AC 4347 GRE 61 II Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1963 Metropolitan Borough of Greenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1963 Printed by Bromley Office Supplies & Printing Co., Ltd. 39 & 41 East Street. Bromley, Kent. CONTENTS Page Public Health Committee 3 Introductory 7 Section A.—General and Vital Statistics 10 „ B.—General Provision of Health and Welfare Services for the Area 43 „ C.—Sanitary Circumstances of the Area 51 „ D.—Housing 111 „ E.—Inspection of Food and Supervision of Food Premises 122 „ F.—Prevalence of, and Control Over Infectious and Other Diseases 149 „ G.—Miscellaneous 163 Appendix—Statistical Tables 3 PUBLIC HEALTH COMMITTEE (as at 31st December, 1963) The Mayor: (ex-officio) Councillor Mrs. I. M. Scales, J.P. Chairman: Councillor D. P. Lynch Vice-Chairman: Councillor A. C. Chrisp, L.C.C. Alderman: W. S. Manners, M.B.E. Councillors: Mrs. M. L. Bennett Mrs. E. Pennington Mrs. J. E. Chrisp H. A. Read Mrs. A. D. A. Kennedy R. Ruston F. E. Mann L. Squirrell P. Noble Mrs. M. L. Wentworth 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 the Home Safety Act, 1961, and the powers and duties of the Council under Section 69 of the London County Council (General Powers) Act, 1961, relating to the provision of meals for invalids, shall stand referred to the Committee. 13.—The powers and duties of the Council under the Offices. Shops and Railway Premises Act, 1963, and of the Animal Boarding Establishments Act, 1963, shall be referred to the Committee. 6 STAFF (as at 31st December, 1963) MEDICAL OFFICER OF HEALTH: John Kerr Brown, B.Sc., M.B., Ch.B., D.P.H. PUBLIC ANALYST: H. A. Williams, Ph.D., A.C.G.F.C., F.R.I.C. PUBLIC HEALTH INSPECTORS: abc G. B. Allen (Chief P.H.I.) ab C. W. Spore (Deputy Chief P.H.I. & Senior Food Inspector) ab W. C. Scales (Food Inspetor) a J. G. Lyons (Clean Air Act Inspector) District Public Health Inspectors: ab G. E. Clayton-Turner (i) ab D. J. Hopgood abc S. A. Radford ab S. Kelly ab D. B. Smith Assistant Clean Air Officer : E. H. Cooper (ii) Student Public Health Inspectors: R. W. Darvill (iii) R. Smart D. Thew PUBLIC HEALTH OFFICERS : abdef Miss B. Hatfield (Senior) def Miss N. A. Fluck df Mrs. M. E. Charteris ADMINISTRATIVE & CLERICAL STAFF : L. A. Westacott (Chief Administrative Assistant) A. H. Wilcox (Senior Administrative Assistant) K. G. Allum, D.F.M. Mrs. M.G. Simpson (Senior S/H Typist) Mrs. D. F. Howard J. A. Sutherland W. C. A. Law (iv) C. Weymouth Miss F. A. Reynolds (v) Miss W. E. Wilson Conveniences Superintendent: W. F. Goodall CLEANSING CENTRE & DISINFECTING STAFF : T. Smith (Foreman) J. J. Keating A. K. Nunn L. Wade Senior Cleansing Officer : Mrs. E. L. Towler (with staff of 4 women) RODENT CONTROL DISINFESTATION AND GENERAL DUTIES: Team of six men a Certificated Public Health Inspector (i) commenced duties 1st July, 1963. b „ Meat and Other Foods (ii) commenced duties 6th May, 1963. c „ Smoke Inspector (iii) commenced duties 1st November, 1963. d „ Health Visitor (iv) commenced duties June, 1963. e „ State Certified Midwife (v) commenced duties 22nd July. 1963. 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 and environmental circumstances of Greenwich for 1963, which has been a year of solid progress and has seen the preliminary steps taken to improve the services available to certain of the more vulnerable sections of the local community. Although the total population shows a decrease of 970, there was a slight increase in births and a decline in deaths. The infant mortality rate at 14.3 per thousand live births was the lowest ever recorded in the history of the Borough, and is all the more gratifying in that, for some years the rate has been higher than one would have wished. It is, of course, trends over several years, perhaps even a decade, that are significant, but after several successive years on the high side it is encouraging to see the rate back to a level which compares favourably with any area in the country. There were corresponding decreases in neo-natal, early neo-natal and peri-natal deaths. Turning to the actual causes of deaths, there were, for the second successive year, no maternal deaths. Apart from deaths from tuberculosis, which increased by four, there were decreases in all the main causative categories. It is pleasing to note a decrease in deaths from lung cancer and cardio-vascular conditions, although it is much too early to draw any conclusions as to the underlying reasons. Enough has been written about stress and respiratory irritants and carcinogenic factors in previous reports to indicate the main lines of prevention but the results of anti smoking and clean air campaigns can only be measured in the long term. The recently published results of an investigation conducted in America into the causative factors of pulmonary malignancy and circulatory disturbances, only serve to emphasise the irrefutable validity of the warnings which have been given in this country about the dangers of cigarette smoking. 8 There were no serious outbreaks of infectious diseases but total notifications show a large increase due particularly to measles and dysentery. The latter illness has affected mostly young school children and the supervision and bacteriological control throw considerable burdens on the staff resources. A measles vaccine is now being developed and perhaps by next year extensive clinical trials can be undertaken by the Medical Research Council. Six notified cases of food poisoning were reported and the incidence of whooping cough increased; there being 35 cases notified. It is not certain how many of the cases had been effectively immunised but this illness, in the early years, can be most debilitating and it is essential that the maximum numbers of young children are protected. The established services in relation to the elderly were expanded still further and two new ventures were inaugurated. One was the introduction of an experimental lunch club to augment "Meals on Wheels", which was commenced in the Minor Hall in October. This is being run by the Old People's Welfare Association, with the financial assistance of the Borough Council, who are also making available the Hall letting at a favourable rate. The other was the commencement of a limited chiropody service for the less able-bodied and physically handicapped of the older groups. The Borough Council have also completed the purchase of a holiday hotel at Westgate-on-Sea for the use of the old people of Greenwich, and a full description is included in the report. Certain alterations are required and it is anticipated that the hotel will be in full occupation by the early spring of next year. This new facility should allow upwards of 1,000 old people to be offered a holiday every year and will be a valuable asset. The main legislation directly affecting the department is the new Offices, Shops and Railway Premises Act, 1963, and a synopsis of the main provisions is included. The effective implementation of the Act will require the engaging of at least another Public Health Inspector, but compulsory improvements of conditions of work in offices and similar establishments are long overdue. As regards atmospheric pollution, another extensive area included in the Smoke Control Order No. 6 awaits ministerial confirmation. In considering the year under review, one can be satisfied that the progressive outlook of the Council has been continued and, notwithstanding any changes which may be impending in London 9 Government, the Metropolitan Borough of Greenwich can take pride that they are in control of a going concern and, in their own field, have much to contribute. Nothing would be possible without the active interest and enthusiasm of the responsible committee and I am mindful of the kindness they have shown to the staff and to me personally. The Chairman and Vice-Chairman have been ever ready with their support and I am grateful to them. In conclusion I must pay tribute to the staff for their loyalty and their efforts. I have the honour to be. Your obedient Servant. J. Kerr Brown, Medical Officer of Health. 10 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, 1961 85,546 Estimated, 1963 (mid-year) 83,760 Density of Population (persons per acre) 21.71 Number of Inhabited Dwellings—end 1963 24,765 (according to Rate Books) Structurally separate dwellings at Census. 1961 25,096 Number of Uninhabited Dwellings— At Census, 1961 488 At end 1963 355 Number of Families or Separate Occupiers— At Census, 1961 27,127 Rateable Value, 1963 £4,974,845 Sum Represented by a Id. Rate. 1963 £20,500 11 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.) 12 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 which, although quite unsuitable for the erection of dwelling-houses, is appropriate for industrial development. 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 inhabi ted for over 2,000 years—certainly Crooms Hill is pre-Celtic whilst Shooter's Hill, along with many other place names, is clearly 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 13 burial mounds and barrows dating from the 6th century are still to be seen in Greenwich Park. 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 been unsuccessful, Greenwich is unquestionably royal by association. It seems clear that the early Norman kings preferred Winchester but, at the time of St. Alfege's martyrdom, the English king was resident and had a Royal Treasury at Greenwich. However, it was not until the reign of Henry IV that Greenwich was regarded as one of the seats of government, at which time Henry was building himself a house in the south-east corner of Blackheath, probably on the site of the present Morden College. Years later the Tudors came by river from Westminster to the Palace of Placentia, their best loved home, built during the 15th century by Humphrey, Duke of Gloucester, brother of Henry V of Agincourt fame. Originally called Bella Court, this fine red bricked edifice was re-named Palace of Placentia by Margaret of Anjou, the wife of Henry VI, who spent large sums of money on beautifying it, tiling the floors and filling the windows with glass. At this munificent palace lived Henry Tudor (Henry VII), the victor of the Battle of Bosworth Field (1485) and the true founder of English maritime power and he it was who began the Tudors' long association with Greenwich. It was here that Henry VIII, his daughter Mary and her half sister Elizabeth, were born and spent much of their time, and where Edward VI, son of Henry VIII, died at the early age of 16 years. At this palace the ill-fated Anne Boleyn, second wife of Henry VIII and mother of Queen Elizabeth I, was arrested and taken by barge to the Tower of London to be beheaded. 14 and, within the precincts of this noble Greenwich residence, the marriage of Henry VIII to Anne of Cleves was celebrated. When Westminster again became the centre of government the Palace of Placentia, the favourite royal resort up to the time of James II (1685), became the scene of countless tournaments, pageants and lavish spectacles. Greenwich in its hey-day and during one of the most colourful periods in English history, was the haunt of most eminent people of the time and the great Elizabethan admirals, statesmen, philosophers, writers, musicians and courtiers thronged the riverside and splendid palace nestling at the foot of Greenwich Hill in some 200 acres of beautiful sward and delightful woodland. Towards the end of this "golden age" 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. Following the execution of Charles I the Palace fell into disrepair but on the restoration of Charles II in 1660 the first of the four blocks of the present Royal Naval College was commenced, to the overall plan of Christopher Wren. This group of imposing and stately buildings, now the Navy's University, were themselves to become equally as world famous as the original palace. 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 aores. Blackheath, one of London's most famous open spaces, forms the southern boundary, 89 acres of which are within the Borough, providing unsurpassed facilities for games, sports and amusements. Excellent recreation grounds serve the Charlton area for in addition to the Maryon and Charlton Parks, there is the L.C.C. Play Centre and Lido with its well-equipped open-air swimming bath, tennis courts and bowling greens. In all, public open spaces amount to 11 per cent of the total area of the Borough, equivalent to approximately five acres per 1,000 of its population. Areas located near the River Thames are, generally speaking, industrial but more densely populated than the upper parts of the Borough. In recent years, however, the commencement of a gradual movement of people away from the river-side has been witnessed. 15 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 oharity 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 and sometimes directly from Kent and Surrey, the vegetables, for the most part, are supplied either from Greenwich market (which obtains its produce predominantly from the Kent area) or from the Covent Garden and Borough markets in London. From its inception as a Borough, Greenwich has always been in the forefront of progressive health authorities and now within its area all aspects of health, personal and environmental, are amply covered. These range from the normal maternity, child welfare and school health services, to the usual general practitioner and hospital services, and from the useful municipally-run chiropody clinics to the special geriatric, thoracic and neuro-surgical units based at local hospitals of which there are four. One military hospital is also located within the Borough. 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. 16 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 sohools in the area which are conducted independently of the County Council and which cater for fee-paying pupils. There are four excellent public libraries, each incorporating reading rooms for free access to daily newspapers, weekly and monthly periodicals, which offer a service of Braille and "talking books" for the blind and, recently, opportunities for the borrowing of gramophone records have been made available to residents over the age of 18 years. In particular, the Central Library is admirably adapted to enable private study to be undertaken in proximity to a comprehensive reference section. Social centres providing for all shades of cultural and educational tastes have been established at Charlton House, Kidbrooke House, the Town Hall and West Greenwich House under the auspices of the Greenwich Community Council in conjunction with the L.C.C. and, in this connection, it can be stated that there are upwards of 65 clubs and societies affiliated to this Community Council. Besides Associations for rowing and barge sailing, the local sports clubs include the famous Blackheath Football Club (the oldest of all rugby football clubs) and the newer professional Charlton Athletic Football Club. Fourteen "Old People's Clubs", each of which receives an annual grant from the Council, cater for the elderly residents of the Borough and in five instances accommodation for these clubs is made available by the Council free of charge. In addition to the five luncheon clubs and an effective "Meals-on-Wheels" service established especially for the "homebound", another three luncheon and three day clubs have been introduced to ameliorate still further the lot of the retired. More recently, realizing the substantial benefits accruing to the aged from a satisfying holiday, the Council purchased a first class hotel at Westgate-on-Sea for the exclusive use of its elderly residents and holidays have now been made available to them throughout the year at nominal cost. 17 In suitable cases, arrangements are made for the elderly to be bathed either in their own homes or at the Council's new Bathing Centre and a special "incontinent laundry" service has been introduced for the cleansing of soiled bed linen and clothing of the bedridden. 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 SUPERFICIAL GEOLOGY Superficial deposits making up the area of the Borough of Greenwich are found to be (a) alluvium, a damp clay soil, impervious to water and generally not more that about 15 feet thick and (b) gravel and sand of various ages, highly permeable to water and not usually more than 20 feet thick. These two series are in the Post Pliocene or tertiaries or drift series, whilst of the Eocene tertiary formations we have (1) the London clay, a stiff bluish clay impervious to water of not more than 450 feet deep; (2) the lower London tertiary consisting of pebble beds, sands, clay and loam, more or less permeable and of a thickness not exceeding 190 feet and (3) chalk, permeable, highly absorbent and about 800 feet thick. These various deposits are found distributed roughly as follow:— The alluvium stretches along the River bank, commencing towards the east at a point on the Riverside in the Royal Dockyard premises, Woolwich: thence roughly following the Woolwich Road and keeping parallel to it on the north side, at a distance of about one hundred yards, until Blackwall Lane is reached, where the line of Pelton Road is followed up to the River Bank, the alluvial deposits finishing off at this point altogether and commencing again on the River Bank at a point near Greenwich Pier: thence crossing Creek Road, near St. Peter's School, the Southern Railway, near the siding, between Greenwich Station and the Deptford Creek, very nearly along the line of Norman Road, crossing the Greenwich High Road almost in line with Egerton Drive, across Blackheath Road to the Borough boundary, thence also following that boundary along the Deptford Creek to the point where the boundary leaves that water, whence the line of alluvial deposits follows roughly the contour of the River Bank, at a distance of about one hundred and fifty yards. The remainder of the district of St. Nicholas, not included in the above delineation, is on gravel and sand. The gravel and sand commences eastwards at a point on the 19 delimiting line of the alluvium, on the north side of the Woolwich Road, about two hundred yards westerly of Anchor and Hope Lane; thence, for its northern margin, it follows the southern delimiting line of the alluvium to Pelton Road, whence to Greenwich Pier the gravel reaches along the River Bank itself, thence again following this line right up to the boundary of the Borough of Lewisham; for the southern delimiting line of the gravel we pass from the point where the gravel begins on the east almost immediately over Woolwich Road, in a direct line to the Westcombe Park Station, thence following fairly closely the line of the Southern Railway until Vanbrugh Hill is reached, whence it passes to the south side of that Railway and continues in almost a direct line to the old Greenwich Park Station premises, thence following on to the old Blackheath Hill Station to join the northern delimiting line near the Borough boundary. A geological fault occurs in the gravel bed and extends in a line running almost centrally through the whole bed as it exists in this Borough, a somewhat narrow strip of chalk is found running almost parallel to the Southern Railway, commencing where that line enters the eastern boundary of the Borough and extending in area for about two hundred yards to the north and south of that line, stopping at a point about four hundred yards west of Westcombe Park Station. A small area of chalk is found again on Blackheath Hill, extending about five hundred yards north and south of old Blackheath Hill Station premises and for two hundred yards east of same. A small pocket of chalk is also found on the Southern Railway line just east of Vanbrugh Hill. The lower London tertiaries are found throughout practically the whole of the remaining portion of Charlton, extending westward along the southern delimiting line of the chalk and gravel passing along the southern boundary of the Borough, across Blackheath to Blackheath Village and Lee Green, thence roughly from Weigall Road to the eastern end of Blackheath Park, thence to Charlton Park Lane and along same to the Borough boundary. 20 SUPERFICIAL GEOLOGY 21 London clay is found throughout the remainder of Kidbrooke. The accompanying sketch map will assist in elucidating the various delimited areas. The altitude throughout the whole of the Borough varies from a few feet below high water mark on the marshes up to 249 feet above sea-level on the Shooters Hill Road just at the Borough boundary. Vacant land on the marshes, consisting chiefly of alluvial deposits, is quite unsuitable at present for the erection of dwelling houses as its level is below that of the River at high water. This fact complicates the drainage problems of the district and the houses already built there are subject to flooding at times of heavy storms. The difficulty has been overcome in some instances in the past by the filling up of the basement rooms but even this treatment is most unsatisfactory. Due to special drainage systems and the introduction of concrete rafts considerable factory development has taken place in this area in recent years. POPULATION General—The Registrar General has submitted his estimate of the population of Greenwich, computed at mid-year 1963, upon which the statistics of this Report have been based. The figure returned is 83,760, indicating a decrease in the population of 970 since last year and a fall of 1,786 since the 1961 Census. However, the current figure shows an advance of 19,960 over that for 1945. Natural Increase—The natural increase for the year, i.e. excess of births over deaths, was 448 compared with 382 for 1962. 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. 22 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 66% and that of "dependent" groups collectively, to 34%. In effect, this means that for every two persons of "working age" there is at least one dependent person outside this group. ESTIMATED AGE COMPOSITION OF THE POPULATION As estimated by the Registrar General: Age No. Approx. % of Total Population Under 1 year 1,340 1.6 1 to 4 years 5,060 6.0 5 to 15 years 11,300 13.5 Total Child Population 17,700 21.1 Estimated locally: 15 to 64 years 55,298 66.0 65 years and over 10,762 12.9 Total Population 83,760 100.0 23 * EXTRACTS FROM VITAL STATISTICS OF THE YEAR LIVE BIRTHS Legitimate Illegitimate Total Birth Rate (Crude) 16.67 (Comparable Rate 16.00) Male 657 63 720 Female 614 58 672 Total 1,271 121 1,392 STILL BIRTHS Legitimate Illegitimate Total Rate per 1,000 12.06 total Births Male 11 – 11 Female 4 2 6 Total 15 2 17 DEATHS—All Causes Male Female Total Death Rate (Crude) 11.30 (Comparable Rate 12.09) 481 463 944 DEATH RATES—Special Causes Infants under 1 year of age No. Rate All infants (per 1,000 live births) 20 14.37 Legitimate Infants (per 1,000 legitimate live births) 18 14.16 Illegitimate Infants (per 1,000 illegitimate live births) 2 16.52 Neo-Natal Deaths (per 1,000 live births) 10 7.18 Early Neo-Natal Deaths (per 1,000 live births) 9 6.46 Peri-Natal Mortality (per 1,000 total births) 26 18.45 Others Maternal Causes (per 1,000 total births) – – Tuberculosis (all forms) (per 1,000 population) 10 0.11 Tuberculosis, Pulmonary (per 1,000 population) 9 0.10 Cancer (per 1,000 population) 187 2.24 Heart (per 1,000 population) 306 3.66 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. 24 MARRIAGES Mrs. V. M. Gilham, 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 1963. The total of 688 gives a marriage rate of 16.48, an increase of 0.38 over that of the previous year. The comparable figure for England and Wales is 14.9 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 1 18 226 682 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 1962 165 132 12 139 232 680 84,730 1963 182 135 8 135 228 688 83,760 ‡ St. Peter's, Creek Road Closed. ‡ Holy Trinity, Blackheath Hill † Parish Church destroyed by enemy action * Parish Church reopened. 25 METEOROLOGICAL OBSERVATIONS—1963 I am indebted to the Director of the National Maritime Museum and, in particular, to Lieutenant-Commander D. W. Waters, R.N., Curator of Navigation and Astronomy, for the following meteorological data for the year ended December, 1963 :— Temperature Highest screen temperature 80° on 23rd July. Lowest screen temperature 26° on 24th January. Maximum in January 41° on 26th. February 42° on 28th. November 60° on 3rd, 5th, 18th and 19th. December 50° on 29th. Sunshine Total for year 1253.7 hours. Sunniest day 13.5 hours on 2nd June. Number of days without sun, 101 distributed as follows:— January 18 February 12 March 5 April 4 May 5 June 4 July 2 August 3 September 5 October 9 November 11 December 23 Rainfall Total 22.22 inches. Highest fall in 24 hours 0.98 inches 6th July. Driest month 0.5 inches March. Wettest month 3.75 inches September. 26 BIRTHS The total number of live births registered in the Borough during the year was 1,965 and of this number 1,576 occurred in St. Alfege's Hospital, and 389 in private dwellings. In 1,053 cases the parents resided outside the Borough and these births were consequently transferred to their appropriate districts, leaving a figure of 912. 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 1,392, an increase of 45 over that of the previous year. Of this total 720 were males and 672 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:— 345 233 39 295 912 Inward Transfers:— 1st Qtr. 42 7 – 65 114 2nd Qtr. 41 19 – 76 136 3rd Qtr. 37 17 – 61 115 4th Qtr. 34 22 3 56 115 Totals 499 298 42 553 1,392 The Birth Rate for the year, calculated on the figure of 1.392 births, is 16.67 per thousand of the population, 0.72 higher than that for 1962. The average rate for the previous ten years is 14.95. The Greenwich Comparability Factor for births is 0.96 which gives an adjusted rate of 16.00. The Rates for the County of London and England and Wales are 20.0 and 18.2 respectively. ILLEGITIMATE BIRTHS These numbered 121 (representing 8.7 per cent of the total live births), an increase of 34 over the figure returned for 1962. STILL BIRTHS The number registered was 17 (11 males-6 females), which is equivalent to a rate of 12.06 per 1,000 total births, a decrease of 4.73 from that of the previous year. London returned a rate of 15.7 and that for England and Wales was 17.2. Causes of Death Sex Deaths at subjoined Ages of "Residents," whether occurring within or without the District. All Ages. Under 1 year 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and over Under 4 Wks 4 wks and under 1 year All Causes M 481 6 5 3 1 5 6 15 53 107 120 160 F 463 4 5 2 1 6 4 11 31 55 112 232 Tuberculosis, Respiratory M 6 – – – – – – – – 1 3 2 F 3 – – – – – – – – 1 1 1 Tuberculosis, Other M – – – – – – – – – – – – F 1 – – – – – 1 – – – – Syphilitic Disease M 1 – – – – – – – 1 – – – F 1 – – – – – – – – – – 1 Diphtheria M – – – – – – – – – – – – F – – – – – – – – – – – – Whooping Cough M – – – – – – – – – – – – F – – – – – – – – – – – – Meningococcal Infections M – – – – – – – – – – – – F 1 – 1 – – – – – – – – – Acute Poliomyelitis M – – – – – – – – – – – – F – – – – – – – – – – – – Measles M – – – – – – – – – – – – F – – – – – – – – – – – – Other Infective and Parasitic Diseases M 2 – - - — – – – – 2 – – F 2 – – - - - - 1 - _ 1 - Malignant Neoplasm, Stomach M 19 – – – – – – 2 9 3 5 F 17 – – – – – – – 1 3 7 6 Malignant Neoplasm, Lung, M 48 – – – – – 1 2 8 18 15 4 F 8 – – – – – – – 2 3 1 2 Malignant Neoplasm, Breast M – – – – – – – – – – – - F 16 – – – – – – 2 2 4 2 6 Malignant Neoplasm, Uterus F 5 – – – – – – 1 1 1 1 1 M 32 – – – – – – – 7 6 10 9 Neoplasms Leukaemia, Aleukaemia F 42 – – - - 1 - - 3 7 9 22 M 2 – - - - - - - 1 - — 1 Diabetes F 2 – - - - - - - 1 - 1 - M 2 – – – – – – – 1 1 - - Vascular Lesions of Nervous F 6 – – – – – – – – 1 4 1 M 26 – – – – – – 1 2 2 8 13 System Coronary Disease, Angina F 54 – — — – 1 – – 2 8 17 26 M 102 – – – – – 1 4 17 26 25 29 Hypertension with Heart Disease F 85 – – – – – – – 4 6 22 53 M 5 – – – – – – – – 2 1 2 Other Heart Diseases F 17 – – – – – – – – 2 4 11 M 44 – – – – – 1 - 2 4 11 26 Other Circulatory Disease F 53 – _ _ _ 1 1 1 4 6 8 32 M 26 – – – – – – 3 2 5 8 8 Influenza F 26 – - - - 1 - 1 1 3 6 14 M 2 -– - - - - - - 1 - - 1 Pneumonia F 2 – – –– – – – – – – 1 1 M 28 – 2 1 _ 1 _ 1 11 12 Bronchitis F 36 – 2 1 - - 1 1 2 29 M 53 – 2 1 16 15 19 Other Diseases of Respiratory F 19 – 1 1 7 10 M 5 – _ 1 _ _ _ _ – 2 _ 2 System Ulcer of Stomach and Duodenum F 1 – – – – – – – – – 1 - M 5 – – – – – – – 1 1 1 2 Gastritis, Enteritis and Diarrhoea F 4 – – – – – – – 1 1 1 1 M – – – – – – – – – – – – Nephritis and Nephrosis F 3 – – – – – – – – – 2 1 M 7 – – – – – – – 1 2 1 3 Hyperplasia of Prostate F 1 – – – – – – – – – 1 – M 9 – – – – – – – – – 3 6 Pregnancy, Childbirth, abortion F – – – – – – – – – – – – M – – – – – – – – – – – – Other defined and ill-defined F 3 – 2 – – – – – – – 1 – M 32 6 1 – 1 _ 1 2 2 5 2 12 Diseases Motor Vehicle Accidents F 39 4 – 1 1 1 2 2 5 5 7 11 M 9 – – – – 4 – 1 1 – 2 1 All other Accidents F 6 – – – – 1 – – _ – 3 7 M 9 – – 1 – – 1 1 2. 1 1 7 Suicide F 3 – – – – – – 1 1 – – 1 M 6 – – – – – 1 1 1 2 – 1 Homicide and Operations of War F 7 – – – – – – 1 2 2 2 – M 1 – – – – – – – – 1 – – F – – – – – – – – – – – – 27 DEATHS The net number of deaths registered during 1963 was 944, of which 481 were males and 463 females, compared with last year's total of 965 comprising 528 males and 437 females. This gives a crude Death Rate for the Borough of 11.30 per thousand of the population, representing a decrease of 0.12 compared with that of the previous year and a rate which is 1.29 greater than the average for the last ten years, viz., 10.01. The Crude Death Rate figure is increased to 12.09 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 1.07 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 12.5 and 12.2 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. 28 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 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 1961 927 647 69.8 1962 965 680 70.5 10-year average 881 566 63.9 1963 944 599 63.5 AGE MORTALITY The age mortality and the distribution of the deaths between the different quarters of the year are shown by the following table:— Deaths 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Under 1 year of age 5 5 5 5 20 Between 1 and 2 years 2 – 1 – 3 Between 2 and 5 years 2 – – – 2 Between 5 and 15 years – 1 1 – 2 Between 15 and 25 years 3 3 2 3 11 Between 25 and 35 years 5 – 2 3 10 Between 35 and 45 years 6 6 10 4 26 Between 45 and 55 years 16 28 12 28 84 Between 55 and 65 years 51 28 38 45 162 Between 65 and 75 years 80 49 44 59 232 75 years and upwards 135 93 82 82 392 Totals 305 213 197 229 944 29 The first quarter of the current year produced 32.3% of the year's total deaths whilst there was little variation between the 2nd and 4th quarters the figures being 22.6 and 24.2 respectively; as expected at 20.9% the 3rd quarter yielded the least. It will be observed from the following table that during 1963 the deaths occurring at 65 years and upwards accounted for 66.1% of the total compared with a figure of 22.8% for 1901. Deaths in the age group 0-5 years show an even more striking comparison; in 1901 the deaths in this group amounted to 37.4% whilst the figure for the current year is 2.6%. Age Group 1901 1911 1921 1931 1951 1961 ###] Under 1 year of age 362 306 175 97 29 30 20 Between 1 and 5 years 187 158 80 39 7 2 5 Between 5 and 15 years 64 67 58 22 10 4 2 Between 15 and 25 years 66 60 67 65 12 8 11 Between 25 and 65 years 454 474 466 382 311 252 282 65 years and over 335 356 387 529 633 631 624 Totals 1,468 1,421 1,243 1,134 1,002 927 944 MATERNAL MORTALITY There were no maternal deaths recorded during the current year, a situation similar to that obtaining during the previous year. One maternal death was registered in each of the years 1961 and 1960, the respective rates being 0.75 and 0.78. Both of these deaths were due to "self-induced" abortions. INFANTILE MORTALITY Infant Mortality of any given locality is measured by relating the number of deaths recorded during the year of children under one year of age to the number of live births registered for that particular area during the same period. Bad housing, overcrowding, poor sanitation, low standards of education, illegitimacy, all tend to produce higher infant mortality rates. It follows therefore that the infant mortality rate should 30 provide a reasonably accurate indication of the social circumstances of any particular area. However, because approximately one third of all infants dying in one year will be found to have been born in the previous year, great care must be exercised when drawing conclusions from any rise or fall in infant mortality rates, for such rates are not comparable year by year unless the birth rates remain more or less constant. Further, it must be borne in mind that as infant mortality has now reached relatively small proportions, any slight deviation in the number of deaths tends to misleading fluctuations in the rate and only a long term appraisal is likely to reflect the true position. As reported on numerous occasions in previous Annual Reports, the refractory core of infant mortality is the perinatal death, for there are as many deaths in this brief period of life as will occur during the next 40 years among the survivors. A recent survey of perinatal mortality instituted by the National Baby Trust Fund, covered 98 per cent of all births in England, Scotland and Wales (17,500) which occurred during one week in March, 1958, and 94 per cent of the 8,000 perinatal deaths during three months of the same year. This valuable survey showed that the risk of perinatal deaths varied geographically from North and West to South and East, as much as 40 per cent and confirmed that poor physique and standards of health, increasing maternal age, multiparity and social class, all exert influences on perinatal mortality; but, having listed these, it is a far cry from providing suitable remedies. For instance, there is the equivalent of a 30 year gap between the infant mortality rates of unskilled workers and the professional group. This is most unexpected when one considers that identical social and welfare services are available to all Social Groups (Groups as defined by the Registrar-General). Paradoxically, the survey revealed that improvements in living standards of the lower social groups would appear not to have had as great an effect as anticipated on the factors concerned with infant mortality. The latest available figures for England and Wales showed that the infant mortality rate of Social Group I was about 19 per thousand compared with 40 for Social Group V. Investigations have indicated that it is likely that "housing" and "education" have a greater effect on infant mortality, but that these are essentially "long term" remedies. In addition, it seems that surprising differences in attitudes towards the use of available welfare and medical services exist among the social groups. (A recent family survey in Newcastle showed that attendances at welfare centres of families of Class II and III were twice as 31 good as those of Class V.) Further, although actual numbers were fortunately small, babies of mothers who had no ante natal care had a mortality rate some 5 times that of the overall national figure. Other facts brought to light by the survey were that during pregnancy ⅓d of all women had no blood test for anaemia and 1/6 th did not have their blood pressure taken at each visit to the doctor. Maternity services are provided in three ways, viz, the hospital, the local authority and the general practitioner, a situation which often leads to frustration and even desperation when the expectant mother is referred in turn from one to the other instead of being allowed to deal with one agency only. Perhaps this situation is responsible for the fact that, in the survey previously mentioned, more than half the mothers did not attend for ante natal care before the 16th week. This information will doubtless give added impetus to those who would make out a case for a unified service while maintaining that such a consolidation will encourage a more ready response for these services from the prospective mother. It has long been recognised that priority for skilled obstetric attention should be afforded the prima para, the young and the rather older mother, and those mothers having their fourth or subsequent child. This, to all intents and purposes, means a hospital bed. At present, when there are more women of child bearing age than ever before and the birth rate is rising quite perceptibly, the pressure on hospital beds for maternity cases is mounting. Unfortunately, staff to attend these cases has not increased pro rata; hospitals, therefore, are driven to institute a system of early discharge which inevitably throws an added volume of work on domiciliary midwives whose numbers are insufficient to cope satisfactorily with such extra cases. Traditionally, the mother of the young wife has been close at hand to assist, but with the mobility of population resulting from the numerous housing projects, one often finds the younger generation far removed from this type of assistance. Domiciliary midwifery is a local authority responsibility and. as hospital facilities are unlikely to expand sufficiently quickly, an increase in births and a growing number of early discharges could create substantial difficulties locally. Fifty years ago infant mortality in Greenwich was at the rate of 108 per 1.000 live births, the actual number of children 32 dying before reaching the age of one year being 261. Comparable figures for the current year are 14.37 and 20 respectively. For the County of London the rate was 21.8 whilst that for England and Wales was 21.1 The present figure of 14.37, which is the lowest ever recorded for the Borough, shows a reduction of 18.29 from that of the previous year and is 6.28 lower than the average for the last 10 years. A table showing the causes of and ages at death is included in the Appendix to the Report. The following table shows the comparative Infantile Mortality Rates for the quinquennial periods since 1931, together with the Rate for 1963:— District Average for Quinquennial Periods Year 1963 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 14.37 London 63 56 60 33 23.8 21.9 21.8 England and Wales 62 55 50 36 26.9 22.7 21.1 The actual number of infantile deaths recorded during the year was 20 (24 less than last year) and these were attributed to the following causes: — Prematurity 4 Pneumonia 4 Congenital Malformation 2 Acute Tracheo Bronchitis 2 Cerebral Anoxia Breech Deliver (result of) 1 (Cord round neck) 1 Birth Injury 1 Haemolytic Disease of Respiratory Distress 1 Newborn 1 Fatty Degeneration of Meningitis Liver 1 (Meningococcal) 1 Meningitis (E. Coli) 1 Of the above, 11 were male and 9 female; 3 died in St. Alfege's Hospital, 3 in the Brook Hospital, 4 at home and 10 in hospitals and institutions outside the Borough. Neo-Natal Mortality —Neo-natal mortality, i.e., infants dying before attaining the age of one month, accounted for 10 deaths equivalent to 50 per cent of all infant deaths and giving a Neonatal Mortality Rate of 7.18 per 1,000 live births. This rate is a reduction of 15.09 from that of the previous year and compares 33 very favourably with the figure of 14.2 returned for England and Wales. Early Neo-Natal Mortality.—Nine neo-natal deaths Which occurred within the first week of birth gave an early neo-natal mortality rate of 6.46 per 1,000 live births, the causes being: — Prematurity 4 Haemolytic Disease 1 Birth Injury 1 Respiratory Distress 1 Breech Delivery 1 Cord round neck 1 Perinatal Mortality—The Perinatal Mortality Rate, calculated from a total of 26 still births and deaths of infants under 1 week, was 18.45 per 1.000 total births compared with 35.76 for the previous year. The equivalent rate for England and Wales is 29.3. Reproductive Wastage.—A sum total of 37 Stillbirths and Infantile deaths gives a reproductive wastage rate of 26.26 per 1,000 total births, a decrease of 22.64 from the 1962 figure. 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 34 and Diarrhoea, no deaths were registered for the current year compared with one for 1962, none for 1961, 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 61st since a death from this disease occurred. Measles.—During 1963 no deaths from measles were recorded compared with none for the previous 2 years and one for 1960. There were no deaths from this complaint during the years 1959 and 1958. Scarlet Fever.—For the 17th 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 compared with one for 1962 and a nil return 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 has 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 1962, 1961, 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 17 years since one was recorded. Tuberculosis.—There were 10 deaths from this disease during the year, giving a death rate of 0.11 compared with 6 deaths and a rate of 0.07 for 1962. The rate for the present year has risen to that for the average of the past 10 years, viz 0.11. an indication that the struggle against this most refractory disease is by no means over. Although in Greenwich the numbers are small and therefore liable to wide fluctuation generally they do reflect the national trend. In 1963 the rate for England and Wales in respect of all forms of tuberculosis was 0.06 compared with a figure of 0.08 for London. 35 Greenwich deaths from tuberculosis for the previous ten years are given, with their appropriate rates, in the following table: Year No . of Deaths Rate 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 1961 7 0.08 1962 6 0.07 10-year average 10 0.11 1963 10 0.11 Tuberculosis of the Respiratory System was responsible for 9 of the deaths in this category, only one death being attributed to the remaining forms of tuberculosis. At 0.10, the Pulmonary Tuberculosis rate was 0.04 higher than that returned for last year. Cancer.—In Greenwich, cancer was responsible for a total of 187 deaths giving a rate of 2.24 per thousand population compared with figures of 206 and 2.44 respectively for the previous year. It accounted for approximately 20% of all registered deaths, a percentage 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 187 is slightly higher than the average for the past ten years, viz. 184. Comparing the current year's figures with those of the previous 5 years, the sites of the affected parts were:— 1958 1959 1960 1961 1962 1963 Cancer of Stomach 14 26 26 26 30 36 „ „ Lung, Bronchus 44 50 63 48 60 56 „ „ Breast 19 14 15 17 22 16 „ „ Uterus 7 2 11 7 5 5 „ „ all Other Sites 95 80 94 105 89 74 Totals 179 172 209 203 206 187 36 General.—In the past a great deal of difficulty and confusion in the minds of the public has surrounded cancer because of the numerous agencies concerned, viz, x-ray, cigarette smoking, atmospheric pollution, cosmetics, cancer-producing hydro-carbons, hormones, etc. Cancer is generally considered to be a disease of middle and old age although in recent times cases have begun to appear in younger age groups. It is a disease which is rapidly becoming one of the main impediments to a healthy nation but, contrary to popular opinion, much can be accomplished if earlier medical advice is sought. In advocating regular examinations of people over the age of 30 years, the World Health Organisation has estimated that three quarters of all cancer deaths could be prevented if diagnosed early enough. In this connection there is a report that a pilot scheme in a section of population in Canada has shown a 45 per cent decrease in cervical cancer among women who were regularly screened over a period of 8 years. For a number of years now it has been known that in some animals leukaemia can be caused by viruses, but that the incidence is allied to a certain pattern of inherited constitution. With regard to humans, this genetic aspect has been accentuated for it has recently been shown that mongolism, a result of chromosomal abnormality, has a high rate of leukaemia and, further, that an abnormal chromosome complement has been found in leucocytes cultured from blood or bone marrow of persons suffering from myeloid leukaemia. The position has been further complicated by the findings of Dr. G. Negroni of the Imperial Cancer Research Fund Laboratory. who has isolated a virus from the bone marrow of a number of patients suffering from various leukaemias. The strains of viruses obtained from different patients have proved to be antigenically similar, but he is careful to emphasise that the virus could well be a "passenger" virus and not the causal agency. Other investigations have shown that some types of cancer are dependent upon such factors as warmth, humidity, altitude, and other climatic conditions, and that these may possibly be due to viruses carried by insect vectors who thrive in these particular conditions. Many medical and scientific teams are engaged on these aspects of cancer and it will be surprising if a break-through in this field is not accomplished within the next few years. Lung Cancer.—Throughout the country in recent years there has been a tendency for cancer of the lung to increase and the 37 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 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 1961 – – 30 1 13 – 2 2 45 3 48 0.56 1962 1 1 22 3 15 4 10 4 48 12 60 0.71 10 yr. Average 1.4 0.7 22.4 3.0 11.6 1.6 5.5 1.6 40.9 6.9 47.8 0.54 1963 3 – 26 5 15 1 4 2 48 8 56 0.67 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 approximately half the deaths attributed to lung cancer. 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 24,422 giving a rate of 0.52 per thousand of the population. This compares with a rate of 0.70 for London and 0.67 for Greenwich. Despite the Royal College of Surgeons' report of 1961 on "Smoking and Health," and the more recent report of the Advisory Committee to the Surgeon General of the United States Public Health Service, which collectively or separately leave no 38 reasonable doubt as to the hazards occasioned by cigarette smoking, the rate of tobacco consumption has continued unabated. Substantial increases in "smoking assisted" diseases such as bronchogenic carcinoma, chronic bronchitis, emphysema, peptic ulcer, circulatory disease and coronary thrombosis have failed to make any permanent impression on the confirmed smoker, who, in continuing to fill the air at home, in the office, workshop, train, bus or plane with obnoxious fumes and ash, neglects the most elementary rules of hygiene and makes exertions for a cleaner atmosphere under the Clean Air Act, a sham. Whilst it would appear that shock tactics have had only a limited success, enforced prohibition, though eminently desirable as a health measure, is impractical and psychologically unsound. Habituees and addicts who, on various frail and flimsy pretexts, refuse to accept the evidence as presented, should be left to their own devices and all efforts concentrated on discouraging the younger generation from commencing this pernicious habit. A survey covering some 10,000 children aged between 7 and 17 years in junior, grammar and secondary modern schools in Staffordshire carried out by its Health Education Officer revealed that enthusiasm and medical know-how were not enough to change the attitudes and behaviour of children to the smoking habit, and the presentation of facts and statistics to the uninitiated led to confusion. Surveys have indicated that, with children, the problem is most acute in the lower strata of any school, that is, among the least intelligent or the least successful and culturally backward children, who develop a "compensating" mechanism for their shortcomings by "showing off". To them smoking is "clever", "big", "grown up" and "manly" and somehow is calculated to endow them with a superiority complex over the "cissy" nonsmoker. This particular kind of attitude is fostered, supported and sustained by a barrage of propaganda in the press and on television, which romanticise this unhygienic and potentially dangerous practice. Somehow such misrepresentation needs to be exposed as counterfeit, and shattered, and as suggested in my previous reports, the most likely method of achieving this aim is by ridicule. Ridicule is destructive, and could be most effective if used in a subtle purposeful manner. Government support, including financial, should be given unstintingly to organisations particularly suitable for the purposes of providing counter-propaganda including the production of comic film strips and cleverly presented cartoons. 39 Loss of revenue resulting from a decline in cigarette smoking would be a serious matter for any Government to contemplate, but losses would be offset by a saving of expenditure on treatment necessarily incurred in connection with preventable lung cancers and the country would benefit from a reduction in the number of man-hours lost as a result of chronic bronchitis. A drop in the number of families falling to public charge resulting from coronary catastrophe would also lead to a substantial financial saving. There is no reasonable doubt that but for the smoking habit the number of deaths from lung cancer would be almost insignificant and, to exemplify the public's illogicality, if an additive to food were suspected of killing some 24,000 persons each year there would be a national outcry as witness the indignation shown in respect of the recent revelations in connection with pesticides and insecticides. Again, it is paradoxical that whereas a yearly total of about 7,000 road deaths provokes, justifiably, a great deal of anxiety in the minds of the public, there is almost complete complacency about the growing menace of already considerable number of lung cancer deaths. As a matter of interest and worthy of comment the U.S. Federal Trade Commission has stated that it was unfair and deceptive for manufacturers not to disclose in their advertising and packaging that smoking is a hazard to health. In the United States of America from 1st January, 1965, all cigarette packets must contain a warning that cigarette smoking is dangerous and may cause death from cancer and that advertisements will have to include a similar warning from 1st July of the same year. Vascular Lesions of Nervous System.—This class, which includes deaths arising from Cerebral Haemorrhage, Embolism and Thrombosis was responsible for a total of 80 deaths (26 males, 54 females). The age distribution was as follows:—1 between 15 and 25 years; 1 between 25 and 45 years; 14 between 45 and 65 years; 25 between 65 and 75 years and 39 from 75 years upwards. This year's total of 80 indicates a fall of 16 from that of 1962 and a reduction in the rate from 1.14 to 0.96. Heart Disease.—Under the new classification this disease has been divided into three sub-headings: (a) Coronary Disease, Angina, (b) Hypertension with Heart Disease, and (c) Other Heart Disease. The total registered deaths allocated to these categories amounted to 306 (151 males—155 females) compared with a figure of 314 for 1962, and as usual, the deaths from this category occupied the principal place in the classification of diseases in that they formed over 32% of the total deaths from all causes. 40 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 particularly in the case of middle-aged males. As a group, the middle-aged man is enjoying unprecedented prosperity and affluence but not the standard of health of prewar days. Heart disability, with particular emphasis on coronary disease, is the main cause of death in these men and approximately ⅔rds of all heart deaths in males occur during this middle period of their lives. The persistently rising death rate of this group and the consequent loss to the nation of such potential is cause for great concern. 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 coronary disease and its hypothetical connection with "stress and strain." Dietary fat is considered to be a cause of coronary atheroma for two very good reasons:— 1. In communities where the habitual diet is low in animal fat, coronorary disease has a low incidence rate. For example, in Southern Italy where the peasants' diet consists mainly of pasta, fish, fruit and vegetables, and where the intake of fat is predominantly vegetable in origin (olive oil), coronary disease is rare. Again, this disease was not common in poor, undernourished Arab-Jews arriving in Israel during 1948, whose diet until then had been low in animal fat. Within ten years of living on a westernised regimen this disease began to make its appearance. 2. In the affected arteries, fat-like substances are found in the atheromatous areas. The lipids in these atheromatous patches are in fact normal constituents of the blood, and cholesterol is the fat present in greatest quantity. Blood cholesterol varies not only from person to person but also from time to time in the same person, even in health. Nevertheless, coronary disease is found more often in patients where the level of the blood cholesterol is relatively raised. 41 Logically, the restriction of fat in the diet, especially that of animal origin, would appear to be indicated to control its deposit in the walls of the arteries. However, as cholesterol is an essential part of the blood and is manufactured by natural processes irrespective of fat intake, it is possible that it may be altered little by a control of fat in the diet. Nevertheless, the clotting power of blood has been proved to increase substantially after a fatty meal and it must be remembered that the most serious aspect of atheroma is the clotting of blood in the diseased blood vessels. Therefore, on this point alone, a reduction in dietary fat could be considered reasonable. One drawback to this regimen is that food not only becomes unpalatable without fat, but as fat is the commodity which slows digestion, the patient will tend to live a miserable existence by being constantly hungry. Diseases of the Respiratory System.—There were altogether 142 deaths from these diseases, bronchitis accounting for 72 and Pneumonia (all forms) 64. The total shows a decrease of 26 from that of the previous year; deaths from Pneumonia fell by 6 and those from Bronchitis by 20. Of the total deaths, 6 were children under one year of age and 108 were in respect of persons 65 years and over. Greenwich rates for Pneumonia and Bronchitis were 0.76 and 0.86 respectively which compare with 0.78 and 0.74 returned for England Wales. The corresponding rates for London were 0.97 and 1.00. Influenza.—There were 4 deaths attributed to this cause during the year compared with 2 for 1962. Deaths from Violence.—These numbered 41 including 15 from Motor Vehicle Accidents, 13 from Suicide, one resulting from homicide, and the remainder being accounted for under the heading of "All Other Accidents." The number of deaths from Motor Vehicle Accidents was similar to that of the previous year while the figure for Suicide decreased by 1. Accidents in the home, deaths from which are running at a rate of about 12,000 per annum, are generally forseeable and therefore preventable but legislation can play only a very small part in the problem, namely, in ensuring the safety of all appliances used domestically. Home safety is essentially a parental responsibility and education of prospective parents in accident prevention should be considered to be of major importance. Experience, which seems to play a great part in enabling parents to anticipate and guard against potential accident conditions, is a commodity difficult to pass on theoretically. 42 Road accidents, which are now the commonest cause of death in adolescents and young adults, were responsible for 6,353 deaths and over 60,000 serious injuries during the year and the totals are mounting. Whether epidemiology can be usefully employed in this field is problematical. Some people are obviously unsuited emotionally to be in charge of a car whilst others with minor physical disabilities should perhaps be advised to give up driving. Undoubtedly safety on the roads depends ultimately upon an individual's ability to recognise and assess the responsibility which he owes to the community at large. Contrary to general belief suicide claims a formidable number of victims. In England and Wales the number of suicides during 1963 reached the staggering total of 5,717. This figure was almost double that for the deaths from tuberculosis and was 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 mid night, 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. In general, it is now agreed that the number of suicides could conceivably be reduced by medical means for in many instances, signs of abnormality were discernible before death and comparatively few cases had received psychiatric treatment. Depression, which appears to be a common factor in elderly suicides, did not receive as urgent attention as it might have. Much can be achieved, on the one hand, by the general practitioner in reassuring and explaining illnesses which often assume monumental proportions in the lives of the lonely and, on the other, by the lady public health officer or social worker who could help to disperse some of the financial worries and assist by bringing community welfare services to bear. 43 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 1963, which will be found on the following pages in table form. NATIONAL WELFARE FOOD ITEMS Distribution Centres M. & C.W. Centres Burney Street, S.E.10 Monday 9.30 a.m.—12 noon 2 p.m.—4 p.m. Thursday 1.30 p.m.—4 p.m. Charlton Lane, S.E.7 Tuesday 9.30 a.m.—12 noon Thursday 1.30 p.m.—4 p.m. Chevening Road, S.E.10 Tuesday 1.30 p.m.—4 p.m. Wednesday 9.30 a.m.—12 noon Friday 1.30 p.m.—4 p.m. Creek Road, S.E.8 Friday 1.30 p.m.—4 p.m. Fairfield Grove, S.E.7 Tuesday 9.30 a.m.—12 noon Thursday 1.30 p.m.—4 p.m. Ridgebrook Road, S.E.3 Tuesday 9.30 a.m.—12 noon 1.30 p.m.—4 p.m. Shooter's Hill Road, S.E.3 Monday Tuesday 1.30 p.m.—4 p.m. Wednesday Thursday 9.30 a.m.—12 noon Friday 1.30 p.m.—4 p.m. Tranquil Vale, S.E.3 Wednesday 9.30 a.m.—12 noon 44 Health Visitors' Records, Attendances at Infant Welfare Sessions, Prophylaxis figures, etc. 1. Health Visiting Quarter Children Over 65 years Mentally Disordered Discharged from Hospital (other than Mental) Infectious Households Total Visits (incl. Re-visits) Under 1 year 1 and under 2 yrs. 2 and under 5 yrs. No. Visited Requested by No. Visited Requested by No. Visited Requested by T.B. Other Effective Unsuccessful G.P. Hosp. G.P. Hosp. G.P. Hosp. March 329 1,372 1,984 89 5 63 14 – 3 35 4 28 11 231 5,731 890 June 464 329 811 78 11 52 2 – 1 17 – 14 3 158 5,850 921 Sept. 447 119 276 56 9 26 2 – 2 11 – 8 5 58 5,333 945 Dec. 383 75 160 43 4 27 – – – 14 1 12 4 73 5,541 1,049 Totals 1,623 1,895 3,231 266 29 168 18 – 6 77 5 62 23 520 22,455 3,805 2. Infant Welfare Clinics Quarter Sessions Attendances Children 0—5 years First Total March 196 2,383 5,750 June 189 796 7,234 September 194 583 7,537 December 190 1,206 7,096 Totals 769 4,968 27,617 45 3. Ante and Post Natal Clinics Quarter Sessions 1st Attendances Total Attendances Ante Natal Post Natal March 61 191 12 321 June 58 121 35 459 Sept 57 114 17 413 Dec 56 105 19 327 Totals 232 531 83 1,520 4. Toddlers Clinics Quarter Sessions Total Attendances Medically Examined March 39 232 165 June 42 207 207 September 42 139 139 December 43 162 162 Totals 166 740 673 5. Relaxation and Educational Sessions Quarter Relaxation and Mothercraft Sessions Total Attendances March 58 755 June 41 524 September 32 388 December 54 693 Totals 185 2,360 46 6. Artificial Sunlight, Massage etc. Quarter Sessions Attendances First Total March 47 22 309 June 37 22 449 September 45 23 434 December 37 20 401 Totals 166 87 1,593 7. Chiropody Treatment No. of Clinic Sessions 1,104 No. of First Attendances 333 Total Attendances 11,755 8. Prophylaxis (a) Immunisation and Vaccination (Children under 5 years) Diphtheria immunisation (completed cases & boosters) 11 Whooping Cough immunisation (completed cases) – Combined Antigen (Diphtheria and Whooping Cough) 1 Combined Antigen (Diphtheria and Tetanus) (including boosters) 124 Triple Antigen (Diphtheria, Whooping Cough and Tetanus) 1,194 Triple Antigen (boosters) 874 Tetanus immunisation 2 Primary Vaccination (Smallpox) 157 (b) B.C.G. Vaccination (Children 13 years old at Greenwich Schools) No. of Children 13 years old 1,499 No. of whom parental consent was obtained 1,235 No. of negative reactors vaccinated 982 No. of positive reactors X-rayed 55 (c) Poliomyelitis Inoculation (Children born 1944-1963 resident or attending Greenwich schools) (i) Two injections given during year 46 (ii) Third injection given during year 87 (iii) Fourth injection (Children 5-12 years) or doses of Sabin following 3 injections of Salk during the year 844 (iv) Completed courses of Sabin 1,584 (Others—namely adults 16-40 years living or working in Greenwich and Exp. Mothers) (i) Two injections given during year 103 (ii) Third injection given during year 83 (iii) Completed courses of Sabin 156 47 9. 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., '63 – 11 589 6 606 92 37 31st Dec., '63 2 12 615 11 640 103 41 Cases attended during 1963: — 43 16 855 42 956 – – (b) Supervision Effective Ineffective Total Visits made by Organising Staff: 2,522 285 2,807 10. District Nursing The staff of the Queens District Nursing Association for Charlton and Blackheath made 39,304 visits during the year. Visits carried out by the Ranyard Nurses and the Nursing Sisters of St. John the Divine were additional to those quoted above. 11. School Health Service Vision Special Investigation Minor Ailments Clinics No. of Attendances 540 214 32,064 No. of New Cases 262 34 8,366 No. of Glasses prescribed 117 – – Note- As appropriate, children from Greenwich also attend special clinics in Deptford and Woolwich. 48 TREATMENT CENTRES AND CLINICS Particulars relating to the local Health Services throughout the Borough are given below:— INFANT WELFARE CLINICS ANTE & POST NATAL CLINICS Burney Street, S.E.10 Burney Street, S.E.10 Charlton Lane, S.E.7 *Charlton Lane, S.E.7 Chevening Road, S.E.10 Chevening Road, S.E.10 Creek Road, S.E.8 Creek Road, S.E.8 Fairfield House, S.E.7 Fairfield House, S.E.7 Ridgebrook Road, S.E.3 Shooter's Hill Road, S.E.3 Shooter's Hill Road, S.E.3 Tranquil Vale, S.E.3 Tranquil Vale, S.E.3 * Fortnightly ARTIFICIAL SUNLIGHT FOOT CLINICS TREATMENT Chevening Road, S.E.10 Chevening Road, S.E.10 Shooter's Hill Road, S.E.3 Fairfield House, S.E.7 Fairfield House, S.E.7 Shooter's Hill Road, S.E.3 IMMUNISATION AND VACCINATION CLINICS Burney Street, S.E.10 Wednesday 2.0 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 Kidbrooke Park School, S.E.3 Halstow School, S.E.10 Sherington Road Kidbrooke School, S.E.3 Treatment Centre. S.E.7 LONDON COUNTY COUNCIL HEALTH SERVICES Enquiries:—Divisional Medical Officer, Division 6, St. Paul's House. Deptford High Street. S.E.8 (TID 4621). 49 CHEST CLINICS (by appointment only) Maze Hill, S.E.10 DAY A.M. P.M. Monday 10.00 2.00 (Allergy Clinics) Tuesday 9.30 (X-rays with Drs. letters, etc.) 2.00 Wednesday 2.00 5.00-6.30 (workers only) Thursday 9.30 2.00 (Contacts) Friday 9.30 (Ante-Natal) SCABIES & CLEANSING CLINICS AND BATHING CENTRE Tunnel Avenue Wednesday 9-12 (School Children) Daily (Saturdays excepted) 9-12 (Wednesdays excented 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. 50 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). NATIONAL HEALTH SERVICE (a) For General Medical, Dental and Pharmaceutical Services, London Executive Council, Insurance House, Insurance Street, W.C.I. (TERminus 7833). (b) For Sight Testing, Supply of Spectacles, London Executive Council, Ophthalmic Department, 91/93, Charterhouse Street, E.C.I. (CLErkenwell 4666). NURSING ASSOCIATIONS Queens District Nursing Association for Blackheath and Charlton, 50, Vanbrugh Park. S.E.3. (GRE 1675). Ranyard Nurses. 110, Kennington Road, S.E.ll (RELiance 4671). Nursing Sisters of St. John the Divine, Watson Street S.E.8 (TIDeway 3028). OTHER ORGANISATIONS British Red Cross Society. Miss K. A. Rackham, Divisional Director, 46, Vanbrugh Park, S.E.3 (GRE 0157). Citizen's Advice Bureaux, 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. 51 SECTION C Sanitary circumstances of the Area The tables on pages 109 to 110 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 13,824 houses and premises have been inspected or re-inspected during the year; 440 intimation notices and 144 statutory notices were served. Of the latter figure 8 were in accordance with the Housing Act, 1957. Registered complaints, numbering 2,056, although showing a decrease of 41 from those of the previous year, is 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: — The Offices, Shops and Railway Premises Act, 1963.—The broad purpose of this Act is to give office and shop workers standards of working conditions and safety as favourable as those which apply to factory workers under the Factories Act, 1961. The Act requires that proper provision shall be made for the premises and furniture to be kept clean and to secure that each worker has adequate space. The premises must also be kept at a proper temperature and effectively lighted and ventilated. Proper sanitary conveniences, first aid and washing facilities, drinking water, accommodation for clothing and facilities for sitting must be provided. Certain requirements are laid down regarding the safety of workers and the Minister of Labour is empowered to make special regulations for securing the safety and health of workers and. in particular, to protect them against noise or vibrations which may affect their health. A Magistrate's Court may on complaint prohibit the use of any premises, machinery or process which they are satisfied cannot be used without risk of injury. The Minister has the power by Order to exempt a class of premises from certain requirements of the Act in special circumstances and the local authority may also exempt individual premises from certain requirements. Stringent provisions as to means of escape in case of fire will be administered by the fire authority. For other purposes, the enforcing authorities will generally be the borough or district councils or, in London, the metropolitan borough councils but. with respect to a local authority's own premises and certain other premises, the Act is to be enforced by Factory Inspectors. Every local authority and fire authority is required to appoint inspectors to enforce the Act in their area. 52 Accidents causing loss of life or disablement for more than three days must be reported to the local authority. Everyone intending to employ people in offices, shops or railway premises after the 1st May, 1964, and those already employing persons in such premises on that date, must register with the local authority and provide certain information to the authority. Specific penalties are laid down for contravention of some provisions of the Act and, in others, general penalties of a fine of up to £60 can be imposed (or up to £300 in a case where contravention might cause death or serious injury). The Minister of Labour has made an Order dated 10th February, 1964, which brings most of the provisions of the Act into operation on the 1st August, 1964, but to give local authorities time to deal with the registration of premises and to make administrative preparations, certain administrative provisions will come into operation on the 1st May, 1964. The Ministry have been consulting with local authority associations and other interested organisations about procedures and forms to be used for administering the Act and. when these questions have been decided, the Ministry will give guidance to authorities on such matters as registration arrangements, annual reports, accident statistics, exemption procedures and safety measures. Animal Boarding Establishments Act, 1963.—In accordance with this Act. introduced to regulate the keeping of boarding establishments for animals and for purposes therewith, no person after 1st January, 1964, shall keep such a boarding establishment except under the authority of a licence granted by the local authority. In granting a licence the local authority must have regard to the fact that the accommodation shall be suitable in respects temperature, lighting, ventilation and cleanliness and that it shall be large enough for the number of occupants and, further, that there shall be sufficient exercising facilities. The Act insists that the animals shall be adequately supplied with food, drink and bedding material and that they shall be exercised and visited at suitable intervals. Precautions must be taken to control the spread of infectious or contagious diseases and there must be adequate isolation facilities. In addition there must be appropriate measures available to ensure the protection of the animals in case of fire or other emergency. Registers must be kept giving all relevant information about the animals and their owners and such registers must be available for inspection at all times by authorised officers. The Council have agreed that, in suitable cases, licences shall be issued at a cost of ten shillings. 53 London County Council (General Powers) Act, 1963.—Under Section 11 of this Act every building which is used or intended to be used for any trade, manufacture or business shall, with certain exceptions, be provided with trade refuse facilities approved by the Borough Council which shall have regard to the use, character and construction of the building, the type of dustbin provided and the quantity and nature of the trade refuse. In connection with the provision of dustbins. Section 12 of the same Act substitutes the term "premises" for that of "house" which is used in Section 12 of the L.C.C. (General Powers) Act, 1954. The Smoke Control Areas (Authorised Fuels) Regulations, 1963.—Made under Section 34(1) of the Clean Air Act, 1956, these Regulations, operative from 29th July, add the National Coal Board's "fluidised char binderless briquettes" to the list of authorised smokeless fuels. Alkali, &c., Works Order, 1963.—This Order, operative from 1st April, was made under Section 4(1) of the Public Health (Smoke Abatement) Act, 1926, as augmented by Section 17(3) of the Clean Air Act, 1956, and extends and varies the list of works scheduled under the Alkali, &c. Works Regulation Act, 1906, and extends the list of noxious and offensive gases mentioned therein. Arrangements are made to notify local authorities individually (a) of works in their area, not at present registered under the Act of 1906, which are registered in accordance with the requirements of the Order and (b) of works which cease to be subject to registration by virtue of the Order. Factories Act, 1961. Under this Act 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. 54 During the year 312 inspections were made by the Council's Inspectors in relation to the 475 registered factories. The latter figure includes 76 premises where mechanical power is not used. Defects were found in 17 instances, all of which were remedied. FACTORIES ACT, 1961 Inspections for purposes of provisions as to health. Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 76 15 – – (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 378 292 2 – (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 21 5 1 – Total 475 312 3 – Cases in which defects were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.1.) 6 6 1 – – Overcrowding (S.2) – – – – – Unreasonable temperature (S.3) – – – – – Inadequate ventilation (S.4) 1 1 – – – Ineffective drainage of floors (S.6) – – – – – Sanitary Conveniences (S.7): (a) insufficient 1 1 – 1 – (b) unsuitable or defective 8 8 – 3 – (c) not separate for sexes – – – – – Other offences against the Act (not including offences relating to Outwork) 1 1 – – – Total 17 17 1 4 – 55 Outwork—(Sections 133 and 134) Nature of Work Section 133 Section 134 No. of out-workers in August list required by Sect. 133 (1) (c) No. of cases of default in sending list to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions Wearing apparel Making, etc. 28 – – – – – Curtains and Furniture Hangings 1 – – – – – Lampshades 2 – – – – – Household Linen 1 – – – – – Carding, etc., of Buttons, etc 2 – – – – – Total 34 – – – – – Outworkers.—Twice yearly, February and August, the Factories 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 23 Notifications received from firms outside the Borough of: — Outworkers resident in the Borough 41 Total number of Greenwich residents employed as outworkers (as given in August list) 34 Premises where homework is carried on were visited on 49 occasions by the Lady Public Health Inspector. In no instance was it necessary to take action because of infectious disease. Defective Dwellings.—Repairs.—With regard to houses found not to be in a reasonable state of repair, the following procedure, classified under two headings is generally adopted: — (1) Complaints from or on behalf of the occupier.—The District Public Health Inspector makes inspection and an intimation is sent to the owner specifying the defect and nature of nuisance found. Where necessary, the circumstances are reported to the Public Health Committee for authority to serve a Statutory Notice to enforce abatement of the nuisance. The premises are re-inspected 56 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, the number of complaints received was identical with that for the previous year viz. 23 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. It is then considered by various authorities to be a pollutant and the predominating cause of the complaints. 57 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. The Pippard Report, entitled Pollution of the Tidal Thames and issued towards the end of 1961, contained much useful and enlightening information on the subject of river pollution. It revealed that the condition of the River Thames had gradually deteriorated and the Report made particular reference to effluents from the London County Council's outfall works, polluting loads, storm water, effect of tributaries, synthetic detergents, heated discharges, etc., and concluded with an evaluation of the measures already adopted and recommended what further action could be taken to reduce pollution. Having long been aware of the shortcomings of its sewage disposal system laid down in the 1860's and which has been unable to keep pace with modern demands, the London County Council took steps in September 1950 to improve the situation and new works in connection with improvements were put into effect. These improvements are expected to be completed early in 1964 at a total cost of about £10 million. This very informative Report points out that since the introduction of these new services there has been a substantial reduction in pollution and the fact that no complaints were received during the current year regarding smells from the river supports the London County Council's contention that there has been a great improvement in the sewage effluent discharged into the river. Storm Flooding.—There were no instances of damage to property due to unusually heavy rainfall recorded during the current year. River Ravensbourne—Improvement and Jurisdiction.— Although no complaints of flooding were received during the year under review, nevertheless, for over a century now at times of heavy rainfall the Ravensbourne has overflowed its banks to inundate the proximal areas, some as many as five times a year. The catchment area of the Ravensbourne, amounting to about 70 square miles, is centred around the South East of 58 London and the contiguous suburban development areas of Kent and, locally, the river carries the surface water from parts of Deptford, Greenwich, Lewisham and Woolwich. In recent years marsh areas have been filled in and the increase in paved areas resulting from the rapid expansion of housing estates and haphazard culverting have all served to swell the rate and quantity of run-off water discharged into the river. Combined sewage systems have tended to lessen the effects but the problem has been considerably aggravated by the indiscriminate dumping of rubbish in the water course. Further development, now taking place and planned for the future, will undoubtedly increase the flow, frequency and intensity of the flooding during storm periods unless measures are taken immediately to off-set these factors. It was for this reason that the River Ravensbourne, etc. (Improvement and Flood Prevention) Act 1961. was introduced to confer like powers on the London and Kent County Councils 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, (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. In administering the Act the County Councils have shouldered a very formidable but necessary task and many practical obstacles must be overcome. For instance sewers and other services cross the stream at many points, some above and some below the river, the one obstructing the flow the other restricting alterations 59 to the level of the river bed. Complications also arise in respect of railway bridges carrying services which must, on no account, be interrupted and improvements must be carried out with the minimum of disturbance to existing buildings. The problem bristles with difficulties not the least of which is the fact that the dry weather flow can be as little as 1/200th of the storm flow. Preliminary work to the extent of over £20.000 has already been carried out and a scheme formulated by the two County Councils is to be put to the Minister of Agriculture, Fisheries and Food for his approval which in the London area, proposes at a cost of £3½ million to effect the following works: — Concrete channels with vertical sides through industrial areas, under bridges and such. Concrete channels with battered sides through industrial and urban areas and in open spaces where more land is not available for improvement purposes. Concrete culverts in industrial and urban areas where culverting is necessitated by existing land use or paid for by landowners. Concrete or masonry-walled channels to contain a proportion of the flood flow with berms and sloping flood banks to contain the remainder. The Scheme if approved will attract Ministry grants and will be implemented in four stages: — 1. Improvements to the outfall and lower regions of the Ravensbourne to a convenient point above the congested areas of Deptford and Lewisham. 2. Improvements to the remainder of the River Ravensbourne and the River Pool up to the County boundary thus allowing for increased flow resulting from the proposed improvement of the River Pool in Kent and the elimination of bottlenecks on the Ravensbourne in the area of Shortlands in Kent. 3. Improvements to the River Quaggy to allow for proposed improvement of the Quaggy. Chin Brook and Kyd Brook. 4. Improvements to the minor tributaries in the London Area. Powers originally given to the Metropolitan Borough Councils under the Rivers (Prevention of Pollution) Act, 1951, are now enforced by the London County Council. Atmospheric Pollution—General.—For many years, smoke and the oxides of sulphur, have been considered to be the most important of the pollutants in the atmosphere and my reports 60 have constantly stressed the enormous and costly damage to life and property occasioned by air pollution. Reduction in atmospheric smoke and grit has been achieved on a substantial scale by improved methods of combustion in industry and the use of smokeless fuels domestically. Indeed, at long last, there seems to be general acceptance in the minds of the public that smoke control should be exercised over the emission of smoke and grit. Perhaps this is because improvement resulting from control over these is tangible and the public can actually see and is aware of its beneficial effects. Sulphur dioxide, however, is not so easily reduced for. unlike smoke, it cannot be eliminated by burning fuel more efficiently and, of all the air pollutants, this substance is perhaps the most important medically by reason of its irritating and damaging effects upon human tissues and vegetation. Recent estimations by the Warren Spring Laboratory of the D.S.I.R. put the reduction of smoke from Britain's chimneys at 35% less than ten years ago, but the emission of sulphur dioxide as 23% higher. In the London area, in particular, the changes have been more significant; while smoke emission has dropped by 60% that of sulphur dioxide has risen by 32% and it would appear that the bulk of this latter increase is from industry and power stations burning coal and fuel oil. Since most of these pollutants are discharged from high chimneys, the increase in the oxides of sulphur has not shown itself at ground level. The latest figures published by the Laboratory show that although in controlled areas smoke was down by 30% at ground level, the fall in sulphur dioxide was only of the order of 4%. Consequently, we now have the paradoxical position of inhabitants of modern high flats being exposed to a higher concentration of sulphur dioxide than those living near the ground. This situation will inevitably give rise to problems in the housing field, especially where urban councils are committed to high-density re-housing in the vicinity of industrial areas, or close to existing power stations. Recognition of the dangers arising from pollution by sulphur dioxide was evidenced as long ago as 1927, when, at the time of the erection of the Battersea Power Station, the Electricity Commissioners insisted that the evolution of this gas should, as far as practicable, be prevented. This led to flue-gas scrubbing, i.e. the flue gas was washed with river water to which had been added an alkali to counteract acidity. Naturally, such a process is limited to the actual physical amount of by-products which the river can safely absorb. Other processes have been tried, some of which, although technically sucessful, have proved uneconomical, 61 but the one most favoured at the moment is the Simon Carves process, where the flue gases are scrubbed with a solution of ammonium salts, which effectively removes the oxides of sulphur and the resultant liquor yields ammonium sulphate and sulphur. However, it suffers from the defect of all wet processes in that the flue gas is cooled and saturated with water, which results in the discharge at the chimney having little buoyancy with a poor dispersion rate. What is required is a dry, regenerative process and one, the German Reinluft process, is at present undergoing tests at the Warren Spring Laboratories. In this connection it is as well to remember that much of the original work of the Department of Scientific and Industrial Research on air pollution was carried out at Greenwich and that the results obtained by this organisation were mainly responsible for the introduction of the Clean Air Act. 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. The Act has, as its aim, four main purposes:— 1. To limit smoke from existing sources. 2. To prevent new sources of industrial smoke. 3. To minimise dust and grit emission. 4. For the first time in nationally applied legislation—to bring about the progressive elimination of domesticsmoke. In a recent survey carried out by the National Society for Clean Air is was revealed that since 1956, industrial smoke has been reduced by half and the amount of dust and grit by two fifths. Such an improvement in the industrial field is understandable, for smoke is simply unburned and wasted fuel and its elimination leads to greater efficiency and economy. Other pollution problems concerning the emission of fumes and noxious gases arise mainly from industrial premises such as iron and steel works, cement works, chemical plants, gas works and power stations, but these come under the jurisdiction of the Alkali Inspectorate. 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 62 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. However, the Public Health Department is concerned mainly with atmospheric pollution at breathing level, and in the average urban area some 80-90 per cent of all pollution arises from household chimneys. Bituminous coal can be burned smokelessly only under strict technical control and in the domestic fire this is impossible. The inference is plain, and demonstrates the need for a change to gas. electricity, oil, or one of the smokeless fuels. An immediate wholesale change-over throughout the country was never practical and the Act seeks to tackle the problem by adopting the principle of smokeless zones or smoke control areas. To date, advancement towards complete smokelessness is faster in Greater London than elsewhere, for approximately 40 per cent of the metropolis is now smoke controlled. Progress, however, is slowing down and is likely to become even slower still because of technological developments in the gas industry, among which is the increasing use made of liquid methane gas, resulting in a decline in quantity of gas coke and other soft smokeless fuels. With such a prospect in view it is more than ever necessary for such fuels that are available to be used in the most efficient manner, i.e., type of fuel should match the appropriate apparatus and the Ministry in its Circular 7/63 has indicated how this may be achieved. In connection with Clean Air, three other Ministry Circulars were issued during the year; one, 25/63 deals with assessment of chimney height, another 54/63 with an addition to the list of authorised fuels and the recognition of smoke control orders as being registerable under the Land Charges Act and, finally. Circular 69/63 giving information about the general pattern of revised arrangements considered necessary in the light of the availability of smokeless fuels in relation to the demand after taking into consideration the technological alterations in the gas industry. Within the Borough a Smoke Inspector and an Assistant arc 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 Clean Air Act, 1956, detailed inspections were completed of the Council's sixth smoke control area 63 GREENWICH No. 6 SMOKE CONTROL AREA 64 and in respect of which an Order was made on 23th October, 1963. Information has just been received that the Order obtained Ministry approval on 21st September, 1964, and that it will become operative on 1st July, 1966. Particulars in connection with the Greenwich No. 6 Smoke Control Order. 1963, are given in the following table and the accompanying plan indicates the area concerned. Particulars Smoke Control Area No. 6 Approximate Acreage 414 No. of Industrial Premises Nil No. of Commercial Premises 29 No. of Dwellings 1,586 No. of Other Premises 8 Pollution Recording.—An atmospheric pollution measuring station is maintained by the Council at the Town Hall and the following table gives the daily mean concentration of smoke and sulphur dioxide as calculated on readings taken at the Council's station during 1963:— Daily Mean Concentration of Smoke and Sulphur Dioxide Month Town Hall Town Hall Smoke Mu/m3 Sulphur Dioxide Mu/m3 Daily Value Daily Value Average Highest Lowest Average Highest Lowest November 1962 260 416 92 344 526 100 *December „ 661 2,896 60 902 4,429 144 January 1963 276 960 116 428 1,063 156 February „ 308 644 144 418 674 177 March „ 172 312 128 202 344 133 April „ 147 252 96 232 467 80 May „ 128 236 52 145 332 53 June „ 76 164 32 162 403 25 July „ 75 204 36 101 231 42 August „ 76 236 20 96 211 28 September „ 117 256 44 197 444 75 October „ 166 304 64 167 336 79 November „ 234 708 48 200 546 57 December „ 290 522 160 445 723 200 January 1964 380 724 164 392 599 186 February „ 287 704 94 389 987 128 * Heavy Smog, 3rd 17th December, 1962. 65 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 5 Number of decisions not to issue certificates 0 Number of decisions to issue certificates: (a) in respect of some but not all defects 3 (b) in respect of all defects 2 5 Number of undertakings given by landlords 1 (under para. 5 of 1 st Schedule) Number of undertakings refused by Council 0 (under proviso to para. 5 of 1 st Schedule) Number of certificates issued 4 66 PART II—Applications for Cancellation of Certificates Applications by landlords to Council for cancellation of certificates 3 Objections by tenants to cancellation of certificates upheld 0 Decisions by Council to cancel notwithstanding tenants' objection 0 Certificates cancelled 3 In addition to the foregoing, 2 applications (Form "O") received from landlords 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 — — Landlord 1 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). No investigations were made in connection with notices of increase served in respect of derequisitioned properties. Noise Abatement Act, 1960.—Local authorities have been empowered to deal with noise or vibration as a statutory nuisance under this Act from 27th November, 1960. Borough Council byelaws concerning pleasure parties and street noises are already in existence and these are unaffected by the new legislation. 67 Recently, under Section 146 of the London Government Act, 1939, the Council made a byelaw prohibiting the operation of any wireless loudspeaker, gramophone, amplifier or similar instrument to the annoyance of the public. Similarly, a further byelaw was made banning shouting or the use of a bell, gong or other noisy instrument for the purpose of hawking, selling, distributing or advertising any article so as to cause annoyance to the inhabitants of the neighbourhood Previously, power to deal summarily with a noise nuisance under the Public Health (London) Act, 1936, was given to Councils of the Metropolitan Boroughs by Section 66 of the L.C.C. (General Powers) Act, 1937, such nuisance being defined in subsection 3 as "any excessive or unreasonable or unnecessary noise which is injurious or dangerous to health". The new Act amends this to read "any noise which is a nuisance", a definition which is very vague and will have to be determined by the magistrate. For a local authority to require its abatement, a noise or vibration nuisance now need not necessarily be injurious or dangerous to health. It must be admitted, having outlined the statutory aspect of the problem, that nuisances arising as a result of noise are extremely difficult to assess for noise constituting a nuisance to one person may pass unnoticed or even be enjoyed by a neighbour. Indeed with regard to noises and vibrations resulting from trade or business it is a defence in any proceedings to show that the best practical means have been used to prevent or counteract the effects and therein lies the difficulty for local authorities. During the year, although some 12 relatively minor complaints were received, most of the department's efforts in respect to noise nuisances were directed towards ameliorating a serious complaint which was being investigated towards the end of the previous year. It concerned a large local firm and the complaint was that noise, sufficient to cause nuisance to the inhabitants of the neighbourhood, was being emitted at all hours of the day and night, the nuisance being more acute during the night and more particularly on warm nights when windows were wide open. With the co-operation of the Scientific Branch of the London County Council, noise readings were taken over a 24-hour period on a number of occasions, as a result of which, observations were sought from the management of the firm concerned. They indicated that the nuisance arose from the fact that, due to large export orders, it was necessary to utilise the plant for the full 24 hours of the day. Some reduction in the noise was achieved by various methods but by the end of the year it was still doubtful whether this improvement would eventually be considered satisfactory. 68 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 4 applications for entry of name in the Council's List of Persons entitled to sell Poisons included in Part II of the Poisons List were received and 59 vendors applied for retention in the Council's List. All were duly considered and approved and, in accordance with the Act, the premises concerned were kept under supervision by the Public Health Inspectors. Poisons Information Service—Circular 16/63 has been received from the Ministry of Health drawing attention to a Poisons Information Service which has been set up at Guys Hospital and which came into operation on the 2nd September, 1963. The functions of the service are:— (i) to maintain an index of substances in common use— medicinal, veterinary, industrial, agricultural, horticultural, household, etc.—showing their composition and, wherever possible, their toxicity and corrective measures in cases of poisoning; (ii) to provide information to medical practitioners so as to facilitate treatment of cases of acute poisoning. The servce is primarily intended to deal with enquiries related to specific cases of poisoning or suspected poisoning. It will not serve as a repository of toxicological information of a general nature, nor will it be able to advise on miscellaneous toxic hazards. 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 became effective from the 19th May, 1961. These Regulations require fireguards to be fitted to gas fires, electric fires and oil heaters which are so designed that they are suitable for use in residential premises and are of such a type that, without a guard, there is a likelihood of injury by burning. Standards regarding construction, fittings for guards, tests and exemptions in cases of sales for scrap are all covered by the Regulations. 69 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. 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. Lack of forethought, carelessness, and, on many occasions, sheer ignorance are the main causes of "home" accidents and the basic need would appear to be appropriate education. As effective propaganda relies on the impact of direct appeal and contact with the public, the Public Health Commitee has asked the Local Safety Advisory Council as being a more suitable organisation, to undertake this aspect of "Home Safety". 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 14 exemption certificates were in operation. From 1st January, 1959, in accordance with the London County Council (General Powers) Act, 1958, the County Council's powers and duties under Section 38 of the Shops Act, 1950, relating to lighting, washing facilities and arrangements for taking meals at shops were, with the excepted premises itemised under Section 18(2), transferred to the Metropolitan Borough Councils. Routine inspections were carried out under the abovementioned Act on 432 occasions. 70 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, 1963 62 Persons registered at 31st December, 1963 67 Rag Flock and Other Filling Materials Act, 1951.—The introduction of this Act, which became operative on the 1st Nov ember, 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. No licences in respect of the manufacture of Rag Flock were issued. Based on the standard of cleanliness of filling materials issued by the British Standards Institution in 1960, regulations prescribe the standards of cleanliness for each type of filling material to which the Act applies, analysts and their fees and all records necessary for these ends, and under the Rag Flock and Other Filling Materials Regulations, 1961, six samples, one each of New White Cotton Felt, Coir Fibre, Rag Flock, Rag Flock Layered, New Cotton Felt and Kapok were obtained and submitted for examination. All proved satisfactory with the exception of a minor infringement concerning the New White Cotton Felt, to which the manufacturer's attention was drawn. 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 71 liquor and further, to introduce rules to control licensed premises and purposes connected therewith. There were 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. The question of suitability of premises is referred to the Public Health Department and, in practice, objections are most likely to arise from insufficient or unsuitable sanitary accommodation or from breaches of the Food Hygiene Regulations. During the year, 23 applications for renewal of registration as licensed premises were made involvinginspections by the Public Health Inspectors. All were considered satisfactory for their particular purposes. 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 5 inspections were carried out by the Public Health Inspectors in connection with the issuing of such licences. Land Charges Act, 1925.—Under this Act, enquiries in respect of properties in the Borough are received from time to time by the Town Clerk concerning outstanding Notices served under the Public Health, Housing and Rent Acts and whether such properties are affected by any Smoke Control Area Orders, existent or proposed. During the year 1,265 reports on such enquiries were forwarded to the Town Clerk's department. 72 Drainage and Sewerage.—During the year 436 drains were tested, 324 were opened, cleansed or repaired and there were 1,039 constructions and re-constructions, alterations and improvements effected. Only two cesspools remain in use in the Borough and under the Borough Engineer's direction these are emptied on request. One hundred and ninety-six plans of drainage and other sanitary works relating to existing and new buildings were examined and approved. Discharge of Trade Effluents into Sewers.—Under the provisions of the London County Council (General Powers Act), 1953, the Borough Engineer's Department consulted with various public bodies and carried out a site survey from which a list of 351 premises was compiled where trade effluents are discharged to the public sewer. A further survey of premises increased the number of premises likely to discharge trade effluents to a total of 392. 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 :— Under the provisions of the London County Council (General Powers) Act, 1953, inspections have been made and samples continued to be taken as follows :— Premises discharging effluents to local sewers 327 Premises discharging effluents to L.C.C. sewers 65 Number of sewer connections inspected 100 Number of samples taken 96 Number of samples found to be unsatisfactory 23 The sampling was concentrated at premises where it was anticipated, by previous years' inspections, that unsatisfactory effluent could be expected to be found. Unsatisfactory samples were obtained from the Gas Board's premises and in conjunction with the London County Council a series of tests were run, by observations made within the sewers. The aim of the tests was to establish the acceptable standard of the effluent to be discharged to the sewer from the Gas Board's plant, with particular reference to atmospheric pollution within the sewers. The tests were by no means conclusive and a further study will have to be made. Of the other unsatisfactory samples these contained oils, acids, formaldehydes and an excess of suspended solids. The discharge 73 of these substances, which can be dangerous to persons working within the sewers, injurious to the fabric of the sewers and detrimental to the treatment of sewage, were due to the improper use of manufacturing plant and lack of proper cleansing and maintenance of the factory drainage systems. The firms concerned were notified and appropriate measures taken. Radioactive Substances Act, I960.—Circular No. 3/63 received from the Ministry of Housing and Local Government, fixed the appointed day for the purposes of the above Act as 1st December, 1963. The Act is concerned with the control of the accumulation and disposal of radioactive wastes and, as from 1st December, 1963, persons keeping or using radioactive material will, unless exempted, be required to register with the Minister and obtain authorisation from him for the accumulation or disposal of radioactive waste. The circular draws the attention of local authorities to certain provisions of the Act, under which, for the purposes of general public health legislation specified in the Act and any local enactment containing powers for the control of nuisances, pollution and discharge of wastes, no account shall be taken of any radioactivity possessed by any article, substance or by any part of any premises. The Act does not remove from local authorities any existing rights or powers to restrain, or take proceedings in respect of, radioactive waste disposals for reasons connected with properties other than radioactivity (e.g., chemical toxicity). Under the provisions of the Act, local authorities must be consulted before authorisations for the disposal of radioactive waste are granted in respect of major nuclear establishments, or where the disposal is likely to involve the need for special precautions to be taken. Where a local authority institutes special precautions in connection with the disposal of radioactive waste, it may recover the costs from the person to whom the authorisation was granted. The circular points out that the policy of the Government concerning radioactive waste disposal contemplates the use, in suitable cases, of local conventional methods, e.g., discharge into sewers or disposal on refuse tips. The Act places a duty on local authorities to accept and deal with radioactive waste sent to their refuse tip under an authorisation from the Minister. Crown establishments are, in general, exempt from the provisions of the Act. So far, the Minister has forwarded copy of one certificate of 74 registration issued under this Act in respect of premises in Greenwich. 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 24,765 dwellings with direct connections to the Board's mains. During the year 399 water supply certificates were granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended, repaired or renewed in 170 cases. Consideration has been given by the Ministry of Housing and Local Government to recent changes in technique, practice and use of new materials in building such as, very high flats and offices, use of plastics for cold water, etc. It was felt that this new situation demanded a revision of the existing Water Byelaws and the Ministry's Circular 57/63 of 10th October introduces new Model Byelaws for the prevention of waste, undue consumption, misuse or contamination of water. 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 and, on occasions, control samples from this latter well are taken by the Council's Public Health Inspector for chemical and bacteriological examination. Fluoridation of Water Supplies.—In recent years dental decay has increased especially among the younger age groups and it 75 has been found that a minute quantity of fluorine assists the formation of healthy teeth and reduces the incidence of decay. Results of a five-year study, particulars of which were given in my previous report, establish the effectiveness of artificial fluoridation of water supplies as a preventive measure against dental 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. Only one survey of public opinion concerning the question of fluoridation has been carried out in this country (that at Watford), whereas there have been several in the U.S.A. and it is of some moment to find that the results in both countries follow a similar pattern. It would appear that, in these surveys, people with reasonable education and who are concerned with the care of children would, with a certain element of caution, favour fluoridation. However, because of the size of the surveys, perhaps the findings should only be considered tentative and their validity a little suspect. It is of interest to note that, after a period of 10 years controversy, it has now been agreed to add fluoride to New York's City's water supplies thus augmenting the 1,200 cities and 4,000 smaller communities in the U.S.A. and Canada who are already doing just this. In Circular 28/62, the Minister of Health indicated that, under Section 28 of the National Health Service Act, 1946, he was ready to approve arrangements made by Councils with water undertakers for the addition of fluoride to water supplies which were deficient in it naturally. Subsequently, the Metropolitan Boroughs' Standing Joint Committee with the support of all its 29 members, agreed to approach the Metropolitan Water Board concerning the introduction of fluoride into London's water supply. The Board 76 intimated that there had been no general request by health authorities in the very wide area covered by the Board and they therefore considered that the present time was not opportune for the introduction of such a measure. Later the M.B.S.J.C. decided to approach the London County Council as the local health authority with a view to securing the artificial fluoridation of water supplies of the Board at an early date. Circular 37/63 of the Ministry of Housing and Local Government suggests that when fluoridation is introduced by water undertakers in accordance with arrangements made with local health authorities, the full cost shall be borne by the authorities concerned and that the water undertakers should satisfy the Minister on the technical aspects of their arrangements to introduce fluoridation Moreover, the Minister hopes that water undertakers will avail themselves of all the information and experience gained in the "study' areas by consulting his department at an early stage on the proposals regarding apparatus and routine control. 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: — Street Sweeping During the year several streets have been closed in connection with comprehensive development of their surrounding areas, but new streets have been constructed and have been adopted by this Council so that the mileage of streets swept remains at approximately 82. Frequency of sweeping continues as follows: — (a) At least once daily (main roads)—25 per cent. (b) Three times weekly—37½ per cent. (c) Twice weekly—37½ per cent. The latest addition to the Council's mechanical aids is a "Johnston" Suction Cleaner/Sweeper which, as its name suggests is a large portable vacuum cleaner having several advantages over the old type rotary broom sweeper. Some 7½ per cent of the mileage swept is done by this machine. The problems created by parking of cars and lorries tend to increase still. Sweepings during the year amounted to 1,297 tons. 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. Refuse Collection The total weight of household refuse collected for the year ending March. 1963 was 22,300 tons from 27,400 (average) 77 premises. This means that in spite of an increase in the use of gas and electric heating, due to the Clean Air Acts, the amount of refuse per hereditament remains at approximately 16¼ cwts. per annum—equivalent to 35 lb. per week. The average weight per 1,000 population per day was 14½ cwts. (83,760 pop.). Most of this is collected from individual bins, but now as blocks of flats are erected more and more communal bins housed in chambers at the bottom of chutes are being provided and at the end of 1963 some 500 were in use. The scheduled frequency of collection throughout the Borough is once weekly. In a number of pre-war blocks of flats, however, sufficient bin storage was not provided and collections are made twice weekly and in a few cases three times weekly. By virtue of 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. To save labour as far as possible the use of large bins is encouraged, as these are tipped into the refuse collection vehicles by mechanical means. 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 to take the place of those absent from work on account of illness. As new types of refuse collection vehicles come on the market these are inspected and tested so that the Council is, as far as is practicable, up to date in its collection fleet. With the introduction of sink waste disposal units, especially in multi-storey blocks of flats, some refuse is now being disposed of via the sewers, but at the moment the amount dealt with in this manner is quite small. Refuse Disposal All refuse (including approximately 200 tons of trade refuse) was conveyed to the Tip at Stone owned by the Land Reclamation Co. Ltd. Public Baths and Washhouses.—Greenwich is in the happy position of having a modern establishment for its Public Baths and Washhouses, situated in Trafalgar Road, and covering an area of 1¼ acres. Originally there were 3 large swimming baths, 74 ladies and gents' slipper baths, medicated vapour and foam baths washhouses and laundry, etc.. but during the war the Ladies' 2nd Class Swimming Bath was demolished by enemy action. Subsequently 78 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. (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, annual attendances which have been averaging over 12,000 have suddenly risen to 24,477 giving rise to difficulties of accommodation. Swimming baths continued to be well patronised, showing an increase in attendances of almost 25,000 over those of last year, while slipper baths and use of the public laundry remained approximately the same. I am indebted to Mr. K. L. Embley, Manager and Superintendent Engineer, for the following statistics: — Attendances.—For the year ended 31st December, 1963:— Slipper Baths 63,073 Swimming Baths *143,806 Russian and Turkish Baths 24,477 Public Laundry 5,046 Total 236,402 *Includes 47,540 school children. In connection with the swimming baths there has been provided a most up-to-date filtration, aeration and chlorination plant capable of purifying the contents of each bath every 3½ hours, thus enabling bathers to use the baths with every confidence. 79 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:— Sample No. Date & Time Nature & Temperature No. of Bathers Plate Count per ml. Yeastral Agar 24 hours 37°C. Probable No. of Coliform bacilli, per 100 ml. MacConkey 2 days 37°C. Faecal Coli. per 100ml. Result 1 29.1.63 11.45 a.m. 2nd Class *Swimming 79 °F. 130 3 — — Satisfactory 2 6.3.63 12.15 p.m. 2nd Class *Swimming 78°F. 60 64 — — Satisfactory 3 9.4.63 11.00 a.m. 2nd Class *Swimming 77°F. 70 — — — Satisfactory 4 20.8.63 1l.00 a.m. 1st Class *Swimming 76 °F. 70 2 — — Satisfactory 5 20.8.63 11.30 a.m. 2nd Class *Swimming 76° F. 35 2 — — Satisfactory 6 1.10.63 11.55 a.m. 2nd Class *Swimming 76° F. 100 — — — Satisfactory 7 19.11.63 11.20 a.m. 1 st Class *Swimming 76° F. 160 1 — — Satisfactory * Mixed Bathing 80 Public Sanitary Conveniences, etc.—The need for public sanitary accommodation is as great as ever and in this respect the 10 Council conveniences situated in the main arteries of traffic continue to provide a most satisfactory service. Particulars of Public Sanitary Conveniences in the Borough Convenience MEN WOMEN HOURS W.C.'s Lavatory basins Urinal stalls W.C.'s Lavatory basins Batley Park (Blackheath) 6 2 12 4 2 7 a.m. to 11 p.m Blackheath Hill (foot of) 3 – 10 4 – Blackwall Tunnel 3 – 6 5 – Charlton House 2 – 4 2 – Creek Road (St. Nicholas, Deptford) 4 • 2 10 4 2 Greenwich South Street (near Town Hall) 4 1 10 4 2 King William Walk (near Greenwich Park) 4 2 9 7 2 *Rodmere Street 5 3 12 5 3 Shooter's Hill Road (junc. Well Hall Road) 3 2 6 3 2 Woolwich Road 5 2 16 6 2 Totals 39 14 95 44 15 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. Action in accordance with plans which were drawn up for the erection of a new convenience at Woolwich Road in the vicinity of Anchor and Hope Lane was postponed by the Council during 1958. However, work was commenced at the latter end of 1962 and the new convenience was officially opened on 9th September of the current year. Notification was 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 81 scheme, they will be requiring, by the end of 1961, the land upon which the Tunnel Avenue Convenience is situated. However, as the work on the tunnel has been somewhat delayed, this site has not yet been required and the convenience is still open to the public. It has been intimated, at the time of going to press, that the site will be required immediately after the end of the financial year ending 5th April, 1964. 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 attendant 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. Tunnel Avenue, East Greenwich. In addition to the above-mentioned Drinking Fountains and Horse Troughs three urinals attached to Public Houses are cleansed daily by the attendant responsible for cleansing the fountains and horse troughs. 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 9,453 9,116 18,569 Creek Road 3,346 4,701 8,047 Greenwich South Street 2,926 3,010 5,936 King William Walk 5,862 5,335 11,197 Rodmere Street 3,461 7,762 11,223 Shooter's Hill Road 5,438 6,985 12,423 *Woolwich Road 2,564 2,763 5,327 Totals 33,050 39,672 72,722 * Commenced 9th September. 1963. 82 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 629 recorded complaints (437 of rats and 192 of mice), 419 were notifications, 44 re-notifications from occupiers or other sources and 166 were found during survey. The monthly average of complaints from all sources was 52 as compared with a figure of 61 for the previous year. In addition to the investigations of recorded complaints, 1,143 other surveys were carried out under the Prevention of Damage by Pests Act, 1949, giving a grand total of 1,772. During investigations, infestation was found to exist on 7 occasions in local authority's premises, 376 in dwelling houses and 137 in miscellaneous properties and places of business. Of these, one major infestation of mice was disclosed in a dwelling house. In all, some 544 treatments were effected by the local authority and 9 by occupiers or other services. Notwithstanding the fact that large industrial firms are inclined to make contracts with servicing companies, periodical treatments were carried out at 11 industrial premises, 5 wharves and storage places and at 3 hospitals in the Borough. Following the policy of tracing the source of each infestation, 16 defective drainage systems were discovered. In these instances Intimation Notices were served under the Public Health (London) Act, 1936, and the drainage defects made good by the owners of the various properties concerned. 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. 83 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, 1963:- 84  TYPE OF PROPERTY Non-Agricultural (1) Local Authority (2) Dwelling Houses (Inc. Council Houses) (3) All Other (including Business Premises) (4) Total of Cols. (1). (2) & (3) (6) Agrlcultura 1. Number of properties In Local Authority's District 49 24,389 4,689 29,127 – 2. Total number of properties inspected as a result of notification 5 306 75 386 – Number of such properties found to be Infested by:— Common rat Major – – – – – Minor 1 124 44 169 – Ship rat Major – – – – – Minor – — 5 5 – House mouse Major – 1 – 1 – Minor 2 120 26 148 – 3. Total number of properties inspected In the course of survey under the Act 3 820 218 1,041 – Number of such properties found Common rat Major – – – – – Minor 1 77 19 97 – Ship rat Major – – –__ – – Minor – – – – – House mouse Major – – – – _ Minor – 13 7 20 – 4. Total number of properties otherwise inspected (e.g. when visited primarily for some other purpose) – 13 3 16 – Number of such properties found to be infested by:— Common rat Major – – – — – Minor – 6 3 9 — Ship rat Major – – – – – Minor – – – –— – House mouse Major – – – – – Minor – – 4 4 – 5. Total inspections carried out— including re-lnspectlons (To be completed only If figures are readily available) 12 1,316 427 1,765 – 6. Number of infested properties (in Sections 2. 3 & 4) treated by the L.A 3 331 96 430 – 7. Total treatments carried outincluding re-treatments. 7 396 146 549 – 8. Number of notices served under Section 4 of the Act: (a) Treatment – – – – – (b) Structural Work (i.e. Proofing) – – – _ 9. Number of cases in which default action was taken following the Issue of a notice under Sect. 4 of the Act. – – – – – 10. Legal Proceedings – – – – – 11. Number of "Block" control schemes carried out – – – – – 12. Where legal proceedings have been Instituted by the Local Authority brief particulars should be given here:— – – – – – 13. Any other points of Interest – – – – – 85 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 have continued in the baiting of sewers at manholes using a highly toxic ready mixed bait containing 25% Fluoracetamide. Stringent safety measures were observed for the protection of the operatives handling the material and each manhole was marked with red paint to indicate that poison was used. In May the bait was introduced into some 1,117 manholes and in October into 1,184 manholes throughout the Borough. No census baitings have been undertaken. Anti-Fly and Anti-Mosquito Campaign.—During the summer period, April to September, the campaign has continued on similar lines to previous years. Two 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 21 complaints regarding flies and mosquitoes were received and a further 32 instances were revealed during survey. Again a 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 then obtained with antimalarial capsules and, as a consequence, complaints from this source were greatly reduced. At the end of the current year, some form of drainage was being instituted which, when completed, should, in a large measure, eliminate the basic cause of complaint. 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 personnel, as soon as possible after dust collection and 1,814 treatments were so carried out. A gradually diminishing number of static water sites, ditches, etc., were sprayed with either D.D.T. in Kerosene or Malariol, and in certain instances dusted with ' Gammexane' powder. 86 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. In this connection 16 external areas were treated. There is no doubt that since the introduction of the anti-fly scheme, control of fly and mosquito breeding has been effectively maintained and succeeding years have shown a progressive reduction in the number of complaints notified to this department. Disinfestation of Verminous Premises.—D.D.T. in kerosene continues to give good results in dealing with verminous premises when alternated with other vermicides such as Chlordane, Lindane and Malathion, etc., to counteract the development of organismal resistance. During the year the department dealt with 39 cases of dirty and verminous premises compared with 42 in 1962. The disinfestation staff sprayed 170 rooms and contents as compared with 123 last year. In 3 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 833 rooms and 227 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 66 complaints received and the further 6 cases found on survey 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 82 treatments involving 145 rooms and 34 external areas were carried out to combat the reported nuisances. 87 One of the commonest of ants, the very small red House or Pharoah's ant (Monomorium pharaonis) was also the cause of a number of complaints. This species, being of tropical origin, is incapable of breeding in England without artificial heat. A temperature of approximately 80°F is considered to be ideal for its propagation and ipso facto it is found infesting bakehouses, restaurants, hospitals and houses especially in larders and kitchens and nests may be found behind wall plasters, behind pipes or ovens, in heating ducts and under floor coverings and foundations. As in previous years this pest was encountered at two of the large hospitals in the Borough where, despite intensive investigation the sources of infestation were not located. The total number of treatments carried out in respect of this ant was 34, a decrease of 4 from the previous year. Although the treatments which involved 117 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 impractical. As usual, prevention offers the best solution to the problem namely, (a) to block or obstruct the entry of the ant, (b) to keep premises clear and free from crumbs and scraps of food, (c) to seal holes and cracks through which ants could enter and (d) to use an effective insecticide, preferably of a residual nature. Cockroaches. The cockroach (Blatta orientalis) and its smaller relative (Blattella germanica) are well known for their destructiveness, especially in relation to stored organic matter, ranging from foodstuffs to book bindings. Food is rendered repulsive from contamination not only with their faeces but also with the 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 78 complaints received concerning this pest came from bakehouses and the three large hospitals in the Borough; very few originated from occupiers of dwelling 88 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, 74 treatments were effected involving 463 rooms and 2 external areas. Clover Mite. Fourteen complaints were received, mainly from tenants in blocks of flats in various parts of the Borough, concerning small red or dark brown insects (Bryobia praetiosa) found moving over walls and windows. This was a reduction of ten 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 18 occasions, spraying of 17 rooms and 12 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. 89 Fifty-seven complaints regarding this pest were received and during the year some 41 nests were destroyed, mainly by means of HCN gas generated from purpose-made proprietary powder. This was an incease of 25 over last year. Many other types of infestation were encountered and the following is a list of the treatments which were carried out in connection therewith:— Complaints Foundon Survey Treatments Rooms External Areas Beetles: Black 15 2 26 55 8 Spider 2 – 2 6 – Earwigs 52 42 101 8 95 Silver Fish 7 1 7 16 – Fleas 4 1 4 18 – Woodlice 1 2 3 12 – Wild Bees 4 7 7 2 5 Misc. Insects 10 4 12 32 2 Thirty-three requests for spraying for other reasons such as bad smells, offensive deposits, etc., were met by a further 55 treatments to 103 rooms and 17 external areas. Precautionary Spraying. During the year, 506 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 514 rooms and 186 external areas. Aged, Infirm and Physically Incapacitated Persons.— One of the most pressing problems of today and one which in future years will intensify, is that of old age. In primitive societies old age was rare and, as a consequence, was an honoured estate, but today with all the advantages of modern science and medicine, it has become commonplace and commands little respect. Animals have no hopes or aspirations and their allotted span of life apparently occasions them no anxiety. It is only in man that we find an insatiable desire for a longer life, etc., and, accompanying advances in culture, education, affluence, etc., and, naturally, these are unattainable without the preservation of health. 90 From time immemorial, questions such as the maintenance of health and the prolongation of life have engaged the attention of wise men. from the Greek and Roman philosophers to the present-day men of science. Nevertheless, despite all that has been said, written, theorised and attempted it is clear that the majority of men and, to a lesser extent, women, have failed to adapt themselves to what, after all. is a normal situation, viz, ageing and the fact that all human life is limited. There would appear to be no doubt but that the "meaning of life" has a great effect upon the equanimity with which some people approach old age and it is obvious that some form of occupation of mind or body tends to maintain health. A woman generally weathers the vicissitudes of life somewhat better than a man. This is very probably due to the fact that, at retiring age, there is no real break in her life comparable with that of a man. Her activities continue, albeit more slowly, on similar lines to those evident before retirement. On the other hand, a man retires not only from a life-long occupation but also from a way of life and his environment becomes more restricted. From being a symbol of strength and the mainstay of the family he often finds himself becoming a somewhat awkward domestic to be humoured or tolerated and is bewildered to find that the outside commercial world is able to carry on without his active participation. Furthermore, due to reduced finances, he is unable to meet on an equal footing his previous friends who still pursue remunerative occupations. All these events tend to widen the gap between his existing world and the one he knew and they furnish a reasonable explanation for the sudden physical and mental deterioration which many men sustain shortly after retirement. Adjustment in these circumstances is extremely difficult, if not impossible, especially if the problems of retirement and old age have not been faced earlier. There is a real need to train people for old age and to teach them to live a life detached from the hurly burly of the fast, modern, existence and yet at the same time to reject the life of a recluse. In certain cases, extension of arrangements with managements for the elderly to continue work in a part-time capacity or in sheltered workshops is desirable in order that they may gradually become accustomed to the drop in the tempo of life. Carl Jung, the famous Swiss psychologist, has said that the second half of life is for culture but this pre-supposes that people are suitably trained and intelligent enough to be able to take advantage of their greater leisure. In relation to many of the elderly, this usually amounts to a completely new approach to 91 life, especially to those whose occupation has been of the manual kind. Many old people have struggled hard all their lives and their independent spirit often involves them in much suffering. They are reluctant to avail themselves of the help and financial assistance offered or provided by voluntary and Government agencies and tend to lapse into apathy and an existence of semi-starvation. The problems of those who maintain some connection with relatives may not be so acute as those who are alone but, unfortunately. as time removes loved ones, whether relatives or friends, many old people find themselves bereft of all personal relationships. In these circumstances perhaps the introduction of "colleges" could meet the situation, where inmates would have private quarters but yet be near enough to some form of communal life and within easy reach of medical attention from a resident matron if this should become necessary; such an arrangement however, would not normally be advocated for the geriatric case requiring regular or special medical care. Geriatric patients are those who suffer from physical and mental disorders resulting from old age. but it must not be forgotten that the elderly form a substantial proportion of admissions to hospitals for other disabilities. For instance, a recent survey of a large general hospital revealed that 40 per cent of all medical and surgical cases were 70 years of age or more and this figure did not include those in the geriatric ward. Nursing of the aged is no less skilled than other aspects of medical care but, for various reasons, there is a mistaken tendency to think that the elderly do not require such expert attention. Recent trends would appear to indicate that the number of nurses with geriatric training and who are still working in this field, are diminishing. Indeed, the doctors' training syllabus, including post graduate courses, make scant provision for geriatrics. This is a serious omission for when he takes up his profession as a general practitioner he finds a large proportion of his efforts are directed to the aged. There is no glamour or enchantment in ministering to the aged and. the fact that this kind of service is so often unrewarding in the sense that there is little prospect of complete recovery, doubtless proves a great disincentive to the medical and nursing profession and is probably the major contributing factor in the shortage of nursing services available to the elderly. Shrinking hospital facilities and personnel especially allocated to the geriatric patient, coupled with a steadily increasing 92 proportion of aged in the population, renders the outlook far from encouraging. There comes a time in most families when they find themselves involved with an elderly relative whose welfare, on occasions, becomes not only a matter of anxiety but also one of urgency. 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 full and continued support. This can be obtained from the health departments for. with the co-operation of the Geriatrician at St. Alfege's Hospital, short-term admissions are arranged for the elderly thus enabling relatives to take a well-earned holiday. Local health authorities and voluntary organisations are helping to fill the gaps in the services for the elderly and it is their duty to help the aged to grow old gracefully and to postpone as long as possible the impairments in health concomitant with age. It is generally agreed that old people are infinitely better off in their own homes especially when infirmity rather than illness seems to predominate and, notwithstanding all that has been written about the elderly from a social medicine point of view, fundamentally there are only two courses of action open for the treatment of their problem, viz., institutional or home care. However, it has already been pointed out that institutional facilities are extremely limited and the problem usually resolves itself into one of arranging for all the ancilliary services to support the aged in their own homes. It is in this particular sphere that the health department can be of the utmost value for it is in the unique position of being able to ensure the closest co-operation at all levels between the various agencies concerned with the wellbeing of the elderly. Home care demands a high standard of co-operation involving, as it does, home nursing, home help services, mealson-wheels, bathing and laundry services, pharmaceutical services and National Assistance. Undoubtedly health in old age is the real key to a happy retirement and, if this remains good, then most other disadvantages can be overcome or, with suitable help, be withstood. But age often brings with it many disagreeable side effects such as failure of muscular power, loss of memory, accident proneness, introspection, etc., and adjustments to environmental changes are badly tolerated. Furthermore minor ailments which, in the young, occasion only a day or so of discomfort, confine the elderly to bed for perhaps two or three weeks. 93 Local authorities are becoming increasingly responsible for softening the effects of some of the disadvantages arising as a result of ageing and, 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. When problems such as mental confusion, incontinence, lack of medical equipment, nutritional difficulties, etc., reach the department they are dealt with expeditiously. 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 carried out by the Lady Public Health Officers during 1963:— No. of Cases on Register at 1st January, 1963 1,841 Cases removed from Register 366 Cases added to Register 612 No. of Cases on Register at 31st December, 1963 2,087 Visits re:— First 566 Subsequent 7,262 Unsuccessful 886 Rest Homes, Hospitals, etc. 86 Miscellaneous 133 8,933 Attendances at Home Baths 77 Arrangements made for:— (a) Statutory Services 552 (b) Others 934 Interviews at Offices 336 Bathing Centre Sessions 103 No. of Baths:—At Home 2,007 At Centre 1,763 *No. of persons receiving foot treatment 73 ‡Chiropody:—No. of Sessions 25 No. of 1st Attendances 99 No. of subsequent Attendances 38 No. of Treatments:—At Home 50 At Centre 87 No. of persons having hair washed 21 No. of articles cleansed 54,696 Attendances at O.P.W. Committee 9 * Males 1,477, Females 2,293 ‡Commenced 19.9.64 94 Cases Referred:— From To 10 G.O.P.W.A 1 176 Hospitals 74 118 Home Help Organiser 149 93 District Nurses 63 48 Relations 1 70 N.A.B 61 63 British Red Cross 134 24 Housing Department 56 49 Doctors 121 3 Church & Club Organisations 30 39 Health Visitors 10 4 W.V.S 5 7 District P.H.I.s 4 5 L.C.C. Welfare 28 1 Chest Clinic — 13 Miscellaneous — 108 Found on District — 103 Personal Request — 30 Neighbours — 31 Councillors — 3 Pensions Book Pink Card — 6 Citizens Advice Bureau — 3 L.C.C. Blind — — L.C.C. Admitting Officers 6 — Medical Officer of Health 3 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 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. 95 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, 1,763 baths were given to dirty or verminous elderly persons at the Cleansing Station and 2,007 home baths were effected. Figures for the previous year were 1,348 and 2,017 respectively and in 1961 the figures were 538 and 1,499. 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. By the end of the year the laundry service, supervised by the Lady Public Health Inspector, had been extended to 237 separate individuals and during the current year, the staff at the Cleansing Station have dealt with 54,696 articles which were collected, laundered and delivered. Greenwich Hotel—Westgate-on-Sea. General.—For several reasons, mainly financial, holidays for the elderly of the Borough have had to be arranged to be taken at "out of season" times. More recently, other Boroughs have been making increasing demands on the available holiday accommodation and the position is becoming even more difficult. Hitherto, the Council have had no property of their own which could have been utilised to ease this particular situation. 96 However, after seriously considering the purchase of a sea-side property in order that holiday accommodation would be available to the elderly throughout the whole year, the Council agreed in principle that suitable properties should be viewed by a subcommittee. Finally, as a result of much search and effort both by members and officers, a choice was made and the Council duly purchased a hotel at Westgate-on-Sea for the exclusive use of Greenwich residents. One of the problems of advancing years, apart from declining physical and, less frequently, mental powers, is the temptation to lapse into apathy and indifference. There is, in most of us, an almost inborn resistance to change which seems to get more pronounced as we grow older but it has been found that, if old people are encouraged to use their faculties to the upmost potential and to get out and about to enjoy the occasional change of scene, the physical and mental well-being is improved and the, as yet, irreversible processes of ageing are delayed. It is for these sound reasons that the Health Committee feel that this additional recreational amenity for old people will add yet another valuable service to the many local facilities which already are available in the shape of meals on wheels, luncheon clubs, home visiting, chiropody and bathing, as well as many other miscellaneous provisions all directed at sustaining local citizens and giving a purpose, interest and perhaps a happiness, to the later years. It should be emphasised that this building is a hotel and not a convalescent home and the intention is to provide a holiday and recreation for the guests. The atmosphere, we hope, will be that of cheefulness and of the holiday spirit. Nevertheless, although most of the guests will be active, the needs of the frail are not forgotten and provision is being made for those elderly citizens burdened with the inevitable concomitants of old age who are for the most part homebound. At the height of the season the ground floor bedrooms will be reserved for their use and it is hoped that, eventually, each party coming down from Greenwich to Westgate. even in the depths of winter, will have a proportion of homebound included so that they too can enjoy the leisure, the comfort and the company, and can return home refreshed and encouraged. If the success of this new service is commensurate with the exertions and the enthusiasm which have gone into the initial preparations. the citizens of Greenwich shall have reason for satisfaction. Westgate Bay Greenwich Hotel—Westgate-on-Sea. 98 Description of Building and its Environs. Building.—Greenwich Hotel is a detached, modern, attractively designed property faced with warm red brick, part tile hung and has a red tiled roof. It is of pleasing appearance, situated in Sea Road overlooking public gardens and the sea, with extensive views of the bay from all the front rooms of the building. A sun lounge located on the first floor over the front entrance affords a most agreeable prospect of the coast line from Birchington to Margate. The forecourt is gravelled and is most convenient for the reception of coaches and cars, whilst the rear garden has a Entrance Hotel 99 tree-lined lawn where afternoon teas may be taken during the summer months. It is expected that, under present conditions, the Hotel when fully booked will accommodate some forty guests. The main accommodation is situated on the ground and first floors and all bedrooms are fitted with wash basins and provided with hot and cold water. In addition to a lounge and the spacious dining room with annexe all facing the sea, there is, opening on to the garden, a sizeable lounge-bar where guests can relax during the evening. For the benefit of the handicapped, the ground floor corridors and all baths and W.C.s are fitted with hand rails and a recently installed central heating system provides the elderly with an added touch of comfort. Environs.—The Hotel could hardly be better situated, for the handicapped are able to enjoy the cliff-top lawns and gardens across the road, whilst for the energetic, a gently sloped promenade leads to an excellent sandy beach. Dining Room 100 The shops, a cinema and the railway station are within a short walking distance from the hotel and if the entertainment at Westgate Pavilion does not meet with approval then Margate, with all its multifarious attractions, can be reached in a few minutes by bus. Westgate is a most convenient centre for visiting the beautiful countryside of Kent and the many places of historical interest in the Isle of Thanet and, for the more venturesome, trips to Canterbury with its Cathedral, Minster Abbey (reputed to be the oldest in England), Ebbsfleet and Pegwell Bay (the centre of Saxon and Roman landings) and the twin towers of Ancient Reculver. will prove very rewarding. Bar Lounge 101 A Bedroom Greenwich Old People's Welfare Association.—This association set up in July, 1954, co-ordinates the activities of Old People's Clubs in the Borough which provide for the physical and mental recreation of their members and although the association obtains money from various sources such as the street appeal and other donations, the bulk of the association's expenditure is sustained by the grant received from the Borough Council. The following are extracts from the tenth Annual Report of the Association. Old People's Clubs—Our main source of contact with elderly citizens in Greenwich lies in the Darby & Joan, Federation and Church Clubs which have continued to flourish, with one exception due to the untiring efforts of members of voluntary organisations who act as escorts and run the clubs with the help of many of the elderly members themselves. The exception is St. John's Old Folks Club which, unfortunately closed on the 24th February, 1964, 102 due to the resignation of the Club Leader, Mrs. Warwick. All efforts to fill the vacancy proved fruitless. These clubs provide companionship and entertainment for many who would otherwise spend a very lonely life in their homes, and also an opportunity for making new friends and taking up new interests. Clubs, whilst receiving a small grant each year from the Borough Council, are self-supporting and leaders and helpers have earned our deepest gratitude for their efforts which bring so much happiness to hundreds of our elderly citizens. Day Rooms at Community Centres— (a) Charlton House Day Club. It is eight years since this day club opened and, except during severe inclement weather, attendances have been maintained and a very happy atmosphere prevails. Members enjoyed two days outings to the coast during the year under review. (b) Kidbrooke House Day Club. This Day Club proved so popular with the homebound elderly that it became necessary to create a waiting list. Arrangements were, therefore, made to extend this service to five days per week catering in all for 50 persons per week with effect from 6th April, 1964. As a result of representations made to the Greenwich Borough Council a new gas cooker and ascot water heater were installed in the kitchen, thus overcoming the difficulties experienced by the helpers when cooking frozen meals for club members. We are very appreciative of the service provided daily by members of the British Red Cross Society and Women's Voluntary Service in connection with this club and take this opportunity of extending to them our sincere thanks. We are also very grateful to the Greenwich Borough Council for their co-operation and assistance. (c) West Greenwich House Day Club. Attendances at this Day Club, which at one time had to be restricted due to lack of accommodation dropped considerably on Mondays, Tuesdays and Wednesdays after the opening of the Minor Hall Luncheon Club, mentioned later on in the Report. It was found that persons attending the Luncheon Club were joining one or other of the Old People's Clubs held on those days in the Minor Hall. However, attendances are once again slightly increasing and a very happy atmosphere exists among the elderly citizens who take advantage of the comfort and service provided. Arrangements were made during 1963 for a day's outing to Eastbourne which members found very enjoyable. 103 Meals-on-Wheels—This service has continued to operate efficiently, a new mini-bus having been purchased in January, 1964, to augment the foui vehicles already in use. The demand for this very essential service has continued to increase, 35,313 meals having been delivered during the Financial Year 1st April, 1963, to 31st March, 1964, compared with 32,852 during the previous year, an increase of 2,461. As a precaution against non-delivery of meals during severe falls of snow or thick fog, emergency packs consisting of a tin of soup and a tin of rice were issued to recipients of meals-on-wheels during the late autumn. We are again indebted to members of the British Red Cross Society for supervising the delivery of meals, to the Greenwich Borough Council for the generous grant made to the Association tov/ards the cost of this service and to the drivers and helpers for their loyalty and devotion in maintaining deliveries throughout the year. Luncheon Clubs— (a) Minor Hall—Our grateful thanks are extended to the Greenwich Borough Council for modernising the Minor Hall kitchen in order that a Luncheon Club for elderly people could be opened on the 7th October, 1963. Initially the club operated on Mondays, Tuesdays and Wednesdays but was extended to a 5-day week on the 16th of April, 1964. 877 meals were served during March, 1964, and attendances range from 60 to 95 daily. We are also greatly indebted to members of the British Red Cross Society and Women's Voluntary Service who have attended daily to assist the two paid staff in the serving of meals and general tidying up afterwards. (b) Oaklands Luncheon Club—This Club was opened on Monday, 1st June, 1964, on a five-day week basis and is already proving very popular. At the end of the second week members had risen to 47 daily and it is anticipated that attendances will eventually reach the 70/90 mark. (c) Halstow Road Luncheon Club—This Luncheon Club was opened on Tuesday, 2nd June, 1964. Unfortunately it is not possible to hold a Luncheon Club at this centre on Mondays and we are, therefore, restricted to a four day week. The accommodation available is considerably smaller than "Oaklands" and it is hoped that within a short period 50/60 meals will be served daily. (d) General—We are indebted to the Greenwich Borough Council for the considerable grant made towards the cost of equipping and converting the above Luncheon Clubs and feel confident 104 that the demand which will be forthcoming will prove that this is a very essential service which will benefit the health of many of our elderly citizens by ensuring that they have properly balanced hot meals at least once daily. Welfare Foods for Old People—The turnover in Welfare Foods during the year under review amounted to £2,831 9s. l0d. and shows an increase of almost 40% over the previous year's sales. During the year Ribena Pastilles were added to the list of foods available to elderly persons. In view of the continued increase in turnover the Women's Voluntary Service felt that they could no longer supervise and administer this scheme efficiently and the Clerk, on behalf of the Association, took over the complete administration on the 22nd November, 1963. We would like to take this opportunity of placing on record our sincere thanks and appreciation for the part played by members of the Women's Voluntary Service in starting and maintaining this service over quite a number of years. Twenty-six welfare food permits were issued on behalf of homebound elderly citizens during the past year making a total of 147 in all and it is hoped that the number of handicapped elderly citizens taking advantage of this service will continue to increase. Chiropody Service—We are pleased to report that the London County Council have agreed to make a grant to the Association in order that a chiropody service be inaugurated consisting of two three-hour sessions per week. This service commenced on the 19th September, 1963, patients being treated at the Borough Council Bathing Centre or, in special circumstances, at their homes. During the period 19th September, 1963, to 31st March, 1964, 297 treatments were provided upon recommendation by the Public Health Visitors of the Borough Council for a total of 135 patients. Invalid Chairs—Due to the marvellous response in connection with the Street Appeal and House to House Collection last year we have been able to purchase four more invalid chairs bringing the total to 21. These chairs are loaned to handicapped elderly citizens in order that they may be taken out of their homes during fine weather. Holidays—During the previous nine years the Association has, with the aid of a considerable grant from the Greenwich Borough Council, been able to arrange holidays at the seaside for nearly 2,000 elderly citizens. Last year the Greenwich Borough Council purchased a hotel at Westgate, now known as the "Greenwich Hotel" which was opened on the 25th March, 1964. The Hotel has accommodation for 40 persons including several handicapped 105 and holiday parties are being arranged fortnightly throughout the year. In all it is expected that nearly 800 elderly citizens will spend a fortnight at the Hotel during 1964. As our contribution towards this service, we have made a grant of £200 for the purchase of amenities, i.e., television set, rose trees and deck chairs in the garden and a teak bench with a plaque bearing the Association's name. Street Appeal and House to House Collection—We reported at the last Annual Meeting that the Worshipful The Mayor (Councillor Mrs. I. M. Scales, J.P.) had offered to make application on behalf of the Association to hold a House-to-House Collection and Street Appeal in aid of the Association's funds. The Appeal was held in the 1st week of September, 1963, and it gives us very great pleasure indeed to report that, despite inclement weather, a total of £226 15s. 1d. was collected. From this sum an expenditure of £11 3s. 8d. was deducted in respect of the purchase of emblems and permits leaving a total of £215 l1s. 5d. which was credited to the Association's Voluntary Funds. We are very grateful indeed to all those who assisted in the Appeal and especially to the large number of elderly persons who helped to collect on the day of the Street Appeal. Carol Service—The Annual Carol Service was held at St. Alfege Church on the 2nd December, 1963, and was attended by approximately 300 elderly citizens. Her Worship the Mayor was also in attendance accompanied by Chief Officers of the Borough Council and members of the Executive Committee. Tea, sandwiches and cakes were served by members of the Women's Fellowship in the Church Hall after the service and our sincere thanks are extended to all who helped to make this occasion so successful. Christmas Food Parcels for the Homebound—Once again, due to the generosity of the Greenwich Borough Council by way of a grant, goods sufficient for 500 parcels of similar content to previous years were purchased. Members of the Committee and friends met in the Minor Hall on 6th December, 1963, and packed the parcels which were distributed by members of the British Red Cross Society, Women's Voluntary Service, the Committee and the Association's Meals-on-Wheels staff. These parcels were given to elderly persons who were genuinely homebound or aged 85 or over and, in accordance with normal practice, members of the Greenwich Borough Council were invited to nominate persons who came within the above two categories. In addition to the above over 300 extra names of deserving 106 elderly citizens were supplied in respect of enquiries from firms and other organisations who desired to distribute their own gifts and parcels. We are greatly indebted to all who gave their time and assistance in packing, distributing and raising private funds in order to bring a little of the Christmas Spirit into the homes of so many of our elderly citizens. Old People's Clubs—Christmas Parties—These Old People's Clubs held their Christmas Parties in the Minor Hall during December, 1963, and January, 1964, and they all proved very successful. Our sincere thanks are extended to the Greenwich Borough Council for their continued co-operation in granting free lettings of the Minor Hall, inclusive of floral decorations, on these occasions. Frozen Christmas Dinners—As in past years consideration was given to those elderly citizens who were known to be entirely alone at Christmas with no one to cook for them. Twenty-four frozen Christmas Dinners were purchased and were delivered on Christmas Eve by Mr. and Mrs. Lewis to whom we are greatly indebted for giving up their time in connection with this very essential service. Concerts—A concert for elderly persons was held in the Borough Hall on the 1st October, 1963, experienced artistes having been engaged. 450 elderly citizens attended and so enjoyed the evening's entertainment that a further concert was held on the 21st of April, 1964. On this occasion also, the ground floor of the Borough Hall was filled almost to capacity and the entertainment provided was thoroughly appreciated. We would like to extend our sincere thanks to Mrs. Gardener and members of the Women's Voluntary Service for carrying out the catering on these occasions. Outing to Kent—On the 11th and 12th July, 1963, two parties of 20 invalids visited the home of the Medical Officer of Health and his wife, tea being provided on the lawn. We are very grateful indeed to the Medical Officer of Health and Mrs. Kerr Brown for their wonderful hospitality on these occasions. Visiting Scheme—Two boys, members of the Young Christian Workers and a young girl, a member of the Girl Guides Association have been visiting three of our senior citizens throughout the year and carrying out small tasks around the home. The visits average one or two per week, and it is most encouraging to note the way that these young people give up their time to provide company and assistance to elderly citizens. 107 Visits to Women's Institutes—On the 28th May, 1964, a party of 33 semi-invalid elderly citizens were entertained by members of the Wingham Women's Institute near Canterbury and thoroughly enjoyed their day's outing. In addition, we have accepted a repeat invitation from Linton Women's Institute, Brentwood, near Maidstone, to entertain a party of 33 semi-invalids on the 29th of June, 1964. Circus—Olympia—Through the good offices of the British Red Cross Society complimentary tickets were obtained for the Circus at Olympia and arrangements were made for a party of 32 elderly persons to visit the circus on the 21st of January. This visit, which proved very enjoyable, was rounded off with a cup of tea and biscuits on the return journey. Linen Store—At the last Annual Meeting we reported that we had allocated the sum of £60 for the purchase of bed linen, draw sheets, etc., to be held in store for issue on loan to homebound elderly citizens in difficulties at home, under the supervision of the Medical Officer of Health. These items have since been in constant demand and we have allocated a further sum of £60 to replace unserviceable equipment. Acknowledgments—Many individual acknowledgments have been made throughout the foregoing Report although it is not possible to mention personally everyone who has assisted in the work of the Association during the past twelve months. It gives us very real pleasure, therefore, to take this opportunity of placing 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 our senior citizens. Special mention must again be made of the Greenwich Borough Council for the many and varied services and facilities which they have continued to make available to the Association; for the increasing financial grants and also for the free use of the Minor and Borough Halls. Our thanks must also be expressed to the Town Clerk, Medical Officer of Health, Borough Treasurer and their staffs for the able and willing assistance given by them during another busy and expanding year which has seen our services continue to improve and extend thus benefiting an even greater number of senior citizens in the Borough. Executive Committee 1963/64—The Committee for the past year has been as follows:— Council Representatives Councillor Mrs. M. L. Wentworth (Chairman) Alderman H. Ingle 108 Alderman W. S. Manners, M.B.E. Councillor Mrs. M. L. Bennett Councillor Mrs. J. E. Chrisp Councillor H. W. H. Icough Councillor Mrs. E. Pennington Elected Representatives Mr. A. S. Churchill (Blackheath Branch N.F.O.A.P.A.) Mrs. M. Gardener (Women's Voluntary Service) Mrs. L. Hildrith (Greenwich Labour Party—Charlton Women's Section) Mrs. H. Howard (Oaklands Darby & Joan Club) Mrs. I. Phillips (British Legion—Women's Section) Miss K. Rackham (Vice-Chairman) (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 1963, arrangements were made under the above Act for the burial of 8 bodies, 7 male and 1 female, at a total cost to the Council of £9 2s. 6d. Exhumations.—No exhumations were carried out during the current year. Mortuary Accommodation.—Arrangements exist between the Greenwich Council and the Councils of Deptford and Lewisham for bodies to be accommodated at their respective mortuaries prior to inquests and post mortems or while awaiting burial. During the current year some 410 bodies were so accommodated (287 at Deptford and 123 at Lewisham) at a cost to the Council of £731 17s. Od. 109 Summary of Work Performed by the Public Health Inspectors during the Year 1963 Inspections— Houses inspected (House-to-House) 177 „ „ (Complaints, nuisances) 1,099 „ „ (Infectious Disease) 520 „ „ (Overcrowding) 84 Inspections of Factories 312 „ „ Shops 54 „ „ Canteens 13 „ „ Hairdressers or Barbers 71 „ „ Licensed Victuallers and Clubs 65 ,, „ Underground Rooms 16 „ „ Pet Shops 5 „ „ Stables and Yards 4 „ „ Urinals 23 „ „ Houses in Multiple Occupation 34 „ „ Outworkers premises 49 „ Under Clean Air Act 3,825 „ Miscellaneous 1,099 Inspection of Premises (Slum Clearance) 60 „ „ „ (Rent Acts) 14 Investigations (Rats and Mice) 450 Investigations (Insect Pests) 80 On notice from Architects and Builders 874 Re-inspections, calls made, etc 4.896 13,824 Drains— Drains tested—by smoke 130 „ „ —by water 306 Opened, cleansed and repaired 324 Reconstructions and additions 260 Inspection chambers constructed 193 New covers to manholes Ill Soil and vent shafts repaired or renewed 187 Traps (gully) 199 Drains sealed off, etc. 50 Yards and forecourts drained 39 W.C. Compartments erected or repaired 228 W.C. fittings repaired or renewed 182 W.C. pedestals installed or renewed 294 Sanitary conveniences or improvements effected to Factories and Workplaces 9 Urinals cleansed or repaired 9 Dustbins— Provided 112 Pavings— Yards and Forecourts 67 General Water Supply— Water Fittings amended 170 Water supply restored 45 Extra water supply to tenement houses Water supply certificates granted (Sect. 95) 399 110 Other Improvements— Houses generally repaired 103 Rooms cleansed and repaired 246 Rooms and staircases lighted and ventilated 17 Verminous rooms cleansed 47 Roofs, gutters and rainwater pipes repaired 326 Dampness abated 184 Underground Rooms (enforcement of Regulations) — Sinks, baths and lavatory basins provided 403 Sink, lavatory and bath waste pipes trapped or amended 335 Stoves and fireplaces 49 Washing coppers repaired or provided . Floors repaired 103 Provision for storage of food 104 Miscellaneous repairs 389 Other Nuisances Abated— Illegal use of Underground rooms discontinued 1 Overcrowding abated 20 Animals kept in unfit places discontinued or removed — Dung receptacles provided — Accumulation of manure and other obnoxious matter removed 26 Rat infestation abated 78 Smoke Nuisances— Observations 265 Statutory Notices served — Notices. &c.— Intimations served under Public Health (London) Act, 1936 440 Statutory Notices served 144 Houses rendered fit by informal action 88 111 SECTION D Housing In no other field of Local Government is it necessary to look so far ahead and plan accordingly than in housing. Much criticism has been levelled by the moderns at the architects and builders of the 19th century when, under severe pressure exerted by the industrial revolution, they became responsible for the urban areas which are now subject to re-planning and re-building. In those days the sudden and pressing demand for housing was met by impulsive design and hurried construction, neither actions being conducive to a satisfactory outcome. Similar pressures are beginning to show themselves to-day and it is conceivable that similar mistakes may now be made, sufficient to warrant similar scathing criticism in future years. Most problems tend to be more easily solved with a little "hind-sight" so it would be wise to consider all re-planning schemes on their respective merits and not to adopt them merely because they happen to be modern. For instance, it was only a few years ago when multi-storey flats were hailed as the answer to the housing problem, not only on the grounds of providing high density resettlement but also on those of finance. To-day, even the Town and Country Planning Association, although acknowledging the need for higher population density in many areas, is suggesting to the Ministry of Housing and Local Government that this should not necessarily result in "high rise" building. They are, in fact, advocating the age-old psychologically sound idea that families should occupy houses with gardens wherever possible and, where this is not possible, then blocks of flats no higher than 3 or 4 storeys, at which height, building costs are little more than for ordinary houses. Considerable ingenuity must be displayed by local authorities in their housing activities, especially in respect of the needs of elderly people. Old people are intolerant of an upheavel such as re-housing represents to them—they become frustrated and confused. It often involves moving to completely new areas away from life-long friends, social activities and environment and all the efforts of welfare authorities and voluntary organisations cannot replace these losses. Generally the re-housing of the elderly involves the allocation of smaller accommodation and makes the disposal of furniture and, often, of personal treasures, a necessity Even here one often finds that there is now no "rag and bone" man to help in such circumstances—like other small traders who used to perform many of the menial tasks he has been "planned" out of the neighbourhood. 112 Whilst considering re-housing of the aged it must not be forgotten that there is a large unfulfilled demand on the part of elderly people who, for various reasons, are not likely to receive help of this nature from the local authority. These would include elderly couples whose houses are too big, who could afford an economic rent and yet who are unable to find alternative accommodation. To cater for just this type of case the National Corporation for the Care of Old People, an offshoot of the Nuffield Foundation, set up the Hanover Housing Association, a non-profit making organisation which is prepared to operate anywhere in the United Kingdom where the local authority will welcome them and provide all the statutory financial help to provide rented accommodation in accordance with the recommendations contained in the Ministry Circular 12/62. Transference of elderly couples from the larger under occupied house would help the local authority in two ways: it would provide the "young and growing family" applicants with three bedroom accommodation and relieve the authority of the future necessity of moving old and frail people at the most inappropriate time of their lives. A rapidly increasing retired population necessitates the production of more housing units of various kinds for the elderly from bungalows and one-bedroom flats of the orthodox type to group schemes where they may enjoy privacy among their own belongings and yet be able to benefit from communal services and social activities. Such measures will not only enable the elderly to maintain a measure of independence but will reduce the heavy demand for residential places provided by welfare authorities. Shortages of land, money, building materials and labour bring limitations to what can be achieved within a given time and. faced with these constrictions, it would seem that, in order to produce a little breathing space, local authorities must give increasing consideration to saving and converting the more structurally sound dwellings. Where demolition is the only alternative, then a greater measure of prefabrication must be introduced to speed up completion of houses and reduce labour costs. In the latter case, expediency must not give rise to the erection of houses of reduced standards or size which will rapidly become obsolete and thereby repeat errors of previous generations. Population, generally, is expected to increase by approximately 8 million during the next 20 years, in which event something like 125,000 new houses a year will be required merely to keep pace with the increase in households and furthermore, slum clearance will also make its own demands. Altogether the building industry will be subject to great strain in attempting to satisfy the need 113 for more schools, colleges, universities, hospitals, power stations, etc. Legislation—The Housing (Payments for Well-Maintained Houses) Order, 1963—Operative from 10th April, 1963, this Order alters the basis upon which payment is calculated in respect of houses which, although unfit for human habitation, have been well-maintained. Housing Act 1961—Houses in Multiple Occupation.—In connection with these types of properties, 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. However, powers enabling the Council to enforce standards under Section 36 proved to be inadequate and were repealed by Part II of the Housing Act, 1961. Regulations were made by the Minister under Section 13 of the new Act providing a management code for Councils to apply to "Houses in Multiple Occupation". Further, for the purpose of implementing the provisions of Section 15 of the Housing Act, 1961, the Council, on the 14th November, 1962, adopted the standards of provision of amenities, as suggested in the joint report of the Advisory Bodies of Town Clerks and Medical Officers of Health of metropolitan borough councils. Full details of the schedule were given in my 1962 Report. During the year 34 visits were made by Public Health Inspectors to houses in multiple occupation and 59 notices were served as follow :— Notice of entry for the purpose of inspection, etc., to occupiers and to owners where known 50 Notice requiring statement of persons sleeping in a house 1 Notice requiring information as to ownership of premises 7 Informal notice requiring execution of works 1 Housing Act, 1957—The following procedures were carried out under Part II of the above Act during 1963. 114 Unfit Houses—Sections 16 and 17.—In accordance with Section 16, the following end of terrace 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 upon the adjoining house and. under Section 17, a Closing Order was accordingly substituted. 28 Ransom Road, S.E.7. (Closing Order.) Underground Rooms—Section 18.—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, 1961. At the undermentioned property two rooms being rooms, the surface of the floors of which were more than 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. 111 Lee Road, S.E.3. (Closing Order.) In respect of the following premises, a Closing Order previously made was determined during the current year. 2 Furzefield Road, S.E.3. (Closing Order Determined.) Part of Building—Section 18.—At the undermentioned property, 5 rooms being the ground floor and back addition, the back addition (off), the first floor front, back and back addition, were considered unfit for human habitation and represented as such. 82, Selcroft Road, S.E.10. (Closing Order.) Slum Clearance—Part III of the Act.—Two areas. No. 2 (Maryon Road) and No. 3 (Rolfe Road) Clearance Areas, 1962. represented during 1962 for slum clearance, obtained Ministry approval during the current year. Six sites, comprising some 29 dwellings, were represented for slum clearance during 1963. However, in respect of the No. 1 (Ransom Road) Area involving 2 vacant houses, the owner objected and submitted details of the works he was prepared to carry out which included improvements. The Council agreed 115 that, subject to the works being satisfactorily effected, the application to the Ministry for confirmation of the Clearance Order be withdrawn. Confirmation from the Ministry is still awaited for the remaining 5 sites. Clearance Areas 1963 Homes Persons to be Displaced Families Adults Children No. 2 (Charlton Lane)* 5 13 2 6 No. 3 (Charlton Lane) 8 17 4 9 No. 4 (Charlton Lane) 3 11 — 3 No. 5 (Lansdowne Lane) 9 15 2 9 No. 6 (Lansdowne Lane) 2 4 — 2 *Following representations from the Ministry, the No. 2 (Charlton Lane) Clearance Area was modified and a Clearance Order substituted for Compulsory Purchase Order covering two properties, viz. Nos. 12 and 14. A resolution was passed by the Council to make a Compulsory Purchase Order in respect of 2 houses, viz. Nos 2 and 4 Charlton Lane adjoining the No. 2 (Charlton Lane) Clearance Area. 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 1962, some 82 houses and a number of prefabricated dwellings had been demolished and some 143 dwellings and 34 garages had been erected. During 1963, the Trustees were responsible for the following operations:— Properties Demolished—1/13 (consec.), 19/21 (consec.) Bennett Grove, (16 dwellings), 53/59 (odd) Morden Street, (4 dwellings), 11 John Penn Street, (1 house), and 5/11 (odd) Orchard Hill (4 dwellings). 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. 116 During the year 72 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 29 such grants had been agreed. Re-Housing.— (a) Borough Council.—There were 68 new dwellings provided by the Council during the year and the number of families housed and re-housed including transfers, casual voids, etc., amounted to 354. Of this number 4 were in respect of overcrowded cases and 25 families re-housed from outside the Borough. The Housing Department now has control of 4.414 Councilowned units of accommodation, an increase of 168 over that of the previous year. (b) London County Council.—During the year ended 31st December. 1963, the L.C.C. had provided alternative accommodation for a total of 424 Greenwich families of which 3 had been certified as overcrowded cases. Of this figure, 217 were housed on L.C.C. housing estates outside the Borough. One family from outside Greenwich was rehoused in the Borough under the L.C.C. scheme. (c) Other.—A further 13 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 31. During 1963 there was a rise in the number of complaints received concerning overcrowding, the year's figure of 59 showing an increase of 25 over that of the previous year. Each complaint was investigated by the Public Health Inspector concerned and as a result of these investigations 15 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 was a definite decline between the years 1946 and 1960 in the number of families found to be living in overcrowded conditions in the Borough. Since then there has been a slight but perhaps significant increase. 117 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 1961 5 1962 4 17-year average 71 1963 15 New Housing Accommodation.—The following table lists the new dwellings erected in the Borough during 1963:— Type of Dwelling G.B.C. L.C.C. Private Total Houses 14 — 64 78 Flats and Maisonettes 54 172 82 308 Mobile Homes — 13 — 13 Total No. of Dwellings 68 185 146 399 The total number of dwellings provided in the Borough since the termination of the war is now 6,354. Movable Dwellings.—The current year saw a substantial increase in the number of homeless seeking accommodation from the County Council. As a consequence, formal applications were received from the London County Council for licences to utilise vacant sites in the Borough for movable dwellings. By the end of the year and in accordance with Section 22 of the London County Council (General Powers) Act, 1959, the 8 undermentioned sites had been so licensed for a maximum period of three years subject to the following condition:— "That compliance be required with the standards recommended by the Metropolitan Boroughs' Standing Joint Committee in 118 connection with the licensing of movable dwellings, with the exception of Condition (1) in as far as it applies to the distance from the boundary of the site and the distance between the dwellings and Condition (2) relating to fire-fighting equipment." Site Area Movable Dwellings Nos. 2-40 (even) Berthon Street and part of Creekside .96 acres 24 Land east of Nos. 1-12 and Nos. 13-18 Watergate House and site of 48 Armada Street .41 acres 8 Nos. 92-100 (even) Grove Street and Nos. 1-7 (odd) Barnes Terrace .37 acres 7 Land fronting Brooklands Park, situated between Casterbridge Road and 83 Brooklands Park 1.1 acres 25 Land northern side of Mirfield Street 3 acres 8 Nos. 117-149 (odd) Eastmoor Street and Nos. 16-21 (consec.) Herringham Road 20 Nos. 37-40 (consec.) Herringham Road and Nos. 2-34 (even) Lydenburg Street 13 *Land bounded by Lydenburg Street, Westmoor Street and Herringham Road 5 *Following representations by this Council to the London County Council that this area was subject to flooding, agreement was reached as to precautionary measures being taken and the original number of 10 movable dwellings was reduced to 5 in order to exclude that part of the site which was at the greatest risk. NOTE: Town planning permission is deemed by virtue of the provisions of Section 42 of the Town and Country Planning Act. 1962. Council Housing Schemes.—(Information supplied by the Borough Engineer). (a) Schemes in progress at the end of the current year :— Site Dwellings Haddo Street 164 Vanbrugh Park 176 119 (b) Building programme for rehousing envisaged for 1964, et seq :— Site Dwellings Plumbridge Street 2 Wellington Gardens 14 Heathway 54 Maze Hill 25 Coleraine Road 54 280 Shooter's Hill Road 27 Woolwich Road/Charlton Church Lane 23 Kidbrooke Park Close 77 R/O 24/28 Hervey Road 4 Old Dover Road 192 Several other schemes are envisaged, some of which will be carried out by Private Architects, but at this stage it is impossible to forecast completion dates. Town and Country Planning Act, 1962.—In exercise of powers under Section 22 of this Act and of article 12 of the Town and Country Planning General Development Order, 1963, the Minister of Housing and Local Government continues the policy originally laid down in 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 1963: — "The year 1963 witnessed continued progress by the Council in the provision of new housing of all types of dwellings within the borough. From the intake of newly completed dwellings and casual vacancies, it has been possible during the period under review to house 170 families from the various categories of slum clearance and redevelopment areas, the housing waiting list, special medical cases, individual unfit dwellings, and properties involved with reconstruction works. 120 New schemes taken over included 31/32, Gloucester Circus, specifically for elderly citizens in this part of the borough. These flatlets meet an urgently growing need, and also assist in resolving the position of older Council tenants under-occupying four and five roomed houses and flats, which are thereby made available for re-occupation by larger families. Like the Hervey Road scheme, Gloucester Circus has every modern labour saving facility; underfloor space heating, constant hot water and in addition a self-operated passenger lift. Resident Warden service is provided for the welfare of all the tenants. The Council's new building programme includes estates of some 350 dwellings of houses, flats and maisonettes, at Vanbrugh Park, Haddo Street, Heathway and Wellington Gardens, all of which will be handed over for occupation during 1964. Further new schemes already approved will increase the housing stock by some 900 homes towards the close of 1966. By arrangement with the London County Council, the Kidbrooke Park Close estate of 48 prefabricated bungalows has been taken over for redevelopment by the Council towards the end of 1964. This scheme will provide 77 new dwellings. The families at present in occupation will be suitably rehoused by the Council elsewhere in the borough. It is also anticipated that during the next three years, other temporary bungalow housing sites will be appropriately dealt with. Progress is also being well maintained under programme of improving and modernising the older type houses, erected by the Council some 30 years previously under earlier legislation. In accordance with the policy established by the Council several years ago, private properties offered for sale are acquired by negotiation with the owners. Where necessary these properties are improved, and in many cases converted into self-contained flats to a very good standard indeed, and form a valuable contribution to the Council's housing resources. General Waiting List—As at 31st December, 1963, the total registrations represented 1,735 compared with 1,647 for the corresponding period of 1962. Having regard to the Council's new house building programme, coupled with the house building activities in the private sector, the waiting list figures under review would appear to be something of a paradox. Two very important reasons are advanced to explain this position: earlier marriages of young people, and 121 the continued migration to the South from other parts of this country and the Commonwealth. Movement through the mutual exchange register continues to be quite active and provides a worthwhile service of mobility to both Council and private tenants, within the borough, or elsewhere in the country. Under-Occupation in the larger type Council dwelling is an important part of housing management, involving many of the Council's older tenants who are able and willing to surrender their tenancies and transfer into smaller type dwellings. As the Council is able to build more of the type of dwelling required, this particular housing service will continue to expand. Medical Cases—On the medical assessment of the Council's Medical Officer of Health, consideration is given as to the degree of priority in housing. Cases involving infective pulmonary tuberculosis are given urgent attention. Others are dealt with on sociological grounds. The degree of housing priority afforded to such special cases over the past twenty years has proved to be a very beneficial service. With something like one-quarter of the citizens living in Council dwellings, inevitably many questions are posed involving a variety of human problems which the staff of the Council's housing management department are called upon to resolve with patience and sympathetic understanding. 122 SECTION E Inspection of Food and Supervision of Food Premises It has been estimated that some 1,500 million people throughout the world today suffer from chronic malnutrition, of which, by far the largest group consists of those deficient in protein. Malnutrition of this nature is rife in Eastern Asia. India, Central and Southern America as well as large areas of Africa and is the cause of high infant mortality, stunting of growth and mental development and leads to reduced resistance to infection and disease in child and adult alike. World population is rising rapidly and is demanding maximum food production not only in the fields but on the farms. Unfortunately, the areas of greatest malnutrition are those of the under-developed and over-populated countries where possibilities of increased food production are remote and minimal and the onus, therefore, of making up the world food deficiency inevitably rests with the more developed and civilised areas of Europe and North America. That surplus food is being produced in these latter areas is already evident but this is being achieved rather more by extensive use of modern technological methods such as increased efficiency in agricultural practices, the introduction of fertilisers, improved mechanisation, better seed varieties and education, than by additional cultivated lands. Stimulated by this world-wide growth in demand, food technology. especially during the past few years, has advanced at an extremely rapid rate and this has shown itself in the increasing use of drugs and chemicals to match the need for bigger and better methods of preservation of greater quantities of more varied types of comestibles. Constant vigilance on the part of health ties is necessary in order that these developments do not prove detrimental to the health of the consumer. In recent years great anxiety has been expressed in connection with the numbers and types of chemicals entering into the composition of food; in fact it has been estimated that the number of substances falling within the present definition of "food additives" notified to the Food and Drugs Administration runs into several thousands. This was never more clearly shown than in the meat trade, which is both the end point of a highly complex industry and the commencement of another, equally intricate, which involves processing, handling, storing, transporting and marketing of the final product. 123 With particular reference to the use of "additives" in livestock, the Expert Committee on Meat Hygiene of the F.A.O./ W.H.O. has drawn attention to the following: — Antibiotics and chemotherapeutics used for the treatment of diseased animals prior to slaughter. Antibiotics, coccidiostatics, tranquillisers and anthelminthics used as feed additives. The use of tranquillisers and preventive chemotherapeutics as anti-shipping fever agents during transport. The use of oestrogenous hormones in food animals. The use of herbicides in plant protection. How to detect these additives and, furthermore, how to determine what tolerances man has for these chemicals is going to be difficult, for this varies with each nation and geographical region. However, in the cases quoted, the Committee has formulated its proposals with regard to the methods most likely to lead to the elimination of possible ill-effects from the consumption by humans of meat and other animal products which may contain residues of these substances. It is obvious that some time must elapse before any standards are agreed and codes of judgment laid down to cover such situations. At the moment these problems are mainly those of the industry at large but they indicate how complex, technical and arduous the question of food inspection is likely to become, especially in a riparian authority's area. Moreover, as if the question of the use of drugs and chemicals was hardly enough with which to cope, the problem of "food borne" infections adds to the complications, viz., bacterial contamination such as salmonellosis; viral and rickettsial infections such as infectious hepatitis; amoebic dysentery resulting from protozoal pollution and the zooparasitical complaints of ascariasis and trichinosis. Meat inspection can no longer be considered as an isolated routine occurring haphazardly, perhaps only once, at the slaughter house. Meat is a perishable commodity liable to damage, mishandling, contamination and deliberate illegal treatment during transportation and storage and inspection is necessary at all these stages. So far, there has been no means of checking that carcases in butchers' shops have been inspected, although the majority have been so examined. Under the new Meat Regulations this is being remedied and arrangements are made for the inspection of every animal slaughtered for sale for human consumption and for them to be marked accordingly. 124 Standards of meat content in pies and canned meats have engaged the attention of the Ministry of Agriculture, Fisheries and Food during the current year and its efforts have also been directed to suitable methods of labelling these commodities. Legislation on these lines has been awaited for a number of years and it is expected that the coming year will see the issue of regulations covering these aspects. On the subject of labelling, it is interesting to note the public's growing concern in the composition of foods, particularly with those which are "out of season" or foods which are normally considered "perishable" but whose life may be prolonged by some kind of processing or treatment with a preservative. This tendency has resulted in the production of a commodity whose colour, texture and taste often has to be chemically sustained and which permits of its easy transportation in containers which are now. more often than not, of plastic material. It is therefore, becoming increasingly important that information concerning the composition or other qualities of the food offered should be clearly displayed and readily understood by the purchaser. Apart from the listing of ingredients, other problems arise in connection with labelling such as shape, design, size of lettering, material upon which information is printed, etc. Labelling of food is extremely complicated but very necessary and the public can rest assured that their interests are uppermost in the minds of the local health authorities' food inspectors operating in accordance with the Labelling of Food Order, 1953. Legislation.—Of the new legislation introduced in the current year concerning food, the following regulations were considered the more important. The Meat Inspection Regulations, 1963—These Regulations, operative from 1st October, were made under Sections 13 and 123 of the Food and Drugs Act, 1955, and they replace, with amendments, the Public Health (Meat) Regulations, 1924/52. The main provisions are that, except where the regulations permit, carcases of animals slaughtered for sale for human consumption must not be removed from the place of slaughter until they have been inspected and, if passed as fit for human consumption, until they have been marked with the mark and in the manner described in Schedule 3 With certain exceptions, prior notice of intention to slaughter must be given; the minimum period of this notice has been extended from three hours to twenty-four hours. Local authorities are empowered to make a charge for inspection. Schedules 1 and 2 contain provisions as to the manner in which inspectors are to carry out inspections and as to the circumstances in which meat is to be regarded as unfit for human consumption. 125 Circular FSH 9/63 issued by the Ministry of Agriculture, Fisheries and Food on 18th July, 1963, gives a summary of the above regulations. The Liquid Egg (Pasteurisation) Regulations, 1963—These Regulations, which come into force on the 1st January, 1964, require that all bulked liquid egg (or frozen whole egg) used for foods for human consumption, shall be pasteurised before use. All liquid whole egg from abroad must be pasteurised before it can be imported into the country. Egg broken out on the food manufacturers' premises and used within 24 hours is specifically exempted. The temperature and holding time for such pasteurisation are laid down as not less than 148°F. for minutes, a time/temperature combination which is lethal to all salmonella organisms. The Alpha Amylase Test— The alpha amylase test in relation to the heal treatment of whole egg is analogous to the phosphatase test which is used for testing the efficiency of the pasteurisation of milk and depends upon the fact that heat destroys the alpha amylase activity in whole egg in proportion to the degree of heat treatment given. If untreated whole egg is mixed with a starch solution the alpha amylase degrades the starch so that the normal blue colouration which occurs when iodine and starch are mixed does not develop and this intensity of blue colour is inversely proportional to the amount of alpha amylase present. The results of an alpha amylase test on whole egg mixture therefore indicate whether or not a satisfactory time/temperature combination has been reached. Bread and Flour Regulations, 1963—These Regulations reenact the Flour (Composition) Regulations, 1960, and will come into force on the 1st September, 1964. In brief the Regulations— (a) lay down requirements as to the composition of various types of bread; (b) prohibit the use in flour and bread of colouring matter except caramel which may be added to flour and bread other than white and soda bread; (c) permit the use in flour, other than wholemeal, of certain bleaching and improving agents; (d) prohibit the sale or advertisement for use in bread and flour of any bleaching or improving agent other than a 126 permitted bleaching or improving agent and impose requirements as to their labelling and advertising; (e) lay down labelling requirements for bread containing ingredients additional to those in the permitted list. Labelling requirements are also laid down for bread described as "high protein" bread; (f) prohibit the labelling or advertising of bread claiming that it is starch-reduced unless the carbo-hydrate content is less than 50% of the weight of the bread calculated on a dry basis or claiming that the bread has specific weight reducing qualities. The Milk (Special Designation) Regulations, 1963—Circular FSH 11/63 received from the Ministry of Agriculture, Fisheries and Food drew attention to The Milk (Special Designation) Regulations, 1963, which re-enact, with amendments. The Milk (Special Designation) Regulations, 1960. The principal features of the new Regulations are that: — (i) from the 1st October. 1964, "Untreated" will replace "Tuberculin Tested" as the special designation for raw milk. The provisions of the Regulations enabling producers' and dealers' licences to use the special designation "Untreated' to be applied for and issued will come into operation on the 1st June, 1964, but the licences will not become valid before 1st October. 1964. A dealers licence granted on or before 31st December, 1965, will remain in force renewable for the same 5 year periods as other dealers' licences. The half-hour "methylene blue" test is prescribed for "Untreated" milk whether it is sold under a dealer's or a producer's licence; (ii) until 31st December, 1964. the provisions of the Regulations about the labelling of "Untreated" milk will be deemed to be satisfied if the milk is labelled "Tuberculin Tested Milk"; any milk so labelled will be required to comply with the conditions applicable to the sale of milk under the special designation "Untreated". This provision is designed to enable stocks of containers bearing the words "Tuberculin Tested Milk" to be used up; (iii) no changes have been made in the conditions applicable to licences to use the special designations "Pasteurised" and "Sterilised", but they do provide that from 29th September. 1963, until 31st December, 1964, milk which has been pasteurised under licence in accordance with the Regulations may be sold as either "Pasteurised Milk" or "Tuberculin Tested Milk (Pasteurised)". Licences 127 to use the special designations issued under the Regulations of 1960 and in force immediately before 1st October, 1964, are continued in force as though they were granted under the new Regulations; (iv) in general producers' licences continue to be valid for 5 year periods from the date of issue but the Regulations provide that the Minister may issue a non-renewable producers' licence for a temporary purpose valid for one month; (v) the licensing authority is specifically permitted to authorise the use of the words "Farm Cartoned" as an alternative, where appropriate, to "Farm Bottled". Soft Drinks Regulations, 1963—These Regulations, which will come into operation on 20th July, 1964, re-enact, with amendments, the Food Standards (Soft Drinks) Order, 1953 and the Food Standards (Soft Drinks) (Amendment) Order, 1954. The principal changes are: — (a) the standards of composition for soft drinks made from citrus fruit or the juice of citrus fruit have been revised and in the case of comminuted drinks the regulations have been extended to cover all citrus fruits; (b) labelling provisions are laid down for all soft drinks made from citrus fruit or the juice of citrus fruit; (c) pictorial devices suggestive of fruit on the labels of flavoured carbonated drinks are prohibited and if the labels contain any word suggestive of fruit a specified labelling provision is prescribed; (d) the minimum sugar requirements for soft drinks have been increased and the maximum permitted quantity of saccharin has been reduced; (e) the labels of soft drinks containing saccharin must carry a specific declaration; (f) the acids permitted for use in soft drinks are specified; (g) the regulations apply to all sales of soft drinks in containers but do not apply to other sales; (h) all letters and words required to be used on labels must conform to specified requirements as to size and colour. The Ice Cream (Heat Treatment, etc.) (Amendment) Regulation, 1963—Made under Sections 4 and 123 of the Food and Drugs Act, 1955, these Regulations amend the Ice Cream (Heat ment. etc) Regulations, 1959, in order to allow the addition of sugar to sterilized or pasteurised mixtures used in the manufacture of ice-cream. They came into operation on 18th June, 1963. 128 During the current year in Circulars 1/63, 5/63, 7/63 and 15/63 the Minister of Agriculture, Fisheries and Food has approved the use of specified chemicals as alternatives to steam or boiling water in the cleansing of vessels used for storage or conveyance of milk and for the purposes of the Public Health (Imported Food) Regulations, 1937/48, certificates in respect of the Federal Republic of Germany, the Bechuanaland Protectorate and the Kingdom of Morocco were officially recognised. In Circular FSH 12/63 the Ministry of Agriculture, Fisheries and Food drew attention to the fact that after 1st October. 1963, H.M. Customs and Excise will discontinue sampling of brewing materials in accordance with the Arsenic in Food Regulations. 1959. This sampling of glucose and invert sugar has been carried out by H.M. Customs and Excise in the course of the revenue control of manufacture, but with the disappearance of the sugar and related duties in the 1962 Budget, the latter function has ceased. The sampling will therefore fall in future within the general enforcement responsibilities of Food and Drugs Authorities and other local authorities. Arsenic in glucose and invert sugar does not call for special attention and its sampling does not present any special problems. At the moment no brewing is carried out in this Borough. Milk Milk consists of approximately 87% of water holding proteins, sugar, vitamins 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. Normally milk contains 3% fat and 8.5% solids-not-fat; it freezes at about—0.53°C. and 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 129 Borough must be registered as a Distributor. The number of Distributors registered at the end of the year was 98, a decrease of 14 from 1962. On 66 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, 1960.—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 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 pre- viously 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, 1963 :— Licences In Operation issued 31.12.63 Distribution of Sterilised Milk 8 93 „ „ Pasteurised Milk 6 67 „ „ Tuberculin Tested 3 45 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, 24 samples of milk consisting of 15 Pasteurised, 8 T.T. Pasteurised and 1 Sterilized were examined in accordance with the prescribed tests. All proved to be satisfactory. 130 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 30 formal samples were submitted to chemical analysis and all proved to be genuine. Three samples of cream were sampled and found to be genuine. Summaries of samples taken from L.C.C. Schools and Nurseries for chemical and bacteriological examination continued to be furnished regularly to that authority. Preserved Food and Ice Cream Premises.—In accordance with the provisions of the Food and Drugs Act, 1955, Section 16, all premises with the exception of schools, clubs, hotels or restaurants used :— (a) for the sale, or manufacture for the purpose of sale, of ice cream, or storage of ice cream intended for sale ; or (b) for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale : are required to be registered by the owner or occupier with the Local Authority. Preserved Food Premises (meat, fish, etc.).—The total number of premises on the register at 31st December, was 89. One hundred and fifty-three visits of inspection were made to Preserved Food premises and Fried Fish shops as a result of which seven sanitary defects were remedied. Ice Cream Premises.—By the end of the year the total number of registered Ice Cream premises stood at 233. Visits to these premises were made on 164 occasions and one improvement was 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. 131 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, 1959/63.— In consolidating and amending the previous Regulations 1947 to 1952, 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 1½ 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. During the current year the Ice Cream (Heat Treatment, etc.) Regulations, 1963, were introduced to allow the addition of sugar to sterilised or pasteurised mixtures used in the manufacture of ice cream. Ice Cream Sampling. (Bacteriological Examination).—As in the previous year the Council continued to make use of the Public Health Laboratory Service as provided for under the National Health Act and 63 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 132 lene 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 29 4J hours or more 1 Satisfactory 10 2½ to 4 hours 2 Sub-standard 18 ½ to 2 hours 3 Unsatisfactory 4 0 hours 4 Most Unsatisfactory 2 Ice-lolly 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." This latter observation may seem somewhat contradictory in view of the number of unsatisfactory samples listed in the preceding table, but following last year's inconsistent results in connection with "soft" ice cream, it was decided to test still further the suitability of this type of ice cream. Of the 63 samples taken during the current year, 51 were of the "soft" variety, 22 of which were reported upon as being unsatisfactory and were graded as such in accordance with the Ministry's scheme. Any danger to health was discounted in these cases by the introduction of a plate count but the results obviously throw doubts on the reliability of the methylene blue test. Significantly, perhaps, all the unsatisfactory samples reported during the year were of the "soft" type indicating that some factors as yet undetermined, but apparently unrelated to the method of manufacture or the hygiene of the product, are affecting the gradings. For instance, all the Grade 4 methylene blue samples have, without exception, yielded low plate counts. This is a clear indication that, with the reductase test, which in reality is a test for organismal activity, it is quite possible for a sample to obtain a low grading of 3 or 4 and yet still be fit for human consumption. Conversely, it could be possible under similar circumstances for a sample to obtain a high grading and yet contain b. coli in sufficient quantity to warrant its classification as unsatisfactory. One fact emerged from this test sampling of "soft" ice cream. Unsatisfactory samples formed 22% of the total taken during the spring period whereas the summer period produced approximately 56%. So far no definite conclusions have been reached and, whilst investigations into the vagaries of "soft" ice cream are to continue to re-assess, 133 in these instances, the true value of the methylene blue tests or perhaps to indicate other and more reliable methods, the double check of the plate count will be continued. Quantitative Analysis.—Standards for the composition of ice cream are contained in the Food Standards (Ice-Cream) Regulations, 1959. In connection with quantitative analysis, one ice lolly was examined and proved to be satisfactory. 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. One hundred and twenty-nine inspections were made to secure compliance with the various Orders but on no occasion was it found necessary to take action against Vendors. 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, 14 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 42 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. 134 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 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 3,250 visits, as result of which 36 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 Improve ments were effected Caterers', Restaurants, etc. 196 9 Grocers, Greengrocers 325 12 Butchers' Shops 127 5 Dairies and Milk Distributors 66 — Wharves and Factories 659 — Bakehouses and Bakers' Shops 31 7 Ice-Cream Premises, Confectioners, etc 164 1 Fried Fish Shops 26 1 Other Fish Shops 31 1 Cooked Meat & Preserved Foods 127 * Visits Re. Shops Act 378 — „ „ Infestations 9 — „ „ Food and Drugs Act 242 — ,, ,, Merchandise Marks Act & Markets 129 - „ „ Food Poisoning 11 — Sampling Visits 233 — Fair Visits 14 — School Visits 4 — Miscellaneous Visits (including Flour MillsCyanide Fumigation) 424 — Interviews 16 — Complaints Investigated 38 — Totals 3,250 36 * Included under Grocers' and Butchers' Shops. 135 Bakehouses.—At the end of the year, 5 premises in the Borough were being used as bakehouses, none of which was underground. Bakehouses and bakers' shops were visited on 31 occasions and, as a result of the inspections, 7 sanitary defects were remedied. Catering Establishments.—Public demand for communal catering continues and as a result of this practice of "eating out" the inspection and supervision of cafes, restaurants, works' canteens etc., remains one of the most important duties of the Food Inspectors. Disregard of normal hygiene in the handling and preparation of food at such establishments can lead to an outbreak of food poisoning on a large scale and it is a tribute to the Inspectors' vigilance that no such outbreaks have occurred. As a result of 196 visits of inspection to the catering establishments, insanitary conditions were remedied and improvements, mainly redecoration and cleansing of kitchens, were effected on 9 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. Two improvements were carried out at public houses as a result of informal action and, in one instance, substantial structural alterations were being made to premises for the establishment of a tavern. In connection with one cafe, legal proceedings were taken for contravention of the Food Hygiene (General) Regulations, 1960, which resulted in the proprietor being fined £30 with £10 10s. Od. costs awarded to the Council. Food Rejected.—The following table is a summary of unsound food voluntarily surrendered during the year under the provisions of the Public Health (London) Act, 1936, Section 180(8) most of which was processed and used for animal feeding:— Shops, Stalls, etc.:— Meat— Beef 460 lbs. Pork 35 „ Mutton 36 „ Lamb 21 „ Rabbits 196 „ Pigs' Spleens 56 „ Pigs' Kidneys 168 „ Veal 53 „ Ox Livers 277 „ Ox Tails 40 „ Ox Kidneys 7 „ 1,349 lbs. 136 Canned and Other Foods— Foods, Various (Canned) 3,422 „ Meats (Canned) 7,144 „ Cheese 20 „ Fish 161 „ Fish (Canned) 96 „ Fruit (Canned) 2,385 „ Fruit Juice (Canned) 6,542 „ Fruit Pulp (Canned) 3,232 „ Currants 168 „ Sultanas 252 „ Jam (Canned) 689 „ Carrots (Canned) 2,894 „ English Frozen Whole Egg (Canned) 896 „ Carrots (Bags) 1,120 „ New Potatoes (Bags) 224 „ Fruit Concentrate (Drums) 450 „ 29,695 lbs. 31,044 lbs. Compared with the previous year, the amount of meat rejected fell by 15 lbs. during 1963, but the total of all food rejected rose by 16,571 lbs. Public Health (Meat) Regulations, 1924/52.—These regulations provide for the supervision of slaughterhouses, butchers' shops, stalls and the protection of meat against contamination by dirt and flies, etc., in transport and handling. Butchers' Shops and Stalls.—These are under the constant supvision of the Food Inspectors who made 127 visits of inspection and arranged for the correction of insanitary defects at 5 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. Slaughter houses.—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. From 1st October of the current year these Regulations were replaced by the Meat Inspection Regulations. 1963. 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. 137 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 hygienicconditions. Imported Food Rejected.—The following unsound or diseased imported foods were surrendered, the meat being passed for nonedible and refining purposes, and other unsound food, with the exception of fruit pulp and iuice, being processed for stock feeding. The following foods were rejected at the wharves :— Meat— Mutton and Lamb 117,427 lbs. Beef 1,18,399 „ Ox Tails 449 „ Ox Kidneys 20 „ Beef Hearts 62 „ Horsemeat 168 „ Bacon 10 „ Veal 19 „ Lambs' Livers 10 „ 136,564 lbs. Canned and Other Foods— Foods, Various (Canned) 3,089 „ Cooked Meats (Canned) 332 „ Butter Beans 20.530 „ Fish (Frozen Salmon) 6,496 „ 30,447 lbs. 167,011 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 16,302 167 — — 138 Bechuanaland Boneless Beef.—Early in 1961 consignments of this commodity began arriving at one of the Cold Stores in the Borough of which an excessive number of samples were positive for Salmonellae. Representations made to the Ministry of Agriculture, Fisheries and Food (Slaughterhouses Division) brought about a great improvement in the bacterial quality of the meat and subsequent sampling has been most satisfactory. During the current year a further 49 samples were taken from a consignment of 2,180 x 60 lbs. cartons, two of which proved to be unsatisfactory. Desiccated Cocoanut.—During the current year 10 samples were taken from a consignment of 500 x 100 lbs. bags, all of which proved to be satisfactory. Dried Egg Albumen and Other Imported Egg Products.— (Conditional Releases.)—Importations of Dried Egg Albumen and other Egg Products continued during the year with the following results:— Country of Origin Quantity Imported Containers Sampled No. of Positives Dried Egg Albumen America 7,613×50 lb. cartons 482 — „ 1,849×44 lb. cartons 107 — „ 22×53 lb. cartons 12 — „ 104×65 lb. cartons 5 — „ 35×100 lb. drums 6 — „ 22×54 lb. cartons 3 — Argentine 223×40 lb. tins 10 4 China 40×116 lb. tins 5 — ,, 108×110 1b. tins 19 1 Sweden 160×110 lb. drums 16 — Dried Whole Egg America 5,990×44 lb. tins 65 — „ 3,910×44 lb. cartons 56 — „ 264×56 lb. cartons 15 — „ 46×175 lb. drums 8 — „ 30×18 lb. cartons 5 — Australia 89×160 1b. drums 10 — Canada 254×45 lb. tins 13 — China 2,410×110 lb. tins 246 14 „ 140×116 1b. tins 15 — „ 30×110 1b. cases 5 — Czechoslavakia 800×55 lb. bags 16 — „ 800×55 lb. cartons 40 — Denmark 3,920×40 lb. tins 40 — „ 2,032×40 lb. cartons 50 — „ 1,944×39 lb. tins 25 — 139 Country of Origin Quantity Imported Containers Sampled No. of Positives Frozen Whole Egg Australia 86,907×28 lb. tins 442 6* Canada 1,472×38 lb. pails 32 — China 19,750×44 lb. tins 521 71 „ 500×22 lb. tins 26 — Czechoslovakia 3,637×11 kilos tins 34 — Holland 50×12 kilos tins 4 — „ 100×6 kilos tins 6 — S. Africa 368×40 lb. tins 12 2 * includes 2 chemical ** includes 58 chemical NOTE:—Due to the industry's inability to install the necessary apparatus for amylase testing in accordance with the Liquid Egg (Pasteurisation) Regulations, 1963, in time to meet the originally suggested date, the Ministry deferred the operative date to 1st January, 1964. Nevertheless, in anticipation of the operation of the Regulations, samples were submitted to the amylase test during the current year with the results given above. Incidence of Salmonella Organism Found Samples Dried Egg Albumen Dried Whole Egg Frozen Whole Egg Salmonella aberdeen — — 2 „ anatum — 4 — „ bovis morbificans 1 — — „ give 2 — — „ montevideo 1 — — „ newport — — 1 „ potsdam 1 — 7 „ thompson — 10 — „ typhimurium — — 9 Dried Hen Egg Albumen.—All landings of this product continue to be submitted to the heat treatment process recommended by the National Albumen Advisory Committee set up by the Ministry of Health. This process is undertaken at the premises 140 of Messrs. J. Palmer (Deptford) Ltd., Prince Street, S.E.8, and the following consignment was so treated during the year. Batch No. No. of Containers Control Samples Bact. Results of Positives after Heat Treatment Positive Negative Positive Negative Percentage rate of Control Sampling 6% 1 243 15 - 4* 11 * Incidence of Salmonellae: Containers Salmonella montevideo 1 ,, give 2 „ bovis morbificans 1 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 40 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. America Spain 1 2,488 lbs. Argentine Saudi Arabia Turkey W. Pakistan 9 3 3 99,501 lbs. Australia Belgium Curacao Cyprus Malta W. Africa 1 2 3 3 2 30,644 lbs. England Spain 3 20,921 lbs. New Zealand Curacao Holland Israel Malta 1 2 1 6 18,403 lbs. Food and Drugs Act, 1955.—In accordance with the Council's contract with the Public Analyst, 464 samples were presented for examination, of which 94 were obtained in accordance with the Public Health (Imported Food) Regulations. The remaining samples, consisting of 48 formal and 322 informal were obtained in the normal course of sampling. 141 Of all the samples obtained, 9 were considered by the Public Analyst to be non-genuine and, of this total, five were in respect of imported foods not on sale to the general public and, in these instances, the importers were notified accordingly. Of the remaining 4 non-genuine samples, all informal, 1 was incorrectly labelled and has therefore been excluded from the calculation of the adulteration figure which at 0.8% shows a decrease of 1.4% from that of last year. Again milk was one of the main foods sampled and in all. 30 samples were procured, of which 6 were in respect of Channel Island Milk. No milk sample was adversely reported upon and. in respect of milk other than Channel Island, the average percentage of milk fat was 3.59% and solids-not-fat 8.62%, 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 4.46% and 8.96% respectively. Flour (Composition) Regulations, 1956.—These regulations provide for the fortification of flour with added nutrients. As the one remaining mill within the Borough ceased production, no samples were taken. With amendments, these Regulations are re-enacted in the Bread and Flour Regulations, 1963, which will operate from 1st September, 1964. Appended at the end of this Food Section is a table listing all the samples reported upon as being " non genuine " and giving the administrative action taken in respect of each unsatisfactory sample. Pharmacy and Medicines Act, 1941.—Three samples, one each of Honey Cough Syrup, Vitamin Tonic Syrup and Bronchial Mixture were taken for analysis during 1963. The Bronchial Mixture was found to be deficient in chloroform to the extent of 52% and the stock was completely withdrawn. The remaining two samples were found to comply with the provisions of this Act. Public Health (Dried Milk) Regulations, 1923 to 1948.— These Regulations control the minimum milk-fat content of dried milk and the labelling of tins or other receptacles in which this commodity is contained. There were no samples examined during the current year. 142 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. There were five samples examined during the current year all of which proved to be satisfactory. Other Food Examinations.—In addition to those obtained under the Food and Drugs Act, other articles not procured in the normal course of sampling were examined either by the Public Analyst or at the Public Health Service Laboratory. These examinations were the outcome of complaints from members of the public or as a result of special investigations into certain foods carried out by the Food Inspectors or as the " follow-up" to reported food poisoning cases. Information concerning the analyses of these samples is given in the following table:— Article How Obtained Examination Bact. or Chem. Result Action Taken Apricots in Syrup Request from Importers to assess fitness for human consumption. Chem. Contained preservatives in excess of amount permitted by the Preservatives in Food Regulations 1962. Importer notified. Consignment duly re-exported. Corned Beef (Canned) Complaint by member of public re fitness for human consumplion. Bact. Satisfactory. Complainant notified. No further action. Part of Chocolate Swiss Roll Complaint by member of public that roll contained foreign body, Chem. Foreign body which was partly covered with masticated chocolate roll comprised a small bone from the tail fin of a fish. Complainant visited and on enquiry stated that the main course of the meal had been fish. No further action. 143 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 6 notifications received during the year, one less than for the previous year. There were 22 for 1961, 42 cases in 1960, 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 1 Salmonella schwarzengrund — No food suspected. Discovered while investigating contacts of sonne dysentery. 1 Salmonella brandenburg — No food suspected. Discovered while investigating contacts of sonne dysentery. 1 Salmonella typhimurium 1 Roast pork suspected. Unable to verify—none available for examination. 3 No organisms — No particular food suspected. 6 1 144 FOOD AND DRUGS ACT, 1955 Number and Description of Samples Submitted for Analysis under the above Act during the year 1963 (including samples taken under the Public Health (Imported Food) Regulations) Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Almonds Ground - 1 1 - - - Aspirin Tablets — 1 1 — — — Baking Powder — 1 1 — — — Barley, Pearl — 1 1* — — — Biscuits — 7 7* — — — Brandy 4 — 4 — — — Bread — 1 1 — — — Bread Mixture — 1 1 — — — Butter — 9 9* — — — Cake&Pudding Mixture — 4 4 — — — Coconut, Dessicated — 1 1* — — — Coffee — 1 1 — — — Coffee and Chicory Essence - 1 1* - - - Coffee Extract, Dry — 3 3* - — — Coffee Extract Liquid — 1 1* - — — Confectionery, Flour — 4 4* - — — Confectionery, Sugar — 5 5* - — — Cooking Fat — 2 2 - — — Cornflour — 1 1* - — — Cornmeal — 1 1 - — — Cream — 1 1* - — — Cream, Sterilised — 2 2* - — — Curry, Canned — 1 1 - — — Drinks, Soft — 7 7* - — — Dripping — 2 2 - — — Fish, Bottled — 1 1* - — — Fish, Canned — 16 16 - 1 1 Fish Paste — 4 4* - — — Fish Salted — 1 1 - — — Fish Spread — 2 2* - — — Flavouring Compounds — 2 2* - — — Flavouring Syrups — 2 2* - — — Flour — 1 1 - — — Flour Self Raising — 1 1 - — — Fruit, Bottled — 1 1* - — — Fruit, Canned — 25 25* - — — Fruit, Dried — 22 22* - 2 2 Fruit Fresh — 2 2 - — — Fruit Glace — 2 2* - — — Fruit Juice—Barrel — 1 1* - 1 1 Bottled — 2 2* - — - 145 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Fruit Juice—Canned — 7 7* — — — Fruit Pie Filling — 2 2 — — — Fruit Curd Lemon — 1 1* — — — Fruit Syrup, Bottled — 1 1* — — — Garlic — 1 1 — — — Gin 6 — 6 — — — Glycerin — 1 1 — — — Gravy Preparation — 1 1 — — — Honey — 1 1* — — — Ice Lolly — 1 1* — — — Icing Compound — 1 1* — — — Icing Mixture — 1 1* — — — Jam — 7 7* — — — Jelly Tablet — 1 1* — — — Jelly Tablet and Compound 2 2* — — Lard — 3 3 — 1 1 Lentils — 1 1 — — — Macaroni — 2 2 — — — Margarine — 4 4* — — — Marmalade — 2 2* — — — Marzipan — 2 2* — — — Mayonnaise — 1 1* — — — Meat, Minced — 4 4* — — — Meat Products 41 41* — — — Meat Products. Bottled — 3 3* — — — Meat Products, Canned — 31 31* — 1 1 Meat Spread — 1 1* — — — Milk (incl. C.I.) 30 — 30* — — — Milk, Condensed — 5 5 — — — Milk Evaporated — 3 3 — — — Milk Pudding Canned — 1 1 — — — Mincemeat — 1 1* — — — Mineral Water — 1 1 — — — Mustard Powder — 1 1 — 1 1 Mustard, Prepared — 2 2 — — — Nuts — 2 2 — — — Oats, Breakfast — 1 1 — — — Paraffin, Medicinal 1 1 — — — Pastry Mixture — 1 1 — — — Pastry Uncooked — 2 2* — — — Pea Flour — 1 1 — — — Peel, Candied 1 1* — — — Pepper — 1 1* — — — Pickles 8 8* — — — Potato Crisps — 3 3 — — — Pudding, Canned — 2 2* — — — Pudding, Christmas — 1 1 — — — Pudding Mixture — 1 1 — — — Pudding, Sponge — 2 2* — — — Rice — 14 14 — 2 2 146 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Rice, Ground — 1 1 — — — Rum 3 — 3 — — — Rye Bread — 1 1 — — — Sago — 1 1* — — — Salad Cream — 1 1* — — — Salt — 2 2 — — — Salt Garlic — 1 1 — — — Sauce — 13 13* — — — Sauce Preparation — 2 2* — — — Sausages — 12 12* — — — Semolina — 1 1 — — — Soup Preparation — 3 3 — — — Spice — 2 2 — — — Spread, Brandy Butter — 1 1* — — — Stuffing Mixture — 2 2 — — — Sugar — 4 4* — — — Sweetening Compound — 1 1* — — — Soup, Canned — 1 1 — — — Tapioca — 5 5* — — — Tea — 5 5 — — — Tomatoes, Canned — 1 1 — — — Vegetables, Canned — 19 19 — — — Vegetables, Dried — 10 10* — — — Vinegar — 2 2* — — — Wheat Germ — 1 1 — — — Whisky 5 — 5 — — — Yeast Dried — 1 1 — — — Yoghurt — 1 1 — — — Totals 48 416 464 — 9 9 Samples of items marked * were tested for preservatives. 147 Administrative Action Taken in Regard to Samples Reported to be NOT GENUINE Sample No. Article Nature of adulteration and/or irregularity Action Taken (a) In respect of normal sampling. T. 100 Tomato Sauce with Minced Beef, Canned Contained an excessive amount of tin. Stock withdrawn. T. 125 Pure American Lard Contained butylated hydroxytoluene 40 parts per million, the presence of which was not disclosed on the label. Following representations suppliers agreed to amend label. T. 162 Evaporated Fruit Salad The sample was infested with mites. Stock withdrawn. Manufacturer warned and that future offences would be likely to result in legal proceedings. T. 262 Evaporated Fruit Salad The sample had been attacked by insects and spoiled by their droppings and webbing. Stock withdrawn and destroyed. (A) In respect of samples taken under Imported Food Regulations. TT. 13 Mustard Powder The sample was deficient in Allyl isothiocyanate. Observations from manufacturer stated that consignment intended for use as pickling mustard to which the Orders do not apply. TT. 39 Rice The sample was badly contaminated by carbon black and suitable only for animal use. Sent for animal use. TT. 40 Rice The sample was heavily contaminated by carbon black. Consignment destroyed. TT. 87 Sprats, Canned Contained Benzoic Acid 1500 parts per million an added preservative not permitted in this article. Intended for ship's stores only. No action possible. 148 Sample No. Article Nature of adulteration and/or irregularity Action taken TT. 94 Concentrated Orange Juice Contained an excess of Sulphur Dioxide. No action. In accordance with the Preservatives in Food Regulations 1962 the consignment was accompanied by a document indicating the limits of sulphur dioxide content and the subsequent use of the commodity. Legal Proceedings Premises Offence Result of Proceedings 44, Deptford Bridge Contraventions of the Food Hygiene (General) Regulations 1960 Fined £30 with £10.10s. costs 149 SECTION F Prevalence of, and Control over, Infectious and Other Diseases By definition, epidemiology is concerned with the occurrence and distribution of all diseases but, until recently, it had acquired a narrower concept linking it, fortuitously, with infectious diseases. Now that the conquest of common infectious disease is all but complete, other non-communicable diseases are assuming relatively greater prominence and are providing a new challenge. This will probably resolve itself into a re-orientation of the preventive health services, changes in clinical and laboratory techniques and assessment of their results and, perhaps, a greater emphasis on health education. Although the outlook with regard to infectious disease is bright, the threat of the importation of disease casts a shadow over the future. Speed of travel has intensified the need for medical supervision at ports and airports in order to arrest the transference from abroad of some of the more serious diseases such as tuberculosis, smallpox, leprosy, enteric infections, etc., and the Ministry has acknowledged the danger by the introduction during the year of the specific legislation outlined below. With particular reference to tuberculosis, there is no doubt but that it constitutes a major public health problem in developing countries and it could, on importation, become once more a serious problem in this country. Under vigorous assault in earlier years, epidemic tuberculosis has waned and, with it, the drive originated by the local authorities. Many of the staff trained in tuberculosis control have retired or, for various reasons, have faded from the scene and there has been a general run down of enthusiasm. However, although tuberculosis no longer has any news value, it is still responsible for some three thousand victims annually with approximately twenty thousand notifications. Such figures are not insignificant and in areas of high hostel and reception centre populations or where importation is a hazard, the situation warrants some re-appraisal. Legislation.—During the current year two Statutory Instruments became operative, viz. the Public Health (Ships) (Amendment) Regulations, 1963 and the Public Health (Aircraft) (Amendment) Regulations, 1963. From 1st August, these Regulations enable the Port and Airport Health Officers respectively to require travellers to produce valid International Vaccination Certificates in respect of smallpox, failing which, they may be placed under surveillance or into isolation. 150 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 1,329. Under the Public Health (Tuberculosis) Regulations, 1952, there were 32 notifications, giving a consolidated total of 1,361 cases notified during the year. The following table indicates the figures for the previous ten years :— Year No. of corrected notifications 1953 1,242 1954 569 1955 2,120 1956 844 1957 1,558 1958 607 1959 1,102 1960 542 1961 1,981 1962 184 10-year average 1,075 1963 1,361 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. If a Medical Officer of Health requests a person to discontinue his employment with a view to preventing the spread of an infectious disease and issues a certificate accordingly, this often 151 results in hardship, for National Health benefits are considerably less than a person's normal earnings. However, under Section 26 of the London County Council (General Powers) Act, 1959, the Council may, if they think fit, compensate such person for any loss occasioned by his compliance with the Medical Officer of Health's request. During the past four years it has not been necessary to issue any such certificates. Smallpox.—There were no cases notified during the year, but a number of contacts were reported arriving in the Borough from abroad, and these were kept under observation for the requisite period. Public Health (Smallpox Prevention) Regulations, 1917.—These Regulations give a Medical Officer of Health power to vaccinate or re-vaccinate without charge, any contacts of Smallpox cases willing to submit themselves for treatment. Vaccination.—Smallpox is a very dangerous and disfiguring disease and prior to the introduction of compulsory vaccination in 1853, nine-tenths of smallpox victims were children under 5 years of age. Subsequent to this period, children, by and large, escaped. However, since 1898, when the 'conscientious objection' clause made its appearance, vaccinations have declined steeply and the position deteriorated still further from 1948 when vaccination became optional. Glycerinated calf lymph is the standard vaccine used in this country and the number of vaccinations carried out in the Borough at the County Council clinics during 1963 was 157. This substantial decrease of 1,240 from that of the previous year contrasts the public's attitude towards vaccination under normal circumstances and its almost hysterical reaction at times of emergency reflecting, perhaps, an anxiety born of a feeling of culpable neglect. In Greenwich during the last 13 years 17,225 births have been registered, and for the same period only 8,983 vaccinations have been effected, a figure equivalent to 52.1%. 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, as witnessed at the beginning of 1962, but generally the trend is downwards. Today, although every precaution is taken at seaports and airports, infected persons do occasionally slip through but the 152 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. Recognising this danger, the Minister of Health has strengthened the powers of the Port and Airport Health Authorities with the introduction of new Regulations operative from 1st August, 1963. International Certificates (Ministry of Health Circular 20/52).—The question of authentication of International Certificates of vaccination has now been settled by the adoption of the International Sanitary Regulations (W.H.O. Regulations No. 2) which replaced the International Sanitary Conventions on 1st October, 1952. The Regulations prescribe inter alia, new forms of International Certificates of vaccination against Cholera and Smallpox and, to be valid, the certificate must bear an approved stamp which certifies that the signature of the Vaccinator is that of a practising medical practitioner. During the year some 359 certificates of persons proceeding abroad were so authenticated, of these 283 were in respect of Smallpox, 58 Cholera, 16 for Typhoid and 2 for Yellow Fever. Measles.—The normal biennial fluctuation was evident in the number of cases notified during the year which rose from a total of 57 in 1962 to 925, the figure for the current year. Of the 925 cases, 439 were males and 486 females and only five were over the age of 15 years. No cases were removed to hospital and there were no deaths recorded. The distribution of the cases was as follows:—East Greenwich 321; West Greenwich 212; St. Nicholas, Deptford, 20; Charlton and Kidbrooke 372. During 1961 there were 1,820 cases, in 1960 there were 47, in 1959 there were 637, in 1958 there were 306 and during 1957, 1.194 cases were recorded. Much research has been carried out in recent years with regard to the control of measles. New vaccines, free of the undesirable reactions noticeable in the earlier types, have been developed and it is anticipated that limited schemes for vaccination against measles will be introduced by County Councils sometime during 1964. Whooping Cough.—Altogether 35 notifications were received in 1963, an increase of 22 over those of the previous year. The years 1961, 1960, 1959 and 1958 produced 26, 168. 34 and 55 respectively whilst there were 97 registered for 1957. 153 No cases were admitted to hospital and there were no deaths. With regard to children under 5 years, one child received a combined antigen (whooping cough and diphtheria) and a further 1,194 received a triple antigen (whooping cough, diphtheria and tetanus) giving a final total of 1,195 whooping cough immunisations carried out during the year by the County Council. This is an increase of 234 over the total for the previous year. Diphtheria.—No notifications were received for the current year, a result similar to that for each of the 7 previous years. 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. Diphtheria immunisation is a County Council service and during the year there were 1,319 completed immunisations carried out in the Borough, an increase of 283 over that of the previous year. Most diphtheria immunisations given formed part of combined antigen therapy. Some 874 "boosters" of triple antigen were also given during 1963. 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.—Eight cases attributed to these causes were registered during the year as compared with a figure of 5 for each of the years 1962 and 1961. One case was removed to hospital but there were no deaths. Typhoid.—No cases were notified during the year, a position similar to that of the previous year. Compared with 2 for 1961, there was a nil return for the years 1960 and 1959. one for 1958, two for 1957 and one for 1956. Scarlet Fever.—A total of 29 confirmed cases for the year shows a decrease of 4 from that returned for 1962 compared with 30 notifications for 1961. There were 44 for 1960, 68 for 1959, 106 for 1958. 102 for 1957, 58 for 1956 and 57 for 1955. One case was removed to hospital but no fatalities were recorded. Erysipelas.—There was 1 notification received during the year. Two were received for the previous year compared with a similar figure for 1961, a nil return for 1960, 6 for 1959, 3 for 1958, a nil return for 1957, 4 for 1956 and 6 for 1955. 154 Zymotic Enteritis or Epidemic Diarrhoea (Children under 5 years of age.—Ten cases were recorded as confirmed compared with 11 for the previous year, 19 for 1961, 57 for 1960, 30 for 1959, 9 for 1958, 12 for 1957 and 17 for 1956. One case received hospital treatment. There were no deaths. Sonne Dysentery.—This disease is usually characterised by diarrhoea, fever and, to a lesser extent, vomiting. Although modern methods of treatment are effective and usually fairly rapid, nevertheless the disease has become a serious nuisance and difficult to control. It is normally mild but in infants and young children it can produce serious illness and debility, especially if the patients are already slightly below normal health. In adults it is an irksome inconvenience and, if they work in the food trade, it can cause economic hardship. The total of 316 notifications received during the current year shows a rise of 287 over that of the previous year. Consisting almost entirely of school children and their parents, the cases were fairly evenly distributed throughout the year. The present figure of 316 is the largest since 1956 when the total of 480 cases was the subject of a detailed investigation and analysis. The distribution of the cases was 53 in East Greenwich, 119 in West Greenwich, 32 in St. Nicholas, Deptford, and 112 in Charlton and Kidbrooke. Two cases were removed to hospital but there were no fatalities. Scabies.—Three cases were notified during 1963 compared with one for 1962, 4 for 1961, 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 7 cases concerning Greenwich residents were brought to the notice of the department, a similar figure being returned the previous year, 5 for 1961, 9 for 1960 and 18 for 1959. All patients received hospital treatment. There were no fatalities. Meningococcal Infection.—Similar to the previous two years there were no notifications received during the current year compared with one for 1960, two for 1959, none for 1958, 2 during 1957, a nil return for 1956 and 5 for 1955. 155 Acute Encephalitis. (Infective or Post Infectious.)—Two cases were notified during the year, only one of which was in respect of a Greenwich resident. This notification, which was posthumous, concerned a male child of 7 years who was found dead when the family doctor was called to home and encephalitis was established at the subsequent post mortem. Investigations revealed that the child had recently had two doses of oral polio prophylactic (Sabin), the last being given some eleven days prior to death. Ophthalmia Neonatorum.—In respect of this disease no notifications were received. There was a nil return for the years 1962 and 1961. one for 1960, none for 1959 and one was recorded for 1958. Poliomyelitis.—It has previously been pointed out that the vagaries of notification procedure have led to misleading statistics concerning specified administrative areas but this proved of no consequence during the current year as no notifications of poliomyelitis were received. Of school children undertaking a poliomyelitis inoculation course, 46 received two and 87 received their third injection during the year. For persons between the ages of 16 and 40 years the figures were 103 and 83 respectively. In addition, a fourth injection or doses of Sabin following 3 injections of Salk were given to 844 children between the ages of 5 and 12 years. School children completing a Sabin course numbered 1,584 and over school age there were 156. Malaria.—Compared with a nil return for this year and for the years 1962, 1961 and 1960. one notification of benign tertian was registered for 1959. Tuberculosis.—During the year 32 notifications in respect of confirmed cases of tuberculosis were received compared with 33 for 1962. Of these, 27 were of the pulmonary type and 5 nonpulmonary, i.e., tuberculosis of parts of the body other than the lungs. 156 The following table gives the distribution: — District Pulmonary Non-Pulmonary Total East Greenwich 6 1 7 West Greenwich 11 3 14 St. Nicolas, Deptford 3 1 4 Charlton and Kidbrooke 7 — 7 Totals 27 5 32 Disinfection was offered and carried out in 2 cases including 6 rooms. During 1963, some 982 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. 1963, was as follows: — PULMONARY NON-PULMONARY Men Women Children Total Men Women Children Total M F M F 555 437 26 18 1,036 29 41 10 6 86 For further clarification I append herewith copy of Form T.137 (revised) for the year under review as forwarded to the County Medical Officer of Health. 157 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 Part I.—Summary of notifications of Tuberculosis during the period from the 1st January, 1963, to the 31st December, 1963. 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 2 4 3 4 3 1 22 Respiratory, Females — — 1 — — 2 — 2 — — — — — 5 Non-Respiratory, Males - - - - - - 1 - - - 1 - - 2 Non-Respiratory, Females - - - - 1 - - - 1 - - 1 3 Part II.—New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Source of Information Number of cases in age Groups 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 - - - - - - - - - - - - - — (D) N.B. Where notification of one form of Tuberculosis is subsequently followed by a notification Totals (A) 2 (B) — of the other, only the first notification is taken into account for the purpose of this return. (C) — (D) — 158 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, short visits covering public and factory surveys (with attention to special groups in each category) 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, 1963. PART I.—General Analysis Men Women Total (a) Total X-rayed 6,344 1,265 7,609 (b) Total previously X-rayed (within 5 years) 4,956 576 5,532 (c) Total number reviewed 371 37 408 (d) Number considered abnormal after review 261 21 282 (e) Not yet attended after review 2 2 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 8 1 9 (c) Requiring close supervision or treatment 2 1 3 (d) Still under investigation — — — (e) Refused further investigation 1 — 1 159  Men Women Total (2) Previously known tuberculous cases 9 2 11 (3) Non-tuberculous cases : (a) investigated 35 3 38 (b) still under investigation 2 — 2 (c) Refused investigation or lost trace 3 _ 3 (4) Cardio-vascular lesions 31 4 35 (5) Abnormalities requiring no action 170 10 180 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 5 27 Children under school age 2 6 School children 33 25 No. of home visit by Lady Public Health Inspector 24 No. of home revisit by Lady Public Health Inspector 49 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: — 160 Rooms and Articles Disinfected, Year ended 31st December, 1963 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 15 1 4 1 8 2 12 - 6 2 9 3 - - 48 Diphtheria - - - - - - - - - - - - - - - - Tuberculosis 2 6 - - - - - - - - - - - - - - Cancer - - - - - - - - - - - - - - - - Meningococcal Infection 8 14 — 1 — 2 — 4 — — 1 — 6 - - 14 Puerperal Pyrexia - - - - - - - - - - - - - - - - Typhoid Fever - - - - - - - - - - - - - - - - Polio-Myelitis - - - - - - - - - - - - - - - - Erysipelas 1 1 - - - - - - - - - - - - - - Acute Encephalitis - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - Scabies 1 1 - - - - - 3 - - - - - - - 3 Other Diseases 101 15 6 26 2 17 14 25 4 3 5 72 - 113 - 287 Verminous Premises 3 1 — 2 — — — 6 4 3 2 30 - - 1 48 Total 127 53 7 33 3 27 16 50 8 12 10 111 9 113 1 400 Articles Destroyed — — 11 58 1 6 — 3 2 — 2 167 — — — 250 Library Books Disinfected 94 161 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 505 400 20 16 941 Non-pulmonary Tuberculosis 17 16 3 6 42 983 Deaths (all causes) (6 results of pulmonary tuberculosis) 23 Twenty-seven new cases of pulmonary tuberculosis were notified during the year in the undermentioned age groups: — Males Years Females 1 1-10 1 2 11-20 1 3 21-30 2 3 31-40 — 5 41-50 — 3 51-60 — 3 61-70 — 3 71-80 — Six cases of non-tuberculosis were notified, four women (2 neck glands, hilar bronchial glands and spine) and two men (left knee and right epididymis). Twenty-seven patients were transferred out to other clinics and 22 have been transferred into this clinic. 134 ante-natal patients have been X-rayed; one tuberculous disease was found amongst these. 106 children and young adults were given B.C.G. inoculation because they were contacts of cases with tuberculosis. 45 positive Mantoux children were referred to us from school because they were found to have positive tuberculin tests. Two hundred and sixty-three new contacts of tuberculous patients were X-rayed. It is of interest that some of our old cases which we have been following up have relapsed with the reappearance of sputum positive for Tb, five cases have so relapsed which is a fairly high figure in comparison with the number of new cases mentioned above. This shows the importance of following up these patients especially those who have not been treated with antituberculous drugs in the past but whose disease was controlled by other 162 measures such as surgical collapse or pneumothorax treatment, etc. A few cases of pulmonary tuberculosis have been treated in Grove Park Hospital but a number of them have been treated at home as out-patients with antituberculous drugs. A number of patients have been found to have cancer of the lung and we are continuing to study the problem of bronchitis and asthma with a view to checking the progress of these conditions and also we are carefully looking into the social and employment problems of these very disabled persons and endeavouring to give them our advice and help where possible. A number of those who are confined to their houses are very much helped as regards their morale and outlook by our Occupational Therapist. 163 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 127 examinations were so made. Of these, 5 candidates were considered unfit for admission to the Council's Superannuation Scheme. Sick Persons.—In addition, the Medical Officer of Health carried out 44 medical examinations of Council's employees who for medical reasons had been absent for 4 weeks from their employment. In consequence, the Council was advised that three of their servants were no longer capable of discharging their duties efficiently by reason of permanent infirmity. Interviews Rehousing.—Under the Council's Rehousing Scheme, additional points are attracted if an applicant's case is supported on medical grounds. In order to ascertain from a medical point of view the degree of priority to be allocated to the housing applicants in the Borough the Medical Officer of Health gave 2 interviews during the year. INDEX Page A Acute Encephalitis 155 Acute Influenzal Pneumonia 153 Acute Poliomyelitis 155 Acute Primary Pneumonia 153 Adoptive Acts, Bye-Laws and Local Regulations 3-5 Age Composition of Population 21-22 Age Mortality 28-29 Aged, Infirm and Physically Incapacitated Persons 89-108 Alkali, etc., Works Order 53, 61 Alpha Amylase Test 125 Analytical Examination of Milk 130, 141 Animal Boarding Establishment Act, 1963 52 Ante and Post Natal Clinics 48 Ante and Post Natal Clinics, Attendances 45 Anti-Fly and Anti-Mosquito Campaign 85 Antitoxin,, Diphtheria 153 Ants, Pharoah's, etc 87 Area of Borough 10 Arsenic in Food Regs., 1959 128 Articles and Rooms Disinfected 160 Articles Destroyed 160 Artificial Sunlight Centres, Attendances 46 Artificial Sunlight Treatment 48 Asthma 162 Atmospheric Pollution 59-64 B Bacteriological Examinations 74, 79, 129, 131, 138-140, 142, 143 Baiting of Sewers 85 Bakehouses 135 Bathing Centre 95 Baths and Wash-houses 77-79 B.C.G. Vaccinations 46 Bechuanaland Boneless Beef 138 Beetles 89 Births 23, 26 Birth Registrations 26 Blackheath Fair 133 Blackwall Tunnel Duplication 80 Bread & Flour Regs., 1963 125 British Red Cross Society 50 Bronchitis 41 Burial or Cremation of the Dead 108 C Cancer 23, 35-39 Cancer of the Lung 36-39 Page Carol Service (for Elderly) 105 Caseous Lymphadenitis 137 Catering Establishments 135 Cerebral Embolism 39 Cerebral Haemorrhage 39 Cerebral Thrombosis 39 Certificates of Guild of Hygiene 163 Chest Clinic 49 Chest Physician's Report 161 Chiropody Clinics, Attendances 46, 104 Chiropody Treatment, Clinics 48 Christmas Food Parcels (O.A.P.s) 105 Citizens Advice Bureaux 50 Classification of Deaths 33 Clean Air Act 61 Cleansing & Bathing Centre 95 Cleansing and Scabies Clinic 49 Cleansing of Children 159 Cleansing of Old People 95 Clinics and Centres 48 Clover Mites 88 Coach Outings (for Elderly) 106 Cockroaches 87 Common Infectious Diseases 23,33 Complaints 51, 109, 116, 142 Condensed Milk Regs., 1959 142 Consumer Protection Act, 1961 68 Conveniences, Public 80 Coronary Disease 39 Council Housing Schemes 118 Council Rehousing 116 Cremation or Burial of the Dead 108 D Day Rooms (for Old People) 102 Death Causes, Remarks 33-42 Death Rates 23 Death Registrations 23,27 Death, Table showing Causes of and Ages at Appendix Deaths 23, 27 Deaths, Table showing Causes of and Ages under 1 yr. Appendix Deaths from Violence 41 Deaths in Institutions 28 Defective Dwellings—Repairs 55 Density of Population 10 Desiccated Cocoanut 138 Diarrhoea and Zymotic Enteritis 34, 154 Diphtheria 34, 153 Diphtheria Antitoxin 153 Diphtheria Immunisation Clinics 48 Diphtheria Prophylaxis Cases 46, 153 INDEX (continued) Page Discharge of Effluents into Sewers 72 Diseases of Respiratory System 41 Disinfecting Station 49 Disinfection 159, 160 Disinfestation of Verminous Premises 86 Distribution Centres—National Welfare Foods 43 District Nursing 47, 50 Domestic Helps 47, 49 Drainage and Sewerage 72 Drainage, New and Alterations to 72 Dried Egg Products 138-140 Drinking Fountains 81 Duties and Powers of the Public Health Committee 3-5 Dwellings 10 Dwellings-Movable 117 Dysentery 154 E Early Neo-Natal Mortality 23, 33 Educational Sessions — Ante- Natal 45 Egg Albumen, Imported 138-140 Elevation of Borough 10, 12, 21 Encephalitis 155 Enteric Fever 34 Entertainment (for Elderly) 106, 107 Erysipelas 153 Exhumations 108 Expectation of Life 21 Export Certificates 140 Extracts from Vital Statistics 23 F Factories Act, 1961 54 Fair on Blackhcath 133 Family Planning Association, Sessions 49 Family Welfare Association 50 Flooding, Storm (Ravensbourne) 57 Flour (Composition) Regs., 1956 141 Fluoridation of Water Supplies 74 Food and Drugs Act, 1955 140, 144-148 Food and Drugs—Non-genuine Samples 147-148 Food and Drugs Act, 1955, Samples taken under 140, 144-146 Food Examination (Other) 142 Food Hygiene (General) Regs., 1960 133, 134, 135 Page Food, Inspection of 122-148 Food Parcels (Old People) 105 Food Poisoning 143 Food—Premises for Preparation of 134, 135 Food Rejected 135, 137 Food Standards (Ice Cream) Regs., 1959 133 Foods Welfare (for Elderly) 104 Foot Clinics 48 Foot Clinics, Attendances 46 Frozen Dinners (for Elderly) 106 G General and Vital Statistics 10-42 General Information 12-17 General Provision of Health and Welfare Services in the Area 43-50 Geology, Superficial 18-21 Greenwich Guild of Hygiene 163 Greenwich Hotel 95 Greenwich Old People's Welfare Association 101 Guild of Hygiene 163 H Habitation Certificates (Water Supply) 74 Hairdressers and Barbers 70 Handwashing Facilities 81 Health Centres 48 Health Visiting 44 Heart Disease 23, 39-41 Heating Appliances (Fireguards) Act, 1952 68 Holiday Hotel 95-101, 104 Holidays (Old People) 95, 104 Home Help Statistics 47 Home Help Service, Applications for 49 Home Safety Act, 1961 69 Horse Troughs 81 Hospitals 50 House to House Collections (O.A.Ps.) 105 House Purchase & Housing Act, 1959 115 Houses, No. in Borough 10 Houses in Multiple Occupation 113 Housing 111-121 Housing Act, 1957 113 Housing Act, 1957, Procedure under 113-115 Housing Act, 1949 115 INDEX (continued) Page Housing Act, 1961 113 Housing (Financial Provisions) Act, 1958 115 Housing Accommodation 117 Housing Homeless Persons 117 Housing (Payments for WellMaintained Houses) Order, 1963 113 Housing Register 120 Housing Repairs and Rents Act, 1954 65,115 Housing Schemes, Council's 118 Housing Survey 119 Housing (Underground Rooms) Act, 1959 114 Hygiene, Guild of 163 I Ice - Cream — Bacteriological examinations 131 Ice-Cream (Heat Treatment, etc.) Regulations 131 Ice-Cream (Heat Treatment etc.) (Amendment) Regs., 1963 127 Ice-Cream Premises 131 Ice-Cream Quantitative Analysis 133 Ice-Cream Sampling 131 Illegitimate Births 23, 26 Immunisation and Vaccination Clinics 48 Immunisation and Vaccination Clinics, Attendances 45 Imported Egg Products 138-140 Imported Food Rejected 137 Infantile Mortality 23, 29-33 Infant Welfare Centres 48 Infant Welfare Clinics, Attendances 44-46 Infectious Diseases 23, 33 Infirm Persons 89 Influenza 23,41 Inhabited Houses 10 Inoculations, Poliomyelitis 46 Inspection of Food and Supervision of Food Premises 122-148 Institution Deaths 28 International Certificates 152 International Statistical Classification of Diseases, Injuries and Causes of Death, 1955 33 Interviews (Re - housing) by M.O.H. 163 Introductory Review 7-9 Invalid Chairs 104 Invalid Holidays 96, 104 Page J Jurisdiction over R. Ravensbourne 57 L Laboratory Work 72, 74, 79, 129, 130, 131, 133, 138-148 Land Charges Act, 1925 71 Laundry Service 95 L.C.C. (Gen. Powers) Act, 1953 72, 95 L.C.C. (Gen. Powers) Act, 1954 70 L.C.C. (Gen. Powers) Act, 1958 69 L.C.C. (Gen. Powers) Act, 1963 53 Legal Proceedings 135, 148 Legislation, New 51-53, 113, 124, 149 Leptospirosis 83 Lettings (Housing) 119 Licensing Act, 1961 70 Linen Store (for Homebound) 107 Liquid Egg (Pasteurisation) Regs., 1963 125 London Government Act, 1939 67 Luncheon Clubs 103 Lung Cancer 36-39 M Malaria 155 Manufacture and Sale of Ice- Cream 130 Marriages 24 Mass Radiography 50, 158 Massage etc., Attendances 46 Maternal Mortality 23, 29 Maze Hill Clinic (Tuberculosis) 49, 161 "Meals on Wheels" 103 Measles 34 Meat Inspection Regs., 1963 124 Meat Regulations 136 Meat Surrendered 175, 137 Medical Inspections (Superannuation) 163 Medical Inspections (Sick Persons) 163 Medical Officer of Health's Review 7-9 Medical Statistics (Schools) 47,48 Meningococcal Infection 154 Merchandise Marks Act 133 Meteorological Observations 25 Mileage of Streets 11 Milk, Analysis of 130, 141 Milk and Dairies Regulations 128 Milk Licences 129 Milk (Special Designation) (Pasteurised & Sterilised Milk) Regulations 129 INDEX (continued) Page Milk (Special Designation) (Raw Milk) Regulations 129 Milk (Special Designation) Regulations, 1960 129 Milk (Special Designation) Regulations, 1963 126 Milk Sampling 129, 141 Milk Supply 128 Minor Aliments Centres (for School Children) 48 Morden College Housing Schemes 115 Mortuary Accommodation 108 Motor Vehicles Accidents 41 Movable Dwellings 117 Mutual Exchanges (Housing) 121 N National Assistance Act 94 National Assistance (Amendment) Act, 1951 94 National Health Services 50 National Insurance Act (Medical Certificates) 150 National Welfare Food's—Distribution Centres 43 Natural Increase 21 Neo-Natal Mortality 23, 32 & Appendix New Housing Accommodation 117 New Legislation 51-53,113,124,149 Noise Abatement Act, 1960 66 Nomenclature Regulations, 1948 33 Non-Genuine Samples 147 Notices, etc 51, 110 Notifications of Infectious Diseases 150-162 & Appendix Notifications of Food Poisoning 143 Nursing Associations 47, 50 O Offices, Shops & Railway Premises Act, 1963 51 Oil Burners (Standards) Act, 1960 68 Old People's Clubs 101 Old People's Welfare Association 101 Open Spaces 11 Ophthalmia Neonatorum 155 Outworkers 55 Overcrowding 116 P Perinatal Mortality 23, 33 Personal Health Services 43-50 Persons Cleansed 95, 159 Page Pet Animals Act 71 Pharaoh's Ants 87 Pharmacy & Medicines Act 141 Pharmacy & Poisons Act 68 P.H. (Aircraft) Regulations 1963 149 P.H. (Dried Milk) Regulations 141 P.H. (Imported Food) Regulations 128. 136, 140 P.H. (London) Act, 1936, Sec. 180(8) 135 P.H. (Meat) Regulations 136 P.H. (Ships) Regulations, 1963 149 P.H. (Smallpox Prevention) Regulations 151 P.H. (Tuberculosis) Regulations 150, 157 Physically Incapacitated Persons 89-108 Pigeon Nuisance 56 Pneumonia 41 Poisons Information Service 68 Poliomyelitis 155 Poliomyelitis Inoculations 46 Pollution, Atmospheric 59, 64 Pollution, River 56 Population 10, 21 Population, Age Composition 22 Post-Natal Attendances 45 Powers & Duties of the Public Health Committee 3-5 Precautionary Spraying 89 Preservatives in Food Regulations, 1962 148 Preserved Food Premises 130 Prevalence of, and Control over Infectious Diseases 149-162 Prevention of Damage by Pests Act 83 Procedure under the Housing Act, 1957 113 Prophylaxis Cases 46 Prophylaxis Clinics 48 Public Baths & Washhouses 77 Public Health Committee 3 Public Health Department Staff 6 Public Health Laboratory Service 74, 79, 129, 131, 138-140. 142, 143 Public Open Spaces 11 Public Sanitary Conveniences 80 Puerperal Pyrexia 154 Q Quantitative Analysis of Ice- Cream 133 Queen's District Nursing Ass¬ciation 47, 50 INDEX (continued) Page R Radioactive Substances Act, 1960 73 Radiography, Mass 50, 158 Rag Flock Act 70 Rag Flock and Other Filling Materials Regulations, 1961 70 Ranyard Mission 47, 50 Rateable Value 10 Rates, Births and Deaths, etc. 23 Rat Repression 82 Ravensbourne, River (Flooding) 57 Redevelopment, Housing 115 Refuse Collection 76 Refuse Disposal 77 Registered Births 23, 26 Registered Deaths 23, 27 Registrar—Office Hours 50 Registration of Preserved Food Premises 130 Rehousing 116 Rehousing Interviews (by M.O.H.) 163 Rejected Food 135-137 Relaxation Sessions—Ante-Natal 45 Remarks on Various Death Causes 33-42 Rent Act, 1957 65 Rent & Mortgage Interest (Restrictions) Acts 65 Report on 'Smoking and Health' R.C.P.) 37 Reproductive Wastage 33 Requisitioned Houses & Housing (Amendment) Act, 1955 66 Respiratory System—Diseases of 41 Review by M.O.H 7-9 River Pollution 56 River Ravensbourne, Flooding 57 River Ravensbourne, Jurisdiction 57 River Smells 56 Rodent Control 82 Royal College of Physicians' Report on 'Smoking and Health' 37 S Sampling of Ice-Cream 131 Sampling of Milk 129, 141 Sampling under Food & Drugs Act 140, 144-148 Sanitary Circumstances of the Area 51-110 Sanitary Conveniences, etc 80 Sanitary Work — Summaries, etc 109-110 Page Scabies 154 Scabies & Cleansing Clinics 49, 95, 159 Scarlet Fever 34, 153 Scavenging and Refuse Disposal 76 Schools (Medical Statistics) 47 Sewerage and Drainage 72 Sewers—Baiting of 85 Shops Act 69 Slaughterhouses 136 Slum Clearance 114 Smallpox 34, 151, 152 Smells from River 56 Smoke and Grit Emission 59 Smoke Control Areas 63 Smoke Control Areas (Authorised Fuels) Regulations. 1963 53 'Smoking and Health' (R.C.P. Report) 37 Social Conditions of the Area 12-17 Soft Drinks Regulations, 1963 127 Sonne Dysentery 154 Spraying, Precautionary 89 Staff of Publfc Health Department 6 Statistical Tables Appendix Statistics, General 10-11 Still Births 23, 26 Street Appeal (for Elderly) 105 Streets, Mileage of 11 Street Traders 133 Storm Flooding 57 Suicide 41, 42 Suicide Act, 1961 42 Summary of Sanitary Work 109-110 Sunlight Treatment 46 Superficial Geology 18-21 Supervision of Food Premises 134 Supplies of Underground Water (Wells) 74 Swimming Baths 77 T Toddlers Clinic Attendances 45 Transfers (Housing) 121 Transported Meals for Old People 103 Treatment Centres and Clinics 48 Tuberculosis 23, 34, 150, 155-159, 161 Tuberculosis Officer's Report 161 Typhoid Fever 34 U Underground Rooms 114 Underground Water Supplies (Wells) 74 INDEX (continued) Page Uninhabited Houses 10 Unsound Food 135, 137 Unfit Houses 114 V Vaccination Cases 46 Vaccination and Immunisation Clinics 48 Vaccination International Certificates 152 Various Death Causes, Remarks on 33-42 Vascular Lesions of Nervous System 39 Verminous Conditions 95, 159 Verminous Premises 86 Violent Deaths 41 Vital Statistics 23 & Appendix Voluntary Organisations 50 W Wash-houses and Public Baths 77 Washing Facilities (Hand) 81 Wasps 88 Water—Underground Supplies (Wells) 74 Page Water Supplies—Fluoridation of 74 Water Supply 74 Water Supply Certificates 74 Weil's Disease 83 Welfare Clinics 48 Welfare Foods (for Elderly) 104 Welfare Foods, National—Distribution Centres 43 Wells 74 Whooping Cough 34, 152 Whooping Cough Prophylaxis Cases 46, 153 Whooping Cough Prophylaxis Clinics 48 Women's Special Clinic 49 Women's Voluntary Services 50 X X-Ray Examinations 158, 161 X-Ray, Mass 50, 158 Z Zymotic Disease 34, 154 Zymotic Enteritis 34, 154 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 year 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and under 75. 75 and over. Under 4 Wks 4 wks and under 1 year All Causes ... M 481 6 5 3 1 5 6 15 53 107 120 160 F 463 4 5 2 1 6 4 11 31 55 112 232 1 Tuberculosis, Respiratory M 6 - - - - - - - - 1 3 2 F 3 1 1 1 2 Tuberculosis, Other M - - - - - - - - - - - - F 1 - - - - - 1 - - - - - 3 Syphilitic Disease M 1 - - - - - - - 1 - - - F 1 - - - - - - - - - - 1 4 Diphtheria M - - - - - - - - - - - - F - - - - - - - - - - - - 5 Whooping Cough M - - - - - - - - - - - - F - - - - - - - - - - - - 6 Meningococcal Infections M - - - - - - - - - - - - F 1 - 1 - - - - - - - - - 7 Acute Poliomyelitis M - - - - - - - - - - - - F - - - - - - - - - - - - 8 Measles M - - - - - - - - - - - - F - - - - - - - - - - - - 9 Other Infective and Parasitic Diseases M 2 - - - - - - - - 2 - F 2 - -- - - - - - - - - - 10 Malignant Neoplasm, Stomach M 19 - - - - - - - 2 9 3 5 F 1 / - - - - - - - 1 3 7 6 Malignant Neoplasm, Lung, Bronchus M 48 - - - - - 1 2 8 18 15 4 F 8 - - - - - - - 2 3 1 2 12 Malignant Neoplasm, Breast M -- - - - - - - - - - - - F 16 - - - - - - 2 1 4 2 6 3 Malignant Neoplasm, Uterus F 5 - - - - - - 1 1 1 1 1 4 Other Malignant and Lymphatic Neoplasms M 32 - - - - - - - 7 6 10 9 F 42 - - - - - i / 9 22 5 Leukaemia, Aleukaemia M 2 — - - - - - — 1 - - 1 F 2 - - - - - - — 1 - 1 - 6 Diabetes M 2 - - - - - - - 1 I - - F 6 - - - - - - - - 1 4 1 7 Vascular Lesions of Nervous System M 26 - - - - - - 1 2 2 8 13 F 54 - - - - 1 - - 2 8 17 26 8 Coronary Disease, Angina M 102 - - - - - 1 4 17 26 25 29 F 85 - - - - - - - 4 6 22 53 9 Hypertension with Heart Disease M 5 - - - - - - - - 2 1 2 F 17 - - - - - - - - 2 4 11 0 Other Heart Diseases M 44 - - - - - 1 - 2 4 11 26 F 53 - - - - 1 1 1 4 6 8 32 1 Other Circulatory Disease M 26 - - - - - - 3 2 5 8 8 F 26 — - - - 1 -- 1 1 3 6 14 2 Influenza M 2 - - - - - - - 1 - - 1 F 2 1 1 3 Pneumonia M 28 - 2 1 - 1 - - 1 11 12 F 36 - 2 1 - - - 1 - 1 2 29 4 Bronchitis M 53 - 2 - - - - - 1 16 15 19 F 19 - - - - - - - 1 1 7 10 5 Other Diseases of Respiratory System M 5 - -- 1 - - - - - 2 - 2 F 1 - - - - - - - - - 1 - 6 Ulcer of Stomach and Duodenum M 5 - - - - - - - 1 1 1 2 F 4 - - - - - - - 1 1 1 1 7 Gastritis, Enteritis and Diarrhoea M - - - - - - - - - - - - F 3 - - - - - - - - - 2 1 8 Nephritis and Nephrosis M 7 - - - - - - - 1 2 1 3 F 1 - - - - - - - - - 1 - Hyperplasia of Prostate M 9 - - - - - - - - - 3 6 Pregnancy, Childbirth, abortion F - - - - - - - - - - - - Congenital Malformations M - - - - - - - - - - - - F 3 — 2 — — — — — — — 1 — Other defined and ill-defined Diseases M 32 6 1 - 1 - 1 2 2 5 2 12 F 39 4 - 1 1 1 2 2 5 5 7 11 Motor Vehicle accidents M 9 - - - — 4 - 1 1 — 2 1 F 6 — - - - 1 — - - - 3 2 All other Accidents M 9 - - 1 - - 1 1 2 1 1 2 F 3 - - - - - - 1 1 - - 1 ISuicide M 6 - - - - - 1 1 1 2 - 1 F 7 - - - - - - 1 2 2 2 - Homicide and Operations of War M 1 - - - - - - - - 1 - - F - - - - - - - - - - - - INFANTILE MORTALITY DURING THE YEAR 1963 Deaths from stated Causes in Weeks and Months under 1 Year of Age. Cause of Death. Under 1 week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under 1 Month. 1—3 Months. 3—6 Months. 6—9 Months. 9—12 Months. Total Deaths under One Year. Small-Pox ... ... ... ... ... ... ... ... ... ... Chicken-Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis ... ... ... ... ... ... ... ... ... ... Acute Bronchitis ... ... ... ... ... ... ... ... ... ... Capillary Bronchitis ... ... ... ... ... ... ... ... ... ... Acute Tracheo-bronchitis ... ... ... ... ... 1 ... 1 ... 2 Bronchopneumonia ... ... ... ... ... 1 ... ... ... 2 Pneumonia ... ... ... ... ... 1 ... 1 ... 2 Premature Birth 3 ... ... ... 3 ... ... ... ... 3 Premature Birth (Placenta Prævia) 1 ... ... ... 1 ... ... ... ... 1 Breech Delivery (Results of) 1 ... ... ... 1 ... ... ... ... 1 Birth Injury 1 ... ... ... 1 ... ... ... ... 1 Cerebral Anoxia (Cord round neck) 1 ... ... ... 1 ... ... ... ... 1 Haemolytic Disease of Newborn 1 ... ... ... 1 ... ... ... ... 1 Respiratory Distress 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformation ... ... ... ... ... 1 1 ... ... 2 Meningitis (Meningococcal) ... ... ... ... ... 1 ... ... ... 1 Meningitis (E.Coli) ... ... 1 ... 1 ... ... ... ... 1 Fatty Degeneration of Liver ... ... ... ... ... ... ... 1 ... 1 Totals 9 — 1 — 10 5 1 3 1 20 Male 11 Female 9 CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1963. 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 Encephalities Infectious 1 1* — — — — — — — — — — 1 1* _ _ — — _ — _ _ — — — 1 — — — — — — — Post-Infectious — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria _ _ _ _ _ _ — _ _ _ — — — — — — — — — — — — — — — — — — — — — — — Dysentery 159 157 9 3 6 4 9 11 16 9 9 7 49 52 16 12 11 17 78 M 4 7 2 1 53 119 32 112 — 2 — — 2 Erysipelas — 1 — — — — — — — — — — — — — — — — — — — 1 — — — — 1 — — — _ — Acute Polio-Myelitis P. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — N.P. _ _ _ _ _ _ _ _ _ _ — — — — — — — — — — — — — — — — — — — — — — — Scarlet Fever 10 19 _ 1 — — 1 _ 1 1 3 1 5 14 _ _ — 2 _ _ _ _ _ 3 8 — 18 — — — 1 1 Typhoid Fever — — — — — — — — — — — — — — — — — — — — _ _ _ _ — — — — — — — — — Paratyphoid Fever — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Scabies 3 _ _ _ _ _ 1 _ _ _ _ — — — _ — 1 — 1 — — — — — — 3 Puerperal Pyrexia — — — — — — — — — — _ _ _ _ — _ — _ — — _ _ _ _ _ — _ _ _ _ _ _ _ Meningococcal Infection — — — — — — — — — — _ — — — _ — _ _ — _ — — — _ — _ _ — _ _ _ _ — Measles 439 486 13 11 65 68 47 72 60 73 61 61 183 191 7 6 1 1 2 1 _ _ _ _ 321 212 ?n 372 _ _ _ _ — Whooping Cough 11 24 1 2 _ 4 3 3 _ 1 2 2 4 10 — 2 1 — — — — — — — 5 18 2 10 — _ _ _ _ Diarrhoea 8 2 2 — 3 2 2 — — — 1 — — — — — — — — — — — — — 1 1 7 6 _ 1 _ _ 1 Ophthalmia Neonatorum — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia, Acute Primary or Acute Influenzal 6 2 — — — — — — — — — — — — — — 1 — — — 3 2 2. — 2 1 — 5 — — — 1 1 Tuberculosis, Pulmonary 22 5 1 — — — — 1 — — — — — — — — 4 2 6 1 7 1 4 — 6 11 3 7 2 4 - 1 7 „ Non-Pulmonary 2 3 —— — — — — — — — — — — — — 1 1 — —- — 1 1 — l 1 3 1 — 1 1 1 — 3 Totals 661 700 26 17 74 78 63 87 77 84 76 73 242 268 23 21 20 22 37 36 15 12 8 2 392 377 61 530 3 8 1 3 15 NOTE:—The above Table refers to "Corrected Notifications" only, i.e. all cases in which diagnosis was not confirmed have been ignored. * Deptford case in Greenwich Hospital TOTAL CAUSES OF, AND AGES AT, DEATH during the year ended 31st December, 1963. No. in Short List Causes of Death. Deaths at Subjoined ages of "Residents" whether occurring within or without the District Deaths at all Ages of "Residents" belonging to Localities, whether occurring in or beyond the District Deaths of "Residents" in Public Institutions Total Deaths whether of "Residents'" or "NonResidents" in Public Institutions in the District All Ages Under 1 1 and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and upwards Greenwich East Greenwich West St. Nicholas, Deptford Charlton and 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. 1 Tuberculosis, Respiratory 9 ... ... ... ... ... ... 4 2 3 4 1 ... 4 1 ... ... ... ... ... 5 8 2 Tuberculosis, Other 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 2 3 Syphilitic Disease 2 ... ... ... ... ... ... ... 1 ... 1 1 ... ... 1 ... ... 1 ... ... ... ... 6 4 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Meningococcal Infections 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 7 Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Other Infective and Parasitic Diseases 4 ... ... ... ... 1 ... 1 2 ... ... ... 4 ... ... ... 2 ... ... ... ... 1 6 10 Malignant Neoplasm, Stomach 36 ... ... ... ... ... ... ... 14 10 12 11 4 ... 21 10 1 4 ... ... ... 5 35 11 Malignant Neoplasm, Lung, Bronchus 55 ... ... ... ... ... ... 3 32 15 5 25 10 ... 20 13 4 3 1 3 ... 11 84 12 Malignant Neoplasm, Breast 17 ... ... ... ... ... ... 2 6 2 7 8 1 ... 8 7 ... ... 1 ... ... 2 20 13 Malignant Neoplasm, Uterus 5 ... ... ... ... ... ... 1 2 1 1 2 ... ... 3 1 ... ... ... ... ... 3 3 14 Other Malignant and Lymphatic Neoplasms 74 ... ... ... ... ... 1 ... 25 19 29 21 16 2 35 22 ... 8 ... 3 1 17 117 15 Leukaemia, Aleukaemia 5 ... ... ... ... ... ... ... 2 1 2 1 2 ... 2 3 ... ... ... ... ... 1 8 16 Diabetes 7 ... ... ... ... ... ... ... 2 4 1 1 2 ... 4 2 ... 1 ... 1 ... 1 8 17 Vascular Lesions of Nervous System 84 ... ... ... ... ... 1 1 15 28 39 30 18 2 34 32 1 16 ... 7 ... 8 220 18 Coronary Disease, Angina 147 ... ... ... ... ... ... 5 42 41 59 51 19 6 71 42 1 11 ... 1 ... 24 163 19 Hypertension with Heart Disease 13 ... ... ... ... ... ... ... 2 3 8 6 4 ... 3 2 ... ... ... ... ... 2 12 20 Other Heart Disease 157 ... ... ... ... ... 1 4 28 31 93 56 22 6 73 57 5 12 ... 5 ... 22 219 21 Other Circulatory Disease 59 ... ... ... ... ... ... 6 13 15 25 23 9 1 26 13 5 9 ... 2 ... 10 71 22 Influenza 4 ... ... ... ... ... ... ... 1 1 2 1 1 ... 2 ... ... ... ... ... ... ... 1 23 Pneumonia 70 ... 4 1 1 1 1 1 3 16 43 29 8 2 31 34 1 7 ... 2 ... 17 153 24 Bronchitis 65 ... 2 ... ... ... ... ... 16 21 26' 20 10 2 33 23 3 5 1 2 ... 12 120 25 Other Diseases of Respiratory System 5 ... ... ... ... ... ... ... 1 1 3 2 1 ... 2 2 ... 1 ... ... ... ... 21 26 Ulcer of Stomach and Duodenum 8 ... ... ... ... ... ... ... 3 2 3 1 2 ... 5 2 1 2 ... ... ... 2 19 27 Gastritis, Enteritis and Diarrhoea 3 ... ... ... ... ... ... ... ... 1 2 1 ... ... 2 2 ... 1 ... ... ... ... 13 28 Nephritis and Nephrosis 7 ... ... ... ... ... l ... 2 1 3 2 1 ... 4 3 ... 1 ... 1 ... 1 10 29 Hyperplasia of Prostate 7 ... ... ... ... ... ... ... ... 2 5 2 ... ... 5 ... ... 2 ... ... ... 2 5 30 Pregnancy, Childbirth, abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 Congenital Malformations 3 ... 2 ... ... ... ... ... ... 1 ... ... 1 1 1 ... ... ... ... 1 ... 1 10 32 Other defined and ill-defined Diseases 59 11 1 l l 1 1 6 17 7 13 19 9 3 28 15 ... 11 ... 2 ... 15 107 33 Motor Vehicle Accidents 11 ... ... ... ... ... 5 ... ... 4 2 ... 1 ... 10 4 ... ... ... ... 7 27 34 All other Accidents 15 ... ... 1 ... ... ... 3 5 2 4 1 4 1 9 3 ... 2 ... 2 ... 7 31 35 Suicide 14 ... ... ... ... ... ... 4 7 2 1 7 1 ... 6 2 ... 2 ... 1 ... 2 13 36 Homicide and Operations of War ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 947 11 10 3 2 2 11 38 245 233 392 325 151 26 445 295 24 99 3 35 8 178 1,513 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