4373 GRE58 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1960 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1960 Printed by Bromley Office Supplies & Printing Co., Ltd. 39 & 41 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 35 „ C.—Sanitary Circumstances of the Area 43 „ D.—Housing 92 „ E.—Inspection of Food and Supervision of Food Premises 101 „ F.—Prevalence of, and Control Over Infectious and Other Diseases 128 „ G.—Miscellaneous 142 Appendix—Statistical Tables 3 PUBLIC HEALTH COMMITTEE as at 31st December, 1960 The Mayor: Councillor H. A. Tatman, J.P. and 13 Members Councillor Mrs. M. L. Wentworth (Chairman) Councillor D. P. Lynch (Vice-Chairman) Alderman: P. Noble Councillors: Mrs. M. L. Bennett R. A. Blatchford A. C. Chrisp, L.C.C. Mrs. J. E. Chrisp Lady Hume Mrs. A. D. A. Kennedy W. S. Manners H. A. Read 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, etc.) Act, 1950, 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 deposits of rubbish on vacant sites in the Borough shall be delegated to the Committee. 4.—The powers and duties of the Council conferred by Section 47 (as amended) of the National Assistance Act, 1948, shall be delegated to the Committee. 5.—The powers and duties conferred upon the Council by the Pet Animals Act, 1951, the Rag Flock and Other Filling Materials Act, 1951, and by the Heating Appliances (Fireguards) Act, 1952, shall be delegated to the Committee. 6.—The powers and duties of the Council conferred by sub-section 1 of Section 18 of the London County Council (General Powers) Act, 1954, to register hairdressers and barbers and their places of business shall be delegated to the Committee. 7.—The functions of the Council under the Clean Air Act, 1956, shall stand referred to the Committee. 3.—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, 1960 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.) District Inspectors: abc S. A. Radford ab S. Kelly a H. D. Dawes a J. G. Lyons abdef Miss B. Hatfield ab D. B. Smith (i) Food Inspectors: ab C. W. Spore (Senior) ab W. C. Scales Public Health Officer: clef Miss N. A. Fluck Assistant Clean Air Officer: J. W. JOSLIN (ii) CLERICAL STAFF : L. A. Westacott (Chief Clerk) A. H. Wilcox Mrs. M. G. Simpson (Senior Clerk) (Senior S/H Typist) K. Allum, d.f.m. Mrs. E. M. Farrell A. G. Lyons C. Weymouth M. R. York (iv) W. F. Goodall (iii) Mrs. D. F. Howard (Conveniences Superintendent) P. J. Cavey (vi) DISINFECTING STAFF: T. Smith (Foreman) A. Moore H. W. C. Scarff (Motor Driver) A. K. Nunn (v) A. Nash RODENT CONTROL, FLY DISINFESTATION, ETC.: Team of five men a Certificated Public Health Inspector (i) commenced duties 22nd August. 1960 b „ Meat and Other Foods (ii) commenced duties 19th April. 1960 c „ Smoke Inspector (iii) commenced duties 22nd February. 1960 d „ Health Visitor (iv) commenced duties 22nd August. 1960 e „ State Certified Midwife (v) commenced duties 24th April. 1960 f „ State Registered Nurse (vi) commenced duties 20th June. 1960 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 privilege of presenting the Annual Report on the health and environmental circumstances of Greenwich for 1960. There was a slight decrease in the population, a decrease in the births and a small increase in the number of deaths. On the other hand the infantile mortality rate and the still birth rate showed a reduction and all the vital statistics recorded in the Report compare favourably with the County rate and the rates in England and Wales. The year was notable for the small number of infectious diseases notified. The total notifications were the lowest in the history of the Borough and the area was free from diphtheria and the enteric fevers. Dysentery was also less troublesome and the stringent control measures adopted by the school authorities and in the homes of cases and carriers, together with the close cooperation of the general practitioners on treatment, undoubtedly contributed to this reduction. Notifications of both pulmonary and non-pulmonary tuberculosis increased slightly but has little statistical significance. There were only four deaths from pulmonary tuberculosis, which is a remarkable tribute to the efficacy of the new therapeutic methods and to the devoted work of the curative and preventive aspects of the Tuberculosis service. Once again I am glad to include an account from Doctors Forgacs and Wraith of the work of the Chest Clinic at Maze Hill. It is gratifying to notice that B.C.G. vaccination of susceptible age groups in schools increased by 24 per cent over the 1959 figure. Although the number of diphtheria immunisations effected was an advance over the previous year there were many fewer vaccinations against smallpox. Protection against poliomyelitis continues to be made readily available at the County Council clinics for the under-40 age group and it is to be hoped that as large a proportion as possible of the young adult group of the population will avail themselves of this valuable protective measure. It is of course of paramount importance that parents make certain that all young children are given full immunisation courses. Turning to non-infectious diseases one must again note the continuing increase in deaths from malignancy, especially from 7 lung cancer. Deaths from coronary artery disease have also increased considerably, although the overall deaths attributable to heart disease show only a slight increase. In our present state of knowledge it is impossible to relate these facts precisely and solely to epidemiological factors although it is indisputable that heavy cigarette smoking encourages the development of lung cancer and an atmosphere polluted with industrial emissions contains cancerinducing substances. There may of course be other factors of an hereditable or selective nature impinging on the population; indeed it would be surprising if conditions apparently so irremediably linked with the fundamental processes of living matter were not subject to the same natural pressures as other deviations from the accepted norm. However, as in most problems of biology, the answer seems to lie in an equation of two factors; an inborn constitutional diathesis in fortuitous association with environmental factors in the widest sense. The environmental chain may be found easier to break than the genetic predisposition to disease. One factor linked to heart trouble is excessive or faulty eating habits and the increasing sedentary nature of our lives. Diet in excess of requirements, either in terms of energy or nutrition, adds a burden to the heart unless the surplus energy can be expended quickly in normal activity. Excessive fat intake may predispose to the development of diseased arteries. Here then is one environmental factor of a personal nature that can be controlled to some effect by precept and by example. On the other hand a diet deficient in the basic necessities of life is equally dangerous and that is why the patent remedies for slimming and weight reduction, which are advertised so widely and with a flagrant disregard of fact, are dangerous. Weight reduction is a question of striking a happy balance between energy intake and output. Large shipments of food continue to be landed or stored in the many wharves in the Borough. A new breaking-out plant for liquid whole egg and albumen was opened and requires regular and careful supervision. Although importations of dried egg products were less and generally of a higher quality, Swedish pig carcases landed in considerable quantities were found to be diseased and had to be condemned. Problems of ante and post mortem inspection in Sweden were resolved with the Swedish Authorities. Desiccated coconut from Ceylon was found to be bacteriologically unsound and necessitated preventive action. An account of all the food condemned or rejected is included in the appropriate section of the Report. The welfare of the aged continued to exercise the attentions of the department and a further appreciable increase in the services 8 provided can be claimed. In addition to the work of the Health Department, the Old People's Welfare Association, which receives generous and enthusiastic support from the Council, continues to provide very valuable supplementary services. The Annual Report of that Association is also included in this Report. Under the Clean Air Act Che Borough continues to be surveyed and the No. 1 Smoke Control Area came into operation on 1st October of the ourrenit year. The second area is due to become operative on 1st July, 1962, and further areas are being prepared for submission to the Council and it is their intention to declare new areas regularly over the next few years. I have included the measurements for smoke and sulphur dioxide recorded in our two stations at the Town Hall and Charlton House. I must acknowledge with thanks the contributions from the various departments of the Council, and the figures for the personal health services kindly supplied by Dr. Waldron the Divisional Medical Officer. I am grateful also for the help and co-operation received from the many voluntary agencies; from the local hospitals particularly the Geriatric Unit at St. Alfege's; from the general practitioners and from other sources too numerous to mention. I wish to thank the staff of the Department most sincerely for their efforts and their loyalty and I want to acknowledge the support and encouragement received from the Chairman and ViceChairman of the Health Committee. 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, 1960 (mid-year) 88,310 Density of Population (persons per acre) 22.88 Number of Inhabited Dwellings—end 1960 (according to Rate Books) 24,549 Structurally separate dwellings at Census, 1951 21,348 Number of Uninhabited Dwellings— At Census, 1951 364 At end 1960 239 Number of Families or Separate Occupiers— At Census, 1951 26,397 Rateable Value, 1960 £1,802,850 Sum Represented by a Id. Rate, 1960 £7,220 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 „ Hughes Fields Recreation Grounds .74 „ Batley Park .97 „ Bellot Memorial Gardens .19 „ Other Open Spaces 6.01 „ Approximately 25.39 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 5½ „ Charlton Park 423/4 „ Hornfair (formerly Charlton Playing Field) 26 „ Sayes Court Recreation Grounds 31/4 „ *St. Nicholas Recreation Grounds l1/4 „ Approximately 216 acres * Shortly to be enlarged and re-named 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 GENERAL INFORMATION AND SOCIAL CONDITIONS The division in 1855 of the Parliamentary Borough of Greenwich as constituted under the Reform Act of 1832 gave rise to the district now known as the Metropolitan Borough of Greenwich which comprises the ancient parishes of St. Nicholas, Deptford (formerly West Greenwich), Greenwich (formerly East Greenwich) and Charlton with the Liberty of Kidbrooke and, as from November 1900, it became one of the twenty-eight municipalities of the County of London. The river Ravensbourne (Deptford Creek) separates St. Nicholas from Greenwich, whilst the Royal Naval College and Greenwich Park divide most of the older part of Greenwich from East Greenwich, the more modern part of the borough, the latter including a large area of marsh land at present quite unsuitable for the erection of dwelling-houses. Although documented history of Greenwich appears to begin only during King Alfred's reign, circa 900, there is evidence that Greenwich has been inhabited for over two thousand years— certainly Crooms Hill is pre-Celtic while Shooters Hill, along with many other place names, is of Celtic origin. 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. Village life survived the Roman's departure and it is difficult to imagine that Greenwich was a most attractive fishing village until comparatively recent times. The occupations of its inhabitants were, and for that matter still are, very closely linked with shipping for here the river affords an excellent roadstead. 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 on 19th April, 1012. Domesday Book, compiled in 1086 records the existence at that time of a church on this site, a situation which has continued to the present day. When Westminster became the centre of government, Greenwich again became a royal resort and was the favourite royal palace from the time of Edward I (1296) to James II (1685) and it was here in its heyday that the great Elizabethan admirals. 12 statesmen, writers, musicians and courtiers thronged the riverside and splendid palace. It was towards the end of this "golden age" that, in 1675 on a Warrant of Charles II, the Royal Observatory was founded and, to the design of Christopher Wren, Flamsteed House was built on the site of Duke Humphrey's Tower. Very early in the 18th century Daniel Defoe described Greenwich as "the most delightful spot of ground in Great Britain" and 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 Greenwich Park with its historical associations and surroundings covering an area of 185 acres. Blackheath, one of London's most famous open spaces, 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. Play Centre and Lido with its well-equipped open-air swimming bath, tennis courts and bowling greens. In all, public open spaces amount to 11 per cent of the total area of the Borough, equivalent to approximately five acres per 1,000 of its population. Areas located near the River Thames are, generally speaking, industrial but 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. 13 Housing has always been given a high degree of priority by the Borough Council from shortly after the first World War when, under the Housing and Town Planning Act, 1919, a number of large houses in the Blackheath area were acquired and converted into flats, to the present time when the Council have control of approximately one sixth of the total dwellings in the Borough. The earliest Council-built permanent dwellings were located in the Charlton area but today their flats and houses are situated in all parts of the Borough. In fact 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. In addition, a number of sizeable estates have been built by the London County Council at Blackheath and Kidbrooke and in East and West Greenwich. Within the Borough boundary over 200 units of accommodation are provided for elderly people by seven groups of almshouses, one group was founded as early as 1558 being the first public charity to be established after the Reformation. 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 Greenwich market (which obtains its produce predominantly from the Kent area) or from the Covent Garden and Borough markets in London. From its inception as a Borough, Greenwich has always been in the forefront of progressive health authorities and now within its area all aspects of health, personal and environmental, are amply covered. These range from the normal maternity, child welfare and school health services, to the usual general practitioner and hospital services, and from the useful municipally-run chiropody clinics to the special geriatric, thoracic and neuro-surgical units based at local hospitals. Virtually first class educational facilities are at the disposal of residents, encompassing as they do the nursery and handicapped children's establishments as well as the normal primary, secondary, grammar and comprehensive schools. Abundant opportunities are also provided for further education whether vocational or cultural or merely for enabling persons to indulge in a particular hobby. 14 Of the nursery schools, that of Rachel McMillan is internationally famous for the McMillan sisters were the pioneers of nursery schools in the British Isles; and in the Roan Schools, founded in 1643 by John Roan the son of a member of the Royal household when it was at the Palace of Placentia, Greenwich has one of the oldest teaching foundations in London. Most educational services are now under the control of the L.C.C. but there are still some private schools in the area which are conducted independently of the County Council and which cater for fee-paying pupils. There are four excellent public libraries, each incorporating reading rooms for free access to daily newspapers, weekly and monthly periodicals, which offer a service of Braille and "talking books" for the blind and, recently, opportunities for the borrowing of gramophone records have been made available to residents over the age of 18 years. In particular, the Central Library is admirably adapted to enable private study to be undertaken in proximity to a comprehensive reference section. 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. 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. 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 five 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. Greenwich can boast of modern public baths. On these premises are to be found first and second class slipper and swimming baths together with newly completed Turkish and Vapour Baths as well as a public laundry. In winter the baths hall is used for recreational purposes such as badminton, table tennis and roller skating, etc. 15 The unique position held by Greenwich in Britain's history has its counterpart in the nation's industrial story. From earliest years its residents have been closely linked with the sea and ships and Britain's ascendancy in respect of them for over 1,000 years. This association, manifest since before the advent of the ancient "wooden walls" until after the birth of the "ironclad" has, to a very large extent, determined the pattern of industry in the Borough. A further influence on local industry was provided early in its history by the siting close to Greenwich Palace of the Royal Armoury. By the reign of Henry VIII, russet steel suits of armour from this armoury had already become renowned, and modern metal products from Greenwich continue this distinction. Indeed, throughout its annals, the country has never demanded armaments and accoutrements from Greenwich industry in vain. Even records covering the last war will clearly reveal the great contributions made by these industries with special reference to PLUTO, FIDO and the famous Mulberry harbour. 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. 16 POPULATION General—The Registrar General has submitted his estimate of the population of Greenwich, computed at mid-year 1960, upon which the statistics of this Report have been based. The figure returned is 88,310, indicating a decrease in the population of 660 since last year and a fall of 1,536 since the 1951 Census. However, the current figure shows an advance of 24,510 over that for 1945. Natural Increase—The natural increase for the year, i.e. excess of births over deaths, was 328 compared with 447 for 1959. Expectation of Life—From 1841, when the expectation of life at birth was 40 years for males and 42 for females, there was a gradual but persistent rise in both these figures until 1954, but since that year the expectation of life at birth has scarcely changed and now stands at 68 years for males and 74 for females. Age Composition of Population—It has been expedient from time to time to make analyses of the population figures with particular regard to age distribution in relation to whooping cough, diphtheria, poliomyelitis and B.C.G. prophylaxis and, more recently, the problem of the aged. In line with the general trend throughout the country, Greenwich has an ageing population and the number of persons outside the normal working range is still increasing. Although since the end of World War II there has been a sharp rise in births compared with those of the immediate pre-war years, a fact which naturally tends to advance the proportion of "under 15s" of the population, the relative size of the "over 65s" group also continues to increase. These two faotors together have augmented the pressure of dependency on the working portion of the population, viz., those between 15 and 65 years —a section of the community whose relative 'size has correspondingly diminished. From details given in the following table it will be seen that the "working" population of Greenwich, i.e. those between 15 and 65 years amounts to approximately 65.1% and that of "dependent" groups collectively, to 34.9%. In effect, this means that for every two persons of "working age" there is one dependent person outside this group. 17 ESTIMATED AGE COMPOSITION OF THE POPULATION Age No. Approx. % of Total Population Ms estimated by the Registrar General. Under 1 year 1,250 1.4 1 to 4 years (inclusive) 5,350 6.0 5 to 14 years (inclusive) 12,600 14.3 Total Child Population under 15 years 19,200 21.7 Estimated locally: 15 to 64 years (inclusive) 57,460 65.1 65 years and over 11,650 13.2 Total Population 88,310 100.0 18 * EXTRACTS FROM VITAL STATISTICS OF THE YEAR LIVE BIRTHS Legitimate Illegitimate Total Birth Rate (Crude) 14.25 (Comparable Rate 13.39) Male 583 30 613 Female 605 36 641 Total 1,188 66 1,254 STILL BIRTHS Legitimate Illegitimate Total Rate per 1,000 total Births 11.04 Male 8 2 10 Female 4 — 4 Total 12 2 14 DEATHS—All Causes Male Female Total Death Rate (Crude) 10.52 481 445 926 (Comparable Rate 11.78) DEATH RATES—Special Causes Infants under 1 year of age No. Rate All infants (per 1,000 live births) 22 17.54 Legitimate Infants (per 1,000 legitimate live births) 21 17.67 Illegitimate Infants (per 1,000 illegitimate live births) 1 27.77 Neo-Natal Deaths (per 1,000 live births) 17 13.56 Peri-Natal Mortality (per 1,000 total births) 29 22.87 Others Maternal Causes (per 1,000 total births) 1 0.78 Tuberculosis (all forms) (per 1,000 population) 4 0.04 Tuberculosis, Pulmonary (per 1,000 population) 4 0.04 Cancer (per 1,000 population) 209 2.37 Heart (per 1,000 population) 282 3.20 Common Infectious Diseases (per 1,000 population) 1 0.01 Influenza (per 1,000 population) — — * These figures, which are supplied by the Registrar-General. may differ slightly from those shown in other parts of the Report. 19 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 1960. The total of 657 gives a marriage rate of 14.93, an increase of 0.79 over that of the previous year. The comparable figure for England and Wales is 15.0. 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 1960 177 120 20 122 218 657 88,310 ‡ St. Peter's. Creek Road ‡ Holy Trinity, Blackheath Hill Closed † Parish Church destroyed by enemy action * Parish Church reopened. 20 METEOROLOGICAL OBSERVATIONS—1960 I am indebted to the Director of the National Maritime Museum and, in particular, to Lieutenant-Commander D. W. Waters, R.N., for the following meteorological data for the year ended December, 1960:— Temperature Highest screen temperature 82° on 19th and 20th June. Lowest screen temperature 26° on 17th February. Maximum in January 61° on 1st. February 57° on 28th. November 62° on 2nd. December 56° on 4th. Sunshine Total for year 1317.9 hours. Sunniest day 14.8 hours, 19th June. Number of days without sun 90 distributed as follows:— January 17 February 11 March 11 April 2 May 6 June 2 July 1 August 2 September 6 October 8 November 6 December 18 Rainfall Total 30.9 inches. Highest fall in 24 hours 1.69 inches 1st September. Driest momth 0.51 inches April. Wettest month 5.24 inches October. 21 BIRTHS The total number of live births registered in the Borough during the year was 1,558 and of this number 1,205 occurred in St. Alfege's Hospital, and 350 in private dwellings. In 787 cases the parents resided outside the Borough and these births were consequently transferred to their appropriate districts, leaving a figure of 771. To this must be added 483 births belonging to the Borough which took place in Institutions outside the Borough, thus making a final figure for Greenwich of 1,254, a decrease of 74 from that of the previous year. Of this total 613 were males and 641 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: — 281 185 58 247 771 Inward Transfers: — 1st Qtr. 35 12 3 74 124 2nd Qtr. 32 6 3 69 110 3rd Qtr. 37 18 1 73 129 4th Qtr. 33 20 2 65 120 Totals 418 241 67 528 1,254 The Birth Rate for the year, calculated on the figure of 1,254 births, is 14.25 per thousand of the population, 0.72 lower than that for 1959. The average rate for the previous ten years is 15.02. The Greenwich Comparability Factor for births is 0.94 which gives an adjusted rate of 13.39. The Rates for the County of London and England and Wales are 17.8 and 17.1 respectively. Illegitimate Births numbered 66 (representing 5.3 per cent. of the total live births) an identical figure to that returned for the previous year. The number of Still Births registered was 14 (10 males - 4 females), which is equivalent to a rate of 11.04 per 1,000 total births, a reduction of 5.25 from that of 1959. 22 DEATHS The net number of deaths registered during 1960 was 926, of which 481 were males and 445 females, compared with last year's total of 881 comprising 497 males and 384 females. This gives a crude Death Rate for the Borough of 10.52 per thousand of 'the population, an increase of 0.59 as compared with that of the previous year and a rate which is 0.58 greater than the average for the last ten years, viz., 9.94. The Crude Death Rate figure is increased to 11.78 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 1.12 and may be regarded as the population handicap to be applied which, when multiplied by the crude Death Rate for the year, modifies the latter so as to make it comparable with the country as a whole or with any similarly adjusted area. The Death Rates for the County of London and for England and Wales are 11.4 and 11.5 respectively. The inset table showing the causes of deaths at all ages has been supplied by the Registrar-General and is included in accordance with the Ministry of Health's request. In the Appendix to the Report will be found a table giving by districts, the causes of, and ages at death of residents whilst indicating the numbers actually dying in Public Institutions. 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 481 16 3 2 7 22 134 148 149 F 445 6 1 - 2 20 90 113 213 1 Tuberculosis, Respiratory M 3 - - - - 1 - 1 1 F 1 -- - - - - - 1 - 2 Tuberculosis, Other M - - - - - - - - - F - - - - - - - - - 3 Syphilitic Disease M 2 - - - - - 1 1 - F - - - - - - - - - 4 Diphtheria M - - - - - - - - - Whooping Cough F - - - - - - - - - 5 M - - - - - - - - - Meningococcal Infections F - - - - - - - - - 6 M - - - - - - - - - Acute Poliomyelitis F - - - - - - - - - 7 M - - - - - - - - - Measles F - - - - - - - - - 8 M 1 - - - - - 1 - - F - - - - - - - - - 9 Other Infective and Parasitic Diseases M - - - - - - - - - F - - - - - - - - - 10 Malignant Neoplasm, Stomach M 14 - - - - 1 2 7 4 F 12 - - - - 1 3 4 4 11 Malignant Neoplasm, Lung, Bronchus M 53 - - - - - 25 19 7 F 10 - - - - 1 3 2 4 12 Malignant Neoplasm, Breast M - - - - - - F 15 - - - - 1 10 3 1 13 Malignant Neoplasm, Uterus F 11 -- - - - 1 3 4 3 14 Other Malignant and Lymphatic M 45 - 1 - 1 2 14 17 10 Neoplasms F 49 - - - - 3 24 5 17 15 Leukaemia, Aleukaemia M 5 - 1 - - - 2 1 1 F 3 - - - - 2 1 - - 16 Diabetes M 1 - - - - - 1 - - F 3 - - - - - - - 3 17 Vascular Lesions of Nervous System M 53 - - 1 - 13 18 21 F 63 - - - - 3 6 21 33 18 Coronary Disease, Angina M 116 - - - - 3 38 42 33 Hypertension with Heart Disease F 67 - - - - 1 15 21 30 19 M 5 - - - - - - 3 2 Other Heart Diseases F 15 - - - - - 1 3 9 20 M 22 - - - - - 2 6 14 Other Circulatory Disease F 59 - - - - 1 4 9 45 21 M 18 - - - - - 5 3 10 Influenza F 24 - - - - 1 2 9 12 22 M - - - - - - - - Pneumonia F - - - - - - - - 23 M 22 1 - - - 1 2 7 11 Bronchitis F 43 1 1 - - - 3 14 24 24 M 38 - - - 1 - 11 10 16 F 16 1 - - - - 1 5 9 ,25 Other Diseases of Respiratory System M 4 - - - - - - 3 1 F - - - - - - - - - 26 Ulcer of Stomach and Duodenum M 9 - - - 1 2 3 3 Gastritis, Enteritis and Diarrhoea F 8 - - - - 1 3 1 3 27 M 2 - 1 1 - Nephritis and Nephrosis F 3 - - - - - - 2 1 28 M 3 - - - - 1 - 2 F - - - - - - - - - 29 Hyperplasia of Prostate M 2 - - - - - - 1 1 30 Pregnancy, Childbirth, abortion F 1 - - - 1 - - - - 31 Congenital Malformations M 5 3 1 1 - - - - - Other defined and ill-defined F 3 3 - - - - - - - 32 M 32 12 - 1 2 2 7 1 7 Diseases . Motor Vehicle Accidents F 33 1 - - 1 2 9 7 13 33 M 7 - - - 1 1 - 3 2 All other Accidents F 3 - - - 1 - 1 1 34 M 10 - - - 1 5 1 1 2 35 Suicide F 1 - - - - - - - 1 M 9 - - - - 3 5 - 1 Homicide and Operations of War F 4 - - - - 1 2 1 - 36 M - - - - - - - - - F - - - - - - - - - 23 DEATHS IN INSTITUTIONS The following table compares the average number of deaths of Greenwich residents in Public Institutions during the previous ten years with those of the current year: — Deaths of Greenwich Residents Year Total In Public Institutions No. % of Total Deaths 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 1959 881 488 55.4 10-year average 888 537 60.3 1960 926 633 68.3 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 6 6 4 6 22 Between 1 and 2 years — — — 1 1 Between 2 and 5 years — 3 — — 3 Between 5 and 15 years 1 1 — — 2 Between 15 and 25 years 4 1 2 4 11 Between 25 and 45 years 10 11 8 12 41 Between 45 and 65 years 64 52 43 61 220 Between 65 and 75 years 79 58 58 69 264 75 years and upwards 114 84 62 102 362 Totals 278 218 177 255 926 24 Little variation in the pattern of death registrations occurred during the year, the first and fourth quarters producing 30% and 27.5% respectively, and the third quarter 19.1%. It will be observed from the following table that during 1960 the deaths occurring at 65 years and upwards accounted for 67.2% of the total compared with a figure of 22.8% for 1901. Deaths in the age group 0-5 years show an even more striking comparison; in 1901 the deaths in this group amounted to 37.4% whilst the figure for the current year is 2.8%. Age Group 1901 1911 1921 1931 1951 1960 Under 1 year of age 362 306 175 97 29 22 Between 1 and 5 years 187 158 80 39 7 4 Between 5 and 15 years 64 67 58 22 10 2 Between 15 and 25 years 66 60 67 65 12 9 Between 25 and 65 years 454 474 466 382 311 266 65 years and over 335 356 387 529 633 623 Totals 1,468 1,421 1,243 1,134 1,002 926 MATERNAL MORTALITY One death from puerperal causes was recorded during the current year, a position similar to that obtaining in 1959, giving a Maternal Death Rate of 0.78. The death was in respect of a woman of 23 years who died in Hammersmith Hospital from renal failure due to septic abortion, self-induced. INFANTILE MORTALITY Fifty years ago infant mortality in Greenwich was at the rate of 108 per 1,000 live births, the actual number of children dying before reaching the age of one year being 261. Comparable figures for the current year are 17.54 and 22 respectively. This substantial reduction reflects the national trend (the rate for England and Wales being 21.9 and that for London 21.6) and serves to emphasize the inestimable value of the preventive health services which, together with advances in chemotherapeutics and in diagnostic techniques, has brought about such a remarkable transformation. Today, generally speaking, hazards to infant life come not from malnutrition nor infectious disease but arise mainly from prematurity, congenital malformation and inherited metabolic disease. Nevertheless, medical research has enabled the damaging 25 effeots of disabilities such as diabetes, phenylketonuria and hæmolytic disease of the newborn to be assessed and has pointed the way to their control if not elimination. Surgery has also played its part in overcoming a number of abnormalities present at birth thus assisting many infants with congenital defects to attain a maturity and expectation of life once thought impossible. However gratifying this picture may appear there is certainly no room for complacency for infant mortality in England and Wales is still continuing at a higher rate than in many foreign and Commonwealth countries. Infants who die before reaching the age of one month form the crux of the problem in that, although there has been a real reduotion in the total number of infant deaths, the neo-natal deaths have not decreased pro rata. This is amply demonstrated by the Borough statistics for if the deaths of babies under four weeks are presented as a percentage of all infant deaths, then over the last 10 years this figure has increased. Nevertheless it must be conceded that further reductions in infant mortality, though possible, are extremely difficult to effect but with the present increased attention devoted to heredity and the emphasis laid on the study of genetics a measure of control and subsequent correction of congenital malformations is to be expected. Such research work is highly specialised and is perhaps to be regarded as long term but the immediate problem is to make every possible endeavour to ascertain by post mortem examination the cause of infant deaths and stillbirths. Efforts on these lines are supported by the Population (Statistics) Act, 1960, by which certain information regarding stillbirths, originally provided on a temporary basis under a 1938 enactment, has now been made compulsory and permanent under the new Act. The Infantile Mortality Rate for Greenwich, measured by the deaths of children under one year of age to the number of live births registered was 17.54 per thousand live births as compared with 18.07 for last year and 19.48, the average for the previous ten years. For the County of London the rate was 21.6, in comparison with 21.9, the figure returned for England and Wales. The present Borough figure of 17.54 shows a decrease of 0.53 from that of the previous year and is 1.94 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. 26 The following table shows the comparative Infantile Mortality Rate for the quinquennial periods since 1931, together with the Rate for 1960: — District Average for Quinquennial Periods Year 1960 1931 to 1935 1936 to 1940 1941 to 1945 1946 to 1950 1951 to 1955 Greenwich 75 50 40 27 18.4 17.54 London 63 56 60 33 23.8 21.6 England and Wales 62 55 50 36 26.9 21.9 The actual number of infantile deaths recorded during the year was 22 (two less than last year) and these were attributed to the following causes: — Prematurity 9 Bronchopneumonia 2 Atelectasis 1 Atelectasis (inhalation) 1 Congenital malformation 7 Ac. tracheo-bronchitis 1 Erythroblastosis 1 Of the above, 16 were male and 6 female; 8 died in St. Alfege's Hospital, 3 in the Brook Hospital, 1 at home and 10 in hospitals and institutions outside the Borough. Neo-Natal Mortality.—Neo-natal mortality, i.e., infants dying before attaining the age of one month, accounted for 17 deaths, equivalent to 77.25% of all infant deaths and giving a Neo-natal Mortality Rate of 13.56 per 1,000 live births. This compares favourably with the figure of 15.6 returned for England and Wales. Fifteen 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 29 still births and deaths of infants under 1 week, was 22.87 per 1,000 total births compared with 25.92 for the previous year. The equivalent rate for England and Wales is 32.9. Reproductive Wastage.—A sum total of 36 Stillbirths and Infantile deaths gives a reproductive wastage rate of 29.18 per 1,000 total births, a decrease of 4.89 from the 1959 figure. Bad housing, overcrowding, poor sanitation, low standards of education, all tend to produce higher Infant Mortality Rates. It 27 follows, therefore, that the Infant Mortality Rate should provide a good index to the social circumstances of any particular area. However, Infant Mortality Rates which are based on the number of births occurring in the same year as the infant deaths are not comparable year by year unless the birth rates remain more or less constant because approximately one-third of the infants dying in any one year will be found to have been born in the previous year. Further, it must be borne in mind that when dealing with small figures the slightest deviation in the number of deaths tends to misleading fluctuations in the rate. Consequently care must be exercised when drawing conclusions from any rise or fall in Infant Mortality Rates. REMARKS ON VARIOUS DEATH CAUSES Recognising the importance of ensuring as far as possible the uniformity and comparability of statistics in relation to diseases and causes of death, the Registrar-General has, from 1st January, 1950, implemented the Nomenclature Regulations, 1948, as suggested by the World Health Organisation. Although these regulations are not binding on Medical Officers of Health, it is essential that the International Statistical Classification of Diseases, Injuries and Causes of Death, 1955, should be adopted in order that local statistics can be compared with national figures and national with international. Classification of Deaths.—It should be borne in mind that the statistical data compiled locally relating to cause of death may not entirely agree with the figures furnished to Local Authorities by the Registrar-General. Classification of the cause of death is taken from one or more causes as stated on the medical certificate in accordance with the rules generally adopted throughout England and Wales. 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 Diarrhœa, one death was registered for the current year compared with a nil return for 1959 and one for 1958. 28 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 58th since a death from this disease occurred. Measles.—One death from measles was recorded during the year and this was in respect of a male of 56 years. There were no deaths from this complaint during the years 1959 and 1958, but 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 fourteenth 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 7 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. Diarrhœa and Zymotic Enteritis.—Compared with a nil return for the current year and for 1959 there was one for 1958, one for 1957 and a nil return for each of the years 1956 and 1955. One death from this cause was registered in 1954, two 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 14 years since one was recorded. Tuberculosis.—There were 4 deaths from this disease during the year, giving a death rate of 0.04 compared with 14 deaths and a rate of 0.15 for 1959. The rate for the present year compares very favourably with the average tuberculosis death rate for the previous ten years, viz., 0.21 and the decrease in the number of deaths since last year is a further acknowledgment, if such were needed, of the effectiveness of modern therapeutic methods. 29 Although in Greenwich the numbers are small and therefore liable to wide fluctuation, they do reflect the national trend, for in 1960 the rate for England and Wales in respect of all forms of tuberculosis was 75 per million population compared with a figure of 85 for 1959. Greenwich deaths from tuberculosis for the previous ten years are given, with their appropriate rates, in the following table: Year No. of Deaths Rate 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 1959 14 0.15 10-year average 19 0.21 1960 4 0.04 Tuberculosis of the Respiratory System was responsible for all of the deaths in this category, not one death being attributed to the remaining forms of tuberculosis. At 0.04, the Pulmonary Tuberculosis rate was 0.10 lower than that returned for last year. Cancer.—In Greenwich, cancer was responsible for a total of 209 deaths giving a rate of 2.37 per thousand population compared with figures of 172 and 1.93 respectively for the previous year. It accounted for 22.5% of all registered deaths, a percentage over five times that returned for 1901, viz. 4.2%, and indicates that approximately one in every four deaths resulted from cancer of one form or another. Comparing the current year s figures with those of the previous 5 years, the sites of the affected parts were: — 1955 1956 1957 1958 1959 1960 Cancer of Stomach 26 20 23 14 26 26 „ „ Lung, Bronchus 35 58 46 44 50 63 „ „ Breast 16 13 15 19 14 15 „ „ Uterus 6 6 5 7 2 11 „ „ all Other Sites 86 90 98 95 80 94 Totals 169 187 187 179 172 209 30 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 1950 1 1 14 3 5 3 1 1 21 8 29 0.32 1951 1 — 26 3 15 — 3 3 45 6 51 0.57 1952 2 — 15 2 9 1 1 1 27 4 31 0.34 1953 3 — 12 4 7 — 1 — 23 4 27 0.29 1954 — — 21 3 13 5 5 — 39 8 47 0.52 1955 2 1 16 3 5 1 6 1 29 6 35 0.39 1956 1 — 29 3 16 1 8 — 54 4 58 0.65 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 1959 — 1 25 3 11 2 7 1 43 7 50 0.56 10 yr. Average 1.7 0.7 22.7 3.4 11.7 1.6 4.8 1.5 40.9 7.2 41.8 0.46 1960 2 1 25 3 19 2 7 4 53 10 63 0.71 From the preceding table it can be seen that the age group 45 to 65 years is still the period of greatest mortality and deaths in this group constitute almost half the total deaths attributed to lung cancer. However the mortality in this group appears to have become stabilized during the past few years in contrast to the 65 to 75 years section which during the current year has recorded a 54 % increase over the 1959 figure. 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 63 and 4 respectively have been recorded showing that 31 the position with regard to these two diseases has been more than reversed. In comparison with the Borough rate of 0.71 for lung cancer, that for London as a whole is 0.70 and for England and Wales 0.48. Nationally as well as locally, recent years have shown an exceptionally rapid decline in the death rate of pulmonary tuberculosis whereas that for cancer of the lung has increased, one might almost say, correspondingly 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. 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. Surveys undertaken in schools in various parts of the country have elicited the information that smoking is more common in the South of England than the North and that, age for age, secondary modern school boys are more likely to be smoking than grammar school boys and further, that by the age of 16 years, approximately 50% of boys and 20% of girls are already smoking and well on the way to addiction. In the field of education, an intermittent programme carried out in Southern England among school children, inter alia, focused attention on the lack of suitable films, posters and other visual aids and on the need for extensive planning and preparation. 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. 32 In cancer of the lung causative agents other than tobacco are also indicted. In particular benzpyrene, a product of coal combustion, is also found in the exhaust fumes from motor vehicles and in both instances substantial reduction if not complete elimination of the emission of this carcinogen is possible. Public awareness and pressure can make this possibility a reality. 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, effective treatment, recovery rates or possible pre-disposing factors. It was just these omissions that registration was intended to cover. In recent years 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 thlis 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. Vascular Lesions of Nervous System.—This class, which includes deaths arising from Cerebral Haemorrhage, Embolism and Thrombosis was responsible for a total of 116 deaths (53 males, 63 33 females). The age distribution was as follows:—1 between 15 and 25 years, 3 between 25 and 45 years; 19 between 45 and 65 years; 39 between 65 and 75 years and 54 from 75 years upwards. This year's total of 116 indicates a rise of 25 over that for 1959 and the increase was wholly sustained by the "over 65 years" group. 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 282 (143 males—139 females) compared with a figure of 278 for 1959, and as usual, the deaths from this category occupied the principal place in the classification of diseases in that they formed 30.4% of the total deaths from all causes. The speed and strain of modern civilisation is thought to have a great bearing on these so-called "stress" diseases but stress, which is recognised as a predisposing factor in the increased incidence of cardiac disability is a somewhat vague term. However, some of the following circumstances undoubtedly give rise to "stress" as we understand it today. Living Standards.—As living standards rise, not unnaturally there is an increase in "high-living" which generally goes hand in hand with bigger meals and an increased intake of fatty foods. This in turn gives rise to over-weight and obesity. Single mindedness.—The concentration on a narrow field or single motive constitutes a "stress". All classes are susceptible from the housewife or humble clerk to the managing director. Indolence.—Inactivity, perhaps largely enforced, by persons having to travel long distances to work, to conferences or to customers by car or train, results in muscles being unable to respond to a call for unusual effort and, with the heart, there is often no recovery. Smoking.—Over recent years there has been a substantial rise in tobacco consumption. Nicotine is known as a cardiac poison which in many instances blunts the desire for physical effort. Modern Living.—An environment of noise, petty irritations, current news, jobs with a time limit, results in an increase in adrenalin demand. Eventually the environment wins and there is a breakdown. 34 Taken in isolation it is impossible to prove that these items have any direct relationship with stress but there is no doubt that collectively they are deeply implicated. Diseases of the Respiratory System.—There were altogether 123 deaths from these diseases. Bronohitis accounting for 54 and Pneumonia (all forms) for 65. The total shows a decrease of 31 from that of the previous year; there was a reduotion of 11 deaths from Pneumonia and a decrease of 19 in regard to Bronchitis. Of the total deaths, 3 were children under one year of age and 100 were in respect of persons 65 years and over. Influenza.—There were no deaths attributed to this cause during the year compared with 5 returned for 1959, 2 for 1958 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 34 including 10 from Motor Vehicle Accidents, 13 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 an increase of 6. 35 SECTION B General Provision of Health and Welfare Services for the Area Since July, 1948, the Personal Health Services available to residents of the Borough have been under the control of the London County Council and Dr. Waldron, the Divisional Medical Officer, has kindly supplied me with information and statistics relating to Health Visitors' records, attendances at Infant Welfare Centres, Prophylaxis figures, etc., for 1960, 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 Friday 1.30 p.m. 4 p.m. Creek Road, S.E.8 Friday 1.30 p.m. 4 p.m. Fairfield Grove, S.E.7 Tuesday 9.30 a.m. 12 noon Thursday 1.30 p.m. 4 p.m. Ridgebrook Road, S.E.3 Tuesday 9.30 a.m. 12 noon 1.30 p.m. 4 p.m. Shooter's Hill Road, S.E.3 Monday Tuesday 1.30 p.m. 4 p.m. Wednesday Thursday 9.30 a.m. 12 noon Friday 1.30 p.m. 4 p.m. St. Alfege's Church Hall, Roan Street, S.E. 10 Monday 9.30 a.m. 2 p.m. 12 noon 4 p.m. Tranquil Vale, S.E.3 Wednesday 9.30 a.m. 12 noon Health Visitors' Records, Attendances at Infant Welfare Sessions, Prophylaxis figures, etc. 1. Health Visiting Quarter Expectant Mothers Premature Babies StillBirths Infants (under 1 year) Children 1—5 years School Children Care of People Miscellaneous Unsuc cessful Total Visits 1st visit Revisit 1st visit Revisit Old Others March 178 173 14 7 318 1,691 3,622 185 121 83 370 630 7,392 June 136 195 11 6 311 1,575 3,331 139 116 67 236 52 6,625 Sept. 122 144 6 6 276 1,444 3,233 112 114 21 238 506 6,222 Dec. 176 198 6 8 253 1,383 3,194 177 113 84 239 584 6,415 Totals 612 710 37 27 1,158 6,093 13,380 613 464 255 1,083 2,222 26,654 36 2. Infant Welfare Clinics Quarter Sessions Attendances 0-1 year 1-2 years 2-5 years 1st Total Total Total March 221 399 4,815 1,206 1,170 June 204 338 4,783 1,156 1,111 September 208 324 4,692 1,080 972 December 201 319 4,415 1,104 983 Totals 834 1,380 18,705 4,546 4,236 37 3. Ante and Post Natal Clinics (a) Ante Natal Quarter Sessions 1st Attendances Total Attendances This Year Current Pregnancy March 205 406 235 1,553 June 189 184 193 1,315 Sept 86 159 177 1,035 Dec 78 193 196 1,191 Totals 559 942 801 5,094 (b) Post Natal (cases seen at Ante-Natal Clinics) Quarter 1st Attendances This Year Since Confinement Total Attendances March 47 44 50 June 34 41 42 Sept 27 32 40 Dec. 43 31 50 Totals 151 148 182 4. Toddlers Clinics Quarter Sessions Total Attendances Medically Examined March 19 157 151 June 21 187 185 September 22 163 162 December 22 154 151 Totals 84 661 649 38 5. Relaxation and Educational Sessions Quarter Relaxation Sessions Educational Sessions* Sessions Total Attendances Sessions Total Attendances March 35 439 48 571 June 21 285 27 334 September 31 289 34 324 December Totals 31 384 39 483 118 1,397 148 1,712 * Includes a Fathercraft Class 6. Artificial Sunlight, Massage etc. Quarter Sessions Attendances First Total March 73 66 1,135 June 55 36 869 September 69 24 583 December 75 55 985 Totals 272 181 3,572 7. Chiropody Treatment No. of Clinic Sessions 1,299 No. of First Attendances 772 Total Attendances 16,298 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., '60 3 11 519 1 534 85 36 31st Dec.,'63 6 11 568 3 588 87 37 Cases attended during 1960: — 60 16 111 4 852 — — 39 (b) Supervision Effective Ineffective Total Visits made by Organising Staff: 3,293 359 3,652 9. Prophylaxis (a) Immunisation and Vaccination (Children under 5 years) Diphtheria immunisation (completed cases) 164 Whooping Cough immunisation (completed cases) 2 Combined Antigen (Diphtheria and Whooping Cough) 68 Triple Antigen (Diphtheria, Whooping Cough and Tetanus) 1,250 Vaccination (Smallpox) 539 (b) B.C.G. Vaccination (Children 13 years old at Greenwich Schools) No. of Children 13 years old 1,871 No. for whom parental consent was obtained 1,513 No. of negative reactors vaccinated 1,316 No. of positive reactors X-rayed 62 (c) Poliomyelitis Inoculation (Children born 1943-1960 resident or attending Greenwich schools) (i) Two injections given during year 1,492 (ii) Third injection given during year 3,923 (Others—mainly adults 16-40 years living or working in Greenwich and Exp. Mothers) (i) Two injections given during year 1,419 (ii) Third injection given during year 2,320 10. District Nursing The staff of the Queens District Nursing Association for Charlton and Blackheath made 24,110 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 686 510 47,338 No. of New Cases 339 53 9,664 No. of Glasses prescribed 149 — — Note- As appropriate, children from Greenwich also attend special clinics in Deptford and Woolwich. 40 TREATMENT CENTRES AND CLINICS Particulars relating to the local Health Services throughout the Borough are given below: — INFANT WELFARE 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 St. Alfege's Parochial Hall, S.E.10 Tranquil Vale, S.E.3 ANTE & POST NATAL CLINICS Charlton Lane, S.E.7 Chevening Road, S.E.10 Creek Road, S.E.8 Fairfield House, S.E.7 Shooter's Hill Road, S.E.3 Tranquil Vale, S.E.3 * Fortnightly ARTIFICIAL SUNLIGHT TREATMENT Chevening Road, S.E.10 Fairfield House, S.E.7 Shooter's Hill Road, 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 Tuesday 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). 41 CHEST CLINICS (by appointment only) DAY A.M. P.M. Maze Hill, S.E.10 Monday 10.00 (Allergy Clinic) 2.00 Tuesday 9.30 2.00 Wednesday 9.30 (X-rays with Drs. letters) 2.00 Thursday 9.30 2.00 (Contacts) 5.00-6.30 (workers only) Friday 9.30 (Ante-Natal) SCABIES & CLEANSING CLINICS Tunnel Avenue Wednesday 9 - 12 (School Children) Daily (Saturdays excepted) 9 - 12 (Wednesdays excepted) 2 - 4 (Adults and Children under school age) WOMEN'S SPECIAL CLINIC (Family Planning Association) Charlton Lane, S.E.7 Wednesday 12.30 HOME HELP SERVICE Applications for this service to be addressed to: — Divisional Medical Officer, London County Council, Greenwich Sub-Office, 105, Shooter's Hill Road, S.E.3. DISINFECTING STATION Applications to: — Medical Officer of Health, Public Health Department, Town Hall, S.E.10. 42 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. 11 (RELiance 4671). Nursing Sisters of St. John the Divine, Watson Street, S.E.8 (TIDDeway 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. 18 (WOOlwich 0047). 173, Walworth Road, S.E.17 (RODney 2860). Family Welfare Association, Area 6 (Deptford, Greenwich and Lewisham), 49, Rushey Green, S.E.6 (HITher Green 1630). Women's Voluntary Services, Mrs. 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. {9 a.m. to 12 noon Fri. 5 p.m. to 7 p.m. Sat. 9 a.m. to 11 a.m. 43 SECTION C Sanitary circumstances of the Area The tables on pages 89 to 91 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 16,343 houses and premises have been inspected or re-inspected during the year; 555 intimation notices and 125 statutory notices were served. Registered complaints, numbering 1,982 show an increase of 790 over those of the previous year, a total 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: — Office Act, 1960.—This Act, introduced to make further and better provisions for health, welfare and safety in offices, received the Royal Assent on July 29th, 1960, but becomes legally enforceable by local authorities only on January 1st, 1962. By the Act the Secretary of State is enabled, in consultation with interested organisations, to make Regulations regarding structure and arrangements, etc., of offices for the health, safety and welfare of persons employed therein and, inter alia, it outlines duties of occupiers and employees. Display, in prominent and accessible places, of abstracts of the Act and subsequent Regulations becomes obligatory. Certain provisions with regard to offices in factories and employment of women after childbirth are to be enforced by Ministry of Labour inspectors and a similar authority is given to the Ministry of Power in respect of mines and quarries. Noise Abatement Act, 1960.—Local authorities have been empowered to deal with noise or vibration as a statutory nuisance under this Act from 27th November, 1960. Previously, power to deal summarily with a noise nuisance under the Public Health (London) Act, 1936, was given to Councils of the Metropolitan Boroughs by Section 66 of the L.C.C. (General Powers) Act, 1937, such nuisance being defined in subsection 3 as "any excessive or unreasonable or unnecessary noise which is injurious or dangerous to health". The new Act amends this to read "any noise which is a nuisance", a definition which is very vague and will have to be determined by the magistrate. Borough Council byelaws concerning loudspeakers, bells and gongs are already in existence and these are unaffected by the new legislation. 44 London County Council (General Powers) Act, 1960.—Section 14 of this Act enables Metropolitan Borough Councils to deal with "any dust or other airborne particles caused by any trade business process or manufacture and being a nuisance or injurious or dangerous to health" as a nuisance under Section 82 of the Public Health (London) Act, 1936. Caravan Sites and Control of Development Act, 1960.— Operative from 29th August, 1960, this Act seeks to make further provisions for the licensing and control of caravan sites, to authorise local authorities to provide and operate caravan sites and to amend the law relating to enforcement and certain other notices issued under the Town and Country Planning Act, 1947. In general, London is excluded from Part I of the Act which refers to caravan sites, their provision and licensing etc., such control being covered by Sections 22 and 23 of the L.C.C. (General Powers) Act, 1959. Oil Burners (Standards) Act, 1960—This Act, operative from 1st January, 1961, enables the Secretary of State to make regulations providing, inter alia, for minimum standards of efficiency and safety in respect of oil burning appliances. Officers of a local authority are authorised to carry out inspections to determine whether such regulations are being observed. 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 276 inspections were made by the Council's Inspectors in relation to the 505 registered factories. The latter figure includes 85 premises where mechanical power is not used. Defects were found in 16 instances, all of which were remedied. 45 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 85 23 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 408 244 2 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises ) 12 9 — — Total 505 276 2 — Cases in which defects were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l.) 7 7 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) insufficient — — — — — (b) unsuitable or defective 7 7 — 4 — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 2 2 — — Total 16 16 — 4 — 46 Outwork—(Sections 110 and 111) Nature of Work Section 110 Section 111 No. of out-workers in August list required by Sect. 110 (1) (c) No. of cases of default in sending list to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel Making, etc. ' 24 — — — — — Curtains and Furniture Hangings 1 Lampshades 4 — — — — — Cardboard Boxes 2 — — — — — Total 31 — — — — — 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 13 (b) Outworkers resident outside the Borough 25 Notifications received from firms outside the Borough of:— Outworkers resident in the Borough 37 Total number of Greenwich residents employed as outworkers (as given in August list) 31 Premises where homework is carried on were visited on 38 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. 47 (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. During the year some 22 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 again showed an increase over those of last year, the figures being 22 and 19 respectively. River Pollution.—Although no complaints were made to this department during the current year, many 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 sulphate which is 48 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. Much useful and enlightening information on the subject of river pollution is expected to be divulged in a report commissioned by the Minister of Local Government and Planning in April, 1951. A committee, headed by Professor Alfred Pippard, Emeritus Professor of Civil Engineering at Imperial College, London, has been engaged for almost ten years in a study of the pollution of the tidal reaches of the Thames and its report is expected to be published during the latter half of 1961. 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 were few and, in the main, found to be due to defective roofs, blocked gutters and drains. However, some complaints of flooding due to the surcharging of sewers were received from Kidbrooke and the East Greenwich and Charlton areas in the vicinity of the river. All reported cases were visited and investigated by the respective Public Health Inspectors and, where necessary, advice and treatment were given. 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 49 dations, 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. Following a conference held at the Ministry with representatives from interested public authorities it was agreed that the London County Council and the Kent County Council should confer with the local authorities in their areas and report their progress to the Ministry. Finally the London County Council advised the Minister 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 within the County". A joint Bill with the Kent County Council was drafted and is in the process of being presented to Parliament. In the interim, the London County Council, in co-operation with the consulting engineers appointed by the Kent County Council, are implementing a co-ordinated scheme for the improvement of the river. Atmospheric Pollution—General.—Recognition of air pollution is not new. In 1306 a Londoner was fined and executed for offending against an Act of Parliament passed in 1273 and John Evelyn the diarist in 1661 complained bitterly of smoke which exposed inhabitants of London to an "impure and thick mist and filthy vapour" rendering them liable to "a thousand inconveniences and corrupting of the lungs". In England and Wales some 30,000 deaths and over 30,000,000 working days per year are lost on account of bronchitis and, according to statistics available from the World Health Organisation it would appear that our overall respiratory death rate is the highest. To many responsible people much of this lung disease is attributable to air pollution. Dr. Lessing, C.B.E., Ph.D., has stated that in Great Britain there is discharged into the air a sulphuric acid equivalent of 12.000,000 tons a year derived from the combustion of coal and oil 50 and their products. There are other pollutants formed but it is this quantity of acidic material which is the main cause of damage by air pollution modestly estimated at a rate of some £250 million per year. He has also stated that a great deal of the atmospheric dust is ash of widely varying chemical composition arising from coal fired furnaces and it is these acid coated particles which on deposition initiate severe metal erosion. However, air pollution is no longer merely the discharge into the atmosphere of simple products of combustion of the common fuels but nowadays includes industrial effluents of varying complexities, including those emitted from internal combustion engines. It follows that as industries develop and expand so the population becomes exposed to greater danger and the means of control becomes progressively more difficult. Measurement of the quantity and quality of some of the pollutants is often hampered by reason of its complication and expense. Nevertheless a great deal of unobtrusive work has been performed and much has been achieved in the field of clean air and. perhaps what is more significant, we have a much clearer idea of the problems. Clean Air Act, 1956. Provisions relating to the installation of new furnaces, smoke control areas, height of chimneys, research and publicity, came into operation on 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 supervising of smoke control areas. Under Section 11 of the above-mentioned Act, detailed inspection was completed of the Council's second smoke control area which obtained Ministry approval on the 24th July, 1961. 51 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. 2 Smoke Control Order, 1961, which becomes operative on the 1st July, 1962, covers an area of some 63 acres and concerns 1,587 dwellings and 82 other premises, most of which have apparatus requiring alteration. The accompanying plan indicates the area concerned. Use of Sticks and Paper in Smoke Control Areas—Circular 28160—In the general interest of progress the Minister of Housing and Local Government has indicated in his Circular that he is prepared to allow the use of sticks and paper for lighting fires and suggests the use of Section 11(3) of the Act for granting exemption in Smoke Control Areas. Pollution Recording.—It is fitting that some mention be made of the closing down during 1959 of the Government Fuel Research Station at Blackwall Lane. For over 40 years this station at East Greenwich indulged in research and development on fuels and their uses which included valuable work in connection with smoke, its measurement and prevention. In 1918, one year after the Department of Scientific and Industrial Research had appointed a Fuel Research Board "to investigate in the broad national interest the nature, preparation, utilization and treatment of coals and other fuels, and of products derived from fuels", the station at Greenwich was established. During its period of activity, the station has dealt with many aspects of fuel research including fuel analysis, carbonization, preparation of coal for the market, gasification of coal and coke, coal constitution, combustion and steam raising, hydrogenation of coal and coal tar, the Fischer-Tropsch synthesis, air pollution and domestic heating. It is with the latter functions that the Public Health department is concerned and the loss in this field of the help and advice so readily and freely given by officers of this station is to be regretted. 53 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 1960:— TABLE I.—Daily Mean Concentration of Smoke Month Town Hall Charlton House Smoke mg/100m3 Smoke mg/100m3 Daily Value Daily Value Average Highest Lowest Average Highest Lowest November 1959 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 March „ 36 52 24 20 29 10 April ,, 26 39 16 22 29 17 May ,, 25 33 15 13 18 6 June „ 18 24 10 12 16 8 July ,, 11 18 4 8 12 4 August ,, September „ October „ NO READINGS TAKEN November „ December „ January 1961 29 75 24 9 49 4 February „ 17 58 10 7 28 4 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 1959 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 March ,, 8.9 19.4 4.3 6.4 9.5 3.3 April ,, 7.3 11.3 3.8 4.8 9.8 2.4 May ,, 6.9 9.9 4.3 3.9 5.8 2.3 June ,, 4.6 7.0 2.7 3.4 5.4 2.1 July ,, 3.0 5.7 0.9 1.8 3.2 0.7 August „ September „ . October „ NO READINGS TAKEN November „ December ,, January 1961 4.6 15.6 3.1 1.8 9.4 1.1 February „ 3 0 9.2 2.6 2.1 6.2 1.0 54 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. 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 ... 19 Number of decisions not to issue certificates ... 0 Number of decisions to issue certificates (a) in resepect of some but not all defects 15 (b) in respect of all defects 4 19 Number of undertakings given by landlords {under para. 5 of Ist Schedule) ... 13 Number of undertakings refused by Council {under proviso to para. 5 of Lvf Schedule) ... 0 Number of certificates issued ... 6 55 PART II—Applications for Cancellation of Certificates Applications by landlords to Council for cancellation of certificates 8 Objections by tenants to cancellation of certificates upheld 0 Decisions by Council to cancel notwithstanding tenants' objection 1 Certificates cancelled 8 In addition to the foregoing, 11 applications (Form "0") 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 1 — In respect of Form 'K' undertaking Tenant — — Landlord 7 3 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, 10 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. 56 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. The Minister has expressed the view that no rigid code should be applied but that all cases should be decided on their respective merits. One house let-in-lodgings was visited by the Public Health Inspector and it was found unnecessary 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. 57 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 no 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 but 71 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, (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 17 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 413 occasions. 58 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, 1960 60 Persons registered at 31st December, 1960 65 Rag Flock and Other Filling Materials Act, 1951.—The introduction of this Act, which became operative on the 1st November, 1951, brought about the repeal of the previous Rag and Flock Acts of 1911 and 1928 as well as Section 136 of the Public Health (London) Act, 1936. This Act seeks to secure the use of clean filling materials in upholstered or other articles which are stuffed or lined and it can be said to be a consolidation of the previous Acts of 1911 and 1928. It is the duty of the Local Authority to enforce the Act and the Medical Officer of Health and the Public Health Inspectors, being duly authorised officers of the Council, have the right at all reasonable times and on production of their "authority" to enter and inspect premises and take samples for the purposes of the Act. Three premises, at which filling and upholstering with new materials is carried out, remained on the register at the end of the year and one licence in respect of the manufacture of Rag Flock was renewed. Regulations prescribe the standards of cleanliness for each type of filling material to which the Act applies and under the Rag Flock and Other Filling Materials Regulations, 1951, nine samples, four of Rag Flock, two of Cotton Felt, two of Kapok, and one of 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 59 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 two licences were in operation and 5 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 in respect of properties in the Borough are received from time to time by the Town Clerk concerning outstanding Notices served under the Public Health, Housing and Rent Acts and whether such properties are affected by any Smoke Control Area Orders, existent or proposed. During the year 1,136 reports on such enquiries were forwarded to the Town Clerk's department. Drainage and Sewerage.—During the year 586 drains were tested, 411 were opened, cleansed or repaired and there were 1,153 constructions and re-constructions, alterations and improvements effected. The former and latter figures show an increase of approximately 50% over those for the previous year. Only two cesspools remain in use in the Borough and under the Borough Engineer's direction these are emptied on request. One hundred and thirty-two plans of drainage and other sanitary works relating to existing and new buildings were examined and approved. Discharge of Trade Effluents into Sewers.—Under the provisions of the London County Council (General Powers) Act, 1953, the Borough Engineer's Department consulted with various public bodies and carried out a site survey from which a list of 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. 60 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 2 Number of samples taken 2 Number of samples found satisfactory 1 Applications for new or modified discharges nil The unsatisfactory sample was 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 24,788 dwellings with direct connections to the Board's mains. During the year 127 water supply certificates were granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended, repaired or renewed in 283 cases. Fluoridation of Water Supplies.—In recent years dental decay has increased especially among the younger age groups and it has been found that a minute quantity of fluorine assists the formation of healthy teeth and reduces the incidence of decay. As a measure to prevent dental decay, fluoridation of water supplies has the backing of the Expert Committee of the World Health Organisation, the British Medical Research Council, the New Zealand Commission on Water Fluoridation, the Royal Swedish Medical Board and many other eminent medical and dental organisations. Authoritatively, it is suggested that fluoridation of public water supplies to the level of one p.p.m. of fluorine although not altering the colour, taste or smell of the water, would be sufficient to reduce the incidence of dental decay. This suggestion has raised a storm of controversy, especially on the grounds of "mass medication" but when one considers that water supplies in towns like Colchester, Slough and South Shields already contain fluorine in excess of this amount and that fluorine in chemical combination as fluoride is found as a trace element in many foods such as vegetables, meat, cereals, fruit, fish and tea etc., this objection cannot really be 61 sustained. Again, in some quarters fluoridation has been opposed on grounds of expense, but it has been estimated that a reduction of one-fifth in existing dental decay would more than justify the cost. It is common practice in many parts of America to introduce fluorine into the domestic water system in the form of sodium silicofluorine and Eire has already considered introducing legislation to enable public water supplies to be similarly treated. It can surely be only a matter of time before similar steps are taken in this country. Underground Water Supplies (Wells).—In August, 1947, at the request of the Ministry of Health, a survey of underground water supplies was made and full particulars were given in the Report for that year. In all, 40 wells are listed, only 2 of which are used for the supply of water for drinking purposes. Of the remaining 38 wells, 13 are used for commercial purposes and 25 disused. During September of 1953 a further shallow well was sunk on the premises of the Tunnel Glucose Refineries Ltd., at Tunnel Avenue, thus making 3 wells in all on this property and bringing the total of wells in the Borough to 41. This new well is to be used for industrial purposes only. As far as this Borough is concerned the two wells providing drinking water are properly supervised and have shown no sign of deterioration. Water from one of these wells is used by the Metropolitan Water Board to supplement the public water supply and is subjected to daily tests by that Authority for purity and palatability. Water from the other well is regularly tested by the commercial firm concerned. Scavenging and Refuse Disposal.—The collection of refuse in the Borough is under the control of the Borough Engineer who has kindly supplied me with the following information:— Scavenging: The mileage of streets cleansed in the Borough is approximately 82 miles. This is done mainly by hand sweeping, only 7J% is swept by mechanical sweeper/collector during the night time, sweeping main roads and other roads where extensive regular parking of vehicles presents difficulties 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% 62 There are approximately 4,500 street gullies in the Borough which are emptied, flushed and refilled with clean water three to four times a year. This is done entirely by mechanical means using two 800 gallon capacity emptying and flushing vehicles. Street sweepings during the year amounted to 1,063 tons and continue to show a decrease in volume, as in previous years. From this it might appear that the general public are becoming more antilitter minded. Refuse Collection The total weight of household refuse, including salvaged waste materials such as paper, rags and metal, was 21,495 tons, the weight of the salvaged materials being 923 tons. This was collected from 27,418 premises in the Borough, an average of approximately 16 cwts. each over the whole year or approximately 34 lbs. each per week. The average weight per 1,000 population per day was 13.2 cwts. Most refuse is collected from householders' individual bins, but with the increase in blocks of flats in the Borough, more is being collected from the large communal bins housed in chambers situated below chutes, into which each individual occupier deposits refuse. The scheduled frequency of collection throughout the Borough is once weekly. In a number of pre-war blocks of flats, however, sufficient bin storage capacity has not been provided and collections are 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 require the provision of adequate bin storage with satisfactory accommodation in new buildings or alterations to existing ones. In the Scavenging and Refuse Collection Sections of the Works Department, there is difficulty in recruiting suitable able-bodied employees who are prepared to undertake this arduous form of labour to fill the vacancies which occur on the retirement of the existing employees or take the place of those absent from work on account of sickness. Refuse Disposal The whole of the household refuse collected, totalling 21,495 tons, less the 923 tons of salvaged materials, was deposited into barges by the Council's refuse collection vehicles at the River Jetty, which forms part of the Council's Tunnel Avenue Depot, and transported by these barges down the Thames for disposal by controlled tipping over low-lying waste land near the mouth of the River. Trade refuse, amounting to 404 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. 63 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 923 tons of salvaged materials collected during the year was disposed of by sales amounting to £6,632, made up as follows: Scrap Metal — 81 tons — £487 Waste Paper — 801 tons — £5,316 Rags, etc. — 41 tons — £829 An income of £1,295 was obtained from the charges made by the Council for the collection and/or disposal of 404 tons of trade refuse arising from business premises in the Borough. 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 638 recorded complaints (408 of rats and 230 of mice), 439 were notifications, 69 re-notifications from occupiers or other sources and 130 were found during survey. The monthly average of complaints from all sources was 53 as compared with a figure of 44 for the previous year. In addition to the investigations of recorded complaints, 4,461 other surveys were carried out under the Prevention of Damage by Pests Act, 1949, giving a grand total of 5,099. During investigations, infestation was found to exist on 8 occasions in local authority's premises, 441 in dwelling houses and 114 in miscellaneous properties and places of business. Of these, 8 major infestations were disclosed, 4 of rats and 4 of mice, of which 4 were located in dwelling houses. In all some 575 treatments were effected by the local authority and 11 by occupiers or other services. Notwithstanding the fact that large industrial firms are inclined to make contracts with servicing companies, periodical treatments were carried out at 10 industrial premises, 5 wharves and storage places and at 3 hospitals in the Borough. 64 Following the policy of tracing the source of each infestation, 16 defective drainage systems were discovered. In these instances Intimation Notices were served under the Public Health (London) Act, 1936, and the drainage defects made good by the owners of the various properties concerned. In addition, a defective council sewer found to be involved in an investigation was made good under the direction of the Borough Engineer. 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 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 year ended 31st December, 1960 65 TYPE OF PROPERTY Non-Agricultural (1) Local Authority (2) Dwelling Houses (including Council H, uses) (3) All other (includg. Bu iness Premises) (4) Total of Cols. (1), (2) & (3) (5) Agricultural 1. Number of properties in Local Authority's District. 41 24,279 4,405 28,725 — 2. Number of properties inspected as a result of: (a) Notification 3 355 80 438 — (b) Survey under the Act 27 4,055 509 4,591 — (c) Otherwise — — — — — 3. Total inspections carried out—including re-inspections 34 4,448 615 5,097 — 4. Number of properties inspected fin Sect. II) which were found to be infested by (a) Rats Major 1 — 2 3 — Minor 4 239 54 297 — (b) Mice Major — 4 — 4 — Minor — 163 26 189 — 5. Number of infested properties (in Sect. IV) treated by L.A. 4 400 68 472 6. Total treatments carried out—including re-treatments 7 463 116 586 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 66 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 with the Ministry of Agriculture, Fisheries and Food, an experiment was conducted during the year 1959. Approximately 1,160 sewer manholes were baited with solid blocks suspended over the benchings. The blocks consisted of pinhead oatmeal, sugar, technical white oil and Warfarin No. 5. Rebaiting was carried out at three-monthly intervals. It had been hoped that this new technique would result in a major reduction in the rat population of sewers, but this expectation was not realised. An experiment limited to 12 months could not be regarded as conclusive, but before proceeding further with this technique a new experiment was carried out. Two areas of the Borough were treated by Ministry personnel using a bait of fluoracetate and fluoracetamide mixed with pinhead oatmeal and water. The results were startingly successful in reducing the rat population in these localised areas. Following these most encouraging results the Council adopted the use of sodium fluoracetate in ready mixed form for baiting sewer manholes. In view of the toxic nature of this material, precautionary measures were taken for the protection of the staff handling the materials and a fresh survey of manholes was taken to select those suitable for the introduction of this bait. In October 1960, the bait was introduced into some 1,270 manholes throughout the Borough. The Rodent Operatives of the Public Health Department handled the material assisted by workmen from the Borough Engineer's Department and baiting has continued at four-monthly intervals. Following three successive treatments a census baiting will be undertaken at a random selection of 250 manholes throughout the Borough, in order to make a new assessment of the effectiveness of this method of treatment. 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. 67 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. There is no doubt that since the introduction of the anti-fly scheme, control of fly and mosquito breeding has been effectively maintained and succeeding years have shown a progressive reduction in the number of complaints notified to this department. 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. During the year the department dealt with 88 cases of dirty and verminous premises compared with 123 in 1959. The disinfestation staff sprayed 256 rooms and contents as compared with 338 last year. In 8 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 539 houses comprising 1,592 rooms and 106 external areas, the following initiated the greater number of complaints:— Ants. Ants carry no disease but their presence in human foodstuffs is objectionable. 68 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 89 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 species, being of tropical origin, is incapable of breeding in England without artificial heat. A temperature of approximately 80°F is considered to be ideal for its propagation and ipso facto it is found infesting bakehouses, restaurants, hospitals and houses, especially in larders and kitchens and nests may be found behind wall plasters, behind pipes or ovens, in heating ducts and 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 54, an increase of 17 over the previous year. 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, complete elimination is extremely difficult Locating each individual nest, especially in old buildings, is not only extremely difficult but commercially impractical. 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. Cockroaches. The cockroach (Blatta orientalis) and its smaller relative (Blattella germanica) are well known for their destructiveness, especially in relation to stored organic matter, ranging from foodstuffs to book bindings. Food is rendered repulsive from contamination not only with their faeces but also with the 69 secretion from their scent glands, and the cockroach is strongly suspected of transmitting to man a number of pathogenic organisms especially those of an enteric nature. Cockroaches shun the light and are most active during the night. Warmth, moisture, darkness and close proximity to food supplies constitute favourable conditions for breeding. As was to be expected 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. 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, 125 treatments were effected. Clover Mite. Complaints were received from tenants in blocks of flats in various parts of the Borough concerning small red or dark brown insects (Bryobia praetiosa) found moving over walls and windows. The clover or gooseberry mite is harmless to humans and to household property. It is vegetarian feeding on a wide range of plants and shrubs and, in some instances, on trees. During the summer months of July and August the adult females leave their feeding grounds to seek winter quarters, emerging the following April to lay eggs on plants in the vicinity. It is during these periods of migration that they cause concern when they move 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 in the immediate neighbourhood. On 45 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. A miscible concentrate of malathion has been used externally on a number of occasions with very good effect. 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 70 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. A number of complaints regarding this pest were received and during the year some 57 nests were destroyed, mainly by means of HCN gas generated from purpose-made proprietary powder. Many other types of infestation were encountered and the following is a list of the treatments which were carried out in connection therewith:— Beetles : Black 19 Larder 4 Carpet 12 Golden Spider 1 Soldier 2 Earwigs 32 Silver Fish 17 Fleas 12 Moths 6 Woodworm 4 Red Mite of Poultry 6 Other Miscellaneous Insects 28 Precautionary Spraying. During the year, 372 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. 71 March 10th of 1959 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. (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 instance the increase of more than 1,500 over the number recorded for the previous year. During the current year 2,701 brine baths were given, mostly to ladies who found this type particularly attractive, and in addition some 4,032 shampoos and massages were effected. I am indebted to Mr. K. L. Embley, Superintendent Engineer, for the following statistics :— Attendances.—For the year ended 31st December, 1960:— Warm Baths 82,899 Swimming Baths 145,944 New Vapour Baths 13,212 Public Laundry 7,813 Total 249,868 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 3^ hours, thus enabling bathers to use the baths with every confidence. Regular chemical tests are taken (twice daily) and bacteriological tests taken periodically. 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 :— 72 Sample No. 1 2 3 4 5 6 7 8 9 10 11 12 * Mixed Bathing Date & Time 26.1.60 2.15 p.m. 12.4.60. 11.35 a.m. 11.5.60 2.30 p.m. 11.5.60 2.30 p.m. 1.6.60 2.00 p.m. 1.6.60 2.00 p.m. 29.6.60 10.40 a.m. 29.6.60 10.45 a.m. 3.8.60 3.15 p.m. 3.8.60 3.20 p.m. 229.60 10.45 a.m. 22.9.60 10.50 a.m. Nature & Temperature 2nd Class *Swimming 76°F. 2nd Class *Swimming 76°F. 1st Class *Swimming 75°F. 2nd Class *Swimming 75 °F. 1st Class *Swimming 74 °F. 2nd Class *Swimming 76°F. 1st Class *Swimming 75°F. 2nd Class *Swimming 75 °F. 1st Class *Swimming 74 °F. 2nd Class *Swimming 76°F. 1st Class *Swimming 76°F. 2nd Class *Swimming 76°F. No. of Bathers 100 110 300 280 250 150 109 90 360 250 6 124 Plate Count per ml. Yeastral Agar 2 days 37°C. 1 — 11 4 2 — 2 — 1 2 1 2 Probable No of Coliform bacilli, per 100 ml. MacConkey 2 days 37°C. — — — — — — — — — — — — Faecal Coli. per 100ml. — — — — — — — — — — — — — Result Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory Satisfactory 73 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 — Blackwall Tunnel 3 — 6 5 — Charlton House 2 — 4 2 — Creek Road (St. Nicholas, Deptford) 4 2 10 4 2 Greenwich South Street (near Town Hall) 4 1 10 4 2 King William Walk (near Greenwich Park) 4 2 9 7 2 *Rodmere Street 5 3 12 5 3 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. *uring Summer Period this convenience opens at 8.30 a.m. on Sunday. †omen's side closed 29th November, 1959, due to damage arising fom a road accident. Notification has been received from the London County Council that, in accordance with the compulsory powers obtained under the London County Council (Tunnel and Improvements) Act, 1938, for the purposes of the Blackwall Tunnel Duplication scheme, they will be requiring, by the end of 1961, the land upon which the Tunnel Avenue Convenience is situated. Representations to the County Council are being made with a view to obtaining an alternative site. 74 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. 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 ol 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 5,072 5,080 10,152 Creek Road 1.968 5.291 7,259 Greenwich South Street 1,891 5,104 6,995 King William Walk 3.288 8.431 11,719 Rodmere Street 2,045 4.139 6,184 Shooter's Hill Road 2,622 3,578 6,200 Totals 16,886 31,623 48,509 Aged, Infirm and Physically Incapacitated Persons.— Now-a-days life is very difficult for the aged. In a Welfare State where most of the emphasis is on youth and where provision for them is on a most lavish scale, it is small wonder that the elderly feel neglected and become somewhat irascible. Post-war years have seen a decline in the cohesion of the family unit and the presence in it of an aged and infirm person is often resented, considered to be a handicap and a disruptive influence. However, it has been postulated that up to 30% of people of pensionable age have no relatives in a younger group; indeed, as time inevitably removes loved ones, whether relatives or friends, many old people find themselves bereft of all personal relationships. 75 Of the many thousands of people who live alone, a large proportion are infirm and it has been estimated that, in urban areas at least, their numbers are twice what they were some 30 years ago. It is patent that medical, social and economic factors have enabled many more people to reach retirement age and, by reason of the extremely high birth rate of the Victorian era and a much lower rate in the succeeding generation, the proportion of elderly people in the population has tended to increase somewhat abnormally; at the present moment this proportion is in the region of one-sixth, a figure which it is anticipated will rise to one-fifth by 1977. The elderly as a group, pose some very difficult problems which, in the main, have always been shouldered by voluntary organisations. Even as far back as the Middle Ages, care of the aged and infirm was the prerogative of the monasteries and convents. Since the last war however, the National Old People's Welfare Council, established in 1940 by the National Council of Social Service, commenced a most productive partnership between voluntary and statutory bodies for today, there are represented on its Board, some 50 voluntary societies, the National Assistance Board and five Government Departments—Health, Labour, Education, Pensions and National Insurance and Housing and Local Government. At the present time, out of nearly eight million people of pensionable age in Britain more than two million are 75 years of age or over, the majority of whom are women. It would appear that approximately 96% of old people live at home and are well and active, but that about three-quarters of a million are homebound through some infirmity, and many are bed-ridden. A further 300,000 are housed by local authorities and voluntary bodies or are provided with accommodation by hospitals, and there remains a million or more living alone who require some special attention. Many old people have struggled hard all their lives and their independent spirit often involves them in much suffering. They are reluctant to avail themselves of the help and financial assistance offered or provided by voluntary and government agencies and they lapse into a semi-starvation existence of the "tea and bread and jam" category. This, coupled with loneliness and a sense of uselessness, predisposes them to the greatest problem of old age—that of severe mental deterioration. Sir John Charles, in his final report as Chief Medical Officer of Health to the Ministry of Health, reported that "the response 76 (of the elderly) to a proper diet is often dramatic" and many an old person with mental infirmity has made a remarkable recovery when regular balanced meals have been forthcoming. For the old people, this country is not yet a Welfare State; many family doctors are far too busy to spare much time for the elderly and hospital accommodation for them is hopelessly inadequate. It is well known that it is extremely difficult for anyone over 75 years of age to get into hospital except as an "acute" case. Nevertheless, there are some one hundred special geriatric units in being, attached to hospitals which are attempting to provide for the special needs of the elderly and, in this field, they are achieving an unexpected measure of success in restoring many to normal health and reducing their hospital stay to a minimum. These beneficial advances can so very easily be lost and it is essential for the geriatric unit to be assured that, on discharge, the patient will return to conditions most likely to lead to his or her re-establishment in life. Information of this nature is usually in the hands of the Medical Officer of Health which could be made readily available to the geriatrician and which should form the basis of their co-operation. In order that the problem shall be seen in its true perspective it must be stated that, not withstanding these geriatric successes, hospital care of the elderly is an enormous burden which can never be borne alone by the existing services and much, therefore, must be accomplished in the home. It is here the environmental health services should assume responsibility. When considering the role which local authorities must play in the general scheme it should be made quite clear that, admirable though modern and well equipped institutions may be, old people are infinitely better off in their own homes, especially as infirmity rather than illness seems to predominate; such a situation demands the best of co-operation at all levels between the various authorities, agencies, organisations, etc., concerned with the well-being of the aged. Accepting the view that old people are better off in their own homes, there is no doubt that many an old and frail person could remain in his or her home with very little domestic help, but only about four old people in every hundred are receiving this kind of assistance. This position is no reflection on the Home Help Service for it is performing splendidly with very limited resources. The cost of such a service is high, something more than £9,000,000 is involved, but residential care, whilst being less satisfactory, is much more expensive. Again, a mobile meals service is invaluable to the homebound and the B.R.C.S., the W.V.S., and others are performing wonders 77 in this respect. On good authority it has been estimated that out of a probable yearly need of at least five million "meals-on-wheels", only two million are served with only 0.3% of the aged receiving two meals per week. Housing is fundamental and a major factor in the welfare of the elderly and houses, functionally designed to reduce physical effort, built to avoid the necessity of "gadgets" and in which safety has been considered of prime importance, are gradually being introduced into programmes of many local authorities, but in general, progress has been painfully slow. Obviously there are times when a residential home has to be considered. In these circumstances it should be possible to arrange for a small, compact unit to be made available which would offer both privacy and companionship and which would accommodate many of the occupants' personal and treasured possessions. Assessment of the whole problem and what will be its extent in future years is very difficult if not impossible, for at present the number of pensionable people (and therefore those who are most likely to be in need of assistance) remains problematical to public health departments. It seems incredible that information available to Pensions Officers should not be at the disposal of the authorities whose purpose would be to administer to the more unfortunate of this group. The present position is far from satisfactory. Services provided by doctors, district nurses, health visitors, home-helps, etc., are all stretched to the limit and the same can be said for other ancillaries and voluntary bodies involved with the problem. All indications are that no satisfactory solution will be found until some government leglisation, probably on the lines of the Maternity and Child Welfare Services, is instituted. Under existing conditions the public health department acts as a "clearing house" and there are very few cases brought to its notice which fail to receive adequate help and advice. Cases are brought to the notice of the department by neighbours, district nurses, secretaries of Old People's Associations and hospital almoners and many visits by the Lady Public Health Officers to old persons result from information supplied by local practitioners. Relations between the department and other organisations have always been excellent and co-operation with Dr. Mester and his Geriatric Unit at St. Alfege's Hospital are close and cordial, all to the benefit of the elderly infirm patient. 78 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 Officers during 1960:— No. of dirty premises inspected 22 No. of verminous premises inspected 5 No. of dirty rooms cleansed 19 No. of verminous rooms cleansed 15 No. of verminous persons visited 7 No. of verminous persons treated:—Heads 47 Other 2 No. of visits to scabies cases 5 No. of visits for Cleansing Service:—First 49 Subsequent 75 No. of articles cleansed 30,457 No. of inspections of factories:—(a) with mechanical power 19 (b) without mechanical power — (c) other premises — No. of inspections of Hairdressers' premises 26 No. of inspections of Outworkers' premises 38 No. of inspections of Houses Let-in-Lodgings — No. of inspections of Women's Conveniences 10 No. of Bathing Centre sessions 99 No. of Baths:—at Home 1,287 at Centre 544 No. of visits to Infirm Persons 4,103 No. of visits to Rest Homes, Hospitals, etc. 35 No. of visits, re: housing 33 No. of visits to Food Premises, re: Meals for O.A.Ps 29 No. of Miscellaneous visits 110 No. of re-inspections, calls made, etc 106 No. of interviews for Holidays 62 No. of interviews at offices 204 No. of complaints received 38 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. 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 79 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, 544 baths were given to dirty or verminous elderly persons at the Cleansing Station and 1,287 home baths were effected. These represent substantial increases over the figures for the previous year which were 436 and 742 respectively. In 1958 the figures were 151 and 224. 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. 80 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 165 separate individuals and during the current year, the staff at the Cleansing Station have dealt with 30,457 articles which were collected, laundered and delivered. New Cleansing and Bathing Centre.—For some time, the Public Health Committee have realised the inadequacy of the present buildings and have merely been awaiting sanction from the Ministry to provide new premises. This permission has now been given and plans are in hand for a new cleansing and bathing centre to be erected and this is expected to be in operation by the and of 1961. Greenwich Old People's Welfare A ssociation.—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 seventh Annual Report of the Association. "Old People's Clubs.—The Darby and Joan Clubs, the Federation Clubs and Church Clubs continue to prove the main source of contact amongst the elderly citizens in the Borough and we are very pleased to report that during the past year one additional club has been opened with the kind co-operation of the Church Authorities, who have offered the use of their Hall at the Congregational Church, Bramshot Avenue, for a Federation Club. In addition, thanks to the generosity of the Greenwich Borough Council, the Greenwich No. 1 Federation Branch, having had to vacate their premises at Park Vista, now meet in the Minor Hall. Peyton Place. There are now 15 old people's clubs in the Borough, meeting each week, where elderly persons are provided with an opportunity for social entertainment and fellowship. The clubs individually arrange many outings by coach to the sea, shows, beauty spots, factories, etc., and these, together with the Christmas, New Year and anniversary parties, provide many happy occasions for their members. 81 We, and the old people, are deeply indebted to the leaders of these clubs and their assistants for the time and service they give so willingly on their behalf week by week. We are also most grateful to the Greenwich Borough Council for the facilities granted to us in providing premises for a number of the clubs to meet and also for the grant provided to reimburse the Charlton Library Club for the additional cost of heating, lighting and cleaning of their premises, when the Darby and Joan Clubs hold their weekly meetings. Day Rooms at Community Centres:— (a) Charlton House Day Club. This Club, which has been operating now for five years, is still very popular and used regularly each day by a steadily increasing number of elderly persons, all of whom are very appreciative of the facilities available. During the year members of this Club have taken part in outings to Shoreham and Brighton, both of which have proved very enjoyable. We would like to express our thanks to Mrs. Markson for her help at this Day Club. (b) Kidbrooke House Day Club. Members will recall that until June, 1960, the Kidbrooke House Day Club had proved one of the very few unsuccessful ventures inaugurated by the Association. However, the scheme for transporting elderly invalids in the minibus from their homes to Kidbrooke House, where they are looked after by members of the British Red Cross Society, has proved so successful that, with the help of members of the Women's Voluntary Service, the scheme has been extended to cover two days per week. The number of elderly invalids desirous of attending this Club is steadily increasing and the possibility of further extending the scheme to cover three days per week is being investigated. We are very appreciative of the services rendered in this connection by members of the two Organisations mentioned above and, in addition, would convey our sincere thanks to the Women's Voluntary Service for the donation of a wireless for this Day Club. We are also indebted to the Greenwich Borough Council for providing a handrail to the outside steps of Kidbrooke House, a hand bar in the toilet and additional heating in the day rooms, thus contributing in no small way to the comfort of the old people concerned. At the last Annual General Meeting, reference was made to the fact that certain of the invalids required two or more cushions in their chairs and we are pleased to report that four 82 additional cushions have been purchased, thus obviating a number of the chairs being rendered unserviceable. Following a visit by a party of 20 old age pensioners to the Regal Cinema in Old Kent Road, to see the film Premiere, "The Sundowners", it was felt that many of the invalid persons would enjoy this film and arrangements were accordingly made for them to visit the Roxy Cinema whilst this film was being shown. In view of the success of this visit, arrangements have been made for invalid persons attending this Day Club to be taken to the Roxy Cinema once a month and we feel that it would be appropriate at this stage to express our sincere appreciation to the Manager of the "Roxy" for his co-operation on these occasions. (c) West Greenwich House. This Day Club is still the most popular of the three and, at one time, the single room available proved inadequate to accommodate the large number of elderly persons attending. In the circumstances, it was found necessary to place a temporary stoppage on the acceptance of new members, although the position appears to have now resolved itself. We regret having to report that Mrs. Crowshaw, the Day Club helper, had to resign for personal reasons and we would like to take this opportunity of expressing our appreciation of the excellent work she carried out in providing for the comfort of the elderly people using this Club. We subsequently appointed Miss Eastwood as helper at this Club. She has proved most efficient in carrying out her duties and is very well liked by the old people. In view of the large attendance, we have purchased a tea trolley to ease the work of carrying teas and meals (now 31 per week) between the kitchen, day room and dining room. During the course of the year members have enjoyed a birthday and a Christmas party, the latter being organised by the Make and Mend Group, affiliated to the Greenwich Community Council; have taken part in a number of outings and are looking forward to visiting Cliffe Women's Institute on 26th June, 1961. Our thanks are due to members of the Central Library Darby and Joan Club, who presented a television set to His Worship the Mayor for use at this Club and also to the Greenwich Borough Council for permitting the installation of same. Altogether a very happy and friendly atmosphere prevails at this Day Club. Meals on Wheels.—The four vans used by the Association for the Meals on Wheels service have been functioning continuously throughout the year and due to the loyalty of the Meals on Wheels drivers and helpers, we have been able to meet the increasing demand for this service. 83 The following is a statement of the number of meals served during the financial year 1st April, 1960 to 31st March. 1961:— British Red Cross Society's van 7,366 Old People's Welfare Association van 5,793 Old People's Welfare Association minibus 6,265 Women's Voluntary Service van 6,983 Grand Total 26,407 The above figures show an increase of 1,056 meals supplied, as compared with the previous year. The Women's Voluntary Service van has not been used on Mondays, as the demand on this day has not been high enough to justify using the four vans. During the year we have issued each member of the Meals on Wheels staff with two overalls, in order to safeguard their personal clothing and obtain some uniformity in the dress of employees. We would take this opportunity of extending our appreciation to the drivers, helpers and members of the voluntary organisations who enable these meals to be delivered each day to homebound and invalid elderly persons, thus providing a really valuable service. Holidays for Elderly Persons.—With the assistance of a grant from the Greenwich Borough Council, we have, since the last Annual Meeting, been able to send two parties of elderly persons to Margate for a fortnight's holiday. The September, 1960 party numbered 136 and the May, 1961 party 170. Once again the holiday parties experienced exceptionally fine weather and many letters of appreciation have been received. Members of the Committee travelled with the coaches on each occasion 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. There are many old people who are not physically capable of being included in our ordinary holiday scheme, but would benefit considerably by a holiday at the sea. Arrangements were therefore made for four parties of invalids to be sent to Lancing in September, 1960 and May and June, 1961 respectively. A further party will be leaving for Lancing on 8th July. These persons are accommodated in a bungalow where all the rooms are on ground floor level and the gardens overlook the sea. No nursing attention is given, but there are many additional facilities to those found at an ordinary boarding house, which help physically handicapped persons to have an enjoyable holiday. 84 In the past we have had to rely on the good offices of the Borough Council for the provision of transport, but during the past year it has been possible to transport each party in the Association's new minibus. In this connection, we have purchased a suitable tarpaulin, in order that cases belonging to members of the invalid holiday parties may be secured to the roof of the minibus and safeguarded from the weather, thus providing for a more comfortable journey. We regret to report, however, that after the present season, the accommodation at Lancing is being sold for development. It thus became necessary to find alternative suitable accommodation in order that this service might be continued in 1962 and, with this in view, arrangements were made for a Viewing Sub-Committee to inspect accommodation at Clacton-on-Sea. Arising from this visit, accommodation suitable in every way for invalid holiday parties has been reserved during May, 1962. Homebound Christmas Tea Party.—It is with great pleasure that we report a new venture. On 13th December last 41 homebound persons were transported to the Minor Hall, where they enjoyed a Christmas dinner, comprising roast turkey, ham, sausages, roast and creamed potatoes, sprouts, cheese, Christmas pudding and brandy sauce (or fruit salad and ice cream). The meal was followed by a film show, tea and biscuits and a small gift for each person before they were returned to their homes. Many letters and expressions of appreciation were received from those who attended and we would like to place on record our sincere thanks to all those who contributed in so many different ways to ensure the success of this occasion. In view of the success of this event, we have decided to arrange other functions for the homebound during 1961, it being felt that this section of the elderly people in the Borough are unable to take advantage of the normal services provided by the Association. Details of some of these events will be found later in the report. Christmas Food Parcels.—Once again, with the aid of a grant from the Borough Council, we were enabled to distribute food parcels to 400 homebound elderly persons. Each person was visited to ensure that only those who were strictly homebound received a parcel and we were able to maintain the high quality of the parcels, each of which contained the following items :— Tea, biscuits, Christmas pudding, tin of fruit salad, tin of cream, box of cheeses, sweets and chocolates. Members of the Committee and other volunteers packed and wrapped the parcels and helped with the distribution and our 85 sincere thanks are due to all who gave their time at such a busy period of the year towards bringing a touch of festive cheer into the homes of so many of our homebound elderly persons. In addition to the above, several donations were received with a request that parcels be bought and distributed and, as a result, approximately 50 additional homebound persons received parcels of varying contents. At this time of the year our thoughts turned to the elderly persons who had nobody to provide for them on Christmas Day and frozen Christmas dinners, consisting of chicken, vegetables and Christmas pudding, were purchased and delivered to 24 such persons. These dinners had merely to be heated for 20 minutes before eating. We also arranged for two elderly ladies, each of whom would have been on her own over Christmas, to spend a week at the Edith Priday Home. Carol Service.—The Carol Service held at St. Alfege Church on 12th December, proved very successful, over 100 elderly persons being in attendance and our appreciation must be expressed to the Church Authorities and also to the members of the Women's Fellowship for their co-operation. Foods for Old People.—Here again is an existing service which has been extended to many more old persons within the Borough. The receipts for sales of welfare foods up to 31st March, 1961, amounted to £1,144 0s. 6d., being an increase over the previous year of £255 8s. 11d. When it is realised that the welfare foods are sold at a price ranging from between 2s. and 2s. 9d. per item, it will be appreciated that this increasing turnover in stock involves a great deal of work for the members of the Women's Voluntary Service, by whom the main distribution is carried out and to whom we are greatly indebted. It is with real pleasure that we report a reduction in the price of Bovril from 3/-d. to 2/9d. subsequent upon an increase in the amount of discount allowed on supplies received from the 1st March, 1961, onwards. To date twenty-eight welfare foods permits have been issued on behalf of homebound elderly persons and every effort is being made to extend this scheme as rapidly as possible. House-to-House Collections and Street Appeal.—We reported to you at the last Annual Meeting that the Worshipful the Mayor had offered to make application on behalf of the Association to hold a House-to-House Collection and Street Appeal in aid of the Association's funds. 86 The Collection was held in the first week of September and was extremely well supported, the total proceeds being £157 3s. Id. After deduction of expenses in respect of emblems and permits, the record sum of £147 3s 3d. was credited to the Association's funds. The Committee are greatly appreciative of the services of all who assisted, and in particular, those elderly people who helped to collect on the day of the Street Appeal. We now have pleasure in reporting that the Worshipful the Mayor (Councillor Mrs. Peggy A. Middleton, J.P., L.C.C.) has also agreed to make application on behalf of the Association for a similar Appeal this year, an offer which we have readily accepted and application has been made for the Appeal to be held on Friday, the 8th September, and for the House-to-House Collection to be carried out during the week preceding that date. As soon as we receive notification that the application has been acceded to, details will be sent to all organisations in the hope that their members will give their wholehearted support in an endeavour to surpass last year's satisfying total. Garden Party and Handicraft Exhibition.—Once again we are arranging to hold a Garden Party and Handicraft Exhibition at Charlton House on the 8th July, 1961, and a verbal report on this event will be given at the Annual Meeting. In view of the additional facilities available at the Minor Hall, especially should the weather prove inclement, we are arranging a tea party on the 9th June for forty homebound persons in the Minor Hall, instead of at Charlton House as in the past. These persons are unable to leave their homes without assistance and they will be transported to the Town Hall, where entertainment will be provided, together with an extra special tea. Entertainment.—Members of the "Nightmares" Concert Party provided excellent entertainment for more than two hundred and fifty elderly persons in the Borough Hall on the evening of the 10th April. 1961. We are extremely grateful to these people for giving their time to rehearsing and presenting a first class concert and also to the Borough Council for granting us the free use of the Borough Hall on this enjoyable occasion. Coach Outings.—As reported at the last Annual Meeting, we had accepted an invitation on behalf of the thirty-three semi-invalid elderly people to visit the Women's Institute, Groombridge, near Tunbridge Wells, on the 18th August. The visit duly took place, the weather being favourable, and everyone agreed that they had enjoyed a very pleasant afternoon. 87 On the 12th May this year a party of thirty-five semi-invalids was taken on a coach tour of the Kentish countryside, stopping at Otford for tea. Once again the weather was favourable and all the members of the party agreed that this outing had proved most successful and enjoyable. In view of the many letters of appreciation which we have received regarding the above-mentioned outings, we have accepted an invitation for a party of thirty-five semi-invalids to visit the Linton Women's Institute, Coxheath. near Maidstone, on the afternoon of the 26th June, 1961. All persons participating in the above outings are unfit to take part in the normal holiday scheme, due to various disabilities and these occasions go a long way to breaking the monotony of their daily lives. Leaflets on Welfare Services.—We reported at the last Annual Meeting that the Central Consultative Committee on the Welfare of Old People, in conjunction with the Ministry of Pensions, proposed to issue leaflets throughout the Metropolitan Police area, to new old-age pensioners when they collected their pension books. These leaflets, giving details of the welfare services for old people, together with the address of the local old people's organisation, have been distributed as from the 1st February this year, many of the elderly persons concerned having been assisted by means of one or more of the services operated by the Association. In addition, five thousand copies of a local leaflet giving detailed information regarding all services available to old people in the Borough have been distributed through the Community Centres, libraries and other organisations and, arising therefrom, numerous requests for assistance in one form or another have been received and dealt with. Young Christian Workers' Scheme.—Having received an offer from the representative of the Young Christian Workers for members of his organisation to assist elderly persons by filling coal buckets, shopping and other similar duties, we interviewed this young representative and were most impressed with the sincerity of his offer on behalf of boys aged thirteen to fifteen. Accordingly arrangements were made to allocate one elderly person to each member of the Young Christian Workers and the scheme commenced on the 13th January last. From reports which we have received, both from the boys and the elderly persons concerned, the scheme is proving extremely successful and the boys deserve the highest praise for giving their time and energy in such a worthwhile cause. 88 Invalid Chairs.—At the moment the Association owns four invalid chairs, which are loaned out to elderly persons requiring same. There is, however, an increasing waiting list for this service and, with the aid of a grant from the Greenwich Borough Council, we propose shortly to purchase a further six invalid chairs which will greatly alleviate the present position. Acknowledgmenls.—Although many individual acknowledgments have been expressed throughout the foregoing report, it is not possible to mention everyone who has helped with the work of the Association during the past year and it is opportune, therefore, for us to place on record our sincere thanks and appreciation to the members of all the voluntary associations who have given so much of their time on behalf of the old people. Special mention must, however, be made of the Greenwich Borough Council for the many and varied facilities made available to us, especially the financial grants which continue to amount to a considerable sum. As mentioned earlier in the report, due to the generosity of the Borough Council, we are this year in a position to purchase half a dozen new invalid chairs. We would also like to express our thanks to the Town Clerk, the Medical Officer of Health, the Borough Treasurer and their staffs for the able and willing assistance given by them during what has proved a busy and expanding year. As stated in our last report, it is our earnest endeavour to extend the scope and influence of our work to every old person within the Metropolitan Borough of Greenwich and we feel that during the past year we have, with the co-operation of our voluntary helpers and friends, gone some way to achieving this end." Executive Committee, 1960/61.—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. J. E. Crisp 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) 89 Mrs. L. Hilldrith (Greenwich Labour Party—Charlton Women's Section) Mrs. N. C. Lewis (Vice-Chairman) (Inner Wheel Club of Greenwich) Miss K. Rackham (British Red Cross Society) Mrs. F. Stapley (British Legion, Women's Section) Burial or Cremation of the Dead.—Under Section 50 of the National Assistance Act, 1948, the Council is required to arrange for the burial or cremation of any person who has died or has been found dead in the Borough if in such cases it appears to the Council that no suitable funeral arrangements have been or are being made. The Council is empowered, if it so desires, to recover expenses for the burial or cremation from the estate of the deceased person or from any person who, for the purposes of this Act, was liable to maintain the deceased person immediately prior to his death. During 1960, arrangements were made under the above Act for the burial of six bodies, 4 male, 1 female and one unknown, at a total cost to the Council of £17 8s. Od. Exhumations.—Two exhumations were carried our 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 1960 Inspections— Houses inspected (House-to-House) 17 „ „ (Complaints, nuisances) 1,040 „ „ (Infectious Disease) 316 „ „ (Overcrowding) 34 Re-inspections, calls made, etc 6,823 Inspections of Factories 276 „ „ Shops 4 „ „ Hairdressers or Barbers 33 „ „ Licensed Victuallers 3 „ „ Pet Shops 5 „ „ Stables and yards 11 „ „ Urinals 62 i„ „ Houses let in Lodgings 1 „ „ Outworkers premises 38 „ Under Clean Air Act 5,662 „ Miscellaneous 1,101 Inspection of Premises (Pharmacy and Poisons Act, 1933) 11 „ „ „ (Rent Acts) 72 Investigations (Rats and Mice) 229 On notice from Architects and Builders 605 16,343 90 Drains— Drains tested—by smoke 137 „ „ —by water 449 Opened, cleansed and repaired 411 Reconstructions and additions 308 Inspection chambers constructed 193 New covers to manholes 127 Soil and vent shafts repaired or renewed 183 Traps (gully) 230 Drains sealed off, etc. 83 Yards and forecourts drained 29 Waterclosets and Urinals— W.C. Compartments erected or repaired 233 W.C. fittings repaired or renewed 263 W.C. pedestals installed or renewed 297 Sanitary conveniences or improvements effected to Factories and Workplaces 7 Urinals cleansed or repaired 38 Dustbins— Provided 108 Pavings— Yards and Forecourts 67 General Water Supply— Water Fittings amended 283 Extra water supply to tenement houses — Water supply certificates granted (Sect. 95) 127 Other Improvements— 126 Houses generally repaired Rooms cleansed and repaired 342 Rooms and staircases lighted and ventilated 6 Verminous rooms cleansed 25 Roofs, gutters and rainwater pipes repaired 421 Dampness abated 263 Sinks, baths and lavatory basins provided 699 Sink, lavatory and bath waste pipes trapped or amended 496 Stoves and fireplaces 162 Washing coppers repaired or provided 3 Floors repaired 146 Provision for storage of food 159 Miscellaneous repairs 532 Other Nuisances Abated— Illegal use of Underground rooms discontinued 2 Overcrowding abated 12 Animals kept in unfit places discontinued or removed 1 Dung receptacles provided — Accumulation of manure and other abnoxious matter removed 46 75 Rat infestation abated / J Smoke Nuisances— Observations 774 Statutory Notices served (Sects. 147 and 148) — Notices. &c.— Intimations served under Public Health (London) Act, 1936 555 Statutory Notices served 125 Houses rendered fit by informal action 54 91 Legal Proceedings Premises Offence Result of Proceedings 14, Azof Street Non-compliance with Statutory Notice Summons withdrawn on payment of 3/- costs. 30, Azof Street do. do. 30, Azof Street do. do. 38, Azof Street do. do. 250, Creek Road do. Summons withdrawn on payment of £1 Is. costs. 256, Creek Road do. do. 268, Creek Road do. do. 304, Creek Road do. do. 16, Eversley Road do. Order for work to be executed within 21 days. £2 2s. costs 16a, Elversley Road do. do. 18, Greenwich High Road do. Adjourned sine die. 14, Ransom Road do. Order for work to be executed within 28 days. £1 Is. costs. 82, Shooters Hill Road do. Order for work to be executed within 14 days. £2 2s. costs 92 SECTION D Housing During the 19th century, under the stimulus of the Industrial Revolution, the population registered a remarkable increase which, among other things, resulted in a substantial impetus to housing especially in urban areas close to the source of employment. This sudden demand for dwellings was met by impulsive design and hurried construction, not perhaps conducive to the production of the best of houses. Often "back-to-back", deficient in lighting and ventilation, many of these houses are reaching the end of their useful lives and, in due course, it will become necessary to clear areas in which this type of property predominates. Clearance of sub-standard dwellings usually presupposes redevelopment and, in these circumstances, a great responsibility rests upon modern architects and planners to ensure that the errors of the past are not perpetuated in the cities of the future. In acknowledging the shortcomings of previous years it might be as well to reflect that, critical though we may be of the towns and buildings of the 19th century, the housing situation today is, in some respects comparable with that period and it is conceivable that house design and construction dictated by present-day pressures may, in its turn, be subject to similar scathing criticism. In no other field in local government is it necessary to look so far ahead and to plan accordingly than in housing and nobody is more aware of local housing conditions than the medical officer of health and his department. Indeed representations of areas for clearance are, in the first instance, dependent upon his assessment of the general grounds of unfitness based on detailed surveys carried out by the Public Health Inspectors. However, complete elimination of the dwellings of the last century is not only impracticable and uneconomic but often undesirable. Some of the bigger and better quality houses of the period are capable of being altered or reconstructed to suit modern requirements and many useful conversions have been and are being made. Recent legislation has empowered local authorities to make grants in order that the lives of some of the older properties may be extended for at least 15 years, the main requirement being that, on completion of outstanding works, the dwelling will be provided with the five "standard" amenities, viz:— (a) a fixed bath or shower in a bathroom, (b) a wash handbasin. (c) a hot water supply. 93 (d) a water closet in or contiguous to the dwelling, and (e) satisfactory food storage facilities. Fortunately many of the more substantial Victorian houses lend themselves to conversion into flatlets for old people as accommodation specifically for the aged is extremely limited; indeed, recent government subsidy policy has encouraged the provision of onebedroom dwellings. But although such housing problems have been with us for a very long time, it is difficult to realise that it is only since 1951 that the existence of an "old persons" housing problem has been officially recognised. In a Ministry of Housing and Local Government Planning publication of that time, viz:— "Housing for Special Purposes", housing difficulties of the aged and disabled were given prominence. Since then, a further two Ministry publications have been issued—one in 1958 and another in 1960, both referring to flats for old people. Perhaps, as a result of the government publications, housing for the aged is now becoming a permanent feature in the plans of many local authorities, but the question of the disabled has received less attention. Nevertheless, on a number of occasions the Greenwich Council have carried out structural alterations to enable disabled persons to undertake a Council tenancy. In this respect some governmental aid is available under the National Assistance Act, 1948, for the adaptation of homes of disabled persons, but there is still great scope in this field. In certain quarters it has been suggested that the problems of the aged and disabled could be amalgamated to their mutual benefit in conversions, which are often less expensive than the cost of new building. Accommodation on floors higher than the first could house a younger and fitter occupant, possibly employed as a warden to handle the heavier duties such as the cleaning of corridors and stairways, attention to a central heating system and to the garden as well as other onerous duties. Further, home helps and district nurses would find it advantageous to have their charges concentrated in one area and the disabled with their transport of wheel chairs etc., could possibly assist with the shopping for the aged, who in turn could perhaps manage to cook occasionally for the disabled. Nevertheless, much more can be achieved for these two classes by purpose-made houses or flats, centrally heated and functionally designed to avoid unnecessary physical effort. Where possible, these flats should be close to shops and public transport and sited to obviate the necessity for hill climbing. Fundamentally the old have need of the young and the young have need of the old, even if only in small doses, but under modern housing policy there is a tendency, albeit unintentional, for the 94 family unit to become divided. More and more young families are being rehoused away from their parents (doubtless very happily at first) but this often leads to difficulties when the young housewife wishes to work to supplement the family income—there is no grandmother to look after the children. Conversely, the grandmother has to face a lonelier life and becomes dependent on neighbours, the local authority or other voluntary organisations. Perhaps a revision in house or flat design would enable a threegeneration family to live side-by-side in independent units with a communicating door normally kept locked, but enabling assistance to be given either way in case of illness or infirmity. In the event of the decease of the grandparents their unit could then be incorporated in that of the younger family to counter the need of additional accommodation necessary for an increasing family. In the new designs which would incorporate some form of sound proofing (a very necessary provision in the noisy world of today) perhaps an enlargement of the bathroom could provide facilities for laundry drying during inclement weather. All-in-all there are great opportunities in local government for the architect and planner. Legislation — Requisitioned Houses Act. 1960 — An Act authorising local authorities, if they find it necessary, to retain possession of requisitioned property until March 31st, 1961. The original date for derequisitioning viz. March 31st, 1960 was specified in Section 1(2) of the Requisitioned Houses and Housing (Amendment) Act, 1955. Housing Act, 1957—General.—Shortage of "housing space" merely adds a further complication to those already besetting housing authorities in urban areas and slum clearance becomes of paramount importance in schemes to achieve a higher density to meet the needs of a growing population with advancing standards of living. Bearing in mind the Housing Department's difficulties in finding resources to re-house tenants from clearance areas, representations have always been made with due regard to the redevelopment potential of any site subject to the provision that any particular family hardship being sustained in an area not scheduled for early representation could be represented as an individual unfit dwelling in advance of the respective clearance area. This has been done on several occasions in respect of L.C.C. areas and a number of basements have been closed by this Council as opportunity has arisen. 95 Underground Rooms—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 general 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. Slum Clearance.— Under Part III of the Housing Act, 1936, two sites comprising some 78 dwellings in the Haddo Street and Norman Road areas were represented for slum clearance and received the Minister's approval by the latter end of 1957. Persons resident in these areas are now being rehoused and their dwellings demolished, and it is expected that the erection on the site of 164 dwellings will commence sometime during 1961. Redevelopment.— A number of houses which would have been included in the Council's slum clearance schemes have already been dealt with by the Trustees of the Morden College Estate in their own redevelopment schemes. Since the war, some 45 houses and a number of prefabricated dwellings have been demolished and the following list indicates new accommodation provided under their auspices :— Banning Street 2 dwellings. Bellot Street 20 dwellings. *Christchurch Way 28 dwellings. Derwent Street 8 dwellings. Kossuth Street 11 dwellings. † Point Close22 dwellings and 12 garages. *Ground floor flats provided for elderly people with maisonettes above. tService flats for upper income groups. 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 96 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 42 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 11 such grants had been agreed. Re-Housing.— (a) Borough Council.—There were 50 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 355. Of this number one was in respect of an overcrowded case and 12 families re-housed from outside the Borough. The Housing Department now has control of 4,136 Councilowned units of accommodation, an increase of 448 over that of the previous year. In addition at the end of the year there were still 35 hutments occupied by 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, 1960, the L.C.C. had provided alternative accommodation for a total of 323 Greenwich families of which 3 had been certified as overcrowded cases. Of this figure, 211 were housed on L.C.C. housing estates outside the Borough. One family from outside Greenwich was rehoused in the Borough under the L.C.C. scheme. (c) Other.—A further 8 families were rehoused by other means. Overcrowding.—As a direct result of rehousing carried out under (a), (b) and (c) above 12 cases of overcrowding were abated during the year under review. The number of unabated certified cases of overcrowding in the Borough now amounts to 54. During 1960 there was a fall in the number of complaints received concerning overcrowding, the year's figure of 29 showing a decrease of 2 from that of the previous year. Each complaint was investigated by the Public Health Inspector concerned and as a result of these investigations 2 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 97 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 1959 10 14-year average 85 1960 2 New Housing Accommodation.—The following table lists the new dwellings erected in the Borough during 1960:— ]Type of Dwelling G.B.C. L.C.C. Private Total Houses 2 25 27 Flats and Maisonettes 50 5 45 100 Total No. of Dwellings 50 7 70 127 Excluding the families accommodated in requisitioned property, the total number of dwellings provided in the Borough since the termination of the war is now 5,624 Council Housing Schemes.—(Information supplied by the Borough Engineer). (a) Schemes completed during the year under review :— ]Site Dwellings Coldbath Street 8 Dutton Street 8 Shooter's Hill Road/Rochester Way 18 Westcombe Hill/Westcombe Park Road 16 50 98 (b) Schemes in progress at the end of the current year:— ]Site Dwellings Trafalgar Road 16 Burney Street/Gloucester Circus 54 70 (c) Building programme for rehousing envisaged for 1961, et sea :— ]Site Dwellings Lansdowne Lane 54 Vanbrugh Park 176 Haddo Street 164 Heathway 51 Maze Hill 24 Kidbrooke Park Close 90 Greenwich Central Area 92 651 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 1960:— "Derequisitioning and its aftermath dominated lettings activity in 1960. Under the provisions of the Requisitioned Houses and Housing (Amendment) Act, 1955, the Council's powers to retain properties under requisition expired on March 31st and in fact the derequisitioning problem was virtually solved by that date. In order to do this, purchasing and leasing formerly requisitioned properties had to be resorted to to a considerable extent and when March 31st came round there were still legal formalities to be completed in a number of instances. Consequently the Minister 99 of Housing and Local Government exercised powers granted to him under the Requisitioned Houses Act, 1960, and made an Order extending requisitioning powers in Greenwich for a limited period to enable the Council to complete the task. This Order expired at the end of September by which time no properties remained under requisition. Altogether some 543 houses and flats had been purchased and another 65 were retained on short leases of up to 10 years. A total of 969 dwellings had been handed back to owners since the 1955 Act came into force. "The termination of requisitioning was however by no means the end of the problem. Practically all of the acquired properties were in need of improvement and in the majority of cases works of conversion into self-contained flats were necessary. In order to qualify for financial assistance from the Exchequer these works were to be carried out by March 1961. In the majority of cases vacant possession of houses had to be obtained so that builders could get to work on them; consequently a large number of families had to be transferred out of these premises so that as much work as possible could be put in hand. The Council's own technical and building resources were used to the limit and much of the work had to be put out to private architects and builders. "The need to obtain vacant possession of properties for the builders to commence work was a most pressing one, and the Housing Committee found it necessary to insist that one offer, and one offer only, of alternative accommodation could be made to tenants. Practically all available lettings were devoted to this operation and during the year a total of 269 families were transferred from one Council property to another. In addition 32 tenants were transferred out of requisitioned premises during the early part of the year so that the dwellings they were occupying could be handed back to the owners. "All this meant that rehousing from the Housing Register came practically to a standstill. In my notes last year I remarked that 1959 was the leanest year since the war as far as the housing of registered applicants was concerned, with only 21 cases being dealt with. 1960 was even worse, only 7 families being housed. Happily this state of affairs is not likely to continue into 1961 because during that year we may expect the completed conversions to become available for letting and, although a high proportion of these will have to be used to accommodate families being moved from slum clearance areas and from sites to be cleared for redevelopment, undoubtedly much more progress will be made in dealing with waiting list cases. 100 "Despite the absence of rehousing activity during 1960 I have to report the continuance of the fall in numbers on the Housing Register to which I have referred in past years. A list of 1,969 cases at the beginning of the year had reduced to 1,783 at the end. New registrations averaged 25 a month, the same as in 1959. The fall in number on the Register is the result of applicants not making annual renewals which they have to do to keep their names on the list. This system helps to keep the number on the Housing Register down to more realistic proportions by removing applicants which are no longer 'live'. "Thirty-nine mutual exchanges were arranged during the year which is about the number we have come to expect in recent years. Since each exchange involved at least two households, the number of tenants who have solved their problems in this way would be about 80. "As mentioned above, the outlook for 1961 is more cheerful than has been the case for the past year or two. Greater lettings activity may be expected and, with completed conversions becoming available, a considerably greater variety of dwellings will be under the management of the Council." 101 SECTION E Inspection of Food and Supervision of Food Premises This year marks the centenary of the passing of the first Act of Parliament for the prevention of adulteration of food and drink. A Report issued by a Select Committee of the House of Commons to the effect that adulteration of common articles of consumption was widespread, resulted in the passing of this Act in 1860. Today the attention of the Medical Officer of Health is more often directed to the spread of infection by food than to the ill effects of its adulteration or chemical contamination. Theoretically such infections are wholly preventable, but the cost to the National Health Service and the loss of man hours with the consequent fall in productivity testify to the present incomplete methods of control. The incidence of food infection and contamination is such that it requires the closest team work between the Medical Officer of Health, the Food Inspector, the Analyst, the Bacteriologist and, not least, the Food Trader himself to reduce it to a minimum. Since the middle of the 18th century the population has grown from 7½ to 51 millions and from an agricultural to an industrial nation. In terms of food and drink, this rise has meant more and more importation and the necessity for greater and better methods of food preservation. The origin of food preservation is ancient and obscure. For centuries man has known how to preserve his milk as butter and cheese, his grapes in the form of wine and his meat by salting. It was only in 1810, when a certain Peter Durand took out a British Patent, that preservation by canning became a practical proposition. However, it is only in recent years that canning ousted the bottling process and reached an estimated world output of 15.3 million tons by 1958. Fifty years ago frozen meat was largely unknown and the nation depended almost entirely on home supplies, but today refrigeration, although of comparatively recent origin is an essential part of the carriage and transport of meat, fish, poultry and eggs, etc., in a country where only approximately 5% of its population is engaged in food production. Even prosaic articles such as cheese, powdered milk, margarine, bacon, ham, etc., all represent various methods of food preservation. To all intents and purposes the tubercle bacillus in milk is eliminated; the production of the loaf is automatic and "untouched by hand"; many other foods are mass produced, pre-packed and distributed mechanically and although we may pride ourselves on having removed the more flagrant forms of adulteration, with all 102 these modern techniques, we are now confronted with subtler forms of contamination, viz. foreign bodies, residues of agricultural sprays on fruits and vegetables, hormones or anti-bodies introduced into meat and poultry, and most recently the possibility of radio-active contamination. A brief resume of this nature can merely indicate the vast field over which the Public Health Department in general and the Food Inspector in particular must exercise supervision with regard to food hygiene. It shows, too, how complex this aspect of public health is becoming and what diverse knowledge is necessary for the maintenance of effective control. Suitable staff is an integral part of the maintenance of a good standard of food hygiene and it is an unpleasant but incontrovertible fact that in past years the food trades have been sadly lacking in proficient staff. In the early 1900's the hotel and catering trade was virtually run by the "continentals" who had always considered it a profession and it was generally acknowledged as such, but in England many hotels and inns etc., were in the hands of unskilled staff whose qualifications were mainly domestic. About this time the Catering Industry began to select suitable employees for training, but the greatest impetus to this kind of arrangement was supplied by the government during the 1939-45 war when emergency rapid training schemes were introduced for the Army. In 1943, the Catering Wages Act, although not a panacea for all the industry's ills, remedied two of the greatest deterrents to the recruitment of suitable persons to the trade, namely, low wages and long hours of duty. Naturally these latter two subjects are still points of dissension, but at least their importance has been recognised by the managerial side of industry. It is of primary importance and to the advantage of Health Departments that this reorganisation of the food trade, in which education plays an increasing part, is taking place, for intelligent and efficient staffing is the foundation upon which "food hygiene" must be based—without it all inspectorial efforts will be brought to nought. With the prospects of a well paid job in up-to-date, pleasant and hygienic conditions to attract the right applicant, it would seem that the public are really on the way to being served by a skilled profession capable of offering well cooked and hygienically safe food, tastefully served. Persuasion has always been the method adopted by the Food Inspectors for raising standards of hygiene, and very successful it has been. Only on isolated occasions has it been necessary to invoke the law for the recalcitrant food trader. 103 Because of deficiencies and ambiguities. Section 13 of the Food and Drugs Act, 1938 and the Model Bye-Laws were of necessity replaced by the Food Hygiene Regulations, 1955, made under the new Act of 1955, and events have moved with such rapidity that even these Regulations have been supplemented by those of 1960. Although by no means perfect, the new legislation remedies many of the defects of previous enactments, and for the first time places a certain responsibility not only on management but on every individual food handler. The provision of constant hot water, wash handbasins and sinks with accompanying nail brushes and towels, accommodation for clothing and personal effects, etc., are all items among the long-awaited improvements and now first aid equipment becomes obligatory. It is evident that the powers necessary for the compulsory registration of eating houses still constitutes a serious omission and domestic animals are still not specifically banned from cafes and food shops. Some reprehensible practices, such as the touching of food when setting it out and the serving of meat sandwiches and cakes by hand still exist and further, the pernicious habit of cooking a joint today for tomorrow's meal persistently produces its yearly crop of infections of staphylococcal origin. Any clean food campaign would be incomplete without public support and, logically, this support must be cultivated at an early age. Children are very impressionable and receptive to information which is given in school time, especially if it provides a break from their normal routine. Suitably schooled children, on reaching adult age will then demand from the caterers and shop-keepers a higher standard of hygiene, and it is here that the foundations of success lie. 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 (Special Designation) Regulations, 1960.—These regulations, operative from the 1st October of the current year, replaced and consolidated, with amendments, The Milk (Special Designation) (Raw Milk) Regulations, 1949-1954 and the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949-1953. The principal changes are that dealers' licences granted by the Authority for the area within which the premises are situated, will now permit the sale of milk in any district, and will last for a period of five years. A dealers' (prepacked milk licence) has been introduced authorising a single form of licence enabling the use of any or all of the appropriate special 104 designations. Licence holders are no longer required to allow samples of milk to be taken free and there are alterations with regard to the prescribed tests. The Food Hygiene (General) Regulations, I960.—These regulations which came into force on 1st October of the current year, amended and consolidated the Food Hygiene Regulations, 19551957. and bring within their scope food businesses carried on from home-going ships and moored vessels. The Food Hygiene (Docks, Carriers, etc.) Regulations, 1960.— Operative from 1st November, 1960, these regulations follow the pattern of the Food Hygiene (General) Regulations, 1960, and prescribed requirements to secure the hygienic handling of food at docks, warehouses, cold stores, carriers' premises, etc., with adaptations to take account of the circumstances in which food is handled at those places. The Skimmed Milk with Non-Milk Fat Regulations, 1960.— These regulations control the labelling and advertising of the "specified foods" that is "skimmed milk with non-milk fat" and the same product in condensed or dried form, these products being defined in the regulations by reference to their appearance and constituents. These regulations come into operation on 19th September, 1961. Other Statutory Instruments and Circulars were published during the year in respect of arsenic in food, additions to the Poisons List Order, and, with regard to imported food, "official certificates" in respect of Eritrea, Gibraltar and Italy were approved. Milk Milk consists of approximately 87% of water holding proteins, sugar and certain salts in solution, has an average specific gravity of 1.032 and has suspended in it finely divided globules of fat to which it owes its whiteness. Its chemical composition is subject to variation on a number of counts such as the season and time of milking, the breed of cow, type of feeding, etc. 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 is one which is sampled extensively 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. 105 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 97 which total includes 6 dairy premises. On 47 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 was prohibited under the above Regulations unless the distributor was licensed for the use of same. Licences issued in accordance with the above Regulations were operative for one year from 1st January and were required to be renewed annually. Principal Licences were granted to Distributors in respect of premises within the Borough and Supplementary Licences to Distributors who sold within the Borough but whose premises were outside. The following licences had been granted and were in force on the 31st December, 1960 :— Licences In Operation Principal Licences issued 31.12.60. Distribution of Sterilised Milk 94 87 „ Pasteurised Milk 60 55 „ Tuberculin Tested 43 39 Supplementary Licences Distribution of Sterilised Milk 19 not applicable from 1st October, 1960, „ „ Pasteurised Milk 14 under the new „ Tuberculin Tested 18 ulations. Sampling.— Under provisions of the Third Schedule to the first of the above-mentioned Regulations, Methylene Blue and Phosphatase tests were prescribed, the former for assessing the "keeping" qualities of milk, and the latter for estimating the efficiency of pasteurisation. In addition, a Turbidity test was also prescribed for ascertaining the effectiveness of the heat treatment of Sterilised milk. During the year 30 samples of milk consisting of 23 Pasteurised milks, 4 Sterilised, and 3 T.T. Pasteurised were examined in accordance with the prescribed tests and all proved to be satisfactory. Since 1st October of the current year there have been alterations made in respect of the prescribed tests under the Milk (Special 106 Designation) Regulations, 1960, but, for all practical purposes, the new provisions with regard to licences made under these new Regulations become effective from 1st January, 1961. 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 41 formal samples were submitted to chemical analysis and all proved to be genuine. Five samples of cream were sampled and found to be genuine. Summaries of samples taken from L.C.C. Schools and Nurseries for chemical and bacteriological examination continued to be furnished regularly to that authority. Preserved Food and Ice Cream Premises.—In accordance with the provisions of the Food and Drugs Act, 1955, Section 16, all premises with the exception of schools, clubs, hotels or restaurants used :— (a) for the sale, or manufacture for the purpose of sale, of ice cream, or storage of ice cream intended for sale; or (b) for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale; are required to be registered by the owner or occupier with the Local Authority. Preserved Food Premises (meat, fish, etc.).—The total number of premises on the register at 31st December, was 90. Eighty-two visits of inspection were made to Preserved Food premises and Fried Fish shops as a result of which 9 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 224. Visits to these premises were made on 137 occasions and 2 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. 107 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 previous year, require, inter alia, that ingredients 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. 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 l½ 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 41 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 18 4 V hours or more 1 Satisfactory 12 2½ to 4 hours 2 Sub-standard - 1½ to 2 hours 3 Unsatisfactory 1 0 hours 4 Most Unsatisfactory 10 Ice-lollies Plate count and bacteria reports showed these samples to be satisfactory. 108 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, five ice creams and one ice lolly were examined in the normal course of food sampling. All samples proved to be satisfactory and reference to the Analyses will be found under the heading of Food and Drugs Act, 1955. Merchandise Marks Act, 1926.—Under the powers conferred by this Act, Orders in Council have been made prohibiting the sale or exposure for sale of imported foodstuffs unless bearing an indication of the country of origin. Seventy-five 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. 109 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 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 3,361 visits, as a result of which 43 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 Improvements were effected Caterers', Restaurants, etc. 144 16 Grocers, Greengrocers 269 8 Butchers' Shops 84 6 Dairies and Milk Distributors 47 1 Wharves and Factories 795 – Bakehouses and Bakers' Shops 34 8 Ice-Cream Premises, Confectioners, etc 137 2 Fried Fish Shops 17 1 Other Fish Shops 25 1 Cooked Meat & Preserved Foods 65 * Visits Re. Shops Act 413 – „ „ Infestations 4 – „ „ Food and Drugs Act 222 – „ „ Merchandise Marks Act & Markets 115 – „ „ Food Poisoning 28 – Sampling Visits 297 – Fair Visits 14 – School Visits 14 – Miscellaneous Visits (including Flour MillsCyanide Fumigation) 573 – Interviews 18 – Complaints Investigated 46 – Totals 3,361 43 * Included under Grocers' and Butchers' Shops. 110 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 34 occasions and, as a result of the inspections eight improvements were 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 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 144 visits of inspection to the catering establishments, insanitary conditions were remedied and improvements effected on 24 occasions. The following is a summary of the improvements carried out:— Type of Improvement Effected Total No. Walls and Ceilings cleaned and redecorated (Premises) 14 (W.C.s) 1 Hot Water Supply installed 2 Dustbins renewed 3 Waste Pipes repaired 1 W.C. Door renewed 1 Yard cleansed 1 Internal Rain Water Pipes renewed 1 Total improvements effected 24 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. Three 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 :— 111 Shops, Stalls, etc.:— Meat— Beef and Pork (Various cuts) 550 lbs. 1,358 lbs. Beef (Argentine boneless) 75 „ Mutton and Lamb (Various cuts) 359 „ Offal (Lambs) 35 ,. Offal (Ox) 24 „ Pig Melts 112 „ Pig Kidneys 112 „ Bacon 37 „ Veal 10 „ Rabbits 44 „ Canned and Other Foods— Foods (Various) (Canned) 2,982 „ 25,025 lbs. Cooked Meats (Canned) 1,828 „ Corned Beef (Canned) 8,774 „ Chicken 3 „ Dogfish 77 „ Skate Wings 42 „ Scampi 35 „ Onions 392 „ Potatoes 10,864 „ Gound Rice 28 „ Total 26,383 lbs. Compared with the previous year, the amount of meat rejected rose by 816 lbs. during 1960, and the total of all food rejected fell by 11,689 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 84 visits of inspection and arranged for the correction of insanitary defects at 6 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. 112 Public Health (Imported Food) Regulations, 1937 and 1948.—The Metropolitan Borough of Greenwich with a river frontage of five miles with more than 30 wharves and two of London's largest and most modern cold stores receives a considerable percentage of London's imported meat stored on behalf of various importers. In addition, considerable quantities of fresh fruit, tinned foods and miscellaneous provisions are dealt with. Visits to wharves and cold stores are made by the Food Inspectors and imported food generally is carefully supervised. Inevitably meat is the commodity to which Food Inspectors must devote most of their time and it is their responsibility to see that each consignment landed is accompanied by an "official" certificate. This may be in the form of a certificate, label, mark stamp or voucher which is recognised by the Ministry of Agriculture, Fisheries and Food as a guarantee that the accompanying product was inspected ante and post mortem and passed as fit in accordance with criteria satisfactory to the Minister and that any necessary packing or preparation had been executed under hygienic conditions. Imported Food Rejected.—The following unsound or diseased imported foods were surrendered, the meat being passed for nonedible and refining purposes, and other unsound food, with the exception of fruit pulp and juice, being processed for stock feeding. The following foods were rejected at the wharves :— Meat— Beef (Various cuts) 4,327 lbs. Veal (Legs) 21 „ Sheep and Lambs (Whole) 900 „ Mutton and Lamb (Various cuts) 270 .. Pigs (Whole) 954 „ *Pigs Heads 4,854 „ Pork (Various cuts) 18 „ Kidneys (Ox and Sheep) 28 „ Rabbit 46 ., 11,418 lbs. Canned and Other Foods— Cooked Meats (Canned) 257 „ Foods (Various) (Canned) 2,849 „ Fruit (Various) (Canned) 1,499 „ Frozen Egg Whites 2,250 „ † Tomato Sauce 95 „ Prepared Cake Flour (Packaged) 183 „ 7,133 lbs. Total 18,551 lbs. * The Pigs Heads were condemned due to tuberculosis. † The Tomato Sauce was condemned due to glass contamination. 113 Caseous Lymphadenitis. This disease, sometimes called "pseudo-tuberculosis" occurs mainly in sheep although it is occasionally found in cattle, rabbits and chickens. It is met usually in imported sheep carcases and is often the cause of meat being rejected as unfit for human consumption. It follows, therefore that much time and attention is given by the Food Inspectors to this disease during their inspections at the wharves and cold storage plants in the Borough. Results of examinations for caseous lymphadenitis are given below. New Zealand Sheep Landed Examined Rejected Weight 68,297 877 Nil — Swedish Pig Carcases.—During the current year the importation of Swedish Chilled and Frozen Pig Carcases through the docks and wharves of Riparian Authorities caused grave concern due to the high percentage found to be diseased. The situation was considered so serious that a meeting convened by the Medical Officer of Health of the Port and City of London at which a Vetinerary Officer of the Riparian Authorities was present, it was decided to place all Swedish Whole Pig Carcases under detention pending examination. It was further agreed that, in the case of consignments bearing the Official Certificates of Examination of Establishments Nos. 3 and 7, there should be a 100% examination while consignments from all other Establishments should be given an initial examination of 10%. At that time, a survey of pig carcases held in store in the Borough indicated that there were approximately 4,000 and that of the 2,000 then examined, about 5% were found to be diseased and were dealt with as such. By the end of the year, of a total of 9,561 carcases examined, some 579 were found to be diseased, a figure representing slightly more than 6%. 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. 114 Bact. Results of Positives Batch No. of Control Samples after Heat treatment no Containers Positive Negative Positive Negative Percentage rate of Control Sampling : 10% *45 36 8 16 7 1 * American Albumen. Incidence of Salmonellae: Containers Salmonella montevideo 3 „ oranienberg 2 tenessee 2 Dried Egg Albumen. (Conditional Releases.)— Country of Origin Quantity Imported Containers Sampled No. of Positives America 269 x 50 lb. drums 28 – „ 22 x 100 lb. drums 5 – „ 179 x 50 lb. cartons 18 – „ 90 x 50 lb. cartons 10 – „ 90 x 50 lb. cartons 10 – „ 34 x 50 lb. cartons 34 – „ 269 x 50 lb. cartons 28 – „ 88 x 50 lb. cartons 10 – „ 22 x 100 lb. drums 5 – „ 175 x50 lb. cartons 18 – „ 179x50 lb. cartons 18 – „ 5 x 50 lb. cartons 5 – „ 45 x 50 lb. cartons 5 – „ 90 x 50 lb. cartons 10 – „ 22 x 50 lb. cartons 5 – „ 88 x 50 lb. cartons 10 – „ 88 x 50 lb. cartons 10 – „ 135 x 50 lb. cartons 15 – „ 25 x 50 lb. cartons 5 – „ 19x50 lb. cartons 5 – „ 117x50 lb. cartons 16 – „ 224 x 50 lb. cartons 23 – „ 132x50 lb. boxes 15 – „ 135 x 50 lb. boxes 15 – „ 22 x 100 lb. drums 5 – „ 135 x50 lb. boxes 14 – „ 45 x 50 lb. boxes 5 – „ 90 x 50 lb. boxes 10 – „ 88 x 50 lb. boxes 10 – „ 90 x 50 lb. boxes 10 – „ 45 x 50 lb. boxes 5 – „ 88 x 50 lb. boxes 10 – „ 225 x 50 lb. boxes 46 1* „ 110x50 lb. cartons 15 – „ 88 x 50 lb. cartons 10 – „ 135 x50 lb. cartons 14 – „ 223 x 50 lb. cartons 23 – „ 44 x 50 lb. cartons 5 – „ 23 x 100 lb. drums 5 – „ 90 x 50 lb. cartons 9 – „ 44 x 50 lb. cartons 5 – „ 134x50 lb. cartons 14 – „ 90 x 50 lb. cartons 9 – „ 225 x 50 lb. cartons 39 2* „ 135 x50 lb. cartons 15 – „ 44 x 50 lb. cartons 10 – Salmonella derby 1 montevideo 1 oranienberg 1 115 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 China Dried Whole Egg 100x50 kilos (1101b.) 10 – „ „ 400 x 50 „ „ 40 – „ „ 400 x 50 „ „ 50 – „ „ 400 x 50 „ „ 50 – „ „ 400 x 50 „ „ 40 – „ „ 100x50 „ „ 10 – „ „ 5x50 „ 5 – „ „ 100 x 50 „ „ 10 – „ „ 500 x 50 „ „ 50 – „ „ 600 x 50 „ „ 60 – „ „ 70 x 50 „ 195 31 (a) America Dried Whole Egg 22 x 200 lb. 5 – „ Dried Yolk 45 x 100 lb. 15 – „ „ 112x 100 lb. 12 – „ „ 56 x 200 lb. 6 – „ „ 33 x 200 lb. 5 – (a) Incidence of Salmonellae: Samples Salmonella potsdam 22 „ thompson 6 „ aberdeen 1 „ unidentified 2 Desiccated Coconut.— Country of Origin Quantity Imported No. of Samples Taken No. of Samples Contaminated Ceylon 100 x 100 lb. bags 15 – Phillipine Islands 35 x 100 lb. bags 25 5 (a) (a) Incidence of Salmonellae: Samples Salmonella seftenburg 5 Inauguration of English Frozen Whole Egg Plant.—On the 25th April, 1960, a Frozen Whole Egg production plant became operational at Payne's Wharf, Borthwick Street, S.E.8. The construction of this plant over a period of approximately one year has been supervised by the Food Inspectors and every effort has been made to ensure a high standard of hygiene. The manufacturers are producing English Frozen Whole Egg for the Egg Marketing Board and it is anticipated that the plant will eventually break 360,000 eggs (1,000 cases) per day. At the present time, 10 men and 80 women are employed and the daily output is approximately 116 500 cases. Samples are being taken weekly to check the bacteriological quality of the product and the plant is being kept under constant surveillance by the Food Inspectors. To date, the product has been sampled for bacteriological purposes on seven occasions and in each instance has been satisfactory. Food and Drugs Act, 1955.—In accordance with the Council's contract with the Public Analyst, 522 samples were presented for examination, of which 116 were obtained in accordance with the Public Health (Imported Food) Regulations. The remaining samples, consisting of 52 formal and 354 informal were obtained in the normal course of sampling. Of all the samples obtained, 11 were considered by the Public Analyst to be non-genuine and of this total, four were in respect of imported foods not on sale to the general public. In these instances representations were made to the importers and the matters brought to the notice of the various Trade Commissioners. Of the remaining non-genuine samples one was formal and six informal, the formal sample being a "follow-up" to previously taken unsatisfactory informal sample of Christmas Pudding which contained an excessive number of dead mites. Legal proceedings were instituted and the manufacturer was fined £5 with £5 5s. Od. costs. One of the unsatisfactory samples was incorrectly labelled and has therefore been excluded from the calculation of the adulteration figure which at 1.5% shows a reduction of 0.4% from that of last year. Again milk was one of the main foods sampled and in all, 41 samples were procured, of which 7 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 3.49 and solids-not-fat 8.66 the standard being 3.00 and 8.50 respectively. However in accordance with the Milk and Dairies (Channel Islands and South Devon Milk) Regulations, 1956, milks in these categories must contain a minimum 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 4.28% and 9.06% respectively. Five ice creams and one ice 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. Nine samples of flour were specially tested for the added nutrients and all were found to comply with the requirements of the regulations 117 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 Cough Syrup, Cough Linctus and Vitamin Tablets both 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. One sample was obtained during the current year which proved to be satisfactory. 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. Nine samples of condensed milk were taken in the normal course of sampling, all of which were declared to be genuine. 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 renorted food noisonine cases. Information concerning the analyses of these samples is given in the following table :— Article How Obtained Examination Action Taken Bact. or Chem. Result 4 samples Chocolate Crumb Taken from store in Borough. Bact. One sample was wet and contained some organisms which might be associated with faecal pollution. The other three samples produced small numbers of coliforms not of faecal origin— probably coliforms normally present in the material. Arrangements made for re-processing to be carried out. 118 Article How Obtained Examination Action Taken Chem. or Bact. Result 4 samples Chocolate Crumb Taken from store in Borough. Chem. Taste and smell unaffected by water. Arrangements made for re-processing to be carried out. Individual Mince Tart Complaint by member of the public that after eating similar tart two people experienced food poisoning symptoms. Bact. No pathogenic organisms were isolated. Complainant notified. Corned Beef (canned) Taken from store in Borough. Chem. Contents blackened due to high proportion of tin. Unlikely, however, to be injurious to health. Storage authorities informed. Nonalcoholic Cordial (bottled) Taken from store in Borough. Chem. Conformed to the requirements of Food Standards (Soft Drinks) Order. Storage authorities informed. Mixed Fruit Dottos Complaint by member of the public that sweets were sold in tins previously used for lubricant, and that the tins were imperfectly cleaned. Chem. The sweets were contained in paper bags which were enclosed in small round tins. The tins were found to be imperfectly cleansed, having traces of dried sugar residue on the inside surfaces. No evidence of contamination of the sweets was found. Complainant informed. Corned Beef (canned) Taken from wharf in Borough. Bact. After incubation of cans at 37°C. for 6 days, all cultures remained sterile. Importer notified. Liquid Whole Egg (Samples taken on 7 occasions during the year) Taken from pipeline where tins are filled at wharf in Borough. Bact. Organisms of salmonella groups not isolated. Importer notified. 119 Article How Obtained Examination Action Taken Bact. or Chem. Result Portion of unwrapped White Loaf Complaint by member of the public that foreign body was embedded in the loaf. Chem. The bread contained a foreign body which consisted of a mixture of flour and bread with dark grease, half of which was of mineral origin and it also contained some finely divided particles of iron. Complainant notified. Warning letter sent to Baker concerned. Alga Flour Obtained from suppliers following letter from M.O.H. regarding an unsatisfactory food sample. Chem. Analysis showed these samples to contain sulphur dioxide to the extent of 540, 530, 560 parts per million. Warning letter sent to Manufacturers. Teething Jelly Complaint by member of the public that when the teething jelly was applied to her child's gums, the baby reacted as though in pain. Chem. Analysis showed the jelly to comply with listed ingredients on the label and the commodity was considered not to be harmful. Complainant informed. Boned Chicken (canned) Taken from wharf in Borough. Bact. After incubation of cans for 5 days at 37°C. all cultures remained sterile. Importer notified. Lunch Tongues (canned) Taken from wharf in Borough. Bact. „ „ Importer notified. Pork in Natural Juice (canned) Taken from wharf in Borough. Bact. „ „ Importer notified. 120 Article How Obtained Examination Action Taken Bact. or Chem Result Rhubarb (canned) Complaint by member of the public that the inside of the can was discoloured. Chem. Parts of the interior of the can had become corroded, probably originating from minute flaws in the protective lacquering, thus causing discolouration. The rhubarb was found to be in good edible condition and free from excessive metallic contamination. Complainant notified. Smoked Salmon Paste Taken from manufacturers following letter from M.O.H., Shoreditch, regarding two cases of suspected food poisoning believed to have been caused by smoked salmon paste manufactured in this Borough. Bact. No pathogenic organisms were isolated, including examination for Staphylococcus aureus and Clostridium Welchii. M.O.H., Shoreditch, and manufacturers notified. Bread Roll Complaint by member of the public that bread roll contained a foreign body. Chem. Foreign body identified as a shred of currant skin. Complainant and manufacturer notified. Tomato Puree (canned) (2 samples) Taken from wharf in Borough. Chem. First sample contained 165 p.p.m. tin. Second sample, 450 p.p.m. tin. This exceeded recommended standard by Food Standards Committee of Ministry. Interior surface of latter can had been badly corroded and puree had unpleasant metallic taste. High tin content coupled with deterioration in flavour rendered one tin unsuitable for human consumption. Importer notified and further tins were taken for sampling. 121 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 one of which was subsequently diagnosed as dysentery giving a final total of 42 for the year. There were 43 cases in the previous year, 39 for 1958, 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 7 Salmonella typhimurium 2 In all cases no particular food was suspected. Three cases occurred in one family. 35 Unknown 1 In the one hospital case "tinned peas" were suspected but could not be verified. In 26 cases no particular food was suspected. The following foods were suspected but could not be verified:— Chicken, Vienna Steak, Liver, Pork, Stuffing and Crab in three cases. 42 3 122 FOOD AND DRUGS ACT, 1955 Number and Description of Samples Submitted for Analysis under the above Act during the year 1960 (including samples taken under the Public Health (Imported Food) Regulations) Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Apple Puree — 1 1 Baking & Golden Raising Powder 2 2 Beans (Oktenoshi) 1 1 — — — Beer 2 2 — — — Beverages 2 2 — — — Brandy 3 — 3 — — — Bread — 1 1 — — — Bread Rolls, Buttered — 3 3 1 1 Butter — 6 6 — — — Butter Beans — 1 1 — — — Cake & Pudding Mixture 3 3 Cereals — 4 4 — — Cheese — 2 2 — — Chutney — 1 1 — — — Coconut, Desiccated — 1 1 — — — Coffee & Chicory — 1 1 — — — Coffee Extract, Dry — 4 4 — — — Confectionery, Flour — 7 7 — — — Confectionery, Sugar — 15 15 — — — Corn, Whole Kernel, Canned _ 3 3 Cream — 6 6 — — — Custard Powder — 2 2 — — — Drinks, Soft — 8 8 — — — Drinks, Soft Powder — 1 1 — — — Dripping — 2 2 — — — Fish — 3 3 — — — Fish, Canned — 27 27 — 2 2 Fish Cakes — 2 2 — — — Fish. Paste — 10 10 — — — Flavouring — 1 1 — — — Flour — 5 5 — — — Flour, Alga — 1 1 — 1 1 Flour, Wheat — 1 1 — — — Fruit, Canned — 35 35 — — — Fruit, Dried — 13 13 — — — Fruit, Fresh — 2 2 — — — Fruit Juice — 8 8 — — — Fruit Pie — 2 2 — — — Gin 6 — 6 — — — Gravy Preparation — 2 2 — — — Herbs — 1 1 — — — Herbs, Stuffing — 2 2 — — 123 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Ice Cream — 5 5 Ice Lolly — 1 1 — — — Jam — 12 12 — — — Jelly Crystals & Tablets 5 5 Lard — 2 2 — — — Macaroni — 1 1 — — — Margarine — 6 6 — — — Marmalade — 3 3 — — — Marzipan — 3 3 — — — Meat — 5 5 — — — Meat, Frozen — 1 1 — Meat Paste — 1 1 — Meat Products — 19 19 — — — Meat Products, Canned 56 56 3 3 Medicines — 3 3 — — Milk 28 13 41 — Milk, Condensed — 9 9 — Milk, Dried — 1 1 — — Milk Pudding, Canned — 1 1 — — Milk Shake Syrup — 2 2 — — Mincemeat — 2 2 _ — Noodles — 1 1 Oil, Cooking — 2 2 — — — Peanuts — 1 1 — — Peas, Dried — 1 1 — Pepper Dust — 1 1 — Pickle — 5 5 — Pineapple & Rice, Bottled _ 1 1 — — — Pudding — 1 1 — — Pudding, Canned — 5 5 — — Pudding. Christmas 1 2 3 1 1 2 Ravioli, Canned — 3 3 Rennett Essence — 1 1 Rice — 4 4 Rice, Canned 2 2 Rum 3 — 3 Sago — 1 1 Salad, Canned — 3 3 1 1 Sauce — 13 13 — — Sausages & Sausage Meat — 28 28 — — — Sausage Rolls — 3 3 Soup, Canned — 4 4 Soup Powder 4 4 Spice 1 1 ___ Sugar 1 1 Sugar, Icing Tea — 1 1 — — — Tomatoes, Canned — 9 5 9 5 — — — Tomato Juice, Canned 2 2 1 1 Tomato Preserve 1 1 Tomato Puree — 1 1 — — 124 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total{/###} Vegetables, Canned — 14 14 — — — Vermicelli — 1 1 — — — Vinegar — 4 4 — — — Vitamin Tablets — 1 1 — — — Walnut Kernels — 1 1 — — — Whisky 6 — 6 — — — Wine, Alcoholic — 2 2 — — — Totals 47 475 522 1 10 11 125 Administrative Action Taken in Regard to Samples Reported to be NOT GENUINE Sample No. Article Nature of adulteration and/or irregularity Action taken (<i) In respect oj normal sampling. T. 33 Buttered Rolls Sample contained bread roll —86%, margarine—14%. As the proprietor of the establishment from which the sample had been obtained had subsequently relinquished his interest in the business, no further action was possible. T. 69 Casserole Meat, Canned Contained meat—70%. In Analyst's opinion, casserole meat should contain at least 75% of meat. Letter to manufacturer stating observations. T. 83 Tomato Juice, Canned Contained added salt, 0.35%, the presence of which was not disclosed on the label. Letter to Economic Councillor for Israel. T. 188 Pork Luncheon Meat, Canned Contained meat—64%. Pork luncheon meat should contain at least 80% of meat. Observations from Manufacturer disclosed, the Pork Luncheon Sausage sold in error for Pork Luncheon Meat. Instructions from Manufacturer to retailers for products to be labelled correctly T. 220 Smoked Salmon in Edible Oil Contained Benzoic Acid, 1,400 parts per million. This product not allowed to contain Benzoic Acid preservative. Importer advised. Stock withdrawn. T. 273 Christmas Pudding Contained dead mites, approx. 1,500 per ounce. In view of the large number of dead mites per ounce, a formal sample was subsequently taken. 126 Sample No. Article Nature of adulteration and/or irregularity Action taken 265 Christmas Pudding Contained dead mites, approx. 3,000 per ounce. In the opinion of the Analyst, the number of mites found in the sample indicated heavy infestation of one or more of the ingredients. Legal proceedings were taken and the manufacturers fined £5. Costs £5 5s. 0d. (b) In respecl of samples taken under Imported Food Regulations. TT. 27 Alga Flour Contained sulphur dioxide, 630 parts per million. There is no provision in the Public Health (Preservatives, etc., in Food) Regulations for a dried seaweed product to contain sulphur dioxide. Letter to Importers and to Norwegian Trade Commissioner. TT. 88 Tomato Sauce & Minced Meat, Canned Contained tin, 480 parts per million, an excessive proportion. The consignment from which the sample was taken having been despatched to a firm in a neighbouring borough, the M.O.H. of that borough was acquainted with the Analyst's findings. TT. 98 Herring Salad, Canned The can was "blown" due to the pressure of gases produced by decomposition and the contents, which had not been sterilised when canned, were unfit for human consumption. The Importers were acquainted with the Analyst's findings and undertook to withdraw all "blown" or otherwise doubtful cans. 127 Sample No. Article Nature of adulteration and/or irregularity Action taken TT. 107 Sardines in Pure Olive Oil Contained lead, 9 parts per million, an excessive proportion. The Importers were acquainted with the Analyst's findings and undertook to take up the matter through their suppliers with the Portuguese packers. A copy of the letter was sent to the Portuguese Trade Commissioner. 128 SECTION F Prevalence of, and Control over, Infectious and Other Diseases The incidence of notifiable infectious diseases during 1960 was the lowest ever recorded for the Borough. It was, however, somewhat disquieting to see a rise in notifications of tuberculosis which again emphasises the need for B.C.G. vaccination. Legislation.—During the current year the following legislation concerning infectious diseases was enacted:— Public Health (Infectious Diseases) Amendment Regulations, 1960.—Made under Sections 143 and 283 of the Public Health Act, 1936, and operative from 1st December, 1960, these Regulations amend Regulation 5 of the 1953 Regulations by adding anthrax to the list of diseases to be notified by Medical Practitioners to the Medical Officer of Health. Such notifications are additional to those to be forwarded to the Chief Inspector of Factories under Section 66 of the Factories Act, 1937. Previously, in the County of London, anthrax has been notifiable under an L.C.C. Order of 1909 and Section 305 of the Public Health (London) Act, 1936. 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 485. Under the Public Health (Tuberculosis) Regulations, 1952, there were 57 notifications, giving a consolidated total of 542 cases notified during the year. The following table indicates the figures for the previous ten years:— Year No. of corrected notifications 1950 1,644 1951 2,266 1952 1,565 1953 1,242 1954 569 1955 2,120 1956 844 1957 1,558 1958 607 1959 1,102 10-year average 1,351 1960 542 129 Particulars of age groups and districts affected are shown in the table at the end of this Report. National Insurance Act, 1946.—From time to time it is necessary for the Medical Officer of Health to insist that a suspected 'carrier' of, or a person in contact with, an infectious disease should be precluded from working in order that the risk of transmission of the disease is minimised. This is especially necessary when the person concerned is a ' food handler.' Regulation 3(b) of the National Insurance (Unemployment and Sickness Benefit) Regulations, 1948, made under the above Act, enables any person so excluded to claim sickness benefit on production of a certificate issued by the Medical Officer of Health. In the Ministry of Health Circular 115/48 it has been suggested that the Medical Officer of Health should be prepared to furnish such a certificate if, in his opinion, circumstances are such that this action becomes necessary. During the current year it was unnecessary to issue any certificates but 3 were furnished in 1959, none in 1958 and 1 in 1957. 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 1960 was 539. This is a decrease of 173 from that of the previous year. In Greenwich during the last 10 years 13,188 births have been registered, and for the same period only 6,891 vaccinations have been effected, a figure equivalent to 52.2%. 130 Occasionally a smallpox scare in the country results in a jump in the number of vaccinations effected but generally the trend is downwards. Today, although every precaution is taken at seaports and airports, infected persons do occasionally slip through but the comparative immunity of the country has hitherto been due mainly to its high vaccination state. With the fall in the number of vaccinations this fortunate state of affairs cannot be expected to continue. International Certificates (Ministry of Health Circular 20/52).—The question of authentication of International Certificates of vaccination has now been settled by the adoption of the International Sanitary Regulations (W.H.O. Regulations No. 2) which replaced the International Sanitary Conventions on 1st October. 1952. The Regulations prescribe inter alia, new forms of International Certificates of vaccination against Cholera and Smallpox and, to be valid, the certificate must bear an approved stamp which certifies that the signature of the Vaccinator is that of a practising medical practitioner. During the year some 334 certificates of persons proceeding abroad were so authenticated, of these 279 were in respect of Smallpox, 36 for Cholera and 19 for Typhoid. One vaccination was carried out by your Medical Officer of Health. Measles.—The current year saw one of the lowest figures for measles ever recorded for the Borough, viz. 47. Although the normal biennial fluctuation was absent during 1960, it was probably merely delayed, for some 29 of these cases were notified during the last two weeks of the year. Of the figure of 47, 23 were males and 24 females, and the total indicates a reduction of 590 from that of the previous year. One case occurred in a child under 1 year of age, 43 in children between 1 and 10 years and 3 in persons over 10 years. One case was removed to hospital and this patient, a man of 56 years died. The distribution of the cases was as follows:—East Greenwich 7; West Greenwich 29; St. Nicholas, Deptford 1; Charlton and Kidbrooke 10. In 1958 there were 306 and during 1957, 1,194 cases were recorded. In 1956 there were 44. Whooping Cough—Altogether 168 notifications were received in 1960, an increase of 134 over those of the previous year. The year 1958 produced 55, there were 97 registered for 1957. and there were 122 for 1956. 131 Area distribution for the current period was:—East Greenwich 48; West Greenwich 50; St. Nicholas, Deptford 8; Charlton and Kidbrooke 62. Eighteen cases were admitted to hospital and there were no fatalities. With regard to children under 5 years, 2 were immunised against whooping cough while 68 other children received a combined antigen (whooping cough and diphtheria) and a further 1,250 received a triple antigen (whooping cough, diphtheria and tetanus) giving a final total of 1,320 whooping cough immunisations carried out during the year by the County Council. Diphtheria.—One notification received was not confirmed so there was a nil return recorded for the current year, a result similar to that for the previous year and for the years 1958, 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. Since 1945, diphtheria notifications for England and Wales have fallen from 18,596 to 52, the figure for the current year. Over the same period deaths have decreased from 722 to 5. Diphtheria immunisation is a County Council service and during the year there were 1,482 completed immunisations carried out in the Borough, an increase of 589 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 12 cases attributed to these causes, as compared with 20 for 1959, 42 for 1958, 28 for 1957 and 14 for each of the years 1956 and 1955. Two occurred in East Greenwich, one in West Greenwich, 1 in St. Nicholas, Deptford, and 8 in Charlton and Kidbrooke. Not one case was removed to hospital and there were no deaths. Typhoid.—No cases of typhoid fever were notified during the year compared with a nil return for 1959, one for 1958, two for 1957 and one for 1956. Scarlet Fever.—A total of 44 confirmed cases for the year shows a decrease of 24 from 1959 compared with 106 notifications for 1958, 102 for 1957, 58 for 1956 and 57 for 1955. Eleven occurred in East Greenwich, 10 in West Greenwich, 2 in St. Nicholas, Deptford, and 21 in Charlton and Kidbrooke. 132 Two cases were removed to hospital and no fatilities were recorded. Erysipelas.—There were no notifications received during the year compared with 6 for last year, 3 for 1958, a nil return for 1957. 4 for 1956 and 6 for 1955. Zymotic Enteritis or Epidemic Diarrhœa (Children under 5 years of age).—Fifty-seven cases were recorded as confirmed compared with 30 for the previous year, 9 for 1958, 12 for 1957 and 17 for 1956. Twelve cases 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, 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 total of 150 notifications received during the current year although showing a fall of 99 from that of the previous year, is still greatly in excess of the 1958 total of 20. Nevertheless, the present figure is only approximately 31% of that 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 35.3% of all notifications. The distribution of the cases was 19 in East Greenwich, 65 in West Greenwich, 12 in St. Nicholas, Deptford, and 54 in Charlton and Kidbrooke. Seven cases were removed to hospital but there were no fatalities. Scabies.—No case was notified during 1960 compared with 4 for 1959, 1 for 1958, 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 was one notification received in accordance with the 1951 Regulations which did not concern a borough resident, but from other sources 9 cases 133 concerning Greenwich residents were brought to the notice of the department, a figure of 18 being returned for the years 1959 and 1958. All patients received hospital treatment. There were no fatalities. Meningococcal Infection.—There was one notification received during the current year compared with two for the previous year, none for 1958, 2 during 1957, a nil return for 1956 and 5 for 1955. Acute Encephalitis. (Infective or Post Infectious).—A Nil return is recorded for the current year, a similar return to those for the years. 1959, 1958, 1957, 1956, 1955 and 1954. Ophthalmia Neonatorium.—In respect of this disease one notification was received. There was none for 1959 and one was recorded for 1958. Poliomyelitis.—It has previously been pointed out that the vagaries of notification procedure have led to misleading statistics concerning specified administrative areas but this proved of little consequence during the current year as only 4 notifications of paralytic poliomyelitis were received, none of which concerned a Greenwich resident. Of school children undertaking a poliomyelitis inoculation course, 1,492 received two and 3,923 received their third injection during the year. For persons between the ages of 16 and 40 years the figures were 1,419 and 2,320 respectively. Malaria.—Compared with a nil return for 1960 one notification of benign tertian was registered for 1959. Tuberculosis.—During the year 57 notifications in respect of confirmed cases of tuberculosis were received compared with 46 for 1959. Of these, 50 were of the pulmonary type and 7 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 18 18 West Greenwich 12 3 15 St. Nicolas, Deptford 2 — 2 Charlton and Kidbrooke 18 4 22 Totals 50 7 57 134 Disinfection was offered and carried out in 6 cases including 6 rooms and 42 articles of clothing and bedding, etc. During 1960, some 1,316 Greenwich school children received B.C.G. vaccination under the direction of the School Medical Officer. The number of notified cases of Tuberculosis remaining on the Register at 31st December, 1960, was a follows: — PULMONARY NON-PULMONARY Men Women Chil dren Total Men Women Chil dren Total M F M F 583 482 27 23 1,115 21 42 13 9 85 For further clarification I append herewith copy of Form T.137 (revised) for the year under review as forwarded to the Countv Medical Officer of Health. 135 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 Part I.—Summary of notifications of Tuberculosis during the period from the 1st January, 1960, to the 31st December, 1960. 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 — 5 3 2 7 4 2 3 27 Respiratory, Females — — — — — 1 4 5 2 4 1 3 — 20 Non-Respiratory, Males — — — — — — — — — 1 — — — 1 Non-Respiratory, Females — 1 — 2 — — — 1 1 — — 1 — 6 Part II.—New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Source of Information Number of cases in age Groups 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total Death Returns from Local Registrars Respiratory M — — — — — — — — — — — — — — (A) F — — — — — — — — — — — — — — (B) Non-Respiratory M — — — — — — — — — — — — — — (C) F — — — — — — — — — — — — — —(D) Death Returns from RegistrarGeneral (Transferable deaths) Respiratory M — — — — — — — — — — — — — — (A) F — — — — — — — — — — — — — — (B) Non-Respiratory M — — — — — — — — — — — — — — (C) F — — — — — — — — — — — — — — (D) Posthumous Notifications Respiratory M — — — — — — — — 1 — — — 1 2 (A) F — — — — — — — — — — — 1 — 1 (B) Non-Respiratory M — — — — — — — — — — — — — — (C) F — — — — — — — — — — — — — - (D) n.B. Where notification of one form of Tuberculosis is subsequently followed by a notification Totals (a) 2 (b) 1 of the other, only the first notification is taken into account for the purpose of this return. (C) — (D) — 136 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 Director for the following analysis of the results received so far Summary of Surveys Carried Out in the Borough from 1st January to 31st December, 1960. PART I.—General Analysis Men Women Total (a) Total X-rayed 887 713 1,600 (b) Total previously X-rayed 533 461 994 (c) Total recalled for large film 40 28 68 (d) Number normal on large film 16 13 29 (e) Number abnormal on large film 22 14 36 (f) Not yet attended for large film 1 1 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 1 1 2 (c) Requiring close supervision or treatment 2 1 3 (d) Still under investigation — — — (e) Refused further investigation 1 — 1 137 (2) Previously known tuberculous cases 2 2 (3) Non-tuberculous cases: (a) investigated 1 — 1 (b) still under investigation — — — (4) Cardio-vascular lesions 2 1 3 (5) Abnormalities requiring no action 13 11 24 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 23 3 Children under school age 27 — School children 131 — No. of home visits by Lady Public Health Inspector 12 No. of home revisits by Lady Public Health Inspector 25 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:— 138 Rooms and Articles Disinfected, Year ended 31st December, 1960 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 26 36 2 27 12 56 32 84 5 9 6 136 58 — 6 433 Diphtheria 1 2 — 1 — 4 2 3 — 1 1 10 — 1 23 Tuberculosis 7 6 — 1 1 6 5 13 1 2 — 7 5 1 42 Cancer 7 8 — 3 1 18 8 16 2 — — 11 5 3 69 Meningococcal Infection ... 4 4 6 2 14 11 12 1 20 10 3 77 Puerperal Pyrexia — — — — — — Typhoid Fever — — Polio-Myelitis 3 6 1 2 2 7 4 13 1 1 i 10 10 1 53 Erysipelas 1 1 Acute Encephalitis — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — Scabies — — — — — — — — — — — — — — — Other Diseases 154 24 9 31 2 29 11 37 3 5 2 50 20 9 5 213 Verminous Premises 8 3 — 9 6 15 7 8 1 — — 3 — — 3 52 Total 211 90 12 80 26 149 80 186 14 18 10 247 108 9 23 962 Articles Destroyed — — 67 189 1 19 4 12 — 15 1 2,915 23 — — 3,246 Library Books Disinfected 59 139 CHEST CLINIC REPORT I am indebted to Drs. P. Forgacs and D. G. Wraith, Chest Physicians at the Greenwich Chest Clinic for the following Report on Tuberculosis in the Borough. The Clinic tuberculosis register is as under:— Men Women Boys Girls Total Pulmonary Tuberculosis 536 440 21 21 1,018 Non-pulmonary Tuberculosis 11 17 6 9 43 1,061 Total No. of new patients referred to the Clinic 1,762 Total No. of attendances 6,597 Deaths (all causes) 11 (7 result of pulmonary tuberculosis) Forty-five new cases of pulmonary tuberculosis were notified during the year, in the undermentioned age groups:— Males yrs. Females 3 10-20 2 3 21-30 6 4 31-40 4 4 41-50 2 6 51-60 2 3 61-70 1 3 71-80 2 Four cases of non-pulmonary tuberculosis were notified (one man, renal tuberculosis, one woman, tuberculosis glands, one girl aged 18 months miliary tuberculosis and one girl aged 8, meningitis). The total number of patients on our Tuberculosis Register is very similar to the figure for the last few years, e.g. 1,080 for 1959, 1,078 for 1958 and 1,075 for 1957. Forty-four patients have been transferred out to other clinics but 20 have been transferred into this clinic and these figures with the addition of the newly notified patients keeps the total figure on our register approximately the same. It is considered advisable that although the tuberculous disease has apparently healed patients should continue to attend the Clinic for follow-up supervision as there is a possibility of occasional unpredictable relapse. If these patients attended a Mass Radiography Unit instead they would only be referred back again to the Chest Clinic as a result of the abnormal X-ray findings. 140 As well as the possibility of exacerbation of the tuberculous disease another serious problem which arises in many of these patients is their disability due to breathlessness caused by permanent damage to the lung by the tuberculous disease or by surgical treatment. Many of these patients are also more susceptible to bronchitis which further increases their disability. This problem is liable to increase as time goes on because more patients are surviving their tuberculous disease and they are living longer. Besides the need for medical supervision and assessment of these patients social problems arise of which the most important is their difficulty in finding suitable employment. Some form of sheltered work would be of great value to these disabled persons and although it would need to be partially subsidised it would greatly improve their morale. Two hundred and eighteen ante-natal patients were X-rayed during the year and one was found to have tuberculous disease. Two hundred and fifty-five persons were examined as contacts, one man and two children were found to have tuberculous disease. During the year a number of children were referred to us from the school tuberculin test team because they were found to have positive tuberculin tests at school as part of the routine testing prior to B.C.G. None of these were found to have active tuberculous disease but it was felt worth while to keep some of them under further supervision for a time and to examine their family contacts. The numbers of school children with a positive tuberculin test are decreased now so much that all positive ones, and their families, may be sufficiently significant to examine. One hundred and twenty-six children and young adults, mainly tuberculous contacts, have been given B.C.G. inoculation. We have continued to admit tuberculous patients to Vanbrugh Ward at St. Alfege's Hospital for treatment. These patients have been mainly those who are infectious and unable to be adequately cared for at home. As treatment has now improved many of these patients stay for one/three months only and we have no "long-stay" patients except for two who are in Sanatoria. Disability due to breathlessness resulting from chronic bronchitis, emphysema and asthma is still a very serious problem and an increasing number of these forms of respiratory disease are being referred to the Clinic. Efforts are being made to investigate the various aspects of this kind of chest trouble and to try and prevent it. Certain persons appear to be more susceptible, or allergic, than others to dusts and other irritants in the air, in their homes or at work. It is felt that the best way of preventing such disability 141 is to see and investigate these persons at an early stage before there is any severe pulmonary damage. A register is kept of the more severely disabled patients and they remain under occasional supervision. As well as the medical problems which arise in the management of these persons there are social difficulties including their inability to find suitable work, which are similar to those disabled by previous tuberculous disease. Some form of sheltered work would help these too. The organisation of the Chest Clinic is particularly well suited to help these disabled persons in the same way as the tuberculous ones. 142 SECTION G Miscellaneous Guild of Hygiene.—As indicated in previous Reports the new Food Hygiene Regulations and their amendments 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. Medicai. Inspection— Superannuation.—All medical examinations of the staff for Superannuation purposes are undertaken by the Medical Officer of Health, and during the current year 95 examinations were so made. Of these, three candidates were considered unfit for admission to the Council's Superannuation Scheme and one case was deferred 12 months for further examination. Sick Persons.—In addition, the Medical Officer of Health carried out 46 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 eight of their servants were no longer capable of discharging their duties efficiently by reason of permanent infirmity. In one of these instances it became necessary for the Medical Officer of Health to make a domiciliary visit. 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 9 interviews during the year. INDEX Page A Acute Encephalitis 133 Acute Influenzal Pneumonia 131 Acute Poliomyelitis 133 Acute Primary Pneumonia 131 Adoptive Acts, Bye-laws and Local Regulations 3-4 Age Composition of Population 17 Age Mortality 23-24 Aged, Infirm and Physically Incapacitated Persons 74-89 Analytical Examination of Milk 106, 116 Ante and Post Natal Clinics 40 Ante and Post Natal Clinics Attendances 37 Anti-Fly and Anti-Mosquito Campaign 66 Antitoxin, Diphtheria 131 Ants, Pharoah's, etc 67 Area of Borough 9 Articles and Rooms Disinfected 138 Articles Destroyed 138 Artificial Sunlight Centres, Attendances 38 Artificial Sunlight Treatment 40 Asthma 140 Atmospheric Pollution 49-53 B Bacteriological Examinations 72, 105, 107, 114, 115, 117-120 Baiting of Sewers 66 Bakehouses 110 Bathing Centre, New 80 Baths and Wash-houses 70-72 B.C.G. Vaccinations 39, 128, 134, 140 Beetles 70 Births 18, 21 Birth Registrations 21 Blackheath Fair 108 British Red Cross Society 42 Bronchitis 34, 140 Burial or Cremation of the Dead 89 C Cancer 18, 29-32 Cancer of the Lung 30-32 Cancer Registration 32 Caravan Sites and Control of Development Act, 1960 44 Carol Service (for Elderly) 85 Caseous Lymphadenitis 113 Catering Establishments 110 Cerebral Embolism 32 Cerebral Haemorrhage 32 Cerebral Thrombosis 32 Page Certificates of Guild of Hygiene 142 Chest Clinic 41,139-141 Chest Physician's Report 139-141 Chinese Dried Egg Products 115 Chiropody Clinics, Attendances 38 Chiropody Treatment, Clinics 40 Christmas Food Parcels (O.A.Ps.) 84 Citizens Advice Bureaux 42 Classification of Deaths 27 Clean Air Act 50 Cleansing & Bathing Centre, New 80 Cleansing and Scabies Clinic 41, 80, 137 Cleansing of Children 80,137 Cleansing of Old People 79 Clinics and Centres 40 Clover Mites 69 Coach Outings (for Elderly) 86 Cockroaches 68 Common Infectious Diseases 18, 27 Complaints 43, 89, 96, 109 Condensed Milk Regs. 1959 117 Conveniences, Public 73-74 Coronary Disease 33 Council Housing Schemes 97 Council Rehousing 96 Cremation or Burial of the Dead 89 D Day Rooms (for Old People) 81 Death Causes, Remarks 27-34 Death Rates 18 Death Registrations 22 Death, Table showing Causes of and Ages at Appendix Deaths 18, 22 Deaths, Table showing Causes of and Ages under 1 yr Appendix Deaths from Violence 34 Deaths in Institutions 23 Defective Dwellings—Repairs 46 Density of Population 9 Dessicated Coconut 115 Diarrhoea and Zymotic Enteritis 28, 132 Diphtheria 28, 131 Diphtheria Antitoxin 131 Diphtheria Immunisation Clinics 40 Diphtheria Prophylaxis Cases 39, 131 Discharge of Effluents into Sewers 59 Diseases of Respiratory System 34 Disinfecting Station 41 Disinfection 137-138 Disinfestation of Verminous Premises 67-70 INDEX (continued) Page Distribution Centres—National Welfare Foods 35 District Nursing 39, 42 Domestic Helps 39-40, 41 Drainage and Sewerage 59 Drainage, New and Alterations to 59 Dried Egg Albumen 113-114 Drinking Fountains 74 Duties and Powers of the Public Health Committee 3-4 Dwellings 9 Dysentery 132 E Educational Sessions — Ante- Natal 38 Egg Albumen, Imported 113-114 Elevation of Borough 9,12 Emission of Grit 49 Encephalitis 133 English Frozen Whole Egg Plant 115 Enteric Fever 28, 131 Entertainment (for Elderly) 86 Erysipelas 132 Exhumations 89 Expectation of Life 16 Extracts from Vital Statistics 18 F Factories Act, 1937/59 44-46 Fair on Blackheath 108 Family Planning Association, Sessions 41 Family Welfare Association 42 Flooding, Storm (Ravensbourne) 48 Flour (Composition) Regs., 1956 116 Fluoridation of Water Supplies 60 Food and Drugs Act, 1955 116, 122-127 Food and Drugs—Non-genuine Samples 125-127 Food and Drugs Act, 1955, Samples taken under 116, 122-127 Food Examination (Other) 117-120 Food Hygiene (Docks Carriers, etc.) Regs., 1960 104 Food Hygiene (General) Regs., 1960 104 Food Hygiene Regs., 1955/57 108 Food, Inspection of 101-127 Food Parcels (Old People) 84 Food Poisoning 121 Food—Premises for Preparation of 106, 109, 110 Food Rejected 110, 111, 112 Page Food Standards (Ice Cream) Regs., 1959 108,116 Foods Welfare (for Elderly) 85 Foot Clinics 40 Foot Clinics, Attendances 38 Frozen Whole Egg Plant 115 G Garden Party (for Elderly) 86 General and Vital Statistics 9-34 General Information 11-15 General Provision of Health and Welfare Services in the Area 35-42 Greenwich Guild of Hygiene 142 Greenwich Old People's Welfare Association 80 Grit Emission 49 Guild of Hygiene 142 H Habitation Certificates (Water Supply) 60 Hairdressers and Barbers 58 Handicraft Exhibition 86 Handwashing Facilities 74 Health Centres 40 Health Visiting 36 Heart Disease 18, 33 Heating Appliances (Fireguards) Act, 1952 56 Holidays (Old People) 83 Homebound, Tea Party 84 Home Help Statistics 38-39 Home Help Service, Applications for 41 Horse Troughs 74 Hospitals 42 House to House Collections (O.A.Ps.) 85 House Purchase & Housing Act, 1959 95, 96 Houses, No. in Borough 9 Houses Let in Lodgings 55-56 Housing 92-100 Housing Act, 1957 55, 94 Housing Act, 1957, Procedure under 94 Housing Act, 1949 95 Housing (Financial Provisions) Act, 1958 96 Housing Accommodation 97 Housing Homeless Persons 96 Housing Register 99 Housing Repairs and Rents Act, 1954 54,95 INDEX (continued) Page Housing Schemes, Council's 97 Housing Survey 98 Housing (Underground Rooms) Act, 1959 95 Hygiene, Guild of 142 I Ice - Cream — Bacteriological examinations 107 Ice-cream (Heat Treatment, etc.) Regulations 107 Ice-cream Premises 106 Ice-cream Quantitative Analysis 108 Ice-cream Sampling 107,116 Illegitimate Births 18,21 Immunisation and Vaccination Clinics 40 Immunisation and Vaccination Clinics, Attendances 39 Imported Egg Products 115 Imported Food Rejected 112 Infantile Mortality 18,24-27 Infant Welfare Centres 40 Infant Welfare Clinics, Attendances 36-38 Infectious Diseases 18, 27, 128-141 Infirm Persons 74-89 Influenza 18, 34 Inhabited Houses 9 Inoculations, Poliomyelitis 39, 133 Inspection of Food and Supervision of Food Premises 101-127 Institution Deaths 23 International Certificates 130 International Statistical Classification of Diseases, Injuries, and Causes of Death, 1955 27 Interviews (Re - housing) by M.O.H 142 Introductory Review 6-8 Invalid Chairs 88 Page Leaflets (Welfare Services) 87 Legal Proceedings 91, 116, 126 Legislation, New 43,44,94, 103-104,128 Leptospirosis 64 Lettings (Housing) 99 Lung Cancer 30-32 M Malaria 133 Manufacture and Sale of Ice- Cream 106 Marriages 19 Mass Radiography 42, 136 Massage etc., Attendances 38 Maternal Mortality 18, 24 Maternal and Child Welfare 35-42 Maze Hill Clinic (Tuberculosis) 41, 139-141 "Meals on Wheels" 82-83 Measles 28, 130 Meat Regulations 111 Meat Surrendered 110,112 Medical Inspections (Superannuation) 142 Medical Inspections (Sick Persons) 142 Medical Officer of Health's Review 6-8 Medical Statistics (Schools) 39 Meningococcal Infection 133 Merchandise Marks Act 108 Meteorological Observations 20 Mileage of Streets 10 Milk, Analysis of 106,116 Milk and Dairies Regulations 105 Milk Licences 105 Milk (Special Designation) (Pasteurised & Sterilised Milk) Regulations 103, 105 Milk (Special Designation) (Raw Milk) Regulations 103,105 Milk (Special Designation) Regulations, 1960 103 Milk Sampling 105 Milk Supply 104 Minor Ailments Centres (for School Children) 40 Motor Vehicles Accidents 34 Mutual Exchanges (Housing) 100 J Jurisdiction over R. Ravensbourne 48-49 L Laboratory Work 60, 71-72, 105, 107, 114-127 Land Charges Act, 1925 59 Laundry Service79-80 L.C.C. (Gen. Powers) Act, 1953 59, 79 L.C.C. (Gen. Powers) Act, 1954 58 L.C.C. (Gen. Powers) Act, 1958 57 L.C.C. (Gen. Powers) Act, I960 44 N National Assistance Act 78 National Insurance Act (Medical Certificates) 129 INDEX (continued) Page Page National Welfare Foods—Distribution Centres 35 Natural Increase 16 Neo-Natal Mortality 18,2S & Appendix New Cleansing & Bathing Centre 80 New Housing Accommodation 97 New Legislation 43, 44, 94, 103-104, 128 Noise Abatement Act, 1960 43 Nomenclature Regulations, 1948 27 Non-Genuine Samples 125-127 Notices, etc 43, 90 Notifications of Infectious Diseases 128-141 & Appendix Notifications of Food Poisoning 121 Nursing Associations 39,42 Powers & Duties of the Public Health Committee 3-4 Precautionary Spraying 70 Preserved Food Premises 106 Prevalence of, and Control over Infectious Diseases 128-141 Prevention of Damage by Pests Act 64 Procedure under the Housing Act, 1957 94 Prophylaxis Cases 39 Prophylaxis Clinics 40 Public Baths & Wash houses 70-72 Public Health Committee Public Health Department Staff 5 Public Health Laboratory Service 72, 105, 107,114-116,117-120 Public Open Spaces 10 Public Sanitary Conveniences 73-74 Puerperal Pyrexia 132 O Office Act, 1960 43 Oil Burners (Standards) Act, 1960 44 Old People's Clubs 80 Old People's Welfare Association 80 Open Spaces 10 Ophthalmia Neonatorum 133 Outworkers 46 Overcrowding 96 Q Quantitative Analysis of Icecream 108, 116 Queen's District Nursing Association 39, 42 p Perinatal Mortality 26 Personal Health Services 35-42 Persons Cleansed 78, 79, 137 Pet Animals Act 58 Pharaoh's Ants 67 Pharmacy & Medicines Act 117 Pharmacy & Poisons Act 57 P.H. (Dried Milk) Regulations 117 P.H. (Imported Food) Regulations 112, 116 P.H. (Infectious Diseases) Amendment Regs., 1960 128 P.H. (London) Act, 1936, Sec. 180(8)\ 110 P.H. (Meat) Regulations 1ll P.H. (Smallpox Prevention) Regulations 129 P.H. (Tuberculosis) Regs. 128, 135 Physically Incapacitated Persons 74-89 Pigeon Nuisance 47 Pneumonia 34, 131 Poliomyelitis 133 Poliomyelitis Inoculations 39, 133 Pollution, Atmospheric 49-53 Pollution, River 47-48 Population 9, 16, 17 Population, Age Composition 17 Post-Natal Attendances 37 R Radiography, Mass 42, 136 Rag Flock Act 58 Ranyard Mission 39, 42 Rateable Value 9 Rates, Births and Deaths, etc 18 Rat Repression 63-66 Ravensbourne, River (Flooding) 48 Redevelopment, Housing 95 Refuse Disposal 61-63 Registered Births 18, 21 Registered Deaths 18, 22 Registrar—Office Hours 42 Registration of Cancer 32 Registration of Preserved Food Premises 103 Rehousing 96 Rehousing Interviews (by M.O.H.) 142 Rejected Food 110, 111, 112 Relaxation Sessions—Ante-Natal 38 Remarks on Various Death Causes 27-34 Rent Act, 1957 54-55 Rent & Mortgage Interest (Restrictions) Acts 54 Reproductive Wastage 26 Requisitioned Accommodation 98-99 INDEX (continued) Page Page Requisitioned Houses Act, 1950 94 Requisitioned Houses & Housing (Amendment) Act, 1955 94,98 Respiratory System—Diseases of 34 Review by M.O.H. 6-8 River Pollution 47-48 River Ravensbourne, Flooding 48 River Ravensbourne, Jurisdiction 48-49 River Smells 47 Rodent Control 63-66 Swedish Pig Carcases 113 Swimming Baths 70 T Toddlers Clinic Attendances 37 Town & Country Planning Act, 1947 98 Transfers (Housing) 100 Transported Meals for Old People 82-83 Treatment Centres and Clinics... 40 Tuberculosis 18, 28-29, 133-135, 139-141 Tuberculosis Officer's Report 139-141 Typhoid Fever 28, 131 S Sampling of Ice-Cream 107, 116 Sampling of Milk 105,116 Sampling under Food & Drugs Act 116,122-127 Sanitary Circumstances of the Area 43-91 Sanitary Conveniences, etc. 73-74 Sanitary Work—Summaries etc. 89-91 Scabies 132 Scabies & Cleansing Clinics 41, 80, 137 Scarlet Fever 28, 131 Scavenging and Refuse Disposal 61-63 Schools (Medical Statistics) 39 Sewerage and Drainage 59 Sewers—Baiting of 66 Shops Act 57 Skimmed Milk with Non-Milk Fat Regs., 1960 104 Slaughterhouses 1ll Slum Clearance 95 Smallpox 28, 129 Smells from River 47-48 Smoke and Grit Emission 49 Smoke Control Areas 50-52 Social Conditions of the Area 11-15 Sonne Dysentery 132 Spraying, Precautionary 70 Staff of Public Health Department 5 Statistical Tables Appendix Statistics, General 9, 10 Still Births 18,21 Street Appeal (for Elderly) 85 Streets, Mileage of 10 Street Traders 108 Storm Flooding 48 Suicide 34 Summary of Sanitary Work 89-91 Sunlight Treatment 38 Supervision of Food Premises 109 Supplies of Underground Water (Wells) 61 U Underground Water Supplies (Wells) 61 Uninhabited Houses 9 Unsound Food 110, 111, 112 V Vaccination Cases 39, 129 Vaccination and Immunisation Clinics 40 Vaccination International Certificates 130 Various Death Causes, Remarks on 27-34 Vascular Lesions of Nervous System 32, 33 Verminous Conditions 78, 79, 137 Verminous Premises 67-70 Violent Deaths 34 Vital Statistics 18 & Appendix Voluntary Organisations 42 W Wash-houses and Public Baths 70-72 Washing Facilities (Hand) 74 Wasps 69 Water — Underground Supplies (Wells) 61 Water Supplies—Fluoridation of 60-61 Water Supply 60 Water Supply Certificates 60 Weil's Disease 64 Welfare Clinics 40 Welfare Foods (for Elderly) 85 Welfare Foods, National—Distribution Centres 35 Welfare Scheme for Old People 87 Welfare Services (Leaflets) 87 Wells 61 Whooping Cough 28,130 INDEX (continued) Page Page Whooping Cough Prophylaxis Cases 39, 131 Whooping Cough Prophylaxis Clinics 40 Women's Special Clinic 41 Women's Voluntary Services 42 Y Young Christian Workers Scheme (for Elderly) 871 X X-Ray Examinations 136 X-Ray, Mass 42, 136 Z Zymotic Disease 28,132 Zymotic Enteritis 28,132 INFANTILE MORTALITY DURING THE YEAR 1960 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 ... v ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Acute Tracheo Bronchitis ... ... ... ... ... ... 1 ... ... ... Bronchopneumonia ... ... ... ... ... ... 1 ... ... 2 Congenital Malformation 3 ... ... ... 5 ... ... ... ... 7 Premature Birth 9 ... ... ... 9 ... ... ... ... 9 Atelectosis 2 ... ... ... 2 ... ... ... ... 2 Erythroblastosis 1 ... ... ... 1 ... ... ... ... 1 Accident ... ... ... ... ... ... ... ... ... ... Totals 15 — 1 i 17 2 2 — 1 22 Male 16 Female 6 CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1960. Notifiable Disease Cases Notified in Whole District Total Cases Notified in each Locality No. of Cases removed to Hospital from each Locality Age & Sex Group 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 Malaria - - — - _ _ _ _ _ _ - - - - - - - - - - - - - - - - - - - - - - Small-Pox - - _ _ — - _ _ — _ _ _ _ - - - - - - - - - - - - - - - - - -- cute Encephalitis Infectious - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Post-Infectious - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria - - - - - - _ _ _ _ _ _ _ - - - - - - - - Dysentery 65 85 6 4 3 1 3 4 6 6 1 2 17 77 7 7 4 7 12 20 4 8 2 4 19 - - - - - - - - Erysipelas - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 7 Acute Polio-Myelitis P 4 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - N.P _ _ _ _ _ _ - - - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 22 22 - - 3 - _ 3 1 2 1 5 11 10 5 2 1 _ - - - - - - 11 10 2 21 1 - - - - Paratyphoid Fever - - - - - - - - - - - - - - - - - - - _ — _ _ - - - - - - - - Scabies — - - - - - - - - - - - — - - — _ _ - _ _ _ _ _ _ _ - - - - - - - Puerperal Pyrexia - 1 - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - Meningococcal Infection 1 — — — 1 — — _ _ _ _ _ _ _ _ - - - - - - - 1 - - - - - - - - Measles 23 24 _ 1 4 4 1 4 7 7 2 1 1? 11 ? 1 - - - - - - - 7 29 - - - - - - - Whooping Cough 69 99 8 14 12 14 6 9 6 11 6 11 ?1 38 9 1 1 - - - - 1 - - 48 - - - - - - - 1 Diarrhoea 32 25 10 11 12 3 7 6 3 3 7 - - - - - - - 15 4 - - - - - 8 18 Ophthalmia Neonatorum _ 1 _ 1 _ _ _ _ - - - - - - - - - - - - - - 1 - - - - - - - - Pneumonia, Acute Primary or Acute Influenzal 4 8 - - - - - - - - - 1 - - 1 - - - 1 4 7 7 - 1 2 1 1 8 - - - - - Tuberculosis, Pulmonary 29 21 - - - - - - - - - - - - 1 _ 5 5 6 7 11 6 6 3 18 12 2 18 - 5 1 - - „ Non-Pulmonary 1 6 - - - 1 - - - - - - - 2 - - - - 2 1 - - 1 3 - 4 - 3 - 1 4 Totals 250 292 24 31 35 23 17 26 15 24 13 22 62 83 25 11 12 12 21 34 18 17 8 9 177 174 28 218 15 19 6 22 62 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, 1960. 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 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 All Ages Under 4 mths. 4 mths. and under 1 yr. Tuberculosis, Respiratory 3 ... ... ... ... ... ... 1 ... 1 1 1 1 ... 1 1 ... ... ... ... ... 1 11 Tuberculosis, Other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Syphilitic Disease 2 ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... ... 1 ... ... ... ... 4 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Infections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Measles 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... Other Infective and Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Malignant Neoplasm, Stomach 25 ... ... ... ... ... ... 2 6 11 6 6 5 1 13 5 1 1 1 ... 4 36 Malignant, Neoplasm, Lung, Bronchus 60 ... ... ... ... ... ... 3 25 22 10 23 10 2 25 26 5 3 ... 3 1 6 102 Malignant Neoplasm, Breast 15 ... ... ... ... ... ... 1 10 3 1 4 4 1 6 6 2 ... ... 2 19 Malignant Neoplasm, Uterus 10 ... ... ... ... ... ... ... 4 4 2 5 1 1 3 3 ... ... 1 7 Other Malignant and Lymphatic Neoplasms 96 ... ... ... 1 ... ... 9 33 24 29 31 20 1 44 39 3 10 ... 7 ... 18 157 Leukaemia, Aleukaemia 9 ... ... ... 1 ... ... 2 3 1 2 3 4 ... 2 ... 2 2 ... 2 ... 2 12 Diabetes 5 ... ... ... ... ... ... 1 4 2 ... 3 ..."4 ... ... ... ... ... 10 Vascular Lesions of Nervous System 124 ... ... ... ... ... 2 3 21 41 57 59 23 5 37 65 5 .8 ... 3 ... 10 246 Coronary Disease, Angina 149 ... ... ... ... ... ... 3 46 54 46 62 19 1 67 36 2 10 ... 1 1 21 113 Hypertension with Heart Disease 14 ... ... ... ... ... ... 1 7 6 3 1 10 4 1 2 ... 1 ... 1 14 20 Other Heart Disease 120 ... ... ... ... ... ... 2 12 25 80 46 24 5 45 45 3 3 ... 3 12 204 21 Other Circulatory Disease : 5 ... ... ... ... ... ... 1 8 18 27 15 17 23 16 11 ... 1 1 10 88 22 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 123 23 Pneumonia 58 ... ... ... ... ... ... 1 8 17 30 22 11 5 20 38 2 4 ... i ... 10 24 Bronchitis 49 ... ... ... ... ... 1 ... 9 13 25 18 9 5 17 22 1 1 ... 2 ... 3 79 25 26 27 Other Diseases of Respiratory System 6 ... ... ... ... ... ... ... 2 3 1 1 ... ... 5 1 ... ... ... 1 ... ... 13 Ulcer of Stomach and Duodenum 14 ... ... ... ... ... ... 1 4 3 6 4 1 ... 9 10 ... ... ... 1 ... ... 20 Gastritis, Enteritis and Diarrhoea 5 ... ... ... ... ... ... ... 1 3 1 4 ... ... 1 3 ... ... ... 1 ... ... 9 28 29 Nephritis and Nephrosis 3 ... ... ... ... ... ... ... ... 1 2 1 1 ... 1 2 ... ... ... ... ... 1 6 Hyperplasia of Prostate 2 ... ... ... ... ... ... ... ... 1 1 1 ... ... 1 1 ... ... ... ... ... 1 7 30 Pregnancy, Childbirth, abortion 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 8 2 31 Congenital Malformations . 10 7 ... ... 1 1 ... ... ... ... ... 2 1 ... 7 1 ... ... ... 1 ... 25 32 33 Other defined and ill-defined Diseases 54 11 ... ... ... 1 5 1 11 6 19 24 6 3 21 18 3 7 ... 6 ... 12 120 Motor Vehicle Accidents 7 ... ... ... ... ... 1 2 1 3 4 ... 3 4 ... 1 ... ... ... 2 20 34 All other Accidents 15 ... ... ... ... ... 1 5 1 4 4 7 4 1 3 6 1 3 ... ... 2 2 37 35 Suicide 14 ... ... ... ... ... 5 7 1 1 9 ... 1 4 4 ... ... ... ... 1 4 13 36 Homicide and Operations of War ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 926 21 2 1 3 2 11 42 215 265 364 353 167 33 373 360 28 69 1 33 9 133 1,503 Note.—All "Transferable Deaths" of residents, i.e., persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have oeen exciu e