4373 GRE 62 II Metropolitan Borough of Breenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1964 Metropolitan Borough of Breenwich REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1964 Printed by Bromley Office Supplies & Printing Co., Ltd. 39 &41 East Street, Bromley, Kent CONTENTS Page Public Health Committee 3 Introductory 8 Section A.—General AND Vital Statistics 11 B.—General Provision OF Health and Welfare Services for the Area 53 „ C.—Sanitary Circumstances OF THE Area 61 „ D.—Housing 126 „ E.—Inspection OF Food AND Supervision OF Food Premises 140 „ F.—Prevalence OF, AND Control Over Infectious AND Other Diseases 172 „ G.—Miscellaneous 191 Short History OF Public Health IN Greenwich, 1901-1965 192 Appendix—Statistical Tables 3 PUBLIC HEALTH COMMITTEE (as at 31st December, 1964) The Mayor: (ex-officio) Councillor Mrs. J. A. Johnson, J.P., L.C.C. Chairman: Councillor A. C. Chrisp, L.C.C. Vice-Chairman; Councillor H. A. Read Alderman: W. S. Manners, M.B.E. Councillors: Mrs. M. L. Bennett P. Noble Mrs. J. E. Chrisp Mrs. E. Pennington Mrs. A. D. A. Kennedy R. Ruston D. P. Lynch L. Squirrell W. J. Manners 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 Parlia— ment, by-laws and regulations dealing with the public health and the sanitary condition of the Borough; the administra— tion 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 enact— ments 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, shall be delegated to the Committee. 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 dwell— ings 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 re— ferred to the Committee. 9.—All plans for the drainage and re-drainage of buildings in the Borough shall be considered by the Committee, and all works 5 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 main— tained 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, 1964) 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 Inspector) a J. G. Lyons (Clean Air Act Inspector) ab D. B. Smith (Housing Act) District Public Health Inspectors: ab G. E. Clayton-Turner ab D. J. Hopgood ab M. E. S. Poultney (i) ab S. Kelly abc S. A. Radford Assistant Clean Air Officer : E. H. Cooper Student Public Health Inspectors: R. W. Darvill R. Smart D. Thew PUBLIC HEALTH OFFICERS : abdef Miss B. Hatfield (Senior) def Miss N. A. Fluck dfg 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. W. C. A. Law Mrs. J. E. Collins (ii) Mrs. M. Lowe (v) Miss J. A. Dyer (iii) J. A. Sutherland R. Hewitt (iv) Mrs. F. A. Webb Mrs. D. F. Howard (Senior S/H Typist) C. Weymouth Conveniences Superintendent: W. F. Goodall 7 Greenwich Hotel Staff Miss W. E. Wilson (Superintendent) J. W. Rogers (Caretaker) 4 Maid/Waitresses 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 6 women) RODENT CONTROL DISINFESTATION AND GENERAL DUTIES: Team of six men a Certificated Public Health Inspector (i) commenced duties 30.11.64. b „ Meat and Other Foods (ii) commenced duties 19.5.64. c „ Smoke Inspector (iii) commenced duties 27.7.64. d „ Health Visitor (iv) commenced duties 25.5.64. e „ State Certified Midwife (v) commenced duties 23.3.64. f „ State Registered Nurse g „ Certified Midwife (S.A.) 8 PUBLIC HEALTH DEPARTMENT, TOWN HALL, GREENWICH, S.E.10. To The Mayor, Aldermen and Councillors, Metropolitan Borough of Greenwich. Ladies and Gentlemen, On the 31st March, the Metropolitan Borough of Greenwich ceased to exist and this report for 1964 will, therefore, be the last to cover the health and environmental circumstances of the borough. After an existence of 65 years it is understandable that the dissolution of the borough should occasion regret and a certain sadness, for this tumultuous century has seen greater improvements both locally and nationally in almost every field of human endeavour than occurred from the Middle Ages to the end of Queen Victoria's reign. Scientific medicine has emerged from processes which were little more than superstitious cults, and the social causes and consequences of disease and deviations from the accepted norm are now being studied in an informed and systematic way. A review of all the progress which has come about since the turn of the century would necessitate a vast canvas but, in the body of this report, an attempt has been made to give some account of the work of the Health Department as it has evolved and been shaped by events, by officers and by many enlightened citizens who have been elected over the years to serve the borough. It would be unfitting if, in this last report, a grateful acknowledgement was not made to our predecessors who, in vastly different circumstances and under the handicap of the restricted knowledge of their time, took far reaching decisions which were based more on a broad spirit of compassion and on a determination to improve matters rather than on cold objective reasoning. I would commend to the readers attention the survey included in the report of the great advances which have been made in the borough in the realms of prevention of illness and disease and the vast improvements in environmental circumstances and in the ideas and techniques of sociology. To return to the year under review, there has been a slight decrease in population and, although births have increased, the birthrate at 16.78 is below both the figure for London and the national average. The infant mortality rate shows a great increase over last year's low figure and, in previous reports, I have commented on the wide fluctuations in this rate over the years and there is nothing to add. Nevertheless, it should be noted that there was an increase of 23 perinatal deaths last year and an analysis 9 indicates that a high proportion is due to prematurity and congenital abnormality. It is clear that this hard core of deaths will have to be reduced and it behoves all having responsibility for ante-natal care and for the maternal services to ensure that the highest possible standards are maintained. Unfortunately, as yet, only a few of possibly many factors predisposing to premature birth and developmental aberration are known and it is certain that major fundamental causes have still to be more clearly defined. In contrast, it is pleasing to report another year without a maternal death. Although there are reports from other parts of the country that the lung cancer death peak may be receding, there is no con— firmation of this tendency in this area. Total cancer deaths increased by 42 and cancer of the lung and bronchus by eight. Notwith— standing the mental gymnastics of some statisticians and even a few scientists (who are not wholly disinterested) to prove that black is white, there can now be no reasonable doubt that the correlation between heavy ciearette smoking and the incidence of lung cancer is a direct one. Whatever other aetiological factors there may be, whether of heredity, of temperament, of constitution or of internal cytology or chemistry, this one fact is incontrovertible and the consumers of tobacco should make their choice in the knowledge that they are consuming a substance which is an irritant and a proven carcinogenic agent. The other main causes of death show decreases, especially diseases of the heart and circulatory system, and bronchitis and other respiratory diseases. The total number of notified infectious diseases decreased by 894, due almost entirely to a decline in measles. On the other hand, there were 234 fewer cases of dysentery and three cases of para— typhoid fever occurred. There were an additional nine cases of notified tuberculosis, three of which were pulmonary, but a compre— hensive and realistic check of the tuberculosis register has enabled the number on that register to be reduced from 1.036 to 811 pulmonary and from 86 to 51 non-pulmonary. Details of other notified diseases are included in the report. The main legislation passed during the year was the Housing Act of 1964. This Act gives valuable additional powers to the local authority to compel the improvement of dwellines and more effective control over houses in multiple occupation, which in certain areas have become a serious public health and social problem. The Protection from Eviction Act, 1964, although of public health interest, will not place very many additional burdens on health departments but will be more of a legal concern. 10 The well established services in relation to old people, housing, clean air and food control continued undisturbed and need not be discussed in detail in these prefatory remarks. Undoubtedly the cloud of extinction hanging over the borough has had an unsettling effect and the attention, both of staff and of many elected members, has had of necessity to be directed to the establishing of an efficient and functioning new local authority unit which is now in being and has been operating alongside the the departing authority. Although many elected members will be serving the new authority it will be in conditions perhaps some— what less intimate than were possible in the Metropolitan Borough and I wish, therefore, to express to the Chairman, Vice-Chairman and members of the Health Committee the thanks and good wishes of all the department's staff for the warmth of friendship which accompanied our official relationships. In conclusion, I wish to thank the staff of the department for their loyalty and enthusiasm and to wish all of them every success at the conclusion of their service with the Metropolitan Borough of Greenwich and at the birth of a new era in London local government. I have the honour to remain, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, J. Kerr Brown, Medical Officer of Health. 11 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA General Statistics Elevation.—Varies from below high-water mark up to 249 feet above sea level. Area of the Borough and Districts— East Greenwich 1,300 acres West Greenwich 453 St. Nicholas, Deptford 115 „ Charlton and Kidbrooke 1.990 3,858 acres Population— At Census, 1961 85,546 Estimated, 1964 (mid-year) 83,630 Density of Population (persons per acre) 21.68 Number of Inhabited Dwellings—end 1964 ... 24,558 (according to Rate Books) Structurally separate dwellings at Census, 1961 25,096 Number of Uninhabited Dwellings— At Census, 1961 488 At end of 1964 454 Number of Families or Separate Occupiers— At Census, 1961 27,127 Rateable Value, 1964 £5,164,693 Sum Represented by a Id. Rate, 1964 £20,500 12 PUBLIC OPEN SPACES Borough Council— Charlton House and Gardens 9.25 acres East Greenwich Pleasaunce 5.93 „ St. Alfege Recreation and Church Grounds 2.30 „ Hughes Fields Recreation Grounds 74 „ Batley Park 97 „ Bellot Memorial Gardens 19 „ Other Open Spaces 6.01 ,, Approximately 25.39 acres H.M. Office of Works— Greenwich Park 185 acres L.C.C.— Blackheath (part of) 89 acres Blackheath—Rangers House and Garden 2$ „ Maryon and Maryon Wilson Parks 51½ ,, Charlton Park 42 „ Hornfair (formerly Charlton Playing Field) 26 Sayes Court Recreation Grounds 3¼ „ King George's Field 4¾ „ Charlotte Turner Gardens 1¾ „ Approximately 221½ acres Total Public Open Spaces in Borough Approx. 432 acres (representing 11% of the total area of the Borough) Mileage of Streets 89.5 (approx.) 13 GENERAL INFORMATION AND SOCIAL CONDITIONS The division in 1855 of the Parliamentary Borough of Green— wich 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 Novem— ber 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. Topography was undoubtedly the basic reason for the importance of Greenwich. At the raised plateau of Blackheath, the great Roman road from Dover almost touched at a tangent the loop of the Thames formed by the Blackwair and Limehouse Reaches. Strategic significance was given to the land between Blackheath and the river by the fact that the two main arteries from the Continent, viz. the road and the river, through which trade or trouble could reach the capital, all but met at this point and, moreover, the peculiar bend in the river gave shelter to unloading shipping. This strip of land, invaluable for defence purposes, was the future site of Greenwich. 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 14 in determining the types of industries located within its boundary with their consequent effects on the social conditions of its com— munity. 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 Maidenstone Hill and Shooter's Hill, along with many other place names, are 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 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 oame 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 15 windows with glass. At this splendid 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, and, within the precincts of this noble Greenwich residence, the marriage of Henry VIII to Anne of Cleves was celebrated. Henry VIII was the first king to put the Royal Navy on a national basis. He established the Deptford and Woolwich Yards and at the latter built the "Henri Grace a Dieu", the greatest warship of her day. He christened the ship and appointed her captain as the first Master of Trinity House, the corporation which still controls the lighthouses and pilotage of the coasts of England. At that time, Trinity House was located beside St. Nicholas, the "seafarers'" church, in an area famous for its association with Peter the Great, Admiral Benbow, John Evelyn, Christopher Marlowe, Grinling Gibbons, Samuel Pepys and others. Unquestionably Henry VIII loved Greenwich. Here within easy water distance of London, he could hawk and hunt, watch his merchant shipping bring valuable merchandise from abroad, visit his ships of war anchored close by, and where he and his great minister Cardinal Wolsey could welcome with grandest pageantry the many illustrious visitors to his sumptuous palace. It is difficult to conceive the magnificence and splendour of the Palace of Placentia during this period for, set amidst gardens laid out with flower beds, sparkling fountains, ornamental summer houses and surrounded by a superb park designed by Le Notre of Versailles fame, it contained everything that money could buy or thought could devise to add to its grandeur. Floors were heavily carpeted; rooms, furnished from the dis-established monasteries and churches, were richly decorated, and the genius of the world's greatest painters was expended on its walls and ceilings which were hung with fine Arras cloth and tapestries, with silk and crimson velvet from Montpelier in Gascony and with ermine, sable and fox from Ireland: cloth of gold, blue cloth of silver broached upon satin ground, white damask, all richlv emblazoned with Royal emblems, were lavishly used: servants' liveries of blue murrev and horses with "hobby harness" of green velvet and aglets of silver, all were here assembled to receive distineuished personages from the world of arts, crafts, trades and professions. 16 From the beginning of the 15th century when Westminster had again become the centre of government, the Palace of Placentia, the favourite royal resort up to the time of James 11 (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 river— side and splendid palace nestling at the foot of Greenwich Hill in some 200 acres of beautiful sward and delightful woodland. Among these could be numbered the painters Holbein, Rubens and Vandyke—men of letters such as Shakespeare, Bacon, More, Jonson, Sidney and Spencer—seamen and explorers such as Raleigh, Blake, Cabot, Lord Howard, Davis, Frobisher, etc.,—Tallis and Bull the composers—Newton the celebrated philosopher and friend of Flamsteed, the Astronomer Royal—Harvey, the physiologist— Gresham, the astute merchant and financier and "money-finder" for the Royal Households—the list seems endless but, with such habitues, it was no wonder that the Court at Greenwich was the most popular in Europe. It was towards the end of this "golden age" in 1675, on a Warrant of Charles II, that the Royal Obser— vatory was founded and, to the design of Christopher Wren, Flamsteed House was built on the site of Duke Humphrey's tower. Almost as if to create a surfeit of grand edifices, an exquisite building designed by Inigo Jones with ceilings by Gentileschi and originally intended by James I as a palace for his Queen, Anne of Denmark, was commenced in 1616 and marked the introduction for the first time in England of the Palladian style of domestic architecture. The Queen's House, as it is now called, was finally completed for Charles I and occupied by Queen Henrietta Maria in 1635. This beautiful house set the fashion for the big country seats which subsequently sprang up all over England. Following the execution of Charles I, the Palace of Placentia fell into disrepair and, during the Cromwellian period, valuable furnishings and pictures were sold. However, on the restoration of Charles II in 1660, the older buildings were demolished for an intended new palace but only one of the four blocks forming the present Royal Naval College was begun. The remaining three blocks were completed by Queen Ann and William and Mary, respectively, with the laudable aim of providing a Royal Hospital for Naval Seamen. For this purpose, a commission had been set up with John Evelyn, the diarist, as its treasurer but it was some years before the Hospital was eventually completed by Vanbrugh, Hawksmoor and later architects in accordance with the overall plans of Christopher Wren. This group of imposing and stately 17 buildings, now the Navy's University, were themselves to become equally famous as the original palace for they now house the nation's Maritime Museum. The commanding position held by Greenwich in the 17th century, began to wane during the 18th century partly due to the conversion of the Palace into a hospital which induced many of the fashionable people to leave the area. Nevertheless, although the Court was no longer in permanent residence and Blackheath was still plagued with highwaymen and footpads, its position continued to appeal to influential people of the times who still frequented Greenwich or lived in the fine buildings in its environs. Lord Chesterfield, friend of Voltaire and Pope, lived and wrote many of his celebrated "Letters" to his son at the Rangers House. McCartney House adjoining was the home of General Wolfe— Angerstein, father of "Lloyds" of London, whose paintings became the foundation of the National Portrait Gallery, lived at the "Wood— lands". Sir John Morden, the founder of Morden College, a delightful Wren masterpiece, lived locally in a handsome mansion at Wricklemarsh. Dr. Johnson, the lexicographer and poet, who lodged locally, composed in and often strolled the park with his biographer, James Boswell. Notable occupants of other stately homes such as Charlton House, one of the country's finest examples of Jacobean architecture, of Vanbrugh Castle and Mince Pie House, both erected by the designer of Blenheim Palace and the Mansion House, and of the Manor Houses at Crooms Hill and East and West Combe, gave evidence of the continued popularity of Greenwich. Within its boundaries Greenwich had two traditional fairs. Granted to Charlton by Henry III at the same time as sanction for its market received Royal Assent, Horn Fair was held on St. Luke's Day, October 18th, when horn trinkets of all kinds were sold and where a carnival of the most restrained kind was included. However, over the years the procession became more ribald and the crowds so disorderly that it was ended by an Order in Council dated March 1872. That Greenwich Fair held on 12th- 14th May and llth-13th October was one of London's brightest attractions is emphasised by the numerous clever skits and drawings which emanated from the various journals and papers of the day. It came into prominence at the beginning of the 18th century originally as a cattle fair but gradually became a place noted not only for the sale of eatables and for its variety of amusement but also for its riotous and disreputable character. Despite its doubtful reputation Charles Dickens thoroughly enjoyed the fair and gives an amusing account of it in his "Sketches by Boz". In addition to theatrical and 18 waxwork shows, there were menageries, prize fighters, thimbleriggers, equestrians, rope performers, quack doctors, dancing booths, and the inevitable quota of pickpockets. Through telescopes on the Observatory and One Tree Hills, gibbets with skeletons attached could be viewed on the river banks for a few pence. The fair drew enormous crowds and thousands of persons, many of whom came by water in every conceivable craft, congregated in the park for rough merrymaking. There were swings and roundabouts, and it is reliably reported that the latter was first introduced to the British public at Greenwich from France in 1835. Stalls were arranged by the roadside from St. Mary's Gate to Blackheath and refreshments included shell fish of all kinds, effervescing drinks, eels in all its stages of cooking (pickled, stewed and in pies), plum pudding, gingerbread, cold fried fish all liberally peppered with dust were being rapidly disposed of by their vendors. In the evenings, the taverns were filled to overflowing and the merrymaking continued well into the night. As a direct result of the increase in the riotous nature of the entertainment, the fair was relegated to the road from Deptford Creek via St. Alfege's Church to the Park Gates and, finally, the local inhabitants succeeded in having it closed down in about 1860. One suspects that Nathaniel Hawthorne, the celebrated American writer who resided in Pond Road for a time, although somewhat critical of the fair, was one of many who regretted its passing. Nevertheless, the fair, a mere shadow of its former glory, is still held on Blackheath at time of Public Holidays. In more recent time, before the quality of the river deteriorated as a result of the population explosion of London in the latter half of the nineteenth century, Greenwich was renowned for its whitebait dinners and suppers. Gladstone, Prime Minister and member of parliament for this constituency in 1868, with his ministers, regularly dined here on whitebait caught in the Thames, off Greenwich, and the "Ship", "Trafalgar" and "Crown and Sceptre" Hotels were famous not only for these occasions but for the literary luncheons which were frequented by such celebrities as Charles Dickens. Lately, with a resurgence of interest in Greenwich and its history, there has been some move to revive these admirable riverside gatherings. At the opening of the present century Greenwich was mainly a shipbuilding and engineering centre giving employment to thousands. In those days the term "shipbuilding" related chiefly to sailing vessels and the century was only a few years on its way when the challenge of the steamship had a profound effect on the life of this Borough. It was usual for fishing fleets to come into Greenwich for revictualling and for their overhauls, but general 19 acceptance of the steamship led to the building of larger ships with bigger draughts. Gradually the building of such ships passed to other and more suitable areas of the country with the result that many local industries were seriously affected. Sailmakers and repairers were no longer required; men engaged in the refitting, etc., of the sailing vessels lost their employment and concerns which catered for the revictualling of such vessels saw their trade wither away. Firms such as Messrs. Humphreys & Tennent, Deptford Dry Docks, Thames Ironworks (John Penn's), Castle's Shipbreaking Co., etc., were compelled to close down owing to competition and the heavy rates and taxes imposed, whilst the world-famous firm, Yarrow's, removed to Scotland for similar reasons. Such movements of industry only tended to aggravate the unemployment problem in the area. The 1914-18 War brought a return of many industries to Greenwich although the post-war period saw the closing of the Foreign Animals' Wharf (commonly known as the Deptford Cattle Market), the area being acquired by the Government for a Supply Reserve Depot. Still later a further compensating movement began when some of the larger buildings and dwelling houses were utilised as new factories and commercial undertakings. As a result of the recent War, housing problems have been accentuated, but in certain instances some benefits have been derived from the fact that many properties which have been demolished by enemy action would, by now, have been unsightly and particularly difficult problems for the Health Department. With the advance of time many old buildings and houses were demolished and improvements effected. The breaking up of large estates, especially in the Westcombe Park area, has led, in the case of the houses concerned, to many new units of accommodation in the shape of flats and, in the case of the extensive grounds, to spacious areas for the erection of houses of the villa type. Very early in the 18th century Daniel Defoe described Greenwich as "the most delightful spot of ground in Great Britain" and in 1738, in a road book of the British Isles, this description was given: "Greenwich on the Thames, 4 miles east of London Bridge, a very delightful place." It can still lay claim to that title. The Borough is well catered for in the way of parks and open spaces, the largest being Greenwich Park with its historical associations and surroundings covering an area of 185 acres. Blackheath, one of London's most famous open spaces, forms the southern boundary, 89 acres of which are within the Borough, providing unsurpassed facilities for games, sports and amusements. Excellent recreation grounds serve the Charlton area for in addition to the Maryon and Charlton Parks, there is the L.C.C. 20 Play Centre and Lido with its well-equipped open-air swimming bath, tennis courts and bowling greens. In all, public open spaces amount to 11 per cent of the total area of the Borough, equivalent to approximately five acres per 1,000 of its population. Areas located near the River Thames are, generally speaking, industrial but more densely populated than the upper parts of the Borough. In recent years, however, the commencement of a gradual movement of people away from the river-side has been witnessed, and the Kidbrooke area, which pre-war had always been described as the "rural" part of the Borough, is almost entirely built over. Housing has always been given a high degree of priority by the Borough Council from shortly after the first World War when, under the Housing and Town Planning Act, 1919, a number of large houses in the Blackheath area were acquired and converted into flats, to the present time when the Council have control of approximately one sixth of the total dwellings in the Borough. The earliest Council-built permanent dwellings were located in the Charlton area but today their flats and houses are situated in all parts of the Borough. In fact considerable alteration has taken place during the post-war period by the erection of modern houses and blocks of flats and the Borough Council, still pressing ahead with its new housing schemes, has behind it a record of sound achievement. In addition, a number of sizeable estates have been built by the London County Council at Blackheath and Kidbrooke and in East and West Greenwich. Furthermore, a Greenwich Housing Society, established in 1958, provides assistance in the housing of elderly people not likely to receive such help from Local Authorities, and within the Borough boundary, over 200 units of accommodation are provided for elderly people by seven groups of almshouses; one group was founded as early as 1558, being the first public charity to be established after the Reformation. Providing for the needs of the Borough residents are some 900 shops, generally of the smaller kind, many being of the oldfashioned "shop on the corner" type, selling a wide range of goods. Food shops form a large percentage of the total and whilst meat and poultry come mainly from Smithfield Market 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, Greenwioh has always been 21 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, grammar and comprehensive schools. Abundant opportunities are also provided for further education whether vocational or cultural or merely for enabling persons to indulge in a particular hobby. Of the nursery schools, that of Rachel McMillan is internationally famous, for the McMillan sisters were the pioneers of nursery schools in the British Isles; and in the Roan Schools, founded in 1643 by John Roan the son of a member of the Royal household when it was at the Palace of Placentia, Greenwich has one of the oldest teaching foundations in London. Most educational services are now under the control of the L.C.C. but there are still some private schools in the area which are conducted independently of the County Council and which cater for fee-paying pupils. There are five 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. Sooial 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 22 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. 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 23 Station, 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, Flour Mills, Aero Parts, Wireless and Vehicle Parts, Tin Box Manufacturing Works, Paint Manufacturers, Newspaper Printers, Electric Welders, Furniture Makers, Joinery and Shopfitting, Works for producing extruded non-ferrous Metals and Alloys, works for the production of oxygen and rare gases, works for producing water-softening and conditioning chemicals, and inevitaby a Lighterage Company. 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. 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 24 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 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. 25 SUPERFICIAL GEOLOGY Metropolitan Borough of Greenwich THAMES DOGS WOOlWICH DEPTFORD LEWISHAM Alluvium Lower London Tertiaries Chalk London Clay Gravel & Sand 26 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. 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 1964, upon which the statistics of this Report have been based. The figure returned is 83,630, indicating a decrease in the population of 130 since last year and a fall of 1,916 since the 1961 Census. However, the current figure shows an advance of 19,830 over that for 1945. Natural Increase—The natural increase for the year, i.e. excess of births over deaths, was 555 compared with 448 for 1963. 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 27 since that year the expectation of life at birth has scarcely changed and now stands at 68 years for males and 74 for females. Age Composition of Population—It has been expedient from lime 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 factors 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 67% and that of "dependent" groups collectively, to 33%. In effect, this means that for every two persons of "working age" there is at least one dependent person outside this group. Current figures are contrasted with those returned at the 1901 Census. ESTIMATED AGE COMPOSITION OF THE POPULATION Approx. % of Total Population As estimated by the Registrar General: Mid-Year 1964 Census 1901 No. % No. % Under 1 year 1,370 1.6 2,368 2.5 1 to 4 years 4,630 5.5 8,682 9.1 5 to 15 years 10,800 12.9 20,559 21.4 Total Child Population 16,800 20.0 31,609 33.0 Estimated locally: 15 to 64 years 55,906 66.9 59,971 62.6 65 years and over 10,924 13.1 4,190 4.4 Total Population 83,630 100.0 95,770 100.0 28 * EXTRACTS FROM VITAL STATISTICS OF THE YEAR LIVE BIRTHS Legitimate Illegitimate Total Birth Rate (Crude) 17.48 (Comparable Rate 16.78) Male 671 63 734 Female 660 63 723 Total 1,331 126 1,457 STILL BIRTHS Legitimate Illegitimate Total Rate per 1,000 total Births 19.51 Male 8 2 10 Female 19 - 19 Total 27 2 29 DEATHS—All Causes Death Rate (Crude) 10.82 (Comparable Rate 11.58 Male Female Total 460 442 902 DEATH RATES—Special Causes Infants under 1 year of age No. Rate All infants (per 1,000 live births) 28 19.21 Legitimate Infants (per 1,000 legitimate live births) 26 19.53 Illegitimate Infants (per 1,000 illegitimate live births) 2 15.87 Neo-Natal Deaths (per 1,000 live births) 23 15.78 Early Neo-Natal Deaths (per 1,000 live births) 20 13.66 Peri-Natal Mortality (per 1,000 total births) 49 32.97 Others Maternal Causes (per 1,000 total births) — — Tuberculosis (all forms) (per 1,000 population) 4 0.05 Tuberculosis, Pulmonary (per 1,000 population) 3 0.03 Cancer (per 1,000 population) 229 2.74 Heart (per 1,000 population) 285 3.41 Common Infectious Diseases (per 1,000 population) — — Influenza (per 1,000 population) — — * These figures, which are supplied by the Registrar-General, may differ slightly from those shown in other parts of the Report. 29 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 1964. The total of 685 gives a marriage rate of 16.44, a decrease of 0.04 from that of the previous year. The comparable figure for England and Wales is 15.1. The following table shows these particulars giving the number of marriages in the Borough for each year since 1938:- Year Churches of England Chapels and Roman Catholic Churches SuperintendentRegistrar's Office Total Approximate Population Greenwich Charlton and Kidbrooke St. Nicholas 1938 309 185 31 101 268 894 95,770 1939 395 218 31 128 397 1,169 94,790 1940 451 243 33 126 345 1,198 74,280 1941 277 174 7† 91 241 790 57,070 1942 257 192 3 79 198 729 60,530 1943 209 166 2 73 171 621 62,870 1944 211 136 — 74 171 592 61,800 1945 228 211 2 87 233 761 63,800 1946 258 196 1 86 235 776 76,840 1947 192 160 13 93 318 776 82,230 1948 202 152 8 104 345 811 84,410 1949 184 129 10 90 272 685 87,680 1950 206‡ 121 6 74 245 652 89,570 1951 210 133 3 60 264 670 89,390 1952 191 144 4 102 279 720 90,880 1953 221 136 4 113 305 779 90,440 1954 200 155 5 86 325 771 90,600 1955 197 116 5 106 290 714 89,490 1956 194 169 6 133 221 723 88,780 1957 177 159 2 118 226 682 88,910 1958 189 142 10* 93 239 673 89,180 1959 161 134 15 107 210 627 88,970 1960 177 120 20 122 218 657 88,310 1961 183 140 14 87 261 685 85,240 1962 165 132 12 139 232 680 84,730 1963 182 135 8 135 228 688 83,760 1964 168 125 10 126 256 685 83,630 ‡ St. Peter's, Creek Road Holy Trinity. Blackheath Hill }closed † Parish Church destroyed by enemy action * Parish Church reopened. 30 METEOROLOGICAL OBSERVATIONS—1964 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, 1964:— Temperature Highest screen temperature 86° on 26th August. Lowest screen temperature 20° on 14th January and 29th December Maximum in January 53° on 31st. „ February 56° on 1st and 27th. „ November 59° on 18th. „ December 57° on 8th. Sunshine TOTAL FOR YEAR Sunniest Day 1417.4 hours. 13.8 hours on 14th May. Number of Days without sun, 104, distributed as follows:— January 23 July 0 February 14 August 3 March 13 September 0 April 6 October 6 May 1 November 14 June 4 December 20 Rainfall TOTAL Highest Fall in 24 hours Driest Month Wettest Month 21.02 inches. 1.07 inches on 18th June. September 0.49 inches. June 3.96 inches. 31 BIRTH AND DEATH RATES 1901-1964 BIRTHS DEATHS 32 BIRTHS The total number of live births registered in the Borough during the year was 1,909 and of this number 1,528 occurred in St. Alfege's Hospital, and 381 in private dwellings. In 1,040 cases the parents resided outside the Borough and these births were consequently transferred to their appropriate districts, leaving a figure of 869. To this must be added 588 births belonging to the Borough which took place in Institutions outside the Borough, thus making a final figure for Greenwich of 1,457, an increase of 65 over that of the previous year. Of this total 734 were males and 723 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: — 331 221 56 261 869 Inward Transfers: — 1st Qtr. 29 11 6 79 125 2nd Qtr. 33 10 1 81 125 3rd Otr. 34 20 2 91 147 4th Qtr. 43 19 3 126 191 Totals 470 281 68 638 1,457 The Birth Rate for the year, calculated on the figure of 1,457 births, is 17.48 per thousand of the population, 0.81 higher than that for 1963. The average rate for the previous ten years is 15.08. The Greenwich Comparability Factor for births is 0.96 which gives an adjusted rate of 16.78. The Rates for the County of London and England and Wales are 20.0 and 18.4 respectively. ILLEGITIMATE BIRTHS These numbered 126 (representing 8.6 per cent of the total live births), an increase of 5 over the figure returned for 1963. This total gives an illegitimacy rate of 86 per 1,000 live births compared with a figure of 72 for England and Wales. STILL BIRTHS The number registered was 29 (10 males - 19 females), which is equivalent to a rate of 19.51 per 1,000 total births, an increase of 7.45 over that of the previous year. London returned a rate of 14.9 and that for England and Wales was 16.4. 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 460 12 5 - 3 6 7 16 42 101 142 126 F 442 11 - 1 1 2 2 10 22 53 103 237 1 Tuberculosis, Respiratory M 1 - - - - - - - - - 1 - F 2 1 1 2 Tuberculosis, Other M 1 - - - - - - - - 1 - - F - - - - - - - - - - - - 3 Syphilitic Disease M 2 - - - - - - - - - - 2 F 1 - - - - - - - - - - 1 4 Diphtheria M - - - - - - - - - - - - F - - - - - - - - - - - - 5 Whooping Cough M - - - - - - - - - - - - F - - - - - - - - - - - - 6 Meningococcal Infections M 1 - - - - - - - - 1 - - F - - - - - - - - - - - - 7 Acute Poliomyelitis M - - - - - - - - - - - - F - - - - - - - - - - - - 8 Measles M - - - - - - - - - - - - F - - - - - - - - - - - - 9 Other Infective and Parasitic Diseases M 2 1 - - - 1 - - - _ _ - F 1 - - - - - - - 1 _ _ _ 10 Malignant Neoplasm, Stomach M 17 - - - - - - - 2 4 10 1 F 12 - - - - - - - - 1 6 5 11 Malignant Neoplasm, Lung, Bronchus M 49 - - - - - - 1 6 16 19 7 F 12 - - - - - 1 - 1 4 3 3 12 Malignant Neoplasm, Breast M 2 - - - - - - - - 1 1 _ F 22 - - - - - - 2 6 3 6 5 13 Malignant Neoplasm, Uterus F 12 - - - - - - 3 1 1 3 4 14 Other Malignant and Lymphatic Neoplasms M 51 - - - - 1 1 2 8 14 13 12 F 52 - - - . - - 1 2 4 10 9 26 15 Leukaemia, Aleukaemia M 4 - - - - - 1 _ - - 2 1 F 1 - - - - - - - - - - 1 16 Diabetes M 2 - - - - - - - - 1 - 1 F 4 - - - - - - - - - 1 3 17 Vascular Lesions of Nervous System M 39 - - - - - - 1 3 2 16 17 F 49 - - - 1 - - - 1 5 17 25 18 Coronary Disease, Angina M 116 - - - - - 1 4 14 34 35 28 F 92 - - - - - - 1 3 15 18 55 19 Hypertension with Heart Disease M 6 - - - - - - - - 2 2 2 F 5 - - - _ _ - _ — - 3 2 20 Other Heart Diseases M 25 - - - _ _ 1 2 3 2 9 8 F 41 - - - - - - - 1 2 9 29 21 Other Circulatory Disease M 14 - - - - - 1 1 - 4 3 5 F 20 - - - - - - - 1 3 10 6 22 Influenza M - - - - - - - - - - - - F - - - - - - - - - - - 23 Pneumonia M 22 1 5 _ _ _ _ _ 1 1 3 11 F 28 1 - - - - - 1 - 1 4 21 24 Bronchitis M 37 _ _ _ 1 _ _ _ 1 10 15 10 F 18 - - - - - - - - 1 _ 17 25 Other Diseases of Respiratory System M 9 - - - - - - - 1 _ 3 5 F 3 - - - - - - - - - - 3 26 Ulcer of Stomach and Duodenum M 2 - - - - - - - - - - 2 F 2 - - - - - - - - - 1 1 27 Gastritis, Enteritis and Diarrhoea M 2 — _ - _ _ _ 1 - _ 1 - F 2 - - - - - - - - - 1 1 28 Nephritis and Nephrosis M 4 - - - - - - - - 3 1 _ F 4 _ - — _ 1 _ _ _ _ 1 2 29 Hyperplasia of Prostate M 4 - - - - - - - - 1 - 3 30 Pregnancy, Childbirth, abortion F - - - - - - - - - - - - 31 Congenital Malformations M 3 2 _ — _ _ _ 1 _ _ _ _ F 3 2 _ 1 - - - - - - - - 32 Other defined and ill-defined Diseases M 25 8 _ _ 1 _ _ 1 1 1 3 10 F 43 8 _ _ - _ _ 1 2 4 8 20 33 Motor Vehicle rtccidents M 9 _ _ _ 1 3 1 _ 1 1 1 1 F 5 _ _ 1 _ - - 1 - 3 34 All other Accidents M 4 - - - - - 1 1 _ 1 1 - F 3 - - - - - - - - 1 1 1 35 Suicide M 6 - - - - - - 1 1 1 3 - F 5 - - - - - - - 1 1 1 2 36 Homicide and Operations of War M 1 - - - - 1 - - - - - - F - - - - - - - - - - - - 33 DEATHS The net number of deaths registered during 1964 was 902, of which 460 were males and 442 females, compared with last year's total of 944 comprising 481 males and 463 females. This gives a crude Death Rate for the Borough of 10.82 per thousand of the population, representing a decrease of 0.48 compared with that of the previous year and a rate which is 0.62 greater than the average for the last ten years, viz., 10.20. The Crude Death Rate figure is increased to 11.58 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 11.0 and 11.3 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. 34 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 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 1963 944 599 63.5 10-year average 891 578 64.6 1964 902 629 69.7 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 7 7 4 10 28 Between 1 and 2 years 1 — — — 1 Between 2 and 5 years — — — — — Between 5 and 15 years — — 4 — 4 Between 15 and 25 years 2 2 2 2 8 Between 25 and 35 years — 4 2 3 9 Between 35 and 45 years 6 5 6 9 26 Between 45 and 55 years 11 19 16 18 64 Between 55 and 65 years 36 32 47 39 154 Between 65 and 75 years 73 48 59 65 245 75 years and upwards 110 90 65 98 363 Totals 246 207 205 244 902 35 In contrast with the position in recent years, there was little variation in the deaths registered during the first and fourth quarters which were 27.2% and 27.0% of the year's total, respectively, and the second and third quarters recorded a similar situation, namely, 22.9% and 22.7%. It will be observed from the following table that during 1964 the deaths occurring at 65 years and upwards accounted for 67.4% of the total compared with a figure of 22.8% for 1901. Deaths in the age group 0-5 years show an even more striking comparison; in 1901 the deaths in this group amounted to 37.4% whilst the figure for the current year is 3.1%. Deaths in the age group 0-5 years show an even more striking comparison; in 1901 the deaths in this group amounted to 37.4% whilst the figure for the current year is 3.1%. Age Group 1901 1911 1921 1931 1951 1961 1964 Under 1 year of age 362 306 175 97 29 30 28 Between 1 and 5 years 187 158 80 39 7 2 1 Between 5 and 15 years 64 67 58 22 10 4 4 Between 15 and 25 years 66 60 67 65 12 8 8 Between 25 and 65 years 454 474 466 382 311 252 253 65 years and over 335 356 387 529 633 631 608 Totals 1,468 1,421 1,243 1,134 1,002 927 902 MATERNAL MORTALITY There were no maternal deaths recorded during the current year, a situation similar to that obtaining during the previous two years. 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. At a time when one is apt to be carried away by the intensity of "anti-drug" campaigns, it is a very sobering thought that, despite the introduction by local authorities of ante natal clinics and other health services in the early part of the century, the maternal death rate in England and Wales remained at or about the consistentlyhigh figure of 4.6 per 1,000 births from 1894 until the middle of the 1930's when the introduction of sulpha drugs and, a little later on, the antibiotics, reduced it to the much more favourable figure it is today. 36 INFANTILE MORTALITY Infant Mortality of any given locality is measured by relating the number of deaths of children under one year of age recorded during the year 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 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. It is generally agreed that there is a direct relationship between foetal loss and the amount of ante natal care received. Some 60 years or so ago in the early 1900's there were no cyetic examinations at all and even when examinations were introduced at about 1909 they were carried out for ascertainment of presentation and detection of albumin only. Undoubtedly the introduction of regular ante natal examination and subsequent treatment will rank as one of the greater achievements of preventive medicine of this century. Nevertheless, despite the introduction of these services and the great advances in chemotherapeutics and diagnostic techniques and notwithstanding the amount of research directed towards elucidating the causes of infant mortality, there still remains the refactory core of perinatal deaths for, in this brief period of life, there are as many deaths as will occur during the next 40 years among the survivors. This is not to say, however, that substantial improvements have not been achieved. On the contrary; in 1901 the infant mortality rate in Greenwich was 130 per 1,000 live births, the actual number of children dying before reaching the age of 1 year being 362. Comparable figures for the current year are 19.21 and 28. But although there has been a real reduction in the total number of infant deaths the neo-natal deaths in recent years have not decreased pro-rata. For example, in 1946 the neo-natal deaths, i.e. those infants dying within four weeks of birth, represented 59.3 per cent of all infant deaths under 1 year, whereas in 1964 the figure INFANTILE MORTALITY 1901-1964 37 38 was 82.1 per cent. Early neo-natal deaths, similarly calculated, are 55.9 and 71.4 per cent respectively. In my Report for last year, I gave a full resume of the various agencies which were influencing perinatal mortality as disclosed by the survey of perinatal mortality instituted by the National Baby Trust Fund. In general, these covered the relationship of age, social class, parity, bad obstetric histories, previous abortions, number of premature and still births, postmaturity, etc., and the varying effects that the institutional and domiciliary maternity and midwifery services had on the perinatal deaths. It is becoming clear that methods which brought about the spectacular successes of recent years in reducing the sum total of all infant deaths under 1 year will not prove so effective in achieving a lowering of the neo-natal and perinatal deaths. Indeed, investigations reveal that hazards to infant life no longer arise as a result of malnutrition or infectious diseases but mainly from prematurity, congenital malformations and inherited metabolic disease. In previous reports I indicated that human variation is due to genetic or environmental difference or a combination of both and, of necessity, the main emphasis of control has been on the "nurture" aspect. As a direct result of the concentration by Medical Officers of Health and their staffs on the environmental and personal health services there has been a perceptible increase in the average life span. In this respect it would appear that such avenues have been almost fully explored and the time has now come for greater efforts to be made in the sphere of "nature". This approach, viz. the field of genetics, is likely to prove most rewarding. It has been claimed, with some justification, that dominant mutant genes, inter alia, lead to disabilities such as achondroplasia, familial polyposis, Huntington's chorea, and recessive mutant genes to fibrocystic disease of the pancreas, phenylketonuria and galactosaemia while haemophilia, diabetes insipidus and a type of muscular dystrophy are attributed to sex-linked recessive mutant genes. Moreover, recent research has pointed to a genetic predisposition in certain common illnesses such as diabetes mellitus, gastric and duodenal ulcers, rheumatic fever, mental retardation and some forms of insanity and epilepsy. Genetics, in relation to common disorders, are extremely complex and difficult to unravel but there is no doubt that a number of diseases and malformations are genetically determined. We have already become familiar with the detection and treatment of haemolytic disease of the newborn, an inherited complication involving the Rh factor in the blood. Conditions resulting from chromosomal abnormalities such as mongolism and the syndromes 39 of Klinefelter and Turner have long been recognised, but only since 1956 has it been possible to verify their aetiologies for it was then that methods evolved by cytologists enabled chromosomes to be accurately counted and examined. By this one advance alone, the cause of an appreciable proportion of mental defect and male sterility has been explained and it is now possible to distinguish from among others, those families with a high risk of mongolism and advice can be given accordingly. Clarification of intra embryonic mortality and congenital deformity may well be the result of further progress in chromosome studies. It seems paradoxial, but the solving of these perinatal problems will pose more difficult questions. Now that environmental causes of illness and infection are, on the whole, being eliminated, successful treatment of disabilities which are genetically determined or partly genetically determined will, unless countered, result in them becoming more numerous, for a greater number of children will survive to pass on the adverse genetic predispositions. Furthermore, with the change from natural to planned parenthood, artificial selection is replacing natural selection, a situation which engenders new moral issues and launches us into eugenics. Fortunately, perhaps, it is the role of the preventive health services to concentrate on the more immediate practical problems of resisting the effects of inherited biochemical disorders and to institute treatment before irreversible changes occur, and also to anticipate and counter the genetically conveyed susceptibility to drugs. Infant mortality is a very pressing and human problem and early and adequate ante natal attention can go a very long way in reducing deaths in this category. Nevertheless, it must be recognised that further substantial reduction in the infant death rate will be attained only by the practical application of modern scientific knowledge and society must face the complicated medical, social, educational and religious problems inherent in such a policy. The present infant mortality rate for the Borough, viz. 19.21, represents an increase of 4.84 over that for the previous year (which itself was the lowest ever recorded for Greenwich) but is still 1.07 lower than the average for the last 10 years and compares favourably with the rates for London and England and Wales which were 21.2 and 20.0 respectively. The following table shows the comparative Infantile Mortality Rates for the year 1901 and the quinquennial periods since 1931, together with the Rate for 1964:— 40 District Year 1901 Average for Quinquennial Periods Year 1964 1931 to 1935 1936 to 1940 1941 to 1945 1946 to 1950 1951 to 1955 1956 to 1960 Greenwich 130 75 50 40 27 18.4 18.89 19.21 London 148 63 56 60 33 23.8 21.9 21.2 England and Wales 146 62 55 50 36 26.9 22.7 20.0 The actual number of infantile deaths recorded during the year was 28 (8 more than last year) and these were attributed to the following causes:— Prematurity 10 Congenital Heart Disease 1 Bronchopneumonia 6 Congenital Malformation 1 Cerebral Haemorrhage 3 Hyaline Membrane 1 Respiratory Distress 2 Afibrinogenaemia 1 Foetal Asphyxia 1 Haemolytic Disease of Newborn 1 Acute Viral Pneumonitis 1 Of the above, 17 were male and 11 female; 6 died in St. Alfege's Hospital, 2 in the Miller Hospital, 2 in the Brook Hospital, 2 at home and 16 in hospitals and institutions outside the Borough. A table showing the causes of and ages at death is included in the Appendix to the Report. Neo-Natal Mortality —Neo-natal mortality, i.e., infants dying before attaining the age of one month, accounted for 23 deaths equivalent to 82.1 per cent of all infant deaths and giving a Neonatal Mortality Rate of 15.78 per 1,000 live births. This rate is an increase of 8.60 over that of the previous year and is 1.98 higher than the figure of 13.8 returned for England and Wales. Early Neo-Natal Mortality.—Twenty neo-natal deaths which occurred within the first week of birth gave an early neo-natal mortality rate of 13.66 per 1,000 live births (which is more than twice the rate for 1963), the causes being:— Prematurity 9 Congenital Heart Disease 1 Cerebral Haemorrhage 3 Congenital Malformation 1 Respiratory Distress 2 Hyaline Membrane 1 Foetal Asphyxia 1 Haemolytic Disease of Bronchopneumonia 1 Newborn 1 41 Perinatal Mortality.—The Perinatal Mortality Rate, calculated from a total of 49 still births and deaths of infants under 1 week, was 32.97 per 1,000 total births compared with 18.45 for the previous year. The equivalent rate for England and Wales is 28.2. Reproductive Wastage.—-A sum total of 57 Stillbirths and Infantile deaths gives a reproductive wastage rate of 38.35 per 1,000 total births, an increase of 12.09 over the 1963 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 and Diarrhoea, no deaths were registered for the current year, a similar return to that for the previous year. There was 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 being the 62nd since a death from this disease occurred. In 1901, the first full year of the newly created Boroughs, Greenwich had 11 cases of smallpox with 3 associated deaths and in the following year there were 100 notifications and 22 deaths. 42 Measles.—During 1964 no deaths from measles were recorded compared with none for the previous 3 years and one for 1960. There were no deaths from this complaint during the years 1959 and 1958. It is difficult to believe that during the year 1901, 52 deaths from measles were registered. Scarlet Fever.—For the 18th 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.—Similar to last year, 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. Whooping Cough claimed 36 deaths during 1901, the first year of Greenwich as a Metropolitan Borough. 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 previous 5 years, there was one death registered for 1958, one for 1957 and a nil return for each of the years 1956 and 1955. This disease used to be one of the deadliest of infantile complaints and in 1901 it was responsible for 89 deaths. Diphtheria.—Again it is gratifying to report that there were no deaths from Diphtheria during the year under review and that it is now 18 years since one was recorded. In 1901, deaths from this cause totalled 21. Tuberculosis.—There were only 4 deaths from this disease during the year, giving a death rate of 0.05 compared with 10 deaths and a rate of 0.11 for 1963. The rate for the present year compares favourably with the average of the past 10 years, viz 0.10, indicating the effectiveness of modern therapeutic methods, despite recent anxiety concerning the production of a resistant form of tubercle bacillus. Although in Greenwich the numbers are small and therefore liable to wide fluctuation generally they do reflect the national trend. In 1964 the rate for England and Wales in respect of all forms of tuberculosis was 0.05 compared with a figure of 0.06 for London. 43 Greenwich deaths from tuberculosis for the previous ten years are given, with their appropriate rates, in the following table: Year No. of Deaths Rate 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 1963 10 0.11 10-year average 9 0.10 1964 4 0.05 Tuberculosis of the Respiratory System was responsible for 3 of the deaths in this category, only one death being attributed to the remaining forms of tuberculosis. At 0.05, the Pulmonary Tuberculosis rate was 0.06 lower than that returned for last year. During the first full year as a Metropolitan Borough, Greenwich recorded 175 deaths from tuberculosis, of which 115 were of the pulmonary type. Cancer.—In Greenwich, cancer was responsible for a total of 229 deaths giving a rate of 2.74 per thousand population compared with figures of 187 and 2.24 respectively for the previous year. It accounted for approximately 25% of all registered deaths, a percentage six times that returned for 1901, viz. 4.2%, and indicates that approximately one in every four deaths resulted from cancer of one form or another. The present total of 229 is some 23% higher than the average for the past ten years, viz. 186. Comparing the current year's figures with those of the previous 5 years, the sites of the affected parts were:— 1959 1960 1961 1962 1963 1964 Cancer of Stomach 26 26 26 30 36 29 „ „ Lung, Bronchus 50 63 48 60 56 61 „ „ Breast 14 15 17 22 16 24 „ „ Uterus 2 11 7 5 5 12 „ „ all Other Sites 80 94 105 89 74 103 Totals 172 209 203 206 187 229 44 With improved diagnosis and more accurate certification and as the proportion of elderly persons in the population grows, so one expects the cancer rate to rise, but the increase since 1950, viz. from a rate of 1.87 to 2.74, seems startling. Since that year, of the sites mentioned above, only cancer of the stomach has remained more or less static. That of the lung registers a 135% increase, that of the breast 100%, that of the uterus 70% while cancer of all other sites shows a 12% advance. 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 a very ancient disease for evidence of it has been found not only in the bones of cave men, but further back still in antiquity, in the bones of the dinosaurs. Despite the fact that cancer has been known for an inordinate length of time, it was not until 1775 that Percival Pott established that skin cancer was often a corollary of chimney sweeping and, today, it is universally recognised that exposure to chemicals is an occupational hazard which can lead to malignant disease. Modern research suggests that in some cases there may be a relationship between inherited chromosomal abnormality and myeloid leukaemia, and in others that climatic conditions may be indirectly responsible for the appearance of some strains of antigenically similar viruses which have been recovered from the bone marrow of patients suffering from various leukaemias, the connection between which, so far, has only been postulated. There is also abundant evidence that cancer of the womb is linked with poor hygiene and clearly this must constitute a challenge to health staffs generally and to health visitors in particular, both of whom are pledged to regard health education as top priority. In this connection, it would not come amiss to mention the Family Planning Association and its invaluable work in the use, among a number of its patients, of diagnostic cytology. Many causes of cancer are still not known with any certainty, although in the last decade there have been remarkable advances in the recognition and understanding of the disease. It is generally considered to be a disease of middle and old age, although in more recent times cases have begun to appear in younger age groups and, moreover, it is a disease which is rapidly becoming a serious impediment to a healthy nation. It is undeniable that fear is a very potent influence in discouraging people from seeking medical advice but if there is 45 one thing which has been proved to the expert's satisfaction it is that, given certain conditions, cancer is a curable disease. Another important circumstance which militates against early diagnosis is the absence of pain or serious symptom until the disease has reached a stage at which the benefit of treatment becomes problematical. The World Health Organisation has estimated that three-quarters of all cancer deaths could be prevented if diagnosed early enough. Time is the most important factor and public education in this field would appear to be well within the province of local authorities. Lung Cancer.—Throughout the country in recent years there has been a tendency for cancer of the lung to increase and the following table has again been included in order that the trend in this Borough may be studied:— DEATHS FROM CANCER OF LUNG (including Bronchogenic Carcinoma) Year AGE GROUPS Totals Grand Total Rate per 1,000 Pop. 25 and under 45 yrs. 45 and under 65 yrs. 65 and under 75 yrs. 75 and upwards M F M F M F M F M F 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 1963 3 — 26 5 15 1 4 2 48 8 56 0.67 10 yr. Average 1.4 0.7 23.8 3.1 12.4 1.7 5.8 1.8 43.4 7.3 50.7 0.57 1964 1 1 22 5 19 3 7 3 49 12 61 0.73 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 46 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 ths national figures. Since 1950 the numbers dying from cancer of the lung in England and Wales has doubled to the current figure of 25,371 giving a rate of 0.54 per thousand of the population and indicating an increase of four per cent over the figure for 1963. In Greenwich, for the same period, the numbers have advanced from 26 to 61, equivalent to a rise of approximately 135 per cent in 15 years. The present Borough rate of 0.73 is still slightly less than that for London, viz. 0.74, but 0.16 higher than the average for the last ten years. Statistics contained in the Registrar General's latest Review show that, in England and Wales, the increase in deaths from lung cancer among men under 45 years was greater in rural areas than in the towns. Among women in the same age group the rise was really significant, the percentage increases being 65 for rural areas and 16 for cities. Following upon evidence of a rise in tobacco consumption, especially by women, and the marked advance of deaths from cancer of the lung in rural areas and in females in particular, it is difficult to resist the conclusion that cigarette smoking rather than atmospheric pollution is the causative agent. Whereas in recent years the death rate of tuberculosis has shown a remarkably rapid decline, that for cancer of the lung has risen, one might say almost correspondingly, and the epidemic proportions of this disease become more apparent each year. The observation that cancer is "man made" may not be completely true but, since the adoption by man of tobacco as his main tranquillizer, he has certainly embraced a very ambiguous friend for there is no reasonable doubt that, but for the smoking habit, the number of deaths from lung cancer would be almost insignificant. Nevertheless, despite the strength of all the accumulated evidence incriminating cigarette smoke as a cause of lung cancer, the consumption of tobacco in this form continues unabated. Facts concerning 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. Tirades about atmospheric pollution from factories and diesel fumes is so often the method used by addicts to counter antismoking propaganda that it comes somewhat as a relief to learn 47 that Swedish research scientists have recently confirmed what has long been held by informed opinion that cigarette smoking, which is acid by nature, can free cancer-producing substances from polluted air. The Swedish Board of Health is shortly to publish their Report on smoking and lung cancer which will serve to emphasise the irrefutable validity of warnings given in this country about the dangers of smoking. Attempts to convert the older and heavier smoker have proved disconcertingly disappointing for, even when they are intellectually convinced of the dangers of smoking, they are still reluctant to take any remedial action. One is drawn, reluctantly, to the conclusion that the time and effort involved would be better spent on discouraging the younger generation from commencing this pernicious habit. However, medical problems are seldom precise and it is clear that propaganda of the "cause and effect" kind has little impact on the immature mind and repetition of available data merely promotes monotony. 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. Girls seem to consider it "alluringly" wicked. 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. At the time of going to press it seems that, for the first time ever, direct action by the Government is likely for it is reliably reported that, in the near future, it will press for the banning of all smoking advertisements on television. Notwithstanding the fact that, as a health measure, enforced prohibition would be eminently desirable, this action is impractical and psychologically unsound. Furthermore, other psychological studies have shown that cancer education with a strong fear content has no lasting effect in inducing permanent changes in attitude. Moreover, many youngsters smoke not only with the parents' consent but with their active co-operation and it is the home influence, i.e. parents' habits and opinions, which is of paramount importance. Health educators are generally agreed that their main anti-smoking measures should rightly be directed to the primary school children where the greatest influence can be exerted at a 48 time when children are still experimenting and before they become committed. Despite protestations to the contrary, young people seldom act as individuals. They imitate and hasten to "conform"—not to the old patterns of behaviour but to the modern "group" idiom and they tend to adopt the attitudes of their own particular group. Perhaps what is needed is not so much an "anti" but a more "pro" approach on a group basis. Cannot the smoking habit be debased by emphasising its effect on taste and smell, by pointing out that tainted breath is not conducive to sex appeal, by highlighting the reduction of physical prowess resulting from shortness of breath and by indicating the social disadvantages of a constant smoker's cough and nicotine stained fingers? Once smoking is made socially unacceptable the battle will be almost won. Vascular Lesions of Nervous System.—This class, which includes deaths arising from Cerebral Haemorrhage, Embolism and Thrombosis was responsible for a total of 88 deaths (39 Males, 49 females). The age distribution was as follows:—1 between 5 and 15 years; 1 between 35 and 45 years; 11 between 45 and 65 years; 33 between 65 and 75 years and 42 from 75 years upwards. This year's total of 88 indicates a rise of 8 over that of 1963 and an increase in the rate from 0.96 to 1.05. 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 285 (147 males—138 females) compared with a figure of 305 for 1963, and as usual, the deaths from this category occupied the principal place in the classification of diseases in that they formed 31.5% of the total deaths from all causes. Besides being responsible for a prodigious loss of man-working capacity in the United Kingdom amounting, it is estimated, to some 12 million week days per year, cardiovascular and atherosclerotic diseases as a group are responsible for more deaths than any other single cause and, as such, constitute the greatest possible challenge to preventive medicine. The urgency of this problem becomes intensified when it is realised that deaths from arteriosclerotic and degenerative heart disease are mounting year by year particularly in the case of middle-aged males. In males between 25 and 45 years the rate of heart attack has doubled during the past ten years. Each week, 2,000 people in Britain die from coronary disease and of the yearly total of 100,000 fatalities, one third will be women of mature years. During a woman's child-bearing epoch her sex hormones appear to give her a "built-in" protection as a result of 49 which, coronary disease in women before the age of 45 years is uncommon. The menopause brings a change in the hormone pattern and her immunity wanes until, in old age, she is as prone to coronary troubles as the male. Epidemiologically it has been noted not only here but in Japan and the United States that the average death rate for middle-aged men is substantially higher in areas where the drinking water is soft than in others where it is hard. 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 the persistently rising death rate of this group and the consequent loss to the nation of such potential is cause for great concern. My previous reports have given information relating to 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 with a consequent rise in weight—coronary disease and its hypothetical connection with "stress and strain" and diabetes and genetic factors. If all or most of these circumstances are present then a patient possesses the right credentials for entry to the "coronary club". 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, coronary 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. To emphasise this point, it is a fact that rats on a starvation diet live twice as long as those which are well fed. 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 50 disease is found more often in patients where the level of the blood cholesterol is relatively raised. 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. However, until our knowledge of cause and effect is complete, it would be unwise to delay the introduction of preventive measures such as weight reduction, restriction of the intake of animal fat, control of smoking, introduction of regular exercise and, most important, the dissemination of reliable information by health education officers. Diseases of the Respiratory System.—Altogether there were 117 deaths from these diseases during the year, pneumonia (all forms) accounting for 50 and bronchitis for 55. While the total shows a decrease of 25 from that of the previous year, deaths from pneumonia fell by 14 and bronchitis by 17. Of the total deaths recorded, 7 were children under one year of age and 92 were in respect of persons 65 years and over. Greenwich rates for pneumonia and bronchitis were 0.60 and 0.66 respectively, which compare favourably with those returned for London, namely, 0.71 and 0.67. The corresponding rates for England and Wales were 0.63 and 0.60. Chronic bronchitis, known abroad as the "English" disease, was responsible for a loss of over 30 million working days during the year compared with only one million from industrial disputes. Largely a preventable disease it has been the cause of 30,000 or more deaths annually for over a quarter of a century. The B.M.A. considers that there are 3 main causes, atmospheric pollution, pollution at work and cigarette smoking and they state that smokers develop the disease some 20 years earlier than nonsmokers. Statistics concerning the incapacity resulting from bronchitis are very sketchy but there is evidence to suggest that, locally, it is 51 of some moment. Doubts could be resolved and much useful information could be accumulated by the introduction of some form of registration of disability arising from this crippling complaint thus enabling a more accurate assessment to be made of the needs of such people. Influenza.—There were no deaths attributed to this cause during the year compared with 4 for 1963 and 2 for 1962. Deaths from Violence.—These numbered 33 including 14 from Motor Vehicle Accidents, 11 from Suicide, one resulting from homicide, and the remainder being accounted for under the heading of "All Other Accidents." Deaths from Motor Vehicle Accidents registered a fall of one from that of the previous year while the figure for Suicide decreased by 3. Accidents in the home, deaths from which are running at a rate of about 7,000 or more per annum, are generally forseable 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. Road accidents, which are now the commonest cause of death in adolescents and young adults, were responsible for 7,066 deaths and 87,323 serious injuries in England and Wales during the year and the totals are mounting. Comparable figures for London are 402 and 5,210, respectively. Justifiably, much has been made of the serious nature of the increase in deaths from cancer and heart disease but it must be recognised that, from a national and economic standpoint, a child who is killed in a road accident is a greater potential loss to the community than a person over 65 years who dies from either of the other causes. 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 continues to claim a 52 formidable number of victims. In England and Wales, the number of suicides during 1964 reached the staggering total of 5,566 giving a rate of 0.12 per 1,000 population. Moreover, of this total, one tenth, viz. 554, were recorded in London giving a rate of 0.17 compared with 11 deaths and a rate of 0.13 for Greenwich. Figures for London in particular throw into relief a psychiatric problem which is becoming very familiar in the cities of countries which sustain high living standards, for they were nearly three times those arising from tuberculosis and substantially more than the total deaths from road accidents. Until recently, suicide remained a felony and attempted suicide an indictable offence and a misdemeanour. It is interesting to recall that until 1824, the original penalty for suicide was to be buried at the crossroads with a stake through the heart. From then onwards until the 1880's the penalty was ameliorated to one of being buried in unconsecrated ground between 9 p.m. and midnight, without ceremony. Confiscation of goods by the Crown which constituted a further penalty was discontinued in 1870. Society, presumably, has become mature enough to respond constructively to suicide by providing the maximum of medical care that these sick people require, for, with the introduction of the Suicide Act, 1961, the law has been brought into line with modern thought and attempted suicide is now considered to be a medical and social problem and not one constituting an indictable offence. 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. With a view to determining the number of "useful years lost" for each of the major causes of death, investigations carried out several years ago revealed that "automobile and other accidents" headed the list as the primary cause of premature death with cancer and heart disease in 3rd and 5th places respectively and that suicide had moved from 13th to 7th position. In the light of recent statistics, there is reason to believe that the leading positions have been further consolidated. 53 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 1964, which will be found on the following pages in table form. NATIONAL WELFARE FOOD ITEMS Distribution Centres M. A C.W. Centres Burney Street, S.E.10 Monday Thursday 9.30 a.m.—12 noon 2 p.m.—4 p.m. 1.30 p.m.—4 p.m. Charlton Lane, S.E.7 Tuesday Thursday 9.30 a.m.—12 noon 1.30 p.m.—4 p.m. Chevening Road, S.E.10 Tuesday Wednesday Friday 1.30 p.m.—4 p.m. 9.30 a.m.—12 noon 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 Thursday 9.30 a.m.—12 noon 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 Wednesday Thursday Friday 1.30 p.m.—4 p.m. 9.30 a.m.—12 noon 1.30 p.m.—4 p.m. Tranquil Vale, S.E.3 Wednesday 9.30 a.m.—12 noon 54 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 350 984 1,644 35 3 8 6 10 - 8 2 9 5,259 902 June 430 224 855 15 3 6 2 - — 2 - 1 2 8 4,861 886 Sept. 402 130 494 18 1 11 — - — 12 — 11 — 7 4,942 1,012 Dec. 408 66 200 35 — 21 — - — 53 — 51 1 12 5,570 1,076 Totals 1,590 1,404 3,193 103 7 46 8 - — 77 - 71 5 36 20,632 3,876 2. Infant Welfare Clinics Quarter Sessions Attendances Children 0—5 years First Total March 194 2,147 7,438 June 181 873 8,095 September 179 562 8,158 December 196 593 7,666 Totals 750 4,175 31,357 55 3. Ante and Post Natal Clinics Quarter Sessions 1st Attendances Total Attendances Ante Natal Post Natal March 44 122 12 317 June 48 101 17 416 Sept. 57 98 18 402 Dec. 60 122 10 517 Totals 209 443 57 1,652 4. Toddlers Clinics Quarter Sessions Total Attendances Medically Examined March 44 209 209 June 53 366 366 September 58 254 254 December 57 278 278 Totals 212 1.107 1,107 5. Relaxation and Educational Sessions Quarter Relaxation and Mothercraft Sessions Total Attendances March 39 517 June 36 561 September 46 656 December 37 407 Totals 158 2,141 56 6. Artificial Sunlight, Massage etc. Quarter Sessions Attendances First Total March 38 31 457 June 39 26 557 September 47 13 343 December 50 27 503 Totals 174 97 1,860 7. Chiropody Treatment No. of Clinic Sessions 1,139 No. of First Attendances 382 Total Attendances 12,704 8. Prophylaxis (a) Immunisation and Vaccination (Children under 5 years) Diphtheria immunisation (completed cases & boosters) 17 Whooping Cough immunisation (completed cases) 7 Combined Antigen (Diphtheria and Whooping Cough) 20 Combined Antigen (Diphtheria and Tetanus) (including boosters) 161 Triple Antigen (Diphtheria, Whooping Cough and Tetanus) 1,441 Triple Antigen (boosters) 928 Tetanus immunisation 3 Measles 149 Primaty Vaccination (Smallpox) 720 (b) B.C.G. Vaccination (Children 13 years old at Greenwich Schools) No. of Children 13 years old 1,349 No. of whom parental consent was obtained 977 No. of negative reactors vaccinated 803 No. of positive reactors X-rayed 35 (c) Poliomyelitis Inoculation (Children born 1945-1964 resident or attending Greenwich schools) (i) Two injections given during year 24 (ii) Third injection given during year 30 (iii) Fourth injection (Children 5-12 years) or doses of Sabin following 3 injections of Salk during the year 1,031 (iv) Completed courses of Sabin 1,757 (Others—namely adults 16-40 years living or working in Greenwich and Exp. Mothers) (i) Two injections given during year 11 (ii) Third injection given during year 35 (iii) Completed courses of Sabin 139 57 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., '64 2 12 615 11 640 103 41 31st Dec., '64 3 9 706 18 736 116 54 Cases attended during 1964:— 61 16 916 61 1,054 — (b) Supervision Effective Ineffective Total Visits made by Organising Staff: 2,051 331 2,382 10. District Nursing The staff of the Queens District Nursing Association for Charlton and Blackheath made 41,374 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 476 236 33,906 No. of New Cases 234 26 9,285 No. of Glasses prescribed 107 — Note- As appropriate, children from Greenwich also attend special clinics in Deptford and Woolwich. 58 TREATMENT CENTRES AND CLINICS (as at 31st December, 1964) Particulars relating to the local Health Services throughout the Borough are given below: — INFANT WELFARE CLINICS Burney Street, S.E.10 Charlton Lane, S.E.7 Chevening Road, S.E.10 Creek Road, S.E.8 Fairfield House, S.E.7 Ridgebrook Road, S.E.3 Shooter's Hill Road, S.E.3 Tranquil Vale, S.E.3 ANTE & POST NATAL CLINICS Burney Street, S.E.10 •Charlton Lane, S.E.7 Chevening Road, S.E.10 Creek Road, S.E.8 Fairfield House, S.E.7 Shooter's Hill Road, S.E.3 Tranquil Vale, S.E.3 * Fortnightly ARTIFICIAL SUNLIGHT TREATMENT Chevening Road, S.E.10 Fairfield House, S.E.7 Shooter's Hill Road, S.E.3 FOOT CLINICS Chevening Road, S.E.10 Shooter's Hill Road, S.E.3 Fairfield House, S.E.7 IMMUNISATION AND VACCINATION CLINICS 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 . . i... Friday 1.30 MINOR AILMENTS CENTRES (for School Children) Brooklands Park School, S.E.3 Kidbrooke Park Schcol, 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). 59 CHEST CLINICS (by appointment only) DAY A.M. P.M. Maze Hill, S.E.10 Monday 10.00 (Allergy 2.00 Clinics) Tuesday 9.30 (X-rays with Drs. letters, etc.) 2.00 Wednesday 2.00 5.00-6.30 (workers only) Thursday Friday 9.30 9.30 (Ante-Natal) 2.00 (Contacts) SCABIES & CLEANSING CLINICS AND BATHING CENTRE Tunnel Avenue Wednesday 9 - 12 (School Children) Daily (Saturdays excepted) 9 - 12 (Wednesdays excepted) 2 - 4 (Adults and Children under school age) WOMEN'S SPECIAL CLINIC (Family Planning Association) Charlton Lane, S.E.7 Wednesday 12.30 HOME HELP SERVICE Applications for this service to be addressed to: — Divisional Medical Officer, London County Council, Greenwich Sub-Office, 105, Shooter's Hill Road, S.E.3. DISINFECTING STATION Applications to: — Medical Officer of Health, Public Health Department, Town Hall, S.E.10. 60 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, Charteihouse 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. 61 SECTION C Sanitary circumstances of the Area The tables on pages 123 to 125 summarise, as far as possible, the sanitary work of the Department; from these it will be seen that a total of 14,953 houses and premises have been inspected or re-inspected during the year; 273 intimation notices and 98 statutory notices were served. Of the latter figure 6 were in accordance with the Housing Act, 1957. Registered complaints, numbering 2,300, show an increase of 244 over those of the previous year, and 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: — Protection from Eviction Act, 1964.—Introduced on 17th December of the current year as an emergency measure prior to the introduction of amending legislation to the Rent Act, 1957, this Act restricts eviction from dwellings except by court order and postpones decontrol of former requisitioned dwellings. With the exception of the latter provision (Section 5) the Act is to remain in force only until the end of 1965. Riding Establishments Act, 1964.—Operative from 1st April, 1965, this Act repeals the previous Act of 1939 and requires any person keeping a riding establishment, not being disqualified under certain specified legislation, to be licensed in accordance with its provisions. It empowers local authorities to inspect such premises and to issue licences on payment of ten shillings only after considering a report submitted by a veterinary officer. The Children's Nightdresses Regulations, 1964.—Made under the powers conferred by the Consumer Protection Act, 1961, these Regulations came into force on 1st October of the current year. The Regulations apply to all nightdresses having both a finished garment chest measurement not exceeding 38" and an overall length not exceeding 46". They do not apply to any nightdress which, although coming within both of these measurements, is so made or designed that it is unsuitable for wear by a child under the age of 13, nor do they apply to any nightdress which is designed as an 62 infant's gown suitable for wear by a newly-born baby. All nightdresses coming within the scope of the Regulations must be made of a fabric which conforms to the low-flammability requirements of the British Standards Institution. Where a children's nightdress is made of a fabric which has been treated with chemicals to make it safer from fire, it must bear a warning against washing it with soap or soap powder and against boiling or bleaching it (such washing reduces the flame resistant qualities of the fabric). A tie-on label is permitted as an alternative to a sew-in label on nightdresses sold up to 1st April, 1965, but after that date a stitched label is required. The Regulations apply to all children's nightdresses sold or offered for sale after the 1st October, irrespective of the date of manufacture. They do not apply to any nightdresses sold by or on behalf of a person not acting in the course of a business or to those sold for export or held for export. The provisions as to inspection, testing and enforcement apply to metropolitan boroughs until the 1st April, 1965, after which they will be carried out by the London Borough Councils. Under the Consumer Protection Act, 1961, officers of the Council may inspect any goods covered by Regulations made under the Act and the Committee authorised the Public Health Inspectors to carry out such inspections. 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. During the year 337 inspections were made by the Council's Inspectors in relation to the 474 registered factories. The latter figure includes 82 premises where mechanical power is not used. 63 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 noticcs Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 82 5 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 381 325 4 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 11 7 1 — Total 474 337 5 — Cases in which defects were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l.) Overcrowding (S.2) - - - — - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - — - — - Ineffective drainage of floors (S.6) 1 1 - - - Sanitary Conveniences (S.7): (a) insufficient - — - — - (b) unsuitableor defective 13 13 - 5 - (c) not separate for sexes — — - — - Other offences against the Act(not including offences relating to Outwork) 3 3 - - Total 17 17 — 5 — 64 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. 29 - - - - - Curtains ana furniture Hangings 1 - - - - - Lampshades 2 - - - - - Cardboard Boxes 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 7 (b) Outworkers resident outside the Borough 18 Notifications received from firms outside the Borough of:— Outworkers resident in the Borough 32 Total number of Greenwich residents employed as outworkers (as given in August list) 34 Premises where homework is carried on were visited on 39 occasions by the Lady Public Health Inspector. In no instance was it necessary to take action because of infectious disease. 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. For the purpose of registration, this Act came into force on 1st August, 1964, and in this connection managements of all known offices, shops and railway premises in the Borough were informed of their responsibilities and were requested to complete and return an enclosed registration form. 65 A statistical summary of the work carried out to 31st December, 1964, in respect of the Act, is given to the following table:— Type of Premises Premises Registered No. of General Inspections No. of Other Visits Total No. of Visits Offices 112 15 32 47 Retail Shops 374 49 111 160 Wholesale Shops, Warehouses 15 - - - Catering Establishments, Canteens 66 5 9 14 Fuel Storage Depots 3 — — — TOTALS 570 69 152 221 Defective Dwellings.—Repairs.—With regard to houses found not to be in a reasonable state of repair, the following procedure, classified under two headings is generally adopted: — (1) Complaints from or on behalf of the occupier.—The District Public Health Inspector makes inspection and an intimation is sent to the owner specifying the defect and nature of nuisance found. Where necessary, the circumstances are reported to the Public Health Committee for authority to serve a Statutory Notice to enforce abatement of the nuisance. The premises are re-inspected by the Public Health Inspector, and, if work required is not executed within a reasonable period, Statutory Notice is served. In cases of non-compliance the Town Clerk is instructed to institute proceedings. (2) Housing Defects.—These are cases where the conditions are such that they cannot be remedied under the procedure of the Public Health (London) Act, 1936, and are dealt with under the Housing Act, 1957, as being houses unfit for human habitation. Representations are made to the Public Health Committee to consider as to whether such houses can be repaired at a reasonable cost having regard to the value of the premises, or whether Closing and Demolition Orders should be made. Pigeon Nuisance.—A local authority is enabled by Section 121 of the Public Health (London) Act, 1936, to deal with a nuisance arising from the congregation of pigeons believed to be ownerless and it has been the practice of this Council to authorize a pigeoncatcher to deal with pigeons on the highway and other public places. 66 During the year, the number of complaints received was 27 compared with that of 23 for the previous year 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. 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. 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 were expected to be completed early in 1964 at a total cost of about £10 million. 67 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 and points out that since the introduction of these new services there has been a substantial reduction in pollution. That salmon may once again be able to gain the upper reaches of the Thames as they did at the beginning of the 19th century is the hope held out to us by the Water Pollution Research Laboratory in its report entitled Effects of Polluting Discharges on the Thames Estuary. Inter alia, the report reveals that during the summer of 1964 the average oxygen concentration was in the order of 7 per cent, of the saturation value compared with a maximum of 30 per cent, expected when the London County Council's new biological treatment plant at Barking becomes fully operative. Since 1893, the County Council have sampled the Northern and Southern outfalls at high and low tides but in recent years a scheme has been introduced whereby weekly samples are taken at 22 points from Richmond to Mucking (downstream of Gravesend) and monthly samples at 29 points from Richmond to the sludgedepositing area of Black Deep. Examination of water over the weir at Teddington is made by the Thames Conservancy Board. Weather during 1964 wa,s unusual in that it was warmer than recent years, abnormally dry in January and February, wetter than usual from March to June and exceptionally dry for the rest of the year. During the summer quarter the average daily flow at Teddington was 40% less than during 1963 and only ¾ of the average daily flow for the past ten years. Nevertheless, there was a very marked decrease of hydrogen sulphide in the water and that at no point during the summer was a sample devoid of oxygen, this being the first occasion since 1921 of such an occurrence. Only 11 samples were reported upon as containing hydrogen sulphide and in no week was the sulphide consistently present. Considering that the fresh water flow over Teddington Weir during the last quarter was the lowest since 1933, the remarkable improvement in the condition of the river must be regarded as being due mainly to the enhanced standards of the discharged effluents at Beckton and Crossness. Unfortunately it must be stated that although the up-river section showed an appreciable improvement throughout during the year, the middle section of some 6 miles which recorded an improvement in 1963 68 remained an area of serious pollution. Moreover, since 1963 there has been a perceptible deterioration in the seaward reaches. 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 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. 69 (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. Preliminary work to the extent of £20,000 was carried out and an outline of the proposals to improve the Ravensbourne and its tributaries was given in my Report for last year. Assurance has recently been received from the Ministry of Agriculture, Fisheries and Food that a scheme concerning the lower section of the river and costing £863,800 will rank for a 33| per cent, grant. 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.—Recognition of air pollution is not new. In 1306 a Londoner was tried and executed for offending against an Act of Parliament passed in 1273, and John Evelyn the diarist, in 1661, complained bitterly of smoke which exposed inhabitants of London to an "impure and thick mist and filthy vapour" rendering them liable to "a thousand inconveniences and corrupting of the lungs". Today, carbon monoxide and hydrocarbons from petrol and diesel eneines respectively undoubtedly foul the air but in the main, pollution is caused by emission into the air of smoke from the burning of raw coal. Constituents of such pollution may be itemised as:— 1. Carbonaceous matter—resulting from incomplete combustion of the volatile part of coal. 2. Tar—formed in the process of destructive distillation of bituminous coal. 3. Ash—drawn up from the fire by the rush of air passing through the fuel. 4. Sulphur—derived from sulphur compounds in coal (eventually forming sulphurous and sulphuric acids). 5: Grit—particles of unburnt coal carried away in the draught. 70 There is no doubt that greater quantities of dust and grit are emitted from industrial furnaces but the domestic fire, because of its comparative low temperature of burning, is responsible for a smoke much higher in hydrocarbon or tar content. Further, the industrial pollution is usually dispersed at higher levels and the concentrations are therefore well diluted by the time they reach street level. Domestic smoke on the other hand is discharged at low level from short flues with the result that it lingers and eddies thus constituting a greater danger to the local inhabitants. In this respect it has been proved that smoke concentration is relative not to the size of the town but to the density of the population and its domestic coal consumption per square mile. Research has revealed that for every ton of coal burned industrially, approximately 4 1/2 lbs. is lost in smoke whereas the comparable figure for a domestic open coal fire is 90 lbs. In England and Wales some 30,000 deaths and over 30.000,000 working days per year are lost on account of bronchitis and. according to statistics available from the World Health Organisation it would appear that our overall respiratory death rate is the highest. To many responsible people much of this lung disease is attributable to air pollution and my Reports have constantly drawn attention to the enormous and costly damage to life and property occasioned by such vitiation. Effects of atmospheric pollution may be summarised thus:— (a) An increase in deaths from respiratory and heart diseases which appears to be proportional to the amount of impurities and length of exposure. Pneumoconiosis, arising in various industries, is attributable to the inhalation of dust and it is reasonable to suppose that constant exposure to a heavily polluted atmosphere could lead to some disability or aggravate one already existent. A normal reaction to the constant inhalation of dust is a low grade inflammation—the lining of the lung is stimulated to secrete mucous in order to remove the soot, dust, ash or other irritant and this can and often does lead to catarrh and bronchitis. In addition, fibrosis resulting from irritation impairs the lungs' elasticity which in turn tends to prevent normal drainage so necessary with respiratory diseases. Besides radio active particles, atmospheric dust is known to contain varying quantities of other carcinogens such as arsenic, benzpyrene and other coal tar products. The latter substances are known to be in greater concentration during the winter months, suggesting very 71 strongly that the domestic stove is at fault. In certain circumstances, soot is also considered carcinogenic and it is easy to see how atmospheric pollution becomes linked, rightly or wrongly, with lung cancer. (b) Absorption and elimination of ultra-violet rays from sunshine. It has been calculated that London loses 300 hours of sunshine per year through fog and smoke and it is a fact that lung cancer in urban areas is noticeably higher than in rural areas. It is possible that the connection between cancer deaths and lack of sunshine could be either that a smoky atmosphere predisposes to lung cancer or that sunshine is important in its prevention. Under the influence of ultra-violet rays, the ergosterol of the skin is stimulated to manufacture vitamin 'D, an essential for the anabolism of healthy bones and teeth. Deficiency of vitamin 'D' leads to rickets and dental caries. (c) Vegetation becomes stunted. It is pertinent to record that the plane tree, which sheds its bark annually, is practically the only tree to flourish in the London area outside the public parks. Comparison between flowers and vegetables grown in towns and those grown in rural areas is superfluous. (d) Damage to buildings. Sulphur dioxide appears to be the culprit in this respect. At York Minster holes more than 9" deep have been discovered as a result of this form of corrosion, and magnesium sulphate crystals were found in cracks and fissures 20" from the surface of the stonework of the Houses of Parliament. The Office of Works calculates that damage to its buildings by the acid amounts to more than £60,000,000 over a 25-year period. (e) Avoidable waste of material which could be of immense value to the community. A former Minister of Fuel and Power pointed out that 82% of the heat potential of coal is lost by wasteful methods and to reduce that loss to 72% would result in a saving of some 60 million tons of coal per year. The Director of the Fuel Research Station when it was at Greenwich, commenting on atmospheric pollution, stated that; "it has been estimated that from the 150 million tons of coal burnt raw during the year, 7 million goes straight up into the air in the form of grit, sulphur dioxide and tarry smoke. It costs the country 72 £50,000,000 a year in loss of fuel, repairs, losses to property and materials and in cleaning up the mess". (f) Increase in laundry costs. An enquiry made just before the recent war revealed the fact that the weekly wash at Manchester took one hour longer than at Harrogate and that the soap and fuel costs averaged per week more. Since then the position in built-up areas has substantially deteriorated and the loss in time and money must be correspondingly greater. Since the introduction of the Clean Air Act 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. 73 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, 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 domestic smoke. 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 74 able, 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 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. Technological advances in the gas industry and their effects upon the future production of gas coke have necessitated changes in legislation. These changes, effective from 16th August of the current year, are contained in Section 95 of the Housing Act, 1964, and the Ministry's Circular 46/64 explains the revised arrangements with regard to definitions, designation of appliances, approved expenditure, special cases and discretionary grants and grants on means of ignition. Further, Circular 60/64 specifically refers to electric space heaters and the occasions when they may attract grants. Within the Borough a Smoke Inspector and an Assistant are employed full time on duties in connection with atmospheric pollution and with the surveying and supervising of smoke control ureas. 75 Particulars in connection with confirmed Greenwich Smoke Control Areas as at 31st December, 1964, are given in the following table and the accompanying plan indicates the areas concerned. Particulars SMOKE CONTROL AREAS Totals No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 Approximate Acreage 76 63 49 262 132 414 996 No. of Dwellings 985 1,587 891 1,212 1,022 1,586 7,283 No. of Industrial Premises 6 2 6 Nil Nil Nil 14 No. of Commercial Premises 40 70 49 Nil 6 29 194 No. of Other Premises 10 14 7 3 1 8 43 Operative Date 1st Oct. '60 1st July '62 1st Oct. '62 1st Oct. '63 1st Oct. '63 1st July '66 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 1964: — 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 1963 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 March „ 214 436 92 340 764 143 April „ 159 432 56 294 751 52 May „ 109 200 52 180 557 48 June „ 126 252 40 124 301 36 July „ 69 136 20 120 222 32 August „ 93 216 36 144 263 49 September „ 128 308 40 173 584 69 October „ 237 456 80 361 579 103 November „ 217 600 60 317 1,021 43 December „ 268 818 48 394 983 77 January 1965 191 468 60 257 593 86 February „ 176 352 102 353 533 212 March „ 203 624 56 360 139 680 76 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 2 Number of decisions not to issue certificates 0 Number of decisions to issue certificates: (a) in respect of some but not all defects 2 (b) in respect of all defects 0 — 2 Number of undertakings given by landlords 1 (under para. 5 of 1st Schedule) Number of undertakings refused by Council 0 (under proviso to para. 5 of 1st Schedule) Number of certificates issued 1 77 PART II—Applications for Cancellation of Certificates Applications by landlords to Council for cancellation of certificates 2 Objections by tenants to cancellation of certificates upheld 0 Decisions by Council to cancel notwithstanding tenants' objection 0 Certificates cancelled 2 In addition to the foregoing, one application (Form "O") received from a landlord for a certificate as to the remedying of defects which the landlord has undertaken to remedy, resulted in the issue of a Certificate (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 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. 78 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. Generally speaking, industry seems unable to accept the fact that noise can be a public health nuisance. Doubtless a certain amount of noise from factory processes is inevitable but legislation to deal with "needless" noise had been long overdue. In the 1960 Act, however, the phraseology lacks the precision so necessary for effective action and there is a crying need for some kind of acceptable standard of "noise curve" (expressed in decibels and cycles per second) to exceed which would constitute an offence. In last year's Report, reference was made to the department's efforts towards securing a reduction in a noise being emitted from a large local factory at all hours of the day which was particularly objectionable during the night and which was giving rise to serious complaints. With the co-operation of the management several schemes were tried without sufficient improvement and, following representations by the Council, work on the particular process was restricted to the hours between 6 a.m. and 10 p.m. During the current year, some 18 relatively minor complaints were received all of which were resolved satisfactorily without recourse to legal action. 79 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 3 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 55 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 received from the Ministry of Health drew 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 repealed the Heating Appliances (Fire guards) 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. Under powers conferred" by the Act, regulations governing the manufacture and sale of children's nightdresses with regard to their 80 flammability, were introduced during the current year and a summary of the provisions appears at the beginning of this Section. Powers and duties of the Council under this Act have been delegated to the Public Health Committee and inspections are carried out by the Public Health Inspectors. 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 main tained, (b) suitable and sufficient temperature is provided and main tained, 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. 81 Routine inspections were carried out under the abovementioned Act on 480 occasions. Hairdressers and Barbers.—Under Section 18 of the London County Council (General Powers) Act, 1954, with certain exceptions, no person shall carry on the business of a hairdresser or barber on any premises in the Borough unless he and those premises are registered by this Council. Byelaws made by the Council under Sub-section 4 of Section 18, were confirmed by the Minister of Housing and Local Government on 21st August, 1956, and became operative on 1st October of the same year. Premises registered at 31st December, 1964 61 Persons registered at 31st December, 1964 69 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. Five 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, two of Rag Flock and one each of Coir Fibre, Cotton Mill Puff, Hair and Kapok were obtained and submitted for examination. All proved satisfactory. 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 82 cating 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 iikely to arise from insufficient or unsuitable sanitary accommodation or from breaches of the Food Hygiene Regulations. During the year, 22 applications for renewal of registration as licensed premises were made involving inspections 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 3 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 1,471 reports on such enquiries were forwarded to the Town Clerk's department. 83 Drainage and Sewerage.—During the year 443 drains were tested, 276 were opened, cleansed or repaired and there were 1,016 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 seventy-five plans of drainage and other sanitary works relating to existing and new buildings were examined and approved. Discharge of Trade Effluents into Sewers.—In October 1961, a report was submitted to the Council, following upon the receipt of details from the Metropolitan Boroughs' Standing Joint Committee, of the decision of a Working Party to establish a register of all premises affected by the London County Council (General Powers) Act, 1953, and undertaking the systematic sampling of trade effluents. It was then agreed that the Council should undertake the work. On the 1st April, 1964, Part II of the London County Council (General Powers) Act, 1962 (which is to be read in conjunction with the Act of 1953), became effective and under its provisions all traders are required to pay a charge for the recention and disposal of their effluents. To enable this to be done, all Councils had the obligation of registering all trade premises and determining volumes and compositions of trade effluents. The greater number of Metropolitan Boroughs (including Woolwich) were in favour of the County Council carrying out this control, mainly on account of the fact that this work would be taken over by the Greater London Council when the amalgamation of Boroughs took place in April 1965. The cost of doing this work is a charge on the Local Authority so far as its sewers are concerned, but the Local Authority will, however, receive some portion of the charges recovered from the premises concerned. The Council, therefore, duly authorised the London County Council to perform on its behalf the functions of the local sewer authority in respect of matters relating to trade effluents under Sections 9 and 12 of the London County Council (General Powers) Act, 1953, and Sections 6, 7 and 9 of the London County Council (General Powers) Act, 1962. Radioactive Substances Act, 1960—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 84 active material will, unless exempted, be required to register with the Minister and obtain authorisation from him for the accumulation or disposal of radioactive waste. Circular 3/63 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 two certificates of 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, a Statutory undertaking, which, as a result of the Metropolis Water Act, 1902, was formed in 1903 when it took over the 8 undertakings which were then supplying London's water. As a Board it is committed to supply a population of some 6£ million people within an area of 540 square miles extending from Ware in the north to Sevenoaks in the South and which has an average daily consumption of about 400 million gallons. 85 Although the River Lee and wells and springs in the Lee Valley and Kent areas make their contribution, two thirds of the Board's supplies are obtained from the Thame.s above Teddington Weir. River water is screened to rid it of extraneous matter and pumped into storage reservoirs where suspended matter falls to the bottom and where most of the pathogenic organisms die out. The water is then subjected to a rapid primary filtration through sand beds at approximately 20 feet per hour and a slow secondary filtration at 8 inches per hour after which it receives a small dose of chlorine as a safeguard to eliminate any undesirable bacteria which may still be present before it is finally distributed. One of this Borough's two wells which supply drinking water is a most prolific contributor to the Board's supplies, having a normal output of 5 million gallons per day. The Board is responsible for the purity of its water and the supplies are regularly tested—chemically and physically for an estimation of its clarity, colour and taste, and bacteriologically for assessment of coliform colonies with confirmatory examinations for Escherichia Coli. There are 24,558 dwellings in the Borough with direct connections to the Board's mains. During the year 497 water supply certificates were granted under Section 95 of the Public Health (London) Act, 1936. Water fittings have been amended, repaired or renewed in 154 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 introduced 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. During 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 number of wells about which we have some knowledge to 41. It would appear that this is an opportune time to consolidate the information and the accompanying table gives the details. In all, 41 wells are listed, only 2 of which are used for the supply 86 of water for drinking purposes. Of the remaining 39 wells, 14 are used for commercial purposes and 25 disused. UNDERGROUND WATER SUPPLIES No. Situation and Owners. Depth of Well —Position. Use. Condition of Water Remarks. 1 British Oxygen Co. Ltd.. Tunnel Avenue, S.E.10. 200 ft. deep 400 yds. from river. Water drawn at 190 ft. Drinking. Bacteriologically a good water; chemically no significant change in composition since March '42; affords no evidence of recent organic pollution and may be considered safe for drinking, but is very hard. Well completely enclosed and protected from pollution. Samples to be taken quarterly. 2 Metropolitan Water Board Pumping Station, Brookmill Road, S.E.8. 1500yds. from river. Do. Water from combination of wells is tested daily. This well is in circuit by adit to main pump supply. 3 Delta Metal Co. Ltd., Delta Works, Tunnel Avenue, S.E.10. 500 ft. deep 50 yds. from river. Water drawn at 490 ft. Industrial. Chemically satisfactory. There is a trace of iron and considerable temporary hardness and salt; no evidence of pollution. Water used for cooling purposes; there are no drinking points. Well is completely enclosed and protected. 4 Christie's Wharf Ltd., Riverside (Lombard Wall), Charlton, S.E.7. 250 ft. deep 300 yds. from river. Water drawn at 30 ft. Do. Chemically satisfactory. There is a trace of iron, the water is very hard, with a high degree of salt. Bacteriologically good; no evidence of recent pollution. The water is used only for industrial purposes, with no drinking points. The well is in good condition and protected from surface water pollution. 5 United Glass Bottle Manufacturers Ltd., Anchor & Hope Lane, Charlton, S.E.7. No. 2 Well— 300 ft. deep 200 yds. from river. Water drawn at 300 ft. Do. Extremely hard water, with a high salt content and traces of iron. Used for industrial purposes only. Enclosed type, protected from pollution. There are no drinking points. 6 Do. No 4 Well— 300 ft. deep 150 yds. from river. Water drawn at 300 ft. Do. Excessively hard water, very high salt content and heavy in iron. Bacteriologically good. Used for industrial purposes only. Enclosed type, protected from pollution. There are no drinking points. Only used in emergency as water is too hard. 7 Do. No. 5 Well— 300 ft. deep 250 yds. from river. Water drawn at 300 ft. Do. Satisfactory, but hard and a little salt. In regular use for industrial purposes only. Enclosed type, protected from pollution. 8 S. P. Mumford & Co. Ltd., Greenwich Flour Mills. Deptford Bridge. S.E.10. 165 ft. deep. Very near to Deptford Creek. Water drawn at 36 ft. Do. Bacteriologically and chemically there is definite evidence of pollution. The water has a high bacteriological count with B. Coli in 1 cc. This water is used for commercial purposes and is subject to chlorination. 9 St. Alfege's Hospital, Vanbrugh Hill, S.E.10. No. 1 Well— 200 ft. deep 400 yds. from river, outside Laundry. Do. A hard water, with no evidence of pollution. This well is used as a reserve supply for the Laundry only. Open type, protected from surface water. 10 St. Alfege's Hospital, Vanbrugh Hill, S.E.10. No. 2 Well— 250 ft. deep 400 yds. from river, under Administrative wing of hospital. Do. A hard water, but showing no evidence of recent pollution. The well is used as a reserve supply to the boiler feed. Protected from surface water. 87 UNDERGROUND WATER SUPPLIES No. Situation and Owners. Depth of Well —Position. Use. Condition of Water Remarks. 11 Thos. Borthwick & Sons. Ltd., Borthwicks Wharf. Butcher Row, S.E.8. 300 ft deep 40 yds. from river. Water drawn at 300 ft. Industrial. Extremely hard water and very salt. Chemically: no evidence of recent pollution. Bacteriologically: evidence of a slight degree of pollution, but sample taken from pump discharge tank. Completely enclosed well, protected from pollution. Used only for industrial purposes. 12 J. Lovibond & Sons, Ltd. Greenwich Brewery, Greenwich High Road, S.E.10. Shallow well, 36 ft. deep 300 yds. from river. Water drawn at 30 ft. Do. Very hard water with high salt content. No evidence of recent pollution. Enclosed type, adequately protected from pollution. 13 Tunnel Glucose Refineries, Ltd., Thames Bank House, Tunnel Avenue, S.E.10. No. 1 Well— 50 ft. deep 100 yds. from river. Water drawn at 25 ft. Do. These three samples of water are extremely hard and contain excessive amounts of dissolved solids and chlorides. They also contain a Open type well, is covered by shed and protected from surface water. Water used for cooling purposes only. Heavy iron deposit. 14 Do. No. 2 Well— 30 ft. deep 100 yds. from river. Water drawn at 26 ft. Do. good deal of iron which is gradually precipitated on exposure to the atmosphere, forming heavy rust-coloured deposits. Closed type well, protected from surface pollution. Water used for cooling purposes 15 Do. No. 3 Well— 25 ft. deep 150 yds. from river. Do. Quite unfit for domestic purposes, but no evidence of recent pollution. only. Heavy iron deposit. Do. 16 R.A.F., No. 1 M.U., Kidbrooke, S.E.3. 30 ft. deep 2,000yds from river. Water drawn at 25 ft. Do. Chemically: very hard and heavy in iron. Bacteriologically : heavy contamination (B. Coli in 1 cc.) This is probably from nearby disused and open well (See No. 21). Used only for reserve fire-fighting supply. Metal shaft capped with iron cover screwed down. 17 Delta Metal Co. Ltd., Greigs Wharf Tunnel Avenue, S.E.10. Greigs Well 20 yds. from river. Disused. Sample taken from resting water alongside pump bore. Bacteriologically: evidence of a slight degree of pollution. Disused for a long period; may be brought back into commission, meanwhile well is protected by manhole cover. 18 South Eastern Gas Board, Ordnance Wharf, Tunnel Avenue, S.E.10. No. 1 Well— 322 ft. deep 90 yds. from river Do. Heavily contaminated by tar seepage. Bacteriologically: evidence of pollution, with B. Coli in 1 cc. Well disused; is situated about 4 yds. from large tar pit. 19 Ministry of Works, Kidbrooke, S.E.3. (Formerly R.A.F. Camp.) No. 1 Well— 30 ft. deep. Do. - Both enclosed type sealed with screwed on metal cap. 20 Do. No. 2 Well— 30 ft. deep. Do. - 21 R.A.F., No. 1 M.U., Kidbrooke, S.E.3. 30 ft. deep. - - Boring unsuccessful and abandoned, shaft left exposed to surface water contamination. To be sealed up. 88 UNDERGROUND WATER SUPPLIES No. Situation and Owners. Depth of Well —Position. Use. Condition of Water Remarks. 22 South Eastern Gas Board, Ordnance Wharf, Tunnel Ave, S.E.10. No. 2 Well— 180 ft. deep 120 yds. from river. Disused. - Closed type well, sealed up. Disused since 1936 because of high salt content. 23 London Transport Executive, Old Woolwich Road, S.E.10. - Disused. - Enclosed type, pump left sealed. Protected from pollution. 24 25 London Electricity Board Power House, S.E.10. 2 Wells 300 ft. deep. Sealed. Yielded brackish and polluted water in 1935. Not used since March 1947. Wells plugged with concrete and back filled. 26 London Electricity Board Stowage Wharf, Deptford, S.E.8. No. 1 Well— 500 ft. deep. Do. - Concreted over. 27 Do. No. 2 Well— 500 ft. deep. Do. — Concreted over. 28 Do. No. 3 Well— 100 ft. deep. Do. — Capped iron and concrete. 29 Do. No. 4 Well— 186 ft. deep. Do. — Concreted over. 30 31 Carbide Stores Ltd.. 1 & 2, Kirkland Place, S.E.10. 2 Wells 184 ft. deep. Do. (Water said to have been salt). Both concreted over. 32 Molassine Co., Riverway, S.E.10. 170 ft. deep. Do. — Concreted over. 33 Formerly Beehive Brewery, Church Street, S.E.10. 276 ft. deep. Abandoned. — Site not traced. 34 Flamsteed's Well. Royal Observatory, S.E.10. In garden of Astronomer- Royal. Do. — Do. 35 Formerly Mr. Hills, Eastney Street, S.E.10 159 ft. deep. Do. — Do. 36 37 House adjoining, "Sunin-the-Sands," Shooter's Hill Road, S.E.3. 139 ft. deep. Do. - Do. 38 39 J. B. Orr, Ltd., Riverside, S.E.10. Four borings. Do. Water extremely hard, brackish when last analysed. Do. 40 41 J Formerly Royal Hospital Brewery, King William Walk, S.E.10. 305 ft. deep. Do. — Exact site not traced, but concreted in under roadway. As far as this Borough is concerned the two wells providing drinking water are properly supervised and have shown no sign of deterioration. 89 As stated above, 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 has been found that a minute quantity of fluorine assists the formation of healthy teeth and reduces the incidence of decay. Five-year studies in three regions of Great Britain have established that artificial fluoridation of water in areas where it is naturally deficient is effective as a preventive measure against dental decay. Results were as follows:— (a) Substantial improvement in teeth of young children in areas of the studies. (b) No evidence of any harmful effects despite the closest of scrutinies. (c) No difficulties were experienced in adding and maintaining the fluoride content at the specified level. (d) Results were in line with studies in other parts of the world. Fluoridation is often opposed on the grounds that it is "mass medication", but fluoride in some form or other is a natural constituent of water and, when absorbed during the formative stages of childhood, reduces dental decay substantially. Fluoridation is merely a method of adjusting to an optimum level, where necessary, the fluoride content of any water supply. Very careful public enquiries have been carried out in a number of countries and the W.H.O. Expert Committee on Fluoridation has stated that it is a practical and effective public health measure which has a marked caries-preventive action and that there is no evidence that it impairs the general health. The Minister of Health's Standing Dental and Medical Advisory Committees have recommended that fluoridation be adopted in England and Wales as soon as possible with a view to reducing the extent of dental caries which is causing great concern particularly among children. Unfortunately the Metropolitan Water Board, probably the biggest water supplier in the country since its re-organisation, has "not had any opinion from local authorities on the subject". After 10 years experiment the Medical Officer of Health of Watford has declared that it is a safe public health measure and, despite active opposition, the move towards fluoridation is growing. 90 In line with other large cities such at New York, Washington, Chicago, Dublin, Canberra, Sydney, Wellington, etc., Birmingham has already decided in favour of a policy of fluoridation and Derby is expected to follow shortly. 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 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 suggested that when fluoridation was introduced by water undertakers in accordance with arrangements made with local health authorities, the full cost should 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 Repuse 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 91 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 1,250 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 was 22,603 tons from 27,802 (average) premises. This means that in spite of an increase in the use of gas and electric heating, due to the Clean Air Act, the amount of refuse per hereditament remains at approximately 16J cwts per annum—equivalent to 35 lb. per week. The average weight per day, per 1,000 population was 14.8 cwts. (pop. 83,630), most of this being collected from individual bins. However, large communal containers housed in chambers at the bottom of chutes are now being provided in greater numbers not only at the new blocks of flats and schools but also to business premises and shops and by the end of 1964 there were 745 such containers 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. 92 Refuse Disposal All refuse (including approximately 350 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 1£ acres. Originally there were 3 large swimming baths, 74 ladies and gents' slipper baths, medicated vapour and foam baths, washhouses and laundry, etc., but during the war the Ladies' 2nd Class Swimming Bath was demolished by enemy action. Subsequently the Council, with Ministry approval, decided that Turkish and Vapour Baths would replace the original Ladies' swimming bath and rebuilding with this aim in view commenced during 1957. March 10th of 1959 saw the opening to the public of the new baths, the accommodation of which consists of the following :— (a) Cooling Room with 23 cubicles for resting, with Attendant's Office and additional locker accommodation for bathers not requiring a cubicle. (b) Shower Room, with plunge pool and adjacent lavatory accommodation, giving access to Turkish Bath, Vapour Bath, Shampooing Room and Special Baths. (c) Turkish bath suite comprising Tepidarium, Caledarium and Lacomcum. (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 risen to 21,290 giving rise to difficulties of accommodation. The present figure for attendances shows a decrease of 3,187 from that of last year resulting from the closure of these baths for a period of 3 weeks for redecoration. Swimming baths continued to be well patronised, showing an increase in attendances of almost 20,000 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, 1964: — Attendances.—For the year ended 31st December, 1964:— Slipper Baths 57,321 Swimming Baths *162,548 Russian and Turkish Baths 21,290 Public Laundry 4.457 Total 245,616 *Includes 50,875 school children. 93 In connection with the swimming baths there has been provided a most up-to-date filtration, aeration and chlorination plant capable of purifying the contents of each bath every 3½ hours, thus enabling bathers to use the baths with every confidence. Regular chemical tests are taken (twice daily) and bacteriological tests taken periodically. 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 14.4.64 11.10 a.m. 1st class *Swimming 76° F. 100 — — — Satisfactory 2 14.4.64 11.15 a.m. 1st class *Swimming 76°F. 100 1 — — Satisfactory 3 28.4.64 11.20 a.m. 1st class *Swimming 76°F. 110 3 — — Satisfactory 4 1.7.64 11.05 a.m. 1st Class *Swimming 75°F. 100 2 — — Satisfactory 5 1.7.64 11.10 a.m. 2nd Class *Swimming 76°F. 60 — — — Satisfactory 6 22.10.64 11.15 a.m. 2nd Class *Swimming 78 °F. 180 — — — Satisfactory * Mixed Bathing 94 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 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 7 a.m. to 11 p.m Greenwich South Street (near Town Hall) 4 I 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. 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 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 had been somewhat delayed, this site was not required until after the end of the financial year ending 5th April, 1964. 95 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 9,118 9,652 18,770 Creek Road 3,446 5,471 8,917 Greenwich South Street 3,253 5,210 8,463 King William Walk 8.839 15,471 24,310 Rodmere Street 4,806 8,084 12,890 Shooter's Hill Road 8,765 9,864 18,629 Woolwich Road 5,850 8,293 14,143 Totals 44,077 62,045 106,122 There has been a substantial increase in the number of free washes recorded, especially at Shooter's Hill Road convenience since the installation of wash-hand basins for this purpose. As was to be expected, this increase has been obtained largely at the expense of "paid" washes. 96 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 929 recorded complaints (575 of rats and 354 of mice), 542 were notifications, 81 re-notifications from occupiers or other sources and 306 were found during survey. The monthly average of complaints from all sources was 77 as compared with a figure of 52 for the previous year. In addition to the investigations of recorded complaints, 2,033 other surveys were carried out under the Prevention of Damage by Pest Act, 1949, giving a grand total of 2,656. During investigations, infestation was found to exist on 13 occasions in local authority's premises, 579 in dwelling houses and 192 in miscellaneous properties and places of business. Of these, three major infestations were disclosed; two were of rats (in a Council depot and a canal-side scrap merchants) and one of mice in an electrical wire works. In all, some 818 treatments were effected by the local authority and 25 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 5 industrial premises, 4 wharves and storage places and at one hospital in the Borough. Following the policy of tracing the source of each infestation, 11 defective drainage systems were discovered. In these instances Intimation Notices were served under the Public Health (London) Act, 1936, and the drainage defects made good by the owners of the various properties concerned. Calls were made on the services of the Borough Engineer's staff to enter sewers during colour-tests or in the tracing of disused drains and also to the lifting of paving to locate sources of infestation ; these services were readily available. Occupiers of business premises and also householders readily report any known or suspected infestation, and the value of routine investigation made in these properties is emphasised by the fact that it is rare to find occupiers tolerating infestation after being made aware of the service available under the Rodent Control scheme. The Rodent Control personnel have performed their duties with diligence throughout the year and have given the Department good service. 97  TYPE OF PROPERTY Non-Agricultural . (6) Agricultural (1) Local Authority (2) Dwelling Houses (Inc. Council Houses) (3) All Other (Including Business Premises) (4) Total of Cols. (1). (2) & (3) 1. Number of properties in Local Authority's District 56 24.542 5,438 30,036 — 2. Total number of properties inspected as a result of notification 4 420 102 526 — Number of such properties found to be infested by:— Common rat Major 1 1 Minor 2 174 55 231 Minor — — 1 1 — House mouse Major 1 1 _ Minor 2 181 24 207 — 3. Total number of properties inspected in the course of survey under the Act 7 1,639 333 1.979 Number of such properties found to be infested by:— Common rat Major — — — — Minor 2 92 32 126 — Ship rat Major _ — — — — Minor — — 2 House mouse Major _ _ — — — Minor — 67 8 75 — 4. Total numberof properties otherwise inspected (e.g. when visited primarily for some other purpose) - 5 1 6 Numberof such properties found to be infested by:— Common rat Major Minor — 1 1 2 - Ship rat Major Minor — — — — — House mouse Major — Minor — — 2 2 — 5. Total inspections carried out— including re-inspections (To be completed only if figures are readily available) 18 2.327 606 2,951 6. Number of infested properties (In Sections 2, 3 & 4) treated by the L.A 7 493 123 623 7. Total treatments carried out— Including re-treatments 13 626 209 848 — 8. Number of notices served under Section 4 of the Act: (a) Treatment (b) Structural Work (i.e. Proofing) - - - - - 9. Number of cases in whlchdefault 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 - - - - - 98 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 report on the previous page was submitted to the Ministry of Agriculture, Fisheries and Food, for the year ended 31st December, 1964. 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:— During the period 23rd November to 19th December of the current year a total of 1,374 sewer manholes were baited, which was the maximum number available for baiting throughout the Borough. The Direct poisoning method was employed and the bait used was fluoracetamide (1081). 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 22 complaints regarding flies and mosquitoes were received and a further 11 instances were revealed during survey. A persistent source of complaint in previous years 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. In recent years effective control has been obtained with anti-malarial capsules and, as a consequence, complaints from 99 this source have progressively diminished. Moreover, during 1963, in anticipation of the construction of the new approach road to Blackwall Tunnel some drainage work has been carried out which has been a great factor in eliminating the basic cause of complaint. As a result, treatment during the current year was limited to routine spraying. 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 2,382 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. 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 69 cases of dirty and verminous premises compared with 39 in 1963. The disinfestation staff sprayed 169 rooms and contents as compared with 170 last year. In 9 cases the bedding and effects were removed to the Council's disinfecting station for treatment by steam or formaldehyde. 100 Of other pests which necessitated the treatment of 1,168 rooms and 178 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 104 complaints received and the further 4 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 108 treatments involving 100 rooms and 56 external areas were carried out to combat the reported nuisances. One of the commonest of ants, the very small red House or Pharoah's ant (Monomorium pharaonis) was also the cause of a number of complaints. This species, being of tropical origin, is incapable of breeding in England without artificial heat. A temperature of approximately 80°F is considered to be ideal for its propagation and ipso facto 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 46, an increase of 12 over the previous year. Although the treatments which involved 152 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. 101 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 83 complaints received con- cerning this pest came from bakehouses and the three large hospitals in the Borough; very few originated from occupiers of dwelling houses. The construction of such premises offers ideal breeding sites in concealed and almost inaccessible places. Thorough investigation and treatment with D.D.T. resulted in the infestations being considerably reduced. In all, 128 treatments were effected involving 623 rooms and 10 external areas. Clover Mite. Four 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. A further 9 cases were found on survey giving a total of 13 during the current year. This was a reduction of one 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 25 occasions, spraying of 6 rooms and 24 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). 102 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. Thirty complaints regarding this pest were received and during the year some 49 nests were destroyed, mainly by means of HCN gas generated from purpose-made proprietary powder. This was an increase of 8 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 : Bacon 1 - 1 2 - Black 14 6 25 28 8 Bread 1 1 2 5 - Spider 2 - 2 4 - Earwigs 5 - 6 4 4 Silver Fish 9 - 10 24 1 Fleas 32 3 37 150 2 Slugs 4 - 6 7 1 Wild Bees 5 2 5 - 5 Misc. Insects 11 6 21 24 5 Twenty-six requests for spraying for other reasons such as bad smells, offensive deposits, etc., were met by a further 38 treatments to 192 rooms and 5 external areas. Precautionary Spraying. During the year, 718 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 795 rooms and 210 external areas. 103 AGED, INFIRM AND PHYSICALLY INCAPACITATED PERSONS "But spite of Heaven's fell rage. Some beauty peep'd through lattice sear'd age." —Shakespeare. The fact that this Report will be the last under the present administration not only justifies reiteration of observations previously made, but calls for an assessment of the problems of an ageing population and an appraisal of the efforts made in Greenwich to meet the situation. Since early times, the community's behaviour to old age has changed. In primitive societies old age was rare and, as a consequence, was an honoured estate. Today, it has become commonplace and commands little respect. There is an understandable tendency on the part of youth to dissociate itself from old age perhaps because it is a constant reminder to the young of its own ultimate fate. Dean Swift once wrote, "Every man desires to live long, but no man would be old" and, if the truth were known, we are all a trifle uneasy about approaching old age. Our attitude towards it naturally depends upon our own philosophy of life and there would appear to be no doubt but that the "meaning of life" has a great effect upon the equanimity with which some people view the advancing years. Moreover, it is obvious that some form of occupation of mind or body tends to maintain health and there can be few human beings who do not feel the better for knowing that they are of some value to society—happy is he who has something to give. At the outset we must disabuse our minds of the notion that the later years of life are somehow separate from those of the earlier periods. This is just not so. Life is rather like a voyage in that there are many delightful and some not so delightful intervals on the way but all are essential to the final destination. Each stage of life has its value and possesses its own peculiar advantages and old age is no exception. It has a.ssets to balance its difficulties What it loses in strength and vigour it gains in experience and the capacity to contemplate and evaluate in a way denied to younger people. However, this is not a refutation of the suggestion that there are problems of old age which require more than just a cursory examination. Largely due to medical progress and improvements in social and environmental conditions, the increase in the number of people reaching retirement age and beyond is likely to continue with a consequent intensification of the problems associated with old age. 104 Only in recent years has any determined official effort been made to understand the needs and improve the lot of the aged. Indeed, services introduced with such intentions must be numbered among the latest additions to those already being administered by local authorities for preventive purposes. 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. 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 become.s 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, by reason of 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. On giving up their jobs, men and women can anticipate up to 20 years of retirement, a period, we must remember, equal to that between birth and marriage. Moreover, with the spread of automation, extension of this period is more than conceivable. So often is retirement looked upon as a well-earned rest from the enervating, fast, modern world of over-packed trains and buses and a welcomed release perhaps from dreary and repetitive work that, on the "day", realisation that a pattern of life built up over half a century is about to disintegrate, comes as a profound shock. In many instances this is probably the first step to mental instability. 105 What, then, are the problems of old age and how is one to handle them? What can be done for those who begin to fail physically and mentally with advancing years? If we should consider these questions merely a facile academic exercise in terms of apportioning public or private social responsibility we would be doing them less than justice. Such human problems warrant a deeper and more compassionate analysis for there is no glamour or enchantment in ministering to the aged. Much of this kind of service is menial, demanding and frustrating in that it seldom leads to a completely satisfactory outcome. Doubtless it is this truth which is the great disincentive to the medical and nursing professions and, therefore, possibly the major contributory factor in the shortage of necessary nursing facilities available to the aged. More than that, one is sometimes left with the impression that the care of old people is considered to be not worthy of the skill and attention of doctors and nurses. However, to confuse old age with dependency would be our greatest mistake. Old age is NOT synonymous with dependency. 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 disajreeable 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. In the first instance, we should recognise the need to clarify our own attitudes towards these issues for it is certain that only real dedication to the task of caring for the elderly will, in the long run, prove successful. Secondly, we should be aware of the magnitude of the problem. In 1962, every third person over 65 years was solely dependent upon the state for his or her income and a further one sixth had less than £1 per week to augment this amount. To this extent the standard of living of more than one half of the elderly was contingent upon state aid. As one would expect, there was a gulf between the levels of income of couples where the husband was over 65 years but was still working and those where the husband had voluntarily or had been compulsorily retired. In the first group, 40% (18% of all elderly couples) had incomes of £15 per week or more and only 3% had less than £6 per week. Of the second group only 12% (5½% of all elderly couples) had 106 the former kind of income with 30% within the lower range. In fact, in the latter group, 50% had weekly incomes below £6 13s. Od. Among the elderly the poorest are the very old, for "employability" declines with age, and the unmarried or widowed woman who, at any age, are less often employed than men. Because of the relationship between health and "employability" it naturally follows that the poorest among the old are, on the whole, more incapacitated than the average elderly person. At mid-year 1964, in England and Wales, the number of men over 65 years and women over 60 years amounted to 7,136,000, or put more prosaically, one person in every 7 was of retirement age; by 1980, the total is expected to reach 10 million. At the present time there are more than 2 million people of 75 years or over, the majority of whom are women. Fortunately, the vast majority of all old people live at home and are well and active, but about three-quarters of a million are home-bound through infirmity and many are bed-ridden. A further 300,000 are housed by local authorities and voluntary bodies or are provided with accommodation by hospitals. There remains a further million or more living alone who require some special attention. This then is the extent of the problem. Thirdly, there is need for greater research into the causes and effects of the ageing processes and information so obtained must be incorporated into the training syllabus of doctors and nurses. Manifestly the place in society of old people is not in institutions because (a) this is practically and economically impossible, (b) it is against the best interests of the elderly themselves, and (c) it is undesirable for it robs them of their independence. In effect this is an endorsement of the truism that old people are infinitely better off in their own homes especially when infirmity rather than illness seems to predominate and all our efforts should be directed towards achieving this objective. Our first aim, therefore, should be to ensure that the prospective pensioner reaches retirement age in the best physical and mental condition in order that he or she may commence the new life as a happy member within the local community. It is surely a little incongruous to harness municipal and voluntary organisations to cope with what Dr. Kemp in his book A New Look at Geriatrics has called "orphans in reverse" and yet not furnish prophylactic facilities for the pre-geriatric. Again, to approach retirement with no better equipment than the limited horizon of one's own job is to court disaster. We must make it possible for people to prepare for retirement by persuading them to consider it some ten or more 107 years in advance and so lay foundations for a fresh pattern of life. This is no easy task but, once accomplished, it enables them to develop new skills and cultivate fresh interests and friendships which will counter the detrimental effects of loneliness so commonly met with in those who have no contacts outside their work. Furthermore, during this period when earnings are still being made, with some encouragement to use a little forethought many repairs, adaptations and alterations such as provision of hand grips to baths, rewiring and re-siting of switches, replacement of stoves or geysers, etc., could be executed in the home with a view to anticipating retirement problems. Comes retirement, then the most promising situation is to be found where elderly couples, well and active, are living in their own homes. In these circumstances only minimal support will be required from the community but, where there is some loss of physical mobility, then all the domiciliary services should be directed towards maintaining or improving the status quo. In cases where retirement has been reached alone, we must provide companionship in the home through voluntary organisations (and here, I feel, is a fertile field of service for religious bodies) or take steps to see that interests in community activities are promoted and sustained. At this juncture it cannot be over-emphasised that, in all cases, a very great deal will depend upon the conduct of the first visit by the local authority's representative and the subsequent accuracy with which the needs of a particular case are assessed. In considering this aspect of assessment there is an unmistakeable need for some form of geriatric clinic attached, perhaps, to a "day club' where members could leisurely discuss with a doctor personal problems in relation to their environment. If necessary, and with the concurrence and co-operation of the patient's own physician, some degree of physical and maybe mental investigation could be carried out over a suitable period to ascertain more accurately his or her needs which could then be dealt with accordingly. Benefits from the introduction of physiotherapy would be two-fold. It would have the direct effect of helping old people to be more active and would be a method of attracting them from their homes and inducing them to enter some form of community life. But, it is clearly not sufficient to organise out-patient clinics for the aged in an effort to prevent invalidism or to provide specific intensive treatment if, fundamentally, they are suffering from malnutrition, inadequate amenities and unsatisfactory social conditions. In such circumstances, the value of a precise initial assessment becomes self-evident. 108 In those rarer cases where elderly people are living happily with their children, serious problems are usually non-existent but, more often than not, the sharing of accommodation with a younger generation produces an explosive situation. Mounting stress and tension within the household leads to frustration, disharmony and a great deal of unhappiness on both sides and, in my opinion, it is here that we need to be particularly discerning. Early diagnosis of family stress and tension is essential and countermeasures taken before the position so deteriorates that strained relationships become irreparable. Young families genuinely seeking to do their best for their older members deserve our full and continued support. Day clubs and holiday schemes can be invaluable in providing the respite so necessary for families to regain their equilibrium, especially if infirmity or illness has been an added burden. Short term admissions to hospital can also play their part in enabling relatives to take a well-earned vacation. On the whole, lodging arrangements entered into by elderly people themselves appear to work reasonably well and the success or otherwise of the venture often depends upon the friendships struck with other lodgers or even with the landlord. All that is necessary in such cases is an occasional visit to ensure that health is being maintained and apathy is being avoided by lively interests. We must remember though, that old people generally, are susceptible to a condition known as hypothermia, where the body temperature falls below 95°F. Caused by a mixture of exogenous (exposure) and endogenous (internal) factors, it is termed "accidental" when used in connection with the aged because of the imperceptible nature of its onset. It can be a medical emergency requiring hospital treatment and, during the winter, elderly people living alone are especially at risk. They should be encouraged to sleep in warm bedrooms, to eat nutritious foods and to wear suitable clothing. However, preventive measures of this nature have obvious economic implications and, where necessary, it is the duty of the local authority to see that these embarrassments are overcome. A little health education would not come amiss in such cases. The problems of elderly persons who maintain some connection with relatives may not be so acute as those who are alone but, as time removes loved ones, many old people eventually find themselves bereft of all personal relationships and it may well be that, in some cases, the question of institutional care has to be considered. At a time when medical thinking and practice are moving away from the static "hospital" or "institution" frame of mind and towards getting people well and home again, it is disconcerting to find that, all too often, the local authority welfare home is still looked upon as the ultimate way of life for many of our old folk. 109 Seldom is the institution regarded as a necessary expedient to resolve what may conceivably be a temporary difficulty. In many instances this is a cruel injustice, for once the decision on admission has been taken it is extremely unlikely to be rescinded if only for the fact that homes have been disposed of and accommodation given up. Indeed, only the most obdurate manage to extricate themselves to set up home again and resume a normal life. To complicate matters still further, too many young people feel that once they have seen mother or father installed into an institution, they are then released from any additional family obligation and the question of the parent's discharge home is conveniently ignored. As a nation we are replete with good intentions and, theoretically, our ideas on institutions are very advanced. Probably they compare favourably with most other countries but, somehow, they miscarry. For example, there is a Ministry recommendation that old people should be encouraged to take at least some of their own furniture with them when they enter a welfare home but, in practice and no doubt for very good reasons, few authorities acquiesce. Within their limitations and with the utmost goodwill, most local authorities make valiant attempts to surmount their former dubious reputations and to convert their institutions into real homes. Unfortunately, many practical difficulties, including potential anti-social behaviour, preclude these aims from being realised. Nevertheless, although institutional care is far from being an ideal solution, it fulfils a very necessary function in our modern society. It caters for the many who have never possessed family ties nor had a settled domicile and who, therefore, find this kind of existence quite satisfactory. In addition to providing food and shelter, it supplies its inmates with most other needs such as entertainment, outings, parties, television and radio, etc., and even arranges for educational and handicraft classes when required. What cannot be disguised or hidden from the elderly, however, is that welfare homes are places where old people are fed and kept clean and neat and tidy until they die. By and large, the aged view the institution as the impersonal juggernaut responsible for the avulsion from the life they knew and for placing them in an environment which has no relevance to their previous one. It makes decisions for them, usurps their responsibilities so that their selfrespect suffers and they lapse into apathy. What if a more enlightened attitude be taken of welfare homes and the sick, tired and frail elderly people, being restored to normality, are not only prepared for but express a wish to return home? How many housing authorities would be sufficiently flexible 110 to provide fresh accommodation for them in the event of such a scheme being put into operation? Yet there is little point in restoring an old person to health if his home is no longer in being or unless one could be provided. A very good case can be made out for sheltered housing such as "colleges" or "warden controlled" accommodation where inmates would have private quarters surrounded by their personal possessions, with prompt attention from a resident matron should the occasion arise and with a communal room or centre within easy reach. This centre could be made the focal point for activities involving all the elderly from the neighbourhood and would provide the therapeutic companionship to counter any feeling of segregation. Schemes for solving the problem of the "ideal welfare home" are legion but it is generally agieed that the small home of not more than 40 beds, recommended by the Ministry, is likely to prove the most satisfactory. As usual with most of these projects money becomes the most formidable obstacle. How much and on what shall it be spent? Such a question is certain to involve basic policy for it is clear that sufficient financial support for all the worthwhile schemes will not be made available. Indeed, in these days of local and national stringency it is difficult to see how enough money will be forthcoming to tackle even the most urgent problems. When faced with a choice of one course of action or another which will set a pattern for the next decade, the policy decision becomes acutely significant and a re-examination of the ground is warranted. At present, of the million retired people, only slightly less than 100,000 are in local authority homes. At first glance this relatively small figure hardly seems to warrant the intensive investigation it has suffered in recent years. However, if we remember that in 20 years time there will be a further 2 million people of pensionable age we will get some idea of the coming problem. Many of the retired people will become eligible for and in fact may require welfare home accommodation but the demand will remain unsatisfied. Homes nowadays are not being built, as previously, large enough to house the family and the grandparents and the leeway is not being made up by the housing authorities. Society itself is not "allowing" for them as it once did. Local authorities are faced with the dilemma of long-term planning of special housing for the elderly or expanding the existing supportive services. To attempt both on limited finances may be to risk "falling between two stools". In either case, the course of action will be plagued with staff shortages. Nevertheless, if we believe in preserving someone's power of self-determination, then we must opt for the supportive services. The Government is pressing local 1ll authorities for their plans in this respect for the next ten years and time is getting short for such a far-reaching decision. Inevitably, the question of in-patient treatment for some of our older citizens will arise. So frequently do the aged look upon the hospital as the end of a "one-way" street that it should be our earnest endeavour to get them to regard it, rightly, as no more than a necessary interruption of limited duration in their home life. Over and above that, however, we must be convinced that hospital admission is necessary. We must be sure that the senile dementia for which treatment is considered essential is not mental depression brought about by financial worry, inadequate fuel or lack of food. Sir John Charles, in his final report as Chief Medical Officer to the Ministry of Health, stated that "the response (of the elderly) to a proper diet is often dramatic" and many an old person with mental infirmity has made a remarkable recovery when regular, balanced meals have been forthcoming. Again, we must be satisfied that the swollen ankles are really symptomatic of heart failure, vein thrombosis, rheumatoid arthritis, chronic bronchitis or emphysema and not merely immobility resulting from inactivity. To say that hospital admission, for the elderly, has certain inherent hazards is not to denigrate the hospital services but simply to state the obvious. There is the ever-present danger of cross-infection, gastric and respiratory, which old people tolerate rather badly. Over-investigation by a zealous staff for such disabilities as coronary disease, hypertension, diabetes and respiratory troubles is not only a dreaded possibility but can sometimes lead, inadvertently, to over-medication despite the fact that the lowered safety margin for drugs in old people is well known. Conversely, in overcrowded geriatric wards, a position unfortunately all too common these days, there is a risk of under-nursing due to staff shortages thus giving rise to understimulation, both physical and mental, with an enforced disregard of personality. This cannot be in the best interests of our old folk. Many things may go awry but only after every environmental aid has been invoked should in-patient treatment be considered. If hospital treatment becomes essential, what then? At the start, we would do well to remind ourselves that restoration to health is really a function of the entire community because all healing depends upon total needs—medical and physical needs, psychological needs and social and specific needs with perhaps the greatest emphasis on the psychological aspects. Keeping this in mind and aiming to reduce chronicity to a minimum, our precept must surely be, quickly into hospital, effective treatment and quickly out again. Nothing short of dire necessity should divert 112 us from this and discharge of the patient back to the community should always be considered the normal outcome of hospitalisation. In order to achieve this there must be, at the very beginning, more of a personal and less of the stereotyped approach. This is of prime importance, for the disturbed conduct of the elderly so often stems from our own attitudes towards them. Who cannot call to mind instances of mental confusion resulting from family argument, close questioning or even intensive medical investigation? In nursing the elderly, disillusionment is almost certain with the "gimic" approach for real achievement is not to be found in the passivisms special cots or ripple or incontinent beds nor in a superfluity of mechanical aids. Successful treatment is much more likely to be found in increased activity and improved amenities. Experience has shown that the more we expect from our older citizens the more we shall get and if we begin with the maxim that rehabilitation starts with the restitution of independence then the outlook will be so much more favourable. Therefore let us render to the aged the respect they deserve and treat them as the responsible individuals they are and would wish to remain. If we are called upon to minister to them let us at least have the courtesy to remember their names and a little of the previous histories leading to their present conditions. If certain actions must be taken or particular treatments instituted then let us credit them with intelligence and explain the reasons and so ensure their active co-operation. They have a right to indulge their own religious and political persuasions and indeed, whenever possible, they should be given opportunities for self-expression for this may well be the means of preventing mental deterioration. Finally, let us try to preserve their dignity. They have the elementary right of privacy when it is required for the reception of their visitors or for the more mundane purpose of using a bed pan. What of the future? Each age group, as it nears retirement, will have to determine its own attitude towards old age. Will it be regarded as a holiday lasting fifteen to twenty years or will it be considered, as Carl Jung suggested, a period for education or artistic pursuits? Is there some purpose which seems to elude the majority of people in such conditions or should it be assumed that old people, having earned their rest, would retire from society? Whatever the problems confronting these people I feel that we are in a unique position to counsel and guide them through their difficulties if given the opportunity. Whether coming events do cast their shadows before may be questionable but it i,s clear that the next decade or so will see an 113 increase in leisure for a greater number of retired people thus complicating an already complicated situation. A widening of the gap between the "have's" and the "have nots" seems a distinct possibility and, with concomitant risks of more social insecurity, increases in neuroses and psychosomatic disturbances are presaged. There is an implication here that even closer links with the hospital geriatric services must be achieved. Recent investigations have revealed that over half our retired citizens want to be occupied. At a time when the country is so desperately short of labour it is surely a profligate waste of the nation's energies not to utilise such a readily available source of man-power. Some way must be found to enable such people not only to regain their self respect and a reasonable standard of living but also to make a not inconsiderable contribution to the efforts needed to right the country's economic plight. A more enlightened housing policy is called for in relation to the aged, particularly at the planning stage, and much more use should be made of governmental aid available under the National Assistance Act, 1948, for the adaptation of homes of disabled old persons. Needs of the elderly are already complex and the resources available to meet them are equally involved. In this there is more than a hint of the necessity for a co-ordinated approach and, ipso facto, for central direction in order that each case attracts the right kind of help or service. Our supportive services have developed along empirical lines and the benefits of these schemes extend far beyond the actual services provided and must be measured in terms of "social contacts" and "wider interests", etc. But, because they have proved to be so successful, we must guard against becoming complacent; we should be alive to new possibilities and be prepared, if necessary, to change our ground for the good of the service as a whole. Let us pay some heed to what the elderly themselves want and not be too dogmatic about what we think they require. Lastly, and not the least of importance, is the fact that little of real worth will be accomplished and no substantial progress made unless we pay more than just lip service to two basic principles, namely, respect for human dignity and good human relationships, not only within the family but between patients and the medical profession and nursing staffs and social workers. Having outlined the main problems of an ageing population and suggested some of the ways in which they might, with profit, be anticipated and overcome, it merely remains for me to record the efforts made by the Council to meet the situation in Greenwich. 114 WELFARE OF THE ELDERLY IN GREENWICH In the early days, despite the fact that Councils, as such, had no specific powers in this direction, the Health Department at Greenwich had always paid some regard to the elderly citizen and his problems. Even in 1934, chiropody was made available to the aged at one of the Council's Welfare Centres for a nominal l/-d. per treatment. Indeed, since 1938 and especially during and after the war, it has always been a duty of the lady Public Health Inspector to investigate and, where possible, relieve the difficulties being experienced by some of our older folk. Moreover, the Home Help Scheme introduced in 1938 for the benefit of the Maternity and Child Welfare services was, in 1945 with Ministry approval, extended to our old and infirm residents and was one of the services eventually transferred to the London County Council in July, 1948, as a going concern. It must be remembered that the old people were the least well provided for under the National Health Service Act and, up to the time of its introduction in 1946, supportive services for the aged, such as they were, were limited to those obtainable from church and other voluntary organisations with tacit approval and not a little "unofficial" assistance from the Council. Voluntary organisations are responsible for much good work performed unobtrusively and unsolicited, but more often than not, they suffer from a lack of funds. However, the multiplicity of agencies concerned directly and indirectly with the welfare of the aged and infirm indicated as early as 1950 that some co-ordination was not only desirable, but essential if maximum benefits were to be made available to the elderly. This was, in a large measure, achieved in 1954 with the formation of the Greenwich Old People's Welfare Association. This body was a reconstitution of the previous Old People's Welfare Committee. It was brought into being not only for the purpose of providing equitable representation between voluntary associations with interest in elderly persons and the elected members of the Borough Council, but so that the resources of the Council and the services of the staff of the Health Department should be made available for the efficient administration of the many schemes which have been developed subsequently. During 1945, hot midday meals obtained from a London County Council Restaurant kitchen were being distributed in the area by the British Red Cross Society. For practical reasons the numbers were limited to 25 daily although meals in bulk were being delivered to one old people's club in Swallowfield Road. Section 31 of the National Assistance Act, 1948, although specifically precluding active participation by the Council, enabled it to make 115 grants to voluntary organisations to permit expansion and extension to their "meals-on-wheels" scheme and, from the 1st January, 1950, the Council made its first grant to the British Red Cross Society for this purpose. At that time the Council felt that the meal provided, although generally satisfactory, was, perhaps, not dietetically suitable for old people and when the London County Council suspended its kitchen service in January, 1955, advantage was taken to enter into a more satisfactory arrangement with a local restaurateur. During 1964, meals-on-wheels were being supplied at an annual rate of 36,000. It was realised by the Greenwich Old People's Welfare Association that the "meals-on-wheels" scheme did not reach all those older folk who required some supplementation to their diet. In 1956, therefore, it made available to the retired people welfare foods at preferential rates and the growth of this scheme has been substantial. Stimulated by the obvious advantages accruing from the "meals-on-wheels" scheme, the Greenwich Old People's Welfare Association made determined efforts to ensure that, not only homebound but other elderly people were afforded the opportunity to obtain a balanced, hot midday meal. Accordingly, as a pilot scheme, a luncheon club was opened at the Minor Hall in October, 1963. This proved so successful that, by the end of 1964, two more luncheon clubs were in operation and the opening of a further two was under active consideration. These luncheon clubs, besides providing a satisfying meal at a nominal price, have an added therapeutic value. They attract the elderly from their homes and, in so doing, maximum benefit is derived by the aged from the effort of dressing and titivating and the energy, mental and physical, involved in mixing with others. Furthermore, the chances of getting the diners interested in outside activities is greatly enhanced. Support in the form of a grant was being given in 1951 to the W.V.S. and its four "Darby and Joan" Clubs and in 1953, the Council, by giving a substantial sum to the Greenwich Old People's Welfare Committee, enabled 114 elderly people to take a holiday at Margate. Homebound were taken to Lancing for their vacation and other groups of people unsuitable for this type of holiday were catered for by outings into the Kent countryside and by parties and entertainments at the Council's Community Centres. These arrangements became permanent and popular annual features in the old people's calendar. Demand for holidays became greater than could be satisfied under the conditions then prevailing, for other Boroughs were making increasing inroads on 116 available holiday accommodation. The Council decided, therefore, to have its own hotel and, after much search and effort, one was purchased at Westgate-on-Sea for the exclusive use of Greenwich residents. It was clearly the Council's intention that the Hotel should not be a convalescent home, but that it should provide a cheerful holiday and recreation for its guests. Nevertheless, although the guests were to be active, provision was made for the frail and handicapped to be accommodated on the ground floor. Success was a foregone conclusion and the scheme is now geared to provide up to nearly 1,000 holidays per year. Since the official opening in April, 1964, 716 elderly people have had the benefit of a holiday at Westgate, of whom 437 were away for the first time under such a scheme. By the end of 1954, the regular bathing of old people in their own homes and at the bathing centre had become established and the introduction of an incontinent laundry service at the same time brought welcome relief to many households. In addition, a scheme was put into operation for the temporary supply of linen, etc., to people whose own was being laundered and co-operation with voluntary organisations resulted in the repair and replacement of outworn articles. It quickly became apparent that the existing premises would prove inadequate for such rapidly expanding services, but economic conditions at that time prevented improvement of facilities beyond providing more staff and equipment in a very restricted space. Government permission was eventually obtained for the building of a new Cleansing and Bathing Centre which was finally opened in October, 1961. From the modest beginning of some 5,000 laundered articles per year and the bathing of a few carefully selected patients the service is now running at an annual rate of 64,000 laundered articles and nearly 5,000 baths, over half of which are given at home. In the interests of old age pensioners generally, special rates for them on certain days were agreed with two local launderettes. With the introduction of the new building, opportunity was taken to provide facilities for foot treatment and in 1963, a chiropody service for our old folk was inaugurated. In addition to treatment at the Centre, arrangements were made for domiciliary visits in specially selected cases. With the formation in July, 1954, of the Greenwich Old People's Welfare Association came the co-ordination and drive which were unobtainable while the voluntary organisations were operating as separate units. Its support enabled old people's clubs to become viable and their numbers rose rapidly. Under its guidance and with the Council's blessing and assistance, a "day 117 club" was set up at Charlton House in November, 1956, and the following year saw two more established, one at Kidbrooke House and the other at West Greenwich House. These latter efforts have proved to be one of the most valuable of all the schemes introduced for the wellbeing of our old folk. From 1954, provision and distribution of Christmas food parcels to the housebound has been organised by the Association which also arranged for the delivery of frozen Christmas dinners on Christmas Eve to those elderly citizens known to be entirely alone at the festive season with no one to cook for them. Twenty-one invalid wheelchairs were purchased and are on free loan to handicapped elderly persons thus enabling friends and relatives to take them out of their homes during fine weather. Bed linen and draw sheets, etc., have been purchased and are held in store for issue on loan to the homebound who are in difficulties. An S.O.S. scheme for the elderly has been implemented and, recently, some thought has been given to introducing a "good neighbour" service but, due to the imminent amalgamation of the borough with Woolwich, it was thought advisable to defer action. Making possible the attendance of the elderly at carol services, the organising of Christmas, garden and other parties, the staging of concerts and handicraft exhibitions, the arranging for outings and visits to film shows and circuses, etc., all these and other features show the Association's concern for the aged. Moreover, in instituting street appeals and house to house collections it demonstrates its belief in self-help. All in all. the Greenwich Old People's Welfare Association is as good an example as can be found of what such an organisation ought to be. The following list gives a summary of the various clubs and services available to the elderly of Greenwich at the end of 1964:— 118 Club Place of meeting Day DARBY AND JOAN CLUBS Charlton House Charlton House, Charlton, S.E.7. Wednesday Club 1.30 p.m. Charlton Liberal 560, Woolwich Road, Charlton, Tuesday 2 p.m. Club S.E.7. Heathside Social Blackheath Hill, Greenwich. Wednesday 2 p.m. Club S.E.10. Minor Hall Club Minor Hall, Royal Hill, Wednesday 2 p.m. Greenwich, S.E.10. "Oaklands" Club Civil Defence Training Centre. Monday 2 p.m. r/o 86. Shooter's Hill Road. Kidbrooke, S.E.3. Sunshine Club Charlton House, Charlton, S.E.7. Wednesday 2 p.m. Victoria Hall Victoria Hall, Woolwich Road. Wednesday 2 p.m. Club Greenwich, S.E.10. NATIONAL FEDERATION CLUBS Blackheath St. Mary's Hall, Cresswell Park, Tuesday 2 p.m. Branch Blackheath, S.E.3. Charlton No. 1 Charlton Conservative Club. Friday 2 p.m. Branch Charlton Church Lane, Charlton, S.E.7. Charlton No. 2 Congregational Church, Bramshot Thursday 2 p.m. Branch Avenue, Charlton, S.E.7. Greenwich No. 1 Minor Hall, Royal Hill, Monday 2 p.m. Branch Greenwich. S.E.10. Greenwich No. 2 Minor Hall, Royal Hill, Tuesday 2 p.m. Branch Greenwich. S.E.10. OTHER CLUBS Albany Institute Creek Road, Deptford, S.E.8. Friday 2 p.m. Kidbrooke Senior St. James' Church, Kidbrooke Wednesday 2 p.m. Citizens' Club Park Road, S.E.3. St. Mary's St. Mary's Church, Charlton Park Alternate Fridays "Over 60" Club Lane. S.E.7. 2.30 p.m. DAY CLUBS Charlton House Charlton House, Charlton, S.E.7. Monday to Friday Day Club 10 a.m.- 4 p.m. Kidbrooke House Kidbrooke House, Shooter's Hill Monday to Friday Day Club Road. S.E.3. 10 a.m. - 3 p.m. (Homebound Persons only by arrangement) West Greenwich 141, Greenwich High Road. Monday to Friday House Day Club S.E.10. 10 a.m. - 4 p.m. 119 120 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. R. V. Boyd 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 1964:— No. of cases on Register at 1st January, 1964 2,087 Cases removed from Register 381 Cases added to Register 643 No. of Cases on Register at 31st December, 1964 2,349 Visits re:— First 571 Subsequent 7,835 Unsuccessful 997 Rest Homes, Hospitals, etc. 96 Miscellaneous 151 9,650 Attendances at Home Baths 5 Arrangements made for:—(a) Statutory Services 408 (b) Others 737 Interviews at Offices 317 No. of visits for Holidays—General 287 Special 151 Bathing Centre Sessions 106 *No. of Baths:—At Home 2,620 At Centre 1,892 No. of persons receiving foot treatment 82 Chiropody:—No. of Sessions 104 No. of 1st Attendances 90 No. of subsequent Attendances 619 No. of Treatments:—At Home 317 At Centre 392 No. of persons having hair washed 8 No. of articles cleansed 63,191 Attendances at O.P.W. Committee 9 *Males 1,682, Females 2,830 121 Cases Referred:— From To 22 G.O.P.W.A 9 218 Hospitals 89 75 Home Help Organiser 167 93 District Nurses 45 51 Relations 17 34 N.A.B 29 80 British Red Cross 150 30 Housing Department 68 39 Doctors 92 13 Church & Club Organisations 13 39 Health Visitors 11 37 W.V.S 26 14 District P.H.I.s 22 8 L.C.C. Mental Welfare 16 2 L.C.C. Blind 6 13 L.C.C. Admitting Officers 43 9 L.C.C. Welfare 9 4 Chest Clinic 5 15 Miscellaneous — 43 Found on District — 98 Personal Request — 30 Neighbours — 29 Councillors — 14 Pensions Book Pink Card — — Citizens Advice Bureau — — Medical Officer of Health 19 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 122 method especially if the situation is explained carefully to old people that the Health Department is here only to serve their best interests. Cleansing of Old People.—Section 43 of the London County Council (General Powers) Act, 1953, provides for the cleansing of any aged person in the district who : (a) is verminous or for any other reason in need of cleansing in order to prevent injury or the danger of injury to health; and (b) is so enfeebled that he is unable to avail himself of any facilities for cleansing himself provided by the authority under any enactment or to cleanse himself properly In this respect, during the current year, 1,892 baths were given to elderly persons at the Cleansing Station and 2,620 home baths were effected. Figures for the previous year were 1,763 and 2.007 respectively and in 1962 the figures were 1,348 and 2,017. 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. Bv the end of the year the laundry service, supervised by the Lady Public Health Inspector, had been extended to 259 separate individuals and during the current year, the staff at the Cleansing Station have dealt with 63,191 articles which were collected, laundered and delivered. 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. 123 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 1964, 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 £11 11s. 6d. Exhumations.— One exhumation was carried out during the current year and the Public Health Inspector was present to see that all the usual precautions were observed. 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 396 bodies were so accommodated (251 at Deptford and 145 at Lewisham) at a cost to the Council of £679 7s. Od. Summary of Work Performed by the Public Health Inspectors during the Year 1964 Inspections— Houses inspected (House-to-House) 16 „ „ (Complaints, nuisances) 885 „ „ (Infectious Disease) 297 „ „ (Overcrowding) 59 Inspections of Factories 337 „ „ Shops 37 „ „ Canteens 16 „ „ Hairdressers or Barbers 63 „ „ Licensed Victuallers and Clubs 85 „ „ Underground Rooms 6 „ „ Pet Shops 3 „ „ Stables and Yards 2 „ „ Urinals 15 „ „ Houses in Multiple Occupation 40 „ „ Outworkers premises 39 „ Under Clean Air Act 4,895 „ Miscellaneous 1,319 Inspection of Premises (Slum Clearance) - „ „ „ (Rent Acts) 5 Inspections of Offices, Shops and Railway premises 69 Investigations (Rats and Mice) 433 Investigations (Insect Pests) 57 On notice from Architects and Builders 847 Re-inspections, calls made, etc 5,428 14,953 124 Drains— Drains tested—by smoke 133 „ „ —by water 310 Opened, cleansed and repaired 276 Reconstructions and additions 235 Inspection chambers constructed 169 New covers to manholes 101 Soil and vent shafts repaired or renewed 167 Traps (gully) 233 Drains sealed off, etc 74 Yards and forecourts drained 37 W.C. Compartments erected or repaired 235 W.C. fittings repaired or renewed 150 W.C. pedestals installed or renewed 284 Sanitary conveniences or improvements effected to Factories and Workplaces 13 Urinals cleansed or repaired 6 Dustbins— Provided 124 Pavings— Yards and Forecourts 57 General Water Supply— Water Fittings amended 154 Water supply restored 19 Extra water supply to tenement houses - Water supply certificates granted (Sect. 95) 497 Other Improvements— Houses generally repaired 70 Rooms cleansed and repaired 290 Rooms and staircases lighted and ventilated 18 Verminous rooms cleansed 23 Roofs, gutters and rainwater pipes repaired 282 Dampness abated 263 Underground Rooms (enforcement of Regulations) 13 Sinks, baths and lavatory basins provided 411 Sink, lavatory and bath waste pipes trapped or amended 295 Stoves and fireplaces 21 Washing coppers repaired or provided - Floors repaired 103 Provision for storage of food 156 Miscellaneous repairs 312 Other Nuisances Abated— Illegal use of Underground rooms discontinued 3 Overcrowding abated 7 Animals kept in unfit places discontinued or removed 4 Dung receptacles provided - Accumulation of manure and other obnoxious matter removed 17 Rat infestation abated 93 Smoke Nuisances— Observations 293 Statutory Notices served - 125 Notices. &c.— Intimations served under Public Health (London) Act, 1936 273 Statutory Notices served 98 House rendered fit by informal action 101 Legal Proceedings Premises Offence Result of Proceedings 27, Hervey Road Non-Compliance of Statutory Notice Order for work to be executed within 21 days. Awarded £3/3/0 costs. 126 SECTION D Housing Prior to 1939, housing difficulties had been encountered mainly in the lower income groups and, until the Housing Act, 1949, local authorities' housing powers were restricted to the benefit of persons of the working class only. Today, all income groups are concerned with this vital question of housing. What is the essence of this perplexing "housing" problem? Curiously enough it has different meanings for different people. To some it is the continued existence of slums or the homeless in Part III accommodation—to others it means heavy mortgage costs or the exorbitant cost of building land. Again, to some it is the lack of houses to rent and to others the shortage of accommodation for our elderly folk. Obviously the problem is the sum total not only of these points but also of a number of others such as finance, materials, building resources and skills, etc. However, in the final analysis, the problem as a whole, cannot be dealt with in isolation but must be judged and afforded its rightful priority in the light of the country's economic position. One thing is certain and that is, if emphasis is laid upon one aspect of the problem, then supporters of other views will consider it unjustified. Nevertheless, that unsuitable housing conditions are responsible for many of the smaller and some of the larger tragedies of life, is beyond doubt. By reason of its importance in the field of preventive medicine housing is, to a great extent, a public health problem and responsibility. Indeed, the selection and presentation of slum clearance areas is a vital duty of the health department. Moreover, the provision of houses of good standard is a prerequisite for the elimination of disease, mental and physical, and a basis for the maintenance of a happy, contented existence. It would be wrong for anyone to predict that the housing problem is one which will be solved easily and quickly—it is not that kind of problem. Ever since the end of the 1914/18 war, housing has been a major concern to local authorities especially in urban areas and the second world war merely served to aggravate an already difficult situation. However, between the wars, the rate of house building, which reached its peak in 1938, was sufficiently satisfactory to enable slum clearance schemes to operate, but post-war conditions forced a system of "repairs and maintenance" upon local authorities and, inevitably, slum clearance plans had to be held in abeyance. 127 This was extremely unfortunate for the clearance of substandard dwellings was, and still remains, the only practical method of increasing the sum total of dwellings in urban areas. It is no wonder, then, that the acute shortage of living accommodation is still with us. Municipal housing in Greenwich dates from the introduction of the Housing and Town Planning Act of 1919, which enabled the Council to provide, with exchequer assistance, housing accommodation to rent. It acquired leases of several large houses in Blackheath and converted them into self-contained flats. Gaining confidence from this first venture the Council, in 1920, made a compulsory purchase order for the acquisition of approximately 40 acres of land in the Charlton area known as the "Hanging Wood Lane" site on which it was proposed to build 464 houses, and the following year saw the commencement of the scheme. Resulting from the purchase in 1925 of Charlton House and its extensive grounds, the Council was enabled to embark upon further housing projects and, by the end of 1934 (at which time the London County Council began its own housing operations in the Borough), some 1,111 dwellings had been constructed since the first scheme of 1920. By 1939, the number of dwellings erected in the Borough had risen to 4,826 of which the Council had built 1,418, the London County Council 911, and private enterprise 2,497. The nation's house building was brought to a standstill by the war in 1939, during which Greenwich suffered heavily from bomb damage and the destruction of a great deal of its residential property. Serious housing problems arose which were partially resolved by the requisitioning of some 2,000 units of private accommodation under war time emergency legislation. Subsequently, in accordance with the Requisitioned Houses and Housing (Amendment) Act, 1955, de-requisitioning of these properties had to be completed within 5 years and the Council was faced with the formidable task of rehousing the occupants. As this proved impracticable, in accordance with Section II of the Act, several hundreds of properties were acquired, which after conversion realised over 750 units of accommodation. After the war, the Council immediately proceeded to reorganise its housing programme to meet the new and urgent situation and sites at Cherry Orchard, Victoria Way, Springfields, Beaconsfield Road, Pond Road, Coldbath Street, etc., were acquired for the provision of housing accommodation. More recently, substantial London County Council housing at Kidbrooke, Blackheath and at East and West Greenwich gave valuable support to the Council's schemes. 128 Dwellings built within the Borough since the war number 6,303 and, of these, the Council have been responsible for 2,275, the London County Council for 2,630, and private enterprise for 1,398. The total includes 434 "rebuilds" but excludes 815 E.F.Ms, constructed jointly by the Council and the Ministry of Works and a further 59 "mobile homes" erected by the County Council since 1962. At the end of 1964, all but 125 of the E.F.Ms, had been dismantled. Future Housing Prospects. A population projection in 1948 by the Registrar General gave an estimated population figure of 45.28 millions for England and Wales by 1971, i.e., a natural increase of 2 millions between 1951 and 1971. But, contrary to his assumption that the birth rate would fall progressively from its peak of 1947, it began to rise from 1955 onwards and the expected increase of 2 millions in twenty years was achieved in ten. Furthermore, insufficient allowances were made for the fact that, with greater prosperity and better housing, young married couples are less likely to live with their in-laws and also that more elderly people would have their own homes. This has resulted in the average size of household falling from 3.02 persons to 2.85 within a period of ten years. As a consequence, more dwellings are required now than in the past to house any given number of people. At the present time, 18 million people—35 out of every 100 persons in Great Britain—live in the South East of England. This fact is brought out in "The South East Study", a report produced by the Ministry of Housing and Local Government in close co-operation and consultation with other government departments, the contents of which were presented to Parliament in the White Paper of March, 1964. The Report also indicates that, by 1981, the same area will see a rise of 3½ millions in the population of which millions will be by natural increase, i.e., excess of births over deaths and the remainder will be accounted for by immigration. Between the years 1951 and 1961, private households increased by 12.1% in England and Wales, 2.3% in Greater London and 1.6% in Greenwich, whereas the rise in the number of private dwellings was 21.3%, 15.9% and 17.3% respectively. During the years in question, Greenwich made greater progress in closing the gap between households and dwellings than Greater London, or, for that matter, England and Wales as a whole. Nevertheless, despite very vigorous efforts on the part of the Council progress has not been all that could be desired for the difference is still considerable and the problem substantial. The position can be more clearly demonstrated by quoting the number 129 of marriages in Greenwich since 1945, viz., 14,215. On the other hand, dwellings erected during the same period amounted only to 7,177 which figure includes 875 E.F.Ms, and L.C.C. mobile homes. Although for various reasons this latter example does not give a strictly accurate picture, it does indicate the current trend and the serious situation confronting housing authorities. The South East Study Report estimates that, up to 1981, London will require 550,000 additional houses over and above replacement building, and Greenwich will doubtless have to take its fair share of the burden. A new, progressive and enlightened housing policy is called for especially towards the elderly whose needs and numbers are increasing perhaps a little more rapidly than other sections of the community. Greater use of prefabrication also seems imperative. Nevertheless, because of the urgency of the situation there must be no stampeding into hasty decisions and premature actions which, in more sober moments, may be found to be faulty. 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 seem prudent 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. However, with regard to slum clearance, whatever the merits or otherwise of any particular project, it is almost certain to be affected by a labour shortage problem for the rate of slum 130 ance is determined by the number of new dwellings a local authority is able to provide. Available manpower resources in the building trade are insufficient to rebuild our "twilight" areas in the near future and there is no shadow of doubt that altogether, the building industry is set a tremendous task and it will be subject to great strain in attempting to satisfy the need for more houses, schools, colleges, hospitals and power stations, etc. Re-developing all suitable sites is as much as the building industry can cope with for the next decade at least. To forestall any slowing down or hiatus in the provision of further housing accommodation perhaps local authorities could, with advantage, review their slum clearance schemes. Some properties may have been included in schemes on the basis that renovation or conversion would have only a limited life of say 20 years and. by today's standards, this might have been considered unsound financially. Productivity is rising and it may well be practical in these days of urgency to countenance such expenditure with a view to writing it off within a few years, e.g., it is now taken for granted that a motor car produced today will be written off in a few years' time. Preserving some properties which, on paper at least, are doomed for demolition will give local authorites vital breathing space. Much of the scorn poured on Victorian building is "fashion" stimulated but many an excellent conversion has been made from such a property to enable it to serve the community still further. Housing subsidies tend to be a subject of intense social and political controversy and whether housing is to be regarded as a social service or a commercial proposition is today's burning and undecided question. Fortunately, perhaps, such matters are not the concern of public health departments but as finance is certain to be a key factor in the country's immediate future housing policy, some settlement is essential if the existing confusion and indecision is to be avoided. Today, housing need is not always identical with financial position but, if it is considered the duty for a local authority to bear the major responsibility for satisfying the housing needs of families at all income levels, then there are sensible and just reasons why subsidies should be reserved for those families which, as a result of lack of earning capacity, old age or other handicaps are unable to afford economic rents. Allocation of housing would be fairer and would continue on a sounder basis. Moreover, in the long run, this would mean more houses and isn't this really what is needed? Legislation— The Housing Act, 1964.—Effective from 16th August, 1964, this Act is designed to assist housing societies to provide housing accommodation and confers on local authorities the powers and duties to compel the carrying out of works for 131 the improvement of dwellings which are without all or any of the standard amenities. It amends the law relating to the giving of financial assistance for the improvement of housing accommodation and extends the powers and duties of local authorities in respect of houses in multiple occupation. Provisions relating to contributions to certain expenditure incurred under the Clean Air Act, 1956, are also amended by the Act. 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 subsequently 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 40 visits were made by Public Health Inspectors to houses in multiple occupation and 40 notices were served as follow: — Notice of entry for the purpose of inspection, etc., to occupiers and to owners where known 30 Notice requiring statement of persons sleeping in a house 2 Notice requiring information as to ownership of premises 4 Informal notice requiring execution of works 4 Housing Act, 1957—The following procedures were carried out under Part II of the above Act during 1964:— 132 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 properties 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. 497, Woolwich Road, S.E.7—Rear Room 746, Woolwich Road, S.E.7—Front and Rear Rooms. (Closing Orders) In respect of the following premises, a Closing Order previously made was determined during the current year. 29, Brand Street, S.E.10. (Closing Order Determined.) Part of Building—Section 18.—In respect of the following premises, a Closing Order previously made was determined during the current year. 82, Selcroft Road, S.E.10. (Closing Order Determined.) Slum Clearance—Part III of the Act.—Although no new clearance schemes were undertaken in 1964, the Lansdowne Lane and Charlton Lane areas represented during the previous year were confirmed by the Minister (both with minor modifications) in June and September respectively of the current year. 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 1963, some 107 houses and a number of prefabricated dwellings had been demolished and some 143 dwellings and 34 garages had been erected. During 1964, the Trustees were responsible for the following operations :— Properties Demolished—1/21 Pelton Road (11 dwellings) and 41 and 43, Banning Street (2 dwellings). 133 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 rehouse 1. New Properties Completed—Thirty-five houses were built— 2/36 (even), Morden Street (18 dwellings), 1/11 (cons.), Bennett Grove (11 dwellings) and 5/15 (odd), Orchard Hill (6 dwellings). I am indebted to Mr. K. B. Leverton, Surveyor to the Morden College Estate, who so kindly provided this information. House Purchase and Housing Acts, 1958 and 1959.— Improvement Grants.—Section 20 of the Housing Act, 1949, as modified by Section 16 of the Housing Repairs and Rents Act. 1954, empowering local authorities to make grants to private owners for improvements and conversions of sums up to £400 or half the cost, whichever is the less, where the dwellings would provide satisfactory accommodation for more than 15 years, has now been replaced by Section 30 of the Housing (Financial Provisions) Act 1958. These grants are now known as discretionary grants. During the year 63 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 28 such grants had been agreed. Re-Housing.— (a) Borough Council.—There were 233 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 464. Of this number 4 were in respect of overcrowded cases and 11 families re-housed from outside the Borough. The Housing Department now has control of 4,693 Councilowned units of accommodation, an increase of 279 over that of the previous year. (b) London County Council.—During the year ended 31st December, 1964, the L.C.C. had provided alternative accommodation for a total of 325 Greenwich families of which 2 had been certified as overcrowded cases. Of this figure, 196 were housed on L.C.C. housing estates outside the Borough. Two families from outside Greenwich were rehoused in the Borough under the L.C.C. scheme. 134 (c) Other.—One family was rehoused by other means. Overcrowding.—As a direct result of rehousing carried out under (a), (b) and (c) above 7 cases of overcrowding were abated during the year under review. The number of unabated certified cases of overcrowding in the Borough now amounts to 35. During 1964 there was a fall in the number of complaints received concerning overcrowding, the year's figure of 36 showing a decrease of 23 from that of the previous year. Each complaint was investigated by the Public Health Inspector concerned and as a result of these investigations 11 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. 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 1963 15 18-year average 68 1964 11 135 New Housing Accommodation.—The following table lists the new dwellings erected in the Borough during 1964:— Type of Dwelling G.B.C. L.C.C. Private Total Houses 46 35 62 143 Flats and Maisonettes 187 80 41 308 Mobile Homes — 46 — 46 Total No. of Dwellings 233 161 103 497 The total number of dwellings provided in the Borough since the termination of the war is now 7,177, which includes 815 E.F.Ms, and 59 mobile homes. Movable Dwellings.—Again the current year saw a substantial increase in the number of homeless seeking accommodation from the County Council. Although no formal applications were received from the London County Council during the current year for licences to utilise vacant sites in the Borough for movable dwellings, 46 mobile homes were erected on vacant sites at Eastmoor Street, Herringham Road, Lydenberg Street and Mirfield Street in accordance with licences issued in the previous year. By the end of the year and in accordance with Section 22 of the London County Council (General Powers) Act, 1959, the 11 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 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." 136 Site Area Movable Dwellings Farjeon/Holburne Road .35 acres 6 McMillan St./Creek Road .3 acres 6 Fairfield Grove .35 acres 7 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 1 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 gi eat est 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 28 Vanbrugh Park 106 Heath way 18 Wellington Gardens 14 Shooters Hill Road 27 Hervey Road 4 137 (b) Building programme for rehousing envisaged for 1965, et seq:— Site Dwellings Maze Hill 25 Coleraine Road/Humber Road 37 Woolwich Road/Charlton Church Lane 39 Kidbrooke Park Close 77 Old Dover Road 150 Rochester Way 42 Delafield Road/Charlton Church Lane 3 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 1964:— "During the year, 272 families were housed as compared with 170 for the corresponding period 1963. Nevertheless, output from new building schemes fell somewhat short of estimated completions through delays affected by supplies and labour difficulties. However, one very gratifying feature of the new building programme was taking over the 18 storey tower block of 72 two bedroom type flats on the Thornham Estate. The completed estate will provide 164 dwellings and incorporate a nursery centre for the under five years old. This redevelopment scheme has been formed by the extinguishment of Thornham Street, Haddo Terrace and the realignment of Norman Road where it joins Creek Road. The block. 138 situated on the outside bend of the river Thames, commands a particularly fine view of the river itself together with the nearby historic buildings. From due east, through north to the southwest, a panoramic view across London is possible. Another estate now completed included Lansdowne Lane of 54 dwellings where the Housing Committee included a specially designed disabled person's ground floor flat with integral garage. This type of disabled persons' flat is one of a number already provided in other new housing schemes. Vanbrugh Park and Heathway, Blackheath, of mixed development, producing a total of 227 dwellings, comprising bedsitters, two, three and four bedroom type flats, maisonettes and houses, is scheduled for completion during the ensuing year. Other schemes so far approved but not yet commenced will provide for 500 additional homes. In addition, plans are being prepared to build a further 500 dwellings during the period 1966/67. The policy of acquiring suitable private dwellinghouse property by free negotiation with the owners has continued. Where necessary, these properties are converted and improved to standard requirements and form a valuable contribution to the general housing pool. General Waiting List. Compared with 1,735 registrations at 31st December, 1963, the number as at 31st December, 1964, was 2,071, an increase of 19.36%. Apart from the accepted fact that young married couples seek security of tenure with the local housing authority, the movement of population into the London area continues unabated from the North East, North Midlands and immigration from Commonwealth countries. Under-Occupation Transfers from larger to smaller type Council dwellings are given priority from which is derived valuable housing accommodation for larger families. 140 transfers were effected during 1964. Sociological and Medical Cases also attract certain priority on the assessment and advice of the Council's Medical Officer of Health and housing Welfare Officer. Reciprocal arrangements continue with the London County Council and other local authorities to the ultimate benefit of families affected by movement involving employment and sociological problems. Another beneficial service undertaken by the department in collaboration with the London County Council is the provision of 139 special amenities, i.e., handrails, ramps and various modifications to assist handicapped persons. Here again the department's Welfare Section is invaluable in establishing re-settlement following rehabilitation. Exchange of accommodation—here 31 cases were approved, involving Council and private housing inside and outside the London area. Another housing service which the Council have for the first time provided is the adaptation of a large house into eight flatlets for occupation by spinsters locally engaged as nurses, teachers, etc., for whom no such provision has so far been made in the Council's allocation scheme. With the advent of amalgamation under the London Government Act, 1963, it may be appropriate to note that from the vesting date, 1st April, 1965, a new era will emerge in London housing. It is anticipated that one result will be to accelerate throughout the new London area the rate of house building to meet demand and so provide good standard type homes in which many at present without a separate home may look forward to the opportunity of living a normal family life." 140 SECTION E Inspection of Food and Supervision of Food Premises In 1959, the Government set up a committee to look into the whole field of consumer protection and its report, now known as the Molony Report, was presented to Parliament in 1962. It had this to say about the Food and Drugs Act, 1955, "it is difficult to conceive of more far-reaching provisions and powers than this Act contains for the protection of the consumer against unfit or deleterious food and drugs"—and with regard to arrangements made for the enforcement of the Act "we are unable to envisage a better system to handle the difficult and contentious issues which inevitably arise". On reflection, this is a most handsome compliment to be paid officially to local authorities throughout the country, and it is perhaps a remarkable co-incidence that this occurred at a time when the Metropolitan Borough Councils were about to be dissolved in the general re-organisation of London government. Such striking confidence is the result of just over a century of the implementation of legislation, for it was in 1860 that the first Act of Parliament for the prevention of adulteration of food and drink was passed, to be followed in 1875 by the Sale of Food and Drugs Act, which made the appointment of public analysts compulsory. No one can deny that there have been many changes in the nation's food habits, and the problems of control are now infinitely more complex. Moreover, although deliberate adulteration has been almost eliminated, other complications have arisen. Broadly these can be directly attributable to the practical application of preventive medicine and the resultant reduction in early deaths and mitigation of disease. World population has expanded correspondingly and the rate of this expansion is accelerating. It follows that there is now an unremitting demand for more food production. Previously, I have commented upon the fact that it has been estimated that 1,500 million people throughout the world to-day are suffering from malnutrition mainly from a protein deficient diet which produces high infant mortality, stunting of physical growth and mental development, and reduced resistance to infection and disease. Moreover, I have indicated that world population is rising rapidly, the rate of increase being in the order of some 65 millions per year, roughly the population of the United Kingdom. Furthermore, when one remembers that although having the highest productivity rate per acre in the world, agriculturally this 141 nation is still not self-supporting, the reasons for a substantial increase in world food production become even more compelling. This has become the world's most human and pressing problem. Strenuous efforts to improve dairy farming and make a positive contribution to reduce the world food deficiency are being made by geneticists who, with the aid of hormones and computers, are trying to increase the reproduction rate of sheep in this country wnicn is notoriously low in the present breeds. Interbreeding with Romanoff stock or with the black sheep of Abyssinia and the rare Landrace of Finland, all of which have four or more lambs yearly, is already showing some startling results. It is estimated that, suitably supported schemes of this nature could, within 10 years, replace Britain's existing breeds with others of greater fecundity. The possibilities in this sphere are unlimited and the extension to other farm animals a mere formality. With similar methods the geneticists have already managed to increase the production rate of chickens by 50 eggs per year on 20% less food. Unfortunately, the areas of greatest malnutrition are those of the under-developed and over-populated countries, where the chances of improved food output are remote, if not impossible. The more developed and civilised areas of Europe and America are, therefore, charged with the responsibility of making good this world food deficiency. However, it cannot be over-stressed that most of the arable land in these countries is already under cultivation, and increases in production are to be achieved only by the use of modern scientific and technological methods which include the use of artificial fertilizers, pesticides and herbicides, not to mention the use of antibiotics, coccidiostatics, tranquillizers, anthelminthics and hormones in dairy farming. If present in sufficient quantities, effects of ingesting many of these compounds can be dangerous and far reaching. It is no small wonder, therefore, that great anxiety has been expressed not only about the increased chemical manipulation of food, but also the use of newer additives in the field of preservation, which, as a result of the need for greater food conservation, has become more vital than ever especially in respect of "out-ofseason" comestibles. As if these burdens were hardly enough for local authorities to carry, other serious problems are threatening. Long-lived fission products such as strontium 90, iodine 131, caesium 137, etc., residues from nuclear experiments, will be held in the soil for many years to come and will eventually find their way into the nation's food. At the moment the amounts are negligible, but the situation requires constant vigilance. Examination of such 142 stuffs is getting progressively more difficult and with these more subtle forms of contamination, analysts are confronted with situations requiring completely new techniques and methods of analysis. The problems of "food borne" infections loom large and food inspectors must be on their guard against bacterial contamination such as salmonellosis, against viral and rickettsial infections such as infectious hepatitis; against amoebic dysentery resulting from protozoal pollution and against the zooparasitical complaints of ascariasis and trichinosis. Generally, until shocked into awareness as in the current Aberdeen typhoid outbreak, the public remain blissfully ignorant of the risk to health from bacterial contamination of food and it is usually only the unfortunate sufferer who realises how much personal inconvenience and loss of working time can be caused by food poisoning. Canned food carries far less risk of salmonellae, Clostridium welchii and staphylococcal infection than ordinary food, the main hazards in this case being under-processing during heat treatment and leakage whilst being cooled. Fundamentally, progress in food hygiene and even the maintenance of existing standards are based upon human factors and no amount of legislation can eliminate this human element. For example, making staffs personally responsible for the notification of certain ailments, although well-intentioned, runs counter to the personal interests of the worker who fears the resultant reduction in wages. Yet it is likely that the majority of our outbreaks of food poisoning arise from just this situation where the food handler fails to notify his illness (assuming he is aware of its potential danger), continues with his duties and so constitutes a hazard to the public at large. There is no doubt but that the answer to most food contamination problems lies in personal cleanliness and health education and, in the food industry generally, a great need exists for the training and retaining of responsible staff. One can only register disappointment with the fact that in a rapid staff turnover, even the present trained personnel are being replaced by relatively unskilled labour unwilling or unable to take advantage of training schemes introduced by enlightened and progressive employers. It is evident that the powers necessary for the compulsory registration of eating houses still constitutes a serious omission and domestic animals are still not specifically banned from cafes and food shops. Some reprehensible practices, such as the touching of food when setting it out and the serving of meat sandwiches and cakes by hand still exist and, further, the pernicious habit of cooking a joint today for tomorrow's meal persistently produces its yearly crop of infections of staphylococcal origin. 143 Approximately half the food consumed in the United Kingdom is imported and some 60% of all meat imports into the country are received at the London Wharves. To a riparian authority such as Greenwich, the resultant food inspection is complicated and often arduous, for examination of food at wharves and in cold stores usually requires a quick decision in order that no delay should be occasioned to the importer or his distributors. Such a situation is aggravated by the time taken for the results of bacteriological and chemical examinations to become known and the fact that storage space at the docks is expensive. However, with mutual respect and co-operation over a number of years a reasonable, workable system has evolved. Despite all the attention paid to imported products, some infected food does slip through as witness the Aberdeen typhoid outbreak. To avoid just such an occurrence it has recently been proposed that all imported meat, frozen or canned, should be subjected to irradiation by 'cobalt 60'. Experiments have shown that this treatment is quick, effective, does not alter the taste or appearance of the meat and carries no risk of induced radio-activity. If proof were needed, this is an example of how technical and scientific food inspection and examination is becoming. Scientific progress is increasing the difficulties of the food inspector for it is revealing hazards, new or previously unrecognised, which demand increased sampling as a temporary measure until the problems can be dealt with at source. Much attention is now being directed towards producing standards of composition and nomenclature for various commodities in relation to their contents, especially with regard to meat products. High pressure sales promofion in the advertising field has resulted in attractively labelled foods which, on analysis, are found not to be what they are purported to be. Accurate labelling is one of the aims of all who are directly involved in consumer protection. To-day, the intricacies of misleading labelling, the very real dangers of infection and contamination are such that it requires the closest team work between the Medical Officer of Health, the Food Inspector, the Analyst, the Bacteriologist and, not least, the Food Trader himself to reduce it to a minimum. Legislation.—Of the new legislation introduced in the current year concerning food, the following regulations were considered the more important:— The Meat (Treatment) Regulations, 1964.—Operative from 23rd January, 1964, these Regulations, made under Sections 4 and 144 123 of the Food and Drugs Act, 1955, make it an offence to sell, consign or deliver any raw and unprocessed meat intended for sale for human consumption which contains any added substance of a kind specified in the Schedule to the Regulations, viz. ascorbic acid, erythorbic acid, nicotinic acid, nicotinamide and any salt or derivative of any of the above-mentioned substances. The Fertilisers and Feeding Stuffs (Amendment) Regulations, 1964.—Made under Section 23 of the Fertilisers and Feeding Stuffs Act, 1926, these Regulations amend those of 1960 and now cover nitrogenous gas liquor and its analysis. Further, the Regulations, which are effective from 1st March, revise and simplify definitions and certain methods of analysis and provide for the marking of bulk containers or tankers containing liquid fertilisers and for taking samples from them. The Dried Milk Regulations, 1964.—Effective from 11th March, 1965, these Regulations re-enact with amendments the Public Health (Dried Milk) Regulations, 1923/48. The principal changes are:— (a) minimum and maximum percentages are prescribed for the milk fat content of dried milk; (b) the upper limit for the milk fat content of dried skimmed milk has been reduced and the description "dried low-fat skimmed milk" is permitted as an alternative description; (c) a maximum moisture content is prescribed for all descriptions of dried milk; (d) containers of dried skimmed milk are required, and containers of any other dried milk are permitted, to carry a declaration as to the milk fat content; (e) the regulations do not apply to dried milk intended for export or for consumption by a visiting force, to any sale of dried milk to a caterer or manufacturer nor to any sale for immediate consumption. The Soft Drinks Regulations, 1964.—These Regulations, made under the Food and Drugs Act, 1955, and fully operative from 2nd June, 1965, revoke the Soft Drinks Regulations, 1963 (which would have come into operation on the 20th July, 1964) and re-enact, with amendments, the Food Standards (Soft Drinks) Order, 1953, and the Food Standards (Soft Drinks) (Amendment) Order, 1954, and the Soft Drinks Regulations, 1963. The principal changes are;— (a) standards of composition have been introduced for semisweet and low calorie soft drinks and labelling provisions for these drinks are laid down; 145 (b) the use of cyclamic acid and its sodium and calcium salts is permitted as artificial sweeteners in soft drinks in place of or in conjunction with saccharin; (c) the descriptions of soft drinks sold from vending machines and, where appropriate, a declaration of the artificial sweetener content must appear on such machines; (d) the regulations do not apply to soft drinks intended for export or for consumption by H.M. forces or by a visiting force nor to sales to manufacturers for their businesses nor to any sale for immediate consumption. The Mineral Hydrocarbons in Food Regulations, 1964.— These Regulations which came into operation on 15th August of the current year, re-enact, with amendments, the Mineral Oil in Food Orders and Regulations, 1949 to 1955, and prohibit (subject to certain exemptions relating to dried fruit, citrus fruit, sugar confectionery, lubricants, cheese, eggs and chewing compounds) the use of any mineral hydrocarbon in the composition or preparation of food, the sale of food containing any mineral hydrocarbon and, on and after 15th February, 1965, the consignment, delivery or importation of any food containing any mineral hydrocarbon. The Regulations make provision for (a) the condemnation of food containing mineral hydrocarbon in contravention of the regulations; (b) penalties for their infringement; and (c) enforcement by food and drugs authorities. During the current year in Circulars 3/64, 12/64, 21/64 and 25/64 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 were officially recognised in respect of the following countries:—France, Singapore, Roumania, U.S.A., Austria, Argentina, Brazil, Paraguay, Uruguay, New Zealand, Australia and Hong Kong. In Circular FSH 15/64 the Ministry of Agriculture, Fisheries and Food drew attention to the Milk and Milk Products Technical Advisory Committee's report on antibiotics. Although providing effective treatment for mastitis in dairy cows, antibiotics are excreted in the milk for a limited period after treatment and medical opinion considers that such milk would have ill-effects on people who are, or may become, sensitive to these substances. The Circular outlines the steps already taken in accordance with the report's recommendations such as testing at dairies and by 146 food and drugs authorities, and arrangements with the pharmaceutical industry for the suitable labelling of antibiotic preparations. It reminds farmers of the need for withholding the milk from treated animals for the requisite period and informs interested authorities of its efforts in the publicity field. 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 Borough must be registered as a Distributor. The number of Distributors registered at the end of the year was 99, an increase of one over that for 1963. On 84 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, 1963.—These regulations, fully operative from the 1st October, 1964, 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 147 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 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". 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, 1964: — Licences In Operation issued 31.12.64 Distribution of Sterilised Milk 4 94 „ „ Pasteurised Milk 4 69 „ „ Tuberculin Tested — 44 148 Sampling.—Under provisions of the Third Schedule to the above-mentioned Regulations, Methylene Blue and Phosphatase tests are prescribed, the former for assessing the "keeping" qualities of milk, and the latter for estimating the efficiency of pasteurisation. In addition, a Turbidity test is also prescribed for ascertaining the effectiveness of the heat treatment of Sterilised milk and, with regard to Tuberculin Tested Milk, the new Regulations have introduced a further test—the clot-on-boiling test. During the year, 30 samples of milk consisting of 13 Pasteurised, and 17 T.T. Pasteurised were examined in accordance with the prescribed tests. Two samples, one of each type of milk, were not subjected to the Methylene Blue test, the atmospheric shade temperature at the time exceeded 70°F. One sample of T.T. Pasteurised milk, taken from an automatic milk machine, failed the Methylene Blue test but investigations revealed a fault in the refrigeration section and this was subsequently rectified. Four "follow-up" samples, all taken from this machine, proved satisfactory. Analytical Examination of Milk.—All designated milks being sold in the Borough were sampled, including those of the superfatted variety, viz., Channel Island, Jersey, South Devon, etc. A total of 26 samples, 24 formal and 2 informal, were submitted to chemical analysis and all proved to be genuine. Seven samples of cream were taken 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 88. 149 One hundred and fifty-seven visits of inspection were made to Preserved Food premises and Fried Fish shops as a result of which several sanitary defects were remedied. Ice Cream Premises.—By the end of the year the total number of registered Ice Cream premises stood at 232. Visits to these premises were made on 180 occasions and six improvements were effected. Manufacture and Sale of Ice Cream.—As the public's appreciation of the food value of ice cream increases, so consumption rises but, as yet, no legal bacteriological standard exists. From time to time representations have been made to the Minister of Health with a view to the adoption of a bacteriological standard of cleanliness but he has made it known that he is satisfied that no existing test is precise or selective enough to justify its adoption as a statutory measure. In his opinion the methylene blue reductase test affords a simple and valuable "rule of thumb" method for the measurement of the bacterial cleanliness of ice cream indicating the necessity or otherwise of further investigation into methods of production. However, in order to minimise the risk of contamination and the spread of infection, the policy in Greenwich has been to encourage the sale of "wrapped" or "carton" ice cream in preference to the manufacture and sale of it " loose." The Ice Cream (Heat Treatment, etc.) Regulations, 1959/63.— 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. 150 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 previous 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 37 samples were submitted for examination and the ice-cream graded according to the Ministry's provisional Grading Scheme. The grading is based on the results of the Methylene Blue Reductase Test and a summary of this year's reports is given below :— Samples Time taken to Reduce Provisional taken Methylene Blue Grade Observations 15 4½ hours or more 1 Satisfactory 5 2½ to 4 hours 2 Sub-standard 3 ½ to 2 hours 3 Unsatisfactory 4 0 hours 4 Most Unsatisfactory 10 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 37 samples taken during the current year, 18 were of the "soft" variety, 7 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 151 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. Only one factor emerged from this test sampling of "soft" ice cream. All the unsatisfactory samples were thrown up during the summer period. So far no definite conclusions have been reached and, whilst investigations into the vagaries of "soft" ice cream are to continue to re-assess, 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. No examinations were undertaken during the current year in connection with quantitative analysis. 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 six 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 152 vendors and to this end a Food Inspector was always in attendance. In all, 8 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. 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 3,235 visits, as result of which 78 improvements were effected. 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. 153 Premises Inspected or Visits Made No. of Visits No. of Premises at which Improvements were effected Caterers', Restaurants, etc. 175 21 Grocers, Greengrocers 356 16 Butchers' Shops 163 19 Dairies and Milk Distributors 84 - Wharves and Factories 600 - Bakehouses and Bakers' Shops 28 9 Ice-Cream Premises, Confectioners, etc 180 6 Fried Fish Shops 27 2 Other Fish Shops 26 5 Cooked Meat & Preserved Foods 130 * Visits Re. Shops Act 443 — „ „ Infestations 14 — „ „ Food and Drugs Act 270 — „ „ Merchandise Marks Act & Markets 106 - „ „ Food Poisoning 10 — Sampling Visits 188 — Fair Visits 8 — School Visits 16 — Miscellaneous Visits (including Flour MillsCyanide Fumigation) 351 - Interviews 23 — Complaints Investigated 37 — Totals 3,235 78 * Included under Grocers' and Butchers' Shops. Bakehouses.—At the end of the year, 6 premises in the Borough were being used as bakehouses, none of which was underground. Bakehouses and bakers' shops were visited on 28 occasions and, as a result of the inspections, 9 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 175 visits of inspection to the catering establishments, insanitary conditions were remedied and improvements, mainly redecoration and cleansing of kitchens, were effected on 21 occasions. 154 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. 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 588 lbs. Pork 67 „ Mutton 60 „ Rabbits 88 „ Pigs' Spleens 14 „ Pigs' Kidneys 203 „ Pigs' Hearts 90 „ Turkey 61 „ Sheep Liver 20 „ Lambs' Liver 10 „ Lambs' Hearts 56 „ 1,257 lbs. Canned and Other Foods— Foods, Various (Canned) 4,738 lbs. Meats (Canned) 1,411 „ Fruit (Canned) 14,683 „ Fruit Juice (Canned) 521 „ Fish 154 „ Fish (Canned) 118 „ Foods, Various (Frozen) 184 „ Steak and Kidney Pies 4 „ New Potatoes 3,808 „ 25,621 lbs. 26,878 lbs. Compared with the previous year, the amount of meat rejected fell by 92 lbs. during 1964, and the total of all food by 4,166 lbs. The Meat Inspection Regulations, 1963.—These Regulations, operative from 1st October, 1963, 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 155 tion, 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. Circular FSH 9/63 issued by the Ministry of Agriculture, Fisheries and Food on 18th July, 1963, gives a summary of the above regulations. Butchers' Shops and Stalls.—These are under the constant supvision of the Food Inspectors who made 163 visits of inspection and arranged for the correction of insanitary defects in 19 instances. As with other premises, legal proceedings are instituted only after disregard of the Officer's warning and in no instance was it necessary to resort to this procedure. Slaughterhouses.—Two premises in the Borough originally licensed as slaughterhouses have not been used as such since the introduction of the Livestock (Restriction of Slaughtering) Order 1940. In both instances the premises are no longer used as slaughterhouses and the issue of the appropriate licences has therefore been discontinued. Public Health (Imported Food) Regulations, 1937 and 1948.—The Metropolitan Borough of Greenwich with a river frontage of five miles with more than 30 wharves and two of London's largest and most modern cold stores receives a considerable percentage of London's imported meat stored on behalf of various importers. In addition, considerable quantities of fresh fruit, tinned foods and miscellaneous provisions are dealt with. Visits to wharves and cold stores are made by the Food Inspectors and imported food generally is carefully supervised. Inevitably meat is the commodity to which Food Inspectors must devote most of their time and it is their responsibility to see that each consignment landed is accompanied by an "official" certificate. This may be in the form of a certificate, label, mark, stamp or voucher which is recognised by the Ministry of Agriculture, Fisheries and Food as a guarantee that the accompanying product was inspected ante and post mortem and passed as fit in accordance with criteria satisfactory to the Minister and that any necessary packing or preparation had been executed under hygienicconditions. 156 Imported Food Rejected.—The following unsound or diseased imported foods were surrendered, the meat being passed for nonedible and refining purposes, and other unsound food, with the exception of fruit pulp and juice, being processed for stock feeding. The following foods were rejected at the wharves:— Meat— Mutton and Lamb 177 lbs. Beef 3,114 „ Pork 20 „ Turkey 20 „ Rabbits 58 „ Calf Liver 22 „ Lambs' Hearts 30 „ Ox Crops 75 „ 3,516 lbs. Canned and Other Foods— Foods, Various (Canned) 15,085 „ Cooked Meats (Canned) 921 „ Margarine 419 „ Butter 62 „ Dried Whole Egg 112 „ Egg White Solid 88 „ 16,687 lbs. 20,203 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 26,025 258 Groundnuts—Presence of Anatoxin.—In Britain, during 1960, a large number of turkeys died from an unknown cause. Investigations revealed that they had been fed on a groundnut meal which contained a toxic factor arising from a mould Aspergillus flavus and this has been named Aflatoxin. Young animals were also found to be susceptible to the toxin. The presence of Aflatoxin appears to develop after the nuts have been lifted and seems to be proportional to the discolouration, amount of damage to the shell and speed of drying. Aflatoxin also 157 shows itself in cases where storage and transport have occurred in conditions of high temperature and humidity. Peanuts in shell arrive in this country mainly from Ethiopia, Eritrea, Libya and India but most eastern Mediterranean countries are known to trade in this commodity. On 1st June, 1964, a meeting was held at the Ministry of Health between Ministry officials and representatives of authorities in whose areas imports of groundnuts in shell were likely to be landed. Discussions concerned the possibility of a hazard to humans and the need for sampling and testing consignments to avoid contaminated nuts being used for human consumption. At this meeting, arrangements were made for the sampling of peanuts in shell and methods, numbers and standards were agreed, as was the manner of disposal. Public Analysts were circulated with details of the Tropical Products Institute's method of physico-chemical analysis, in accordance with which, toxicity would be measured. A further meeting was held at the Ministry on 14th October, 1964, to assess results so far obtained and to decide future policy. Medical Officers of Health of represented authorities were asked to continue sampling on an agreed basis and make the results of their sampling available to the Ministry at 6-monthly intervals or earlier if information was substantial. Meanwhile the Ministry would seek co-operation of the trade to secure the satisfactory labelling of consignments. During the year, 13 samples were taken, one of which was reported upon as containing aflatoxin to the extent of being classified as "medium" toxicity. Details of this sample are to be found in the list of "non-genuine" samples appended at the end of this section. Corned Beef.—Typhoid Outbreak at Aberdeen.—On 7th May of the current year, 2 students purchased corned beef from a medium-sized supermarket in the main shopping street of Aberdeen and they were subsequently admitted to hospital on the 12th. Two days later, blood cultures were found to be positive for Salmonella typhi of phage type 34 indicating that the organism's origin was either Spain or the American continent but certainly not Britain. This supported the contention that corned beef was the vehicle of infection in the early cases. Instructions were received from the Ministry that, as a precautionary measure, all 6 lbs. tins of corned beef bearing identification marks of an Argentine or an Uruguayan Establishment should be withdrawn because of the unsatisfactory arrangements in their canning processes. 158 Immediately, all retail shops, wholesalers, office and works canteens, hospital stores, etc., in the Borough were visited by the Public Health Inspectors with the object of preventing the use or distribution of tins so marked. As a result of this prompt action some 136 tins were withdrawn and returned to the importers. 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 Unsatisfactory Bact. Chem. Dried Egg Albumen America 1,254 x 44 lbs. cartons 78 — — „ 8,235 x 50 lbs. cartons 485 2 — „ 172x65 lbs. cartons 20 1 — Argentine 504 x 55 lbs. cartons 35 1 — Canada 173 x 65 lbs. cartons 10 — — China 90 x 110 lbs. tins 10 — — „ 50 x 110 lbs. cases 3 — — Holland 21 x 110 lbs. drums 6 2 — Japan 100 x 22 lbs. cartons 10 — — Sweden 140 x 110 lbs. cartons 10 — — „ 100 x 110 lbs. drums 11 — — Dried Whole Egg America 692 x 44 lbs. cartons 24 — — „ 45 x 50 lbs. cartons 4 — — „ 16,086 x56 lbs. cartons 401 13 — „ 10 x 165 lbs. drums 2 — — „ 55 x 175 lbs. drums 7 — — Australia 2 x 32 lbs. cartons 2 — — „ 771 x 160 lbs. drums 60 — — „ 50 x 206 lbs. drums 3 — — China 2,900 x 44 lbs. cartons 90 1 — „ 380 x 110 lbs. cartons 41 3 — „ 310 x 110 lbs. cases 17 — — „ 240 x 110 lbs. drums 24 — — „ 2,298 x 110 lbs. tins 114 — — Czechoslovakia 2,800 x 55 lbs. bags 123 14 — Denmark 121 x 40 lbs. cartons 8 — — Frozen Whole Egg Australia 76,539 x 28 lbs. tins 386 — — China 125 x 22 lbs. tins 9 — — „ 500 x 28 lbs. tins 25 — 15 „ 375 x 44 lbs. tins 14 — — Czechoslovakia 910 x 110 lbs. tins 55 — 35 Holland 416x 13 lbs. tins 20 — — „ 840 x 26 lbs. tins 28 — 4 „ 1,140 x 40 lbs. tins 48 — — Frozen Egg White Holland 850 x 13 lbs. tins 27 — — „ 580 x 40 lbs. tins 20 — — 159 Incidence of Salmonella Organism Found Samples Dried Egg Albumen Dried Whole Egg Frozen Whole Egg Salmonella alachua — 1 — „ bareilly — 2 — „ enteritidis 2 — — „ infantis 1 1 — „ manhatten 1 — — „ montevideo — 1 — „ muenchen — 5 — „ newport 1 — — „ oranienberg — 1 — „ seftenberg — 2 — „ taxony — 1 — „ tennessee — 1 — „ thompson — 1 — „ typhimurium — 15 — „ worthington 1 — — Dried Hen Egg Albumen.—All landings of this product are submitted to the heat treatment process recommended by the National Albumen Advisory Committee set up by the Ministry of Health. This process is undertaken at the premises of Cory Associated Wharves Ltd., Palmers Wharf, Prince Street, S.E.8. There were no landings during the current year. English Frozen Whole Egg Plant.—On the 25th April, 1960, a Frozen Whole Egg production plant became operational at Payne's Wharf, Borthwick Street, S.E.8. The construction of this plant over a period of approximately one year had been supervised by the Food Inspectors and every effort has been made to ensure a high standard of hygiene. In producing English Frozen Whole Egg for the Egg Marketing Board the manufacturers anticipated that the plant would eventually break 360,000 eggs (1,000 cases) per day. During the year, the product has been sampled for chemical and bacteriological examinations on seven occasions and in each instance has been satisfactory. 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. 160 During the year 55 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. Argentine France 4 }159,234 lbs. Saudi Arabia 13 Australia Belgium 8 } 58,296 lbs. Bermuda 2 Curacao 1 Cyprus 1 France 1 Germany 1 Holland 4 West Africa 1 England Belgium 3 7,320 lbs. New Zealand Ascension Islands 4 } 51,132 lbs. Belgium 3 Ghana 1 Holland 4 Malta 2 Norway 1 Uruguay Belgium 1 2,100 lbs. Food and Drugs Act, 1955.—In accordance with the Council's contract with the Public Analyst, 459 samples were presented for examination, of which 109 were obtained in accordance with the Public Health (Imported Food) Regulations. The remaining samples, consisting of 43 formal and 307 informal were obtained in the normal course of sampling. Of all the samples obtained, 9 were considered by the Public Analyst to be non-genuine and of this total two 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 7 non-genuine samples, all informal, one was incorrectly labelled and has therefore been excluded from the calculation of the adulteration figure which at 1.7% shows an increase of 0.9% over that of last year. Again milk was one of the main foods sampled and in all, 26 samples were procured, of which 7 were in respect of Channel Island Milk. No milk sample was adversely reported upon and, in respect of milk other than Channel Island, the average percentage of milk fat was 3.59% and solids-not-fat 8.60%, the standard being 161 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 4-39% and 8-97% respectively. Bread and Flour Regulations, 1963—These Regulations reenacted the Flour (Composition) Regulations, 1960, and came 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 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. As the one remaining mill within the Borough ceased production, no samples were taken. 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.—During the year, one sample of Syrup of Glycerine, Honey and Lemon was taken for analysis and was 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. 162 On 11th March, 1965, these regulations were replaced by the Dried Milk Regulations, 1964. 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 four 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 Slice of White Bread Complaint from member of public that bread contained foreign bodies. Chem. Foreign bodies consisted of fragments of bread crust each measuring nearly ⅜". Complainant notified. No further action. Well Water (from tap in factory) On request to ascertain its fitness for drinking purposes. Bact. Satisfactory. Firm notified. Well Water (from tap in factory) On request to ascertain its fitness for drinking purposes. Chem. Although very hard and containing a rather high proportion of dissolved mineral sulphates, was quite suitable for use by adults for drinking purposes. Firm notified. Loaf of White Bread Complaint from member of public that bread contained foreign matter. Chem. Contained a partly burnt cigarette end, which had been baked in the loaf. Legal proceedings taken. Firm fined £10 with £2 2s. Od. costs and ordered to pay Public Analyst's fee of £3 18s. 163 Article How Obtained Examination Bact. or Chem. Result Action Taken Consignment of Cheddar Cheese (9 samples) Taken from Cold Store in Borough to ascertain fitness for human consumption. Bact. Satisfactory. Firm notified. Corned Beef, exMinistry Stock (2 tins) Taken from local Warehouse to ascertain its fitness for human consumption. Bact. Satisfactory. Firm notified. Horseradish Sauce Complaint from member of public that sauce had "vile" taste. Chem. The sauce had an unpleasant taste apparently due to bacterial decomposition. No abnormal chemical constituents were detected. Manufacturer warned of the serious view taken of the offence. Remainder of stock at shop withdrawn from sale. Orange Drink Complaint from member of public that orange drink contained foreign matter. Chem. Contained 2 large growths of fungal slime including several black nodules of sporing mycelium and was unfit for consumption. Bottle was only a quarter full and complainant could not recall date of purchase. On inspection of the remaining stock no evidence of deterioration was found and further action was not possible. Grapefruit Segments, Canned Complaint from member of public that grapefruit segments contained foreign matter. Chem. Foreign matter identified as naringin, the bitter principle to which the characteristic taste of grapefruit is mainly due. This glucoside is always present to some extent but is higher in less ripe fruit and sometimes tends to crystallise out when the canned fruit is stored. Complainant notified. No further action. 164 Article How Obtained Examination Bact. or Chem. Result Action Taken Rice From several sacks of rice contaminated with river water to ascertain fitness for human consumption. Bact. Satisfactory. Firm notified and suggestion made that this part of of the consignment be re-bagged. Mains Water Supply From kitchen tap following complaint from tenant that mains water supply was discoloured. Chem. The water was of a good potable quality of exceptionally low organic content and in other respects similar to the normal Metropolitan Water Board supply. No discolourisation was observed but the presence of iron was noted and although the proportion was too small to be objectionable it might be that on occasions when the water has remained for a longer time in contact with an iron supply service, the proportion would rise to a level at which discolourat i o n would result. Complainant notified. No further action. Large White Sliced Loaf Complaint from member of public that loaf contained foreign matter. Chem. Specimen contained, penetrating the crumb of four slices near the upper crust green streaks caused by the inclusion of a small quantity of a compound o f copper. The manufacturer gave a satisfactory explanation b u t was warned of the serious view taken of the offence. 165 Article How Obtained Examination Bact. or Chem. Result Action Taken Large White Sliced Loaf Complaint from member of public that loaf contained foreign matter. Chem. Specimen contained discoloured areas in the crumb caused by the inclusion of a small quantity of a mixture of charred flour, iron particles and grease. The manufacturer gave a satisfactory explanation b u t was warned of the serious view taken of the offence. 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. Twelve notifications were received during the year, of which, one was subsequently diagnosed as sonne dysentery. Four other cases notified as dysentery were re-diagnosed as food poisoning thus giving a final total of 15 cases. The numbers of food poisoning cases during previous years were as follows:— Year Notifications Year Notifications 1963 6 1958 39 1962 7 1957 17 1961 22 1956 23 1960 42 1955 14 1959 43 1954 12 All the current cases, which were of the sporadic type, were investigated with the following results:— 166 No. of Cases Organism (if known) No. of Hospital Cases Remarks 1 Salmonella kiambu — No particular food suspected. Case occurred at end of year. Early in 1965 3 other members of family discovered to be symptomless excretors. 1 Salmonella montevideo — No particular food suspected. Remainder of family negative. 3 Salmonella typhimurium The three cases occurred in separate households. No particular food suspected and family contacts were negative. 7 Staphylococcus aureus Two cases occurred in one family, the remainder were single cases. A meal consumed in a cafe outside the Borough was suspected in one case. The two patients from one family suspected a chicken consumed at Christmas. In one other case a cream bun was thought to be the cause. In no instance was it possible to verify the cause. Four of these were originally notified as dysentery. 3 No organisms — No particular food suspected. 15 — 167 FOOD AND DRUGS ACT, 1955 Number and Description of Samples Submitted for Analysis under the above Act during the year 1964 (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 — — — Arrowroot — 1 1* — — — Baby Food, Canned — 2 2* — — — Baby Food, Bottled — 1 1* — — — Barley, Pearl — 1 1* — — — Batter Mixture — 2 2 — — —- Biscuits — 6 6* — — — Brandy 3 — 3 — — — Bread — 1 1 — — — Breadcrumbs — 2 2 — — — Breadsticks — 1 1 — — — Butter — 8 8* — — — Butter Oil — 1 1 — — — Cheese — 1 1 — — — Chestnut Puree, Canned — 1 1* — — — Chocolate, Drinking — 2 2 — — — Coconut, Dessicated — 2 2* — — — Coffee & Chicory — 1 1 — — — Coffee Extract, Dry — 2 2* — — — Confectionery, Flour — 2 2* — — — Confectionery, Sugar — 2 2* — — — Cough Mixture — 1 1 — — — Cream — 7 7* — — — Curry Powder — 1 1 — — — Dessert Powder — 2 2* — — — Drinks, Soft — 5 5* — — — Drinks, Soft, Powder — 2 2* — — — Dripping — 1 1 — — — Fish, Canned — 20 20 — — — Fish Pastes — 3 3* — — — Fish. Salted — 1 1* — — — Fish Spread — 1 1* — — — Flour, Batter — 1 1 — — — Fruit — 1 1* — — — Fruit, Bottled — 1 1* — — — Fruit, Canned — 38 38 — — — Fruit, Dried — 17 17* — — — Fruit Juice, Canned — 9 9 — — — Fruit Pie — 1 1* — — — Gin 7 — 7 — — — Jam — 7 7* — — — 168 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Jelly Tablet — 2 2* — — — Lager — 1 1* — — — Lard — 6 6 — 1 1 Lentils — 1 1 — — — Macaroni — 1 1 — — — Margarine — 4 4* — — — Marmalade — 1 1* — — — Marzipan — 3 3* — — — Meat, Minced 1 12 13* — 1 1 Meat Products — 26 26* — — — Meat Products, Canned 47 47* — 2 2 Meat Paste — 4 4* — — — Meringues — 1 1 — — — Milk (inc. C.I.) 24 2 26* — — — Milk, Condensed — 4 4 — — — Milk, Evaporated — 6 6 — — — Mustard Powder — 1 1 — 1 1 Pastry, Uncooked — 1 1 — — — Peanuts — 9 9 — 1 1 Peanut Butter — 2 2* — — — Peanut Flakes — 4 4 — — — Pease Pudding, Canned — 2 2 — — — Peel, Candied — 2 2* — — — Pepper — 2 2* — — — Pickles — 6 6* — — — Potato Chips — 3 3 — — — Pudding, Canned — 1 1 — — — Pudding, Fruit — 1 1* — — — Pudding, Sponge — 1 1* — — — Rice — 4 4 — — — Rum 3 — 3 — — — Salad Cream — 1 1* — — — Sauce — 10 10* — — — Sauce Preparation — 2 2* — — — Sausages — 21 21* — 3 3 Soup, Canned — 1 1 — — — Soup Mixture — 1 1 — — — Soup, Preparation — 1 1 — — — Spice — 3 3 — — — Spice, Pickling — 1 1 — — — Stuffing Mixture — 1 1 — — — Sugar — 4 4* — — — Tapioca — 1 1* — — — Tea — 18 18 — — — Tomatoes. Canned — 4 4 — — — Tomato Puree, Canned — 2 2 — — — Vegetables, Canned — 15 15 — — — Vegetables, Dried — 7 7* — — — 169 Article Number Examined Number Adulterated, &c. Formal Informal Total Formal Informal Total Vinegar, Imitation — 1 1* — — — Vinegar, Malt — 1 1* — — — Walnuts. Shelled — 1 1 — — — Welsh Rarebit Preparation 1 1 — Whisky. 5 — 5 — — — Totals 43 416 459 — 9 9 Samples of items marked * were tested for preservatives. 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. 31 Pork Sausages, Canned. Contained fat 38% and fatfree meat 26%. In the Public Analyst's opinion the proportion of fat in sausages should not exceed 50% of the total amount of meat. Satisfactory explanation from Manufacturers. H © Minced Steak. Contained Ascorbic Acid 0.020% and Nicotinic Acid 0.017% the proportions of which were higher than those found naturally present and therefore indicated that the substances had been added. The addition of these acids to meat is prohibited by the Meat (Treatment) Regulations, 1964. Manufacturer warned. Further samples taken which proved satisfactory. T. 67 Stewed Steak with Gravy, Canned. Contained meat 64%. In the Public Analyst's opinion the meat content should be at least 75%. Satisfactory explanation from Manufacturer. 170 Sample No. Article Nature of adulteration and/or irregularity Action taken T. 87 Pork Sausages. Contained fat 35% and fatfree meat 30%. In the Public Analyst's opinion the proportion of fat in sausages should not exceed 50% of the total amount of meat. Manufacturer informed of Analyst's report. Further samples taken which proved satisfactory. T. 136 Lard. Contained butylated hydroxyanisole, 25 part per million. The compound is an antioxidant permitted in lard, but its presence was not disclosed on the label as required by the Labelling of Food Order, 1953. Satisfactory explanation from Suppliers. Labels in process of being reprinted. T. 264 Preserved Pork Sausage Meat. Contained fat 36% and fatfree meat 28%. In the Public Analyst's opinion the proportion of fat in sausages should not exceed 50% of the total amount of meat. Manufacturer informed of Analyst's report. Further sample taken which proved satisfactory. T. 306 Preserved Beef Sausages. Contained fat 32.5% and fatfree meat 21%. In the Public Analyst's opinion the proportion of fat in sausages should not exceed 50% of the total amount of meat. Manufacturer informed of Analyst's report. Further sample taken which proved satisfactory . (b) In respect of samples taken under Imported Food Regulations. TT. 23 Mustard Powder. Consisted of white mustard flour and yielded allyl isothiocyanate 0.05%. Mustard should consist of a blend of brown and white mustard flours and yield not less than 0.35% allyl isothiocyanate to comply with the Food Standards (General Provisions) Order, 1944, and the Food Standards (Mustard) (No. 2) Order, 1944. Importer stated the mustard powder was to be used for blending purposes only and therefore no action possible as such Orders do hot apply. 171 Sample No. Article Nature of Adulteration and/or irregularity n taken TT. 101 Groundnuts in Shell. The kernels contained aflatoxin, the Toxicity category as defined by the Tropical Products Institute being Medium. A Detention Notice was placed on the consignment a s being unfit for human consumption with the proviso that if to be used for animal feeding purposes, then release would be granted only if this Authority received prior notice of its destination in order that the receiving authority could be advised accordingly. Legal Proceedings (as result of complaint from a member of the public) Premises Offence Result of Proceedings Porcherot Bakeries. 25, Plumbridge Street, S.E.10. Loaf of white bread contained a partly burnt cigarette end. Fined £10 with £2 2s. costs and ordered to pay Public Analyst's fee of £3 18s. 172 SECTION F Prevalence of, and Control over, Infectious and Other Diseases Treatment of infections by the use of drugs has its origins in antiquity. Specifics evolved and febrile conditions were countered with quinine, looseness of the bowels with ipecacuanha and emetine and syphilis with mercury compounds. Chemotherapy, the term given to this type of treatment, is today much more extensive and extremely successful but it required the discoveries of Pasteur, Lister and Koch in the field of bacteriology and the advances in chemistry of Perkin and Ehrlich for its full potential to be realised. Five years after the discovery of the causative organism of syphilis in 1905, came the curative arsenical compound known as "salvarsan" but it was not until the middle 1930's that this advance was exploited and the therapeutic value of a synthesized dye against streptococcal infection was demonstrated. Other drugs such as sulphanilamide made their appearance to be quickly followed by more sulphonamides, but the discovery of penicillin in 1928 by Fleming led to the introduction, albeit very leisurely it seems, of a completely new range of substances known as antibiotics. An antibiotic is a substance produced by one form of living organism which is pathogenic to another and, although the world had to wait until 1939 before the value of penicillin was firmly established, there was a subsequent intensive search for other similar substances which led to the introduction of streptomycin, Chloromycetin, and aureomycin, the first of the tetracyclines. Relatively speaking, however, immunology is a product of more modern times. As far back as the 1850's there was only one disease against which immunity could be given, namely, smallpox and even this had to be introduced on a compulsory basis in 1853. Again, society had to wait for the growth of bacteriology and the experiments of Pasteur and others before further protection could be offered. Since then, and with the emergence of toxoids, routine immunity procedures have been introduced for use against diphtheria, tuberculosis, typhoid, cholera, yellow fever, whooping cough, tetanus and poliomyelitis and there is good reason to think that measles will shortly join this list. The whole theory and practice of substitution therapy which is saving countless lives, rests upon the isolation in earlier years of substances such as insulin, cortisone, thyroxin and the oestrogens, whilst many a patient suffering from a deficiency disease will live a normal life following the discovery of the "vitamines" at the turn of the century. 173 Inevitably, perhaps, many of these measures by their very own success have produced a sense of false security in that there is now growing up a generation of parents with no knowledge of the disfiguring consequences of smallpox or the devastating effects of diphtheria. Moreover, despite the control which has been gained over bacterial infections by the almost unbelievable advances in pharmocology, several disturbing features are threatening to mar the apparent bright future. There is the development of resistant haemolytic streptococcal infections in hospital and maternity homes—an increase in venereal disease, especially among the younger age groups—a rise in the incidence of leukaemia and an accentuation in certain areas of the tuberculosis problem by immigrants and the introduction by them of unfamiliar complaints and helminthic infections. Whatever success has been achieved in environmental health has been through dedication, education and "toil, sweat and tears" and it would be nothing short of criminal to allow complacency and apathy to whittle away such outstanding progress gained with such great efforts. Legislation.—During the current year no legislationing infectious diseases was enacted. The total number of Infectious Diseases notified under Section 144 of the Public Health Act, 1936, Section 192 of the Public Health (London) Act, 1936, and associated Orders and Regulations was 426. Under the Public Health (Tuberculosis) Regulations, 1952, there were 41 notifications, giving a consolidated total of 467 cases notified during the year. The following table indicates the figures for the previous ten years :— Year No. of corrected notifications 1954 569 1955 2,120 1956 844 1957 1,558 1958 607 1959 1,102 1960 542 1961 1,981 1962 184 1963 1,361 10-year average 1,086 1964 467 174 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 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 five 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. The last real smallpox outbreak in the Borough was as long ago as October, 1901, and, by August of the following year, 104 cases had been notified of which 25 died. 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. 175 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 1964 was 720. This figure, although showing an increase of 563 over that for the previous year, contrasts unfavourably with that of 1,397 for 1962 (the year of the last 'scare') and indicates 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 14 years 18,617 births have been registered, and for the same period only 9,703 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 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 thenational 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 ofnational 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 670 certificates of persons proceeding abroad were so authenticated, of these 548 were in respect of Smallpox, 97 Cholera and 25 for Typhoid. 176 Measles.—The normal biennial fluctuation was evident in the number of cases notified during the year which fell from a total of 925 in 1963 to 240, the figure for the current year. Of the 240 cases, 115 were males and 125 females and only three were over the age of 15 years. Only three cases were removed to hospital and there were no deaths recorded. The distribution of the cases was as follows:—East Greenwich 88; West Greenwich 45; St. Nicholas, Deptford, 8; Charlton and Kibrooke 99. During 1962 there were 57 cases, in 1961 there were 1,820, in 1960 there were 47, in 1959 there were 637, in 1958 there were 306 and during 1957, 1,194 cases were recorded. Measles was a prevalent cause of death in children when the Metropolitan Boroughs were first founded and, in Greenwich was responsible for 52 deaths in 1901 and an even higher figure of 55 during 1907. The complaint, however, was not made notifiable until 1st January, 1916, and during that year 1,378 cases were so notified. Prior to 1916, information with regard to cases of measles came to the department via the parents, guardians, school teachers, etc. Notifications reached their highest in 1928 when there were 2,934. Much research has been carried out in recent years with regard to the control of measles. New vaccines, free of the undesirable reactions of the earlier types, have been developed and under the control of the Medical Research Council, a limited scheme for vaccination with a new vaccine was introduced during the current year. Some 149 children were treated, the results of which are to be assessed during the coming year. Scarlet Fever.—A total of 52 confirmed cases for the year shows an increase of 23 over that returned for 1963 as compared with 33 notifications for 1962. There were 30 for 1961, 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. Scarlet fever has been a persistent, but not often fatal, cause of ill-health since 1901. The greatest number of notifications received was during 1921 when the total reached 958 with 6 associated deaths. Today, the disease appears to be much milder than hitherto but, as the average number of notifications over the last 10 years indicates, viz., 58, the complaint is still responsible for a regular amount of illness in the community. 177 Whooping Cough.—Altogether 33 notifications were received in 1964, a decrease of 2 from those of the previous year. The years 1962, 1961, 1960, 1959 and 1958 produced 13, 26, 168, 34 and 55 respectively whilst there were 97 registered for 1957. No cases were admitted to hospital and there were no deaths. With regard to children under 5 years, 7 completed whooping cough immunisation, 20 received a combined antigen (whooping cough and diphtheria) and a further 1,441 received a triple antigen (whooping cough, diphtheria and tetanus) giving a final total of 1,468 whooping cough immunisations carried out during the year by the County Council. This is an increase of 273 over the total for the previous year. Only since 1st June, 1912, has whooping cough been notifiable, a measure which seemed to have had the desired beneficial effect for, since 1910 when there were 56 deaths recorded, control of this disease has been more effective and that total has never been surpassed. Today, a death from this cause is rare. Notifications received were at their highest in 1925 when there were 655. Diphtheria.—No notifications were received for the current year, a result similar to that for each of the 8 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 In 1901, the number of notifications received was 183 and this figure rose to its highest level in 1922 with a total of 707 notifications and 42 associated deaths. Since that time, notifications and deaths have progressively declined and today's favourable position is, without doubt, due to the diphtheria immunisation scheme introduced during the latter half of 1936. Diphtheria immunisation is now a County Council service and during the year there were 1,639 completed immunisations carried out in the Borough, an increase of 320 over that of the previous year. Most diphtheria immunisations given formed part of combined antigen therapy. Some 928 "boosters" of triple antigen were also given during 1964. 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.—No cases of pneumonia were registered during the year as compared with a figure of 8 for last year and 5 for each of the years 1962 and 1961. 178 Typhoid.—No cases were notified during the year, a position similar to that of the previous two years. 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. Following the request from a local practitioner to obtain faecal specimens from a male child of 3½ years who was suffering from diarrhoea and vomiting, salmonella paratyphi 'B' of phage type 'Beccles' was isolated. Subsequently, the father and another child, a female of 7 weeks, were also found to be paratyphoid cases. On request, samples of tap water from the family's residence were taken by the Metropolitan Water Board with negative results. Typing the organism had proved to be a little difficult but finally, when the phage type had been established, it transpired that it had recently been encountered in the Streatham area. No connection of the family with Streatham was discovered but the father had been to St. Tropez and Cannes during the latter end of 1963 and since then had suffered from some intestinal disturbance from time to time for which he had not sought medical advice. Typhoid fever, a disease which was known to the ancients and certainly in the time of the Roman Empire, is still endemic in some parts of the world and can still be just as virulent as shown by the recent outbreak in Aberdeen. It was only in 1849 that Jenner finally managed to differentiate this disease from typhus as both were present in conditions of squalor, filth, overcrowding and poor sanitation generally. Furthermore, paratyphoid was not distinquishable from typhoid until more recent years and only became notifiable in its own right in 1941. Zymotic Enteritis or Epidemic Diarrhoea (Children under 5 years of age).—Eleven cases were recorded as confirmed compared with 10 for the previous year, 11 for 1962, 19 for 1961, 57 for 1960, 30 for 1959, 9 for 1958, 12 for 1957 and 17 for 1956. No case received hospital treatment, and there were no deaths. In earlier years this complaint was known as "summer diarrhoea' and, although at the beginning of the century it was not compulsorily notifiable, it was one of the "killer' infectious diseases. During 1911, some 159 children in the Borough died from this disease, a factor Which resulted in the Council making it notifiable the following year. Since then, the disease has never been as devastating. Although there are always a number of notifications received in the department each year, with better hygiene, improved social conditions and the use of modern drugs the danger has become minimal. 179 Erysipelas.—There were no notifications received during the year. One was received for the previous year compared with 2 for 1962 and a similar figure was returned for 1961. 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 82 notifications received during the current year shows a fall of 234 from that of the previous year. The highest total for the Borough was in 1956 when 480 cases were the subject of a detailed investigation and analysis. The distribution of the current cases was 20 in East Greenwich, 2 in West Greenwich, 1 in St. Nicholas, Deptford, and 59 in Charlton and Kidbrooke. One case was removed to hospital but there were no fatalities. Scabies.—Two cases were notified during 1964 compared with 3 in the previous year, 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 vear three notifications were received in accordance with the 1951 Regulations and from other sources, a further 12 cases concerning Greenwich residents were brought to the notice of the department, givine a total of 15. Seven cases were recorded for each of the years 1963 and 1962, 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 three years there were no notifications received durine 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. Acute Encephalitis. (Infective or Post Infectious.)—No cases were notified during the current year compared with 2 for 1963. Ophthalmia Neonatorum.—In respect of this disease no 180 notifications were received. There was a nil return for the years 1963, 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. There have been no Greenwich cases since 1958 when there was one. Of school children undertaking a poliomyelitis inoculation course, 24 received two and 30 received their third injection during the year. For persons between the ages of 16 and 40 years the figures were 11 and 35 respectively. In addition, a fourth injection or doses of Sabin following 3 injections of Salk were given to 1,031 children between the ages of 5 and 12 years. School children completing a Sabin course numbered 1,757 and over school age there were 139. Malaria.—Compared with a nil return for this year and for the years 1963, 1962, 1961 and 1960, one notification of benign tertian was registered for 1959. Tuberculosis.—During the year 41 notifications in respect of confirmed cases of tuberculosis were received compared with 32 for 1963. Of these, 30 were of the pulmonary type and 11 nonpulmonary, i.e., tuberculosis of parts of the body other than the lungs. The following table gives the distribution:— District Pulmonary Non-Pulmonary Total East Greenwich 13 4 17 West Greenwich.. 4 2 6 St. Nicholas, Deptford 2 — 2 Charlton and Kidbrooke 11 5 16 Totals 30 11 41 Disinfection was offered and carried out in 3 cases including 3 rooms. During 1964, some 803 Greenwich school children received B.C.G. vaccination under the direction of the School Medical Officer. 181 Elimination of tuberculosis from the community probably ranks as one of the most important tasks ever falling to the lot of the medical profession and public health staffs. For some time, progress was seriously hampered by the fact that tuberculosis was only voluntarily notifiable until the introduction of the Public Health (Tuberculosis) Regulations in 1912. Once the disease had become compulsorily notifiable, there was the initial flood of noti fications with more accurate diagnosis and, by 1917, the Borough had sustained its highest number of deaths, viz. 219, of which 182 were of the pulmonary type. Since that time, there has been a gradual diminution of notifications and deaths until the present, more satisfactory, situation was reached. Nevertheless, tuberculosis is likely to smoulder on for a decade or two yet. However, the current year shows an increase of 9 notified cases over those of the previous year and a suspicion that the disease is being imported by immigrants not subject to medical examination gains ground. Vagrancy is perhaps too strong a word for the people who wander the countryside and have no fixed abode but the practice is growing especially among the younger age groups. Control of infectious cases under these conditions is virtually impossible and the infected immigrant and the grossly infected mobile patient, in close contact with susceptible groups, could lead to latent pools of infection throughout the community. The situation presents grave difficulties to health departments in general and to chest clinics in particular. That elderly people may suffer from tubercu'osis which remains undiagnosed until they are admitted to hospital for other reasons or until a post mortem is undertaken is revealed in a recent examination of 1,713 post mortems carried out in a South East London hospital between 1950/64, on patients over 70 years. Thirty-one cases of tuberculosis were discovered and in only 4 cases was there a previous tuberculosis history. Fifteen of these were found durine the terminal illness and 12 at post mortem. In these cases there is a potential risk to other patients in the hospital and there must be a certain number of inaccuracies in clinical diagnoses and death certificates if a post mortem is not performed. Thirty-one cases over a period of 15 years may not be much but if this situation is common throughout the country then there is a need for routine necropsy and examination of all sputum specimens for acid-fast bacilli. The number of notified cases of Tuberculosis remaining on the Register at 31st December, 1964, was as follows:— 182 PULMONARY Men Women Children Total M F 451 339 13 8 811 NON-PULMONARY Men Women Children Total M F 20 22 3 6 51 During the current year and in co-operation with the Greenwich Chest Clinic, a comprehensive check of each case on the register was undertaken with the result that the total number of cases remaining at the end of the year was 862 (811 pulmonary and 51 non-pulmonary) compared with the 1963 figure of 1,122 (1,036 pulmonary and 86 non-pulmonary). Many cases about which nothing has been heard for at least five years and who, according to the electoral roll, did not reside at the address given, were found to have removed from the district; many more were considered by the Chest Physician to have recovered. All these were extracted from the register. Investigations on these lines are continuing and 1965 should show a further decrease in the numbers remaining on the Tuberculosis Register although perhaps not on such a scale as the present year. 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. 183 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1952 Part I.—Summary of notifications of Tuberculosis during the period from the 1st January, 1964, to the 31st December, 1964. Age Periods Formal Notifications Number of Primary Notifications of new cases of tuberculosis 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total (all ages) Respiratory, Males — — — — — — 1 3 7 6 3 2 22 Respiratory, Females — — — — — 1 — 6 — 1 — — — 8 Non-Respiratory, Males — — — 1 — 1 — 1 1 1 I — — 6 Non-Respiratory, Females — — — — — — — 1 2 1 — 1 — 5 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 — — — — — — — — — — — — 2 2 (B) Non-Respiratory M — — — — — — — — — — — — - (C) F — — — — — — — — — — — — — - (D) Death Returns from RegistrarGeneral (Transferable deaths) Respiratory M — — — — — — — — — — — — — — (A) F — — — — — — — — — — 1 — — 1 (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) 1 (B) 3 of the other, only the first notification is taken into account for the purpose of this return. (C) — (D) — 184 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, 1964. PART I.—General Analysis Men Women Total (a) Total X-rayed 9,537 3,034 12,571 (b) Total previously X-rayed (within 5 years) 6,458 1,319 7,777 (c) Total number reviewed 458 96 554 (d) Number considered abnormal after review 306 58 364 (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 10 1 11 (c) Requiring close supervision or treatment 10 2 12 (d) Still under investigation 1 — 1 (e) Refused further investigation — — — 185  Men Women Total (2) Previously known tuberculous cases 12 5 17 (3) Non-tuberculous cases : (a) investigated 49 16 65 (b) still under investigation 5 1 6 (O Refused investigation or lost trace 2 — 2 (4) Cardio-vascular lesions 19 10 29 (5) Abnormalities requiring no action 198 21 219 ANALYSIS OF SURVEYS Numbers Examined Cases of Tuberculosis requiring treatment or close supervision Not Previously Examined Numbers Cases Men Women Total Men Women Total Men Women Total Men Women Total Public Surveys 2,274 2,063 4,337 2 - 2 1.331 1,316 2,647 - - - Public Surveys— Examination of Special Groups 326 67 393 - - - 52 39 91 - - - Firms— Full-scale visits 4.586 652 5,238 7 2 9 1,593 265 1,858 3 1 4 Firms— Examination of Special groups 2,272 1 2,273 - - - 66 - 66 - - - Colleges. Hospitals, etc. 47 218 265 - - - 16 79 95 - - - Lodging houses. Homes, etc. 32 33 65 1 — 1 21 16 37 - - - TOTAL 9,537 3,034 12.571 10 2 12 3,079 1,715 4,794 3 1 4 186 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 32 Children under school age 8 5 School children 66 45 No. of home visits by Lady Public Health Inspector 15 No. of home revisits by Lady Public Health Inspector 37 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:— 187 Rooms and Articles Disinfected, Year ended 31st December, 1964 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 18 33 1 3 2 8 4 22 _ 5 2 20 2 69 Diphtheria — — — — — — — — — — — — — — — Tuberculosis 3 3 1 1 1 3 — 5 — 2 — — 5 — — 18 Cancer 4 4 — 3 1 4 — 5 1 — — — — — — 14 Meningococcal Infection 2 2 — — — — —— — — — — — — — — — Puerperal Pyrexia — — — — — — — — — — — — — — — — Typhoid Fever 1 1 — — — — — — — — — — — — — — Polio-Myelitis — — — — — — — — — — — — — — — — Erysipelas — — — — — — — — — — — — — — — — Acute Encephalitis — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — Scabies — — — — — — — — — — — — — — — — Other Diseases 69 11 1 3 — 15 4 20 1 — — 1 — — — 45 Verminous Premises 9 6 — 7 — 14 13 23 1 — — 25 36 1 7 127 Total 106 60 3 17 4 44 21 75 3 7 2 26 61 1 9 273 Articles Destroyed — — 21 104 — 9 — — 1 — — 182 — 5 — 322 Library Books Disinfected 49 188 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. Thirty new cases of pulmonary tuberculosis were notified during the year in the undermentioned age groups:— Males Years Females — 11-20 1 1 21-30 3 2 31-40 3 4 41-50 1 7 51-60 — 6 61-70 — 2 71-80 — It is of interest to note that these figures for new cases have remained more or less static in the last few years although previously there was a gradual decrease. Eleven cases of non-pulmonary tuberculosis were notified, five women (2 neck glands, 2 spine and 1 hip) and five men (1 spine, 1 kidney, 1 ankle, 1 glands and 1 sacro-iliac joint) and one boy aged 9 (left hip). In addition to these new cases it is of interest and justifies the follow-up supervision of old standing cases of tuberculosis, that we have found a relapse of tuberculosis infection in 6 patients who were treated before the time when antituberculous drugs were used. For this reason we consider it important to follow up the oldstanding cases with X-rays and sputum tests at least at annual intervals. There are still a total of 1,147 patients who have had tuberculosis in the past who are still being followed up. One hundred and two ante-natal patients have been X-rayed, two were found to have tuberculous disease. One hundred and ninety-one contacts of tuberculous patients were X-rayed but evidence of infection was only found in one patient. One hundred and twenty-three children and young adults were given B.C.G. inoculation because they were contacts of cases with tuberculosis. Fiftyone positive Mantoux children were referred to us from school because they were found to have positive tuberculin tests but none was found to have active tuberculous disease. The total number of attendances at the Chest Clinic for both tuberculous and non-tuberculous chest conditions was 8,339 and the total number of chest X-rays taken was 6,082 during the course of the year. 189 Very many patients have attended the Clinic for investigation and treatment of non-tuberculous chest diseases including neoplasm of the lung, bronchitis and asthma. Forty patients with carcinoma of the lung have been diagnosed of which a few have had surgical treatment at the Brook Hospital, but the majority have been unfit for surgery and have been treated with radiotherapy as a palliative measure or symptomatic treatment only. Twenty-one have died. The prevention of lung disability resulting from bronchitis and asthma is important and every effort is being made to do this. Those who have already become disabled as a result of these various chest conditions have many problems, mainly of a social nature. It is important that these patients are suitably housed away from dampness and atmospheric pollution and it is hoped that when more houses become available it will be possible to rehouse those early cases of chest disease as this might prevent them from becoming worse. Many of those who are disabled would be able to continue at work provided some sheltered employment was available, but unfortunately it is very difficult to find suitable work of this nature. 191 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 101 examinations were so made. Of these, 3 candidates were considered unfit for admission to the Council's Superannuation Scheme. Sick Persons.—In addition, the Medical Officer of Health carried out 20 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 4 interviews during the year. 192 Greenwich Church Street before the Foot Tunnel. 193 A SHORT HISTORY OF PUBLIC HEALTH IN GREENWICH 1901—1965 No comparison of today's conditions with those of yesteryear is possible without a brief outline of the social and environmental circumstances prevailing at the beginning of the century when the re-organisation of London Government was established under the London Government Act of 1899. Conditions in 1900 The Metropolitan Borough Councils were inaugurated during the South African war at the very end of Queen Victoria's reign and, in Greenwich at this time, poverty and overcrowding were common and of long standing in the St. Nicholas area and those regions in the vicinity of Deptford Creek and the environs of St. Alfege's, St. Peter's and Christchurch. This is perhaps not surprising when it is realised that the population in these areas had risen by almost 50% during the previous 20 years without a corresponding increase in housing accommodation. However, a newer kind of poverty was growing in the Marsh area of the Borough where poor quality housing, then recently erected, was being overcrowded with many people displaced from Poplar who, with the opening of the Blackwall Tunnel in 1897, were now able to make their way south of the river without impediment. Generally, the more affluent people who had moved away from the river side and were occupying bigger and better accommodation on the higher ground to the south were being replaced by a poorer element who, wishing to remain close to their places of employment, tended to overcrowd the now ageing property adjacent to the river. According to the census of 1901, there were on an average, 6.73 persons per inhabited dwelling throughout the Borough. As one would expect, rents were varied and many families lived in "rooms", the rents of which ranged from 3s. to 3s. 6d. per room, whilst the "better-off" craftsmen could rent two-storied houses of four rooms from 5s. to 7s. 6d., and newer houses from 10s. to 12s. 6d. per week. For the richer classes who could afford a servant or two, new houses in the Charlton area south of the main Woolwich Road were being sold for £380 (99 years Greenwich Church Street before the Foot Tunnel. 194 Poverty in Greenwich (circa 1900) The Blind Beggar (above) and (left) the young "Match Seller". 195 lease), whilst other new artisan houses of six rooms and washhouse were fetching 14s. 6d. per week, a rent which in itself was a rise of 3s. or 4s. a week over that demanded three years previously. This latter point serves to indicate the "building up" of pressure for living accommodation in an area which previously had no such problem. It is remarkable to think that, with a great deal of local opposition and criticism, the London County Council built several blocks of dwellings specially for working classes in Armada Street which were considered well arranged and in marked contrast to other housing in the neighbourhood. These same dwellings today are considered substandard from the amenities point of view and are ripe for redevelopment or conversion. In these early years, Blackheath and Kidbrooke were still rural areas and the song of the nightingale was to be fairly common on Shooters Hill for several years yet. Eight cowhouses were registered with the Public Health Department and among other registerable premises were 76 bakehouses (of which 29 were underground), 7 slaughterhouses and one knackers' yard. Offensive trades operating within the Borough with the consent of the Council consisted of a fat melter, a blood boiler, 9 gut scrapers and 3 tripe boilers, none of which is functioning today. Men in West Greenwich obtained their employment mainly at the Deptford Cattle Market, the victualling yard, in occupations on or near the river and at the Electricity Generating Station, although a fair number of people were occupied in the gas, chemical, candle, manure, cement, linoleum, soap and asphalte works, in the flour mills and timber and wood chopping yards. At the Charlton end of the Borough, the Royal Arsenal, the Royal Dockyard and cable works were the main sources of employment and, due to wartime demand, these were naturally the more lucrative occupations. For women there was little variety and, if not "in service" or "taking in washing", they were engaged in cleaning of slaughtered animals, making bags and sacks, tin boxes, dresses, shirts, lawn-tennis balls and, what is most interesting, gold and silver thread spinning. Some women and girls who were prepared to travel obtained a steady job in a match factory not far away and a number suffered from "phossy jaw" due to the solvent action on teeth of yellow phosphorus, the principle ingredient of matches in those days. Females formed 29% of all the labour force in 1901 and 6% of all married women were working. Times were hard and there was heavy drinking among all 196 OLD GREENWICH PROPERTIES (now demolished) Richardson's Place Brewhouse Lane 197 classes. Beer was cheap at l½d. to 3d. a pint, gin 8d. a pint or 4d. for a "double" and this prevalent taste for liquor was amply met by the more than numerous public houses in areas close to the river. Tea had not yet become a serious competitor to alcoholic beverages and nearly 6 out of every 1,000 persons were charged with being drunk and disorderly. In the streets, shoeless children were a common sight and elderly women were sometimes to be seen standing on doorsteps in "coarse aprons" occasionally smoking clay pipes. Compulsory education, which was then under the jurisdiction of the School Board for London, had not long been removed from the voluntary "2d. per week for infants and 4d. for others" kind of tuition and was not to become a County Council responsibility for a couple more years yet. Children were still leaving school at 12 years of age in order to work and add a little to the family's income. By modern standards the Board of Guardians seemed harsh, requiring disposal of many family and personal effects before relief, mainly "in kind" was given. A curious corollary to this was that acceptance of official assistance resulted in a loss of franchise. Many people, jealous of their independence, preferred to starve rather than have recourse to that odious but well-meant effort, the workhouse, where refusal to carry out the workhouse master's orders rendered an inmate liable to prosecution on the charge of "refusing to carry out his allotted task". A most distressing sign of the times was the early Monday morning queue of penurious women at the pawnshop ready to pledge the family's possessions for food and the next week's rent. Nevertheless, much good work and assistance were offered and accepted from the various church organisations which, supported by many well-to-do and influential people, appeared to be much more numerous then than now. Toye's orphanage, a barracklike establishment in Lewisham Road, typified the unobtrusive one-man charity so common in those days. It brought into many young lives the love and care so often sadly lacking and, although pathetic by modern standards, the bodily needs of many a deserted and lonely child were met by this dominating, bearded and patriarchal figure from his own resources and with the aid of gifts from a small band of sympathisers. Some twenty or so elderly ladies were similarly catered for by a Miss Distant at three or four houses in Evelyn Street. 198 Coldbath Street before demolition. A day on the "Beach" at Greenwich. 199 Eating houses offered substantial dinners for 9d. and "tea, shrimps and cake" for 6d. with a special rate for tea of 4d. per head for large parties. In the shops and at the Nelson Street and Trafalgar Road markets, bread was 4½d. the quartern loaf (4 lbs), good chops at 5½d. and tomatoes at 3d. per pound. Best quality coal was to be had for 27/- per ton and pipe smokers could obtain their shag at l½d. or 2d. an ounce. Early closing usually meant five o'clock instead of any time up till midnight. Many a Sunday joint was purchased by the poorer people at midnight on Saturday when it could confidently be expected that the butcher, at his weekly auction, would finally reduce his meat to 3d. per pound in order to clear his shop. The following morning, Sunday's dinner would be taken round to the nearest bakehouse where it could be cooked for a ½d., often while parents were socializing in the "local". For the children, Sunday tended to be strictly observed and one suspects that the regular attendance at Sunday School was due more to the prospect of "excursions", "outings", or "parties" rather than to religious conviction. Holidays, as we know them, were almost non-existent and entertainment was usually at weekends by way of paddle steamer trips to Southend or Margate for the princely sum of 2s. 6d. return. Many would spend a day on the "beach" at Greenwich or at the fair on Blackheath at Bank holiday times, those most colourful occasions where, with almost complete abandon, factory girls resplendent in their magenta velvet dresses and royal blue hats trimmed with ostrich feathers would dance the whole day long. At night, in the glare of naphtha flares, the stalls and sideshows would have their own particular fascinating attraction. Long, open, four-horsed "brakes" seating twelve or fourteen each side would provide the transport for the local public houses' annual men's outings to Southend or the countryside. Amusements were limited to local theatres with their Victorian melodramas or to the more popular, vociferous music halls such as the local "Crowders" establishment. London theatres were rarely visited except by the more affluent. Travel was exciting although roads and carriageways, usually of cobble stones or packed flint and grit, were pot-holed from age and neglect rather than use, except in the main thoroughfares where the local Board of Works had made arrangements with the proprietors of the horse tramways to keep their portion of the road in good repair. Although London's 200 "Hokey Pokey" 201 first railway ran through Greenwich, rail travel was still considered unreliable in those days and people were inclined to put their trust in the slower but more dependable horse tram. Bicycles with pneumatic tyres had just begun to take the place of the old solid tyred "bone-shakers" and heavy road transport was exemplified by the steam traction engine preceded by a man with a red flag. At dusk and at dawn, lamplighters were to be seen going their rounds, for gas was the method usually adopted for public and domestic lighting. The first telephone exchanges were being built and, believe it or not, postal services consisted of 11 deliveries and 9 collections daily. This alteration of London Government occurred at a time when Britain's power and influence was at its zenith and the golden sovereign was the world's most stable currency. It was an era when, in road transport, the horse was supreme. Landaus, victorias and growlers were common and travel in town meant a hansom, a brougham or horse tram, for the motor car was still an unaccepted "new fangled" machine. Naturally, in these conditions the blacksmith's forge was a fairly familiar sight. Streets rang with the cries of the lavender sellers, tinkers and peg-doll makers, which mingled with those from the itinerant vendors of flowers, fruit and vegetables, salt and vinegar, the "hokey-pokey" man in summer and the "baked-potato" or "hot chestnut" man in winter. Having once seen him, who could fail to remember the vendor of those poisonous arsenical flypapers ostentatiously displaying his wares around his bowler hat and who constantly and monotonously cried "catch 'em orl alive, those tormenting flies"? Nor could one forget the familiar and homely sight of the "cat's meat" man, the "pied piper" of his day. With his basket of thinly carved, wooden-skewered horsemeat, he would be followed along the street by cats of all colours, shapes and sizes, attracted by his call and mesmerised by the smell of his titbits. If the house owner was away, the tasty morsel was lodged, out of reach, under the doorknocker to be paid for on some future occasion. Visits from travelling musicians with their hurdy gurdys, barrel organs or street pianos, regularly attracted their spellbound youthful audiences. For the average family in the early 1900's Sundays were the "treat" days which were noted for their shrimps and winkles and water cress teas, bolstered with well-buttered crumpets from the "muffin" man, whose approach at lighting-up time was 202 fish "All Alive—OH " 203 The itinerant vendor of "Wild Rabbits" (right) and a typical butcher's Shop in the early 800's (below). Fish "All Alive—OH 204 Milk delivery in Victorian times. (right) "Same Again", and (below) "Under the Yoke". 205 heralded by the vigorous ringing of his hand-bell. In many instances, I suspect, the butter was really margarine. There were no pre-packed foods at this time and only a few commodities such as salmon, condensed milk, corned beef and sardines were canned. Meat was being sold from open-fronted shops and raw milk dispensed from uncovered cans at street doors. People bought groceries "loose" and items such as jam, syrup and pickles were weighed out on highly polished scales in the customer's own bowl or container—there were no automatic scales at that time. Tea was sold directly from open wooden chests, sugar "moist", "lump", or "pieces" was taken straight from the sack and packed into thick blue paper "pokes" or cones made up then and there, and butter was scooped from a solid decorated block, patted into shape by wooden patters, weighed and delivered to the purchaser in grease-proof paper. Ice-cream, manufactured mainly by Italians in the one room where the family ate and slept, was being sold from hand-carts under most reprehensible conditions. Sweetmeats such as ginger snaps were hawked from portable trays with little regard for the dirt-laden atmosphere. Saveloys, pease pudding, faggots, pig's trotters, tripe and bullock's cheeks often cooked in, and sold from the front rooms of dwellings of doubtful cleanliness, were the delicacies of a colourful but unhygienic bygone age, when the average man's wage was often no more than £1 a week. Household refuse was collected from ill assorted bins or merely shovelled from ash pits to be conveyed to the Council's depot in topless horse-drawn carts to lie exposed on the quayside to await transportation by barge to the dumping areas in the North Sea. Some main streets were surfaced with wooden blocks and street orderlies had great difficulty in cleaning away the filth and horse manure ground into its surface by passing traffic. During dry weather, dust from these sources provided a constant stream of pathogenic organisms on to the contents of open-fronted shops and the uncovered comestibles. In extreme weather conditions horses would die and it was no rare sight to see a carcass in the street waiting removal to the knacker's yard. More often than not, a standpipe in an open yard was the only means of providing a number of families in the vicinity with a not too reliable water supply and similar arrangements for the use of water closets were common. Unlike today, there was no national scheme for medical attention and arrangements for such treatment were a trifle 206 Fair Time at Green wich (above) "Fizzy Sherbet Drinks", (left) "Hot Pies' 207 haphazard, especially for the poorer classes. Unemployed persons could obtain from the Relieving Officer permission to visit the parish doctor who would, in dire emergencies, allow the apothecary to dispense a bottle of medicine. Others could procure a bottle of medicine for 6d. from a doctor of their choice and for a 1/- this would include an examination. However, organised medical care was not completely lacking for in Nelson Street there was the "Doctors' Club", a provident scheme which, for the regular payment of 6d. per week, enabled a family to choose from a list of half a dozen doctors or so, one who would attend to their various medical necessities. Moreover, on production of a medical certificate, sickness benefit of 10/a week for six weeks could be obtained by a member of a "slate" club for his weekly contribution of 6d. An added incentive to membership was that at the end of the year the residue of funds was distributed at the Christmas "share-out" in the local public house where it was usual to conduct such business. Hospitals were of the voluntary kind and nursing was still a vocation only for the dedicated and physically strong young lady. Criticism in respect of them should be somewhat restrained for, within the limitations of their times, they generally fulfilled their functions with distinction. Free of charge, they were prepared to attend to all who presented themselves for treatment with scant regard for time or effort expended. Financial support from various sources enabled these establishments to continue to serve the community and "Jack-in-theGreen", that merry frequenter of May Day sports was often called upon to raise funds for the Miller Hospital. With his gaily dressed mummers and followed by brightly decorated horses and carts filled with merrymakers, his procession would wend its way along the streets to the sounds of a brass band, barrel organ and concertina players while collections would be taken from upstairs windows by numerous men on stilts. Enumeration at the 1901 Census gave the population in Greenwich as 95,770, an increase of 22% over the 1891 figure and this has since fluctuated from a highest total of 112,935 in 1910 to 57,070 in 1941 during the last war when evacuation was the order of the day. In the same year, the birth and death rates returned were 28.94 and 15.31 respectively with an expectation of life at birth of 43 years for males and 45 for females. Infant mortality, the most sensitive indicator of the social and environmental conditions of any area, was high at 130 per 1,000 live births, there being 362 such deaths forming 24% of all deaths 208 registered. The average number of children in each completed family has been estimated at between 5½ and 6 but evidence, necessarily a priori in character, seems to indicate that there were some 10 pregnancies per married woman and, furthermore, each year would claim 4 or 5 mothers in childbirth. A similar number of children under 5 years would die of congenital syphilis, a disease which was still rife at this time. In November 1900, when the new Borough Councils replaced the old Boards of Works, public health standards were being maintained largely by the application of the following Acts:— Metropolis Local Management Act, 1855. Food and Drugs Acts, 1875/1899. Local Government Acts, 1888/1894. Public Health (London) Act, 1891. In those days little was known of, and scant attention given to hygiene and, in ordinary homes, ventilated food cupboards and refrigerators were virtually unknown. Bacteriology and immunology were young and growing sciences; medicine and surgery, generally, were at long last throwing off the stagnation of centuries and a new, vigorous and enlightened attitude towards community and personal health was taking shape. Notification of infectious diseases had just been made compulsory (1899) and the implementation of regulations concerning the qualifications of midwives was imminent. It was in this atmosphere that the Council of the Metropolitan Borough of Greenwich was born and appointed Dr. E. G. Annis as its first Medical Officer of Health. Events since 1900 Exemplifying the remarkable improvements obtained in environmental conditions during the period of the Metropolitan Boroughs is the rise in the expectation of life at birth from the figures quoted for 1901, namely, 43 years for males and 45 for females to the present 68 years and 74 years respectively. Again, the infant mortality rate, which is now at 19 per 1,000 live births, is only one seventh of that returned at the beginning of the century and, the number of children dying during the first year of their life constitutes only 3% of all recorded deaths today in contrast to the 24% of 1901. Such improvements have not been achieved without very strenuous efforts and dedicated service not only on the part of the staff but also by those public spirited residents who were 209 prepared to serve their community by becoming members of the Borough's Health or Maternity and Child Welfare Committees during its lifetime as a Metropolitan Council. A list of such persons is given at the end of this section. During 1901, the Borough's first full year, the co-operation of general practitioners was sought by the Medical Officer of Health for the voluntary notification of tuberculosis with little result. Diphtheria anti-toxin was made available to local practitioners for the first time and arrangements were made with the Clinical Research Association for bacteriological examination of specimens. At this time Dr. Annis queried the accuracy of death certificates and suggested that, in the interests of demographical research, payment of fees for certification would be most likely to prove efficacious. In reviewing the high infant mortality rate, the Medical Officer of Health in his report for 1902, emphasised the need for educating the public by means of suitable literature but his suggestion that this could better be accomplished by the appointment of health visitors was not then acted upon. The same year brought the introduction of the Midwives Act and under the London County Council (General Powers) Act of 1902, registration of Ice Cream premises became compulsory. Supervision and control of mortuaries became the responsibility of the Public Health Committee and a site was purchased for the erection of a mortuary in Lamb Lane (now Bardsley Lane). An effort was made by the Medical Officer during this year to obtain information regarding probable causes of Cancer and investigations were carried out for several years without any definite results. In the following year, 1903, responsibility for Sanitary Conveniences, Horse-troughs and Drinking Fountains passed to the Public Health Committee and in 1904 a new convenience at Blackwall Lane was opened and the erection of a new Mortuary at Lamb Lane was completed. A conference of the Metropolitan Sanitary Authorities in this same year advocated the opening of creches but this resolution was not implemented. At this time Birth Registration could not be compelled under a period of six weeks and, in an attempt to check infantile mortality, an arrangement was made with the London County Council for a list of cases attended by their midwives to be sent to the Public Health Department in order that advice on infant care, feeding, etc., could be despatched with the least possible delay to the mothers. 210 Concern was expressed not only with regard to the disparity between notifications and deaths from tuberculosis but also the lack of public facilities for the treatment of this disease. The subject of the provision of a sanatorium for the area was referred to the Metropolitan Asylums Board who indicated that it would take no action unless authorised by the Local Government Board. A recommendation for the establishment of a Municipal Milk Depot to supply clean humanised milk, principally as a measure to reduce infant mortality, was accepted by the Council and a request to the London County Council to include a clause to this effect in their next General Powers Act was made accordingly. In November, 1904, a conference of local authorities was held at County Hall to discuss methods to be adopted to prevent the spread of infection by vagrants. A resolution to give local authorities greater powers of control over such matters was carried as was a request to the London Government Board to set up "labour bureaux" and "labour colonies" and to give the Guardians parental powers over children of habitual vagrants. Such sentiments were to be conveyed to the Government Committee on the Vagrancy Question. Inter alia, powers were given to Sanitary Authorities under the L.C.C. (General Powers) Act, 1904, to cleanse filthy or unwholesome articles or verminous houses. A Night Census of Homeless Poor conducted at the request of the L.C.C. on 17th February, 1905, failed to discover any persons sleeping out in any part of the Borough. To exclude the possibility of a "freak" result, arrangements were made for the Police to carry out similar surveys in the week preceeding and the week after the appointed day but the outcome was the same. Chief matters requiring attention as outlined by the Medical Officer of Health in his report for 1905 were, "firstly, the adoption of whatever measures are possible to check infant mortality; secondly, adopting whatever measures are practical for obviating the flooding with sewage of houses built on lowlying land; thirdly, the provision of more up-to-date arrangements for disposing of house refuse; fourthly, an increase in the staff of Inspectors in this Department; together with, fifthly, the adoption of more efficient means for ventilating the main sewers running through the Borough in order to obviate the serious pollution of the atmosphere which is particularly noticeable in the warmer weather". 211 In 1906, after many representations had been made to the L.C.C. regarding the continual flooding of the Marsh Wards of the Borough at times of heavy rainfall, two new sewers were constructed in an effort to control the storm waters. During 1907 a new Sanitary Convenience at the junction of Creek Road and Deptford High Street was opened and in the same year the Notification of Births Act, which compelled notification of births within 36 hours to the Medical Officer of Health was passed but was not adopted by this Council although advised by the Health Committee to do so. Following an inspection of Greenwich Market in 1902, many unhealthy insanitary and dangerous conditions were found not only in the premises which were badly lit, ill-ventilated and generally deplorable, but the paved portion of the Market was never cleaned down with water and consequently had become coated with a firm layer of fruit and vegetable matter "trodden down by the foot of man, the hooves of horses and finally rendered firm with waggon wheels". These matters were reported to the Council and notices were duly served requiring abatement but this proved a slow, laborious task by reason of dual authority, viz., the Admiralty and the Collector of Tolls (the highest bidder at public auction for this position). The latter could not, without permission of the Admiralty, put on water supply for the cleansing and flushing of the Market. Finally, an ad hoc Council Committee met a Departmental Committee of the Admiralty to resolve the problem, agreement was eventually reached and the improvements were completed by 1907. A voluntary health organisation was formed in 1908 called the "Greenwich Health Society", its objects being to foster among the people a desire to secure the best possible health and sanitation for the Borough and to give special attention to the feeding, clothing and environment of infants and young children. The Borough was divided into 8 districts, each having a Superintending Visitor who would visit at least once a month and when necessary advise mothers to seek medical attention for themselves or for their children and at the same time report any sanitary defects in the household to the Public Health Department. It was a pre-requisite that the Visitor should be conversant with the Poor Law in order to give needy families the benefit of her advice. The following year brought about the formal adoption by the Council of the Notification of Births Act, 1907, and three 212 Consultation Centres were opened under the control of the Greenwich Health Society. During 1910 the Council appointed a Woman Sanitary Inspector specifically for supervising Houses-let-in-lodgings under the L.C.C. Byelaws, but as the Medical Officer's efforts to obtain the appointment of a Health Visitor had failed, the assistance of the Woman Sanitary Inspector was obtained to carry out certain health visiting duties. Important legislation was introduced in 1911 including the National Insurance Act and the Public Health (Tuberculosis) Regulations which made pulmonary tuberculosis compulsorily notifiable. These latter regulations enabled the Health Department to assess more fully the extent of the problem in the area and the Medical Officer of Health was pressing the Council to provide a local Tuberculosis Dispensary in order that greater control could be obtained over this serious and distressing disease. At this time it would appear that cases of ophthalmic neonatorum were often coming to the notice of the M.o.H. too late to prevent permanent eye damage and it was with some relief that an order by the L.C.C. making this infection notifiable was received. It was during this same year that the Greenwich Health Society ceased to function as it was thought that the Council would more readily appoint a Health Visitor if the Society was disbanded. Even at this period of the Council's history complaints concerning the East Greenwich Generating Station were common and during 1911 an action was taken against the owners, viz., the London County Council. In 1912 the Local Government Board under the Public Health (London) Act, 1891, sanctioned the notification of Whooping Cough for a period of 5 years from the 1st June, and Cerebro-Spinal Meningitis and Poliomyelitis were added permanently to the list of notifiable diseases. For a number of years, summer diarrhoea had been one of the prime causes of infant mortality and during this year the Council made this complaint notifiable within the months of June and September and, in addition, a temporary Health Visitor was appointed for the summer months and arrangements were made with the Ranyard Nurses and Sisters of St. John the Divine for systematic home visiting. Subsequent investigations revealed that many babies of 2 to 3 months were being regaled with "toffee apples", i.e. small, unripe "windfalls" dipped in syrup 213 and this was undoubtedly responsible for some of the reported cases. A case of leprosy found to be living in the Borough in unsuitable conditions was first removed to the Council's Isolation Shelter and accommodation was finally procured for him in a more rural suburb. This year also saw the establishment by Miss McMillan of a school Clinic or Health Centre at Deptford Green, and the Council's Isolation Shelter was first used for the cleansing of verminous children and the disinfection of their clothes. Negotiations begun during 1912 resulted in the establishment in 1913 of a Tuberculosis Dispensary with a Medical Officer and two nurses in attendance and in the first Tuberculosis Report for that year emphasis was laid on the need for an After-Care Committee. At this time three Welfare Centres were in operation: one at Deptford Green under the control of Miss McMillan, one at the Albany Institute (which was also being used as a Babies' Residential Home), and one at Conduit House. During this period cod-liver oil, Parrish's food and ointments were being distributed at these Centres at reduced cost. It was during the following year, 1914, that the term "Maternity and Child Welfare" was first used and this year saw the appointment of the first full-time Health Visitor. By 1915 an After-Care Committee for Tuberculosis patients had been organised and it was about this time that the Council took over the Voluntary Consultation Centre at Conduit House and arranged for the distribution of dried milk, etc., at reduced prices. Further centres and creches were opened in 1917 and by 1918 there were three Health Visitors on the permanent staff. In 1919 Diarrhoea and Zymotic Enteritis became permanently notifiable and arrangements were made under the Maternity and Child Welfare scheme for dental treatment; other arrangements included similar treatment for tuberculosis patients at the Dispensary. It was pointed out in the Medical Officer's Annual Report for 1919 that conversion of premises by the London Housing Board, acting on behalf of the Council, had contravened Section 96 of the Public Health (London) Act, 1891, and in consequence the Council had become owners of properties not complying with legal requirements in regard to basement and underground rooms. It was also indicated in this Report that the L.C.C. had added to the overcrowding problem by 214 demolishing a number of houses to make way for a new school without providing alternative housing accommodation and the Council accordingly registered its protest. The year 1920 heralded the formation of a Maternity and Child Welfare Committee and an increase in staff to 7 Health Visitors and 8 Sanitary Inspectors. During this year a Minor Ailments Centre was opened at the Borough Hall, the Ministry of Health's sanction was obtained for the purchase of 105 Shooters Hill Road for M. & C.W. activities and the Council acquired the lease of Conduit House for similar purposes. This year also saw the first marked decrease in infantile mortality. At this time, in addition to the normal functions of the Health Clinics, the mothers' interests were sustained by the introduction of Baby Shows, Mothercraft competitions, Christmas parties, etc. Regarding other Public Health work during this period, a yearly "Rat Week" was instituted throughout the Borough in accordance with the Rats and Mice (Destruction) Act, 1919, and Royal approval was given to the Rent and Mortgage Interest Restrictions Act, 1920. A temporary Order for the notification of Measles and German Measles made in 1915 having expired, these diseases were made compulsorily notifiable from 1st July in accordance with the Regulations of 1920. After strong representations had been made by the Medical Officer to the London County Council concerning unnecessary duplication of visits by Health Visitors, authority was given in 1921 for the Greenwich Borough Council to assume powers under Section 2(2) of the Children Act, 1908, in respect of Foster-Mothers. Prior to 1921 discussions had taken place concerning the purchase of a site for a Maternity Home but as the suggested premises in Maze Hill proved unsuitable the house at 78 Shooter's Hill Road was, with the Ministry's consent, acquired by the Council for this purpose. The year 1921 also saw the conversion of Conduit House and 105 Shooter's Hill Road and 7 Infant Welfare and 2 Ante-Natal sessions were being conducted there each week. At this juncture the interim Tuberculosis Care Committee in its work was obtaining assistance from six voluntary organisations and the Council commenced its housing schemes with the erection of 190 houses on the "Hanging Wood Lane" site which had been compulsorily acquired in the previous year. The early months of 1922 witnessed the opening of the 215 Council's Maternity Home at 78 Shooter's Hill Road, a project which had first received formal approval in June, 1919, and, in this respect, the Council must be commended on being pioneers in the establishment of a Municipal Maternity Home. Accommodation at that time consisted of 12 beds and during the first year of its existence the Home dealt with 121 confine ments. On 21st November, 1923, the Council, with Ministry approval, decided to form a permanent Tuberculosis Care Committee to consist of annually elected members from various interested organisations, voluntary and statutory. In 1924 the Cleansing Station was opened and an Artificial Sunlight Centre was suggested. This latter proposal led eventually to the establishment in the following year of the Council's first Sunlight Centre at Conduit House. Facts about cancer and the need for early diagnosis and treatment were contained in a pamphlet generally circulated throughout the Borough during 1924. In the same year a new Refuse Disposal plant was brought into operation which was disposing of 30 tons per diem, such treatment involving sorting and disposal of saleable materials. Such plant was expected to reduce the nuisance arising from the dumping of refuse on the low-lying marsh areas of the Borough. Purchase of Charlton House and its estates during 1925 enabled the Council to contemplate considerable expansion of its housing scheme. During 1926 the accommodation at the Maternity Home was increased to 20 beds, distributed in two general, one private, one isolation and two labour wards. There was an ingenious suggestion from the M.o.H. during this year that, to encourage the medical profession to greater efforts a capitation fee be introduced, based upon a standard death rate, which would rise as the rate fell and, conversely, fall should the rate rise. In an effort to combat the rising cancer deaths, the Council, with the Ministry's consent, opened a Tumour Diagnostic Clinic towards the end of the year 1927. Provision for a further Health Service was contained in a suggestion by the Medical Officer that a plan for "Schick" testing and Diphtheria immunisation should be introduced, but the scheme was not taken up. This year also saw the compulsory registration and licensing of street traders under the London County Council (General Powers) Act, 1927. 216 In the summer of the same year a "Health and Infant Welfare" Week was held, at which suitable films were displayed and popular lectures delivered by competent speakers. This exhibition, in addition to being very attractive on the commercial side, was supported by the Health and Cleanliness Council, British Social Hygiene Council, Dental Board of the United Kingdom, National Milk Publicity Council, College of Pestology, etc., all of whom contributed interesting exhibits. From 1st July, 1927, under the new Births and Deaths Registration Act of 1926, medical practitioners were required to deliver the new style death certificate to the Registrar direct, and registration of Stillbirths became compulsory. In January, 1928, the level of the Thames rose 18ft. 5ins. above datum line, with the result that a considerable proportion of the Borough adjacent to the river bank was flooded to a depth of several feet. Happily no cases were recorded of persons having been drowned but the inundation caused considerable damage to property, furniture, bedding, etc. The Public Health Department was given the task of visiting and estimating the damage sustained in the various areas in order that the "Flood Fund" could be correctly allocated. During this same year the Tuberculosis Handicraft Hut and classes were opened, the Greenwich edition of the journal "Better Health" was introduced and in July registration of all Nursing Homes was compelled. Another "Health Week" was held in June, 1929, at the Borough Hall and this again achieved remarkable success. The Local Government Act of this year which became operative in April, 1930, gave greater freedom in the administration of the Health Services and an important provision was the substitution of block grants for percentage grants. Another important feature was that under the provisions of this Act, control of hospitals directly supported by rates was vested in the London County Council. A differential rent scheme for the benefit of large poor families was commended to the Council without result. In November, 1930, a new Welfare Clinic was opened at 105 Shooter's Hill Road and the Council introduced a scheme for the supply, at reduced cost, of sterilised maternity outfits for home confinements. A Ministry of Health Memorandum issued in the same year recommended the introduction of Birth Control Clinics for cases where control was advised on medical grounds. 217 This year also saw the introduction of the Public Health (Tuberculosis) Regulations, 1930, which became operative in January of the following year and it was during 1931 that arrangements were made for non-residents of the Borough to obtain, on payment of a small fee, Artificial Sunlight treatment during winter months. The London County Council (General Powers) Act introduced during 1932 made the registration of Preserved Food premises and the notification of Food Poisoning compulsory. In June of the same year a new Welfare Centre at Chevening Road was opened and a Housing Inspector was appointed in September. A conference between the Medical Officer of Health and local Medical Practitioners concerning the establishment of a Rheumatism Clinic to function two or three sessions per week, eventually proved abortive. Toward the end of 1932 a survey of the Council's Public Health Services was made by Inspectors of the Ministry of Health. Whilst approving the standard of the services provided, the Minister stated that in addition to making provision for a Welfare Centre to serve the Charlton area, the Council should take into consideration the appointment of a Food Inspector and a full-time Junior Assistant M. & C. W. Medical Officer. Early in 1933 the latter two appointments were duly made and tenders were invited for the erection of a Welfare Centre in the Charlton district, whilst in September the Minister approved the Council's regulations concerning conditions to be observed in connection with underground and basement rooms. During the same year the Council's Maternity Home was officially recognised as a Training Institute for Pupil Midwives and in this respect 80 Shooter's Hill Road was purchased to provide an extension of the Home which then became necessary. Duties of the L.C.C. under the Children Acts, 1908 and 1932, concerning supervision of foster-mothers, etc., were transferred during this period to the Council and arrangements were made with the Roan School Authorities for their pupils to obtain Artificial Sunlight treatment at the Council's Welfare Centres. It was fitting that Dr. E. G. Annis should retire at a time when the foundations of efficient "personal health services" were well and truly laid. He was succeeded in his post as Medical Officer of Health by Dr. M. Macdonald who had been Tuberculosis Officer since 1920. 218 The extension to the Maternity Home was opened in 1934, as was the new Sanitary Convenience at Creek Road, and it was during this year that the Board of Education asked for the co-operation of the Medical Officer in approving the source and quality of pasteurised milk to be supplied at reduced cost to schools in the area. The first "toddlers" Clinic was also introduced during this period. The year 1935 was a landmark in Greenwich Public Health —two new Welfare Centres were opened, one at Charlton Lane in January and one at Creek Road in June—the Maternity Home was renovated and electricity installed—a Birth Control Clinic commenced in Woolwich Road—a Foot Clinic was established affording chiropody facilities at 1/- per treatment and a scheme was devised to enable necessitous diabetic people to obtain regular supplies of insulin. The overcrowding survey carried out under the Housing Act, 1935, was practically completed during this year and it was estimated that there were approximately 1,000 basement rooms in the Borough only a few of which were of the worst type. In 1936 there was a spate of legislation including a new Public Health (London) Act and a new Housing Act, both of which became operative in 1937. Owing to increased demand an extension of the Foot Clinics became necessary and an additional chiropodist was appointed, the total treatments given during 1936 numbering 3,557. It was during this period that ozonisation was introduced in the Cold Air Stores in the Borough to rid products of smells and tastes of pungent flavours acquired during transit or storage. As a result of application and enquiries from parents regarding diphtheria prophylaxis, the Council resolved in September of 1936 to inaugurate a scheme for Diphtheria Immunisation for children up to the age of 14 years, immunisation being carried out mainly at the Seamen's Hospital Laboratory. Dr. M. Macdonald relinquished his post in August 1936 upon his reaching retiring age and Dr. F. R. Waldron, who at that time was Assistant Medical Officer and Tuberculosis Officer, succeeded him in this assignment. At the beginning of 1937 the Public Health staff evacuated its offices and took up temporary accommodation at Devonport House in order that the work of the erection of the New Town Hall on the site of the old Borough Hall could proceed. It was during this year that the appointment of a full-time clerk to the 219 Tuberculosis Dispensary became necessary when, in order to obviate duplication of records, the Notification Register was transferred from the Public Health Department. The Tuberculosis Handicraft Centre Committee was formed during this period and immediately effected affiliation to the National Association for the Prevention of Tuberculosis. In the 1937 Annual Report, attention was drawn to the increase in atmospheric pollution, the Astronomer Royal having indicated that in Greenwich this pollution was some 25% greater than that of the previous year. As a result of the substantiation by a special survey of the Astronomer Royal's comments for 1937 concerning atmospheric pollution, the Council had under consideration in 1938 the question of instituting proceedings against the owners of the Generating Station at East Greenwich. This action was eventually settled on the understanding that existing plant would be exchanged for more efficient apparatus during the next few years. The increasing usefulness of the Foot Clinics necessitated a change in 1938 to an "appointment" system in order to avoid long waiting periods by patients. The Public Health Committee also agreed to adopt a "Home Helps" Service to be run in conjuction with the new Midwives Act introduced at this time. During 1938 the Tumour Diagnostic Clinic was discontinued and replaced by a Women's Special Clinic, which, unfortunately, had a very short existence as it was closed down at the outbreak of war. Under the Factories Act, 1937, a survey of Basement Bakehouses was made and Suitability Certificates were issued in appropriate instances. A new Food and Drugs Act made its appearance during 1938. which, curiously, amended previous legislation dating back to Henry VlII's time. The Public Health Department moved into the New Town Hall in June, 1939, just prior to the outbreak of the War, the latter event resulting in the closure of the Council's Maternity Home. In addition, the new Disinfestation scheme and the proposed establishment of a Central Dental Clinic, both planned in 1938, were held in abeyance. A scheme for the supervision of Rheumatic Children was also set aside. Civil Defence organisation was set in motion by the 1938 "crisis" and by the outbreak of war in September, 1939, the staff of the Public Health Department had supervised the 220 221 MODERN HOUSING SCHEN GREENWICH Springfield Grove Estate Elderly Persons Bungalows, Fulthorp Road, S.E.3 Houses in Woolacombe Road, S.E.3 Merryfield, Pond Road Estate, S.E.3 222 formation of the Light Rescue Parties and had formed the nucleus of the First Aid Posts established at various Hospitals and Welfare Centres throughout the Borough. Younger members of the staff were conscripted into the Services and employment of temporary clerical assistance became necessary. War-time conditions compelled the introduction of a further Rent Restriction Act to safeguard the interests of the community and this Act, which was made effective from April, 1939, extended the life of the principal Rents Acts until an end to the National emergency had been declared. Normal life of the Borough was inevitably upset by bomb damage which first occurred in September, 1940, and continued with very little respite until the cessation of hostilities, but disruption of the health services was kept to a minimum. Owing to extensive war-damage additional work was required of the Sanitary Inspectors in connection with the Landlord and Tenant (War Damage) Acts and the Food Inspectors were untiring in their efforts to save as much food material as possible from wrecked food premises. Insanitary conditions brought about by the constant use of air-raid shelters, resulted in the introduction of the Scabies Order, 1941, making this complaint a notifiable disease. Three Wartime Day Nurseries were established during 1942 and, due to the rationing of Clothes and Furnishings, a scheme for the supply of extra clothing coupons to expectant mothers was introduced. Vitamins and fruit juices were also made available to nursing and expectant mothers and infants by the Ministry of Food under a National Scheme. In 1943 the Government ratified allowances for dependants of sufferers from Tuberculosis who were expected to return to work within a reasonable period. Mass Miniature Radiography was introduced by the London County Council in 1944 and in the same year the Council agreed to participate in the Metropolitan Borough Councils' scheme for the Care of Illegitimate Children. About this time the Ministry, in order to reduce neo-natal deaths, asked for a special investigation and report on all premature infants, i.e., children born at 5½ lbs. weight or less. In 1945 Domestic Helps were introduced for the benefit of the old and infirm. The Council adopted schemes for housing development throughout the Borough and, similarly the London County Council were also considering the 223 ment of the Brook Estate in the Kidbrooke area. Meanwhile the difficult housing situation was being met by the erection of E.F.M. dwellings on Blackheath and other vacant sites. During 1946, the Shooter's Hill Road and Pound Park Nurseries were taken over by the L.C.C. and a "points" system was introduced by the Housing Department to determine housing priorities. At the same time the Council indicated its intention to participate in the Ministry of Food Rodent Control scheme and appointed 16 special investigators and operatives. The year 1946 was of great significance in the life of the Metropolitan Boroughs. Introduction of the National Health Service Act of this year was eventually to lead to the transference to alien authorities of the M. & C.W. and many other services which had been brought to a high level of efficiency over a period of years by local management. The first official attempt to secure the elimination of pathogenic organisms from Ice Cream was made in 1947 by the introduction of the Ice Cream (Heat Treatment, etc.) Regulations. By direction of the Ministry a survey of underground water supply was undertaken to ascertain the quality and use to which it was being put and a summary of the results were included in the 1947 Annual Report. An extension of the Rodent Control Scheme was made during this period and the Council's decision concerning the establishment of an Anti-Fly and Mosquito Scheme which had been taken the previous year was implemented. The Anti-Fly and Mosquito campaign is now a well established Public Health Service and commences in May of each year and continues until October. In anticipation of the establishment of a Regional Hospital Chest Clinic under the recently introduced Health Service Act, a new Tuberculosis Care Committee was formed in 1947 and an Almoner was appointed specifically for this work. At the same time arrangements were made with Dr. Young for the Senior Chiropodist to treat diabetic patients, one session per week, at St. Alfege's Hospital. In accordance with decisions taken earlier two new Clinics—Fairfield House and Ridgebrook Road—were also opened by the Council during 1947, bringing the total number of Welfare Clinics in operation to 8. The year 1948 witnessed the greatest change in Public Health Administration since the inception of the Metropolitan 224 Boroughs—in July all M. & C.W. functions, Day Nurseries, Chiropodists, Home and Domestic Helps, Welfare Centres, Cleaners and Caretakers were transferred to the London County Council, and the Tuberculosis Medical Officer, Dispensary, Clerk and Caretaker were transferred to the Regional Hospital Board. Whether centralisation of control of the Personal Health Services would prove as efficient as the original local control remained to be seen. Under Section 47 of the National Assistance Act, 1948, and with certain safeguards, power was given to remove compulsorily from their homes, aged or infirm persons unable to care for themselves. In July, 1948, following the changes resulting from the transfer of functions under the National Health Service Act, Dr. Waldron took up his appointment with the London County Council as Divisional Medical Officer for Division 6. He continued, however, to act in a part-time capacity as Medical Officer of Health for the Borough until June, 1949, when the present Medical Officer assumed responsibility. Power was given under the Housing Act of 1949, to enable local authorities to make grants to owners of dwellings for improvements or conversions of their properties. During 1949, much legislation was introduced to ensure a purer and more wholesome supply of milk to the public and an attempt to standardise Rodent Control was made by the introduction of the Prevention of Damage by Pests Act, 1949, which became operative early in 1950. In commenting upon the provision of hot midday meals for old people by the B.R.C.S., the Medical Officer expressed the hope that the service would be extended to the bedridden invalids of all ages now that the Council was making its contribution under Section 31 of the National Assistance Act, 1948. With a view to raising the hygienic standards in food and other premises throughout the Borough to a level above those strictly enforceable in law, a Guild of Hygiene was inaugurated in January of 1950 thus providing, in the Council's Jubilee Year, an appropriate climax to 50 years of solid progress. In his report for 1950, the Medical Officer strongly recommended full exploitation of B.C.G. Vaccination in order to achieve similar results with tuberculosis as were obtained with smallpox. He expressed disapproval of the County Council's suspension of whooping cough, diphtheria and other prophy- 225 laxis measures on account of the steep rise in poliomyelitis. In counselling the most economical use of the country's resources, the advantages of fully co-ordinated health services were stressed and the saving in money and human suffering which would accrue from greater emphasis on prevention. Being specifically excluded from actively participating in schemes for providing expansion and extension of "Meals-on- Wheels" schemes for elderly people, the Council made a grant of £200 to the B.R.C.S. on 1st January of this year for such purposes. Following complaints by a number of riparian authorities et al regarding the deterioration in the condition of the Thames resulting from the discharge of sewage effluent, the County Council took steps to improve the situation and a £10 millions scheme for its amelioration was commenced in September, 1950. There was a brisk increase in the incidence of sonne dysentry during 1951 and regulations were introduced requiring medical practitioners to notify the Chief Medical Officer of the Ministry of any case of leprosy coming to their notice. Welfare of animals prior to their sale was the object of the Pet Animals Act of this year. The year 1952 was notable if only for the great fog which engulfed the capital early in December for four days and was responsible for some 4,000 deaths in the Greater London area. This year the Council's first slum clearance scheme since the war was realised with the representation of three houses in Park Vista. A resurgence of sonne dysentry, such as that of 1951, occurred during 1953 which also saw the beginning of holiday schemes for elderly residents when the Council made its first grant to the Greenwich Old People's Welfare Committee to enable it to send 114 old persons to Margate for a fortnight. On 1st February, 1953, a high tide caused the Thames to overflow its banks and damage in this Borough was confined mainly to industrial premises although some dwellings in the vicinity of the river were flooded. Under departmental arrangements soiled articles were cleansed and dried, essential repairs effected, disinfection carried out and emergency feeding schemes were introduced. An R.A.F. ground heater was used to dry out a number of basement rooms which had been inundated. 226 Stimulated by the "smog" tragedy of 1952, the Beaver Report on atmospheric pollution was published in November, 1954, indicating the cost to the nation in terms of death and physical disability as well as financial loss in this poisoning of the air. Much of the original work by the D.S.I.R. which became the basis of the future Clean Air Act was carried out at Greenwich. Increase in lung cancer was most marked and was the subject of strong comment in the 1954 report. After much prompting by the Metropolitan Borough Councils and in an effort to improve the hygiene of persons and premises, an L.C.C. (General Powers) Act of 1954, laid down that no person was to be permitted to engage in the business of hairdresser or barber in the Borough unless he and the premises were registered with the Health Department. Baths for the elderly, at home and at the Bathing Centre, were introduced and an incontinent laundry service was established to deal with soiled articles from bedridden aged persons. Arrangements were also made with voluntary organisations for the repair and replacement of bedding and clothing. The Greenwich Old People's Welfare Association, with financial and practical assistance from the Council, was formed in July, 1954, for the express purpose of promoting the well-being of all elderly residents in the Borough. During 1955, in accordance with the Housing Repairs and Rent Act, 1954, a complete survey of the Borough was undertaken to ascertain the number of unfit houses with a view to their clearance either by the County or Borough Council. More efficient control by local authorities over food and food establishments was given by the Food and Drugs Act of 1955 with its associated Hygiene Regulations. With the co-operation of the staff of the Fuel Research Station, apparatus for measuring atmospheric pollution was set up at Charlton House and the Town Hall. Greater powers over the causes of the emission of smoke, grit and dust were given to local authorities with the introduction of the Clean Air Act, 1956, and the new legislation enabled the Council to establish smoke control areas to free the atmosphere of dangerous pollutants. As a riparian authority Greenwich receives substantial food imports from many parts of the world and increasing importations of egg albumen were causing concern by reasons of the frequency of salmonella and paratyphoid "B" organisms 227 discovered when it was sampled. Representations to the Ministry resulted in the establishment of a Heat Treatment Centre at Palmers Cold Stores. The following year, 1957, saw the introduction of the very controversial Rent Act which presented the Health Department with difficulties both of administration and interpretation, and a consolidation of previous housing legislation was effected by the Housing Act of the same year. Anxiety regarding the importation of contaminated egg albumen was again expressed by the Public Health Committee and the Ministry was made aware of the Council's concern in the limitations of its power to detain or condemn, viz., for 48 hours, which was insufficient time for its Health Department to receive results of bacteriological examinations. Work on behalf of the elderly had expanded and necessitated the engagement of a further Woman Public Health Officer in January, 1959. Exchequer assistance was made available to certain large building societies to enable more loans to be made for house purchase or improvement and grants for standard amenities could be claimed as a right under the House Purchase and Housing Acts, 1958/59. Noise abatement and the control of caravan sites were the subjects of legislation during 1960 and, with increasing deaths from inefficient oil burning appliances, regulations and standards covering such articles made their appearance during this year. A date of 1st October, 1960, was agreed with the Minister for the Council's first Smoke Control Order. Under the supervision of, and in accordance with, the advice of the Food Inspectors, a frozen whole egg plant was constructed at Payne's Wharf and became operative during this year. It was expected to break 360,000 eggs per day when it was fully employed. During the year 1960 and for some time after, a great deal of extra effort was demanded of food inspectors as a result of the importation of meat more than usually bacteriologically contaminated or diseased. In the main, the causes of complaint were Swedish pig carcases and Bechuanaland boneless beef but, following protestations from this Council, meetings with other riparian authorities and the Ministry were convened and the matters were eventually resolved satisfactorily with the various countries concerned. 228 THE NEW CLEANSING AND BATHING CENTRE. Laundry Bathroom 229 In their outstanding publication, "Smoking and Health" of October, 1961, the Royal College of Physicians reviewed all the evidence for and against the hypothesis that smoking causes lung cancer and other disabling diseases and made recommendations as to what action was required. Legislation in the form of the Housing Act, 1961, in addition to re-aligning subsidies and encouraging slum clearance, gave valuable new powers to local authorities with regard to houses in multiple occupation to prevent and alleviate squalid conditions. Services for the elderly of the Borough were expanded and improved still further by the opening, in October, of the Council's new Bathing and Cleansing Centre and another Woman Public Health Officer was engaged. After numerous representations to the Ministry of Agriculture, Fisheries and Foods over the years by the Council regarding the frequent overflowing of the River Ravensbourne and the damage caused to adjacent dwellings, an Act for the improvement and prevention of flooding of this river and its tributaries was introduced during 1961. A case of smallpox in a neighbouring Borough in 1962, occasioned strenuous efforts on the part of the Department and the County Council and emergency vaccinations were carried out at Clinics and, when necessary, in homes of suspected contacts. Substantial increases in the numbers of homeless in the London area resulted in the L.C.C. seeking licences to use vacant sites in the Borough for the erection of mobile homes. It further stimulated the Government to set up the Milner Holland Committee which published a Report in 1965 which was ultimately to arouse deep feelings and prompt a movement for further housing legislation. Two new ventures in relation to services for the elderly were made during 1963; one, the introduction of luncheon clubs to augment the "Meals-on-Wheels" scheme and the other, a chiropody service for the less able-bodied and physically handicapped of the older groups. Moreover, in order to ensure vacations for its elderly citizens, the Council purchased a holiday hotel at Westgate-on-Sea which became fully operational in March, 1964. 230 GREENWICH OLD PEOPLE'S HOTEL—Westgate-on-Sea. (left) Dining Room (below) A Bedroom 231 For the first time ever, legislation covering sanitary coditions in offices was introduced in the Offices, Shops and Railway Premises Act of 1963 and, during the same year, results were published of a very valuable survey of perinatal mortality instituted by the National Baby Trust Fund which will be quoted for some years to come. Further housing legislation was brought into being by the Act of 1964 which, inter alia, gave local authorities powers to compel improvement of dwellings and extended their control over houses in multiple occupation. As a temporary measure, the Government, at the latter end of the year, introduced the Prevention from Eviction Act in order to relieve the rising anxiety and distress occasioned to tenants by the threat of dispossession under the Rent Act of 1957. Naturally, the final year of the Council as a Metropolitan Borough Authority was overshadowed by its impending elimination and much attention had to be given to establishing rapport with the amalgamating authorities. Inaugurated at a time when education was limited, hygiene almost unknown and preventive health was some obscure, abstract science, the Metropolitan Boroughs, often against overwhelming odds and great prejudice and superstition, were destined to lay the foundations of stable community health which were to be the envy of most other countries. Vital statistics for 1964 give factual evidence, if such were needed, of the enormous advances achieved in social and environmental health during the lifetime of the Metropolitan Boroughs. The pattern of disease has already changed, for immunisation and extensive use of chemotherapeutic drugs and antibiotics have made control of all lethal infections a practical possibility. Despite periodical outbreaks, communicable disease is no longer of vital consequence and attention of health authorities must now be directed towards the degenerative diseases and ailments associated with the stresses of modern living. Indeed, a new concept of Public Health and Social Medicine is already emerging and even further changes are presaged. At the passing of the Metropolitan Borough of Greenwich, what problems in the health field still remain? Despite much theorising, housing problems are unresolved and are likely to be 232 matters of controversy for some time to come. Fluoridation of water supplies, although generally supported by the Metropolitan Boroughs has yet to be implemented. Causes of perinatal mortality have still to be fully explained and cancer of the lung is reaching epidemic proportions. However, a note of encouragement and confidence can be struck for, with advances in medical research recently made public, the future prospects of successful treatment of cancer can be considered bright. Such a short resume can hardly be expected adequately to cover the whole of the 65 years of the Borough's existence, from its birth to retirement, but it does show quite clearly that the Greenwich Borough Council has always been in the van of progressive local authorities and that it can be satisfied with its part in the foundation and maintenance of excellent Public Health Services. A.H.W. 233 ROLL OF PERSONS WHO SERVED THE GREENWICH COMMUNITY ON THE HEALTH OR MATERNITY AND CHILD WELFARE COMMITTEES 1901 - 1965 A. Akam 1903 D. Amos 1906 B. R. Angell 1955-62 W. Arter 1939-40 J. Ashby 1902-03 W. Aylett 1933-34 Capt. R. T. Baker 1901-03 W. G. R. Ball 1925 Mrs. E. M. Banfield 1925 H. Baron 1916-19 T. F. Battle 1920-22 Mrs. P. M. Beacham 1926-48 T. H. P. Beacham 1930-47 H. I. Benn 1902 Mrs. M. L. Bennett 1945-64 Mrs. O. Bennett 1935-44 Mrs. C. Berry 1949-58 Mrs. E. C. Berry 1925-32 R. A. Blatchford 1959-61 G. Bowden 1939 E. A. Brandon 1906 J. A. P. Brown 1944-47 G. Brace 1946-50 Mrs. L. E. G. Bruce 1935-37 G. C. Budd 1927 Mrs. K. P. Bullard 1956 A. Burnett 1904-08 M. G. Byerley 1923-37 S. M. Carpenter 1923-24 A. Carr 1901-02 Mrs. F. Carter 1927-52 A. Cathles 1935-37 G. B. Catt 1907-09 R. A. Challenor 1938-39 A. C. Chrisp 1949-64 Mrs. J. E. Chrisp 1959-64 F. W. Clifton 1920-22 S. J. Clothier 1924-25 A. E. Cooney 1910-12 B. W. Cooney 1907-09 Mrs. F. P. Cooper-Key 1920 R. J. Cummings 1927-34 Mrs. N. Cunis 1930-38 J. R. Dabin 1929-46 J. Davey 1914-16 T. L. Dawes 1946-54 H. F. Defrates 1919 Mrs. A. Dence 1926 E. M. Dence 1923 J. D. Dixon 1912 G. F. Drakley 1939-47 F. S. Eason 1946 Mrs. A. M. Edwards 1921-25 R. G. Evans 1921-22 W. J. Evans 1946 A. T. Furlong 1910-12 H. C. Gallehawk 1927-29 H. H. Gibbons 1927-45 J. B. Gillard 1956-58 Mrs. J. Gollogly 1944-59 Miss M. Gollogly 1949-52 R. Gooding 1901-03 C. Gordon 1910 Dr. J. Gordon-Parker 1907-19 H. W. Gorman 1947-54 R. Graf 1904-06 Lieut.-Col. W. J. B. Graham 1902-03 L. C. Green 1959 Major R. H. Green 1926-28 E. N. Greenwood 1914-22 H. Groves 1915 Mrs. M. Hamilton 1920-26 H. D. Hardee 1932-34 H. C. De Havilland 1907 A. J. Haylock 1923-25 H. G. Hayter 1901-05 Mrs. M. M. Hayter 1944-48 R. H. Hayter 1946 T. Hearn 1923 Miss C. H. Hervey 1927-30 A. L. Hewitt 1938-40 Mrs. L. Hilldrith 1938-58 Dr. W. R. Hodgkinson 1923-28 J. Hogg 1920-22 W. Holland 1924-27 S. N. Home 1914-32 Lady Hume 1951-61 G. H. Hume 1901 A. J. Hunt 1913-25 H. W. H. Icough 1929-40 H. Ingle 1952 R. G. Ingrey 1956 W. J. Jackman 1920-22 R. S. Jackson 1901-06 Mrs. I. Jaggers 1938-48 R. G. Jaggers 1935-37 T. P. Jaques 1938-47 Mrs. J. A. Johnson 1964 Mrs. L. M. Jones 1929-32 F. Jukes 1901 234 T. A. Keating 1944-47 Mrs. S. A. Kelly 1920-26 A. R. Kempt 1929-31 Mrs. A. D. A. Kennedy 1932-64 Mrs. F. M. Kerins 1953-54 J. H. Killick 1901-06 F. W. Lamley 1929-30 Major L. F. Land 1946-47 C. H. Latter 1937 A. Lawes 1901 B. J. Lemmon 1921 W. O. Little 1948-52 Gen. S. S. Long 1913 Mrs. B. J. T. Lord 1929-32 Lt.-Col. E. A. Lovibond 1911-19 D. P. Lynch 1949-64 F. W. Mander 1920-25 F. E. Mann 1962-63 W. J. Manners 1964 W. S. Manners 1948-64 A. Matthews 1910-12 Lt.-Col. M. C. Matthews 1923-34 D. McCall 1903-15 G. Meers 1908-09 Mrs. P. A. Middleton 1961 W. W. Middleton 1923-25 A. Miles 1944-46 Mrs. S. H. Mills 1926-31 W. F. Mills 1947 W. J. Moore 1935-37 Dr. H. B. Morgan 1922-26 Dr. W. G. S. Neely 1955 C. Newberry 1910 Col. H. A. H. Newington 1931-33 C. Nixon 1904-19 D. W. Noakes 1917-18 P. Noble 1953-64 Col. E. L. Ommanney 1901 Capt. A. R. Owen 1901-03 Dr. J. G. Parker 1916-17 A. D. Patton 1940-48 Mrs. E. Pennington 1962-64 Mrs. R. P. Perry 1931-32 F. Powell 1916-18 Mrs. S. Pridden 1927-28 Mrs. A. Purkiss 1924 R. F. A. Purkiss 1911-29 Col. A. C. Ralph 1926-32 H. A. Read 1958-64 G. Redgrove 1923-26 H. Richardson 1909 W. Richardson 1905-07 J. M. Roberts 1932 J. M. Rokes 1923-32 Miss K. E. H. Ross 1949-52 J. H. Round 1926 R. Ruston 1955-64 A. E. Rutter 1949-50 Mrs. H. G. Sargent 1921 Mrs. I. M. Scales 1963 Mrs. H. S. Scarr 1923 Mrs. L. E. Scarr 1924 W. S. Scarr 1913 F. C. Selfe 1924-27 H. K. Sewell 1914 Miss M. Sherman 1920-45 W. Simms 1905-06 C. L. Skinner 1921-22 T. Skinner 1907 G. W. J. Sloman 1931-32 A. Smith 1920-21 J. Smith 1902-11 Mrs. K. W. A. Smith 1922 T. E. Smith 1952-62 Dr. W. Smith 1947-61 W. F. Soames 1904-14 W. K. Soames 1916-18 G. H. Springett 1929-35 L. Squirrell 1962-64 W. H. Stevenson 1948 Sir Charles Stone 1901-20 J. M. Stone 1915 W. F. Strong 1953-55 E. Sydney 1902 H. A. Tatman 1960 T. Tebbutt 1951 Mrs. C. H. Thackeray 1924-34 F. Thome 1926 Rev. R. C. Thurley 1901-06 Mrs. C. R. Turner 1920-45 G. Turner 1932 R. E. Warry 1913-14 Mrs. M. L. Wentworth 1953-64 G. F. Westmacott 1934-47 F. Whatley, B.A. 1917-22 D. A. Whitenstall 1927-36 R. Wild 1908-09 C. S. Willatt 1920-22 E. Pascoe Williams 1903-12 H. Williams 1904-06 W. O. Willis 1927-31 F. Winchcombe 1926-39 Mrs. M. J. Woodnut 1920-23 E. R. Woodward 1913-19 Mrs. M. Woolner 1926-31 A. G. Woolven 1946 Mrs. K. M. Yarlett 1938-47 E. Yates 1953-54 INDEX Page A Acute Encephalitis 179 Acute Influenzal Pneumonia 177 Acute Poliomyelitis 180 Acute Primary Pneumonia 177 Adoptive Acts, Bye-Laws and Local Regulations 3-5 Afiatoxin in Groundnuts 156 Age Composition of Population 26-27 Age Mortality 34-35 Aged, Infirm and Physically Incapacitated Persons 103-122 Alkali, etc., Works Order 74 Analytical Examination of Milk 148. 160 Ante and Post Natal Clinics 58 Ante and Post Natal Clinics, Attendances 55 Anti-Fly and Anti-Mosquito Campaign 98 Antitoxin, Diphtheria 177 Ants, Pharaoh's, etc 100 Area of Borough 11 Articles and Rooms Disinfected 187 Articles Destroyed 187 Artificial Sunlight Centres, Attendances 56 Artificial Sunlight Treatment 58 Asthma 189 Atmospheric Pollution 69-75 B Bacteriological Examinations 85, 93, 148, 150, 159. 162-166 Baiting of Sewers 98 Bakehouses 153 Bathing Centre 122 Baths and Wash-houses 92 B.C.G. Vaccinations 56 Beetles 102 Births 28,32 Birth Registrations 32 Blackheath Fair 151 Blackwall Tunnel Duplication 94 Bread & Flour Regs., 1963 161 British Red Cross Society 60,114 Bronchitis 50 Burial or Cremation of the Dead 122 C Cancer 28,43-48 Cancer of the Lung 45-48 Caseous Lymphadenitis 156 Catering Establishments 153 Cerebral Embolism 48 Page Cerebral Haemorrhage 48 Cerebral Thrombosis 48 Certificates of Guild of Hygiene 191 Chest Clinic 59 Chest Physician's Report 188 Children's Nightdresses Regs.. 1964 61 Chiropody Clinics, Attendances 56, 120 Chiropody Treatment, Clinics 58 Citizens Advice Bureaux 60 Classification of Deaths 41 Clean Air Act 73 Cleansing and Bathing Centre 122 Cleansing and Scabies Clinic 59 Cleansing of Children 186 Cleansing of Old People 122 Clinics and Centres 58 Clover Mites 101 Cockroaches 101 Common Infectious Diseases 28.41,176 Complaints 61, 123,134,162 Condensed Milk Regs., 1959 162 Consumer Protection Act, 1961 79 Conveniences. Public 94 Corned Beef—Typhoid Outbreak 157 Coronary Disease 48 Council Housing Schemes 136 Council Rehousing 133 Cremation or Burial of the Dead 122 D Day Rooms (for Old People) 118 Death Causes, Remarks 41-52 Death Rates 28 Death Registrations 28, 33 Deaths, Table showing Causes of and Ages at Appendix Deaths 28,33 Deaths, Table showing Causes of and Ages under 1 yr. Appendix Deaths from Violence 51 Deaths in Institutions 34 Defective Dwellings — Repairs 65 Density of Population 11 Diarrhoea and Zymotic Enteritis 42,178 Diphtheria 42,177 Diphtheria Antitoxin 177 Diphtheria Immunisation Clinics 58 Diphtheria Prophylaxis Cases 56,177 Discharge of Effluents into Sewers 83 INDEX (continued) Page Diseases of Respiratory System 50 Disinfecting Station 59 Disinfection 186 Disinfestation of Verminous Premises 99 Distribution Centres—National Welfare Foods 53 District Nursing 57,60 Domestic Helps 57,59 Drainage and Sewerage 83 Drainage, New and Alterations to 83 Dried Egg Products 158 Dried Milk Regs., 1964 144 Drinking Fountains 95 Duties and Powers of the Public Health Committee 3-5 Dwellings 11 Dwellings—Movable 135 Dysentery 179 E Early Neo-Natal Mortality 28,40 Educational Sessions — Ante- Natal 55 Egg Albumen, Imported 158 Elevation of Borough 11,13.26 Encephalitis 179 Enteric Fever 42 Erysipelas 179 Exhumations 123 Expectation of Life 26 Export Certificates 159 Extracts from Vital Statistics 28 F Factories Act, 1961 62 Fair on Blackheath 151 Family Planning Association. Sessions 59 Family Welfare As-ociation 60 Fertilisers & Feeding Stuffs (Amendment) Regs., 1964 144 Flooding, Storm (Ravcnsbourne) 68 Flour (ComDosition) Regs., 1956 161 Fluoridation of Water Supplies 89 Food and Drugs Act, 1955 160,167 Food and Drugs—Non-genuine Samples 169 Food and Drugs Act, 1955. Samnles taken under 160, 167 Food Examination (Other) 162 Food Hygiene (General) Regs.. 1960 152 Food, Inspection of 140-171 Food Poisoning 165 Page Food—Premises for Preparation of 152 Food Rejected 154, 156 Foot Clinics 58 Foot Clinics, Attendances 56 G General and Vital Statistics 11-52 General Information 13-23 General Provision of Health and Welfare Services in the Area 53-60 Geology, Superficial 23-26 Greenwich Guild of Hygiene 191 Greenwich Hotel 116 Greenwich Old People's Welfare Association 114 Ground Nuts—Aflatoxin Content 156 Guild of Hygiene 191 H Habitation Certificates (Water Supply) 85 Hairdressers and Barbers 81 Handwashing Facilities 95 Health Centres 58 Health Visiting 54 Heart Disease 28,48-50 Heating Appliances (Fireguards) Act, 1952 79 History of Public Health in Greenwich 1901-1965 192 Holiday Hotel 116 Holidays (Old People's) 116 Home Help Statistics 57 Home Help Service, Applications for 59 Home Safety Act, 1961 80 Horse Troughs 95 Hospitals 60 House Purchase & Housing Acts, 1958/59 133 Houses, No. in Borough 11 Houses in Multiple Occupation 131 Housing . 126-139 Housing Act, 1957 131 Housing Act, 1957, Procedure under 131-133 Housing Act, 1949 133 Housing Act, 1961 131 Housing Act. 1964 130 Housing (Financial Provisions) Act. 1958 133 Housing Accommodation 135 Housing Homeless Persons 135 Housing Register . 138 INDEX (continued) Page Housing Repairs and Rents Act, 1954 76, 133 Housing Schemes, Council's .... 136 Housing Survey 137 Housing (Underground Rooms) Act, 1959 132 Hygiene, Guild of 191 1 Ice-Cream — Bacteriological examinations 150 Ice-Cream (Heat Treatment, etc.) Regulations 149 Ice-Cream Premises 149 Ice-Cream Quantitative Analysis 151 Ice-Cream Sampling 150 Illegitimate Births 28, 32 Immunisation and Vaccination Clinics 58 Immunisation and Vaccination Clinics, Attendances 56 Imported Egg Products 158 Imported Food Rejected 156 Infantile Mortality 28,36-41 Infant Welfare Centres 58 Infant Welfare Clinics, Attendances 54-56 Infectious Diseases 28,41,172 Infirm Persons 103 Influenza 28,51 Inhabited Houses 11 Inoculations, Poliomyelitis 56, 180 Inspection of Food and Supervision of Food Premises 140-171 Institution Deaths 34 International Certificates 175 International Statistical Classification of Diseases, Injuries and Causes of Death, 1955 41 Interviews (Re-housing) by M.O.H 191 Introductory Review 8-10 Invalid Chairs 117 Invalid Holidays 115 J Jurisdiction over R. Ravens- bourne 68 L Laboratory Work 67,72, 75, 85, 93, 148, 150, 157, 159, 160-171 Land Charges Act, 1925 .... 82 Laundry Service 122 L.C.C. (Gen. Powers) Act, 1953 83,122 Page L.C.C. (Gen. Powers) Act, 1954 81 L.C.C. (Gen. Powers) Act, 1958 80 Legal Proceedings 125, 171 Legislation, New 61-62, 130, 143 Leptospirosis 98 Lettings (Housing) 137 Licensing Act, 1961 81 Linen Store (for Homebound) 117, 122 London Government Act, 1939 78 Luncheon Clubs 115 Lung Cancer 45-48 M Malaria 180 Manufacture and Sale of Ice- Cream 149 Marriages 29 Mass Radiography 60, 184 Massage etc., Attendances . . 56 Maternal Mortality 28, 35 Maze Hill Clinic (Tuberculosis) 59, 188 "Meals on Wheels" 115 Measles 42, 176 Meat Regulations 154 Meat Surrendered 154,156 Meat (Treatment) Regs., 1964 143 Medical Inspections (Superannuation) 191 Medical Inspections (Sick Persons) 191 Medical Officer of Health's Review 8-10 Medical Statistics (Schools) 57 Meningococcal Infection 179 Merchandise Marks Act 151 Meteorological Observations . 30 Mileage of Streets 12 Milk, Analysis of 148, 160 Milk and Dairies Regulations 146 Milk Licences 147 Milk (Special Designation) Regulations, 1963 146 Milk Sampling 148, 160 Milk Supply 146 Mineral Hydrocarbons in Food Regs., 1964 145 Minor Ailments Centres (for School Children) 58 Morden College Housing Schemes 132 Mortuary Accommodation 123 Motor Vehicles Accidents 51 Movable Dwellings 135 Mutual Exchanges (Housing) 139 INDEX (continued) Page N National Assistance Act 121 National Assistance (Amendment) Act, 1951 121 National Health Services 60 National Insurance Act (Medical Certificates) 174 National Welfare Foods—Distribution Centres 53 Natural Increase 26 Neo-Natal Mortality 28,40 & Appendix New Housing Accommodation 135 New Legislation 61-62,130,143 Noise Abatement Act, I960 77 Nomenclature Regulations, 1948 41 Non-Genuine Samples 169 Notices, etc 61,125 Notifications of Infectious Diseases .... 172-189 & Appendix Notifications of Food Poisoning 165 Nursing Associations 57.60 O Offices, Shops & Railway Premises Act, 1963 64 Oil Burners (Standards) Act, 1960 79 Old People's Clubs 118 Old People's Welfare Association 114 Open Spaces 12 Ophthalmia Neonatorum 179 Outworkers 64 Overcrowding 134 P Perinatal Mortality 28,41 Personal Health Services 53-60 Persons Cleansed 122,186 Pet Animals Act 82 Pharaoh's Ants 100 Pharmacy & Medicines Act 161 Pharmacy & Poisons Act 79 P.H. (Dried Milk) Regulations 161 P.H. (Imported Food) Regulations 145, 155, 160 P.H. (London) Act, 1936. Sec. 180(8) 154 P.H. (Meat) Regulations 154 P.H. (Smallpox Prevention) Regulations 174 P.H. (Tuberculosis) Regulations 173, 183 Physically Incapacitated Persons 103-122 Page Pigeon Nuisance 65 Pneumonia 50 Poisons Information Service 79 Poliomyelitis 180 Poliomyelitis Inoculations 56 Pollution. Atmospheric 69-75 Pollution, River 66 Population . 11, 26, 106, 110, 128 Population, Age Composition 27 Post-Natal Attendances 55 Powers & Duties of the Public Health Committee 3-5 Precautionary Sprayin 102 Preserved Food Premises 148 Prevalence of. and Control oyer Infectious Diseases 172-189 Prevention of Damage by Pests Act 98 Procedure under the Housing Act, 1957 131 Prophylaxis Cases 56 Prophylaxis Clinics 58 Protection from Eviction Act, 1964 61 Public Baths & Washhouses 92 Public Health Committee Public Health Department Staff 6-7 Public Health in Greenwich, 1901-1965 192 Public Health Laboratory Service 93, 148, 150, 159, 162-166 Public Open Spaces 12 Public Sanitary Conveniences 94 Puerperal Pyrexia 179 Q Quantitative Analysis of Ice- Cream 151 Queen's District Nursing Association 57,60 R Radioactive Substances Act, 1960 83 Radiography, Mass 60, 184 Rag Flock Act 81 Rag Flock and Other Filling Materials Regulations. 1961 81 Ranyard Mission 57, 60 Rateable Value 11 Rates, Births and Deaths, etc. 28 Rat Repression 96 Ravensbourne, River (Flooding) 68 Redevelopment. Housing 132 Refuse Collection 91 INDEX (continued) Page Refuse Disposal 92 Registered Births 28, 32 Registered Deaths 28,33 Registrar—Office Hours 60 Registration of Preserved Food Premises 148 Rehousing 133 Rehousing Interviews (by M.O.H.) 191 Rejected Food 154,156 Relaxation Sessions—Ante-Natal 55 Remarks on Various Death Causes 41-52 Rent Act, 1957 76 Rent & Mortgage Interest (Restrictions) Acts 76 Reproductive Wastage 41 Requisitioned Houses & Housing (Amendment) Act, 1955 77, 127 Respiratory System—Diseases of 50 Review by M.O.H 8-10 Riding Establishments Act, 1964 61 River Pollution 66 River Ravensbourne, Flooding 68 River Ravensbourne, Jurisdiction 68 River Smells 66 Rodent Control 96 S Sampling of Ice-Cream 150 Sampling of Milk 148, 160 Sampling under Food & Drugs Act 160, 167 Sanitary Circumstances of the Area 61-125 Sanitary Conveniences, etc 94 Sanitary Work — Summaries, etc 123-125 Scabies 179,186 Scabies & Cleansing Clinics 59,186 Scarlet Fever 42. 176 Scavenging and Refuse Disposal 90 Schools (Medical Statistics) 57 Sewerage and Drainage 83 Sewers—Baiting of 98 Shops Act 80 Slaughterhouses 155 Slum Clearance 132 Smallpox 41,174 Smells from River 66 Smoke and Grit Emission 69 Smoke Control Areas 75 Social Conditions of the Area 13-23 Soft Drinks Regulations, 1963 144 Soft Drinks Regs.. 1964 144 Sonne Dysentery 179 Page South East Study 128 Spraying, Precautionary 102 Staff of Public Health Department 6-7 Statistical Tables Appendix Statistics, General 11-12 Still Births 28,32 Street Appeal (for Elderly) 117 Streets, Mileage of 12 Street Traders 152 Storm Flooding 68 Suicide 51,52 Suicide Act, 1961 52 Summary of Sanitary Work 123-125 Sunlight Treatment 56 Superficial Geology 23-26 Supervision of Food Premises 152 Supplies of Underground Water (Wells) 85 Swimming Baths 92 T Toddlers Clinic Attendances 55 Transfers (Housing) 139 Transported Meals for Old People 114 Treatment Centre and Clinics 58 Tuberculosis 28,42,180-183, 188 Tuberculosis Officer's Report 188 Typhoid Fever 42 Typhoid Outbreak—Corned Beef 157 U Underground Rooms 132 Underground Water Supplies (Wells) 85 Uninhabited Houses 11 Unsound Food 154, 156 Unfit Houses 132 V Vaccination Cases 56 Vaccination and Immunisation Clinics 58 Vaccination International Certificates 175 Various Death Causes, Remarks on 41-52 Vascular Lesions of Nervous System 48 Verminous Conditions 122,186 Verminous Premises 99 Violent Deaths 51 Vital Statistics 28 & Appendix Voluntary Organisations 60 INDEX (continued) Page W Wash-houses and Public Baths 92 Washing Facilities (Hand) 95 Wasps 101 Water—Underground Supplies (Wells) 85 Water Supplies — Fluoridation of 89 Water Supply 84 Water Supply Certificates 85 Weil's Disease 93 Welfare Clinics 58 Welfare Foods (for Elderly) 115 Welfare Foods, National—Distribution Centres 53 Wells 85 Page Whooping Cough 42, 177 Whooping Cough Prophylaxis Cases 56, 177 Whooping Cough Prophylaxis Clinics 58 Women's Special Clinic 59 Women's Voluntary Services 60 X X-Ray Examinations 184, 188 X-Ray, Mass 60,184 Z Zymotic Disease 42, 178 Zymotic Enteritis 42, 178 CASES OF INFECTIOUS DISEASE notified during the Year ended 31st December, 1964. 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 - - — — - — _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Infectious . — — — — — — — — — — — — — — _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Acute Encepnantis Post-infectious — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Dysentery 40 42 1 1 3 2 3 2 3 2 — 2 10 7 3 3 5 5 4 13 7 4 1 1 20 2 1 59 1 — — — 1 Erysipelas - - _ _ _ _ — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 P — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Acute Polio-Myelitis p — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Scarlet Fever 24 28 - - 2 - 1 — _ 3 3 7 14 13 3 3 1 2 — — — — — — 21 13 4 14 1 _ _ _ 1 Typhoid Fever - - - - - - - - - _ _ _ — _ — _ _ _ _ _ - - - _ _ - — _ _ _ _ — Paratyphoid Fever 2 1 - 1 — — — — 1 — — — — — — — — — 1 — — — — — — — — 3 _ _ — — Scabies 1 1 — — — — — — — — — — — — — — 1 1 — — — — — — — 2 _ — _ _ _ — — Puerperal Pyrexia - 3 - - - - _ _ _ _ _ _ _ — _ 1 _ 2 _ _ _ _ 2 — 1 _ _ _ _ Meningococcal Infection — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Measles 115 125 5 9 11 11 20 19 27 17 18 22 32 43 2 1 _ 1 _ 2 _ _ _ _ 88 45 8 99 _ _ 3 _ — Whooping Cough 11 22 - 1 1 4 2 5 4 6 1 4 3 2 — — — — — — — — — — 8 15 1 9 _ _ _ _ — Diarrhoea 4 7 2 3 1 2 - _ 1 1 1 — — — — — — — — — — — — 4 1 _ 6 _ _ — _ Ophthalmia Neonatorum — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Pneumonia, Acute Primary or Acute Influenzal — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Tuberculosis, Pulmonary 22 8 — — — — — — — — — — — — — — 1 1 3 6 13 1 5 _ 13 4 2 11 2 1 1 1 5 „ Non-Pulmonary 6 5 - - - - - - - - - - 1 - - - 1 1 3 2 1 1 — 1 4 2 — 5 3 1 — 5 9 Totals 225 242 8 15 18 19 26 26 35 29 23 35 60 5 8 7 9 12 11 25 21 6 6 2 160 84 16 207 7 2 4 6 19 NOTE:—The above Table refers to "Corrected Notifications" only, i.e. all cases in which diagnosis was not confirmed have been ignored. INFANTILE MORTALITY DURING THE YEAR 1964 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. Premature Birth, Hydramnios 1 ... ... ... 1 ... ... ... ... 1 Prematurity 5 1 ... ... 6 ... ... ... ... 6 Prematurity: Cerebral Anoxia 1 ... ... ... 1 ... ... ... ... 1 Placental Insufficiency 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Respiratory Distress: Metabolic Acidosis 1 ... ... ... 1 ... ... ... ... 1 Mongol 1 ... ... ... 1 ... ... ... ... 1 Foetal Asphyxia 1 ... ... ... 1 ... ... ... ... 1 Acute Bronchopneumonia ... ... ... ... ... 1 ... ... ... 1 Bronchopneumonia 1 ... ... ... 1 1 1 1 ... 4 Bronchopneumonia: Cerebral Damage—(Prolonged intra-uterine anoxia — prolapsed cord) ... ... 1 ... 1 ... ... ... ... 1 Acute Viral Pneumonitis ... ... ... ... ... ... 1 ... ... 1 Cerebral Haemorrhage 2 ... ... ... 2 ... ... ... ... 2 Cerebral Haemorrhage: Breech Delivery—(Tentorial tear) 1 ... ... ... 1 ... ... ... ... 1 Congenital Heart Disease 1 ... ... ... 1 ... ... ... ... 1 Anencephaly 1 ... ... ... 1 ... ... ... ... 1 Afibrinogenaemia—(with C.H.D.) ... 1 ... ... 1 ... ... ... ... 1 Hyaline Membrane 1 ... ... ... 1 ... ... ... ... 1 Haemolytic Disease of Newborn 1 ... ... ... 1 ... ... ... ... 1 Totals 20 2 1 — 23 2 2 1 — 28 Male 17 Female 11 TOTAL CAUSES OF, AND AGES AT, DEATH during the year ended 31st December, 1964. 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 IS 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 wks. 4 wks. and under 1 yr. 1 Tuberculosis, Respiratory 3 ... ... ... ... ... ... ... ... 2 1 1 ... ... 2 ... ... 1 ... ... ... 1 2 2 Tuberculosis, Other ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Syphilitic Disease 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 4 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 Meningococcal Infections 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 2 7 Acute Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Other Infective and Parasitic Diseases 3 1 ... ... ... ... 1 ... 1 ... ... 1 ... ... 2 1 ... ... 1 ... ... 1 5 10 Malignant Neoplasm, Stomach 31 ... ... ... ... ... ... ... 7 16 8 17 3 ... 11 13 1 3 ... ... ... 5 46 11 Malignant Neoplasm, Lung, Bronchus 54 ... ... ... ... ... ... 2 27 19 6 24 6 ... 24 13 2 1 ... 3 ... 16 85 12 Malignant Neoplasm, Breast 20 ... ... ... ... ... ... 3 8 5 4 9 4 ... 7 6 ... 2 ... ... ... 3 18 13 Malignant Neoplasm, Uterus 12 ... ... ... ... ... ... 2 2 3 5 3 2 ... 7 2 ... 1 ... ... ... 5 9 14 Other Malignant and Lymphatic Neoplasms 105 ... ... ... ... ... 2 8 34 25 36 35 21 4 45 28 2 17 ... 3 ... 25 143 15 Leukaemia, Aleukaemia 3 ... ... ... ... ... ... ... ... 2 1 ... ... 1 2 1 ... 1 ... ... ... ... 10 16 Diabetes 5 ... ... ... ... ... ... ... 1 1 3 3 1 ... 1 2 ... 1 ... ... ... 1 8 17 Vascular Lesions of Nervous System 86 ... ... ... ... ... ... 2 13 35 35 32 11 5 38 39 2 9 ... 1 ... 13 212 18 Coronary Disease, Angina 166 ... ... ... ... ... ... 6 55 40 65 57 21 6 82 47 3 15 ... 7 ... ... 190 19 Hypertension with Heart Disease 3 ... ... ... ... ... ... ... 1 ... 2 ... 1 1 1 2 ... ... ... ... ... 1 6 20 Other Heart Disease 113 ... ... ... ... ... ... 3 14 36 60 40 16 2 55 41 5 9 ... ... ... 20 185 21 Other Circulatory Disease 58 ... ... ... ... ... ... 1 7 17 3 21 12 4 21 13 2 8 ... ... ... 15 83 22 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 23 Pneumonia 55 ... ... ... ... ... ... 2 4 7 36 14 5 4 32 24 ... 4 ... ... ... 11 154 24 Bronchitis 47 ... ... ... ... ... ... 1 9 15 22 22 8 2 15 19 2 6 ... ... ... 4 74 25 Other Diseases of Respiratory System 11 ... ... ... ... ... ... ... 1 4 6 5 ... ... 6 4 2 ... ... ... ... 9 26 Ulcer of Stomach and Duodenum 5 ... ... ... ... ... ... ... ... 2 3 2 ... 1 2 3 ... ... ... ... ... 2 22 27 Gastritis, Enteritis and Diarrhoea 5 ... ... ... ... ... ... 1 ... 2 2 4 1 ... ... 3 ... 1 ... ... ... 1 14 28 Nephritis and Nephrosis 9 ... ... ... ... ... 1 2 1 2 3 3 2 ... 4 5 ... ... ... ... ... 2 11 29 Hyperplasia of Prostate 4 ... ... ... ... ... ... ... 1 ... 3 ... 2 ... 2 ... 1 1 ... ... ... 1 9 30 Pregnancy, Childbirth, abortion ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 31 Congenital Malformations 7 6 ... 1 ... ... ... ... ... ... ... 1 2 ... 4 2 ... ... ... 2 ... 3 17 32 Other defined and ill-defined Diseases 60 15 ... ... ... 2 1 5 9 11 17 20 11 1 28 15 2 9 ... 4 ... 21 110 33 Motor Vehicle Accidents 10 ... ... ... ... 2 1 1 2 ... 4 2 2 ... 6 4 1 ... ... ... ... 5 28 34 All other Accidents 10 ... ... ... ... ... 3 2 2 2 1 2 3 1 4 ... ... 4 ... 2 ... 2 41 35 Suicide 12 ... ... ... ... ... ... 1 4 5 2 6 3 ... 3 3 ... 3 ... ... ... ... 11 36 Homicide and Operations of War 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... Totals 900 23 5 1 5 10 42 204 251 359 324 138 32 406 290 24 98 2 29 183 1,508 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 JR 2/68