ' Darby and Joan' Clubs, and the many other welfare services devoted to the old folk. In conclusion, I wish to thank the Chairman and the ViceChairman of the Health Committee for their help and support. The Town Clerk, his deputy and my Chief Officer colleagues have shown me much kindness and I am glad to record my gratitude to the staff for loyalty and application to duty. I have the honour to be, Your obedient Servant, J. Kerr Brown, Medical Officer of HeaUh 9 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA General Statistics Elevation.—Varies from below high-water mark up to 249 feet above sea level. Area of the Borough and Districts— East Greenwich 1,300 acres West Greenwich 453 „ St. Nicholas, Deptford 115 „ Charlton & Kidbrooke 1,990 „ 3,858 acres Population— At Census, 1951 89,846 Estimated, 1957 (mid-year) 88,910 Density of Population (persons per acre) 23.0 Number of Inhabited Dwellings—end 1957 (according to Rate Books) 23,888 Structurally separate dwellings at Census, 1951 21,348 Number of Uninhabited Dwellings— At Census, 1951 364 At end 1957 177 Number of Families or Separate Occupiers— At Census, 1951 26,397 Rateable Value,1957 £1,444,028 Sum Represented by a 1d. Rate, 1957 £5,639 10 PUBLIC OPEN SPACES Borough Council— Charlton House and Gardens 9.25 acres East Greenwich Pleasaunce 5.93 „ 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 6.01 „ Approximately 26.64 acres H.M. Office of Works— Greenwich Park 185 acres L.C.C.— Blackheath (part of) 89 acres Blackheath—Rangers House and Garden 2½ „ Mary on 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 % of the total area of the Borough) Mileage of Streets 88.6 (approx) 11 SOCIAL CONDITIONS The Metropolitan Borough of Greenwich comprises three districts viz., Greenwich, Charlton and Kidbrooke and St. Nicholas, Deptford, all of which are now united into one civil parish. There is evidence that Greenwich has been an inhabited place for perhaps 2,000 years. In Latin it was described as Grenovicum viridis sinus a viridariis and in Saxon Grenawic, i.e., the Green Town or dwelling upon the bank of the river. Saxon burial mounds and barrows dating from the 6th century are still to be seen in Greenwich Park and recovered coins and fragments of pottery 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 historical connection with royalty, that it owes its fascination. The sub-soil of the greater portion of the Borough consists of gravel and sand, the exception being in the Kidbrooke area which is mainly clay. The altitude varies from a few feet below high-water mark on the Marshes up to 249 ft. above sea level on the Shooter's Hill Road by the Borough boundary. The Borough is well catered for in the way of parks and open spaces, the largest being the famous Greenwich Park with its historical surroundings covering an area of 185 acres. Blackheath forms the southern boundary, 89 acres of which are within the Borough, providing unsurpassed facilities for games, sports and amusements. In all, public open spaces amount to 11% of the total area of the Borough, equivalent to approximately 5 acres per 1,000 of its population. 12 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, Merryweather's Works (Fire Engines), Cement and Stone Works, Asbestos Works, Cold Meat Storage, Pressed Tool Works, Constructional Engineering Works, Galvanizing and Sheet Metal Works, Brewery, Flour Mills, Aero Parts, Wireless and Vehicle Parts and Tin Box Manufacturing Works. The numbers employed at 11 of the larger factories range between 500 and 5,000 each, whilst 17 smaller works each employ between 100 and 400. 13 POPULATION The Registrar General has submitted his estimate of the population of Greenwich, computed at mid-year 1957, upon which the Statistics of this Report have been based. The figure returned is 88,910 indicating an increase in the population of 130 since last year but a decrease of 936 since the 1951 Census. The current figure shows an advance of 25,110 over that for 1945. The natural increase for the year, i.e., excess of births over deaths was 393. The Child Population at mid-year 1957, as estimated by the Registrar General was:— Age No. Approx. per cent. of Total Population Under 1 year 1,300 1.4 1 to 4 years inclusive 5,500 6.2 5 to 14 years inclusive 14,200 16.0 Total 21,000 23.6 14 * EXTRACTS FROM VITAL STATISTICS OF THE YEAR. LIVE BIRTHS Legitimate Illegitimate Total Birth Rate (Crude) 14.09 Male 591 36 627 Female 583 39 622 (Comparable Rate (13.25) Total 1,174 75 1,249 STILL BIRTHS Legitimate Illegitimate Total Rate per 1,000 total Births 23.45 Male 15 2 17 Female 13 — 13 Total 28 2 30 DEATHS—All Causes Death Rate (Crude) 9.66 Male Female Total 467 389 856 (Comparable Rate l1.01) DEATHS—Special Causes Puerperal Causes 1 Tuberculosis (all forms) 8 Tuberculosis, Pulmonary 7 Cancer (all ages) 187 Measles (all ages) 2 Whooping Cough (all ages) Nil Diarrhoea (under 2 years of age) 1 Influenza 8 •These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 15 DEATH RATES Infants under 1 year of age All infants per 1,000 live births 28.82 Legitimate Infants per 1,000 legitimate live births 29.81 Illegitimate Infants per 1,000 illegitimate live births 13.33 Others Puerperal Causes (per thousand total births) 0.01 Tuberculosis (all forms) per 1,000 population 0.09 Tuberculosis, Pulmonary per 1,000 population 0.08 Cancer per 1,000 population 2.11 Common Infectious Diseases per 1,000 population 0.03 Influenza per 1,000 population 0.09 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 1957. The total of 682 gives a marriage rate of 15.39, a decrease of 0.95 from that of the previous year. The following table shows these particulars giving the number of marriages in the Borough for each year since 1946 :— Year Churches of England Chapels and Roman Catholic Churches SuperintendentRegistrar's Office Total Approximate Population 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 1957 177 159 2 118 226 682 88,910 ‡ St. Peter's Creek Road Holy Trinity, Blackheath Hill Closed. 16 METEOROLOGICAL OBSERVATIONS—1957. 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, 1957 :— Temperature: The highest screen temperature was 94°F. on 29th June. The temperature exceeded 80°F. on 15th June (82°F.) 29th June (94 °F.) 16th „ (81°F.) 30th „ (91°F.) 17th „ (84°F.) 3rd July (85°F.) 18th „ (85°F.) 4th „ (84°F.) 27th „ (81°F.) 6th „ (92°F.) 28th „ (87°F.) 1st Aug. (80°F.) The lowest screen temperature was 22°F. on 17th December. The maximum temperatures during January, February, November and December were :— 56°F. on 4th, 5th and 26th January 57°F. on 4th February 56°F. on 3rd November 54°F. on 7th, 8th and 20th December. Sunshine : Total hours recorded (1453.9 hours), the May total being estimated. The sunniest dav was 13th June when 15.6 hours were recorded. Number of days in each month when there was no sunshine recorded. January 16 days July 0 days February 9 „ August 2 „ March 5 „ September 2 „ April 3 „ October 9 „ May 1 ,, * November 14 „ June 1 „ December 14 „ * No record for first four days of month. Total 76 days Rainfall: Total for the year 20.41 inches. Highest in 24 hours .82 inches on 10th July and 3rd November. Driest month April (.19 inches) Wettest month July (3.90 inches) 17 BIRTHS The total number of live births registered in the Borough during the year was 1,320 and of this number 985 occurred in St. Alfege's Hospital, and 335 in private dwellings. In 564 cases the parents resided outside the Borough and these births were consequently transferred to their appropriate districts, leaving a figure of 756. To this must be added 493 births belonging to the Borough which took place in Institutions outside the Borough, thus making a final figure for Greenwich of 1,249, a decrease of 78 from that of the previous year. Of this total 627 were males and 622 females. The following table gives by districts the number of registrations of Greenwich Births during the current year :— Source of Information DISTRICT Total Green wioh Births East West St. Nicholas Charlton & Kidbrooke Greenwich Registrar's Returns:— 260 193 51 252 756 Inward Transfers:— 1st Qtr. 47 15 1 66 129 2nd Qtr. 52 24 1 60 137 3rd Qtr. 46 14 2 62 124 4th Qtr. 27 10 3 63 103 Totals 432 256 58 503 1,249 The Birth Rate for the year, calculated on the figure of 1,249 births, is 14.09 per thousand of the population, 0.90 lower than that for 1956. The average rate for the previous ten years is 16.73. The Greenwich Comparability Factor for births is 0.94 which gives an adjusted rate of 13.25. The Rates for the County of London and England and Wales are 16.2 and 16.1 respectively. Illegitimate Births which numbered 75 (representing 6.0 per cent, of the total live births) showed an increase of 12 over those of the previous year. The number of Still Births registered was 30 (17 males . 13 females), which is equivalent to a rate of 23.45 per 1,000 total births, a reduction of 0.81 from that of 1956. 18 DEATHS The net number of deaths registered during 1957 was 856, of which 467 were males and 389 females, compared with last year's total of 874 comprising 494 males and 380 females. This gives a crude Death Rate for the Borough of 9.66 per thousand of the population, a decrease of 0.21 as compared with that of the previous year and a rate which is 0.55 less than the average for the last ten years, viz., 10.21. The crude Death Rate figure is increased to 11.01 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 orude Death Rates therefore fail as true comparative mortality indexes in that their variations are not due to mortality alone, but arise also from differences in their population constitution. For instance a town with a population consisting of aged persons would register more deaths than one composed entirely of young and vigorous adults. Again a town containing a larger number of males than females records more deaths with a consequent higher Death Rate than one in which females preponderate. To overcome this difficulty the Registrar-General has worked out for each area in the country an adjusting factor which is termed the ' Comparability Factor ' and is based on the last census population figure. The Comparability Factor for Greenwich is 1.14 and may be regarded as the population handicap to be applied which, when multiplied by the crude Death Rate for the year, modifies the latter so as to make it comparable with the country as a whole or with any similarly adjusted area. The Death Rates for the County of London and for England and Wales are 11.4 and 11.5 respectively. The inset table showing the causes of deaths at all ages has been supplied by the Registrar-General and is included in accordance with the Ministry of Health's request. In the Appendix to the Report will be found a table giving by districts, the causes of, and ages at death of residents whilst indicating the numbers actually dying in Public Institutions. No. in Short List. Causes or Death Sex Deaths at subjoined Ages of "Residents," whether occurring within or without the District. All Ages. Under 1. I and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and under 75. 75 and over. All Causes M 467 22 3 4 8 24 160 112 134 F 389 14 1 3 4 20 66 86 195 1 Tuberculosis, Respiratory M 5 ... ... ... ... 2 ... 2 1 F 2 ... ... ... ... 1 ... ... 1 2 Tuberculosis, Other M 1 ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 3 Syphilitic Disease M ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... 1 ... 4 Diphtheria M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 8 Whooping Cough M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 6 Meningococcal Infections M ... ... ... ... ... ... ... ... ... F 1 ... 1 ... ... ... ... ... ... 7 Acute Poliomyelitis M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 8 Measles M 2 ... 1 ... 1 ... ... ... ... F ... ... ... ... ... ... ... ... ... 9 Other Infective and Parasitic Diseases M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 10 Malignant Neoplasm, Stomach M 15 ... ... ... ... 1 8 3 3 F 8 ... ... ... ... ... 3 2 3 11 Malignant Neoplasm, Lung, Bronchus M 39 ... ... ... ... 2 24 8 5 F 7 ... ... ... ... 2 2 1 2 12 Malignant Neoplasm, Breast M ... ... ... ... ... ... ... ... ... F 15 ... ... ... ... 4 5 3 3 13 Malignant Neoplasm, Uterus F 5 ... ... ... ... ... 3 2 ... 14 Othei Malignant and Lymphatic Neoplasms M 55 ... 2 ... ... 6 21 9 17 15 F 43 ... ... ... 2 2 12 13 14 Leukaemia, Aleukaemia M 1 ... ... 1 ... ... ... ... ... F 3 ... ... 1 ... ... 2 ... ... 16 Diabetes M 2 ... ... ... ... ... 2 ... ... F 4 ... ... ... ... ... ... 2 2 17 Vascular Lesions of Nervous System M 30 ... ... ... 1 1 5 14 9 F 47 ... ... ... 1 ... 4 17 25 18 Coronary Disease, Angina M 76 ... ... ... ... 4 38 23 11 F 44 ... ... ... ... ... 6 12 26 19 Hypertension with Heart Disease M 9 ... ... ... ... ... 1 2 6 F 14 ... ... ... ... ... 2 3 9 20 Other Heart Disease M 34 ... ... ... ... ... 6 1 27 F 58 ... ... ... ... 2 8 5 43 21 Other Circulatory Disease M 18 ... ... ... ... ... 6 5 7 F 25 ... ... ... ... 2 5 3 15 22 Influenza M 4 ... ... ... ... 2 1 1 ... F 4 ... ... ... ... 1 ... ... 3 23 Pneumonia M 25 2 ... 1 2 ... 4 4 12 F 19 2 ... l ... ... 1 4 11 24 Bronchitis M 64 3 ... ... ... ... 19 23 19 F 16 ... ... ... ... ... 1 7 8 25 Other Diseases of Respiratory System M 2 ... ... ... ... ... ... 1 1 F 1 ... ... ... ... ... ... ... 1 20 Ulcer of Stomach and Duodenum M 20 ... ... ... ... ... 7 7 6 F 6 ... ... ... ... ... 1 1 4 27 Gastritis, Enteritis and Diarrhoea M 4 1 ... ... ... ... 2 1 ... F 2 ... ... ... ... ... ... ... 2 28 Nephritis and Nephrosis M 1 ... ... ... 1 ... ... ... ... F 6 ... ... ... ... 1 2 2 1 29 Hyperplasia of Prostate M 3 ... ... ... ... ... 1 2 30 Pregnancy, Childbirth, abortion F 1 ... ... ... 1 ... ... ... ... 31 Congenital Malformations M 3 2 ... ... ... 1 ... ... ... F 5 3 ... 1 ... ... ... 1 ... 32 Other defined and ill-defined Diseases M 35 14 ... ... ... ... 8 5 8 F 35 9 ... ... ... 2 6 3 15 33 Motor Vehicle Accidents M 4 ... ... ... 2 ... 1 1 ... F 2 ... ... ... ... ... ... ... 2 34 All other Accidents M 9 ... ... 1 1 2 4 1 ... F 6 ... ... ... ... 1 1 1 3 35 Suicide M 5 ... ... ... ... 2 3 ... ... F 9 ... ... ... ... 2 2 3 2 36 Homicide and Operations of War M 1 ... ... ... ... 1 ... ... ... F ... ... ... ... ... ... ... ... ... 19 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 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 1956 874 574 65.6 10-year average 898 520 57.8 1957 856 565 66.0 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 14 10 8 4 36 Between 1 and 2 years — 1 — 1 2 Between 2 and 5 years — 1 1 — 2 Between 5 and 15 years 1 2 3 2 8 Between 15 and 25 years 2 2 3 4 11 Between 25 and 45 years 10 8 10 17 45 Between 45 and 65 years 61 47 56 to 224 Between 65 and 75 years 55 46 39 59 199 75 years and upwards 85 87 67 90 329 Totals 228 204 187 237 856 20 Little variation in the pattern of death registrations occurred during the year, the fourth quarter producing the most (27.6%) and the third quarter the least (21.7%). It will be observed from the following table that during 1957 the deaths occurring at 65 years and upwards accounted for 61.6% of the total compared with a figure of 22.8% for 1901. Deaths in the age group 0-5 years in 1901 amounted to 37.4% whilst the figure for the current year is 4.7%. Age Group 1901 1911 1921 1931 1951 1957 Under 1 year of age 362 306 175 97 29 36 Between 1 and 5 years 187 158 80 39 7 4 Between 5 and 15 years 64 67 58 22 10 7 Between 15 and 25 years 66 60 67 65 12 12 Between 25 and 65 years 454 474 466 382 311 270 65 years and over 335 356 387 529 633 527 Totals 1,468 1,421 1,243 1,134 1,002 856 MATERNAL MORTALITY One maternal death was recorded during the current year, this being the first such death since 1952 when there were 3. At the coroner's inquest the death (that of a registered nurse of 23 years) was attributed to ' acute bacterial endocarditis due to septic abortion with retained products. Not fully nor further disclosed by evidence.' No indictment of the Public Health Services can follow such a verdict. 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 28.82 per thousand live births as compared with 15.07 for last year and 20.89, the average for the previous ten years. For the County of London the rate was 21.9 and for England and Wales 23.1 per 1,000 related live births. The present Borough figure of 28.82 is 6.92 higher than that for London and, in addition to showing an increase of 13.75 over that returned for the previous year, is 7.93 greater than the average for the last 10 years. Deaths occurring during the first week of the neo-natal period account mainly for the increase. 21 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 1957:— District Average for Quinquennial Periods Year 1957 1931 to 1935 1936 to 1940 1941 to 1945 1946 to 1950 1951 to 1955 Greenwich 75 50 40 27 18.4 28.82 London 63 56 60 33 23.8 21.9 England & Wales 62 65 50 36 26.9 23.1 The actual number of infantile deaths recorded during the year was 36 (16 more than last year) and these were attributed to the following causes :— Prematurity 20 Atelectasis 1 Congenital Malformations 5 Injury at Birth 1 Tracheo-bronchitis 3 Asphyxia Neonatorum 1 Capillary Bronchitis 1 Ileocaecal Intussusception 1 Pneumonia 1 Gastro-enteritis 1 Haemolytic Disease of Newborn 1 Of the above, 22 were male and 14 female; 15 died in St. Alfege's Hospital, 5 in the British Home for Mothers and Babies, 4 in the Brook Hospital, 1 in the Miller Hospital, 7 in Hospitals and Maternity Homes outside the Borough and 4 at home. Neo-Natal Mortality.—Neo-natal mortality, i.e., infants dying before attaining the age of one month, accounted for 26 deaths, equivalent to 72.2% of all infant deaths and giving a Neo-natal Mortality Rate of 20.81 per 1,000 live births. This compares with a figure of 16.5 for England & Wales. Twenty-three of these neonatal deaths occurred within the first week of birth, the main cause being Prematurity. 22 Perinatal Mortality.—The Perinatal Mortality Rate, calculated from a total of 53 stillbirths and deaths of infants under 1 week,was 41.43 per 1,000 total births compared with 33.1 for the previous year. The equivalent rate for England & Wales is 36.2. Reproductive Wastage.—A sum total of 66 Stillbirths and Infantile deaths gives a reproductive wastage rate of 51.6 per 1,000 total births. 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, 1955, 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. 23 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. Common Infectious Diseases.—Under this classification comprising Measles, Scarlet Fever, Diphtheria, Whooping Cough and Diarrhoea, 3 deaths were registered for the current year. There were no deaths for 1956, 2 deaths for 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 55th since a death from this disease occurred. Measles.—There were 2 deaths arising from this cause during the year compared with a nil return for the previous year. Prior to 1955 when 2 were recorded, no deaths had been registered since the year 1947 when there was one. Scarlet Fever.—For the eleventh 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 3 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 one death for the current year and a nil return for each of the years 1956 and 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 11 years since one was recorded. Tuberculosis.—There were 8 deaths from this disease during the year giving a Death Rate of 0.09 compared with 13 deaths and a 24 Rate of 0.14 for the previous year. This year's Rate is 0.05 lower than that for 1956 and still compares favourably with the average T.B. Death Rate during the previous 10 vears, viz : 0.38. Again current figures throw into relief the remarkable improvement in the Tuberculosis situation in the Borough during recent years. Actual deaths from Tuberculosis have been reduced to approximately one eighth and the rate to one ninth of the corresponding figures for 1947 as the following table will indicate :— Year No. of Deaths Rate 1947 69 0.82 1948 62 0.73 1949 46 0.53 1950 44 0.49 1951 35 0.39 1952 32 0.35 1953 18 0.19 1954 15 0.16 1955 8 0.08 1956 13 0.14 1957 10-year Average 34 0.38 8 0.09 Tuberculosis of the Respiratory System was responsible for 7 of the deaths in this category, only one death being attributed to the remaining forms of tuberculosis. At 0.08, the Pulmonary Tuberculosis rate was 0.05 lower 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 deaths. 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, figures identical with those of the previous year. Again 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 21.9 the figure for 1957. 25 Comparing the current year's figures with those of the previous 5 years, the sites of the affected parts were:— 1952 1953 1954 1955 1956 1957 Cancer of Stomach 24 33 23 26 20 23 „ „ Lung, Bronchus 31 27 47 35 58 46 „ „ Breast 11 12 18 16 13 15 „ „ Uterus 6 11 3 6 6 5 ,, „ all Other Sites 89 76 75 86 90 98 Totals 161 159 166 169 187 187 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 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 10 yr. Average 1.4 0.2 17.5 2.5 9.4 1.4 3.0 0.7 31.3 4.8 36.1 0.40 1957 2 2 24 2 8 1 5 2 39 7 46 0.52 26 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 more than 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 1947, there were 25 deaths of Greenwich residents from cancer of the lung, approximately one third of the total registered for pulmonary tuberculosis, viz : 69. During the current year, figures of 46 and 7 respectively have been recorded showing that lung cancer is now claiming nearly 7 times as many victims as pulmonary tuberculosis. In comparison with the Borough rate of 0.52 for lung cancer, that for London as a whole is 0.61 and for England and Wales 0.43. Nationally as well as locally, recent years have shown an exceptionally rapid decline in the death rate of pulmonary tuberculosis whereas that for cancer of the lung has increased, one might almost say, correspondingly. In this connection, facts presented by the Medical Research Council emphasize the hazard to life occasioned by the smoking habit but unfortunately, smoking is a personal habit not known to involve risk to non-smokers and therefore the usual approach on epidemiological grounds for its elimination can hardly be justified. It is clear, however, that Health Authorities have a real part to play in the dissemination of information in such a way as, on the one hand, to be easily understood by the layman and on the other, not to increase apprehension or alarm or to produce hypochondriasis. It seems logical that education in these matters should commence with the young in first preventing the adoption of the ' smoking ' habit and then to persuade the moderates and unaddicted to refrain. The hard core of heavy smokers however, presents a much more formidable obstacle and it is difficult to know what practical steps can be taken to break this pernicious habit other than a reasoned statement of the true facts, to counteract the enormous amount of propaganda met with in modern advertisements. 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. 27 Vascular Lesions of Nervous System.—This class, which includes deaths arising from Cerebral Haemorrhage, Embolism and Thrombosis was responsible for a total of 77 deaths. The age distribution was as follows :— 2 between 15 and 25 years ; 1 between 25 and 45 years ; 9 between 45 and 65 years ; 31 between 65 and 75 years and 34 from 75 years upwards. Heart Disease.—Under the new classifications this disease has been divided into three sub-headings : (a) Coronary Disease, Angina, (b) Hypertension with Heart Disease, and (c) Other Heart Disease. The total deaths occasioned by such maladies amounted to 235 (119 males—116 females) compared with a figure of 259 for 1956, and as usual, the deaths from this category occupied the principal place in the classification of diseases in that they formed 27.4% of the total of deaths from all causes. The speed and strain of modern civilisation is thought to have a great bearing on diseases of the heart and circulation and it is pertinent to state here that in Greenwich over 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 73%. This heavy mortality in middle-aged man in the more civilised countries has been the subject of intensive investigation and although social and environmental conditions are probably pre-disposing factors in hypertension and coronary disease recent research has focussed attention on diet and, in particular, on fatty acids. In animals where atherosclerosis has been artificially induced occlusion is so rare that it would appear that the problem is not simply the thickening of arteries but of their blockage or occlusion and some research workers are confident that the cause is to be found in a disturbance of the fat and cholesterol metabolism and coagulability of the arterial blood. Diseases of the Respiratory System. — There were altogether 127 deaths from these diseases. Bronchitis accounting for 80 and Pneumonia (all forms) for 44. The total shows a decrease of 31 from that of the previous year but there was an increase of 8 28 in deaths from Bronchitis compared with a reduction of 35 in regard to Pneumonia. Of the total deaths, 7 were children under one year of age and 91 were in respect of persons 65 years and over. Influenza.—There were 8 deaths attributed to this cause during the year compared with 3 returned for last year. One was registered in 1955, none in 1954 but fifteen were recorded during 1953. Deaths from Violence.—These numbered 36 including 6 from Motor Vehicle Accidents, 14 from Suicide, one from Homicide and the remainder being accounted for under the heading of ' All Other Accidents.' Deaths from Motor Vehicle Accidents were identical in number to those of the previous year while the figure for suicide showed an increase of 6. 29 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 1957, which will be found on the following pages in table form. NATIONAL WELFARE FOOD ITEMS Distribution Centres M. & G. W. Centres. Blackheath Hill S.E.10 Thursday 1.30 p.m.—4 p.m. Charlton Lane, S.E.7. Tuesday 9.30 a.m.—12 noon Thursday 1.30 p.m.—4 p.m. Chevening Road, S.E.10 Tuesday 1.30 p.m.—4 p.m. Wednesday 9.30 a.m.—12 noon Friday 1.30 p.m.—4 p.m. 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.—5 p.m. Shooter's Hill Road, S.E.3 Monday 1.30 p.m.—4 p.m. Tuesday Wednesday Thursday 9.30 a.m.—12 noon Friday 1.30 p.m.—4 p.m. St. Alfege's Church Hall, Roan Street, S.E.10 Tuesday 2 p.m.—4 p.m. Tranquil Vale, S.E.3. Wednesday 9.30 a.m.—12 noon 30 1. Health Visitors' Records, Attendances at Infant Welfare Sessions, Prophylaxis figures, etc. Health Visiting Quarter Expectant Mothers Premature Babies StillBirths Infants (under 1 year) Children 1—5 years School Children Care of Peop'e Miscellaneous Unsuc cessful Total Visits 1st visit Revisit 1st visit Revisit Old Others March 99 126 27 24 346 1,129 2,902 239 71 68 171 514 5,716 June 107 119 20 14 367 1,244 2,888 327 66 94 217 534 6,095 Sept. 107 128 9 16 328 1,314 2,884 198 88 62 186 538 5,858 Dec. 104 141 11 4 352 1,292 2,849 160 85 67 179 536 5,780 Totals 417 514 67 58 1,393 5,079 11,521 924 310 291 753 2,122 23,449 2. Infant Welfare Clinics Quarter Sessions Attendances 0-1 year 1-2 years 2-5 years 1st Total 1st Total 1st Total March 214 312 4,913 52 1,131 27 805 June 203 288 4,568 12 1,174 31 853 September 213 242 4,264 12 1,078 27 783 December 211 246 4,147 13 1,096 16 669 Totals 841 1,088 17,892 89 4,479 101 3,110 31 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 Pregnancy March 206 193 179 494 206 171 87 970 June 185 126 126 402 185 87 87 819 Sept 195 133 133 418 195 72 72 790 Dec 106 128 128 431 106 101 101 870 Totals 692 580 566 1,745 692 431 347 3,449 (b) Post Natal (cases seen at Ante-Natal Clinics) Quarter 1st Attendances Total Attendances This Year Since Confinement March 31 30 51 June 44 44 77 Sept. 36 36 44 Dec. 31 31 35 Totals 142 141 207 32 4. Toddlers Clinics Quarter Sessions Total Attendances Medically Examined Found to require Treatment March 13 103 98 9 June 14 127 127 12 September 17 117 116 19 December 17 86 80 15 Totals 61 433 421 55 5. Ante Natal Educational Sessions (including exercises) Quarter Sessions Total Attendances March 50 617 June 40 590 September 31 450 December 35 450 Totals 156 2,107 6. Artificial Sunlight and Children's Exercise Classes Quarter Sessions Attendances Artificial Sunlight Exercise Classes First Total First Total March 63 73 1,071 — 164 June 57 30 1,041 — 135 September 70 27 531 — 126 December 75 45 300 — 141 Totals 265 175 3,543 - 566 7. Chiropody Treatment No. of Clinic Sessions 294 No. of First Attendances 420 Total Attendances 16,310 33 3, Home Help Service (a) Analysis of Cases, etc. Cases Home Helps Maternity Tuberculosis Chronic Sick, Aged & Infirm Others Total No. Part Time Whole Time Equivalent On live Register at: 1st Jan. '57 2 13 513 3 531 81 38 31st Dec. '57 6 12 536 5 559 77 34.5 Cases attended during 1957:— 31 13 194 28 266 - - (b) Supervision Effective Ineffective Total Visits made by Organising Staff: 2,634 293 2,927 9. Prophylaxis (a) Immunisation and Vaccination (Children under 5 years) Diphtheria immunisation (completed cases) 1,256 Whooping Cough immunisation (completed cases) 1,127 Vaccinated 928 (b) B.C.G. Vaccination (Children 13 years old at Greenwich Schools) No. of Children 13 years old 1,394 No. for whom parental consent was obtained 1,085 No. of negative reactors vaccinated 913 No. of positive reactors X-rayed 119 (c) Poliomyelitis Inoculation (Resident children and those attending Greenwich Schools) No. of completed cases 4,000 10. District Nursing The staff of the Queens District Nursing Association for Charlton and Blackheath made 30,533 visits during the year. Visits carried out by the Ranyard Nurses and the Nu sing Sisters of St. John the Divine were additional to those quoted above. 11. School Health Service Vision Minor Ailments Clinics No. of Attendances 844 43,773 No. of New Cases 408 — No. of Classes pros ribed 246 - Note: As appropriate children from Greenwich also attend special cliniee in Deptjord and Woolwich. 34 TREATMENT CENTRES AND CLINICS Particulars relating to the local Health Services throughout the Borough are given below :— INFANT WELFARE CLTNICS ANTE & POST NATAL CLINICS Blackheath Hill, S.E.10 Blackheath Hill, S.E.10. Charlton Lane, S.E.7. Charlton Lane, S.E.7. Chevening Road, S.E.10 Chevening Road, S.E.10. Creek Road, S.E.8. Creek Road, S.E.8. Fairfield House, S.E.7. Fairfield House, S.E.7. Ridgebrook Road, S.E.3. Ridgebrook Road, S.E.3. Shooter's Hill Road, S.E.3. Shooter's Hill Road, S.E.3. St. Alfege's Parochial Hall, Tranquil Vale, S.E.3 S.E.10 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.3. Shooter's Hill Road, S.E.3. IMMUNISATION AND VACCINATION CLINICS Chevening Road, S.E.10 Friday 9.30 1.30 Fairfield House, S.E.7. Monday 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). 35 CHEST CLINICS (By appointment only). DAY A.M. P.M. Maze Hill, S.E. 10. Monday 2.00 Tuesday 9.30 2.00 Wednesday 9.15 - 10.00 (Ante-Natal) 2.00 Thursday 9.30 5 - 6.30 (workert only) Handicraft Centre Wednesday 2.00-4.00 SCABIES & CLEANSING CLINICS Tunnel Avenue Wednesday 9 - 12 (School Children) Daily (Saturdays excepted) 9-12 (Weds, except.) 2-4 (Adults and Children under school age) WOMEN'S SPECIAL CLINIC (Family Planning Association) Charlton Lane, S.E.7.Wednesday 2.30 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. (GREenwich 3115) DISINFECTING STATION Applications to Medical Officer of Health, Public Health Department, Town Hall, S.E.10. (GREenwich 3210) 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) 36 MASS RADIOGRAPHY New Cross General Hospital, Avonley Road, S.E.14 (NEW Cross 1522 for appt.) NURSING ASSOCIATIONS. Queens District Nursing Association for Blackheath and Charlton, 78, Elliscombe Road, S.E.7. (GRE. 1675). Ranyard Nurses, 110, Kennington Road, S.E.ll. (RELiance 4671). Nursing Sisters of St. John the Divine, Watson Street, S.E.8. (TIDeway 3028). OTHER ORGANISATIONS. British Red Cross Society, Mrs. E. M. Wigley, Divisional Director, 46, Vanbrugh Park, S.E.3 (GRE. 0157). Citizens' Advice Bureaux. 71, Rectory Place, S.E.I8 (WOOlwich 0047). 173, Walworth Road, S.E.17. (RODney 2860). Family Welfare Association, Area 6, (Deptford, Greenwich and Lewisham), 49, Rushey Green, S.E.6. (HITher Green 1630). Women's Voluntary Services, W.V.S., West Greenwich House, S.E.10. (GRE. 1383). W.V.S. Sub-Centre, Blackheath Park, S.E.3. REGISTRATION OF BIRTHS, DEATHS AND MARRIAGES. Town Hall, S.E.10. Mon - Fri 2 p m to 4 30 p m Fri. 6 p.m. to 7 p.m. Sat. 9 a.m. to 11 a.m. 37 SECTION C Sanitary circumstances of the Area The tables on pages 74 to 76 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 14,586 houses and premises have been inspected or re-inspected during the year; 628 intimation notices and 135 statutory notices were served. Registered complaints, numbering 1,270 show a decrease of 211 from those of the previous year, a total, however, still greatly in excess of the pre-war average of 700. Legislation.—The current year saw the introduction of a major piece of legislation, which, in its field is the most important enactment since The Increase of Rent and Mortgage Interest (Restrictions) Act, of 1920, and because of its importance a summary of the Rent Act, 1957 is included in this Section. RENT ACT, 1957 (As applicable to England and Wales) This Act, which came into force 6th July of this year, introduced new legislation for the issue and cancellation of certificates of disrepair, repealed the relevant sections of the Housing Repairs and Rents Act, 1954, appertaining thereto and makes certain amendments to the Rents Acts 1920/1939. Any certificate previously issued and in force immediately before the commencement of this Act shall, to the extent that it specifies any defects as regards, the state of repair of any dwelling, be dealt with as if it were a certificate of disrepair under this Act. Lettings Released from Control (a) With certain exeptions, privately owned dwellings where the rateable value exceeds £40 in London and £30 elsewhere. (b) Owner-occupied dwellings where they are let after 6th July, 1957. (c) All other privately owned dwellings when re-let to a new tenant except where :— (i) the tenancy passes either to the widow or other member of the family entitled to succeed under the Rents Acts. (This can only occur once). 38 (ii) the landlord obtained possession on grounds of overcrowding. (iii) there is an agreement in writing between the statutory tenant and the incoming tenant to which the landlord is a party. Properties Remaining in Control Subject to (c) above any privately owned letting with a rateable value of £40 or less in London remains controlled. The provisions made for increasing rents vary from l⅓rd to 2⅓rd times the gross value, according to responsibility for repairs between landlord and tenant. The resultant figures arrived at are the maximum rents which can be charged exclusive of any additions for rates, services or improvements. Subject to the foregoing, the notice of increase may specify more than one date and amount but the initial increase must not, except in certain cases, take effect earlier than 3 months nor exceed 7/6d. within 9 months from the date of service. This limit of 7/6d. is exclusive of any adjustment in respect of increased rates, services or improvements, to which the landlord may become entitled. Where, however, any rent is already above the limit such rent will continue unaffected provided it was lawfully chargeable under the Rents Acts. Procedure of Abatement for Disrepair. The procedure laid down in Part II of the First Schedule is considerably more involved than any previous legislation and is as follows :— 1. Service of Form O. The tenant serves on the landlord a notice (Form G) specify" ing the defects of the dwelling. The tenant must retain at least one copy of this notice. 2. Application for certificate of Disrepair. If, on the expiration of 6 weeks from the date of service of Form G the defects have neither been remedied nor has the landlord given an undertaking (Form H) to remedy those defects within 6 months (or such of them as the tenant may agree in writing to accept as sufficient), the tenant may on Form I apply to the local authority for a certificate of disrepair enclosing a copy of Form G and a fee of 2/6d. Note : If the certificate is granted the tenant is entitled to deduct the fee from any subsequent payment of rent to the landlord. 39 3. Proposal to issue Certificate of Disrepair. On receipt of the application (Form I) the dwelling is inspected in strict relation to the alleged defects. Consequent upon the report, if the local authority are satisfied that all or some of the defects ought reasonably to be remedied, they must serve on the landlord notice Form J. This notice specifies the defects proposed to be included in the certificate of disrepair which will not, however, be issued if within 3 weeks from the date of service the landlord gives to the tenant an undertaking (Form K) to remedy the defects within 6 months and serves a copy of same on the local authority. In the event, however, of such an under taking being given by any landlord designated in Paragraph 5 subsections (a), (b), (c) or (d) (one who has already defaulted in respect of previous Public Health notices), then the local authority may refuse to accept the undertaking and issue a certificate of disrepair, in which case the undertaking shall be deemed never to have been given. 4. Acceptance of Undertaking or Issue of Certificates of Disrepair. Where a copy of the undertaking (Form K) is received then, subject to the conditions made in (3) above being satisfied, notice of acceptance is sent to the landlord and a copy to the tenant by this authority. If, however, no copy of an undertaking is received within the prescribed 3 weeks, the local authority issue a certificate of disrepair (Form L) and serve a copy on the landlord. 5. Application for Cancellation of Certificate of Disrepair. Following receipt of an application (Form M) from the landlord for the cancellation of the certificate with the statutory fee of 2/6d., the local authority must serve on the tenant notice Form N. This notice states that the Council propose to cancel the certificate of disrepair unless an objection on the ground that all or any of the defects specified in the certificate remain unremedied is received within 3 weeks from the date of service. Where no objection is received this authority accordingly send to the landlord notice of cancellation of the certificate of disrepair. If, however, an objection is received the local authority must cause an inspection to be made and, if in their opinion, it is not justified the same action is taken as mentioned in the preceding paragraph with an additional notice of rejection from this authority to the tenant. Where they are satisfied that the objection is 40 justified the Council send a notice of refusal to cancel the certificate to the landlord and a copy to the tenant. In this eventuality the landlord must reapply to secure cancellation. Note : Any landlord or tenant aggrieved by the local authority's action as to the issue or refusal to issue a certificate of disrepair, inclusion or deletion of defects, refusal to cancel or uphold objection, may appeal to the County Court. Effect on Rent Whilst Certificate of Disrepair Remains in Force. Unless a landlord applies to the County Court for the cancellation of a certificate of disrepair as respects all the defects specified therein within 3 weeks of the date of such certificate (in which event the full rent would be recoverable until the proceedings were concluded) , the rent to be determined falls into one of the 3 undermentioned categories and all references to rent or the gross value are exclusive of rates, services or improvements. (a) Certificate applied for within 6 months of the date of service of notice of increase. The notice of increase has no effect (except for rates or improvements) and the rent to be paid will be either the old rent or l^rd times the' gross value whichever is the lesser amount. In addition the tenant may recover from future payments of rent any increase paid but the deduction from each payment must not exceed the amount by which the rent has been adjusted. (b) Certificate applied for after 6 months from the date of service of notice of increase. The rent increase has taken effect and the differences between this case and that in (a) are as follow :— (i) there can be no return to the old rent and the increased rent must be reduced to 1⅓rd times the gross value as from the date of application if it was above that amount when the notice of increase was served. (ii) Subject to (i) above, the rent paid which the tenant may recover is the difference between these two amounts accruing during the period between the date of application and receipt of the certificate but, in future payments of rent, the deduction must not exceed the amount by which the rent has been adjusted. 41 (c) Certificate applied for where no increase has been served and the rent is above 1⅓rd times the gross value. The rent is reduced to ljrd times the gross value as from the date of application and the recoverable rent is as stated in b(ii) above, omitting the proviso. Note: In all 3 instances the reduction and any deductions being made must cease after the cancellation of the certificate. Effect of Undertaking. Any increase being paid and any further increase which falls due (except where any condition in subsection 2(c) of Section 2 of the main Act is fulfilled) must be paid by the tenant whilst the undertaking is operative. If on the expiration of 6 months from the giving of either undertaking (Form K or H) any defects to which the undertaking relates remain unremedied, the consequences are the same as if a certificate of disrepair had then been issued and had continued in force until the remedying of the defects. As regards Form H the date of such undertaking is taken as the date of application. Further to the above, the landlord or the tenant may on Form O apply to the local authority (enclosing a fee of 2/6d. and, where it is in respect of a Form H undertaking, a copy of same), for a certificate (Form P) as to the remedying of defects specified in a landlord's undertaking to remedy defects. The local authority must cause an inspection of the premises to certify whether any, and if so, which of the defects relative to the undertaking remain unremedied. In this respect the tenant is necessarily precluded from applying before the expiration of 6 months from the date of the undertaking but if the certificate specifies that any defects remain unremedied the tenant is entitled to deduct the fee from any subsequent payment of rent to the landlord. The value of this certificate is that it shall in any proceedings be evidence of the matters certified until the contrary is proved. Applications Received under the Act. The action taken in respect of applications received up to the end of the current year were :— (a) One Form 0 application from a landlord. Form P was issued certifying that the defects had been remedied. 42 (b) One Form M application for cancellation of a certificate of disrepair issued under the Housing Repairs and Rents Act, 1954. As a result of no objection being received from the tenant following service of Form N the certificate was duly cancelled. (c) Eighty-two applications for certificates of disrepair. Of these 5 were refused and 1 deemed inadmissible. Form J notices were served in respect of the remaining 76 of which 53 specified some of the defects and 23 specified all the defects as listed in the copies of Form G. Resulting from these notices 29 certificates of disrepair were issued and, of 48 undertakings received, one was refused under the proviso giving a total of 47 undertakings accepted. General. The provisions of abatement for disrepair appear to be substantially between landlord and tenant, the local authority where the occasion arises, assuming the role of arbitrator whose decisions in the main may be challenged in the County Court by either party. The procedure is almost entirely different from the previous legislation. The tenant must specify the existence of defects from which deletions only are permissible by the local authority following receipt of an application for a certificate of disrepair. No further inspections may be made unless an application in respect of an undertaking or an objection to the cancellation of a certificate is received. Since, in either undertaking, there is no obligation on the part of the landlord or the tenant to apply for a certificate as to whether or not the defects have been remedied, the effect of the Act as to the reasonable maintenance of properties may not be easy to assess. At least no such difficulty arises as to the initial effect on the general public for enquiries have been numerous both before and after action taken by the Council and has resulted in considerable additional work. Section 22.—This section amends Section 4 (2), (3) of the Requisitioned Houses and Housing (Amendment) Act, 1955, and applies the new rent limit to houses which have been released from requisition on the owner's undertaking to accept the occupant as a statutory tenant. Notices of increase of rent up to this new limit must be served on the local authority as well as on the tenant, and 43 the local authority must be a party to any agreement affecting the rent. (Local Authorities are liable under Section 4 (4) of the Act of 1955 to pay part of the rent in respect of these houses). In connection with notices of increase served in respect of derequisitioned properties, 282 investigations were made into the department's records of the respective premises. 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 Temperature 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 443 inspections were made by the Council's Inspectors in relation to the 499 registered factories. The latter figure includes 87 premises where mechanical power is not used. Defects were found in 17 instances, all of which were remedied. 44 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 87 35 ― ― (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 391 374 2 ― (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers'premises) 21 34 ― Total 499 443 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. 1.) — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors(S.6) - - Sanitary Conveniences (S.7) (a) insufficient ― ― ― (b) unsuitable or defective 14 14 — 6 — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 3 3 ― — — Total 17 17 — 6 — 45 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. 29 — — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 1 ― ― ― ― ― Lampshades 30 Flower Mounting 1 — Cardboard Boxes 1 — — — — — Warding, etc. of Buttons, etc. 7 — — — — — Total 69 — — — — — 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 26 (b) Outworkers resident outside the Borough 30 Notifications received from firms outside the Borough of:— Outworkers resident in the Borough 79 Total number of Greenwich residents employed as outworkers (as given in August list) 69 Premises where homework is carried on were visited on 69 occasions by the Lady Public Health Inspector. In no instance was it necessary to take action because of infectious disease. 46 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. Whilst there can be no objection to the feeding of a limited number of pigeons in any particular area, it is noticeable that, persons who are so inclined, make available supplies of food of such proportions that birds lose their natural feeding habits and tend to congregate in the vicinity of the source of their sustenance to the detriment of the surrounding property. It is to be regretted that in some instances the pigeon-catcher's work has been interrupted and even curtailed by the action of wellmeaning residents who, feeling that his methods of pigeon disposal are not all that may be desired, have consulted a representative of the R.S.P.C.A. During the year some eight complaints were received, including one petition, and arrangements were made to reduce the pigeons to a reasonable number. River Pollution.—Works being carried out by the London County Council at their Northern and Southern outfalls with the intention of improving the sewage effluent discharged into the river would appear already to have had a beneficial effect—there was only one complaint received during the current year regarding smells emanating from the river. Atmospheric Pollution.—Clean Air Act, 1956.—Provisions relating to the installation of new furnaces, smoke control areas, height of chimneys, research and publicity came into operation on 31st December, 1956, the remaining provisions are due to come into force on 1st June, 1958. With a view to implementing Section 11 of the above-mentioned Act, several preliminary surveys were made during the latter part of the year in order that a zone suitable as a smoke control area could be selected. 47 One area, that comprising the North West, North and Marsh wards, was considered and some 3,900 dwellings were inspected. Two other surveys were made before eventually an area of approximately 76 acres bounded by Vanbrugh Hill, Woolwich Road, Victoria Way and the Southern Railway was finally chosen as one which, being centrally situated, would readily lend itself to extension in any direction. After a detailed inspection has been carried out and the necessary data collated, the matter will be submitted to the Council for eventual representation to the Minister. 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 1957 :— 48 table i—Daily Mean Concentration of Smoke Month Town Hall Smoke mg/100m3 Daily Value Charlton House Smoke mg/10()m3 Daily Value Average Highest Lowest Average Highest Lowest November 1956 35.00 59.00 23.70 34.11 58.00 14.45 December „ 59.77 203.99 8.50 51.10 144.50 3.80 January 1957 59.11 106.24 26.27 38.44 90.58 4.66 February „ 66.01 111.01 28.90 39.52 90.58 12.04 March „ 24.40 54.76 8.16 14.99 58.26 2.42 April „ 14.88 38.52 6.67 13.46 36.12 6.23 May „ 16.33 28.22 6.76 8.29 16.84 1.21 June ,, 14.93 25.41 5.65 5.68 16.84 1.44 July „ 12.16 28.22 2.26 6.08 16.80 1.20 August „ 10.83 28.22 3.29 8.93 36.08 1.21 September ,, 8.85 14.45 3.61 3.88 16.80 1.20 October „ 19.64 50.56 6.22 9.01 34.48 2.41 November „ 24.50 50.57 14.45 11.49 30.34 1.20 December „ 38.23 120.40 15.08 36.04 121.40 3.80 January, 1958 32.03 70.85 1.13 21.12 75.86 10.11 February „ 19.70 38.24 10.50 19.54 37.93 4.33 TABLE II—Dally Mean Concentration of Sulphur Dioxide Month Town Hall Sulphur Dioxide p.p. 100m. Daily Value Chablton House Sulphur Dioxide p.p. 100m. Daily Value Average Highest Lowest Average Highest Lowest November 1956 11.7 19.5 3.9 11.8 23.3 3.5 December „ 12.6 36.2 3.5 9.7 37.3 1.3 January 1957 9.7 21.2 4.4 7.4 19.7 2.5 February ,, 9.3 20.0 3.5 7.8 15.8 2.0 March „ 5.9 15.8 2.5 4.0 10.2 2.1 April „ 7.6 14.7 2.3 5.6 7.9 2.4 May „ 6.7 9.8 2.3 4.1 10.4 2.1 June „ 6.3 9.2 3.6 4.2 7.2 2.6 July 3.8 7.4 1.8 3.6 6.0 2.0 August „ 2.9 7.4 0.9 4.0 7.8 2.1 September „ 2.3 5.0 1.4 1.6 2.6 0.7 October ,, 5.7 16.3 1.7 2.7 7.2 0.6 November ,, 7.5 16.6 1.8 3.4 9.1 0.5 December „ 8.8 25.8 3.1 6.0 23.4 2.5 J anuary 1958 7.0 36.5 1.2 4.8 20.9 1.0 February ,, 6.6 14.1 1.8 4.6 9.9 0.9 49 As in previous years I am indebted to Dr. WiJkins, 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 SO3 mg./day/100 cm2 of Batch A Lead Peroxide tons per square mile November 1956 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 March „ 17 24.9 6.5 31.4 1.5 April „ 4 30.9 6.2 37.1 1.9 May „ 23 48.8 9.0 57.8 1.1 June „ 13 24.4 7.5 31.9 1.4 July „ 88 32.0 12.1 44.1 1.1 August ,, 71 33.0 8.8 41.8 1.0 September „ 65 24.5 8.0 32.5 1.2 October „ 73 40.9 9.8 50.7 1.7 November „ 29 33.1 12.1 45.2 3.0 December „ 47 29.7 8.4 38.1 2.9 January 1958 36 47.2 8.2 55.4 3.0 February „ 54 34.6 12.3 46.9 4.9 (a) No figures available. (b) Not ascertainable. TABLE IV.—Concentration of Smoke and Sulphur Dioxide by the Volumetric Method. Month Smoke mg/100m3 Sulphur Dioxide p.p. 100 million Monthly Average Highest Daily Average Monthly Average Highest Daily Average November 1956 25 54 13 29 December „ 23 54 11 34 J anuary 1957 17 38 9 29 February „ 21 39 10 20 March „ 15 42 8 15 April „ 14 32 8 17 May „ 8 15 6 11 J une „ 6 15 6 13 July „ 4 7 5 12 August „ 9 18 7 20 September „ 5 10 6 11 October „ 18 47 11 28 November „ 18 46 12 31 December ,, 24 73 15 64 January 1958 18 61 13 33 February ,, 13 20 1 1 19 50 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, 1957, 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. Housing Repairs and Rent Acts, 1954.—Until the introduction of the Rent Act, 1957, on 6th July of the current year no applications for Certificates of Disrepair were received but one application for the revocation of such a certificate was received and granted. Houses Let in Lodgings.—Recent legislation in connection with houses in multiple occupation contained in the Housing Repairs and Rents Act, 1954, (Sections 11 and 12) has now been superseded by Sections 36 and 90 of the Housing Act, 1957. The general powers given to the Council under the previous legislation viz, Natural Lighting Ventilation Water Supply Drainage and Sanitary Conveniences Facilities for storage, preparation and cooking of food and for the disposal of waste water Prevention of overcrowding of sleeping rooms have been retained and with regard to these items, briefly, Section 36 of the 1957 Act enables the Council to enforce standards whilst 51 giving the person in control of the house a choice of action ; either (a) to carry out works specified in the notice or (b) to reduce the density of occupation, in which case possession of the whole or part of the premises can be obtained notwithstanding the Rents Acts. Under Section 90, the Council may, if it considers the numbers of persons accommodated in a house let-in-lodgings to be excessive having regard to the rooms available, serve on the person having control of the said premises, a notice specifying the maximum number of people permitted to occupy for sleeping purposes any room therein. After the notice becomes operative an offence is committed if any room is occupied contrary to the terms of such notice or where persons of opposite sex over the age of 12 years and not living as man and wife are allowed to occupy the same sleeping accommodation. The Minister has expressed the view that no rigid code should be applied but that all cases should be decided on their respective merits. Houses let-in-lodgings were visited on 17 occasions by the Public Health Inspector and in no instance was it found necessary to serve a notice. 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. 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 52 relate to the Sale of Poisons used for domestic, horticultural and sanitary purposes. During the year 1 application for a licence to sell poisons under Part II was received and 69 vendors applied for retention in the Council's List. All were duly considered and approved. Ninety-five 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 293 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 on 21st August, 1956, and became operative on 1st October of the same year. Premises registered at 31st December, 1957 59 Persons registered at 31st December, 1957 64 53 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, seven samples, 3 each of Rag Flock and Cotton Felt and 1 of Kapok, 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. At the end of the year four licences were in operation and 10 inspections were carried out by the Public Health Inspectors in connection with the issuing of such licences. 54 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 880 reports on such enquiries were forwarded to his department. Drainage and Sewerage.—During the year 545 drains were tested, 378 were opened, cleansed or repaired and there were 840 constructions and re-constructions, alterations and improvements effected. Only two cesspools remain in use in the Borough and under the Borough Engineer's direction these are emptied on request. One hundred and twenty-nine 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 dischaiged to the public sewer. Of these, 65 connections are directly to sewers under the control of the London County Council and will be dealt with by that authority, under the provisions of the Act. In connection with this matter the Borough Engineer has kindly supplied the following information :— " Number of sewer connections inspected 23 Number of samples taken 18 Number of samples found unsatisfactory 4 Applications for new discharges 1 In the case of the unsatisfactory samples at commercial firms, remedial measures have been taken. In the case of the unsatisfactory samples at the Gas Board's premises, whilst it is acknowledged that the samples are at present below a desirable standard and that the problem is well understood, developments proposed in the future may be able to eliminate these 55 bad effluents. The Act provides the Gas Board with a measure of exemption from the provisions of the Act. Arrangements are now in hand for taking an increased number of samples, per annum." 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 23,888 dwellings with direct connections to the Board's mains. During the year 360 water supply certificates were granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended in 230 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 :— 56 " Scavenging.—Sweeping the streets still presents a problem because of the continued difficulty in recruiting suitable labour. Also many of the Council's employees are getting old and the rate of sickness, particularly in the winter months, is very high. The mechanical street sweeper is now employed on night sweeping after 12 midnight and by this means many streets are swept where cars and vehicles are parked during the daytime. A large number of additional litter bins have, during the year, been fixed to posts in the streets, particularly in areas adjacent to shops and at bus stops and it is hoped this will materially help in keeping the streets tidier in appearance. Street sweepings collected during the year amounted to 1,485 tons which shows a substantial decrease on the previous year. Refuse Collection.—Here too there is difficulty in recruiting suitable labour and due to the high rate of sickness amongst the ageing employees, it has at times been impossible to maintain the normal regular collection service, even though a number of street sweepers capable of doing the work have been used on occasions. The amount of household and trade refuse collected during the year totalled 22,686 tons, which was practically the same amount collected the previous year, although the number of dwellings in the Borough has increased since then. This would indicate that the refuse is lighter in weight, but more bulky in character, including as it appears to do a lot more paper and cartons, etc., and a lot less ashes from coal fires. This is due, no doubt to the increased use of gas, electric and oil heating appliances in the homes and the increased use of cartons for packaging foodstuffs. Refuse Disposal.—The whole of the household and trade refuse except the salvaged materials, were disposed of by barge to tip. The salvaged materials, comprising paper, cardboard, rags and scrap metal, amounting to 974 tons, were disposed of by sale and the income from this source was £8,189. Alternative means of disposal by controlled tipping into pits in Kent and/or the composting of refuse is still being discussed." 57 RODENT CONTROL General.—During the year the Rodent Control scheme, as approved by the Ministry of Agriculture, Fisheries and Food, has been continued. A total of 3,674 investigations were made, 536 of which were the result of notifications and 3,138 carried out during survey under the Act. The monthly average of complaints from occupiers, coupled with infestations found as a result of routine investigation, was 50 compared with 46 last year. In all, 537 treatments were carried out and infestation was found to exist at 418 dwelling houses and 108 at miscellaneous premises and places of business. Reinfestation occurred in 75 instances. There were 5 major infestations at dwelling houses and 8 at other properties caused by the common rat. 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 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, 39 defective drainage systems were discovered. Intimation Notices were served under the Public Health (London) Act, 1936, and the drainage defects made good by the owners of the properties. Bombed sites and dumps were test-baited, resulting in 9 infestations being found and treated. Periodic treatments were carried out at 6 industrial premises and 2 hospitals. Calls were made on the services of the Borough Engineer's staff to enter 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. 58 Prevention of Damage by Pests Act, 1949.—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 Prevention of Damage by Pests Act, 1949, has placed the onus for the destruction of these pests on Local Authorities and makes obligatory the notification to these authorities by occupiers of any rodent infestation. The following report was submitted to the Ministry of Agriculture, Fisheries and Food, for the 12 months ended 31st March, 1958 59  TYPE OF PROPERTY Non - Agricultural (5) Agricultural (1) Local Authority (2) Dwelling Houses (including Council Houses) (3) All other (includg. Business Premises) (4) Total of Cols. (1), (2) & (3) 1. Number of properties in Local Authority's District. 34 23,529 4,059 27,622 - 2. Number of properties inspected as a result of: (a) Notification 1 360 73 434 - (b) Survey under the Act 11 3,335 514 3,860 - (c) Otherwise — — — — - 3. Total inspections carried out — including re-inspections 12 3,739 633 4,384 4. Number of properties inspected (in Sect. II) which were found to be infested by: (a) Rats Major 2 7 9 - Minor — 204 34 238 — (b) Mice Major — 3 — 3 - Minor 1 165 27 193 - 5. Number of injetted properties (in Sec. IV) treated by L.A. 1 346 64 411 - 6. Total treatments carried out — including re-treatments 1 412 114 527 - 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 60 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 7th Oct. to 25th Oct., 1957 8th April to 30th April, 1957 1. No. of Manholes in foul and connected systems 1,190 1,189 2. Bait base and poison used Bread rusk/ arsenious oxide and paranitrophenol Bread rusk/ arsenous oxide and paranitrophenol 3. No. of Manholes baited 1,158 1,158 4. No. of Manholes showing prebait takes 795 842 5. No. of Manholes showing complete prebait take (on one or both days) 462 375 6. Schemes of baiting used (e.g.: consecutive days or 1st, 3rd and 5th days) Extenced Extended 7. No. of Manholes test-baited in conjunction with this treat ment and not included in No. 3 above Nil Nil Remarks: During the April treat ir.ent 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 as 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 are employed in this important preventive aspect of the Department's work consisting -of dealing with complaints and carrying out routine 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 con-taincd in the dust chutes and dustbins, food shops, cafes and canteens, static water sites, ponds and ditches, etc. 61 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, 70 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 174 cases of dirty and verminous premises compared with 144 in 1956. The disinfestation staff sprayed 427 rooms and contentsas compared with 270 last year. In 3 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, silverflsh, moths, etc. were again troublesome, and 293 houses comprising 1,263 rooms were treated effectively with D.D.T. as compared with 322 and 887 respectively last year. Australian Spider Beetle.—Ptinus tectns. Investigations following a complaint from a confectioner that the outer covers of cardboard cartons and their contents were deteriorated and covered with a larval webbing, revealed a severe infestation of ptinus tectus in the store room. 62 The larvae of this pest, which are omnivorous, are found in many types of food premises attacking a wide variety of foodstuffs such as dried pears and apricots, sultanas, figs, almonds and chocolate powder. They are voracious feeders boring through food and its covering of sacks or cardboard containers and occasionally through floorboards in order to pupate on the outside and in dark corners. Treatment consists of the complete destruction of the infested food and containers and the use of an effective insecticide. The maintenance of a high standard of cleanliness is essential. 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 1£ acres. Originally there were 3 large swimming baths, 74 ladies and gents' slipper baths, medicated vapour and foam baths, washhouses and laundry, etc. During the war the Ladies 2nd Class Swimming Bath was demolished by enemy action and the Council decided that when Ministry permission had been obtained for reinstatement, Turkish and Vapour Baths would replace the original swimming bath. With the Minister's approval, work commenced during the current year to provide the proposed Turkish and Vapour Bath accommodation which is to consist of:— (a) Cooling Room with 23 cubicles for resting, with Attendant's Office and additional locker accommodation for bathers not requiring a cubicle. (b) Shower Room, with plunge pool and adjacent lavatory accommodation, giving access to Turkish Bath, Vapour Bath, Shampooing Room and Special Baths. (c) Turkish bath suite comprising Tepidarium, Caledarium and Laconicum. (d) Vapour Bath. (e) Shampooing Room. (f) Special Baths. It is expected that the alterations will be completed by the end of 1958. In connection with the swimming baths there has been provided a most up-to-date filtration, aeration and chlorination plant 63 capable of purifying the contents of each bath every 3£ hours, thus enabling bathers to use the baths with every confidence. Regular chemical tests are taken (twice daily) and bacteriological tests taken periodically. I am indebted to Mr. K. L. Embley, Superintendent Engineer, for the following statistics:— Attendances.—For the year ended 31st December, 1957:— Slipper Baths 88,462 * Swimming Baths 131,551 Vapour and Medicated Baths 9,715 Public Laundry 10,229 Total 239,957 *Includes 43,343 School-children. A Summary of Bacteriological Samples taken during the year, with the results of the examinations, is given in the following table, particulars of which were communicated, to the Adoptive Acts Committee and the Baths Superintendent at the time of receipt of the Reports:— 64 Sample No. Date & Time Nature & Temperature No. of Bathers. Plate Count per ml. Yeastral Agar 2 days 37°C. Probable No. of Coliform bacilli, per 100 ml. MacConkey 2 days 37°C. Faecal Coli. per 100 ml. Result 1 15.4.57 12.10 p.m. 2nd Class Swimming 72°F. 30 Less than 10 Nil — Satisfactory 2 9.5.57 14.30 p.m. 2nd Class Swimming 75°F. 32 Nil Nil — Satisfactory 3 9.5.57 14.45 p.m. 1st Class Swimming 74°F. 6 Nil Nil — Satisfactory 4 11.6.57 10 a.m. 2nd Class Swimming 75°F. 72 10 Nil — Satisfactory 5 11.6.57 10.20 a.m. 1st Class Swimming 74°F. 28 1,000 2 2 Satisfactory 6 17.6.57 11 a.m. 1st Class Swimming 74°F. 5 250 1 — Satisfactory ('follow up' to sample No. 5.) 7 25.7.57 14.20 p.m. 2nd Class Swimming 74°F. Nil 50 Nil — Satisfactory 8 25.7.57 14.30 p.m. 1st Class Swimming 74°F. 68 2 Nil — Satisfactory 9 20.8.57 11.40 a.m. 2nd Class Swimming 74°F. 25 Nil Nil — Satisfactory 10 20.8.57 11.50 a.m. 1st Class Swimming 74°F. 43 Nil Nil — Satisfactory 11 26.9.57 10.30 a.m. 2nd Class Swimming 75°F. Nil 10 Nil — Satisfactory 12 26.9.57 10.40 a.m. 1st Class Swimming 74°F. Nil 10 Nil — Satisfactory 13 6.11.57 14.45 p.m. 2nd Class Swimming 75°F. 7 2 Nil — Satisfactory 14 10.12.57 11 a.m. 2nd Class Swimming 75°F. 47 27 Nil — Satisfactory 65 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" still 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 7a.m. to 11p.m. Blackheath Hill (foot of) 3 - 10 4 - Blackwall Tunnel 3 — 6 5 — Charlton House 2 - 4 2 — Creek Road (St. Nicholas, Deptford) 4 2 10 4 2 Greenwich South Street (near Town Hall) 4 1 10 4 2 King William Walk (near Greenwich Park) 4 2 9 7 2 Rodmere Street* 5 3 12 5 3 Shooters Hill Road (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. 66 The following are the Drinking Fountains and Horse Troughs in the Borough which are cleansed daily by the attendants attached to the Department:— Drinking Fountains Armada Street, Deptford. Blackheath (Andrew Gibb Memorial). Blackheath (Greenwich Park). Blackheath Hill, West Greenwich. Charlton Church Lane. Westcombe Hill, Blackheath. Horse Troughs Charlton Church Lane. Creek Road, Deptford. Invicta Road, Blackheath. Tunnel Avenue, East Greenwich. In addition to the above-mentioned Drinking Fountains and Horse Troughs one Council urinal and three others attached to Public Houses are cleansed daily by two attendants, responsibility for the repairs of the Public House urinals remaining with the Brewers concerned. Free hand-washing facilities, introduced in the interests oi 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 2,811 3,599 6,410 Creek Road 1,299 1,868 3,167 Greenwich South Street 1,554 3,240 4,794 King William Walk 2,173 3,199 5,372 Rodmere Street 1,578 2,782 4,360 Shooter's Hill Road 1,494 2,560 4,054 Totals 10,909 17,248 28,157 67 Aged and Physically Handicapped Persons.—With the expectation of life increasing and a corresponding decline in the birth rate, the resulting ratio of elderly people in the community is rising steadily and it is anticipated that by 1977 people over the age of 65. years will form one fifth of the total population. In these circumstances it is to be expected that the problems associated with old age will increase and this has been our experience at Greenwich. Recognising the implications of the situation, the Council have made generous grants to the Greenwich Old People's Welfare Association for the provision of holidays and recreational facilities. Information, advice and assistance are readily available from the Public Health Department and in this respect great reliance is placed on the Lady Public Health Inspector and the following is a summary of her work during 1957 :— No. of dirty premises inspected 27 No. of verminous premises inspected 13 No. of dirty rooms cleansed 29 No. of verminous rooms cleansed 33 No. of verminous persons visited 31 No. of verminous persons treated :—Heads 165 Other . 41 No. of visits to scabies cases 17 No. of visits for Cleansing Service :—First 48 Subsequent 62 No. of articles cleans vi 9,380 No. of inspections of factories :—(a) with mechanical power 48 (6) without mechanical power — (r) other premises — No. of inspections of Hairdressers'pramises 38 No. of inspections of Outworkers' premises 69 No. of inspections of Houses Let-in-Lodgings 13 No. of inspections of Women's Conveniences 32 No. of Bathing Centre sessions 84 No. of Home baths 99 No. of visits to Infirm Persons 1,262 No. of visits to Rest Homes, Hospitals, etc. 32 No. of visits, re : housing 26 No. of visits to Food Premises re: Meals for O.A.Ps. 22 No. of Miscellaneous visits 228 No. of re-inspections, calls made, etc. 299 No. of interviews for Holidays 152 No. of interviews at offices. 136 No. of complaints received 47 No. of Intimation Notices served Nil National Assistance Act, 1948.—No action under Section 47 of the above Act has been required in respect of compulsory removal of aged and infirm persons unable adequately to care for themselves. 68 Cleansing of Old People.—Section 43 of the London County Council (General Powers) Act, 1953, provides for the cleansing of any aged person in the district who : (a) is verminous or for any other reason in need of clean sing in order to prevent injury or the danger of ipjury to health; and (b) is so enfeebled that he is unable to avail himself of any facilities for cleansing himself provided by the authority under any enactment or to cleanse himself properly. _. In this respect, during the current year, 41 baths were given to dirty or verminous elderly persons at the Cleansing Station and 99 home baths were effected. Laundry Service.—Under Section 122 of the Public Health (London) Act, 1936, the Council is empowered to cause to be cleansed " any articles which are filthy, dangerous or unwholesome and liable to affect or endanger health." Advantage has been taken not only of this section but also Sections 124 and 194 to introduce a laundry service in order to deal suitably with what has always been a major problem, namely, the treatment of badly soiled clothes, bedlinen, etc., from the homes of elderly people. Cases in need of such assistance are brought to the notice of the department by Hospitals, District Nurses, Doctors and by ordinary routine investigation of complaints. From the Council's limited stocks of bedding and clothing it is possible in certain circumstances for temporary supplies of linen, etc., to be made to people whose own is being laundered, and cooperation with voluntary organisations often results in the repair or replacement of outworn articles. By the end of the year the laundry service, supervised by the Lady Public Health Inspector, had been extended to 97 separate individuals and during the current year, the staff at the Cleansing Staion have dealt with 9,380 articles which were collected, laundered and delivered. Greenwich Old People's Welfare Association.—This association set up in July, 1954 co-ordinates the activities of Old People's Clubs in the Borough which provide for the physical and mental recreation of their members and the following extracts are from the fourth Annual Report of the Association. " Old People's Clubs.—We feel we must commence our Annual Report by mentioning the Darby and Joan Clubs, the Federation Clubs and Church Clubs which are our greatest source of contact amongst the elderly of the Borough. We know that their great 69 success is due to the untiring efforts of those who organise the Clubs and their helpers, and to them we would like to extend our sincere thanks on behalf of the old people for the hours of voluntary work so cheerfully given. As we have mentioned before, the Clubs, in the main, are selfsupporting but they do receive each year a small grant from the Borough Council, for which we extend our sincere thanks. This year again it is the turn of the National Federation of Old Age Pensions Association to report that an additional Club has been opened. This Branch, to be known as the Blackheath Branch, has been formed at the St. Mary's Church Hall, Cresswell Park, and will, we feel, be able to cater for a large area of the Borough which up to now has not had the facilities for forming an Old People's Club. There are now thirteen clubs in the Borough meeting each week and the relevant details are given in the following list. Club Place of Meeting Day of Meeting Darby & J oan Clubs Oaklands Civil Defence Monday afternoons Training Centre, r/o 86 Shooter's Hill Road, S.E.3 Charlton Liberal Club, Tuesday afternoons 560 Woolwich Road, S.E.7 Minor Hall, Wednesday afternoons Peyton Place, S.E.10 Central Library Wednesday afternoons Woolwich Road, S.E.10 Assembly Rooms, Wednesday afternoons Charlton Village, S.E.7 Heathside Social Club, Wednesday afternoons Blackheath Hill, S.E.10 Charlton House, Thursday afternoons Charlton, S.E.7 National Federation of Old Age Pensions Association Greenwich R.A.C.S. Education Dept. Monday afternoons No. 1 Branch Park Vista, S.E.10 Charlton Branch Charlton Conservative Club, Friday afternoons Charlton Church Lane, S.E.7 Greenwich Minor Hall, Tuesday afternoons No. 2 Branch Peyton Place, S.E.10 Blackheath Branch St. Mary's Hall, Tuesday afternoons Cresswell Park, S.E.3 Church Clubs St. John's Old Folks Club, Monday afternoons Church Hall, Furzefield Road, S.E.3 Albany Institute Albany Institute, Daily Devtford Fund Creek Road, S.E.8 70 Day Rooms at the Community Centres.—The first formed Day Clubs at Charlton House and Kidbrooke House have been functioning quite successfully although the attendance at both Clubs has not been up to expectations. We are pleased to be able to report that the Borough Council, with the agreement of the Community Council, have granted us permission to change the Day Club at Charlton House to two rooms formerly used by the Civil Defence. These rooms are in the front of Charlton House and have very fine views, and we hope that with the brighter interior and pleasant outlook, the Day Club will be used to a greater extent than previously. We reported last year that a room had been made available for the formation of a Day Club at the West Greenwich House (formerly the Old Town Hall) Community Centre. This, we are pleased to report, was opened on Wednesday, 11th September, 1957 by The Worshipful the Mayor (Councillor Mrs. M. L. Wentworth, J.P.) Meals on Wheels.—The three vans used by the Association for the Meals on Wheels Service have been functioning continuously throughout the year and for the first time we are able to given complete picture of the number of meals served in a full year. On a few occasions the demand did meet the number of meals whic could be supplied in any one day but, as a general rule, it has been possible to meet all requests and for as many days in the week as the homebound person required such a meal. There has not been a great demand on Mondays however, and the Women's Voluntary Service van has not been in service on this day. A great improvement in the service has been achieved by the caterer supplying the meals obtaining the use of a more suitably placed kitchen from which the meals can be served. This has meant an improved meal, and a far better means of loading the vans, thus ensuring a prompt and early start to the deliveries. The following is a statement of the number of meals served during the financial year 1st April, 1957, to 31st March, 1958:— British Red Cross Society's van 8,395* Old People's Welfare Association van 7,073 Women's Voluntary Service van 4,475 Grand Total 19,943 *This figure includes the delivery of meals to Old People's Lunch Clubs. Holidays for Elderly Persons.—Since the last Annual Meeting we have again been able to send away two parties each for a fortnight's holiday. The party sent in September 1957 numbered 109 71 and went to Margate, but the party sent in May 1958 and numbering 92, went to Heme Bay. It had been suggested for some time that possibly some elderly people would like a change of venue for their holiday, particularly that we were now able to offer some a second financially assisted holiday. We circularised many seaside resorts along the Kent and Sussex coasts, and from those resorts which operate a special scheme for old people, Herne Bay offered the best terms, in addition to extending their period until the 14th June. On the whole, the reports which have reached us from those people who were included in the May Holiday Party, appear to have been favourable and so we have given instructions for reservations to be made at Heme Bay for the September Holiday Party. We have now been able to include for a second financially assisted holiday those who went away previously with the September 1953 and May 1954 Holiday Parties. We shall now commence sending away for a second such holiday those who went with the September 1954 party, but as these numbered 240, it must be appreciated that it will take some time before all those persons who wish to go away for a second holiday can be accommodated. We know that these holidays are appreciated by all the old people who are able to be included and we are sure that they benefit both in health and by making new friends and acquaintances. We would like to thank the Women's Voluntary Service helpers who travel on the coaches with the old people, and also to the drivers of Lewis (Greenwich) Ltd. for all they do to assist our old people to have a comfortable and enjoyable journey. Christmas Food Parcels.—Once again we were able to distribute food parcels to homebound elderly persons at Christmas from a grant made to us by the Borough Council. The numbers of such persons on our list increases each year, and the Committee felt that there might be a possibility that persons who were not strictly homebound were included on the list. The Committee therefore, with the help of leaders of the Darby & Joan and other old people's clubs within the Borough, sifted through the lists most diligently. Members of the Committee then visited old people personally to ascertain as to their degree of physical incapacity, and when finally collated, the list then numbered approximately 350. The Committee felt that as the contents of the parcels have been identical for the past three years, to try to improve the parcel to give a greater feeling of the festive spirit. Accordingly the following ingredients were purchased and packed by members of the Committee —Tea, Biscuits, Christmas Pudding, Tin of Fruit Salad, Tin of Cream, 72 Box of Cheeses, Sweets and Chocolate. The parcels, which were packed in attractive Christmas paper were distributed by volunteers and the Meals on Wheels vans and we are most grateful to all who helped so readily in this scheme. We know that these parcels are appreciated very much indeed by the number of letters of thanks which we receive from the recipients each year. Welfare Foods for Old People.—The Welfare Food Scheme has been working very successfully and is appreciated by all concerned. The turnover of stock for the year has been in the region of £600. Such an appreciable sum has meant a lot of work by the members of the Women's Voluntary Service who have carried out the distribution of the Welfare Foods and we would thank them most earnestly. Garden Party.—As reported to you verbally at the last Annual Meeting, the Garden Party held at Charlton House was a complete success both socially and financially and we are pleased to report that our voluntary funds were increased by the addition of £115, which was the net profit arising from the Garden Party. Once again we would wish to thank everyone who took part in making this such a success. House to House Collection and Street Appeal.—This was held in the week 2nd-6th September and was extremely well supported, ths total proceeds being £162. The Association's voluntary funde benefited by £145 after deduction of expenses such as the purchase of emblems and permits. The Committee appreciated most sincerely the efforts of all who assisted, in particular those elderly people who helped to collect on the day of the Street Appeal. Carol Service.—The Carol Service was again held in the Parish Church of St. Alfege and although the inclement weather at the time had a bearing on the number of elderly persons who could attend, we are of the opinion that the service proved very successful and we would thank all those persons who so willingly helped. Handcraft Exhibition.—An Exhibition of Handcrafts made by elderly residents of the Borough was held at Charlton House on the 7th March, 1958. The Exhibition attracted 92 entries and whilst this number was rather disappointing the quality of the work submitted was very high indeed. The Committee hopes to make this an annual feature so that all elderly persons, particularly the homebound, can prepare work well in advance. 73 The Committee is most appreciative for the help given by Miss Cuthbertson in assisting to arrange the entries and for carrying out the judging. Executive Committee.—We have to report with much regret the decease of Mrs. M. E. Kidd, Centre Organiser for the Women's Voluntary Service, Vice Chairman of our Association and of our Committee, a long serving member for the interests of old people in particular. Mrs. Kidd's staunch work throughout the post-war years is borne out by the number of Darby and Joan Clubs there are in the Borough and we are sure that these Clubs will continue to serve as a reminder to all of her devotion and untiring service to the cause of the elderly. We must also thank Mrs. P. M. Beacham, representative of the Greenwich and Deptford Hospital Management Committtee for the work she has carried out, particularly as a member of this Committee, for the welfare of the aged. We are sorry to have to report that Mrs. Beacham is no longer a member of the Hospital Management Committee and her membership of our Committee therefore ceases." The Committee for the past year has been as follows:— Council Representatives. The Worshipful the Mayor (President) (Councillor Mrs. M. L. Wentworth, J.P.) Alderman Mrs. L. Hilldrith (Chairman) Alderman H. W. H. Icough Councillor Mrs. C. Berry Councillor Mrs. K. P. Bullard Councillor H. Ingle. Councillor W. S. Manners Councillor T. E. Smith Elected Representatives Name of Organisation Mrs. P. M. Beacham Greenwich & Deptford Hospital Management Committee Mrs. M. E. Kidd, (Vice-Chairman) Women's Voluntary Service Mrs. N. C. Lewis Inner Wheel Club of Greenwich Mrs. A. Palumbo Family Welfare Association Mrs. E. M. Wigley British Red Cross Sooiety Miss E. Bertrand Deptford Fund Albany Institute Mr. T. Essex Federation of Old Age Pensions Association 74 Burial or Cremation of the Dead.—Under Section, 50 of the National Assistance Act, 1948, the Council is required to arrange for the burial or cremation of any person who has died or has been found dead in the Borough if in such cases it appears to the Council that no suitable funeral arrangements have been or are being made. The Council is empowered, if it so desires, to recover expenses for the burial or cremation from the estate of the deceased person or from any person who, for the purposes of this Act, was liable to maintain the deceased person immediately prior to his death. During 1957, arrangements were made under the above Act for the burial of 4 bodies. In 2 instances expenses were recovered from death grants and from relatives but in the remaining cases the burials were arranged at a cost to the Council of £9.16s.5d. Exhumations.—One exhumation was carried out during the year and the Public Health Inspector of the district was present to see that the usual precautions were observed. Summary of Work Performed by the Public Health Inspectors during the Year 1957 Inspections— Houses inspected (House-to-House) 16 „ „ (Complaints, nuisances) 1,344 „ „ (Infectious Disease) 275 ,, ,, (Overcrowding) 62 Re-inspections, calls made, etc. 9,631 Inspections of Factories 443 „ „ Shops 30 „ „ Hairdressers or Barbers 68 „ „ Licensed Victuallers 28 „ „ Pet Shops 10 „ „ Stables and yards 21 „ „ Urinals 100 „ „ Houses let in Lodgings 17 „ ,, Outworkers premises 69 „ Under Clean Air Act 87 „ Miscellaneous 1,129 Inspection of Premises (Pharmacy and Poisons Act, 1933) 95 „ ,, (Rents Acts) 120 Investigations (Rats and Mice) 491 On notice from Builder 550 14,586 75 Drains— Drains tested—by smoke 202 „ „ —by water 343 Opened, cleansed and repaired 378 Reconstructions and additions 190 Inspection chambers constructed 136 New covers to manholes 108 Soil and vent shafts repaired or renewed 117 Traps (gully) 196 Drains sealed off, etc. 61 Yards and forecourts drained 32 Waterclosets and Urinals— Closets erected 142 W.C.s repaired 185 Sanitary conveniences or improvements effected to Factories and Workplaces 22 W.C. pedestals installed 255 Urinals cleansed or repaired 25 Dustbins— Provided 193 Payings— Yards and Forecourts 45 General Water Supply— Water Fittings amended 230 Extra water supply to tenement houses — Water supply certificates granted (Sect. 95) 360 Other Improvements— Houses generally repaired 88 Rooms cleansed and repaired 586 Rooms and staircases lighted and ventilated 12 Verminous rooms cleansed 96 Roofs, gutters and rainwater pipes repaired 443 Dampness abated 396 Sinks, baths and lavatory basins 257 Sink, lavatory and bath waste pipes trapped or amended 249 Stoves and fireplaces 136 Washing coppers repaired or provided 11 Floors repaired 171 Provision for storage of food 36 Miscellaneous repairs 569 76 Other Nuisances Abated— Illegal use of Underground rooms discontinued — Overcrowding abated 41 Animals kept in unfit places discontinued or removed 1 Dung receptacles provided — Accumulation of manure and other obnoxious matter removed 32 Rat infestation abated 146 Smoke Nuisances— Observations 85 Statutory Notices served (Sects. 147 and 148) — Notices, &c.— Intimations served under Public Health (London) Act, 1936 628 Statutory Notices served 135 Houses rendered fit by informal action 141 Legal Proceedings Premises Offence Result of Proceedings 26, Armitage Road Non-compliance with Statutory Notice Summons withdrawn on payment of 6/- costs. 32, Armitage Road do. Order for work to be executed within 28 days. £2 2s. costs. 115, Creek Road do. Summons withdrawn on payment of 6/- costs. 119, Creek Road do. Summons withdrawn on payment of 10/- costs. 21, Dacca Street do. Summons withdrawn on payment of 3/- costs. 23, Fingal Street do. Summons withdrawn on payment of 6/- costs. 25, Fingal Street do. do. 3, Prince Street do. Summons withdrawn on payment of 3/- costs. 17, Wellington Gardens do. do. 77 SECTION D Housing Legislation.—Housing Act, 1957.—With the exception of certain financial provisions which are to be the subject of future legislation, this Act which became effective on 1st September, consolidated previous housing legislation and, as a result of a court decision, modified the provisions relating to the closure of underground rooms. Procedure under Housing Act, 1936.—The following representation was made under Part II of the above Act during 1957 :— Section 11.—Houses unfit for human habitation and not capable at reasonable expense of being rendered so fit. 148, Westmoor Street, S.E.7. Slum Clearance.—The following area represented by the Council under Part III of the above Act received the Minister's approval on 25th September, 1957 : Area No. of Persons to be Properties Displaced Families Norman Road 22 75 {70 Adults 5 Children 24 Procedure under Housing Act, 1957.—The following representation was made under Part II of the above Act during 1957 :— Section 18.—Part of building unfit for human habitation, i.e. a room, the surface of the floor of which is more than 3ft. below adjoining ground level and defective in matters listed in Section 4 of the said Act. 278, Creek Road, S.E.10. 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, twenty-four grants were so made. 78 Re-Housing.— (a) Borough Council.—There were 14 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 143. Of this number 8 were in respect of overcrowded cases and 18 families re-housed from outside the Borough. The Housing Department now has control of 3,211 Councilowned units of accommodation, an increase of 10 over that of the previous year. At the end of the year, in addition to 56 occupied hutments, a total of 466 properties giving 883 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, 1957, the L.C.C. had provided alternative accommodation for a total of 241 Greenwich families of which 6 had been certified as overcrowded cases. Of this figure, 100 were housed on L.C.C. housing estates outside the Borough. Two families from outside Greenwich were rehoused in the Borough under the L.C.C. scheme. (c) Other.—A further 27 families were rehoused by other means. Overcrowding.—As a direct result of rehousing carried out under (a), (b) and (c) above 41 cases of overcrowding were abated during the year under review. The number of unabated certified cases of overcrowding in the Borough now amounts to 137. During 1957 there was a fall in the number of complaints received concerning overcrowding, the year's figure of 58 showing a decrease of 39 from that of the previous year. Each complaint was investigated by the Public Health Inspector concerned and as a result of these investigations 25 families were found to be overcrowded according to the standards laid down by the Housing Act, 1957, 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 :— 79 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 1956 38 11-year average 104 1957 25 New Housing Accommodation.—The following table lists the new dwellings erected in the Borough during 1957:— Type of Dwelling G.B.C. L.C.C Private Total Permanent Houses 8 115 57 180 Permanent Houses (rebuilt) — — — — Flats 6 92 82 180 Flats (rebuilt) — — — — Total No. of Dwellings 14 207 139 360 Excluding the families accommodated in requisitioned property, the total number of dwellings provided in the Borough since the termination of the war is now 4,940 Council Housing Schemes.—(Information supplied by the Borough Engineer). (a) Schemes completed during the year under review. Site Dwellings 26 Kidbrooke Grove 6 Merriman Road 12 80 (b) Schemes in progress at the end of the current year. Site Dwellings Woolwich Road/Troughton Road 32 Devonshire Drive 32 Sunfields Place 46 Coleraine Road 32 Hardy Road 6 Greenwich High Road 40 (c) Building Programme for 1958. Site Dwellings Roan Street 13 Dutton Street 8 Coldbath Arches 8 84/86, Shooter's Hill Road 18 Tunnel Avenue 47 Plumbridge Street 4 Westcombe Hill (Corner Site) 16 (d) Whilst not finally confirmed the following schemes are envisaged by the Council for completion after 1958. Site Burney Street/Gloucester Circus Haddo Street Lansdowne Lane } Final design under Vanbrugh Park West consideration Quadrangle Heathway Town and Country Planning Act, 1947.—In exercise of powers under Section 15 of this Act and para. 3 of article 9 of the Town and Country Planning General Development Order, 1950, the Minister of Housing and Local Government has issued the Town and Country Planning (Housing Accommodation) Direction, 1952. Consequent upon the issue of this Direction, the Borough Council is consulted by the London County Council (the Planning Authority) before any application for planning permission involving change of use of premises from use as a dwelling is determined. Such consultations are designed to prevent any unnecessary aggravation of the housing situation by the encroachment of business premises into residential property. 81 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 1957 :— " Last year I concluded my remarks by forecasting that 1957 would not be a good year from the point of view of rehousing from the general housing register, and this rather gloomy prediction has proved to be the case. Only twenty-two new dwellings were handed over for letting during the year, in addition to which there were eight flats provided as the result of converting formerly requisitioned properties which had been purchased by the Council. Altogether the number of lettings from the general register amounted to only 54 as compared with 118 in 1956. Transfers also fell drastically as compared with the previous year, there being 59 as against 110 in 1956. Having regard to the particularly acute shortage of accommodation during the year, every effort was made to encourage mutual exchanges between tenants and this showed an increase, there being 46 such exchanges effected in 1957 compared with 33 in 1956. Notwithstanding this reduction in lettings activities, the fall in the number on the housing register which has been noted over the past few years continued. There were 2,555 applicants registered at the beginning of the year which figure had dropped to 2,384 by 31st December, 1957. The derequisitioning of properties has continued, but at a much slower rate. As I mentioned last year, a large proportion of the properties released then were taken back by owners with the families remaining in occupation as their statutory tenants. Releases under this provision of the Requisitioned Houses and Housing (Amendment) Act, 1955 diminished considerably particularly in the first part of the year, although there was a slight increase in the number of owners interested in accepting early release of properties under this scheme after the passing of the Rent Act, 1957 as a result of which owners could increase the rents of their statutory tenants to the new rent limits provided for in the Act. The Council decided, as a matter of policy, that in such cases the statutory tenants of formerly requisitioned properties released under this arrangement would only have to pay an amount equal to what they were already paying, or what they would have had to pay if they were still in requisitioned properties whichever was the greater. The balance was made up by the Council as provided for in the 1955 Act. Altogether 189 dwellings were released from requisition in one way or another during the year and this included several properties which were purchased by the Council. 82 It has become abundantly clear that, without purchasing a considerable number of properties, it will be impossible to comply with the provisions of the 1955 Act, which lays down that requisitioning shall come to an end on 31st March, 1960. Having regard to this, owners of requisitioned properties were circularised to see how many would be willing to sell their properties to the Council. There was quite a good response from owners, but little headway was made in the actual purchase of properti s due in part to shortage of technical staff in the Borough Engineer's Department required for preliminary surveys and to the somewhat lengthy administrative procedures which have to be gone through in dealing with the Ministry of Housing and Local Government on the question of Exchequer grants. The general shortage of Council properties to let prompted the Housing Committee to set up a Sub-Committee to look into the question of under-occupation. Briefly, the recommendations of this Sub-Committee, which were adopted by the Housing Committee, provided for the continuation of the existing policy of voluntary transfers from under-occupied houses and flats into smaller dwellings, to be encouraged by the Council paying the removal expenses of tenants transferring to smaller premises, thus releasing larger accommodation to be put to better use. To facilitate such moves and mutual exchanges, an earlier requirement that no tenant might transfer or exchange accommodation within two years of taking up his tenancy was rescinded and it was further decided to authorise the admission of related lodgers in certain circumstances so as to make the best use of available accommodation. The execution of the policy of encouraging transfer to smaller dwellings was facilitated by the introduction of a new rent structure in April 1957 whereby rents are now linked with the rateable values of properties. Hitherto it had often transpired that the rents of small post-war flats were more than pre-war houses and tenants were understandably reluctant to move from larger premises to the smaller type if higher rents were involved. With the new rent structure however, this impediment has been removed. To sum up, it can be said that 1957 was a lean year from the point of view of accommodation and the emphasis has been on making the best use of the diminished resources at the disposal of the Housing Committee. It is anticipated that 1958 will show considerable improvement in the number of dwellings available from all sources for general letting." 83 SECTION E Inspection of Food and Supervision of Food Premises Legislation.—The following legislation in connection with the inspection and supervision of food and food premises was introduced during the current year:— The Public Analysts Regulations, 1957.—Effective from 27th May, these regulations, made under the Food and Drugs Act, 1955, revoke and substantially re-enact the provisions of the Public Analysts Regulations, 1939, and prescribe a revised form of certificate to be given in cases where the public analyst is unable personally to undertake the analysis but forwards a sample to the public analyst of some other area. Colouring Matter in Food Regulations, 1957.—From 30th June, these regulations revoke and re-enact with modifications the Public Health (Preservatives, etc., in Food) Regulations, 1925/53, in so far as they relate to the use of colouring matter in food. The regulations prescribe a list of permitted food colours, prohibit the importation and sale of food containing colouring matter not included in the list and, with the exception of clearly marked citrus fruit, also prohibit the addition of colouring matter to certain natural foods sold in a raw and unprocessed state. The Food Hygiene (Amendment) Regulations, 1957.—These regulations, made under Sections 13 and 123 of the Food & Drugs Act, 1955, amend Regulation 7 of the Food Hygiene Regulations, 1955, and from 1st June, 1958, permit the giving out of shrimps, prawns and onions for peeling on domestic premises if such premises are registered for the preparation of the food in question under Section 16 of the 1955 Act and comply with certain other requirements. During the year under review, in accordance with the Milk and Dairies Regulations, 1949/54, several additions were made to the list of approved oxidising or preserving agents and an official certificate for Hungary was approved under the Public Health (Imported Food) Regulations, 1937/48. In addition there was an amendment to the Memo. 3/Meat in connection with the detection of cysticercus bovis in post mortem inspection. 84 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. 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 Agriculture, Fisheries and 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 6 dairy premises. On 72 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, 1949/53 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, 1957 :— 85 Licences In Operation Principal Licences issued 31.12.57 Distribution of Sterilised Milk 92 87 „ ,, Pasteurised Milk 47 46 „ ,, Tuberculin Tested 32 32 Supplementary Licences Distribution of Sterilised Milk 20 20 ,, ,, Pasteurised Milk 17 17 „ „ Tuberculin Tested 17 17 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 58 samples of milk consisting of 47 Pasteurised milks, 2 Sterilised and 9 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, the producers were warned and further samples taken. These samples subsequently proved to be satisfactory. Analytical Examination of Milk.—All designated milks being sold in the Borough were sampled, including those of the super-fatted variety, viz., Channel Island, Jersey, South Devon, etc. A total of 49 samples, 24 formal and 25 informal, were submitted to chemical analysis and, with the exception of an informal sample of Channel Island milk, all proved to be genuine. There was a slight deficiency of milk fat in this sample of Channel Island milk and investigation revealed that the deficiency was due to insufficient mixing at the dairy, a fault which the producer was instructed to remedy. Six samples of cream (one synthetic) 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. 86 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. Preserved Food Premises (meat, fish, etc.).—The total number of premises on the register at 31st December, was 90. One hundred and twenty-seven visits of inspection were made to Preserved Food premises and Fried Fish shops as a result of which four 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 195. Visits to these premises were made on 184 occasions and 10 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. 87 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 56 samples were submitted for examination and grading according to the Ministrv's nrovisional Grading Scheme. The grading is based on the results of the Methylene Blue Reductase Test and a summary of this year's reports is given below:— Samples taken Time taken to Reduce Methylene Blue Provisional Grade Observations 33 4½ hours or more 1 Satisfactory 15 2½ to 4 hours 2 Sub-standard 2 ½ to 2 hours 3 Unsatisfactory — 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 are contained in the Food Standards (Ice Cream) Order, 1953. In connection with quantitative analysis, 7 samples of ice-cream 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. 88 Food Rejected.—The following table is a summary of unsound food voluntarily surrendered during the year under the provisions of the Public Health (London) Act, 1936, Section 180(8) most of which was processed and used for animal feeding:— Shops, Stalls, etc.:— Meat— Beef & Beef Trimmings 32,634 lbs. Sheep 618 „ Ox & Sheep Livers 40 „ Ox Tongue 5 „ Poultry 1,372¾ „ Pigs Kidneys 268 „ 34,937¾ lbs. Other Foods— Frozen Foods (Various) 1,490 lbs. Fruit Juices & Pulp 121 „ Foods, (Various) 1,529 „ Cooked Meats 1,271 „ Dogfish 126 „ Sultanas 1,380 „ Pears (Canned) 814 „ Cheese Trimmings 90 „ Skate Wings 62 „ Confectionery 896 Butter 50 „ Smoked Haddock Fillet 130 „ Bacon & Cooked Ham 22½ „ Tapioca 36 „ Whiting 56 „ Margarine 48 „ Plaice 28 „ Peeled Tomatoes (Canned) 590 „ Mangoes 34 „ Saveloy 6 „ 8,779½ lbs. Total 43,717¼ lbs. Compared with the previous year, the amount of meat rejected rose by 21,296 lbs. during 1957, but the total of all food rejected fell by 81,525¼ lbs. 89 Public Health (Meat) Regulations, 1924/52.—These regulations provide for the supervision of slaughterhouses, butcher's 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 7 premises. As with other premises, legal proceedings are instituted only after disregard of the Officer's warning and in no instance was it necessary to resort to this procedure. Slaughterhouses.—Two premises in the Borough originally licensed as slaughterhouses have not been used as such since the introduction of the Livestock (Restriction of Slaughtering) Order 1940. In both instances the premises are no longer to be used as slaughterhouses and the issue of the appropriate licences has therefore been discontinued. Public Health (Imported Food) Regulations, 1937 and 1948.—The Metropolitan Borough of Greenwich with a river frontage of five miles with more than 30 wharves and two of London's largest and most modern cold stores receives a considerable percentage of London's imported meat stored on behalf of various importers. In addition, considerable quantities of fresh fruit, tinned foods and miscellaneous provisions are dealt with. Visits to wharves and cold stores are made by the Food Inspectors and imported food generally is carefully supervised. Inevitably meat is the commodity to which Food Inspectors must devote most of their time and it is their responsibility to see that each consignment landed is accompanied by an " official" certificate. This may be in the form of a certificate, label, mark, stamp or voucher which is recognised by the Ministry of Agriculture, Fisheries and 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 juice, being processed for stock feeding. 90 The following foods were rejected at the wharves:— Meat— Beef 2,577 lbs. Lamb & Mutton 1,933½ „ Corned Beef 52 „ Cooked Meats (Canned) 22¼ „ 4,584¾ lbs. Other Foods— Fruits (Canned) 1,677 lbs. Fruit Juices 1,068 „ Tomato Juice 168 „ Fruit Cocktail 4¾ „ Salted Cucumbers 456 „ Fish 7 „ Marmalade & Jam 7½ „ 3,388¼ lbs. Total 7,973 lbs. Caseous Lymphadenitis.—This disease, sometimes called " pseudo-tuberculosis" occurs mainly in sheep although it is occasionally found in cattle, rabbits and chickens. It is met usually in imported sheep carcases and is often the cause of meat being rejected as unfit for human consumption. It follows, therefore that much time and attention is given by the Food Inspectors to this disease during their inspections at the wharves and cold storage plants in the Borough. Results of examinations for caseous lymphadenitis are given below. Landed. Examined Rejected Weight Australian Sheep, Ewes & Wethers 3,035 63 Nil — New Zealand sheep 33,862 354 Nil — Imported Egg Products.—As a riparian authority Greenwich receives substantial landings of these products and although since the introduction of the heat chamber treatment dried egg albumen no longer presents any serious problem, great difficulty arises in connection with the effective sterilisation of frozen whole egg, frozen liquid albumen, spray-dried whole egg and spray dried egg yolk. In this connection it has been found scientifically unsound to draw any conclusions on the bacteriological purity or otherwise of consignments sampled in accordance with present methods which are not only tedious but often technically difficult and productive of laboratory results which are most equivocal. A satisfactory outcome is arrived at in some countries where egg products are subjected to pasteurisation before processing but, as far as is known, no such pasteurising plants exist in China, a country whose egg exports are causing us such concern. 91 The seriousness with which the Public Health Committee viewed the importation of contaminated Chinese egg products was communicated to the Chief Medical Officer of the Ministry of Health and in subsequent correspondence it transpired that a meeting at the Ministry of all interested local authorities was under active consideration. During the current year, large importations of egg products from various countries continued to enter the Borough and each consignment was subjected to a percentage sampling in order to ascertain its freedom or otherwise from salmonella infection, a form of contamination to which these products are prone and the following tables summarise the results :— Chinese Dried Hen Egg Albumen.—All landings of this product during the year have continued to be submitted to the heat treatment process recommended by the National Albumen Advisory Committee set up by the Ministry of Health. This process is undertaken at Messrs. J. Palmer (Deptford) Ltd., Prince Street, S.E.8. Batch No. No. of Tins of 100 lbs. Control Samples Bact. Results of Positives after Heat Treatment Positive Negative Positive Negative Percentage rate of Control Sampling: 33⅓ % 13 224 1 84 — 1 14 201 2 68 — 2 15 111 2 40 — 2 16 158 2 79 — 2 17 56 — 18 — — 18 143 2 52 — 2 19 99 — 35 — — Percentage rate of Control Sampling: 10% 20 371 6 53 — 6 21 125 8 5 — 8 22 334 — 33 — — 23 418 — 42 — — 24 404 4 36 — 4 25 355 1 40 — 1 26 313 4 27 — 4 27 112 — 11 — — 28 110 — 11 — — Incidence of Salmonellae: Salmonella potsdam 8 tins „ thompson 22 tins „ san diego 1 tin „ paratyphoid B (type 1) 1 tin 92 Chinese Frozen Whole Egg.—A special shipment of 12,727 packages was detained pending a 2% examination and of the 297 packages sampled, 31 gave evidence of salmonella contamination as under :— Salmonella thompson 28 packages „ paratyphoid B 2 „ „ seftenberg 1 „ Detention notices were issued in respect of 11,634 packages and subsequently a meeting was held at the Ministry of Health at which representatives from the Commercial Counsellor's Department of the Chinese Charge d'Affaires were present. Eventually the consignment was sold for re-exportation and the Port of London Health Authority was duly notified of details regarding the vessels involved and estimated dates of departure from this country. Other imported Egg Products.— Country of Origin Type of Egg Quantity Imported No. of Samples taken No. of Samples Contaminated Denmark Pasteurised Flaked Hen Egg Albumen 40 X 1 cwt. kegs. 40 36 (a) Holland Frozen Egg White 855 X 13 lbs. tins 17 Nil Norway Dried Egg Albumen 6 X 2 cwts. drums 4 Nil China Dried Whole Egg 898 X 100 lbs. tins 141 6(b) 1,613 X 50 kgs. tins 88 2(c) Dried Egg Yolk 101 X 50 kgs. tins 5 Nil (a) Salmonella typhimurium—heat treated and. rendered negative. (b) Salmonella thompson—5 tins re-exported ,, aberdeen—1 tin (c) Salmonella thompson—re-exported 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 twenty-nine inspections were made to secure compliance with the various Orders but on no occasion was it found necessary to take action against Vendors. 93 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. Regulation 26 of the Food Hygiene Regulations, 1955, requires inter alia, that each stallholder's name and address shall be clearly displayed on his stall. In the past it has been necessary, on occasions, to warn vendors but such action was not required during the current year. 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 42 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 3,542 visits, as a result of which 81 premises were improved. The following table is a statistical record ot the major portion of the duties performed and inspections undertaken during the year by the Food Inspectors. 94 Premises Inspected or Visits Made No. of Visits No. of Premises at which Improvements were effected Caterers', Restaurants, etc. 282 19 Grocers, Greengrocers 310 21 Butchers' Shops 119 7 Dairies and Milk Distributors 72 — Licensed Victuallers 28 7 Wharves and Factories 626 — Bakehouses and Bakers' Shops 67 11 Ice-Cream Premises, Confectioners, etc. 184 10 Fried Fish Shops 40 4 Other Fish Shops 39 2 Cooked Meat & Preserved Foods 87 * Visits Re. Shops Act 263 — „ „ Infestations 12 — „ „ Food and Drugs Act 208 — „ „ Merchandise Marks Act & Markets 284 - „ „ Food Poisoning 42 — Sampling Visits 337 — Fair Visits 13 — School Visits 35 — Miscellaneous Visits (including Flour Mills- Cyanide Fumigation) 372 - Interviews 29 — Complaints Investigated 93 — Totals 3,542 81 * Included under Grocers' and Butchers' Shops 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 67 occasions and, as a result of the inspections, 11 improvements were realised. 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. 95 As a result of 310 visits of inspection to the catering establishments, insanitary conditions were remedied and improvements effected on 112 occasions. The following is a summary of the improvements carried out:— Type of Improvement Effected Total No. Walls, Ceilings, Repaired, Cleaned & Redecorated (Premises) 46 (W.C's.) 10 (Wine Cellars) 2 Urinal Supplied 1 Urinal Redecorated 1 Floors Repaired or Resurfaced 3 Roofs Repaired 3 W.C. Supplied 1 W.C. Seat Repaired 1 Tiling Repaired 1 Handbasins & Sinks Installed 12 Water Heater Installed 16 Ventilation Improved 2 Cutting Tables & Blocks Renewed 4 Locker Accommodation for Staff provided 2 Dustbins Renewed 2 Drainage Cleared & Cleansed 1 Nail Brush & Towel Supplied 1 Protection for Cooked Meats 1 First Aid Equipment Supplied 2 Total Improvements effected 112 Many licenced victuallers have instituted a catering service during the last few years, some providing prepared food to be consumed at the bar counter and others supplying a cooked lunch in a separate dining room. Seven improvements were carried out at public houses as a result of informal action. Food and Drugs Act, 1938.—In accordance with the Council's contract with the Public Analyst, 398 samples were obtained under the provisions of the above Act and presented for examination. Of this total 36 samples were formal and 362 informal of which 14 (one formal and 13 informal) were reported to be non-genuine. Three of the unsatisfactory samples were only incorrectly labelled and have therefore been excluded in the calculation of the adulteration figure. The adulteration figure at 2.7% shows a decrease of 0.1 from that of last year. Again milk was the main food sampled and only one of the 49 samples submitted for analysis proved to be unsatisfactory. This was a Channel Island milk 2% deficient in milk-fat-a contravention of the Milk and Dairies (Channel Islands and South Devon Milk) 96 Regulations, 1956. After investigations had taken place it trans pired that the deficiency was due to insufficient mixing and the producer was warned that future lapses would be treated more seriously. Twelve flour samples were taken during the year of which one failed to comply with the Flour (Composition) Regulations, 1956, in that it contained an excess of creta praeparata. After investigation, inadequate mixing was considered to be the cause of the excess and the manufacturers were notified accordingly. Seven ice-cream samples were obtained and submitted to the Public Analyst for examination. All proved to be genuine and 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 Cough Syrup, Anadin Tablets, Iodised Sarsaparilla Blood Purifier and Energy Tablets, all of which complied with the provisions of the above Act. With regard to the ' Energy Tablets,' the manufacturers were advised to change the name as the Public Analyst was of the opinion that the label was inclined to be misleading. Public Health (Dried Milk) Regulations, 1923 to 1948.— These Regulations control the minimum milk-fat content of dried milk and the labelling of tins or other receptacles in which this commodity is contained. No samples were obtained during the current year. Public Health (Condensed Milk) Regulations, 1923 to 1948.—Minimum percentages of milk-fat and milk-solids of condensed milk as well as the standards of labelling of receptacles are covered under the provisions of these Regulations. Eight samples of condensed Milk were taken in the normal course of sampling of which 2 were declared as unsatisfactory, one on account of its tin content (2.1 grains per pound) and the other by reason of being overheated in the processing plant. In each case all remaining stocks were withdrawn from sale. Other Food Examinations.—In addition to those obtained under the Food & Drugs Act, other articles not procured in the 97 normal course of sampling were examined either by the Public Analyst or at the Public Health Service Laboratory. These examinations were the outcome of complaints from members of the public or as a result of special investigations into certain foods carried out by the Food Inspectors or as the "follow-up" to reported food poisoning cases. Information concerning the analyses of these samples is given in the following table:— Article How Obtained Examination Action Taken Bact. or Chem. Result New Zealand Boneless Veal (7 Samples Casserole Steak Taken from Cold Store in Boro'. Bact. Salmonella not isolated. Importer notified. Submitted by a member of the public. Reputed to have turned green when soup powder was added. Chem. Dyes used in soup powder broke down under heat treatment. Letter to Manufacturer. Salted Back Fat Taken from Cold Store in Boro'. Bact. Salmonella not isolated. Importer notified. Norwegian Crystal- line Egg Albumen (2 Samples) Taken from Cold Store in Boro'. Bact. Salmonella not isolated. Importer notified. Coral extracted from Chinese Quick Frozen Prawns (2 Samples) Taken from Cold Store in Boro'. Bact. Faecal coli not found. Importer notified. Chinese frozen Prawns Taken from Cold Store in Boro'. Bact. Faecal coli not isolated. Importer notified. Chinese frozen Prawns Taken from Cold Store in Boro'. Chem. Genuine Importer notified. Polish Water White Potato Syrup (6 Samples) Taken from Cold Store in Boro'. Samples taken as the result of advice from Min. of Ag. Fisheries & Food. Chem. (a) SO2 215p.p.m. (b) SO2 55p.p.m. (c) SO2 185 p.p.m. (d)SO2 175 p.p.m. (e) SO2 165 p.p.m. (f) SO2 45 p.p.m. Information to Ministry of Agriculture, Fisheries & Food and to Importers. 98 Article How Obtained Examination Action Taken Bact. or Chem. Result Ground Coffee Submitted by a member of the public who alleged, diarrhoea, headache and malaise after consumption. Chem. Genuine ground roasted coffee. No admixture or contamination detected. Complainant notified. White Granulated Sugar (6 Samples Taken from Cold Store in Boro'. Chem. No arsenical contamination detected. Ministry of Health notified. Portion of School Meal (Cold Roast Lamb) From James Wolfe School. Meal reputed to be the cause of outbreak of diarrhoea. Bact. No pathogenic organisms found. M.O.H., L.C.C. notified. Portion of School Meal Minced and reheated From James Wolfe School. Meal reputed to be the cause of outbreak of diarrhoea. Bact. No pathogenic organisms found. M.O.H., L.C.C. notified. Norwegian Dried Egg Albumen (2 Samples) Taken from Cold Store in Boro'. Bact. Salmonella not isolated. Importer notified. Tea Submitted by a member of the public alleging bitter taste and presence of sediment. Chem. Tea was above average in strength and no foreign substances were detected. Complainant notified. Crab Meat (Canned) (2 Samples) Letter from Corp. of London alleging that tin examined by P.H.L.S. Reading contained heavy bact. growth. Bact. After incubation for 3 days at 37°C cans and contents sound. Cultures sterile. Corporation notified accordingly. Beef Tails Australian frozen. Taken from Cold Store in Boro'. Bact. Staphylococcus Aureus present. No other pathogens isolated. No action. 99 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 17 notifications received during the year compared with 23 for the previous year, 14 for 1955, 12 for 1954 and 9 for 1953. All cases, which were of the sporadic type, were investigated with the following results:— Unknown Cause 10 Salmonella typhimurium 6 Staphylococcus pyogenes 1 In no instance was direct connection with any specific food established. Six cases received hospital treatment (1 nurse in Miller Hospital and 5 Servicemen in Royal Herbert Hospital) and each patient made a complete recovery. 100 FOOD AND DRUGS ACT, 1955 Number and Description of Samples Submitted for Analysis under the above Act during the year 1957 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Ale & Stout - 3 3 - - - Almonds, Ground - 2 2 - — — Baby Foods, Bottled — 1 1 — — — Baby Foods, Canned — 1 1 — — — Baking & Golden Raising Powder — 2 2 — — — Bamboo Shoots, Canned — 1 1 — — — Biscuits — 1 1 — — — Blackcurrant Syrup — 1 1 — — — Blood Pudding, Canned — 1 1 — 1 1 Brandy 2 — 2 — — — Breadcrumbs — 1 1 — — — Butter — 10 10 — 1 1 Calcinate Tablets — 1 1 — — — Caraway Seeds — 1 1 — — — Cheese & Cheese Spread — 3 3 — — — Cocoa — 1 1 — — — Coconut, Desiccated — 1 1 — — — Coffee & Chicory Essences — 3 3 — — — Confectionery, Flour — 9 9 — — — Confectionery, Sugar — 2 2 — — — Cooking Fat — 3 3 — — — Cordial, Alcoholic — 1 1 — — — Cream — 5 5 — — — Cream, Imitation — 1 1 — — — Custard Powder — 2 2 — — — Drinks, Soft — 6 6 — — — Dripping — 2 2 — — — Fish, Various Canned — 32 32 — 1 1 Fish, Pudding, Canned — 1 1 — 1 1 Fish Cakes — 1 1 — — — Fish Paste — 3 3 — — — Flavouring Essences — 1 1 — — — Flour — 13 13 — 1 1 Forcemeat — 1 1 — 1 1 Fruit, Canned — 22 22 — — — Fruit, Dried — 7 7 — — — Fruit Curd, Lemon — 2 2 — — — Fruit Juice — 6 6 — — — Fruit Pie — 2 2 — 1 1 101 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Gelatine — 1 1 — — — Gin 3 — 3 — — — Ginger, Ground — 1 1 — — — Gravy Preparation — 3 3 — — — Groundnut Kernels — 1 1 — — — Gum Chewing — 1 1 — — — Honey — 2 2 — — — Ice Cream — 7 7 — — — Jam, Various — 9 9 — 1 1 Jelly Tablets — 4 4 — — — Lard — 5 5 — — — Lentils — 1 1 — — — Macaroni — 1 1 — — — Malt Extract — 1 1 — — — Margarine — 7 7 — — — Marmalade, Canned — 2 2 — — — Marzipan — 1 1 — — — Meat Products — 16 16 — 1 1 Meat Products, Canned — 18 18 — — — Meat Extract - 2 2 - — — Meat, Minced - 1 1 - — — Mincemeat - 1 1 - — — Meringue Powder - 1 1 - — — Milk 24 25 49 1 — 1 Milk, Condensed — 8 8 - 2 2 Milk Pudding, Canned — 2 2 — — Mushrooms, Canned — 1 1 - — — Oats — 1 1 - — — Oil, Olive & Groundnut — 2 2 — — — Pastry & Pudding Mixture — 5 5 — — — Parish's Food — 1 1 - — — Peanut Butter — 1 1 - — — Peel, Candied — 1 1 - — — Pepper — 1 1 - — — Pickles, Various — 5 5 - — — Proprietary Medicine - 1 1 — — — Pudding, Xmas — 2 2 — — — Rice — 1 1 - — — Rum 2 — 2 - — — Rum Butter — 1 1 — - - Rusks — — 1 - - — Salad Cream — 5 5 - — — Sauce, Various — — 7 - — — Sausages — 10 10 - — — Soup, Canned — 7 7 - 1 — Soup Preparation — 4 4 — — — 102 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Spaghetti — 2 2 — — — Spice — 3 3 — — — Suet, Shredded — 2 2 — 1 1 Sugar — 4 4 — — — Tea — 3 3 — — — Tomato Purée — 1 1 — — — Vegetables, Potatoes — 1 1 — — — Vegetables, Dried — 1 1 — — — Vegetables, Various, Canned — 6 6 — - - Vinegar, Malt, Cider — 2 2 - - - Whisky 5 1 6 — — — Wine, Alcoholic — 1 1 — — — Yeast — 1 1 — — — Totals 36 362 398 1 13 14 103 Administrative Action Taken in Regard to Samples Reported to be NOT GENUINE Sample No. Article Nature of adulteration and/or irregularity Action taken T. 7 Forcemeat Article was one of stuffing mixture. Sample contained no meat although its ingredients were correctly disclosed on label. Matter taken up with manufacturers. T. 19 Sild in Tomato Sauce (Canned) Incorrectly labelled. Failed to comply with Labelling of Food Order, 1953. Matter taken up with importers. T. 76 Tomato Soup (Canned) Contained tin 3.3 grains per pound. Stock destroyed. T. 97 Shredded Beef Suet Slightly deficient in Beef Fat. Satisfactory explanation from manufacturers. T. 114 Blood Pudding (Canned) No statement of ingredients on label. Matter taken up with importers. T. 116 Condensed Full Cream Milk Contained tin, 2.1 grains per pound. Stock withdrawn. 133 Channel Island Milk Deficient in Milk-Fat to the extent of 2%. Warning letter after manufacturer's explanation. T. 145 Fruit Pie (Blackcurrant) Contained a seeding flower head of the common creeping thistle. (Cirsium arvenae). Matter taken up with manufacturer T. 186 Condensed Full Cream Milk, Sweetened Abnormally dark in colour; "fishy" taint—contained brown lumps—apparently overheated when processed. Stock withdrawn. T. 192 Butter (Salted) Slightly rancid and contained 16.1 % of water. Importer advised. T. 198 Fish Pudding (Canned) No statement of ingredients on label. Letter to importer. T. 326 Lingonberry Jam According to the Food Standards (Preserves) Order, the sample was deficient in soluble solids. Letters to Importers & Trade Commissioner, Royal Norwegian Embassy. T. 330 Meat Pie According to the generally accepted standard the sample was deficient in meat content. Warning letter. F. 11 Flour Contained 440 mgms. of creta prneparala per 100 gms, 50 mgms. per 100 gms. in excess of the maximum specified under the Flour (Composition) Regulations, 1956. Letter to manufacturer. 104 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 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 Section 144 of the Public Health Act, 1936, Section 192 of the Public Health (London) Act, 1936, and associated Orders and Regulations was 1,481. Under the Public Health (Tuberculosis) Regulations, 1952, there were 80 notifications, giving a consolidated total of 1,561 cases notified during the year. In 3 of these cases the diagnoses were not confirmed, thus giving a corrected figure of 1,558. The following table indicates the figures for the previous ten years:— 105 Year No. of corrected notifications 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 1956 844 10-year Average 1,426 1957 1,558 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 the issue of one certificate became necessary compared with seven during 1956. 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. 106 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 1957 was 928. This is an increase of 331 over the previous year. In Greenwich during the last 7 years 9,271 births have been registered, and for the same period only 5,147 vaccinations have been effected, a figure equivalent to 55.5%. 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. During the year some 496 certificates of persons proceeding abroad were so authenticated, of these 458 were in respect of Smallpox, 25 for Cholera and 13 for Typhoid. One vaccination was actually carried out by your Medical Officer of Health. 107 Measles.—The normal biennial fluctuation was evident in the sharp increase in the number of notified cases from a figure of 44 confirmed in 1956 to 1,194 for the current year of which 630 were males and 564 females. Forty-two cases occurred in children under one year of age, 1,123 between 1 and 10 years, 23 between 10 and 15 years and 6 over 15 years. Fifteen cases were removed to hospital and there were 2 deaths. One concerned a child of 1¾ years and the other an acting Sub/Lieut, of 21 years who contracted the disease whilst on an instructional course at the Royal Naval College, was removed to the Royal Naval Hospital at Gillingham where he subsequently died. No notification in respect of this latter death was received. The distribution of the cases was as follows:—East Greenwich 440 ; West Greenwich 123; St. Nicholas, Deptford 43 ; Charlton and Kidbrooke 588. During 1955, 1,684 cases were recorded and in 1954 there were 28. Whooping Cough.—Altogether 97 notifications were received in 1957, a decrease of 25 from the previous year. The year 1955 produced 165 and there were 223 for 1954. Area distribution for the current period was:—East Greenwich 33; West Greenwich 28; St. Nicholas, Deptford, 9; Charlton and Kidbrooke 27. Four cases were admitted to hospital and there were no fatalities. During the year, 1,127 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, a result similar to that for 1956. One case was confirmed in each of the years 1955 and 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 40, the figure for the current year. Over the same period deaths have decreased from 722 to 6. Diphtheria immunisation is a County Council service and during the year there were 1,256 completed immunisations carried out in the Borough an increase of 449 over that of the previous year. 103 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 28 cases attributed to these causes, as compared with 14 for each of the years 1955 and 1956. Six occurred in East Greenwich, 1 in St. Nicholas, Deptford, and 21 in Charlton and Kidbrooke. Six cases were removed to hospital where one, a man of 37 years, died from acute influenzal pneumonia. Typhoid.—There were 2 cases of paratyphoid fever notified this year compared with one for 1956. Both cases (2 sisters from Belgium visiting their grandmother in this Borough) were removed to hospital. Scarlet Fever.—A total of 102 notifications for the year shows an increase of 44 over 1956 compared with 57 cases for 1955. Twenty one occurred in East Greenwich, 30 in West Greenwich, 1 in St. Nicholas, Deptford, and 50 in Charlton and Kidbrooke. Nine cases were removed to hospital and no fatalities were recorded. Erysipelas.—No cases were notified during the year compared with 4 last year and 6 for 1955. Zymotic Enteritis or Epidemic Diarrhoea (Children under 5 years of age).—Twelve cases were recorded as confirmed compared with 17 for the previous year. One case, a male child of one month, was admitted to hospital where he died. 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 infanta 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. 109 There was a remarkable fall in the incidence of dysentery during 1957. Originally there were 23 cases notified but one was subsequently re-diagnosed as food poisoning and 22 were eventually recorded as confirmed compared with a figure of 480 for the previous year. The distribution of the cases was 9 in East Greenwich, 1 in West Greenwich ; 1 in St. Nicholas, Deptford, and 11 in Charlton and Kidbrooke. Two cases were removed to hospital but there were no fatalities. Scabies.—Four cases were so notified compared with 6 for the previous year and 4 for 1955. Treatment of all cases of scabies is carried out at the Tunnel Avenue Centre. Puerperal Pyrexia.—During the year there were 4 notifications received in accordance with the 1951 Regulations, 2 of which concerned Deptford residents, but from other sources 15 cases concerning Greenwich residents were brought to the notice of the department compared with 19 for 1956. All patients received hospital treatment. There were no fatalities. Meningococcal Infection.—There were 2 notifications received during 1957 compared with a nil return for last year and 5 for 1955. Both cases were removed to hospital where one, a female of 20 months succumbed shortly after admission. Acute Encephalitis. (Infective or Post Infectious).—A NIL return is recorded for the current year, a similar return to those for the years 1956, 1955 and 1954. Ophthalmia Neonatorum.—In respect of this disease, one notification was received. The case was kept under observation by the Health Visitor at home and the child made a full recovery. Poliomyelitis.—It has already been pointed out at the commencement of this Section that the vagaries of notification procedure have led to misleading statistics concerning specified administrative areas and this is emphasised by the notifications received in respect of poliomyelitis. 110 During the year, 10 notifications were received of which I was re-diagnosed as virus meningitis (cocksackie 'B'). Of the 9 confirmed cases, only 7 were in respect of Greenwich residents and a further case concerning a resident notified to Lewisham gave a final total of 8 for the Borough. Of these 3 were of the paralytic type and 5 non-paralytic, six being children of school-age. All cases received hospital treatment and there were no deaths. Mataria.—One notification of benign tertian believed to have been contracted abroad was received from the Royal Herbert Hospital in connection with a serviceman of 21 years. Tuberculosis.—During the year 80 notifications in respect of confirmed cases of tuberculosis were received compared with 86 for 1956. Of these, 77 were of the pulmonary type and 3 nonpulmonary, i.e., tuberculosis of parts of the body other than the lungs. The following table gives the distribution:— District Pulmonary Non-Pulmonary Total East Greenwich 26 2 28 West Greenwich 15 — 15 St. Nicholas, Deptford 4 — 4 Charlton and Kidbrooke 32 1 33 Totals 77 3 80 Disinfection was offered and carried out in 12 cases including 23 rooms and 87 articles of clothing and bedding, etc. The number of notified cases of Tuberculosis remaining on the Register at 31st December, 1957 was as follows:— PULMONARY NON-PULMONARY Men Women Children Total Mon Women Children Total M F M F 573 489 28 22 1.112 23 42 12 6 83 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. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 Part I.-Summary of notifications of Tuberculosis during the period from the 1st January, 1957, to the 31st December, 1957. 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 — 3 8 7 7 8 6 4 2 46 Respiratory, Females — — — — 2 2 5 7 6 5 1 2 - 30 Non-Respiratory, Males — — — — — — — — — — — — — — Non-Respiratory, Females — — — — — — — 1 1 — — — — 2 Part II.—New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Source of Information Number of cases in age Groups 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total Death Returns from Local Registrars Respiratory M — — — — — — — — — — — — — —(A) F — — — — — — — — — — — — — —(B) Non-Respiratory M — — — — — — — — — — — — — —(C) F — — — — — — — — — — — — — —(D) Death Returns from RegistrarGeneral (Transferable deaths) Respiratory M — — — — — — — — — — — — — —(A) F — — — — — — — — — — — — — —(B) Non-Respiratory M — — — — — — — — — — — — — —(C) F — — — — — — — — — — — — — —(D) Posthumous Notifications Respiratory M — — — — — — — — — — — — — —(A) F — — — — — — — — — — — — 1 1 (B) Non-Respiratory M — — — — — — — — — — — — — — (C) F — — — — — — — — — — — — — - (D) 11l N.B. Where notification of one form of Tuberculosis is subsequently followed by a notification Totals (A)- (B) 1 of the other, only the first notification is taken into account for the purpose of this return. (C)- (D) - 112 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, tne 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. A number of surveys, public and specific, were carried out in the Borough during the year by the South East London Mass Radiography Unit and I am indebted to Dr. J. M. Morgan, the Director, not only for the following analysis of the results but also for his general dissertation on the place of mass radiography in the prevention and elimination of pulmonary tuberculosis and the early diagnosis of other chest disabilities. Summary of Surveys Carried Out in Respect of the General Public, Firms, Schools and Hospitals From 1st January to 31st December, 1957 PART 1.—General Analysis Men Women Total (a) Total X-rayed 10,282 6,887 17,169 (b) Total previously X-rayed 6,562 3,308 9,870 (c) Total recalled for large film 450 246 696 (d) Number normal on large film 119 101 220 (e) Number abnormal on large film 324 145 469 (f) Not yet attended for large film 7 — 7 113 PART II.—Analysis of Abnormal Large Films (1) Cases considered tuberculous and referred elsewhere: Men Women Total (a) No further action required 2 1 3 (b) Occasional supervision only 16 15 31 (c) Requiring treatment 64 17 81 (d) Still under investigation 7 2 9 (e) Refused further investigation 3 — 3 (2) Non-tuberculous cases: (a) investigated 47 20 67 (b) still under investigation — — — (3) Cardio vascular lesions 11 11 22 (4) Previously known tuberculous cases 22 6 28 (5) Abnormalities requiring no action 152 73 225 Dr. Morgan's Comments.—"A recent analysis of the results of examinations carried out by the South East London Mass X-ray Service in 1956 shows that the over-all incidence of active tuberculosis in those examined was 3.6 per thousand, with figures of 2.9 for the factory, office, hospital group, and 4.0 for general public. These figures are based on the examination of about 150,000 persons annually in South East London and North Kent, and although they do represent the actual incidence found, it is perhaps unwise to draw too many conclusions in individual areas where the number of persons examined may be too small to give a statistically sound result. Nevertheless, the figures show that the likely incidence of active tuberculosis in the population as a whole is a great deal higher than is commonly thought. The elimination of pulmonary tuberculosis in a population must depend upon the reduction of the number of infectious cases to a sufficiently low level and experience has shown that the number of cases discovered by the usual channels of general practitioner, hospital and chest clinic is not sufficient to reduce the pool of infection to a low enough level. This statement is borne out by the fact that the current mass radiography figure of significant tubterculosis in South East London amongst the general population is four 114 per thousand, and that this figure has not materially changed over the last ten years. Valuable work has been done by B.C.G. vaccination but the duration of the protection thus given is uncertain and in any event it will be many years before the number of persons protected in this way rises to a sufficient level to achieve any material effect. The only other means of reduction of the infectious pool is by mass radiography, and this service should be directed at examining the largest possible number of adults who have not been previously X-rayed. Attention must, of course, be given to certain high incidence groups, but these groups represent a very small part of the population and an equally small part of the total pool of infection. As far as the Borough of Greenwich is concerned, due to its particular geographical lay-out, we have always been up against the problem in the past of finding a focal point that would serve all parts of the community. The best site, and the most known one, has been at the Greenwich Public Baths, which the Council have put at our disposal on several occasions. In 1957 there were administrative difficulties which prevented our using the Baths during the summer months, and we decided to experiment with a mobile caravan for office accommodation. This partly did away with our dependence on buildings and we took the opportunity to penetrate into parts of the Borough we have not previously tackled. A great many possible sites were seen and considered but finally, with the advice of the Town Clerk and the Borough Engineer, five sites were chosen. They were at Charlton House, Batley Park, Greenwich Station, Christ Church and the Cecil Rooms. They were chosen with three objects in mind. First of all, they had to be places well known to the public ; secondly, sites that could be easily seen from the main highways ; and lastly, the natural centres of communities. The response was reasonable throughout the period but the Unit could have X-rayed far higher numbers during the available times. We should have liked to see many more of the small firms and shops vigorously supporting the daytime sessions. In addition to the public centres, the Unit visited all the major industrial concerns. Here again, although much co-operation is given by the managements, we should like to see an even higher response from the workpeople. It is only by X-raying a very large proportion of the population that tuberculosis will eventually be eradicated. These surveys resulted in the figures which are quoted elsewhere in this Report." 115 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 es Adults 144 3 Children under school age 16 1 School children 205 12 No. of home visits by Lady Public Health Inspector 29 No. of home revisits by Lady Public Health Inspector 78 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:— Rooms and Articles Disinfected, for the year ended 31st December, 1957 Diseases, etc. Premises Entered Booms Beds Mattresses Bolsters Pillows Sheets Blankets Eiderdowns Cushions Quilts Odd Articles Wearing Apparel Rugs and Mats Covers Total No. of Articles Disinfected Scarlet Fever 76 153 16 74 52 204 141 269 36 60 48 238 283 - 59 1,480 Diphtheria — — — — — — — — - - - - - - - - Tuberculosis 12 23 2 9 3 17 4 30 — 3 1 15 - 1 2 87 Cancer 7 13 2 7 3 14 5 28 2 11 4 22 33 - 7 138 Meningococcal Infeation 16 29 — 15 8 29 26 52 9 12 8 48 116 — 10 333 Puerperal Pyrexia — — — — — — — — — — — — — - - — Typhoid Fever — — — — — — — — — — — — — - — — Polio-Myelitis 12 26 3 12 7 33 24 55 9 8 8 54 25 2 8 248 Erysipelas — — — — — — — — — — — — — — — — Acute Encephalitis 2 2 — 1 1 4 2 8 — 2 1 — 10 — 1 30 Measles 4 8 1 4 — 8 6 16 — 5 — 14 — 1 3 58 Scabies 1 — — — — — — 1 - - - - - - - 1 Other Diseases 171 40 19 57 17 62 18 151 5 9 14 99 105 13 9 578 Verminous Premises 3 7 2 7 — 17 - 22 1 5 — - - - - 54 Total 304 301 45 186 91 388 226 632 62 115 84 490 572 17 99 3,007 Articles Destroyed — — 68 218 5 24 — 8 — 8 — 1,364 12 — — 1,707 116 Library Books Disinfected 98 117 CHEST CLINIC REPORT I am indebted to Dr. J. L. Brown, 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. Notified cases on Clinic Register Pulmonary Tuberculosis Non-pulmonary Tuberculosis Total Men Women Children Men Women Children 31st Dec. 1956:- 495 431 41 15 19 10 1,011 31st Dec. 1957:- 531 456 45 13 19 11 1,075 Inward Transfers during 1957 29 26 6 2 1 — 64 Outward Transfers during 1957 20 19 2 — — — 41 Recovered 11 De-notified 3 Primary notifications 75 New Patients 1,981 Ante Natal X-rays 424 118 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 two new certificates issued, and 84 were renewed on application by the members, leaving a final total of 86 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 74 examinations were so made. Sick Persons.—In addition, the Medical Officer of Health carried out 23 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 two 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 31 interviews during the year, 4 of which were carried out in the applicants' own homes. INDEX Page A Page Acute Encephalitis 109 Acute Influenzal Pneumonia 108 Acute Poliomyelitis 109 Acute Primary Pneumonia 108 Adoptive Acts, Bye-laws and Local Regulations 3-4 Age Mortality 19-20 Aged, Infirm and Physically Incapacitated Persons 67-73 Analytical Examination of Milk 85, 95, 96 Ante and Post Natal Clinics 34 Ante and Post Natal Clinics, Attendances 31 Anti-Fly and Anti-Mosquito Campaign 60-61 Antitoxin, Diphtheria 108 Area of Borough 9 Articles and Rooms Disinfected 116 Articles Destroyed 116 Artificial Sunlight Centres, Attendances 32 Artificial Sunlight Treatment 34 Atmospheric Pollution 46-49 Australian Spider Beetle 61 B Bacteriological Examinations 64, 85, 87, 91-92, 97-98, 99 Baiting of Sewers 60 Bakehouses 94 Baths and Wash-houses 62-64 B.C.G. Vaccinations 33, 114 Births 14, 17 Birth Registrations 17 Blackheath Fair 93 British Red Cross Society 36, 70 Bronchitis 27-28 Burial or Cremation of the Dead 74 C Cancer 14, 15, 24-26 Caseous Lymphadenitis 90 Catering Establishments 94-95 Cerebral Embolism 27 Cerebral Haemorrhage 27 Cerebral Thrombosis 27 Certificates of Guild of Hygiene 118 Chest Clinic 35, 117 Chest Physician's Report 117 Children's Exercise Classes 32 Chinese Dried Hen Egg Albumen 91 Chinese Frozen Whole Egg. 92 Chiropody Clinics, Attendances 32 Chiropody Treatment 34 Citizens Advice Bureaux 36 Classification of Deaths 22 Clean Air Act 46 Cleansing and Scabies Clinic 35,115 Cleansing of Children 115 Cleansing of Old People 68 Clinics and Centres 34 Colouring Matter in Food Regf., 1957 83 Common Infectious Diseases 15,23 Complaints 37, 74, 78 Conveniences, Public 65-66 Coronary Disease 27 Council Housing Schemes 79-80 Council Rehousing 78 Cremation or Burial of the Dead 74 D Day Rooms (for Old People) 70 Death Causes, Remarks 22-28 Death Rates 15 Death Registrations 18 Death, Table showing Causes of and Ages at Appendix Deaths 14, 18 Deaths, Table showing Causes of and Ages under 1 yr. Appendix Deaths from Violence 28 Deaths in Institutions 19 Defective Dwellings—Repairs 50 Density of Population 9 Diarrhoea and Zymotic Enteritis 14, 23, 108 Diphtheria 23, 107 Diphtheria Antitoxin 108 Diphtheria Immunisation Clinics 34 INDEX (continued) Page Diphtheria Prophylaxis Cases 33, 107 Discharge of Effluents into Sewers 54 Diseases of Respiratory System 27-28 Disinfecting Station 35 Disinfection 115-116 Disinfestation of Verminous Premises 61-62 Distribution Centres—National Welfare Foods 29 District Nursing 33 Domestic Helps 33, 35 Domiciliary Confinements 31 Drainage and Sewerage 54 Drainage, New and Alterations to 54 Drinking Fountains 66 Duties and Powers of the Public Health Committee 3-4 Dwellings 9 Dysentry 108-109 E Egg Albumen, Imported 90-92 Elevation of Borough 9, 11 Emission of Grit 46-49 Encephalitis 109 Enteric Fever 23, 108 Erysipelas 108 Exercise Classes, Ante Natal 32 Exercises Classes, Children's 32 Exhumations 74 Extracts from Vital Statistics 14, 15 F Factories Acts, 1937/48 43-45 Fair on Blackheath 93 Family Planning Association, Sessions 35 Family Welfare Association 36 Flour (Composition) Regs., 1956 96 Food and Drugs Act, 1955 83, 95 Food and Drugs—Non-genuine Samples 103 Food and Drugs Act, 1955, Samples taken under 95, 100-103 Food Hygiene Regs., 1955 83, 93 Food Hygiene (Amendment) Regs., 1957 83 Food, Inspection of 83-103 Page Food Parcels (Old People) 71 Food Poisoning 99 Food—Premises for Preparation of 86, 93 Food Rejected 88, 90 Foot Clinics 34 Foot Clinics, Attendances 32 G General and Vital Statistics 9-28 General Provision of Health & Welfare Services in the Area 29-36 Grants to Voluntary Organisations 67, 69 Greenwich Guild of Hygiene 118 Grit Emission 46-49 Guild of Hygiene 118 H Habitation Certificates (Water Supply) 55 Hairdressers and Barbers 52 Handicraft Centre 35 Handwashing Facilities 66 Health Centres 34 Health Visiting 30 Heart Disease 27 Heating Appliances (Fireguards) Act, 1952 51 Holidays (Old People) 70-71 Home Help Statistics 33 Home Help Service, Applications for 35 Horse Troughs 66 Hospitals 35 Hospital Confinements 31 Houses, No. in Borough 9 Houses Let in Lodgings 50-51 Housing 77-82 Housing Act, 1957 50, 77 Housing Acts, 1936 and 1957, Procedure under 77 Housing Act, 1949 77 Housing Accommodation 79 Housing Homeless Persons 78 Housing Register 81 Housing Repairs and Rents Act, 1954 50 Housing Schemes, Council's 79-80 Housing Survey 81 Hygiene, Guild of 118 INDEX (continued) I Page Ice-Cream — Bacteriological examinations 87 Ice-Cream (Heat Treatment, etc.) Regulations 86 Ice-Cream Premises 86 Ice-Cream Quantitative Analysis 87 Ice-Cream Sampling 87, 96 Illegitimate Births 14, 15, 17 Immunisation and Vaccination Clinics 34 Immunisation and Vaccination Clinics, Attendances 33 Imported Food Rejected 89-90 Infantile Mortality 15, 20-22 Infant Welfare Centres 34 Infant Welfare Clinics, Attendances 29-31 Infectious Diseases 14, 23, 104-117 Infirm Persons 67-73 Influenza 14, 15, 28 Inhabited Houses 9 Inspection of Food and Supervision of Food Premises 83-103 Institution Deaths 19 International Certificates 106 International Statistical Classification of Diseases, Injuries, and Causes of Death, 1955 22 Interviews, (Re-housing) by M.O.H 118 Introductory Review 6-8 L Laboratory Work 53, 54, 64, 85, 87, 90-92, 95-103 Land Charges Act, 1925 54 Laundry Service 67, 68 L.C.C. (Gen. Powers) Act, 1953 54 L.C.C. (Gen. Powers) Act, 1954 52 Legal Proceedings 76 Legislation, New 37-43, 77, 83 Leptospirosis 58 Lettings (Housing) 81 M Malaria 110 Manufacture and Sale of IceCream 86 Page Marriages 15 Mass Radiography 36, 112-114 Maternal Mortality 14, 15, 20 Maternal and Child Welfare 29-36 Maze Hill Clinic (Tuberculosis) 35, 117 "Meals on Wheels" 70 Measles 14, 23, 107 Meat Regulations 89 Meat Surrendered 88, 90 Medical Inspections (Superannuation) 118 Medical Inspections (Sick Persons) 118 Medical Officer of Health's Review 6-8 Medical Statistics (Schools) 33 Meningococcal Infection 109 Merchandise Marks Act 92 Meteorological Observations 16 Mileage of Streets 10 Milk, Analysis of 85, 96 Milk and Dairies Regulations 84 Milk Licences 84-85 Mi,lk (Special Designation) (Pasteurised & Sterilised Milk) Regulations 84 Milk (Special Designation) (Raw Milk) Regulations 84 Milk Supply 84 Minor Ailments Centres (for School Children) 34 Motor Vehicles Accidents 28 Mutual Exchanges (Housing) 81 N National Assistance Act 67 National Insurance Act (Medical Certificates) 105 National Welfare Foods—-Distribution Centres 29 Natural Increase 13 Neo-Natal Mortality 21 & Appendix New Housing Accommodation 79 New Legislation 37-43, 77, 83 Nomenclature Regulations, 1948 22 Non-Genuiile Samples 103 Notices, etc. 37,76 Notifications of Infectious Diseases 104-117 & Appendix Notifications of Food Poisoning 99 Nursing Associations 30 INDEX (continued) O Page Old People's Clubs 68-69 Old People's Welfare Association 68 Open Spaces 10 Ophthalmia Neonatorum 109 Outworkers 45 Overcrowding 78 P Perinatal Mortality 22 Personal Health Services 29-36 Persons Cleansed 67, 115 Pet Animals Act 53 Pharmacy & Medicines Act 96 Pharmacy & Poisons Act 51-52 P.H. (Condensed Milk) Regulations 96 P.H. (Dried Milk) Regulations 96 P.H. (Imported Food) Regulations 83, 89 P.H. (Meat) Regulations 89 P.H. (Preservatives, etc., in Food) Regulations 83 P.H. (Smallpox Prevention) Regulations 106 P.H. (Tuberculosis) Regs. 104, 111 Physically Incapacitated Persons 67-73 Pigeon Nuisance 46 Pneumonia 27, 108 Poliomyelitis 109 Pollution, Atmospheric 46-49 Pollution, River 46 Population 9, 13 Post-Natal Attendances 31 Powers & Duties of the Public Health Committee 3-4 Preserved Food Premises 86 Prevalence of, and Control over Infectious Diseases 104-117 Prevention of Damage by Pests Act 58 Procedure under the Housing Acts, 1936 & 1957 77 Prophylaxis Cases 33 Prophylaxis Clinics 34 Public Analysts Regs., 1957 83 Public Baths & Washhouses 62-64 Public Health Committee 3 Public Health Department Staff 5 Public Health Laboratory Service 64, 85, 87, 91-92, 97-98 Page Public Open Spaces 10 Public Sanitary Conveniences 65-66 Puerperal Pyrexia 109 Q Quantitative Analysis of Ice- Cream 87 Queen's District Nursing Association 33, 36 R Radiography, Mass 36,112-114 Rag Flock Act 53 Ranyard Mission 33, 36 Rateable Value 9 Rates, Births and Deaths, etc. 14, 15 Rat Repression 57-60 Refuse Disposal 55-56 Registered Births 14, 17 Registered Deaths 14, 18 Registrar—Office Hours 36 Registration of Preserved Food Premises 86 Rehousing 78 Rehousing Interviews (by M.O.H.) 118 Rejected Food 88, 90 Remarks on Various Death Causes 22-28 Rent Act, 1957 37-43 Rent & Mortgage Interest (Restrictions) Acts 37 Reproductive Wastage 22 Requisitioned Accommodation 78 Requisitioned Houses & Housing (Amendment) Act, 1955 42, 81 Respiratory System—Diseases of 27 Review by M.O.H. 6-8 River Pollution 46 River Smells 46 Rodent Control 57-60 S Sampling of Ice-Cream 87,96 Sampling of Milk 85,95 Sampling under Food & Drugs Act 95, 100-103 INDEX (continued) Page Sanitary Circumstances of the Area 37-76 Sanitary Conveniences, etc. 65-66 Sanitary Work—Summaries etc. 74-76 Scabies 109 Scabies & Cleansing Clinics 35, 115 Scarlet Fever 23, 108 Scavenging and Refuse Disposal 55-56 Schools (Medical Statistics) 33 Sewerage and Drainage 54 Sewers—Baiting of 60 Shops Act 52 Slaughterhouses 89 Slum Clearance 77 Smallpox 23, 105-106 Smells from River 46 Smoke and Grit Emission 46-49 Social Conditions of the Area 11-12 Sonne Dysentery 108-109 Staff of Public Health Department 5 Statistical Tables Appendix Statistics, General 9, 10 Still Births 14, 17 Streets, Mileage of 10 Street Traders 93 Suicide 28 Summary of Sanitary Work 74-76 Sunlight Treatment 32 Supervision of Food Premises 93 Supplies of Underground Water (Wells) 55 Swimming Baths 62-64 T Toddlers Clinic Attendances 32 Town & Country Planning Act, 1947 80 Transfers (Housing) 81 Transported Meals for Old People 70 Treatment Centres and Clinics 34 Tuberculosis 14, 15, 23-24, 110-114, 117 Tuberculosis — Handicrafts Centre Sessions 35 Tuberculosis Officer's Report 117 Typhoid Fever 23, 108 U Page Underground Water Supplies (Wells) 55 Uninhabited Houses 9 Unsound Food 88, 90 V Vaccination Cases 33, 106 Vaccination and Immunisation Clinics 34 Vaccination International Certificates 106 Various Death Causes, Remarks on 22-28 Vascular Lesions of Nervous System 27 Verminous Conditions 67, 115 Verminous Premises 61-62, 67 Violent Deaths 28 Vital Statistics 14, 15 & Appendix Voluntary Organisations 36 Voluntary Organisations, Grants to 67, 69 W Wash-houses & Public Baths 62-64 Washing Facilities (Hand) 66 Water—Underground Supplies (Wells) 55 Water Supply 55 Water Supply Certificates 55 Weil's Disease 58 Welfare Clinics 34 Welfare Foods, National — Distribution Centres 29 Welfare Scheme for Old People 72 Wells 55 Whooping Cough 14, 23, 107 Whooping Cough Prophylaxis Cases 33, 107 Whooping Cough Prophylaxis Clinics 34 Women's Special Clinic 35 Women's Voluntary Services 36 INDEX (continued) X Page X-Ray Examinations 112, 117 X-Ray, Mass 36, 112 Z Page Zymotic Diseases 24, 108 Zymotic Enteritis 24, 108 INFANTILE MORTALITY DURING THE YEAR 1957 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-Pox ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Tubercular Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... ... ... ... ... Capillary Bronchitis ... ... ... ... ... 1 ... ... ... 1 Tracheo Bronchitis ... ... ... ... ... ... 3 ... ... 3 Pneumonia 1 ... ... ... 1 ... ... ... ... 1 Gastro-Enteritis ... ... ... ... ... 1 ... ... ... 1 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformation ... 1 ... ... 1 1 2 1 ... 6 Premature Birth 18 1 1 ... 20 ... ... ... ... 20 Haemolytic Disease of Newborn 1 ... ... ... 1 ... ... ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Ileo-caecal Intussusception ... ... ... ... ... ... 1 ... ... 1 Asphyxia Neonatorum (Tight cord round neck) 1 ... ... ... 1 ... ... ... ... 1 Totals 23 2 1 ... 26 3 6 1 ... 36 Male 22 Female 14 CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1957. Notifiable Disease Cases Notified in Whole District Total Cases Notified in each Locality No. of Cases removed to Hospital from each Locality Total Age & Sex Group At all Ages 0 to 1 1 to 3 3 to 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-Fox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... Acute Encephalitis Infectious ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Post-Infectious ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 11 11 1 1 ... 1 ... 2 3 1 1 3 2 ... 2 3 2 ... ... ... 9 1 1 11 1 ... ... 1 2 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Polio-Myelitis P. ... 3 ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... 1 1 ... 1 1 1 ... 1 3 N.P. 4 2 ... ... ... ... 1 1 2 ... 1 ... ... 1 ... ... ... ... ... ... ... ... 1 5 ... ... 1 5 6 Scarlet Fever 65 37 ... ... 4 4 15 9 38 17 6 6 1 1 1 ... ... ... ... ... 21 30 1 50 4 1 ... 4 9 Paratyphoid Fever ... 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Scabies 2 2 ... ... ... l ... ... ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... Puerperal Pyrexia ... 4 ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... ... 3 ... ... 1 3 ... ... 1 4 Meningococcal Infection 1 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Measles 630 564 23 19 116 124 196 150 281 256 12 11 1 1 ... 3 1 ... ... ... 440 123 43 588 2 ... 3 10 15 Whooping Cough 48 49 7 3 9 13 15 17 17 16 ... ... ... ... ... ... ... ... ... ... 33 28 9 27 1 2 ... 1 4 Diarrhoea 5 7 1 4 4 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... 9 1 ... ... ... 1 Ophthalmia Neonatorum ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Pneumonia, Acute Primary or Acute Influenzal 15 13 ... ... 1 ... 1 ... 1 ... ... 1 1 1 3 2 7 7 1 2 6 ... 1 21 ... ... 1 5 6 Tuberculosis, Pulmonary 46 31 ... ... ... ... ... ... 1 ... ... 2 11 7 14 13 14 6 6 3 26 15 4 32 2 5 1 2 10 „ Non Pulmonary ... 3 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... 2 ... ... 1 ... ... ... ... ... Totals 828 730 32 28 135 145 228 181 343 294 22 24 17 16 20 24 24 13 7 5 544 199 60 755 15 9 6 35 65 NOTE:—The above Table refers to "Corrected Notifications" only, i.e. all cases in which diagnosis was not oonfirmed have been ignored. TOTAL CAUSES OF, AND AGES AT, DEATH, during the year ended 31st December, 1957. No. in Short List Causes of Death. Deaths at Subjoined ages of "Residents" whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of "Residents" In Public Institutions Total Deaths whether of "Residents" or "NonResidents" in Public Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton and Kldbrooke St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital Other Institutions Outside Institutions Under 4 mths. 4 mths. and under 1 yr. 1 Tuberculosis, Respiratory 9 ... ... ... ... ... ... 4 1 2 2 5 1 2 1 2 1 ... ... ... ... 3 25 2 Tuberculosis, Other 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 2 3 Syphilitic Disease 1 ... ... ... ... ... ... ... ... 1 ... l ... ... ... 1 ... ... ... ... ... ... 9 4 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Meningococcal Infections 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 2 7 Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 8 Measles 2 ... ... 1 ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 2 ... 9 Other Infective and Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 10 Malignant Neoplasm, Stomach 23 ... ... ... ... ... ... 1 12 6 4 5 6 1 11 11 1 ... ... ... ... 2 44 11 Malignant, Neoplasm, Lung, Bronchus 41 ... ... ... ... ... ... 4 21 9 7 14 6 2 19 13 ... 1 ... 6 ... 8 88 12 Malignant Neoplasm, Breast 14 ... ... ... ... ... ... 4 4 3 3 9 2 ... 3 6 ... ... ... ... ... 3 21 13 Malignant Neoplasm, Uterus 5 ... ... ... ... ... ... ... 3 2 ... 2 1 ... 2 1 ... ... ... ... ... ... 11 14 Other Malignant and Lymphatic Neoplasms 104 ... ... ... 2 1 2 9 34 24 32 29 19 6 50 36 6 6 ... 2 1 23 188 15 Leukaemia, Aleukaemia 4 ... ... ... ... 2 ... ... 2 ... ... l 1 ... 2 ... ... ... ... ... ... 4 10 16 Diabetes 5 ... ... ... ... ... ... ... 2 2 1 2 1 ... 2 2 ... ... ... ... ... 2 11 17 Vascular Lesions of Nervous System 85 1 ... ... ... ... ... 1 13 31 39 29 15 3 38 44 2 2 ... 2 1 8 189 18 Coronary Disease, Angina 109 ... ... ... ... ... ... 4 36 36 33 39 12 6 52 22 6 1 ... 1 6 12 179 19 Hypertension with Heart Disease 20 ... ... ... ... ... ... 1 4 2 13 7 2 ... 11 6 ... ... ... ... ... 2 29 20 Other Heart Disease 96 ... ... ... ... ... ... 2 17 9 68 34 21 5 36 46 4 5 ... ... 1 5 203 21 Other Circulatory Disease 48 ... ... ... ... ... ... 1 14 10 23 22 5 1 20 21 5 2 ... 1 ... 3 128 22 Influenza 5 ... ... ... ... ... ... 2 1 ... 2 1 2 ... 2 2 ... ... ... ... ... 1 11 23 Pneumonia 41 1 ... ... ... 2 1 ... 4 8 25 14 10 1 16 23 3 2 ... 1 ... 5 143 24 Bronchitis 74 1 3 ... ... ... ... ... 18 29 23 26 20 2 26 28 6 3 ... 1 ... 6 129 25 Other Diseases of Respiratory System 7 ... ... ... ... ... ... ... 1 2 4 5 ... ... 2 3 ... ... ... ... 1 ... 19 26 Ulcer of Stomach and Duodenum 24 ... ... ... ... ... ... ... 8 7 9 5 4 1 14 13 4 1 ... 1 ... 1 44 27 Gastritis, Enteritis and Diarrhoea 8 1 ... ... ... ... ... ... 2 2 3 6 ... ... 2 2 ... 2 ... 3 ... 1 12 28 Nephritis and Nephrosis 7 ... ... ... ... ... 1 1 2 2 1 2 1 1 3 2 ... 2 ... ... ... 3 17 29 Hyperplasia of Prostate 3 ... ... ... ... ... ... ... ... ... 3 1 ... 1 1 ... ... 2 ... ... ... 1 7 30 Pregnancy, Childbirth, abortion 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 31 Congenital Malformations 10 3 2 ... ... 1 2 1 ... 1 ... 3 ... 1 6 2 ... ... ... 2 ... 4 18 32 Other defined and ill-defined Diseases 68 23 1 ... ... ... ... 2 12 5 25 24 18 5 21 27 1 6 ... 1 1 19 146 33 Motor Vehicle Accidents 6 ... ... ... ... ... 2 ... 1 1 2 1 1 1 3 1 ... 1 ... 1 ... 3 32 34 All other Accidents 14 ... ... ... ... 1 1 3 5 2 2 5 5 ... 4 5 ... 1 ... 2 2 3 25 35 Suicide 14 ... ... ... ... ... ... 4 5 3 2 3 5 1 5 5 ... 1 ... ... ... 1 21 36 Homicide and Operations of War 1 ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 Totals 851 30 6 2 2 8 11 45 222 199 326 297 160 41 353 327 39 38 ... 24 14 125 1,775 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 h ave been excluded. R7/67