4373 GRE57 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1959 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1959 Printed by Bromley Office Supplies & Printing Co., Ltd. East Street, Bromley. Kent. CONTENTS Page Public Health Committee 3 Introductory 6 Section A.—General and Vital Statistics 9 „ B.—General Provision of Health and Welfare Services for the Area 32 „ C.—Sanitary Circumstances of the Area 40 „ D.—Housing 82 „ E.—Inspection of Food and Supervision of Food Premises 89 „ F.—Prevalence of, and Control Over Infectious and Other Diseases 115 „ G.—Miscellaneous 130 Appendix—Statistical Tables 3 PUBLIC HEALTH COMMITTEE as at 31st December, 1959 The Mayor: Councillor L. C. Green, J.P. and 13 Members Councillor Mrs. M. L. Bennett (Chairman) Councillor Mrs. M. L. Wentworth (Vice-Chairman) Aldermen: Mrs. J. Gollogly P. Noble Councillors: R. A. Blatchford D. P. Lynch A. C. Chrisp, L.C.C. W. S. Manners Mrs. J. E. Chrisp H. A. Read Lady Hume 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 manufacture or sale of ice cream, preserved 4 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, 1958 (licensing of slaughtermen), and also the functions of the Council for dealing with the deposit of rubbish on vacant sites in the Borough shall be delegated to the Committee. 4.—The powers and duties of the Council conferred by Section 47 (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 Pel 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 (safety in the home), shall stand referred to the Public Health Committee. 5 STAFF as at 31st December, 1959 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 : abc G. B. Allen (Chief P.H.I.) (i) District Inspectors: abc S. A. Radford a H. D. Dawes abdef Miss B. Hatfield ab S. Kelly (ii) a J. G. Lyons a S. E. Thelner Food Inspectors: ab C. W. Spore (Senior) (iii) ab W. C. Scales Public Health Officer: def Miss N. A. Fluck (iv) Assistant Clean Air Officer: G. Follett (v) a Certificated Public Health Inspector b „ Meat and Other Foods c „ Smoke Inspector d „ Health Visitor e „ State Certified Midwife f „ State Registered Nurse (i) w.e.f. 1st April, 1959. (ii) commenced duties 17th August, 1959 (iii) w.e.f. 18th March, 1959. (iv) commenced duties 1st January, 1959. (v) commenced duties 9th November, 1959. CLERICAL STAFF : L. A. Westacott (Chief Clerk) A. H. Wilcox (Senior Clerk) K. Allum, d.f.m. A. G. Lyons Mrs. M. G. Janman Mrs. D. F. Howard f Mrs. M. G. Simpson (Senior S/H Typist) Mrs. E. M. Farrell* C. Weymouth F. C. Smart (Conveniences Superintendent) DISINFECTING STAFF: T. Smith (Foreman) H. W. C. Scarff (Motor Driver) A. Moore W. Clements A. Nash RODENT CONTROL, FLY DISINFESTATION, ETC.: Team of five men * Commenced duties 20th April, 1959. † Commenced duties 27th August, 1959. 6 PUBLIC HEALTH DEPARTMENT, TOWN HALL, GREENWICH, S.E.10. To The Mayor, Aldermen and Councillors, Metropolitan Borough of Greenwich. Ladies and Gentlemen, I have the honour to present the Annual Report on the health and environmental circumstances of Greenwich for 1959. There has been a slight decrease in population and births ; at the same time deaths have decreased by 38 and still births by 4. There is a small increase in the infantile mortality rate as compared with last year and this is accounted for entirely by a sharp increase in the deaths of illegitimate babies. There was no change in the neo-natal death rate and the peri-natal rate (still births and deaths within the first week of life), declined by 7. There was one maternal death and one cannot help reflecting that even the comparatively small number of maternal deaths could be reduced still further by closer ante-natal care. In considering causes of death one must note the increase in deaths due to pulmonary tuberculosis. This is not a local but a national trend and may be due to the increasing resistance of the tubercle bacillus to modern chemo-therapeutic drugs. It is not without significance that while total notifications dropped to an all time low, the death rate rose. The final phase in the eradication of pulmonary tuberculosis has begun but until the problems of drug resistance and the latent pool of residual infection in the community are solved, tuberculosis will continue to smoulder for many decades. The infected immigrant and the grossly infectious patient, resolute in refusing treatment, present grave difficulties to health departments and chest clinics especially when in close contact with susceptible groups. Once again I include a report of the Mass Miniature Radiography Unit in Greenwich kindly supplied by the Director, Dr. J. M. Morgan, and I am grateful for a contribution from the Chest Physicians, Drs. Forgacs and Wraith. There were 50 deaths from cancer of the lung and bronchus, an increase of 6 over last year. Despite the most sober and authoritative warnings about the direct connection between lung cancer and heavy smoking there is no evidence that the general public are smoking less. Indeed, the contrary is true and judging by the barrage of propaganda to which we are subjected in the press and on commercial television by the tobacco manufacturers it is not sur- 7 prising that most of us have been conditioned to minimising or ignoring the risks to our health. Compare the vast sums spent to publicise the wonders of the tobacco weed, on the most powerful advertising medium ever known to mankind, with the facilities which exist or are given any support, to present the other side of the picture. I wonder how many would bother about "flavour blur" or any of the other meaningless nonsense of the professional advertiser if they could observe the terminal phases of a bronchial carcinoma. As one would expect, heart and circulatory diseases are still the major cause of deaths but there was a reduction of 32 this year. Coronary thrombosis and high blood pressure are diseases primarily of the favoured nations and heart and coronary deaths seem to increase in direct proportion to the standard of living of a community. Heredity of course plays some part in pre-disposing to coronary disease but the secret may lie in the diet, particularly in the consumption of fats, and the ratio of the different fats one to the other. Notification of measles was largely responsible for the large increase in notifications of infectious diseases. Dysentery was also troublesome and necessitated a great deal of work in the department in regard to contact control and the bacteriological examination of specimens. Poliomyelitis was practically absent, the only two notifications being in respect of non-residents. Food poisoning accounted for 43 notifications, all of which were closely investigated. Work in connection with the campaign for clean air continued and detailed information is available in the body of the Report. Polluted atmosphere almost certainly encourages lung malignancy and for very much the same reasons as tobacco smoke, namely that a polluted atmosphere contains chemicals and irritants which predispose to malignant tumour growth. The first Smoke Control Order in Greenwich has been confirmed by the Minister and others will follow with increasing speed. No informed citizen now doubts the eventual benefit to be derived from Smoke Control Areas and the public are now demanding a clean atmosphere with the same emphasis as our forefathers demanded sewerage systems and a wholesome water supply. The work of the Old People's Welfare Association is allied closely to that of the department and I include an account of the work for the year. Our staff has been increased and the work done for aged persons has naturally expanded. Once again we have called heavily on the hospital and institution facilities and our thanks are due to the many agencies, both official and voluntary, who have given much help. 8 The Borough receives imported food in large quantities and the Food Inspectors spend a great deal of time examining a wide variety of food stuffs from all over the world. Infected egg products were again troublesome and representations were made by the Council to the Ministry (so far without success) to make pasteurisation or some sterilising process obligatory before frozen or dried eggs are allowed to be imported. One cannot but be disappointed at the apparently slow progress being made in the matter. The new Food Hygiene Regulations have now been in operation for four years and while there are naturally some premises which lag behind in equipment and desirable practices, generally the standard of cleanliness in food shops and cafes in the Borough is of a very high order. Once again it is my pleasure to acknowledge the help and support which I have received from the Chairman and ViceChairman of my Committee, and to the staff of the department I offer my thanks for their loyalty and diligence. I have the honour to be, Your obedient Servant, J. Kerr Brown, Medical Officer of Health. 9 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA General Statistics Elevation.—Varies from below high-water mark up to 249 feet above sea level. Area of the Borough and Districts— East Greenwich 1,300 acres West Greenwich 453 „ St. Nicholas, Deptford 115 „ Charlton and Kidbrooke 1,990 3,858 acres Population— At Census, 1951 89,846 Estimated, 1959 (mid-year) 88,970 Density of Population (persons per acre) 23,06 Number of Inhabited Dwellings—end 1959 24,507 (according to Rate Books) Structurally separate dwellings at Census, 1951 21,348 Number of Uninhabited Dwellings— At Census, 1951 364 At end 1959 202 Number of Families or Separate Occupiers— At Census, 1951 26,397 Rateable Value, 1959 £1,827,342 Sum Represented by a 1d. Rate, 1959 £7,260 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 „ Maryon and Maryon Wilson Parks 51½ „ Charlton Park 42¾ „ Hornfair (formerly Charlton Playing Field) 26 „ Sayes Court Recreation Grounds 3$ „ Approximately 215 acres Total Public Open Spaces in Borough Approx. 426 acres (representing 11 % of the total area of the Borough) Mileage of Streets 89.5 (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. Excellent recreation grounds serve the Charlton area for, in addition to the Maryon and Charlton Parks, there is the L.C.C. 12 Play Centre and Lido with its well-equipped swimming bath, tennis courts and bowling greens. 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. Besides Associations for rowing and barge sailing, the local sports clubs include the famous Blackheath Football Club (the oldest of all rugby football clubs) and the newer professional Charlton Athletic Football Club. More recently, social centres providing for all shades of cultural and educational tastes have been established at Charlton House, Kidbrooke House, the Town Hall and West Greenwich House under the auspices of the Greenwich Community Council in conjunction with the L.C.C. and, in this connection, it can be stated that there are upwards of 65 clubs and societies affiliated to this Community Council. Fourteen " Old People's Clubs," each of which receives an annual grant from the Council, cater for the elderly residents of the Borough and in 5 instances accommodation for these clubs is made available by the Council free of charge. The lot of the aged, especially the " home-bound," is further ameliorated by an effective " Meals-on-Wheels " service. Within the Borough boundary over 200 units of accommodation are provided for elderly people by seven groups of almshouses, one group being founded as early as the Sixteenth Century. 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. Providing for the needs of the Borough residents are some 900 shops, generally of the smaller kind, many being of the oldfashioned "shop on the corner " type, selling a wide range of goods. Food shops form a large percentage of the total and whilst meat and poultry come mainly from Smithfield Market in London and sometimes directly from Kent and Surrey, the vegetables, for the most part, are supplied either from the Borough's own market (which obtains its products predominantly from the Kent area) or from the Covent Garden and Borough markets in London. 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. 13 Areas located near the River Thames are, generally speaking, industrial and are 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, and the Kidbrooke area, which pre-war had always been described as the "rural" part of the Borough, is almost entirely built over. The majority of the industries and sources of employment in the Borough are to be found in close proximity to the River Thames which forms the Borough boundary on the north side. Chief among these are large Cable and Engineering Works, Ship Repairing Works, Gas Works, Soap and Candle Works, L.T.E. Generating Station and Carriage Repair Depot, The British Electricity Authority's Works, Glass Bottle Works, Rope Works, Ship Propelling Works, Merryweather's Works (Fire Engines), Cement and Stone Works, Asbestos Works, Cold Meat Storage, Pressed Tool Works, Constructional Engineering Works, Galvanising and Sheet Metal Works, Brewery, Flour Mills, Aero Parts, Wireless and Vehicle Parts and Tin Box Manufacturing Works. The numbers employed at 11 of the larger factories range between 500 and 5.000 each, whilst 17 smaller works each employ between 100 and 400. 14 POPULATION The Registrar General has submitted his estimate of the population of Greenwich, computed at mid-year 1959, upon which the statistics of this Report have been based. The figure returned is 88,970, indicating a decrease in the population of 210 since last year and a fall of 876 since the 1951 Census. However, the current figure shows an advance of 25,170 over that for 1945. The natural increase for the year, i.e., excess of births over deaths, was 447 compared with 416 for 1958. In preventive medicine it has been expedient from time to time, and for specific purposes, to make analyses of the population figures with particular regard to age distribution, e.g., diphtheria and poliomyelitis prophylaxis and, more recently, the problem of the aged. The following figures give an indication of the general position in respect of "child," "working," and "elderly" groups in the Borough. ESTIMATED AGE COMPOSITION OF THE POPULATION Aee No. A pprox. per cent of Total Population As estimated by the Registrar General: Under 1 year 1,330 1.5 1 to 4 years (inclusive) 5,370 6.0 4 to 14 years (inclusive) 13,300 15.0 Total Child Population under 15 years 20,000 22.5 Estimated locally: 15 to 64 years (inclusive) 57,270 64.4 65 years and over 11,700 13.1 Total Population 88,970 100.0 15 * EXTRACTS FROM VITAL STATISTICS OF THE YEAR LIVE BIRTHS Legitimate Illegitimate Total Birth Rate (Crude) 14.97 Male 656 33 689 Female 606 33 639 (Comparable Rate 14.07) Total 1,262 66 1,328 STILL BIRTHS Legitimate Illegitimate Total Rate per 1,000 total Births} 16.29 Male 12 1 13 Female 9 — 9 Total 21 1 22 ' DEATHS—All Causes Male Female Total Death Rate (Crude) 9.93 (Comparable Rate 11.22) 497 384 881 DEATH RATES—Special Causes Infants under 1 year of age No. Rate All infants (per 1,000 live births) 24 18.07 Legitimate Infants (per 1,000 legitimate live births) 19 15.05 Illegitimate Infants (per 1,000 illegitimate live births) 5 75.75 Neo-Natal Deaths (per 1,000 live births) 15 11.29 Others Maternal Causes (per 1,000 total births) 1 0.74 Tuberculosis (all forms) (per 1,000 population) 14 0.15 Tuberculosis, Pulmonary (per 1,000 population) 13 0.14 Cancer (per 1,000 population) 172 1.93 Heart (per 1,000 population) 278 3.13 Common Infectious Diseases (per 1,000 population) — — Influenza (per 1,000 population) 5 0.05 * These figures, which are supplied by the Registrar-General, may differ Slightly from those shown in other parts of the Report. 16 MARRIAGES Mr. J. Abercrombie, the Superintendent Registrar of the Greenwich Registration District, has kindly furnished me with particulars relating to the number of marriages solemnised or registered in the Borough of Greenwich during 1959. The total of 627 gives a marriage rate of 14.14, a decrease of 1.00 from that of the previous year. The following table shows these particulars giving the number of marriages in the Borough for each year since 1938: — Year Churches of England Chapels and Roman Catholic Churches SuperintendentRegistrar's Office Total Approximate Population Greenwich Charlton and Kidbrooke St. Nicholas 1938 309 185 31 101 268 894 95,770 1939 395 218 31 128 397 1,169 94,790 1940 451 243 33 126 345 1,198 74,280 1941 277 174 7† 91 241 790 57,070 1942 257 192 3 79 198 729 60,530 1943 209 166 2 73 171 621 62,870 1944 211 136 — 74 171 592 61,800 1945 228 211 2 87 233 761 63,800 1946 258 196 1 86 235 776 76,840 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 1958 189 142 10* 93 239 673 89,180 1959 161 134 15 107 210 627 88,970 ‡ St. Peter's, Creek Road ‡ Holy Trinity, Blackheath Hill} Closed † Parish Church destroyed by enemy action * Parish Church reopened. 17 METEOROLOGICAL OBSERVATIONS—1959 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, 1959:— Temperature Highest screen temperature 91° on 5th and 8th July. Lowest screen temperature 24° on 17th, 25th and 26th January. Maximum in January 53° on 22nd. February 61° on 28th. November 60° on 2nd. December 54° on 16th, 17th, 19th and 29th. Sunshine Total for year 1637.7 hours. Sunniest day 15.1 hours, 4th July. Number of days without sun 71 distributed as follows :— January 14 February 16 March 10 April 2 May 3 June — July — August 2 September — October 3 November 7 December 14 Rainfall Total 18.22 inches. Highest fall in 24 hours 0.65 inches, 21st August. Driest month February, 0.04 inches. Wettest month December, 3.23 inches. 18 BIRTHS The total number of live births registered in the Borough during the year was 1,466 and of this number 1,072 occurred in St. Alfege's Hospital, and 303 in private dwellings. In 672 cases the parents resided outside the Borough and these births were consequently transferred to their appropriate districts, leaving a figure of 794. To this must be added 534 births belonging to the Borough which took place in Institutions outside the Borough, thus making a final figure for Greenwich of 1,328, a decrease of 7 from that of the previous year. Of this total 689 were males and 639 females. The following table gives by districts the number of registrations of Greenwich Births during the current year: — Source of Information DISTRICT Total Greenwich Births East West St. Nicholas Charlton & Kidbrooke Greenwich Registrar's Returns: — 279 187 55 273 794 Inward Transfers:— 1st Qtr. 40 22 3 84 149 2nd Qtr. 34 15 1 64 114 3rd Qtr. 55 12 1 81 149 4th Qtr. 33 12 3 74 122 Totals 441 248 63 576 1,328 The Birth Rate for the year, calculated on the figure of 1,328 births, is 14.97 per thousand of the population, 0.05 lower than that for 1958. The average rate for the previous ten years is 15.30. The Greenwich Comparability Factor for births is 0.94 which gives an adjusted rate of 14.07. The Rates for the County of London and England and Wales are 17.3 and 16.5 respectively. Illegitimate Births which numbered 66 (representing 4.9 per cent, of the total live births) showed a decrease of 10 from those of the previous year. The number of Still Births registered was 22 (13 males - 9 females), which is equivalent to a rate of 16.29 per 1.000 total births, a reduction of 4.97 from that of 1958. No. in Short List. Causes of Death Sex Deaths at subjoined Ages of "Residents,"whether occurring within or without the District. All Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and under 75. 75 and over. All Causes M 497 13 2 4 7 19 151 144 157 F 384 11 2 - 2 13 73 102 181 1 Tuberculosis, Respiratory M 9 - - - - - 7 1 1 F 4 - - - - 2 1 1 - 2 Tuberculosis, Other M 1 - - 1 - - - - - F - - - - - - - - - 3 Syphilitic Disease M 3 - - - - 1 1 1 - F 1 - - - - - - - 1 4 Diphtheria M - - - - - - - - - F - - - - - - - - - 5 Whooping Cough M - - - - - - - - - F - - - - - - - - - 6 Meningococcal Infections M 1 1 - - - - - - - F - - - - - - - - - 7 Acute Poliomyelitis M - - - - - - - - - F - - - - - - - - - 8 Measles M - - - - - - - - - F - - - - - - - - - 9 Other Infective and Parasitic Diseases M - - - - - - - - - F - - - - - - - - - 10 Malignant Neoplasm, Stomach M 15 - - - - - 7 5 3 F 11 - - - - - 2 4 5 11 Malignant Neoplasm, Lung, Bronchus M 43 - - - - - 25 11 7 F 7 - - - - 1 3 2 1 12 Malignant Neoplasm, Breast M - - - - - - - - - F 14 - - - - - 7 1 6 13 Malignant Neoplasm, Uterus F 2 - - - - 2 - - - 14 Other Malignant and Lymphatic Neoplasms M 45 - - - - 2 12 16 15 F 35 - - - - 2 11 12 10 15 Leukaemia, Aleukaemia M 4 - - 1 - - 1 1 1 F - - - - - - - - - 16 Diabetes M 1 - - - - - 1 - - F 3 - - - - - 1 2 - 17 Vascular Lesions of Nervous System M 41 - - - - 1 10 10 20 F 50 - - - - 2 11 15 22 18 Coronary Disease, Angina M 90 - - - - 7 35 26 22 F 47 - - - - - 8 15 24 19 Hypertension with Heart Disease M 14 - - - - - 2 5 7 F 14 - - - - - 2 6 6 20 Other Heart Diseases M 46 - - - - 2 9 14 21 F 67 - - - - 1 8 12 46 21 Other Circulatory Disease M 18 - - - - - 8 3 7 F 17 - - - - - 3 5 9 22 Influenza M 1 - - - - - - 1 - F 4 - - - - - - 2 2 23 Pneumonia M 41 2 - - 1 - 3 14 21 F 35 - - - - - 5 6 24 24 Bronchitis M 51 - - - - - 14 23 14 F 22 - - - - - 1 7 14 25 Other Diseases of Respiratory System M 4 - - - 1 - 1 2 - F 1 - - - - - - 1 - 26 Ulcer of Stomach and Duodenum M 9 - - - - - 2 2 5 F 2 - - - - - - 2 - 27 Gastritis, Enteritis and Diarrhoea M 3 - - - - - 1 1 1 F 2 - - - - - - - 2 28 Nephritis and Nephrosis M 3 - - - - 1 1 1 - F 5 - - - - 1 3 - 1 29 Hyperplasia of Prostate M 7 - - - - - - 1 6 30 Pregnancy, Childbirth, abortion F 1 - - - - 1 - - - 31 Congenital Malformations M 3 1 1 1 - - - - - F 9 5 1 - - - 3 - - 32 Other defined and ill-defined Diseases M 27 9 - 1 3 2 7 2 3 F 19 5 - - 1 - 2 5 6 33 Motor Vehicle Accidents M 7 - 1 - 1 2 1 1 1 F 3 - - - 1 - - 2 - 34 All other Accidents M 6 - - - - 1 2 2 1 F 6 1 1 - - 1 - 1 7 35 Suicide M 4 - - - 1 - 1 1 1 F 3 - - - - - 2 1 - 36 Homicide and Operations of War M - - - - - - - - - F - - - - - - - - - 19 DEATHS The net number of deaths registered during 1959 was 881, of which 497 were males and 384 females, compared with last year's total of 919 comprising 478 males and 441 females. This gives a crude Death Rate for the Borough of 9.93 per thousand of the population, a decrease of 0.41 as compared with that of the previous year and a rate which is 0.10 less than the average for the last ten years, viz., 10.03. The crude Death Rate figure is increased to 11.22 when the comparability figure furnished by the Registrar General for adjusting Local Deaths, is taken into account. The adjusted Death Rate is in effect a "corrected" Death Rate. The Registrar-General has pointed out that if the population of all areas were similarly constituted as regards the proportion of their sex and age group components, their crude death rates (deaths per 1,000 population) could be accepted as valid comparative measures of the mortalities experienced by the several populations. Populations, however, are not similarly constituted and their crude Death Rates therefore fail as true comparative 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 1.13 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 11.9 and 11.6 respectively. The inset table showing the causes of deaths at all ages has been supplied by the Registrar-General and is included in accordance with the Ministry of Health's request. In the Appendix to the Report will be found a table giving by districts, the causes of, and ages at death of residents whilst indicating the numbers actually dying in Public Institutions. 20 DEATHS IN INSTITUTIONS The following table compares the average number of death 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 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 1957 856 565 66.0 1958 919 600 65.3 10-year average 894 536 59.9 1959 881 488 55.4 AGE MORTALITY The age mortality and the distribution of the deaths between the different quarters of the year are shown by the following table:— Deaths 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Under 1 year of age 8 7 4 5 24 Between 1 and 2 years - 2 1 1 4 Between 2 and 5 years - - - - - Between 5 and 15 years - 2 2 - 4 Between 15 and 25 years 3 2 3 1 9 Between 25 and 45 years 10 5 5 12 32 Between 45 and 65 years 72 41 54 57 224 Between 65 and 75 years 102 38 48 58 246 75 years and upwards 122 68 65 83 338 Totals 317 165 182 217 881 21 Little variation in the pattern of death registrations occurred during the year, the first and fourth quarters producing 36% and 24.6% respectively, and the second quarter 18.7%. It will be observed from the following table that during 1959 the deaths occurring at 65 years and upwards accounted for 66.3% of the total compared with a figure of 22.8% for 1901. Deaths in the age group 0-5 years show an even more striking comparison; in 1901 the deaths in this group amounted to 37.4% whilst the figure for the current year is 3.2%. Age Group 1901 1911 1921 1931 1951 1959 Under 1 year of age 362 306 175 97 29 24 Between 1 and 5 years 187 158 80 39 7 4 Between 5 and 15 years 64 67 58 22 10 4 Between 15 and 25 years 66 60 67 65 12 9 Between 25 and 65 years 454 474 466 382 311 256 65 years and over 335 356 387 529 633 584 Totals 1,468 1,421 1,243 1,134 1,002 881 MATERNAL MORTALITY One death from puerperal causes was recorded during the current year, a position similar to that obtaining in 1958, giving a Maternal Death Rate of 0.74. The death was in respect of a woman of 38 years who died in Whipps Cross Hospital, the coroner's verdict being I (a) Paralytic ileus due to (b) General peritonitis due to (c) Obstructed labour (caesarian section). INFANTILE MORTALITY At the turn of the century, Greenwich infant mortality, i.e. deaths of children in the first year of life, was at the rate of 140 per 1,000 live births ; the current figure is 18 per 1,000. This remarkable reduction is nation wide and is doubtless due to a combination of factors, not the least of which are, the almost complete absence of malnutrition with its associated disorders such as rickets and scurvy, the introduction of modern chemotherapy including the "sulpha" drugs and antibiotics, the prevention of haemolytic disease of the newborn and lastly, accurate diagnosis with conscientious nursing. Over the years, however, owing to recent medical advances, the problem has changed somewhat. The threat to infant life from the dreaded "diarrhoea and vomiting" has largely disappeared, scarlet fever and kindred diseases have become much milder, whilst tuberculosis and diphtheria have been all but eliminated. 22 Care of the premature and the control and correction of congenital malformation and abnormalities are now the fields in which lie the greatest possibilities of reducing infant mortality. In this connection interest has centred on heredity, with a corresponding stimulation in the study of genetics. It has been shown that surgery on the newborn and young babies can effectively deal with abnormalities of the gullet, the food tract and the heart, whilst certain mental defects associated with faulty metabolism can, in certain instances, be greatly ameliorated by selective diets. Even the psychological aspects of infant care are being vigorously tackled in the child welfare clinics and hospitals where the relationship of mother and child are seen to be of the utmost importance in the emotional behaviour and disturbances of early life. It would appear that what has previously been considered an irreducible core of infant deaths may eventually prove to be reducible. The Infantile Mortality Rate, measured by the deaths of children under one year of age to the number of live births registered was 18.07 per thousand live births as compared with 14.98 for last year and 20.07, the average for the previous ten years. For the County of London the rate was 22.3, in comparison with 22.2, the figure returned for England and Wales. The present Borough figure of 18.07 shows an increase of 3.09 over that of the previous year and is 2.00 lower than the average for the last 10 years. 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 1959 :— Average for Quinquennial Periods Year 1959 District 1931 to 1935 1936 to 1940 1941 to 1945 1946 to 1950 1951 to 1955 Greenwich 75 50 40 27 18.4 18.07 London 63 56 60 33 23.8 22.3 England and Wales 62 55 50 36 26.9 22.2 23 The actual number of infantile deaths recorded during the year was 24 (4 more than last year) and these were attributed to the following causes:— Prematurity 9 Congenital Malformations 6 Bronchitis 2 Nephrogenic Diabetes Insipidens 1 Accident 1 Bronchopneumonia 1 Meningococcal Infection 1 Haemolytic Disease of the Newborn 1 Birth Injury 1 Unascertainable 1 Of the above, 13 were male and 11 female; 10 died in St. Alfege's Hospital, 1 in the Miller Hospital, 2 at home and 10 in hospitals and institutions outside the Borough. One newly born male child was found on the river foreshore. Neo-Natal Mortality.—Neo-natal mortality, i.e., infants dying before attaining the age of one month, accounted for 15 deaths, equivalent to 62.5% of all infant deaths and giving a Neo-natal Mortality Rate of 11.29 per 1,000 live births. This compares favourably with the figure of 15.8 returned for England and Wales. Thirteen of these neo-natal deaths occurred within the first week of birth, the main cause being Prematurity. Perinatal Mortality.—The Perinatal Mortality Rate, calculated from a total of 35 still births and deaths of infants under 1 week, was 25.92 per 1,000 total births compared with 30.79 for the previous year. The equivalent rate for England and Wales is 34.2. Reproductive Wastage.—A sum total of 46 Stillbirths and Infantile deaths gives a reproductive wastage rate of 34.07 per 1,000 total births, a decrease of 1.85 from the 1958 figure. 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. 24 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. 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. No deaths were registered for the current year compared with one for 1958. There were 3 deaths for 1957, 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 57th since a death from this disease occurred. 25 Measles.—There were no deaths arising from this cause during the year, a similar return to that of the previous year. There were 2 for 1957, none for 1956 and 2 for 1955. Prior to 1955 no deaths had been registered since the year 1947 when there was one. Scarlet Fever.—For the thirteenth 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 6 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 have been recorded since 1941. Only 2 deaths from Typhoid Fever have been registered during the last 25 years. Diarrhoea and Zymotic Enteritis.—Compared with a nil return for the current year and one for the previous year there was a nil return for each of the years 1956 and 1955, one death from this cause was registered 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 13 years since one was recorded. Tuberculosis.—There were 14 deaths from this disease during the year, giving a death rate of 0.15 compared with 7 deaths and a rate of 0.07 for the previous year. Despite the fact that the rate for the present year still compares favourably with the average tuberculosis death rate for the previous ten years, viz. 0.25, the increase in the number of deaths since last year represents an advance of 100% and, as such, must give rise to anxiety and apprehension should such a trend continue. There has been some recent speculation to the effect that the use of the drugs introduced after the war, which produced such a decline in the mortality of this disease, has now produced a resistant form of the tubercle bacillus and that there may well be a period in which rates will rise or, at best, remain static. Although in Greenwich numbers are small, the current increase indicates that there is no room for complacency in the fight against tuberculosis. 26 Deaths from tuberculosis for the previous ten years are given, with their appropriate rates, in the following table: Year No. of Deaths Rate 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 8 0.09 1958 7 0.07 10-year average 23 0.25 1959 14 0.15 Tuberculosis of the Respiratory System was responsible for 13 of the deaths in this category, one death being attributed to the remaining forms of tuberculosis. At 0.14, the Pulmonary Tuberculosis rate was 0.09 higher than that returned for the previous year. Cancer.—Cancer is generally considered to be a disease of middle and old age and, as indicated in my Annual Report for 1950, as the proportion of middle-aged and elderly persons in the population becomes greater, one would normally expect a rise in the incidence of this disease. In addition, improved diagnosis and more accurate certification will effect an apparent rise in the number of cancer deaths. An increase in numbers therefore, is not, per se, necessarily an indication of increased morbidity. General.—As a disease cancer is rapidly becoming one of the main impediments to a healthy nation. Much can be done in the field of preventive medicine by vigorously attacking such problems as cigarette smoking and air pollution and, in addition, judiciously altering the popular attitude towards cancer which is that it is incurable. It is true that some 100 years ago all cancers eventually proved fatal but the situation to-day is rather different. Some cases are serious and incurable—some become serious if not dealt with expeditiously—others, taken in time are curable. More patients each year are cured of cancer and although this is doubtless due to improved techniques in treatment, a significant portion of the cures can be attributed to the fact that more people seek earlier medical advice. In Greenwich, cancer was responsible for a total of 172 deaths giving a rate of 1.93 per thousand compared with 2.01 for the previous year, still indicating that approximately one in every five deaths resulted from cancer of one form or another. Since 27 1901 the yearly percentage of cancer deaths has risen from 4.2 to 19.5 the fieure for 1959 Comparing the current year's figures with those of the previous 5 years, the sites of the affected parts were:— 1954 1955 1956 1957 1958 1959 Cancer of Stomach 23 26 20 23 14 26 „ „ Lung, Bronchus 47 35 58 46 44 50 „ „ Breast 18 16 13 15 19 14 „ „ Uterus 3 6 6 5 7 2 „ all Other Sites 75 86 90 98 95 80 Totals 166 169 187 187 179 172 Lung Cancer.—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 Total 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 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 I 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 1957 2 2 24 2 8 1 5 2 39 7 46 0.52 1958 3 1 20 5 9 — 4 2 36 8 44 0.49 10 yr. Average 1.6 0.5 18.8 3.1 9.7 1.3 3.7 1.1 33.8 6.0 39.8 0.44 1959 — 1 25 3 11 2 7 1 43 7 50 0.56 28 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 1948, there were 28 deaths of Greenwich residents from cancer of the lung, approximately one half of the total registered for pulmonary tuberculosis, viz. 62. During the current year, figures of 50 and 14 respectively have been recorded showing that the position with regard to these two diseases has been more than reversed. In comparison with the Borough rate of 0.56 for lung cancer, that for London as a whole is 0.64 and for England and Wales 0.46. Nationally as well as locally, lecent 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 and the epidemic proportions of this disease become more apparent each year. In this connection, facts presented by the Medical Research Council emphasize the hazard to life occasioned by the smoking habit. Indeed, the Government felt the evidence so strong that in a statement of June, 1957, the Minister of Health charged the local health authorities with the duty of informing the public of the risks involved in cigarette smoking. 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 hypochondriases. Personal abstention by health workers in public could be a power for good in that it would be taken by others to be a practical demonstration of their belief. It seems logical that education in these matters should commence first with the young in preventing the adoption of the "smoking" habit and then to persuade the moderates and unaddicted to refrain. Unhappily it is a fact that juveniles find the task of obtaining cigarettes far too easy and the risk of their age being questioned by the police is negligible. Hence, by the age of 16 years, approximately 50% of boys and 20% of girls are already smoking and well on the way to addiction. 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. 29 Cancer Registration.—Consideration has been given at various times to the question of making malignant diseases notifiable for. 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 deaths, effective treatment, recovery rates or possible pre-disposing factors. In recent years, however, the World Health Organisation has emphasised the value of a system of cancer registration and " follow up " and its reasons given for such a scheme are fourfold. viz.:— (a) for improving the possibility that patients developing cancer shall in future receive the earliest and best treatment available ; (b) for increasing knowledge of cancer morbidity and its relationship with social and environmental factors ; (c) for providing indications for scientific studies on particular points of the aetiology of cancer ; (d) for ascertaining the prospects of survival and apparent recovery with a view to measuring in the future the value of steps taken to secure earlier and better treatment. In this connection. Great Britain makes available to this Organisation a progressively increasing volume of information on the incidence and epidemiology of cancer, mainly by reason of its cancer registration scheme now widely established in this country. On the implementation of the National Health Act, arrangements for cancer registration, begun in 1930 by the Radium Commission, became the responsibility of the fifteen Regional Hospital Boards and although such arrangements for registration were not of a compulsory nature, some fourteen of the Regions had in fact some sort of registration scheme in operation by the end of 1959, albeit some of these schemes do not cover the whole of their respective regions. Since 1947 statistical control and analysis has been undertaken by the General Register Office. For historical reasons cancer registration has always been more complete for cases receiving radiotherapy than for others but bias in this direction is gradually being eliminated and total registrations, which have increased from 27,865 for 1945 to 82,318 in 1956, are expected to exceed 90,000 when figures for 1958 become available. This latter figure is estimated to be approximately three quarters of the national incidence of cancer, an augury which gives great hopes of covering the remaining quarter during the next decade. 30 The value of a cancer registration scheme is proportional to its completeness which can be achieved only by the co-operation of doctors and administrators in all types of hospitals for the recording of data and general practitioners and consultants for "follow up" care and, where necessary, for accurate death certification. Medical Officers of Health and research workers also have their parts to play in building up a complete and comprehensive picture of the cancer problem. In June, 1959, the Central Health Services Council, in the light of advice given by the Minister's Standing Advisory Committee on Cancer, adopted the following resolution:—"In view of the national importance of the cancer registration scheme, every effort should be made to obtain full co-operation from the responsible authorities in each hospital region." Vascular Lesions of Nervous System.—This class, which includes deaths arising from Cerebral Haemorrhage, Embolism and Thrombosis was responsible for a total of 91 deaths (41 males. 50 females). The age distribution was as follows: —3 between 25 and 45 years ; 21 between 45 and 65 years ; 25 between 65 and 75 years and 42 from 75 years upwards. Heart Disease.—Under the new classification 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 278 (150 males—128 females) compared with a figure of 310 for 1958. and as usual, the deaths from this category occupied the principal place in the classification of diseases in that they formed 31.6% of the total 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 approximately 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. 74.3% . 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 predisposing factors in hypertension, atherosclerosis, and coronary disease, recent research has focussed attention on diet and, in particular, on fatty acids. To date, however, evidence is insufficient to sustain any official preventive action. 31 Diseases of the Respiratory System.—There were altogether 154 deaths from these diseases. Bronchitis accounting for 73 and Pneumonia (all forms) for 76. The total shows an increase of 19 over that of the previous year and there was an increase of 27 deaths from Pneumonia compared with a reduction of 3 in regard to Bronchitis. Of the total deaths, 2 were children under one year ot age and 126 were in respect of persons 65 years and over. Influenza.—There were 5 deaths attributed to this cause during the year compared with 2 returned for last year and 8 for 1957. Three were registered for 1956. one in 1955, none in 1954 but 15 were recorded during 1953. Deaths from Violence.—These numbered 29 including 10 from Motor Vehicle Accidents, 7 from Suicide and the remainder being accounted for under the heading of "All Other Accidents." The number of deaths from Motor Vehicle Accidents was identical with that of the previous year while the figure for Suicide showed a decrease of 4. 32 SECTION B General Provision of Health and Welfare Services for the Area Since July, 1948, the Personal Health Service availabl 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 1959, which will be found on the following pages in table form. NATIONAL WELFARE FOOD ITEMS Distribution Centres M. & C.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 Creek Road, S.E.8 Friday 1.30 p.m.— 4 p.m. 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.— 1.30 p.m.— 12 noon 4 p.m. Shooter's Hill Road, S.E.3 Monday . Tuesday 1.30 p.m.— 4 p.m. Wednesday j 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 9.30 a.m.— 2 p.m.— 12 noon 4 p.m. Tranquil Vale, S.E.3 Wednesday 9.30 a.m.— 12 noon 33 Health Visitors' Records, Attendances at Infant Welfare Sessions, Prophylaxis figures, etc. 1. Health Visiting Quarter Expectant Mothers Premature Babies StillBirths Infants (under I year) Children 1—5 years School Children Care of People Miscellaneous Unsuc cessful Total Visits 1st visit Revisit 1st visit Revisit Old Others March 178 179 10 5 371 1,527 3,415 169 136 68 264 629 6,951 June 127 211 10 7 320 1,675 4,070 235 106 77 310 750 7,898 Sept. 129 153 18 9 325 1,551 3,437 152 94 56 257 602 6,783 Dec. 102 150 6 3 283 1,477 3,416 139 82 52 289 520 6,519 Totals 536 693 44 24 1,299 6,230 14,338 695 418 253 1,120 2,501 28,151 2. Infant Welfare Clinics Quarter Attendances Sessions 0-1 year 1-2 years 2-5 years 1st Total Total Total 218 340 4 565 1 016 729 June 213 390 5,330 1,152 976 September 219 334 5,141 1,268 1,018 December 219 286 4,545 1,164 927 Totals 869 1,350 19,581 4,600 3,650 34 3. Ante and Post Natal Clinics (a) Ante Natal Quarter Sessions 1st Attendances Total Attendances This Year Current Pregnancy March 168 372 226 1,401 June 187 204 204 1,336 Sept. 190 233 233 1,297 Dec. 184 173 173 1,342 Totals 729 982 836 5,376 (b) Post Natal (cases seen at Ante-Natal Clinics) Quarter 1st Attendances Total Attendances This Year Since Confinement March ... 47 47 48 June 51 51 61 Sept. 45 45 52 Dec. 36 36 57 Totals 179 179 218 4. Toddlers Clinics Quarter Sessions Total Attendances Medically Examined March 14 98 97 June 17 152 150 September 19 114 114 December 20 116 99 Totals 70 480 460 35 5. Relaxation and Educational Sessions Quarter Relaxation Sessions Educational Sessions* Sessions Total Attendances Sessions Total Attendances March 44 451 47 511 June 38 459 43 520 September 59 641 58 592 December 35 388 40 420 Totals 176 1,939 188 2,043 * Includes a Fathercraft Class 6. Artificial Sunlight, Massage etc. Quarter Sessions Attendances First Total March 73 54 1,030 June 63 39 748 September 69 20 479 December 73 60 739 Totals 278 173 2,996 7. Chiropody Treatment No. of Clinic Sessions 1,117 No. of First Attendances 646 Total Attendances 15,442 8. 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., '59 1 8 503 1 513 84 35 31st Dec., '59 3 11 519 1 534 85 36 Cases attended during 1959:— 57 24 787 6 874 — — 36 (b) Supervision Effective Ineffective Total Visits made by Organising Staff : 3,006 395 3,401 9. Prophylaxis (a) Immunisation and Vaccination (Children under 5 years) Diphtheria immunisation (completed cases) 29 Whooping Cough immunisation (completed cases) Combined Antigen (Diphtheria and Whooping Cough) 53 Triple Antigen (Diphtheria, Whooping Cough and Tetanus) 811 Vaccination (Smallpox) 712 (b) B.C.G. Vaccination (Children 13 years old at Greenwich Schools) No. of Children 13 years old 1,652 No. for whom parental consent was obtained 1,178 No. of negative reactors vaccinated 1,056 No. of positive reactors X-rayed 78 (c) Poliomyelitis Inoculation (Children born 1943-1959 resident or attending Greenwich schools) (i) Two injections given during year 4 (ii) Third injection given during year 10,165 (Others—mainly adults 16-25 years living or working in Greenwich and Exp. Mothers) (i) Two injections given during year 3,518 (ii) Third injection given during year 1,633 10. District Nursing The staff of the Queens District Nursing Association for Charlton and Black-heath made 27,250 visits during the year. Visits carried out by the Ranyard Nurses and the Nursing Sisters of St. John the Divine were additional to those quoted above. 11. School Health Service Vision Special Investigation Minor Ailments Clinics No. of Attendances 773 390 51,014 No. of New Cases 373 33 9.667 No. of Glasses prescribed 190 — — Note- As appropriate, children from Greenwich also attend special clinics in Deptford and Woolwich. 37 TREATMENT CENTRES AND CLINICS Particulars relating to the local Health Services throughout the Borough are given below: — INFANT WELFARE CLINICS Blackhcath Hill, S.E.10 Charlton Lane, S.E.7 Chevening Road, S.E.10 Creek Road, S.E.8 Fairfield House, S.E.7 Ridgebrook Road, S.E.3 Shooter's Hill Road, S.E.3 St. Alfege's Parochial Hall, S.E.10 Tranquil Vale. S.E.3 ARTIFICIAL SUNLIGHT TREATMENT Chevening Road, S.E.10 Fairfield House, S.E.7 Shooter's Hill Road, S.E.3 ANTE & POST NATAL CLINICS Blackheath Hill, S.E.10 Charlton Lane, S.E.7 Chevening Road, S.E.10 Creek Road, S.E.8 Fairfield House, S.E.7 Ridgebrook Road, S.E.3 Shooter's Hill Road, S.E.3 Tranquil Vale, S.E.3 FOOT CLINICS Chevening Road, S.E.10 Shooter's Hill Road, S.E.3 Fairfield House, S.E.7 IMMUNISATION AND VACCINATION CLINICS Chevening Road, S.E.10 Friday 9.30 Creek Road, S.E.8 Friday 1.30 Fairfield House, S.E.7 Monday 1.30 Ridgebrook Road, S.E.3 T uesday 1.30 Shooter's Hill Road, S.E.3 .... Wednesday 1.30 Tranquil Vale, S.E.3 Friday 1.30 minor AILMENTS CENTRES (for School Children} Brooklands Park School, S.E.3 Halstow School, S.E.10 Kidbrooke School, S.E.3 Kidbrooke Park School, S.E.3 Sherington Road 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). 38 CHEST CLINICS (by appointment only) DAY A.M. P.M. Maze Hill, S.E.10 ... ... Monday 10.00-12.30 (Allergy Clinic) 2.00 Tuesday 9.30 2.00 Wednesday 9.15-10.00 (Ante-Natal) 9.30-10.00 (X-rays with Drs. letters) 2.00 Thursday 9.30 2.00-3.00 (Allergy Clinic) 3.00-4.30 (Contacts) 5.00-6.30 (workers only) Handicraft Centre Wednesday 2.00-4.00 SCABIES & CLEANSING CLINICS Wednesday 9 - 12 (School Children) Tunnel Avenue Daily 9 - 12 2 - 4 (Saturdays excepted) (Wednesdays excepted) (Adults and Children under school age) WOMEN'S SPECIAL CLINIC (Family Planning Association) Charlton Lane, S.E.7 Wednesday 1 12.30 HOME HELP SERVICE Applications for this service to be addressed to:— Divisional Medical Officer, London County Council, Greenwich Sub-Office, 105, Shooter's Hill Road, S.E.3. DISINFECTING STATION Applications to:— Medical Officer of Health, Public Health Department, Town Hall, S.E.10. 39 HOSPITALS Brook Hospital (WOOlwich 1172) Miller Hospital (TIDeway 1136) Royal Herbert Hospital (WOOlwich 1166) St. Alfege's Hospital (GREenwich 2655) Seamen's Hospital (GREenwich 3433) MASS RADIOGRAPHY New Cross General Hospital, Avonley Road, S.E.14 (NEW Cross 1522 for appointment). NURSING ASSOCIATIONS Queens District Nursing Association for Blackheath and Charlton, 50, Vanbrugh Park, S.E.3. (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, Miss K. A. Rackham, Divisional Director, 46, Vanbrugh Park, S.E.3 (GRE 0157). Citizen's 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, Mrs. Gardener, 56, Beaconsfield Road, S.E.3 (GRE. 0902). W.V.S., West Greenwich House, S.E.10 (GRE. 1383). W.V.S. Sub-Centre, Blackheath Park, S.E.3 (LEE Green 0791). REGISTRATION OF BIRTHS. DEATHS AND MARRIAGES Town Hall, S.E.10 Mon.-Fri. Fri. Sat. 9 a.m. to 12 noon 2 p.m. to 4.30 p.m. 5 p.m. to 7 p.m. 9 a.m. to 11 a.m. 40 SECTION C Sanitary circumstances of the Area The tables on pages 80 and 81 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 13,301 houses and premises have been inspected or re-inspected during the year; 552 intimation notices and 94 statutory notices were served. Registered complaints, numbering 1,192 show a decrease of 38 from those of the previous year, a total, however, still greatly in excess of the pre-war average of 700. Legislation.—With reference to this Section the most important statutory instruments passed during the year are listed below:— Public Health Officers' Regulations, 1959. These regulations, in addition to making applicable to all local authorities the requirements that a Public Health Inspector shall perform his duties under the general direction of the Medical Officer of Health, substantially repeat the provisions of the former regulations as to the qualifications, duties and tenure of office of Medical Officers of Health and Public Health Inspectors. Smoke Control Areas (Exempted Fireplaces) Order, 1959. With certain restrictions the Order, inter alia, exempts from the provisions of Section 11 of the Clean Air Act, 1956 (which relates to Smoke Control Areas), furnaces installed on or after the 31st December, 1956, which are equipped with mechanical stokers and do not burn pulverised fuel. Factories Act, 1959. An Act introduced on the 29th July, 1959, to revoke Regulation 59 of the Defence (General) Regulations, 1939, and to amend the Factories Acts, 1937 and 1948. and make further provisions as to the health, safety and welfare of persons employed in factories or in premises or operations to which these Acts apply. London County Council (General Powers) Act, 1959. Section 22 of this Act gives power to the borough council to control movable dwellings used, or intended to be used (whether temporarily or otherwise), for the purpose of human habitation. In this instance, "movable dwelling" includes (a) a structure capable of being moved from place to place ; and (b) a vehicle or other conveyance whether on wheels or not. A further Section of the Act empowers borough councils to require refuse storage accommodation in buildings where work of a specified structural nature takes place on or after 1st April, 1960. 41 In accordance with Section 25 a borough council may by notice require the owner or occupier of any inn, refreshment house or place of public entertainment in the borough to provide and maintain in a suitable position such number of sanitary conveniences for the use of persons frequenting the premises as may be reasonable, certain types of premises being specifically excluded. Factories Acts, 1937/59. 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 384 inspections were made by the Council's Inspectors in relation to the 508 registered factories. The latter figure includes 86 premises where mechanical power is not used. Defects were found in 29 instances, all of which were remedied. FACTORIES ACTS 1937—1959 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 86 25 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 406 321 4 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises ) 16 38 Total 508 384 4 — 42 Cases in which defects were found. Number of cases in which defects were found Number of cases in which prosecutions were instituted Particulars Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l.) 7 7 Overcrowding (S.2) — — - — — Unreasonable temperature - - - - - Inadequate ventilation (S.4) Ineffective drainage of floors - - - - - Sanitary Conveniences (S.7): - - - - - (a) insufficient 3 3 - 2 - (b) unsuitable or defective 17 17 - I — (c) not separate for sexes 1 1 - — Other offences against the - - - - - Act (not including offences - - - - relating to Outwork) 1 1 - — — Total 29 29 - 3 - 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 unwhole some premises Notices served Prosecutions Wearing apparel Making, etc. 34 - - - - - Cosaques, Christmas crackers, Christmas stockings, etc. 1 - - - - - Lampshades 12 — — — — - Card boa rd Boxes 1 Carding, etc., of Buttons, etc. 4 - - - - - Brushes 3 — — — — - Total 55 — — — — 43 Outworkers.—Twice yearly, February and August, the Factory Act requires all employers of outworkers to forward to the Local Authority a list giving the names and addresses of all employed in homework during the previous six months. Notifications received from Greenwich firms of: — (a) Outworkers resident in the Borough 15 (b) Outworkers resident outside the Borough 24 Notifications received from firms outside the Borough of: — Outworkers resident in the Borough 63 Total number of Greenwich residents employed as outworkers (as given in August list) 55 Premises where homework is carried on were visited on 47 occasions by the Lady Public Health Inspector. In no instance was it necessary to take action because of infectious disease. 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 non-compliance 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. 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 authorize a pigeoncatcher to deal with pigeons on the highway and other public places. 44 During the year some 19 complaints were received and, where justified, arrangements were made to reduce the pigeons to a reasonable number. Remarks concerning this matter bear constant repetition, viz., that whilst there can be no objection to the feeding of a limited number of pigeons in any particular area, it is reprehensible 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. A failure in "public relations" seems evident in this respect for, despite an appeal to residents to refrain from feeding these birds, the number of complaints showed a substantial increase over those of last year, the figures being 19 and 8 respectively. The situation is further complicated as the result of the Council's difficulty in obtaining the services of a satisfactory " pigeon catcher." River Pollution.—Although no complaints were made to this department during the current year, numerous complaints have been lodged in previous years, not only with this department but with other riverside boroughs, concerning obnoxious smells arising from pollution of the river by sewage effluent. This has brought into relief the whole problem of sewage disposal. In the London area, sewage and its disposal, amounting to a daily dry flow of approximately 300 million gallons, is under the control of the London County Council and after treatment at the northern and southern outfalls at Beckton and Crossness respectively, the resultant sewage effluent is discharged into the Thames. It is then considered by various authorities to be a pollutant and the predominating cause of the complaints. By way of explanation it may be said that when the concentration of dissolved oxygen falls to zero, the suphate which is found in tidal waters is reduced by bacterial action and hydrogen sulphide is formed. In this respect, the Director of the Water Pollution Research Laboratory at Stevenage has asserted that during dry weather many miles of the Thames Estuary contains no oxygen and in this region hydrogen sulphide is evolved, giving rise to complaints both because of its smell and because of the corrosion it causes. The London County Council having been long aware of the shortcomings of its sewage disposal system laid down in the 1860's. and which has been unable to keep pace with modern demands, took steps in September 1950 to improve the situation and new works in connection with these improvements are expected to be completed by 1963 at a cost of some £10 million. 45 However, despite the improvements achieved and visualised, an action, one of the most formidable in recent times against a local authority, was brought against the London County Council (and incidentally the Middlesex County Council) by a Greenwich firm. The allegation was that the Councils discharged into the river an effluent consisting of sewage matter insufficiently treated and purified and, inter alia, that because of this the river waters from Waterloo Bridge downwards were at all times grossly polluted, almost devoid of dissolved oxygen and that foul and putrifying matter was deposited on the river bed where it formed banks of filthy mud. It was further alleged that this mud, together with the condition of the river water, was responsible for the corrosion and destruction of the steel bottoms of the Greenwich firm's barges. After a hearing lasting eight days, judgment for the case was entered for the London County Council and the Middlesex County Council with costs to the defendants. Since the new primary sedimentation plant at the Northern outfall was brought into operation in 1955, the London County Council's Rivers and Drainage Committee have reported that there has been considerable improvement in the effluent discharged and recent analyses have tended to confirm this assertion. Storm Flooding.— Damage to property during the year due to unusually heavy rainfall was of a minor nature and complaints received regarding premises affected by storm damage during August were few and, in the main, found to be due to defective roofs, blocked gutters and drains. In several instances, with the agreement and co-operation of the Baths Superintendent, soft furnishings such as bedding, carpets, etc., soaked with rainwater were collected, dried and subsequently returned. River Ravensbourne— Jurisdiction. Floodings accompanying recent heavy storms have emphasised the need for preventing the overflowing of the Ravensbourne and its tributaries at times of heavy rainfall. Many properties in the Borough in close proximity to the River Ravensbourne have suffered from inundations once or twice a year in recent years and flood waters have penetrated to the foundations, resulting in extreme discomfort to the inhabitants besides tending to produce in the dwellings ideal conditions for the spreading of dry rot. Last year it was reported that the problem was being investigated under the auspices of the Ministry of Agriculture, Fisheries and Food which invited the London County Council to consider in what way jurisdiction over the river could best be exercised. 46 The preliminary investigation instigated by the General Purposes Committee of the L.C.C., in conjunction with its Rivers and Drainage Committee, revealed that at an initial cost of about £70,000 the incidence of flooding could be reduced by the removal of silt and the trimming-up of banks where necessary, but that the removal of certain obstructions and the carrying out of some improvements would increase the cost to approximately £600.000. At present it was impossible to estimate the cost of full-scale improvement but the available data suggested a figure in the region of £3 million, with an annual maintenance expenditure of about £12.000. After the London County Council's preliminary investigation a conference was held at the Ministry in July, with representatives present from the following public authorities within the river's catchment area:— Ministry of Agriculture, Fisheries and Food. Ministry of Housing and Local Government. County Councils—London, Kent and Surrey. Metropolitan Boroughs—Camberwell. Deptford, Greenwich and Lewisham. County Boroughs—Croydon. Municipal Boroughs—Beckenham and Bromley. Urban Districts—Chislehurst and Sidcup. Caterham and Warlingham, Orpington and Penge. Rural Districts—Godstone. Kent River Board. In the course of the meeting each authority was called upon to give information as to the extent and frequency of the flooding in its area and after some discussion it was decided that, in general, existing legal powers were insufficient to deal with the problems involved which varied in character from the very serious to the insignificant. Finally it was agreed that the London County Council and the Kent County Council should confer with the local authorities in their areas and that the two Counties should report to the Ministry on the progress of discussions by the end of the year. Following consultation with the officers of the Kent County Council, the London County Council advised the Minister of Agriculture, Fisheries and Food that "it was the Council's opinion that the River Ravensbourne should be dealt with as a water course under the jurisdiction of the Land Drainage Authority and that legislation should be sought to confer such functions on the Council in respect of that part of the river which is within the County boundary. In this event it is understood that the Council would become eligible, under the Agricultural Act, 1937, for grant towards the cost of an approved drainage scheme designed to prevent flooding 47 within the County. Preparations are accordingly being made for the drafting of a joint Bill with the Kent County Council with a view to presentation in the Parliamentary Session of November, 1960." In the interim, the London County Council, in co-operation with the consulting engineers appointed by the Kent County Council, is proceeding on the preparation of a co-ordinated scheme of improvement of the river. Atmospheric Pollution—General.— Pollution of the atmosphere and its alleged association with cancer is still engaging the attention of eminent men of medicine and surgery. In a recent paper entitled "Cancer and its Cause," Professor F. C. Pybus, Emeritus Professor of Surgery of Durham University, has postulated that cancer forming agents in smoke are the main cause of the disease and that "since man discovered fire and learned to use it he doomed himself and posterity to the possibilities of cancer." In essence, the inference was that cancer was man made; that it was in effect a dirt disease and therefore preventable. Other conclusions reached by Professor Pybus were, that Britain is said to be the smokiest country in the world ; that everything is contaminated by smoke and soot; that estimates of benzpyrene show that most persons could get a "lethal" dose and that domestic smoke causes carcinoma in animal experiments. He further stated that "those who produce smoke—individuals, public and local authorities, State institutions and boards—are guilty of an anti-social act and are indeed public enemies." In support of this view a paper entitled "Epidemiology of Cancer" by Dr. Percy Stocks ended with the following statement:— "In my opinion the inescapable answer to all this is that in face of the rapidly rising mortality from lung cancer and the strength of the evidence jointly incriminating atmospheric and cigarette smoke, everything possible should be done to remove or prevent the production of carcinogens already known to be present, to educate people as to the risks and discourage boys and girls from acquiring the cigarette habit and to reduce the pollution of the air in towns by potentially carcinogenic substances." In this respect the most suitable agency for the dissemination of information regarding the relationship between air pollution and cancer would appear to be the local authority whose responsibility it is to ensure that its area becomes effectively smoke controlled at the earliest opportunity. Clean Air Act, 1956. Provisions relating to the installation of new furnaces, smoke control areas, height of chimneys, research 48 and publicity, came into operation on the 31st December, 1956, whilst the remaining provisions became effective on the 1st June, 1958. In accordance with the Alkali, etc. Works Order, 1958, the Minister of Housing and Local Government has indicated the works located in the Borough which will be subject to the control of the Alkali Inspector under the Alkali, etc. Works Regulation Act, 1906; the works will include such industries as metal smelting and synthesis, gas works, electricity generation, etc. In these instances, however, it is understood that the Alkali Act deals only with the particular processes which are registered under the Act. Any other works, processes or plant carried on or operated at the premises— e.g. ordinary power plant fired by coal or oil—will not come under the Alkali Act but will be subject to the relevant provisions of the Clean Air Act, 1956. A Smoke Inspector and an Assistant are employed full time on duties in connection with atmospheric pollution and with the surveying and supervision of smoke control areas. During recent years a great deal of attention has been paid to industry in the Borough, with some measure of success, but during the current period greater attention has been paid to domestic smoke and under Section 11 of the above-mentioned Act detailed inspection was completed of the Council's first smoke control area which obtained Ministry approval on the 18th December, 1959. Procedure for establishing a smoke control area is laid down and, for convenience, is divided into four stages:— (i) the location, size of area and types of property to be included having been decided, the Council notify the Minister of their provisional plan; (ii) when the Minister's approval and comments are received a detailed survey of the area is made; (iii) the survey having been completed the Council make an Order and submit it to the Minister for confirmation; (iv) after the Minister's confirmation the Council then proceed to enforce the Order. This stage concerns the conversion of fire grates, the payment of grants and the subsequent claim for Exchequer contributions. The Greenwich No. 1 Smoke Control Order, 1959, which becomes operative on the 1st October, 1960, covers an area of some 76 acres and concerns approximately 1.000 premises, most of which have apparatus requiring alteration. The accompanying plan indicates the area concerned. Greenwich no. 1 Smoke Control Area 50 A second smoke control area is contemplated of approximately 58 acres and some 1,500 houses and sundry other buildings and a preliminary survey is now being carried out. This area is bounded on the north side by Mauritius Road, on the north-east by Tunnel Avenue, on the south by Woolwich Road and on the west by Christchurch Way. The Ministry's approval is expected to be obtained during the latter half of 1960. In his Circular 5/59 the Minister of Housing and Local Government stated that he had received an encouraging response by local authorities to the Clean Air Act but that he hoped it would be possible to make faster progress, especially in the "black" areas (which includes London). Councils were asked to consider their domestic smoke problem as a whole, to decide on the smoke control orders that are needed and in what priority they should be made, to estimate how long the whole operation is likely to take, to prepare a phased programme for establishing smoke control areas over the next five years and finally to inform the Minister by the 30th June, 1959, of their conclusions. 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 1959:— TABLE I.—Daily Mean Concentration of Smoke Month Town Hall Charlton House Smoke mg/100m3 Smoke nig/100m3 Daily Value Daily Value Average Highest Lowest Average Highest Lowest November 1958 49 90 23 39 74 23 December „ 58 121 20 38 103 14 January 1959 65 202 12 42 132 12 February „ 54 132 33 43 123 20 March „ 31 58 16 21 49 10 April „ 28 58 10 19 35 1 May „ 35 58 17 14 57 4 June „ 23 66 4 16 57 2 July „ 22 34 5 9 34 4 August „ 19 34 8 13 29 4 September „ 27 49 10 20 29 3 October „ 34 57 15 20 32 4 November „ 43 104 21 38 89 4 December „ 35 72 23 34 59 14 January 1960 56 182 19 33 128 9 February „ 42 98 26 34 69 21 51 TABLE II.—Daily Mean Concentration of Sulphur Dioxide Month Town Hall Charlton House Sulphur Dioxide p.p. 100m. Sulphur Dioxide p.p. 100m. Daily Value Daily Value Average Highest Lowest Average Highest Lowest November 1958 14.5 28.8 7.4 7.6 13.3 4.5 December 13.9 42.0 4.7 9.1 25.3 3.0 January 1959 18.3 64.1 3.6 10.9 31.9 1.5 February „ 15.9 43.8 6.8 7.8 22.6 3.5 March „ 9.3 14.7 3.9 4.1 5.7 2.7 April „ 5.5 9.6 2.3 3.3 8.2 1.4 May „ 5.8 9.5 3.6 3.6 5.1 1.7 June ,, 5.0 7.6 2.7 2.9 5.1 1.4 July „ 3.9 6.8 2.4 2.0 4.7 1.2 August „ 3.6 5.6 1.1 2.7 4.1 1.2 September „ 8.0 11.2 5.2 5.4 7.5 2.8 October „ 6.3 11.1 3.2 6.1 9.7 3.3 November „ 10.7 27.4 5.8 9.1 23.1 4.7 December „ 7.3 11.5 4.1 6.1 9.5 2.7 January 1960 13.9 34.5 4.8 14.5 30.1 5.4 February „ 10.4 18.5 4.6 7.7 11.2 5.6 Rent Act, 1957.—This Act, which came into force on 6th July, 1957, 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 made 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. The provisions of abatement for disrepair are 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 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. 52 The following table gives details regarding applications received, certificates issued and action taken during the current year in accordance with the Rent Act, 1957:— PART I—Applications for Certificates of Disrepair Number of applications for certificates 29 Number of decisions not to issue certificates 2 Number of decisions to issue certificates: (a) in respect of some but not all defects 24 (b) in respect of all defects 3 27 Number of undertakings given by landlords 20 (under para. 5 of lst Schedule) Number of undertakings refused by Council - (under proviso to para. 5 of 1st Schedule) Number of certificates issued 7 PART II—Applications for Cancellation of Certificates Applications by landlords to Council for cancellation of certificates 21 Objections by tenants to cancellation of certificates upheld 8 Decisions by Council to cancel notwithstanding tenants' objection 2 Certificates cancelled 13 In addition to the foregoing, 16 applications (Form "O") received from landlords and tenants for a certificate as to the remedying of defects which the landlord has undertaken to remedy, resulted in the issue of Certificates (Form "P") as follows: — Applications By whom made Form 'P' Certificates issued in respect of:— Defects Remedied Defects not/not wholly Remedied In respect of Form 'H' undertaking Tenant — — Landlord — — In respect of Form 'K' undertaking Tenant — 2 Landlord 10 4 53 Section 22.—This section amends subsections 2 and 3 of Section 4 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 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, 46 investigations were made into the department's records of the respective premises. 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 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 Rent 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. 54 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 14 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 5 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 relate to the Sale of Poisons used for domestic, horticultural and sanitary purposes. During the year 5 applications for entry of name in the Council's List of Persons entitled to sell Poisons included in Part II of the Poisons List were received and 64 vendors applied for retention in the Council's List. All were duly considered and approved. Eleven inspections were carried Out in accordance with the above Act. Shops Act, 1950.—Under this Act, which became effective from 1st October, 1950, the Council is responsible for ensuring that, 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, 55 (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 16 exemption certificates were in operation. From 1st January, 1959, in accordance with the London County Council (General Powers) Act, 1958, the County Council's powers and duties under Section 38 of the Shops Act, 1950, relating to lighting, washing facilities and arrangements for taking meals at shops were, with the excepted premises itemised under Section 18(2), transferred to the Metropolitan Borough Councils. Routine inspections were carried out under the abovementioned Act on 229 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, 1959 60 Persons registered at 31st December, 1959 66 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. 56 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, 8 samples, three of Rag Flock, two of Cotton Felt and one each of Kapok, Coir Fibre and Cotton Mill Puff were obtained and submitted for examination. All proved satisfactory. Pet Animals Act, 1951.—This Act, introduced to regulate the sale of pet animals with particular reference to their welfare prior to sale, became operative from 1st April, 1952, since when it became an offence to keep a pet shop except under licence from the Local Authority. 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 three licences were in operation and 9 inspections were carried out by the Public Health Inspectors in connection with the issuing of such licences. Land Charges Act, 1925.—Under this Act enquiries concerning outstanding notices under the Public Health and Housing Acts on properties in the Borough are received from time to time by the Town Clerk. During the year 1.449 reports on such enquiries were forwarded to his department. Drainage and Sewerage.—During the year 405 drains were tested, 422 were opened, cleansed or repaired and there were 766 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 sixty-one plans of drainage and other sanitary works relating to existing and new buildings were examined and approved. 57 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 351 premises was compiled where trade effluents are discharged to the public sewer. A further survey of premises has increased the number of premises likely to discharge trade effluents to a total of 356. 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:— Premises discharging trade effluent to local sewers 291 Premises discharging trade effluent to L.C.C. sewers 65 Number of sewer connections inspected 26 Number of samples taken 19 Number of samples found satisfactory 15 Applications for new or modified discharges nil The unsatisfactory samples were found to be caused by errors in operating manufacturing plant and lack of maintenance of drainage systems. Remedial measures were taken by the firms concerned. It is understood that negotiations are still proceeding between the L.C.C. and the South Eastern Gas Board concerning discharges to the Tunnel Avenue sewers. 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 24,507 dwellings with direct connections to the Board's mains. During the year 166 water supply certificates were granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended in 249 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. 58 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:— Scavenging: The mileage of streets cleansed in the Borough is approximately 82 miles. This is done mainly by hand sweeping, only 7½% being swept by mechanical sweeper/collector which is employed during the night time on main roads and other roads where, because of extensive regular parking of vehicles, it is impossible for these to be swept by hand during the daytime. The scheduled frequency of cleansing the streets is as follows :— (a) At least once daily (main roads) 25% (b) Three times weekly 37½% (c) Twice weekly 37½% Every endeavour is made to adhere to the above schedule, but owing to the high level of sickness amongst the ageing workmen employed as sweepers and the difficulty still experienced in recruiting new employees of better physique, it has not always been found possible to do so. There are approximately 4,500 street gullies in the Borough which are each emptied and refilled with clean water four times a year. This is done entirely by mechanical means by the use of two 800 gallon capacity emptying and flushing vehicles. Street Sweepings collected and disposed of during the year amounted to 1,342 tons and continues to show a decrease in volume as in previous years. From this it might appear that the general public are becoming more anti-litter minded. Refuse Collection The total weight of household refuse, including salvaged waste materials such as paper, rags and metal, was 21,619 tons, the weight of salvaged materials being 861 tons. This was collected from 27,257 premises in the Borough which gives an average of approximately 16 cwts. for each over the whole year or approximately 34 lbs. each per week. The average weight per 1,000 population per day was 13.3 cwts. Most of the refuse is collected from householder's individual bins, but with the increase in number of blocks of flats in the Borough, more each year is being collected from the 59 large communal bins housed in chambers situated at the bases of chutes into which each individual occupier deposits their refuse. The scheduled frequency of collection throughout the Borough is once weekly except where in a number of pre-war built blocks of flats sufficient bin storage capacity has not been provided, collections have of necessity to be made twice weekly and in a few cases three times weekly. Under new powers given by the London County Council (General Powers) Act, 1959, it is now possible to enforce the provision of adequate bin storage capacity with satisfactory accommodation in all new buildings or alterations to existing ones. Similarly, as occurs in the scavenging section of the Works Department, there is still some difficulty in recruiting suitable able-bodied employees who are prepared to undertake this arduous form of labour and fill the vacancies which occur on the retirement of the existing ageing employees or take the place of those absent from work on account of sickness. Refuse Disposal The whole of the household refuse collected totalling 21,619 tons less the 861 tons of salvaged materials was deposited into barges at the river jetty which forms part of the Council's Tunnel Avenue Depot, and transported by these barges down the Thames and disposed of by controlled tipping over low-lying waste land near the mouth of the river. Trade refuse amounting to 291 tons was also disposed of in the same manner. This barging away and disposal of the refuse is undertaken by a Contractor employed by the Council. During recent years efforts have been made to provide an alternative means of disposal of household and trade refuse by controlled tipping after transportation in the Council's own vehicles into disused chalk pits in Kent and over the low-lying disused land at the extreme eastern end of the Woolwich Arsenal, but without success up to the present. The possibility of disposal of refuse by composting as a further alternative is still being pursued. The 861 tons of salvaged materials collected during the year was disposed of by sales amounting to £6.702 made up as follows: Scrap Metal — 67 tons — £392 Waste Paper — 758 tons — £5,669 Rags, etc. — 36 tons — £641 An income of £991 was obtained from the charges made by the Council for the collection and/or disposal of 291 tons of trade refuse arising from business premises in the Borough. 60 RODENT CONTROL General.—During the year the Rodent Control Scheme, as approved by the Ministry of Agriculture, Fisheries and Food, has continued, although with the introduction in 1959 of "block" grants to local authorities, direct financial assistance by the government to this service ceased. Of a total of 2,033 investigations made, 419 were as a result of notification, 45 were from re-notification and 1,569 were from surveys carried out under the Prevention of Damage by Pests Act, 1949. Notification by occupiers, coupled with the number of infestations found as a result of routine investigations gave an average monthly rate of 44 compared with a figure of 46 for the previous year. In all, 464 treatments were carried out and infestation was found to exist at 5 Local Authority Premises, 335 dwelling houses and 105 miscellaneous premises and places of business. Reinfestation occurred in 43 instances. Twelve major infestations, 10 of rats and 2 of mice, were disclosed, two of which were located in dwelling houses. Notwithstanding the fact that large industrial firms are inclined to make contracts with servicing companies and to train their own personnel, periodical treatments were carried out at 6 industrial premises and 3 hospitals. Following the policy of tracing the source of infestation in each case, 27 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. 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. 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. The Rodent Control personnel have performed their duties with diligence throughout the year and have given the Department good service. Prevention of Damage by Pests Act, 1949.—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 61 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. It has not been found necessary during the year to take legal action to enforce the provisions of the Act. The following report was submitted to the Ministry of Agriculture, Fisheries and Food, for the 9 months ended 31st December, 1959:— 62  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. 37 24,193 4,334 28,564 2. Number of properties inspected as a result of: (a) Notification 6 260 55 321 — (b) Survey under the Act 2 1,060 124 1,086 — (c) Otherwise — — — — — 3. Total inspections carried out — including re-inspections 8 1,330 195 1,533 4. Number of properties inspected (in Sect. 11) which were found to be infested by: (a) Rats ( Major 1 — 1 2 — Minor 2 162 38 202 — (b) Mice j Major — — — — — Minor 2 87 17 106 — 5. Number of infested properties (in Sect. IV) treated by L.A. 5 238 50 293 — 6. Total treatments carried out — including re-treatments 6 266 73 345 — 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 Nil 63 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:— "In collaboration and at the suggestion of officials of the Ministry of Agriculture, Fisheries and Food, an experiment was conducted over the whole Borough using 12 oz. bait blocks (com prising pinhead oatmeal, sugar, technical white oil and Warfarin No. 5) suspended in each manhole just over the benchings. Approximately 1,160 manholes were each treated with one block at intervals of three months. The efficiency of the blocks will be gauged from a pre-experiment census taken in October, 1958, and a further census to be undertaken in January, 1960. Inspection of the blocks during the year's treatment has shown them to be susceptible to mould growth in the humid atmosphere usually found in sewer manholes and it is considered that this will reduce palatableness. There was evidence that many blocks were partly consumed and in a small number of cases whole blocks were missing which could, of course, be accounted for by sewer surcharge. No indication of the Warfarin block treatment's efficiency will be known until the proposed census to be undertaken by Ministry officials next year, but it is clear that a block treatment is simple and safe to operate and has much to commend it, particularly economy of labour." 64 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 contained in the dust chutes and dustbins, food shops, cafes and canteens, static water sites, ponds and ditches, etc. 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 regular 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, surreptitiously dumped on vacant spaces because the public, in the main, are unaware that this authority will, upon request, collect and destroy such articles. 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 Disinfestation of Verminous Premises.—D.D.T. in kerosene continues to give good results in dealing with verminous premises when alternated with other vermicides to counteract the development of organismal resistance. 65 During the year the department dealt with 123 cases of dirty and verminous premises compared with 262 in 1958. The disinfestation staff sprayed 338 rooms and contents as compared with 610 last year. In 5 cases the bedding and effects were removed to the Council's disinfecting station for treatment by steam or formaldehyde. Of other pests which necessitated the treatment of 376 houses comprising 1,379 rooms, the following initiated the greater number of complaints:— Ants. Ants carry no disease but their presence in human foodstuffs is objectionable. Foods of a relatively high sugar content are particularly attractive to ants and the insects are prepared to go to great lengths in order to obtain a sufficiency for their community. In the main, complaints received concerned either the black garden ant (Lasius niger) or the yellow meadow ant (L. flavis), the workers of which will gain access to houses through cracks in the walls or floors, over sills or through window frames in search of food and 132 treatments were carried out to combat the reported nuisances. One of the commonest of ants, the very small red House or Pharoah's ant (Monomorium pharaonis) was also the cause of a number of complaints. This insect is often found infesting bakehouses, restaurants, hospitals and houses, especially in larders and kitchens and nests may be found behind wall plasters, behind pipes or ovens, under floor coverings and foundations. As in previous years this pest was encountered at two of the large hospitals in the Borough where, despite intensive investigation the sources of infestation were not located. The total number of treatments carried out in respect of this ant was 37. Although the treatments effected a reasonable measure of success, complete control can be achieved only by the destruction of the colonies, for once ants become established in a building. 66 complete elimination is extremely difficult. As usual, prevention offers the best solution to the problem namely, (a) to block or obstruct the entry of the ant, (b) to keep premises clear and free from crumbs and scraps of food, (c) to seal holes and cracks through which ants could enter and (d) to use an effective insecticide, preferably of a residual nature. Wasps. Complaints received implicated three types, the Common, the German and the Tree wasp. (Vespula vulgaris, V. germanica and V. sylvestris). Fear of the wasp is often misplaced for they rarely sting unless they are roused or frightened and, contrary to popular belief, wasps are not entirely harmful for in Spring and early Summer they feed mainly on insects, many of which are themselves injurious. However, after mid-summer their diet becomes more vegetarian and the workers feed on ripening fruit and other sweet substances, thus effecting serious damage in orchards, sugar warehouses, grain factories, etc., where they cause considerable wastage of goods. In houses they become a nuisance during cooking and at meal times and it is conceivable that they are instrumental in the spread of food poisoning. The queen wasp, the only survivor from the previous year's colony, emerges from hibernation in the Spring to choose a site for nesting, usually in cavity walls, lofts, under roof tiles and other sites which evoke a certain ingenuity on the part of the disinfestors in order satisfactorily to deal with the nuisance. The exceptionally fine summer gave rise to a substantial increase in the number of complaints received regarding this pest and during the year some 91 nests were destroyed, mainly by means of H.C.N, gas generated from purpose-made proprietary powder. Cockroaches. The cockroach (Blatta orientalis) is well known for its destructiveness, especially in relation to stored organic matter, ranging from foodstuffs to book bindings. Food is rendered repulsive from contamination not only with its faeces but also with the secretion from its scent glands, and the cockroach is strongly suspected of transmitting to man a number of pathogenic organisms especially those of an enteric nature. Most of the complaints received concerning this pest came from bakehouses and the three large hospitals in the Borough: very few originated from occupiers of dwelling houses. 67 The construction of such premises offers ideal breeding sites in concealed and almost inaccessible places. Thorough investigation and treatment with D.D.T. resulted in the infestations being considerably reduced. In all, 109 treatments were effected. Clover Mite. Complaints were received from tenants in blocks of flats in various parts of the Borough concerning small red insects (Bryobia praetiosa) found moving over walls and windows. These insects are not considered harmful to humans or to household property but they cause concern when, during the Spring season they migrate from their natural environment into nearby buildings. Some infestations in fact were reported from houses and flats where natural breeding conditions were non-existent but where a recent laying of turfs had occurred. On 97 occasions, spraying of interior and exterior surfaces with D.D.T. and Kerosene produced satisfactory results. Such treatment also extended to the spraying of trees and plants in close proximity to the source of complaint. During the course of the year, complaints concerning other pests such as black beetles, earwigs, crickets, fleas, silver fish, etc., were satisfactorily dealt with. Precautionary Spraying. During the year, 260 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 by the Borough Engineer's refuse disposal section. Public Baths and Washhouses.—Greenwich is in the happy position of having a modern establishment for its Public Baths and Washhouses, situated in Trafalgar Road, and covering an area of 1¼ acres. Originally there were 3 large swimming baths, 74 ladies and gents' slipper baths, medicated vapour and foam baths, washhouses and laundry, etc., but during the war the Ladies' 2nd Class Swimming Bath was demolished by enemy action. Subsequently the Council, with Ministry approval, decided that Turkish and Vapour Baths would replace the original swimming bath and rebuilding with this aim in view commenced during 1957. March 10th of the current year saw the opening to the public of the new baths, the accommodation of which consists of the following :— (a) Cooling Room with 23 cubicles for resting, with Attendant's Office and additional locker accommodation for bathers not requiring a cubicle. 68 (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. Since their inauguration these baths have proved to be extremely popular as can be seen by the attendance figures given below. Brine baths, in particular, have found favour with the ladies. In connection with the swimming baths there has been provided a most up-to-date filtration, aeration and chlorination plant capable of purifying the contents of each bath every 3½ hours, thus enabling bathers to use the baths with every confidence. Regular chemical tests are taken (twice daily) and bacteriological tests taken periodically. I am indebted to Mr. K. L. Embley, Superintendent Engineer, for the following statistics :— Attendances.— For the year ended 31st December, 1959:— Slipper Baths 85,806 *Swimming Baths 162,970 New Vapour Baths 11,526 Public Laundry 8,506 Total 268,808 * Includes 46,686 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 :— 69 Sample No. Date & Time Nature & Temperature No. of Bathers Plate Count per ml. Yeastral Agar 37°C. Probable No. of Coliform bacilli, per 100 ml. Mac Conkey 2 days 37°C. Faecal Coli. per 100ml. Result 1 21.1.59 12.20 p.m. 2nd Class Swimming (Mixed Bathing) 77 °F. 33 2 (24 hours) - - Satisfactory 2 3.3.59 11.15 a.m. 2nd Class Swimming (Mixed Bathing) 75 °F. 31 154 (24 hours) - - Satisfactory 3 10.8.59 11.30 a.m. 2nd Class Swimming (Mixed Bathing) 77 °F. 14 3 (2 days) - - Satisfactory 4 20.8.59 11.20 a.m. 2nd Class Swimming (Mixed Bathing) 75 °F. 40 1 (2 days) - - Satisfactory 5 20.8.59 11.30 a.m. 1st Class Swimming (Mixed Bathing) 75 °F. 30 3 (2 days) - - Satisfactory 6 25.9.59 11.35 a.m. 1st Class Swimming (Mixed Bathing) 75 °F. 3 6 (2 days) - - Satisfactory 7 25.9.59 11.30 a.m. 2nd Class Swimming (Mixed Bathing) 75 °F. 40 20 (2 days) - - Satisfactory 8 20.10.59 11 a.m. 2nd Class Swimming (Mixed Bathing) 76°F. 100 0 (24 hours) - - Satisfactory 9 18.12.59 11.45 a.m. 2nd Class Swimming (Mixed Bathing) 76 °F. 25 3 (24 hours) - - Satisfactory 70 Public Sanitary Conveniences, etc.—The need for public sanitary accommodation is as great as ever and in this respect the 9 Council conveniences situated in the main arteries of traffic continue to provide a most satisfactory service. Particulars of Public Sanitary Conveniences in the Borough Convenience MEN WOMEN HOURS W.C.'s Lavatory basins Urinal stalls W.C.'s Lavatory basins Batley Park (Blackheath) 6 2 12 4 2 7 a.m. to 11 p.m †Blackheath Hill (foot of) 3 — 10 4 Black wall 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 Shooter's Hill Road (junc. Well Hall Road) 3 1 6 3 1 Totals 34 11 79 38 12 NOTES.—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. † Women's side closed 29th November, 1959, due to damage arising from a road accident. 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 (disused). Charlton Church Lane. Westcombe Hill, Blackheath. 71 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. Free hand-washing facilities, introduced in the interests of Public Health during 1951, were continued with marked success during the year and the following table gives an indication of the growing use made of these facilities:- Convenience Men Women Total Batley Park 4,300 3,559 7,859 Creek Road 1,800 3,405 5,205 Greenwich South Street 2,648 3,853 6,501 King William Walk 2,126 5,873 7,999 Rodmere Street 1,966 4,008 5,974 Shooter's Hill Road 1,633 3,439 5,072 Totals 14,473 24,137 38,610 Aged, Infirm and Physically Incapacitated Persons.— Largely due to medical progress and improvements in social and environmental conditions the increase in the expectation of life is likely to continue with an intensification of the accompanying problems associated with an ageing population. As a class, ageing people suffer progessively from defects and diseases of which they apparently often remain unaware and as a consequence a doctor's advice and treatment is not sought. Metabolism slows down with some degree of thyroid deficiency, and the lack of an adequately balanced diet tends to lead to gradual and undetected deficiency diseases. Doubtless the slow development of official services specifically for the aged is due, in a large measure, to the lack of tangible results when compared with those obtained from facilities afforded the pediatrician—geriatricians at present are unable to make substantial wage-earners of old-age pensioners. Nevertheless, much invalidism of old age is preventable and economically it is preferable (and cheaper) to keep the elderly mobile and independent than to expend vast sums in hospitalisation. 72 The present situation throws a great onus on to the Public Health departments generally. Owing to senescence or ill health many old persons are unable to maintain an adequate standard of cleanliness and cases are brought to the notice of the department by neighbours, secretaries of Old Peoples' Associations and, occasionally by hospital almoners ; additional cases are brought to light following the staffs visits to almshouses. In the course of dealing with these particular problems this department becomes somewhat of a " clearing house " and there are very few cases brought to our notice which fail to receive adequate help or advice. During the year the staff dealing with this aspect of the department was increased and the following is a summary of the work carried out by the Lady Public Health Inspector and the Health Visitor during 1959:- No. of dirty premises inspected 48 No. of verminous premises inspected 17 No. of dirty rooms cleansed 75 No. of verminous rooms cleansed 49 No. of verminous persons visited 24 No. of verminous persons treated:-Heads 66 Other 31 No. of visits to scabies cases 25 No. of visits for Cleansing Service:-First 53 Subsequent 71 No. of articles cleansed 21,020 No. of inspections of factories:-(a) with mechanical power 46 (b) without mechanical power - (c) other premises - No. of inspections of Hairdressers' premises 33 No. of inspections of Outworkers' premises 47 No. of inspections of Houses Let-in-Lodgings 7 No. of inspections of Women's Conveniences 10 No. of Bathing Centre sessions 115 No. of Baths:-at Home 742 at Centre 436 No. of visits to Infirm Persons 3,830 No. of visits to Rest Homes, Hospitals, etc. 32 No. of visits, re: housing 47 No. of visits to Food Premises, re: Meals for O.A.Ps. 36 No. of Miscellaneous visits 200 No. of re-inspections, calls made, etc. 288 No. of interviews for Holidays 228 No. of interviews at offices 186 No. of complaints received 48 No. of Intimation Notices served Nil National Assistance Act, 1948.—Section 47 of this Act enables the Medical Officer of Health compulsorily to remove to hospital or institution any aged or infirm persons unable, adequately to care for themselves. 73 Where delay of even a few hours may prove decisive the Medical Officer of Health, in accordance with the National Assistance (Amendment) Act, 1951, is empowered to arrange for the removal of urgent cases without the necessity of giving 7 days notice. Orders for removal can be made by a Court of Summary Jurisdiction or a single Justice on an application certified by the Medical Officer of Health and another registered general medical practitioner and where agreement to receive such patients has been reached with the hospital or institution authorities. If necessary the court or justice may act ex parte. Orders so made under the Amendment Act are limited to a period not exceeding 3 weeks and applications for extensions of this period must be made in accordance with the procedure laid down in Section 47. During the year no cases occurred where the provisions of the National Assistance Act for compulsory removal had to be enforced. Experience shows that friendly persuasion is the best method especially if the situation is explained carefully to old people that the Health Department is here only to serve their best interests. Cleansing of Old People.—Section 43 of the London County Council (General Powers) Act, 1953, provides for the cleansing of any aged person in the district who : (a) is verminous or for any other reason in need of cleansing in order to prevent injury or the danger of injury to health ; and (b) is so enfeebled that he is unable to avail himself of any facilities for cleansing himself provided by the authority under any enactment or to cleanse himself properly. In this respect, during the current year, 436 baths were given to dirty or verminous elderly persons at the Cleansing Station and 742 home baths were effected. These represent substantial increases over the figures for the previous year which were 151 and 224 respectively. 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, bed-linen, 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. 74 From the Council's limited stocks of bedding and clothing it is possible in certain circumstances for temporary supplies of linen, etc., to be made to people whose own is being laundered, and co-operation with voluntary organisations often results in the repair or replacement of outworn articles. By the end of the year the laundry service, supervised by the Lady Public Health Inspector, had been extended to 222 separate individuals and during the current year, the staff at the Cleansing Station have dealt with 21,020 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 although the association obtains money from various sources such as the street appeal and other donations, the bulk of the association's expenditure is sustained by the grant received from the Borough Council. The following are extracts from the sixth Annual Report of the Association. " Old People's Clubs.—In accordance with past practice, we commence our Annual Report by mentioning the Derby and Joan Clubs, the Federation Clubs and Church Clubs which are one of the main sources of contact amongst the elderly in the Borough. These clubs continue to thrive through the untiring efforts of members of voluntary bodies who organise the clubs and their helpers. Whilst each club receives a small grant made each year by the Borough Council, for which we extend our sincere thanks, the Clubs are self supporting and, on behalf of the many hundreds of old people who attend the clubs, we would like to extend our appreciation to the organisers and helpers for their work in this field. Arrangements have also been made with the Manager of the local National Assistance Board to address the Clubs on the benefits available from this source and we are pleased to report that, as a result, a number of our elderly people have been advised to apply for National Assistance. Day Rooms at the Community Centres.—Once again, we feel that separate reports should be made in respect of each of the Day Clubs, but it is opportune to mention that Mr. D. C. R. Munro, the Chief Welfare Officer of the London County Council and Chairman of the Consultative Committee on the Welfare of Old People, visited the three Day Clubs accompanied by the Chairman and ViceChairman and stated that the excellent facilities provided should be greatly appreciated by all using them. 75 Charlton House Day Club This Club, which has been operating for over four years is still very popular and regularly used, especially by quite a number of elderly gentlemen who meet daily. Kidbrooke House Day Club The Kidbrooke House Day Club has, until recently, not proved very successful and during the past year, has not been used by elderly people. We have been very concerned at this state of affairs and have investigated many suggestions to popularise this Club. Finally, on the 2nd June, 1960, a scheme came into operation whereby six elderly invalids were collected from their homes in the Minibus and taken to Kidbrooke House where they were looked after by members of the British Red Cross Society and provided with Meals on Wheels. They were then returned home during the late afternoon. The scheme, which operates on one day per week at the moment, is greatly appreciated by the old people concerned and it is hoped to extend this service in the very near future. West Greenwich House Day Club The West Greenwich House Day Club which opened on the 11th September, 1957, is proving very successful and membership has increased over the past 12 months, largely due to the paid helper, Mrs. A. Crowshaw, to whom we extend our sincere appreciation. The average daily attendance over the past year has been 35 and lunches are served each day to approximately 6/10 old persons. We are deeply indebted to the Greenwich Borough Council for the facilities which they have made available to us at the Community Centres. Meals on Wheels.—Thanks to the generosity of the Greenwich Borough Council, we are very pleased indeed to report the purchase of a Morris Minibus to augment the meals-on-wheels service. This vehicle came into operation on the 1st April this year and, whilst easing the position regarding the number of meals delivered by each van, has also enabled additional meals to be served daily. The following is a statement of the number of meals served during the Financial Year 1st April, 1959, to 31st March, 1960:- British Red Cross Society's Van 9,461 Old People's Welfare Association Van 9,099 Women's Voluntary Services Van 6,791 25,351 76 The above figures show an increase of 3,535 meals supplied compared with the previous year. Demand on Mondays is still light and the Women's Voluntary Services Van has not been used on this day. On the 2nd May, 1960, the price of a meal to old people was increased from 10d. to 1/- with a corresponding increase in the grant received from the London County Council. This increase was imposed after negotiations on our behalf, between the Medical Officer of Health and the caterer, Mrs. MacDonald, had resulted in an improvement in the quality of the meal served. We would like to express our sincere appreciation to the drivers and helpers who deliver these meals each day to homebound and invalid elderly persons and cannot praise too highly the value of this service. Holidays for Elderly Persons.—Since the last Annual Meeting, we have again been able to send two parties of elderly persons to Margate for a fortnight's holiday. The September, 1959, party numbered 125 and the May, 1960, party 120. On each occasion, exceptionally fine weather was experienced and, from the many letters of appreciation received, everyone benefited from the holiday. Members of the Committee travelled with the coaches as escorts, and in view of the favourable reports received, we have given instructions for reservations to be made for a further party of 136 in September next. Quite apart from the large holiday parties sent to Margate, there are many old people who are not physically capable of being included in such parties and, in order that these persons should not be deprived of the benefits of a holiday by the sea, arrangments were made for a party to be sent to Lancing in July of last year and two parties during June, 1960. These persons are accommodated at a boarding house at Lancing where all the rooms are on the ground floor level and the gardens overlook the sea. No nursing attention is given, but there are many additional amenities to those found at an ordinary boarding house and the staff go out of their way to ensure that these invalid persons enjoy their holiday to the full. Transport has been a problem in the past and our sincere thanks are due to the Borough Council for loaning us their Minibus to take our parties to Lancing. With the purchase of the new Minibus, however, we are now able to provide our own transport in this connection and we would like to place on record our appreciation to the drivers and escorts for voluntarily carrying on this very important service. 77 Christmas Food Parcels.—As in past years, we received the customary grant from the Borough Council and were able to distribute food parcels to 350 homebound elderly persons. Each person was vetted to ensure that only those who were strictly homebound received a parcel containing the following items :— Tea, biscuits, Christmas pudding, tin of fruit salad, tin of cream, box of cheeses, sweets and chocolate. Members of the Committee and other volunteers packed and wrapped the parcels and helped with the distribution and our sincere thanks are due to all who helped at such a busy time of the year. In addition to the above, several donations were received with a request that parcels be bought and distributed and, as a result, approximately 70 additional homebound persons received parcels of varying contents. After investigating the position very closely, twenty-four frozen Christmas dinners were purchased and delivered to elderly persons who had nobody to provide for them on Christmas Day. These dinners had merely to be heated to provide a meal consisting of Chicken, vegetables and Christmas Pudding. Foods for Old People.—Once again we are pleased to report a substantial increase over the previous year in the receipts for sales of Welfare Foods up to the 31st March, 1960. These sales totalled £888 11s. 7d. On the recommendation of the Medical Officer of Health an additional food was this year added to those available to elderly persons and this service, which contributes in no small way to the good health of our elderly citizens, is greatly appreciated. This large turnover in stock does, however, mean a great deal of work for the members of the Women's Voluntary Services, by whom the main distribution is carried out and we would thank them most sincerely for this service. In order that homebound persons should not be deprived of this service, we have authorised the printing and issue of Welfare Food Permits to relatives or friends of homebound old people in order that they may purchase Foods from the Women's Voluntary Services or their nearest Old People's Club on their behalf. House-to-House Collection and Street Appeal.—The House-toHouse Collection and Street Appeal which was held during the first week of September, 1959, resulted in the sum of £90 17s. 4d. being credited to the Association's voluntary funds. The Committee appreciate most sincerely the efforts of all who assisted, and in particular, those elderly people who helped to collect on the day of the Street Appeal. Carol Service.—Once again we are pleased to report that a Carol Service, held at St. Alfege's Church on the 14th December, 78 1959, was very well attended, nearly 200 old people being present, many of whom were transported to the Church by voluntary drivers. Our sincere thanks are due to the Vicar, Members of the Church Council and the Church Organist for the facilities and willing co-operation provided in arranging this Service. Tea was provided in the Parish Hall by the Women's Fellowship under the direction of Councillor Mrs. K. P. Bullard, the cost being met by the Association, and this was greatly appreciated by the old people who attended. Entertainment.—The Nightmares Concert Party provided excellent entertainment for over 600 elderly people in the Borough Hall on 11th April, 1960. We are extremely grateful to the Borough Council for granting us the free use of the Borough Hall and also to the employees of Siemens (Brothers) Ltd. for giving the time to rehearsing and presenting this concert. Exhibition of Aids for the Disabled.—Arising out of a talk given by the late Secretary, Mrs. E. M. Wigley, to a Quarterly Meeting, an Exhibition of Aids for the Disabled was held in the Minor Hall on the 14th and 15th June, 1960. Exhibits were provided by the British Red Cross Society, Miller Hospital and various industrial firms and approximately 300 persons visited the Exhibition. Whilst this is not a large number, we feel that we have brought these aids to the notice of persons such as Doctors, Hospital Staffs, etc., who are in a position to recommend them to infirm and disabled persons, thus enabling them to live a fuller and more independent life. Leaflets on Welfare Services.—The Central Consultative Committee on the Welfare of Old People, in conjunction with the Ministry of Pensions, propose to issue leaflets throughout the Metropolitan Police Area to new Old Age Pensioners when they collect their Pension books. These leaflets will provide details of the welfare services for old people together with the addresses of the local Old People's organisations. We have agreed to participate in this scheme and, in addition, have arranged to issue a local leaflet giving detailed information regarding all services available to old people in the Borough of Greenwich. It is hoped that these latter leaflets will be available for distribution in the near future. Acknowledgments.—It is not possible to mention individually all who have helped with the work of the Association during the past year and we would, therefore, like to say a sincere " thank you " to all the voluntary workers who have given up their time so willingly on behalf of the old people. We feel, however, that we must make special mention of the Greenwich Borough Council for the very many facilities made available to us and especially for the financial grants which have amounted to a considerable sum. As mentioned earlier in the Report, due to the generosity of the 79 Borough Council, we have been enabled to purchase a new Minibus and provision has also been made to cover the cost of equipping, staffing and maintaining this vehicle. As a result we have been enabled, not only to maintain, but also to extend, the services offered to our elderly people. Our thanks are also due to the Town Clerk, the Medical Officer of Health, the Borough Treasurer and their staffs for the willing assistance they have afforded us during the past year. Mention must also be made of our late Honorary Secretary, Mrs. E. M. Wigley, whose life was devoted to the welfare of old people. As Divisional Director of the local British Red Cross Society, her duties were many and varied and her cheerful outlook and unflagging work on behalf of this Association will be greatly missed. We, the Executive Committee, are inspired by the willing cooperation of all the voluntary helpers and friends and, not least, by the appreciation shown by the old people themselves. It is a privilege to engage in this work and our earnest endeavour is to extend its scope and influence to every old person within the Metropolitan Borough of Greenwich." Executive Committee, 1959/60.—The Committee for the past year has been as follows :— Council Representatives: Councillor Mrs. M. L. Wentworth (Chairman) Councillor Mrs. M. L. Bennett Councillor Mrs. K. P. Bullard Councillor Lady D. Hume, J.P. Councillor H. W. H. Icough Councillor H. Ingle Councillor C. Shaw Elected Representatives: Miss E. Bertrand (Albany Institute) Mrs. E. Cummings (Townswomen's Guild) Mrs. M. Gardener (Women's Voluntary Services) Mrs. N. C. Lewis (Vice-Chairman) (Inner Wheel Club of Greenwich) Mrs. F. Stapley (British Legion, Women's Section) Mrs. E. M. Wigley (British Red Cross Society) Mrs. F. A. Williamson (Family Welfare Association) 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 80 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 1959, arrangements were made under the above Act for the burial of 5 bodies, one female and 4 males (one a male infant found on the river foreshore) at a total cost to the Council of £7 15s. Od. Exhumations.—Two exhumations were carried out during the year and the Public Health Inspector of the district was present on each occasion to see that the usual precautions were observed. Summary of Work Performed by the Public Health Inspectors during the Year 1959 Inspections- Houses inspected (House-to-House) 16 „ „ (Complaints, nuisances) 1,222 „ „ (Infectious Disease) 418 „ „ (Overcrowding) 39 Re-inspections, calls made, etc 7,764 Inspections of Factories 384 „ „ Shops 6 „ „ Hairdressers or Barbers 42 „ „ Licensed Victuallers 16 „ „ Pet Shops 9 „ „ Stable; and yards 6 „ „ Urinals 95 „ „ Houses let in Lodgings 14 „ „ Outworkers premises 47 „ Under Clean Air Act 1,225 „ Miscellaneous 1,137 Inspection of Premises (Pharmacy and Poisons Act, 1933) II „ „ „ (Rent Acts) 94 Investigations (Rats and Mice) 356 On notice from Builder 400 13,301 Drains— Drains tested—by smoke 125 „ „ —by water 280 Opened, cleansed and repaired 422 Reconstructions and additions 212 Inspection chambers constructed 95 New covers to manholes 58 Soil and vent shafts repaired or renewed 102 Traps (gully) 175 Drains sealed off, etc. 89 Yards and forecourts drained 35 81 Waterclosets and Urinals— Closets erected 106 W.C.s repaired 143 Sanitary conveniences or improvements effected to Factories and Workplaces 21 W.C. pedestals installed 200 Urinals cleansed or repaired 20 Dustbins— Provided 151 Pavings— Yards and Forecourts 71 General Water Supply- Water Fittings amended 249 Extra water supply to tenement houses — Water supply certificates granted (Sect. 95) 166 Other Improvements— Houses generally repaired 109 Rooms cleansed and repaired 416 Rooms and staircases lighted and ventilated 5 Verminous rooms cleansed 83 Roofs, gutters and rainwater pipes repaired 380 Dampness abated 415 Sinks, baths and lavatory basins 324 Sink, lavatory and bath waste pipes trapped or amended 210 Stoves and fireplaces 81 Washing coppers repaired or provided 2 Floors repaired 169 Provision for storage of food 25 Miscellaneous repairs 700 Other Nuisances Abated- Illegal use of Underground rooms discontinued 2 Overcrowding abated 50 Animals kept in unfit places discontinued or removed 3 Dung receptacles provided — Accumulation of mature and other abnoxious matter removed 58 Rat infestation abated 105 Smoke Nuisances- Observations 1,033 Statutory Notices served (Sects. 147 and 148) — Notices, &c.- Intimations served under Public Health (London) Act, 1936 552 Statutory Notices served 94 Houses rendered fit by informal action 67 82 SECTION D Housing Whenever the subject of housing is raised, attention is more usually directed to and concentrated on the number and quality of dwellings being provided by the various agencies concerned. In the general scheme of public health, however, this most vital, albeit complicated problem, is viewed from a slightly different angle in that health, rather than actual provision of houses, is paramount and it is perhaps unavoidable in these days of extreme shortage that the psychological aspects of the situation should be overshadowed by the emphasis laid on new housing and slum clearance. That unsuitable housing conditions are responsible for many of the smaller and some of the larger tragedies of life is beyond doubt and it is inevitable that an unsympathetic approach to the problem merely serves to aggravate an already serious situation. Many details which on the surface and in themselves appear pointless have a great relevance to the happiness and well-being of the public at large. Most people, more especially perhaps townsfolk, are very much creatures of habit with their likes and dislikes and this is particularly so with regard to housing. Many like their own district better than any other and often prefer to make their day to day purchases at the small shop " over the way " than travel to large and modern emporiums so evident in new housing schemes. Some people choose to form part of a large group while others prefer living in a small community. Very close living is often the cause of mental illness but so is loneliness enforced on people as a result of slum clearance or other schemes which remove them from their normal surroundings. It is evident that uncongenial housing conditions, in large communities or small, whether from compulsory re-housing or from choice, whether in new property or old, beget mental discomfort often with deleterious results in the young and old alike. Much of the supposed advantage of present day high density housing achieved by building upwards appears to be illusory. It seems paradoxical when, in order to house the maximum number of people in a given area, local authorities, of necessity, are driven to the construction of multi-storey dwellings and, having done so. utilise the so-called " saved " space either as " prohibited " lawns or for buildings considered essential for a full social and cultural life. Again, where people are constrained to take up " flat" life difficulties in attaining a successful family life soon arise, for the pursuit of hobbies and pastimes has mainly to be made away from 83 the home and its influence, a situation for which television is hardly the panacea. In old established urban areas this may not be too great a problem but in newly built up areas where few social amenities exist and there is no community background, the effect, especially on the young, is most marked. In this context much can be said for a somewhat less spacious or spectacular dwelling with an area of garden private to each individual family. Naturally everyone's particular and personal housing needs cannot be met in full in any local authority's housing programme, for decisions are dependent on so many factors ; nevertheless, within certain limits it should be possible for attention to be afforded to some preferences in order to avoid a future legacy of social and perhaps mental instability. In addition to the problems of increasing population and shortage of " housing space" there is that of finance. In this instance the Town and Country Planning Act, 1959, has added to these difficulties now that local authorities, on acquiring land for housing purposes, must pay compensation on a basis of " open market price " as opposed to the previous " existing use " value. This Act, introduced to provide owners with a more equitable settlement, nevertheless adds to the strain on local government resources However, the government, in furthering a policy of encouraging home ownership, of raising housing standards and of increasing emphasis on slum clearance, introduced additional legislation in the shape of the House Purchase and Housing Act, 1959, parts of which are paraphrased below. It is of interest to recall that on 7th December of this year, after being welcomed by the Mayor of Greenwich, Councillor L. C. Green. J.P., the Minister of Housing. Mr. Henry Brooke. M.P. proceeded to Blackheath to declare open the millionth privately built house since the war. This dwelling incidentally was No. 16. Corner Green. Blackheath. S.E.3. Legislation.—House Purchase and Housing Act, 1959. Briefly this Act, operative from the 14th June, provided inter alia, for Exchequer grants to and deposit of trust funds with certain designated building societies to enable them to make more and bigger loans (up to 95%) for the purchase and improvement of pre-1919 houses up to a value of £3,000 in the London area. Provisions enabled such societies also to advance loans to cover the owner's share of the cost of carrying out to older properties, improvements attracting grants under the Act. 84 Where assistance is given under Part II, the Act introduced a new system of grants which can be claimed as a right, provided the standard amenities, viz.: (a) fixed bath or shower in bathroom, (b) a wash hand basin, (c) a hot water supply, (d) a water closet in or contiguous with the dwelling, (e) satisfactory facilities for storing food, are introduced for the exclusive use of the occupants of the property in question and that the dwelling will be fit for human habitation for at least 15 years. The Housing (Underground Rooms) Act, 1959.—The purpose of this Act, operative from the 14th june, was to restore to local authorities the powers which they previously had under Section 12 (2) of the Housing Act, 1936. and subsequently consolidated in Section 18 (2) of the Housing Act. 1957. to close insanitary basement rooms. Procedure under Housing Act, 1957.—The following representations were made under Part II of the above Act during 1959 :— Section 18.—Part of building unfit for human habitation, i.e. a room, the surface of the floor of which is more than 3 ft. below adjoining ground level and defective in matters listed in Section 4 of the said Act. 8, Georgette Place, S.E.10. 4. King George Street. S.E.10. The Council's powers to close underground rooms were originally provided by Section 12 of the Housing Act, 1936, but in a Judgement of May 1957, the Court of Appeal took the view that as a result of the Housing Repairs and Rents Act, 1954, the exercise of these powers had become subject to the application of the genera) standards of fitness itemised in Section 4 of the Housing Act, 1957. Underground room regulations previously made by local authorities under Section 12 (2) (b) of the 1936 Act therefore became virtually ineffectual. This legal interpretation deprived local authorities of a simple, quick and effective means of obtaining the closure of unhealthy underground rooms and representations made to the Minister of Housing and Local Government indicating the restricting nature of the recent legislation resulted in the Housing (Underground Rooms) Act, 1959, which restored the former position. 85 Slum Clearance.—In addition to the areas previously agreed with the L.C.C. as suitable for slum clearance, a site in Maryon Road was surveyed with a view to an acquisition by the Council on a voluntary basis. Purchase terms have been agreed and the legal formalities are awaiting completion. House Purchase and Housing Acts, 1958 and 1959.— Improvement Grants.—Section 20 of the Housing Act, 1949, as modified by Section 16 of the Housing Repairs and Rents Act, 1954, empowering 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 15 years, has now been replaced by Section 30 of the Housing (Financial Provisions) Act, 1958. These grants are now known as discretionary grants. During the year 17 grants were so made. Section 4 of the House Purchase and Housing Act, 1959, introduces a new system of grants known as standard grants which, if certain conditions are fulfilled, can be claimed as a right. Up to the close of the year no such grants had been agreed. Re-Housing.— (a) Borough Council.—There were 45 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 233. Of this number 2 were in respect of overcrowded cases and 17 families re-housed from outside the Borough. The Housing Department now has control of 3.688 Councilowned units of accommodation, an increase of 246 over that of the previous year. At the end of the year, in addition to 37 occupied hutments, a total of 203 properties giving 395 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, 1959, the L.C.C. had provided alternative accommodation for a total 319 Greenwich families of which 6 had been certified as overcrowded cases. Of this figure, 200 were housed on L.C.C. housing estates outside the Borough. Four families from outside Greenwich were rehoused in the Borough under the L.C.C. scheme. (c) Other.—A further 42 families were rehoused by other means. 86 Overcrowding.—As a direct result of rehousing carried out under (a), (b) and (c) above 50 cases of overcrowding were abated during the year under review. The number of unabated certified cases of overcrowding in the Borough now amounts to 64. During 1959 there was a fall in the number of complaints received concerning overcrowding, the year's figure of 31 showing a decrease of 27 from that of the previous year. Each complaint was investigated by the Public Health Inspector concerned and as a result of these investigations 10 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 1946 in the number of families found to be living in overcrowded conditions in the Borough:- Year No. of cases of overcrowding reported 1946 261 1947 128 1948 162 1949 168 1950 148 1951 56 1952 52 1953 53 1954 39 1955 39 1956 38 1957 25 1958 18 13-year average 91 1959 10 New Housing Accommodation.—The following table lists the new dwellings erected in the Borough during 1959:- Type of Dwelling G.B.C. L.C.C. Private Total Houses 45 - 54 99 Houses (rebuilt) - 2 1 3 Flats - 20 44 64 Total No. of Dwellings 45 22 99 166 Excluding the families accommodated in requisitioned property, the total number of dwellings provided in the Borough since the termination of the war is now 5,497. 87 Council Housing Schemes.—(Information supplied by the Borough Engineer). (a) Schemes completed during the year under review :— Site Dwellings Tunnel Avenue Group 47 (b)Schemes in progress at the end of the current year:— Site Dwellings Coldbath Street 8 Dutton Street 8 Shooter's Hill Road/Rochester Way 18 Westcombe Hill/Westcombe Park Road 16 50 (c) Building programme for rehousing envisaged for 1960, et seq:— Site Dwellings Trafalgar Road 16 Burnley Street/Gloucester Circus 54 70 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. 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 1959:— "Last year in these notes I referred to the fact that a very high proportion of all vacancies in Council properties in 1959 would have to be allocated to families transferred from requisitioned accommodation in view of the cessation of requisitioning powers on 31st 88 March, 1960. This forecast has been amply borne out since only 21 families were rehoused from the housing register during the year compared with 114 in 1958. It was certainly the leanest year in this respect since the war, the situation being aggravated by the fact that only 47 new dwellings were handed over for letting. One hundred and fifty-five families were transferred from one property to another during the year and these included a high proportion of transfers from requisitioned premises. The number of mutual exchanges effected was 36 which is up to the average for the last few years. " Considerable progress was made in solving the requisitioning problem and 367 dwelling units were released from requisitioning during the year. Quite a number of these were purchased by the Council and at the end of 1959 a total of 255 dwelling units had been purchased since the Requisitioned Houses and Housing (Amendment) Act, 1955, come into operation. Three hundred and twenty-seven had been released to owners with vacant possession during that 3½ year period and in 589 cases owners had accepted licensees as their tenants. " By the end of the year there remained 397 dwelling units still requisitioned but of these all but 98 were accounted for in one way or another, mainly as a result of negotiations for purchase or lease. In connection with the purchasing programme it had been necessary to make three Compulsory Purchase Orders affecting some 58 dwellings. " Despite the reduction in the numbers rehoused from the housing register the latter once again showed a fall during the year. This trend has been evident for some years now. The average number of new registrations per month was 25 but cancellations were such that the number registered at the end of the year was 1,969 compared with 2,142 at the beginning. " The outlook for next year is that again very little progress will be made in rehousing from the housing register since the end of requisitioning will not be the end of the problem. The vast majority of acquired requisitioned premises will have to have works of repair, adaptation and conversion carried out on them and this will mean that a large number of properties will have to be vacated to enable these works to be carried out. Furthermore there will be families to be transferred from sites to be redeveloped so that the emphasis will be once again on transfers and not on the rehousing of housing applicants." 89 SECTION E Inspection of Food and Supervision of Food Premises Food hygiene has always been of the utmost importance in the life of the community but, until recent years, it has been very difficult to impress upon the public the consequences of inadequate standards in the handling and preparation of food. Some three years have now elapsed since the Government introduced Food Hygiene Regulations for improving the standards of environmental and personal hygiene in food shops, canteens, restaurants, etc., with particular emphasis on the control of staff suffering from acute infections or who were carriers of pathogenic organisms responsible for the spread of food poisoning. Control of bacterial infection in home-produced and imported foods is still a serious problem. It has been proved conclusively that meat and meat products, eggs and their derivatives are the media by which food poisoning is largely disseminated and there is growing evidence that cross infection of meat in slaughterhouses is an increasing hazard. Whilst it is clear that a great deal has already been achieved in raising standards of hygiene, much remains to be accomplished and to this end the Food Inspectors have sought the co-operation of all food traders in the Borough with an encouraging measure of success. Advice on food problems is offered by the inspectors on all suitable occasions in an endeavour to break the chain of events leading to the spread and multiplication of food poisoning organisms. This has, in many instances, led to the introduction of improvements in food shops especially with regard to refrigeration. In general co-operation from shopkeepers and management is very cordial although interest in the practical application of hygiene, with particular reference to food, appears to be inversely proportional to the status of the individual in the business. Even in the most hygienic factory, equipped with the most up-to-date apparatus and despite advice and instruction from the Food Inspector concerning the most effective and hygienic practices, one ignorant, careless or apathetic employee can jeopardise the health of hundreds of people. Chance contamination however is not confined merely to the worker in the catering industry, it can be perpetrated by the man at the market, the delivery man or even the customer. Negligence at any level is to be deprecated and a high standard of food hygiene is 90 attainable only by a knowledge of the principles involved and an intelligent attention to detail. There is no doubt that an educated public, more than legislation, will ensure that restaurants and food shops maintain a satisfactory standard of hygiene. Legislation.—Of the new legislation introduced in the current year concerning food, the following enactments and their associated Orders and Regulations were considered the more important:— The Milk and Dairies (General) Regulations, 1959.—These Regulations re-enacted with amendments the Milk and Dairies Regulations, 1949 to 1954, and came into force on 8th March of the current year. The principal changes are :— (a) the registration of distributors is now required to be effected only with the local authority in whose area the premises from which the milk is distributed are situated; (b) suitable and properly trapped internal drains are permitted in a milking house which is not used for the housing of cattle where no other means of drainage is reasonably practicable ; (c) provision is made for the local authority to pay compensation to a person who sustains damage or loss through being debarred from certain employment connected with cows or with milk because he is suffering, or has been in contact with a person suffering, from a disease liable to cause infection of milk ; (d) where milk is infected, or suspected of being infected with disease :— (i) the appropriate notice may be served by a medical officer of health on the occupier of registered premises outside (as well as inside) his district and, in the case of tuberculosis, it shall operate until it is withdrawn; (ii) the conditions as to compensation have been considerably modified ; (e) an electric or gas boiler may be used in a milking house or milk room and bottles which have contained certain foods other than milk may be cleansed in a milk room ; (f) there are new provisions as to personal cleanliness, precautions against contamination or infection of milk and the provision of first aid equipment; (g) the Minister may permit milk to be cooled in a closed container in a milking house not used for the housing of cattle where the cows are milked by mechanical means direct to such container; 91 (h) there are new provisions relating to the misuse of milk churns, the cleansing of vessels and appliances, the storage of cartons and non-returnable containers and the use of bottle-washing machines for cleansing glass bottles ; (i) the collection of milk by milk tanker from a tank on a farm is permitted ; (j) a person selling milk as, or as part of, a meal or refreshment is exempted from the prohibition against opening any receptacle containing milk or transferring milk from one receptacle to another elsewhere than on registered premises. The Food Standards (Ice Cream) Regulations, 1959.—Operative from 27th April, these Regulations, made under Sections 4 and 123 of the Food and Drugs Act, 1955, revoke and replace the Food Standards (Ice Cream) Order, 1953, and prescribe amended standards of composition for Ice Cream and Kosher Ice and introduce separate standards of composition for Dairy Ice Cream and Milk Ice. Alternative standards are prescribed for certain descriptions of ice cream containing fruit, fruit pulp or fruit puree. The Ice Cream (Heat Treatment, etc.) Regulations, 1959.— These Regulations which came into force on 27th April consolidate and amend the Ice Cream (Heat Treatment, etc.) Regulations, 1947-1952, and require that ingredients used in the manufacture of ice cream are to be pasteurised by one or other of three specified methods or sterilised and thereafter kept at a low temperature until the freezing process is begun. It now becomes an offence to sell or offer for sale ice cream which has not been so treated or which has been allowed to reach a temperature exceeding 28°F. without again being treated. Water Ices and Ice Lollies which are sufficiently acid are exempt from the requirements. The Labelling of Food (Amendment) Regulations, 1959.— From 27th April, new provisions relating to Ice Cream are introduced by these Regulations. In amending the Labelling of Food Order, 1953, they control the labelling, marking or advertising of Ice Cream and impose requirements concerning pre-packed ice cream. The Condensed Milk Regulations, 1959. Operative from the 26th June, 1959. these Regulations substantially re-enact in a consolidated and revised form, the Public Health (Condensed Milk) Regulations, 1923/52. New provisions have been introduced, the principal ones being :— (a) to provide for the sale of condensed, partly skimmed (half cream) milk labelled "should not be used for babies except under medical advice" ; 92 (b) to define half cream milk as meaning milk which contains not less than 10.8% of milk solids, including not less than 1.8% of milk fat; (c) to prescribe minimum percentages of milk fat and milk solids including fat for condensed, partly skimmed (half cream) milk. Other Statutory Instruments and Circulars were published during the year in respect of arsenic and fluorine in foods, approved chemical agents, etc., and with regard to imported food, " official certificates " for Poland were sanctioned. Some further Regulations and Orders were issued in connection with slaughterhouses covering among other items, hygiene, prevention of cruelty, forms and records, etc. 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 (General) Regulations, 1959.—Under the provisions of these 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 111 which total includes 6 dairy premises. On 30 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. 93 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, 1959 :— Licences In Operation Principal Licences issued 31.12.59 Distribution of Sterilised Milk 81 75 „ Pasteurised Milk 46 45 „ „ Tuberculin Tested 35 31 Supplementary Licences Distribution of Sterilised Milk 20 20 „ Pasteurised Milk 18 17 „ Tuberculin Tested 18 18 Sampling.—Under provisions of the Third Schedule to the first of the above-mentioned Regulations, Methylene Blue and Phosphatase tests have been prescribed, the former for assessing the " keeping" qualities of milk, and the latter for estimating the efficiency of pasteurisation. In addition, a Turbidity test is also prescribed for ascertaining the effectiveness of the heat treatment of Sterilised milk. During the year 59 samples of milk consisting of 44 Pasteurised milks, 2 Sterilised, and 13 T.T. Pasteurised were examined in accordance with the prescribed tests and all proved to be satisfactory. Analytical Examination of Milk.—All designated milks being sold in the Borough were sampled, including those of the superfatted variety, viz., Channel Island, Jersey, South Devon, etc. A total of 24 formal samples were submitted to chemical analysis and all proved to be genuine. Eight samples of cream (one sterilised) were sampled and found to be genuine. Summaries of samples taken from L.C.C. Schools and Nurseries for chemical and bacteriological examination continued to be furnished regularly to that authority. Preserved Food and Ice Cream Premises.—In accordance with the provisions of the Food and Drugs Act, 1955, Section 16, all premises with the exception of schools, clubs, hotels or restaurants used :— (a) for the sale, or manufacture for the purpose of sale, of ice cream, or storage of ice cream intended for sale ; or 94 (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 89. One hundred and thirteen visits of inspection were made to Preserved Food premises and Fried Fish shops as a result of which 13 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 215. Visits to these premises were made on 126 occasions and 5 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. From time to time representations have been made to the Minister of Health with a view to the adoption of a bacteriological standard of cleanliness but he has made it known that he is satisfied that no existing test is precise or selective enough to justify its adoption as a statutory measure. In his opinion the methylene blue reductase test affords a simple and valuable " rule of thumb" method for the measurement of the bacterial cleanliness of ice cream indicating the necessity or otherwise of further investigation into methods of production. 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." The Ice Cream (Heat Treatment, etc.) Regulations, 1959.—In consolidating and amending the previous Regulations 1947 to 1952, these Regulations, operative from 27th April of the current year, require, inter alia, that ingreients used in the manufacture of icecream be pasteurised by one or other of three specified methods, viz.:— Method I. The mixture shall be raised to and kept at a temperature of not less than 150°F. for at least 30 minutes. Method II. The mixture shall be raised to and kept at a temperature of not less than 160°F. for at least 10 minutes. 95 Method III. The mixture shall be raised to and kept at a temperature of not less than 175°F. for at least 15 seconds. An alternative to pasteurisation is given, namely, sterilisation and in this instance the mixture shall be raised to and kept at a temperature of not less than 300°F. for at least 2 seconds. Subsequent to pasteurisation or sterilisation the mixture shall be reduced to a temperature of not more than 45°F. within 1^ hours and shall be kept at such a temperature until frozen, after which it must be kept at a temperature not exceeding 28°F. up to the time of sale. 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 47 samples were submitted for examination and the ice-cream graded according to the Ministry's provisional Grading Scheme. The grading is based on the results of the Methylene Blue Reductase Test and a summary of this year's reports is given below:- Samples taken Time taken to Reduce Methylene Blue Provisional Grade Observations 23 4½ hours or more 1 Satisfactory 11 2½to 4 hours 2 Sub-standard 2 ½ to 2 hours 3 Unsatisfactory - 0 hours 4 Most Unsatisfactory 11 Ice-lollies From the reports received these lollies were bacteriologically 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) Regulations, 1959. In connection with quantitative analysis, one ice lolly and one of ice cream mix were examined in the normal course of food sampling. Both samples proved to be satisfactory and reference to the Analyses will be found under the heading of Food and Drugs Act, 1955. Merchandise Marks Act, 1926.—Under the powers conferred by this Act, Orders in Council have been made prohibiting the sale 96 or exposure for sale of imported foodstuffs unless bearing an indication of the country of origin. Eighty-two inspections were made to secure compliance with the various Orders but on no occasion was it found necessary to take action against Vendors. Blackheath Fair.—At Easter. Whitsun and the August Bank Holiday, many thousands of Londoners from this and adjacent Boroughs once again availed themselves of the opportunity of making a visit to this source of entertainment. Constant supervision of refreshment stalls, etc., was necessary to ensure that a safe standard of cleanliness was maintained by the vendors and to this end a Food Inspector was always in attendance. In all, some 14 visits were made to the fair during the holiday periods. 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, and Part VII of the London County Council (General Powers) Act, 1957, registration with the local Council is compulsory for all street traders. During the year 43 applications were made and licences granted to street traders engaged in the retailing of articles of food. Only certain streets in the Borough are designated for street trading; it is not the policy of the Council to grant licences for such trading in streets other than those designated. No contraventions of Regulation 26 of the Food Hygiene Regulations, 1955/57, 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 97 of the manufacturers of pharmaceutical sundries, mineral waters and ice cream as well as fruit-canning factories, flour millers and brewers. To these establishments the Food Inspectors made 3,211 visits, as a result of which 45 premises were improved. The following table is a statistical record of the major portion of the duties performed and inspections undertaken during the year by the Food Inspectors. Premises Inspected or Visits Made No. of Visits No. of Premises at which Improvements were effected Caterers', Restaurants, etc. 177 13 Grocers, Greengrocers 190 10 Butchers' Shops 95 10 Dairies and Milk Distributors 30 — Wharves and Factories 711 — Bakehouses and Bakers' Shops 37 1 Ice-Cream Premises, Confectioners, etc 126 5 Fried Fish Shops 28 3 Other Fish Shops 42 1 Cooked Meat & Preserved Foods 85 * Visits Re. Shops Act 229 - „ „ Infestations 45 - „ „ Food and Drugs Act 218 1 „ „ Merchandise Marks Act & Markets 112 - „ „ Food Poisoning 64 - Sampling Visits 345 - Fair Visits 12 - School Visits 12 1 Miscellaneous Visits (including Flour MillsCyanide Fumigation) 567 - Interviews 17 - Complaints Investigated 65 - Totals 3,207 45 * Included under Grocers' and Butchers' Shops. Bakehouses.—At the end of the year, 8 premises in the Borough were being used as bakehouses, none of which was underground. Bakehouses and bakers' shops were visited on 37 occasions and, as a result of the inspections one improvement was effected. 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 98 Inspectors. Disregard of normal hygiene in the handling and preparation of food at such establishments can lead to an outbreak of food poisoning on a large scale and it is a tribute to the Inspectors' vigilance that no such outbreaks have occurred. As a result of 177 visits of inspection to the catering establishments, insanitary conditions were remedied and improvements effected on 26 occasions. The following is a summary of the improvements carried out:- Type of Improvement Effected Total No. Walls, Ceilings, Repaired Cleaned and Redecorated (Premises) 8 (Kitchen) 2 New Branch Drain 2 New Gullies 4 New Sinks 2 New Handbasins 2 Floors resurfaced (premises) 1 Ventilation Improved 1 Water Heater installed 3 Cooker repaired 1 Total improvements effected 26 Many licensed victuallers have instituted a catering service during the last few years, some providing prepared food to be consumed at the bar counter and others supplying a cooked lunch in a separate dining room. Six improvements were carried out at public houses as a result of informal action. Food Rejected.—The following table is a summary of unsound food voluntarily surrendered during the year under the provisions of the Public Health (London) Act, 1936, Section 180(8) most of which was processed and used for animal feeding :- Shops, Stalls, etc.:— Meat- Beef and Pork (Various cuts) 302 lbs. Cow Heels 11 „ Mutton and Lamb (Various cuts) 4 „ Bacon 118 „ Kidneys—Pigs' 28 „ Poultry 14 „ Rabbits 65 „ 542 lbs. 99 Canned and Other Foods- Foods (Various) (Canned) 2,920 lbs. Corned Beef (Canned) 20,616 „ Cooked Meats (Canned) 1,385 „ Chicken Fat (Canned) 800 „ Haddock (Fresh) 28 „ Cheese 82 „ Cheese Trimmings 8 „ Rice 119 „ Jam 22 „ Pears (Canned) 2,179 „ Cherries (Canned) 2,433 „ Oranges (Canned) 2,830 „ Pineapple (Canned) 3,568 „ Tomatoes (Canned) 255 „ Walnuts 285 „ 37,530 lbs. Total 38,072 lbs. Wines and Minerals 38 Bottles Compared with the previous year, the amount of meat rejected rose by 249½ lbs. during 1959, and the total of all food rejected increased by 22,236 lbs. 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 95 visits of inspection and arranged for the correction of insanitary defects at 10 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 100 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. The following foods were rejected at the wharves :— Meat— Beef (Various Cuts) 1,144 lbs. Sheep and Lambs (whole) 263 „ Mutton and Lamb (Various Cuts) 405 „ Kidneys—ox and sheep 62 „ Livers—sheep 1½ „ 1,875½ lbs. Canned and Other Foods— Cooked Meats (Canned) 794 lbs. Foods (Various) (Canned) 2,632 „ Fruit (Various) (Canned) 983 „ Whole Dried Egg 203 „ 4,612 lbs. Total 6,487½ 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. 101 Results of examinations for caseous lymphadenitis are given below. Landed Examined Rejected Weight Australian Sheep, Ewes & Wethers 3,993 41 Nil — New Zealand Sheep 63,365 637 Nil — Importation of Diseased Livers.—For some time livers have been arriving in this country marked "Livers, Inedible—Not for Human Consumption" or "For animal feeding only" and a high percentage of these have been affected with hydatid cysts (a stage in the life cycle of a tape worm). Absence of legislation governing this type of importation has meant that there has been a real danger of this diseased meat finding its way into channels from whence it might be used for human consumption. In order to control just such commodities, the Ministry of Agriculture, Fisheries and Food introduced the Meat (Staining and Sterilising) Regulations, 1959, which were to become effective on 1st April of the current year but before this date they were withdrawn. It is to be hoped that these or similar Regulations will shortly be issued to enable riparian authorities to protect the public against these suspect importations. Imported Egg Products.—Greenwich, as a riparian authority, has been receiving since June, 1956. substantial landings of egg products imported mainly from China. From the commencement, sampling revealed the presence of salmonella organisms in a large proportion of the consignments and on one or two occasions contamination with paratyphoid bacilli. In the case of flaked and powdered albumen, the problem has largely been overcome with the introduction of the heat treatment chamber but no satisfactory arrangement has yet been arrived at with other egg products such as 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 most difficult situation could arise should an importer demand action in accordance with Sec. 8(2) of the Public Health (Imported Food) Regulations, 1937, namely, either release or condemnation of his consignment within 48 hours-a time limit which proscribes the use of bacteriological results by the Medical Officer of Health in his deliberations whether to release or alternatively to condemn a commodity which would involve the importer in a serious financial loss. 102 In 1958 the Chief Medical Officer of the Ministry of Health was made aware of the seriousness with which the Public Health Committee viewed importations of this nature. Resulting from this approach a meeting which was tentatively arranged for the latter end of 1958 was finally held on the 9th September of the current year at the Ministry between Council and Ministry representatives. On behalf of the Council, attention was drawn to the very great concern felt with regard to the dangers of salmonella and paratyphoid infection arising from the importation of egg products from China and other foreign sources. It was pointed out that Greenwich was particularly involved in that large quantities of such products were being imported through wharves which were the subject of inspection by the Council's Food Officers and. further, that the sampling procedure at present in use did not appear to be a satisfactory safeguard in that from the results obtained it was clear that some of the unsampled products were likely to be infected to a greater or lesser degree. From the information available to the Council it seemed that the best solution would be to require the pasteurisation of egg products in the country of origin under conditions approved by the Ministry. In reply the Ministry officials emphasised that they fully agreed that the position was not entirely satisfactory and that they would certainly like to see some better method of control. The whole problem was under very active consideration and there was every hope that a satisfactory answer would be found to the considerable difficulties involved. Egg products were, however, a very valuable food for which there was no real substitute and the possible loss involved had to be weighed against the danger of infection. With regard to the sampling procedure at present followed by local authorities, the Ministry officials expressed the opinion that it served a most valuable purpose. Not only did it give some protection in regard to individual consignments, but perhaps of equal importance it had kept exporters alive to the need to improve standards and had in fact led to the acceptance by them of important safeguards. It had also resulted in the Ministry advising importers to refuse supplies from certain sources. In conclusion, the Council representatives were given an assurance that the Ministry were making every effort to achieve a satisfactory solution of the problem at the earliest possible date. (l) 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 the premises of Messrs. J. Palmer (Deptford) Ltd., Prince Street, S.E.8. 103 Batch No. No. of Containers Control Samples Bact. Results of Positives after Heat Treatment Positive Negative Positive Negative Percentage rate of Control Sampling : 10% 40 60 11 4 5* 6 41 101 — 11 — — 42 34 14 20 4 30 43 75 4 1 — 4 44 132 4 11 — 4 * American Albumen. Incidence of Salmonellae: Containers Salmonella bareilly 1 „ blockly 1 „ give 1 „ meleagradis 2 „ oranienberg 2 „ seftenberg 1 „ typhimurium 1 (ii) Dried Egg Albumen. (Conditional Releases.)- Country of Origin Quantity Imported Containers Sampled No. of Positives America 88 x 50 lb. boxes 24 2* „ 32 x 100 lb. drums 4 — „ 22 x 100 lb. drums 3 — „ 110x 100 lb. drums 11 — „ 88 x 50 lb. drums 44 — „ 110 x 100 lb. drums 11 — „ 55 x 100 lb. drums 6 — „ 88 x 50 lb. drums 9 — „ 165 x 100 lb. drums 17 — „ 132 x 100 lb. drums 14 — „ 44 x 100 lb. drums 6 — „ 154 x 100 lb. drums 16 — „ 88 x 50 lb. boxes 8 — „ 110 x 100 lb. drums 11 — „ 88 x 100 lb. drums 10 — „ 219 x 100 lb. drums 22 — „ 22 x 100 lb. drums 3 - „ 92 x 50 lb. boxes 11 — „ 220 x 100 lb. drums 24 — „ 154 x 100 lb. drums 16 — „ 143 x 100 lb. drums 18 — „ 88 x 50 lb. boxes 10 — „ 88 x 100 lb. drums 9 — „ 110 x 100 lb. drums 11 — „ 81 x 100 lb. drums 15 — „ 5 x 200 lb. drums 5 — „ 44 x 100 lb. drums 16 — „ 22 x 100 lb. drums 5 — „ 110 x 50 lb. drums 11 — „ 110 x 100 lb. drums 11 — „ 132 x 200 lb. drums 15 — „ 33 x 100 lb. drums 10 — „ 88 x 100 lb. drums 11 — „ 134 x 100 lb. drums 22 — „ 88 x 50 lb. drums 10 — „ 221 x 100 lb. drums 50 — „i 45 x 50 lb. drums 10 — „ 112 x 50 lb. drums 12 — „ 67 x 100 lb. drums 20 — „ 88 x 50 lb. boxes 10 — Holland 20 x 55 lb. drums 20 - * Salmonella thompson. 104 (iii) Other Imported Egg Products.—The following consignments were subjected to a percentage bacteriological examination: — Country of Origin Type of Egg Product Quantity Imported No. of Samples Taken No. of Samples Contaminated America Dried Whole Egg 21 x 100 lbs. 3 Argentine „ 812 x 55 lbs. 82 - China „ 3,602 x 110 lbs. 587 32 (a) East Germany „ 3,000 x 44 lbs. 181 - Holland „ 437 x 100 lbs. 45 - 68 x 66 lbs. 8 - Sweden „ 60 x 110 lbs. 6 - 17 x 90 lbs. 2 - America Glycerinated Hen Egg Yolk 1 x 165 lbs. 1 - (a) Incidence of Salmonellae: Samples Salmonella aberdeen 1 „ meleagridis 1 „ potsdam 1 „ thompson 21 „ typhimurium 8 (iv) Spray Dried Albumen. (Chemical Examination.)—In order to calculate more accurately the heat treatment necessary for a satisfactory outcome to be obtained in respect of this type of egg product, four samples of American Spray Dried Hen Egg Albumen and four samples of American Flake Albumen were examined for moisture content and pH values and the results were as follows:- Sample Type of Albumen % Moisture pH Value "A" Spray Dried Albumen 5.02 5.7 "B" 6.47 5.5 "C" 7.13 5.5 "D" 3.78 5.8 "E" Flake Albumen 12.90 5.1 "F" 12.78 5.1 "G" 11.58 5.0 "H" 13.90 5.3 Food and Drugs Act, 1955.—In accordance with the Council's contract with the Public Analyst, 529 samples were presented for examination, of which 116 were obtained in accordance with the Public Health (Imported Food) Regulations. The remaining samples, consisting of 36 formal and 377 informal were obtained in the normal course of sampling and of these. 13, all informal, 105 were reported to be non-genuine. Five of the unsatisfactory samples were only incorrectly labelled and have not therefore been included in the calculation of the adulteration figure which, at 1.9%, shows a decrease of 1.7% from that of last year. Again milk was one of the main foods sampled and in all. 24 samples were procured, of which 6 were in respect of Channel Island Milk. No milk sample was adversely reported upon and, in respect of milk other than Channel Island, the average percentage of milk fat was 3.57 and solids-not-fat, 8.56, the standard being 3.00 and 8.50 respectively. In passing, it should be pointed out that included in these figures are 4 samples which, although slightly deficient in solids-not-fat, were certified by the Public Analyst to be genuine. However, in accordance with the Milk and Dairies (Channel Islands and South Devon Milk) Regulations, 1956, milks in these categories must contain a minumum of 4% milk fat and 8.50% solids-not-fat. Channel Island milks sampled in the Borough during the year proved to have an average content of 4.26% and 8.87% respectively. The one ice cream lolly obtained and submitted to the Public Analyst for examination proved to be genuine and fulfilled the requirements of the Food Standards (Ice Cream) Regulations, 1959. Flour (Composition) Regulations, 1956.—These regulations provide for the fortification of flour with added nutrients. Seven samples of flour were specially tested for the added nutrients and all were found to comply with the requirements of the regulations. 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.—Three samples were taken for analysis, one each of Cararrh Pastilles, Blood Mixture and Cherry Cough Linctus. all of which complied with the provisions of the above Act. Public Health (Dried Milk) Regulations, 1923 to 1948.— These Regulations control the minimum milk-fat content of dried milk and the labelling of tins or other receptacles in which this commodity is contained. No samples were obtained during the current year. The Condensed Milk Regulations, 1959.—In addition to minimum percentages of milk-fat and milk-solids of condensed milk, the standards of labelling of receptacles are covered under the provisions of these Regulations. Six samples of condensed milk were taken in the normal course of sampling, all of which were declared to be genuine. 106 Other Food Examinations.—In addition to those obtained under the Food and Drugs Act, other articles not procured in the normal course of sampling were examined either by the Public Analyst or at the Public Health Service Laboratory. These examinations were the outcome of complaints from members of the public or as a result of special investigations into certain foods carried out by the Food Inspectors or as the "follow-up" to reported food poisoning cases. Information concerning the analyses of these samples is given in the following table:- Article How Obtained Examination Action Taken Bact. or Chem. Result Corned Beef (canned) Taken from Cold Store in Borough. Bact. After incubation of cans and contents at 37°C for 4 days all cultures remained sterile. Importer notified. Chinese Butter Taken from Cold Store in Borough. Bact. Organisms of the Salmonella group not isolated. Importer notified. Portion of Sliced Loaf Complaint by member of the public that fragments of a razor blade were embedded in bread. Chem. Fragments of a razor blade were found in the wrapped, cut loaf of bread. Legal proceedings taken against the Bakers concerned. Fined £10 and ordered to pay £5 5s. 0d. costs. Pineapple Chunks (canned) Taken from Cold Store in Borough. Chem. Contents found in reasonably sound condition with no evidence of fermentation. Importer notified. Portion of Unwrapped White Loaf Complaint by member of the public of strange taste and foreign body found in the bread. Chem. A piece of torn cotton material measuring 3½" x 1½" and also various other fragments of cotton found in the bread. Warning letter sent to Baker concerned. Boiled Egg with pink colouration of white Complaint from a local hospital. Chem. The analysis indicated that the dye was not one of the permitted colouring matters specified in the Colouring Matters in Food Regulations, 1957, but a synthetic dye of the oil-soluble azo class. No action possible. 107 Article How Obtained Examination Action Taken Bact. or Chem. Result Portion of Cut Wrapped Loaf Complaint by member of the public of small particles of black extraneous matter embedded in the bread. Chem. The analysis indicated that the black particles were composed of burnt flour and would not render the bread injurious to health. Complainant informed. Remains of Joints of Lamb which had been cooked and reheated Taken from a local canteen after an outbreak of food poisoning amongst people who had eaten part of the lamb. Bact. Staphylococcus aureus infection was present in the meat, due to careless food handling. A 30-minute lecture on the clean and careful handling of food was given to the canteen staff. Remains of Roast Beef which had been cooked and reheated Taken from a local canteen after an outbreak of food poisoning amongst people who had eaten part of the joint. Bact. No pathogenic organisms were isolated. Canteen authorities informed. Portion of Cut Wrapped Loaf of Bread Complaint by a member of the public that bread contained a foreign body. Chem. The analysis revealed that the foreign body consisted of a black substance composed of mineral grease containing a quantity of iron in the form of very small particles. Warning letter sent to Bakers concerned. Corned Beef with Cereal (canned) Taken from a Cold Store in the Borough. Bact. After incubation for 5 days at 37°C, all cans remained normal. Contents normal All cultures sterile. Importer notified. A tin halffull of Coffee Preparation and the residue from a cup of Coffee which had been prepared with this powder Complaint by a member of the public that the coffee in the cup became a dark bluish/black colour and tasted bitter. Chem. The analysis revealed that the coffee extract powder was normal. The residue in the cup had an abnormally high, iron content, possibly due to some iron already deposited in the cup before the coffee was made. Consumption of this residue would not be harmful. Complainant notified. 108 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 43 notifications received during the year compared with 39 for the previous year, 17 for 1957, 23 for 1956, 14 for 1955, 12 for 1954 and 9 for 1953. All cases, which were of the sporadic type, were investigated with the following results:— No. of Cases Organism (if known) No. of Hospital Cases Remarks 13 Salmonella typhimurium 2 One hospital case-no particular food was suspected. In the other hospital case, ham was suspected but could not be verified. In two home cases faggots were suspected but this could not be confirmed. In the other nine home cases no particular food was suspected. 1 Salmonella polsdam - This patient, an elderly lady of 77 years was discharged from the Brook Hospital still positive having originally been admitted as a dysentery case. Food poisoning was not notified until she had been discharged. No investigation was therefore possible. 29 Unknown - In five cases meat pies were suspected. The following foods were suspected in individual cases; salmon, cherries, pears, chicken jelly. None of these could be verified. With regard to the other twenty cases no particular food was suspected. 43 2 109 FOOD AND DRUGS ACT, 1955 Number and Description of Samples Submitted for Analysis under the above Act during the year 1959 (including samples taken under the Public Health (Imported Food) Regulations) Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Ale — 1 1 — — — Almonds — 1 1 — — - Batter Mixture — 1 1 — — — Beans, Butter - 1 1 — — — Beverages — 4 4 — — — Biscuits — 2 2 — — — Blancmange Powder — 1 1 — — — Brandy 2 — 2 — — — Bread — 4 4 — — — Butter — 10 10 — — — Butter, Chinese — 1 1 — — — Cake Mix — 4 4 — — — Capers — 1 1 — — — Caraway Seeds — 1 1 — — — Caviar Paste — 1 1 — 1 1 Cereals — 1 1 — — — Cheese — 1 1 — — — Cheese Spread — 3 3 — — — Coconut, Desiccated — 1 1 — — — Coffee Extract — 1 1 — 1 1 Coffee Chicory — 1 1 — — — Coffee & Chicory Essence - 2 2 - - - Confectionery, Flour — 5 5 - — — Confectionery, Sugar — 9 9 - — — Cooking Fat — 1 1 - — — Cornflour — 2 2 - — — Cream — 9 9 - — — Custard Powder — 1 1 - — — Drinks, Soft — 6 6 - 1 1 Drinks, Soft, Powder — 1 1 - — — Dripping — 1 1 - — — Eel in Jelly — 1 1 - — — Egg, Dried — 1 1 - — — Fish, Fresh — 1 1 - — — Fish, Canned — 42 42 - 4 4 Fish Paste — 9 9 - — — Flavouring — 6 6 - — — Flour — 8 8 - — — Fruit, Canned — 62 62 - 2 2 Fruit, Dried — 9 9 - — — Fruit, Fresh - 4 4 - — — Fruit, Glace - 1 1 - — — Fruit Curd - 1 1 - — — Fruit Juice - 5 5 - - - 110 Article Number Examined Number Adulterated. &c. Formal Informal Total Formal Informal Total Fruit Pie — 1 1 - — - Fruit Puree — 2 2 — — — Gin 4 — 4 — — Glucose — 1 1 — — — Gravy Preparation — 1 1 — — — Honey — 1 1 — — — Ice Cream Mixture — 1 1 — — — Ice Lolly — 1 1 — — — Jam — 12 12 — 1 1 Jelly Crystals & Tablets — 3 3 — — — Lard — 2 2 — — — Macaroni — 1 1 — — — Macaroni, Canned — 1 1 — — — Malt Extract with Cod Liver Oil - 1 1 - - - Margarine - 4 4 — — — Marmalade - 1 1 — — — Marmalade, Sugarless - 1 1 — — — Marzipan - 2 2 — — — Meat, Fresh - 3 3 — — — Meat Paste - 6 6 — — — Meat Products - 66 66 — 6 6 Medicines - 5 5 — — — Milk 24 — 24 — — — Milk, Condensed — 6 6 — — — Milk, Evaporated — 2 2 — — — Mincemeat — 1 1 — — — Pancake Mixture — 1 1 — — — Pasties, Cornish — 2 2 — — — Pastry, Puff — 1 1 — — — Pea Flour — 1 1 — — — Peanut Butter — 1 1 — — — Pease Pudding, Canned — 1 1 — — — Pepper — 2 2 — — — Pickle — 9 9 — 2 2 Potato Mixture — 1 1 — — — Potato Whirls — 1 1 — — — Pudding, Canned — 1 1 — — — Pudding, Christmas — 1 1 — — — Puppodums — — 1 — 1 1 Rice — 1 2 — — — Rice, Canned — 2 2 - — — Rum 2 2 2 - - — Rum Butter — 1 1 - — — Sago, Canned — 3 3 — — — Sauce — 13 13 — — — Sausages, Canned — 1 1 — — — Sausages & Sausage Meat 25 25 - 2 2 Sausage Rolls — 6 6 — — — Semolina — 1 1 — — — Soup, Canned — 4 4 - — — Soup, Prepared — 1 1 — — — Spaghetti, Canned — 2 2 — — — Spice — 5 5 - - - 111 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Suet, Shredded — 2 2 — — — Sugar — 9 9 — — — Table Creams — 1 1 — — — Tapioca — 1 1 — — — Tea — 1 1 - — — Tea Extract — 1 1 - — — Vegetables, Canned — 23 23 - 1 1 Vegetable Juice — 1 1 - — — Vinegar — 5 5 - — — Whisky 4 — 4 - — — Wine, Alcoholic — 1 1 - — — Yeast — 1 1 - — — Yoghourt — 1 1 - — — Totals 36 489 525 — 22 22 112 Administrative Action Taken in Regard to Samples Reported to be NOT GENUINE Sample No. Article Nature of adulteration and/or irregularity Action taken (a) In respect of normal sampling. T. 21 Preserved Pork Sausages Meat contents 58%. There was no evidence of preservative. Warning letter sent to manufacturers T. 342 Preserved Pork Sausages Meat contents 58%. There was no evidence of preservative. Pork Sausages should in, Analyst's opinion, contain not less than 65% meat and if labelled as preserved, should contain preservative. T. 25 Bartlett Pear Halves in Syrup Metallic contamination had rendered the fruit unfit for human consumption. Letter to Importer. Consignment surrendered and destroyed. T. 44 Apricot Jam Jam was deficient in soluble solids according to the Food Standards (Preserves) Order. Letter to Hungarian Commercial Attache. T. 127 Puppodums Not labelled in conformity with Labelling of Food Order. Letter to Wholesaler. T. 130 Apricot Halves, Canned Contained an excessive proportion of iron. All existing stocks destroyed. T. 173 Smoked, sliced saithe, in soya bean oil Contained prohibited preservative, Benzoic acid. Letter to Norwegian Commercial Attache. T. 192 Faggots Product was composed of pieces of luncheon meat and had neither the composition, flavour, texture or colour of faggots. Letter to manufacturer. Name of Product was subsequently changed. T. 240 Tirhoot Chutney Not labelled in conformity with Labelling of Food Order. No statement of ingredients attached. Remaining stock withdrawn. 113 Sample No. Article Nature of adulteration and/or irregularity Action taken T. 242 Lemonade Crystals Not labelled in conformity with Labelling of Food Order. No statement of ingredients attached. Letter to Wholesaler for observations. T. 266 Pork Luncheon Meat, Canned Meat contents 68%. In Analyst's opinion Pork Luncheon Meat should contain not less than 80% meat. Manufacturer's observations sought. T. 273 Coffee Consisted of Dry Coffee Extract although described as "100% Pure Coffee." No statement of ingredients as required by the Labelling of Food Order. Manufacturer's observations sought. (b) In respect of samples taken under Imported Food Regulations. TT. 4 Pickled Beelroot Contained an excess of Ben zoic Acid. Consignment re-exported TT. 7 Casserole Steak (canned) Meat content 60%. Letter to Importer and Australian Government Trade Commissioner. TT. 10 Casserole Steak (canned) Meat content 76%. In the Analyst's opinion, the meat was deficient. TT. 15 Asparagus Tips Not labelled in conformity with the Labelling of Food Order. Letter to Importer and Australian Government Trade Commissioner. TT. 42 Beef Steak with Gravy (canned) Meat content 60%. In the Analyst's opinion the meat content should be not less than 75%. Letter to Importer and Australian Trade Commissioner. TT. 43 Luncheon Meat Loaf (canned) Meat content 59%. In the Analyst's opinion the meat content should be not less than 80%. Letter to Importer and Australian Trade Commissioner. TT. 70 Smoked Sliced Saithe Contained a prohibited preservative—Benzoic Acid. Letter to Importer and Norwegian Commercial Attache. TT. 78 Smoked Sliced Saithe in Soya Bean Oil 114 Sample No. Article Nature of adulteration and/or irregularity Action taken TT. 79 Caviar Fish Spread Contained an oil-soluble coaltar colour which did not correspond to any of the permitted colouring matters listed in the Colouring Matter in Food Regulations. Letter to Importer and Norwegian Commercial Attache. TT. 97 Anchovy Sprats Contained a prohibited preservative—Benzoic Acid. Letter to Importer and Norwegian Commercial Attache. 115 SECTION F Prevalence of, and Control over, Infectious and Other Diseases Infectious diseases such as tuberculosis, typhoid, cholera, plague, smallpox, etc., no longer threaten the community as hitherto. Better nutrition, improved social conditions and, in more recent years, immunisation and the introduction of sulpha drugs and antibiotics have together brought about a complete transformation in the field of preventive medicine. It is now possible to contemplate complete control of infectious disease in the near future by existing measures. It must be remembered that, in 1900 at the time of the formation of the Metropolitan boroughs, pulmonary tuberculosis throughout the country was claiming some 40,000 victims per year and diphtheria a further 7,000. Comparable figures for 1958 were 4,000 and 2 respectively, showing what a tremendous impact organised preventive medicine can have on the health and longevity of life of the nation. Nevertheless there are certain disturbing features in the use of modern chemotherapeutic drugs which will require intensive investigation. Firstly, there is a tendency for the production of resistant strains of causal organisms ; secondly, in many cases patients may have or may develop sensitivity to new drugs, and thirdly, there is a strong possibility that the use of these modern drugs is partly responsible for an increase in " collagen " diseases. Today, in the management of the infectious diseases, emphasis is made on vaccination and immunisation, the methods which proved so successful in the control of smallpox and diphtheria. In poliomyelitis the incidence of paralysis has been drastically reduced (some experts put the reduction as high as 80%) by effective vaccination and great strides are being made in this field in controlling epidemic influenza. During the current year, no new Statutory Instruments were issued in respect of Infectious Diseases. Legislation introduced since 1949, in accordance with Section 144 of the Public Health Act, 1936, concerning the notification of poliomyelitis, encephalitis, meningococcal meningitis, puerperal pyrexia, etc., has in common with other London boroughs, led to the allocation to Greenwich of notifications in respect of non-residents merely as the result of the accidental location of hospitals in the vicinity. Statistics in connection with the notification of these diseases therefore, have no specific relevance to the population of the Borough and, with the uninitiated, could even be misleading. 116 Irrespective of the area of occurrence, births and deaths art 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 1,056. Under the Public Health (Tuberculosis) Regulations, 1952. there were 46 notifications, giving a consolidated total of 1,102 cases notified during the year. The following table indicates the figures for the previous ten years:— Year No. of corrected notifications 1949 1,335 1950 1,644 1951 2,266 1952 1,565 1953 1,242 1954 569 1955 2,120 1956 844 1957 1,558 1958 607 10-year average 1,375 1959 1,102 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. 117 During the current year it was necessary to issue three certificates, one in respect of Scarlet Fever, and two in respect of Food Poisoning. One was furnished during 1957 and none in 1958. Smallpox.—There were no cases notified during the year, but a number of contacts were reported arriving in the Borough from abroad, and these were kept under observation for the requisite period. Public Health (Smallpox Prevention) Regulations, 1917.—These Regulations give a Medical Officer of Health power to vaccinate or re-vaccinate without charge, any contacts of Smallpox cases willing to submit themselves for treatment. Vaccination.—Smallpox is a very dangerous and disfiguring disease and prior to the introduction of compulsory vaccination in 1853, nine-tenths of smallpox victims were children under 5 years of age. Subsequent to this period, children, by and large, escaped. However, since 1898, when the ' conscientious objection' clause made its appearance, vaccinations have declined steeply and the position deteriorated still further from 1948 when vaccination became optional. Glycerinated calf lymph is the standard vaccine used in this country and the number of vaccinations carried out in the Borough at the County Council clinics during 1959 was 712. This is an increase of 219 over the previous year. In Greenwich during the last 9 years 11,934 births have been registered, and for the same period only 6,352 vaccinations have been effected, a figure equivalent to 53.2%. 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 oe 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 118 national 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 285 certificates of persons proceeding abroad were so authenticated, of these 241 were in respect of Smallpox, 30 for Cholera and 14 for Typhoid. Three vaccinations were carried out by your Medical Officer of Health. Measles.—The normal biennial fluctuation was less evident during 1959. The increase in the number of confirmed cases rose from 306 in 1958 to 637 for the current year. Of these 338 were males and 299 females. Twenty-seven cases occurred in children under one year of age. 589 between 1 and 10 years and 21 over 10 years. Four cases were removed to hospital and there were no deaths. The distribution of the cases was as follows: —East Greenwich 218; West Greenwich 162; St. Nicholas, Deptford 15; Charlton and Kidbrooke 242. During 1957, 1,194 cases were recorded and in 1956 there were 44. Whooping Cough.—Altogether 34 notifications were received in 1959, a decrease of 21 from the previous year. The year 1957 produced 97 and there were 122 for 1956. Area distribution for the current period was: —East Greenwich 5; West Greenwich 11; St. Nicholas, Deptford 5; Charlton and Kidbrooke 13. One case was admitted to hospital and there were no fatalities. With regard to children under 5 years, 7 were immunised against whooping cough while 53 other children received a combined antigen (whooping cough and diphtheria) and a further 811 received a triple antigen (whooping cough, diphtheria and tetanus) giving a final total of 871 whooping cough immunisations carried out during the year by the County Council. Diphtheria.—There was a Nil return recorded for the current year, a result similar to that for the previous year and for the years 1957 and 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. 119 Since 1945, diphtheria notifications for England and Wales have fallen from 18,596 to 103, the figure for the current year. Over the same period deaths have decreased from 722 to nil. Diphtheria immunisation is a County Council service and during the year there were 893 completed immunisations carried out in the Borough, an increase of 228 over that of the previous year. Most diphtheria immunisations given formed part of combined antigen therapy. 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 20 cases attributed to these causes, as compared with 42 for 1958, 28 for 1957 and 14 for each of the years 1955 and 1956. Seven occurred in East Greenwich, none in West Greenwich, 1 in St. Nicholas, Deptford, and 12 in Charlton and Kidbrooke. One case was removed to hospital and there were no deaths. Typhoid.—No cases of typhoid fever were notified during the year compared with one last year, two for 1957 and one for 1956. Scarlet Fever.—A total of 68 confirmed cases for the year shows a decrease of 38 from 1958 compared with 102 notifications for 1957, 58 for 1956 and 57 for 1955. Thirteen occurred in East Greenwich, 13 in West Greenwich, 6 in St. Nicholas, Deptford, and 36 in Charlton and Kidbrooke. Three cases were removed to hospital and no fatalities were recorded. Erysipelas.—Six cases were notified during the year compared with 3 for last year, a Nil return for 1957, 4 for 1956 and 6 for 1955. Zymotic Enteritis or Epidemic Diarrhoea (Children under 5 years of age).—Thirty cases were recorded as confirmed compared with 9 for the previous year, 12 for 1957 and 17 for 1956. One case received hospital treatment and no deaths were recorded. 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, 120 nevertheless the disease has become a serious nuisance and difficult to control. It is normally mild but in infants and young children it can produce serious illness and debility, especially if the patients are already slightly below normal health. In adults it is an irksome inconvenience and, if they work in the food trade, it can cause economic hardship. The remarkable fall in the incidence of dysentery during the previous two years was not continued during the current year for there was a resurgence from the figure of 20 for 1958 to 249 for 1959. The present figure, however, is still only approximately 50% of the total returned for 1956 (viz. 480), the year in which a detailed investigation and analysis was made of a most explosive outbreak. As in 1956, the age group 5-15 years was most affected providing some 47.4% of all notifications. The distribution of the cases was 37 in East Greenwich, 20 in West Greenwich, 41 in St. Nicholas, Deptford, and 151 in Charlton and Kidbrooke. Thirteen cases were removed to hospital but there were no fatalities. Scabies.—Four cases were so notified compared with one for the previous year, 4 for 1957, and 6 for 1956. Treatment for all cases of scabies is carried out at the Tunnel Avenue Centre. Puerperal Pyrexia.—During the year there were three notifications received in accordance with the 1951 Regulations, only one of which concerned a borough resident, but from other sources 18 cases concerning Greenwich residents were brought to the notice of the department, a similar figure being returned for 1958. All patients received hospital treatment. There were no fatalities. Meningococcal Infection.—There were two notifications received during the current year compared with none for the previous year, 2 during 1957, a nil return for 1956 and 5 for 1955. The one death registered concerned a male child of 10 months who died at home from acute meningococcal septicaemia. Acute Encephalitis. (Infective or Post Infectious).—a Nil return is recorded for the current year, a similar return to those for the years 1958. 1957, 1956, 1955 and 1954. 121 Ophthalmia Neonatorum.—In respect of this disease no notifications were received. One was recorded for 1958. 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 but this proved of no consequence during the current year as only 2 notifications of paralytic poliomyelitis were received, neither one of which concerned a Greenwich resident. Malaria.—One notification of benign tertian believed to have been contracted in the Middle East was received from the Royal Herbert Hospital in connection with a serviceman. Tuberculosis.—During the year 46 notifications in respect of confirmed cases of tuberculosis were received compared with 60 for 1958. Of these, 43 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 15 1 16 West Greenwich 4 1 5 St. Nicolas, Deptford 4 — 4 Charlton and Kidbrooke 20 1 21 Totals 43 3 46 Disinfection was offered and carried out in 5 cases including 9 rooms and 31 articles of clothing and bedding, etc. The number of notified cases of Tuberculosis remaining on the Register at 31st December, 1959, was as follows :— PULMONARY NON-PULMONARY Men Women Children Total Men Women Children Total M F M F 582 494 26 24 1,126 23 41 13 7 84 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. 122 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 Part I. —Summary of notifications of Tuberculosis during the period from the 1st January, 1959, to the 31st December, 1959. 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 2 5 4 4 8 1 - 28 Respiratory, Females — — — — 1 — 1 3 1 1 2 4 1 14 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 Respiratory M - - - - - - - - - - - - - - (A) Death Returns F - - - - - - - - - - - - - - (B) from Local Non-Respiratory M - - - - - - - - - - - - - - (C) Registrars F - - - - - - - - - - - - - - (D) Death Returns Respiratory M - - - - - - - - - - - - - - (A) from Registrar- F - - - - - - - - - - - - - - (B) General (Trans- Non-Respiratory M - - - - - - - - - - - - - - (C) ferable deaths) F - - - - - - - - - - - - - - (D) Respiratory M - - - - - - - - - - - - - - (A) Posthumous F - - - - - - - - - 1 - - - 1 (B) Notifications Non-Respiratory M - - - 1 - - - - - - - - - 1 (C) F - - - - - - - - - - - - - - (D) 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) 1 (D) — 123 Mass Radiography.—In London, Mass Radiography was originally carried out under the direction of the London County Council, but since January, 1948, the responsibility for this service has rested with the South East Metropolitan Regional Hospital Board. Introduced primarily for the early detection of Tuberculosis, the Mass Radiography service is responsible for revealing many other chest malformations and disabilities which would doubtless have remained undetected perhaps for years. As a direct consequence of the diagnosis of these ailments treatment is made possible at a very early stage, thereby enabling a much more favourable prognosis to be entertained. 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 Dirprtor for the following analysis of the results: — Summary of Surveys Carried Out in the Borough from 1st January to 31st December, 1959. PART I.—General Analysis Men Women Total (a) Total X-rayed 3,906 2,384 6,290 (b) Total previously X-rayed 2,662 1,742 4,404 (c) Total recalled for large film 172 87 259 (d) Number normal on large film 59 35 94 (e) Number abnormal on large film 111 52 163 (f) Not yet attended for large film 2 — 2 PART II.—Analysis of Abnormal Large Films (1) Cases considered tuberculous and referred for further investigation: Men Women Total (a) No further action required — — — (b) Occasional supervision 6 4 10 (c) Requiring close supervision or treatment 9 5 14 (d) Still under investigation — — — (e) Refused further investigation 2 — 2 124 (2) Previously known tuberculous cases 7 4 11 (3) Non-tuberculous cases: (a) investigated 30 7 37 (b) still under investigation — — — (4) Cardio-vascular lesions 2 4 6 (5) Abnormalities requiring no action 55 28 83 Verminous Conditions. —The procedure adopted to combat infestation by lice and general verminous conditions is essentially the same. In addition to the notified cases of Scabies, all suspected cases are followed up and the homes visited by the Lady Public Health Inspector who gives advice and instruction concerning treatment. Treatment for all cases is carried out at the Tunnel Avenue Cleansing Station and the following Return summarises the work carried out during the year:— Attendances Vermin Scabies Adults 45 17 Children under school age 30 15 School children 127 30 No. of home visits by Lady Public Health Inspector 49 No. of home revisits by Lady Public Health Inspector 82 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: — 125 Rooms and Articles Disinfected, Year ended 31st December, 1959 Diseases, etc. Premises Entered Rooms Beds Mattresses Bolsters Pillows Sheets Blankets Eiderdowns Cushions Quilts Odd Articles Wearing Apparel Rugs and Mats Covers Total No. of Articles Disinfected Scarlet Fever 33 65 12 31 14 73 50 130 19 23 10 173 192 — 19 746 Diphtheria — — — — — — — — — — — — — — — — Tuberculosis 5 9 — 2 1 7 2 3 1 — 1 10 3 — 1 31 Cancer 12 13 5 10 2 28 9 15 2 15 1 96 30 — 2 215 Meningococcal Infection 6 13 3 4 1 13 4 15 1 4 — 45 10 — 2 102 Puerperal Pyrexia — — — — — — — — — — — — — — - - Typhoid Fever — — — — — — — — — — — — - — - - Polio-Myelitis 2 4 — 1 — 4 2 8 1 — 1 8 5 — 1 31 Erysipelas — — — — — — — — — — — — — — — Acute Encephalitis — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — Scabies 1 2 — 1 1 2 3 5 1 3 — 5 8 — 2 31 Other Diseases 194 23 36 39 4 71 16 32 4 21 1 80 136 — 3 443 Verminous Premises 5 14 5 7 1 10 5 13 1 8 — 748 28 — 1 827 Dysentary 5 1 — 18 — — — — — — — — — — — 18 Total 263 144 61 113 24 208 91 221 30 74 14 1,165 412 — 31 2,444 Articles Destroyed — — 88 239 6 29 12 196 43 8 — 4,261 40 — 2 4,924 Library Books Disinfected 114 126 CHEST CLINIC REPORT 1 am indebted to Dr. D. G. Wraith, Chest Physician at the Greenwich Chest Clinic for the following Report on Tuberculosis in the Borough. STAFF Physicians Dr. Paul Forgacs Dr. Derek G. Wraith Tuberculosis Health Visitors Miss D. M. Noakes, Mrs. L. Smith, Miss E. Wells Clinic Nurse Mrs. M. Hawkins Radiographer Mr. A. Tinling (Locum) Care Organiser Miss B. Mould Occupational Therapist Miss M. Moncur Dressmaking Instructress Mrs. J. Wilkins Clerical and Administrative Mrs. E. M. Brown Mrs. M. Shackleton Mrs. K. Hicks (part-time) Mrs. A. Payne (part-time) Dr. Paul Forgacs was appointed to the Chest Clinic as Consultant Physician in June, 1959, and Dr. Derek G. Wraith was appointed Chest Physician in September, 1959. Since the resignation of Dr. C. W. L. Jeanes in July, 1958, the working of the Clinic has been carried on by Dr. Joyce Brown and Dr. Margaret Moore, who continued to uphold the same high standard of efficient service at Greenwich Chest Clinic. 127 Tuberculosis The Clinic tuberculosis register is as under:— Men Women Boys Girls Total Pulmonary Tuberculosis 538 456 20 22 1,036 Non-pulmonary Tuberculosis 13 18 6 7 44 1,080 The total figure for 1958 was 1,078 and for 1957 it was 1,075. This figure remains almost constant because many tuberculous patients who are apparently healed continue to attend the Clinic for follow-up supervision as a necessary precaution against relapse. Furthermore a number of these patients, whose disease has been healed by chemotherapy or surgical treatment, remain very disabled due to breathlessness and subject to bronchitis and this is another reason why they remain under supervision. The total number of new out-patients referred to the Clinic was 1,638 and total number of attendances 6,592. In 1958 the total number of attendances was 5,958. As the tuberculous patients are attending less frequently as time goes on, the attendance figure represents an increase of patients attending for non-tuberculous chest conditions. There were 17 deaths of patients on the Clinic register from all causes, of which 12 were from the result of their pulmonary tuberculosis. Forty-three new cases of pulmonary tuberculosis were notified during the year; last year there were 53 new cases notified and 75 in 1957. The 43 new cases were in the undermentioned age groups:— Males Females 1 Under 1 year — 2 10-20 1 6 21-30 4 2 31-40 2 6 41-50 2 4 51-60 2 6 61-70 3 - 71-80 1 - 81-90 1 Three cases of non-pulmonary tuberculosis were notified, one boy aged 12, meningitis, and 2 women, one aged 37, cervical glands, and one aged 33, peritonitis. 128 It will be seen from the age and sex distribution of these new diagnosed pulmonary cases that the majority fell into the older age group. The majority of these new cases were referred here from their Family Doctors, six having been notified from patients sent by the Mass Radiography Unit. Two hundred and eighteen ante-natal patients were X-rayed as a routine measure, but none of these was found to have any tuberculous disease. Two hundred and twentyeight persons were examined as contacts of tuberculous patients, 4 of these were found to have tuberculous disease. Treatment Periods of treatment of at least 18 months to two years with anti-tuberculous drugs have been found to be very effective provided these drugs are taken regularly by the patients. The results are so effective that surgical treatment is only occasionally required and the pneumothorax and pneumoperitoneum has been completely stopped in this Clinic. It is usual for a new patient to be admitted to hospital at the start of his treatment especially if he is infectious but it is aimed to keep the time in hospital as short as possible and to get the patient home and back to work soon and to continue the drugs as an out-patient. In this respect the tuberculosis ward at St. Alfege's Hospital has proved of considerable value as it is situated locally and is within easy access for relatives to visit and enables the treatment to be continued by the clinic Chest Physician. Prevention B.C.G. inoculation of children and young adults who are tuberculin negative has been continued. It is noticeable that the proportion of adults who are tuberculin negative is increasing but this state of affairs is now being changed by the routine B.C.G. inoculation of school children. Social work During the year Miss B. Mould was appointed as Care Organiser in the place of Miss Fischer who resigned. Besides acting as Secretary to the Care Committee the Care Organiser deals with all the routine investigation of the patients' financial affairs and also there are innumerable problems about which patients consult her and where her advice and encouragement is sometimes of greater value than material assistance. Unfortunately much difficulty arises for patients who are disabled by breathlessness as the result of previous tuberculous disease or by other chronic lung disease, in finding work which is physically suitable, in view of their disability, and financially adequate. 129 There are still a number of patients awaiting rehousing mainly those suffering from bronchitis and asthma, whose unsatisfactory housing is considered to play a part in making their symptoms worse. It is known that dampness in the house or surroundings tends to increase the symptoms especially in those suffering from allergic respiratory disease as well as bronchitis and the anxiety associated with inadquate housing also accentuates the condition. Miss Moncur, the Occuptional Therapist, continues to encourage and assist a number of our home-bound patients who are disabled as a result of tuberculosis and other chronic respiratory disease and this considerably improves the morale of these patients. Non-tuberculous chest disease The attention of Chest Physicians has in recent years been directed to the other major chest condition, chronic bronchitis, which is now responsible for far more disability than pulmonary tuberculosis. Many of these patients attend the Chest Clinic regularly and their assessment is carried out at the Respiratory Unit of the Brook Hospital with which we have a close liaison. A register of the more seriously disabled patients is kept at the Chest Clinic so that follow-up supervision with a special watch for the onset of respiratory failure is kept. At the same time advice about the many problems concerning employment, housing, financial difficulties, etc., is given. Asthma An Asthma Clinic has been started for treatment of these patients with a view to trying to prevent permanent respiratory disability which sometimes results and which can often be prevented by suitable treatment at an early stage. The diagnosis of many other chest conditions, including carcinoma of the lung, continues. 130 SECTION G Miscellaneous Guild of Hygiene.—As indicated in previous Reports 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. However, 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 no new certificates issued leaving a final total of 81 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 85 examinations were so made. Of these, one candidate was considered unfit for admission to the Council's Superannuation Scheme and two cases were defered 12 months for further examination. One examination was carried out in accordance with Section 106 of the L.C.C. (General Powers) Act, 1937, as amended by Section 28 of the 1951 Act (Widows Pensions). Extension of Service.—Of the five employees examined with a view to ascertaining their fitness for continuation of service after reaching retiring age, the Council were advised that all were so fit. Sick Persons.—In addition, the Medical Officer of Health carried out 39 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 three 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 17 interviews during year. INDEX Page A Acute Encephalitis 120 Acute Influenzal Pneumonia 119 Acute Poliomyelitis 121 Acute Primary Pneumonia 119 Adoptive Acts, Bye-laws and Local Regulations 3-4 Age Mortality 20-21 Aged, Infirm and Physically Incapacitated Persons 71-79 Aids for Disabled Exhibition 78 Analytical Examination of Milk 93, 105 Ante and Post Natal Clinics 37 Ante and Post Natal Clinics, Attendances 34 Anti-Fly and Anti-Mosquito Campaign 64 Antitoxin, Diphtheria 119 Ants, Pharoah's, etc 65 Area of Borough 9 Articles and Rooms Disinfected 125 Articles Destroyed 125 Artificial Sunlight Centres, Attendances 35 Artificial Sunlight Treatment 37 Asthma 129 Atmospheric Pollution 47-51 B Bacteriological Examinations 69, 93, 95, 101, 103, 104, 106, 107, 108 Baiting of Sewers 63 Bakehouses 97 Baths and Wash-houses 67-69 B.C.G. Vaccinations 36,128 Births 15, 18 Birth Registrations 18 Blackheath Fair 96 British Red Cross Society 39 Bronchitis 31 Burial or Cremation of the Dead 79-80 C Cancer 15,26-30 Cancer of the Lung 27, 28 Cancer Registration 29 Carol Service (for Elderly) 77 Caseous Lymphadenitis 100 Catering Establishments 97-98 Cerebral Embolism 30 Cerebral Haemorrhage 30 Cerebral Thrombosis 30 Certificates of Guild of Hygiene 130 Chest Clinic 38,126-129 Page Chest Physician's Report 126-129 Chinese Dried Hen Egg Albumen 101,104 Chiropody Clinics, Attendances 35 Chiropody Treatment 37 Christmas Food Parcels (O.A.P.'s) 77 Citizens Advice Bureaux 39 Classification of Deaths 24 Clean Air Act 47 Cleansing and Scabies Clinic 38, 124 Cleansing of Children 124 Cleansing of Old People 73 Clinics and Centres 37 Clover Mites 67 Cockroaches 66 Common Infectious Diseases 15, 24 Complaints 40, 80, 86, 97 Condensed Milk Regs. 1959 91, 105 Conveniences, Public 70-71 Coronary Disease 30 Council Housing Schemes 87 Council Rehousing 85-86 Cremation or Burial of the Dead 79-80 D Day Rooms (for Old People)74-75 Death Causes, Remarks 24-31 Death Rates 15 Death Registrations 19 Death, Table showing Causes of and Ages at Appendix Deaths 15, 19 Deaths, Table showing Causes of and Ages under 1 yr Appendix Deaths from Violence 31 Deaths in Institutions 20 Defective Dwellings—Repairs ... 43 Density of Population 9 Diarrhoea and Zymotic Enteritis 25, 119 Diphtheria 25, 118 Diphtheria Antitoxin 119 Diphtheria Immunisation Clinics 37 Diphtheria Prophylaxis Cases 36, 119 Discharge of Effluents into Sewers 57 Diseases of Respiratory System 31 Disinfecting Station 38 Disinfection 124-125 Disinfestation of Verminous Premises 64-67 Distribution Centres—National Welfare Foods 32 District Nursing 36, 39 Domestic Helps 35-36, 38 INDEX (continued) Page Drainage and Sewerage 56 Drainage, New and Alterations to 56 Dried Egg Albumen 102-104 Drinking Fountains 70 Duties and Powers of the Public Health Committee 3-4 Dwellings 9 Dysentery 119 E Educational Sessions — Ante- Natal 35 Egg Albumen, Imported 101-104 Elevation of Borough 9, 11 Emission of Grit 47 Encephalitis 120 Enteric Fever 25,119 Entertainment (for Elderly) 78 Erysipelas 119 Exhibition of Aids for Disabled 78 Exhumations 80 Extracts from Vital Statistics15 F Factories Act, 1937/59 40-43 Fair on Blackheath 96 Family Planning Association, Sessions 38 Family Welfare Association 39 Flooding, Storm (Ravensbourne) 45 Flour (Composition) Regs., 1956 105 Food and Drugs Act, 1955 104,109-114 Food and Drugs—Non-genuine Samples 112-114 Food and Drugs Act, 1955, Samples taken under 104, 109-114 Food Hygiene Regs., 1955/57 89, 96 Food, Inspection of 89-114 Food Parcels (Old People) 77 Food Poisoning 89, 108 Food—Premises for Preparation of 93, 96-97 Food Rejected 98, 100 Food Standards (Ice Cream) Regs., 1959 91 Foods Welfare (for Elderly) 77 Foot Clinics 37 Foot Clinics, Attendances 35 Frozen Liquid Whole Egg 101 G General and Vital Statistics 9-31 General Provision of Health and Welfare Services in the Area 32-39 Page Greenwich Guild of Hygiene 130 Greenwich Old People's Welfare Association 74 Grit Emission 47 Guild of Hygiene 130 H Habitation Certificates (Water Supply) 57 Hairdressers and Barbers 55 Handicraft Centre 31 Handwashing Facilities 71 Health Centres 37 Health Visiting 33 Heart Disease 15,30 Heating Appliances (Fireguards) Act, 1952 54 Holidays (Old People) 76 Home Help Statistics 35-36 Home Help Service, Applications for 31 Horse Troughs 71 Hospitals 39 House to House Collections (O.A.Ps.) 77 House Purchase & Housing Act, 1959 83,85 Houses, No. in Borough 9 Houses Let in Lodgings 53 Housing 82-88 Housing Act, 195 7 53,84 Housing Act, 1957, Procedure under 84 Housing Act, 1949 85 Housing (Financial Provisions) Act, 1958 85 Housing Accommodation 86 Housing Homeless Persons 85 Housing Register 88 Housing Repairs and Rents Act, 1954 51,84 Housing Schemes, Council's 87 Housing Survey 87 Housing (Underground Rooms) Act, 1959 84 Hygiene, Guild of '30 I Ice - Cream — Bacteriological examinations " Ice-Cream (Heat Treatment, etc.) Regulations 91,94 Ice-Cream Premises 93,94 Ice-Cream Quantitative Analysis 95 Ice-Cream Sampling 95,105 INDEX (continued) Page Illegitimate Births 15, 18 Immunisation and Vaccination Clinics 37 Immunisation and Vaccination Clinics, Attendances 36 Imported Egg Products 101-104 Imported Food Rejected 100 Imported Livers—Unfit 101 Infantile Mortality 15,21-24 Infant Welfare Centres 37 Infant Welfare Clinics, Attendances 33-35 Infectious Diseases 15, 24, 115-129 Infirm Persons 71-79 Influenza 15, 31 Inhabited Houses 9 Inoculations, Poliomyelitis ... 36 Inspection of Food and Supervision of Food Premises 89-114 institution Deaths 20 International Certificates 117 International Statistical Classification of Diseases, Injuries, and Causes of Death, 1955 24 Interviews (Re - housing) by M.O.H 130 Introductory Review 6-8 J .'urisdiction over R. Ravensbourne 45-47 L Labelling of Food (Amendment) Regs 91 Laboratory Work 57, 93, 95, 101-114 Land Charges Act, 1925 56 Laundry Service73-74 L.C.C. (Gen. Powers) Act, 1953 57, 73 L.C.C. (Gen. Powers) Act, 1954 55 L.C.C. (Gen. Powers) Act, 1958 55 L.C.C. (Gen. Powers) Act, 1959 40 Legal Proceedings 106 Legislation, New40, 83, 84, 90 Leptospirosis 61 Lettings (Housing) 88 Livers, Imported (Unfit) 101 Lung Cancer 27-28 M Malaria 121 Manufacture and Sale of Ice- Cream 94 Marriages 16 Mass Radiography ... 39,123,128 Page Maternal Mortality 15, 21 Maternal and Child Welfare 32-39 Maze Hill Clinic (Tuberculosis) 38, 126-129 "Meals on Wheels" 75 Measles 25, 118 Meat Regulations 99 Meat Surrendered 98, 99, 100 Medical Inspections (Superannuation) 130 Medical Inspections (Sick Persons) 130 Medical Officer of Health's Review 6-8 Medical Statistics (Schools) 36 Meningococcal Infection 120 Merchandise Marks Act 95 Meteorological Observations 17 Mileage of Streets 10 Milk, Analysis of 93,105 Milk and Dairies Regulations 90, 92 Milk Licences 93 Milk (Special Designation) (Pasteurised & Sterilised Milk) Regulations 92 Milk (Special Designation) (Raw Milk) Regulations 92 Milk Sampling 93 Milk Supply 92 Minor Ailments Centres (for School Children) 37 Motor Vehicles Accidents 31 Mutual Exchanges (Housing) 88 N National Assistance Act 72 National Insurance Act (Medical Certificates) 116 National Welfare Foods—Distribution Centres 32 Natural Increase 14 Neo-Natal Mortality 15,23 & Appendix New Housing Accommodation 86 New Legislation 40, 83, 84, 90 Nomenclature Regulations, 1948 24 Non-Genuine Samples 112-114 Notices, etc 40, 81 Notifications of Infectious Diseases 115-129 & Appendix Notifications of Food Poisoning 108 Nursing Associations 39 O Old People's Clubs 74 Old People's Welfare Association 74 INDEX (continued) Page Open Spaces 10 Ophthalmia Neonatorum 121 Outworkers 42, 43 Overcrowding 86 P Perinatal Mortality 23 Personal Health Services 32-39 Persons Cleansed 72, 124 Pet Animals Act 56 Pharaoh's Ants 65 Pharmacy & Medicines Act 105 Pharmacy & Poisons Act 54 P.H. (Dried Milk) Regulations 105 P.H. (Imported Food) Regulations 99, 101 P.H. (London) Act, 1936, Sec. 180(8) 98 P.H. (Meat) Regulations 99 P.H. (Smallpox Prevention) Regulations 117 P.H. (Tuberculosis) Regs. 116,122 Physically Incapacitated Persons 71-79 Pigeon Nuisance 43-44 Pneumonia 31, 119 Poliomyelitis 121 Poliomyelitis Inoculations 36 Pollution, Atmospheric 47-51 Pollution, River 44-45 Population 9, 14 Post-Natal Attendances 34 Powers & Duties of the Public Health Committee 3-4 Precautionary Spraying 67 Preserved Food Premises 93-94 Prevalence of, and Control over Infectious Diseases 115-129 Prevention of Damage by Pests Act 60-62 Procedure under the Housing Act, 1957 84 Prophylaxis Cases 36 Prophylaxis Clinics 37 Public Baths & Washhouses 67-69 Public Health Committee 3 Public Health Department Staff 5 Public Health Laboratory Service 62, 93, 95, 101-104, 106-108 Public Heath Officers Regs., 1959 40 Public Open Spaces 10 Public Sanitary Conveniences 70-71 Puerperal Pyrexia 120 Page Q Quantitative Analysis of Ice- Cream 95,105 Queen's District Nursing Association 36,39 R Radiography, Mass 39,123,128 Rag Flock Act 55 Ranyard Mission 36,39 Rateable Value 9 Rates, Births and Deaths, etc 15 Rat Repression 60-63 Ravensbourne, River (Flooding) 45 Refuse Disposal 58-59 Registered Births 15,18 Registered Deaths 15,19 Registrar—Office Hours 39 Registration of Cancer 29 Registration of Preserved Food Premises 94 Rehousing 85 Rehousing Interviews (by M.O.H.) 130 Rejected Food 98,100 Relaxation Sessions—Ante-Natal 35 Remarks on Various Death Causes 24-31 Rent Act, 1957 51-53 Rent & Mortgage Interest (Restrictions) Acts 51 Reproductive Wastage 23 Requisitioned Accommodation 85,87 Requisitioned Houses & Housing (Amendment) Act, 1955. 88 Respiratory System—Diseases of 31 Review by M.O.H. 6-8 River Pollution44-45 River Ravensbourne, Flooding 45 River Ravensbourne, Jurisdiction 45-47 River Smells 44 Rodent Control 60-63 S Sampling of Ice-Cream 95, 105 Sampling of Milk 93,105 Sampling under Food & Drugs Act 104-105, 109-114 Sanitary Circumstances of the Area 40-8 Sanitary Conveniences, etc. 70-71 Sanitary Work—Summaries etc. 80-81 Scabies 120 INDEX (continued) Page Scabies & Cleansing Clinics 38, 124 Scarlet Fever 25,119 Scavenging and Refuse Disposal 58-59 Schools (Medical Statistics) 36 Sewerage and Drainage 56 Sewers—Baiting of . 63 Shops Act 54 Slaughterhouses 92, 99 Slum Clearance 85 Smallpox 24, 117 Smells from River 44 Smoke and Grit Emission 47 Smoke Control Areas 48, 49 Smoke Control Areas (Exempted Fireplaces) Order, 1959 40 Social Conditions of the Area 11-13 Sonne Dysentery 119 Spray Dried Albumen (Chem. Analysis) 104 Spraying, Precautionary 67 Staff of Public Health Department 5 Statistical Tables Appendix Statistics, General 9, 10 Still Births 15, 18 Street Appeal (for Elderly) 77 Streets, Mileage of 10 Street Traders 96 Suicide 31 Summary of Sanitary Work 80-81 Sunlight Treatment 35 Supervision of Food Premises 96-97 Supplies of Underground Water (Wells) 57 Swimming Baths 68 Storm Flooding 45 T Toddlers Clinic Attendances 34 Town & Country Planning Act, 1947 87 Transfers (Housing) 88 Transported Meals for Old People 75 Treatment Centres and Clinics 37 Tuberculosis 15, 25-26,121-124, 126-129 Tuberculosis—Handicrafts Centre Sessions 38 Tuberculosis Officer's Report 126-129 Typhoid Fever 25,119 Page U Underground Water Supplies (Wells) 57 Uninhabited Houses 9 Unsound Food 98, ,99 100 V Vaccination Cases 36,117 Vaccination and Immunisation Clinics 37 Vaccination International Certificates 117 Various Death Causes, Remarks on 24-31 Vascular Lesions of Nervous System 30 Verminous Conditions 72, 73,124 Verminous Premises 64-67 Violent Deaths 31 Vital Statistics 15 & Appendix Voluntary Organisations 39 W Wash-houses and Public Baths. 67-69 Washing Facilities (Hand) 71 Wasps 66 Water — Underground Supplies (Wells) 57 Water Supply 57 Water Supply Certificates 57 Weil's Disease 61 Welfare Clinics 37 Welfare Foods (for Elderly) 77 Welfare Foods, National—Distribution Centres 32 Welfare Scheme for Old People 78 Wells 57 Whooping Cough 25,118 Whooping Cough Prophylaxis Cases 36, 118 Whooping Cough Prophylaxis Clinics 37 Women's Special Clinic 38 Women's Voluntary Services 39 X X-Ray Examinations 123,128 X-Ray, Mass 39, 123, 128 Z Zymotic Disease 25,119 Zymotic Enteritis 25,119 INFANTILE MORTALITY DURING THE YEAR 1959 Deaths from stated Causes in Weeks and Months under 1 Year of Age. Cause of Death. Under 1 week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—3 Months. 3—6 Months. 6—9 Months. 9—12 Months. Total Deaths under One Year. Small-Pox ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Acute Meningococcal Septicaemia ... ... ... ... ... ... ... ... 1 1 Bronchitis ... ... ... ... ... ... 2 ... ... 2 Bronchopneumonia ... ... ... ... ... ... 1 ... ... 1 Nephrogenic Diabetes Insipidens ... ... ... ... ... ... ... 1 ... 1 Congenital Malformation 2 1 ... ... 3 1 ... ... 2 6 Premature Birth 8 1 ... ... 9 ... ... ... ... 9 Haemolytic Disease of Newborn 1 ... ... ... 1 ... ... ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Accident ... ... ... ... ... 1 ... ... ... 1 Unascertainable (newly born child found on river foreshore) 1 ... ... ... 1 ... ... ... ... 1 Totals 13 2 — — 15 2 3 1 3 24 Male 13 Female 11 CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1959. Notifiable Disease Cases Notified in Whole District Age & Sex Group Total Cases Notified in each Locality No. of Cases removed to Hospital from each Locality At all Ages 0 to 1 1-2 2-3 3-4 4-5 5-10 10-15 15-25 25-45 45-65 65 and over Greenwich East Greenwich West St. Nicholas Charlton and Kidbrooke Greenwich East Greenwich West St. Nicholas Charlton and Kidbrooke Total M F M F M F M F M F m F m F m F m F M F M F M F Malaria 1 — - - - - - - - - - - - - - - 1 - - - - - - - - - - 1 - - - 1 1 Small-Pox - - - - - - - - - - - - - — - - - - - - - - - - - - - - - - - - - Acute Encephalitis Infectious - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Post-Infectious - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - — - - - - - - - - - - - - - - - - - - - - - - Dysentery 114 135 5 1 5 7 11 3 5 7 3 11 48 35 11 24 4 10 14 20 3 11 5 6 37 20 41 151 9 1 - 3 13 Erysipelas 3 3 - - - - - - - - - - - - - - - - 1 - 2 1 - 2 3 2 - 1 - - - - - Acute Polio-Myelitis P - 2 -- - - - — — — - - - - - - - - 1 - 1 - - - - l - 1 - 1 - 1 2 N.P. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 35 33 - - - - - 2 3 3 4 6 18 14 6 7 3 1 - - 1 - - - 13 13 6 36 1 1 1 - 3 Paratyphoid Fever — — — - — - - - - - - - - - - - - - - - - - - - - - - - - - - - - Scabies 3 1 - - - - 1 - - - - - - - - - - 1 1 - - - - - 1 1 1 1 - - - - - Puerperal Pyrexia -- 3 - - - - - - - - - - - - - - - 2 - 1 - - - - 2 1 - - 1 - - - 1 Meningococcal Infection 2 — 1 - - - - - - - - - - - - - - - - - - - 1 - - 1 1 - - 1 - - 1 Measles 338 299 18 9 35 36 31 32 48 46 41 35 153 132 7 6 4 3 1 - - - - - 218 162 15 242 1 2 - 1 4 Whooping Cough 17 17 1 2 4 3 2 - 4 3 1 - 5 8 - 1 - - - - - - - - 5 11 5 13 - - - 1 1 Diarrhoea 18 12 2 2 7 4 4 3 3 2 1 1 1 - - - - - - - - - - - 6 1 3 20 - 1 - - 1 Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Pneumonia, Acute Primary or Acute Influenzal 10 10 - - - - - - - - - - 2 - - - - - 1 6 4 2 3 2 7 - 1 12 - - - 1 1 Tuberculosis, Pulmonary 27 16 1 - - - - - - - - - - - - 1 5 1 8 5 12 4 1 5 15 4 4 20 4 2 - 4 10 „ Non-Pulmonary 1 2 - - - - - - - - - - - - - - - - - 2 - - - - 1 1 - 1 - 1 - - 1 Totals 569 533 28 14 51 50 49 40 63 61 50 53 227 189 26 39 17 19 26 35 22 18 10 15 308 218 77 499 16 10 1 12 39 NOTE:—The above Table refers to "Corrected Notifications" only, i.e. all cases in which diagnosis was not confirmed have been ignored. TOTAL CAUSES OF, AND AGES AT, DEATH during the year ended 31st December, 1959. Causes of Death. Deaths at Subjoined ages of "Residents" whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of "Residents" in Public Institutions Total Deaths whether of "Residents" or "NonResidents" in Public Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton and Kidbrooke St. 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. Tuberculosis, Respiratory 10 ... ... ... ... ... ... 2 5 2 1 4 ... 2 4 1 ... 1 ... 1 ... 5 24 Tuberculosis, Other 2 ... ... ... ... 1 ... ... 1 ... ... 1 1 ... ... 1 ... ... ... 1 ... ... 4 Syphilitic Disease 3 ... ... ... ... ... ... ... 2 ... 1 1 ... ... 2 2 ... ... ... ... ... 1 4 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... l Meningococcal Infections 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Infective and Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Malignant Neoplasm, Stomach 28 ... ... ... ... ... ... ... 11 10 7 10 5 1 12 9 ... 3 ... 2 1 2 39 Malignant, Neoplasm, Lung, Bronchus 52 ... ... ... ... ... ... 1 28 15 8 14 9 3 26 16 2 3 ... 4 ... 8 113 Malignant Neoplasm, Breast 13 ... ... ... ... ... ... ... 6 1 6 4 2 1 6 3 ... ... ... ... ... 3 12 Malignant Neoplasm, Uterus 2 ... ... ... ... ... ... 2 ... ... ... ... ... 1 1 1 ... ... ... ... ... 1 4 Other Malignant and Lymphatic Neoplasms 75 ... ... ... ... ... ... 3 22 25 25 24 11 6 34 32 1 6 ... ... ... 14 140 Leukaemia, Aleukaemia 4 ... ... ... ... 1 ... ... 1 1 1 2 1 ... 1 2 1 ... ... ... ... 1 10 Diabetes 4 ... ... ... ... ... ... ... 2 2 ... 2 1 ... 1 2 1 1 ... ... ... ... 13 Vascular Lesions of Nervous System 99 ... ... ... ... ... ... 3 23 32 41 35 22 7 35 43 1 8 ... 2 1 8 223 Coronary Disease, Angina 123 ... ... ... ... ... ... 8 41 33 41 47 18 5 53 31 1 3 ... 1 2 17 120 Hypertension with Heart Disease 13 ... ... ... ... ... ... ... ... 8 5 5 4 1 3 6 ... 2 ... ... ... 1 32 Other Heart Disease 124 ... ... ... ... ... ... 4 19 32 69 42 19 7 56 54 4 6 ... 3 10 10 228 Other Circulatory Disease 48 ... ... ... ... ... ... ... 11 14 23 14 12 4 18 21 2 4 ... 1 ... 8 93 Influenza 6 ... ... ... ... 1 ... ... 3 2 ... ... ... 6 ... ... ... ... ... ... 2 3 Pneumonia 73 ... 1 ... ... ... 1 ... 10 16 45 37 13 3 20 49 4 2 ... 4 1 7 178 Bronchitis 72 ... ... ... ... ... ... ... 15 27 30 25 17 2 28 22 2 6 ... 3 3 3 84 Other Diseases of Respiratory System 9 ... ... ... ... ... ... ... 3 5 1 4 ... ... 5 ... 1 1 ... 1 1 2 13 Ulcer of Stomach and Duodenum 9 ... ... ... ... ... ... ... 2 3 4 5 2 ... 2 6 1 1 ... 1 ... ... 28 Gastritis, Enteritis and Diarrhoea 4 ... ... ... ... ... ... ... 1 ... 3 2 1 1 ... 2 ... ... ... ... ... 1 8 Nephritis and Nephrosis 7 ... ... ... ... ... ... 2 2 1 2 3 2 ... 2 1 2 ... 1 ... 1 18 Hyperplasia of Prostate 8 ... ... ... ... ... ... ... ... 1 7 3 1 ... 4 5 ... 1 ... ... ... ... 16 Pregnancy, Childbirth, abortion 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... Congenital Malformations ... 11 4 2 1 ... 1 ... ... 3 ... ... 3 2 ... 6 1 ... ... ... 1 ... 8 l7 Other defined and ill-defined Diseases 51 10 3 1 ... 1 4 3 12 9 8 19 11 1 20 22 2 6 ... 3 ... 11 122 Motor Vehicle Accidents 8 ... ... 1 ... 1 2 1 2 1 1 1 1 5 1 ... 3 ... 1 ... 3 34 All other Accidents 12 2 ... 1 ... ... ... 2 2 2 3 7 2 ... 3 4 ... ... ... 1 2 3 25 Suicide 7 ... ... ... ... ... 1 ... 3 2 1 3 2 1 1 2 ... 2 ... ... ... 1 7 Homicide and Operations of War ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 879 16 7 4 ... 4 8 33 226 246 335 317 159 48 355 338 24 61 ... 31 21 122 1,619 N0TE—All 'Transferable Deaths" of residents, i.e., persons resident in the Borough who died outside it have been included. The transferable Icaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded