LEW 38 METROPOLITAN BOROUGH OF LEWISHAM REPORT of the Medical Officer of Health for the Year 1950 E. H. R. Smithard, M.B.E., M.D., D.P.H. CONTENTS page Staff 2 Introduction 3 Vital Statistics 9 General Provision of Health Services 22 Sanitary Circumstances of the Area 40 Housing 48 Inspection and Supervision of Food 55 Infectious Diseases 65 Appendix A—Statutory Instruments 77 Appendix B—Legal Proceedings 79 Appendix C—Special Reports to Health Committee 84 List of Tables 85 Index 86 2 STAFF as at 31/12/50 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 Deputy Senior Sanitary Inspector E. Walker (a) (b). A. J. Phillips (a) (b). Group Sanitary Inspectors A. G. Thomas (a) (Food) R. Mahoney (a) (b) (District) J. R. Craven (a) (A) (Housing) District Inspectors Food Inspectors and Sampling Officers J. W. Bevan (a) (b) H. W. Ellery (a) (b) R. C. Brittain (a) (b) T. R. A. Fitzherbert (a) (b) C. L. Connor (a) H. Tolson (a) (b) S. G. Cocks (a) J. Edmunds (a) G. E. Fallows (a) (b) Housing Inspectors A. Gartside (a) (b) W. Hodson (a) R. S. Lane (a) (b) F.E. Levermore (a) W. S. Parsons (a) (b) Miss D. M. Parnell (a) K. R. Wagener (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 J. A. Enright Miss I. Coppin L. Gardiner C. R. Coleman Miss D. J. Miles Miss I. L. Hatton One vacancy L. J. Cleverly Coroner's Court and Mortuary W. Richardson, officer-in-charge Disinfecting Station, etc. J. G. Beale, superintendent R. A. Sharman, foreman rodent Foreman disinfector operative Disinfectors 9 Rodent operatives 3 Bathing attendants 2 Drain testers 2 Public Analyst A. J. Lickorish, f.i.c. Bacteriologists J. E. McCartney, d.sc., m.d., m.b., ch.b., and E. H. Bailey, m.r.c.s., l.r.c.p. of the Public Health Laboratory Service. 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 1950. The Registrar-General's estimate of the population in midyear 1950 at 228,300 was only 600 more than in the previous year, and this number also included members of the armed forces stationed in the area (which it has not done in previous years). I am not aware of the numbers of the armed forces. The prewar estimate of the total population, in June, 1939, was 231,000. The birth rate for the year at 15.3 again shows a drop; the figures in 1947 and successive years being 21.9, 18.9 and 16.8. The death rate shows a slight increase, from 10.2 to 10.6, and compares with 11.8 for the whole county of London. The infant mortality rate, which in the previous year dropped precipitously to 19, last year rose to 26; six out of the seven units of increase were in respect of the deaths of infants under one month of age —a rate which has altered very little in the last 30 years. Further comments on this appear both in the body of the report and in the paragraph of this introduction headed Maternity and Child Welfare. Eleven of the infant deaths occurred amongst the 147 illegitimate babies, which gives the very high illegitimate infant mortality rate of 75. The stillbirth rate showed a slight further drop this year to 14.7, and this is quite satisfactory. Two maternal deaths occurred during the year, giving a maternal mortality rate per thousand live and still births of 0.57. The various comparative figures since 1901 are shown on pages 20 and 21 (table 11). In connection with the work carried out during the year 1950, special mention may be made of the following:— Tuberculosis The number of new notifications increased from 371 to 406, showing an increase in the notification rate per hundred thousand population from 163 to 178. This increase is contrary to the national figures, which show a decrease in the rate from 102 to 99, and underlines the fact that although there may be possibly some little reason for the delight of the Ministry of Health when issuing the national figures, tuberculosis remains, as I have often said in previous annual reports, the most important infectious disease and one calling for a great deal of national and local effort. Further details of the work done in the borough will be found in the body of the report. The number of deaths from tuberculosis showed a welcome reduction, from 107 to 72. Last year I stated that the increased public interest in tuberculosis was a good thing because there was little doubt that more could be done by early treatment and above all by the protection of the young child and the susceptible adult to cut down considerably both the rate of 4 incidence and the rate of mortality. It is good, therefore, to learn from the 1950 report of the Lewisham group hospital management committee that hospital nurses are now offered the opportunity of being vaccinated against tuberculosis with BCG vaccine, a vaccine which has been in use abroad for many years, but which has only recently begun to find favour in official circles here. This vaccine is designed to produce a resistance to tuberculosis, so that when the person vaccinated receives a chance dose of infection he or she will be more easily able to overcome it. During 1950, 20 nurses were vaccinated in this way. Maternity and child welfare After a record low rate (19 per thousand live births) for any large town in the country, which Lewisham experienced in 1949, the infant mortality rate for 1950 increased to 25.8. This is disappointing although of course there is no special reason why Lewisham should have the lowest rate; it has still, at 25.8, a slightly lower rate than for the county of London (26.3) and for the country as a whole (29.8). The causes of the increase, as can be seen from table 4, are mainly immaturity, which accounted for 14 more deaths than in 1949, and pneumonia, etc., which accounted for four. It is not known accurately what percentage of Lewisham babies are breast fed and for how long they are breast fed, but when we took part in a national enquiry some three years ago we were among the better boroughs as far as breast feeding was concerned. There has been a considerable amount of controversy about the advantages of breast feeding and an enquiry, based on the national survey and published by Dr. J. W. B. Douglas during 1950, suggests that, statistically, bottle fed babies if reared in poor surroundings are less likely to survive than breast fed babies; where however their home conditions are good their chances of survival are not impaired. Bottle fed babies are also more likely to suffer from measles and, during the early months of life, from lower respiratory infections and minor attacks of diarrhoea. In spite of these findings, however, it is not felt that any marked reduction in infant deaths or illness would be brought about solely by raising the incidence of breast feeding. The mortality from infant diarrhoea seems in fact to be more related to the prosperity of the district than to the type of feeding. The report goes on to emphasise a point which has been made several times before and should be again repeated here, namely that the main risk associated with artificial feeding would be avoided if mothers were more aware of the dangers of infection and were particularly aware of the need for cleanliness in preparing bottle feeds. Food hygiene The food poisoning outbreaks which came to the notice of the department showed a decrease in the number of cases involved compared with the previous year. Altogether 38 cases of food poisoning were formally notified, but in addition a number of minor cases came to our notice as a result of other enquiries. Throughout the year the food inspectors continued to give advice to occupiers of food shops with regard to general hygiene, and particularly in relation to the avoidance 5 of flies and other pests. It is likely that this form of education is more effective when spread over the year in the form of oft-repeated advice than it would be if it were concentrated into a few days or a week such as may happen in a special clean food campaign. The opportunity was, however, taken at an exhibition held at the town hall in the autumn in connection with the jubilee celebrations of the borough council to pay special attention to food hygiene and food handling. Infectious diseases Tuberculosis, the most important of the infectious diseases, has been mentioned separately above and is dealt with at considerably greater length in the body of the report. With regard to the more acute infections the number of cases of measles was very slightly higher than in the previous year (2084 as against 1940), but by the end of the year an epidemic appeared to be in full swing. A graph showing this is printed on page 67. There was again a slight increase in the number of cases of pneumonia (108 as against 84). Poliomyelitis (infantile paralysis) cases numbered 38, roughly equivalent to the number the year before. This was in spite of the summer not being abnormally hot or sunny and in spite of its being considerably wetter than normal. It has been thought that there is a close connection between hot, dry weather and the number of cases of poliomyelitis, but as yet there is insufficient scientific proof of this. Scabies continued its decline and last year only 22 cases were notified ; this compares with a peak figure of 654 in 1944. Scarlet fever showed a decrease after four successive years of increase, and remained of a very mild type. Whooping cough increased considerably, the 813 cases notified probably being a record for the borough and being 24 cases more than the number in 1948, which was probably a record until then. Dysentery cases increased to 63 and towards the end of the year the number in the country generally was exceptionally high, and there was evidence that the wave, which started in the north of the country, was moving south and had reached London. For the first year on record there was no case of diphtheria notified and subsequently confirmed in the borough. The reasons for this may be multiple, but doubtless one of them, and probably the most potent of them all, is the protection conferred on children by artificial immunisation. Thus, national figures recently published have shown that there were 12,514 cases in children under 15 in 1945 and that this dropped rapidly to 1,322 in 1949. In the former year there were 493 deaths in such children while in 1949 there were 63. Analysing this material into the children who were non-immunised and the children who were immunised, it is found that the fatality rate, i.e., the likelihood of diphtheria killing the attacked child, remains much the same over the years, being 69 per thousand for the non-immunised in 1945 and 67 in 1949, while for the immunised it was only 8 in 1945 and 9 in 1949. Unfortunately in 1950 national figures indicated that for the first time for many years the number of children immunised against diphtheria dropped considerably. This also took place in Lewisham and table 52 shows that 3,091 children under 15 were immunised here as opposed 6 to 3,944 in the previous year. The drop was mainly in the age period one to three, and could have been caused in part by its becoming known that there was a very slightly greater risk of a child who had been recently immunised developing poliomyelitis than there was in a child who had not been immunised. This risk, however, is very small indeed and is only apparent when there are many cases of poliomyelitis about. While, therefore, until the exact size of the risk has been estimated (an investigation is now being carried out by the Medical Research Council) a parent, if seeking advice, would probably have it suggested to him that his child should be immunised in the first half of the year, thus avoiding the main months when poliomyelitis is more frequent, he would also be advised that the risk of the child getting diphtheria, if non-immunised, was considerably higher than the risk of the child developing poliomyelitis through being immunised. It is not possible of course to balance exactly risks of this nature, but rather than put off diphtheria immunisation permanently it would certainly seem much better to take the slightly added risk of having a child done during the second half of the year; the best advice of all of course, which cannot be emphasised too much, is to have the child immunised against diphtheria as soon as practicable after it is four months or so of age, but preferably in the first half of the year. Old people Comments on the position in 1950, and in particular on the help which the borough council was able to give to old people's organisations in the area, are made on page 35. Some real progress in the care of old people was made, but with this increasing problem ("naturally" increasing because of the relative increase in old people and the decrease in young people in the community) a very great deal more is required. It may be that this will be obtainable from voluntary effort, but it may be that the local authorities will be required, as time goes on, to increase their support of voluntary organisations financially and otherwise, or even to take over certain parts of the work themselves. Social medicine statistics In section A, vital statistics, I have included some comments on and statistics of social classes in relation to births and deaths. In future years these may be enlarged to cover analysis of the type of house involved. I commented on social class statistics in the last annual report and pointed out that although there are several hundred occupations which persons may follow, these can very approximately be grouped into five different social classes:— 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 Over the country as a whole it has been found that for certain causes, particularly stillbirths and infant deaths, the rates vary greatly according to social class, and in the report of the Biological and Medical committee for the Royal Commission on Population (published in 1950) it was shown that for 1939 the stillbirth rate increased from 24 for social class I to 40 for social class V, and the death rate of infants (from one month to the end of the first year) increased similarly from 8 to 30. It is by such analyses as this that the exact causes of suffering and death may sometimes be shown and this helps to suggest appropriate ways of overcoming such difficulties. It is hoped in future years to compare Lewisham with other towns in the country of approximately the same population, and further details with regard to this are also published in section A of the report. Divisional statistics In the last report many of the figures were for the first time analysed into the parliamentary divisions of the borough, namely, West Lewisham, North Lewisham and South Lewisham. All three 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 much less old property than do either of the other two divisions. A map was shown on pages 8 and 9 of last year's report to indicate the principal boundaries of the divisions. As an indication of the way in which infectious diseases can differ in the three divisions a graph is printed on page 66, showing the incidence of scarlet fever in west, north and south Lewisham separately. It shows that the greatest incidence was in the west division and particularly so in the first half of the year. After that time the west division had rather less cases than the others. In ending the introduction to this report I wish to express my thanks to the health department staff for their work during the year. In June, Mr. C. E. Holifield, the senior sanitary inspector, retired on reaching the age limit. This followed the retirement only three years previously of Mr. C. C. Summers, the chief clerk of the department. Mr. Holifield and Mr. Summers had devoted almost all their working life to the service of the borough ; Mr. Holifield having been an officer of the Council since 1914 and Mr. Summers since 1905. During their time here they saw very considerable alterations in the character of the borough and in its populatioh and in the problems arising therefrom, and their own work and energy had a definite influence on the way in which the health services of the borough developed to deal with the new problems which appeared. The best wishes of the Council and of the staff were expressed to them on their retirement. 8 My thanks are also due to the Public Health committee for their support and guidance in the work done. The committee at the end of the year was constituted as follows:— Councillor H. M. Pinnell (Chairman); Councillor C. P. Braithwaite (Vice-Chairman); The Mayor (Alderman Stafford W. Moys, j.p.).; Aldermen Mrs. N. M. Huggett and C. Street; Councillors Mrs. S. H. Armstrong, Mrs. B. Beardwell, Mrs. N. L. Bunce, A. O. Carter, Mrs. B. M. Drapper, j.p., R. L. Evans, W. J. Fisher, Miss M. S. Halsey, E. F. Hasling, F. E. G. Hawes, Mrs. G. M. M. Land, Mrs. M. Smith, P. E. Stoffel and J. H. Tutt. 9 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 home population at midyear 1950 was 228,300 (this includes members of the armed forces stationed in the area).* Rateable value County of London rateable value of the borough at April 1, 1950 £1,804,961 Estimated net product of a penny rate, 1950/51 £7,280 Number of separately assessed dwellings at April 1, 1950 61,350 Births (adjusted for inward and outward transfers) No. of live births 3,487 Males Females Total Legitimate 1,712 1,628 3,340 Illegitimate 73 74 147 Totals 1,785 1,702 3,487 Birth rate per 1,000 of the estimated population 15.3 Birth rate for England and Wales15.8 Birth rate for London administrative county 17.8 Stillbirths The total number of stillbirths allocated to the borough during the year was 52. This represents a stillbirth rate per thousand live and stillbirths of 14.7. Deaths The total number of deaths belonging to the borough registered during the year was 2,413, consisting of 1,234 males and 1,179 females, giving a death rate per thousand of the estimated population of 10.6 as compared with a rate of 11.6 for England and Wales and 11.8 for the administrative county of London. Infant mortality Number of infant deaths 90 Legitimate 79 Illegitimate 11 Rates: 1. All infants per thousand live births 25.8 2. Legitimate infants per thousand live legitimate births 23.6 Illegitimate infants per thousand live illegitimate births 74.8 Neonatal deaths (under one month of age) 67 Neonatal death rate (per 1,000 live births) 19.2 Reproductive wastage- Stillbirths plus infant deaths 142 Rate per thousand live and stillbirths 40.1 * A preliminary report indicates that at the census in 1951 the population was 227,551 10 Maternal deaths Number of maternal deaths 2 Maternal mortality rate per thousand live and stillbirths 0.57 Other special causes of death Number of deaths from Measles 1 „ „ „ Whooping Cough 2 ,, ,, „ Diarrhoea (under 2 years) 2 „ „ „ Road Traffic Accidents 12 „ „ „ Suicide 18 „ „ „ Tuberculosis (all forms) 72 „ „ „ Cancer (Code Nos. 10—15) 473 „ „ „ Heart and Circulation Diseases (Code Nos. 17-21) 1,127 Comparative statistics for the year 1950 Table 1 Birth rate (per 1,000 population) Death rate (per 1,000 population) Infant mortality rate (per 1,000 live births) Live births Still births Lewisham 15.3 0.23 10.6 25.8 England and Wales 15.8 0.37 11.6 29.8 London Administrative County 17.8 0.36 11 .8 26.3 General summary of Vital Statistics for the last ten years Table 2 Year Estimated population Births Deaths Deaths under one year Deaths from pulmonary tuberculosis Number Rate Number Rate Number Rate Number Rate 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 1950 228,300 3487 15.3 2413 10.6 90 26 66 0.29 *based, by Registrar-General, on 1558 births registered locally. 11 Causes of death at different periods of life during the year 1950 The following table shows the causes of and ages at death during the calendar year 1950:— Table 3 Code No. Cause 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 25 25 and under 45 45 and under 65 65 and under 75 75 and over Totals, all causes 2413 90 13 5 24 139 578 621 943 1 Tuberculosis, respiratory 66 - - - 7 29 21 8 1 2 Tuberculosis, other 6 - - - - 3 2 1 - 3 Syphilitic disease 11 — — — — 2 3 S 1 4 Diphtheria — — — — — — — — — 5 Whooping cough 2 — 2 - - - - - - 6 Meningococcal infections... 1 1 - - - - - - - 7 Acute poliomyelitis - - - 1 - - - - - Measles 1 - - 1 - - - - - 9 Other infective and parasitic diseases 13 - 1 1 - 3 2 4 2 10 Malignant neoplasm, stomach 61 - - - - 2 24 16 19 11 Malignant neoplasm, lung, bronchus 78 - - - - 5 48 22 3 12 Malignant neoplasm, breast 56 — — — — 7 27 7 15 13 Malignant neoplasm, uterus 22 — — — — 2 11 5 4 14 Other malignant and lymphatic neoplasms 244 - 2 - 1 10 85 73 73 15 Leukaemia, aleukaemia 12 - 1 - 2 1 3 5 - 16 Diabetes 21 - - - - 2 5 6 8 17 Vascular lesions of nervous system 248 - - - - 8 42 91 107 18 Coronary disease, angina 281 - - - - 8 79 82 112 19 Hypertension with heart disease 81 - - - - - 15 30 36 20 Other heart disease 438 - - - - 11 52 91 284 21 Other circulatory disease 79 - - - - 1 12 27 39 22 Influenza 24 2 - - 1 2 2 7 10 23 Pneumonia 85 7 2 - - 4 17 15 40 24 Bronchitis 149 2 - 1 - 1 39 39 67 25 Other diseases of respiratory system 16 - 1 - - - 5 5 5 26 Ulcer of stomach and duodenum 33 - - - - 1 10 8 14 27 Gastritis, enteritis and diarrhoea 13 2 - - - - 2 3 6 28 Nephritis and nephrosis. 25 - - - 2 6 8 4 5 29 Hyperplasia of prostate ... 33 - - - - - 2 12 19 30 Pregnancy, childbirth, abortion 2 - - - - 1 1 - - 31 Congenital malformations 29 17 1 1 4 2 2 2 - 32 Other defined and illdefined diseases 204 57 2 1 4 14 45 33 48 33 Motor vehicle accidents 12 - - - 1 3 2 5 1 34 All other accidents 49 2 1 - 2 8 6 8 22 35 Suicide 18 - - - - 3 6 7 2 36 Homicide and operations of war — — — — — — — — — *Deaths under 1 year are further analysed in the next table. 12 Deaths under 1 year of age Table 4 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 1 yr. Meningococcal infection M _ _ _ _ _ _ - _ 1 _ 1 F - - - - - - - - - - - Influenza with pneumonia M - - - - - - - - - - - F - - - - - - - - 1 1 2 Pneumonia M - - - - - - 1 1 - 1 3 F - - - - - - - 2 1 1 4 Bronchitis M - - - - - - - 1 1 - 2 b Hernia M 1 - - - - 1 - - - - 1 F - - - - - - - - - - - Gastroenteritis and diarrhoea M - - - - - - 2 - - - 2 F - - - - - - - - - - - Congenital malformations M 1 3 1 1 - 6 1 1 - - - F 2 3 1 - 1 7 - - 2 - 9 Birth injury etc. M 2 2 - - - 4 - - - - 4 F 1 - - - - 1 - - - - 1 Asphyxia and atelectasis M 3 3 - - - 6 - - - - 6 F 1 1 - - - 2 - - - - 2 Illdeflned diseases peculiar to early infancy M - - - - - - 1 - - 1 F - - - - - - - - - - - Immaturity M 5 11 - - - 16 1 - - 17 F 3 8 1 - - 12 - - - 12 Diseases of the newborn M - 2 - - - 2 - - - - 2 F 1 4 3 - - 8 1 - - - 9 Lack of care M 1 - - - - 1 - - - - 1 F 1 - - - - 1 - - - - 1 Other causes M - - - - - - - 1 - - 1 F - - - - - - - - - 1 1 TOTALS M 13 21 1 1 36 5 5 2 1 49 F 9 16 5 - 1 31 1 2 4 3 41 GRAND TOTAL 22 37 6 1 1 67 6 7 6 4 90 13 Statistics of social medicine It is useful, for comparative purposes, to observe the statistics of towns or areas of roughly equal size. It is known that many factors may go to make up a vital statistic—latitude, rainfall, social class, type of industry carried on, proportion of unemployment, overcrowding and condition of housing being some of these. One of the most important vital statistics, because it is generally accepted as the most accurate index of a community's health insofar as any one statistic can be taken as a measure of that health, is the infant mortality rate, that is the number of deaths of children under one year of age per thousand live births in the year. It so happened that in 1949 the infant mortality rate for Lewisham was lower than that for any other community in the British Isles of comparable size or larger, and Lewisham was the only large community to have a rate below 20. The rate was in fact 19.1. This very satisfactory and almost spectacular record was not known at the time of writing last year's annual report. The rate itself was known and published, but the comparable rates of other communities were not known. There are many factors which must have gone to produce this low rate, some of which are "natural" factors as indicated above, but in addition some credit must fall on the health services and hygiene services which have been built up by the borough council over the years. Some of these, namely the personal health services, were transferred to the county council a little time previously—too short a time, however, for that particular rate to be significantly affected, but the infant mortality rate is not the only interesting rate for the comparison of different communities. I thus came to the conclusion that it would be desirable not only for ourselves, but for other communities, to make a more exact comparison of the vital statistics of those communities. Certain comparable vital statistics are obtainable through the RegistrarGeneral though, as already stated, they are often obtainable too late to comment on in the succeeding year, and therefore a scheme was got out by which additional statistics were to be kept for the communities concerned and which could be compared early in the succeeding year. Communities with a population between 200,000 and 300,000 were chosen, of which there are 14 in England and Wales, and nearly all the health departments of these communities have promised to keep the special statistics for the year 1951. These however obviously cannot be reported and commented on until 1952, but as indicated in my annual report for last year (page 7), we have ourselves been keeping certain statistics in social class order for the past two years and an analysis of these for 1950 is set out below. They are mainly for record purposes and for comparison in future years, and it would be unwise to make any major deductions from them. I hope however next year to deal with this matter at greater length and to publish a comprehensive table giving the special statistics for the 14 areas of population between 200,000 and 300,000, which are as follows — Bradford, Cardiff, Coventry, Croydon, Harrow, Hull, Islington, Lambeth, Leicester, Lewisham, Newcastle, Plymouth, Portsmouth, Stoke-on-Trent. 14 Not quite all these boroughs however will be able to furnish enough statistics for a complete comparison. The main comparable figures, in addition to simple rates, will be as follows:— (1) Registered births divided into social class. (2) Notified premature births divided into social class. (3) Registered stillbirths divided into social class. (4) Infant deaths in social class. (5), (6), (7) and (8). The above four statistics further analysed separately into the type of house, i.e., the mother's recognised home at the time of the birth (whether the birth is in hospital or elsewhere) or the infant death. The three sub-divisions of this are (i) council property; (ii) requisitioned property; (iii) other property. (9) Analysis of total deaths by social class, and, as separate figures, deaths from (10) Tuberculosis of the respiratory system, (11) Heart disease, (12) Pneumonia, (13) Bronchitis. (14) and (15). Analysis of all new notifications (excluding inward transfers) and posthumous "new cases" of tuberculosis of respiratory system, for social class and type of house. (16) Analysis of the incidence of certain other infectious diseases in relation to social class and type of house. Cases occurring in hospitals or institutions (if likely to have been infected there) are excluded. Social class in relation to cause of death Of the 2,414 deaths analysed by us the social categories were as follows :- Table 5 Social class 1 II III IV V Total No information Males 53 231 611 162 162 1219 20 Females. 37 207 593 162 126 1125 50 Total 90 438 1204 324 288 2344 70 Percentage 4 18 51 14 13 100 — It will be seen that the total number of deaths computed by us is one more than the number computed by the Registrar-General. The approximation is surprisingly good. 15 The social class, related to cause of death, was as follows :— Table 6 Code No. Cause of death Male Female 1 II Ill IV V Total 1 II Ill IV V Total 1 Tuberculosis, respiratory _ 1 22 5 7 35 2 3 19 5 2 31 2 Tuberculosis, other - 1 — — — 1 - — 1 — — 1 3 Syphilitic disease 1 — 3 1 2 7 - — — — 1 1 4 Diphtheria -- - - - - - - - - - - - 5 Whooping cough - — 1 — — 1 - — 1 — — 1 6 Meningococcal infections - — 1 — — 1 - — — — — — 7 Acute poliomyelitis - - - - --- - - - - - - - 8 Measles - 1 — — — 1 — — 1 - - 1 9 Other infective and parasitic diseases - - 2 2 - 4 - - 2 2 - 4 10 Malignant neoplasm, stomach 2 4 14 6 9 35 2 2 12 4 5 25 11 Malignant neoplasm, lung, bronchus 3 6 35 9 12 65 1 5 1 2 9 12 Malignant neoplasm, breast ... - — — — — — - 13 27 6 9 55 13 Malignant neoplasm, uterus ... - 2 3 11 4 1 21 14 Other malignant and lymphatic neoplasms 5 24 71 16 18 134 3 18 70 19 9 119 I5 Leukaemia, aleukaemia - - - - - - - - - - 1 1 16 Diabetes - 3 6 2 - 11 - 2 7 2 1 12 17 Vascular lesions of nervous system... 30 34 6 5 75 4 24 45 19 10 102 18 Coronary disease, angina 9 28 69 18 18 142 4 15 36 11 8 74 19 Hypertension with heart disease 7 25 47 10 7 96 7 21 47 9 14 98 20 Other heart disease 6 29 63 24 24 146 5 38 105 25 27 200 21 Other circulatory disease 2 17 20 11 7 57 1 12 27 9 3 52 22 Influenza - - 5 1 2 8 1 2 9 3 - 15 23 Pneumonia 3 7 25 14 9 58 - 8 26 6 3 43 24 Bronchitis 6 12 53 11 17 99 - 7 39 14 7 67 25 Other diseases of respiratory system 26 Ulcer of stomach and duodenum 1 6 12 3 5 27 1 1 3 1 - 6 27 Gastritis, enteritis and diarrhoea - 1 2 2 - 5 — 2 2 - - 4 28 Nephritis and nephrosis - 3 10 1 - 14 2 7 8 1 3 21 29 Hyperplasia of prostate 2 4 17 5 3 31 - — — — — - 30 Pregnancy, childbirth, abortion — - — — — — - - — 1 1 2 31 Congenital malformations - - 1 1 - 2 - - 8 1 - 9 32 Other defined and illdefined diseases 5 22 66 12 12 117 3 21 73 12 15 124 33 Motor vehicle accidents - 1 4 - - 5 — 1 1 1 2 5 34 All other accidents 1 3 13 2 5 24 _ 4 10 5 2 21 35 Suicide - 3 9 - - 12 - 2 3 1 - 6 36 Homicide and operations of war - - - - - - - - - - - - No social class assessed - — — — — 20 - — — 50 16 Comparing tables 3 and 6 it will be seen that there are many discrepancies in the totals for the different causes of death. This, apart from error in computation, may be due to several causes. For example, the death returns as they arrive in the office do not always clearly indicate the basic cause of death, and this has sometimes to be deduced. A death certificate may show three or four or even more diseases and unless the basic cause is clearly specified it may have to be taken as a probability. Furthermore, doctors will ascribe deaths to various basic causes according to their own views as to which cause is more basic than the others. Thus in a patient dying of cerebral haemorrhage, which may be due to high blood pressure, which in turn may be due to general hardening of the arteries, any one of these three causes may be thought to be the basic one. If the patient in addition had pulmonary tuberculosis none of the three would count but the patient's death would be ascribed to code No. 1 (tuberculosis). For comparative purposes therefore it is safer to group the causes which are linked together. Thus code numbers 10 to 15 may be regarded as all different kinds of cancer, while numbers 17 to 21 are all diseases of the heart and circulation. Similarly 22 to 25 are best grouped together. Certain statistics have therefore been extracted from table 6 and grouped in this way. They are shown in table 7 which also includes the percentages of each social class for each disease or group of diseases. The percentages should be compared with those shown in table 5 for all deaths. Table 7 Male Female 1 II III IV V Total 1 II III IV V Total 1, 2 TB No. - 2 22 5 7 36 2 3 19 5 2 31 °/ /o — 6 61 14 19 100 6 10 62 16 6 100 10-15 Cancers No. 10 34 120 31 39 234 7 37 125 34 27 230 % 4 15 51 13 '17 100 3 16 54 15 12 100 17-21 Heart and circulation No. 24 129 233 69 61 516 21 110 260 74 62 527 % 5 25 45 13 12 100 4 21 49 14 12 100 22-25 Lung, non-TB No. 9 19 83 26 28 165 1 17 74 23 10 125 % 5 12 50 16 '7 100 / 14 59 18 8 100 33, 34 Accidents No. 1 4 17 2 5 29 — 5 11 6 4 26 % 3 14 58 7 18 100 — 19 42 23 16 100 35 Suicide No. — 3 9 _ — 12 — 2 3 1 _ 6 % — 25 75 — - 100 — 33 50 17 _ 100 17 The following table shows the social classification in relation to registered births, to registered infant deaths, to notified stillbirths and to notified premature births, an extra line being added to each group to indicate the percentages. Apart from the registered births the figures are too small to be significant, but they will build up over the course of years; the percentages in the category of registered births can be compared with those for the registered deaths shown in table 5. Table 8 Social classification Total Not classifiable I II III IV V Registered births No. 155 489 2136 478 224 3482 8 % 4 14 61 14 7 100 Registered infant deaths No. 1 16 56 7 7 87 3 % / 18 65 8 8 100 Registered stillbirths No. 6 13 27 5 1 52 - % 12 25 51 10 2 100 Notified premature births No. 5 31 114 29 10 189* 4 % 3 16 60 16 5 100 *This number is of children born in the borough and whose mothers are domiciled in the borough. Quite apart from any connection with births or deaths, the percentages shown for registered births in table 8 and those shown for registered deaths in table 5 are interesting. The parents of newborn babies probably average 25-30 years of age and are divided amongst the social classes as to 1 in 25 in class I, 1 in 7 in class II, 3 out of 5 in class III, 1 in 7 in class IV, and 1 in 14 in class V. People dying in the borough, who probably average about 65 years of age, are divided amongst the social classes as to 1 in 25 for class I, 1 in 6 in class II, 1 in 2 in class III, 1 in 7 in class IV and 1 in 8 in class V. In other words, while the percentages in classes I, II and IV remain about the same there is a greater percentage in class III amongst the births and a greater percentage in class V among the deaths. This is a little surprising, and it will be interesting to see if figures in subsequent years bear it out. There is roughly a 40-year gap between the two groups and one would have thought that the birth classifications would have shown a somewhat lower social status than the deaths. But of course there have been other factors concerned—for example the difference in social status on a national scale, the local differences due to the growth of the borough and the differing local occupations, and so on, quite apart from possibilities like differences in the reproduction rates in the social classes. 18 An analysis of certain of the infant mortality figures in social classes is given in he subjoined table :— Table 9 Social class I II III IV V Not classifiable Total Influenza, bronchitis, pneumonia - 2 8 1 - _ 11 Diarrhoea - - 1 1 - - 2 Congenital malformations - 1 13 2 1 - 17 Immaturity - 7 16 2 4 - 29 All infant deaths 1 16 56 7 7 3 90 Premature births The satisfactory reduction in the infant mortality rate in Lewisham over the years has been, as table 11 shows, much more marked in the age group of one month to 12 months than it has been in the age group of birth to one month. The latter is called the neonatal period and the infant mortality rate for that period is called the neonatal rate. It will be seen from table 11 that whereas the neonatal rate has, over the last 20 or so years, fallen from just over the twenties to just under the twenties, the rest of the first year rate has fallen from the twenties to 6 or 7, which, of course, is a much greater reduction. A more detailed analysis of neonatal mortality, which has been given in tables in the annual reports, indicates that there are certain factors which particularly stand out in causing the deaths of young babies. One of these factors is prematurity. Before the war over 40 percent of neonatal deaths were ascribed to prematurity, but in the last three years the percentage has decreased to 23—possibly in part due to better diagnosis of other conditions. A premature baby in the strict meaning of the language is a baby which is born before the 40th week of gestation, but in medical practice an easier definition is accepted, namely any child born after the 27th week of pregnancy who weighs lbs. or less. The number of such premature children born in relation to the total number of children born (the premature birthrate) varies slightly, and the figures for the last two years during which statistics have been kept show that while the male rate went up slightly, the female rate, which was high in 1949, approximated to the male rate in 1950 (table 10). It should be noted that these figures are based on the notified births (i.e., births occurring in the borough) as the proportion of prematures to registered births is not known. It is highly likely however that it is substantially the same. 19 Table 10 Notified births Premature births Rate per 1000 births 1949 Males 2008 113 56 Females 1867 140 75 Total 3875 253 65 1950 Males 1911 110 58 Females 1817 114 63 Total 3728 224 60 Though prematurity may be caused by many factors, in a recent investigation by Dr. J. W. B. Douglas after a national survey, it was stated that (1) mothers of premature babies make less use of the available antenatal services than mothers of babies born at term; (2) the incidence of premature births is abnormally high among first babies where the mother is doing paid work during the last month of pregnancy. (Neither of these two conditions can be explained statistically by the shorter duration of the pregnancy, nor the greater youth or poverty of the mothers); (3) the harmful effects of work late in pregnancy are not limited to those gainfully employed outside the home—it appears that lack of domestic help is also associated with a high risk of prematurity. Perhaps one of the most important factors as far as public health is concerned, is the nutrition of the mother. It is thought that the improved national nutrition which has occurred since the enlightened policy of the Ministry of Food (which commenced early in the war), was started has caused the rate of prematurity to drop, just as the stillbirth rate has dropped, but there are no certain statistics to cover this point. Local authorities under circular 20/44 of the Ministry of Health were encouraged to arrange for special help for such children. Certain arrangements were made in this borough, but it is generally thought that in a built-up area such as this, with easy transport to hospital, it is better for a premature baby to be removed to hospital, so that it can have the benefit of the expert nursing care and specially designed apparatus which is available there and nowhere else. 20 General Statistics from 1901 Table 11 Year Births Maternal death rate† Stillbirth rate† Neonatal death rate§ One month to one year death rate§ (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 NJ Table 11 Year Births Maternal death rate† Stillbirth rate† Neonatal death rate § One month to one year death rate § (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 1950 3487 15.3 0.6 15 19 7 26 40 1.6 0.29 Nil *per 1,000 population. †per 1,000 live and stillbirths. §per 1,000 livebirths. — equals figure not available. 22 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 12 Disinfecting station West North South Total Disinfections Premises visited 330 220 207 757 Rooms disinfected 720 501 434 1655 Articles disinfected 3806 6110 2051 11967 Disinfestation Premises visited 117 104 33 254 Rooms disinfested 419 301 91 811 Articles disinfested 265 214 43 522 Articles treated Beds 100 61 85 246 Mattresses 343 684 216 1243 Bolsters 108 56 63 227 Pillows 678 1000 337 2015 Cushions 86 41 36 163 Quilts 197 198 138 533 Blankets 810 766 491 2067 Sheets 231 386 125 742 Other household articles 741 1154 370 2265 Wearing apparel 777 1978 233 2988 Total articles 4071 6324 2094 12489 Articles received from cleansing station 2254 2252 2256 6762 Articles received from Coroner's court 375 - 375 Public library books treated after infection 267 401 211 879 Private library books treated after infection 94 54 21 169 Articles treated under the Public Health (London) Act S.122 60 157 -- 217 Cleansing station Children treated for verminous condition 410 483 322 1215 Adults treated for verminous condition 20 38 18 76 Scabies baths, children ... 19 27 47 93 Scabies baths, adults 18 33 11 62 Treatment by disinfection Rooms and furniture are sprayed with a solution of Izal. Bedding is steam treated with a pressure from 10-20 lbs. per square inch. 23 Articles are either steam treated with a pressure from 5-101bs. per square inch, or placed in the formalin chamber, according to their nature. Treatment by disinfestation Rooms and furniture are sprayed with a proprietary solution containing 5 percent DDT. Bedding is steam treated with a pressure of 201bs. per sq. in. Articles are steam treated with a pressure of lOlbs. per sq. in. Antifly and antimosquito campaign The campaign, which lasted from May 1 to September 30, was organised on similar lines to the campaigns held in previous years. Four men were employed working as two pairs, using motor cycles with sidecars as transport. The number of sites and spraying points visited was 1,098, an increase from the previous year's figure of 589, due mainly to the inclusion of dust chutes in blocks of flats. These 1,098 sites were visited as a routine and during the season each site was treated on various occasions. General sites, e.g., bombed sites, grass verges, etc., were each visited on 9 occasions, and special sites consisting of stables, allotments, dust chutes, etc., were each visited on 22 occasions during the course of the campaign. Altogether 17,656 visits and treatments were made, and in addition sprayings were carried out in 17 houses by the permanent disinfecting staff where special complaints were received. Twelve of these complaints were in the neighbourhood of the Hither Green Sidings. In each case where a complaint was received, a supply of insecticide containing 5 percent DDT was left with the householders for use in their own sprays, a total of 8 gallons of insecticide being dispensed in this way. In addition to the above, measures were taken to deal with especially offensive deposits, including such things as old mattresses or dead animals, either by destruction on the site or by collection and destruction centrally. Sixty gallons of paraffin were used for destruction of such items on site, and amongst the items dealt with were 89 mattresses. 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 3¾ tons of gammexane powder was used. With regard to fly infestation in the neighbourhood of Hither Green Siding the Railway Executive (Southern Region) promised to carry out work on the track, consisting of spraying and cleaning, which it was hoped would be effective in combating a possible fly nuisance. A sprayer and insecticide were supplied by the Railway Executive and the site where the loading of manure takes place was sprayed daily, and further steps were taken to control the loading of this traffic. Laboratory facilities As from January 1 specimens for examination concerning bacteriology and epidemiology in relation to the diagnosis, prevention and control of infectious disease were sent to the Southern Group Laboratory 24 at Park Hospital instead of to Dr. Bousfield's laboratory at 134, Denmark Hill, S.E.5. This service is provided by the Public Health Laboratory Service which is directed by the Medical Research Council, and 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, provision is also made for the examination of water, shellfish, 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 pathogenic 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 1950 :— (1) Throat/nose swabs Diphtheria bacilli 1 Haemolytic streptococci 160 Vincent's angina 1 Negative 278 Total - 440 (2) Faeces Shigella 29 Salmonella 19 Protozoa 1 Negative 251 Total - 300 (3) Sputum TB smear 2 Other organisms 3 Negative 54 Total - 59 (4) Pertussis Cough plate — Postnasal swab - Negative 2 Total -2 (5) Milk, etc. Pasteurized 40 Other 10 Icecream 101 Total 151 (6) Water Domestic supplies, etc 13 Swimming pools 10 Total 23 (7) Miscellaneous 98 1073 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. 25 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 in no instance was it necessary to apply to the court for an order for compulsory removal. 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 accepted responsibility for the burial of 7 persons, at a net cost of £A\ 0s. 6d. 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 575, of which 255 were received from hospitals. 575 postmortem examinations were made and inquests were held in 108 cases. Details are shewn in the following table :— Table 13 Month bodies received from hospitals Others Post-mortem examinations sts/ January 18 35 53 5 February 21 32 53 7 March 25 30 55 9 April 23 27 50 11 May 22 18 40 9 June 17 26 43 6 July 21 19 40 11 August 19 30 49 12 September 20 25 45 11 October 23 27 50 6 November 17 23 40 9 December 19 28 57 12 TOTALS 255 320 575 108 26 Rodent control A small section, consisting of a foreman and 3 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 14 Parliamentary Division Total West North South Number of complaints received 1213 2473 1770 5456 Number of premises baited :— Initial treatments 499 784 653 1936 retreatments 1251 1097 824 3172 Investigations :— no infestation found 714 1689 1117 3520 total number of visits 6781 7195 5653 19629 estimated kill 2313 2683 2040 7036 In addition, special liaison is made twice yearly with the Borough Engineer's department for the baiting of sewers. In the year 1950 the work took place from June 5 to 28 and from November 30 to December 20. Bait was laid on three consecutive days and consisted of sausage rusk (on the first two days) with 2½ percent zinc phosphide on the third day. 2836 manholes were baited in the summer and 2839 in the winter. 1845 (summer) and 1640 (winter) showed a prebait take and of these 1034 (summer) and 1060 (winter) showed a complete prebait take on one or both days. The manholes were not inspected after the poison bait was laid. In order to cope with the increasing number of complaints of rat and mouse infestation, approval has been given to retaining the services of the four men employed on the antifly and antimosquito campaign at the termination of this campaign and in future to use them during the winter months as rodent operatives. These four men will thus spend 5 months of the year on work in connection with the antifly and antimosquito campaign and the remaining seven months on rat and mice repression. Rodent control—treatment of rivers In addition to the measures taken to deal with the destruction of rats in private and business premises, special efforts are made to cope with this problem as it affects the rivers in the borough. The normal practice followed in treating rivers is to lay prebait on three consecutive days followed by poison bait on the fourth dayThe poison bait used is zinc phosphide mixed with sausage rusk and water. 27 The following table gives a summary of work carried out in respect of the rivers during 1950:— Table 15 River Location No. of base points Prebaiting Poison bait Estimated rats killed No. of days on which prebait laid Results Amount laid (ozs.) Amount taken (ozs.) Takes Small takes No takes Quaggy Lee Green to Silk Mills Path 33 3 80 10 9 60 39 88 Ravensbourne Ladywell Recreation ground to Catford Bridge 14 3 15 9 18 16 10½ 23 Brangbourne Road to Bamford Road 15 4 52 - 8 26 10 20 Bamford Road to Chelford Road 10 4 32 - 8 16 5 10 Chelford Road to Flower House Estate 15 4 44 - 16 30 8½ 17 Pool Southend Lane (Bell Green) to South Eastern Gas Board works 14 3 12 30 - 28 18 40 South Eastern Gas Board works to Winsford Road 16 3 15 12 21 18 14 33 Prevention of Damage by Pests Act, 1949 This Act, which came into operation on March 31, 1950, replaced the Rats and Mice (Destruction) Act, 1919. The new Act emphasises that the primary obligation is on the local authority to ensure that, so far as practicable, its area is kept free from rats and mice. Under the old Act the primary duty was laid upon the individual occupier, coupled with a right to the local authority to enforce the requirement upon him. A duty is laid upon the occupier of any premises to give written notice to the local authority when he has knowledge that rats or mice are present in substantial numbers. This new requirement is based primarily on recognition of the probable relation of presence of rats or mice in particular premises to a general infestation of the locality, and the notices required of individual occupiers are intended to furnish evidence which may lead to the source of the trouble, where effective action can be taken by, or to the satisfaction of, the local authority. This new requirement does not remove the right of the occupier to arrange for the destruction of rats or mice on his premises, nor does the exercise of that right relieve him of the duty of giving notice of their presence in substantial numbers. "Substantial" numbers is determined by the character of the occupation, the size of the premises and other relevant factors. 28 Owners and occupiers of food premises are required to notify the Minister of Agriculture and Fisheries, and not the local authority, of any infestation on their premises which involves an immediate or potential risk of substantial loss of, or damage to, food. This provision relieves the occupier from the duty of dual notification, the local authority being informed by the Minister of all such notifications where the infestation is by, or includes, rats or mice. The Act places for the first time a duty on the owners as well as on the occupiers of premises, according to the nature of their interest, thus removing the former serious impediment which was inseparable from the sole duty being upon occupiers, with limitation to the steps which it was reasonably practicable for them to take. Formal notice may be served on owners and occupiers of property requiring them to comply with requirements in conformity with the general duty on local authorities to secure that their districts, so far as practicable, are kept free from rats and mice. Notices may specify methods to be used for destruction of pests and for the execution of structural work. There is one exception to the principle that the owner or occupier has a right to arrange for the destruction of rats or mice on his property and that this is where the local authority is satisfied that rats or mice are present in substantial numbers in a group of separately occupied premises in a "block" and that the service of notices giving to each individual occupier a reasonable period within which to effect a satisfactory clearance would not be effective. In this event the " block " can be treated as a unit, the local authority taking the necessary measures after service of notice on each occupier. Penalties are provided for failure to comply with the provisions of the Act. The Act also requires the submission of reports to the Minister as directed and a copy of the first report submitted to the Minister covering the period March 31 to December 31 is shown in the following table:— 29 Prevalence of rats and mice Table 16 Type of property Number of properties in Lewisham (i) (ii) (iii) (iv) Analysis of column (iv) (v) (vi) (vii) Total in which infestation was Number infested by Notified by occupier Otherwise discovered Recorded (Total of ii and iii) *Rats Mice only Major Minor Local authorities' property 108 3 3 1 2 Dwelling houses 61,350 773 1,473 2,246 11 1,252 983 Business premises 3,635 77 — 77 — 58 19 Agricultural property 48 — — — — — — Total 65,141 853 1,473 2,326 12 1,312 1,002 Measures of control by Local Authority No. of properties inspected No. of inspections made Number of notices served under section 4 Number of treatments carried out Block treatments of properties in different occupancies under section 6(1) or by informal arrangement By arrangement with occupier Under section 5 (1) Treatments Works Rats* Mice only Rats* Mice only Number of blocks Surface— Number of separate occupancies Associated sewers— Number of manholes treated Local authorities' property 3 6 - - 3 - - - - - - Dwelling houses 4,153 4,536 1,263 983 1 77 Business premises 174 216 58 19 Agricultural property 3 18 — — — — — — - — — Total 4,333 I 4,776 — — 1,324 1,002 — - 1 77 - *Properties infested with both rats and mice are included under this heading. †Excluding treatments included under block treatments. 30 Administration No proceedings were taken under the Act, i.e., under sections 3(+), 4(4), 4(5), 5(2), 8(2), 9(2) and 22(4). There were no special circumstances to which any undue presence of rats and mice in the district could be attributed. Lymphocytic choriomeningitis This disease is a special type of meningitis which has always been regarded as rare but of which recently more cases have been diagnosed. The disease is caused by a virus which may be caught from mice. Mice are frequently infected and the infection may stay with them throughout their lives and even be handed on by the female mouse to her offspring. A case of this disease was diagnosed in 1949 and one mouse was trapped in the house from which the patient was removed. This mouse when examined at the laboratory, was not found to be suffering from the virus infection. In March, 1950 another patient in the same road, 18 houses away, was also diagnosed as a case of lymphocytic choriomeningitis. Traps were laid for mice in her house and eventually three were caught, all of which were found to be infected with the virus. A special offensive against mouse infestation was made in the rectangle formed by the four roads in the neighbourhood (enclosing the two houses from which the patients came), as it seemed highly suspicious that the only two cases of this disease diagnosed in the borough during the past year should have come from houses only a few yards distant from each other. Many of the occupants said that they had never had a mouse in their house while some others admitted to varying degrees of infestation. Each of the 73 houses contained in the block was visited and the purpose of the visit explained. For various reasons traps were set in only 34 of the 73 houses and as a result sixteen more mice from ten houses were caught and examined for virus. The virus was isolated in four of these mice. With one exception these mice were caught in houses in two of the roads, and the back gardens of these houses are separated by an old, low brick wall or a wooden fence. The main structures of the two sets of houses are 80-90 feet apart and many ot the gardens contain sheds which mice might inhabit, but in fact mice were only trapped in the houses. An inquiry into the possible occurrence of further cases in Lewisham was carried out and over 200 doctors were circularised but no other cases, suspected or confirmed, were reported. Seven of the eight medical officers of health of surrounding districts stated that no cases had occurred in their areas during the preceding two years. The other medical officer of health reported a case which occurred in 1950 in a house 3i miles from the block of houses containing the two reported cases. No mice were caught in the rooms occupied by the patient but two were trapped in the flat below and from them the virus was isolated. These boroughs, with Lewisham, cover an area of 66 square miles with a population of 950,000. 31 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 water supply to Lewisham is divided into three zones; the low zone is supplied from Deptford well and by Thames-derived filtered water; the Eltham zone is supplied from Wilmington, Darenth and Bexley wells and should the occasion arise, with a small proportion from the low zone; the Bromley zone to the south of the Borough is supplied from Shortlands well and again on occasions with additional Thames-derived filtered water. River Thames water is abstracted at the Board's intakes at Walton and Laleham and is stored in the Queen Mary, Island Barn and Walton reservoirs. The water is filtered at Hampton, Surbiton and Walton Works and 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 for the greater part of the year free or almost free from residual chlorine. A similar contact tank is in an advanced stage of construction at Walton works and plans are being prepared for a contact tank at Surbiton works. 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 at least five times a week and in the case of the river-derived supplies, the water is analysed at all stages of purification. All new and repaired mains are chlorinated before being restored to use and samples are collected for analysis to establish that the quality of the water is up to the standard normally supplied. None of the supplies is plumbo-solvent. All houses in Lewisham are supplied directly and not by means of standpipes. Appended are the average results of the chemical and bacteriological analyses of the various supplies as fowarded by the Metropolitan Water Board. 32 Average results of the examination of the water supply to the Borough of Lewisham for 1950 parts per million (unless otherwise stated) (o) CHEMICAL Table 17 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 3 0.007 0.023 7.5 33.8 0.13 350 125 7.1 550 Wilmington well 4 0.023 0.034 7.0 22.0 0.12 292 67 7.2 500 Darenth well 4 0.008 0.028 4.8 17.0 0.09 274 57 7.3 450 Bexley well 5 0.006 0.031 5.3 19.3 0.09 291 69 7.2 450 Shortlands well 4 0.004 0.025 4.3 18.6 0.13 298 90 7.2 475 River Thames filtered water from : Hampton works 0.016 0.091 4.1 25.8 1.18 274 83 7.9 475 Surbiton works — 0.026 0.093 3.9 27.1 1.28 258 82 7.8 450 Walton works — 0.018 0.097 5.1 27.6 1.32 260 81 7.8 450 (b) BACTERIOLOGICAL Table 18 No. of samples Agar colony count Percentage of samples negative to Bact. coli in 100 ml. Bact. coli per 100 ml. Deptford well 255 100.0 Nil Wilmington well 248 — 100.0 Nil Darenth well 256 100.0 Nil Bexley well 217 100.0 Nil Shortlands well 256 100.0 Nil River Thames water filtered at: Hampton works 817 6.9 99.9 0.002 Surbiton works 512 11 .6 99 8 0.002 Walton works 254 15.3 100.0 Nil 33 Swimming baths The following is a report prepared by the Baths Superintendent on the use of breakpoint chlorination at the Council's baths:— The breakpoint process was first introduced at the Open Air Pool, Bellingham, in the spring of 1948, and resulted in an immediate improvement in the condition of the water. It was, however, soon realised that an alteration to the circulating system would have to be made. This pool, 140ft. long, is provided with two inlets at the shallow end. Effluent at the inlets would contain 2 parts of chlorine per million, but by the time the freshly chlorinated water reached the deep end of the pool the chlorine content would have diminished to 0.5 parts per million. This condition was remedied by providing an additional inlet at the deep end. During the summers of 1949 and 1950, the standard of water, physically, chemically, and bacteriologically, was first class. The higher chlorine content affected the alkalinity (pH value) of the water and it was necessary to inject more alkali to neutralise the extra acidity created by the addition of the extra chlorine. It also soon became apparent that the reagents previously used in determining the amount of chlorine residual and the pH values did not adequately fulfil the requirements with this new process of water conditioning. Neutral ortho-tolidine used for determining the residual chlorine in the marginal method was replaced by acid ortho-tolidine and sodium arsenite, and instead of one test, three tests are taken to ascertain the correct amount of free chlorine in the sample of water. The phenol red solution used to indicate the pH value in the former treatment, did not give an accurate reading in the higher values, and was replaced by diphenol purple. It also became necessary to add sodium thiosulphate to dechlorinate the sample before testing, to prevent the bleaching effect the superchlorinated water would otherwise have had on the indicator. A keener watch had to be kept on the pH value because if this was allowed to fall below 7.2 irritation to bathers' eyes resulted. At the Open Air Pool we have not been troubled with offensive odours. Breakpoint chlorination was commenced in the covered Baths in August, 1949. Full use was made of the experience gained at the Open Air Pool, but the production of nitrogen trichloride, peculiar to covered baths, giving rise to offensive odours, was soon manifested. A lower water temperature and making the best use of the ventilation system did much to keep the development of this trouble to tolerable limits. Whilst low water temperature (72° to 74°F.) and adequate ventilation do much to eliminate a concentration of nitrogen trichloride, an open mind and watchful eye are being kept for any treatment that will neutralise this odour trouble. The additional alkali needed to maintain the correct pH value is obtained by injecting sodium carbonate in the bath water circulating pipeline near to the point where the chlorine solution is added, but in spite of this arrangement there was a tendency on occasions for the water in the pools to develop a milky opalescence. This was due to the sodium carbonate acting as a softening agent resulting in a precipitation of calcium carbonate. 34 To overcome this trouble a milder alkali — sodium bicarbonate, was used. This proved to be too expensive as it was necessary to use much larger quantities of this chemical. Further experiments were carried out with sodium carbonate and this time sodium metaphosphate was added to the alkali solution, before injecting it into the pipeline, the metaphosphate preventing the precipitation of calcium carbonate above referred to, and for several months this method has been employed and highly satisfactory results obtained. In addition to the tests for free chlorine residual and pH value, previously mentioned, a quantitative test is made from time to time to determine the bicarbonate alkalinity. Apart from the above tests, which are carried out three times each weekday, the Council's sampling officers frequently visit the Baths and take samples for submission to the laboratories for chemical and bacteriological examination. The reports on these tests have never once indicated, an adverse condition of the water. It can be said that the standard of purity and all round quality of the swimming bath water at the Council's baths has never been higher than at the present time, but the acme of perfection has by no means been reached and it is hoped in the near future to achieve still better results from a wider knowledge and experience in this new treatment. The colorimetric tests referred to for free residual chlorine and pH value, are taken at 9 a.m., 1 p.m. and 6 p.m. on weekdays and at 9 a.m. on Sundays and the results are recorded on log sheets kept for the purpose. The following is a summary of samples taken by the health department staff for submission to the public analyst for chlorine content, during the year:— Ladywell—first class 5 —second class 7 Forest Hill—first class 2 —second class 5 Downham 4 Bellingham 3 Washing facilities at public conveniences In the previous report I stated that there were many reasons why free washing facilities should be available and that although little progress had been made in the previous year, the matter was again being brought before the appropriate committee. The ideal system would be to provide a constant supply of hot water, together with free soap and towels. Unfortunately in existing public conveniences of the Council no constant hot water is on supply and it was stated that it would be a very costly business to provide this. Members of the public can, however wash their hands at the conveniences in cold water free of cost, but it is unlikely that this facility will be much used, particularly during the colder months. The matter was considered by the appropriate committee on more than one occasion in 1950, but the committee felt that it would be 35 inopportune at the present time to endeavour to comply with the suggestion of free washing with hot water, having regard to the fact that the conveniences were not provided with a hot water system. The committee have in mind modernising one or more of the conveniences, and at the end of the year the matter was still under consideration. Old people The Council continued to make grants to organisations in the borough which are carrying out work for old people, whether by recreational facilities or by the provision of meals. A sum of £1,500 was included in the annual estimates for the year 1950-51 for such organisations as accepted the Council's conditions and to assist any other such voluntary organisations as might be established during that year. Reports were made to the public health committee giving details of the work undertaken by the voluntary organisations and as a result grants were made as follows:— £ Lewisham Old People's Welfare Association 850 Lewisham Darby and Joan Club 250 Over 60's Club 50 St. Mark's Old Folk's Club 50 Talbot Settlement Old People's Club 25 Good Companions Personal Service 25 This left a sum of money available for new clubs which might qualify for grant, but by the end of the calendar year no further applications had been made. It is hoped that such old people's organisations as can will not only provide the usual afternoon's recreation with a little tea, but will also make arrangements to provide lunch either on the day the club meets or another day. To this end the Lewisham Old People's Welfare Association is prepared to cooperate by conveying the meals in bulk from the central kitchen, where they are obtained, to the luncheon club. Nutrition is a large factor in the health and wellbeing of the aged, and it seems likely that many of the minor troubles which particularly affect the aged could be prevented, or at any rate postponed for some years, by better nutrition. The tendency of the old person who lives alone is to eat either too little or too unvaried food. It is just a bit too much trouble for him (or sometimes her) to cook a meal for the one person. Furthermore, the actual amount in calories of food required in old age is considerably less than in middle age, and these factors, together with reduced appetite and available money, often lower the old person's diet to below the danger mark. By ensuring that a group of old people have at least one good hot meal a week a proportion of them will be saved from getting beyond this danger line. Others of them, of course, in addition to the one hot meal provided at the club, will obtain hot meals on other days of the week by cooking them themselves or by help from neighbours, etc., but the luncheon club remains a highly desirable facility in the care of old people. There is an excellent luncheon club at the Lewisham Darby and Joan Club and this has been present from the opening of that Club. In August, 1950 a luncheon club was started at the Old Folk's club held at St. Mark's 36 Church Hall, of which club Mr. W. W. Hitching is the energetic president. In certain of the other grant-aided clubs, however, such facilities are not practicable. The health department, during the year, continued to take a detailed interest in the work for old people generally, and remained in the closest possible touch with the Lewisham Old People's Welfare Association. Thus, I was reelected the honorary medical adviser of the association during the year; and in addition to providing office accommodation, for a nominal sum, for the secretary, the department lends clerical assistance from time to time when this can be spared, and it also helps to keep the work of the association ticking over at times when the secretary (who is the association's only full time officer) is away on leave. The Lewisham Old People's Welfare Association continued its work during the year and that work expanded in nearly all directions. During the year it became obvious that one of the early necessities was the provision of more accommodation for old people, whether in flatlets or otherwise, and a special subcommittee was eventually set up to report and to make recommendations. The following are extracts from the report of the secretary of the Association on the work during the year. "The Office is now used extensively by an increasing number of old people and their relatives, friends and neighbours, who come for advice and help with their problems, and in addition cases are referred by doctors, nurses, hospitals and other agencies in the Borough. Where possible, cases are passed on to the appropriate agency for action, but a great many are still left to be dealt with by the Office itself. "The problems dealt with are many and varied, but the acute shortage of suitable accommodation of all types is at the root of the majority of the old people's troubles. It is almost impossible to get a sick old person into hospital; there is a long waiting list of old people of limited means who, though not sick, are still in need of Homes with the provision of care and attention; and many of the more able bodied old people could, with the assistance of a part-time home help, continue to live as independent members of the community for a number of years if only suitable accommodation were available for them. "The Meals-on-wheels service has continued to serve dinners to the more infirm old people in the borough. In July the old van was replaced by a new one, smaller and much more economical to run. The cost of the new van was almost entirely covered by two very generous grants from the Alexandra Rose Day (£300) and the Lewisham Parochial Trustees (£100). A further grant of £300 has since been received from the Alexandra Rose Day Fund towards the cost of a second van, which has been on order since last August. The present van, delivering an average of about 144 dinners a week, is working almost to capacity and the demand for dinners would increase if we were able to deliver more often than once a week to each old person. In addition, LOPWA gives financial help and makes arrangements for holidays for old age pensioners who could not otherwise afford them. One of the greatest causes of unhappiness however amongst old people is loneliness, which clearly is greater if the old person is 37 infirm or housebound. During the course of the year efforts were made by LOPWA to buiid up a body of friendly people who would undertake to visit regularly in their own neighbourhood. This work is making slow progress and volunteers are still urgently needed. During the year domestic helps were supplied by the LCC to 626 old people in the borough. A further service which the borough was able to expand during the year was for that small number of old people living at home whose infirmity is such as to make them incontinent of urine or faeces. These cases are often distressing to the relatives and other people living in the house and, above all in most cases, to the old persons themselves. Difficulties arise in the laundering of soiled sheets and bedclothes and commercial laundries are often loth to undertake such work regularly. The Council, however, is able to help because under section 122 of the Public Health (London) Act they have powers which cover most of these cases. Accordingly, whenever a case is reported to us, whether by LOPWA, the district nurse, the sanitary inspector or otherwise, the Council gives free service in cases where s. 122 applies. This is a help which has been highly appreciated where it has been used. Cases for aid in this way have not so far been actively sought, because of the limited facilities available at the disinfection and cleansing station, but if the proposals of the committee bear fruit the facilities will be increased during 1951, and more active steps will be taken to find out all the persons in the borough who can be helped. Many of those in the early stages of incontinence make efforts to hide their condition, but it has been found that with improvement in physical condition (such as by overcoming a minor ailment or by improving nutrition) many old people who are incontinent, even doubly incontinent, can be cured of their incontinence. Accordingly, when the Council decided to make facilities under s. 122 available, I wrote to the local hospital group management committee to find out if it were proposed to set up geriatric facilities in the local hospitals, as I would have liked to have had a scheme whereby certain incontinent persons were taken into hospital for a short period for treatment. Such cases would I hoped be regarded as priority cases for admission, and for our part we would not expect them to be kept in hospital more than a relatively short time during which they would be reeducated. Unfortunately, however, the reply received indicated that there was no geriatrician appointed by the regional hospital board to the Lewisham group of hospitals and also no special accommodation for the care and training of incontinent aged persons could be provided. I thereupon took the matter up with the regional hospital board, but so far no final decision can be reported. Meteorology and atmospheric pollution It is wellknown that weather and climate have an effect on disease even if that word is only taken in its literal meaning, namely the opposite of ease, but many sufferers go further. For example, quite a proportion of patients with "rheumatism" say they can tell when a change in the weather is on its way. Many people, whether suffering from an organic disease or not, feel much better in warm, sunny weather and, conversely, feel physically miserable in cold damp weather. A correlation 38 between the symptoms in rheumatism and the weather has not been satisfactorily demonstrated on a scientific basis, but in other diseases the association is or has been more obvious; thus it was shown many years ago that the death rate from diarrhoea or gastroenteritis in young children began rising steeply when the temperature of the earth a few feet below ground level rose over a certain limit. This phenomenon does not occur now, but the explanation is quite simple. In the old days (prior to world war I), when the earth temperature got to the particular limit it meant that there had been a fairly long spell, or a succession of spells, of warm or hot weather, and with the relatively bad hygienic conditions then prevailing this meant that there had been a great increase in the number of flies and thereby a great increase in the number of cases of fly-borne disease, of which gastroenteritis and diarrhoea in infants were outstanding examples. With the more energetic methods now made to deal with flies, and with the education of the parent and the shopkeeper in general hygiene and in storing and preparing food, high temperatures have ceased to have any appreciable effect on the infant mortality rate. For a number of years a high correlation was noticed between hot summers and the number of cases of infantile paralysis (poliomyelitis). This occurred between the wars, and also in 1947 and again in 1949, both of which were hot summers with long periods of sunny weather; but in 1950, which was a less hot and also a wet summer, the cases of poliomyelitis in the country were roughly as numerous in 1947 and 1949. Nevertheless the association between poliomyelitis and hot weather does not necessarily receive a death blow from the figures for last year, as it might well be that the number of cases of poliomyelitis last year, though large, would have been larger had there been a hot summer. These are two examples of possible association of disease and meteorology, and others have been put forward. The evidence, though inconclusive, is sufficient to justify records being kept in health departments, so that in future years it may be possible in retrospect to pick out the true correlations. Some figures are published (Table 19) in this present report of sunshine, rainfall, etc., but these are not specifiic to the borough, having been obtained from the RegistrarGeneral, who, in his turn, obtained them from the Director of the meteorological office. I also include some figures on temperature which were obtained at the Town Hall by the Borough Engineer's department in connection with plans for concreting. The thermometer is in an alleyway 5 feet from the ground. During the year 1950 I put before the committee a suggestion that we should cooperate with the Department of Scientific and Industrial Research of the Medical Research Council in setting up stations in the borough for the measurement of atmospheric pollution. This pollution has an effect on the amount of sunlight available, and it has an effect on the comfort of the inhabitants. It may also have a more marked and serious effect on individual inhabitants, for example, a person with lung disease living near a source of atmospheric pollution from which some irritant, such as sulphur trioxide, occurs might be badly affected. No decision was come to during 1950, but in the early part of 1951 the committee decided, in principle, to authorise the setting up of three stations in the borough and a first report on these will be given in the next annual report. 39 Weather conditions in 1950 Table 19 Month Air temperature Rainfall Remarks Average values 1881-1915 Lewisham Town Hall— Air temperature Highest °F Lowest °F Difference from average daily mean °F Percentage of average No. of days difference from average Sunshinepercentage of average Daily mean temperature °F Total rainfall mm. No. of days Daily sunshine hrs. Highest  est January 57 15 + 0.3 40 —8 77 Dry and dull. 39.4 56 16 1.68 53 27 February 63 18 + 3.4 212 + 3 105 Unsettled and excessively wet. 40.1 52 15 2.64 60 30 March ... 67 17 + 3.8 46 —5 117 Mainly mild and dry. 42.1 52 15 3.94 60 27 April 68 27 + 0.5 137 + 3 116 Unsettled and wet. 46.7 43 13 5.65 63 34 May 77 30 -0.1 92 —2 94 Changeable. 52.2 45 13 6.90 78 42 June 92 39 + 4.1 79 —3 126 Warm & sunny. 57.7 48 11 7.20 94 50 July 86 40 + 0.9 140 + 2 103 Unsettled and wet. 61.1 55 13 6.96 82 54 August ... 83 40 + 0.7 126 + 2 107 Unsettled and thundery. 60.9 59 14 6.48 84 52 September 74 31 —0.5 138 + 9 80 Excessively wet. 57.3 54 13 5.43 73 45 October 75 23 —0.3 22 —9 103 Dry. 50.8 88 17 3.44 66 36 November 59 20 + 0.1 191 + 4 100 Excessive rainfall. 44.9 78 17 2.15 57 34 December 54 15 -6.2 72 —3 98 Excessively cold and snowy. 41.3 79 18 1.44 51 27 40 SECTION " C " — SANITARY CIRCUMSTANCES OF THE AREA The following table gives a summary of the inspections, etc., carried out by the district sanitary inspectors, food inspectors and housing inspectors during the year:— Table 20 Reason for inspection West North South Total Visits of district sanitary inspectors: Dwelling-houses — PH Act 2918 1938 1053 5909 Dwelling-houses— Housing Act 123 149 31 303 Applications for rehousing 445 552 485 1482 Rent Acts and Landlord and Tenant Acts 11 11 22 44 Notice from builder 458 315 53 826 Building licences and certificates for materials 126 248 46 420 Infectious diseases 16 18 11 45 Infestation 98 204 93 395 Factories, mechanical 83 37 21 141 Factories, non-mechanical 25 22 14 61 Outworkers 175 145 214 534 Smoke observations 4 4 Keeping of animals in such a state as to be a nuisance 4 7 2 13 Water certificates 13 26 161 200 Futile visits 862 917 634 2413 All other matters 1072 1094 274 2440 Reinspections 5810 9105 3231 18146 Totals 12239 14792 6345 33376 Visits of food inspectors: Dwelling-houses— PH Act 20 46 37 103 Notice from builder 26 19 27 72 Building licences and certificates for materials 2 5 7 Infectious diseases 3 7 16 26 Infestation 6 21 4 31 Factories, mechanical 12 18 113 143 Factories, non-mechanical 11 4 15 Smoke observations 1 1 Food shops — registered 167 72 177 416 Food shops — not registered 162 91 151 404 Milkshops and dairies 90 63 69 222 Icecream premises 278 343 227 848 Restaurants and eating houses. 182 130 109 421 Bakehouses 100 54 54 208 Other shops 14 79 13 106 Food inspections 389 354 215 958 Markets and stalls 23 1045 217 1285 Pharmacy and poisons 75 70 47 192 Slaughterhouses — 7 — 7 Futile visits 29 21 13 63 All other matters 374 458 299 1131 Reinspections 613 260 266 1139 Totals 2576 3163 2059 7798 41 Reason for inspection West North South Total Visits of housing inspectors: Dwelling-houses — PH Act 5 5 Dwelling-houses — Housing Act 956 426 35 1417 Applications for rehousing 782 587 632 2001 Notice from builder 8 18 — 26 Building licences and certificates for materials 7 19 1 27 Infestation 2 2 4 Futile visits 198 160 136 494 All other matters 34 63 3 100 Reinspections 1053 1054 420 2527 Totals 3038 2334 1229 6601 Grand total — all inspectors 17853 20289 9633 47775 Number of factories on register at December 31, 1950:- Mechanical 153 196 92 441 Non-mechanical 29 53 15 97 Number of outworkers on register at December 31, 1950 121 107 139 367 42 The following table gives further information on certain sanitary circumstances in the area:— Table 21 Premises No. in borough on 31 Dec., 19S0 No. of inspections No. of prosecutions Common lodging houses Nil — — Seamen's lodging houses Nil — — Cowsheds (licensed) Nil — — Slaughterhouses (licensed) 2 — — Other offensive trades Nil — — Dairies and distributors 159 222 — Icecream premises 333 848 — Restaurants and eating houses 296 421 — Smoke nuisances Number of observations 5 Number of intimations served — Number of complaints received 5 Number of statutory notices served — Number of legal proceedings — Number of convictions — Cleansing and disinfection Number of adults cleansed 76 Number of children cleansed 1,215 Number of premises cleansed:— (a) after infectious diseases 757 (b) for vermin 254 Water supply to tenement houses Number of premises supplied Nil Number of prosecutions — 43 Summary of notices served in 1950 Table 22 West North South Total Intimation notices:— Public Health (London) Act, 1936 1002 1167 429 2598 Informal intimations under Factories Act, 1937 21 10 9 40 Informal intimations under Housing Act, 1936 11 7 3 21 Total intimations 1034 1184 441 2659 Statutory notices : Public Health (London) Act, 1936: Nuisances 311 421 156 888 Drainage (s.40) 38 63 99 200 Sanitary fittings (s.109) 16 5 21 Dustbins (s.105) 50 23 32 105 Housing Act, 1936 22 8 7 37 Factories Act, 1937 1 4 2 7 Byelaws (other than Housing byelaws) : Drainage 26 3 7 36 Water cisterns 9 7 — 16 Water closets - — 3 3 Total statutory notices 473 534 306 1313 Noncompliance with abatement orders In three instances where abatement orders had been obtained, the owners of the properties concerned, because of financial difficulties, requested the Council to carry out the works required to comply with the orders in default, and to recover the cost by instalments. Nuisances remedied Table 23 Nuisance West North South Total Premises cleansed and repaired 736 542 255 1533 Drains repaired and/or reconstructed 40 62 81 183 WC's cleansed or repaired 109 110 36 255 Soil pipes renewed or repaired 28 26 21 75 Waste pipes renewed or repaired 50 35 41 126 RWP's renewed or repaired 106 82 49 237 Roofs and gutters repaired 538 402 197 1137 Dampness in premises remedied 507 271 117 895 Yards drained or paved 31 23 10 64 Dustbins provided 49 25 20 94 Water cisterns cleansed or repaired 15 9 - 24 Water fittings repaired 33 65 33 131 Defective fireplaces repaired 233 151 71 455 Offensive accumulations - Other nuisances remedied 20 19 16 55 TOTALS 2495 1822 947 5264 44 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 105 notices were served and on 2 of these the persons on whom the notices were served exercised their right of appeal. In one case the appeal was allowed and in the other the tenant, on whom the notice had been served, agreed to allow the use of his own bin by the subtenant. A report is submitted whenever a dustbin is required, 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. The wording of the Act makes for difficulty as it allows the service of a notice on either the owner or the occupier with the subsequent right of appeal to a committee of the county council, against whose decision there is no appeal. It is understood that legislation is contemplated which will amend the provisions of the Public Health (London) Act, 1936 by allowing appeals to be heard by a petty sessional court instead of by the appeals committee of the county council. The Council has had under consideration the provision of dustbins under section 67 of the London County Council (General Powers) Act, 1939 by the Council. Two alternative schemes have been considered, the first being a scheme by which the Council would supply dustbins to particular premises as and when they were required in consideration of an annual charge not exceeding 5s. Od. levied upon the person, whether the owner or occupier, paying the rates for those premises, and the second a scheme whereby the Council would undertake the supply of dustbins generally throughout the borough, charging the cost as an addition to the general rate. Owing to the present shortage of certain metals and the rearmament programme, however, the time would not appear to be opportune to adopt either of these schemes and the matter has been deferred. Rent and Mortgage Interest (Restrictions) Acts In 39 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 14 cases the necessary statements were issued as the premises concerned had been made fit. Landlord and Tenant (War Damage) (Amendment) Act, 1941 No certificates were issued during the year under the above Act. 45 Water certificates Certificates were issued in respect of 185 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 24 Premises Number of Inspections Written notices Occupiers prosecuted (1) Factories in which ss. 1, 2, 3, 4 and 6 are enforceable 76 2 — (ii) Factories not included in above in which s. 7 is enforceable 284 5 — (iii) Any other premises in which s. 7 is enforceable (excl. outworkers) — — — Cases in which defects were found Table 25 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 4 3 - 5 - Overcrowding 1 1 - - - Unreasonable temperature 3 2 — 2 - Inadequate ventilation 2 2 - — — Ineffective drainage of floors - - - - - Sanitary conveniences— (a) insufficient 8 8 — •4 - (b) unsuitable or defective 24 21 - 9 - (c) not separate for sexes 8 8 - 3 - Other offences against the Act (not including offences relating to outwork) _ - _ _ _ TOTAL 50 45 - 23 - 46 Outworkers Outworkers are visited periodically by the woman sanitary inspector. The following is a list of trades concerned, extracted from the lists received :— No. of Trade outworkers employed Wearing apparel 295 Boxmaking 48 Carding 6 Sacks 4 Artificial flowers 3 Crackers 3 Brushes 3 Bags 2 Lampshades 2 Curtains 1 367 Complaints of industrial grit and smoke Complaints have been received over a period of years of nuisance caused by smoke and emission of grit from the gas works situated at Lower Sydenham. Improvements in the type of plant used, and methods of working, have from time to time been made but complaints still persist. During the year a grit arrestor was provided on the boiler house and, according to the staff at the works, this plant functioned satisfactorily and some 6-7 cwts of dust were being removed from it daily. A noticeable improvement was experienced at the works after its installation. After a short period, however, residents in the vicinity of the gas works stated that there was no evidence that the emission of grit had been reduced. At the request of the local residents a meeting was arranged at the Town Hall between members of the staff of the health department, the divisional engineer and local technical engineer on behalf of the South Eastern Gas Board, and six local residents. After a very full discussion it appeared that certain relatively minor matters could be remedied but the main cause of complaint appeared to be due to the smoke and grit arising from the coking process. This is apparently caused in part by the inferior quality of the coal delivered to the works, and the smoke from the coking process, because given off at a fairly low level, spreads to houses adjoining the works. A different type of retort has lessened this problem to some extent and experiments are in hand to arrange for the collection of the smoke, separation off of some of the solid and oily matter, or dispersal of the smoke at a much higher level. It is evident from observations, that many of the complaints are justified, and the matter will be pursued with a view to obtaining any possible amelioration of the existing conditions. 47 Dog nuisances The Council operates a byelaw to prevent the fouling of the public footpaths by dogs. The form of the byelaw is as follows :— (1) No person being in charge of a dog in any street or public place having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. (2) Any person offending against this byelaw shall be liable to a penalty not exceeding forty shillings. Complaints are sometimes received from members of the public and the police, but difficulty is experienced in enforcing the byelaw owing to the fact that it only relates to dogs which are on a lead, and possibly also from the reluctance of witnesses to appear in court to give evidence. Several complaints were received during the year and in each case a warning letter was sent. Fly-tipping on vacant sites As a result of discussions between the Metropolitan Boroughs' Standing Joint Committee and the Home Office the text of a model byelaw was issued prohibiting the placing or depositing of any rubbish or waste on the public highways, unfenced ground abutting on highways and certain other public places. The Council, being of the opinion that a byelaw dealing with this question should be in force in the borough, made a byelaw in pursuance of section 146 of the London Government Act, 1939 in the following terms :— No person shall (except by permission in writing of the owner or occupier, or of the person or authority having control thereof, or unless authorised by law so to do) place or deposit and leave on or in :— (a) Any highway or roadside waste, or any unfenced ground abutting on any highway ; (b) Any common, park, recreation ground or other open space to which the public have access for the time being ; or (c) Any water, watercourse, or ditch in or abutting on any such highway, roadside waste or other place aforementioned ; any rubbish or waste or discarded matter whatsoever so as to create or tend to create, a litter. Provided that where an offence is committed against this. byelaw and against any byelaw with respect to any pleasure ground, public walk, recreation ground, park, roadside waste, common, or open space, or any limitation or condition imposed by the Minister of Agriculture and Fisheries under section 193 of the Law of Property Act, 1925, a person shall not be liable to more than one penalty in respect of the same offence. Any person offending against this byelaw shall be liable on summary conviction to a fine not exceeding five pounds. This byelaw came into operation on March 1, 1950. 48 SECTION "D" —HOUSING Building The following new houses or flats were completed by the Council during the year :— Randisbourne Gardens 20 Shackleton Close 96 Hether Grove 21 Marler Road 4 Passfields 101 Pikethorne 50 Perystreete 47 Wydeville Manor 70 Total 409 Families rehoused During the year the following families were rehoused for first time :— 1. By the Lewisham borough council :— (a) Permanent properties 224 (b) Temporary bungalows 12 (c) Emergency hutments 6 (d) Requisitioned properties 329 Total 571 2. By the London county council (figures supplied by district office) 469 Grand Total 1040 Applications for rehousing The number of cases dealt with by the public health department during the year was as follows :— Table 26 West North South Total (a) Lewisham borough council housing applications :— Number visited 1017 894 849 2850 Number found overcrowded 142 68 113 323 Insanitary conditions found 5 8 2 15 (b) London county council housing applications :— Number visited 171 308 309 788 Number found overcrowded 58 85 147 290 (c) Housing applications referred from other authorities :— Number visited 92 81 71 244 Number found overcrowded 9 1 3 13 (d) Inspected on request of occupier :— Number visited 6 3 6 15 Number found overcrowded - 1 2 3 Total visited 1376 1286 1235 3897 Total overcrowded 209 155 265 629 Percentage overcrowded 15.2 12.1 21.5 16.2 49 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 shall, unless 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 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. 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. Section 10 involves numerous technicalities and in view of the difficulties experienced today as compared with the period before the war, when building repairs were much easier and no special licences were required, it was decided in June to adopt the practice of serving informal notices under section 9 in the first place. In cases where it is considered that informal procedure would be useless or where in fact it has failed, a formal notice is served. During the year 21 informal and 37 formal notices were served. 29 properties were repaired by the owners after the service of notices under section 9 and 1 property was repaired by the Council under section 10 in default of the owner. Work was being carried out in respect of 9 other properties under section 10, but had not been completed by the end of the year. Demolition orders (section 11) The following is a list of cases involving demolition order procedure which originated in or were complied with during 1950, together with the present position of cases originating in the previous year which had not been complied with at the end of 1949 :— 50 Table 27 Properties Number of dwellings involved Present position 391 to 405 (odd), Southend Lane 8 Demolished 6 June, 1950. 302,Sydenham Road 1 Demolished July, 1950. 40, Lee Church Street 1 Offer of works accepted. 42, Lee Church Street 1 Offer of works accepted. 78 and 80, Kirkdale 2 Adjourned. Possibility of inclusion by LCC in Draft Development Plan. 20, Lee Church Street 1 Offer of works accepted. 96 and 98, Hither Green Lane 2 Adjourned. Negotiations pending for acquisition of sites by agreement. 19, 21, 23, 25, 27-37 (odds) and 43-47 (odds), Lee Church Street 13 Adjourned. Under discussion with LCC. 41, Lee Church Street 1 Undertaking not to relet accepted. 1-4, Suncroft Place 4 Orders operative. 11, Springfield Rise 1 Offer of works accepted. 67, Fludyer Street 1 Undertaking not to relet accepted. 120, Wells Park Road 1 Offer of works accepted. 11, 13,5, 17, Lee Church Street 4 Adjourned. Under discussion with LCC. 1-4, Avenue Cottages 4 To be demolished as soon as occupants have been rehoused 55a, 55b and 55c, Bell Green 3 Works carried out. 323, Baring Road 1 Order operative. 180 and 182, Marvels Lane 2 Orders operative. 86, Hither Green Lane 1 Demolished May, 1950. 58, Dacre Park 1 Offer of works accepted. 38, St. Germans Road 1 Demolished. 6-14 (consecutive) and 19, Ardmere Road. 10 12, 13 and 14 demolished. 48 and 50, Beacon Road 2 Offer of works accepted. 95, 97 and 99, Hither Green Lane 3 Offer of works accepted. 33, Brandram Road 1 Adjourned to allow owner to submit amended offer of works. 22, Lee Church Street 1 Offer of works accepted. Closing orders (section 12) The following is a list of closing orders which were originated in, determined, became operative, or were varied during 1950 :— Table 28 Properties Port of House Present position 4, Sydenham Park Basement rooms Amended closing order made allowing basement rooms to be used as an office or workroom. 62, Eltham Road Basement flat Works carried out to render basement flat fit for human habitation. Determining order issued. 37, Blessington Road Basement flat Offer of works accepted. 29, Devonshire Road Basement flat Order operative. 103,Kirkdale Bottom flat Statutory undertaking not to relet for human habitation accepted. 2a, Sydenham Hill Basement flat Order operative. 51 Projected clearance areas (section 25) I mentioned in my report for 1949 that work was proceeding on the preparation 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 or (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. This information was required by the London county council. The information required was obtained and forwarded to the county council in March, 1950. The following is a list of the areas included :— No. 1 Lee No. 5 Sydenham No. 2 Sydenham No. 6 Forest Hill No. 3 Hither Green No. 7 Forest Hill No. 4 Sydenham No. 8 Forest Hill It was estimated that in all, 561 families would be displaced by the clearance of these areas, and the priority in which the areas should be cleared is in accordance with the numerical order in which the areas are placed. For the administrative county of London as a whole, the following numbers of unfit houses have been estimated :— Category I — Probably representable at once ... 10,347 II — For consideration after, say, five years 9,066 III — For consideration later, probably not within, say, ten years 19,614 The list of areas in category I was examined by the LCC in detail to ascertain their zoning in the Draft Development Plan. Allowing for reduced densities for new development under postwar standards and for multiple occupation and overcrowding, it was thought that areas which could be redeveloped for housing purposes would absorb at most only about two-thirds of the families displaced from them, and areas which could not be redeveloped for housing would need approximately one and a half times their present number of houses to accommodate the displaced population. From the figures available, it appears that the clearance of 12,500 houses might require the provision of over 7,500 additional dwellings elsewhere than on the sites of the cleared areas. A conference was held in February, 1951 between representatives of the Lewisham borough council and the London county council with reference to this council's reponsibilities in connection with the projected resumption of slum clearance generally and in particular the No. 1 Lee area. It was explained by officers of the London county council that the Minister of Health was not contemplating authorising a general resumption of slum clearance, but was intending to fix the number of slum dwellings which might be dealt with in certain specified areas year by year. The county council had suggested to the Minister that so 52 far as the administrative county of London was concerned, the number for the first year should be fixed at 4,500. The Minister however, was not prepared to approve this figure and it was hoped that he could be persuaded to fix the figure at 3,000, in which case the county council would deal with 1,500 slum dwellings and would allocate the remaining 1,500 to the different borough councils according to the degree of urgency. With regard to the No. 1 Lee area it appeared as a result of the conference that the council's proposals for the redevelopment of the area would be acceptable to the county council and I have been requested to furnish the county council with information as to the actual number of houses which can be represented as slum properties and the number which it is considered should be dealt with during the first year. This is in order that agreement can be reached as to the number of properties to be dealt with by the borough council during the first year. House-to-house inspections Detailed inspections have been made of all houses in certain roads in the borough where the age of the property is such that a moderate amount of work may be necessary to put the houses into a reasonable condition, but where the age and condition of the property is not such as to indicate clearance or demolition procedure. One sanitary inspector has been employed for this purpose and during the year 613 houses were inspected, and 227 intimation notices and 76 statutory notices served. 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 comitting an offence. Section 59(3) of the Act covers the case of the family whose house becomes overcrowded in course of time owing to increases in the number or ages of children. An occupier whose house becomes overcrowded in such circumstances is not guilty of an offence if he applies to the local authority for suitable alternative accommodation unless either suitable alternative accommodation is offered to him and he refuses it or he fails, in a particular case in which it would be reasonable and practicable to do so, to ameliorate the overcrowding by the displacement of some lodger or subtenant who is not a member of his family. Where, therefore, the overcrowding occurs by natural increase and the occupier has not deliberately aggravated it by subsequently taking in additional persons an application by him for his name to be put on the local authority's waiting list will in general be sufficient to give him protection. During the year three licences were issued under section 61 on the application of tenants of overcrowded premises, each licence remaining in force for a period not exceeding 12 months. 53 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 as, or following, the service of an intimation or nuisance notice. The following table shows the monthly value of civil building licences issued by the department, divided into parliamentary divisions :— Table 29 Month West North South Total £ £ £ £ January 6,528 12,331 4,040 22,899 February 8,710 12,861 3,299 24,870 March 9,371 8,402 6,297 24,070 April 674 4,621 684 5,979 May 757 1,923 1,205 3,885 June 2,132 5,184 1,866 9,182 July 638 3,691 232 4,561 August 2,300 7,564 2,130 11,994 September 4,530 6,100 962 11,592 October 2,849 6,964 1,778 11,591 November 2,590 4,134 5,396 12,120 December 4,941 8,431 787 14,159 TOTALS £ 46,020 82,206 28,676 156,902 *In April and subsequently, a new procedure was adopted under which licences were only issued for work ready to be commenced. This allowed the total sum to be considerably reduced and obviated a number of licences having to be re-issued or re-dated. 54 The following is a tabulated statement of various other housing statistics :— Table 30 Item Total Total number of houses in the borough (separately assessed dwellings) 61,350 Public Health Act Number of houses inspected on account of complaints or illness 6,781 Number of statutory notices served 1,214 Number of houses repaired or nuisances remedied 5,264 Housing Act, 1936 Number of houses inspected — house to house (Housing Consolidated Regulations, 1925)... 613 Number of houses included by representations by the M.O.H. under s.25 Number of houses demolished following representation by the M.O.H. under s.25 Number of houses repaired under ss. 9 and 10— (a) by owners 29 (b) by local authority in default of owners Number of houses demolished— 1 (a) inpursuanceofordersunders.il 5 (b) voluntarily — Number of houses (wholly or in part) the subject of closing orders (excluding underground rooms) 2 Number of closing orders determined (i.e., houses made fit) 2 Overcrowding (Housing Act, 1936) Number of families found to be living in overcrowded conditions 478 Number of overcrowded families who have obtained alternative accommodation :— (a) by L.B.C 152 (b) by L.C.C 125 Number of dwellings erected by the borough council during the year 409 Underground Rooms (the Council has no regulations for underground rooms) Number occupied but unfit... — Number closed or modified occupation approved — Houses let in lodgings Not known Number in borough 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 55 SECTION " E " — INSPECTION AND SUPERVISION OF FOOD Milk and Dairies Regulations, 1949 Under these regulations the local authority is responsible for keeping a register of persons carrying on the trade of distributor and of all premises within their district which are used as dairies, not being dairy farms. The definitions of " distributor " and " dairy " are as follows :— " Distributor " means a person trading as a dairyman elsewhere than at or from premises in relation to which he is registered as a dairy farmer under these regulations. " Dairy " includes any farm, cowshed, milking house, milk store, milk shop, or other premises from which milk is supplied on or for sale, or in which milk is kept or used for the purpose of sale or of manufacture into butter, cheese, dried milk or condensed milk for sale, or in which vessels used for the sale of milk are kept, but does not include a shop from which milk is supplied only in the properly closed and unopened vessels in which it is delivered to the shop, or a shop or other place in which milk is sold for consumption on the premises only. At the end of the year there were 120 persons registered for the distribution of milk from premises within the borough and 23 persons registered for the distribution of milk within the borough from premises in the area of another authority. Forty-three premises in the borough were registered as dairies. Milk (Special Designations) Licences Number of licences issued for the sale of pasteurised milk (dealer's) 46 the sale of tuberculin tested milk (dealer's) 46 the sale of sterilised milk (dealer's) 60 the sale of accredited milk (dealer's) 1 supplementary 53 Analysis of milk During the year under review, 78 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 31 Period Average composition of samples examined Percentage of Milk fat Solids not fat Water First quarter 3.47 8.80 87.73 Second quarter 3.29 8.88 87.83 Third quarter 3.62 8.89 87.40 Fourth quarter 3.74 9.00 87.26 Average for year 3.53 8.89 87.58 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat 56 In addition, the following samples of heat-treated milk were submitted to the laboratory for bacteriological examination :— Table 32 Milk Parliamentary division Total Result West North South Pasteurised 4 6 21 31 All satisfactory Sterilised — - 5 5 All satisfactory Icecream — grading During the year 101 samples of icecream were submitted to the laboratory for bacteriological examination with the following results Table 33 Grading Parliamentary division Total West North South Grade I 3 41 9 S3 Grade II 9 13 6 28 Grade III 4 5 5 14 Grade IV 2 1 3 6 TOTAL 18 60 23 101 In general grades I and II are satisfactory, while grades III and IV may indicate some defect in manufacture, handling or storage. Such cases are followed up and advice is given. Icecream — fat content An extra allocation of sugar was allowed to manufacturers of icecream during the year and at the request of the Ministry of Food, who were seeking to improve a standard, samples of icecream were analysed for fat content and the results of the analyses communicated to the Ministry. 57 A summary of the samples which were submitted to the public analyst during the year, is appended :— Table 34 Percentage of fat Parliamentary division Total West North South Under 2½ percent - - - - 2½-5 percent 1 3 — 4 5 -7½ percent 1 2 4 7 7½ -10 percent 16 4 6 26 10-12½percent 20 7 27 54 Over 12½ percent — 1 5 6 TOTAL 38 17 42 97 (The Food Standards (Icecream) Order, 1951 which came into operation on March, 1, 1951, now lays down a standard for the composition of icecream and obviates the requirement that the results of samples submitted for analysis should be communicated to the Ministry of Food). 58 Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 763, of which 2 were formal samples and 761 informal. After examination the public analyst reported that 1 of the formal samples and 6 of the informal samples were adulterated or below standard. The percentage of adulteration amounted to 50 in the case of the formal samples and 0.78 in the informal samples, whilst it was 0.91 of all the samples submitted compared with 1.10 percent in the previous year. The following table gives details of the samples analysed :— Table 35 DRUGS Number examined Number adulterated Informal Formal Total Informal Formal Total w N s W N S W N s W N S Alum - 1 - - - - - - - - - - - - Borax — 1 — — — - - — — - - - — - Boric acid - 1 - - - - 1 - - - - - - Castor oil — — 1 — 1 - - - - - - Cream of tartar — 2 - - - - - - - - - - - - Ginger, ground 3 8 — — — — 11 - — - - - — - Linctus 1 — — — — - 1 - - - - - - - Linseed meal - 1 - - - - 1 - - - -- Lozenges and tablets : Aspirin 1 4 1 — - - - Digestive - — 1 — - 1 - — - Koray - - 1 — — — 1 - — — - — - Saccharin - 2 1 — — — - — — - - — - Sulphur - 1 — — — - — - Magnesium sulphate - 1 — — — — 1 - — - - - Ointment : Boric - 1 — - — — - - - — Sulphur - 2 - — - Wintergreen 1 — — — - - - - — - Zinc 1 3 - - 4 — - Powders : Headache - — 2 — — 2 — - Liquorice - 2 — — 2 - — - Seidlitz 1 1 -- -- — - Senna powder 1 1 -- — - Sodium bicarbonate - 3 1 4 - - — - Sodium sulphate 2 2 — - Syrup of figs 1 1 -- — - Tinctures : Benzoin 1 - - - - - 1 -- - — - Toothache - 1 1 - — Vaseline - 1 — — — — 1 - — — — — — - TOTALS 8 38 10 — 56 — — — — — — 59 OTHER ARTICLES Number examined Number adulterated Informal Formal Total Informal Formal Total W N s W N s W N s W N s Almonds 1 1 - - - 2 - - - - - - - Arrowroot - 1 1 — — 2 — — — — — — — Bacon 1 — 1 — Baking powder 7 9 2 - 13 leverages 14 10 71 1 , 46 2 2 Blancmange powder ... 1 1 - — — 2 — — — — — — Bread — 2 — - — — 2 — — — — — — — Butter 5 14 9 28 1 1 Cakes, tarts, etc. 14 7 1 22 — Cereals 7 7 — Cheese 6 16 8 30 Coconut — 1 — - — — 1 — — — — — — Condiments and Favourers 40 71 40 - - - 151 - - - - - - - Cooking fat 4 15 2 - - - 21 - - - - - - - fish 2 2 3 - - 7 - - flour 3 4 1 - 8 - - - - - - - Fruit and fruit juices 4 2 3 - - 9 - - - - - - - Icecream 44 17 43 - — — 104 - — — — — — — lams and spreads 4 2 1 7 1 -- 1 jellies 1 4 - - - - 5 - lard ... 1 1 7 - - - 9 - - - - - - - luncheon meat 4 - 1 - - - 5 - - - - - - - Margarine 6 16 9 - - - 31 - - - - - - - Meat pie 3 . - 3 - - - - - - - Milk. 10 56 - 66 - - - - - - - Milk (tinned) - 1 11 12 - - Masses 2 - 2 - - - - - - Olive oil - 1 1 - 2 - Pancake mixture 1 - - 1 - - - - - - - paste 10 70 4 - - 34 - - - - - - - Pudding mixture - 3 - - - - 3 - - - - - - - Sausages 13 2 26 — — 1 42 1 1 1 3 Soup 2 6 - — 8 Spirits and wines 2 2 -- Suet 4 3 — 7 Sugar 1 1 4 - - - 6 Sultanas. 2 - - - 2 - - - - - - - Vegetables 1 - - - 1 - - - - - - - Yeast and raising powders 3 - - - - 3 - - - - - - - totals 204 241 260 1 - 1 707 5 - 1 - - 1 7 60 Adulterated samples Table 36 mentary division Article Formal or informal Adulteration or irregularity Action taken West Butter Informal Contained glass. Sample supplied by retailer. Wholesaler supplied as received from Ministry of Food (prepacked). Deptford Borough Council (wholesaler's area) notified. West Apple conserve Informal Sulphite preservative equivalent to 95 parts of sulphur dioxide per million. Formal sample taken and found to be genuine. South Pork sausages ... Informal Sulphite preservative equivalent to 220 parts per million. Formal sample taken and found to contain sulphite preservative. See next entry. South Pork sausages ... Formal Sulphite preservative equivalent to 125 parts of sulphur dioxide—per million. Warning letter sent. West Beef sausages Informal Sulphite preservative equivalent to 270 parts of sulphur dioxide per million. Notice subsequently displayed in shop to legal requirement. West Coffee and chicory extract. Informal 440 parts of benzoic acid per million. Formal sample taken and found to be genuine. West Tomato juice Informal 2-4 grains of tin per pound. Stock withdrawn from sale. Unsound food A considerable amount of food was surrendered as unfit for human consumption. In all, approximately 15 tons was dealt with by the Council's food inspectors, consisting of meat, fruit pulp, fish, vegetables, 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. 61 Table 37 West North South Washingup water Tap water Mincemeat Milk (cond.) Meringue Pus from carcase of sheep Tea cups Celery soup Biscuits Peas (tinned) Meat with foreign body Split peas Corned beef Sweetmeat bar Iced lollies Soil, plaster, debris, wood Synthetic cream Bread with maggot Dead rat Milk (cond.) Sponge biscuits Bun Honey Christmas pudding Duck egg Jelly Food poisoning The following is the annual return of food poisoning notifications (corrected) furnished to the Ministry of Health :— (1) Food poisoning notifications (corrected) returned to RegistrarGeneral :— First quarter ... ... ... 4 Second quarter ... ... 6 Third quarter ... ... ... 18 Fourth quarter ... 10 38 (2) Outbreaks due to identified agents :— Total outbreaks ... 2 Total cases ... 7 Outbreaks due to :— (a) chemical poisons (ib) Salmonella organisms ... 1 (c) Staphylococci (including toxin) - (d) CI. botulinum ... ... - (e) Other bacteria ... ... 1 (3) Outbreaks of undiscovered cause :— Total outbreaks ... 1 Total cases ... 1 (4) Single cases :— Agent identified ... 14 ; Unknown cause ... 16 ; Total ... 30 Pharmacy and Poisons Act, 1933 and Pharmacy and Medicines Act, 1941 The names of 13 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 179 persons previously registered were retained on the register. 192 visits were paid by the food inspectors in connection with the granting and renewal of these licences. 62 Shops Act, 1950 This Act consolidates the Shops Acts, 1912 to 1938 and certain other enactments relating to shops. Section 10 of the Shops Act, 1934 relating to ventilation, temperature, sanitary conveniences, lighting, washing facilities and facilities for the taking of meals, which is the section with which this authority is concerned, has been repealed and reenacted in section 38 of the Shops Act, 1950 without any amendment other than a trifling verbal alteration. The new Act came into force on October 1. Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950 This Act came into operation on January 1, 1951 and makes no change in the law but consolidates certain enactments relating to milk, dairies and artificial cream. Part I of the Act provides for the making of regulations to secure the purity of milk, the registration of dairymen, dairy farms and dairy farmers. The sale of tuberculous milk and milk from cows suffering from tuberculosis is prohibited as is also the addition of water, colouring matter or various other substances. Part II of the Act deals with regulations regarding licences to use special designations and makes the use of a special designation obligatory in areas to be specified by the Ministers of Food and Agriculture and Fisheries. Part III deals with artificial cream and prohibits a person from selling or offering for sale for human consumption under a description or designation including the word " cream " any substance purporting to be cream or artificial cream, unless the substance is cream or, where the substance is artificial cream, the word " cream " is immediately preceded by the word " artificial." Any premises where artificial cream is manufactured or sold are required to be registered by the Food and Drugs Authority within their area. Registration of food premises The following premises were registered during the year for the purposes stated in accordance with the requirements of section 14 (1) of the Food and Drugs Act, 1938 :— Sale and storage of icecream 55 Manufacture of sausages, preparation or manufacture of potted, pickled or preserved meat 1 Fish frying 5 Preserved fish 3 The total number of premises on the register is as follow Icecream 326 Fish fryers 46 Sausages 105 Preserved meats 157 Preserved fish 27 Other preserved foods 1 63 Shops Act, 1934 — section 10 (but see also Shops Act, 1950, above) 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 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 three 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. 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 38 Cattle excl. cows Cows Calves Sheep and lambs Pigs Goats Number killed - - - - 7 - Number inspected - - - - 7 ~ 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 - - - - - - Percentage of number inspected, affected - - - - - " 64 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. 4 such licences were granted during the year. A licence can only be granted to a person of the age of 18 years or upwards who is, in the opinion of the local authority, a fit and proper person to hold such licence, and the licence shall be in force for any period up to 3 years and is subject to renewal at the discretion of the local authority. The licence is in force in the district of the local authority granting it and also in the district of any other local authority. The operation of the licence may be suspended within the area of the authority at any time and for such period as the authority may determine and, if the authority are satisfied that the person is no longer a fit and proper person to hold a licence they may revoke it. Applicants for a licence must state whether they hold a licence in any other area, whether they have been refused a licence or have had a licence suspended or revoked in any other area, and whether there is any similar application pending in any other area. Mobile canteens It is very difficult to obtain as good hygienic conditions in a mobile canteen as are normally obtainable in a fixed shop canteen. One of the major factors is the quantity of water available, and its disposal, and another factor of importance is the ability to heat sufficient quantities of water to ensure hygienic washing of crockery. Mobile canteens may still serve a useful purpose in scattered areas, but in a built-up borough such as this it seems on the face of it that fixed shops should be available if the traffic is sufficient, and mobile canteens should not be necessary except possibly in special circumstances, such as sports events, bank holiday aggregations of people, and so on. The committee are in general agreement with this view and no encouragement is given to applications for licences or for other approval of mobile canteens. A difficulty which is met with from time to time is that, from reports we have, it appears that the Ministry of Food is prepared to grant a general licence to mobile canteen owners to cover an area within a certain radius, which may be much greater than the boundaries of the borough. There is an LCC General Powers Act which is concerned with the regulation of trading in streets, but except to a very minor degree it is not concerned with the type of trading which is carried on. The borough council gets applications for approval under this Act, but it cannot have regard to any public health matters when giving or refusing its approval. Nevertheless any cases coming to our knowledge are followed up with a view to ensuring that, if practicable, the committee's policy is put into force. 65 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 amoebic) 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 Number of Notified Cases (corrected for revised diagnosis) during the year 1950 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 39 Diseases Number of cases notified 1950 1949 1948 1947 1946 1945 1944 Anthrax 1 - - - - - Continued and relapsing fever — — — 1 Diphtheria 3 5 9 8 24 24 Dysentery 63 9 24 26 57 31 65 Encephalitis (acute) 1 1 Enteric or typhoid fever 1 3 2 4 2 Erysipelas 41 35 33 45 34 50 86 Food poisoning 38 50 12 3 1 — — Hydrophobia — — 1 — _- Malaria 2 1 2 4 15 Measles 2,084 1,940 2,642 810 1,307 462 688 Meningococcal infection 7 3 5 19 11 3 4 Ophthalmia neonatorum 3 6 9 9 4 1 4 Pneumonia 108 84 67 104 108 71 110 Poliomyelitis (acute) and polioencephalitis 38 35 9 72 5 Puerperal pyrexia 29 27 50 43 32 25 20 Scabies 22 29 54 122 348 566 654 Scarlet fever 358 521 332 254 155 197 270 Smallpox — — — 1 — — 1 Tuberculosis 406 371 502 426 437 371 390 Whooping cough 813 363 789 362 291 238 275 TOTALS 3,608 3,109 4,035 1,887 2,375 1,674 2,201 For comments on the incidence of certain of these diseases, see the paragraph on infectious diseases in the introduction of the report (Page5). Notifications of infectious diseases in 1950 showing sex and age groups:— 66 Table 40 Diseases 0-1 1-5 5-/5 15-45 45-65 65 up M F M F M F M F M F M F M F Diphtheria - - - - - - - - - - - - - - Dysentery 3 2 21 12 7 10 2 3 1 1 — 1 34 29 Encephalitis (acute) - - - - - - - - - - - - 1 - Enteric and paratyphoid... - 1 - - - - - 1 Erysipelas — — — — - - 5 5 11 11 5 4 21 29 Food poisoning 4 — 1 2 2 3 1 7 — 3 1 2 71 17 Malaria — — — — — — 2 — - - Measles 43 37 547 476 496 470 3 12 1089 995 Meningococcal infection 1 4 2 - - - - - - - - 4 3 Ophthalmia neonatorum ... 2 1 __ _ - - 2 1 Pneumonia / / 13 5 7 / 16 14 10 7 9 6 62 46 Poliomyelitis (acute) 1 — 6 6 6 4 5 10 — — — — 18 20 Puerperal pyrexia — — — — — — — 29 — — — — — 29 Scabies — — 1 2 3 5 6 1 1 2 1 11 11 Scarlet fever — 1 56 51 129 111 5 4 1 190 168 Tuberculosis 1 4 15 5 11 15 132 145 44 18 9 7 212 194 Whooping cough 40 38 188 217 135 177 6 11 — — — 1 369 444 Totals 101 91 858 778 796 802 190 242 67 43 24 22 .036 1978 67 Analyses of certain diseases in table 40 into divisional areas:— Table 41 0-1 1-5 5-15 15-45 45-65 65 up Total Measles W 24 415 384 6 _ - 829 N 34 320 313 6 - - 673 S 22 288 269 3 - - 582 Pneumonia w 4 5 4 7 4 4 28 N 6 5 7 13 8 5 44 S 4 8 3 10 5 6 36 Poliomyelitis w - 2 7 3 _ _ 12 N 1 6 - 3 - - 10 S - 4 3 9 - - 16 Scarlet fever w 1 52 115 4 _ _ 172 N 24 54 2 1 - 81 S - 31 71 3 - - 105 68 Infectious disease visiting The Council employs 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. The work they do is in addition to visits paid by the food inspectors to cases of food poisoning and by the district sanitary inspectors on certain other occasions. 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 in visiting infectious diseases carried out during the year, which is in addition to the visits paid by the sanitary inspectors referred to in table 20:— Table 42 W N 5 Total Visits 866 696 620 2,182 Futile visits 192 256 241 689 Revisits 44 14 20 78 Total 1,102 966 881 2,949 Tuberculosis The number of primary notifications of new cases received during the year 1950, and deaths, together with comparative figures for the previous year, were as follows :— Table 43 Number of primary notifications of new cases Deaths 1949 1950 1949 1950 Pulmonary 333 361 92 66 Non-pulmonary 38 45 15 6 Totals 371 406 107 72 69 The age distribution of the new cases of tuberculosis notified by formal notification and the deaths from tuberculosis during the year are shown in the following table:— Table 44 Age periods New cases notified Deaths Pulmonary NonPulmonary Totals Pulmonary NonPulmonary Totals M F M F M F M F M F M F 0- 1 3 _ 1 1 4 _ _ _ _ _ 1- 4 1 - - 4 1 - - - - - - 2- 8 4 3 — 11 4 5- 2 4 3 1 5 5 - - - - - - 10- 6 8 - 2 6 10 15- 19 23 4 3 23 26 2 5 - - 2 5 20- 29 34 2 2 31 36 25- 46 48 3 8 49 56 l1 18 2 1 13 19 35- 29 70 - 7 29 17 45- 26 9 1 3 27 12 11 10 1 1 12 11 55- 17 6 - - 17 6 65- 7 4 - 1 7 5 7 1 _ 1 7 2 75- 2 1 - 1 2 2 1 - - - 1 Totals 196 165 16 29 212 194 31 35 3 3 34 38 Analysis of new cases of tuberculosis into divisional areas:— Table 45 Division Sex 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total Pulmonary M - 2 3 1 3 7 7 11 12 13 7 2 1 69 F - 1 - 1 4 8 6 14 7 3 2 2 1 49 West Non-pulmonary M - - 1 1 - 1 - 2 - - - - - 5 F 1 - - - 1 1 1 4 1 - - 1 1 11 Total M - 2 4 2 3 8 7 13 12 13 7 2 1 74 F 1 1 - 1 5 9 7 18 8 3 2 3 2 60 Pulmonary M - 1 3 - 1 3 12 22 10 6 5 3 - 66 F 2 - 1 1 2 7 16 22 8 3 2 1 - 65 North Non-pulmonary M - - - 2 - 3 1 1 - - - - - 7 F - - - 1 1 1 - 3 3 1 - - - 10 Total M - 1 3 2 1 6 13 23 10 6 5 3 - 73 F 2 - 1 2 3 8 16 25 11 4 2 1 - 75 70 Table 45—continued Division Sex 0- 1- 2- 5- 10 15- 20- 25- 35- 45- 55- 65- 75- Total South Pulmonary M 1 1 2 1 2 9 10 13 7 7 5 2 1 61 F 1 3 2 2 8 12 12 5 3 2 1 - 51 Non-pulmonary M - - 2 - - - 1 - - 1 - - - 4 F - - - - - 1 1 1 3 2 - - - 8 Total M 1 1 4 1 2 9 11 13 7 8 5 2 1 65 F 1 - 3 2 2 9 13 13 8 5 2 1 - 59 Cases of tuberculosis coming to the notice of the department other than by formal notification:— Table 46 Age period Pulmonary Non-pulmonary Total M F M F M F 0- - _ - 1 - 1 1- - 2 - - - 2 2- 1 1 1 - 2 1 5- 2 2 - - 2 2 10- 2 2 1 - 3 2 15- 3 6 - 2 3 8 20- 9 14 - - 9 14 25- 29 32 - 1 29 33 35- 8 12 - - 8 12 45- 4 3 1 - 5 3 55- 4 4 1 - 5 4 65- 4 1 - - 3 1 75- - - 1 - 1 - Total 66 79 5 4 71 83 The sources from which information of the cases in table 46 was obtained were as follows:— Table 47 Source of information Pulmonary Non-pulmonary Death returns — from local registrars 1 1 Death returns — from Registrar General 4 3 Posthumous notifications 1 1 Transfers from other areas (other than transferable deaths) 139 4 Other sources - - Totals 145 9 71 Quarterly revision of tuberculosis register:— Table 48 Pulmonary Non-pulmonary M F M F Number of cases on register at December 31, 1949 1,389 1,031 236 306 Number of cases added during the year 264 249 19 33 Number of cases deducted during the year (deaths, transfers, etc.) 151 142 22 22 Number of cases on register at December 31, 1950 1,502 1,138 233 317 Summary of Statistics as to Tuberculosis for the last ten years Table 49 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 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 1950 228,300 406 1.78 72 66 0.29 Note:—The 1950 death rate from pulmonary tuberculosis for the County of London was 0.36. Public Health (Tuberculosis) Regulations, 1930. Environmental investigations Investigations are made under the above regulations into 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 by the sanitary inspectors and 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 necessary measures are taken by the district sanitary inspector or myself. 72 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 number of visits paid by the infectious disease visitors during 1950 is shown in the following table:— Table 50 W N s Total Visits 139 124 183 446 Futile visits 100 134 182 416 Revisits 1 2 — 3 Total 240 260 365 865 These visits are in addition to those paid by the sanitary inspectors under the general heading "infectious diseases" as indicated in table 20. Results of visiting During the year 536 cases came to notice for enquiries to be made at the premises for proper investigation of the environmental side, but in 107 of these details were not obtained. In some of the cases the patient and his family had left the borough, in a few the patient had already died, while in others permission had been refused or, because of special circumstances, visits had not been thought necessary. In 429 cases details of the environmental conditions were obtained and in the subjoined table I have set out some of the results. For comparative purposes these have been divided into three groups (a) where there had been only one case reported in the house ; (b) where there had been a second case in the house, the new case becoming ill while resident in the borough; and (c) where there had been a second case in the house, but where the notification was in respect of a transfer from another borough. The columns have also been subdivided to show percentages of the environmental conditions found so as to make for easier comparison. 73 TB cases visited in 1950 Table 51 (a) Primary case in house (b) Second case in house Non transfer (c) Second case in house Inward transfer Social condition : Poor 15 358 2 53 Nil 18 Moderate 252 40 12 Superior 91 11 6 Not visited '. 90 11 6 Total 448 64 24 Of those visited: % % % Isolated in (a) Separate room 162 45 27 52 5 28 (b) Separate bed 205 57 43 81 8 44 (c) In bed 147 41 32 60 1 5 Satisfactory window area 351 98 52 98 18 100 Satisfactory lighting and ventilation 339 94 52 98 18 100 Satisfactory food cupboard 225 63 24 45 18 100 Separate water supply 333 92 48 91 18 100 Separate water closet 291 81 41 77 18 100 Separate bath 244 68 36 68 18 100 No bath 60 17 8 15 Nil - Defects requiring attention 64 18 11 21 1 5 74 It will be seen, comparing column (b) with column (a), that where there had been a second case in the house there was a greater tendency for the second case to be isolated in a separate bed than where there was merely the one case in a house. Window area, lighting, ventilation were about the same in each group, but in the multiple cases there was a lower percentage with satisfactory food storage facilities. The percentages of the two groups having separate water supply, separate water closets and separate baths were almost identical and, similarly, the percentages having no bath available (17 in one case, 15 in the other) show no significant difference. There was, however, a slight increase in the percentage of the houses requiring attention for sanitary defects in the group of multiple cases compared with the group of single cases. The better results in column (c) can be explained by the fact that nearly all the inward transfers were rehousing cases to new or newish houses in the borough. Analysis of the record cards was also made from the angle of crowding or overcrowding. In this case 419 cards were reviewed (10 less than those dealt with in the paragraphs above) and of these 105 were not assessed. This was due to the fact that at the beginning of the year exact measurements were not made of the rooms in the houses. This leaves 314 cases and of these, 18 were found to be overcrowded on the standard laid down in the Housing Act, 1936, and 296 were not overcrowded (see Fig. on p. 73). The numbers are not further analysed into a group where there was only one case in a house and into a group where there was more than one case in a house. The percentage overcrowded of those assessed is therefore 5.7. In the 1935 overcrowding survey, when the whole borough was reviewed, the percentage of families overcrowded was 3.1. Mass radiography unit The south-east London mass radiography unit visited the borough during March and April and was stationed at various centres. 5,190 men and 5,360 women were examined. Of the 5,190 men 206 were asked to return so that larger X-rays could be taken, and of these 4 did not reattend. Of the 202 remaining 38 were found to have no abnormality and 80 were thought to have old trouble not requiring further treatment; 65 were referred to their doctors as probably tuberculous and a further 10 for some other reason probably not tuberculous. Nine cases were still being investigated at the time of the report. Of the 5,190 men, therefore, 65 or 1.3 per cent. were thought to be cases of tuberculosis. Of the 5,360 women 228 were asked to return for larger X-rays, but 3 did not attend. Of the 225 remaining 38 showed no abnormality and 97 showed old trouble not requiring treatment. 68 were referred to their doctor as probably tuberculous and 16 for other reasons nontubercular. Six were still being investigated. Of the 5,360 women, therefore, 68 or 1.3 per cent. were thought to be tuberculous. The figures were also divided up amongst the various firms and groups, and in 6 cases amongst the men and in 2 cases amongst the women there was more than one probably tuberculous person present 75 in a group. In addition, amongst the private residents there were 34 cases of tuberculosis in 2,266 males examined and 55 cases amongst 3,370 females examined. Amongst the groups referred to were Lewisham borough council staff where there were 5 probable cases of tuberculosis amongst 465 men and nil cases amongst 82 women. Some further enquiries were made with regard to one of the firms which showed a fairly high incidence of cases, but no further action was required. If schools are excluded from the figures, the percentages are somewhat different as school children of course have a much smaller rate of disease. Of the private residents, as has been stated, there were 34 cases of probable tuberculosis amongst 2,266 men, giving a percentage of 1.5 per cent., and 55 cases amongst 3,370 women, giving a percentage of 1.6 per cent., but taking these out and also the school children, the remaining figures for the borough council or for firms show 28 cases of tuberculosis amongst 2,400 men, giving an incidence of 1.2 per cent., and 13 cases amongst 1,296 women, giving an incidence of 1.0 per cent. It will be seen therefore that the incidence of tuberculosis amongst private residents is fairly considerably higher than it is in firms and administrative groups. This can probably be explained in large part, if not completely, by the fact that amongst the private residents those who have some symptoms are more attracted to being X-rayed, and therefore they rather overweight their particular group, whilst amongst firms and commercial undertakings the tendency is for all the staff to go for examination, and therefore there is less weighting from those cases which are more likely to be tuberculous. 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 52 December 31, 1950 Under 1 1 2 3 4 5-9 10-14 Total under 15 in year 1950 1949 1948 1947 1946 1941-45 1936-40 Diphtheria and c omtaed diphtheria and wooping cough:— Immunised during year Estimated number immunised by end of year 176 1,678 421 172 110 415 119 3,091 176 1,860 3,001 2,925 2,349 14,769 8,554 33,634 Estimated mid-year Population 20,250 27,940 48,190 'Wooping cough only:— immunised during the year . - 111 37 25 23 18 - 214 76 (iii) Vaccination against smallpox Age at December 31, 1950 Under 1 1-4 5-14 15 and over Total Primary:— At clinics 455 447 47 35 984 By private doctors 191 329 65 83 668 Re-vaccination:— At clinics — 9 14 92 115 By private doctors 2 9 35 178 224 Town Hall, S.E.6. 9 July, 1951 E. H. R. SM1THARD, Medical Officer of Health. 77 APPENDIX A Acts of Parliament, Statutory Instruments and Circular Letters issued by Government Departments, with regard to the Public Health services, during the year 1950:— Statutes Shops Act, 1950. Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950. Diseases of Animals Act, 1950. Statutory Instruments No. 6 Public Health (Aircraft) Regulations, 1950. 189 The Food and Drugs (Whalemeat) (Amendment) Regulations, 1950. 363 The Housing Acts, 1936-1949 (Forms of Orders and Notices) (Amendment) Regulations, 1950. 409 Milk (Special Designation) (Raw Milk) (Amendment) Regulations, 1950 and Milk (Special Designation) (Pasteurised and Sterilised Milk) (Amendment) Regulations, 1950. 410 Milk (Special Designation) (Raw Milk) (Amendment) Regulations, 1950. 589 The Food Standards (Fish Cakes) Order, 1950. 842 Factories — The Local Authorities (Transfer of Enforcement) (Amendment) Order, 1950. 1056 The Food Standards (Preserves) (Amendment) Order, 1950. 1061 The Labelling of Food Order, 1950. 1213 Poisons List Order, 1950. 1214 Poisons Rules, 1950. 1239 Mineral Oil in Food (Amendment) Order, 1950. 1763 Landlord and Tenant (Rent Control) (Amendment) Regulations, 1950. 1764 Meat Products and Canned Meat (Amendment) Order, 1950. 1871 Food Standards (Preserves) (Amendment) (Commencement) Order, 1950. Ministry of Health Circulars No. 2 Preparation of Annual Reports of Medical Officers of Health. 5 Reduction in Capital Expenditure—Control of Building Operations. 7 Public Health (Aircraft) Regulations, 1950. 11 Welfare of old people. 22 Public Health (Tuberculosis) Regulations, 1940. 54 Housing Acts, 1936-1949 — Preservation of certain unfit houses — model forms. 112 Annual reports of Medical Officer of Health for 1950. 78 Ministry of Food Circulars MF 2 The Food and Drugs (Whalemeat) (Amendment) Regulations, 1950. 4 Milk (Special Designation) (Raw Milk) (Amendment) Regulations, 1950 and Milk (Special Designation) (Pasteurised and Sterilised Milk) (Amendment) Regulations, 1950. 9 The Milk and Dairies Regulations, 1949. 10 The Food Substitutes Control Order, 1941. 11 The Milk and Dairies Regulations, 1949. 12 The Labelling of Food Order, 1950. 13 Mineral Oil in Food (Amendment) Order, 1950. 14 Milk (Special Designation) Act, 1949, Milk (Special Designation) Regulations, 1949 and Milk and Dairies Regulations, 1949. 15 Vinegar and Solution of Acetic Acid. 17 Milk and Dairies Regulations, 1949 — approved oxidising and preservative agents. 19 Labelling of Cake and Pudding Mixtures. 21 Meat products. 22 Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950. 23 Starch Food Powders Control Order, 1944. Memorandum No. 2 Whalemeat. 79 APPENDIX B Legal Proceedings in 1950 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 6 March Non-compliance with abatement order in respect of 46, Springfield Rise. — £ s. d. Adjourned to 17 April Licences to be applied for shortly, and work to be commenced as soon as they are issued. 17 April Non-compliance with abatement order in respect of 46, Springfield Rise. 10/- 2 2 0 6 March Non-compliance with abatement order in respect of 48, Springfield Rise. Adjourned to 17 April. Licences to be applied for shortly, and work to be commenced as soon as they are issued. 17 April Non-compliance with abatement order in respect of 48, Springfield Rise. 10/- 2 2 0 - 6 March Non-compliance with abatement order in respect of 7, Rosamond Street. Adjourned to 17 April. Licences to be applied for shortly, and work to be commenced as soon as they are issued. 17 April Non-compliance with abatement order in respect of 7, Rosamond Street. Work completed. Summons withdrawn. 6 March Non-compliance with nuisance notice in respect of 38, Eltham Road. " 1 1 0 Order made for abatement of nuisance within 14 days. 6 March Non-compliance with nuisance notice in respect of 48, Eltham Road. Adjourned to 17 April. Owner contended that property was unfit and could not be made fit at reasonable cost. 17 April Non-compliance with nuisance notice in respect of 48, Eltham Road. 2 2 0 Order made for abatement of nuisance within 56 days. 6 March Non-compliance with nuisance notice in respect of 45, Longton Grove. 1 1 0 Order made for abatement of nuisance within 28 days. 24 March Non-compliance with nuisance notice in respect of 2, Handen Road. 1 1 0 Order made for abatement of nuisance within 28 days. 17 April Non-compliance with abatement orders (2) in respect of 52, Leyland Road. £4 1 1 0 On each summons. 17 April Non-compliance with abatement order in respect of 54, Leyland Road. £4 1 1 0 — 17 April Non-compliance with nuisance notice in respect of 62, Brownhill Road. Order made for abatement of nuisance within 56 days. 80 Date of hearing Nature of offence Fine Costs Remarks 17 April Non-compliance with nuisance notice in respect of 84, Stanstead Road. 10/- £ s. d. — 2 2 0 10 May Non-compliance with nuisance notice in respect of 28, Bradgate Road. - 1 10 0 Order made for abatement of nuisance within 56 days. 10 May Non-compliance with nuisance notice in respect of 18, Knighton Park Road. Adjourned to 26 June. Defendant stated that he was not the owner and had no interest in the property. 26 June Non-compliance with nuisance notice in respect of 18, Knighton Park Road. Case dismissed. Ownership not proved. 5 June Non-compliance with nuisance notices in respect of 6, 9, 10, 11, 13, 15, 32 and 33, Stanton Square. Adjourned to 26 June. Summonses incorrectly served. 26 June Non-compliance with nuisance notices in respect of 6, 9, 10, 11, 13, 15, 32 and 33, Stanton Square. Adjourned sine die. Some work completed and other work in progress. Remainder of work held up pending agreement with WDC. 5 June Non-compliance with nuisance notice in respect of 50, Wisteria Road. 1 0 0 Order made for abatement of nuisance within 28 days. 5 June Non-compliance with nuisance notice in respect of 62, Taunton Road. Adjourned sine die. Urgent repairs carried out. Remainder of work will be carried out when agreement reached with WDC. 5 June Non-compliance with nuisance notice in respect of 125, Taunton Road. Adjourned sine die. Urgent repairs carried out. Remainder of work will be carried out when agreement reached with WDC. 9 June Non-compliance with nuisance notice in respect of 32, Dallas Road. Summons withdrawn. House sold to tenant who will carry out necessary repairs. 9 June Non-compliance with nuisance notice in respect of 78, Taunton Road. 1 0 0 Order made for abatement of nuisance within 28 days. 9 June Non-compliance with nuisance notice in respect of 14, Old Road. 1 0 0 Order made for abatement of nuisance within 28 days. 9 June Non-compliance with nuisance notice in respect of 3, Northbrook Road. 1 0 0 Order made for abatement of nuisance within 56 days. 8 Sept. Non-compliance with nuisance notice in respect of 28, Leyland Road. 1 0 0 Order made for abatement of nuisance within 28 days. 81 Date of hearing Nature of offence Fine Costs Remarks 8 Sept. Non-compliance with nuisance notice in respect of 119, Manor Park. — £ s. d. Order made for abatement of nuisance within 56 days. 8 Sept. Non-compliance with nuisance notices (2) in respect of 23, Fairlawn Park. (first 1 0 0 summons) Orders made for abatement of nuisances on each summons within 28 days. 8 Sept. Non-compliance with nuisance notice in respect of 34, Canadian Avenue. Adjourned for one month. Magistrate to consider question of structural defects in view of existence of agreement between landlord and tenant. 6 Oct. Non-compliance with nuisance notice in respect of 34, Canadian Avenue. Adjourned for hearing by magistrate originally taking case. 18 Oct. Non-compliance with nuisance notice in respect of 34, Canadian Avenue. Adjourned sine die. Defendant promised to put work in hand. 18 Oct. Non-compliance with nuisance notice in respect of 15, Darfield Road. - Magistrate refused to make an order. 18 Oct. Non-compliance with nuisance notice in respect of 12, Charleville Circus. Adjourned sine die. Court had received letter from owner, stating that she had no money to spend on repairs. 18 Oct. Non-compliance with nuisance notice in respect of 89, Sydenham Park Road. Adjourned sine die. Some work done. Court had received letter stating that remainder of work would be put in hand. 18 Oct. Non-compliance with nuisance notice in respect of 53, Venner Road. 1 0 0 Order made for abatement of nuisance within 28 days. 27 Oct. Non-compliance with nuisance notice in respect of 39, Summerfield Street. - Order made for abatement of nuisance within 21 days. 17 Nov. Non-compliance with nuisance notice in respect of 13, Taunton Road. Summons withdrawn. Work done. 17 Nov. Non-compliance with nuisance notice in respect of 10, Manor Lane Terrace. 1 1 0 Order made for abatement of nuisance within 28 days. 17 Nov. Non-compliance with nuisance notice in respect of 15, Taunton Road. Summons withdrawn. Work done. 17 Nov. Non-compliance with nuisance notice in respect of 100, Manor Park. - - Order made for abatement of nuisance within 42 days. 17 Nov. Non-compliance with nuisance notice in respect of 61, Coombe Road. 1 1 0 Order made for abatement of nuisance within 28 days. 82 Date of hearing Nature of offence Fine Costs Remarks 17 Nov. Non-compliance with nuisance notice in respect of 48, Dallas Road. — £ s. d. Order made for abate ment of nuisance within 42 days. 1 1 0 17 Nov. Non-compliance with nuisance notice in respect of 92, Fairlawn Park (ground floor flat). 0 6 Order made for abate ment of nuisance within 14 days. 17 Nov. Non-compliance with nuisance notice in respect of 92, Fairlawn Park (first floor flat). 0 6 Order made for abatement of nuisance within 14 days. 17 Nov. Non-compliance with nuisance notice in respect of 37, Dallinger Road. Adjourned s/ne die. Work commenced. 1 Dec. Non-compliance with notice requiring provision of a dustbin in respect of 85, Farley Road. Summons withdrawn, Dustbin supplied. 1 Dec. Non-compliance with nuisance notice in respect of 41, Limes Grove. Adjourned to 12 January, 1951 (and then adjourned sine die). 15 Dec. Non-compliance with nuisance notice in respect of 30, Silvermere Road (first floor flat). Adjourned for one month. 15 Dec. Non-compliance with nuisance notice in respect of 30, Silvermere Road (ground floor flat). Adjourned for one month. 15 Dec. Non-compliance with abatement order in respect of 28, Leyland Road. Adjourned sine die. Owner stated that property is heavily mortgaged and that she has no money to pay for repairs. BYELAWS MADE BY THE LONDON COUNTY COUNCIL Date of hearing Nature of offence Fine Costs Remarks £ s. d. 24 July Exchange of balloons for old rags on 15 June at Elfrida Crescent. £2 Summonses against two persons each of whom was fined £1. 24 July Exchange of balloons for old rags on 16 June at Ballamore Road. £1 15 Dec. Non-compliance with notice served under drainage byelaws in respect of 30, Silvermere Road. Adjourned for one month. 83 CASES HEARD BY APPEALS COMMITTEE OF THE LONDON COUNTY COUNCIL Date of hearing Nature of appeal Remarks 3 April Appeal by tenant against notice served under s.105 Public Health (London) Act, 1936, requiring him to provide a dustbin. Appeal allowed. 24 Nov. Appeal by tenant against notice served under s.109 Public Health (London) Act, 1936, requiring him to provide a new water closet pan. Appeal allowed. 24 Nov. Appeal by tenant against notice served under s.105 Public Health (London) Act, 1936, requiring him to provide a dustbin for the use of his subtenant. Tenant agreed to allow subtenant to use his own dustbin. Adjourned sine die and liberty to apply granted to both Council and tenant. HOUSING ACT, 1936 Date of hearing Nature of offence Fine Costs Remarks £ s. d. 26 June Non-compliance with requirements of s.168 in respect of 82, Westwood Hill. Adjourned sine die. Information as required subsequently supplied and summons withdrawn. 20 Nov. 20 Nov. Appeal against orders served under s.11 in respect of 40 and 42, Lee Church Street. Adjourned. Case did not go to court. Owner's offer of works accepted. Appeal under order made under s.11 in respect of 323, Baring Road. Appeal withdrawn. Appeal against notice served under s.9 in respect of 43, Addington Grove. Appeal withdrawn. 30 Nov. Appeal against notices served under s.9 in respect of 10, 14 and 16, Morena Street. Adjourned to 29 January, 1951 (and then appeal withdrawn). 84 Milk and Dairies Regulations, 1949 Date of hearing Nature of offence Fine Costs Remarks 30 Nov. Milk contained in dirty bottle delivered to a school. Defendants pie on each of 3 aded guilty summonses £ s. d. £ s. d. 30 Nov. Milk contained in dirty bottles (7) delivered to a school. (1) 2 0 0 3 3 0 (2) 1 10 0 - (3) 1 10 0 — Food warnings In addition to legal proceedings authorised for contravention of the Food and Drugs Act, 1938, etc., and Milk and Dairies Regulations, 1949, warning letters were sent in respect of the following matters, where the evidence was not sufficient to warrant legal proceedings being instituted:— Adhesive tape in bread. String in bread. Milk contained in dirty bottle. Cockroach in bread (2 cases). Beetle in bread. Foreign matter in bread. Sausages containing preservative (notice not displayed as required by Public Health (Preservatives) in Food Regulations. Cigarette end and tobacco in bun. APPENDIX C List of special reports submitted to the Public Health Committee by the Medical Officer of Health during 1950:— January 3 Icecream control. March 28 Retirement of senior sanitary inspector, and consequent suggested changes in the department. June 6 Icecream control. Pharmaceutical services. Lymphocytic choriomeningitis. Borough of Lewisham TB care committee and representation on proposed divisional TB care committee. Provision of dustbins. Old people's welfare —grants to voluntary organisations. October 3 Standards for licensing of slaughtermen. October 31 Laundry facilities for the aged sick who remain at home. November 28 Rodent control and fly control. 85 TABLES TABLE NO. SUBJECT PAGE 1 Comparative statistics 10 2 General summary of vital statistics in last ten years 10 3 Causes of death by age groups 11 4 Deaths under one year of age 12 5 Social class mortality 14 6 Causes of death by social class 15 7 Grouped causes of death by social class 16 8 Births, infant deaths, etc. by social class 17 9 Certain infant mortality figures by social class 18 10 Notified and premature births 19 11 General statistics from 1901 20—21 12 Disinfecting station 22 13 Public mortuary 25 14 Rodent control 26 15 Rodent control — treatment of rivers 27 16 Prevalence of rats and mice 29 17 Water supply samples — chemical 32 18 Water supply samples — bacteriological 32 19 Weather conditions in 1950 39 20 Sanitary inspection 40 21 Special sanitary circumstances 42 22 Summary of notices 43 23 Nuisances remedied 43 24 Factories and workshops — inspections 45 25 Factories and workshops — defects 45 26 Applications for rehousing 48 27 Demolition orders 50 28 Closing orders 50 29 Civil building licences 53 30 Various housing statistics 54 31 Analysis of milk 55 32 Heat-treated milk 56 33 Icecream — grading 56 34 Icecream — fat content 57 35 Food and Drugs Act — samples analysed 58 36 Food and Drugs Act — adulterated samples 60 37 Other samples 61 38 Meat inspection 63 39 Principal notifiable diseases 65 40 Notifications of infectious diseases by age and sex 66 41 Analysis of certain diseases into divisional areas 67 42 Infectious disease visiting 68 43 Tuberculosis notifications and deaths 68 44 Age distribution of tuberculosis cases 69 45 Analysis of new cases of tuberculosis into divisional areas 69 46 Cases of tuberculosis not formally notified 70 47 Sources of information of cases in table 46 70 48 Revision of tuberculosis register 71 49 Summary of statistics as to tuberculosis for the last ten years 71 50 Tuberculosis — environmental investigations 72 51 Tuberculosis cases visited in 1950 73 52 Immunisation against infectious disease 75 CHARTS Scarlet fever in parliamentary divisions 66 Measles — weekly incidence 67 Tuberculosis — environmental investigations 73 86 INDEX SUBJECT PAGE Acts, regulations and orders 77 Area of borough 9 Atmospheric pollution 37 Birth rate 9 Civil building licences 53 Death rates 9 Deaths, causes of 11 Disinfection and personal cleansing 22 Dog nuisances 47 Dustbins — provision of 44 Factories and workshops 45 Flies and mosquitoes 23 Flytipping on vacant sites 47 Food — adulteration of 58 Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950 62 Food — inspection and supervision 55 Food poisoning 61 Health services — general provision of 22 Housing:— New building 48 Families rehoused 48 Applications for rehousing 48 Housing Act, 1936 49 Icecream — fat content 56 Icecream grading 56 Immunisation against infectious disease 75 Infant mortality 9 Infant mortality table 12 Infectious diseases 65 Infectious disease visiting 68 Introduction 3 Laboratory facilities 23 Landlord and Tenant (War Damage) (Amendment) Act, 1941 44 Legal proceedings 79 Lymphocytic choriomeningitis 30 Maternal deaths 10 Measles chart 67 Meat inspection 63 Meteorology 37 Milk — analysis of 55 Milk and Dairies Regulations, 1949 55 Mobile canteens 64 Mortuary and Coroner's Court 25 SUBJECT PAGE National Assistance Act, 1948:— Section 47 24 Section 50 25 Nuisances remedied 43 Offensive trades 63 Old people 35 Outworkers 46 Pharmacy and Poisons Act, 1933 61 Population 9 Premature births 18 Prevention of Damage by Pests Act, 1949 27 Rateable value 9 Registration of food premises 62 Rent and Mortgage Interest (Restrictions) Acts 44 Rodent control 26 Sampling 58 Sanitary circumstances of the area 40 Scarlet fever chart 66 Shops Act, 1934 63 Shops Act, 1950 62 Slaughterhouses 63 Slaughtermen's licences 64 Smoke nuisances 46 Social class statistics 13 Staff 2 Stillbirths 9 Swimming baths 33 Tables, list of 85 Tuberculosis:— Age and sex distribution 68 Analysis in divisional areas 69 Cases other than by formal notification 70 Environmental investigations 71 Mass miniature radiography 74 Quarterly revision of register 71 Unsound food 60 Vital statistics 11 Washing facilities at public conveniences 34 Water certificates 45 Water supply 31