LIBRARY LEW 35 METROPOLITAN BOROUGH OF LEWISHAM ABRIDGED REPORT OF THE Medical Officer of Health. for the Year 1947 E. H. R. SMITHARD, M.D., D.P.H. / London : Printed by E. G. Berryman & Sons, Ltd., Blackheath Road, S.E.10. LEW 35 METROPOLITAN BOROUGH OF LEWISHAM ABRIDGED REPORT of the Medical Officer of Health for the Year 1947 E. H. R. Smithard, M.B.E., M.D., D.P.H. CONTENTS page Staff 3 Introduction 5 Vital Statistics 10 General Provision of Health Services 13 Sanitary Circumstances 23 Housing 24 Inspection and Supervision of Food 24 Infectious Diseases 26 3 STAFF as at 31/12/47 Medical Officer of Health E. H. R. Smithard, m.b.e., m.d., b.s., m.r.c.s., l.r.c.p., d.p.h. Deputy Medical Officer of Health and Senior Maternity and Child Welfare Officer Ella G. F. Mackenzie, m.a., m.d., d.p.h. Assistant Medical Officers B. Helen Bakewell, m.b., ch.b., d.p.h., d.r.c.o.g. Evelyn M. Davies, m.r.c.s., l.r.c.p., d.p.h. Florence E. Cowlin, m.r.c.s., l.r.c.p. (part-time). Mary A. Stoker-Murdy, m.b., b.s., m.r.c.s., l.r.c.p. (part-time). Elise F. Meyer, m.d., l.r.c.p.. l.r.c.s., l.r.f.p.s. (part-time). Tuberculosis Officer J. E. Stokes, m.a., m.d., b.a.o., d.p.h. Assistant Tuberculosis Officer J. P. V. Rigby, m.a., b.m., b.ch., m.r.c.s., l.r.c.p. Senior Sanitary Inspector C. E. Holifield. District Inspectors Food Inspectors R C. Brittain H. W. Ellery C. J. Cooley T. R. A. Fitzherbert J. R. Craven A. G. Thomas J. W. Dale H. Tolson O. B. Dodds G. E. Fallows Inspectors for special purposes R. Mahoney W. S. Parsons Miss D. M. Parnell A. J. Phillips F.E. Levermore E. Walker Health Visitors Miss V. E. Bryant Miss H. A. Steel Miss H. M. Buckley Mrs. G. Wilce Miss D. Charles Miss K. L. Young Mrs. E. Coomber Miss M. Young Miss W. Eve Miss R. Rainbird* Miss E. Gibson Miss M. Hanlon* Mrs. M. Jennison Miss W. Cresswell† Miss D. M. Pittock Miss G. Simpson** Miss I. Rippon *Child life protection visitors †Central Clinic. **Supervisor Home and Domestic Helps Service. Tuberculosis Visitors Miss I. C. Atkins Miss E. A. Rowe Miss R. M. Banyard Mrs. M. Wardle 4 CLERICAL STAFF General administration E. W. Cheesman . . principal clerk. S. Burridge .. senior clerk. Miss E. Dewdney Miss J. Sparling W. D. Back Miss I. Coppin Miss E. B. Kettle C. Coleman K. Sandford R. E. Sweett Miss G. Springett 2 part-time clerks Central Clinic Mrs. M. lies, clerk I dispenser. Mrs. F. A. Norris Home and Domestic Helps Service Mrs. B. Kneller Miss L. Smith Mrs. D. McGillivray Miss K. Rogers Miss P. Nelson Miss E. Simms Mrs. E. Blake Mrs. B. Baseley Mrs. B. Ward MISCELLANEOUS SERVICES Tuberculosis Dispensary Miss M. L. Burland . . radiographer. Miss M. Colquhoun .. clerk/dispenser. Miss O. Fergusson . . Care Committee secretary. Mrs. H. Anderson . . assistant Care Committee secretary. Miss M. N. Clare .. secretary to T.O. Mrs. Hewish .. ..1 Miss R. L. Nurse . . [ shorthand-typists. Chiropodist Miss S. K. Margach Vaccination Officer M. J. Harrison Officer-in-Charge, Coroner's Court and Mortuary W. Richardson Disinfecting Station J. G. Beale, superintendent. Foreman disinfector and 9 disinfectors. Rodent operatives . . 4 Drain testers . . 2 Cleansing station attendants . . 4 Caretaker at Health Centre R. Bullen Matrons at Day Nurseries Mrs. E. Trott, Rushey Green Mrs. E. Musselbrook, Downham Mrs. H. Maguire, Ladywell Park Mrs. D. Frensham, Perry Rise Nursery Clerk Mrs. B. Bailey Other Nursery Staff 4 deputy matrons 4 assistant nurses 3 staff nurses 4 nursery assistants 28 nursery nurses 42 nursery students 4 wardens 18 domestic staff 5 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewis ham. Mr. Mayor, Ladies and Gentlemen, The Annual Report for 1947 is presented again in an abridged form and is chiefly a compilation of statistical information. The Registrar General's estimate of the population in mid-year, 1947 at 221,170 was some 14,000 more than the estimate for the previous year, and compares with the pre-war estimate in June, 1939 of 231,000. The birth rate for the year at 21.9 again shows an increase and is the highest rate with the exception of one year since 1909, the exceptional year being 1920 when the rate was 22.8. The death rate rose from 10.6 to 11.9, but is still under the rates from 1940-45. The infant mortality rate at 33 was the same as in the previous year (a record low) and is still less than the average for London as a whole and for England and Wales. In connection with the work carried out during the year 1947, special mention may be made of the following:— Tuberculosis Although recently the death rate had not significantly increased the number of new cases coming to light had done so. This was probably due to several factors, including the increase in population, the effects of war conditions, and also the effects of propaganda associated with the mass radiography scheme. As a result the committee decided to increase the dispensary staff by the addition of a third Tuberculosis Officer, an extra Health Visitor, and extra clerical and technical assistance. This was in order to cope with the increase of cases and also to undertake artificial pneumothorax treatment which heretofore had been undertaken for us by other hospitals. Some of these additions to the dispensary staff and work were brought about in 1947 and the others were completed in the first half of 1948. Foot clinics During the year the committee approved the establishment of foot clinics in two premises in the borough, the premises being the Central clinic in Lewisham High Street, and Louise House. A full-time chiropodist was appointed and commenced her duties in August. Details of the scheme and of the attendances are shown in the body of the report. 6 Work of the sanitary inspectors It became clear that having regard to war damage, general deterioration in housing repair of the borough, and the necessity for carrying out new types of work, the staff of sanitary inspectors was too small. During the year, approval was obtained from the Ministry of Health to an increase in the staff of inspectors, but owing to a general shortage of inspectors in London it had not been possible by the end of the year to bring our strength up to the approved establishment. Nevertheless some steps were taken in the reorganisation of the work, and this included dividing the borough into four food inspectors districts, each inspector acting as sampling officer. The previous set-up had been two food inspectors districts and one sampling officer to cover the whole borough. Food hygiene The committee gave continued attention to the general problems of food hygiene particularly with regard to eating utensils in public restaurants and to food (including ice-cream) shops. The position cannot yet be considered as satisfactory, but during the year there was no serious outbreak of food poisoning or food infection. Various minor outbreaks were reported and were investigated, advice being given where practicable to prevent a recurrence. Propaganda A series of six lectures, most of them illustrated by short films, was arranged for the autumn under the title of Autumn Health Campaign. The subjects included Marriage guidance, Protection of children against infectious disease, Venereal disease, Hygiene in the home, Infectious diseases conveyed by food, and Parentcraft. They were held in the Small Hall of the Town Hall, and in spite of preliminary publicity, the attendances were disappointing, although they improved towards the end of the series. Infectious diseases The most serious problem with regard to infectious disease which confronted the department during the year was the outbreak of poliomyelitis (infantile paralysis). As is well known this outbreak was spread all over the country, but amongst the London boroughs we were one of the worst affected. The cases started towards the end of June and continued until the late autumn, the maximum number occurring 7 in early August. Altogether 72 cases of poliomyelitis and polioencephalitis were confirmed, although about double this number were removed to hospital as suspected, the others subsequently being found not to be cases. Various measures were taken to acquaint the public with advice as to precautions which might be observed, but this is a disease which has so far baffled scientific enquiry and it is doubtful if any precautions, other than those general precautions common to other cases of droplet or faecal infection, are of value. Retrospect and prospect The report for 1947 has its sad side as far as the Borough Council is concerned and this is because it is the last full year for which the Borough Council will be responsible for the personal health services. Under the National Health Service Act these services were transferred to the London County Council on 5 July 1948. Health statistics go back in the main to the year 1901 and comparison of a few of them may be interesting. For convenience they are set out in the following table:— Rate 1901 Highest rate since Lowest rate since 1947 Birth rate 25.9 26.2 (1902) 12.1 (1933) 21.9 Death rate 13.0 15.7 (1940) 9.6 (1910) 11.9 Infant mortality rate 128 122 (1904) 33 (1946) 33 Maternal mortality rate 3.9 5.2 (1929) 0.95 (1930) 1.0 Tuberculosis death rate 0.93 1.05 (1902) 0.53 (1946) 0.55 It is just 100 years since the first Medical Officer of Health was appointed in England — Dr. Duncan of Liverpool. It is approximately true to say that public health as such only started at that time, although some efforts had been made to deal with environmental health conditions for many years before that. After 1847 the growth of public health was very slow, and it was not until the last decades of the last century that anything in the nature of a spurt was made. As with other subjects, there seems to be little progress during normal quiet times, and it needs a specific stimulus to advance public opinion to the stage where rapid progress can be made. Such a stimulus was apparent at different times in the last century from serious outbreaks of infectious disease, and I need only mention the heavy mortality from smallpox, and the large, though localised, outbreaks of cholera which occurred in England 8 and especially in London during that time. It was probably in this way that public health became related so intimately to the environment, and most of the work done in the first half of the hundred years which has elapsed since the appointment of the first medical officer of health was of an environmental nature. The improvement of water supplies, improvement of drainage, improvement of sanitation, proper disposal of refuse, general increase in cleanliness of streets, private houses and shops, were all things which took first place. At the turn of the century, however, another stimulus occurred, and that was due to the South African War. At this time it was found that recruits for the Army were, on the whole, of very poor physique, and had relatively little stamina. The public disquiet at all this resulted in a crop of welfare legislation, notably the Midwives Act of 1902, the Notification of Births Act of 1907 and legislation for the beginnings of a school medical service, also in 1907. This group of enactments brought in the personal health services as opposed to the purely environmental health services, and since then there had been an increasing development of the personal health services in what was regarded as the field of general public health. More and more power was given to local authorities to develop personal health services, and it will be remembered that, again through stimulus of war, namely, the first German war, when the fact was apparent that we still had a considerable number of C3 people in our population, an Act was passed which, though short in extent, had the potentialities for very comprehensive development. This was the Maternity and Child Welfare Act, passed in the darkest days of 1918, which enabled maternity and child welfare authorities to do almost anything (with the consent of the Ministry of Health), for the health and well-being of expectant and nursing mothers and for children under 5 years of age not in attendance at school. Welfare centres, health visiting, and the various clinics attached to the centres can be regarded as dating from this Act, although in fact it must be remembered that in many localities similar clinics and visiting had been carried out on a small scale for a considerable number of years before. All this time however there was a gradual integration of the personal with the environmental health services, and the medical officer of health, being after all a medical practitioner, was naturally biased towards the development of the personal health services to an even greater extent than the environmental health services. Now the National Health Service Act, passed through the stimulus of the second German war, has brought the position of the district 9 M.O.H. almost full circle. Nearly all his personal health services have been transferred to the counties, and even the counties and county boroughs have lost many of their personal health services (hospitals, tuberculosis, etc.) to the new Regional Hospital Boards. In other words there will be a reversion to the position of fifty years or so ago and the district M.O.H. will specialise more and more on environmental hygiene such as food and drink, infectious diseases, housing, infestation and so on, not forgetting the highly important item of propaganda and education of the public in health matters. This is perhaps more in accordance with the new term " Social medicine," but it seems doubtful if social medicine can make much progress while environmental health services and personal health services remain in almost watertight compartments — a danger which may be present, in London in particular. I would like, before concluding the introduction of this report, to express my thanks to the staff for their work during the year under review, and also my thanks to the Public Health Committee (with Councillor Miss M. Davies, M.sc., as chairman until November, followed by Councillor F. W. M. Pettit, j.p.) and to the Maternity and Child Welfare Committee (with Councillor Mrs. N. M. Palmer as chairman) for their support and guidance in the work done. 10 SECTION "A" —VITAL STATISTICS Area The area of the Borough is 7,015 acres. Population Census 1931 219,953 The Registrar-General's estimate of the resident civilian population mid-year 1947 was 221,170. Rateable value £1,732,948 Estimated product of a penny rate £6,600 No. of separately assessed dwellings at 6 April 1947 57,698 Births No. of live births 4,841 Males Females Totals Legitimate 2,381 2,268 4,649 Illegitimate 102 90 192 2,483 2,358 4,841 Birth rate per 1,000 of the estimated population 21.9 Birth rate for England and Wales 20.5 Birth rate, London Administrative County 22.7 Still-births The total number of still-births allocated to the Borough during the year was 106. This represents a still-birth rate per thousand live and still-births of 21.4. Deaths The total number of deaths belonging to the borough registered during the year 1946 was 2,452 consisting of 1,274 males and 1,178 females, giving a death rate per thousand of the estimated population of 11.9 as compared with a rate of 12.0 for England and Wales and 12.8 for the Administrative County of London. Infant mortality Number of infant deaths 161 Legitimate 151 Illegitimate 10 1. All infants per thousand live births Rate 33.3 2. Legitimate infants per thousand live legitimate births Rate 32.5 3. Illegitimate infants per thousand live illegitimate births Rate 52.1 11 Maternal deaths Number of maternal deaths 5 (a) Puerperal sepsis 1 (b) Other maternal causes 4 Maternal mortality rate per thousand total live and still births 1.01 Other deaths Number of deaths from Measles (all ages) — „ „ „ Whooping-Cough 6 „ ,, ,, Diarrhoea (under 2 years) 16 „ „ „ Tuberculosis 134 „ „ „ Cancer 407 „ „ „ Heart Diseases 749 Comparative statistics for the year 1947 birth rate (per 1,000 civilian population) Death rate (per 1,000 civilian, population) Infant mortality rate (per 1,000 live births) Live births Still births Lewisham 21.9 0.48 11.9 33 England and Wales. *20.5 *0.50 *12.0 41 London Administrative County 22.7 0.49 12.8 37 *Rates per thousand total population. General summary of Vital Statistics for the years 1938-1947 Year Estimated Population Births Deaths Deaths under one year Deaths from Pulmonary Tuberculosis Number Rate Number Rate Number Rate Number Rate 1938 229,000 3188 13.9 2403 10.5 151 47 153 0.61 1939 220,300 3135 13.6 2356 10.8 129 42 140 0.63 1940 192,540 2833 14.7 2898 15.8 119 45 129 0.67 1941 148,150 2068 13.9 2128 14.3 54 34 137 0.92 1942 161,800 2732 16.8 1955 12.0 103 37 118 0.73 1943 168,530 3151 18.7 2359 13.9 134 42 128 0.76 1944 163,320 3046 18.6 2416 14.8 123 40 129 0.79 1945 171,280 3030 17.7 2068 12.1 102 34 122 0.71 1946 207,410 4491 21.7 2208 10.6 148 33 110 0.53 1947 221,170 4841 21.9 2452 11.9 161 33 121 0.55 12 Causes of death at different periods of life during the year 1947 The following table shows the causes of and ages at death during the calendar year 1947:— Code No. Causes of death Nett deaths at the subjoined ages of " Residents," whether occurring within or without the borough All Ages Under 1 year 1 and under 5 5 and under 15 15 and under 45 45 and under 65 65 and over Totals, all causes 2452 161 27 13 217 609 1425 1 Typhoid and paratyphoid fevers - - - - - - - 2 Cerebro-spinal fever 2 1 1 - - - - 3 Scarlet fever - - - - - - - 4 Whooping cough 6 2 4 — — — — 5 Diphtheria 2 — 2 — — — — 6 Tuberculosis of resp. system 121 — — 2 69 41 9 7 Other forms of tuberculosis 13 1 2 1 7 — 2 8 Syphilitic diseases 19 1 — — 1 8 9 9 Influenza 6 - - — 1 1 4 10 Measles - - - - - - - 11 Acute poliomyelitis and encephalitis 9 - 1 4 3 1 - 12 Acute infectious encephalitis 2 — — — 1 1 — 13 Cancer, buccal cavity and oesophagus(M), uterus (F) 24 - - - 1 5 18 14 Cancer, stomach and duodenum 59 - - - 1 13 45 15 Cancer, breast 50 — - — 5 31 14 16 Cancer, all other sites 274 - - — 24 123 127 17 Diabetes 13 - - — - 3 10 18 Intra-cranial vascular lesions 230 1 - — 3 40 186 19 Heart diseases 749 - - 1 24 144 580 20 Other circulatory diseases 64 — - — 1 19 44 21 Bronchitis 151 1 - — 1 36 113 22 Pneumonia 116 27 6 — 5 28 50 23 Other respiratory diseases 36 — — — 3 10 23 24 Ulcer, stomach & duodenum 26 — — — 3 11 12 25 Diarrhoea (under 2 years) 16 16 — — — — — 26 Appendicitis 8 — — — 3 1 4 27 Other digestive diseases 49 2 2 1 7 14 23 28 Nephritis 48 — 1 1 9 12 25 29 Puerperal and post-abortive sepsis 1 - - - 1 - - 30 Other maternal causes 4 — — — 4 - - 31 Premature birth 38 38 - - - - - 32 Congenital malformations, birth injury, infantile diseases 66 62 - - 4 - - 33 Suicide 22 — — — 5 11 6 34 Road traffic accidents 13 — 1 1 3 4 4 35 Other violent causes 64 7 3 1 8 15 30 36 All other causes 151 2 4 1 20 37 87 13 Summary of Statistics as to Tuberculosis for the years 1935-1947 Year Population No. of new coses notified (all forms) (excluding inward transfers) Notif. rate per thousand pop. Deaths Death rate from pulmonary tuberculosis per thousand population All forms Respiratory 1935 223,000 347 1.56 147 131 0.58 1936 224,000 379 1.69 157 141 0.62 1937 226,000 413 1.83 147 134 0.59 1938 229,000 330 1.44 175 153 0.61 1939 220,300 301 1.37 159 140 0.63 1940 192,540 262 1.36 149 129 0.67 1941 148,150 315 2.13 156 137 0.92 1942 161,800 354 2.20 131 118 0.73 1943 168,530 403 2.40 150 128 0.76 1944 163,320 390 2.39 146 129 0.79 1945 171,280 371 2.17 138 122 0.71 1946 207,410 437* 2.11 126 110 0.53 1947 221,170 426 1.93 134 121 0.55 Notes:—The 1947 death rate from pulmonary tuberculosis for the County of London was 0.62. The figure of 467 in the report for 1946 included 30 inward transfers. SECTION "B" — GENERAL PROVISION OF HEALTH SERVICES Notification of births The total number of births notified in the year was 4,848. Of this number 96 were still-births. 4,841 live births and 106 still-births were registered as belonging to the borough. Professional nursing in the home The number of visits paid to cases by nurses from Nursing Associations at the Council's expense was 3,590 at a cost of £388 17s. 4d. 14 Health visiting The following is a brief summary of the visits made by the health visitors during the year:— Total visits To expectant mothers 1,445 To children under 1 year 9,672 To children 1-5 years 11,194 Infant Welfare Centres The number of children who attended the 13 Maternity and Child Welfare Centres was as follows:— Babies 4,252 Children 1-5 years of age 6,349 The attendances at the various centres was as follows:— Infants Children Municipal Clinics under 1 year 1-5 years Louise House 5,668 2,481 Central Clinic 2,204 735 North Downham 1,876 928 Spalding House 2,062 741 Shaftesbury House 2,560 700 T otals 14,370 5,585 Voluntary Welfare Centres Bellingham 7,040 3,314 Catford 7,677 2,188 Downham 4,559 2,228 Forest Hill 11,325 4,571 Grove Park 3,475 3,330 Hither Green 4,904 2,712 Lee and Blackheath 5,412 5,034 Ladywell 5,473 2,679 Totals 49,865 26,056 Grand Totals 64,235 31,641 15 Ante-natal and post-natal clinics No. of women who attended antenatal clinics 4,135 ,, ,, „ ,, postnatal clinics 659 Total number of attendances 18,880 The attendances at the various centres were as follows:— Antenatal Postnatal Louise House 2,669 168 Central Clinic 11,930 595 Downham and North Downham 2,091 109 Spalding House 1,195 123 Totals 17,885 995 Light clinic The attendances at the Light Clinic which is held at the Central Clinic were as follows:— Infants Adults 5,616 236 Child Life Protection The number of Foster Mothers on the register at the end of the year was 55. 128 children were received during the year and there were 104 on the register at the end of the year. Summary of visits paid by the Child Life Protection Officers Primary visits to foster mothers 50 Primary visits to foster children 50 Revisits to foster mothers 648 Revisits to foster children 700 Number of illegitimate children at end of year 298 Home Helps and Domestic Helps The Council's scheme for the provision of home helps for mothers during confinement, which has been in operation since 1930 was continued and was provided for 953 cases. In a further 471 cases domestic help was provided for sick, aged and infirm persons. 47 whole-time and 151 part-time workers were employed at the end of the year. 16 Care of premature infants In compliance with Ministry of Health Circular No. 20/44, it is arranged that the weight of each newly born child is entered on the birth notification in order that early contact can be made between the health visitor and the mothers of premature babies born at home. Convalescence for children under five — Invalid Children's Aid Association The arrangement with the Invalid Children's Aid Association for the provision of convalescent treatment for children under five was continued. 159 children were sent away by the Lewisham branch of the Association during the year. Supply of sheets for expectant mothers In accordance with Ministry of Health Circular 154/44, and by arrangement with the Board of Trade, priority dockets were issued to enable expectant mothers who were to be confined in their own homes to purchase sheets. These dockets were in great demand and during the year 4,923 were issued at the Maternity and Child Welfare Centre. Supply of national milk and vitamin supplements These were supplied to expectant mothers and children under 5 years of age at all the Welfare Centres and Clinics in the borough throughout the year. Dental treatment Dental treatment for expectant and nursing mothers and children under five years of age continued to be carried out under arrangements made with the London County Council at their minor ailment treatment centres and also at local hospitals. Dentures were supplied in 57 cases. Provision of insulin The number of persons suffering from diabetes who received insulin supplied under the Council's scheme during the year was 32. Laboratory facilities The bacteriological work of the Council is carried out under contract by St. John's Hospital, Lewisham. Routine examinations of throat 17 and nasal swabs, sputum and blood specimens, etc., were submitted, and the following is a brief summary of the work undertaken:— Positive Negative Total Diphtheria 11 876 887 Tuberculosis 329 1,420 1,749 Typhoid 1 2 3 Miscellaneous 22 22 Totals 341 2,320 2,661 Vaccination The annual return made by the vaccination officer to the Registrar General respecting the vaccination of children whose births were registered in the Borough during the year ended 31 December 1946 shews that of the 3,599 births so registered 1,909 or 53 per cent, were successfully vaccinated. Public Mortuary and Coroner's Court The number of bodies taken to the Council's Public Mortuary during the year was 500. Of this number 223 were received from hospitals. Inquests were held in 141 cases. Tuberculosis Dispensary Service The attendances of persons examined at the Council's Tuberculosis Dispensary was 12,170. Of this number, 2,547 were made by new cases and 819 by contacts. The number of definite cases of tuberculosis on the dispensary register at the beginning of the year was 1,942, and 2,067 at the end of the year. The Council's tuberculosis health visitors paid 3,510 visits to the homes of patients during the year. 18 Tuberculosis allowances The scheme for the payment of allowances to persons suffering from pulmonary tuberculosis who have to give up remunerative employment to undergo treatment, continued during the year 1947, as well as the supply of extra nourishment. Number of maintenance allowances granted 339 Number of discretionary allowances granted 49 Number of special allowances granted 66 War-time day nurseries The following table shews the average daily attendances (excluding Saturdays) each month during 1947 while the nurseries were open:— Month Catford (approved places—50) Ladywell (approved places—88) Forest Hill (approved places—65) Downham (approved places—56) January 38 82 63 38 February 33 79 52 39 March 40 78 59 39 April 48 78 74 44 May 51 78 69 55 June 50 76 64 40 July 41 79 62 58 August 40 68 57 46 September 53 81 63 50 October 51 85 64 56 November 52 83 58 56 December 50 76 55 51 Average for yr. 46 79 62 48 Foot clinics Two clinics were opened during the week ended 15 August. One full-time chiropodist was appointed working six sessions a week at 410, Lewisham High Street and four sessions a week at Louise House. During the period to the end of the year 266 patients made a total of 629 attendances at 410, Lewisham High Street and 175 patients made 401 attendances at Louise House. Under the scheme approved by the Council patients are charged 2s. 6d. an attendance but old age pensioners, patients referred from the maternity and child welfare centres or tuberculosis dispensary, and "borderline" cases approved by the medical officer of health, are treated free. 19 Water supply In am indebted to the Director of Water Examination and the Clerk of the Metropolitan Water Board for the following report on Lewisham's water supply. "The supply to Lewisham during 1947 was satisfactory as regards quantity, with the exception of short interruptions in certain parts of the borough during the summer at a time of exceptionally heavy demand. The shortage lasted for about a day and during that time emergency distribution was carried out by means of tankers. "No standpipe supplies were provided and houses throughout the borough received their supplies direct from the public water mains. "From the point of view of water supply the borough is supplied in three zones; the low zone is supplied from Deptford well and by Thames derived filtered water; the Eltham zone is supplied from Wilmington, Darenth and Bexley wells with an additional small proportion from the low zone should the occasion arise; the Bromley zone to the south of the Borough is supplied from Shortlands well and on occasions with additional Thames derived filtered water. "All the Thames derived filtered water is chlorinated as it leaves the works. All the well water is chlorinated and any residual chlorine should wholly or almost completely be removed before the water leaves the works. "Bacteriological analyses are made five times a week of all supplies and consistently satisfactory results have been obtained. Chemical analyses are also made at regular intervals. In the case of the river-derived supply the water is tested bacteriologically and chemically at all stages of purification. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bacteriologically. " None of the supplies is plumbo-solvent. "We have no information with regard to the proportion of the total number of dwelling-houses and population in Lewisham which are supplied by the Board from the above mentioned sources. All the houses are supplied directly and not by means of stand pipes. "The closest watch is kept for any form of contamination and immediate action is taken if the results of the analyses are not up to standard. "Appended are the average results of the chemical and bacteriological analyses of the various supplies for 1947." Results of the Chemical and Bacteriological Examination of the water supply to the Borough of Lewisham January - December, 1947 PARTS PER MILLION (unless otherwise stated) Description of the sample No. of samples Ammon- iacal Nitrogen Albuminoid Nitrogen Oxidised Nitrogen Chlorides as CI. Oxygen abs. from Permanganate 3 hrs. at 800 F. Turbidity in terms of Silica Colour m.m. brown 2ft. tube Burgess's Tintometer Hardness (Total) Hardness (Permanent) PH. Value Residual chlorine in water leaving the works Conductivity Nitrite Nitrate Deptford Well 4 0.003 0.021 - 5.1 37.9 0.17 - 0 351 164 7.1 Nil 625 Wilmington Well 8 0.010 0.025 - 5.8 21.0 0.20 - 0 313 100 7.1 0.1 500 Darenth Well 4 0.010 0.020 - 4.5 16.9 0.13 - 0 307 101 7.1 Nil 450 Bexley Well 1 0.000 0.020 - 5.0 17.5 0.12 - 0 215 109 7.1 0.1 500 Shortlands Well Thames derived filtered water 4 0.008 0.029 - 4.8 19.5 0.21 - 2 313 107 7.1 Nil 475 (Walton) 253 0.152 0.092 — 3.5 25.5 1.28 0.9 21 236 70 7.6 Nil to 0.35 450 BACTERIOLOGICAL RESULTS No. of samples Colony Count on Agar at 37°C. Bact. coli Test Percentage of samples negative per 10 ml. Bact. coli per 100 ml. Deptford Well 254 — 100.0 Nil Wilmington Well 502 — 100.0 Nil Darenth Well 252 — 99.6 0.008 Bexley Well 249 — 100.0 Nil Thames derived filtered water (Walton) 256 27.9 98.1 0.031 21 RODENT CONTROL The block control scheme which was commenced on 5 July 1946 under the direction of the senior sanitary inspector was completed on 19 April 1947. A summary of the work done is as follows:— Block No. and area Total No. of primary visits Major infestations found Estimated No. of rats killed at primary baiting Dwellinghouses Business premises 1. Lower Sydenham 4,397 7 4 1,317 2. Parts of Sydenham and Forest Hill 3,656 17 1 2,128 3. Forest Hill 5,592 10 4 1,454 4. Honor Oak Park 2,246 1 1 208 5. Ladywell and Brockley 3,646 3 4 1,081 6. Lewisham Village 3,093 13 8 1,410 7. Hither Green 3,855 10 1 763 8. Catford 3,115 11 2 1,116 9. North Downham 3,901 11 5 1,319 10. Bellingham 3,838 10 3 1,164 11. Downham 4,582 3 2 415 12. Grove Park and Lee 3,290 12 - 1,121 13. Part of Lee and Blackheath 3,881 14 5 1,309 Totals 49,092 122 40 14,805 Retreatments and post baiting Where premises were baited and the greater 1part of the bait was taken retreatment was automatically carried out after an interval of two or three weeks. In this way 540 premises were dealt with, of which 309 were in fact found to be free from infestation, and 709 rats were destroyed. At premises where there had been rat infestation, the work of post baiting was subsequently carried out, that is to say a test bait was laid and if this was taken the premises were retreated. In this way, 1,091 premises were dealt with, of which 708 were found to be free from infestation, 311 treatments were carried out and 1,053 rats were destroyed. 22 Business premises The rat officer visited 323 business premises which were reported to be infested. At 120 of these premises he found no evidence of rats. At 113 premises the occupiers refused to agree to pay for the cost of treatment by the Council and stated that they would take action themselves. These premises were revisited and on inspection it was found that there was no evidence of rats in 110 cases and at three premises, where there was evidence of rat infestation, the occupiers agreed to pay the cost of the treatment to be carried out by the Council. At 90 other premises the occupiers agreed to pay the cost of treatment by the Council. The necessary work was carried out and the occupier of the premises was charged with the cost. Lewisham Borough Council properties Rat infestation was found at Molesworth Street, Wearside Road and Home Park Depots and in the Forster Memorial Park, and the necessary disinfestation work was carried out. Rivers It was found that there was extensive rat infestation along the banks of the rivers Pool, Quaggy and Ravensbourne, and gassing of holes and baiting on the banks was carried out. Altogether 776 rat runs were found and gassed, 2,062 bait points were laid, and 1,648 rats destroyed by poison bait in addition to probably a large number destroyed by gassing. Railways The operatives reported rat infestation on Southern Railway property and 18 infestations were notified to the Company, which took the necessary action and reported to us when the work was completed. Summary The number of rats destroyed under the scheme is an estimate, based on the Ministry of Food's method of calculation. Altogether 18,215 rats were estimated to have been destroyed in this way, plus an unknown number through gassing. 23 SECTION "C" —SANITARY CIRCUMSTANCES OF THE AREA The following table shows a summary of the inspections, etc., carried out by the sanitary and food inspectors during the year:— Cause of Inspection Totals On complaint 6,155 Infectious disease 1,030 Notice from builder 662 Smoke observation 1 Certificates for materials 1,488 Water certificates 241 Vermin 167 Rent Act certificates 98 Landlord and Tenant Act certificates 23 Building licences 911 Housing 5,136 Requisitioned properties house-to-house 484 Factories and workshops 377 Butchers 508 Registered food premises 558 Bakehouses 161 Fishmongers 271 Provision merchants 562 Greengrocers 81 Food factories 27 Restaurants and eating houses 327 Dairies 80 Milk purveyors 80 Ice cream premises 290 Other food premises 181 Pharmacy and Poisons Act 87 Shops Act 214 Miscellaneous 2,797 Markets and stalls 232 Slaughterhouses 6 Legal proceedings 27 Reinspections 5,365 Intimation Notices served 3,816 Statutory Notices served 828 Number of factories on register at 31-12-47 518 Number of outworkers on register at 31-12-47 162 24 SECTION "D" —HOUSING During the year the following families were rehoused:— By the Lewisham Borough Council (a) In dwellings erected by the council:— (i) Emergency hutments 28 (ii) Temporary bungalows 174 (iii) L.B.C. properties 13 - 215 (b) In requisitioned properties 1,039 Total 1,254 By the London County Council 557 Grand Total 1,811 SECTION "E" — INSPECTION AND SUPERVISION OF FOOD Milk Supply Analysis of milk During the year under review, 48 samples of milk were submitted by the Council's inspectors to the Public Analyst for examinations and none of these samples was certified as adulterated or below standard. The average composition of the samples is set out in the following table:— Period Average composition of samples examined. Percentage of Milk Solids not fat Water First quarter 3.61 8.79 87.60 Second quarter 3.49 8.85 87.66 Third quarter 3.61 8.70 87.69 Fourth quarter 3.86 8.74 87.40 Average for year 3.65 8.77 87.58 The legal standard is 3.0 per cent. milk fat and 8.5 per cent. solids not fat. 25 Bacteriological examinations of milk 75 samples of heat-treated milk were submitted to the laboratory for bacteriological examination, and of these 74 satisfied the prescribed tests. A warning letter was sent to the vendor of the one unsatisfactory sample. Milk shops and dairies Number of dairy premises on the Register at the end of the year 75 Number of purveyors of milk on the Register 111 Milk (Special Designations) Regulations Number of licences issued for the sale of pasteurised milk (Dealers') 40 the sale of tuberculin tested milk (Dealers') 14 Supplementary 16 Adulteration of food The total number of samples taken during the year under the Food and Drugs Act was 906, of which number 33 were formal samples and 873 informal samples. After examination the public analyst reported that four of the formal samples and six of the informal samples were found to be adulterated or below standard. The percentage of adulteration amounted to 12.1 in the case of the formal samples and 0.69 in the informal samples, whilst it was 1.10 of all the samples submitted, compared with 0.86 per cent. in the previous year. Premises where food is prepared or offered for sale These premises were kept under observation by the Council's Food Inspectors, in addition to those registrable under the provisions of the Food and Drugs Act, 1938. The work of revising the Registers, deferred by war conditions and put in hand during 1945 in order to bring the records up to date, was continued. Unsound food A considerable amount of food was surrendered as unfit for human consumption. In all, approximately 48 tons 6 cwts. of foodstuffs was dealt with by the Council's food inspectors, consisting mainly of meat at the Wholesale Meat Depot and fruit pulp, fish, etc. In co-operation with the Salvage Division of the Ministry of Food, in order to prevent wastage where possible, most of this unsound food was forwarded to the appropriate authorities for re-conditioning or animal feeding. 26 SECTION "F" — PREVALENCE OF, and CONTROL OVER, INFECTIOUS AND OTHER DISEASES Principal notifiable diseases (other than Tuberculosis) Number of Notified Cases (corrected for revised diagnosis) during the year 1947 with comparative figures for the previous six years. It should be borne in mind that some of the war-time figures were considerably affected by evacuation of population. Number of cases notified Diseases 1947 1946 1945 1944 1943 1942 1941 Cerebro-spinal fever 19 11 3 4 8 25 31 Continued and relapsing fever — — 1 — - — — Diphtheria 9 8 24 24 26 53 82 Dysentery 26 57 31 65 23 34 13 Encephalitis lethargica (acute) — 1 — — — — — Enteric or typhoid fever 4 2 — — 1 2 11 Erysipelas 45 34 50 86 57 52 60 Hydrophobia — 1— — — — — Malaria 4 15 — — — — — Measles 810 1,307 462 688 1,270 858 726 Ophthalmia neonatorum 9 4 1 4 17 4 4 Pneumonia 104 108 71 110 176 103 148 Polioencephalitis (acute) 11 — — — — — — Poliomyelitis (acute) 61 — 5 — — 5 1 Puerperal pyrexia 43 31 21 19 20 27 19 Scabies* 122 348 566 654 515 * * Scarlet fever 254 155 197 270 683 255 98 Smallpox 1 — — 1 — — — Puerperal fever — 1 4 1 1 3 2 Whooping cough 362 291 238 275 219 254 415 TOTALS 1,884 2,374 1,674 2,201 3,016 1,675 1,612 *Notifiable as from 1 August 1943. Tuberculosis The number of new cases notified during the year 1947 and the number of deaths (together with comparative figures for the previous year) were as follows:— New cases notified Deaths 1946 1947 1946 1947 Pulmonary 371 367 110 121 Non-pulmonary 66 59 16 13 Totals 437 426 126 134 27 The age distribution of the new cases of tuberculosis notified and the deaths from tuberculosis during the year are shewn in the following table:— Age periods New cases notified Deaths Pulmonary NonPulmonary Totals Pulmonary NonPulmonary Totals M F M F M F M F M F M F 0 - 1 2 1 2 2 - - 1 - 1 - 1 4 4 5 6 9 10 - - - 2 - 2 5 4 6 1 1 5 7 2 - — 1 2 1 10 7 5 3 3 10 8 15 22 37 - 5 22 42 39 30 3 4 42 34 20 32 40 2 4 34 44 25 44 43 4 9 48 52 35 36 17 3 2 39 19 45 25 7 2 1 27 8 34 7 - - 34 7 55 16 3 3 1 19 4 65 12 2 - 1 12 2 9 - 1 1 10 1 Totals 202 165 25 34 227 199 84 37 5 8 89 45 Town Hall, S.E.6 19 July, 1948 E. H. R. SMITHARD, Medical Officer of Health