LEW 37 METROPOLITAN BOROUGH OF LEWISHAM REPORT OF THE Medical Officer of Health for the Year 1949 E. H. R. Smithard, M.B.E., M.D., D.P.H. CONTENTS page Staff 2 Introduction 3 Vital Statistics 11 General Provision of Health Services 18 Sanitary Circumstances 30 Housing 34 Inspection and Supervision of Food 41 Infectious Diseases 53 Appendix A — Statutory Instruments 64 Appendix B — Legal Proceedings 66 Appendix C— Special Reports to Health Committee 70 List of Tables 71 Index 72 2 STAFF as at 31/12/49 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. Senior Sanitary Inspector C. E. Holifield (a) (6). District Inspectors Food Inspectors and Sampling Officer: J. W. Bevan (a) H. W. Ellery (a) (4) R. C. Brittain (a) (b) T. R. A. Fitzherbert (a) (b) C. L. Connor (a) A. G. Thomas (a) (b) J. R. Craven (a) (b) H. Tolson (a) (b) J. Edmunds (a) G. E. Fallows (a) (b) A. Gartside (a) (b) Housing Inspectors R. Mahoney (a) (b) R. S. Lane (a) W. S. Parsons (a) (b) F. E. Levermore (a) P. A. Traynier (a) Miss D. M. Parnell (a) K. R. Wagener (a) (b) A. J. Phillips (a) (b) E. Walker (a) (b) (a) Sanitary inspector's certificate. (b) Food inspector's certificate. Infectious Disease Visitors Miss M. E. K. Johnston Miss J. M. Price Principal Clerk E. W. Cheesman Clerical Staff S. Burridge senior clerk L. Gardiner Miss I. Coppin J. W. Marritt Miss I. L. Hatton Miss D. J. Miles C. R. Coleman Mrs. M. K. Wood L. J. Cleverly Coroner's Court and Mortuary W. Richardson officer-in-charge Disinfecting Station, etc. J. G. Beale superintendent Foreman rodent operative Foreman disinfector Rodent operatives 3 Disinfectors 9 Drain testers 2 Bathing attendants 2 Public Analyst A. J. Lickorish, f.i.C. Bacteriologist G. W. J. Bousfield, m.d., b.s. 3 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisham. Mr. Mayor, Ladies and Gentlemen, I submit herewith my report for the health department for the year 1949. The Registrar-General's estimate of the population in mid-year 1949 at 227,700 was only 1,600 more than the estimate for the previous year, compared with an increase of some 5,000 the year before. The prewar estimate in June, 1939 was 231,000. The birth rate for the year at 16.8 shows a further drop from the figure for 1947, when it was 21.9, and for 1948 when it was 18.9. It is still however in excess of what it was in the prewar years. The death rate went up slightly, from 9.9 to 10.2, but this is still a lower figure (apart from 1948) than for many years past. However, as pointed out in my previous report, the death rate is not a good index of health, as there are too many and too complex factors involved. The infant mortality rate, which in 1948 had fallen to 28, which was then a record low for the borough, dropped steeply in 1949 to 19. Compared with the earlier years of the century, when it was frequently over 100 and once reached 128, the figure now can only be regarded as remarkable. This figure of 19 compares with 29 for London as a whole and 32 for England and Wales. The death rate of illegitimate infants was 21, the difference between this and the legitimate rate being insignificant. One maternity death occurred during the year, giving a maternal mortality rate per thousand live and still births of 0.26, which again creates a low record for the borough. A table which compares births, maternal deaths, stillbirths, neonatal deaths and total deaths under one year of age (together with other statistics) is printed on pp. 16 and 17 (Table 8) and makes an interesting comparison of the figures in each of the 49 years from 1901. In connection with the work carried out during the year 1949 special mention may be made of the following:— Tuberculosis The number of new notifications dropped considerably — from 502 to 371, showing a decrease in the notification rate per thousand of population from 2.22 to 1.63. This was a welcome sign after the considerable increase in 1948 over previous years, and in fact this is the lowest rate since 1940, when it was 1.36. The reason for the drop is not apparent. The death rate from pulmonary tuberculosis once more decreased, this time from 0.48 to 0.40, and compared with previous figures this may be regarded as reasonably satisfactory. Tuberculosis remains the most important of the infectious diseases, and it appeared from correspondence in the newspapers and articles in the nonmedical press during the year to be much more in the public mind and on the 4 public conscience. This is all to the good because there is little doubt that more can be done by early treatment and above all by protection of the young child and the susceptible adult to cut down both the rate of incidence and rate of mortality much more. During the year the Government did agree to the use of a special BCG vaccine where it could be used under satisfactory supervision, and this no doubt is the first step to a considerably increased use of this form of prevention. More details with regard to tuberculosis will be found on p. 57 of the report. Food hygiene The food poisoning outbreaks which came to the notice of the department showed a considerable increase in the number of cases involved. Altogether 50 cases of food poisoning were formally notified, and in addition a number of minor cases came to our notice as a result of other enquiries. Most of these cases occurred in one group, as a result of eating shellfish, and in this connection shellfish landed in the Thames estuary were incriminated. Cases occurred, both in people who journeyed down to Thames estuary resorts and ate the shellfish there, and in people who bought shellfish in the borough itself. All shellfish are treated before being put on sale and it is likely that the wholly abnormal conditions of the late summer and early autumn were the cause. The warm weather, combined with the decreased flow of the Thames, and possibly other factors joined together in increasing the number of germs to an extent with which the normal process of cleaning could not deal sufficiently. The matter cleared up soon after the increased rain came in the autumn, and fortunately almost all the cases were mild. It was thought advisable to issue a warning to the public when the outbreak was at its height and the aid of the press was sought. Two local papers were good enough to publish the warning. Throughout the year the food inspectors gave advice to occupiers of food shops with regard to general hygiene, and particularly in relation to avoidance of flies and other pests. The summer was a hot one and therefore conducive to heavy fly infestation, but in point of fact very few complaints were received of infestations of shops, and observations made by the inspectors confirmed the absence of any serious nuisance. Advice was given by the health department also in the form of printed pamphlets, and it is likely that this continuous semipersonal advice from the health department or from the food inspectors themselves is of as great benefit or of even greater benefit than a special campaign, food guilds and the rest. Clean food guilds have proved their value in certain towns, but the towns where they have been most successful have been relatively small provincial towns, which by their nature are almost selfcontained. This is a very different matter to a town which is a suburb of London and which has no natural boundaries dividing it from other suburbs, and where a considerable proportion of the population move out of the town to work. Nevertheless two or three London boroughs have, in fact, started a clean food guild and the results and effects are being watched with interest as it may be that this borough also, at a later date, might think a guild on similar lines might be helpful. 5 Infectious diseases Tuberculosis, at present the most important of the infectious diseases, has been dealt with separately above. With regard to the more acute infections the number of cases of measles dropped (from 2,600 to 1,900), but not to so great an extent as to indicate a return to the prewar biennial periodicity of this disease. There were slightly more cases of pneumonia (84 against 67 in the previous year), but 84 is in itself a relatively small number and can probably be accounted for by the second mild winter in succession. Poliomyelitis (infantile paralysis) cases increased from 9 to 35. This number was just about half that of the peak year 1947, but was of course considerably more than the average in the early war years and the prewar years. It appears that poliomyelitis is becoming more endemic and it is also attacking a rather higher age group. This has often been found to occur in communities which are fairly well developed hygienically; the reason given being that the hygienic development postpones the likelihood of infection in infancy, which otherwise would be the most susceptible time. This in itself is evidence in favour of poliomyelitis being a disease spread in an alimentary way (food, flies, dirty fingers and so on), but it remains almost as true as it did two years ago that very little is known as to the exact method of spread of this infection. Some interesting figures comparing 1949 and 1947 (both were hot summers) are given in table 37 on p. 56, and the charts on p. 55. It must be remembered, however, that for every case of poliomyelitis which is notified there may be 10 to 20 or more other cases which are not recognised. These are the socalled abortive or nonparalytic cases and they may be thought to be merely a sore throat, mild influenza, etc. Particular advice is always given to contacts to be on the lookout for such symptoms and to take precautions with regard to avoiding excessive exercise and keeping themselves away from other people, as it cannot be said in advance whether any particular spread of infection from a case of poliomyelitis will be of the paralytic or of the abortive type. Scabies, a disease primarily of defective hygiene in its widest sense, again dropped very considerably (from 54 in 1948 to 29 last year) and this compares with the peak figure of 654 in 1944. Scarlet fever was up considerably for the fourth year running and there were 520 cases compared with 332 in the previous year. This was the highest number since 1943. The disease was however of a very mild type compared with that of years ago, but this mildness in itself tends to result in an increased number of cases. The reasons are that cases may be missed, or the child appears to recover so rapidly that it is not isolated for a sufficiently long period, or it may not even be isolated at all but continue to go about by public transport. Whooping cough showed a welcome reduction in the number of cases, from 789 to 363, but even this number was in excess of those of several previous years. The number of dysentery cases dropped from 29 to 9, but dysentery nowadays is usually of a mild type (the socalled Sonne dysentery) and it is likely that many other cases occur which are not diagnosed and therefore not notified. Old people I have dealt with this increasingly important matter in some detail 6 on p. 27 of this report. In summary it can be said that the Lewisham Old People's Welfare Association, and other organisations in the borough for the care of old people, increased their work and their effort, and in addition machinery was laid down on the administrative side, particularly as far as LOPWA is concerned, on which a detailed superstructure for the care of old people can easily be built, provided money and voluntary effort are available. Maternity and child welfare In the introduction of my last report I commented in some detail on the end of local maternity and child welfare as far as the borough council was concerned. I drew attention to the spectacular improvements made in various death rates and sickness rates and said that although the borough council had ceased its direct responsibility for maternity and child welfare the influence of the services which they had themselves set up and administered would probably be felt for some time. It should therefore be of considerable interest to members of the council to know of the still further improvements in death rates in 1949. Some of these have been specifically mentioned at the beginning of this introduction and others will be seen in the section dealing with vital statistics. I would however particularly draw attention to table 8 on pp. 16 and 17. Last year when I reported a then record low infant mortality rate of 28 (for 1948) I said from an analysis of the causes of death that it might be possible to halve that rate, i.e. bring it down to about 14 per thousand, but that it was doubtful if in the present state of medical knowledge it could be brought down further. It will now be seen that the rate has in fact been brought down a considerable way to the 14 per thousand (19 per thousand is more than half way), but on analysis of table 5 on p. 14, which shows the causes of the 73 infant deaths, it would appear that theoretically there could be a further reduction in the rate. The stillbirth rate last year was 16.2, which represents a slight increase from the very low figure of 14.8 the previous year. This indicates a field in which further improvement can be made in preventing reproductive wastage. The reproductive wastage rate, which I thought might have 24 as its near-future objective, is in fact 35 (as against 43 last year). The most spectacular decrease in infant deaths has however been in the age period one month to 12 months. National statistics indicate that there is a considerable difference in infant death rates according to social class. The Registrar-General divides adults into five different social classes which in very general terms can be described as follows:— I The professions, service officers and welltodo people concerned in finance, shipping, etc. II Intermediate, between class I and the skilled workers. III The skilled workers IV Intermediate, between skilled and unskilled workers V The unskilled workers (A baby or child of course is put into the class in which its parent is.) 7 It has been found that in England and Wales both the stillbirths and the infant deaths differ greatly according to social class, as can be seen in the following table:— Table 1* Social class I II III IV V Stillbirths per 1,000 maternities 24.4 33.4 35.6 37.6 39.7 Infant mortality (legit.) per 1,000 live births 26.8 34.4 44.4 51.4 60.1 Neonatal mortality rate 18.9 23.4 25.4 27.7 30.1 Death rate from 1 month to 1 year 7.9 11.0 19.0 23.7 30.0 *These figures are for 1939 and are extracted from volume IV of the papers of the Royal Commission on Population (Reports of the Biological and Medical Committee), 1950 HMSO When infant deaths are analysed it is found that the causes of death do not always correspond in the same way to social class; thus for the same year, injury at birth which was 2.6 in social class I, was 2.9 in social class II and 2.7 in social class V, whereas premature birth, which was 8.7 in social class I gradually increased to 16.4 in social class V. For certain infections the difference was even more remarkable; for example, for diarrhoea and enteritis the figure for social class I was 1.1 and increased uniformly to 5.7 (more than 5 times as much) for social class V, and that for bronchitis and pneumonia increased from 1.8 in social class I to 13.2 (over 7 times as much) in social class V. We are using the Registrar-General's social class distinctions for certain statistics available to this department and an indication of this will be found in tables 6 and 7 on p. 15. They will be used in connection with various other deaths in future years. Divisional statistics It has been recommended from time to time that certain statistics should be shown in fairly small areas, so that the various areas can be compared. Wards are sometimes taken as the unit, but usually the ward population is so small as to make statistics based on that population highly variable and therefore of relatively little value. On the other hand, dealing with a very large area as one unit does not give a sufficiently accurate analysis of statistical causes and trends within that area. Such an area is a borough like this with a population approaching a quarter of a million. To counteract this, and in anticipation of the proposed new electoral divisions, statistics wherever possible were from January 1, 1949 kept in parliamentary divisional areas, and it will be noticed on looking through this report that many of the tables are thus divided. 10 The parliamentary divisions of Lewisham, namely West, North and South, are of roughly equal population, although considerably different in other ways; for example, the South division consists in large part of two very big LCC estates, and contains many less shops and very much less old property than do either of the other two divisions. A sketch map is shown (pp. 8 & 9) to indicate the principal boundaries of the divisions. When it is realised that the average population of each of the divisions is some 76,000 persons it will be apparent that in fact this report of the health department can be regarded as equivalent to the reports of three different health areas of reasonable size. Furthermore, comparing with the 80-odd all-purpose authorities in England and Wales, i.e., the county boroughs, each one of the three Lewisham divisions contains a greater population than some 20 of these county boroughs; but such is the peculiarity of local government law in this country that an area like this, with the equivalent of three times the population of many all-purpose county boroughs, does not itself have many of the powers possessed by these latter authorities. 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:— To May 16, 1949— Councillor F. W. M. Pettitt, j.p. (Chairman); Alderman 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. From May 25, 1949— Councillor Mrs. G. M. M. Land (Chairman); The Mayor (Councillor G. R. D. Bradfield, j.p., l.c.c.); Aldermen A. D. Bartlett, j.p., Mrs. Goldthorpe and C. Street; Councillors C. P. Braithwaite, T. C. Brooks, Mrs. Bunce, A. O. Carter, L. G. Coulson, R. L. Evans, Miss Halsey, E. F. Hasling, F. E. G. Hawes, F. W. O'Reilly, Mrs. Smith, P. E. Stoffel, Miss Trickey, C. F. Turtle, J. H. Tutt and A. W. Walker. 11 SECTION "A" — VITAL STATISTICS Area The area of the borough is 7,015 acres. Public open space comprises 652 acres. Population Census 1931 219,953 The Registrar-General's estimate of the resident civilian population at midyear 1949 was 227,700. Rateable value County of London rateable value of the borough at April 6, 1949 £1,762,936 Estimated net product of a penny rate, 1949/50 £7,150 Number of separately assessed dwellings at April 1, 1949 60,889 Births (adjusted for inward and outward transfers) No. of live births 3,823 Males Females Total Legitimate 1,859 1,731 3,590 Illegitimate 122 111 233 Totals 1,981 1,842 3,823 Birth rate per 1,000 of the estimated population 16.8 Birth rate for England and Wales 16.7 Birth rate for London administrative county 18.5 Stillbirths The total number of stillbirths allocated to the borough during the year was 63. This represents a stillbirth rate per thousand live and stillbirths of 16.2. Deaths The total number of deaths belonging to the borough registered during the year was 2,326, consisting of 1,191 males and 1,135 females, giving a death rate per thousand of the estimated population of 10.2 as compared with a rate of 11.7 for England and Wales and 12.2 for the administrative county of London. Infant mortality Number of infant deaths 73 Legitimate 68 Illegitimate 5 Rates: 1. AH infants per thousand live births19.1 2. Legitimate infants per thousand live legitimate births 18.9 3. Illegitimate infants per thousand live illegitimate births 21.4 Neonatal deaths (under one month of age) 48 Neonatal death rate (per 1,000 live births) 12.5 Reproductive wastage— Stillbirths plus infant deaths (see p. 6) 136 Rate, per thousand live and stillbirths 35 12 Maternal deaths Number of maternal deaths 1 (a) puerperal sepsis - (b) other maternal causes 1 Maternal mortality rate per thousand live and stillbirths 0.26 Other special causes of death Number of deaths from Measles 1 „ „ „ Whooping Cough 1 „ „ „ Poliomyelitis 3 ,, „ „ Diarrhoea (under 2 years) 4 „ „ „ Suicide 15 „ „ „ Road Traffic Accidents 15 „ „ „ Tuberculosis (all forms) 107 „ „ „ Cancer 409 „ „ ,, Heart Diseases 803 Comparative statistics for the year 1949 Table 2 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 16.8 0.32 10.2 19.1 England and Wales *16.7 *0.39 *11.7 32.0 London Administrative County 18.5 0.37 12.2 29.0 *Rates per thousand total population. General summary of Vital Statistics for the last ten years Table 3 Year Estimated population Births Deaths Deaths under one year Deaths from pulmonary tuberculosis Number Rate Number Rate Number Rate Number Rate 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 1949 227,700 3823 16.8 2326 10.2 73 19 92 0.40 * based, by Registrar-General, on 1558 births registered locally. 13 Causes of death at different periods of life during the year 1949 The following table shows the causes of and ages at death during the calendar year 1949:— Table 4 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 2326 73 17 10 149 563 1514 1 Typhoid and paratyphoid fevers - - - - - - - 2 Cerebro-spinal fever - - - - - - - 3 Scarlet fever - - - - - - - 4 Whooping cough 1 1 - - - - - 5 Diphtheria - - - - - - - 6 Tuberculosis of respiratory system 92 - - - 39 45 8 7 Other forms of tuberculosis 15 1 4 2 5 1 2 8 Syphilitic diseases 15 - — — — 4 11 9 Influenza 16 1 — — 2 5 8 10 Measles 1 - 1 — — — — 11 Acute poliomyelitis and polioencephalitis 3 - - - 3 - - 12 Acute infectious encephalitis 3 - - - 2 1 - 13 Cancer, buccal cavity and oesophagus (M), uterus (F) 25 - - 1 3 11 10 14 Cancer, stomach and duodenum 66 - - - 3 25 38 15 Cancer, breast 45 - — — 7 17 21 16 Cancer of all other sites 273 1 — — 7 104 161 17 Diabetes 17 - — — — 4 13 18 Intra-cranial vascular lesions 194 1 — — — 43 150 19 Heart diseases 803 - 1 — 20 143 639 20 Other circulatory diseases 81 - 1 — 3 14 63 21 Bronchitis 156 2 — — 1 37 116 22 Pneumonia 79 4 4 — 3 12 56 23 Other respiratory diseases 38 — — — 5 14 19 24 Ulcer, stomach or duodenum 40 - - - 2 13 25 25 Diarrhoea (under 2 years) 4 4 — — — — — 26 Appendicitis 6 — — 1 — 2 3 27 Other digestive diseases 37 1 1 — 5 4 26 28 Nephritis 37 — — — 6 11 20 29 Puerperal and post-abortive sepsis - - - - - - - 30 Other maternal causes 1 — — — 1 — — 31 Premature births 11 11 - - - - - 32 Congenital malformations, birth injury, infantile diseases 45 42 1 1 1 - - 33 Suicide 15 — — — 2 9 4 34 Road traffic accidents 15 — 1 1 6 3 4 35 Other violent causes 42 2 — 3 4 5 28 36 All other causes 150 2 3 1 19 36 89 * Deaths under 1 year are further analysed in the next table. 14 Deaths under 1 year of age Table 5 Cause of death Sex Under 1 day 1-6 days 1 week 2 weeks 3 weeks Total under 4 wks. 1-2 mths. 3-5 mths. 6-8 mths. 9-11 mths. Total under l yr. Whooping cough M - - - - - - - - - 1 1 F - - - - - - - - - - - Tetanus M - - - - - - - - - - - F - - - - - - - 1 - - 1 Tuberculosis M - - - - - - - - - - - F - - - - - - - - - 1 1 Influenza M - - - - - - - - - - - F - - - - - - - - 1 - 1 Bronchitis M - - - - - - - - 1 - 1 F - - - - - - - 1 - - 1 Pneumonia M - - 1 - - 1 1 1 - - 3 F - - - - - - - - - 1 1 Diarrhœa M - - - - - - 1 - 1 1 3 F - - - - - - 1 - - - 1 Intestinal obstruction M - - - - - - - - - - - F - - - - - - - - - 1 1 Congenital malformations M - 1 2 1 - 4 2 1 - 1 8 F 1 3 2 - - 6 1 1 - - 8 Congenital debility M - 1 - - - 1 - - - - 1 F 1 - - - - 1 - - - - 1 Premature birth M 4 1 1 - - 6 - - - - 6 F - 7 - - - 7 - - - - 7 injury at birth M 1 2 - - - 3 - - - - 3 F 1 - - - - 1 - - - - 1 Other diseases peculiar to first year of life M 8 3 - - - 11 - - - - 11 F 3 2 2 - - 7 - - - - 7 All other causes M - - - - - - 1 1 1 - 3 F - - - - - - 1 1 - - 2 TOTALS M 13 8 4 1 - 26 5 3 3 3 40 F 6 12 4 - — 22 3 4 1 3 33 GRAND TOTAL 19 20 8 1 - 48 8 7 4 6 73 Social class mortality With regard to the effect of social class on the death rate (see p. 6), it is clearly not possible to compare social classes (as evidenced by mortality figures) with each other unless it is known what are the social IS class proportions in the population as a whole. This will not be accurately known until after the census due in 1951. It is however possible to compare mortality in social classes for different diseases. For an example two separate groups of diseases have been extracted, namely 1, the intracranial vascular diseases and 2, bronchitis and pneumonia. The social class mortalities in 1949 are shown in the subjoined table, percentages (for easier comparison) being added in italics:— Table 6 Social class I II III IV V Total 1. Intracranial vascular diseases M 8 14 37 13 12 84 F 8 24 51 16 11 110 Total 16 38 88 29 23 194 % 8 20 45 15 12 100 2. Bronchitis and pneumonia M 1 25 63 20 26 135 F 4 14 46 20 16 100 Total 5 39 109 40 42 235 % 2 17 46 17 18 100 From the table it will be seen that whereas the percentage deaths in social class III were approximately the same for both groups 1 and 2, there was a tendency for group 1 cases (intracranial vascular diseases) to be relatively more frequent in social classes I and II, and for group 2 cases (bronchitis, pneumonia) to be relatively more frequent in social classes IV and V. The figures are not suffciently large to do anything except to note this tendency, and to see if it is repeated in subsequent years. An analysis of certain of the infant mortality figures in social classes is given in the subjoined table:— Table 7 Social class I II III IV V Total Influenza, bronchitis, pneumonia - 1 4 1 1 7 Diarrhœa - - 2 1 1 4 Congenital malformations - 1 11 2 2 16 Prematurity, and congenital debility - 2 12 1 - 15 All infant deaths — 10 47 8 8 73 Here also the figures are for record purposes as they are not of sufficient size to be significant. 16 General Statistics from 1901 Table 8 Year Births Maternal death rate† Stillbirth rate† Neonatal death rate§ One month to one year death rote§ (8) - (6) Infant mortality rate§ Reproductive wastage rate (5) + (8) Pulmonary tuberculosis Notif. rate* Death rate* Under 15 death rate* No. Rate* (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) 1901 3320 25.9 3.9 - - - 128 - - 0.93 0.062 1902 3491 26.3 4.3 - - - 122 - - 1.06 0.063 1903 3563 26.1 2.5 - - - 92 - - 0.78 0.037 1904 3589 25.6 3.6 - - - 122 - - 0.84 0.028 1905 3633 25.2 2.8 - 30 63 93 - - 0.87 0.048 1906 3446 23.2 2.0 - 30 83 113 - - 0.80 0.013 1907 3622 23.7 2.5 - 34 56 90 - - 0.90 0.053 1908 3632 22.8 1.4 - 30 57 87 - - 0.85 0.025 1909 3507 21.9 2.0 - 35 40 75 - - 0.78 0.042 1910 3412 20.7 2.6 — 29 50 79 — — 0.55 0.030 1911 3421 21.2 2.3 - 31 73 104 - - 0.64 0.012 1912 3512 20.3 2.8 - 30 39 69 - 2.1 0.68 0.018 1913 3502 20.3 2.6 - 28 48 76 - 1.8 0.73 0.064 1914 3306 19.5 3.3 - 27 46 73 - 1.4 0.77 0.037 1915 3267 19.3 4.0 - 30 49 79 - 1.5 0.90 0.075 1916 3265 18.4 — - - - 75 - - - - 1917 2686 14.9 - - - - 87 - - - - 1918 2362 13.8 — - - - 66 - - - - 1919 2910 16.6 3.1 - 28 32 60 - 1.8 0.86 0.037 1920 3984 22.8 3.8 - 32 30 62 — 1.6 0.73 0.017 1921 3433 19.5 2.6 - 23 31 54 - 1.3 0.81 0.022 1922 3208 18.1 2.5 - 26 28 54 - 1.5 0.74 0.017 1923 3297 18.0 3.6 - 20 23 43 - 1.5 0.76 0.021 1924 3066 16.4 3.6 - 23 24 47 - 1.5 0.68 0.042 1925 2907 15.6 1.6 - 23 32 55 - 1.3 0.63 0.016 1926 2885 15.4 2.1 - 18 22 40 - 1.6 0.71 0.011 1927 2848 15.1 2.1 - 25 21 46 - 1.6 0.92 0.021 1928 3036 15.2 2.3 - 22 30 52 - 1.7 0.77 0.010 1929 3261 15.7 5.3 - - - 44 - 1.4 0.74 0.020 1930 3147 15.1 0.9 37 — — 42 79 1.5 0.76 0.027 17 Table 8 Year Births Maternal death rate† Stillbirth rate† Neonatal death rate§ One month to one year death rote§ (8) - (6) Infant mortality rate§ Reproductive wastage rate (5) + (8) Pulmonary tuberculosis Notif. rate* Death rate* Under 15 death rate* No. Rate* (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) 1931 3115 14.1 4.9 31 25 24 49 80 1.3 0.69 0.010 1932 2817 12.7 3.4 32 31 23 54 86 1.2 0.59 0.004 1933 2702 12.2 2.6 31 21 18 39 70 1.2 0.68 0.010 1934 2715 12.2 1.5 36 21 22 43 79 1.3 0.58 0.022 1935 2792 12.5 4.3 35 24 19 43 78 1.2 0.58 0.026 1936 2932 13.0 2.0 37 23 32 55 92 1.3 0.62 0.009 1937 3019 13.4 1.3 39 18 29 47 86 1.5 0.59 Nil 1938 3188 13.9 2.1 26 - - 47 73 1.1 0.61 0.004 1939 3135 13.6 2.9 34 - - 42 76 1.1 0.64 Nil 1940 2833 14.7 1.0 24 — — 45 69 1.1 0.67 0.005 1941 2068 13.9 1.9 29 - - 34 63 1.8 0.93 0.007 1942 2732 16.8 3.2 37 - - 37 74 1.8 0.73 Nil 1943 3151 18.7 3.1 25 - - 42 67 1.9 0.76 0.012 1944 3046 18.6 1.0 22 - - 40 62 1.9 0.79 0.012 1945 3030 17.7 1.9 18 - - 34 52 1.8 0.71 0.005 1946 4491 21.7 1.1 21 - - 33 54 1.9 0.53 0.010 1947 4841 21.9 1.0 21 — — 33 54 1.6 0.55 0.010 1948 4274 18.9 0.5 15 15 13 28 43 2.0 0.48 0.004 1949 3823 16.8 0.3 16 13 6 19 35 1.5 0.40 Nil *per 1,000 population, †per 1,000 live and stillbirths. §per 1,000 livebirths. — equals figure not available. 18 SECTION "B" — GENERAL PROVISION OF HEALTH SERVICES 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:— Table 9 Disinfecting station West North South Total Disinfections Premises visited 331 264 241 836 Rooms disinfected 770 583 498 1851 Articles disinfected 3563 3713 2307 9583 Disinfestation Premises visited 140 88 26 254 Rooms disinfested 394 271 92 757 Articles disinfested 458 172 99 729 Articles treated Beds 127 104 96 327 Mattresses 349 371 201 921 Bolsters 95 93 69 257 Pillows 617 676 390 1683 Cushions 108 54 44 206 Quilts 207 152 134 493 Blankets 779 697 468 1994 Sheets 250 312 181 743 Other household articles 715 823 450 1988 Wearing apparel 774 603 373 1750 Total articles 4021 3885 2406 10312 Articles received from cleansing station 3062 3059 3067 9188 Articles received from Coroner's court - 355 - 355 Public library books treated after infection 319 519 352 1190 Private library books treated after infection 56 53 117 226 Cleansing station Children treated for verminous condition 523 508 476 1507 Adults treated for verminous condition 30 19 21 70 Scabies baths, children 22 57 41 120 Scabies baths, adults 31 65 56 152 Treatment by disinfection Rooms and furniture are sprayed with a solution of izal. Bedding is steam treated with a pressure from 10-20lbs. per square inch. Articles are either steam treated with a pressure from 5-101bs. per square inch, or placed in the formalin chamber, according to their nature. 19 Treatment by disinfestation Rooms and furniture are sprayed with a proprietary solution containing 5 per cent. DDT. Bedding is steam treated with a pressure of 20 1bs. per sq. in. Articles are steam treated with a pressure of l0 lbs. per sq. in. Antifiy and antimosquito campaign The campaign, which lasted from May 2 to September 30, was organised on almost exactly similar lines to the one held in 1948. Four men were employed working as two pairs, using motor cycles with sidecars as transport. The number of sites dealt with was slightly less than in the previous year because some of the original sites had been built on or otherwise dealt with. 589 sites were visited as a routine and during the season each site was treated on approximately 11 occasions. In addition there were 7 special areas which were visited once a week, consisting of stables, allotments, etc. Altogether 6,633 visits and treatments were made and in addition miscellaneous sprayings were carried out by the permanent disinfecting staff in houses where special complaints were received. This was particularly in the neighbourhood of the Hither Green sidings and in this connection, too, certain of the residents who requested it were supplied with an insecticide containing 5 percent DDT for use in their own sprays, a total of 10 gallons of insecticide being dispensed in this way. In addition to the above, special measures were taken to deal with especially offensive deposits, including such things as old mattresses or dead animals. These were either destroyed on the site, or, in most cases, collected and destroyed centrally. The public seems unaware of the fact that this Department will collect and destroy discarded mattresses from houses; many people apparently pay a general dealer to take these away, and he in turn often dumps them on the nearest piece of waste ground. No actual record was kept of the number of such cases dealt with, but it is estimated to be in the neighbourhood of 100 — many more than in the previous year. The summer was very hot, one of the hottest on record, and one with the greatest amount of sunshine. Conditions therefore were almost ideal for fly infestation and multiplication. It is not surprising therefore that more complaints were received than in the previous year, but this I think was general over the country as a whole. The complaints in this borough on analysis appeared to be particularly centred round Hither Green sidings, and towards the end of the summer I was in correspondence with the British Railways Executive with regard to this. Two departments are apparently involved, one being the estates department which deals with the user of allotments and other land on either side of the railway, and the other, the department covering the track itself. It appeared from an inspection that both departments might be concerned. Representatives of the estates department came down and made a thorough inspection with us as a result of which they have taken certain action which it is hoped will get rid of most of the animals kept near the railway and near the houses from which complaints 20 have come. In spite of a follow-up letter to the department covering the track itself, no satisfactory answer has been received and the matter is still being pursued. It is quite clear that there is some centre of potential fly infestation in the neighbourhood which should be either got rid of or treated before the next summer season begins. The Borough Engineer's department cooperated with us throughout the campaign by the treatment of dustbins with a powder we supplied containing gammexane, this being applied at the time of refuse collection. Altogether 3f tons of gammexane oowder was used. Laboratory facilities As from April 1 the Council arranged with the Public Health Laboratory Service, which is directed by the Medical Research Council, for examinations concerning bacteriology and epidemiology in relation to the diagnosis, prevention and control of infectious disease, to be carried out by that service at Dr. Bousfield's laboratory, 134, Denmark Hill, S.E.5. This service was in substitution for the previous arrangement by which such examinations were carried out at St. John's Hospital, Lewisham. Apart from examinations of nose and throat swabs, sputum, faeces, urine, blood, cerebrospinal fluid, exudates, swabs from situations other than the nose and throat, washings of infected cavities, hair and scales for ringworm, biopsy material for trichina larvae, and so on, the service provides for the examination of water, shell fish, sewage, milk, icecream, retail food and certain other materials. Specimens from general practitioners were in the main sent to the Town Hall and taken by messenger daily to the laboratory. Samples of milk may be submitted by the Department for examination for pathogenic bacteria in relation to suspected cases or outbreaks of milkborne disease; for tubercle bacilli in certain cases, and for grading under the Milk (Special Designations) Regulations. Samples of icecream are submitted for evidence of bacterial contamination and for grading, whilst samples of foods offered for sale are submitted for suitability for human consumption, for pathoganic organisms and for evidence of bacterial toxins in relation to outbreaks of cases of suspected food poisoning. The following summary relates to the work carried out by the laboratory on behalf of the Council during 1949:— Swabs 325 Sputum 43 Icecream 67 Water 3 Faeces 125 Food samples 6 Milk 43 Blood 3 Since January 1, as a result of rearrangement within the Public Health Laboratory Service, the laboratory now used is the Southern Group Laboratory at the Park Hospital. 21 National Assistance Act, 1948 — section 47 Under section 47 of the above Act persons suffering from grave chronic disease, or who are aged, infirm or physically incapacitated, and who are living in insanitary conditions and unable to devote to themselves and not receiving from other persons proper care and attention, may be removed compulsorily. For this the medical officer of health must be satisfied, after thorough inquiry and consideration, that in the interests of any such person or for preventing injury to the health of, or serious nuisance to, other persons it is necessary to remove that person. The local authority may then apply to a court of summary jurisdiction for an order for the removal of the person to a suitable hospital or other place in, or within convenient distance of, the area of the local authority and for his detention and maintenance therein. Several possible cases were investigated during the year but only one was taken as far as the police court. The matter had to be adjourned, and as conditions then improved somewhat, further action was withheld. National Assistance Act, 1948 — section 50 Under section 50 of the above Act, it is the duty of the local authority to arrange for the burial or cremation of the body of any person who has died or been found dead in their area if it appears that no suitable arrangements for the disposal of the body have or are being made. The local authority can recover expenses incurred from the estate of the deceased person or from any person liable to maintain the deceased person immediately before his death. The recovery of expenses is subject to any payment received by the authority from the Ministry of National Insurance under the National Insurance Act, 1946. During the year the Council thus accepted responsibility for the burial of 23 persons, at a net cost at December 31 of £84 5s. 6½d. 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 523, of which 228 were received from hospitals. 523 postmortem examinations were made and inquests held in 139 cases. Details are shewn in the following table:— Table 10 Month Bodies received from hospitals Others Post mortem examinations Inquests January 16 21 37 7 February 21 41 62 14 March 37 41 78 25 April 14 24 38 10 May 13 23 36 12 June 17 13 30 6 July 15 17 32 7 August 16 23 39 10 September 14 16 30 12 October 15 15 30 6 November 26 29 55 20 December 24 32 56 10 TOTALS 228 295 523 139 22 Rodent control A small section, consisting of a foreman and three operatives, is maintained for the purpose of repressing rat infestation 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:— Table 11 Parliamentary Division Total West North South Number of complaints received 1024 1680 1177 3881 Number of premises baited:— initial treatments 421 493 438 1352 retreatments 1003 1112 740 2855 Investigations:— no infestation found 603 1187 739 2529 total number of visits 5567 7460 4985 18012 estimated kill 2200 3037 1715 6952 In addition, special liaison is made twice yearly with the Borough Engineer's department for the baiting of sewers. A table is appended giving the results of these treatments in the year 1949:— Table 12 Dates of treatment 8 June to 2 July 1-21 December Scheme of baiting 3 consecutive days 3 consecutive days Bait base and poison Sausage rusk and 2½ per cent. zinc phosphide (4:4:8 oz.) Sausage rusk and 2½ per cent. zinc phosphide (4:4:8 oz.) No. of manholes baited 2846 2835 No. of manholes shewing preliminary prebait take 1663 1610 No. of manholes shewing complete prebait take 825 1023 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. The supply of water to Lewisham during 1949 was satisfactory as regards quantity. No standpipe supplies were provided and houses throughout the borough received their supplies direct from the public water mains. The borough is supplied in three zones: the low zone is supplied from Deptford well and by Thames-derived filtered water; 23 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 Thamesderived filtered water. All the Thames-derived filtered water is chlorinated after filtration. In the case of Hampton, a contact tank has been built where the chlorine has time to exert its full effect before the water is pumped into supply; consequently the water in the distribution system is free or almost free from residual chlorine. All the well water is chlorinated and, in addition, contact tanks are provided at Deptford, Wilmington and Bexley Wells; any residual chlorine is wholly or almost completely 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 riverderived 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. 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 as forwarded by the Metropolitan Water Board:— 24 Average results of the examination of the water supply to the Borough of Lewisham for 1949 PARTS PER MILLION (unless otherwise stated) (a) CHEMICAL Table 13 Description of the sample No. of samples Ammoniacal nitrogen Albuminoid nitrogen Oxidised nitrogen (nitrate) Chlorides as CI. Oxygen abs. from Permanganate (3 hrs. at 80°F) Hardness (total) Hardness (permanent) pH value Conductivity Deptford well 4 0.004 0.026 6.9 35.0 0.19 350 153 7.1 600 Wilmington well 8 0.013 0.022 6.0 20.8 0.21 295 81 7.1 450 Darenth well 4 0.006 0.019 5.0 15.9 0.08 290 74 7.1 425 Bexley well 2 0.000 0.023 4.8 16.3 0.04 285 91 7.1 450 Shortlands well 5 0.001 0.038 4.7 22.3 0.40 261 95 7.3 450 Hampton (Thames filtered) 250 0.015 0.087 4.3 27.4 1.13 244 71 7.7 450 Surbiton (Thames filtered) 300 0.017 0.084 4.1 28.1 1.14 236 66 7.7 450 Walton (Thames filtered) 247 0.017 0.093 4.6 28.8 1.26 238 69 7.6 450 (b) BACTERIOLOGICAL Table 14 No. of samples Agar colony count Percentage of samples negative to Bact. coli in 100 ml. Bact. coli per 100 ml. Deptford well 254 - 100.0 Nil Wilmington well 422 — 100.0 Nil Darenth well 254 — 100.0 Nil Bexley well 234 — 100.0 Nil Shortlands well 255 — 99.2 0.016 Hampton (Thames filtered) 980 7.5 99.7 0.006 Surbiton (Thames filtered) 512 10.5 99.4 0.055 Walton (Thames filtered) 255 20.8 100.0 Nil 25 Swimming baths At the beginning of the summer, as a result of two cases of infantile paralysis being notified, I thought it desirable to suggest that all the public swimming baths should be equipped with the apparatus necessary for breakpoint chlorination. This enables a very much higher amount of chlorine to act on the water, and because of some differences in the chemical reactions the effects on persons bathing (such, for example, as possible slight smarting of the eyes) are even less than when a small amount of chlorine is used. Although swimming baths have never definitely been proved to be the vehicle of poliomyelitis infection (infantile paralysis) yet they cannot altogether be excluded as there is some evidence that poliomyelitis infection may be water-borne. Nevertheless experimental work with the virus of the infection has indicated that it is very rapidly killed by free chlorine even if this is present in a concentration of a little less than one part per million, and therefore if the free chlorine contained in swimming bath water is kept over one part per million the chances of transmission of poliomyelitis infection through swimming bath water are negligible. It was for this reason that I recommended that breakpoint chlorination should be installed, because the public is very sensitive during the time when poliomyelitis cases occur frequently, and in many areas (due I think mainly to this public sensitivity) swimming baths have been closed. We did not close our baths in 1947 when we had a fairly large number of cases, although we certainly advised parents in general against allowing their children to take excessive exercise, such as competitive swimming, as if the child were already infected with the virus this could cause a very severe degree of paralysis of the muscles involved. We therefore aimed at getting this year a residual chlorine content of between one and two parts per million as, if this were done, I was quite satisfied there would be no need to close the baths even although we might have a large number of cases of poliomyelitis. During the season the Council installed the breakpoint apparatus at all the baths in which it had not previously been placed. The following colorimetric tests are taken by the staff of the Baths department at 9 a.m., 1 p.m., and 6 p.m., each weekday and at 9 a.m. on Sundays, and the results are recorded on log sheets for the purpose:— 1. Free residual chlorine. 2. pH value. Periodically quantitative tests are taken to determine the bicarbonate alkalinity. Samples are also taken by Health department staff and submitted periodically to the Public Analyst for chlorine content. The following is a summary of the samples submitted during the year:— Lady well first class 8 second class 9 Forest Hill first class 2 second class 4 Downham 5 Bellingham 2 26 Washing facilities at public conveniences Besides the ever-present danger of the serious typhoid infection, there appears to be an increasing number of cases of mild food poisoning occurring in the country generally, and although much of this increase can be put down to more exact diagnosis, most of it is undoubtedly due to defective hygiene and to the increased amount of meals taken communally ; the latter in its turn is probably due to rationing and to the fact that communal meals, e.g., in cafes or restaurants, are off the ration. It may well be also that with the gradual improvement in hygiene over the last hundred years less immunity is produced in the body because of less frequency of infection. As a result, when infection does occur, it produces a much greater effect. The method of attacking the increased number of cases of food poisoning is to strengthen every means of supervision of food from the time it is produced (that is from the animal or vegetable source) through every process of manufacture, wholesale and retail handling, to final consumption. It is well-known that of all food poisoning cases the vast majority are through germs or the poison produced by germs. It is also wellknown that these germs are most often introduced into the food through infected fingers ; the fingers being infected either by defective toilet hygiene or by other defective personal hygiene, such as touching a sore on the face or nose. Once fingers are infected they may remain dangerous for a long time, even hours, unless they are washed ; and washing does not merely mean dipping in cold water, but means a fairly thorough washing with soap and warm water and preferably even a scrubbing brush. It is for this reason that any way in which the public can be induced to maintain a high state of cleanliness will be helpful in reducing the chance of infection, and this applies more particularly to food handlers, including especially stallholders in markets or streets. It was mainly for this reason that I have suggested free washing facilities might be installed in each of the sanitary-convenience premises where at all practicable. When a charge is made this charge tends rather to neutralise health education and the importance of washing the hands after urination or defaecation. I do not think that cold water is sufficient because, apart from the increased difficulty, there is a natural disinclination to wash hands in cold water for some eight or nine months of the year, and as we want to do all we can to encourage washing I think attractive facilities should be provided. These should be hot and cold water, liquid soap and either a hot air drier or individual towels. (The process by which a long roller towel can be automatically pulled out a little further to expose a clean part is much better than an ordinary roller towel, but not so good as an individual towel whether of cloth or of paper). I feel sure that if these facilities could be included in each set of public conveniences they would be made use of by an increasing number of persons and as a result the public health would benefit. It is likely that the facilities could not be made available in some of the existing conveniences without much alteration, but it is suggested that they 27 should be made available even now wherever practicable, and certainly when any new public lavatories are provided. Although what has been stated is mainly in connection with food and food diseases, there are of course other reasons— assthetic as well as health— why free washing facilities should be available. The ideal to be aimed at is to get every member of the public to wash their hands automatically after defaecation (and, one hopes, urination), and if the facilities are not readily available in public conveniences or elsewhere, this objective stands no chance of being attained. This matter was again brought before the appropriate committee early in 1950. Old people In my last report I stated that it was estimated that the number of old people (men 65 and over, women 60 and over) in Lewisham was some 31,000 then and would rise to about 48,000 in 40 years' time. I also stated that in 1947 the Lewisham Old People's Welfare Council had been formed and included representatives of most of the agencies in the borough interested in the care of old people. A grant had been made by the Borough Council to the Lewisham Old People's Welfare Council in order to allow them to continue their Meals on Wheels service, and during the year 1949 further consideration was given to claims from that Council and from other agencies in the borough. A sum of £1,000 had been included in the estimates for the year 1949/50 for help to old people and in the summer it was decided to review in a preliminary way the work of the various agencies in order to see the best way in which any grant might be allocated. Already £300 of the sum had been earmarked for the Lewisham Old People's Welfare Council, bearing particularly their Meals on Wheels service in mind. Accordingly an advertisement was inserted in the local papers at the beginning of July asking for voluntary organisations to contact me setting out very briefly the type of work they were doing and the name and address of the secretary. As a result information was obtained with regard to 17 voluntary organisations, of which a group of 10 were under the control of the Women's Voluntary Services. As it was not possible at that stage to make an exact assessment of the differences between the various clubs and organisations, nor, without detailed enquiry, to find out the degree of their need, it was decided to make a nominal grant of £24 to each of the smaller clubs, a further grant of £168 to the Lewisham Old People's Welfare Council and a grant of £72 to the Lewisham Darby and Joan Club, subject to the following provisos:— 1. The organisation to submit its accounts annually. 2. The medical officer of health or his representative to have the right to inspect the premises. 3. Any grant made to be reviewed annually in the light of any proposals for developing the service. 28 4. Paid helpers not to be employed without the approval of the public health committee (this approval was to be in general terms and not for details). 5. The organisation to become and remain affiliated to the Lewisham Old People's Welfare Council. There was also a proviso for representation on the governing committee of the organisation where the grant made was more than the minimum. The scheme did not commend itself wholeheartedly to all the organisations, though the Lewisham Old People's Welfare Council, the Lewisham Darby and Joan Club, the Over 60 Years Club at the Goldsmiths' Community Centre, the Old Folks' Club at St. Mark's Church Hall, the Talbot Settlement at Bromley Hill and the Good Companions Personal Service were being grant-aided or had been accepted for grant by the end of the financial year. In addition to this the Lewisham Branch of the British Red Cross Society became affiliated to the Lewisham Old People's Welfare Association although not able to accept grant. The Lewisham Old People's Welfare Association At the end of the year the Lewisham Old People's Welfare Council decided to change its name to the Lewisham Old People's Welfare Association. The Lewisham Old People's Welfare Association is regarded by the Council as its main link with the voluntary work in the borough for the care of old people. The borough makes grants to all other approved organisations who are prepared to agree to the provisos set out above and therefore it has a direct link with those organisations, but it would clearly be an administrative difficulty to remain in close touch with them individually, particularly as it is hoped that they will multiply in the years to come, and therefore although it makes a direct grant its chief connection with them is through their being affiliated to the Lewisham Old People's Welfare Association. On that association the borough council is strongly represented in that, in addition to the Mayor being President, on the executive committee of that association it has four members of its public health committee (two elected and two coopted), one other member, and further, the Borough Treasurer is the honorary treasurer of the association and I am its honorary medical adviser. The association, towards the end of the year, decided to appoint a wholetime organising secretary and Miss L. H. Ellis, who has had a large experience of social welfare work, was selected and took up her duties at the very beginning of 1950. To help the association still further the council agreed to office accommodation being found for the organising secretary in the health department, in return for a nominal rental. The Lewisham Old People's Welfare Association, besides being a coordinating body for the work for old people in the borough, has executive functions. The main one of these is the Meals on Wheels service for which there is one van in existence now and for which there will be two vans a little later in 1950. Other functions are the ascertainment of old people, particularly those in need such as the house-bound ; 29 help in the formation of luncheon clubs, with the possibility of a chiropody service being included ; friendly visiting of old people (which will normally be, it is hoped, through the agency of other old people's organisations in the borough, but some of which will have to be an executive duty of the association); the possible formation of a care committee (which might be the welfare committee of the association, or a subcommittee of that committee) to help old people in cash or kind or advice. For the future, when the association is on a sound financial footing and can extend, it has in mind the question of homes, more particularly a holiday home where old people can get away for two weeks or so at much expected benefit to themselves and also in some cases to the benefit of relatives who look after them for the rest of the year, and secondly, residential homes on an almost selfsupporting basis where old people can have their own apartments and yet have the addition of some communal services if they so desire. In effect therefore considerable progress was made during the year on the care of old people in the borough, but possibly it could be said that the progress was relatively greater on the administrative side, i.e., on setting up the machinery, than on the actual executive side, i.e., work in the field. There is no reason however, now that the machinery has been reasonably well assembled, that the field work should not increase rapidly. The two main requirements are sufficient financial support and sufficient voluntary effort. The borough council can help the former, but additional financial help will without doubt be required, and an almost unlimited amount of voluntary effort can be absorbed. The care of old people now is in some ways in a rather similar position to the care of babies and young people some 30 years ago. Before the advent of the Maternity and Child Welfare Act of 1918 a great amount of work had been done for infants and mothers by voluntary effort, and in fact the voluntary workers were the pioneers in such activities. In the same way care for old people is starting with a great deal of voluntary effort and this will probably need to continue indefinitely. At the same time however it must be remembered that all statistics indicate that the proportion of old people will rise steeply over the next 30 or 40 years, so that as time goes on there will be relatively more old people and relatively less younger people to look after them. It is therefore likely that local government authorities will have to help out more and more as time goes on. During the year domestic helps were supplied by the LCC to 456 old people in the borough. 30 SECTION "C"—SANITARY CIRCUMSTANCES OF THE AREA The following table shows a summary of the inspections, etc., carried out by the district sanitary inspectors, food inspectors and housing inspectors during the year :— Table 15 Reason for inspection West North South Total Dwelling-houses—PH Act 2750 2606 1294 6650 Dwelling-houses — Housing Act 369 510 342 1221 Applications for rehousing 2105 1866 1970 5941 Rent Acts and Landlord and Tenant Acts 23 8 14 45 Notice from builder 304 309 61 674 Building licences and certificates for materials 289 293 41 623 Infectious diseases 73 68 48 189 Infestation 102 109 34 245 Factories, mechanical 12 22 4 38 Factories, non-mechanical 12 7 3 22 Outworkers 72 124 123 319 Smoke observations 8 1 10 19 Keeping of animals in such a state as to be a nuisance 8 9 7 24 Food shops—registered 142 94 37 273 Food shops — not registered 118 162 63 343 Milkshops and dairies 86 65 23 174 Icecream premises 208 225 147 580 Restaurants and eating houses 206 83 46 335 Bakehouses 86 45 32 163 Other shops 95 55 57 207 Food inspections 360 442 286 1088 Markets and stalls 27 215 11 253 Pharmacy and poisons 62 50 24 136 Slaughterhouses 2 6 — 8 All other matters 2232 2751 1729 6712 TOTAL INSPECTIONS 9751 10125 6406 26282 Reinspections 4989 6299 2129 13417 Intimation notices served 1235 1529 560 3324 Statutory notices served 432 535 264 1231 Number of factories on register at December 31, 1949 :— Mechanical 153 201 99 453 Non-mechanical 38 61 15 114 Number of outworkers on register at December 31, 1949 48 83 87 218 *Food and Drugs Act s.14(i) (a). †ditto s. 14(i) (b) 31 The following table gives further information on certain sanitary circumstances in the area :— Table 16 Premises No. in borough on 31 Dec., 1949 No. of inspections No. of prosecutions Common lodging houses Nil — — Seamen's lodging houses Nil — — Cowsheds (licensed) Nil — — Slaughterhouses (licensed) 2 8 — Other offensive trades Nil — — Milkshops and Dairies 185 174 2 Icecream premises 279 580 1 Restaurants and eating houses 233 335 — Smoke nuisances Number of observations 19 Number of intimations served — Number of complaints received 7 Number of statutory notices served — Number of legal proceedings — Number of convictions — Cleansing and disinfection Number of adults cleansed 163 Number of children cleansed 1,649 Number of premises cleansed :— (a) after infectious diseases 943 (b) for vermin 326 Water supply to tenement houses Number of premises supplied Nil Number of prosecutions — 32 Nuisances remedied Table 17 Nuisance West North South Total Premises cleansed and repaired 325 399 152 876 Drains repaired 57 45 29 131 Drains entirely reconstructed 3 1 1 5 WC's cleansed or repaired 81 98 43 222 Soil pipes renewed or repaired 27 23 16 66 Waste pipes renewed or repaired 48 51 13 112 RWP's renewed or repaired 50 63 27 140 Roofs and gutters repaired 249 298 130 677 Dampness in premises remedied 184 220 105 509 Yards drained or paved 22 20 9 51 Dustbins provided 28 27 14 69 Water cisterns cleansed or covered 7 6 2 15 Water fittings repaired 34 68 17 119 Defective fireplaces remedied 106 101 16 223 Offensive accumulations removed — 2 — 2 Other nuisances remedied 20 19 13 52 TOTALS 1241 1441 587 3269 Provision of dustbins Notices requiring the provision of dustbins are served under section 105 of the Public Health (London) Act, 1936, on the owner or occupier of the premises for which a dustbin is required and the person on whom the notice is served has a right of appeal to the London County Council. During the year 73 notices were served, and on one of these the owner exercised his right of appeal. The case was heard by an appeals committee of the London County Council on July 25, and was allowed, without costs, no reasons being given. The wording of the Act, which allows the notice to be served on either the owner or the occupier, makes for difficulty and it is hoped that there will be amending legislation. In the meantime, a report is submitted whenever a dustbin is required, the report giving information as to rateable value, type of tenancy, rental, subletting, whether there has been any negligent usage of the dustbin, and any other relevant information ; on the facts before them the committee authorises the service of a notice on either the owner or the occupier. Rent and Mortgage Interest (Restrictions) Acts In 35 instances certificates were issued to tenants under the above Acts in respect of premises which were not in a reasonable state of repair. Applications were also received from owners for the rescission of certificates previously issued and in 28 cases the necessary statements were issued as the premises concerned had been made fit. Landlord and Tenant (War Damage) (Amendment) Act, 1941 Two certificates were issued under the above Act in respect of premises repaired following war damage, the repairs being sufficient to render the premises capable of being used for housing purposes in accordance with the provisions of the Act. 33 Water certificates Certificates were issued in respect of 579 premises certifying that under the provisions of the Public Health (London) Act, 1936 a proper and sufficient supply of water had been provided. Factories and Workshops The following tables give more detailed information of work done under the Factories Acts :— Inspections Table 18 Premises Number of Inspections Written notices Occupiers prosecuted (I) Factories in which ss. 1, 2, 3, 4 and 6 are enforceable 22 — — (ii) Factories not included in above in which s. 7 is enforceable 38 9 — (iil) Any other premises in which s. 7 is enforceable (excl. outworkers) 8 3 — Cases in which defects were found Table 19 Defects 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 – – – – – Overcrowding – – – – – Unreasonable temperature – – – – – Inadequate ventilation – – – – – Ineffective drainage of floors – – – – – Sanitary conveniences— (a) insufficient - 3 - 3 – (b) unsuitable or defective – 14 – 15 – (c) not separate for sexes – 1 – 1 – Other offences against the Act (not including offences relating to outwork) 1 1 – – – TOTAL 1 19 – 19 – 34 Outworkers Outworkers are visited periodically by the woman sanitary inspector. The following is a list of trades concerned, extracted from the autumn lists received :— No. of Trade outworkers visited Wearing apparel 203 Curtains and furnishing 2 Paper bags 4 Boxmaking 3 Miscellaneous (surgical appliances, etc.) 6 218 SECTION "D" —HOUSING Building The following new houses or flats were completed by the Council during the year :— Sunderland Mount 1 flat Hether Grove 119 flats Byron Close 30 flats Bromley Road No. 1 25 flats Total 175 flats Families rehoused During the year the following families were rehoused :— 1. By the Lewisham Borough Council:— (a) In dwellings erected by the Council:— (i) Emergency hutments 24 (ii) Temporary bungalows 12 (iii) L.B.C. properties 107 143 (b) In requisitioned properties 323 Total 466 2. By the London County Council 940 Grand Total 1406 35 Applications for rehousing The number of cases dealt with by the public health department during the year was as follows :— Table 20 West North South Total (a) Lewisham borough council housing applications :— Number visited 1810 1432 1442 4684 Number found overcrowded 289 124 144 557 Insanitary conditions found 82 75 25 182 (b) London county council housing applications :— Number visited 175 324 455 954 Number found overcrowded 56 95 187 338 (c) Housing applications referred from other authorities :— Number visited 113 96 70 279 Number found overcrowded 11 10 7 28 (d) Inspected on request of occupier :— Number visited 4 8 14 26 Number found overcrowded 1 4 9 14 Total visited 2102 1860 1981 5943 Total overcrowded 357 233 347 937 Percentage overcrowded 17.0 12.5 17.5 15.8 Housing Act, 1936 Repair of houses (sections 9 and 10). Under section 9 of the Housing Act, 1936, a local authority if satisfied upon consideration of an official representation, or a report from any of their officers, or other information, that any house is in any respect unfit for human habitation they shall, unless they are satisfied that it is not capable at a reasonable expense of being rendered so fit, serve upon the person having control of the house a notice requiring him within a reasonable time to execute the works specified in the notice and stating that in the opinion of the authority those works will render the house fit for human habitation. In determining whether a house can be rendered fit for human habitation at a reasonable expense, regard is had to the estimated cost of the works necessary to render it so fit and the value which it is estimated the house will have when the works are completed. In June, one of the district sanitary inspectors was seconded to carry out duties in general under the Housing Acts, and his duties include work under section 9. To the end of the year 43 notices had been served in respect of properties in various parts of the borough, and of these notices the necessary works required to secure compliance with the notices had been completed in 7 cases by December 31. Section 10 of the Act allows the local authority to do the work required by the notice themselves if the notice has not been complied with. The expenses incurred by the local authority in executing such works are recoverable from the person having control of the house. 36 It was not necessary for the Council to carry out any work in default of compliance with notices served under section 9. Demolition orders (section 111. The following is a list of demolition orders originated in or complied with during 1949 :— Table 21 Properties Number of dwellings involved Present position Blackheath Hill, numbers 80, 82, 84 3 Demolished in January, 1949. Southend Lane, numbers 391-405 (odd). 8 To be demolished as soon as all lawful occupants have been rehoused. Order operative. Bell Green, numbers 55a, 55b, 55c 3 Offer of works accepted. Ardmere Road, numbers 6-14 (consecutive), and 19. 10 Orders operative. Avenue Cottages, Romer Avenue, numbers 1-4 (consecutive). 4 Orders operative. Lee Church Street, number 62 1 Formal undertaking not to re-let accepted. Beacon Road, numbers 48, 50 2 Offer still under consideration. Hither Green Lane, numbers 95, 97, 99. 3 Offer still under consideration. Brandram Road, number 33 1 Offer still under consideration. Baring Road, number 323 1 Offer still under consideration. St. German's Road, number 38 1 Offer still under consideration. Lee Church Street, numbers 22, 23, 25. 3 Offer still under consideration. Closing orders (section 12). The following is a list of cfosing orders which were originated in or became operative during 1949 :— Table 22 Properties Part of House Present position 10, Dartmouth Row Basement rooms Order operative. 88, Loampit Vale Rooms over shop Order operative. 4, Sydenham Park Basement rooms Order operative. 35, Wells Park Road Basement flat Order operative. 24, St. German's Road Basement flat Order operative. 22, St. German's Road Basement flat Order operative. 192, Kirkdale Basement flat Undertaking not to re-let accepted. 267, Lee High Road Basement flat Order operative. 2a, Sydenham Hill Basement flat Hearing of offer adjourned. Projected clearance areas (section 25). A meeting was held in the autumn between officers of the Council and officers of the London county council for the purpose of discussing the problems likely to arise in the event of the Minister of Health allowing local authorities to proceed with the exercise of their clearance duties under the provisions of the 1936 Act. 37 The difficulty which arises from the submission of applications for building licences in respect of premises likely to be included in a clearance area or to become the subject of demolition orders was also discussed at the meeting, and the Council, to overcome this difficulty as far as is practicable, agreed at a later date upon a revised list of properties which it is proposed either to deal with by way of demolition order procedure under Part II of the Act, or, if more appropriate, to include in areas which the Council, or the London county council, as soon as practicable will be recommended to define as clearance areas under Part III of the Act. The London county council further asked to be supplied with copies of a map of the borough showing areas of about ten houses or more which, without a detailed survey, were considered to be (a) representable and (b) likely to be representable in a few years, and copies of a schedule of the properties concerned showing, according to the condition of the slums, the priority in which the areas should be cleared, and giving an estimate of the number of families which the clearance would displace. Work on this was proceeding at the end of the year on the basis that the houses considered as representable, subject to a detailed survey, could be those included in the list of properties mentioned above. The total number of properties included in this list amounts to 599 whilst the total of properties included in the provisional list prepared in 1941 was 2,999. Since the provisional list was prepared, 392 of the properties were destroyed by enemy action and 69 have been demolished in order to carry to completion clearance orders left in abeyance during the war, which means that the number of properties which the Council would have been asked to consider as representable at this stage had the original list been adhered to has been reduced by 1,939. It may, of course, become necessary to regard some of the 1,939 houses excluded from the provisional list as representable in a few years, or indeed (particularly if deterioration is rapid), at any time. Clearance orders Certain of the clearance orders made by the Council prior to the outbreak of war had not been carried to completion and it was felt that the time had now arrived when action should be taken to enforce compliance with the orders. Fresh notices were therefore served upon the persons concerned for the demolition of the following properties:— Avenue Square Numbers 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12. Patrol Place Numbers 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20. Queen's Bench Numbers 1, 2, 3 and 4. Bromley Road (No. 1 area) Numbers 280, 282, 284, 286 and 288. Bromley Road (No. 3 area) Numbers 370, 372 and 374. Eliot Place Numbers 16 and 17. 38 All these properties were demolished during the year by the owners. The whole of the clearance orders confirmed by the Minister of Health prior to September, 1939 have now been carried to completion. Numbers 340, 342 and 344, Bromley Road, which were also the subject of a clearance order, were demolished by enemy action. Overcrowding (section 61). Under section 61 of the Housing Act, 1936, the Council is empowered to issue a licence to an occupier to enable him to remain in possession of overcrowded premises without committing an offence. One application for such a licence was received during the year from an occupier the owner of whose premises was taking steps to obtain possession on the grounds of overcrowding. The tenant had resided at the premises concerned for ten years and the overcrowding had been caused by natural increase in the size of the family. The applicant had applied to the Council for rehousing. The equivalent number of persons was 6, the permitted number of persons allowed to sleep in the premises was 5 and the premises were therefore overcrowded by 1 person. A licence was issued to the applicant permitting not more than six equivalent persons to sleep in the premises for a period not exceeding 12 months from the date of the licence. Housing Act, 1949 The following summarises the provisions of the Act which may affect the work of the Department:— 1. Account is taken of the housing conditions and housing needs of all members of the community, by removing the previous limitation whereby such conditions and needs were confined to the provision of housing accommodation and houses for the working classes. 2. The owner of a house in respect of which a demolition order became operative before January 1, 1946 may apply, within a period of 12 months, i.e., up to July 30, 1950, to the local authority by whom the order was made, to have such order cancelled. If the local authority are satisfied that, as a result of the execution of works since the time when the order became operative the house is fit for human habitation, they may apply to the County Court for an order quashing the demolition order, which the Judge may make if satisfied that the house is so fit. 3. Where, under the Act of 1936, a local authority would be under a duty to make a demolition order with respect to a house of architectural or historic interest they shall, instead, make a closing order prohibiting the use of the house for any purpose other than a purpose approved by them. 4. Local authorities are empowered to advance money for the purpose of altering, enlarging, repairing or improving houses and for other purposes specified in the Act. 5. A "house" includes any part of a building, being a part which is occupied or intended to be occupied as a separate dwelling, and, in particular, includes a flat. 39 Civil building licences As from May, 1948 the health department has been allocated a monthly quota of the money which can be authorised to be spent on repair work in the borough, and the sanitary inspectors are able to issue the necessary licences, either at the same time or following the intimation or nuisance notice. The following table shows the monthly value of civil building licences issued by the department, divided into parliamentary divisions :— Table 23 Month West North South Total £ £ £ £ January 9,778 23,778 4,680 38,236 February 6,707 26,254 2,646 35,607 March 10,844 22,268 2,907 36,019 April 9,811 20,459 1,719 31,989 May 4,825 11,559 4,461 20,845 June 5,484 17,626 3,737 26,847 July 6,618 21,983 6,264 34,865 August 5,465 12,016 2,449 19,930 September 10,483 11,574 5,241 27,298 October 6,082 7,195 4,228 17,505 November 12,687 11,027 6,436 30,150 December 6,344 14,761 6,700 27,805 TOTALS £ 95,128 200,500 51,468 347,096 40 The following is a tabulated statement of various other housing statistics :— Table 24 Item Total Total number of houses in the borough (separately assessed dwellings) 60,889 Public Health Act Number of houses inspected on account of complaints or illness 8,353 Number of statutory notices served 1,229 Number of houses repaired or nuisances remedied 3,262 Housing Act, 1936 Number of houses inspected — house to house (Housing Consolidated Regulations, 1925) 148 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 36 Number of houses repaired under ss. 9 and 10— (a) by owners 7 (b) by local authority in default of owners — Number of houses demolished— (a) inpursuanceofordersunders.11 (22 awaiting rehousing of tenants). 3 (b) voluntarily — Number of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms) 5 Number of Closing Orders determined (i.e., houses made fit) — Overcrowding (Housing Act, 1936) Number of families found to be living in overcrowded conditions 937 Number of overcrowded families who have obtained alternative accommodation 876 Number of dwellings erected by the Borough Council during the year 175 Underground Rooms (the Council has no regulations for underground rooms) Number occupied but unfit 1 Number closed or modified occupation approved — Houses let in lodgings Number in borough (estimated) 255 Number of inspections under the byelaws Nil Number of prosecutions Nil Number of complaints remedied under the byelaws (not included under any other heading) Nil 41 SECTION "E"—INSPECTION AND SUPERVISION OF FOOD Milk and Dairies Regulations, 1949 These regulations, which were made jointly by the Minister of Health, the Minister of Agriculture and Fisheries and the Minister of Food, supersede the Milk and Dairies Regulations, 1926 and came into operation on October 1, 1949. The Minister of Agriculture has now become responsible for the registration of dairy farms, and of persons carrying on or proposing to carry on the trade of dairy farmer, while the local authority retains responsibility for those provisions which apply outside dairy farms, for the provisions relating to diseases communicable to man and for the registration of dairies which are not dairy farms and of dairymen who are not dairy farmers. There are a number of minor changes in the regulations relating to buildings, the cleansing of vessels and utensils, and the distribution of milk and its protection against contamination and infection with disease and, in particular, provision is made for modern practices in dairying including the use of mechanical refrigeration for cooling and the use of approved chemical agents for the cleansing of appliances. Milk (Special Designations) Regulations (a) Milk (Special Designations) (Raw Milk) Regulations, 1949. These regulations, which now apply solely to raw milk as distinct from heat treated milk, are made jointly by the Minister of Health, the Minister of Agriculture and Fisheries and the Minister of Food. They provide that licences to producers of raw milk to use any special designation shall be granted by the Minister of Agriculture and Fisheries, while the local authority will continue to grant licences to dealers to use special designations in respect of such milk. The conditions subject to which the designations may be used are laid down in these regulations, and where certain conditions cannot be or are not being complied with there are provisions for the revocation, suspension and refusal of licences. After October 1, 1957, the special designation "Tuberculin Tested" may only be used in respect of milk from a herd which is on the Register of Attested Herds kept by the Minister of Agriculture and Fisheries, and no application to use that designation will be granted after September 30, 1954 unless the herd is registered as an Attested Herd. After October 1, 1954 the special designation " Accredited " will no longer be permitted to be used and no new application to use that designation will be granted after September 30, 1952. The regulations provide that milk sold under a special designation shall satisfy a prescribed test. There are some minor amendments in the procedure for the granting of licences and in the conditions subject to which licences may be granted. 42 (b) Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949. The principal changes effected by these new regulations re-enacting with amendments the Milk (Special Designation) Regulations, 1936 to 1948 so far as they relate to pasteurised milk and providing for a new special designation " sterilised milk " are consequent upon the provisions of the Food and Drugs (Milk and Dairies) Act, 1944 and the Milk (Special Designations) Act, 1949. In accordance with the first mentioned Act, as modified by the Transfer of Functions (Food and Drugs) Order, 1948, regulations dealing with the special designations of raw milk are made jointly by the Minister of Health, the Minister of Agriculture and Fisheries and the Minister of Food and are contained in separate regulations, the Milk (Special Designation) (Raw Milk) Regulations, 1949. The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949, made jointly by the Minister of Health and the Minister of Food, are, therefore, concerned only with the special designations of heat-treated milk. Pasteurised milk must be heated to a temperature between 145°F. and 150°F. for a period of 30 minutes, or to a temperature of 161°F. or above for a period of at least 15 seconds, and then cooled to a temperature not exceeding 50°F., or it may be heated to such other temperature for such a period as may be approved by the Minister of Food. Sterilised milk is required to be filtered or clarified, homogenised and heated in bottles to a temperature not below 212°F. for such period as to ensure that it will comply with a prescribed test. The regulations provide for the use of the special designations "Tuberculin Tested Milk (Pasteurised) " and " Tuberculin Tested Milk (Sterilised)." From a future date to be appointed by the Minister of Food, a flow diversion device must be fitted to pasteurising plant in which the milk is heated to a temperature higher than 150°F. and bottles or other containers must be securely fastened with an overlapping cap. From October 1, 1950, pasteurised milk may only be sold in bottles or other containers which must be filled on the premises of a person holding a licence under these regulations. From October 1, 1954, the bottles or other containers must be filled at the pasteurising premises. (c) Milk (Special Designations) Licences Number of licences issued for the sale of pasteurised milk (dealer's) 42 the sale of tuberculin tested milk (dealer's) 40 the sale of sterilised milk (dealer's) 54 the sale of accredited milk (dealer's) 2 supplementary 54 43 Analysis of milk During the year under review, 46 samples of milk were submitted to the public analyst by the Council's inspectors for examination. None of these samples was certified as adulterated or below standard. The average composition of the samples is set out in the following table :— Table 25 Period Average composition of samples examined Percentage of Milk fat Solids not fat Water First quarter 3.51 8.81 87.68 Second quarter. 3.76 9.01 87.23 Third quarter 3.75 8.80 87.45 Fourth quarter 3.54 8.89 87.57 Average for year 3.64 8.88 87.48 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. In addition, the following samples of heat-treated milk were submitted to the laboratory for bacteriological examination :— Table 26 Milk Parliamentary division Total Result West North South Pasteurised 11 4 31 46 All satisfactory Sterilised — – 4 4 All satisfactory Icecream — grading During the year 68 samples of icecream were submitted to the laboratory for bacteriological examination with the following results :— Table 27 Grading Parliamentary division Total West North South Grade I 1 11 13 25 Grade II 6 — 12 18 Grade III 4 — 4 8 Grade IV 10 1 6 17 TOTAL 21 12 35 68 44 Icecream — fat content At the beginning of the year the Ministry of Food decided to make an extra allocation of sugar to all manufacturers of icecream who undertook to produce icecream containing a minimum of 2\ percent fat. Within a short time the sugar position had apparently improved and the extra allocation was made to all manufacturers. At the request of the Ministry of Food samples of icecream are analysed for fat content and the results of the analyses are communicated to the Ministry, who hope to collect statistics as a result of which they can insist on minimal standards of icecream quality. A summary of the samples which were submitted to the public analyst during the year, is appended :— Table 28 Percentage of fat Parliamentary division Total West North South Under 2½ percent 1 2 – 3 2½-5 percent 6 12 2 20 5 -7½ percent 10 14 7 31 7½-10 percent 3 15 15 33 10 - 12½ percent 2 7 12 21 Over 12½ percent 2 1 1 4 TOTAL 24 51 37 112 45 Adulteration of Food The number of samples taken during the year under the Food and Drugs Act was 813, of which 16 were formal samples and 797 informal. After examination the public analyst reported that 2 of the formal samples and 7 of the informal samples were found to be adulterated or below standard. The percentage of adulteration amounted to 12.5 in the case of the formal samples and 0.88 in the informal samples, whilst it was 1.10 of all the samples submitted compared with 0.5 percent in the previous year. The following table gives details of the samples analysed :— Table. 29 DRUGS Number examined Number adulterated Informal Formal Total Informal Formal Total W N S W N S W N S W N S Alum – 3 – – – – 3 – – – – – – – Ammoniated quinine 1 – – – – – 1 – – – – – – – Aspirin – 5 – – – – – – – – – – – – Bicarbonate of soda 3 – – – – 3 – – – – – – Borax 1 – – – – 1 – – – – – – – Boric acid ointment – 1 – – – – 1 – – – – – – – Camphorated oil – 1 – – – – 1 – – – – – – – Castor oil 2 1 – – – – – – – – – – – – Cough pastilles 1 – – – – 1 – – – – – – – Cream of tartar – 4 – – – – – – – – – – – – Epsom salts 1 2 – – – – 3 – – – – – – – Ginger wine essence 1 – – – – – 1 – – – – – – – Glauber salts – 2 – – – – – – – – – – – – Glycerine 1 – – – – 1 – – – – – – – Ground ginger – 9 1 – – – 10 – – – – – – – Killgerm ointment 1 – – – – 1 – – – – – – – Lanoline — 1 – — — — 1 — — — — — – Laxative tablets 1 – – – – – 1 – – – – – – – Liniment of camphor 1 – – – – – 1 – – – – – – – Liver pills 1 – – – – – 1 – – – – – – – Paraffin 1 – – – – – 1 – – – – – – – Saccharin — 2 — — — – – — — — — — – Sedative 1 – – – – – – 1 – – – – – – – Senna pods – 1 – – – – 1 –– – – – – – – Sodamint tablets 1 – – – – – 1 – – – – – – – Sulphur ointment 1 – – – – – 1 – – – – – – – Vaseline – 1 1 – Zinc ointment 1 2 — — — — 3 — — — — — — — TOTALS 17 38 1 – – – 56 – – – – – – – 46 OTHER ARTICLES Number examined Number adulterated Totls. Inform al Formal Total Informal Formal W N S W N S W N S W N S Almonds, ground 1 1 1 1 Angelica 1 .— — — — — 1 — — — — — — _ Apple pie 1 — — — — — 1 — — — — — — - Apple prune and custard — 1 — — — — 1 — — — — — — _ Arrowroot — — 1 — — — 1 — — — — — — _ Baking powder 3 8 2 — — — 13 — — — — — — - Barley flakes — 1 — — — — 1 – – – – – – — Biscuits 1 – – – – – 1 – – – – – – _ Bisto 1 — — 1 – – – – – – — Brawn — — — — 1 1 – – – – – 1 1 Bread rolls 1 — — — 1 _ Bun, buttered 1 — — 1 _ Bun flour — 1 1 — — — 2 — _ Butter 4 20 7 — — 31 _ Cake 2 1 — — – — 3 – – – – – – — Cake flour mixture 4 3 1 — — — 8 — – – – – — _ Calves foot jelly — — 1 — — — 1 — — — — – — _ Caraway seeds. — 5 — — — — 5 — — — — — — – Celery powder — 1 — — — — 1 — — — — — — – Chippolatas (pork) 1 – – – – – 1 – – – – – – – Chocolate spread 1 — 1 — — — 2 — — — — — — – Cheese — 20 8 — — — 28 – – – – – – – Chutney 1 — — — — — 1 — — — — — — – Cinnamon 3 1 — — — 6 — — — — — — — Cloves, ground – 7 — – — — 7 – – – – – – — Cocoa 3 5 5 — — 13 – – – – – – — Coffee 1 — 5 — — — 6 – – – – – – — Coffee and chicory cubes 1 – – – – – 1 – – – – – – – Coffee and chicory essence 3 1 1 – – – 5 – – – – – – – Coffee essence 1 — 5 – — — 6 — — — — — — Cooking fat 18 1 – — — 23 — — — — — Cornflour — — 1 – — — 1 — Curry — — 1 – — — 1 – – – – – – – Curry powder... 3 13 2 – — — 18 – – – – – – — Custard flavouring 1 — — – — — 1 — — — — — Custard powder 7 — – — — 9 — — — – Dessert powder 1 1 — – — — 2 — — Doughnuts 14 — — – — — 14 — — 1 — — — 1 Eggs, dried 1 — — – — — 1 — — — — — Farinaca — 1 — – — — 1 — - Fizz bars 1 — — – — — 1 — — — — - Flavouring essence 1 2 — – — — 3 — — Flour 1 1 — – — — 2 – – – – – – — Fruit bar — — 1 – — — 1 – Fruit malt syrup 1 — — – — — 1 — — — — — — – Fruit pastry — 1 — – — — 1 – – – – – – – Gelatine 1 4 1 – — — 6 – – – – – – – Gherkins — — 1 – — — 1 – Ginger, preserved 1 – 1 – – – – – – – Glace cherries 1 — — – — — 1 – – – – – – – Gravy browning – – 1 – – – 1 – – – – – – – Carried forward 62 128 50 — — 1 241 — — 2 — — 1 3 47 OTHER ARTICLES Number examined Number adulterated Informal Formal Total Informal Formal Total W N S W N S W N S W N S 1 Brought forward 62 128 50 — — 1 241 — — 2 — — 1 3 Gray powder 3 – 2 — — — 5 — — — — — — — Higis 1 1 — — — — — — — Herbs 4 — 1 — — — 5 — — — — — — — Honey 1 — — — — — 1 — — — — — — — Horrseflesh 1 — — — — — 1 — — — — — — — Horse radish cream — 1 1 — — — 2 — — — — — — — Icecream 27 50 35 — — — 112 — — — — — — — Jelly. table — 1 — — — — 1 — — — — — — — Junket powder — 1 — — — — 1 — — — — — — — Kippers 1 — — — — — 1 — — — — — — — Kipper sausages 1 — — — — — 1 — — — — — — — Lard 1 — 6 — — — 7 — — — — — — — Lemon crystals — 2 — — — — 2 — — — — — — — Lemon flavouring — 2 — — — 2 — — — — — — — Lemon powder 2 1 — — — — 3 — — — — — — —— Lentils — 1 — — — — 1 — — — — — — — Macaroni — 1 — — — — 1 — — — — — — — Maltose 1 — — — — — 1 — — — — — — — Margarine 4 18 8 — — — 30 — — — — — — — Mayonnaise 1 — — — — — 1 — — — — — — — Meat extract — — 1 — — — 1 — — 1 — — — 1 Meat pie 6 — — — — — 6 — — — — — — — Meringues 1 — — — — — 1 — — — — — — — Mlik 8 — 28 1 1 8 46 — — — — — — — Milk. condensed — — 6 6 — — — — — — — Milk macaroni 1 — — — — — 1 — — — — — — — Milo — — 1 — — — 1 — — — — — — — Mince pie 1 — 1 — — — — — — — Mint sauce — — 3 — — — 3 — — — — — — — Mustard 5 9 — — — — — — — — — — — — Mutard cream 1 1 — — — — — — — Norwegian spread — — 1 — — — 1 — — — — — — — Numeg, ground — 6 6 — — — — — — — Oatmeal — 7 — — — — — 2 — — — — — — — 0live oil — 1 1 — — — 2 — — — — — — — 0lion, sliced — 1 — — — 1 — — — — — — — parsley, dried 1 3 — — — 4 — — — — — — — Paste, fish 8 10 6 — — — 24 — — — — — — — Paste, meat 5 11 5 — — — — 21 — — — — — — — Pastry 2 1 1 — — — 4 — — — — — — — pea flour — 1 — — — 1 — — — — — — — Pearl barley — 7 — — — — 2 — — — — — — — Peel. citron 1 — — — — — 1 — — — — — — — PeeI mixed — — 1 — — — 1 — — — — — — — Pepper 5 5 7 — — — 12 — — — — — — — Pepper, white 2 7 1 — — — 10 — — — — — — — Pi ckles — 7 — — — 7 — — — — — — — Pock pie — 1 — — — — 1 — — — — — — — Potato crisps 7 — — — — — 2 — — — — — — — Puree, prune 1 — — — — — 1 — — — — — — — Pudding powder 2 1 — — — — 3 — — — — — — — Carried forward 161 264 171 1 1 9 607 — — 3 — — 1 4 48 OTHER ARTICLES Number examined Number adulterated Informal Formal Total Informal Formal Total. W N S W N S W N S W N S Brought forward 161 264 171 1 1 9 607 — — 3 — — 1 4 Roe — — 1 — — — 1 — — — — — — — Rissoles 1 — — — — 1 — — — — — — _ Sage and onion stuffing 1 — — — — — 1 — — — — — — _ Sagion — 1 — — 1 — — — — — — _ Sago and creamola — 2 — — — — 2 — — — — — — _ Salad dressing 1 — — — — — 1 — — — — — — — Salad cream 3 — 1 — — — 4 — — — — — — — Salt — 2 — — — — 2 — — — — — — — Sausages 14 1 1 1 — 1 18 1 — — — — 1 2 Sausages, beef 1 — — — — — 1 — — — — — — — Sausages, preserved 1 — — — — — 1 — — — — — — — Sausage rolls 4 — — — 4 — — — — Sauce 5 5 4 — — 14 — — — — — — — Saveloy 1 — — — — 1 — — — — — — Scone mixture 3 — — — — — 3 — — — — — — _ Semolina 4 2 — — — — 6 — — — — — — _ Sherbert fizz — 1 — — — — 1 — — — — — — — Shortbread 3 — — — — 3 — — — — — — — Soup — 5 — — — — 5 — — — — — — _ Soup, desiccated — 2 — — — — 2 — — — — — — — Soup powder 9 — — 2 — — 11 2 — — — — — 2 Soya flour — 1 1 — — — 2 — — — — — — Spaghetti in sauce 1 — — — — — 1 — — — — — — — Spice, mixed 2 5 2 — — — 9 — — — — — — Spice, pickling 2 — — — — — 2 — — — — — — Sponge mixture — 1 — — — — 1 — — — — — — — Steak & kidney pudding 2 1 — — — — 3 — — — — — — - Steak, stewed 1 — — — — — 1 — — — — — — — Suet — 1 5 — 1 7 — — 1 — — — 1 Sugar .• — — 7 — — — 7 — — — — — — — Sultanas — — 1 — — — 1 — — — — — — — Tapioca — 2 — — — — 2 — — — — — — — Tarts — 1 — — 1 — — — — Tarts, cherry — 1 — — — — 1 — — — — — — — Tarts, jam 3 2 — — — — 5 — — — — — — — Tea 1 1 7 — — — 9 — — — — — — — Tomato spread 1 1 — — — — 2 — — — — — Tuck bars 1 — — — — — 1 — — — — — — — Vanilla flavour 2 — — — — 2 — — — — — — — Veal, cooked 1 — — — — — 1 — — — — — — — Vermicelli 1 — — — — 1 — — — — — — — Vinegar — 1 4 — — — 5 — — — — — — — Vitamin toffees 1 — — — — — 1 — — — — — — Whale sausages 1 — — — — — 1 — — — — — — — Yeast 1 — — — — — 1 — — — — — — — TOTALS 230 305 206 4 1 11 757 3 — 4 — — 2 9 49 Adulterated samples Table 30 Parliamentary division Article Formal or informal Adulteration or irregularity Action taken South Ground almonds Informal Groundnut 100%. Stock sold before formal sample could be taken. South Meat extract Informal Boric acid 0.31%. Existing stock sold before formal sample could be taken. South Sausage meat Formal Meat content only 32%. Case heard 15-7-49. Conviction under sections 38/1 and 3 of Food and Drugs Act, 1938. South Brawn Formal Contained horse meat. Case heard 15-7-49. Conviction under sections 38/1 and 3 of Food and Drugs Act, 1938. West Sausages Informal Meat content only 40%. Formal sample taken and found to be genuine. South Cream doughnuts Informal Mineral oil present. Formal sample taken and found to be genuine. South Shredded suet Informal Fat only 74%. Formal sample taken and found to be genuine. West Soup powder Informal Cocoons, grubs, etc. Formal sample taken and found to be genuine. West Soup powder Informal Cocoons, grubs, etc. Formal sample taken and found to be genuine. Unsound food A considerable amount of food was surrendered as unfit for human consumption. In all, approximately 24 tons was dealt with by the Council's food inspectors, consisting of meat, fruit pulp, fish, etc. In order to prevent waste where possible, most of this unsound food was forwarded to the appropriate authorities for reconditioning or animal feeding. Other samples In addition to samples submitted to the Public Analyst by the food inspectors during their routine sampling, the following were also submitted either to the public analyst or for bacteriological examination. They were submitted for various reasons, but mainly because of complaints received or as a result of enquiries made into cases of food poisoning. 50 Table 31 West North South Cooked veal Foreign body in loaf Piecrust and pastry mixture Colander (suspected to be of faulty manufacture causing flaking of the surface) Cherries Sponge sandwich Stewed meat Stewed apple Lard Fried fish Mincemeat Pastry Chocolate dates National dried milk Coffee and chicory essence Jellied eels Cockle brine Condensed milk Chocolate spread Water from basement of a house Cockles Scotch oats Suet Pastry mixture Beans in tomato Washing-up water Food poisoning The following is a summary of cases of food poisoning investigated during the year :— Table 32 Outbreaks due to identified agents Number of outbreaks Number of cases Organism or agent Food 1 3 Staphylococci Chocolate dates 1 2 Bacterial toxin Meat 1 3 Salmonella Duck egg 1 4 Salmonella ? potted brawn. ? salad 1 42 Presumably toxin School meal Outbreaks of undiscovered cause Number of outbreaks Number of cases Food 1 2 ? Tinned stewed steak 1 2 ? stewed steak 1 41 Cockles and/or mussels 1 25 School meal 1 2 Cockles and/or mussels 57 Tuberculosis The numbers of new cases notified during the year 1949, and deaths, together with comparative figures for the previous year, were as follows :— Table 39 New cases notified † Deaths 1948 1949 1948 1949 Pulmonary 448 333 109 92 Non-pulmonary 54 38 10 15 Totals 502 371 119 107 † excluding inward transfers from other areas The age distribution of the new cases of tuberculosis notified and the deaths from tuberculosis during the year are shewn in the following table :— 51 Single cases due to identified agents Organism or agent Food Salmonella Unknown Salmonella Unknown Salmonella Unknown Salmonella ? fish; ? duck egg Salmonella ? duck egg Salmonella ? duck egg Salmonella Icecream or meat Salmonella Mussels Single cases of undiscovered cause ? Grapes ? School meal ? Pig's liver ? Mussels ? fish ? chicken ? icecream ? Rissoles ? Drinking water ? Rabbit Unknown Registration of food premises The following premises were registered for the purposes stated in accordance with the requirements of section 14(1) of the Food and Drugs Act, 1938:— Sale or storage of icecream 28 Sale, manufacture and storage of icecream 1 Manufacture of sausages, preparation or manufacture of potted, pickled or preserved meat 1 Fish frying 2 Preserved fish 1 Shops Act, 1934 — section 10 Subsection (2) of section 10 of the Shops Act, 1934 requires that in every shop, not being a shop exempted from the provisions of this subsection, there shall be provided and maintained suitable and sufficient sanitary conveniences available for the use of persons employed in or about the shop. Under subsection (6) a shop shall be exempted from the provisions of subsection (2) if there is in force a certificate of exemption granted by the authority whose duty it is to enforce these provisions. A certificate is granted if the authority is satisfied that by reason of restricted accommodation or other special circumstances it is not practicable to provide the required sanitary conveniences in the shop and that suitable and sufficient sanitary conveniences are otherwise conveniently available. Certificates of exemption in respect of sanitary conveniences were issued in connection with five shops during the year. Offensive trades There are no offensive trades carried on in the borough. Slaughterhouses There are two private slaughterhouses in the borough, but very little killing is done. The premises are visited periodically by the food inspectors. Two applications as required by section 144 of the Public Health (London) Act, 1936, for the renewal of licences to use premises as slaughterhouses were received. In both instances the licences were renewed. 52 Meat inspection A report on meat inspection in the following form is included in the report to comply with the provisions of Ministry of Health circular 2/50:— Table 33 Cattle excl. cows Cows Calves Sheep and lambs Pigs Goats Number killed - - - - 2 2 Number inspected - - - - 2 2 All diseases (except tuberculosis)— Whole carcases condemned - - - - - - Carcases of which some part or organ was condemned - - - - - - Percentage of number inspected, affected - - - - - - Tuberculosis only— Whole carcases condemned - - - - - - Carcases of which some part or organ was condemned - - - - 1 - Percentage of number inspected, affected - - - - 50 - Slaughtermen's licences The Slaughter of Animals Act, 1933 provides that no animal shall be slaughtered or stunned in a slaughterhouse or knacker's yard by any person who is not the holder of a licence granted by a local authority. 5 such licences were granted during the year. Basement bakehouses Notices were served in October, 1948 on the owners of two basement bakehouses informing them that the certificates of suitability required by section 54 of the Factories Act, 1937 would cease to have effect after July 31, 1949. One of these basement bakehouses was closed during the year and replaced by a newly constructed bakehouse above ground level, and the other basement bakehouse was closed. At the end of the year there were six basement bakehouses remaining in the borough. Pharmacy and Poisons Act, 1933 and Pharmacy and Medicines Act, 1941 The names of 20 persons were entered on the Council's list of persons entitled to sell poisons included in Part II of the poisons list and the names of 165 persons previously registered were retained on the register. 136 separate visits were paid by the food inspectors in connection with the granting and renewal of these licences. 53 SECTION "F" — PREVALENCE OF and CONTROL OVER INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASES The undermentioned diseases are notifiable by Medical Practitioners:— Anthrax Ophthalmia neonatorum Cholera Plague Continued fever Pneumonia, acute influenzal Diphtheria Pneumonia, acute primary Dysentery (bacillary or amœbic) Poliomyelitis, acute Encephalitis, acute 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 Meningococcal infection Principal notifiable diseases (other than Tuberculosis) Number of Notified Cases (corrected for revised diagnosis) during the year 1949 with comparative figures for the previous six years. It should be borne in mind, that some of the wartime figures were considerably affected by evacuation of population. Table 34 Diseases Number of cases notified 1949 1948 1947 1946 1945 1944 1943 Anthrax 1 - - - - - - Cerebrospinal fever 3 5 19 11 3 4 8 Continued and relapsing fever - — — — 1 — — Diphtheria 3 5 9 8 24 24 26 Dysentery 9 24 26 57 31 65 23 Encephalitis lethargica (acute) — — — 1 — — — Enteric or typhoid fever 3 2 4 2 — — 1 Erysipelas 35 33 45 34 50 86 57 Food poisoning 50 12 3 1 — — — Hydrophobia — — — 1 — — — Malaria 1 2 4 15 — — — Measles 1,940 2,642 810 1,307 462 688 1,270 Ophthalmia neonatorum 6 9 9 4 1 4 17 Pneumonia 84 67 104 108 71 110 176 Polioencephalitis (acute) — — 11 — — — — Poliomyelitis (acute) 35 9 61 — 5 — — Puerperal pyrexia 27 50 43 32 25 20 21 Scabies 29 54 122 348 566 654 515 Scarlet fever 520 332 254 155 197 270 683 Smallpox — 1 — — 1 — Whooping cough 363 789 362 291 238 275 219 TOTALS 3,109 4,035 1,887 2,375 1,674 2,201 3,016 54 Notifications of infectious diseases in 1949 showing sex and age groups:— Table 35 Diseases 0-1 1-5 5-15 15-45 45-65 65 up Total M F M F M F M F M F M F M F Anthrax - - - - - - 1 - - - - - 1 - Cerebrospinal fever 2 - - - 1 - - - - - - - 3 - Diphtheria - - - - - - 1 2 — - - - 1 2 Dysentery 1 - 2 3 1 1 1 5 4 Enteric or typhoid fever - - - - 2 - - - - 1 - - 2 1 Erysipelas - - - - 1 - 3 6 10 11 - 4 14 21 Food poisoning 1 - 3 1 2 1 12 11 7 7 4 1 29 21 Malaria - - - - - - 1 - - - — - 1 - Measles 44 48 568 546 365 343 11 15 - - - - 988 952 Ophthalmia neonatorum 4 2 - - - - - - - - - - 4 2 Pneumonia 1 1 2 5 6 1 16 11 13 8 9 11 47 37 Poliomyelitis 2 — 10 5 6 3 5 4 - - - - 23 12 Puerperal pyrexia - - - - - - - 27 - - - - - 27 Scabies - - - 4 8 6 3 5 1 1 - 1 12 17 Scarlet fever 1 - 75 82 154 189 7 12 - — - - 237 283 Whooping cough 26 19 97 123 44 50 1 3 - - - - 168 195 Totals 82 70 757 769 590 594 62 96 31 28 13 17 1,535 1,574 Analysis of certain diseases in table 35 into divisional areas:— Table 36 0-1 1-5 5-15 15-45 45-65 65 up Total Measles W 21 236 122 4 - - 383 N 34 505 297 12 - - 848 S 37 373 289 10 - - 709 Pneumonia w _ 3 1 6 10 9 29 N 2 4 2 10 7 7 32 S - - 4 11 4 4 23 Poliomyelitis w - 2 4 5 - _ 11 N - 10 3 3 - - 16 S 2 3 2 1 - - 8 Scarlet fever w _ 72 162 6 - _ 240 N 1 44 94 7 — - 146 S - 41 87 6 - - 134 Whooping Cough w 15 65 43 1 _ _ 124 N 20 89 33 2 - - 144 S 10 66 18 1 - - 95 55 CHART COMPARING NOTIFIED CONFIRMED CASES IN 1947 AND 1949, BY DATE OF REPORT POLIOMYELITIS 1947 CHART COMPARING ALL CONFIRMED CASES, BY DATE OF ONSET POLIOMYELITIS 1947 1949 56 Poliomyelitis Comparison of all confirmed cases of poliomyelitis in 1949 with those received in 1947 (See also chart on p. 55). Table 37 Age group 1949 1947 Number percentage Number percentage 0- 2 5.7 2 2.6 1- 15 42.9 23 30.2 5- 9 25.7 26 34.2 15- 9 25.7 24 31.6 45-65 — — 1 1.4 Total 35 100.0 76 100.0 A comparison of the dates the cases were notified in the two years is shown on the chart. infectious disease visiting In the earlier part of the year the Council appointed two infectious disease visitors whose duty it is to visit the homes of persons who are stated to be suffering from a notifiable infectious disease. Both infectious disease visitors are State Registered Nurses and also Registered Fever Nurses. This work was formerly carried out in part by the sanitary inspectors and in part by the health visitors, but the infectious disease visitors now visit all notifiable infectious diseases except food poisoning, cases of which continue to be investigated by the food inspectors. The work of the infectious disease visitors as agents of the medical officer of health includes the investigation of home conditions, the giving of advice to patients and contacts particularly where the patient is left at home, and in general the taking of such measures as may be necessary to combat the spread of infection. The following is a summary of the work for ordinary infectious diseases carried out during the year, which is in addition to the visits paid by sanitary inspectors referred to in table 15. Table 38 W N S Total Visits 599 513 535 1,647 Revisits 145 93 91 329 Futile visits 100 125 174 399 Total 844 731 800 2,375 57 Tuberculosis The numbers of new cases notified during the year 1949, and deaths, together with comparative figures for the previous year, were as follows :— Table 39 New cases notified † Deaths 1948 1949 1948 1949 Pulmonary 448 333 109 92 Non-pulmonary 54 38 10 15 Totals 502 371 119 107 † excluding inward transfers from other areas 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 40 Age periods New coses notified Deaths Pulmonary NonPulmonary Totals Pulmonary NonPulmonary Totals M F M F M F M F M F M F 0- _ _ _ 1 _ 1 _ _ _ 1 _ 1 1- 5 8 7 4 7 12 _ _ 1 3 1 3 5- 4 3 1 3 5 6 _ - 1 1 1 1 10- 5 6 3 1 8 7 15- 78 73 1 _ 79 73 16 23 3 2 19 25 20- 32 33 1 3 33 36 25- 40 37 3 1 43 38 35- 20 20 2 5 22 25 45- 78 8 4 _ 37 8 34 11 1 - 35 11 55- 23 3 _ 23 3 65- 6 1 1 2 7 3 8 - 1 1 9 1 Totals 191 142 18 20 209 162 58 34 7 8 65 42 58 Analysis of new cases of tuberculosis into divisional areas:— Table 41 Division Sex 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total West Pulmonary M - 4 - 2 10 7 12 10 8 5 2 60 F - 2 1 1 6 13 10 4 2 2 1 42 Non-pulmonary M - 1 - 2 - - 2 1 - - - 6 F 1 - 3 - - 1 1 2 - - - 8 Total M - 5 - 4 10 7 14 11 8 5 2 66 F 1 2 4 1 6 14 11 6 2 2 1 50 North Pulmonary M - - 3 1 6 12 10 3 12 9 1 57 F - 1 1 2 2 10 13 6 1 1 - 37 Non-pulmonary M - 1 1 - - 1 1 - 2 - 1 7 F - 2 - 1 - 1 - 1 - - 2 7 Total M - 1 4 1 6 13 11 3 14 9 2 64 F - 3 1 3 2 11 13 7 1 1 2 44 South Pulmonary M - 1 1 2 12 13 18 7 8 9 3 74 F - 5 1 3 15 10 14 10 5 - - 63 Non-pulmonary M - - - 1 1 - - 1 2 - - 5 F - 2 - - - 1 - 2 - - - 5 Total M - 1 1 3 13 13 18 8 10 9 3 79 F - 7 1 3 15 11 14 12 5 - - 68 Cases of tuberculosis coming to the notice of the department other than by formal notification:— Table 42 Age period Pulmonary Non-pulmonary Total M F M F M F 0- - - - - - - 1- 2 2 _ — 2 2 5- 3 4 - - 3 4 10- 1 - - 1 1 1 15- 2 7 - - 2 7 20- 10 14 1 - 11 14 25- 35 36 - 3 35 39 35- 16 7 — — 16 7 45- 5 1 - - 5 1 55- — - - - - - 65- 4 1 1 - 5 1 Total 78 72 2 4 80 76 59 The sources from which information of the cases in table 42 was obtained were as follows:— Table 43 Source of information Pulmonary Non-pulmonary Death returns — from local registrars - - Death returns — from Registrar General - - Posthumous notifications 2 1 Transfers from other areas (other than transferable deaths) 147 5 Other sources - - Totals 149 6 Quarterly revision of tuberculosis register:— Table 44 Pulmonary Non-pulmonary M F M F Number of cases on register at December 31, 1948 1,310 973 240 307 Number of cases added during the year 269 213 19 25 Number of cases deducted during the year (deaths, transfers, etc.) 190 155 23 26 Number of cases on register at December 31, 1949 1,389 1,031 236 306 Summary of Statistics as to Tuberculosis for the last ten years Table 45 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 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 1949 227,700 371 1.63 107 92 0.40 Note:—The 1949 death rate from pulmonary tuberculosis for the County of London was 0.52. 60 Public Health (Tuberculosis) Regulations 1930. Environmental investigations: Investigations are made under the above regulations of the home conditions of persons notified as suffering from tuberculosis. This work includes not only visits in respect of primary notifications, i.e., the first notification that a person is suffering from tuberculosis, but applies also to persons diagnosed as suffering from tuberculosis in some other district who subsequently move into Lewisham. The work is carried out mainly by the infectious disease visitors. The primary object of this visiting is to ascertain under what housing conditions the patient and his contacts are living and if any conditions are found which call for action by the health department the matter is referred to the district sanitary inspector, or other action of a remediable nature is taken. The work is solely concerned with the environment of the patients and their home contacts and does not include the giving of advice as to treatment or precautions to be observed, this aspect of tuberculosis work being continued by the staff at the chest clinic. The following table shows the number of visits made in 1949 :— Table 46 W N S Total Visits 11 13 19 43 Futile visits 5 15 29 49 Tuberculosis — Mass Radiography Unit A note was published in the annual report for 1946 on the results of the visit of the Mass Radiography Unit to the borough in 1946. In that year 8,556 persons were X-rayed (3,234 males and 5,332 females) of whom 80 were found to be cases, active or inactive, of tuberculosis (35 males and 45 females) giving an incidence of tuberculosis of 9.3 in 1,000 (10.8 per thousand males and 8.0 per thousand females). In 1948 the mass radiography unit was again available for Lewisham residents and workers but during the campaign it was unfortunately not possible for the unit to be stationed in the borough. It was in fact in a building some two miles or so away. This seriously reduced the popularity of the unit and in fact only 1,854 persons were X-rayed (873 males and 981 females). Of these 26 (12 males and 14 females) were thought to be cases of tuberculosis, whether active or inactive, giving an incidence of tuberculosis of 14.0 in 1,000 (13.7 per thousand males and 14.3 per thousand females). Although the unit was available in the latter part of 1948 these figures were unavailable for inclusion in the annual report for that year and therefore they are included now. The mass radiography unit again visited the borough early in 1950. A report of this will be included in the next annual report but meanwhile it can be said that the campaign, which had the active support of the health department, was a considerable success and over 10,000 persons were examined. 61 Drugs and preparations in the treatment and prevention of tuberculosis During the year two methods of dealing with tuberculosis were brought prominently before the public; first, prevention by means of BCG vaccination (as reported briefly on p. 5 of my report for 1948), and secondly, treatment by means of the drug streptomycin. With regard to BCG vaccination there is little new to report except that a Ministry of Health sponsored scheme of limited size has now started. With regard to streptomycin much public confusion has been caused by incorrect or exaggerated reports in the press and therefore it may be helpful to quote from a leaflet on the drug recently issued by the National Association for the Prevention of Tuberculosis. Streptomycin "is a powerful drug which was reported in America in the year 1944. It is made from an extract of a mould which grows in the soil. People imagine that streptomycin can produce successful results in a large number of cases of tuberculosis. This is quite incorrect. Streptomycin is certainly useful in the treatment of tuberculosis, but it is by no means an absolute and infallible cure for all cases. In fact, streptomycin can only be used successfully for a relatively small number of patients suffering from this disease. One severe, and usually fatal form of tuberculosis is that known as tuberculous meningitis — a condition affecting the covering of the brain. Before streptomycin was discovered, tuberculous meningitis was nearly always fatal. But streptomycin, given properly and under very careful conditions, can cure tuberculous meningitis in a number of cases — though not in all. Unfortunately, streptomycin is a very powerful drug and may injure certain nerve cells and fibres. It may indeed cause serious damage to the nerves which control the muscular balance. Newer forms of streptomycin may not be quite so dangerous in this respect and, in time, we may be able to avoid these dangerous effects altogether. Yet the risk remains. There is another unexpected and serious result which streptomycin may have when given to a tuberculous patient. Some of the germs of tuberculosis inside the patient's body may become what is called "resistant" to streptomycin—that is, they may be quite unaffected by it, indeed they may continue to grow in large numbers even while the patient is receiving the drug. So that the patient becomes entirely "proof" against streptomycin and the drug will be no good whatever. If a serious moment should come in that patient's illness, he will be deprived of streptomycin at the critical time. It might have been much better for such a patient to "save up" streptomycin for a particular crisis or dangerous stage in his illness, when no other drug would do him so much good. Streptomycin should be used at the right moment or not at all. Worse than that. Such a patient may infect other healthy people with the "resistant" strains of the tuberculosis germs. So that more and more people may develop a form of the disease in which streptomycin would be valueless. 62 These dangers we can avoid by giving streptomycin at the right time, for the correct period of time and in the right dosage. Only a physician experienced in the use of this drug can decide when it should be used, without danger to the patient or risk to other New research suggests that the greatest value of streptomycin may be found when it is used in conjunction with other drugs. For the present, we shall still have to rely upon the well-tried existing methods of treating and curing tuberculosis: rest, open air, artificial pneumothorax (lung rest). These are our permanent allies. Streptomycin used at the right moment may be a life saver; used at the wrong moment it may be disastrous." Immunisation against infectious disease I am indebted to the Divisional Medical Officer of the London County Council for the information on which the following table is based: Immunisation against diphtheria ; whooping cough ; smallpox Table 47 Age at December 31, 1949 Under 1 1 2 3 4 5-9 10-14 Total under 15 Born in year 1949 1948 1947 1946 1945 1940-44 1935-39 (i) Diphtheria and combined diphtheria and Immunised during year 182 2,363 636 251 79 380 53 3,941 Estimated number immunised by end of year 182 2,580 2,753 2,239 2,222 14,613 6,833 31,422 Estimated mid-year population 20,350 27,140 47,490 (ii) Whooping cough only:— Immunised during the year 2 23 72 62 42 60 1 262 *This figure is broken down as follows :— Under 5 Over 5 At child welfare clinics and day nurseries 2,594 6 At schools 58 389 By private doctors 859 38 Totals 3,511 433 63 (iii) Vaccination against smallpox Age at December 31, 1949 Under 1 1-4 5-14 15 and over Total Primary:— At clinics 443 393 23 48 907 By private doctors 137 159 4 32 332 Re-vaccination:— At clinics — 3 14 75 92 By private doctors 1 3 17 68 89 Town Hall, S.E.6. 3 June 1950 E. H. R. SMITHARD Medical Officer of Health. 64 APPENDIX A Acts of Parliament, Statutory Instruments and Circular Letters issued by Government Departments, with regard to the Public Health services, during the year 1949 Statutes Milk (Special Designations) Act, 1949. Agriculture (Miscellaneous Provisions) Act, 1949. Landlord and Tenant (Rent Control) Act, 1949. Prevention of Damage by Pests Act, 1949. Housing Act, 1949. Ministry of Health Circulars No. 3 Annual reports of medical officers of health. 13 National Assistance Act, 1948, section 50—Burial, etc., of the dead. 27 Timber licences: services other than housing—removal of wood from licensing control. 28 Removal of hardwood from licensing control. 17 Housing Act, 1936 — possession of overcrowded premises. 40 Diphtheria prophylaxis — publicity campaigns. 45 International statistical classification of diseases, injuries and causes of death. 49 Conferences. 46 Food and Drugs Act, 1938—Food poisoning. 51 Contributions to old people's welfare organisations. 59 Landlord and Tenant (Rent Control) Act, 1949. 66 National Assistance Act, 1948, section 50 and National Insurance Act, 1946, section 22(5). 66a National Assistance Act, 1948 — section 50, and National Insurance Acts, 1946 and 1949. 67 Building licensing— (1) Extension of present financial limits. (2) Use of "free" allowance. (3) Contravention of defence regulation 56a. 72 BCG vaccination against tuberculosis. 87 Food and Drugs Acts, 1938 and 1944—Milk and Dairies Regulations, 1949. 86 National Assistance Act, 1949 — Regulation and inspection of disabled and old persons' homes. 90 Housing Act, 1949. 100 Timber for housing. 103 Economy in the use of softwood. 113 Timber licensing control. 106 Infectious diseases — notification of contacts travelling to and from Irish Republic. Memorandum Revision of Memo 188/Med.—Food poisoning. 65 Ministry of Food Circulars MF 1 Food and Drugs (Whalemeat) Regulations, 1949. 2 Food and Drugs (Whalemeat) Regulations, 1949 (Recognition of a veterinary certificate). 3 Icecream sampling. 5 Mineral oil in food order, 1949. 7 Food and Drugs Act, 1938—Meat manufacturing premises. 8 Food and Drugs (Whalemeat) Regulations, 1949—New Zealand veterinary certificate. 9 Public Health (Imported Food) Regulations, 1937 and 1948 — U.S.A. official certificate. 10 Food and Drugs Act, 1938—Meat inspection and condemnation certificates for canned meat. 11 Meat products; whalemeat; soft drinks ; limejuice and soda; 12 Clean food campaigns. 13 Public Health (Imported Food) Regulations, 1937 and 1948— Hungary: official certificate. 14 Milk and Dairies Regulations, 1949. 15 Milk (Special Designations) (Raw Milk) Regulations, 1949 and Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949. 17 Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949. 18 Model Byelaws: Series I—clean food. 19 Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949—allowances for "heat treatment." 20 Transport and handling of meat. Memorandum No. 1 Whalemeat inspection. Ministry of Agriculture and Fisheries Circular NS No. 21 la Financial Assistance to Local Authorities in respect of Rodent control work, financial year 1949-50. Statutory Instruments No. 120 The Local Authorities (Charges for Dustbins) Order, 1949. 404 Food and Drugs (Whalemeat) Regulations, 1949. 538 Poisons List Order, 1949. 539 Poisons Rules, 1949. 614 Mineral Oil in Food Order, 1949. 1096 The Landlord and Tenant (Rent Control) Regulations, 1949. 1102 Control of Building Operations (No. 13) Order, 1949. 1587 The Food and Drugs (Milk and Dairies) Act, 1944 (appointed day) Order, 1949. 1588 Milk and Dairies Regulations, 1949. 1589 Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949. 1590 Milk (Special Designations) (Raw Milk) Regulations, 1949. 1656 Food Standards (Table Jellies) Order, 1949. 1816 Food Standards (Curry Powder) Order, 1949. 1817 Food Standards (Tomato Ketchup) Order, 1949. 1893 Food Standards (Preserves) Amendment Order, 1949. 2259 Public Health (Acute Poliomyelitis, Acute Encephalitis and Meningococcal Infection) Regulations, 1949. 66 APPENDIX B Legal Proceedings in 1949 The following is a list of legal proceedings instituted during the year:— Public Health (London) Act, 1936 Date of hearing Nature of Offence Fine Costs Remarks £ s. d. 17 January Non-compliance with nuisance notice in respect of 70, 71, 72, Robins Court, Chinbrook Road. - 2 2 0 Order made for abatement of nuisance within 14 days. 17 January Non-compliance with nuisance notice in respect of 83, Burnt Ash Road. - - Adjourned sine die. 19 January Non-compliance with nuisance notice in respect of 100, Burnt Ash Road. - - Order made for abatement of nuisance within 6 weeks. 4 Feb. Non-compliance with nuisance notice in respect of 52, Leyland Road. - 1 1 0 Order made for abatement of nuisance within 56 days. 4 Feb. Non-compliance with nuisance notice in respect of 54, Leyland Road. - 1 1 0 Order made for abatement of nuisance within 56 days. 28 Feb. Non-compliance with nuisance notice in respect of 24, Inchmery Road. - 1 1 0 Summons withdrawn, work nearly completed. 28 Feb. Non-compliance with nuisance notice in respect of 24, Jutland Road. - 1 1 0 Order made for abatement of nuisance within 14 days. 28 Feb. Non-compliance with nuisance notice in respect of 26, Balloch Road. - 1 1 0 Order made for abatement of nuisance within 56 days. 28 Feb. Non-compliance with nuisance notice in respect of 42, Killearn Road. - 1 1 0 Order made for abatement of nuisance within 56 days. 28 Feb. Non-compliance with nuisance notice in respect of 32, Devonshire Road. - 1 1 0 Order made for abatement of nuisance within 84 days. 28 Feb. Non-compliance with nuisance notice in respect of 323, Baring Road. - - Adjourned sine die. 28 Feb. Non-compliance with nuisance notice in respect of 91, Burnt Ash Hill. - - Adjourned sine die. 9 March Non-compliance with nuisance notice in respect of 7, Rosamund Street. - - Adjourned sine die. 9 March Non-compliance with nuisance notice in respect of 46, Springfield Rise. - - Adjourned sine die. 9 March Non-compliance with nuisance notice in respect of 48, Springfield Rise. - - Adjourned sine die. 13 April Non-compliance with nuisance notice in respect of 35, Boone Street. - - Order made for abatement of nuisance within 28 days. 67 Date of hearing Nature of Offence Fine Costs Remarks £ s. d. 13 April Non-compliance with nuisance notice in respect of 27, Boone Street. - - Case dismissed. It appeared from the evidence that the alleged nuisance was caused by failure of Council to render flank wall down to foundations, when carrying out War Damage repairs in 1943. 11 May Non-compliance with nuisance notice in respect of 8, Meadow Close. - - Order made for abatement of nuisance within 28 days. 20 May Non-compliance with nuisance notice in respect of 7, Rosamumd Street. - - Order made for abatement of nuisance within 84 days. 20 May Non-compliance with nuisance notice in respect of 46, Springfield Rise. Order made for abatement of nuisance within 84 days. 20 May Non-compliance with nuisance notice in respect of 48, Springfield Rise. - - Order made for abatement of nuisance within 84 days. 20 May Non-compliance with nuisance notices in respect of 56a, 58a, 60, 60a, 62, 62a, 64, 64a(2), 66, 66a, 68,70(2), 70a(2), 72, 72a, 76(2), 88, 88a, 94a(2) and 102, Manor Park. - 5/- on each of the 25 summonses Orders made for abatement of nuisances within 56 days. 13 July (2) indicates 2 summonses). Non-compliance with nuisance notice in respect of 115, Amblecote Road. — 1 1 0 Order made for abatement of nuisance within 28 days. 13 July Non-compliance with nuisance notice in respect of 37, Summerfield Street. - - Summons withdrawn, Work completed. 13 July Non-compliance with nuisance notice in respect of 1, Chinbrook Road. - - Adjourned sine die. Work in hand. 13 July Non-compliance with abatement order in respect of 32, Dowanhill Road. - - Summons withdrawn. Work completed. 13 July Non-compliance with nuisance notice in respect of 67, Birkhall Road. - - Adjourned sine die. Work held up by tenant, but now well in hand. 13 July Non-compliance with nuisance notice in respect of 8, Malham Road. - - Adjourned sine die. Sanitary Inspector ill. 22 July Non-compliance with nuisance notice in respect of 50, Eltham Road. - - Adjourned sine die, to enable defendant to consider whether to carry out necessary repairs in order to comply with notice, or alternatively to take immediate steps to eject occupier, who, the defendant alleges, is in fact a trespasser. 68 Date of hearing Nature of Offence Fine Costs Remarks £ s. d. 25 July Defective dustbin at 29, Woolstone Road. Appeal by owner under section 105(5) to appeals committee of London County Council. - - Appeal allowed. 8 August Non-compliance with nuisance notice in respect of 52, Leyland Road. - 1 0 0 Order made for abatement of nuisance within 2 months. 8 August Non-compliance with nuisance notice in respect of 54, Leyland Road. - 1 0 0 Order made for abatement of nuisance within 2 months. 8 August Non-compliance with abatement order in respect of 100, Burnt Ash Road. £1 1 0 0 - 8 August Non-compliance with abatement order in respect of 52, Leyland Road. £2 1 0 0 - 8 August Non-compliance with abatement order in respect of 54, Leyland Road. £2 1 0 0 - 19 Sept. Non-compliance with nuisance notice in respect of 85, Malham Road. - - Summons not served. Defendant gone to South Africa. Notices to be reserved on agents at present collecting rent. 10 Oct. Non-compliance with nuisance notice in respect of 8, Malham Road. - 2 2 0 Order made for abatement of nuisance within 42 days. 19 Oct. Non-compliance with nuisance notice in respect of 17, Rinestead Road. - 2 2 0 Order made for abatement of nuisance within 28 days. 24 Oct. Non-compliance with nuisance notice in respect of 5, Waldram Crescent. - 1 1 0 Order made for abatement of nuisance within 28 days. Against both defendants 26 Oct. Non-compliance with nuisance notice in respect of 103, Tressillian Road. - 2 2 0 Order made for abatement of nuisance within 56 days. 18 Nov. Non-compliance with nuisance notice in respect of 18, Barmeston Road. - - Summons withdrawn. Work satisfactorily completed. 18 Nov. Non-compliance with nuisance notice in respect of 28, Algiers Road. - - Adjourned sine die. Work well in hand. 28 Nov. Non-compliance with nuisance notice in respect of 112, Marvels Lane. - - Adjourned sine die. Work well in hand. 69 BYELAWS MADE BY THE LEWISHAM DISTRICT BOARD OF WORKS Date of hearing Nature of Offence Fine Costs Remarks £ s. d. 10 Oct. Non-compliance with yard paving byelaw in respect of 8, Malham Road. (No. 10 of the byelaws for the prevention of nuisances). - - Dismissed on the grounds that the magistrate was not satisfied that actual insanitary conditions arose from the defective yard paving. 24 Oct. Non-compliance with byelaw notice in respect of 4, Broseley Grove. (Nos. 3 and 4 of the byelaws with respect to the cleansing of cisterns). - - Adjourned sine die. Order for work already placed with builder. HOUSING ACT, 1936 Date of hearing Nature of Offence Fine Costs Remarks £ s. d. 19 Oct. Non-compliance with No. 10 of the byelaws as to lodging houses for the working classes made by the London County Council under section 6 of the Housing Act, 1936. - - Summons withdrawn. Byelaw complied with before hearing. Non-compliance with No. 14(a) and various others of the last mentioned byelaws. in respect of 27, Manor Park. - - Adjourned sine die. Work in progress. FOOD AND DRUGS LEGISLATION Milk and Dairies Order, 1926 Date of hearing Nature of Offence Fine Costs Remarks £ s. d. 23 May Dead mouse in milk bottle. £20 15 15 0 — 29 June Dirty milk bottle. £10 2 2 0 — 70 Food and Drugs Act, 1938 15 July (1) Selling sausages containing horse flesh. £20 2 2 0 Joint case with Ministry of Food. (2) Selling brawn containing horse flesh. £20 2 2 0 — (3) Selling horse flesh for human consumption in premises without displaying notice to that effect. £5 2 2 0 - 29 July Insect in bread. £5 3 3 0 8 August Sale of icecream from unregistered premises on three occasions. £1 3 3 0 — £5 — £10 — Food warnings In addition to legal proceedings authorised for contraventions of the Food and Drugs Act, 1938, and Milk and Dairies Order, 1926, warning letters were sent in respect of the following matters, where the evidence was not sufficient to warrant legal proceedings being instituted:— Bandage in rhubarb. Nail in cake (2). Glass in milk bottle. Penny in cake. Insect in tart. Insect in bread. Nail in bread (2). Foreign body in bread. Piece of wire in cake. Wire in jam. Nail in toffee. Mice excreta in bread. APPENDIX C List of special reports submitted to the Public Health Committee by the Medical Officer of Health during 1949:— February 1 Old people's welfare. Health department staff. March 1 Influenza. ,, 29 Noise near Hither Green railway sidings. Campaign against flies and mosquitoes. June 13 Pharmaceutical services. Tuberculosis : mass-radiography unit. Cleansing station staff. Food wrapping. July 5 Infantile paralysis. September 6 Additional clerical assistance. Old people's organisations. October 4 Clean food. Food poisoning. Old people's organisations — help to voluntary organisations. Nov. 29 Icecream control. 71 TABLES TABLE NO. SUBJECT PAGE 1 Social class — stillbirths and infant mortality 7 2 Comparative statistics 12 3 General summary of vital statistics in last ten years 12 4 Causes of death, by age groups 13 5 Deaths under one year of age 14 6 Social class mortality 15 7 Social class infant mortality 15 8 General statistics from 1901 16-17 9 Disinfecting station 18 10 Public mortuary 21 11 Rodent control 22 12 Treatment of sewers for rats 22 13 Water supply samples—chemical 24 14 Water supply samples—bacteriological 24 15 Sanitary inspection 30 16 Special sanitary circumstances 31 17 Nuisances remedied 32 18 Factories and workshops—inspections 33 19 Factories and workshops—defects 33 20 Housing 35 21 Demolition orders 36 22 Closing orders 36 23 Civil building licences 39 24 Various housing statistics 40 25 Analysis of milk 43 26 Heat-treated milk 43 27 Icecream—grading 43 28 Icecream—fat content 44 29 Food and Drugs Act—samples analysed 45 30 Food and Drugs Act—adulterated samples 49 31 Other samples 50 32 Food poisoning 50 33 Meat inspection 52 34 Principal notifiable diseases 53 35 Notifications of infectious diseases by age and sex 54 36 Analysis of certain diseases into divisional areas 54 37 Poliomyelitis in 1947 and 1949 56 38 Infectious disease visiting 56 39 Tuberculosis notifications and deaths 57 40 Age distribution of tuberculosis cases 57 41 Analysis of new cases of tuberculosis into divisional areas 58 42 Cases of tuberculosis not formally notified 58 43 Sources of information of cases in table 42 59 44 Revision of tuberculosis register 59 45 Summary of statistics as to tuberculosis for the last ten years 59 46 Tuberculosis—environmental investigations 60 47 Immunisation against infectious disease 62 CHARTS Poliomyelitis in 1947 and 1949 55 MAP Divisional areas of the borough 8-9 72 INDEX SUBJECT PAGE SUBJECT PAGE Acts, regulations and orders 64 National Assistance Act, 1948:— Area of borough 11 Section 47 21 Section 50 21 Basement bakehouses 52 Nuisances remedied 32 Birth rate 11 Offensive trades 51 Civil building licences 39 Old people 27 Outworkers 34 Death, causes of 13 Death rates 11 Pharmacy and Poisons 52 Disinfection and personal Poliomyelitis 56 cleansing 18 Poliomyelitis—charts 55 Dustbins, provision of 32 Population 11 Public Health Committee — Factories and workshops 33 special reports 70 Flies and mosquitoes 19 Food, adulteration of 45 Food, inspection and supervision Rateable value of Kent and Mortgage Interest Food poisoning 50 (Restrictions) Act 32 Food premises, registration of 51 Rodent control Health services, general pro- Sanitary circumstances of the vision of 18 area 30 Housing Act, 1936 35 Shops Act, 1934—section 10 51 Housing Act, 1949 38 Slaughterhouses 51 Housing:— 34 Slaughtermen's licences 52 New building 34 Smoke nuisances 31 Families rehoused 34 Social class mortality 14 Applications for rehousing 35 Staff 2 Stillbirths 11 Icecream—fat content 44 Swimming baths 25 Icecream—grading 43 Immunisation against infectious Tables list of 71 disease 62 Tuberculosis:— Infant mortality 11 Age and sex distribution 57 Infant mortality table 14 Analysis in divisional areas 58 Infectious diseases 53 Cases other than by formal Infectious disease visiting 56 notification 58 Introduction 3 Drugs and preparations in the treatment and prevention of 61 Laboratory facilities 20 Environmental investigation 60 Landlord and Tenant (War Mass miniature radiography 60 Damage) (Amendment) Act, Notifications and deaths 57 1941 32 Quarterly revision of register 59 Legal proceedings 66 Summary of statistics 59 Lewisham Old People's Welfare Association 28 Map of borough 8-9 Unsound food 49 Mass miniature radiography 60 Maternal deaths 12 Vaccination 62 Meat inspection 52 Vital statistics 11 Milk, analysis of 43 Milk and Dairies Regulations, 1949 41 Washing facilities at public Milk (Special Designations) conveniences 26 Regulations 41 Water certificates 33 Mortuary and Coroner's court 21 Water supply 22