AC4374 LIBRA LEW36 METROPOLITAN BOROUGH OF LEWISHAM REPORT OF THE Medical Officer of Health for the Year 1948 E. H. R. Smithard, M.D., D.P.H. London : Printed by E. g. Berryman & Sons, Ltd., Blackheath Road, S.E.10. 68629 METROPOLITAN BOROUGH OF LEWISHAM REPORT OF THE Medical Officer of Health for the Year 1948 E. H. R. Smithard, M.B.E., M.D., D.P.H. CONTENTS page Staff 3 Introduction 4 Vital Statistics 11 General Provision of Health Services 15 Sanitary Circumstances 27 Housing 30 Inspection and Supervision of Food 33 Infectious Diseases 40 Appendix A — Statutory Instruments 43 Appendix B — Legal Proceedings 45 List of Tables 46 Index 47 3 STAFF as at 31/12/48 Medical Officer of Health E. H. R. Smithard, m.b.e., m.d., b.s., m.r.c.s., d.p.h. Senior Sanitary Inspector C. E. Holifield (a) (b). District Inspectors Food Inspectors and Sampling Officers J. W. Bevan (a) H. W. Ellery (a) (b) F. R. Bray (a) T. R. A. Fitzherbert (a) (b) R. C. Brittain (a) (b) A. G. Thomas (a) (b) J. R. Craven (a) (b) H. Tolson (a) (b) J. W. Dale (a) (b) G. E. Fallows (a) (b) R. Mahoney (a) (b) Inspectors for special purposes W. S. Parsons (a) (b) Miss D. M. Parnell (a) A. J. Phillips (a) (b) F. E. Levermore (a) D. A. Traynier (a) E. Walker (a) (b) (a) Sanitary inspector's certificate. (b) Food inspector's certificate. Principal Clerk E. W. Cheesman Clerical Staff S. Burridge senior clerk Miss I. Coppin R. E. Sweett Miss I. L. Hatton C. Coleman. L. J. Cleverley Mrs. A. Hullett 1 part-time clerk Coroner's Court and Mortuary W. Richardson, officer-in-charge Disinfecting Station, etc. J. G. Beale, superintendent. Foreman disinfector and 9 disinfectors. Cleansing station attendants 4 Rodent operatives 4 Drain testers 2 Public Analyst A. J. Lickorish, f.l.c. Bacteriologist K. E. A. Hughes, m.r.c.s., l.r.c.p. (St. John's Hospital). 4 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisham. Mr. Mayor, Ladies and Gentlemen, I submit herewith my report on the work of the health department for the year 1948. The Registrar-General's estimate of the population in mid-year 1948 at 226,100 was some 5,000 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 18.9 shows a drop from the high figure of 21.9 in 1947, but is still above the pre-war years. The death rate also dropped, from 11.9 to 9.9, and this is a lower figure than for many years past. Factors in the death rate, however, are too complex to allow any simple reason to be given for the drop. The infant mortality rate fell to 28, which is a record low for the borough. It remains less than the average for London as a whole (31) and for England and Wales (34), but the difference has been decreasing over the years. The death rate of illegitimate infants was 26 and this is no doubt the first time that the illegitimate rate has been less than the legitimate rate ; it has usually been considerably higher. Two maternal deaths occurred during the year ; this gives a maternal mortality rate of 0.46, which is a very low figure — but still unfortunately means two deaths. In connection with the work carried out during the year 1948 special mention may be made of the following :— Tuberculosis The number of new notifications increased considerably — from 426 to 502. At the same time the death rate from pulmonary tuberculosis (the main form of the disease) decreased from 0.55 per thousand population to 0.48. This may say something for advances in treatment but the fact that there is an increased number of notifications is of potentially serious importance. The notification rate in fact (per thousand population) has only twice been exceeded in the last 15 years or more, both times during the late war years. To some extent this present high rate may be due to more exact ascertainment through improved methods of diagnosis, including the mass miniature X-ray, but while housing conditions remain bad, more particularly with regard to overcrowding, the incidence of tuberculosis must be regarded as a major public health problem. It is too often forgotten that tuberculosis is in fact an infectious disease, but a disease where the infectivity may last for many years instead of for merely a few weeks or days. In the past numerous measures on a national scale have been taken with regard to prevention of tuberculosis, and this work, together with treatment of the disease, has become a specialised branch of medicine and public health. The present proposals therefore to join up tuberculosis work with other work involving other organs of the body, to do away with what has always been known as the TB Dispensary and attach it to a general hospital as part of the chest department, and to replace the 5 well-known " tuberculosis officers " by rather vaguer " chest physicians" are all matters which may take away from tuberculosis its importance in the eyes of the public as a specialised infectious disease. Many countries have experimented with a vaccine to give protection to babies and young children who are susceptible to tubercular infection ; in fact this work may now be considered to have passed the experimental stage and to be well established in Europe, particularly the Scandinavian countries, and elsewhere. Little however has been done in England to encourage the use of the vaccine, and in the meanwhile it will be necessary to rely on other measures of a preventive nature. Housing and early hospital treatment must remain in the forefront of these ; both of them unfortunately beset with difficulties owing to shortages either of materials or of staff. It is mentioned in the body of the report that the dispensary staff was increased during the year to deal with extra work being carried out there. On July 5 the service was handed over to the regional hospital board, but for some three months afterwards we acted as the board's agents for this change-over period. Food hygiene A table (No. 26) is included for the first time to show the food poisoning outbreaks which came to the notice of the department. This table is no doubt very incomplete as many cases of what is in fact food poisoning do not come to the notice of the department. The symptoms may be transient, just a little abdominal pain, sickness or diarrhoea lasting two or three hours, all symptoms and signs having completely cleared up two or three hours later. Nevertheless with the increase in communal feeding any infection in food, or which gets into food through defective hygiene in kitchens, is likely to have a more widespread effect than it would if the food were prepared in an individual family. There is still much that can be done in protecting food in shops and in seeing that it is properly wrapped. Some relaxation of the regulations covering the use of paper in foodshops has recently occurred and therefore more wrapping of food should be possible. It is desirable, however, to get the position in correct perspective. There are many foods which are wrapped nowadays and which need not be wrapped at all insofar as avoidance of food infection is concerned. It is aesthetically more pleasing for them to be wrapped, but it is not essential. Much more danger is likely to occur from the person handling the food, either in the shop or in the kitchen, than is probable from chance contamination through the food being insufficiently wrapped. This applies of course particularly to food which is eaten without further cooking, such as cooked meats, cheese, butter, meat pies and so on, and one shop assistant or communal cook with infected fingers through deficient personal hygiene may well infect a large number of customers. Again it is necessary to differentiate between the different types of food, some of which will grow the causal germs much more easily and much more rapidly than others. For example, fat in the 6 the form of butter, or cooking fat, or margarine is not likely to grow food poisoning germs, but this is very likely indeed in the case of brawn or pork or other meat pies, cream fillings (whether real or artificial) in cakes, ice-cream and so on, and it is these items which have to be very carefully guarded. Infectious diseases Tuberculosis, being the most important of the infectious diseases, particularly as far as loss of working years is concerned, has been dealt with separately above. With regard to the more acute infections, 1948 was a "measles year"; there being 2,642 cases as against 810 in 1947. Before the war thcre used to be a definite biennial periodicity in measles incidence, but this flattened out during the war, possibly due to evacuation. It has, however, shown signs of recurring since the war ended. There were less cases of pneumonia (67 against 104 in the previous year) and in fact there were less cases of this disease than for many years past. Poliomyelitis (infantile paralysis), after the heavy number of cases in 1947 when there were 72 of this and allied diseases, dropped to 9 in 1948. Scabies, a disease of overcrowding, poverty, defective hygiene and sanitation, has been dropping each year since the peak period during the war in 1944, when there were 654 cases, to 54 in 1948. Scarlet fever was up slightly, but with the extremely mild type of disease which is common now, it is of little significance. Whooping cough, however, showed a considerably increased incidence, there being 789 cases notified which was more than double the number notified in any of the previous six years. Whooping cough, in fact, can be regarded as the most important acute infectious disease in childhood, not only because of the fact that children may die during the disease, particularly from broncho-pneumonia, but also because they may develop later complications such as lung abscess or enlarged glands in the chest which may incapacitate them for many months or years. In view of the fact that there have been recent advances in the methods of preventing these later complications and because there have been better means of treating the actual disease, it is desirable that a greater proportion of whooping cough cases should be removed early to hospital. The bed position, I understand, is not so bad that cases of whooping cough requiring in-patient treatment cannot be taken in. Old people The committee at the end of the year had before them a comprehensive report on old people which I had prepared and they later decided on various methods in which they could help agencies dealing with old people in the borough. Further details with regard to this are found on page 21 of this report. The end of local maternity and child welfare In my last report I commented on the fact that 1947 was the last full year for which the borough council would be reponsible for most of 7 the personal health services, as under the National Health Service Act these were transferred to the county council on 5 July, 1948. This present report therefore, as far as maternity and child welfare statistics go, deals in the main with those up to 5 July, but it quotes various statistics for the full year because the borough council must be held responsible in large measure for the rest of the period since there must be a time lag of several months or even a year or more before the effects of the new regime will be reflected in statistics. Since, therefore, this is the last report which will deal in detail with any maternity and child welfare work it is perhaps not out of place to make one or two general comments. As an illustration I am including a graph (page 10) which indicates the infant mortality rate in the borough since the year 1901. Infant mortality means the deaths of live-born infants up to the age of one year. It does not cover those who are born dead — those for whom the mother and the family have undergone all the preparation for a birth which has not come to a successful conclusion. These are the stillbirths, which, by definition, include any child born dead after the 28th week of pregnancy. Stillbirths were not separately notified until the late '20's and statistics were not available in this borough until 1930 onwards. The stillbirth rate since 1930 has been added to the chart by means of outlined figures superimposed on the corresponding infant mortality rates, and the two together may be regarded as the reproductive wastage rate. The reproductive wastage rate in fact shows the number of late pregnancies per thousand live births which do not result in the birth of a child who lives beyond the age of one year. It includes therefore, the number of stillbirths and the number of babies dying in the first year of life. It should also strictly include the number of abortions but as these are not notifiable and as the vast majority occur within the first month or two of pregnancy they may be regarded as of less account than children dying any time between the sixth month of pregnancy and the end of the first year of life. There are several points of interest in the chart. First, the considerable reduction in the infant mortality rate since 1901. This reduction, from 128 to 28, is rather less than that which some areas are able to claim, mainly, I think, because Lewisham was an open, relatively uncrowded borough for many years before the war and therefore started to the left of the graph with a lower figure than occurred in many other areas. Nevertheless the drop in the rate of deaths of infants has been quite noteworthy. Even more spectacular, though not so well appreciated by the public, is the drop in the stillbirth rate. This rate reached 39.4 per thousand births in 1937 and last year it was only 14.8. The factors in the stillbirth rate are numerous and complex, but it is probable that nutrition of the mother is the most important. Nutrition in itself is a complex factor, but good food and varied food insofar as the main classes of foodstuffs are concerned is perhaps the most important of the sub-factors. I am quite certain that the general system of rationing which has occurred from 1939 onwards and has ensured fair distribution of all essential foods, combined with the special system of rationing 8 priorities for expectant and nursing mothers which has ensured a sufficiency of special types of foods, has been the main cause of the average higher state of nutrition in expectant mothers as a group, and this in its turn has caused part of the decline in the stillbirth rate. Maternal mortality is also influenced, but to a much lesser extent, by the nutrition of the mother and it probably has been more greatly influenced by advances in treatment of maternal infections. This rate too has shown a very considerable decrease over the years. It was 3.9 per thousand births in 1901, it had a maximum of 5.2 per thousand in 1929, while in 1947 it had dropped to 1.0 and in 1948 to 0.46. What then of the future ? These rates can be still further improved. There is no reason why maternal mortality should not be almost zero. At the moment there is no such hope of reducing infant mortality to zero, mainly because there will be for some considerable time a number of developmental defects in the baby which we are unable to treat before birth. On the other hand, advances have been made, and are still being made ; it is only in recent years that it has been noticed that there is a correlation between certain congenital defects in the baby and an infection of the mother during early pregnancy. Thus, certain defects in the development of the eyes of the baby can be correlated with the infection of german measles in the pregnant woman at a time when the baby is undergoing particularly rapid development. It may be that other similar reasons for developmental defects in the baby will come to light and by preventing the infection of the mother or by other ways, including therapeutic abortion, it will be possible to prevent a baby from being born maimed for life. Table 4 on page 14 gives a detailed analysis of the causes of death in the 120 babies who died during the year. The first seven causes of death, accounting for 38 of the 120 cases (or nearly one-third), are in theory preventable and to these can be added certain other causes shown in the table. Even at present therefore it could be said that the infant mortality rate might be halved, i.e., brought down to about 14 per thousand, but it is doubtful if in the present state of medical knowledge it could be brought down further. Such low rates have in fact been approached in different countries, and Iceland in 1947 had a rate of only 22 per thousand; the New Zealand rate was 27. Little is known of the figure to which stillbirths might be reduced but it is certainly less than the present 15 per thousand and may be, in our present state of knowledge, about 10 per thousand, thus giving a reproductive wastage rate of say 14 plus 10, or 24 per thousand. Then there is a whole field of effort in preventing deaths of children from 1 to 5, of which 28 died last year. In other words there are goals which should be attainable in the fairly near future, and it will be interesting to see how quickly the very large health authority now responsible for maternity and child welfare services in London reaches them. Meanwhile, the Council can, on looking back, be reasonably satisfied with the results obtained; they will also have in mind that the maternity and child welfare staff, particularly the health visitors, were also factors in the improvements. 9 In ending the introduction of this report I wish to express my thanks to the staff for their work during the year under review and also my thanks to the public health committee for their support and guidance in the work done. The public health committee during the year was constituted as follows :— 9 Councillor F. W. M. Pettit, J.P. (Chairman) ; Councillor R. M. Oxenburgh (Vice-Chairman); The Mayor (Alderman J. T. Cummings.'M.B.E., J.P.) ; Aldermen Miss Ball and C. Street; and Councillors A. O. Carter, Mrs. Dadson, Miss Davies, M.Sc., Mrs. Farrance, Mrs. Gadd, Mrs. Hayes, Mrs. Land, Mrs. Miller, L. M. Minty, Ph.D., LL.B., Mrs. Palmer and A. A. Vincent. © 11 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 1948 was 226,100. Rateable value £1,739,488. Estimated product of a penny rate £6,950 No. of separately assessed dwellings at 6 April, 1948 58,113 Births (adjusted for inward and outward transfers) No. of live births 4,274 Males Females Totals Legitimate 2,114 1,968 4,082 Illegitimate 99 93 192 2,213 2,061 4,274 Birth rate per 1,000 of the estimated population 18.9 Birth rate for England and Wales 17.9 Birth rate, London Administrative County 20.1 Stillbirths The total number of stillbirths allocated to the borough during the year was 64. This represents a stillbirth rate per thousand live and stillbirths of 14.8. Deaths The total number of deaths belonging to the borough registered during the year 1948 was 2,253, consisting of 1,087 males and 1,166 females, giving a death rate per thousand of the estimated population of 9.9 as compared with a rate of 10.8 for England and Wales and 11.6 for the Administrative County of London. Infant mortality Number of infant deaths 120 Legitimate 115 Illegitimate 5 1. All infants per thousand live births Rate 28.0 2. Legitimate infants per thousand live legitimate births Rate 28.1 3. Illegitimate infants per thousand live illegitimate births Rate 26.0 12 Maternal deaths Number of maternal deaths 2 (a) Puerperal sepsis 1 (b) Other maternal causes 1 Maternal mortality rate per thousand total live and still births 0.46 Other deaths Number of deaths from Measles (all ages) 2 „ „ „ Whooping Cough 7 „ „ „ Diarrhoea (under 2 years) 7 „ „ „ Tuberculosis 111 „ „ „ Cancer 431 „ „ „ Heart Diseases 696 Comparative statistics for the" year 1948 Table 1 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 18.9 0.28 9.9 28 England and Wales 17.9 0.42 10.8 34 London Administrative County 20.1 0.39 11.6 31 *Rates per thousand total population. General summary of Vital Statistics for the last ten years Table 2 Year Estimated Population Births Deaths Deaths under one year Deaths from Pulmonary Tuberculosis Number Rate Number Rate Number Rate Number Rate 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 1948 226,100 4274 18.9 2253 9.9 120 28 109' 0.48 * 220,300 for death-rate ; 231,000 for birth-rate. 13 Causes of death at different periods of life during the year 1948 The following table shows the causes of and ages at death during the calendar year 1948 :— Table 3 Code No. Causes of Death Nett deaths at the subjoined ages of " residents " whether occurring within or without the borough All ages Under 1 yr. 1 and under 5 5 and under 15 15 and under 45 45 and under 65 65 and over Totals, all causes 2253 120 28 19 185 567 1335 1 Typhoid and paratyphoid fevers 2 Cerebro-spinal fever 2 1 1 3 Scarlet fever — 4 Whooping cough 7 4 3 — — — — 5 Diphtheria — — — — — — — 6 Tuberculosis of respiratory system 109 _ 1 65 34 9 7 Other forms of tuberculosis 10 — 1 8 1 8 Syphilitic diseases 11 — — 2 2 7 9 Influenza 2 — — 1 1 10 Measles 2 2 11 Acute poliomyelitis and encephalitis 1 _ _ 1 12 Acute infectious encephalitis 1 1 13 Cancer, buccal cavity and oesophagus (M), uterus (F) 37 2 19 16 14 Cancer, stomach and duodenum 63 3 23 37 15 Cancer, breast 44 — 6 17 21 16 Cancer, all other sites 287 — 1 1 20 123 142 17 Diabetes 10 — — 10 18 Intra-cranial vascular lesions 218 — — 2 54 162 19 Heart diseases 696 — — 17 141 538 20 Other circulatory diseases 63 — — 2 14 47 21 Bronchitis 142 6 2 — 5 26 103 22 Pneumonia 96 18 6 1 1 10 60 23 Other respiratory diseases 35 1 — 1 3 12 18 24 Ulcer, stomach and duodenum 28 13 15 25 Diarrhoea (under 2 years) 7 7 — — — — — 26 Appendicitis 10 — 4 — — 3 3 27 Other digestive diseases 40 1 — 1 2 14 22 28 Nephritis 45 — — 3 8 19 15 29 Puerperal and post-abortive sepsis 1 1 30 Other maternal causes 1 _ — — 1 31 Premature birth 23 23 32 Congenital malformations, birth injury, infantile diseases 54 45 2 1 3 1 33 Suicide 16 — — 4 8 4 34 Road traffic accidents 15 1 3 2 4 5 35 Other violent causes 39 8 3 1 7 3 17 36 All other causes 140 6 2 6 19 25 82 *Deaths under 1 year are further analysed in the next table. 14 Deaths under 1 year of age Table 4 Cause of Death Sex Under 1 day 1-6 days 2nd week 3rd week 4th week Total under 4 wks. 1-2 mths. 3-5 mths. 6-8 mths. 9-11 mths. Total under 1 yr. Cerebro-spinal fever M - - -'- - - - - - - - - F - - - - 1 1 - - - - 1 Whooping cough M _ _ _ — _ _ 1 1 — - 2 F - - - - - - 1 1 - - 2 Bronchitis M _ _ _ 1 1 - 2 1 2 6 F - - - - - - - - - - - Pneumonia M - _ _ _ _ 3 4 1 _ 8 F - 2 - - - 2 1 2 2 3 10 Other respiratory diseases M _ _ _ _ _ _ 1 — - 1 F - - - - - - - - - - - Inflammation of the stomach M - - - - - - - - - - - F - - - 1 - 1 - - - - 1 Diarrhoea M _ _ _ 1 1 1 2 _ _ 4 F - - - - - - 1 1 1 - 3 Congenital malformations M 4 2 _ _ _ 6 5 _ _ _ 11 F 1 4 - - - 5 1 1 - - 7 Premature birth M 4 4 _ _ 2 10 1 1 - _ 12 F 3 6 2 - - 11 - - - - 11 Injury at birth M 2 2 _ 1 _ 5 _ 5 F 1 1 - - - 2 - - - - 2 Other diseases peculiar to first year of life M 7 1 - 1 - 9 - - - 9 F 4 5 - - 1 10 1 - - 11 Accidental mechanical suffocation M - - - - - - - - 1 1 2 F - - - - - - 1 2 - - 3 Food poisoning M _ - - - - - - - - 1 1 F - - - - - - - - - - - Accidental injury by fall, etc. M _ - - - - - - - 1 _ 1 F - - - - - - - - - - - All other causes M _ _ _ 1 1 1 1 _ 1 4 F 1 - - - - 1 - 2 - - 3 TOTALS M 17 9 _ 2 5 33 12 12 4 5 66 F 10 18 2 1 2 33 6 9 3 3 54 GRAND TOTAL 27 27 2 3 7 66 18 21 7 8 120 15 Summary of Statistics as to Tuberculosis for the last ten years Table 5 Year Population No. of new cases notified (all forms) (excluding inward transfers) Notif. rate per thousand pop. Deaths Death rate from pulmonary tuberculosis per thousand population  All forms Respiratory 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 1948 226,100 502 2.22 119 109 0.48 Note. :—The 1948 death rate from pulmonary tuberculosis for the County of London was 0.63. SECTION "B" —GENERAL PROVISION OF HEALTH SERVICES Notification of births The total number of births notified to 4 July, 1948 was 2,042. Of this number 27 were stillbirths. 4,274 live births and 64 stillbirths were registered as belonging to the borough during the whole year. Nursing in the home The number of visits paid to cases by nurses from Nursing Associations at the Council's expense during the period 1 January to 4 July, 1948 was 2,008 at a cost of £217 10s. 8d. Health visiting The following is a summary of the visits made by the health visitors during the period January 1 to July 4:— Total visits To expectant mothers 637 To children under 1 year 3,636 To children 1-5 years 6,367 To infectious diseases cases, included above 923 Infant Welfare Centres The number of children who attended the 14 Maternity and Child Welfare Centres to July 4 was as follows :— Babies 2,317 Children 1-5 years of age 3,519 16 The attendances at the various centres were as follows :— Municipal Clinics Infants Children under 1 year 1-5 years Louise House 3,122 1,367 Central Clinic 820 441 North Downham 1,094 505 Spalding House 1,097 442 Shaftesbury House 1,355 481 St. John's Hospital 700 215 Totals 8,188 3,451 Voluntary Welfare Centres Bellingham 3,621 2,471 Catford 3,526 1,471 Downham 2,557 2,221 Forest Hill 5,187 3,063 Grove Park 1,904 2,226 Hither Green 2,245 1,577 Lee and Blackheath 3,620 3,010 Ladywell 2,688 1,866 Totals 25,348 17,905 Grand Totals 33,536 21,356 Antenatal and postnatal clinics (to July 4) No. of women who attended antenatal clinics 1,983 „ ,, ,, „ postnatal clinics 307 Total number of attendances 9,227 The attendances at the various centres were as follows :— Antenatal Postnatal Louise House 1,288 160 Central Clinic 5,983 273 Downham and North Downham 998 51 Spalding House 427 47 Totals 8,696 531 Light clinic The attendances at the Light Clinic, which is held at the Central Clinic, for the period to July 4, were as follows :— Infants Adults 6,743 261 17 Child Life Protection The number of Foster Mothers on the register at July 4, 1948 was 56. 63 children were received and there were 101 on the register at the end of the period. Summary of visits paid by the Child Life Protection Officers Primary visits to foster mothers 9 Primary visits to foster children 30 Revisits to foster mothers 379 Revisits to foster children 510 Number of illegitimate children on July 4, 1948 294 Home Helps and Domestic Helps (to July 4) The Council's scheme for the provision of home helps for mothers during confinement, which had been in operation since 1930, was continued and was provided for 293 cases. In a further 386 cases domestic help was provided for sick, aged and infirm persons. 49 whole-time and 163 part-time workers were employed at the end of the period. Diphtheria immunisation mobile campaign A street campaign was organised during 1948 and lasted two months. It was held in order to offer immunisation to children who might not be reached through the medium of the regular immunisation clinics. The prophylactic used was APT, necessitating two injections, and a van toured streets in the borough in the first four weeks, repeating the same itinerary in the second four weeks in order that the second injection might be given at the proper time. The van was accompanied by a doctor, nurse and clerk and injections were given to children either in the van or in their homes. Publicity was given to the campaign by means of posters, cinema slides, leaflets, press announcements and by personal propaganda on the part of the health visitors. The final results of the campaign were as follows :—; Completed cases (i.e., children who received two injections) 635 First injections only 596 Total injections 1,866 Children who had received only one injection at the completion of the campaign were invited to the immunisation clinics in order to receive the second injection and so complete the course of immunisation. 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 wa? continued. 22 children were sent away by the Lewisham branch of the Association during the period under report. 18 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 period. Dental treatment Because of the difficulty in obtaining dental treatment under the previous arrangements for expectant and nursing mothers and for children under five, an agreement was made with the British Dental Hospital, Lewisham branch, whereby certain sessions were reserved for cases referred through the child welfare centres and antenatal clinics. The first sessions were held in March, 1948 and the work done from then until the end of June is summarised in the following table:— Summary of dental treatment during the months March to June, 1948 at the British Dental Hospital, Lewisham Table 6 Particulars of patients March April May June Totals Wmn. Chdn. Wmn. Chdn. Wmn. Chdn. Wmn. Chdn. Wmn. Chdn. No. of attendances 19 17 73 30 73 12 80 47 245 106 No. of simple fillings — — 4 3 12 5 19 3 35 11 Extraction cases— local administration ... 5 5 gas administration 1 23 11 34 11 19 19 77 41 no. of teeth extracted 2 - 73 33 94 34 39 46 208 113 Dentures— upper — — 2 — 3 — 2 — 7 — lower — — 2 — 3 — 1 — 6 — repairs — — 1 — — — — — 1 — No. of patients receiving advice and preliminary exam 18 10 44 - 16 20 27 25 105 55 Denture visits — — 13 — 9 — 14 — 36 — No. of new patients 11 15 32 20 25 21 28 25 116 81 Number of dentures provided at St. John's Hospital during the months January to June, 1948 Month Full Partial January 6 2 February 8 3 March 8 1 April 10 3 May 6 2 June 9 2 Preliminary treatment was given where required in these cases. Provision of insulin The number of persons suffering from diabetes who received insulin supplied under the Council's scheme during the period was 34, 19 Laboratory facilities The bacteriological work of the Council is carried out under contract by St. John's Hospital, Lewisham. Routine examinations of throat and nasal swabs, sputum and blood specimens, etc., were submitted, and the following is a summary of the work undertaken :— Table 7 Positive Negative Total Diphtheria 7 817 824 Tuberculosis 26S 1402 1667 Typhoid — 9 9 Dysentery 4 24 28 Foodstuffs 1 10 11 Food poisoning — 13 13 Scarlet fever 28 25 53 Others 1 10 11 TOTALS 306 2310 2616 Table 8 Month Bodies received from hospitals • Others Post mortem exams. Inquests January 19 23 42 8 February 17 27 44 6 March 21 28 49 11 April 15 9 24 10 May 19 11 30 5 June 11 20 31 5 July 17 23 40 10 August 15 25 40 7 September 7 17 24 4 October 12 14 26 6 November 13 29 42 13 December 32 33 65 10 TOTALS 198 259 457 95 Vaccination No return was required by the Registrar-General in respect ofthe period January 1 to July 4, 1948. Public Mortuary and Coroner's Court The premises are situated in Ladywell Road and comprise a Court Room, Witness Room, Coroner's Office, Caretaker's apartments and Mortuary. The number of bodies taken to the mortuary during the year was 457. Of this number 198 were received from hospitals. Inquests were held in 95 cases. Details are shewn in the following table :— 20 Tuberculosis Dispensary Service Owing to increased work at the Dispensary, particularly with regard to treatment by artificial pneumothorax, the Council decided that a third tuberculosis officer was needed. After agreement with the London County Council, Dr. Donnelly of Portsmouth was appointed to the position, and he took up his duties a few days before the Dispensary was transferred to the Regional Hospital Board. The attendances up to July 4 of persons at the Dispensary was 2,461. Of this number, 2,012 were new cases and 449 contacts. The number of definite cases of tuberculosis on the dispensary register at the beginning of the year was 2,067, and was 2,140 at July 4, 1948. The Council's tuberculosis health visitors paid 2,185 visits to the homes of patients during the period. Tuberculosis allowances (to July 4) The scheme for the payment of allowances to persons suffering from pulmonary tuberculosis who have to give up remunerative employment to undergo treatment, as well as the supply of extra nourishment, continued. Number of maintenance allowances granted 234 Number of discretionary allowances granted 80 Number of special allowances granted 43 Day nurseries The following table shews the average daily attendances (excluding Saturdays) each month during the first six months of 1948 :— Table 9 Month Catford (approved places—50) Ladywell (approved places—88) Forest Hill (approved places—65) Downham (approved places—56) January 50 70 46 54 February 41 74 63 45 March 45 79 62 52 April 50 84 63 60 May 49 86 64 55 June 49 85 54 56 Average for six months 47 80 59 54 Foot clinics Owing to the heavy bookings for this service it became necessary to appoint a second full-time chiropodist. He took up his duties on April 5, 1948, working five sessions at 410, Lewisham High Street and five at Louise House. 21 During the period January 1 to July 4, 295 patients made a total of 1,257 attendances at 410, Lewisham High Street and 262 patients made 1,033 attendances at Louise House. Under the scheme approved by the Council, patients paid 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 were treated free. Old people The question of help for old people has been coming more to the fore in recent years. This is because of the gradual realisation that it is almost inevitable that the proportion of old people in the population will considerably increase during the next 40 or so years. The estimated figures for England and Wales are that 13.5 per cent, of the population are of pensionable age — that is men 65 and over, women 60 and over. This percentage will gradually rise until in 40 years' time, namely 1989, it will be 19.2. This very large increase in the percentage of old people is only in small part due to the greater age to which people live. Whereas it is known that the expectation of life at birth has increased very considerably (15 or so years) during the last half-century, the expectation of life at the ages of 60 to 65 has in fact only increased by about two years. The remainder of the expected percentage increase in old people is due to the lowering of the birth rate which has occurred also over the last 40 or 50 years, thus producing a shift in the age distribution of the population. There has been some increase in the birth rate during and since the end of the war but the probability is that it will return to near its pre-war level fairly shortly. It must be emphasised however that these percentage figures are based on three assumptions : firstly that mortality will still fall slightly ; secondly that the fertility of married and unmarried women at each age will remain constant throughout the period at the rates recorded in * 1938 and 1939; and thirdly that the marriage rates of women at various ages remain constant at the 1938 levels. As far as Lewisham is concerned, this borough can be regarded as a fairly typical crosssection of the population. Its mortality rate and its birth rate are also sufficiently near the rates for England and Wales that they can be regarded as similar. Its total population, which is now thought to be about 230,000, is not likely to rise beyond 250,000. We can, therefore, make an estimate of the old people (see definition above) in Lewisham, during the next 40 years, as follows :— Estimated Estimated Estimated Old yearPopulation Old People % People No. 1949 230,000 13.5 31,050 1959 240,000 14.9 35,760 1969 250,000 17.1 42,750 1979 250,000 18.8 47,000 1989 250,000 19.2 48,000 22 It will thus be seen that the estimated number of old people will have increased from just over thirty thousand now to nearly fifty thousand in 40 years time. It must not be assumed that more than a very small proportion of old people require help. The vast majority of them would in fact spurn it, as they like to feel independent, but as old age increases so frailty and illness increases and as a result an enlarging proportion of old people require some sort of help according to the age they have reached. Further, the proportion of old people who work after they become of pensionable age varies according to particular circumstances. At the moment, when increased production is required, there is a considerable propaganda movement to keep old people in industry. I am quite sure, however, that should there be anything corresponding to the slump which occurred between the wars the propaganda would be reversed and old people would be unemployed when they reached pensionable age. There are two other general considerations: with the smaller families which have become increasingly common in the last half-century there are less grown-up children to look after the old person and therefore the chances of the old person being left on his own are considerably increased. Secondly, even though the proportion of old people who require help may be small, or very small (and no-one knows at the moment what it really is), when we are dealing with a matter of thirty to fifty thousand old people even a "very small" proportion might well mean some thousands. Help to old people can be of various kinds, some of which is obtainable through voluntary agencies and some of which can be given by the local authority, whether it be the local health authority (i.e., the L.C.C.) or the local sanitary authority (i.e., the borough council). There are at least 20 local agencies (possibly many more) who are interested in the care of old people, and in 1947 the Lewisham Old People's Welfare Council was formed, and included representatives of most of these agencies. This Council, in spite of many difficulties, financial and otherwise, has made a start in the care of old people and by the end of 1948 it had organised a small "Meals on Wheels" service. There are, however, many other ways in which the Old People's Council and other local agencies can help old people. As far as the health department is concerned, such help might be of great benefit in postponing for a considerable time, if not indefinitely, the date when an old person becomes a burden on his or her friends, relatives or neighbours, and may, as a result, require admission to hospital or a home. I put forward a comprehensive report on old people to the Health committee at its meeting on December 13, 1948 and as a result a grant was made to the Lewisham Old People's Welfare Council in order to allow them to continue with their "Meals on Wheels" service and further consideration to their claims was promised. Water supply I am indebted to the Director of Water Examination and the Clerk of the Metropolitan Water Board for the information on which the following report on Lewisham's water supply is based. 23 "The supply during 1948 was adequate at all times. The Borough is supplied in three zones: the low zone from Deptford well and by Thames-derived filtered water; the Eltham zone from Wilmington, Darenth and Bexley wells with an additional small proportion from the low zone should occasion arise, and the Bromley zone to the south of the Borough from Shortlands well and on occasion with additional Thames-derived filtered water. "All the Thames-derived filtered water is chlorinated as it leaves the works. All the wall 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. 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 1948 as forwarded by the Metropolitan Water Board." Average results of the examination of the water supply to the Borough of Lewisham for 1948 PARTS PER MILLION (unless otherwise stated) (a) CHEMICAL Table 10 Description of the sample No. of samples Ammoniacal nitrogen Albuminoid nitrogen Oxidised nitrogen Chlorides as Cl. Oxygen abs. from Permanganate (3 hrs. at 80°F) Hardness (total) Hardness (permanent) pH. value Conductivity Deptford well 4 0.002 0.024 5.1 33.9 0.16 354 150 7.2 625 Wilmington wells 8 0.007 0.018 6.0 20.4 0.14 312 79 7.1 475 Darenth well 5 0.001 0.012 3.5 16.4 0.15 301 96 7.1 450 Bexley well 3 0.003 0.015 4.2 16.7 0.14 310 80 7.1 475 Shortlands wells 3 0.000 0.024 4.5 19.0 0.15 315 129 7.2 475 Hampton (Thames filtered) 250 0.097 0.080 3.8 27.5 0.96 248 71 7.7 475 Surbiton (Thames filtered) 504 0.131 0.086 3.3 28.7 1 .07 227 69 7.6 450 Walton (Thames filtered) 252 0.043 0.097 4.4 28.7 1 .18 237 72 7.6 450 (b) BACTERIOLOGICAL Table 11 No. of samples Agar colony count Percentage of samples negative 100 ml. Bact. coli per 100 ml. Deptford well 258 — 100.0 Nil Wilmington wells 404 — 100.0 Nil Darenth well 257 — 100.0 Nil Bexley well 253 — 100.0 Nil Shortlands wells 255 — 100.0 Nil Hampton (Thames filtered) 1,065 4.7 100.0 Nil Surbiton (Thames filtered) 516 7.3 98.3 0.035 Walton (Thames filtered) 258 14.8 100.0 Nil 24 25 Disinfection and personal cleansing The Disinfecting station and the Cleansing station are situated at Wearside Road Depot. Details of the work carried out during the year are as follows:— Disinfecting station Premises visited 762 Rooms disinfected 1,781 Articles disinfected:— beds 212 mattresses 698 bolsters 224 pillows 1,213 cushions 147 quilts 355 blankets 1,503 sheets 465 household articles 1,029 wearing apparel 833 Public Library books 1,661 Private Librarv books 232 Verminous rooms treated 559 Verminous articles treated 261 Cleansing station Children treated for vermin 1,422 Adults treated for vermin 99 Scabies baths, children 342 Scabies baths, adults 309 Rodent control A small section, consisting of chargehand and three operatives, is maintained for the purpose of repressing rat infestations in private properties and business premises and this section is supervised by the senior sanitary inspector. A summary of the work carried out during the year is appended:— Number of complaints received 4,630 Number of premises baited:— initial treatments 1,119 retreatments 1,455 No infestation found 3,511 Total number of visits 17,835 Estimated number of rats killed 7,226 In addition, liaison is made twice yearly with the Borough Engineer's department for the baiting of sewers. 26 A table is appended giving the results of these treatments in the year 1948:— Table 12 Dates of Treatment 21st May to 23rd June, 1948. 29th November to 22nd December, 1948. Scheme of Baiting Bait base and poison 3 consecutive days Sausage rusk and 2½% Zinc Phosphide (4:4:8oz.) 3 consecutive days Sausage rusk and 2½% Zinc Phosphide (4:4:8oz.) No. of manholes baited 2836 2836 No. of manholes showing preliminary pre-bait take 1476 1810 No. of manholes showing complete pre-bait take 954 1104 Campaign against flies and mosquitoes The Public Health Committee during the winter of 1947-48 made arrangements for a campaign during the summer months against flies and mosquitoes. This campaign lasted from the beginning of May until the end of September, and a sum of £1,445 was included in the estimates for it. The campaign consisted in the main of having two pairs of motor cyclists with helpers to tour round the borough, area by area, and to deal with any potentially infested site, paying particular attention to bombed sites and static water tanks. For the purpose two motor cycles, plus special sidecars were hired from the Borough Engineer's department, and various items of apparatus were bought. The insecticides used were DDT and a rather similar powder called gammexane. At the same time the Borough Engineer's department co-operated with us in arranging for the dustmen to place gammexane powder in the dustbins when they were emptied. We provided the powder, the shakers and any other apparatus required. Owing mainly to a lesser sum than estimated being spent on hiring the motor cycles with drivers, the actual expenditure came to a little under £1,200. Previous to the commencement of the campaign a survey of the borough had been carried out and 750 sites were listed for treatment. These sites included, besides the bombed sites and static water tanks referred to, vacant land, grass verges, allotments, stables, pig sties, river banks and ditches. The aim was to get round each area at least once a month, but where necessary additional sprayings were applied. Furthermore, rooms and private dwellings were sprayed at the request of the occupiers. During the campaign Very few complaints of fly infestation were received and members of the public expressed, verbally and by letter, their appreciation of the work carried out by the council in dealing with flies and mosquitoes. However, it must be pointed out that last summer, was, in this and other areas, almost an ideal summer as far as freedom from flies and mosquitoes was concerned, and this was in 27 large measure due to the climatic conditions—namely lack of sun and lack of high maximum temperature. It is not possible, therefore, to say to what extent the lack of complaints was due to the measures carried out but it is felt that even if the climatic conditions had been highly suitable for fly development, the work done would have had an appreciable effect on the number of flies and mosquitoes in the area. The anti-fly campaign is being repeated during the summer months of 1949. 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:— Table 13 Cause of Inspection Totals On complaint 6,514 Infectious disease 570 Notice from builder 886 Smoke observation 4 Certificates for materials 172 Water certificates 288 Vermin 189 Rent Act certificates 78 Landlord and Tenant Act certificates 21 Building licences 963 Housing applications 4,041 Requisitioned properties, house-to-house 447 Houses let in lodgings 11 Underground rooms 24 Outworkers premises 202 Factories and workshops 283 Butchers 648 Icecream premises* 505 Registered food premises† 203 Bakehouses 307 Fishmongers 388 Provision merchants 759 Greengrocers 138 Food factories 39 Restaurants and eating houses 540 Dairies 182 Milk purveyors 111 Other food premises 200 Pharmacy and Poisons Act 133 Shops Act 205 Miscellaneous 4,781 Markets and stalls 415 Slaughterhouses 13 Legal proceedings 16 Reinspections 5,387 Intimation Notices served 4,316 Statutory Notices served 955 Number of factories on register at 31-12-48 568 Number of outworkers on register at 31-12-48 172 *Food and Drugs Act, S. 14 (i) (a) †ditto S.14 (i)(b). 28 The following table gives further information on certain sanitary circumstances in the area:— Table 14 Premises No. in borough on 31 Dec., 1948 No. of inspections No. of prosecutions Common lodging houses Nil — — Seamen's lodging houses Nil — — Cowsheds (licensed) Nil — — Slaughterhouses (licensed) 2 13 Nil Other offensive trades Nil — — Milkshops (Purveyors 112, Dairies 76) 188 293 1 Icecream premises 247 505 Nil Restaurants and eating houses 161 540 Nil Registered foster-mothers* 56 388 Nil Nurse children kept* 101 540 Nil *To July 4, 1948. Smoke nuisances Number of observations 4 Number of intimations served Nil Number of complaints received 16 Number of statutory notices served Nil Number of legal proceedings — Number of convictions — Amount of penalty and costs imposed in each case — Cleansing and disinfection Number of adults cleansed 273 Number of children cleansed 1,592 Number of premises cleansed:— (a) after infectious diseases 583 (b) for vermin 179 Water supply to tenement houses Number of premises supplied as a result of health department action Nil Number of prosecutions — 29 Factories and Workshops The following tables give more detailed information of work done under the Factories Acts:- Inspections Number of Premises Inspections Written notices Occupiers prosecuted (i) Factories in which ss. 1, 2, 3, 4 and 6 are enforceable 27 1 — (ii) Factories not included in (i) in which s. 7 is enforceable 20 13 — (iii) Any other premises in which s. 7 is enforceable (excl. outworkers) Nil — — Cases in which defects were found Table 15 Particulars Number of cases in which defects— No. of cases in which prosecutions instituted[/##/] Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 4 4 - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation 2 2 - - - Ineffective drainage of floors - - - - - Sanitary conveniences— (a) insufficient 2 2 - 2 - (b) unsuitable or defective 15 12 - 15 - (c) not separate for sexes 1 1 - 1 - Other offences against the Act (not including offences relating to outwork) 7 4 - 6 - TOTAL 31 25 - 24 - 30 Outworkers Outworkers are visited periodically by the woman sanitary inspector. The following is a list of the trades concerned, extracted from the autumn lists received:— Trade No. of outworkers visited Making of wearing apparel 141 Household linen 5 Umbrellas 1 Sacks 9 Paper bags 2 Making of boxes or other receptacles from paper 5 Brush making. 1 Carding, etc., of buttons 1 Christmas crackers 1 Lampshades 1 Leather goods 3 Surgical instruments 2 SECTION "D"—HOUSING Building The following new houses and flats were completed by the Council during the year:— Dowson Court 21 flats Whitefoot Lane 52 houses Adamsrill Road 2 houses Hether Grove 16 flats Sunderland Mount 28 flats Total 119 dwellings Families rehoused During the year the following families were rehoused:— I. By the Lewisham Borough Council (a) In dwellings erected by the council:— (i) Emergency hutments 27 (ii) Temporary bungalows 16 (iii) L.B.C. properties 72 115 (b) In requisitioned properties 382 Total 497 II. By the London County Council 659 Grand Total 1,156 31 Applications for rehousing The number of cases dealt with by the public health department during the year was as follows:— (a) Lewisham Borough Council housing applications— Number visited 2,995 Number found overcrowded 1,056 Insanitary conditions found 516 (b) London County Council housing applications- Number visited 708 Number found overcrowded 282 {c) Housing applications referred from other authorities— Number visited 264 Number found overcrowded 37 (d) Inspected on request of occupier— Number visited 74 Number found overcrowded 26 Total visited 4,041 Total overcrowded 1,401 Housing Act, 1936 Closing Orders were made in respect of the following houses or Darts of houses:— 42, Belmont Park. 33, Blessington Road. 8, Dartmouth Row. 44, Lee Terrace. 344, Lee High Road. One closing order, in respect of 11, Blythe Vale, was varied. Demolition orders were made in respect of the following premises:— 80, 82, 84, Blackheath Hill. 395, 397, Southend Lane. 391, 393, 399-405, Southend Lane. 32 The following is a tabulated statement of various other housing statistics:— Table 16 Item Total Total number of houses in the borough (separately assessed dwellings) 58,113 Public Health Act Number of houses inspected on account of complaints or illness 7,084 Number of statutory notices served 955 Number of houses repaired or nuisances remedied 2,743 Housing Act, 1936 Number of houses inspected—house to house (Housing Consolidated Regulations, 1925) Nil Number of houses included by representations by the M.O.H. under s.25 Nil Number of houses demolished following representation by the M.O.H. under s.25 Nil Number of houses repaired under ss. 9 and 10— (a) by owners 1 (b) by L.A. in default of owners Nil Number of houses demolished— (a) in pursuance of orders under s.11 (plus 8 awaiting rehousing of tenants). 3 (b) voluntarily Nil Number of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms) 6 Number of Closing Orders determined (i.e., houses made fit) Nil Overcrowding (Housing Act, 1936) Number of families found to be living in overcrowded conditions 1,401 Number of overcrowded families who have obtained alternative accommodation Not known Number of houses and flats erected by the Borough Council for the working classes during year 119 Underground Rooms Number occupied but unfit... Not known Number closed or modified occupation approved Nil Houses let in lodgings Number in borough Not known Number of inspections 11 Number or prosecutions Nil Number of complaints remedied under the Bye-laws (not included under any other heading) Nil 33 Civil building licences Increasing difficulties were experienced by the district sanitary inspectors in getting urgently needed repair work done to dwellinghouses. These difficulties were partly due to shortages of material, partly to shortage of labour, partly to multiplicity of licences and permits which might be required. As from May, 1948 the health department was allocated a monthly quota of the money which could be authorised to be spent on repair work in the borough, and the sanitary inspectors issued the necessary licences, either at the same time or following the intimation or nuisance notices. The following table shows the monthly value of civil building licences issued by the health department from the commencement of the arrangement in May until the end of the year:— Table 17 Month Total issued on intimation notice Total issued on nuisance notice Total £ £ £ May 36,517 15,433 51,950 June 23,162 23,782 46,944 July 24,111 23,354 47,465 August 22,551 6,406 28,957 September 24,005 22,120 46,125 October 24,298 20,740 45.038 November 35,041 2,697 37,738 December 32,906 2,911 35,817 TOTALS £222,591 £117,443 £340,034 SECTION "E"—INSPECTION AND SUPERVISION OF FOOD Analysis of Milk Milk Suplly During the year under review, 33 samples of milk were submitted by the Council's inspectors to the Public Analyst for examination and none of these samples was certified as adulterated or below standard. average composition of the samples is set out in the following table:- Table 18 Period Average composition of samples examined. Percentage of Milk fat Solids not fat Water First quarter 3.52 8.69 87.79 Second quarter 3.24 8.67 88.09 Third quarter 3.50 8.72 87.78 Fourth quarter 3.93 9.04 87.03 Average for year 3.54 8.78 87.67 34 The legal standard is 3.0 per cent. milk fat and 8.5 per cent. solids not fat. Milk shops and dairies Number of dairy premises on the register at the end of the year 76 Number of purveyors of milk on the register at the end of the year 112 Milk (Special Designations) Regulations Number of licences issued for the sale of pasteurised milk (dealer's) 40 the sale of tuberculin tested milk (dealer's) 26 Supplementary 16 Bacteriological examinations During the year 124 samples of food were submitted to the laboratory for bacteriological examination. The results were as follows:— Table 19 Food No. of samples Remarks Heat-treated milk 40 All satisfactory Icecream 83 Grade I 20 II 32 III 29 IV 2 Corned beef 1 Sterile Grading for icecream It will be seen from table 19 that icecream is divided into four grades as a result of examination. In brief, grades I and" II are satisfactory hygienically, while grades III and IV are doubtful or bad, necessitating review of the conditions of manufacture, handling, storage or sale. Tracing the mode of contamination may be easy or difficult, and the food inspectors give what help they can to the manufacturer or retailer. The person from whom the sample is taken is notified by me if the sample is in grades II, III or IV, and general advice is given. Clean food campaign A campaign was held during the spring and summer which sought by means of lectures and demonstrations to promote and encourage the proper handling of foodstuffs in shops in order to minimise the dangers of food and drink infections. 35 The campaign commenced with an inaugural meeting at the Town Hall in April to which owners and managers of food shops together with their assistants, educationalists, members of adult organisations and other interested members of the public were invited. The general plan of the campaign was outlined and the principal speaker was Dr. Robert Sutherland, an expert on health education. The borough was divided into four areas for the purpose of the campaign and it was intended to hold in each area a course of three lectures, each with a demonstration, for food handlers of the supervisory grades and single lectures addressed to the junior grades in shops such as shop assistants, waitresses, etc. In spite of the fact that the inaugural meeting was crowded and that every effort was made to publicise the campaign, attendances at the area lecture demonstrations were disappointing and in consequence meetings in certain areas were cancelled and in other areas were combined. As a preliminary to the campaign a competition was run for the best slogans to advertise the subject and modest prizes were awarded. The following slogans were used and were printed as double-crown posters:— CLEAN HANDS ARE ESSENTIAL TO PREPARE CLEAN FOOD KEEP DIRT OFF THE RATION INSIST ON CLEAN FOOD IN SHOP AND HOME FOOD EXPOSURE—GERMS' DELIGHT; KEEP IT COVERED DAY AND NIGHT CLEANLINESS PAYS; SLACKNESS SLAYS ALWAYS WASH YOUR HANDS BEFORE PREPARING FOOD A loudspeaker van was also used to tour the area of the borough where the campaign was being held and this emitted messages on the subject from the Mayor, the chairman of the Health Committee and the medical officer of health. Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 1,016 of which 15 were formal samples and 1,001 informal. After examination, the public analyst reported that 2 of the formal samples and 5 of the informal samples were found to be adulterated or below standard. The percentage of adulteration amounted to 13.3 in the case of the formal samples and 0.5 in the informal samples, whilst it was 0.6 of all the samples submitted compared with 1.10 per cent. in the previous year. 36 The following table gives details of the samples analysed:— Table 20 Article Number examined Number adulterated, etc. F'mal Infml. Pte. Total F'mal Infml. Pte. Total SPIRITS Brandy 1 — — 1 — — — — Gin 1 1 — 2 — — Rum 1 1 — 2 — — — — Whisky 1 — — 1 — — — — TOTALS 4 2 — 6 — — — — Article Number examined Number adulterated, etc. F'mal Infml. Pte. Total F'mal Infml. Pte. Total DRUGS Alum — 5 — 5 — — — — Borax — 3 — 3 — — — — Borax of honey — 1 — 1 — — — — Cod liver oil — 1 — 1 — — — — Camphorated oil — 3 — 3 — — — — Chewing plugs — 1 — 1 — — — — Cough mixture — 2 — 2 — — — — Cream of tartar — 1 — 1 — — — — Embrocation — 1 — 1 — — — — Epsom salts — 5 — 5 — — — — Friars balsam — 1 — 1 — — — — Ginger, ground — 22 — 22 — — — — Glycerine — 1 — 1 — — — — Glycerine and thymol — 3 — 3 — — — — Iodine, solution 1 1 2 — — — — Lozenges — 3 — 3 — — — — Lysol — 1 — 1 — — — — Oil, castor — 3 — 3 — Oil, olive — 4 — 4 — — — — Ointment, boric 1 1 — — — — Ointment, mustard — 1 — 1 — — — Ointment, sulphur — 2 — 2 — — — — Ointment, zinc — 1 — 1 — — — — Paraffin, liquid — 4 4 — — — — Plaster, belladonna — 1 — 1 — — — — Powder, seidlitz — 3 — 3 — 1 — 1 Quinine, tincture — 1 — 1 — — — — Senna — 2 2 — — — — Soda bicarbonate — 3 3 — — — — Sodium sulphate — 7 7 — — — — Sulphur, flowers of — 1 1 — — — Syrup of figs — 3 — 3 — — — — Tablets — 10 — 10 — — — — Vaseline — 2 — 2 — — — — Wine, medicated — 1 — 1 — — — — TOTALS 1 105 — 106 — 1 — 1 37 Article Number examined Number adulterated, etc. F'mal Infml. Pte. Total F'mal Infml. Pte. Total OTHER ARTICLES Aerated beverage — 3 — 3 — — — — Allspice — 1 — 1 — — — — Arrowroot — 1 — 1 — — — — Baking powder 1 24 — 25 — 1 — 1 Barley — 4 — 4 — — — — Barley water — 1 — 1 — — — — Bread — 2 — 2 — — — — Butter — 49 — 49 — — — — Cake — 1 — 1 — — — — Capers — 1 — 1 — — — — Caraway seeds — 1 — 1 — — — — Cheese — 40 — 40 — — — — Chocolate, drinking — 2 — 2 — — — — Chutney — 1 — 1 — — — — Cinnamon — 8 — 8 — — — — Cloves — 4 — 4 — — — — Cocktails — 1 — 1 — — — — Cocoa — 15 — 15 — — — — Coffee — 11 — 11 — — — — Coffee and chicory — 9 — 9 — — — — Confectionery — 17 — 17 — — — — Cornflour — 4 — 4 — — — — Curry powder — 19 — 19 — — — — Custard powder — 2 — 2 — — — — Egg, dried — 2 — 2 — — — — Fish, canned — 11 — 11 — — — — Fish, paste — 45 — 45 — — — — Flavouring — 9 — 9 — — — — Flour — 33 — 33 — — — — Fruit, canned — 3 — 3 — — — — Fruit, dried — 2 — 2 — — — — Fruit, fresh — 2 — 2 — 1 — 1 Gelatine — 3 — 3 — — — — Ginger cordial — 1 — 1 — — — — Golden raising powder — 2 — 2 — — — — Gravy powder — 9 — 9 — — — — Honey — 1 — 1 — — — — Icecream — 11 — 11 — — — — Jam 2 — 2 — — — — Jelly — 7 — 7 — — — — Lard — 47 — 47 — — — — Lemon curd 1 — 1 — — — — Lemonade powder — 15 — 15 — — — — Lentils — 1 — 1 — — — — Macaroni — 1 — 1 — — — — Margarine — 47 — 47 — — — — Meat — 3 — 3 — — — — Meat, canned — 3 — 3 — — — — Meat extract — 1 — 1 — — — — Meat pie — 9 — 9 — — — — Meat, potted — 1 — 1 — — — Meat, paste — 28 — 28 — — — — Milk 6 27 — 33 — — — — Milk, condensed — 4 — 4 — — — — Milk preparations — 1 — 1 — — — — Mincemeat — 1 — 1 — — — — 38 Article Number examined Number adulterated, etc. F'mal Infml. Pte. Total F'mal Infml. Pte. Total OTHER ARTICLES, contd. Mustard — 26 — 26 — — — — Nutmeg — 11 — 11 — — — — Oatmeal — 2 — 2 — — — — Oil, olive — 3 — 3 — — — — Oil, teaseed — 1 — 1 — — — — Orange juice — 1 — 1 — — — — Peas — 5 — 5 — — — — Pea flour — 8 — 8 — — — — Pepper — 34 — 34 — — — — Pickles — 33 — 33 — — — — Sage — 1 — 1 — — — — Salad dressing — 2 — 2 — — — — Salt — 2 — 2 — — — — Sauces — 26 — 26 — — — — Sausages — 18 — 18 — 1 — 1 Saveloy — 1 — 1 — — — — Semolina — 4 — 4 — — — — Spaghetti — 1 — 1 — — — — Soup — 33 — 33 — — — — Soft drink powder — 2 — 2 — — — — Soya flour — 2 — 2 — — — — Spice 1 69 — 70 1 — — 1 Starch — 2 — 2 — — — — Stuffing — 2 — 2 — — — — Sugar — 8 — 8 — — — — Tea — 10 — 10 — — — — Tizer — 1 — 1 1 1 Tomato juice — 1 — 1 — — — — Vegetables, preserved — 5 — 5 — — — — Vinegar — 14 — 14 — — — — Water, aerated — 1 — 1 — — — — Wheat preparations — 3 — 3 — — — — Wines 2 — — 2 1 — — 1 Wines, non-alcoholic — 2 — 2 — — — — Yeast preparations — 5 — 5 — — — — Yoghourt — 1 — 1 — — — — TOTALS 15 1001 — 1016 2 5 — 7 39 Adulterated Samples Table 21 Article Formal or informal Adulteration or irregularity Action taken Baking powder Informal Available carbon dioxide deficient 50% Formal sample taken. Found to be genuine. Mixed herbs Formal Siliceous matter 14.5% Vendor cautioned and stock withdrawn from sale and destroyed. Liqueur ginger wine Formal Proof spirit deficient 2.5 degrees. Legal proceedings instituted. Case dismissed under Probation of Offenders Act on payment of £7s. 0d. costs. Seidlitz powder Informal Tartaric acid content of white paper 0.07 grammes. Remainder of stock withdrawn from sale. Fruit drink Informal Cresylic acids 1.1 parts per million. Source of acid could not be traced. Sausage meat Informal Sulphur dioxide 170 parts per million. It was established that preservative notices were duly exhibited. Apple informal Arsenic 3/100ths grain per pound. Apples as far as could be traced were washed. Subsequent samples proved that apples were free from arsenic in appreciable quantities. Unsound food A considerable amount of food was surrendered as unfit for human consumption. In all, approximately 25 tons 12 cwts. of foodstuffs was dealt with by the Council's food inspectors, consisting mainly of meat, 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 reconditioning or animal feeding. Meat inspection A report on meat inspection in the following form is included in the annual report to comply with the provisions of Ministry of Health circular 3/49. 40 Carcases inspected and condemned Table 22 Cattle excl. cows Cows Calves Sheep and lambs Pigs Number killed (if known) - - - - 4 Number inspected 12 - 4 6 4 All diseases except tuberculosis— Whole carcases condemned - - - - - Carcases of which some part or organ was condemned 11 - 4 6 - Percentage of number inspected affected with disease other than tuberculosis 92 - 100 100 - Tuberculosis only— Whole carcase condemned - - - - - Carcases of which some part or organ was condemned 1 - - - - Percentage of the number inspected affected with tuberculosis 8 - - - - SECTION "F"—PREVALENCE OF, and CONTROL OVER, INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASES The undermentioned diseases are notifiable by Medical Practitioners:- Anthrax Ophthalmia neonatorum Cerebro-spinal meningitis Plague Cholera Pneumonia (acute influenzal) Continued fever Pneumonia (acute primary) Diphtheria Polioencephalitis (acute) Dysentery (bacillary or amoebic) Poliomyelitis (acute) Encephalitis lethargica Puerperal pyrexia Enteric fever Relapsing fever Erysipelas Scabies Food poisoning Scarlet fever Glanders Smallpox Hydrophobia Tuberculosis (all forms) Malaria Typhoid fever (including paratyphoid) Measles Typhus fever Membranous croup Whooping cough. Principal notifiable diseases (other than Tuberculosis) Number of Notified Cases (corrected for revised diagnosis) during the year 1948 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. 41 Table 23 Diseases Number of coses notified 1948 1947 1946 1945 1944 1943 1942 Cerebro-spinal fever 5 19 11 3 4 8 25 Continued and relapsing fever — — — 1 — — — Diphtheria 5 9 8 24 24 26 53 Dysentery 24 26 57 31 65 23 34 Encephalitis lethargica (acute) — — 1 — — — — Enteric or typhoid fever 2 4 2 — — 1 2 Erysipelas 33 45 34 50 86 57 52 Hydrophobia — — 1 — — — — Malaria 2 4 15 — — — — Measles 2,642 810 1,307 462 688 1,270 858 Ophthalmia neonatorum 9 9 4 1 4 17 4 Pneumonia 67 104 108 71 110 176 103 Polioencephalitis (acute) — 11 — —. — — — Poliomyelitis (acute) 9 61 — 5 — — 5 Puerperal pyrexia or fever 50 43 32 25 20 21 30 Scabies* 54 122 348 566 654 515 * Scarlet fever 332 254 155 197 270 683 255 Smallpox — 1 — — 1 — — Whooping cough 789 362 291 238 275 219 254 TOTALS 4,023 1,884 2,374 1,674 2,201 3,016 1,675 *Notifiable as from 1 August 1943 Tuberculosis The number of new cases notified during the year 1948 and the number of deaths (together with comparative figures for the previous year) were as follows:— Table 24 New cases notified Deaths 1947 1948 1947 1948 Pulmonary 367 448 121 109 Non-pulmonary 59 54 13 10 Totals 426 502 134 119 42 The age distribution of the new cases of tuberculosis notified and the deaths from tuberculosis during the year are shewn in the following table:— Table 25 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 — — — 1 — — — — — — — 1- 10 10 2 3 12 13 1 — — — 1 _ 5- 9 8 6 5 15 13 — — — 1 — 1 10- 6 11 6 2 12 13 15- 23 37 2 4 25 41 32 33 3 5 35 38 20- 35 51 3 5 38 56 25- 56 58 3 7 59 65 35- 36 79 2 2 38 31 45- 26 9 — — 26 9 24 10 — 1 24 11 55- 17 6 1 — 18 6 65- 9 1 1 — 10 1 8 1 — — 8 1 Totals 228 220 26 28 254 248 65 44 3 7 68 51 Food poisoning outbreaks In compliance with Ministry of Health circular 3/49 the following table on food poisoning outbreaks is given:— Table 26 Total number of outbreaks Number of cases Number of deaths Organisms or other agents responsible with number of outbreaks of each Foods involved with number of outbreaks of each 6 13 1 Salmonella typhimurium isolated in 3 outbreaks 1 (1 case). ? fish. 1 (3 cases). ? imported hen eggs. (4 cases). 1 (5 cases). ? minced meat. definite organism was found. 1 (2 cases). ? duck eggs. 1 (case of child of 2 months) occurred in hospital. No further information obtained. 1 (1 case). Unknown. Town Hall, S.E.6. 10 June, 1949. E. H. R. SMITHARD, Medical Officer of Health. 43 APPENDIX A Acts of Parliament, Statutory Instruments and Circular Letters issued by Government Departments, with regard to the Public Health and Maternity and Child Welfare Services during the year 1948. Statutes National Assistance Act, 1948. Children Act, 1948. Factories Act, 1948. Local Government Act, 1948. Nurseries and Child Minders Regulation Act, 1948. Water Act, 1948. Ministry of Health Circulars No. 5 Veneral diseases—expiry of Defence Regulation 33B. 14 Building licensing—work done under statutory notices. 23 Food and Drugs Acts, 1938 and 1944, Ministers of the Crown (Transfer of Functions) Act, 1946. Transfer of Functions (Food and Drugs) Order, 1948. 30 Notification of Measles and Whooping-cough, S.I. 1948, No. 420. 36 National Health Service Act, 1946—publicity regarding services available to the public. 37 Diphtheria Immunisation. Annual returns, 1947. 60 Certificates of vaccination aud inoculation—authentication. 65 Local Government Act, 1948. 67 Icecream (Heat Treatment) Amendment Regulations, 1948. 74 Public Health (Aircraft) Regulations, 1948. 80 Apportionment of property used partly for hospital purposes. 81 Food and Drugs Act, 1938 and 1944. Transfer of functions (Food and Drugs) Order, 1948. Amendment regulations transferring certain functions to Ministry of Food. 93 Building materials components priority distribution scheme. The control of building materials (amendment) Order, 1948. 97 Diphtheria prophylaxis publicity campaigns. 115 National Insurance Act, 1946—contacts with cases of infectious disease. 133 Nurses and midwives' salaries. 151 Claims for grant on increases in salaries and improvements in conditions of service of public health nurses and state registered nurses in residential and day nurseries, etc. 167 (1) Control of Building. (2) Priority distribution of building materials and components. 174 Tuberculosis annual return of notifications Form T.137 (Revised) 1948. 175 Public Health (Tuberculosis) Regulations, 1940. LRL 11 Building licences for repair and maintenance. 44 Ministry of Food Circulars MF 1 Memo. 62B. Foods. Meat Inspection. MF 3 Unsound food. The Salvaged Goods Order, 1948 MF 4 Building Licences. Food and Drugs Act. MF 5 Infestation of cattle. MF 8 Food and Drugs Act, 1938, Milk (Control and Maximum Prices) (Great Britain) Order, 1947. MF 9 The Labelling of Food Order, 1946 (Amendment No. 4)—Soft drinks. NS 19 Rodent control—grant aid. FSL 36 Food Standards (Mustard) (No. 2) Order, 1944 (Amendment No. 2) Order, 1948. FSL 37 The Labelling of Food (General Licence) Order, 1947 (Amendment) Order, 1948. Home Office Circular No. 204 Children Act (Compensation of officers) Regulations, 1948 and Children Act (Transfer and superannuation of officers) Regulations, 1948. Statutory Instruments No. 107 Transfer of Functions (Food and Drugs) Order, 1948. 387 Public Health (Aircraft) Regulations, 1948. 567 National Health Service (Transfer of local authority functions) Regulations, 1948. 819 Icecream (Heat Treatment, etc.) Amendment Regulations, 1948. 840 Poisons List (Amendment) Order, 1948 and Poisons (Amendment) Rules, 1948. 886 Public Health (Imported Food) Amendment Regulations, 1948. 888 National Health Service (Apportionment and Transfer) Regulations, 1948. 1073 Food Standards (Mustard) (No. 2) Order, 1944 (Amendment No. 2) Order, 1948. 1117 The Milk (Special Designations) (Amendment) Regulations, 1948. 1118 The Public Health (Preservatives, etc., in Food) (Amendment) Regulations, 1948. 1119 The Public Health (Meat) (Amendment) Regulations, 1948. 1122 The Public Health (Condensed Milk) (Amendment) Regulations, 1948. 1123 The Public Health (Dried Milk) (Amendment) Regulations, 1948. 1218 National Assistance Act (Appointed Day) Order, 1948. 1310 Control of building operations (No. 11) Order, 1948. 1438 The Labelling of Food (General Licence) Order, 1947 (Amendment) Order, 1948. 1501 Children Act (Compensation of Officers) Regulations, 1948. 1502 Children Act (Transfer and superannuation of officers) Regula- tions, 1948. 2141 The Salvaged Goods Order, 1948. 2198 Food and Drugs Act, 1938 Milk (Control and Maximum Prices) (Great Britain) Order, 1947. 2598 Labelling of Food Order, 1946 (Amendment No. 4) Order —soft drinks. 45 APPENDIX B Legal Proceedings in 1948 The following is a list of legal proceedings instituted during the year. Public Health (London) Act, 1936 Date Nature of Offence Fine Costs Remarks 1948 £ s. d. 4 Feb. Non-compliance with nuisance notice in respect of 12, Brandram Road. — — — — Adjourned sine die. Building licence applied for. 4 Feb. Insufficient ashpit accommodation at 205, Kirkdale. 40/- 1 1 0 — 19 March Non-compliance with nuisance notice in respect of 279, Leahurst Road. — 1 1 0 Order made for abatement of nuisance within 56 days. 19 March Non-compliance with nuisance notice in respect of 110, Effingham Road. — — — — Adjourned sine die. Building licence issued. 28 April Non-compliance with nuisance notice in respect of 163, Burnt Ash Hill. — — — — Order made for abatement of nuisance within 56 days. 28 April Non-compliance with nuisance notice in respect of 108, Catford Hill. — — — — Adjourned sine die. Work in hand. 28 April Non-compliance with nuisance notice in respect of 12, Perry Hill. — — — — Adjourned sine die. Work in hand. 28 April Non-compliance with nuisance notice in respect of 89, Brookdale Road. — — — — Adjourned sine die. Work in hand. 28 May Insufficient ashpit accommodation at 82, Westwood Hill. — — — — Adjourned sine die. 16 June Non-compliance with nuisance notice in respect of 8, Noel Terrace. — 1 1 0 Order made to abate nuisance within 7 days. 15 Sept. Insufficient ashpit accommodation at 82, Westwood Hill. 40/- 2 2 0 — 10 Nov. (i) Insufficient ashpit accommodation at 82, Westwood Hill—failure to comply with Magistrate's Order. £5 2 2 0 — (ii) Non-compliance with nuisance notice in respect of 82, Westwood Hill. — 2 2 0 Order made to abate nuisance within 28 days. 24 Nov. Non-compliance with nuisance notice in respect of 8, Meadow Close. Adjourned sine die. 46 FOOD AND DRUGS ACT, 1938 ETC. Date of hearing Nature of Offence Fine Costs Remarks 1948 £ s. d. 2 Jan. Cockroach in loaf of bread. £15 2 2 0 — 2 Jan. Spider in bottle of milk. — — — — Dismissed. 19 March Liqueur ginger wine under strength. — 7 7 0 Dismissed under Probation of Offenders Act. 9 July Piece of tape in sausages. — 5 5 0 Dismissed under Probation of Offenders Act. 9 July Cockroach in loaf of bread. — 3 3 0 Dismissed under Probation of Offenders Act. 25 Aug. (i) Selling sugar at price beyond maximum. £5 — — — Proceedings brought by Lewisham Food Control Committee and Borough Council. (ii) Manufacturing popcorn without a licence. £1 — — — (iii) Preparing popcorn for sale in room which was in a dirty condition, contrary to section 13 of Food and Drugs Act. £1 — — — 3 Nov. Packet of barley flakes found — — — — Case dismissed. Defendant to contain rat excreta. awarded £7 7s. 0d. costs. TABLES TABLE NO. SUBJECT PAGE. 1 Comparative statistics 12 2 General summary of vital statistics in the last ten years 12 3 Causes of deaths, in age groups 13 4 Deaths under one year of age 14 5 Tuberculosis statistics for the last ten years 15 6 Dental treatment 18 7 Bacteriological work 19 8 Public mortuary 19 9 Attendances at day nurseries 20 10 Water supply samples—chemical 24 11 Water supply samples—bacteriological 24 12 Treatment of sewers for rats 26 13 Sanitary inspections 27 14 Special sanitary circumstances 28 15 Factories and workshops 29 16 Housing 32 17 Civil building licences 33 18 Analysis of milk 33 19 Bacteriological examinations of food 34 20 Food and Drugs Act—samples analysed 36 21 Food and Drugs Act—adulterated samples 39 22 Meat inspection 40 23 Principal notifiable diseases 41 24 Tuberculosis notifications and deaths 41 25 Age distribution of tuberculosis cases 42 26 Food poisoning outbreaks 42 CHART Infant mortality from 1901 to 1948 10 47 INDEX SUBJECT PAGE Acts, regulations and orders 43 Antenatal clinics 16 Area of borough 11 Artificial sunlight clinic 16 Bacteriological examinations 19 Birth rate 11 Births, notification of 15 Building licences 33 Child life protection 17 Clean food campaign 34 Convalescent treatment 17 Day nurseries 20 Deaths, causes of 13 Death rates 11 Dental treatment 18 Diphtheria immunisation 17 Disinfection 25 Factories and workshops 29 Flies and mosquitoes 26 Food, adulteration of 35 Food poisoning 42 Foot clinics 20 Health visiting 15 Home and domestic helps 17 Housing 30 Infant mortality 11 Infant mortality table 14 Infant welfare centres 15 Infectious diseases 40 Insulin, provision of 18 Laboratory facilities 19 Legal proceedings 45 SUBJECT PAGE Maternal deaths 12 Meat inspection 39 Milk, analysis of 33 Milk shops and dairies 34 Milk (special designations) regulations 34 Mortuary and Coroner's Court 19 Nursing in the home 15 Old people 21 Outworkers 30 Personal cleansing 25 Population 11 Postnatal clinics 16 Rateable value 11 Rodent control 25 Sanitary circumstances 27 Staff 3 Stillbirths 11 Tables, list of 46 Tuberculosis— summary of statistics 15 dispensary service 20 allowances 20 notification 23 Unsound food 39 Vaccination 19 Vital statistics 11 Water supply 22