C 4373 GRE59 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1961 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1961 Printed by Bromley Office Supplies & Printing Co., Ltd. 39 A 41 East Street, Bromley, Kent. CONTENTS Page Public Health Committee 3 Introductory 7 Section A.—General and Vital Statistics 11 „ B.—General Provision of Health and Welfare Services for the Area 41 „ C.—Sanitary Circumstances of the Area 49 „ D.—Housing 105 „ E.—Inspection of Food and Supervision of Food Premises 116 F.—Prevalence of, and Control Over Infectious and Other Diseases 141 „ G.—Miscellaneous 155 Appendix—Statistical Tables 3 PUBLIC HEALTH COMMITTEE (as at 31st December, 1961) The Mayor: (ex-officio) Councillor Mrs. Peggy A. Middleton, J.P., L.C.C. and 13 Members Chairman: Councillor Mrs. M. L. Wentworth Vice-Chairman Councillor D. P. Lynch Alderman: P. Noble Councillors: Mrs. M. L. Bennett Mrs. A. D. A. Kennedy R. A. Blatchford W. S. Manners A. C. Chrisp, L.C.C. H. A. Read Mrs. J. E. Chrisp R. Ruston Lady Hume. J.P. 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. The powers and duties contained in Section 38 of the Shops Act, 1950, relating to lighting, washing facilities and facilities for taking meals at shops, as transferred to the Council under Section 18 of the London County Council (General Powers) Act, 1958, shall be delegated to the Committee. 4 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 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. The powers and duties of the Council under the Oil Burners (Standards) Act, 1960, and the powers and duties of the Council under the Consumer Protection Act. 1961. shall stand referred to the Committee. 6.—The powers and duties of the Council conferred by sub-section 1 of Section 18 of the London County Council (General Powers) Act, 1954, to register hairdressers and barbers and their places of business shall be delegated to the Committee. 7.—The functions of the Council under the Clean Air Act, 1956, shall stand referred to the Committee. 8.—The powers and duties of the Council in connection with the repair, closure or demolition of individual insanitary dwellings under the Housing Act, 1957, and the powers and duties of the Council under the Rent Act, 1957, to issue Certificates of Disrepair shall be delegated to the Committee. The powers and duties of the Council under Section 22 of the London County Council (General Powers) Act, 1959. relating to the control of movable dwellings, shall stand referred to the Committee. 5 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), and the powers and duties of the Council under Section 69 of the London County Council (General Powers) Act, 1961, reating to the provision of meals for invalids, shall stand referred to the Committee. 6 STAFF (as at 31st December, 1961) MEDICAL OFFICER OF HEALTH: John Kerr Brown, B.Sc., M.B., Ch.B., D.P.H. PUBLIC ANALYST : H. A. Williams, Ph.D., A.C.G.F.C., F.R.I.C. CHIEF PUBLIC HEALTH INSPECTOR : abc G. B. Allen District Public Health Inspectors: a H. D. Dawes a J. G. Lyons «b S. Kelly abc S. A. Radford ab D. B. Smith Food Inspectors: ab C. W. Spore (Senior) ab W. C. Scales Public Health Officers: abdef Miss B. Hatfield (Senior) df Mrs. M. E. Charteris (i) def Miss N. A. Fluck Assistant Clean Air Officer: J. W. Joslin 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. J. A. Sutherland (ii) Mrs. D. F. Howard C. Weymouth Mrs. M. B. Marshall (iv) Miss W. E. Wilson (iii) W. F. Goodall (Conveniences Superintendent) CLEANSING CENTRE & DISINFECTING STAFF : T. Smith (Foreman) A. Moore J. J. Keating A. Nash A. K. Nunn Mrs. E. L. Towler (Senior Cleansing Officer) and Staff of five women RODENT CONTROL, FLY DISINFESTATION, ETC.: Team of six men a Certificated Public Health Inspector (i) commenced duties 13th November, 1961 b „ Meat and Other Foods (ii) commenced duties 17th April, 1961 c „ Smoke Inspector (iii) commenced duties 4th December, 1961 d „ Health Visitor (iv) commenced duties 20th March, 1961 e „ State Certified Midwife f „ State Registered Nurse 7 PUBLIC HEALTH DEPARTMENT, TOWN HALL, GREENWICH. S.E.10. To The Mayor, Aldermen and Councillors. Metropolitan Borough of Greenwich. Ladies and Gentlemen, I have the honour to present the Annual Report on the health of Greenwich for 1961. According to the census taken in April the population declined to 85,885, and the Registrar General's mid-year figure of 85,240 estimates a further reduction. A preliminary report on the census indicated that there has been an increase of 17.3% of private dwellings but only 1.6% of private individual householders since the last census 10 years ago. The birth rate shows a small increase and illegitimate births have also increased by 36.4% over the last year. At the same time the infantile mortality rate has risen by almost the same proportion. Usually this is not without significance because as a general rule the ante natal care sought by unmarried mothers is much less comprehensive and of course this lack of care is reflected in higher mortality rates. For the current year, however, this is not borne out by the Borough figures. Once again, prematurity and congenital malformations constitute the greater proportion of infant deaths and, as expected, deaths within the first week of life predominated. Congenital malformations are very much in our minds at the moment. Certain virus diseases, particularly german measles, contracted in early pregnancy can damage the developing foetus and some drugs which in the normal way may bring indispensible benefits, have been shown to have disastrous effects in early pregnancy. This is not the place to discuss the wider national implications of these distressing findings but two points can be made. A woman in early pregnancy should be protected as far as possible from contracting infectious diseases, particularly the virus diseases. If known to have been exposed she should be given the appropriate anti-serum, if one exists, to give temporary passive protection. Fortunately most women, by the time they reach maturity, have acquired strong immunity to the infectious diseases and it is only the rare case which is found to be susceptible. Nevertheless, with the decline in the incidence of infectious diseases it may soon be possible to lead a normal active life and perhaps not be exposed to these infectious diseases which are gradually being eliminated. The second point which should be stressed is that drugs, apart from minerals such as iron and calcium and food supplements. 8 should be prescribed with the utmost caution to pregnant women. This last decade has seen an enormous increase in the amount of drugs consumed for all sorts of purposes. The discoveries made in the realm of pharmacology in the last 25 years have been almost beyond belief and yet there is still a place in medicine one would hope, for the natural recuperative capacity of living tissue and for the individual patient to accept some responsibility for, and make some contribution towards, his or her own recovery. In the majority of maladies nature can still effect a cure unaided if given sufficient encouragement. Last year it was noted that the total notifications of infectious diseases were the lowest in the history of the Borough. The year under review is a "measles" year and this is reflected in the number of notifications. However, if one excludes measles one finds a further substantial decrease in tuberculosis, dysentery, whooping cough, infantile diarrhoea and pneumonia. The Borough was free from diphtheria and small-pox but there was a case of typhoid and paratyphoid, both acquired on the Continent. The introduction of the poly-valent poliomyelitis live oral vaccine is another effective instrument in individual and community immunisation and in the controlling of any epidemic incident. The work at present being done on virus anti-bodies, one of which is known as " Interferon," gives hope that before long virus diseases will be as effectively controlled in the individual patients as most of the bacterial diseases have been subjugated by the wide-spectrum antibiotics. There were only 37 cases of pulmonary tuberculosis last year, the lowest ever recorded, and there were 6 deaths. This achievement is a further tribute to the preventive and promotive work of the Chest Clinic at Maze Hill, complementing the many environmental improvements over the years which to a substantial degree are the result of the efforts of the District Public Health Inspectors. Statistics are apt to be accepted passively without a realisation of the preliminary work involved in effecting improvements in basic living standards so intimately linked with the general improvement in health and longer expectation of life. Diseases of the heart and arteries accounted for a high proportion of total deaths reported, followed closely by malignant conditions particularly of the lung, stomach and intestinal tract. For the first time in many years the number of deaths from lung cancer dropped. It is doubtful if this is a permanent trend for it is not reflected in the national figures. Mention has been made in previous reports regarding the correlation between heavy cigarette smoking and incidence of lung cancer. In this connection the 9 Royal College of Physicians, in October, published a study on this subject and a precis of their findings and recommendations appears in the main report. Despite the irrefutable evidence of the dangers of cigarette smoking the tobacco manufacturers show no disposition to take any serious measures to reduce the consumption of tobacco among the vulnerable age groups. Indeed the contrary is true. I venture to suggest that there has been more money spent on publicity and advertising this year than in any previous year and even further inducements are being considered. Already there is an indication that the main manufacturers are including gift tokens and other direct and indirect bribes to increase tobacco sales. One can only hope that the modest efforts of health authorities in bringing the facts about cigarette smoking to public notice will have some effect on tobacco consumption especially among the younger generation. Irksome smoking restrictions in places of entertainment and on public transport act only as irritants to the public who, in a free society must be allowed to make their own choice in matters which affect them solely as individuals. Legislation coming into force during the year has been included in the report but a brief word must be said about the new Housing Act, 1961. This Act gives valuable new powers to local authorities particularly in regard to houses in multiple occupation or occupied by members of more than one family. Certain discretion is now given to local authorities to prescribe maximum numbers of occupants and to insist on reasonable standards of amenities in order to prevent or alleviate squalid conditions. As yet there is no indication that such houses constitute a serious problem in our Borough but isolated cases do come to our attention where conditions are appalling and where the new powers given to the authority will be of great assistance. I would commend to readers the chapters on food inspection and the progress which is being made in extending Smoke Control areas. It is hoped to cover the whole Borough by 1970 and great efforts will be made to meet that target. Services for the old people continue to expand and improve. Another lady visitor was engaged and there are now three Public Health Officers in the department, one of whom has important inspectorial duties relating to hygiene. The new Bathing Station was opened in October and a full description of the building and its services has been included. It is a fine building, well designed, and is proving of immense value to the Borough. Many people have made notable contributions to this report. Figures relating to the personal health services have been kindly 10 supplied by Dr. Waldron the Divisional Medical Officer. I am conscious too of my debt to the General Practitioners; to the Public Health Laboratory Service; to the many voluntary organisations; to the Geriatric Unit at St. Alfeges and also to the staff of the Health Department who have shown me every loyalty and kindness. I must end by recording my grateful thanks to my Chairman who is forever vigilant, enthusiastic and encouraging, and to my ViceChairman who has given great support at all times. I have the honour to be. Your obedient Servant, J. Kerr Brown, Medical Officer of Health. 11 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 At Census, 1961 (preliminary figure) 85,585 Estimated, 1961 (mid-year) 85,240 Density of Population (persons per acre) 22.09 Number of Inhabited Dwellings—end 1961 24.492 (according to Rate Books) Structurally separate dwellings at Census, 1951 21,348 Structurally separate dwellings at Census, 1961 (preliminary figure) 25,048 Number of Uninhabited Dwellings— At Census, 1951 364 At end 1961 244 Number of Families or Separate Occupiers— At Census, 1951 26,397 At Census, 1961 (preliminary figure) 26,813 Rateable Value, 1961 £1,825,400 Sum Represented by a Id. Rate, 1961 £7,280 12 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 51½ „ Charlton Park 42¾ „ Hornfair (formerly Charlton Playing Field) 26 „ Sayes Court Recreation Grounds 3¼ „ King George's Field 4¾ „ Charlotte Turner Gardens 1¾ „ Approximately 221½ acres Total Public Open Spaces in Borough Approx. 432 acres (representing 11% of the total area of the Borough) Mileage of Streets 89.5 (approx.) 13 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. This 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, in accordance with the Local Government Act, 1899, 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 includes a large area of marsh land at present quite unsuitable for the erection of dwelling-houses. 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 and throughout the whole of the borough 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. Greenwich, which in Latin 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, lies mainly on a natural slope from the Thames to Blackheath thereby affording 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. Few residential districts near the city of London are so full of historical associations as Greenwich whose streets are among the most interesting of any in the Capital and whose wealth of surviving buildings is unrivalled. History has played a large part in determining the types of industries located within its boundary with their consequent effects on the social conditions of its community. Notwithstanding that documented history of Greenwich appears to begin only during King Alfred's reign when he was Lord of the Manor, circa 900, there is evidence that Greenwich has been inhabited for over 2,000 years—certainly Crooms Hill is pre-Celtic whilst Shooter's Hill, along with many other place names, is of Celtic origin. Recovered coins and fragments of pottery show an almost continuous Roman settlement from 41 B.C. to 423 A.D. and Saxon burial mounds and barrows dating from the 6th century are still to be seen in Greenwich Park. 14 Village life, which survived the Romans' departure and the coming of the Jutes in the mid 5th century, was predominantly that of men whose business was with the sea and ships with the trade of waterman as their most important occupation. Indeed, even up to 100 years' ago fishing smacks were sailing regularly from Greenwich, a busy attractive little Thames-side town, to the North Sea, Iceland and Greenland. This was hardly surprising for here the river affords an excellent roadstead for shipping. So much so that in the time of King Ethelred (1011 A.D.) the whole Danish Fleet lay off Greenwich for three or four years whilst the army was for the most part encamped on Blackheath. This army ravaged the whole country and sacked the City of Canterbury from whence they brought Archbishop Alfege to his martyrdom at Greenwich on April 19th, 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. Although efforts to obtain a Royal Charter have so far proved unsuccessful, Greenwich is unquestionably royal by association for, although the early Norman Kings preferred Winchester, at the time of St. Alfege's martyrdom the English king was resident and had a Royal Treasury at Greenwich. Later, at the Palace of Placentia, Henry VIII, his daughter Queen Elizabeth I and her half sister Mary, were born and spent much of their time and 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 (1272) to James II (1685). It was here in its heyday that the great Elizabethan admirals, statesmen, writers, musicians and courtiers thronged the riverside and splendid palace and 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. 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. 15 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. 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 16 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. 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 17 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. 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. 18 POPULATION General—The Registrar General has submitted his estimate of the population of Greenwich, computed at mid-year 1961, upon which the statistics of this Report have been based. The figure returned is 85,240, indicating a decrease in the population of 3,070 since last year and a fall of 4,606 since the 1951 Census. However, the current figure shows an advance of 21,440 over that for 1945. Natural Increase—The natural increase for the year, i.e. excess of births over deaths, was 371 compared with 328 for 1960. 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 64% and that of "dependent" groups collectively, to 36%. In effect, this means that for every two persons of "working age" there is one dependent person outside this group. 19 ESTIMATED AGE COMPOSITION OF THE POPULATION Estimated As estimated by the locally : Registrar General: Age No. Approx. % of Total Population Under 1 year 1,260 1.5 1 to 4 years (inclusive) 5,340 6.2 5 to 14 years (inclusive) 12,100 14.2 Total Child Population under 15 years 18,700 21.9 15 to 64 years (inclusive) 54,540 64.0 65 years and over 12,000 14.1 Total Population 85,240 100.0 CENSUS, 1961 In modern times, exact information regarding the population not only becomes more urgent but pressure for the inclusion of new questions becomes greater; the need, therefore, for a periodical census grows rather than diminishes. Although the full list of questions for 1961 is larger than for 1951 the introduction of sampling methods meant that 9 out of 10 people were asked for less information than in any previous census this century. The 16th Census of the population of England and Wales was taken on the 23rd April, 1961. There is, of necessity, an interval of some 3 years or so before a complete census picture can be presented and in order to meet the more urgent needs, a Preliminary Report has been issued which relates to numbers only, by sex, of the population and the numbers of private dwellings and households for local authorities' areas. Previous experience has shown that the final figures are unlikely to differ materially from these provisional figures. In this preliminary Report, the population of Greenwich is given as 85,585, comprising 41,477 males and 44.108 females, which shows a decrease of 4,261 (4.7%) from the 1951 Census and a fall of no less than 15,339 since 1931. The excess of females over males is 2,631 a figure which compares with 2,264 for 1951 and 1,828 for 1931 and, furthermore, the female content of the Borough's population has risen from 50.9% in 1931 and 51.3% in 1951 to 51.5% for the current Census. Compared with the London figure of 1,096, the sex ratio in Greenwich, i.e., the number of females per 1,000 males was 1,063, a rise of 11 over that for 1951. The Report also indicated a 17.3% rise in the number of private dwellings from 21,348 in 1951 to 25,048 in 1961, and private households increased by 1.6% from 26,397 to 26,813 respectively. 20 * EXTRACTS FROM VITAL STATISTICS OF THE YEAR LIVE BIRTHS Legitimate Illegitimate Total Birth Rate (Crude) 15.28 Male 613 53 666 Female 595 37 632 (Comparable Rate 14.67) Total 1,208 90 1,298 STILL BIRTHS Legitimate Illegitimate Total Rate per 1,000 total Births 22.59 Male 13 1 14 Female 15 1 16 Total 28 2 30 DEATHS—All Causes Male Female Total Death Rate (Crude) 10.91 486 441 927 (Comparable Rate 11.89) DEATH RATES—Special Causes Infants under 1 year of age No. Rate All infants (per 1,000 live births) 30 23.11 Legitimate Infants (per 1,000 legitimate live births) 29 24.00 Illegitimate Infants (per 1,000 illegitimate live births) 1 11.11 Neo-Natal Deaths (per 1,000 live births) 23 17.72 Early Neo-Natal Deaths (per 1,000 live births) 18 13.87 Peri-Natal Mortality (per 1,000 total births) 48 36.15 Others Maternal Causes (per 1,000 total births) 1 0.75 Tuberculosis (all forms) (per 1,000 population) 7 0.08 Tuberculosis, Pulmonary (per 1,000 population) 6 0.07 Cancer (per 1,000 population) 203 2.39 Heart (per 1,000 population) 297 3.50 Common Infectious Diseases (per 1,000 population) — — Influenza (per 1,000 population) 4 0.05 *These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 21 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 1961. The total of 685 gives a marriage rate of 16.13, an increase of 1.20 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 1961 183 140 14 87 261 685 85,240 ‡ St. Peter's, Creek Road ‡ Holy Trinity, Blackheath Hill Closed † Parish Church destroyed by enemy action * Parish Church reopened. 22 METEOROLOGICAL OBSERVATIONS—1961 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, 1961:— Temperature Highest screen temperature 92° on 1st July. Lowest screen temperature 23° on 25th, 29th & 30th December. Maximum in January 52° on 29th and 30th. February 64° on 15th. November 62° on 1st. December 58° on 11th and 12th. Sunshine Total for year 1397.1 hours. Sunniest day 15.0 hours on June 29th. Number of days without sun 59 distributed as follows:— January 13 February 6 March 0 April 4 May 1 June 1 July 1 August 0 September 5 October 1 November 12 December 15 Rainfall Total 30.9 inches. Highest fall in 24 hours 1.44 inches 4th May. Driest month 0.08 inches March. Wettest month 3.28 inches October. 23 BIRTHS The total number of live births registered in the Borough during the year was 1,661 and of this number 1,301 occurred in St. Alfege's Hospital, and 360 in private dwellings. In 843 cases the parents resided outside the Borough and these births were consequently transferred to their appropriate districts, leaving a figure of 818. To this must be added 480 births belonging to the Borough which took place in Institutions outside the Borough, thus making a final figure for Greenwich of 1,298, an increase of 44 over that of the previous year. Of this total 666 were males and 632 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:— 282 186 55 295 818 Inward Transfers:— 1st Qtr. 32 13 3 65 113 2nd Qtr. 34 11 - 72 117 3rd Qtr. 38 17 3 73 131 4th Qtr. 36 12 — 71 119 Totals 422 239 61 576 1,298 The Birth Rate for the year, calculated on the figure of 1,298 births, is 15.28 per thousand of the population, 1.03 higher than that for 1960. The average rate for the previous ten years is 14.78. The Greenwich Comparability Factor for births is 0.96 which gives an adjusted rate of 14.67. The Rates for the County of London and England and Wales are 18.7 and 17.4 respectively. Illegitimate Births numbered 90 (representing 6.9 per cent, of the total live births) a rise of 24 over the figure returned for 1960. The number of Still Births registered was 30 (14 males-16 females), which is equivalent to a rate of 22.59 per 1,000 total births, an increase of 11.55 over that of the previous year. 24 DEATHS The net number of deaths registered during 1960 was 927, of which 486 were males and 441 females, compared with last year's total of 926 comprising 481 males and 445 females. This gives a crude Death Rate for the Borough of 10.91 per thousand of the population, representing an increase of 0.39 compared with that of the previous year and a rate which is 0.95 greater than the average for the last ten years, viz., 9.96. The Crude Death Rate figure is increased to 11.89 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 1.09 and may be regarded as the population handicap to be applied which, when multiplied by the crude Death Rate for the year, modifies the latter so as to make it comparable with the country as a whole or with any similarly adjusted area. The Death Rates for the County of London and for England and Wales are 11.9 and 12.0 respectively. The inset table showing the causes of deaths at all ages has been supplied by the Registrar-General and is included in accordance with the Ministry of Health's request. In the Appendix to the Report will be found a table giving by districts, the causes of, and ages at death of residents whilst indicating the numbers actually dying in Public Institutions. No. in Short List Causes 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 486 11 1 3 5 7 150 132 177 F 441 19 1 1 3 19 76 106 216 1 Tuberculosis, Respiratory M 4 — — — — — 1 1 2 F 2 — — — — — 2 - - 2 Tuberculosis, Other M - - - — - - - - - F 1 — — — — — — — 1 3 Syphilitic Disease M 1 — — — — — — 1 — F 2 — — — — — — 1 1 4 Diphtheria M — — — — — — — — — F — — — — — — — — — 5 Whooping Cough M — — — — — — — — — F — — — — — — — — — 6 Meningococcal Infections M — — — — — — — — — F — — — — — — — — — 7 Acute Poliomyelitis M — — — — — — — — — F — — — — — — — — — 8 Measles M — — — — — — — — — F — — — — — — — — — 9 Other Infective and Parasitic Diseases M 1 — — — — — — — 1 F — — — — — — — — — 10 Malignant Neoplasm, Stomach M 13 — — — — — 5 2 6 F 13 — — — — — 1 4 8 11 Malignant Neoplasm, Lung, Bronchus M 45 - - - - — 30 13 7 F 3 — — — — — 1 — 2 12 Malignant Neoplasm, Breast M - - - - - - - - - F 17 — — - — 2 10 7 3 13 Malignant Neoplasm, Uterus F 7 - - - - 2 2 1 2 14 Other Malignant and Lymphatic Neoplasms M 58 - 1 - 2 2 16 17 20 F 47 - - - - 5 14 16 12 15 Leukaemia, Aleukaemia M 2 — — — — — 2 — — F 2 — — - 1 1 - — — 16 Diabetes M 2 - - — - - 1 - 1 F 4 — — — — — — 3 1 17 Vascular Lesions of Nervous System M 6 - - - 1 - 8 17 20 F 4 — — - - 1 9 10 24 18 Coronary Disease, Angina M 89 - - - - 1 33 30 25 F 62 - - - - 1 10 24 27 19 Hypertension with Heart Disease M 9 — — — — — l 4 4 F 8 — — — — — — 2 6 20 Other Heart Diseases M 47 - - - - 1 5 11 30 F 82 — — - - 2 7 10 63 21 Other Circulatory Disease M 20 — — — — — 2 5 13 F 16 - - - - - 2 6 8 22 Influenza M 2 - - - - - - 1 1 F 2 — — — — — 1 1 — 23 Pneumonia M 25 2 - - - - 8 2 13 F 41 4 — — — - 3 11 23 24 Bronchitis M 39 - - - - 9 13 17 F 25 — - - - 1 1 3 20 25 Other Diseases of Respiratory System M 3 — — — — — 2 1 - F 3 - - - - - 1 1 1 26 Ulcer of Stomach and Duodenum M 11 - - - - - 3 3 5 F 1 — — — — — 1 - - 27 Gastritis, Enteritis and Diarrhoea M — — — — — — — — — F 2 — — — — — 1 - 1 28 Nephritis and Nephrosis M 1 — — — — — — - 1 F 3 — — — — 1 1 — 1 29 Hyperplasia of Prostate M 5 — — — — — — — 5 30 Pregnancy, Childbirth, abortion F 1 - - — 1 — — — — 31 Congenital Malformations M 5 3 - - 1 — 1 — — F 6 6 — — — — — — — 32 Other defined and ill-defined Diseases M 32 6 - - - 1 13 4 8 F 34 9 - 1 - 1 6 8 9 33 Motor Vehicle Accidents M 10 - - 2 - — 4 2 2 F 4 — — — — — 1 3 - 34 All other Accidents M 11 - - 1 1 2 4 3 - F 5 — 1 — — 1 1 — 2 35 Suicide M 5 - - - - — 2 2 1 F 4 - - - 1 1 1 — 1 36 Homicide and Operations of War M — — — — — — — — — F — — — — — — — — — 25 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 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 1960 926 633 68.3 10-year average 888 546 61.3 1961 927 647 69.8 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 9 8 5 8 30 Between 1 and 2 years — — 1 — 1 Between 2 and 5 years — 1 — — 1 Between 5 and 15 years 1 1 1 1 4 Between 15 and 25 years 2 2 2 2 8 Between 25 and 45 years 7 10 4 9 30 Between 45 and 65 years 60 54 52 54 220 Between 65 and 75 years 71 44 45 77 237 75 years and upwards 126 86 81 103 396 Totals 276 206 191 254 927 26 Little variation in the pattern of death registrations occurred during the year, the first and fourth quarters producing 29.8% and 27.4% respectively, and the third quarter 20.6%. It will be observed from the following table that during 1961 the deaths occurring at 65 years and upwards accounted for 68.3% of the total compared with a figure of 22.8% for 1901. Deaths in the age group 0-5 years show an even more striking comparison; in 1901 the deaths in this group amounted to 37.4% whilst the figure for the current year is 3.4%. Age Group 1901 1911 1921 1931 1951 1961 Under 1 year of age 362 306 175 97 29 30 Between 1 and 5 years 187 158 80 39 7 2 Between 5 and 15 years 64 67 58 22 10 4 Between 15 and 25 years 66 60 67 65 12 8 Between 25 and 65 years 454 474 466 382 311 252 65 years and over 335 356 387 529 633 631 Totals 1,468 1,421 1,243 1,134 1,002 927 MATERNAL MORTALITY One death from puerperal causes was recorded during the current year, a position similar to that obtaining in 1960. giving a Maternal Death Rate of 0.75. This registered maternal death was in respect of a girl of 17 years who died from an air embolism due to insufflation of the uterus. The Coroner's verdict at the inquest was recorded as "selfinduced abortion." 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 23.11 and 30 respectively. 27 This substantial reduction reflects the national trend (the rate for England and Wales being 21.6 and that for London 21.5) 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 effects of disabilities such as phenylketonuria, diabetes and haemolytic 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. For instance, in the Netherlands the infant mortality rate is only 16 per 1,000 live births and in Australia, New Zealand and Sweden the figures are 20, 19 and 16 respectively. Infants who die before reaching the age of one month and more especially, those who die in the first week of life 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 point is amply demonstrated in the following graph which clearly shows that, in this Borough, the total of neo-natal deaths, when given as a percentage of the total infant deaths, is higher now than it was in 1946. In a recent study of perinatal mortality involving approximately 4,500 cases, it was found, as expected, that developmental difficulties formed the under-lying cause of still and neonatal births which resulted in congenital malformations or incomplete development, viz. prematurity or immaturity but that, happily, modern techniques have helped to reduce infant deaths arising from difficulties of labour. 28 INFANTILE MORTALITY Deaths under 1 month and 1 week respectively as a_percentage of the total of deaths under 1 year. 29 One factor which was not in line with current opinion emerged from the investigation in connection with congenital malformation. This was to the effect that influenza rather than rubella could have been implicated and, further, that with particular reference to still births attributed to malformation of the central nervous system there was a predominance of females over males which defied explanation but which could possibly be caused by a sex-linked genetic factor. Improvement in national reproductive wastage figures from 111.4 per 1,000 total births in 1929 to 43.6 in 1958 (a fall equivalent to 61 per cent.) has not been followed by a similar improvement in perinatal mortality. This on the other hand has decreased only by 43 per cent., namely from 61.4 to 35.0 during the same period. 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. At a time when the problem of infant mortality is already sufficiently complicated it is little short of calamitous and extremely discouraging to learn, at the end of the current year, that recent investigations have indicated that the use of certain modern drugs by the expectant mother in early pregnancy can be a prime cause of congenital malformation. 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 23.11 per thousand live births as compared with 17.54 for last year and 18.63, the average for the previous ten years. For the County of London the rate was 21.5 in comparison with 21.6. the figure returned for England and Wales. The present Borough figure of 23.11 shows an increase of 5.57 over that of the previous year and is 4.48 higher 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. 30 The following table shows the comparative Infantile Mortality Rate for the quinquennial periods since 1931, together with the Rate for 1961:— District Average for Quinquennial Periods Year 1961 1931 to 1935 1936 to 1940 1941 to 1945 1946 to 1950 1951 to 1955 1956 to 1960 Greenwich 75 50 40 27 18.4 18.89 23.11 London 63 56 60 33 23.8 21.9 21.5 England and Wales 62 55 50 36 26.9 22.7 21.6 The actual number of infantile deaths recorded during the year was 30 (eight more than last year) and these were attributed to the following causes:— Prematurity 10 Fibroelastosis 1 Bronchopneumonia 2 Congenital malformation 7 Pulmonary Atelectasis 1 Capillary Bronchitis 3 Fibrocystic Disease of Erythroblastosis 1 Pancreas 1 Placenta Praeira 1 Failure to establish Hyaline Membrane 1 normal respiration 1 Umbilical Sepsis 1 Of the above, 11 were male and 19 female; 10 died in St. Alfege's Hospital, 3 in the Brook Hospital, 2 in the Miller Hospital, 2 at home and 13 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 23 deaths, equivalent to 76.66% of all infant deaths and giving a Neo-natal Mortality Rate of 17.72 per 1,000 live births. This compares with a figure of 15.5 returned for England and Wales. Eighteen of these neo-natal deaths occurred within the first week of birth, the main causes being Prematurity and Congenital Malformation. Perinatal Mortality.—The Perinatal Mortality Rate, calculated from a total of 48 still births and deaths of infants under 1 week, was 36.15 per 1.000 total births compared with 22.87 for the previous year. The equivalent rate for England and Wales is 32.2. Reproductive Wastage.—A sum total of 60 Stillbirths and Infantile deaths gives a reproductive wastage rate of 45.18 per 1,000 total births, an increase of 16.00 over the 1960 figure. 31 Bad housing, overcrowding, poor sanitation, low standards of education, all tend to produce higher Infant Mortality Rates. It follows, therefore, that the Infant Mortality Rate should provide a good index to the social circumstances of any particular area. However, Infant Mortality Rates which are based on the number of births occurring in the same year as the infant deaths are not comparable year by year unless the birth rates remain more or less constant because approximately one-third of the infants dying in any one year will be found to have been born in the previous year. Further, it must be borne in mind that when dealing with small figures the slightest deviation in the number of deaths tends to misleading fluctuations in the rate. Consequently care must be exercised when drawing conclusions from any rise or fall in Infant Mortality Rates. REMARKS ON VARIOUS DEATH CAUSES Recognising the importance of ensuring as far as possible the uniformity and comparability of statistics in relation to diseases and causes of death, the Registrar-General has, from 1st January, 1950, implemented the Nomenclature Regulations, 1948, as suggested by the World Health Organisation. Although these regulations are not binding on Medical Officers of Health, it is essential that the International Statistical Classification of Diseases, Injuries and Causes of Death, 1955, should be adopted in order that local statistics can be compared with national figures and national with international. Classification of Deaths.—It should be borne in mind that the statistical data compiled locally relating to cause of death may not entirely agree with the figures furnished to Local Authorities by the Registrar-General. Classification of the cause of death is taken from one or more causes as stated on the medical certificate in accordance with the rules generally adopted throughout England and Wales. The Registrar-General is able, in cases where it is deemed desirable, to obtain fuller information from the certifying practitioner. This enables his department to modify the original classification—hence the possibilities of discrepancies in some cases between the figures prepared locally and those referred by the Registrar-General. Common Infectious Diseases.—Under this classification comprising Measles, Scarlet Fever, Diphtheria, Whooping Cough and Diarrhoea, no deaths were registered for the current year 32 compared with one for 1960 and a nil return for each of the years 1959 and 1958. Smallpox.—No deaths from Smallpox have been recorded during the year, this year being the 59th since a death from this disease occurred. Measles.—During 1961 no deaths from measles were recorded compared with one for the previous year. There were no deaths from this complaint during the years 1959 and 1958. Scarlet Fever.—For the fifteenth 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 8 years. Two deaths were registered for 1953, none for 1952 and one for each of the years 1951 and 1950. Enteric Fever.—There were no deaths arising from this cause during the year and none have been recorded since 1941. Only 2 deaths from Typhoid Fever have been registered during the last 25 years. Diarrhoea and Zymotic Enteritis.—Compared with a nil return for the current year and for the years 1960 and 1959 there was one for 1958, one for 1957 and a nil return for each of the years 1956 and 1955. Diphtheria.—Again it is gratifying to report that there were no deaths from Diphtheria during the year under review and that it is now 15 years since one was recorded. Tuberculosis.—There were 7 deaths from this disease during the year, giving a death rate of 0.08 compared with 4 deaths and a rate of 0.04 for 1960. The rate for the present year compares favourably with the average tuberculosis death rate for the previous ten years, viz., 0.16 and is a further acknowledgment, if such were needed, of the effectiveness of modern therapeutic methods. Although in Greenwich the numbers are small and therefore liable to wide fluctuation, they do reflect the national (trend, for in 1961 the rate for England and Wales in respect of all forms of tuberculosis was 0.07 compared with a figure of 0.10 for London. 33 Greenwich deaths from tuberculosis for the previous ten years are given, with their appropriate rates, in the following table: Year No. of Deaths Rate 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 1960 4 0.04 10-year average 15 0.16 1961 7 0.08 Tuberculosis of the Respiratory System was responsible for 6 of the deaths in this category, only one death being attributed to the remaining forms of tuberculosis. At 0.07, the Pulmonary Tuberculosis rate was 0.03 higher than that returned for last year. Cancer.—In Greenwich, cancer was responsible for a total of 203 deaths giving a rate of 2.39 per thousand population compared with figures of 209 and 2.37 respectively for the previous year. It accounted for 21.9% of all registered deaths, a percentage over five times that returned for 1901, viz. 4.2%, and indicates that approximately one in every five deaths resulted from cancer of one form or another. The present total of 203 is 14% higher than the average for the past ten years. Comparing the current year's figures with those of the previous 5 years, the sites of the affected parts were:— 1956 1957 1958 1959 1960 1961 Cancer of Stomach 20 23 14 26 26 26 „ „ Lung, Bronchus 58 46 44 50 63 48 „ „ Breast 13 15 19 14 15 17 „ „ Uterus 6 5 7 2 11 7 „ „ all Other Sites 90 98 95 80 94 105 Totals 187 187 179 172 209 203 Lung Cancer.—Throughout the country in recent years there has been a tendency for cancer of the lung to increase and the 34 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 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 1960 2 1 25 3 19 2 7 4 53 10 63 0.71 10 yr. Average 1.6 0.6 21.3 3.1 11.2 1.3 4.7 1.4 38.8 6.4 45.2 0.50 1961 - - 30 1 13 - 2 2 45 3 48 0.56 From the preceding table it can be seen that the age group 45 to 65 years continues to be the period of greatest mortality, and deaths in this group consistently constitute over half the deaths attributed to lung cancer. In fact, deaths in this group formed 64.6% of the total of all lung cancer deaths recorded for 1961. At present the trends in Greenwich with regard to lung cancer closely follow those discernable in the national figures. Since 1950 the numbers dying from cancer of the lung in England and Wales has almost doubled to the current figure of 22,798 giving a rate of 0.49 per thousand of the population. This compares with a rate of 0.67 for London and 0.56 for Greenwich. 35 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. Indeed, for some time, statistics have indicated that serious illnesses and in particular lung cancer were affecting smokers rather than non-smokers but controversy regarding the implication of the smoking habit was widespread. In order that physicians should be in possession of up-to-date and relevant information to enable them to advise their patients, the Royal College of Physicians accordingly decided in April, 1959, to set up a committee " to report on the question of smoking and atmospheric pollution in relation to carcinoma of the lung and other diseases." Although the committee was asked to report on the effects of smoking and atmospheric pollution, the preventive measures are so dis-similar that it was decided to report separately on these two hazards. The committee's Report "Smoking and Health," which was approved for publication on the 26th October, 1961, recounts the history of tobacco smoking in Britain, emphasises recent trends, reviews the evidence for and against the hypothesis that smoking causes various kinds of diseases, discusses the psychological aspects of smoking and makes recommendations as to the action which may be required in the light of present evidence. Notwithstanding that the Report sustains its conclusions with what almost amounts to a surfeit of facts and figures, it is a publication capable of being read and understood by the layman and no attempt is made here to cover the Report in full. However, several of the most important aspects justify inclusion and these follow in an abbreviated form. In dealing with diseases in relation to smoking the Report makes particular reference to cancer of the lung and in recapitulating and assessing the mass of evidence incriminating the cigarette it endorses all the grave warnings which have been given by medical authorities during the past few years. It acknowledges the fact that during the past 45 years lung cancer in many countries has changed from being an infrequent disease to a major cause of death and that this increase has been most serious in men and women in late middle age. Undoubtedly some of this increase is due to more accurate diagnosis but the evidence indicates unquestionably that not only is a large part of the increase real but also that it bears a direct relationship to the rise in cigarette consumption. It has been estimated that heavy cigarette smokers may 36 have up to thirty times the death rate of non-smokers and, inter alia, it has been shown that cigarette smokers are much more affected than pipe or cigar smokers and also that those who had given up smoking had lower death rates than those who continued to smoke. Naturally there has been vigorous criticism to the effect that these results have been based on errors of selection and of diagnosis and that the association between smoking and lung cancer in these studies is therefore spurious. Despite the fact that these criticisms have been substantially refuted and that it is generally agreed by authoritative bodies that there is an association between lung cancer and cigarette smoking, it has been sincerely postulated that there may be possible explanations of this association other than the straightforward one of cause and effect. These have been itemised as follows:— (a) That people who are going to get lung cancer have an increased desire to smoke throughout their adult lives. (b) That smoking produces cancer only in the lungs of people who are in any case going to get cancer somewhere in the body so that smoking determines only the site of the cancer. (c) That lung cancer affects people who would have died of tuberculosis in former times but have now survived with lungs susceptible to cancer. (d) That smokers inherit their desire to smoke and, with it, inherit a susceptibility to some other undiscovered agent that causes lung cancer. (e) That smokers are, by their nature, more liable to many diseases including lung cancer, than the "self protective" minority of non-smokers. (f) That smokers tend to drink more alcohol than nonsmokers so that drinking and not smoking may cause lung cancer. (g) That motor car exhausts, or (h) that generalised air pollution may render the lungs of smokers more liable to cancer. Of the abovementioned explanations, none fits the facts enumerated in the Report as well as the "obvious" one, viz.: that smoking is a cause of lung cancer and from the point of view of public health importance, perhaps only items (d), (g) and (h) warrant elucidation. 37 With regard to item (d), the hypothesis that smokers inherit susceptibility to unidentified environmental influences is not borne out in a recent comparison between a non-smoking religious sect and a control group. Incidence of lung cancer among the sect was only one eighth of that of the control group and, moreover, in contrast with a much higher incidence in males in the control group, there was equal sex distribution in the religious sect. As cancer of other sites not associated with smoking occurred with equal frequency in both groups, the inference is clear. In item (g), road haulage workers would have been expected to return a higher than normal rats for lung cancer due to exposure to exhaust gases but this has proved to be not so. Only in item (h), which asserts that general air pollution has some relationship with cancer, does there appear to be any substance. Evidence in this lespect is somewhat conflicting for, in Finland, a country of heavy smokers and where the population is predominantly rural, the lung cancer rate is the second highest in Europe, being only slightly less than that for England. Conversely, immigrants from the United Kingdom to South Africa and New Zealand who have the same level of smoking as the native born inhabitants, show a higher lung cancer rate than the indigenous population, which suggests an exposure in early life to an environmental factor which pre-disposes them to cancer of the lung. This factor might well be atmospheric pollution and the Report suggests that a reduction in air pollution would reduce the risks involved in smoking. It is important to remember that although the Royal College of Physicians has made an excellent case against the smoking habit it is fair to state that their report does not indicate that every heavy smoker will get lung cancer nor that every non-smoker will avoid it. Certain preventive measures are suggested, namely:— (i) More education and especially school children. (ii) Restrictions on the sale of tobacco to children. (iii) Restriction on tobacco advertising. (iv) Wider restriction on smoking in public places. (v) Increased tobacco tax. (vi) The analysis of the tar and nicotine content of tobacco smoke to be displayed on each cigarette packet. (vii) The setting up of anti-smoking clinics. 38 In connection with remedial or preventive measures suggested, success with school children is hampered by the fact that from the age of 9 or 10 years many youngsters are determined to "ape" their elders and demonstrate their maturity by smoking, not only with parents' consent but often with their active co-operation. The herd instinct also appears to be a big factor linking school children with smoking, and advertisements specifically slanted to influence the young militate against efforts to secure abandonment of the habit. At this point it is pertinent to record that recent education campaigns among adults in Edinburgh and school children in Hertfordshire failed, although this failure could conceivably be due to inappropriate methods. Some amendment to the Children and Young Persons Act. 1933, is necessary for stricter control over the sale of cigarettes to children under 16 years. Experience has shown that higher tobacco taxation, although resented, will eventually be paid by the true addict. Some authorities feel that shock tactics will bring the desired results and others that a more subtle psychological approach will prevail. Perhaps the answer lies in the establishment locally of organisations similar to that highly successful one instituted by the Manchester Committee on Cancer which is staffed on a permanent basis by medical personnel specifically trained in cancer, experienced in health education, and having a flair for lecturing and writing. Ridicule of smoking as a social attribute seems to be a practical approach not so far officially recognised but possibly worthy of exploitation. From observations it seems clear that repetition merely promotes monotony, a risk which must be avoided at all costs in educating the public and in this respect abstinence is more likely to be achieved by inspiring conviction rather than invoking fear. Vascular Lesions of Nervous System.—This class, which includes deaths arising from Cerebral Haemorrhage, Embolism and Thrombosis was responsible for a total of 90 deaths (46 males, 44 females). The age distribution was as follows:—1 between 15 and 25 years, 1 between 25 and 45 years; 17 between 45 and 65 years: 27 between 65 and 75 years and 44 from 75 years upwards. This year's total of 90 indicates a fall of 26 from that for 1960. 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. 39 The total deaths occasioned by such maladies amounted to 297 (145 males—152 females) compared with a figure of 282 for 1960, and as usual, the deaths from this category occupied the principal place in the classification of diseases in that they formed 36% of the total deaths from all causes. Besides being responsible for a prodigious loss of man-working capacity in the United Kingdom amounting, it is estimated, to some 12 million week days per year, cardiovascular and atherosclerotic diseases as a group are responsible for more deaths than any other single cause and, as such, constitute the greatest possible challenge to preventive medicine. The urgency of this problem becomes intensified when it is realised that deaths from arteriosclerotic and degenerative heart disease are mounting year by year. Information has been given in previous reports relating to the aetiological factors which, in the light of present day knowledge are thought to be implicated, namely: excess of animal fat in the diet producing a rise in serum cholesterol—the association of smoking with heart disease—the lack of physical activity and coronar disease and its hypothetical connection with "stress and strain." Although the causes of heart and circulatory diseases are still subjects of a great deal of research, the exact aetiology remains obscure. Nevertheless, to counter some of the agencies known to be connected with heart disabilities, it would appear to be unwise to delay the introduction of preventive measures such as weight reduction, restriction of the intake of animal fat, control of smoking, introduction of regular exercise and, most important, education. until our knowledge of cause and effect is complete. Diseases of the Respiratory System.—There were altogether 136 deaths from these diseases. Bronchitis accounting for 64 and Pneumonia (all forms) for 66. The total shows an increase of 13 over that of the previous year; deaths from Pneumonia decreased by one whereas those from Bronchitis increased by 10. Of the total deaths, 6 were children under one year of age and 105 were in respect of persons 65 years and over. Influenza.—There were 4 deaths attributed to this cause during the year compared with a nil return for 1960. Deaths from Violence.—These numbered 39 including 14 from Motor Vehicle Accidents, 9 from Suicide and the remainder being accounted for under the heading of "All Other Accidents." The number of deaths from Motor Vehicle Accidents increased by 4 over that of the previous year while the figure for Suicide decreased by a similar margin. 40 Contrary to general belief suicide claims a formidable number of victims. In England and Wales the number of suicides, approximately 5,000 annually, far exceeds deaths from tuberculosis and is almost equivalent to the total of deaths from motor vehicle accidents. In some countries which sustain high living standards it has become a most important psychiatric problem. Until recently, suicide remained a felony and attempted suicide an indictable offence and a misdemeanour. It is interesting to recall that until 1824, the original penalty for suicide was to be buried at the crossroads with a stake through the heart. From then onwards until the 1880's the penalty was ameliorated to one of being buried in unconsecrated ground between 9 p.m. and midnight, without ceremony. Confiscation of goods by the Crown which constituted a further penalty was discontinued in 1870. Society, presumably, has become mature enough to respond constructively to suicide by providing the maximum of medical care that these sick people require, for, with the introduction of the Suicide Act, 1961, the law has been brought into line with modern thought and attempted suicide is now considered to be a medical and social problem and not one constituting an indictable offence. 41 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 1961, 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 1.30 p.m.—4 p.m. Tuesday Wednesday Thursday 9.30 a.m.—12 noon Friday 1.30 p.m.—4 p.m. St. Alfege's Church Hall, Roan Street, S.E.10 Monday 9.30 a.m.—12 noon 2 p.m.—4 p.m. Tranquil Vale, S.E.3 Wednesday 9.30 a.m.—12 noon 42 Health Visitors' Records, Attendances at Infant Welfare Sessions. Prophylaxis figures, etc. 1. Health Visiting Quarter Expectant Mothers Premature Babies Still-Births Infants (under 1 year) Children 1—5 years School Children Care of People Miscellaneous Unsuc cessful Total Visits 1st visit Revisit 1st visit Revisit Old Others March 173 220 6 7 272 1,279 3,749 523 123 62 268 538 7,220 June 184 226 15 8 350 1,591 3,673 400 153 72 220 704 7,596 Sept. 198 221 17 5 384 1,616 3,262 288 134 55 292 740 7,212 Dec. 165 178 23 4 335 1,548 3,278 305 98 78 181 649 6,842 Totals 720 845 61 24 1,341 6,034 13,962 1,516 508 267 961 2,631 28,870 2. Infant Welfare Clinics Quarter Sessions Attendances 0-1 year 1-2 years 2-5 years 1st Total Total Total March 207 436 4,815 1,190 1,010 June 198 339 4,758 1,175 1,040 September 202 409 4,794 1,276 1,105 December 191 300 4,529 1,204 938 Totals 798 1,484 18,896 4,845 4,093 43 3. Ante and Post Natal Clinics (a) Ante Natal Quarter Sessions 1st Attendances Total Attendances This Year Current Pregnancy March 62 494 195 1,445 June 63 191 189 1,141 Sept. 64 177 177 1,112 Dec. 63 182 188 1,174 Totals 252 1,044 749 4,872 (b) Post Natal (cases seen at Ante-Natal Clinics) Quarter 1st Attendances Total Attendences This Year Since Confinement March 42 40 44 June 61 54 63 Sept. 36 36 45 Dec. 32 33 37 Totals 171 163 189 4. Toddlers Clinics Quarter Sessions Total Attendances Medically Examined March 16 159 153 June 23 147 147 September 24 132 132 December 33 234 208 Totals 96 672 640 44 5. Relaxation and Educational Sessions Quarter Relaxation Sessions Educational Sessions* Sessions Total Attendances Sessions Total Attendances March 34 473 40 497 June 32 397 40 546 September 30 301 36 383 December 34 385 39 486 Totals 130 1,556 155 1,912 * Includes a Fathercrafl Class 6. Artificial Sunlight, Massage etc. Quarter Sessions Attendances First Total March 74 50 992 June 60 35 710 September 69 34 613 December 74 59 1,233 Totals 277 178 3,548 7. Chiropody Treatment No. of Clinic Sessions 1,223 No. of First Attendances 616 Total Attendances 14,865 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., '61 6 11 568 3 588 87 37 31st Dec., '61 2 11 571 8 592 83 37 Cases attended during 196!: — 63 18 801 26 908 — — (b) Supervision Effective Ineffective Total Visits made by Organising Staff: 3,344 404 3,748 45 9. Prophylaxis (a) Immunisation and Vaccination (Children under 5 years) Diphtheria immunisation (completed cases) 9 Whooping Cough immunisation (completed cases) 1 Combined Antigen (Diphtheria and Whooping Cough) 8 Combined Antigen (Diphtheria and Tetanus) 16 Triple Antigen (Diphtheria, Whooping Cough and Tetanus) 701 Tetanus immunisation 9 Vaccination (Smallpox) 538 (b) B.C.G. Vaccination (Children 13 years old at Greenwich Schools) No. of Children 13 years old 2,012 No. for whom parental consent was obtained 1,655 No. of negative reactors vaccinated 1,337 No. of positive reactors X-rayed 68 (c) Poliomyelitis Inoculation (Children born 1943-1961 resident or attending Greenwich schools) (i) Two injections given during year 1,354 (ii) Third injection given during year 1,679 (iii) Fourth injection (Children 5-12 years) 3,802 (Others—mainly adults 16-40 years living or working in Greenwich and Exp. Mothers) (i) Two injections given during year 378 (ii) Third injection given during year 1,163 10. District Nursing The staff of the Queens District Nursing Association for Charlton and Blackheath made 26,247 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 Minors Ailments Clinics No. of Attendances 444 403 41,172 No. of New Cases 250 35 9,549 No. of Glasses prescribed 102 — — Note: As appropriate, children from Greenwich also attend special clinics in Deptford and Woolwich. 46 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 ARTIFICIAL SUNLIGHT TREATMENT Chevening Road, S.E.10 Fairfield House, S.E.7 Shooter's Hill Road, 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 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). 47 CHEST CLINICS (by appointment only) DAY A.M. P.M. Maze Hill, S.E.10 Monday 10.00 CAllergy 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 AND BATHING CENTRE Tunnel Avenue Wednesday Daily (Saturdays excepted) 9 - 12 (School Children) 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. 48 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 (TIDeway 3028). OTHER ORGANISATIONS British Red Cross Society, Miss K. A. Rackham, Divisional Director, 46, Vanbrugh Park, S.E.3 (GRE 0157). Citizen's Advice Bureaux. 141, Greenwich High Road, S.E.10. (GREenwich 4981). 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 2 p.m. to 4.30 p.m. Fri. 5 p.m. to 7 p.m. Sat. 9 a.m. to 11 a.m. 49 SECTION C Sanitary circumstances of the Area The tables on pages 103 to 104 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 16,887 houses and premises have been inspected or re-inspected during the year; 462 intimation notices and 170 statutory notices were served. Registered complaints, numbering 2,166 show an increase of 184 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: — Home Safety Act, 1961.—Operative from 18th May, 1961, this Act, in repealing Section 82 of the London County Council (General Powers) Act, 1957, enables the Council to promote safety in the home and to make contributions to voluntary organisations whose activities consist of or include the promotion of safety in the home. Responsibilities of the Council under the Act have been referred to the Public Health Committee. Consumer Protection Act, 1961.—In seeking provisions to protect consumers this Act repeals the Heating Appliances (Fireguards) Act, 1952, and the Oil Burners (Standards) Act, 1960, although regulations made under the repealed Acts remain enforceable under the new Act which becomes effective from the 19th May, 1961. Licensing Act, 1961.—This Act, extending to England and Wales only, was introduced to amend the Licensing Act, 1953, to make further provisions concerning the sale and supply of intoxicating liquor and further, to introduce rules to control licensed premises and purposes connected therewith. There are two operative dates involved, namely, 1st November, 1961 and the 1st March, 1962, and the Council's duties under the Act are twofold. The first is in respect of the suitability of premises for the purpose in view (Section 27, sub-section (b)), and secondly, their conformity with the Town and Country Planning Acts. 50 Factories Act, 1961.—Operative from the 1st April, 1962, this Act consolidates the Factories Acts, 1937/59, and introduces certain other enactments relating to the safety, health and welfare of employed persons. Public Health Act, 1961.—Effective from the 3rd October, 1961, the relevance to London of this Act, which amends the Public Health Act, 1936, is limited to Section 79 which deals with annual reports to the Minister regarding canal boats. This report is now discontinued. Rag Flock and Other Filling Materials Regulations, 1961.— Based on the standard of cleanliness of filling materials issued by the British Standards Institution in 1960, these Regulations supersede the previous Regulations of 1951 and 1954 and prescribe the materials to which the Act applies, standards of cleanliness, analysts and their fees and all records necessary for these ends. The new Regulations became operative from 1st August of the current year. 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 430 inspections were made by the Council's Inspectors in relation to the 505 registered factories. The latter figure includes 82 premises where mechanical power is not used. Defects were found in 12 instances, all of which were remedied. 51 FACTORIES ACTS 1937-1959 Inspections for purposes of provisions as to health. Premises Number on Register Inspections Number of Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 82 36 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 406 359 1 — (iii) Other Premises in which Sec tion 7 is enforced by the Local Authority (excluding outworkers' premises) 17 35 — — Total 505 430 1 — 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.) 1 1 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7): — — — (a) insufficient 1 1 — (b) unsuitable or defective 7 7 2 (c) not separate for sexes 1 1 — — — Other offences against the Act (not including offences relating to Outwork) 2 2 __ Total 12 12 — 2 — 52 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 1 Making, etc. apparel ) 28 — — — — — Curtains and Furniture Hangings 1 — — — — — Lampshades 6 — — — — — Cardboard Boxes 3 — — — — — Household Linen 1 — — — — — Brass and brass articles 1 — — — — — Total 40 — — — — — 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 14 (b) Outworkers resident outside the Borough 20 Notifications received from firms outside the Borough of: — Outworkers resident in the Borough 48 Total number of Greenwich residents employed as outworkers (as given in August list) 40 Premises where homework is carried on were visited on 72 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 53 Public Health Committee for authority to serve a Statutory Notice to enforce abatement of the nuisance. The premises are re-inspected by the Public Health Inspector, and, if work required is not executed within a reasonable period, Statutory Notice is served. In cases of non-compliance the Town Clerk is instructed to institute proceedings. (2) Housing Defects.—These are cases where the conditions are such that they cannot be remedied under the procedure of the Public Health (London) Act, 1936, and are dealt with under the Housing Act, 1957, as being houses unfit for human habitation. Representations are made to the Public Health Committee to consider as to whether such houses can be repaired at a reasonable cost having regard to the value of the premises, or whether Closing and Demolition Orders should be made. Pigeon Nuisance.—A local authority is enabled by Section 121 of the Public Health (London) Act, 1936, to deal with a nuisance arising from the congregation of pigeons believed to be ownerless and it has been the practice of this Council to authorize a pigeoncatcher to deal with pigeons on the highway and other public places. During the year some 9 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. 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. 54 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 in the river falls to zero, the sulphate which is found in tidal waters is reduced by bacterial action and hydrogen sulphide is formed. In this respect, the Director of the Water Pollution Research Laboratory at Stevenage has asserted that during dry weather many miles of the Thames Estuary contains no oxygen and in this region hydrogen sulphide is evolved, giving rise to complaints both because of its smell and because of the corrosion it causes. A Ministry statement in 1957 that river pollution, although serious, was decreasing, was received with a certain amount of reservation in some quarters. However, with regard to the Thames, the London County Council's Rivers and Drainage Committee reported that there had been a considerable improvement in the sewage effluent discharged into the river from the Northern outfall since the new primary sedimentation plant was brought into operation in July, 1955. The fact that no complaints were received during the current year regarding smells emanating from the river supports the contention made by the London County Council that there has been a great improvement in the sewage effluent discharged into the river. 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. 55 Many properties in the Borough in close proximity to the River Ravensbourne have suffered from inundations once or twice a year in recent years and flood waters have penetrated to the foundations, resulting in extreme discomfort to the inhabitants besides tending to produce in the dwellings ideal conditions for the spreading of dry rot. It was reported in 1959 that the problem was being investigated under the auspices of the Ministry of Agriculture, Fisheries and Food which had 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 watercourse 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 presented to Parliament and, on the 3rd August of this year, the River Ravensbourne, etc. (Improvement and Flood Prevention) Act, 1961, received the Royal Assent. This Act confers like powers on the London County Council and Kent County Council for " the improvement and protection of and the prevention of flooding from the River Ravensbourne and its tributaries and for purposes connected therewith." In London it applies not only to the rivers Ravensbourne, Pool, and Quaggy, the Kid Brook, Kyd Brook and the Lower Kid Brook but also to the parts of all tributaries, brooks and watercourses (whether open or covered) that flow into these rivers or streams. Powers are given to both these County Councils to make bylaws and, in the prevention of pollution, (a) to dredge, cleanse and scour the stream, (b) to reduce or remove any shoals, shelves, banks or other accumulations in the stream, 56 (c) to abate or remove, or cause to be abated or removed, all or any impediments, obstructions or nuisances whatsoever in the stream or on the banks thereof. Such powers include the purchase of any necessary land by agreement or compulsorily and the prohibition of the deposition of any articles, matter, etc. in the stream or on the banks. Dredging of streams covered by the Act is also prohibited except with the express permission of the respective County Council. The County Council's consent is also required in connection with the erection of any buildings, etc., in or over the said streams. Powers originally given to the Metropolitan Borough Councils under the Rivers (Prevention of Pollution) Act, 1951, are now to be enforced by the London County Council. Atmospheric Pollution—General.—The Royal College of Physicians' publication " Smoking and Health," although very naturally concentrating on cigarette smoking and its relation to lung cancer, nevertheless suggested with some emphasis that from the evidence already to hand it would appear that air pollution might well be a potent factor in the incidence of cancer of the lung. In my previous reports much has been written about the enormous and costly damage to life and property by air pollution but little with regard to the apportionment of responsibility. At the time of the Beaver Committee's report on air pollution in 1954 it was already recognised that domestic smoke was deeply implicated but more recent investigations have shown that this connection is greater than at first supposed. There is no doubt that greater quantities of dust and grit are emitted from industrial furnaces but the domestic fire, because of its comparative low temperature of burning, is responsible for a smoke much higher in hydrocarbon or tar content. Further, the industrial pollution is usually dispersed at higher levels and the concentrations are therefore well diluted by the time they reach street level. Domestic smoke on the other hand is discharged at low level from short flues with the result that it lingers and eddies thus constituting a greater danger to the local inhabitants. In this respect itj has been proved that smoke concentration is relative not to the size of the town but to the density of the population and its domestic coal consumption per square mile. Research has revealed that for every ton of coal burned industrially, approximately 4½ lbs. is lost in smoke whereas the comparable figure for a domestic open coal fire is 90 lbs. 57 Emission of sulphur dioxide continues to engage the attention of research teams for it is conceded that this commodity is really the dangerous constituent of atmospheric pollution. So far no convenient and inexpensive method has been found for its elimination, although it has been estimated that a general change from open coal fires to closed stoves would reduce the sulphur dioxide content of the atmosphere to one third of its present level. At first glance the obvious solution to the smoke problem seems to be either a replacement of the open coal fire with one of gas or electricity or a change to some other form of smokeless fuel. However, each new method of heating faces objections, some serious such as higher costs, unsatisfactory fuels and installations, local shortages and lack of storage space, etc., and some not so serious such as interference with personal liberty or that fumes are greater with the new smokeless fuels, all of which have to be countered in one way or another. Fortunately the present clean air policy coincides with the public's demand for cleaner and more efficient heating systems for the home. Nevertheless a great deal of prejudice has to be overcome especially in the smaller homes where the "cost" item is paramount. 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 new Alkali, etc. Works Order, 1961, comes into operation on the 1st of January, 1962 and whilst inter alia the Order defines a Caustic Soda Works so to include some of its products, it adds to the list of noxious or offensive gases, fumes containing uranium, beryllium, selenium, sodium potassium or their compounds, and carbon monoxide. 58 Within the Borough 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 third smoke control area which obtained Ministry approval on the 12th March, 1962. 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. Circular 1/61 issued by the Minister of Housing and Local Government modified the requirements contained in paragraph 42 of his Memorandum of 1956 on Smoke Control Areas in that it is no longer necessary for the Council to notify the Minister of their proposals for a Smoke Control Order, as detailed in (i) above, before formally submitting it for his approval. Advice to householders was proffered by the Minister in his Circular 28/61 regarding the importance of installing firebars sufficiently widely spaced to enable coke to be burned satisfactorily and he indicated that replacements by suitable bars would now rank for grant. In his Circular 31/61 the Minister has also stated that now methods of ignition by electricity have been developed, these will rank for grant in a similar way to those of gas. The Greenwich No. 3 Smoke Control Order, 1961, which becomes operative on the 1st October, 1962, covers an area of some 49 acres and concerns 891 dwellings and 62 other premises, most of which have apparatus requiring alteration. The accompanying plan indicates the area concerned. 59 60 Pollution Recording.—Two atmospheric pollution measuring stations are maintained by the Council, one at the Town Hall and the other at Charlton House and the following tables give the daily mean concentration of smoke and sulphur dioxide as calculated on readings taken at the Council's two stations during 1961 :— TABLE I.—Daily Mean Concentration of Smoke Month Town Hall Charlton House Smoke Mu/m3 Smoke Mu/m3 Daily Value Daily Value Average Highest Lowest Average Highest Lowest November 1960 NO READINGS TAKEN December „ January 1961 288 750 24 87 490 40 February „ 170 580 100 70 280 40 March „ 480 1,300 90 450 1,060 30 April „ 90 180 40 50 80 20 May 70 120 40 40 90 10 June „ 60 110 20 20 66 — July 60 100 30 20 50 August „ 41 120 10 15 30 September „ 92 180 30 23 40 10 October „ 135 280 50 No Readings Taken November „ 216 578 71 150 658 26 December 344 720 72 January 1962 239 590 110 No Readings Taken February „ 185 350 100 TABLE II,—Daily Mean Concentration of Sulphur Dioxide Month Town Hall Charlton House Sulphur Dioxide Mu/m3 Sulphur Dioxide Mu/m3 Daily Value Daily Value Average Highest Lowest Average Highest Lowest November 1960 NO READINGS TAKEN December January 1961 193 446 91 74 269 31 February 145 263 74 97 172 31 March 3 199 359 129 217 417 77 April 123 306 51 139 296 40 May 80 119 37 84 126 30 June 112 215 54 109 369 29 July 123 223 60 85 129 54 August 78 126 34 74 137 49 September 131 263 60 88 177 40 October 140 292 66 No Readings Taken November 325 756 125 231 447 84 December 479 780 171 January 1962 301 926 122 No Readings Taken February 327 569 157 61 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 9 Number of decisions not to issue certificates 0 Number of decisions to issue certificates: (a) in respect of some but not all defects 5 (b) in respect of all defects 4 — 9 Number of undertakings given by landlords 6 (under para. 5 of 1st Schedule) Number of undertakings refused by Council 0 (under proviso to para. 5 of ljf Schedule) Number of certificates issued 3 62 PART II—Applications for Cancellation of Certificates Applications by landlords to Council for cancellation of certificates 3 Objections by tenants to cancellation of certificates 2 Decisions by Council to cancel notwithstanding tenants' objection 1 Certificates cancelled 1 In addition to the foregoing, 4 applications (Form "O") re ceived from landlords and tenants for a certificate as to the remedying of defects which the landlord has undertaken to remedy, resulted in the issue of Certificates (Form "P") as follows: — Applications By whom made Form 'P' Certificates issued in respect of:— Defects Remedied Defects not/not wholly Remedied In respect of Form 'H' undertaking Tenant — — Landlord — — In respect of Form 'K' undertaking Tenant — 1 Landlord 2 1 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 empowered 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, 2 investigations were made into the department's records of the respective premises. 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 63 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. Despite the fact that, on the 19th May of the current year this Act was repealed by the Consumer Protection Act, 1961, the Regulations made under the previous Act remain enforceable. Powers and duties of the Council under this new 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 one application for entry of name in the Council's List of Persons entitled to sell Poisons included in Part II of the Poisons List was received but 55 vendors aoplied 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. 64 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 391 occasions. Hairdressers and Barbers.—Under Section 18 of the London County Council (General Powers) Act, 1954, with certain exceptions, no person shall carry on the business of a hairdresser or barber on any premises in the Borough unless he and those premises are registered by this Council. Byelaws made by the Council under Sub-section 4 of Section 18, were confirmed by the Minister of Housing and Local Government on 21st August, 1956, and became operative on 1st October of the same year. Premises registered at 31st December, 1961 61 Persons registered at 31st December, 1961 67 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 65 Rag Flock, four of Cotton Felt, and one of Coir Fibre were obtained and submitted for examination. All proved satisfactory. Since the 1st August, however, the 1951 Regulations have been replaced by the Rag Flock and Other Filling Materials Regulations, 1961, and these prescribe the materials to which the Act applies, standards of cleanliness, analysts and their fees and all records necessary for these ends. Pet Animals Act, 1951.—This Act, introduced to regulate the sale of pet animals with particular reference to their welfare prior to sale, became operative from 1st April, 1952, since when it became an offence to keep a pet shop except under licence from the Local Authority. The Act defines "the keeping of a pet shop" as the carrying on at premises of any nature (including a private dwelling) of a business of selling animals as pets and as including the keeping of animals in such premises with a view to their being sold in the course of such business, whether by the keeper thereof or by any other person. The term "animal" includes any form of vertebrate. "Premises" includes any stall or barrow in a market but not any stall elsewhere or any part of a street or public place. Licences, renewable annually, are issued on payment of 10/and are valid to the 31st December of each year. At the end of the year two licences were in operation and 7 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 1,328 reports on such enquiries were forwarded to the Town Clerk's department. Drainage and Sewerage.—During the year 581 drains were tested, 389 were opened, cleansed or repaired and there were 1,525 constructions and re-constructions, alterations and improvements effected. Only two cesspools remain in use in the Borough and under the Borough Engineer's direction these are emptied on request. 66 One hundred and sixty-nine plans of drainage and other sani tary works relating to existing and new buildings were examined and approved. Discharge of Trade Effluents into Sewers.—Under the provi sions 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 372. Of these, 65 connections are directly to sewers under the control of the London County Council and will be dealt with by that authority, under the provisions of the Act. In connection with this matter the Borough Engineer has kindly supplied the following information :— Premises discharging trade effluent to local sewers 307 Premises discharging trade effluent to L.C.C. sewers 65 Number of sewer connections inspected 88 Number of samples taken 76 Number of samples found satisfactory 20 Some eleven of the unsatisfactory samples were from the premises of the South Eastern Gas Board and negotiations are still proceeding concerning discharge to the Tunnel Avenue sewers. In conjunction with the London County Council's Scientific Adviser a series of tests are to be run to establish the acceptable standards of effluent to be discharged with particular reference to the atmospheric pollution within the sewers. The remaining unsatisfactory samples were found to be caused by errors in operating manufacturing plant and lack of maintenance of drainage systems. Remedial measures were taken by the firms concerned. 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 24,736 dwellings with direct connections to the Board's mains. During the year 91 water supply certificates were granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended, repaired or renewed in 292 cases. 67 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. 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 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. Following a Report in 1953 on fluoridation of water supplies issued by the United Kingdom Mission to North America, study areas in England, Wales and Scotland were selected along with appropriate controls to implement recommendations contained in the Report. This was some five years ago and the results obtained have served only to corroborate the views of the British Dental Association as expressed to the Guillebaud Committee when it was investigating possible economies in the Natonal Health Services. Improvements accruing as a result of the treatment of water supplies by fluoride was most noticeable in those children who had been subjected to such supplies for the whole or greater part of their lives and with teeth which were calcified in that period. Briefly, for children of 3 years there was a reduction in caries of 66 per cent., for 4-year-olds the reduction was 57 per cent, and for the 5-year-olds it was 50 per cent. As expected, reductions recorded in the 6- and 7-year-olds, were somewhat less, namely, 26 and 14 per cent, respectively. The Control areas also showed reductions but only of the order of 2 per cent, to 7 per cent, in a random pattern. Posssible adverse effects on health generally were countered by requests to medical practitioners in the study areas to report any cases suspected to be the result of fluoridation with specific 68 investigation into osteochondritis juvenalis of the spine, accumulation of fluoride in the bones, mongolism, peptic ulcer, absenteeism from school and a careful study of the vital statistics. In this respect, the outcome was completely reassuring. The results of the five year experiment can be considered a complete vindication of the attitude taken up previously by the dentists and, in consequence, the Minister of Health is being urged to adopt fluoridation of water supplies as a normal procedure. 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. During the year, contractors engaged in the work concerning the duplication of the Blackwall Tunnel indicated to the Metropolitan Water Board that they had reached a point at which they would require to dispose of effluent pumped from pilot tunnels. It was stated \that this effluent from grouting wqrk contained chemical spillage diluted in ground water which could not be discharged directly into the river. If such effluent were to be discharged via a borehole, as had been suggested by the contractors, there was a distinct possibility that there would be a change in the chemical constitution of the ground water in the area. This, in turn, would doubtless affect the water in the local wells. 69 A meeting was convened by your Medical Officer of Health to which representatives of interested parties were invited to discuss the situation. These representatives from the Contractors, the Consultant Engineers, the Metropolitan Water Board, the Port of London Authority and the South Eastern Gas Board decided on the following course of action, viz.: (a) Approach to be made by the Medical Officer of Health for Greenwich, per the Borough Engineer, to the London County Council regarding the possibility of utilising the existing drainage system. (b) A formal approach by the Company to the Port of London Authority about the possibility of discharging this effluent directly to the river. (c) A further meeting to be convened if neither of the above recommendations were practicable. Arrangements have now been made with the London County Council for this effluent to be discharged into their drainage system with daily sampling by that authority to ensure that no untoward results accrue. This department has arranged for the sampling of the water from the well located at the British Oxygen's premises which is sometimes utilised for drinking purposes. Samples obtained so far have indicated that no deterioration has taken place. 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 approxi mately 82 miles. This is done mainly by hand sweeping, only 7½ % 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 37£% (c) Twice weekly 37£% 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. 70 Street sweepings during the year amounted to 710 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 21,645 tons, the weight of the salvaged materials being 1,041 tons. This was collected from 27,171 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 13.4 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 and converted buildings. 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 21,645 tons, less the 1,041 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 293 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. 71 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 1,041 tons of salvaged materials collected during the year was disposed of by sales amounting to £7,670, made up as follows: Scrap Metal — 97 tons — £751 Waste Paper — 894 tons — £6,076 Rags, etc. — 50 tons — £843 An income of £1,581 was obtained from the charges made by the Council for the collection and /or disposal of 293 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 661 recorded complaints (447 of rats and 214 of mice), 508 were notifications, 50 re-notifications from occupiers or other sources and 103 were found during survey. The monthly average of complaints from all sources was 54 as compared with a figure of 53 for the previous year. In addition to the investigations of recorded complaints, 2,430 other surveys were carried out under the Prevention of Damage by Pests Act, 1949, giving a grand total of 3,091. During investigations, infestation was found to exist on 6 occasions in local authority's premises, 428 in dwelling houses and 92 in miscellaneous properties and places of business. Of these, 2 major infestations of rats were disclosed, one on Local Authority premises and one on an open site. In all some 570 treatments were effected by the local authority and 2 by occupiers or other services. 72 Notwithstanding the fact that large industrial firms are inclined to make contracts with servicing companies, periodical treatments were carried out at 14 industrial premises, 3 wharves and storage places and at 3 hospitals in the Borough. Following the policy of tracing the source of each infestation, 14 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. 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, 1961: — The following report was submitted to the Ministry of Agriculture, Fisheries and Food, for the year ended 31st December, 1961: — 73  TYPE OF PROPERTY Non-Agricultural (1) Local Authority (2) Dwelling Houses (including Council Houses) (3) All other (includg. Business Premises) (4) Total of Cols. (1), (2) & (3) (5) Agricultural 1. Number of properties in Local Authority's District. 41 24,232 4,466 28,739 2. Number of properties inspected as a result of: (a) Notification 1 407 78 486 — (b) Survey under the Act 4 2,268 244 2,516 — (c) Otherwise — 13 2 15 — 3. Total inspections carried out — including re-inspections 8 2,729 347 3,084 4. Number of properties inspected (in Sect. II) which were found to be infested by: (a) Rats Major 1 — 1 2 — Minor 1 239 47 287 — (b) Mice Major — — — — Minor 1 158 26 185 — 5. Number of infested properties (in Sect. IV) treated by L.A. 3 385 65 453 6. Total treatments carried out — including re-treatments 7 470 95 572 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 74 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 :— The Council continued in the use of sodium fiuoracetate in ready mixed form for the baiting of sewer manholes as adopted in the previous year. Stringent safety measures were taken for the protection of the staff handling the materials and each manhole was clearly marked after baiting to indicate that poison had been used. In both February and June, 1961, 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 the workmen from the Borough Engineer's Department and baiting is to continue on this basis during the coming year. A disadvantage of the single treatment of manholes without pre-baiting, which is not considered necessary when using sodium fiuoracetate, is that there is no ready assessment available of the rodent infestation. It is proposed that census baiting will be undertaken preceding the next sewers' 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 5 cwt. van 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, water butts, derelict baths and tanks, ponds and ditches, etc. During the year 43 complaints regarding flies and mosquitoes were received and a further 8 instances were revealed during survey. One persistent source of complaint arose from the S.E.G.B.'s allotment area where, during the summer period, the Bendix outfall left pockets of stagnant water on the low-lying land which gave rise to conditions ideally suited for the breeding of mosquitoes. Effective control was obtained with anti-malarial capsules. 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. Dust chutes in the numerous blocks of flats received regular treatment with ' Gammexane' powder by anti-fly 75 personnel, as soon as possible after dust collection and 3.878 treatments were so carried out. 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. 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 11 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 Ladies' swimming bath and rebuilding with this aim in view commenced during 1957. 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. 76 (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 and during the current year 1,138 brine baths were given, mostly to ladies who found this type particularly attractive, and some 3,969 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, 1961: — Warm Baths 81,779 Swimming Baths 139,798 New Vapour Baths 12,785 Public Laundry 6,696 Total 241,058 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 :— 77 Sample No. Date & Time Nature & Temperature No. of Bathers Plate Count per ml. Yeastral Agar 2 days 37°C. Probable No. of Coliform bacilli, per 100 ml. MacConkey 2 days 37°C. Faecal Coli. per 100ml. Result 1 22.3.61 3.00 p.m. 2nd Class *Swimming 77°F. 230 1 — — Satisfactory 2 17.4.61 11.55 a.m. 2nd Class *Swimming 75 °F. 110 — — — Satisfactory 3 30.6.61 10.00 a.m. 1st Class *Swimming 73°F. 50 — — — Satisfactory 4 30.6.61 10.00 a.m. 2nd Class *Swimming 74°F. 50 — — — Satisfactory 5 18.7.61 11.10 a.m. 2nd Class *Swimming 74 °F. 115 1 (24 hrs.) — — Satisfactory 6 18.7.61 11.15 a.m. 1st Class *Swimming 73°F. 162 2 (24 hrs.) — — Satisfactory 7 22.9.61 11.15 a.m. 1st Class *Swimming 76" F. 12 80 cols./ml. (24 hrs.) — — Satisfactory 8 22.9.61 11.20 a.m. 2nd Class *Swimming 77*F. 200 45 cols./ml. (24 hrs.) — — Satisfactory 9 11.12.61 11.45 a.m. 2nd Class *Swimming 77°F. 50 15 cols./ml. (24 hrs.) Satisfactory * Mixed Bathing 78 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 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. 'During Summer Period this convenience opens at 8.30 a.m. on Sunday. The Women's side of the Blackheath Hill convenience which was closed on 29th November, 1959, consequent upon damage arising from a road accident, was re-opened on 29th May of the C year. It will be recalled that, during 1958, the Council decided to postpone action with regard to the erection of a new convenience at Woolwich Road in the vicinity of Anchor and Hope Lane. Plans have now been drawn up for this new convenience and work is expected to commence during 1962. 79 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 have been made with a view to obtaining an alternative site. 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 of Public Health during 1951, were continued with marked success during the year and the following table gives an indication of the growing use made of these facilities :— Convenience Men Women Total Batley Park 6,007 5,896 11,903 Creek Road 2,722 3,307 6,029 Greenwich South Street 2,880 5,160 8,040 King William Walk 2,788 16,837 19,625 mere Street 2,580 4.326 6,906 er's Hill Road 4,128 4,231 8,359 Totals 21,105 39,757 60.862 Disinfestation of Verminous Premises.—D.D.T. in kerosene continues to give good results in dealing with verminous premises when alternated with other vermicides such as Chlordane, Lindane 80 and Malathion, etc., to counteract the development of organismal resistance. During the year the department dealt with 75 cases of dirty and verminous premises compared with 88 in 1960. The disinfestation staff sprayed 240 rooms and contents as compared with 256 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 1,826 rooms and 98 external areas, the following initiated the greater number of complaints. Ants. Ants carry no disease but their presence in human foodstuffs is objectionable. Foods of a relatively high sugar content are particularly attractive to ants and the insects are prepared to go to great lengths in order to obtain a sufficiency for their community. In the main, the 47 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 57 treatments involving 127 rooms and 23 external areas 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 il 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 undei 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 57, an increase of 3 over the previous year. Although the treatments which involved 391 rooms effected a reasonable measure of success, it must be stated that 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 im 81 practical. 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 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, 101 treatments were effected involving 829 rooms and 5 external areas. Clover Mite. Twenty-five complaints were received from tenants in blocks of flats in various parts of the Borough and 9 further cases were found during survey concerning small red or dark brown insects (Bryobia praetiosa) found moving over walls and windows. This was a reduction of 11 from the previous year. 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 34 occasions, 82 ing of 41 rooms and 21 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 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. Twenty-eight complaints regarding this pest were received and during the year some 27 nests were destroyed, mainly by means of HCN gas generated from purpose-made proprietary powder. This was a decrease of 30 from 1960. 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 13 Carpet 1 Earwigs 7 Silver Fish 16 Fleas 16 Moths 11 Woodlice 2 Other Miscellaneous Insects 20 83 Precautionary Spraying. During the year, 396 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 and this involved the treatment of a further 627 rooms and 93 external areas. It is interesting to illustrate the reliance placed on the department by the general public by recounting the fact that on one occasion the staff was called in to deal with a scorpion's nest which had arrived in the Borough from the Middle East with a case of machinery spare parts. On another occasion the department was asked to deal with a nuisance arising from wild cats breeding indiscriminately at, and in the vicinity of, a local hospital. This necessitated 20 visits with purpose-made wire traps before the nuisance was abated. Aged, Infirm and Physically Incapacitated Persons.— Ways in which local authorities can improve and augment provisions for the well-being of old people were contained in a publication issued in March of the current year by the Ministry of Housing and Local Government jointly with the Ministry of Health (Circulars 10/61 and 12/61 respectively). In stressing the need for the closest co-operation between housing, health, welfare and voluntary organisations the circular pointed out the extent of the problem and the role which the general practitioner would have to play if any appreciable advancement is to be made in covering the needs of the elderly. Later in the year the circular was followed by a memorandum entitled "Services Available to the Aged and Chronic Sick" which had been prepared by the Standing Medical Advisory Committee. This memorandum describes the problems of an ageing population and, in order to help the general practitioner, sets out the kinds of services provided by the local health and welfare authorities, housing department and hospitals, etc., that are available to his older patients. Much of the material contained in this latter publication has already been discussed at great length in my previous Annual Reports including possible action which can be taken by the various authorities mentioned therein. Notwithstanding all that has been written about the elderly from a social medicine point of view, fundamentally there are only 84 two courses of action open for the treatment of their problem, viz. institutional care or home care. Not unnaturally, it is generally agreed that old people are infinitely better off in their own homes especially when infirmity rather than illness seems to predominate but the usual assumption that this is also economically sound is rather open to question. It has been estimated that short-term acute hospital cases could cost from £25 to £30 per week but that in the long-term stay so often met with in geriatric wards, the weekly cost may be as low as £10, a figure which is usually augmented by a contribution from the patient's pension. On the other hand, effective home-care demands a high standard of co-operation at all levels from all the various agencies concerned with the wellbeing of the aged. In effect, this involves home nursing, home help services, meals-on-wheels, bathing and laundry services, pharmaceutical services and National Assistance, the overall costs of which are likely to outstrip the cost of a place in a geriatric ward and, moreover, it is doubtful whether such arrangements make the most economical use of personnel. However, the salient fact in all these deliberations is not the cost in terms of money and personnel, important though it may be, but the happiness of the aged in the twilight of their lives. Undoubtedly the person most fitted to exercise an overall control and watching brief is the Medical Officer of Health. Environmental health, which plays a vital part in maintaining the moral of the aged, is his prerogative and his department, being the centre of a collection of loosely-knit organisations, is likely to be able to ascertain very early on whether a break-down in home-care is probable and if so, what methods can be expected to provide a satisfactory solution. So often one finds, in this connection, that the nearer one approaches the home the less enthusiastic are the people who have to bear the burden of caring for the old folk. This formidable obstacle of "family strain", so inimical to the maintenance of a smooth-running home-care system must be surmounted and a family genuinely seeking to do its best for its older members deserves our full and continued support. With this aim in view and with the co-operation of the Geriatrician at St. Alfege's Hospital, short-term admissions are arranged for the elderly to enable relatives to take a well-earned holiday. 85 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. It would appear that there is room for still further co-operation between Health and Housing departments especially with regard to the social aspects of rehousing. All too often rehousing of the younger generation produces an acute home-care problem for the aged person subsequently left stranded, a situation which perhaps with a little more investigation and understanding either could have been avoided or settled more satisfactorily. On a number of occasions the department has been instrumental in arranging for structural alterations to houses or flats to be made to enable disabled persons to pursue a more active life. Again, once such problems as incontinence, mental confusion, lack of medical equipment, nutritional difficulties, etc., reach the department they are dealt with expeditiously. Altogether 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 legislation is introduced giving powers to the Medical Officer of Health enabling him to unite all these various activities into an efficient, economic home-care service. 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. During the year the staff dealing with this aspect of the department was increased and the following is a summary of the work 86 carried out by the Lady Public Health Officers during 1961 :— No. of dirty premises inspected 27 No. of verminous premises inspected 11 No. of dirty rooms cleansed ? 25 No. of verminous rooms cleansed 30 No. of verminous persons visited 18 No. of verminous persons treated:—Heads 29 Other 26 No. of visits to scabies cases 9 No. of visits for Cleansing Service:—First 71 Subsequent 165 No. of articles cleansed 43,773 No. of inspections of factories:—(a) with mechanical power 40 (b) without mechanical power 1 (c) other premises — No. of inspections of Hairdressers' premises 41 No. of inspections of Outworkers' premises 72 No. of inspections of Houses Let-in-Lodgings 1 No. of inspections of Women's Conveniences 17 No. of Bathing Centre sessions 129 *No. of Baths : at Home 1,499 at Centre 538 No. of visits to Infirm Persons 5,313 No. of visits to Rest Homes, Hospitals, etc 78 No. of visits, re: housing 36 No. of visits to Food Premises, re: Meals for O.A.Ps 40 No. of Miscellaneous visits 130 No. of re-inspections, calls made, etc 205 No. of interviews at offices 198 No. of complaints received 38 No. of Intimation Notices served Nil * 462 Males—1,575 Females 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 notice. Orders for removal can be made by a Court of Summary Jurisdiction or a single Justice on an application certified by the 87 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, 538 baths were given to dirty or verminous elderly persons at the Cleansing Station and 1,499 home baths were effected. Figures for the previous year were 544 and 1,287 respectively and in 1959 the figures were 436 and 742. 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. 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. 88 By the end of the year the laundry service, supervised by the Lady Public Health Inspector, had been extended to 212 separate individuals and during the current year, the staff at the Cleansing Station have dealt with 43,773 articles which were collected, laundered and delivered. This represents an increase of some 44 per cent over last year. New Cleansing and Bathing Centre General—This new cleansing and bathing centre is to provide for the logical development of services for the elderly citizens of Greenwich which were commenced on a modest scale in September, 1954. In that year about 5,000 articles from aged, infirm and incontinent persons were being laundered per annum and a few carefully selected patients were bathed either in their own homes or at the old premises. There was, at that time, one ordinary domestic washing machine in use and laundry and bathing duties were being performed by one lady attendant. By 1960, such was the expansion that over 30,000 articles were laundered and nearly 2,000 baths were given in that year. The staff had been increased to the equivalent of four full-time attendants who were by then using four large capacity domestic washing machines. Recent census figures indicate that there are now nearly 12,000 citizens in Greenwich over the age of 65 years, constituting approximately 14 per cent of the populace. This compares with 9.8 per cent in 1951 and present population trends suggest that by 1977 one citizen in five in this borough will be of pensionable age. It had, therefore, long been apparent to the Health Committee that the old premises were inadequate to meet the needs of the rapidly increasing demands for these services but, because of economic conditions, it had been found to be impossible greatly to improve the facilities apart from providing more staff and equipment in a very restricted space. At last permission was given by the Government to build a new centre and this building has been designed specifically to cater for the cleansing needs of the elderly. Opportunity has been taken also to provide modern facilities for the cleansing of schoolchildren and for the treatment of scabies and verminous conditions. It is hoped that the facilities now provided will meet in the future the increased needs of an ageing population for certain basic services which, although perhaps lacking in glamour, are necessary for the well-being and indeed the self respect of those citizens who become handicapped or neglected in advanced years. 89 These services are part of the wider concept of prevention of illness and promotion of health in this particular field and will supplement the already extensive home visiting of the elderly which is undertaken by the Women Health Officers and also the work of the Old People's Welfare Association on which are co-opted most of the voluntary agencies concerned with the welfare of the aged. It may be of interest to note that home visits by the Women Public Health Officers to the old people during the last year totalled 5,700 and the number of old people on the register in the Health Department who have been found to require regular visiting and supervision is now over 1,200 and is increasing every week. It is felt that, apart from the laundering and bathing facilities provided in this building, the mere contact with the outside world which a visit to this centre will give is of inestimable benefit to elderly home-bound citizens. An attempt has been made to make the centre friendly and bright and it is hoped that the old folk who make use of it will look forward to their regular visits as much as they did to the outdated building where so much valuable and pioneer work in this new sphere was performed. Description of Building and Equipment. Building—The structure, erected on pile and beam foundations is on one level and the facing brickwork of "Sevenoaks" stocks imparts a pleasing warm effect to the whole exterior elevation. A feature of the building is the provision of three entrances, one each for the laundry, the baths and the treatment room, to enable all services to function simultaneously with the minimum of congestion and confusion. Floors are of solid concrete overlaid with "Semtex" P.V.C. tiling which again gives a bright but warm appearance to the interior. Walls to entrance hall, corridor, waiting rooms, bathrooms. W.Cs., children's department and staff cloaks are all finished in cement glazing with egg-shell oil paint to all ceilings and the remaining walls. All rooms concerned with the treatment of patients or handling of laundry are furnished with flourescent lighting giving excellent working visibility. New Cleansing and Bathing Centre—Plan. 92 Heating—With the exception of bathrooms where additional electrical heaters have been installed, all heating is by thermostatically controlled gas-fired boilers equipped with electric time switches for automatic operation. Hot Water—This is supplied by an Ideal Boiler having a capacity of 142,000 B.T.Us per hour working on an indirect system incorporating a 200 gallon calorifier and storage cylinder. Space Heating—Room temperatures are maintained by radiators of the hospital type supplied by an Ideal Boiler of a capacity of 118,000 B.T.Us. per hour. Ironing Machine—A "Controlled Flame" gas-fired boiler of a capacity of 200 lbs. per hour provides steam at a pressure of 60 lbs. per sq. in. for the "Ritchie Decoudun" ironer which is electrically driven. This boiler is of such size that if the necessity arises, steam sufficient for two ironing machines could be supplied. Laundry—On arrival at the Centre the laundry is sorted, checked and pre-rinsed before being washed in one of the three "Bendix" commercial-type washing machines. The time allocated for the washing of laundry is obviously dependent upon the condition of the articles to be laundered. Laundry 93 Ironing Room After washing, water is extracted from the laundry in the "Bendix" Hydro-extractor and from there the articles are transferred to the "Bendix" gas-heated tumbler dryer which thereby renders all but the thickest or very absorbent materials ready for ironing. Ironing—The electrically driven " Ritchie Decoudun " steamheated ironing machine with its continuously revolving roller permits uninterrupted working with the added advantage of delivering the articles back to the operator on the same side. Steam consumption is at the rate of approximately 60/65 lbs. per hour at a pressure of 60 lbs. per sq. in. with the condensate being returned to the boiler. Airing—Subsequent to ironing, the laundry is conveyed to the airing room which obviates the necessity for outside drying. To this end, some heating from the primary circuit has been introduced with an electric fan to provide air circulation. Bathrooms—Low, dropped-side baths have been provided and sited to enable attendants to operate from both sides without restriction—a very necessary precaution when dealing with the elderly In addition to the normal background space heating, electric heater.' have been provided in the bathrooms in order that a comfortable temperature may be maintained. 94 From the very pleasant waiting rooms the patients are conducted to the bathroom where after bathing they receive some minor Bathroom foot treatment and for this purpose special footbaths have been installed. During the following half-hour the elderly are provided Treatment Room 95 with a cup of hot tea with biscuits and an opportunity to sit and chat whilst waiting for transport home. Treatment room—In this room, designed mainly for the treatment of verminous conditions, free-standing basins have been installed, again in order that treatment may be conducted from either side without restriction and, further, two electric hair dryers are available. Greenwich Old People's Welfare Association.—This association set up in July, 1954, co-ordinates the activities of Old People's Clubs in the Borough which provide for the physical and mental recreation of their members and although the association obtains money from various sources such as the street appeal and other donations, the bulk of the ?sscciation's expenditure is sust' ined by the grant received from the Borough Council. The following are extracts from the eighth Annual Report of the Association. "Old People's Clubs—The Darby and Joan Clubs, Federation Clubs and Church Clubs continue to increase in popularity, many of them now having to keep a waiting list of elderly prospective members. It gives us great pleasure to report that, with the cooperation of the Church Authorities a new club known as ' The St. Mary's Over 60 Club' has been opened at the church .§11 of St. Mary's in Charlton Park Lane. Unfortunately due to iack of accommodation, the club can only accommodate 50 members at any time, but nevertheless, we feel that this is a very welcome addition to the club facilities which enable our elderly citizens to find an interest outside of their own homes. In addition to the above, the other 15 clubs continue to meet weekly, providing pleasure, entertainment and companionship and arranging individually many outings, shows, parties and other occasions for the members' entertainment. To the leaders of these clubs and their assistants, we would say a very sincere ' thank you ' for the considerable amount of time and labour they put in throughout the year on behalf of the old people. Our appreciation must also be recorded to the Greenwich Borough Council for the facilities granted in providing premises where a number of clubs meet and also for the grant towards the cost of heating, lighting and cleaning the Charlton Library Club, where the Darby and Joan Club hold their weekly meetings. Day Rooms at Community Centres— (a) General. During the year a Sub-Committee visited each of the three day clubs and arising therefrom, arrangements were made for the supply of new curtains and chair backs at the Charlton House and West 96 Greenwich House Day Clubs. These have now been fitted and the rooms look considerably brighter and more attractive. (b) Charlton House Day Club. This Club has now been in operation for six years and the number of persons using this Day Club is slowly, but steadily increasing. We would like to express our sincere appreciation to Mrs. Markson for the assistance she has given in the day to day running of the Club. During the year, members of this Club were taken on a coach outing through the countryside, which was greatly appreciated by all concerned. (c) Kidbrooke House Day Club. The scheme for transporting elderly invalids by Minibus from their homes to Kidbrooke House has proved extremely popular and we are pleased to report that the proposal to extend this service to cover three days per week was put into operation on Tuesday, 12th June. The operation of the scheme would not, of course, be possible without the assistance of members of the British Red Cross Society and the Women's Voluntary Service who escort and cater for the needs of these elderly people from the time they leave their homes until they return and we would like to take this opportunity of recording our sincere thanks and appreciation for the part they play in brightening the lives of this section of our community. Members attending this Day Club look forward with anticipation to their monthly visits to the Roxy Cinema and we are very grateful indeed to the Manager of the "Roxy" for the facilities afforded on these occasions. (d) West Greenwich House. Although attendance at Charlton House Day Club is increasing, the West Greenwich House Day Club still proves the most popular and at the moment, the number of old people attending is such that the accommodation available is adequate. Mrs. Eastwood, the helper, is very popular with the members and we are very grateful indeed to her for the way in which she looks after their comfort and wellbeing. During the year members have attended a number of functions organised by the " Make and Mend Group," affiliated to the Greenwich Community Council, in addition to a Christmas Tea Party and outings and our sincere appreciation must be extended to the 97 Warden, Mr. Jones and his wife for the very happy and friendly atmosphere prevailing at this Day Club, which is due in no small measure to their unfailing interest in and efforts on behalf of club members. Meals on Wheels—With the exception of one day in February when severe icing of the roads made driving hazardous, the four vehicles used by the Association for the Meals on Wheels Service have functioned continuously and our sincere thanks are due to the drivers and helpers for their loyalty and devotion in all weathers. The following is a statement of the number of Meals on Wheels served during the financial year 1st April, 1961 to 31st March, 1962: British Red Cross Society's van 7,693 Old People's Welfare Association van 7,720 Old People's Welfare Association minibus 7,161 Women's Voluntary Service van 6,336 Grand Total 28,910 The above figures show an increase of 2,503 meals supplied as compared with the previous year. Demand on Mondays is still not excessive and the Women's' Voluntary Service van has not been used on this day. The Association's van, having been in service for six years was no longer considered serviceable and was replaced in May, 1962, with a new Morris Minibus, which vehicle now serves the dual purpose of delivering Meals on Wheels and transporting elderly persons when necessary. We are deeply indebted to the members of the British Red Cross Society for supervising the delivery of Meals on Wheels and would express our deep gratitude to the Greenwich Borough Council for the grant made to the Association, thus enabling us to purchase the new Minibus and continue this very essential service. Holidays for Elderly Persons—In the past the majority of holiday parties of elderly persons have spent a fortnight at Margate. This year, however, it was suggested that accommodation might be booked at a different seaside resort and the Worship the Mayor accompanied by the Chairman, Vice-Chairman, the Clerk and a Public Health Visitor, visited Clacton and reserved the whole accommodation at three hotels and one guest house for the period 4th May to 1st June, 1962. 98 With the assistance of a considerably increased grant from the Greenwich Borough Council, two parties each comprising 154 persons (amongst whom were a number of invalids) spent a fortnight's holiday at Clacton during this period and a considerable number of letters have been received praising the accommodation and the services provided. On the whole the weather proved kind and everyone appears to have thoroughly enjoyed themselves. The Worshipful the Mayor accompanied by the Chairman and a member of the Executive Committee visited the first holiday party on the 14th May and reported that, having met the majority of old people, not one complaint had been received. Members of the Committee travelled with the coaches and acted as escort and in view of the reports which have been submitted we have reserved the same accommodation for the period 3rd—31st May, 1963. At the last annual meeting we reported having been informed that accommodation at Lancing reserved for invalid holidays was being sold for development. However, the sale did not materialise and we have been fortunate in being able to reserve accommodation for 32 invalids to spend a fortnight's holiday there during the period 2nd June—14th July. Each party will travel in two Minibuses. For the benefit of new members of the Assocation we would state that these invalid persons are accommodated in a bungalow where all the rooms are on ground floor level, with gardens overlooking 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. We would like to record here our thanks to the Greenwich Borough Council for the considerable grant which they make towards the cost of this service and also to the drivers and escorts for volunteering to look after our invalids on the outward and homeward journeys. Dinner and Tea Parties for the Homebound—In last year's report we drew attention to a Christmas Tea Party which had been arranged for 41 homebound persons in the Minor Hall. This venture proved so successful that 40 homebound persons were brought to the Minor Hall on the 5th October, 1961, for a tea party and a further 30 on the 2nd April, 1962, for a dinner followed on each occasion by entertainment. The 70 elderly invalids who attended on these occasions were all unable to take advantage of the normal services provided by the Association and many letters expressing appreciation were received proving that functions of this nature are invaluable where handicapped persons are concerned. 99 We would like to place on record our sincere thanks to all those who assisted in preparing and serving the meals and looking after the old people's comfort. Christmas Food Parcels—As in past years, with the aid of a grant from the Borough Council we were able to distribute food parcels to 400 elderly homebound persons each of whom were visited to ensure that only those who were strictly homebound or aged 90 or over received a parcel. The high quality of the parcels was maintained each containing the following : Tea, biscuits, Christmas pudding, tin of fruit salad, tin of cream, box of cheeses, sweets and chocolates. Members of the Committee and other volunteers once again packed and wrapped the parcels and assisted with the distribution. Christmas is a busy time for everybody and we would like to express our sincere thanks and appreciation to all those who, in spite of the personal demands made upon them, devoted their time and energy towards bringing a touch of Christmas cheer into the homes of so many of our elderly homebound persons. Several donations were also received with a request that parcels be bought and distributed and, as a result, approximately 45 additional homebound persons received parcels of varying contents. Once again elderly persons with nobody to provide for them on Christmas Day were not forgotten and 24 frozen Christmas dinners consisting of chicken, vegetables and Christmas pudding were purchased and delivered. These dinners merely had to be heated for 20 minutes before eating. Carol Service—The Carol Service held at St. Alfeges on the 7th December was well attended, nearly 180 elderly persons enjoying the service. We are pleased to report that the church hall was available for our use on this occasion and members of the Women's Fellowship very kindly served tea, sandwiches and cakes, provided by the Association, to all those present. Included in the congregation were 20 invalid elderly persons for whom transport had been arranged. The service was also attended by the Deputy Mayor and Mayoress of Greenwich and several Chief Officers of the Borough Council. We are greatly indebted to the Church Authorities for the facilities provided and would record our sincere appreciation to the members of the Women's Fellowship and all others who helped to make this service so successful. Nativity Play—Having received an offer from the Headmistress of Sherington Road Junior Girls' School to present a Nativity Play 100 for elderly persons an approach was made to the Greenwich Borough Council, as a result of which arrangements were made for the play to be presented in the Minor Hall on the 11th December, 1961. Nearly 240 elderly persons attended the play in which 130-140 school children took part. Light refreshments were provided for the audience and the children, and all who attended were unanimous in praising the school children for an afternoon of first class entertainment. We are very grateful indeed to the Headmistress and her staff for the time and patience given by them in making the costumes and training the children so efficiently and also to members of the Women's Voluntary Service and all others who worked so hard on this occasion. Film Premier—"The Young Ones"—An invitation having been received for a party of 20 Old Age Pensioners to visit the Regal Cinema, Old Kent Road, on the evening of the 17th December last, arrangements were made for a party consisting of two members from each of the 10 Old People's Clubs, selected by ballot, to attend the film premier—"The Young Ones " and letters received after the event indicated that the party had a very enjoyable evening's entertainment. Chipperfields Circus—Thanks to the generosity of the Management of Chipperfields Circus in allocating complimentary tickets which were circulated throughout the Old People's Clubs, nearly 270 elderly persons in the Borough were enabled to enjoy a performance at Blackheath during the week ended 16th September, 1961. The show was greatly enjoyed by those who attended and numerous letters of appreciation were received. Welfare Foods for Old People—The receipts for the sale of welfare foods up to the 31st March, 1962, amounted to £1,325 lis. 5d. an increase of £181 10s. lid. as compared with the previous financial year. Many more elderly persons are taking advantage of this scheme and this naturally reflects itself in the amount of work involved in distribution which is carried out by members of the Women's Voluntary Service to whom we are greatly indebted. Fifty-seven welfare food permits were issued on behalf of homebound persons during the past year making a total of 85 in all and it is anticipated that this scheme will continue to expand. Street Appeal and House to House Collection—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 101 a House to House Collection and Street Appeal in aid of the Association's funds The collection was held in the first week of September and was extremely well supported, the total proceedings being £201 7s. 7d. After deduction of expenses amounting to lis. 7d. in respect of permits a record sum of £200 16s. Od. was credited to the Association's funds. This was a really wonderful effort and the Committee are very grateful indeed to all those who assisted in any way and, in particular, to those elderly people who helped to collect on the day of the Street Appeal. We are pleased to report that the Worshipful the Mayor (Alderman T. E. Smith, J.P.) has agreed to make application on behalf of the Association for a similar appeal this year, an offer which we readily accepted and application has been made for the appeal to be held on Friday, 7th September, and for the House to House Collection to be carried out during the week preceding that date. Details will be sent to all organisations in the knowledge that their members will once again give their wholehearted support in an endeavour to exceed last year's very creditable result. Visits to Old People's Homes—Arrangements were made for those members of the Association who so desired, to visit Plumstead Lodge on the 30th November, 1961, and Drake Court on the 1st February, 1962. On both occasions the parties were made most welcome and spent a very enjoyable afternoon, being very impressed with the accommodation and facilities provided for the old people at these two homes. Invalid Wheelchairs—We reported at the last Annual Meeting the proposed purchase of a number of invalid chairs for loan to invalid persons. The Association now has nine of these chairs in use. There are however, a small number of exceptionally heavy invalids for whom the chairs at present in stock are inadequate and we propose shortly to purchase a heavyweight chair for loan to this type of invalid. Acknowledgments.—Although many individual acknowledgments have been expressed throughout the foregoing report, it is not possible to mention personally everyone who has helped with the work of the Association during the past year and we therefore take this opportunity to place on record our sincere thanks and appreciation to the members of all voluntary organisations and many others who have given so much of their time on behalf of the old people. We would especially mention the Greenwich Borough Council for the many and varied services they have continued to make 102 able to us, especially for the financial grants which amount to a considerable sum and the free use of the Borough and Minor Halls. We would also like to express our thanks to the Town Clerk, the Medical Officer of Health and the Borough Treasurer and their staffs for the able and willing assistance given by them during another busy and expanding year, which has seen many more of our elderly citizens receiving the benefits of the services provided by the Association." Executive Committee, 1961/62.—The Committee for the past year has been as follows: — Council Representatives : Councillor Mrs. M. L. Wentworth (Chairman) Councillor Mrs. M. L. Bennett Councillor Lady D. Hume, J.P. Councillor H. W. H. Icough Councillor H. Ingle Councillor C. S. Jones Elected Representatives: Miss E. Bertrand (Albany Institute) Mr. A. S. Churchill (Blackheath Branch N.F.O.A.P.A.) Mrs. M. Gardener (Women's Voluntary Services) Mrs. L. Hilldrith (Greenwich Labour Party Charlton Women's Section) Mrs. N. C. Lewis (Inner Wheel Club of Greenwich) Mrs. Phillips (British Legion—Women's Section) Miss K. Rackham (British Red Cross Society) Burial or Cremation of the Dead.—Under Section 50 of the National Assistance Act, 1948, the Council is required to arrange for the burial or cremation of any person who has died or has been found dead in the Borough if in such cases it appears to the Council that no suitable funeral arrangements have been or are being made. The Council is empowered, if it so desires, to recover expenses for the burial or cremation from the estate of the deceased person or from any person who, for the purposes of this Act, was liable to maintain the deceased person immediately prior to his death. During 1961, arrangements were made under the above Act for the burial of eight bodies, 6 male and 2 female, at no cost to the Council. (All costs were recovered.) Exhumations.—No exhumations were carried out during the current year. 103 Summary of Work Performed by the Public Health Inspectors during the Year 1961 Inspections— Houses inspected (House-to-House) 10 (Complaints, nuisances) 1,113 (Infectious Disease) 183 (Overcrowding) 49 Hairdressers or Barbers 67 Licensed Victuallers 29 Underground Rooms 24 Pet Shops 7 Stabler and yards 11 Urinals 25 Houses let in Lodgings 3 Outworkers premises 72 Under Clean Air Act 4,885 Miscellaneous 977 Inspection of Premises (Slum Clearance) 79 (Rent Acts) 28 Investigations (Rats and Mice) 259 Investigations (Insect Pests) 53 On notice from Architects and Builders 651 Re-inspections, calls made, etc 7,904 16,887 Drains— Drains tested—by smoke 95 —by water 486 Opened, cleansed and repaired 389 Reconstructions and additions 313 Inspection chambers constructed 260 New covers to manholes 137 Soil and vent shafts repaired or renewed 249 Traps (gully) 327 Drains sealed off, etc 138 Yards and forecourts drained 101 Waterclosets and Urinals— W.C. Compartments erected or repaired 309 W.C. fittings repaired or renewed 229 W.C. pedestals installed or renewed 445 Sanitary conveniences or improvements effected to Factories and Workplaces 9 Urinals cleansed or repaired 17 Dustbins— Provided 166 Pavings— Yards and Forecourts 96 General Water Supply— Water Fittings amended 292 Water supply restored 11 Extra water supply to tenement houses — Water supply certificates granted (Sect. 95) 91 104 Other Improvements— Houses generally repaired 161 Rooms cleansed and repaired 888 Rooms and staircases lighted and ventilated 47 Verminous rooms cleansed 36 Roofs, gutters and rainwater pipes repaired 400 Dampness abated 301 Underground Rooms (enforcement of Regulations) 49 Sinks, baths and lavatory basins provided 958 Sink, lavatory and bath waste pipes trapped or amended 663 Stoves and fireplaces 165 Washing coppers repaired or provided 1 Floors repaired 213 Provision for storage of food 286 Miscellaneous repairs 549 Other Nuisances Abated— Illegal use of Underground rooms discontinued — Overcrowding abated 20 Animals kept in unfit places discontinued or removed 1 Dung receptacles provided — Accumulation of manure and other obnoxious matter removed 99 Rat infestation abated 71 Smoke Nuisances— Observations 487 Statutory Notices served 4 Notices. &c.— Intimations served under Public Health (London) Act, 1936 462 Statutory Notices served 170 Houses rendered fit by informal action 82 Legal Proceedings Premises Offence Result of Proceedings 61, Eversley Road Non-compliance with Statutory Notice do. Summons withdrawn on payment of 3/6d. costs. 280, Shooter's Hill Road Prohibition Order against a recurrence of smoke nuisance. 105 SECTION D Housing Last year a brief resume of the housing situation was given together with an account of measures introduced to improve these conditions followed by suggestions as to how special housing problems peculiar to particular groups could be met. Since then there has been a Census of the population and this enables a more accurate assessment to be made of the housing position. It would appear that there are in England and Wales approximately 14| million dwellings, of which 11 million are privately owned and million publicly owned, the latter attracting a subsidy of some £61 million per annum. In the 15 years since 1945 more than 3£ million new houses and flats have been built and almost half a million older houses improved. In fact a building rate of some 300,000 new dwellings each year has been maintained during the last 8 years. In the Registrar General's Preliminary Report on the 1961 Census the following figures have been made available :— AREA Private Households Private Dwellings No. % increase over 1951 Census No. % increase over 1951 Census England and Wales 14,702,823 12.1 14,647,922 21.3 Greater London 2,720,036 2.3 2,477,138 15.9 Greenwich 26,813 1.6 25,048 17.3 It can be seen from figures quoted in the above table that, during the last 10 years, Greenwich has made greater progress in closing the gap between households and dwellings than has Greater London or, for that matter, England and Wales as a whole. Nevertheless, for this Borough the difference is still considerable and the problem substantial. From this same table is can be seen that, statistically, the housing situation in England and Wales is of no great moment—merely a shortage of approximately 50,000 dwellings which a few months building effort could conceivably put right. Unfortunately this is hardly the complete picture for although on paper there are almosi enough dwellings to go round, many are in wrong places and many under-occupied. Some extremely bad housing conditions remain 106 and some serious shortages exist in many areas and there is certainly nowhere near enough accommodation suitable for the elderly. Of the total of 14f million dwellings, some 3f million were built before 1880 and consequently in accordance with modern requirements the majority of these are substandard either on the basis of design and provision of amenities or for the simple reason that they have come to the end of their useful lives. Indeed it has been estimated that in addition to the fact that 29 per cent of all households have no bath, 28 per cent no hot water, 6 per cent no flush lavatory and 3 per cent no kitchen sink, there are 600,000 houses unfit for human habitation and waiting for demolition under slum clearance schemes, mostly from among the houses built prior to 1880. Although the size of the overall problem can be more or less gauged, there are certain inherent difficulties which must be overcome when going "at full speed" for new dwellings, such as avoiding the swamping or overstraining of local building resources and skills, and the necessity for ensuring that the accommodation being provided must be what the people actually want at a price which they can afford to pay. Due to financial difficulties some smaller authorities are unable to produce the necessary housing and an amalgamation of some of them, in housing projects, would doubtless keep the economics of the situation at a reasonable level. Perhaps further economies could be affected by new building techniques, particularly prefabrication and standardisation, bearing in mind that new materials should be used with caution. However, standardisation and prefabrication presupposes the existence of a sufficiency of comparatively large building organisations. This however is not so, for the building industry is still predominantly one of the "small man" who is either unable or unwilling to re-equip or modernise his firm and whose answer to labour shortages and troubles, more often than not, is to restrict his order book. Clearance of substandard dwellings still remains the main method of providing housing in urban areas but if we are not to be left a legacy of psychological problems in the future, this must proceed with utmost prudence and humanity. It must be remembered that slum clearance means the uprooting of families from life-long environments and the destruction of well established and successful communities and that these items are not necessarily reproduced by modern dwellings in new areas. This aspect is particularly noticeable with the rehousing of the elderly, for many are provided with accommodation and amenities beyond their dreams and yet some seem to wither in their new surroundings. 107 Some further alleviation of the housing situation is possible if citizens are encouraged and enabled to acquire their own houses on reasonable terms for it is axiomatic that for every family rehoused by its own exertions, accommodation is made available for some other home-seeking applicant. At the moment, aid in housing is somewhat haphazard. Some council tenants are subsidised indiscriminately, others are subjected to a differential rent schemesome tenants derive benefits from rent control while others get nothing. There does appear to be an urgent need for a more equitable approach. Legislation—Housing Act, 1961—On the 24th November of the current year this new Act became operative. It introduces a new system of housing subsidies and gives to local authorities extensive new powers for dealing with bad living conditions in houses let-in-lodgings or occupied by members of more than one family. It also makes a number of changes in the law affecting condemned houses, improvement grants to private owners, repairing obligations and town development. Although under this new Act the Minister, by a realignment of subsidies, seeks to encourage the building of new houses and flats and the clearing of existing slums by local authorities, the duties of public health departments are more likely to be concerned with the sections dealing with the proper control and managemenl of houses in multiple occupation. "Houses in multiple occupation" is a term which includes houses let-in-lodgings and dwellings which are not self-contained but which form part of a larger block with shared amenities. The sharing of a house by more than two households is not new. In fact, until recent years it was accepted as a normal way of life, and young people married and founded new households in the homes of their parents. Today houses in multiple occupation are more likely to be found in industrial areas among the older and possibly obsolescent type of Victorian and Edwardian property which in bygone days used to form the centre of desirable residential districts. Such a state of affairs arises from a variety of causes, not least of which is an increase in the standard of living and social amenities resulting from increased incomes and smaller families. This often prompted a move from the centre of town to the more desirable detached or semi-detached residences on the outskirts, the older vacated properties being bought up and, under new management, let-off in rooms or sub-let. Sub-letting, unfortunately, generally leads to a deterioration of property more rapid than 108 normal, as a result of which, houses which could have provided good accommodation for perhaps another 30 years, prematurely become subjects ripe for slum clearance. Loss of housing accommodation resulting from the last war, increase in population since then and, more recently, the influx of immigrants from abroad collectively have led to extreme pressure on our housing resources and have aggravated an already serious situation. Also complicating the position is the fact that many immigrants are hazy about the principles of health and hygiene and the standards demanded by the Public Health Acts and by-laws. Previously, in London, houses let-in-lodgings were subject to by-laws made by the London County Council under Section 6 of the Housing Act, 1936. These by-laws, although by no means ideal, were specific in that registration was obligatory, as was compliance with standards of cleanliness, sanitation, etc. Imposition of these requirements besides being positive and clear cut, enabled local authorities to exercise some compulsion to prevent deterioration of property and sanitary conditions and that the repeal of these by-laws by the 1954 Act was considered by many to be a retrograde step. However, it had been anticipated that the introduction of the new Act of 1961 would restore the original control but it would seem that this is not yet to be for the situation will depend upon regulations still to be made under Section 13. In these regulations, which are to provide a code for the management of houses in multiple occupation, it is to be hoped that terms which are arbitrary, indecisive and capable of variable interpretations, will be avoided. What appears to be a significant defect in the new Act has already been brought to light. If notices served upon a landlord of a house in multiple occupation requiring him to carry our certain works are not complied with, there is no provision for the imposition of a penalty and the local authority is left to do the work in default and to recover expenses as a civil debt. At a time when local authorities are experiencing great difficulty in engaging suitable staff this is a duty which often has to be put out to local contractors and already some authorities are finding that, due to the appalling conditions found in some of these premises, contractors are unwilling to become embroiled financially or otherwise. Housing Act, 1957—The following procedures were carried out under Part II of the above Act during 1961. Unfit Houses—In accordance with Section 16 the following terraced house was represented as being unfit for human habitation and not capable at reasonable expense of being rendered so fit. Demolition was considered inadvisable due to the possible effects 109 upon other houses in the terrace and. under Section 17 a Closing Order was accordingly substituted. 12, Selcroft Road, S.E.10. (Closing Order.) Underground Rooms—At the undermentioned property two rooms being rooms, the surface of the floor of which were more that 3 ft. below adjoining ground level and not complying with the Local Authority's Regulations, were considered unfit for human habitation and were represented as such. However, in this case, an undertaking to the effect that these rooms would not be used for human habitation was accepted. 227, Westcombe Hill, S.E.3. (Undertaking accepted.) A Closing Order previously made in respect of the undermentioned premises was determined. 3, Egerton Drive, S.E.10. (Closing Order determined.) The Council's powers to close underground rooms are provided by Section 18 of the Act, of 1957, as qualified by the Housing (Underground Rooms) Act, 1959. New regulations for securing the proper ventilation, lighting and the protection against dampness and effluvia or exhalation of underground rooms received the Minister's approval and became operative on 28th August of the current year. Slum Clearance—Under Part III of the Act, two sites comprising some 41 dwellings were represented for slum clearance and the Minister's approval was obtained in February 1962. Area House, FamiUe, No. I (Creek Road) Clearance Area, 1961 17 23 56 No. 2 (Creek Road) Clearance Area, 1961 7 11 26 No. 3 (Woodland Walk) Clearance Area, 1961 15 19 42 No. 4 (Woodland Grove) Clearance Area, 1961 2 1 5 Houses in Multiple Occupation—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 were retained under Sections 36 and 90 of the 1957 Act. 110 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. Previously Section 36 of the 1957 Act enabled 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. However, as these powers proved to be inadequate, on 24th November of the current year, this Section was repealed under the Housing Act, 1961. This new Act, inter alia, gives power to the Council to implement a code of management which has yet to be formulated by the Minister in accordance with Section 13 of the 1961 Act. At the time of writing Regulations establishing a code of management were before Parliament for ratification. A new power authorizing a local authority to carry out works in default of the owner and to recover the costs as a civil debt is also contained in the new Act. By-laws as to artificial lighting of common staircases in tenement houses and flats made under Section 63 of the L.C.C. (General Powers) Act, 1956, were confirmed by the Minister and came into operation on 1st August this year. During the year three visits were made by Public Health Inspectors to houses in multiple occupation and on no occasion was it found necessary to serve a notice. 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, and up to the end of I960, some 45 houses and a number of prefabricated dwellings had been demolished and some 91 dwellings and 12 garages had been erected. During 1961, although no new dwellings were completed, a further 11 properties, as listed, were demolished. 1ll 27/33, Bennett Grove, S.E.I3—9 Houses. (Including 28a and 29a.) 51 and 53, Coldbath Street, S.E.13—2 Houses. These properties form part of a larger demolition scheme relating to the redevelopment of the Coldbath Estate. Demolition commenced during 1960 and has continued throughout the current year as tenants were rehoused. I am indebted to Mr. K. B. Leverton, Surveyor to the Morden College Estate, who so kindly provided this information. House Purchase and Housing Acts, 1958 and 1959.— Improvement Grants.—Section 20 of the Housing Act, 1949, as modified by Section 16 of the Housing Repairs and Rents Act, 1954, empowering local authorities to make grants to private owners for improvements and conversions of sums up to £400 or half the cost, whichever is the less, where the dwellings would provide satisfactory accommodation for more than 15 years, has now been replaced by Section 30 of the Housing (Financial Provisions) Act, 1958. These grants are now known as discretionary grants. During the year 47 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 7 such grants had been agreed. Re-Housing.— (a) Borough Council.—Although a number of dwellings were under construction there were no new dwellings provided by the Council during the year but the number of families housed and re-housed including transfers, casual voids, etc., amounted to 503. Of this number 13 were in respect of overcrowded cases and 30 families re-housed from outside the Borough. The Housing Department now has control of 4,170 Councilowned units of accommodation, an increase of 34 over that of the previous year. In addition at the end of the year there was still one hutment 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, 1961, the L.C.C. had provided alternative accommodation for a total of 267 Greenwich families of which 3 had been certified as overcrowded cases. Of this figure, 176 were housed on L.C.C. housing estates outside the Borough. One family from 112 outside Greenwich was rehoused in the Borough under the L.C.C. scheme. (c) Other.—A further 4 families were rehoused by other means. Overcrowding.—As a direct result of rehousing carried out under (a), (b) and (c) above 20 cases of overcrowding were abated during the year under review. The number of unabated certified cases of overcrowding in the Borough now amounts to 39. During 1961 there was a rise in the number of complaints received concerning overcrowding, the year's figure of 37 showing an increase of 8 over that of the previous year. Each complaint was investigated by the Public Health Inspector concerned and as a result of these investigations 5 families were found to be overcrowded according to the standards laid down by the Housing Act. 1957, and were subsequently certified as such. It can be seen by the figures in the following table that there has been a definite decline since 1946 in the number of families found to be living in overcrowded conditions in the Borough :— Year No. of cases of overcrowding reported 1946 261 1947 128 1948 162 1949 168 1950 148 1951 56 1952 52 1953 53 1954 39 1955 39 1956 38 1957 25 1958 18 1959 10 1960 2 15-year average 80 1961 5 113 New Housing Accommodation.—The following table lists the new dwellings erected in the Borough during 1961 :— Type of Dwelling G.B.C. L.C.C. Private Total Houses 8 42 50 Flats and Maisonettes — — 41 41 Total No. of Dwellings — 8 83 91 Excluding the families accommodated in requisitioned property, the total number of dwellings provided in the Borough since the termination of the war is now 5,715. Council Housing Schemes.—(Information supplied by the Borough Engineer). (a) Schemes in progress at the end of the current year :— Site Dwellings Trafalgar Road (Palliser House) 16 Lansdowne Lane 54 "Maribor", Burney Street 54 124 (b) Building programme for rehousing envisaged for 1962, et seq :— Site Dwellings "Maribor", Burney Street 54 (Completion May 1962) Sunfields/Nadine Street 4 (Completion July 1962) 31/32 Gloucester Circus 22 (Completion December 1962) Lansdowne Lane 54 (Completion February 1963) Vanbrugh Park 176 (Completion July 1963) Maze Hill 24 (Estimated September 1963) Haddo Street 164 (Estimated January 1964) Heathway 51 (Estimated March 1964) 549 114 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 1961: — "During the year under review work associated with de-requisitioning continued to demand housing priority under the Requisition Houses and Housing (Amendment) Act, 1955, during which year "clearing up" operations were completed. Preparatory works on new building schemes were accelerated by expanding the architectural section of the Borough Engineer's Department and concurrent with the new building policy the Council continued to acquire suitable type properties in the open market for conversion into self-contained dwellings as a further contribution towards the general housing pool. Nearly 200 dwellings were provided through these agencies thereby making a very valuable contribution indeed to the housing resources of the Council which were used primarily to accommodate families in need from the general waiting list and thereby alleviate the pressure which had been building up over the previous two years because of de-requisitioning procedure. During the year the Housing Committee again reviewed the conditions governing applicants on the waiting list and as a result decided to divide the register into two groups "A" and "B" to distinguish between demand for accommodation as opposed to need. Group "A" which is equivalent almost to one half of the total waiting list deals with applicants who are in need of more suitable accommodation, the governing factors being bedroom deficiency, sharing facilities such as living room, kitchen, bathroom, toilet, cookers, inadequacy of hot water facilities and medical considerations. It is anticipated that the most deserving cases in this particular category will have been provided with better housing accommodation by the end of 1965. 115 The Group "B" section comprises applicants who have built up points representing residential qualification and period of waiting on the register itself or who have 10 or less points affecting housing need. Owing to the heavy demands which the Housing Committee have to meet during the next 5-year period, it is recognised that very little progress can be made in the direct housing of these families. Nevertheless the Committee recognise that many of these families are living in dwellings which fall short of present day housing standards and because of these circumstances it has been decided to approach the owners to ascertain if they would be willing to sell these properties to the Council in order that a scheme of improvement might be applied and thereby secure a further valuable contribution towards the housing pool for general letting purposes. In previous reports I have indicated a continued fall in the number of registered applicants on the general waiting list and I find that again this trend has continued during the year. This is indicative of housing progress and also attributable to the constant revision of the register itself because it means that of the total number of applicants seeking more suitable housing accommodation, the figure is at least realistic since applications are cancelled in cases where the registration cards are not submitted for endorsement each year. The mutual exchange system continues to serve a very good purpose. It is available to any person who is interested in trying to effect a mutual exchange to solve their housing problem. Council or private tenants inside or outside the Borough are eligible for consideration and the system is particularly helpful in the case of families with bona fide reasons who desire to move into Greenwich from some other part of the country coupled with the movement of the family out of the Borough. Another main function of the register is to assist tenants of Council dwellings to solve their housing and domestic problem by exploring the possibility of exchanging with another within the Borough. At the present time some 392 names are listed on the mutual exchange register. During the year 43 cases involving mutual exchanges were arranged as compared with 39 during the corresponding period of 1960. From the end of 1962 onwards the intake of accommodation from the Council's new building programme shows considerable improvement on the immediate past two years, it being anticipated that about 750 additional dwellings will be provided up to the end of 1965 which figure, of course, will include a certain number of acquisitions of existing properties under the Council's general redevelopment plan." 116 SECTION E Inspection of Food and Supervision of Food Premises Last year marked the centenary of the passing of the first Act of Parliament for the prevention of adulteration of food and drink. In my Annual Report for that year, advances in food technology were reviewed, together with a resume of the growth of the use of preservatives in food and the legislation introduced during that period for their control. Deliberate adulteration has been almost eliminated and emphasis is now on the correct labelling of foods. In the meantime, however, other forms of contamination have arisen, one might say, accidentally. These include residues from fungicides and pesticides used in agriculture, hormones or antibodies and, more recently, radio-active contamination, much of which requires new expertise in detection and analysis. At the time of going to press there is talk of Britain entering into the Common Market. Should this materialise, a wider and fuller flow of foodstuffs from the member countries must be expected and this is likely to throw into relief the many inconsistencies between ourselves and continental countries with regard to food, its standards, inspection, etc. For instance, meat inspection as carried out in Britain, although having full Ministry approval, has no counterpart in the countries of the Common Market. Food standards, methods of production, packeting and marketing seem to vary in most countries and this will doubtless give rise to countless problems to be settled only at international level. Such aspects of food inspection will inevitably demand, in the next few years, more intensive sampling and closer control of imported foods—duties which can only add to the already heavy programme carried out by the department. Legislation.—Of the new legislation introduced in the current year concerning food, the following regulations were considered the more important. The Lead in Food Regulations, 1961—These Regulations made under the 1955 Act and operative from 16th April, 1962, restricts the amount of lead which may be present in food (including drink) intended for sale for human consumption. Lead-content of ready-to-drink non-alcoholic beverages is limited to 0.2 p.p.m. and to 2.0 p.p.m. in other foods. The Regulations do not apply to fish, crustacea and molluscs where a natural lead content in excess of 2.0 p.p.m. has already been established nor, under certain conditions, to some other foods. 117 Certain specified beverages and foods will be allowed different limits for a limited period. The Authorised Officers (Meat Inspection) Regulations, 1961. —Operative from 10th March of the current year, these Regulations re-enact with amendments those made in 1960 and prescribe further qualifications with regard to meat inspectors. During the year other Regulations were introduced concerning approved chemical agents for the cleansing of milk containers and, for the purposes of the Public Health (Imported Food) Regulations, 1937/48, a certificate in respect of Bulgaria was officially recognised. 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. 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 109, an increase of 12 over 1960. On 79 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) Regulations, I960.-— These regulations, operative from the 1st October, 1960, replaced and consolidated, with amendments, The Milk (Special Designation) (Raw Milk) Regulations, 1949-1954 and the Milk (Special Designation) (Pateurised and Sterilised Milk) Regulations, 1949-1953. All milk now sold in the Borough has been Sterilised, Pasteurised or Tuberculin Tested and the use of these Special Designations in 118 relation to the sale of milk is prohibited under the above Regulations unless the distributor is licensed for the use of same. With the coming into force of the new Regulations, the granting of Supplementary Licences (issued to firms who sold within the Borough but whose premises were outside) has been discontinued and, in accordance with these Regulations, licences (which previously were annually renewed) have a fixed five year period at the end of which they become renewable for a further five years. No milk processing plants are located in the Borough and all licences granted were in relation to milk obtained in pre-packed form for sale to the general public. The following licences had been granted and were in force on the 31st December, 1961 :— Licences In Operation issued 31.12.61. Distribution of Sterilised Milk 19 91 Pasteurised Milk 14 63 Tuberculin Tested 8 41 Sampling.—Under provisions of the Third Schedule to the above-mentioned Regulations, Methylene Blue and Phosphatase tests are prescribed, the former for assessing the "keeping" qualities of milk, and the latter for estimating the efficiency of pasteurisation. In addition, a Turbidity test is also prescribed for ascertaining the effectiveness of the heat treatment of Sterilised milk and, with regard to Tuberculin Tested Milk, the new Regulations have introduced a further test—the clot-on-boiling test. During the year, 30 samples of milk consisting of 21 Pasteurised milks, 3 Sterilised and 6 T.T. Pasteurised were examined in accordance with the prescribed tests. Of these, 2 samples of Pasteurised and one of T.T. Pasteurised milk failed the Methylene Blue tests but the results were declared void by reason of the permissible atmospheric shade temperature being exceeded. The remainder of the samples proved to be satisfactory with the exception of one of Pasteurised milk taken from a milk machine. This failed the Methylene Blue test but investigations revealed that this was probably the result of faulty loading. Analytical Examination of Milk.—All designated milks being sold in the Borough were sampled, including those of the superfatted variety, viz., Channel Island, Jersey, South Devon, etc. A total of 24 formal samples and 1 informal were submitted to chemical analysis and all proved to be genuine. Four samples of cream were sampled and found to be genuine. 119 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. One hundred and twenty four visits of inspection were made to Preserved Food premises and Fried Fish shops as a result of which 3 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 232. Visits to these premises were made on 148 occasions and 3 improvements effected. Manufacture and Sale of Ice Cream.—As the public's appreciation of the food value of ice cream increases, so consumption rises but, as yet, no legal bacteriological standard exists. From time to time representations have been made to the Minister of Health with a view to the adoption of a bacteriological standard of cleanliness but he has made it known that he is satisfied that no existing test is precise or selective enough to justify its adoption as a statutory measure. In his opinion the methylene blue reductase test affords a simple and valuable " rule of thumb " method for the measurement of the bacterial cleanliness of ice cream indicating the necessity or otherwise of further investigation into methods of production. However, in order to minimise the risk of contamination and the spread of infection, the policy in Greenwich has been to encourage the sale of " wrapped" or " carton" ice cream in preference to the manufacture and sale of it " loose." The Ice Cream (Heat Treatment, etc.) Regulations, 1959.—In consolidating and amending the previous Regulations 1947 to 1952, 120 these Regulations, operative from 27th April, 1959 require, inter alia, that ingredients used in the manufacture of ice-cream 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 1J 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 38 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 10 hours or more 1 Satisfactory 12 2½ to 4 hours 2 Sub-standard 6 ½ to 2 hours 3 Unsatisfactory 2 0 hours 4 Most Unsatisfactory 8 Ice-lollies Plate count and bacteria reports showed these samples to be satisfactory. On receipt of a Grade 3 or 4 report it is the practice in this Borough to obtain further samples from a vendor before administrative action is taken. It was not necessary during the year to have recourse to " administrative action." 121 Quantitative Analysis.—Standards for the composition of ice cream are contained in the Food Standards (Ice-Cream) Regulations, 1959. 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. Ninety 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 15 visits were made to the fair during the holiday periods. Regulation 26 of the Food Hygiene (General) Regulations, 1960, 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 the London County Council (General Powers) Acts, 1947, 1957 and 1958, registration with the local Council is compulsory for all street traders. During the year 36 applications were made and licences granted to street traders engaged in the retailing of articles of food. Only certain streets in the Borough are designated for street trading ; it is not the policy of the Council to grant licences for such trading in streets other than those designated. No contraventions of Regulations 26 to 28 of the Food Hygiene (General) Regulations, 1960, 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 122 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 3,310 visits, as a result of which 25 premises were improved. The following table is a statistical record of the major portion of the duties performed and inspections undertaken during the year by the Food Inspectors. Premises Inspected or Visits Made No. of Visits No. of Premises at which Improvements were effected Caterers', Restaurants, etc. 143 7 Grocers, Greengrocers 280 5 Butchers' Shops 105 8 Dairies and Milk Distributors 73 — Wharves and Factories 708 — Bakehouses and Bakers' Shops 35 2 Ice-Cream Premises, Confectioners, etc 148 3 Fried Fish Shops 20 Other Fish Shops 39 Cooked Meat & Preserved Foods 104 * Visits Re. Shops Act 336 — „ „ Infestations 8 - „ „ Food and Drugs Act 248 — „ „ Merchandise Marks Act & Markets 118 — „ „ Food Poisoning 37 - Sampling Visits 267 Fair Visits 15 School Visits 2 Miscellaneous Visits (including Flour MillsCyanide Fumigation) 568 — Interviews 12 — Complaints Investigated 44 — Totals 3,310 25 * Included under Grocers' and Butchers' Shops. Bakehouses.—At the end of the year, 8 premises in the Borough were being used as bakehouses, none of which was underground. Bakehouses and bakers' shops were visited on 35 occasions and, as a result of the inspections two 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 123 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 143 visits of inspection to the catering establishments, insanitary conditions were remedied and improvements, mainly redecoration and cleansing of kitchens, were effected on 7 occasions. Many licensed victuallers have instituted a catering service during the last few years, some providing prepared food to be consumed at the bar counter and others supplying a cooked lunch in a separate dining room. One improvement was carried out at a public house as a result of informal action. Food 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 ot which was processed and used for animal feeding :— Shops, Stalls, etc.:— Meat— Beef 3,777 lbs. Beef (chilled) 64 „ Mutton and Lamb 2,558 „ Veal 76 „ Pork 12 „ Bacon 61 „ Rabbits 196 „ Lambs' Livers 64 „ Pigs' Hearts 28 „ Pigs' Kidneys 140 „ Sweetbreads 10 „ 6,986 lbs. Canned and Other Foods— Foods, Various (Canned) 1,620 „ Cooked Meats (Canned) 22,290 „ Corned Beef (Canned) 3,516 „ Sausages, Pork 9 „ Cheese 28 „ Fish 554 „ Fish (Canned) 646 „ Tomato Ketchup 96 „ Tomatoes (Canned) 10,155 „ Rice, Creamed (Canned) 248 „ Rice, Ground 28 „ Fruit (Canned) 8,461 „ Fruit Juice (Canned) 11,260 „ Chocolate Confectionery 40 „ Jam 15 „ Marmalade (Canned) 342 „ 59,308 lbs. 66,294 lbs. 124 Compared with the previous year, the amount of meat rejected rose by 5,628 lbs. during 1961, and the total of all food rejected increased by 39,911 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 115 visits of inspection and arranged for the correction of insanitary defects at 8 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 used as slaughterhouses and the issue of the appropriate licences has therefore been discontinued. Public Health (Imported Food) Regulations, 1937 and 1948.—The Metropolitan Borough of Greenwich with a river frontage of five miles with more than 30 wharves and two of London's largest and most modern cold stores receives a considerable percentage of London's imported meat stored on behalf of various importers. In addition, considerable quantities of fresh fruit, tinned foods and miscellaneous provisions are dealt with. Visits to wharves and cold stores are made by the Food Inspectors and imported food generally is carefully supervised. Inevitably meat is the commodity to which Food Inspectors must devote most of their time and it is their responsibility to see that each consignment landed is accompanied by an " official " certificate. This may be in the form of a certificate, label, mark, stamp or voucher which is recognised by the Ministry of Agriculture, Fisheries and Food as a guarantee that the accompanying product was inspected ante and post mortem and passed as fit in accordance with criteria satisfactory to the Minister and that any necessary packing or preparation had been executed under hygienic conditions. Imported Food Rejected.—The following unsound or diseased imported foods were surrendered, the meat being passed for nonedible and refining purposes, and other unsound food, with the exception of fruit pulp and juice, being processed for stock feeding. 125 The following foods were rejected at the wharves:— Meat- Mutton and Lamb 1,092 lbs. Beef 1,040 „ Beef, Chilled 184,734 „ Veal 54 „ Sheep's Kidneys 561 „ Sheep's Livers 61 „ Lambs' Hearts 2,014 „ Sweetbreads 11 „ Pigs' Heads 92 „ 189,659 lbs. Canned and Other Foods— Foods, Various (Canned) 3,245 „ Cooked Meats (Canned) 1,495 „ Lemon Juice 36,000 „ 40,730 lbs. 230,389 lbs. Caseous Lymphadenitis. This disease, sometimes called "pseudo-tuberculosis" occurs mainly in sheep although it is occasionally found in cattle, rabbits and chickens. It is met usually in imported sheep carcases and is often the cause of meat being rejected as unfit for human consumption. It follows, therefore that much time and attention is given by the Food Inspectors to this disease during their inspections at the wharves and cold storage plants in the Borough. Results of examinations for caseous lymphadenitis are given below. Landed Examined Rejected Weight New Zealand Sheep 54,273 532 Nil — Bechuanaland Boneless Beef.—In January of the current year a consignment of 2,979 cartons of this commodity was received into one of the Cold Stores in the Borough and. of the 296 samples taken, 59 (approx. 20%) were positive for Salmonellae. Of the 7 strains isolated, 6 had already been encountered but one strain was completely new and this was subsequently named Lobatsi (after the abbatoir in Bechuanaland). As a result of these bacteriological examinations, representations were made to the Ministry of Agriculture, Fisheries and Food 126 (Slaughterhouses Division) and the matter was taken up with the appropriate authorities in the Bechuanaland Protectorate. During August, 3 further consignments totalling 9,036 cartons, by rail from Southampton, were received into the Cold Store, all of which were sampled. Two consignments were found to be satisfactory and were released but, of the 50 samples taken from the third consignment, 5 proved to be contaminated with Salmonellae. This necessitated further sampling and, of another 25 samples drawn, 2 proved to be positive. In an analysis of the results it was revealed that only 5 cuts were suspect for contamination and that these involved only three packing dates. It was agreed that cartons relating to the positive cuts should be sorted in order that those packed on the 3 relevant days should be detained whilst those giving negative results should be released. In all, 3,618 cartons were released and 936 detained for use only in processes requiring sterilisation temperatures. Our representations regarding these imports would appear to have had a beneficial effect for subsequent sampling has shown a considerable improvement in the bacteriological quality of the meat. Frozen Cooked Meat.—The first landings of Australian Frozen Cooked Meat were received into a Cold Store in the Borough in September of this year. It was stated by the importers that this commodity was destined for a high temperature canning process and the 20 samples taken from the consignment of 920 cartons all gave satisfactory results. Swedish Pig Carcases.—During 1960 the importation of Swedish Chilled and Frozen Pig Carcases through the docks and wharves of Riparian Authorties 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 at that time to place all Swedish Whole Pig Carcases under detention pending examination. Since representations were made to the Swedish Authorities there has been a marked improvement in the standard. Examination during the current year of 262 pigs from a total of 3,525 landed resulted in the condemnation of only 13 pigs' heads. 127 Dried. Egg Albumen. (Conditional Releases.)—Importations of Dried Egg Albumen continued during the year with the following results:— Country of Origin Quantity Imported Containers Sampled No. of Positives America 90x50 lb. cartons 10 ,, 87x50 lb. cartons 30 3 ,, 224x50 lb. cartons 23 — ,, 1x200 lb. drum 1 — ,, 45x50 lb. cartons 5 — ,, 22x100 lb. drums 5 — ,, 224x50 lb. drums 46 1 ,, 45x50 lb. cartons 10 — ,, 44x50 lb. cartons 10 — ,, 132x50 lb. cartons 30 — ,, 44x50 lb. cartons 10 — ,, 88x50 lb. cartons 20 — ,, 135x50 lb. cartons 15 2 ,, 45x50 lb. cartons 5 1 ,, 135x50 lb. cartons 15 — ,, 224x50 lb. cartons 46 2 ,, 269x50 lb. cartons 29 — ,, 472x50 lb. cartons 62 8 ,, 90x50 lb. cartons 9 — ,, 44x50 lb. cartons 10 — ,, 290x50 lb. cartons 38 — ,, 88x 50 lb. cartons 20 — ,, 66x50 lb. cartons 20 9 ,, 135x50 lb. cartons 14 — ,, 167x66 lb. tins 17 7 ,, 15x150 lb. drums 10 — ,, 42x50 lb. cartons 10 — ,, 15x100 lb. drums 10 1 ,, 15x150 lb. drums 10 — ,, 248x50 lb. cartons 25 — ,, 45x50 lb. cartons 5 — ,, 88x50 lb. cartons 20 — ,, 15x150 lb. drums 10 — ,, 309x50 lb. cartons 33 — ,, 224x50 lb. cartons 35 5 China 100x50 kilos tins (110 lbs.) 35 Norway 13 x 112 lb. drums 13 — Incidence of Salmonella: Samples Salmonella tennessee 17 „ montevideo 4 give 2 „ anatum 8 „ cerro 1 „ newport 1 „ oranienburg 4 „ typhimurium phage type la 1 „ typhimurium phage type 12 1 128 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 cases (110 lbs.) 30 4 ,, ,, 33x50 „ „ 5 — ,, ,, 100x50 „ „ 10 — ,, ,, 100x100 lb. cases 10 — ,, ,, 100x50 kilos, cases (110 lbs.) 35 8 Mexico ,, 342x64 lb. bags 34 — ,, ,, 175x64 lb. „ 18 — ,, ,, 483x64 lb. „ 30 — America ,, 26x100 lb. drums 5 — ,, ,, 20x100 lb. „ 10 — ,, ,, 100x45 lb. „ 10 — ,, Frozen Egg White 47x28 lb. tins 5 — ,, Dried Egg Yolk 50 x 200 lb. drums 6 — Australia Frozen Whole Egg 8,000x28 lb. tins 40 - Incidence of Salmonella: Samples Salmonella potsdam 5 „ thompson 3 „ senftenburg 1 „ unidentified 3 Desiccated Coconut.— Country of Origin Quantity Imported No. of Samples Taken No. of Samples Contaminated Ceylon 100x100 lb. bags 10 ,, 50x112 lb. cases 10 — 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 had been supervised by the Food Inspectors and every effort has been made to ensure a high standard of hygiene. In producing English Frozen Whole Egg for the Egg Marketing Board the manufacturers anticipate that the plant will eventually break 360,000 eggs (1,000 cases) per day. 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 three occasions and in each instance has been satisfactory. 129 Export Certificates.—Many consignments of meat are exported from the Cold Stores located within the Borough and each has to be accompanied by an appropriate " Certificate " to the effect that such consignments have been examined and are considered fit for export for human consumption. During the year 120 certificates were so issued and the following table indicates the country of origin of the samples, their destinations and the amounts involved:— Country of Origin Certificates Issued Total Weight of Meat Exported Country No. New Zealand Cyprus 32 321,604 lbs. Bermuda 6 Malta 2 Israel 2 Ghana 1 Norway 1 Australia Cyprus 28 322,890 lbs. Bermuda 8 Malta 5 Norway 1 Holland 1 Argentine Saudi Arabia 28 131,765½ lbs. Hong Kong 1 Scotland Germany 1 3,648 lbs. Ireland Cyprus 1 72 lbs. England Saudi Arabia 1 50 lbs. America Hong Kong 1 39 lbs. Food and Drugs Act, 1955.—In accordance with the Council's contract with the Public Analyst, 475 samples were presented for examination, of which 77 were obtained in accordance with the Public Health (Imported Food) Regulations. The remaining samples, consisting of 42 formal and 356 informal were obtained in the normal course of sampling. Of all the samples obtained, 26 were considered by the Public Analyst to be non-genuine and of this total, seven 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 19 non-genuine samples, all informal, 7 were incorrectly labelled and have therefore been excluded from the calculation of the adulteration figure which at 3% shows an increase of 1.5% over that of last year. 130 Again milk was one of the main foods sampled and in all, 25 samples were procured, of which 5 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 3.53% and solids-not-fat 8.58% 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 Islands milks sampled in the Borough during the year proved to have an average content of 4.33% and 8.97% respectively. Flour (Composition) Regulations, 1956.—These regulations provide for the fortification of flour with added nutrients. Seven samples of flour were specially tested for the added nutrients and all were found to comply with the requirements of the regulations Appended at the end of this Food Section is a table listing all the samples reported upon as being " non genuine " and giving the administrative action taken in respect of each unsatisfactory sample. Pharmacy and Medicines Act, 1941.—No samples were taken for analysis during 1961. 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. There were no samples examined during the current year. The Condensed Milk Regulations, 1959.—In addition to minimum percentages of milk-fat and milk-solids of condensed milk, the standards of labelling of receptacles are covered under the provisions of these Regulations. Five 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 reported food poisoning cases, 131 Information concerning the analyses of these samples is given in the following table:— Article How Obtained Examination Action Taken Bact. or Chem. Result Cheddar Cheese Complaint by member of the public that cheese contained foreign body. Chem. Sample contained corrugated iron staple which had been in cheese for some considerable time. Warning letter to retailer. Tomato Purée (canned) Taken from store in Borough. Chem. Some internal corrosion. Tin content below recognised limit. Importer notified. Boneless Cooked Shoulder Ham (canned) Taken from store in Borough. Bact. Total bacteriological count more than 1 million per gramme. Coliform count greater than 100 cols./gm. All consignments destroyed. Butter Beans Taken from store in Borough for sampling after insecticide treatment. Chem. No contamination found. Importer notified. Grapefruit Segments (canned) Taken from store in Borough after long storage. Chem. Sample edible although discoloured by overheating. Importer notified. Brisket of Beef (canned) Taken from store in Borough after long storage. Bact. Total count less than 100 cols./ gm. Coliform count less than 100 cols./gm. Importer notified. Portion of Wrapped Sliced White loaf Complaint by member of the public that bread contained foreign body. Chem. Foreign matter consisted almost entirely of aluminium turnings and powder mixed with mineral oil. Warning letter to Baker. Chocolate Drink Obtained from machine outside dairy. Bact. Total count less than 100 cols./ gm. Coliform count less than 100 cols./gm. Vendor informed that sample was satisfactory. 132 Article How Obtained Examination Action Taken Bact. or Chem. Result Pineapple (canned) Part of salvaged stock. Chem. Contents satisfactory. Cafe proprietor informed. Peaches (canned) Part of salvaged stock. Chem. Contents satisfactory. Liquid Whole Egg Taken from pipeline where tins are filled at Wharf in Borough. Bact. Organisms of Salmonella group not isolated. Importer notified. Bulgarian Prunes (6 samples) Taken from store in Borough. Chem. Two samples seriously attacked by mites and therefore unfit. Other samples could be used commercially after thorough washing and cleaning. Importer notified. Granulated Sugar Contaminated by sea water. Part of cargo of ship holed in collision. Chem. Sugar was slightly moist and contained ammonium sulphate. Unfit. Importer notified. Iced Bun Purchased by worker from Works' Canteen. Complaint that it contained a foreign body. Bun contained bent 2 in. iron nail. Condition of nail and its positionconsistent with its having been introduced after bun had been baked but whilst it was still fresh and soft. No action possible. Pilchards in Tomato Sauce (canned) Returned by H.M. ships to Victualling Depot. Chem. Slight internal corrosion—no excessive metallic contamination— fair edible condition. Depot advised accordingly. Herrings in Tomato Sauce (canned) Returned by H.M. ships to Victualling Depot. Chem. Slight internal corrosion but contents appeared to be in fair edible condition. Depot advised accordingly. 133 Article How Obtained Examination Action Taken Bact. or Chem. Result Brisling in Oil (canned) Returned by H.M. ships to Victualling Depot. Chem. Evidence of internal corrosion— 180 ppm.—not regarded as injurious but deterioration likely to become excessive on further storage. Depot advised accordingly. Corned Beef (canned) Returned by H.M. ships to Victualling Depot. Chem. Sound and in good edible condition. Depot advised accordingly. Bacon (canned) Returned by H.M. ships to Victualling Depot. Chem. Sound and in good edible condition. Depot advised accordingly. Carnation Milk (canned) Returned by H.M. ships to Victualling Depot. Chem. Can slightly attacked, contained tin 80 ppm. Considered of inferior quality but not unfit. Depot advised accordingly. Half pint Tuberculin Tested (Pasteurised] Homogenised Milk Complaint from member of the public that milk contained insects. Chem. Bottle found to contain flies, larvae, and pupae and small quantity of dirty matter. Legal proceedings instituted. Case dismissed. 134 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 25 notifications received, one of which was subsequently re-diagnosed as Typhoid Fever and two were corrected as they referred to symptomless excreters. This gave a final total of 22 for the year. There were 42 cases in the previous year, 43 for 1959, 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 10 Salmonella typhimurium 5 No particular food was suspected in nine cases. Eclairs (cream cakes) were suspected in the other case but could not be verified. 1 Salmonella Stanley 1 No particular food suspected. 11 Unknown - No particular food was suspected in ten cases. Canned baked beans were suspected in the other case but verification was not possible. 22 6 135 FOOD AND DRUGS ACT, 1955 Number and Description of Samples Submitted for Analysis under the above Act during the year 1961 (including samples taken under the Public Health (Imported Food) Regulations) Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Almonds, Ground — 4 4 — — — Arrowroot — 1 1 — — — Batter Mixture — 1 1 — — — Barley, Pearl — 1 1 — — — Biscuits — 6 6 — — — Brandy 2 — 2 — — — Bread — 2 2 — — — Butter — 12 12 — — — Cake Mixture — 1 1 — — — Calves Feet Jelly — 1 1 — 1 1 Castor Oil — 1 1 — — — Cereal — 1 1 — — — Cheese & Cheese Spread 3 3 — Coffee - 1 1 — — — Coffee Extract (Dry) - 3 3 — — — Confectionery (Flour) - 2 2 — — — Confectionery (Sugar) - 19 19 — 4 4 Corn (Popping) - 1 1 — — — Cough Mixture - 2 2 — — — Custard Powder - 2 2 — — — Cream - 4 4 — — — Cream of Tartar - 1 1 — — — Drinks, Soft - 9 9 — 2 2 Drinks, Soft, Powder - 1 1 — — — Drinks, Soft, Tablet - 1 1 — — — Dripping - 1 1 — — — Figs, Compound Syrup 1 1 — Fish, Bottled - 3 3 — — — Fish, Canned - 27 27 — 1 1 Fish, Paste - 6 6 — — — Flavouring Essence - 2 2 — — — Flour - 8 8 — — — Fruit, Bottled - 1 1 — — — Fruit, Canned - 35 35 — — — Fruit, Dried - 22 22 — — — Fruit, Fresh - 1 1 — — — Fruit, Glacé - 2 2 — — — Fruit, Curd - 1 1 — — — Fruit Juice - 5 5 — — — Fruit Purée - 1 1 — 1 1 Fruit & Nuts - 1 1 — — — Gelatine - 1 1 — — — Gin 6 - 6 — — — 136 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Glucose Tablets — 1 1 — — — Gravy Preparation — 2 2 — — — Groats — 1 1 — 1 1 Herbs, Dried — 1 1 — — — Icing Mixture — 2 2 — — — Jam & Preserves — 13 13 — 2 2 Jelly Compound — 1 1 — — — Jelly Tablet — 2 2 — — — Lard — 3 3 — 1 1 Lager — 1 1 — — — Margarine — 2 2 — — — Marmalade — 2 2 — — — Marzipan — 2 2 — — — Meat, Bottled — 1 1 — — — Meat, Minced — 7 7 — — — Meat Products — 27 27 — 1 1 Meat Products, Canned _ 40 40 — 2 2 Meat Paste - 1 1 — — — Medicine - 1 1 — — — Milk (including Channel Islands) 24 1 25 — — — Milk Condensed — 5 5 - — — Milk Pudding, Canned __ 1 1 - - - Mincemeat — 2 2 - — — Mustard — 1 1 - 1 1 Nuts — 5 5 - 1 1 Nuts & Raisins — 1 1 - — — Oatmeal — 1 1 - — — Oil, Cooking — 4 4 - — — Peel, Candied — 1 1 - — — Pepper — 3 3 - — — Pickles — 14 14 - — — Proprietary Medicines — 2 2 - 1 1 Proprietary Food — 1 1 - — — Potato Crackers — 1 1 - — — Protein, Hydrolised — 2 2 - — — Pudding, Canned — 4 4 - — — Rennett, Essence of — 1 1 - 1 1 Rice — 5 5 - — — Rice, Spanish, Canned — 1 1 - — — Rusks — 2 2 - — — Rum 3 — 3 - — - Sauce — 7 7 - — - Sausages & Sausage Meat 24 24 - 1 1 Seasoning — 1 1 - — — Semolina — 1 1 - — - Soda, Bicarbonate of — 1 1 - — - Soup, Canned — 5 5 - 1 1 Soup, Preparation — 1 1 - — — Spaghetti, Dinner — 1 1 - — — Spice — 5 5 - — — Spreads — 2 2 - — — 137 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Stuffing Mixture — 2 2 — — — Sugar — 4 4 — 1 1 Tapioca — 1 1 — — — Tea — 4 4 — 1 1 Tomato Paste — 1 1 — 1 1 Vegetables, Canned — 10 10 — — — Vegetables, Dehydrated 3 3 — 1 1 Vegetables, Dried — 3 3 - — — Vegetable Juices, Canned 1 1 - — — Vermicelli — 1 1 - — — Vinegar, Imitation — 1 1 - — — Welsh Rarebit Preparation 1 1 - — — Whisky 7 — 7 - — — Wine, Alcoholic — 2 2 - — — Yogurt — 1 1 - — — Totals 42 449 491 — 26 26 138 Administrative Action Taken in Regard to Samples Reported to be NOT GENUINE Sample No. Article Nature of adulteration and/or irregularity Action taken (a) In respect oj normal sampling. T. 1 Irish Coffee Milk Chocolate Contained 0.4% whiskey. Label claimed "Contains Genuine Irish Whiskey." In view of the insignificant proportion of whiskey the label was likely to mislead. Manufacturer agreed to alter label. T. 48 Glycerine, Honey and Oil of Lemon Contained 1% Glycerine, insufficient to have any appreciable effect. Label considered misleading. Stocks withdrawn. T. 70 Black Bean Soup with Imported Sherry Wine (canned). Contained 0.3% alcohol, corresponding to not more than 2% Sherry Wine. Label claimed "lavishly flavoured with best Sherry Wine." This was misleading. Importers asked to comply with Labelling of Food Order, 1953. T. 78 Instant Mashed Potato. Contained 60 p.p.m. sulphur dioxide, the presence of which not disclosed on label. Manufacturers agreed to amend label to comply with Labelling of Food Order, 1953. T. 85 Bubbly Gum Balls. Unwrapped and from a machine. So contaminated by dust as to be unfit for consumption. Complete stock withdrawn. T. 88 Preserved Pork Sausages. Meat content 55%. Pork sausages normally contain 65% meat. Warning letter to Manufacturer. T. 107 Blackcurrant Health Drink. Contained 370 p.p.m. sulphur dioxide. Limit is 350 p.p.m. Warning letter to Manufacturer. T. 108 Orange Drink. Contained orange juice not more than 10% Orange Squash intended for dilution should contain at least 25% fruit juice. Letter to Manufacturer regarding title of commodity. 139 Sample No. Article Nature of adulteration and/or irregularity Action taken T. 110 French Mustard. Stated to contain vitamin "C" but proportion not specified. Analysis showed no ascorbic acid. Letter to Manufacturer and the stock was withdrawn. T. 157 Blackcurrant Purée (canned). Deficiency of 23% vitamin "C." Both samples were from old stock taken over by new proprietor. In each case stocks were withdrawn and destroyed. T. 158 Essence of Rennet Sample deteriorated and failed to produce satisfactory junket. T. 190 Calves' Feet Jelly Sample was fluid when received and did not set even when refrigerated at 36°F. Stock withdrawn. T. 212 Tea Buds Sample contained no significant proportion of bud. Description on label considered to be misleading. Stock withdrawn after representations. T. 225 Shelled Walnuts Damaged by insects and contained pupae of moth. Stock withdrawn and destroyed. T. 231 Tomato Paste Contained excessive amount of fungus indicating the use of partly rotten tomatoes. Letter to Importers and Manufacturers. Stock withdrawn. T. 285 Vienna Sausages (canned). Contained 60% meat. Vienna sausages normally contain at least 80% meat. Letter to Importer. (Product of South Africa.) T. 296 Pork in Natural Juices (canned). Contained nitrate 950 p.p.m. Contained nitrite 25 p.p.m. Not disclosed on label. Letter to Importer. (Product canned in Denmark.) T. 302 Groats Sample contained insect droppings, webbing and small dead moth. Stock withdrawn. T. 348 Barbados Sugar. Contained Rhodamine B. not permitted by the Colouring Matter in Food Regulations. Letter to Wholesaler. Stock withdrawn. Source still under detention. 140 Sample No. Article Nature of adulteration and/or irregularity Action taken (b) In respect of samples taken under Imported Food Regulations. TT. 6 Lard. Not pure lard. Results consistent with the presence of hardened fat or stearine. Letter to Importers. TT. 25 Anchovies Sprats. No anchovies found. Sample consisted of whole sprats. Description misleading. Importers indicated that goods intended for "ships stores" only. TT. 52 Coffee Beans Both contained coal-tar dye not conforming ,to the Colouring Matters in Food Regulations, 1957. Suppliers informed. TT. 53 Dragee Cherries TT. 75 Preserve (Powidel). Contained excessive proportion of copper—85 p.p.m. Limit of 20 p.p.m is generally recognised. Undertaking obtained from Importers that goods will be sold for manufacturing purposes only. TT. 78 Prune Preserve (Powidel). Contained excessive proportion of copper—45 p.p.m. Limit of 20 p.p.m is generally recognised. TT. 76 German Sausage. Unfit for sale—skin covered by mould growth. Mould removable by washing, sausage quite edible. Importers agreed to this procedure. 141 SECTION F Prevalence of, and Control over, Infectious and Other Diseases In Greenwich, the biennial periodicity of measles prevented this year from being considered completely satisfactory, for most other infectious diseases showed substantial reductions. In these circumstances it seems ironic that a discordant note should be sounded but, at all costs, complacency must be avoided. Bacteriological infections have undoubtedly been suppressed but they have not been eliminated and they can so very quickly become, once again, a menace to the health of the community. Danger arising from such indifference is exemplified in the fact that several London areas reported small outbreaks of diphtheria which, without prompt and effective action by the public health authorities, could have been extremely serious. From a national point of view, several disturbing features have come to light during the current year, viz. the remarkable increase in the resistance of the haemolytic streptococcus in hospitals and maternity homes—the increase in venereal disease especially among the younger groups of adults—the increase in the incidence of leukaemia—the accentuation in certain areas of the tuberculosis problem by immigrants and the introduction by them of unfamiliar complaints and helminthic infections. As has so often been stated, public health is that part of preventive medicine directed towards the protection of the health of the community, or such regulation of the communal physical environment as may be necessary not only to prevent disease but actively to promote health. In the earliest days of public health authorities, these functions were primarily concerned with the control of epidemics of cholera, plague, smallpox, typhoid, etc., but within the last two or three decades the whole picture relating to infectious diseases has changed, largely as a result of the environmental and preventive health services. As far back as the 1850's there was only one disease against which immunity could be given, namely, smallpox and even this had to be introduced on a compulsory basis in 1853. Since then routine immunity procedures have been introduced for use against diphtheria, tuberculosis, whooping cough, tetanus and poliomyelitis and there is reason to think that, as a result of recent experiments, measles will also join this list. Inevitably, perhaps, these measures, by their own success have introduced a sense of false security in that there is now growing up a generation of parents with no knowledge of the disfiguring consequences 142 of smallpox or the devastating effects of diphtheria. Moreover, apathy bred in this way is difficult to overcome except by education and sustained publicity. Doubtless the actual injections and vaccinations in themselves are obstacles to the acceptance of protection by the public of these immunising agents but in this respect combined antigens have provided a partial answer. In particular, a further step to make immunisation against poliomyelitis more acceptable was contained in the Cohen Committee's recommendation regarding the use of the new Sabin oral vaccine. The Committee's advice, which has been taken by the Government is as follows: — (a) Sabin vaccine may be used both safely and effectively for primary vaccination. (b) Pending further study, Sabin vaccine should not be used to complete a course of vaccination started with Salk vaccine. (c) So long as Salk vaccine is available, it should also be provided for primary vaccinations if the doctor prefers it. A Ministry of Health spokesman emphasised that while the new vaccine will be made available for routine vaccination as soon as possible, there must first be full discussion of technical and other aspects with those who will be responsible for carrying out this new form of vaccination, for while the vaccine is simple to administer, its use on a widespread scale will entail special arrangements for distribution and storage. For routine immunisations a trivalent form of the vaccine, i.e. one which contains polio virus of all three types, will be used and the course will comprise three doses at intervals of four to eight weeks. The vaccine is likely to be given as drops on a lump of sugar, or in syrup in the case of babies. Financially and physically prevention is always better than cure and health authorities, with the active support of parents should take all practical steps to ensure that their charges are furnished with the means to obtain the highest level of resistance. Legislation.—During the current year no legislation concerning infectious diseases was enacted. The total number of Infectious Diseases notified under Section 144 of the Public Health Act, 1936, Section 192 of the Public Health (London) Act, 1936, and associated Orders and Regulations was 1,944. Under the Public Health (Tuberculosis) Regulations. 143 1952, there were 37 notifications, giving a consolidated total of 1,981 cases notified during the year. The following table indicates the figures for the previous ten years :— Year No. of corrected notifications 1951 2,266 1952 1,565 1953 1,242 1954 569 1955 2,120 1956 844 1957 1,558 1958 607 1959 1,102 1960 542 10-year average 1,241 1961 1,981 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 and 1960 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. 144 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 1961 was 538. This is a decrease of one from that of the previous year. In Greenwich during the last 11 years 14,486 births have been registered, and for the same period only 7,429 vaccinations have been effected, a figure equivalent to 51.3%. In this connection it is only fair to state that a number of these vaccinations were effected in conformity with the requirements concerning the issue of international vaccination certificates. 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. In order that a high vaccinal state be maintained in the department, your Medical Officer of Health carried out 29 vaccinations to members of the staff who would most likely be involved should any outbreak of smallpox occur in the area. 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 145 which certifies that the signature of the Vaccinator is that of a practising medical practitioner. During the year some 437 certificates of persons proceeding abroad were so authenticated, of these 371 were in respect of Smallpox, 46 for Cholera and 20 for Typhoid. One vaccination was carried out by your Medical Officer of Health. Measles.—Although the normal biennial fluctuation was absent during 1960, it was merely delayed, for some 1,820 cases were notified in the early part of the current year. Of the figure of 1,820, 864 were males and 956 were females and the total indicates an increase of 1,773 over that of the previous year. Only 18 cases occurred over the age of 15 years the most affected being the 5 to 10 years age group in which 827 notifications were registered. Twenty-eight cases were removed to hospital but there were no deaths recorded. The distribution of the cases was as follows:—East Greenwich 320; West Greenwich 563; St. Nicholas, Deptford 113, Charlton and Kidbrooke 824. During 1959 there were 637 cases, in 1958 there were 306 and during 1957 1,194 cases were recorded. In 1956 there were 44. Whooping Cough.—Altogether 26 notifications were received in 1961, a decrease of 142 from those of the previous year. The years 1959 and 1958 produced 34 and 55 respectively whilst there were 97 registered for 1957. Area distribution for the current period was :—East Greenwich 6; West Greenwich 5; St. Nicholas, Deptford 3; Charlton and Kidbrooke 12. Six cases were admitted to hospital and there were no fatalities. With regard to children under 5 years, one was immunised against whooping cough while 8 other children received a combined antigen (whooping cough and diphtheria) and a further 701 received a triple antigen (whooping cough, diphtheria and tetanus) giving a final total of 710 whooping cough immunisations carried out during the year by the County Council. This is a decrease of 610 from the total for the previous year. Diphtheria.—No notifications were received for the current year, a result similar to that for the previous year and for the years 1959. 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. 146 Diphtheria immunisation is a County Council service and during the year there were 734 completed immunisations carried out in the Borough, a decrease of 748 from 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.—Only 5 cases attributed to these causes were registered during the year as compared with 12 for 1960, 20 for 1959, 42 for 1958, 28 for 1957 and 14 for each of the years 1956 and 1955. Two occurred in West Greenwich. 1 in St. Nicholas, Deptford, and 2 in Charlton and Kidbrooke. Four cases were removed to hospital but there were no deaths. Typhoid.—One case of typhoid and one of paratyphoid fever were notified during the year compared with a nil return for the years 1960 and 1959, one for 1958, two for 1957 and one for 1956. The one case of typhoid fever occurred in a 24-years-old geological student who had recently returned from Spain. Two months after his discharge, however, he suffered a relapse and the hospital reported that although no organisms were recovered from his stools there was a positive result from his blood specimen. In the case of the paratyphoid notification which concerned the 35-years-old wife of an air-line pilot, it was finally assumed that the infection was contracted abroad. Scarlet Fever.—A total of 30 confirmed cases for the year shows a decrease of 14 from 1960 compared with 68 notifications for 1959, 106 for 1958, 102 for 1957, 58 for 1956 and 57 for 1955. Twelve occurred in East Greenwich, 6 in West Greenwich, 4 in St. Nicholas, Deptford, and 8 in Charlton and Kidbrooke. No case was removed to hospital and no fatalities were recorded. Erysipelas.—There were 2 notifications received during the year compared with a nil return for last year, 6 for 1959, 3 for 1958. a nil return for 1957, 4 for 1956 and 6 for 1955. Zymotic Enteritis or Epidemic Diarrhoea (Children under 5 years of age).—Ninteen cases were recorded as confirmed compared with 57 for the previous year 30 for 1959, 9 for 1958, 12 for 1957 and 17 for 1956. Six cases received hospital treatment but no deaths were recorded. 147 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 35 notifications received during the current year shows a fall of 115 from that of the previous year and 214 from 1959. The present figure is approximately 7% of that returned for 1956, viz. 480, the year in which a detailed investigation and analysis was made of a most explosive outbreak. The distribution of the cases was 4 in East Greenwich, 15 in West Greenwich, 5 in St. Nicholas. Deptford, and 11 in Charlton and Kidbrooke. No cases were removed to hospital and there were no fatalities. Scabies.—Four cases were notified during 1961 compared with a nil return for 1960, 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 were no notifications received in accordance with the 1951 Regulations but from other sources 5 cases concerning Greenwich residents were brought to the notice of the department, a figure of 9 being returned for the year 1960 and 18 for 1959. All patients received hospital treatment. There were no fatalities. Meningococcal Infection.—There were no notifications received during the current year compared with one for the previous year, two for 1959, 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 1960, 1959, 1958, 1957, 1956 and 1955. Ophthalmia Neonatorum.—In respect of this disease no notifications were received. There was one for 1960. none for 1959 and one was recorded for 1958. However, from other sources, 2 cases concerning Greenwich residents were brought to the notice of the department both of whom received hospital treatment. 148 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 no consequence during the current year as no notifications of poliomyelitis were received. Of school children undertaking a poliomyelitis inoculation course, 1,354 received two and 1,679 received their third injection during the year. For persons between the ages of 16 and 40 years the figures were 378 and 1,163 respectively. In addition, a fourth injection was given to 3,802 children between the ages of 5 and 12 years. Malaria.—Compared with a nil return for this year and for 1960, one notification of benign tertian was registered for 1959. Tuberculosis.—During the year 37 notifications in respect of confirmed cases of tuberculosis were received compared with 57 for 1960. Of these, 32 were of the pulmonary type and 5 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 8 8 West Greenwich 8 1 9 St. Nicolas, Deptford 6 — 6 Charlton and Kidbrooke 10 4 14 Totals 32 5 37 Disinfection was offered and carried out in 6 cases including 13 rooms. During 1961, some 1,337 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. 1961, was as follows:— PULMONARY NON-PULMONARY Men Women Children Total Men Women Children Total M F M F 577 480 25 20 1,102 25 44 11 6 86 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. 149 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 Part I.—Summary of notifications of Tuberculosis during the period from the 1st January, 1961, to the 31st December, 1961. Age Periods Formal Notifications Number of Primary Notifications of new cases of tuberculosis 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total (all ages) Respiratory, Males - - - 1 - 1 3 1 2 2 10 2 2 24 Respiratory, Females — — — — — — — 4 1 2 1 — — 8 Non-Respiratory, Males — — — — — 1 1 — — — — — — 2 Non-Respiratory, Females — — — — — — 1 — — 1 — — — 2 Part II.—New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Source of Information Number of cases in age Groups 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total Death Returns from Local Registrars Respiratory M - - - - - - - - - - - - 1 1 (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) Death Returns from RegistrarGeneral (Transferable deaths) Respiratory M - - - - - - - - - - - 1 — 1 (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - - - (D) Posthumous Notifications Respiratory M - - - - - - - - - - - - - - (A) F - - - - - - - - - - - - - - (B) Non-Respiratory M - - - - - - - - - - - - - - (C) F - - - - - - - - - - - - 1 1 (D) N.B. Where notification of one form of Tuberculosis is subsequently followed by a notification of the other, only the first notification is taken into account for the purpose of this return. Totals (A) 2 (B) — (C) — (D) 1 150 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. Although no major surveys were undertaken, 25 short visits 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. 1961. PART I.—General Analysis Men Women Total (a) Total X-rayed 6,081 347 6,428 (b) Total previously X-rayed (within 5 years) 5,597 199 5,796 (c) Total number reviewed 370 8 378 (d) Number considered abnormal after review 237 5 242 (e) Not yet attended after review 4 — 4 PART II.—Analysis of Abnormal Films (1) Cases considered tuberculous and referred for further investigation: Men Women Total (a) No further action required — — — (b) Occasional supervision 7 1 8 (c) Requiring close supervision or treatment 10 2 12 (d) Still under investigation — — — (e) Refused further investigation — — — 151 (2) Previously known tuberculous cases 8 — 8 (3) Non-tuberculous cases: (a) investigated 30 1 31 (b) still under investigation — — — (4) Cardio-vascular lesions 13 — 13 (5) Abnormalities requiring no action 165 1 166 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 18 14 Children under school age 19 7 School children 57 17 No. of home visits by Lady Public Health Inspector 27 No. of home revisits by Lady Public Health Inspector 51 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:— 152 Rooms and Articles Disinfected, Year ended 31st December, 1961 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 11 16 2 9 1 24 6 34 - 13 - 6 15 - 1 111 Diphtheria 2 3 — 1 — 3 2 3 - - 1 — - - 1 11 Tuberculosis 6 13 — - - - - - - - - - - - - - Cancer 8 6 - 4 3 18 2 12 1 8 - 23 - - 2 73 Meningococcal Infection 10 17 2 8 1 19 4 25 - 5 1 30 - - — 95 Puerperal Pyrexia — — — — — — — — - — - — - - - — Typhoid Fever — — — — — — — — - — - — - - — - Polio-Myelitis 1 1 — 1 — 2 — 3 - — - — - - - 6 Erysipelas — — — — — — — - — - — - - - — Acute Encephalitis — — — — — — — — — — — — — — — — Measles — — — — — — — — - — - — - - — Scabies 1 2 — 1 1 2 — 9 - - - — - - - 13 Other Diseases 114 16 2 18 1 37 - 11 1 3 1 29 33 16 - 152 Verminous Premises 8 6 2 15 4 24 14 16 1 — 8 20 10 - — 114 Total 161 80 8 57 11 129 28 113 3 29 11 108 58 16 4 575 Articles Destroyed — — 38 115 — 15 3 12 — — — 301 — — — 484 Library Books Disinfected 35 153 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 528 437 19 18 1,002 Non-pulmonary 15 19 4 6 44 1,046 Total No. of new patients referred to the Clinic 2,037 Total No. of attendances 7,055 Deaths (all causes) 16 (8 result of pulmonary tuberculosis) 31 new cases of pulmonary tuberculosis were notified during the year in the undermentioned age groups:— Males years Females 1 0—10 0 2 10—20 0 1 21—30 2 2 31-40 3 3 41—50 0 7 51—60 2 3 61—70 1 2 71—80 0 2 81—90 0 Five cases of non-pulmonary tuberculosis were notified (two men, Rt. kidney) and three women (one renal tuberculosis, one tuberculous ulceration left leg and one spine). Forty patients have been transferred out to other Clinics and 29 have been transferred into this Clinic. 138 ante-natal patients have been X-rayed but there was no tuberculous disease found amongst these. The majority (26) new cases of pulmonary tuberculosis were referred to the Chest Clinic from the family doctor, two were diagnosed posthumously and three were found as a result of routine follow-up examination of family contacts of known tuberculous cases. 168 contacts of tuberculous persons have been X-rayed. 55 children were referred to us from school following the B.C.G. school programme because they were found to have positive 154 culin tests. No active tuberculosis was found amongst these nor their family contacts but in view of the fact that these children were found to be positive at school age it was felt worth while to keep them under observation with annual X-rays for a few years to be sure that there was no tuberculous disease developing. 112 children and young adults were given B.C.G. inoculation because they were contacts of cases with tuberculosis. We are continuing to keep under supervision with annual, or sometimes more frequent, X-rays all those people who have had tuberculous disease in the past, as a precaution against relapse. Of these patients 9 who have had tuberculous disease in the past have been found to have had a relapse of their disease during the year. Our beds for tuberculous patients have been transferred to Grove Park Hospital from Vanbrugh Ward, St. Alfege's Hospital during the year. This arrangement is not so suitable for relatives who have to travel further to visit patients but the arrangements for the care of these patients at Grove Park Hospital are proving very satisfactory. Although there are less new cases of tuberculous disease and there are fewer patients attending the Clinic under treatment for tuberculosis, there are many problems which arise concerning those who have had the disease in the past. Most important is disability due to breathlessness in which the disease has left residual lung damage and this is liable to have an increasing affect on their activity as they grow older. Both for these and those with bronchitis who are similarly affected in the older age groups there are difficulties in finding suitable employment. Unfortunately many of these are unable to find suitable work to the detriment of their morale. This group of disabled persons is liable to increase as time goes on and perhaps some form of sheltered workshops would be of help. In order to keep up their interest our Occupational Therapist visits a number of these and persuades them to undertake some form of occupational therapy. Housing is still a problem for many of these increasingly disabled and older persons for whom an environment free of dampness, dust and other air pollution is important and also a minimum of stairs. As well as the investigation and treatment of tuberculous patients an ever increasing amount of work in the Clinic is being devoted to non-tuberculous chest conditions, such as cancer of the lung, bronchitis and asthma. 155 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. Medical Inspection— Superannuation.—All medical examinations of the staff for Superannuation purposes are undertaken by the Medical Officer of Health, and during the current year 93 examinations were so made. Of these, four candidates were considered unfit for admission to the Council's Superannuation Scheme and four cases were deferred for further examination. Sick Persons.—In addition, the Medical Officer of Health carried out 49 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 twelve 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 5 interviews during the year. INDEX Page A Acute Encephalitis 147 Acute Influenzal Pneumonia 146 Acute Poliomyelitis 148 Acute Primary Pneumonia 146 Adoptive Acts, Bye-laws and Local Regulations 3-5 Age Composition of Population 18,19 Age Mortality 25-26 Aged, Infirm and Physically Incapacitated Persons 83-85 Alkali, etc., Works Order 57 Analytical Examination of Milk 118,130 Ante and Post Natal Clinics 46 Ante and Post Natal Clinics, Attendances 43 Anti-Fly and Anti-Mosquito Campaign 74 Antitoxin, Diphtheria 146 Ants, Pharoah's, etc 80 Area of Borough 11 Articles and Rooms Disinfected 152 Articles Destroyed 152 Artificial Sunlight Centres, Attendances 44 Artificial Sunlight Treatment 46 Asthma 154 Atmospheric Pollution 56-60 Authorised Officers (Heat Inspection) Regs.. 1961 117 B Bacteriological Examinations 77, 118, 120, 125-128, 131-133 Baiting of Sewers 74 Bakehouses 122 Bathing Centre, New 88-95 Baths and Wash-houses 75-77 B.C.G. Vaccinations 45, 148, 153 Bechuanaland Boneless Beef 125 Beetles 82 Births 20, 23 Birth Registrations 23 Blackheath Fair 121 Blackwall Tunnel Duplication (Discharge of Effluent) 68 British Red Cross Society 48 Bronchitis 39 Burial or Cremation of the Dead 102 C Cancer 20, 33-38 Cancer of the Lung 33-38 Carol Service (for Elderly) 99 Caseous Lymphadenitis 125 Catering Establishments 122 Page Census. 1961 19, 105 Cerebral Embolism 38 Cerebral Haemorrhage 38 Cerebral Thrombosis 38 Certificates of Guild of Hygiene 155 Chest Clinic 47 Chest Physician's Report 153-154 Chinese Dried Egg Products 127,128 Chiropody Clinics, Attendances 44 Chiropody Treatment, Clinics 46 Christmas Food Parcels (O.A.Ps.) 99 Citizens Advice Bureaux 48 Classification of Deaths 31 Clean Air Act 57 Cleansing & Bathing Centre, New 88-95 Cleansing and Scabies Clinic 47, 87, 151 Cleansing of Children 151 Cleansing of Old People 87 Clinics and Centres 46 Clover Mites 81 Coach Outings (for Elderly) 101 Cockroaches 81 Common Infectious Diseases 20, 31 Complaints 49, 103, 112, 130 Condensed Milk Regs. 1959 130 Consumer Protection Act, 1961 49 Conveniences, Public 78-79 Coronary Disease 38 Council Housing Schemes 113 Council Rehousing 111 Cremation or Burial of the Dead 102 D Day Rooms (for Old People) 96 Death Causes, Remarks31-41 Death Rates 20 Death Registrations 20, 24 Death, Table showing Causes of and Ages at Appendix Deaths 20, 24 Deaths, Table showing Causes of and Ages under 1 yr Appendix Deaths from Violence 39 Deaths in Institutions 25 Defective Dwellings—Repairs 52 Density of Population 11 Dessicated Coconut 128 Diarrhoea and Zymotic Enteritis 32, 146 Diphtheria 32, 145 Diphtheria Antitoxin 146 Diphtheria Immunisation Clinics 46 Diphtheria Prophylaxis Cases 45, 146 Discharge of Effluent (Blackwell Tunnel Duplication) 68 INDEX (continued) Page Discharge of Effluents into Sewers 66 Diseases of Respiratory System 39 Disinfecting Station 47 Disinfection 151-152 Disinfestation of Verminous Premises 79-83 Distribution Centres—National Welfare Foods 41 District Nursing 45, 48 Domestic Helps 44, 47 Drainage and Sewerage 65 Drainage, New and Alterations to 66 Dried Egg Albumen 127-128 Drinking Fountains 79 Duties and Powers of the Public Health Committee 3-5 Dwellings 11 Dysentery 147 E Early Neo-Natal Mortality 20, 30 Educational Sessions — Ante- Natal 44 Egg Albumen, Imported 127-128 Elevation of Borough 11,13 Emission of Grit 56 Encephalitis 147 English Frozen Whole Egg Plant 128 Enteric Fever 32, 146 Entertainment (for Elderly) 100 Erysipelas 146 Exhumations 102 Expectation of Life 18 Export Certificates 129 Extracts from Vital Statistics 20 F Factories Act, 1961 50 Factories Act, 1937/59 50-52 Fair on Blackheath 121 Family Planning Association, Sessions 47 Family Welfare Association 48 Flooding, Storm (Ravensbourne) 54 Flour (Composition) Regs., 1956 130 Fluoridation of Water Supplies 67 Food and Drugs Act, 1955 129,135-140 Food and Drugs—Non-genuine Samples 138-140 Food and Drugs Act, 1955, Samples taken under 129, 135-137 Food Examination (Other) 130-133 Page Food Hygiene (General) Regs., 1960 121 Food, Inspection of 116-140 Food Parcels (Old People) 99 Food Poisoning 134 Food—Premises for Preparation of 119,121 Food Rejected 123, 124, 125 Food Standards (Ice Cream) Regs., 1959 121 Foods Welfare (for Elderly) 100 Foot Clinics 46 Foot Clinics, Attendances 44 Frozen Cooked Meat 126 Frozen Whole Egg Plant 128 G General and Vital Statistics 11-40 General Information 13-17 General Provision of Health and Welfare Services in the Area 41-48 Greenwich Guild of Hygiene 155 Greenwich Old People's Welfare Association 95 Grit Emission 56 Guild of Hygiene 155 H Habitation Certificates (Water Supply) 66 Hairdressers and Barbers 64 Handwashing Facilities 79 Health Centres 46 Health Visiting 42 Heart Disease 20, 38 Heating Appliances (Fireguards) Act, 1952 49,62 Holidays (Old People) 97 Homebound, Tea Party 98 Home Help Statistics 44 Home Help Service, Applications for 47 Home Safety Act) 1961 49 Horse Troughs 79 Hospitals 48 House to House Collections (O.A.Ps.) 100 House Purchase & Housing Act, 1959 111 Houses, No. in Borough 11 Houses in Multiple Occupation 107, 109 Housing 105-115 Housing Act, 1957 62, 108 Housing Act, 1957, Procedure under 108 INDEX (continued) Page Housing Act, 1949 111 Housing Act, 1961 107 Housing (Financial Provisions) Act, 1958 111 Housing Accommodation 113 Housing Homeless Persons 111 Housing Register 114 Housing Repairs and Rents Act, 1954 61, 111 Housing Schemes, Council's 113 Housing Survey 114 Housing (Underground Rooms) Act, 1959 109 Hygiene, Guild of 155 I Ice - Cream — Bacteriological examinations 120 Ice-Cream (Heat Treatment, etc.) Regulations 119 Ice-Cream Premises 119 Ice-Cream Quantitative Analysis 121 Ice-Cream Sampling 120 Illegitimate Births 20, 23 Immunisation and Vaccination Clinics 46 Immunisation and Vaccination Clinics, Attendances 45 Imported Egg Products 127, 128 Imported Food Rejected 124, 125 Infantile Mortality 20, 26-31 Infant Welfare Centres 46 Infant Welfare Clinics, Attendances 42-44 Infectious Diseases 20, 31, 141-154 Infirm Persons 83-95 Influenza 20, 39 Inhabited Houses 11 Inoculations, Poliomyelitis 45, 148 Inspection of Food and Supervision of Food Premises 116-140 Institution Deaths 25 International Certificates 144 International Statistical Classification of Diseases, Injuries, and Causes of Death, 1955 31 Interviews (Re - housing) by M.O.H 155 Introductory Review 7-10 Invalid Chairs 101 J Jurisdiction over R. Ravensbourne 54-56 Page L Laboratory Work 66, 76-77, 118, 120, 125-140 Land Charges Act, 1925 65 Laundry Service 87 L.C.C. (Gen. Powers) Act, 1953 66, 87 L.C.C. (Gen. Powers) Act, 1954 64 L.C.C. (Gen. Powers) Act, 1958 64 Lead in Food Regs., 1961 116 Legal Proceedings 104, 133 Legislation, New 49,50,107,116,117 Leptospirosis 72 Lettings (Housing) 114 Licensing Act, 1961 49 Lung Cancer 33-38 M Malaria 148 Manufacture and Sale of Icecream 119 Marriages 21 Mass Radiography 48, 150 Massage etc., Attendances 44 Maternal Mortality 20, 26 Maternal and Child Welfare 41-48 Maze Hill Clinic (Tuberculosis) 47, 153-154 "Meals on Wheels" 97 Measles 32, 145 Meat Regulations 124 Meat Surrendered 123, 125 Medical Inspections (Superannuation) 155 Medical Inspections (Sick Persons) 155 Medical Officer of Health's Review 7-10 Medical Statistics (Schools) 45 Meningococcal Infection 147 Merchandise Marks Act 121 Meteorological Observations 22 Mileage of Streets 12 Milk, Analysis of 118, 130 Milk and Dairies Regulations 117 Milk Licences 118 Milk (Special Designation) (Pasteurised & Sterilised Milk) Regulations 117 Milk (Special Designation) (Raw Milk) Regulations 117 Milk (Special Designation) Regulations, 1960 117 Milk Sampling 118 Milk Supply 117 INDEX (continued) Page Minor Ailments Centres (for School Children) 46 Motor Vehicles Accidents 39 Mutual Exchanges (Housing) 115 N National Assistance Act 86 National Insurance Act (Medical Certificates) 143 National Welfare Foods—Distribution Centres 41 Natural Increase 18 Neo-Natal Mortality 20,30 & Appendix New Cleansing & Bathing Centre 88-95 New Housing Accommodation 113 New Legislation 49, 50, 107, 116, 117 Nomenclature Regulations, 1948 31 Non-Genuine Samples 138-140 Notices, etc 49, 104 Notifications of Infectious Diseases 141-154 & Appendix Notifications of Food Poisoning 134 Nursing Associations 45,48 O Oil Burners (Standards) Act, 1960 49 Old People's Clubs 95 Old People's Welfare Association 95 Open Spaces 12 Ophthalmia Neonatorum 147 Outworkers 52 Overcrowding 112 P Perinatal Mortality 20-30 Personal Health Services 41-48 Persons Cleansed 86, 87, 151 Pet Animals Act 65 Pharaoh's Ants 80 Pharmacy & Medicines Act 130 Pharmacy & Poisons Act 63 P.H. (Dried Milk) Regulations 130 P.H. (Imported Food) Regulations 117, 124, 129 P.H. (London) Act, 1936, Sec. 180(8) 123 P.H. (Meat) Regulations 124 P.H. (Smallpox Prevention) Regulations 144 P.H. (Tuberculosis) Regs. 142, 149 Physically Incapacitated Persons 83-95 Pigeon Nuisance 53 Pneumonia 39, 146 Poliomyelitis 148 Page Poliomyelitis Inoculations 45, 148 Pollution, Atmospheric 56-60 Pollution, River 53 Population 11, 18, 19 Population, Age Composition 18, 19 Post-Natal Attendances 43 Powers & Duties of the Public Health Committee 3-5 Precautionary Spraying 83 Preserved Food Premises 119 Prevalence of, and Control over Infectious Diseases 141-154 Prevention of Damage by Pests Act 72 Procedure under the Housing Act, 1957 108 Prophylaxis Cases 45 Prophylaxis Clinics 46 Public Baths & Washhouses 75-77 Public Health Act, 1961 50 Public Health Committee 3 Public Health Department Staff 6 Public Health Laboratory Service 77, 118,120,125-128, 131-133 Public Open Spaces 12 Public Sanitary Conveniences 78-79 Puerperal Pyrexia 147 Q Quantitative Analysis of Ice- Cream 121 Queen's District Nursing Association 45, 48 R Radiography, Mass 48, 150 Rag Flock Act 64 Rag Flock and Other Filling Materials Regs., 1961 50 Ranyard Mission 45, 48 Rateable Value 11 Rates, Births and Deaths, etc. 20 Rat Repression 71-74 Ravensbourne, River (Flooding) 54 Redevelopment, Housing 110 Refuse Disposal 69-71 Registered Births 20, 23 Registered Deaths 20, 24 Registrar—Office Hours 48 Registration of Preserved Food Premises 119 Rehousing 111 Rehousing Interviews (by M.O.H.) 155 Rejected Food 123, 124, 125 INDEX (continued) Page Relaxation Sessions—Ante-Natal 44 Remarks on Various Death Causes 31-40 Rent Act, 1957 61-62 Rent & Mortgage Interest (Restrictions) Acts 61 Report on 'Smoking and Health' (R.C.P.) 35 Reproductive Wastage 30 Requisitioned Accommodation 114 Requisitioned Houses & Housing (Amendment) Act, 1955 62 Respiratory System—Diseases of 39 Review by M.O.H. 7-10 River Pollution 53 River Ravensbourne, Flooding 54 River Ravensbourne, Jurisdiction 54-56 River Smells 53 Rodent Control 71-74 Royal College of Physicians' Report on ' Smoking and Health' 35 S Sampling of Ice-Cream 120 Sampling of Milk 118, 130 Sampling under Food & Drugs Act 129, 135-140 Sanitary Circumstances of the Area 49-104 Sanitary Conveniences, etc. 78-79 Sanitary Work—Summaries etc. 103-104 Scabies 147 Scabies & Cleansing Clinics 47, 87, 151 Scarlet Fever 32, 146 Scavenging and Refuse Disposal 69-71 Schools (Medical Statistics) 45 Sewerage and Drainage 65 Sewers—Baiting of 74 Shops Act 63 Slaughterhouses 124 Slum Clearance 109 Smallpox 32, 143 Smells from River 53 Smoke and Grit Emission 56 Smoke Control Areas 57-59 'Smoking and Health' (R.C.P. Report) 35 Social Conditions of the Area 13-17 Sonne Dysentery 147 Spraying, Precautionary 83 Staff of Public Health Department 6 Statistical Tables Appendix Statistics, General 11, 12 Still Births 20, 23 Page Street Appeal (for Elderly) 100 Streets, Mileage of 12 Street Traders 121 Storm Flooding 54 Suicide 39, 40 Suicide Act, 1961 40 Summary of Sanitary Work 103-104 Sunlight Treatment 44 Supervision of Food Premises 121 Supplies of Underground Water (Wells) 68 Swedish Pig Carcases 126 Swimming Baths 75-77 T Toddlers Clinic Attendances 43 Town & Country Planning Act, 1947 114 Transfers (Housing) 115 Transported Meals for Old People 97 Treatment Centres and Clinics 46 Tuberculosis 20, 32, 148-151, 153-154 Tuberculosis Officer's Report 153-154 Typhoid Fever 32, 146 U Underground Rooms 109 Underground Water Supplies (Wells) 68 Uninhabited Houses 11 Unsound Food 123, 124, 125 Unfit Houses 108 V Vaccination Cases 45, 144 Vaccination and Immunisation Clinics 46 Vaccination International Certificates 144 Various Death Causes, Remarks on 31-40 Vascular Lesions of Nervous System 38 Verminous Conditions 86, 87, 151 Verminous Premises 79-83 Violent Deaths 39 Vital Statistics 20 & Appendix Voluntary Organisations 48 W Wash-houses and Public Baths 75-77 Washing Facilities (Hand) 79 Wasps 82 Water — Underground Supplies (Wells) 68 INDEX (continued) Page Water Supplies—Fluoridation of 67 Water Supply 66 Water Supply Certificates 66 Weil's Disease 72 Welfare Clinics 46 Welfare Foods (for Elderly) 100 Welfare Foods, National—Distribution Centres 41 Wells 68 Whooping Cough 32, 145 Whooping Cough Prophylaxis Cases 45, 145 Page Whooping Cough Prophylaxis Clinics 46 Women's Special Clinic 47 Women's Voluntary Services 48 Z Zymotic Disease 32, 146 Zymotic Enteritis 32,146 X X-Ray Examinations 150 X-Ray, Mass 48, 150 INFANTILE MORTALITY DURING THE YEAR 1961 Deaths from stated Causes in Weeks and Months under 1 Year of Age. Cause of Death. Under 1 week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—3 Months. 3—6 Months. 6—9 Months. 9—12 Months. Total Deaths under One Year. Small-Pox ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... influenza ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Capillary Bronchitis ... ... ... ... ... 1 1 ... 1 3 Bronchopneumonia 1 ... ... ... 1 1 ... ... ... 2 Placenta Praevia 1 ... ... ... 1 ... ... ... ... 1 Premature Birth 9 1 ... ... 10 ... ... ... ... 10 Congenital Malformation 3 1 ... 2 6 ... 1 ... ... 7 Pulmonary Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Hyaline Membrane 1 ... ... ... 1 ... ... ... ... 1 Erythroblastosis 1 ... ... ... 1 ... ... ... ... 1 Umbilical Sepsis ... 1 ... ... 1 ... ... ... ... 1 Fibrocystic Disease of Pancreas ... ... ... ... ... ... 1 ... ... 1 Fibroelastosis ... ... ... ... ... ... 1 ... ... 1 Failure to establish normal Respiration 1 ... ... ... 1 ... ... ... ... 1 Totals 18 3 — 2 23 2 4 — 1 30 Male 11 Female 19 CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1961. 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 m f Malaria - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Small-Pox - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Acute Encephalitis Infectious - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Post-Infectious - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria — — — — - — - - - - - - - - - - - - - - - - - - - - - - — — — — - Dysentery 15 20 2 1 3 2 - 3 3 - - - 3 2 3 2 - 4 1 6 - 2 - - 4 15 5 11 - - - - - Erysipelas - 2 - - - - - - - - - - - - - - - - - 1 - 1 - - 1 - - 1 - - - - - Acute Polio-Myelitis P. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - N.P - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 11 19 - - - - - 1 - 3 3 - 4 12 3 3 1 - - - - - - - 12 6 4 8 - - - - - Typhoid Fever 1 - - - - - - - - - - - - - - - 1 - - - - - - - - - - 1 - - - 1 1 Paratyphoid Fever - 1 - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - Scabies 3 1 - - - - - - - - - - - - 1 1 - - 2 - - - - — 2 - - 2 - - - - - Puerperal Pyrexia - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal Infection - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Measles 864 956 22 30 92 91 113 85 108 117 117 165 390 437 18 17 3 8 1 6 - - - - 563 320 113 824 5 3 2 4 14 Whooping Cough 14 12 2 2 2 — 2 3 2 3 2 - 3 3 1 1 - - - - - - - - 6 5 3 12 - 2 - 1 3 Diarrhoea 10 9 5 3 2 3 2 3 1 - - - - - - - - - - - - - - - 6 3 - 10 — 2 — 1 3 Ophthalmia Neonatorum - 1 - 1 - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - 1 Pneumonia, Acute Primary or Acute Influenzal 3 2 - - - - - - - - - - 1 - - - - - - 1 2 1 - - - 2 1 2 - 1 - 1 2 Tuberculosis, Pulmonary 24 8 - - - - - - - - 1 - - - - - 4 1 4 5 11 2 4 - 8 8 6 10 3 2 — 1 6 „ Non-Pulmonary 2 3 - - - - - - - - - - - - - - 2 1 - - - 1 - 1 - 2 - 3 - 1 - 3 4 Totals 947 1,034 31 37 99 96 117 95 114 123 123 165 401 454 26 22 11 14 8 20 13 7 4 1 602 362 132 885 8 12 2 12 34 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, 1961. Causes of Death. Deaths at Subjoined ages of "Residents" whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of "Residents" in Public Institutions Total Deaths whether of "Residents" or "NonResidents" in Public Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton and Kidbrooke St. Alfege's Hospital Seamen's Hospital Miller Hospital Herbert Military Hospital Brook Hospital Other Institutions Outside Institutions Under 4 mths. 4 mths. and under 1 yr. Tuberculosis, Respiratory 6 ... ... ... ... ... ... ... 3 1 2 1 1 ... 4 4 1 ... ... ... ... ... 22 Tuberculosis, Other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Syphilitic Disease 2 ... ... ... ... ... ... ... ... 2 ... ... ... ... 2 ... ... ... ... ... 1 ... 3 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Infections ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Infective and Parasitic Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Malignant Neoplasm, Stomach 27 ... ... ... ... ... ... ... 6 6 15 8 5 ... 14 9 3 2 ... ... ... 6 39 Malignant, Neoplasm, Lung, Bronchus 50 ... ... ... ... ... ... ... 30 14 6 19 10 3 18 19 2 4 ... 2 ... 11 95 Malignant Neoplasm, Breast 18 ... ... ... ... ... ... 3 10 2 3 5 2 ... 11 5 ... ... ... ... 1 7 17 Malignant Neoplasm, Uterus 10 ... ... ... ... ... ... 2 3 2 3 3 ... ... 7 4 ... ... ... 1 ... 4 6 Other Malignant and Lymphatic Neoplasms 98 ... ... 1 ... ... 2 6 28 32 29 38 12 3 45 26 2 9 ... 4 1 27 139 Leukaemia, Aleukaemia 4 ... ... ... ... ... 1 1 2 ... ... 2 1 ... 1 ... 1 ... ... 1 ... 1 9 Diabetes 6 ... ... ... ... ... ... ... 1 3 2 4 1 ... 1 3 ... ... ... ... ... ... 9 Vascular Lesions of Nervous System 89 ... ... ... ... ... 1 1 21 25 41 23 14 6 46 45 2 4 ... 7 2 11 205 Coronary Disease, Angina 114 ... ... ... ... ... ... 2 37 33 42 39 17 ... 58 20 3 8 ... 1 3 18 107 Hypertension with Heart Disease 23 ... ... ... ... ... ... ... 2 7 14 5 4 ... 14 3 1 2 ... 2 ... 4 30 Other Heart Disease 175 ... ... ... ... ... ... 3 19 41 112 66 27 10 72 83 2 9 ... 6 6 19 291 Other Circulatory Disease 41 ... ... ... ... ... 1 1 4 12 23 11 10 ... 20 17 2 3 ... ... 1 7 63 Influenza 4 ... ... ... ... ... ... ... 1 2 1 2 ... ... 2 1 ... ... ... ... 1 ... 2 Pneumonia 64 ... 4 ... ... ... ... ... 9 14 36 25 13 3 23 40 ... 4 ... 5 1 5 169 Bronchitis 55 ... ... ... ... ... ... ... 9 17 29 19 17 4 15 25 1 4 ... 1 1 2 91 Other Diseases of Respiratory System 8 ... ... ... ... ... ... 1 3 2 2 2 ... 3 3 2 ... 1 ... 1 ... ... 17 Ulcer of Stomach and Duodenum 17 ... ... ... ... ... ... ... 6 5 6 4 5 3 5 8 2 2 ... ... ... 4 18 Gastritis, Enteritis and Diarrhoea 4 ... ... ... ... ... ... ... 1 1 2 1 1 ... 2 1 ... 2 ... ... ... 1 8 Nephritis and Nephrosis 3 ... ... ... ... ... ... 1 ... ... 2 1 ... ... 2 1 ... ... ... ... ... 1 5 Hyperplasia of Prostate 5 ... ... ... ... ... ... ... ... 1 4 2 2 ... 1 2 ... l ... ... ... 2 12 Pregnancy, Childbirth, abortion 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 12 Congenital Malformations 9 7 2 ... ... ... ... ... ... ... ... 5 1 ... 3 1 ... 2 ... ... ... 6 Other defined and ill-defined Diseases 57 15 1 ... ... 1 ... 1 16 7 16 17 14 2 24 24 ... 6 ... 1 2 20 118 Motor Vehicle Accidents 9 ... ... ... ... 2 ... ... 3 2 2 2 ... 2 5 ... ... 1 ... ... ... 8 18 All other Accidents 19 ... ... ... ... 1 1 3 6 5 2 8 4 ... 7 4 2 1 ... 2 ... 8 28 Suicide 9 ... ... ... ... ... 1 1 3 2 2 3 ... ... 6 3 ... ... ... ... ... 1 10 Homicide and Operations of War ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 927 23 7 1 — 4 8 26 223 238 396 315 161 39 412 350 24 65 — 34 20 173 1,549 Note.—All "Transferable Deaths" of residents, i.e., persons resident in the Borough who died outside it have been included. The transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales, and who died in the Borough in like manner have been excluded