METROPOLITAN BOROUGH OF LEWISHAM REPORT OF THE Medical Officer of Health for the Year 1951 E. H. R. Smithard, MBE, MD, DPH London : e. g. Bbrryman 8c Sons, Ltd., Blackheath Road, s.e.10. METROPOLITAN BOROUGH OF LEWISHAM REPORT OF THE Medical Officer of Health for the Year 1951 E. H. R. Smithard, MBE, MD, DPH CONTENTS page Staff 2 Introduction 3 Vital Statistics 6 General Provision of Health Services 18 Sanitary Circumstances of the Area 34 Housing 40 Inspection and Supervision of Food 47 Infectious Diseases 54 Appendix A—Statutory Instruments 66 Appendix B—Legal Proceedings 68 Appendix C—Special Reports to Health Committee 74 Appendix D—1 Percent Sample, 1951 Census 75 List of Tables 77 Index 78 STAFF as at 31/12 /51 Medical Officer of Health E. H. R. Smithard, mbe, md, bs, mrcs, lrcp, dph Senior Sanitary Inspector Deputy Senior Sanitary Inspector E. Walker (a) (6) A. J. Phillips (a) (6) Group Sanitary Inspectors A. G. Thomas (a) (b) (Food) R. Mahoney (a) (6) (District) J. R. Craven (a) (b) (Housing) District Inspectors Food Inspectors and Sampling Officers J. W. Bevan (a) (6) H. W. Ellery (a) (b) C. L. Connor (a) T. R. A. Fitzherbert (a) (6) S. G. Cocks (a) (b) H. Tolson (a) (b) J. Edmunds (a) G. E. Fallows (a) (b) A. Gartside, dpa (a) (b) W. Hodson (a) (b) Housing Inspectors R. I. W. Owen (a) R. C. Brittain (a) (b) W. S. Parsons (a) (b) H. Rogers (a) K. R. Wagener (a) (b) Inspector for special purposes Miss D. M. Parnell (a) (a) Sanitary inspector's certificate. (b) Food inspector's certificate. Infectious Disease Visitors Miss M. E. K. Johnston, srn, srfn, scm Mrs. J. M. Wheeler, srn, srfn Principal Clerk E. W. Cheesman Clerical Staff S. Burridge, senior clerk J. A. Enright Miss I. D. Coppin L. Gardiner Miss I. L. Hatton Miss D. J. Miles C. R. Coleman 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 Rodent/fly operatives 4 Drain testers 2 Public Analyst A. J. Lickorish, fic Bacteriologists E. H. Bailey, mrcs, lrcp, and C. H. R. Knowles, mb, bs, mrcs, lrcp, 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 1951. Introduction The RegistrarGeneral's estimate of the population in mid year 1951 at 227,200 was 1,100 less than his estimate for mid year 1950, but since the former estimate was made the census was taken, in April, 1951, and the preliminary report indicates that the figure then was 227,551. The present figure includes members of the armed forces stationed in the area. The prewar estimated total population, in June, 1939, was 231,000. The birth rate for the year at 15.3 is the same as for the previous year, being well below the immediate postwar figures. The death rate again shows an increase, from 10.6 to 11.2, but as the rate for the county of London increased from 11.8 to 13.1 the increase in the local rate was not so great. The infant mortality rate at 25 showed a drop of 1 from the previous year ; the neonatal rate (i.e., under one month of age) decreasing from 19 to 17 while the one month to one year rate increased from 7 to 8. The stillbirth rate increased slightly, from 14.7 to 16.1, but this is still reasonably satisfactory ; the combined stillbirth and infant death rate therefore remain approximately the same. One maternal death occurred during the year, giving a maternal mortality rate per thousand live and stillbirths of 03. The various comparative figures since 1901 are shown on page 17 (table 10). Tuberculosis The number of new notifications dropped from 406 to 299, showing a decrease in the notification rate per thousand population from 1.8 to 1.3. The number of deaths from tuberculosis also showed a slight but welcome reduction from 72 to 68. As indicated in section F of the report (the infectious disease section) there is much better news of tuberculosis generally and it seems that the various methods of dealing with it, increased and improved as they have been over recent years, are now showing a definite effect, which might well prove to be a rapidly increasing effect year by year. Maternity and child welfare There was very little variation in the principal rates but the neonatal rate did (as indicated in the last but one paragraph) decrease from 19 to 17. This rate is still high, and the drop in the rate for the age of one month to one year has left it far behind. The neonatal rates from 1921 to 1926 were respectively 23, 26, 20, 23, 23 and 18, so rates last year of 17 and of 19 the year before do not show that there has been much improvement during the 25 or so years' interval. An analysis of the neonatal deaths indicates that 10 of the 59 were due to congenital deformities, 8 (against 5 last year) to injury at birth and 21 (against 28 last year) to prematurity or immaturity. 4 Food hygiene The notified cases of food poisoning during the year amounted to 26, 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 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. Infectious diseases With regard to the more acute infections the year was remarkable for the high number of measles cases, no less than 3,546 being notified ; these were mostly concentrated into the first three months of the year. Two deaths resulted. There was a considerable increase in the number of dysentery notifications — 365 as against 63. This however at present is a mild disease and it is likely that many other cases occur which because of their mildness are not notified. There were 173 cases of pneumonia against 108 the year before and these occurred mainly at the beginning of the year when there was a small influenza epidemic. Puerperal pyrexia was another notifiable condition which showed a considerable increase, there being 63 cases against 29 the year before, but the difference can in part be ascribed to an alteration in the definition of the disease, as a result of which more cases fall to be notified. Whooping cough was prevalent, as it also was the previous year, and one death resulted therefrom. For the second year in succession there was no case of diphtheria notified and subsequently confirmed in the borough, but in point of fact this rather emphasizes the necessity for the protection of young children against the disease by immunisation. Not all areas of the country are free from infection and unless the child population remains well immunised there is always a danger, and a very real danger, of virulent diphtheria becoming again prevalent. When it is remembered that some 25 years ago there was an average number of 20 deaths from diphtheria each year in Lewisham and something over 250 cases (each of which meant pain and discomfort to the patient, anxiety to relatives, and much work and cost to the hospital services) it will be appreciated how well the immunisation campaign has succeeded. It is thought that, in order to safeguard the community against a diphtheria epidemic, it is necessary to secure that not less than 75 percent of babies are immunised before their first birthday. But the wise parent will not run the risk of merely sheltering behind the 75 percent; he will insist on his own child being protected as an individual. Old people During the year one further club helping old people in the borough applied for and qualified for grant, and a grant was made. This club, besides running an afternoon session, arranges for lunch facilities on 5 the same day, and both sides of the club have been very successful. The committee is glad to help clubs which are looking after the needs of old people, and since good nutrition is so highly important in preventing a breakdown of physical and mental conditions in old age, the committee does what it can to encourage organisations to provide lunches. These lunches are usually obtained in bulk through the Meals on Wheels service of the Lewisham Old People's Welfare Association and they are retailed at a price made low by the fact that they receive a central grant. • Social medicine statistics In section A, vital statistics, will be found some comments on the statistics of occupational or social class which have been obtained from 11 of the 14 towns in the United Kingdom which have a population between 200,000 and 300,000. This analysis shows promise of revealing some intersting factors and it is hoped to keep it on for three years in all, mainly for two purposes : first, that this will produce much greater numbers in the statistics and thereby make them more accurate, and secondly, it will iron out differences which may occur through certain events which might take place in one year and not in another, e.g., a bad winter leading to increased cases of pneumonia and bronchitis ; or an epidemic of influenza. Included in this section also will be found a more detailed analysis of the Lewisham births and deaths in social class. In ending the introduction to this report I wish to express my thanks to the health department staff for their work during the year. 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 C. P. Braithwaite (Chairman); Councillor New (Vice-Chairman); The Mayor (Councillor H. M. Pinnell, j.p.) ; Aldermen Carter, Mrs. Huggett and Street; Councillors Mrs. Armstrong, Mrs. Bunce, Mrs. Drapper, j.p., Duhan, m.c., Evans, Fisher, Hasling, Hawes, Mrs. Land, Oliver, Mrs. Smith, Spencer and P. E. Stoffel. 6 SECTION "A" —VITAL STATISTICS* Area The area of the borough is 7,015 acres. Public open space comprises 652 acres. Population Census 1951 (preliminary report) 227,551 The Registrar.General's estimate of the home population at midyear 1951 was 227,200 (this includes members of the armed forces stationed in the area). Rateable value County of London rateable value of the borough at April 1, 1951 £1,830,235 Estimated net product of a penny rate, 1951/52 £7,4.25 Estimated number of separately assessed dwellings at April 1, 1951 61,800 Births (adjusted for inward and outward transfers) No. of live births 3,481 Males Females Total Legitimate 1,679 1,670 3,349 Illegitimate 63 69 132 Totals 1,742 1,739 3,481 Birth rate per 1,000 of the estimated population 15.3 Birth rate for England and Wales 15.5 Birth rate for London Administrative County 17.8 Stillbirths The total number of stillbirths allocated to the borough during the year was 57. This represents a stillbirth rate per thousand live and stillbirths of 16.1. Deaths The total number of deaths belonging to the borough registered during the year was 2,542 consisting of 1,278 males and 1,264 females, giving a death rate per thousand of the estimated population of 11.2 as compared with a rate of 12.5 for England and Wales and 13.1 for the administrative county of London. Infant mortality Number of infant deaths 86 Legitimate 82 Illegitimate 4 Rates : 1. All infants per thousand live births 24.7 2. Legitimate infants per thousand live legitimate births 24.5 Illegitimate infants per thousand live illegiti. 3. mate births 30.3 Neonatal deaths (under one month of age) 59 Neonatal death rate (per 1,000 live births) 16.9 * See also Appendix D 7 Reproductive wastage— Stillbirths plus infant deaths 143 Rate per thousand live and stillbirths 40.4 Maternal deaths Number of maternal deaths 1 Maternal mortality rate per thousand live and stillbirths 0.28 Other special causes of death Number of deaths from Whooping Cough 1 „ „ „ Measles 2 „ ,, „ Diarrhoea (under 2 years) 2 „ „ „ Motor Vehicle Accidents 18 „ „ „ Suicide21 „ „ „ Tuberculosis (all forms) 68 „ „ „ Cancer (Code Nos. 10—15) 470 „ „ „ Heart and Circulation Diseases (Code Nos. 17.21) 1,165 Comparative statistics for the year 1951 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 0.25 11.2 24.7 England and Wales 15.5 0.36 12.5 29.6 London Administrative County 17.8 0.37 13.1 26.4 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  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 1951 227,200 3481 15.3 2542 11.2 86 25 60 0.26 8 Causes of death at different periods of life during the year 1951 The following table shows the causes of and ages at death during the calendar year 1951 :— Table 3 Code No. Cause of death Nett deaths at the subjoined ages of "residents" 1 whether occurring within or without the borough 1 All ages Under 1 yr. 1 and under 5 and under 15 and under 25 and under 45 and under 65 and under 75 and vover  5 15 25 45 65 75 Totals, all causes 2542 86 19 13 12 126 598 657 1013 1 Tuberculosis, respiratory 60 _ 1 25 22 6 6 2 Tuberculosis, other 8 1 1 1 1 1 1 1 1 3 Syphilitic disease 10 — — — — — 4 4 2 4 Diphtheria — — _ — — — — — - 5 Whooping cough 1 — 1 — — — — — - 6 Meningococcal infections — — — — — — — — - 7 Acute poliomyelitis — — — — — — — — - 8 Measles 2 — 1 1 — — — - 9 Other infective and parasitic diseases 6 - 1 - - 1 2 2 10 Malignant neoplasm, stomach 50 - - - - 1 22 13 14 11 Malignant neoplasm, lung and bronchus 78 - - - - 3 37 30 8 12 Malignant neoplasm, breast 48 — — — 5 17 11 15 13 Malignant neoplasm, uterus 14 — — — — 2 7 3 2 14 Other malignant and lymphatic neoplasms 267 1 2 1 __ 20 78 84 81 15 Leukaemia, aleukaemia 13 2 2 — 2 2 2 3 16 Diabetes 19 — 1 — 7 5 6 17 Vascular lesions of nervous system 271 - - - - 8 52 85 126 18 Coronary disease, angina 288 — — — — 5 87 92 104 19 Hypertension with heart disease 73 - - - - 3 10 25 35 20 Other heart disease 455 — _ 9 43 98 12 305 21 Other circulatory disease 78 1 — 1 1 2 14 47 22 Influenza 47 1 — — — 1 9 13 23 23 Pneumonia 110 13 5 — 2 5 14 21 50 24 Bronchitis 213 1 — 2 54 69 87 25 Other diseases of respiratory system 24 _ 1 _ _ 2 8 5 8 26 Ulcer of stomach and duodenum 31 - - - - 1 16 12 2 27 Gastritis, enteritis and diarrhoea 9 2 - - - - 4 3 28 Nephritis and nephrosis 24 - — 1 1 3 9 6 4 29 Hyperplasia of prostate 24 - — — — — 2 8 14 30 Pregnancy, childbirth, abortion 1 - - - - 1 - — - 31 Congenital malformations 18 11 1 — 1 3 1 1 - 32 Other defined and illdefined diseases 220 52 2 2 1 8 53 41 61 33 Motor vehicle accidents 18 2 2 2 3 4 2 3 34 All other accidents 41 3 — 2 5 8 6 17 35 Suicide 21 - _ 1 5 11 2 2 36 Homicide and operations of war — — — — — — — - - 9 Deaths under 1 year of age Table 4 Cause of death Sex Under 1 day 1-6 days / week 2 weeks 3 weeks Total under 4 wks. 1-2 mths. 3-5 mths. 6-8 mths. 9-11 mths. Total l-ll mths. Total under lyr.  Other tuberculosis M - - - - - - - - - 1 1 1 F - - - - - - - - - - - - Influenza M - - - - - - - - - - - _ F - - - - - - 1 - - - 1 1 Pneumonia M _ _ _ _ _ - 1 2 2 _ 5 5 F - - - - - - 2 4 2 - 8 8 Bronchitis M _ _ _ _ _ - 1 _ _ _ 1 1 F - - - - - - - - - - - - Gastritis and duodenitis M _ _ _ _ _ _ 1 _ _ _ 1 1 F - - - - - - - - - - - - Hernia, intestinal obstruction M 1 _ _ _ - 1 - _ _ _ 1 F - - - - - - - - - - - - Congenital malformation M 7 1 - 2 1 6 1 - - - 1 7 F 2 2 - - - 4 - - - - - 4 Injury at birth M 5 1 1 _ - 7 _ _ _ 7 F 1 - - - - 1 - - - - - 1 Postnatal asphyxia and atelectasis M 3 2 _ - _ 5 _ - - 5 F 3 1 - - - 4 - - - - - 4 Prematurity, Immaturity M 3 2 1 2 _ 8 1 _ _ 1 _ 9 F 7 5 - 1 - 13 - - - - - 13 Other diseases of early infancy M 3 _ - _ 3 _ _ _ - 3 F 1 3 - 1 - 5 2 - - - 2 7 Lack of care of newborn M 1 - - - - 1 - - - - - 1 F - - - - - - - - - - - - Nl other causes M _ - - - - - 1 1 2 4 4 F - - - - 1 1 - 1 1 - 2 3 totals M 18 6 2 4 1 31 5 3 3 3 14 45 F 14 11 - 2 1 28 5 5 3 - 13 41 grand total 32 17 2 6 2 59 10 8 6 3 27 86 10 Ages at death Table 3 on page 8 shows the ages at death during 1951. If this table is looked at as it is printed year by year probably nothing much is apparent to the ordinary reader, but if it is compared with a considerable number of years ago the differences are obvious. To make the comparison more vivid the following diagrams have been constructed in circular form to show the proportion of deaths at different ages in 1901 and in 1951, 50 years later. Certain points are immediately obvious. First, that in 1901 the proportion of deaths under the age of one year was a quarter of the total, whereas in 1951 this had fallen to a narrow segment of the circle. Secondly, the proportion of deaths from ages 1 to 5 in 1901 made quite a substantial slice of the " cake " whereas in 1951 they were so small that their indicator has had to be put outside the circle; the position with regard to deaths from ages 5 to 15 is very similar. Thirdly, in 1901 the deaths over the age of 65 were just over a quarter of the total whereas in 1951 those over the age of 75 alone are considerably more than a quarter and those over the age of 65 are considerably more than a half, in fact almost two-thirds of all deaths. Nevertheless, while noting with approval what has happened, we must not be in any way complacent about these matters for it will be seen that the proportion of deaths between the ages of 15 and 65 (the cross hatched area) has not altered greatly over the years, being somewhat over a quarter of the whole both in 1901 and 1951. Improvements in the control of disease in future years, particularly of cancer and heart affections, will be necessary to contract the 15 to 65 slice and so save many years of able-bodied manpower. 11 Special causes of death at 10 year intervals The diagrams show the changes which have taken place in the proportions of death from certain causes in the last 50 years. The symbols used are : V, violence; CI, childhood infections; TB, tuberculosis; R, respiratory conditions; C, cancer; H/C, heart and circulatory affections ; and O, other causes of death. It will be seen that whereas the proportion of deaths by violence has not altered greatly (except in 1941), childhood infections have almost vanished, and tuberculosis has shown a considerable contraction in the last decade. Respiratory conditions do not vary greatly, but cancer shows a steady increase throughout the period, as also does disease of the heart and circulation. " Other " disease shows a large decrease latterly but this means that many cases which were undiagnosed, or put in a miscellaneous group in years gone by, are now included with defined diseases. To some extent this reflects a change of fashion in death certification — many cases, for example, previously classified as deaths from senility, are now classified as deaths from heart disease. The diagrams therefore are not exact (they also do not take into account the difference in age grouping of the population) but they do give some indication of progress and frustration in 50 years. 12 Local sickness Through the courtesy of the Regional Medical Officer of the Ministry of National Insurance, I am sent weekly a return indicating for the various areas of London the first certificates of sickness benefit received at the local offices. These give some indication of the amount of sickness in the borough, but the figures as shown in the table below must be read with certain explanations :— (1) Until the middle of April, 1951 what is given as the Lewisham area in the table was split into two areas, namely Blackheath and Catford. (2) The areas for Ministry of National Insurance statistics are in the main coterminous with postal areas of London and not with borough boundaries. " Lewisham " in the table is almost entirely in the borough area and " Downham " is entirely so. The two together cover most of the borough but relatively small sections are in the " Kidbrooke " and the " Norwood " office areas of the Ministry of National Insurance. The sickness returns for all four offices are therefore shown. Bearing these factors in mind, however, the table, which has been compiled from the weekly returns, does indicate the major trend of sickness during the year. Table 5 Average of four weeks ending Lewisham Downham Kidbrooke od/ January 30 1684 385 511 679 February 27 840 204 257 363 March 27 580 129 189 221 April 24 539 116 160 196 May 22 430 97 128 170 June 19 378 87 130 165 July 17 316 72 158 152 August 14 297 75 150 142 September 11 335 81 152 156 October 9 430 135 210 226 November 6 544 155 275 271 December 4 425 108 202 225 January 1, 1952 387 106 200 185 Corresponding figure for November, 1950 . 590 160 190 240 Social class in relation to cause of death Of the 2,527 deaths analysed by us the social categories were as follow :— Table 6 Social class 1 II III IV V Total No information  Males 33 204 714 171 134 1256 13 Females 38 206 682 162 97 1185 73 Total 71 410 1396 333 231 2441 86 Percentage 3 17 57 14 9 100 — 13 The social class, related to cause of death, was as follows :— Table 7 Code No. Cause of death Male Female 1 II Ill IV V Total 1 II Ill IV V Total  1 Tuberculosis, respiratory _ 5 26 8 4 43 2 2 7 4 1 16 2 Tuberculosis, other _ 1 — 1 2 _ — 2 __ 2 3 Syphilitic disease _ 2 — 1 3 _ 2 2 4 Diphtheria — — — — — _ —_ — — — — S Whooping cough — — — — — — — — 2 — 2 6 Meningococcal infections — — — 1 — 1 — — — — 7 Acute poliomyelitis _ — — — — _ — 8 Measles — — — 1 — — 1 9 Other infective and parasitic diseases — — 2 — — 2 — — 3 — — 3 10 Malignant neoplasm, stomach . _ 1 23 6 1 31 _ 6 8 4 2 20 11 Malignant neoplasm, lung, bronchus 1 14 33 11 4 63 — 4 4 4 2 14 12 Malignant neoplasm, breast — — 2 — 1 3 1 7 32 5 2 47 13 Malignant neoplasm, uterus — — — — — — — 3 6 3 1 13 14 Other malignant and lymphatic neoplasms 5 24 76 25 8 138 3 19 70 19 14 125 15 Leukaemia, aleukaemia — — 10 1 — 11 — 1 — 1 — 2 16 Diabetes _ 1 3 1 5 1 — 5 1 7 17 Vascular lesions of nervous system 4 18 47 10 13 92 5 33 101 24 14 177 18 Coronary disease, angina 7 34 97 17 8 163 3 12 60 11 10 96 19 Hypertension with heart disease _ 7 37 6 9 59 4 11 38 9 1 63 20 Other heart disease 5 25 80 23 20 153 7 45 127 30 17 226 21 Other circulatory disease 1 9 13 4 3 30 1 3 16 3 2 25 22 Influenza 2 1 6 5 3 17 1 _ 15 1 3 20 23 Pneumonia 1 10 31 11 9 62 3 10 42 11 11 77 24 Bronchitis 2 20 93 18 22 155 3 12 31 4 9 59 25 Other diseases of respiratory system — 1 3 — — 4 — — — 1 — 26 Ulcer of stomach and duodenum — — 12 2 5 19 1 1 8 — — 10 27 Gastritis, enteritis and diarrhoea — — 2 — — 2 — — — — — — 28 Nephritis and nephrosis — 2 15 4 1 22 1 4 11 3 1 20 29 Hyerplasia of prostate 1 2 12 1 6 22 — — — — — — 30 Pergnancy, childbirth abortion — — 3 — — — — — 2 — — 2 31 Congenital malformations — — 3 — — 3 — — 2 1 — 3 32 Other defined and illdefined diseases 2 21 61 10 10 104 1 28 68 17 5 119 33 Motor vehicle accidents _ 2 7 2 1 12 — — 4 1 5 34 All other accidpnfe 4 3 11 3 3 21 1 3 12 4 1 21 35 Suicide. 1 2 8 2 1 14 — 2 3 2 — 7 36 Homicideand and operations of war - - — - - — — — — — - — No social class assessed - — — — — 13 - — — — — 73 14 There are discrepancies between the above table and table 3 for various reasons as given on page 16 of the last annual report. For comparative purposes therefore it is safer to group the causes of death 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 7 and grouped in this way. They are shown in table 8 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 6 for all deaths.* Table 8 Male Female 1 11 I11 IV V Total 1 11 I11 IV V Total  1, 2 TB No. — 5 27 8 5 45 2 2 9 4 1 18 % — 11 60 18 11 100 11 11 5O 22 6 100 10-15 Cancers No. 6 39 144 43 14 246 4 40 120 36 21 221 % 2 16 58 17 7 100 2 18 54 16 10 100 17-21 Heart and circulation No. 17 93 274 60 53 497 20 104 342 77 44 587 % 3 19 55 12 11 100 3 18 58 13 8 100 22-25 Lung, non-TB No. 5 32 133 34 34 238 7 22 88 17 23 157 % 2 13 57 14 14 100 4 14 56 11 I5 100 33, 34 Accidents No. 1 5 18 5 4 33 1 3 16 4 2 26 % 3 IS 55 I5 12 100 4 12 61 IS 8 100 35 Suicide No. 1 2 8 2 1 14 — 2 3 1 - 7 % 7 14 58 14 7 100 — 29 42 29 - 100 * See also sample census figures in appendix D 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 6. 15 Table 9 Social classification Total Not classifiable  1 II III IV V Registered births No. 137 588 1988 532 230 3475 23 % 4 17 57 I5 7 100 Registered infant deaths No. 1 18 52 8 4 83 2 % 1 22 62 10 5 100 Registered stillbirths No. 1 10 21 12 7 51 1 % 2 20 40 24 14 100 Notified premature births No. 2 31 124 32 14 203 2 % 1 IS 61 16 7 100 Comparative occupational class statistics As stated in the last report an arrangement was sought with other large towns in the United Kingdom to keep and compare some special vital and social class statistics for the year 1951. There are 14 such large towns, but for one reason or another Harrow, Hull and Stoke were unable to take part. This left 11 towns and the following are some of the statistics obtained under the scheme. The towns all have a population between 200,000 and 300,000 and the total population of the 11 was 2,760,783. The average density was 21 persons an acre, the lowest being Bradford with 11 per acre and the highest Islington with 76; Lewisham had 32.4. The average number of individuals per tenement was 3.76, the lowest being Bradford with 3.2 and the highest Islington with 4.6 (Lewisham 3.7). The percentage of municipally. owned property did not vary very greatly, but it was lowest in Portsmouth (11) and highest in Plymouth (24), (Lewisham 23). Requisitioned property outside London was insignificant in amount, but in the four greater London boroughs it varied between 3 per cent. (Croydon) and 4.6 per cent. (Lambeth) (Lewisham 4.3 per cent.). In the 11 towns there were 31,176 births, giving a rate of 14.91 per thousand population, of which 12 per cent, were in social classes I and II, 67 per cent, in class III and 21 per cent, in classes IV and V. Of the notified premature births the same percentage was in class III, but classes I and II dropped to 10 per cent whereas in classes IV and V there were 23 per cent. For the registered stillbirths class III had again almost the same percentage at 66, whereas classes I and II dropped further to 9 per cent., and classes IV and V increased to 25 per cent. With regard to infant deaths class III remained the same at 67 per cent., while classes I and II fell to 8 per cent, and classes IV and V rose to 25 per cent. Thus comparing infant deaths with total births it is seen that while the social class III percentage is the same in the two categories the social class I and II percentage has dropped from 12 to 8 16 and the social class IV and V percentage has risen from 21 to 25. In other words the social class advantage which has always been possessed by the baby in classes I and II as compared with classes IV and V still persists in spite of the levelling out of the social classes and in the medical services available for them. These figures however are not the same for all the towns and in Lewisham, for example, there is some evidence that the social class IV and V babies do not have a worse survival rate than the social class I and II babies. This is also the position in Lambeth, but in none of the other towns, and it will be interesting to see if the figures are coincidental or. whether they will be repeated this year. With regard to the other main figures obtained, namely, tuberculosis notifications and deaths, deaths from heart disease, deaths from pneumonia and deaths from bronchitis, it is not possible to give a social/occupation class comparison until the social/occupation class percentages are known for the various areas. These should soon be available as a result of the April, 1951 census. However the figures for the towns can be compared with each other and also, though to a more limited extent, they might be compared with the social class percentages amongst the births — but only on the assumption that these show a fair cross.section of the population. Over the towns as a whole the pulmonary tuberculosis notifications were 131 per 100,000 population (Lewisham 117), and the deaths from respiratory tuberculosis gave a rate of 33 (Lewisham 26). Deaths from heart disease were 344 per 100,000 population, deaths from pneumonia 56 and deaths from bronchitis 88 per 100,000 population (Lewisham 349, 66 and 94, respectively). The pulmonary tuberculosis notifications show that only 8 per cent, were in classes I and II, 67 per cent, in class III and 25 per cent, in classes IV and V. On the other hand, deaths from heart and circulatory diseases show that 18 per cent, were in classes I and II, 57 per cent, in class III and 25 per cent, in classes IV and V. Deaths from pneumonia and from bronchitis occupied a rather intermediate position in the social classification. In pneumonia 15 per cent, were in classes I and II and 29 per cent, in classes IV and V, whilst in bronchitis 12 per cent, were in classes I and II and 30 per cent, in classes IV and V, leaving 55 per cent, in the case of pneumonia and 57 per cent, in the case of bronchitis in class III. Reverting to the child welfare statistics the social class divisions are even more apparent. The notified premature birth rate for the towns was 60.5 per thousand births, the rate of social class I being 40.7, II 51.4, III 60.6, IV 67.0 and V 63.7. The registered stillbirth rate for the towns was 21.1, but here the social class I rate was only 9.3 whereas classes II to V were 16.9, 20.6, 23.6 and 26.0 respectively. The infant death rate for the towns was 32.4, but here again there was a wide divergence as between the social classes, class I being 14.9, II, 21.2, III 32.1, IV 38.0 and V 41.7. 17 General Statistics from 1901 Table 10 yearr Births Maternal death rote t Stillbirth rate t Neonatal death rate§ One month to one year death rate§ (8) .(6) Infant 'mortality rate§ Reproductive wastage rate (5)+ (8) Pulmonary tuberculosis Tuberculosis (all forms) No. Rate* Notif. rate* Death rate* % notif. rate under 15  (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) 1901 3320 25.9 3.9 128 — 0.93 1902 3491 26.3 4.3 — — — 122 — — 1.06 — 1903 3563 26.1 2.5 — — — 92 — — 0.78 — 1904 3589 25.6 3.6 — — — 122 — — 0.84 — 1905 3633 25.2 2.8 — 30 63 93 — 0.87 — 1906 3446 23.2 2.0 — 30 83 113 — — 0.80 — 1907 3622 23.7 2.5 — 34 56 90 — — 0.90 1908 3632 22.8 1.4 30 57 87 — 0.85 1909 3507 21.9 2.0 35 40 75 — — 0.78 910 3412 20.7 2.6 — 29 50 79 — — 0.55 — 1911 3421 21.2 2.3 31 73 104 — 0.64 — 1912 3512 20.3 2.8 — 30 39 69 — 2.1 0.68 11.0 1913 3502 20.3 2.6 — 28 48 76 1.8 0.73 25.2 1914 3306 19.5 3.3 — 27 46 73 — 1.4 0.77 17.8 1915 3267 19.3 4.0 — 30 49 79 — 1.5 0.90 26.4 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 22.2 1920 3984 22.8 3.8 — 32 30 62 — 1.6 0.73 21.8 1921 3433 19.5 2.6 23 31 54 — 1.3 0.81 18.4 1922 3208 18.1 2.5 — 26 28 54 — 1.5 0.74 15.7 1923 3297 18.0 3.6 — 20 23 43 — 1.5 0.76 16.9 1924 3066 16.4 3.6 — 23 24 47 — 1.5 0.68 21.6 1925 2907 15.6 1.6 — 23 32 55 — 1.3 0.63 15.4 1926 2885 15.4 2.1 — 18 22 40 — 1.6 0.71 16.9 1927 2848 15.1 2.1 — 25 21 46 — 1.6 0.92 12.3 1928 3036 15.2 2.3 — 22 30 52 — 1.7 0.77 15.1 1929 3261 15.7 5.3 — — — 44 — 1.4 0.74 13.3 1930 3147 15.1 0.9 37 — — 42 79 1.5 0.76 12.3 1931 3115 14.1 4.9 31 25 24 49 80 1.3 0.69 13.6 1932 2817 12.7 3.4 32 31 23 54 86 1.2 0.59 10.7 1933 2702 12.2 2.6 31 21 18 39 70 1.2 0.68 9.2 1934 2715 12.2 1.5 36 21 22 43 79 1.3 0.58 14.4 I935 2792 12.5 4.3 35 24 19 43 78 1.2 0.58 12.7 1936 2932 13.0 2.0 37 23 32 55 92 1.3 0.62 11.6 1937 3019 13.4 1.3 39 18 29 47 86 1.5 0.59 11.9 1938 3188 13.9 2.1 26 — — 47 73 1.1 0.61 12.4 1939 3135 13.6 2.9 34 — 42 76 1.1 0.64 11.6 1940 2833 14.7 1.0 24 — — 45 69 1.1 0.67 11.1 1941 2068 13.9 1.9 29 34 63 1.8 0.93 10.2 1942 2732 16.8 3.2 37 — — 37 74 1.8 0.73 15.3 1943 3151 18.7 3.1 25 — — 42 67 1.9 0.76 13.6 1944 3046 18.6 1.0 22 — — 40 62 1.9 0.79 10.8 1945 3030 17.7 1.9 18 — — 34 52 1.8 0.71 13.2 1946 4491 21.7 1.1 21 — — 33 54 1.9 0.53 15.4 1947 4841 21.9 1.0 21 — — 33 54 1.6 0.55 12.4 1948 4274 18.9 0.5 15 15 13 28 43 2.0 0.48 15.7 1949 3823 16.8 0.3 16 13 6 19 35 1.5 0.40 12.4 1950 3487 15.3 0.6 15 19 7 26 40 1.6 0.29 12.6 1951 3481 15 .3 0.3 16 17 8 25 41 1.2 0.26 14.7 Per 1,000 population, jper 1,000 live and stillbirths. §per1,000 livebirths. — equals figure not available. Disinfecting Station Table 11 West North South Total Disinfections Premises visited 218 168 159 545 Rooms disinfected 447 339 339 1125 Articles disinfected 3165 5508 2363 11036 Disinfestation Premises visited 38 68 20 126 Rooms disinfested 115 200 68 383 Articles disinfested 29 548 31 608 Articles treated Beds• ... 74 73 66 213 Mattresses 372 239 177 788 Bolsters 73 42 41 156 Pillows 536 646 295 1477 Cushions 54 64 39 157 Quilts 128 141 92 361 Blankets 718 569 499 1786 Sheets 156 235 92 483 Household articles 606 781 433 1820 Wearing apparel 477 3266 660 4403 Total articles 3194 6056 2394 11644 Articles received from cleansing station 1819 1819 1820 5458 Articles received from Coroner's court — 378 — 378 Public library books treated after infection 276 429 400 1105 Private library books treated after infection 50 8 20 78 Articles treated under the Public Health (London) Act s.122 2024 1728 1582 5334 Cleansing station Children treated for verminous condition 351 372 264 987 Adults treated for verminous condition 17 27 15 59 Scabies baths, children 15 22 14 51 Scabies baths, adults 8 11 19 38 18 SECTION "B"—-GENERAL PROVISION OF HEALTH SERVICES Disinfection and personal cleansing The disinfecting station and the cleansing station are situated at Wearside Road Depot. Details of the work carried out during the year are as follows :— 19 Verminous conditions Table 12 First cleansing Second cleansing Third cleansing Fourth cleansing  Children under 5 76 5 1 - School children 814 87 3 1 Adults 59 — - - TOTALS 949 92 4 1 Scabies Cases Treatments Children under 5 8 18 School children 12 33 Adults 15 38 TOTALS 35 89 A more detailed analysis of treatments for verminous conditions and for scabies is shown :— Treatment by disinfection Rooms and furniture are sprayed with a solution of Izal. Bedding is steam treated with a pressure from 10-201bs. per square inch. Articles are either steam treated with a pressure from 5-101bs. per square inch, or placed in the formalin chamber, according to their nature. 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 square inch. Articles are steam treated with a pressure of lOlbs. per square inch. Premises treated for bed-bugs are revisited and if necessary retreated the following summer. 20 Antifly and antimosquito campaign The campaign, which lasted from May 7 to September 29, was organised on similar lines to the campaigns 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 1,274, an increase from the previous year's figure of 1,098, due mainly to the inclusion of dust chutes in blocks of flats. These 1,274 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 visited on 10 occasions, and special sites, consisting of stables, allotments, dust chutes, etc., were each visited on 21 occasions during the course of the campaign. Altogether 20,813 visits and treatments were made, and in addition sprayings were carried out in 19 houses by the permanent disinfecting staff where special complaints were received. In each of these latter cases, a supply of insecticide containing 5 percent DDT was left with the householders for use in their own sprays, a total of 4 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 55 mattresses, 17 pillows and 17 cushions. 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 4| tons of powder containing 0 • 5 percent gamma benzene hexachloride was used. Materials used for the campaign were as follows :— General spraying—1,158 gallons tip dressing (approximately 4½ percent DDT in aqueous suspension). Static tanks and stagnant water on river edges — 93 gallons of 5 percent DDT in kerosene. Accumulations of rubbish, dog excreta, etc. — 611bs. of 10 percent DDT powder and 561bs. of gammexane powder. Of the 561bs. of gammexane, 281bs. were distributed to caretakers of blocks of flats for sprinkling round chute containers when emptied by the dustmen. Laboratory facilities Specimens for examination concerning bacteriology and epidemiology in relation to the diagnosis, prevention and control of infectious disease are sent to the Southern Group Laboratory at Park Hospital. This service is provided by the Public Health Laboratory Service which 21 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 are 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 of outbreaks of milkhorne 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 food 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 1951 :— (1) Throat/nose swabs (4) Pertussis Diphtheria bacilli 1 Cough plate - Haemolytic streptococci 80 Postnasal swab — Vincent's angina 2 Negative 2 Negative 182 Total 265 Total 2 (2) Faeces (5) Milk, etc. Shigella 306 Pasteurised 10 Salmonella 15 Other 2 Protozoa 1 Icecream 36 Negative 785 Total 1,107 Total 48 (3) Sputum (6) Water TB smear 3 Domestic supplies, Other organisms - etc. 5 Negative 37 Swimming pools 8 Total 40 Total 13 (7) Miscellaneous* 223 1698 *Covers urine, blood counts, Widal reactions, Wasserman reactions and Kahn tests, pregnancy tests, specimens of various types of food, Paul Bunnell tests and vaginal swabs. 22 National Assistance Act, 1948 — section 47 Under section 47 of the above Act, as amended by the National Assistance (Amendment) Act, 1951, 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 themselves and not receiving from other persons proper care and attention, may be removed compulsorily. For this the medical officer of health must be satisfied, after thorough inquiry and consideration, that in the interests of any such person or for preventing injury to the health of, or serious nuisance to, other persons it is necessary to remove that person. The Local Authority may then apply to a court of summary jurisdiction for an order for the removal of the person to a suitable hospital or other place in, or within convenient distance of, the area of the local authority and for his detention and maintenance therein. In order to enable local authorities to deal expeditiously with certain types of cases, the procedure required under section 47 of the National Assistance Act, 1948 has been simplified by the National Assistance (Amendment) Act, 1951, which enables the medical officer of health to make direct application to the court, provided there is supporting medical evidence. 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 11 persons, at a net cost of ^51 14s. 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 690, of which 364 were received from hospitals. 690 postmortem examinations were made and inquests were held in 127 cases. 23 Details are shewn in the following table :— Table 13 Month Bodies received from hospitals Others Post-mortem examinations Inquests Lewisham residents Others January 38 56 55 39 13 February 23 27 28 22 7 March 30 35 44 21 6 April 31 29 36 24 15 May 33 16 26 23 16 June 26 26 29 23 6 July 30 23 29 24 15 August 30 17 32 15 8 September 23 17 19 21 10 October 42 26 41 27 14 November 30 19 27 22 7 December 28 35 33 30 10 TOTALS . 364 326 399 291 127 Rodent control A section, consisting from May to September of a foreman and three operatives and from October to April of the foreman and seven 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 West North South Total  Number of properties inspected on complaint 482 435 276 1193 Number of properties otherwise initially inspected 349 397 408 1154 Number of premises baited :— Initial treatments 586 714 625 1925 Retreatments (infestation found) 1168 757 669 2594 No infestation found (initially or at reinspection) 585 2107 1691 4383 Total number of visits 6078 6648 5854 18580 Estimated kill 2037 2033 2717 6787 In addition, special liaison is made twice yearly with the Borough Engineer's Department for the baiting of sewers. In the year 1951 the work took place from May 30 to June 26 and from November 21 to December 18. In the summer treatment bait was laid on three consecutive days and consisted of sausage rusk (on the first two days) 24 with 2½ percent zinc phosphide on the third day. 2,855 manholes were baited. 1,680 showed a prebait take and of these 729 showed a complete prebait take on one or both days. For the first time the manholes were inspected on the fourth day for poison take. 1,233 manholes showed poison take, of which 338 were complete takes. In the winter treatment, an attempt was made to carry out the doubling up process recommended by the Ministry of Agriculture and Fisheries, and amounts of bait deposited were based on results of the rat treatment of May - June. If in June the poison bait in a manhole was not taken, or only partially so, the amounts deposited remained at 4ozs., 4ozs., 8ozs. If in June there was a complete poison take at a manhole, the first day prebait was doubled. If this showed only a partial take, the amounts deposited were 8ozs., 8ozs., 16ozs., whereas if it showed a complete take the second day prebait was doubled to 16ozs. If this second 16ozs. prebait showed only a partial take, 16ozs. of poison bait were deposited on the third day whereas if it showed a complete take, 24ozs. of poison bait were used. A total of 2,877 manholes were baited in the winter. 1,063 showed poison takes, 171 of which were complete. During the year a new type of poison, which has the effect of reducing the coagulability of the blood and thereby causing haemorrhages from which the rat dies, came into use. Such drugs have been used in medical practice for some years under the title of anti-coagulants. The main one used at present in rodent control work is Warfarin and during the year this method was tried at a factory where infestation had remained in spite of other attempts at control over many months or years. So far it appears to have worked with considerable success. It is interesting to note that there is a tendency to criticize the principles on which the present methods of rat control are based. Even by the newest methods of poisoning this control remains difficult and expensive and it has been suggested that the better solution may be found in the study of the behaviour of rat populations. According to an annotation in The Lancet of recent literature on this subject, if a few rats begin to breed in a favourable area their rate of increase will be slow at first, then more rapid ; but as the area fills up the rate of increase will slow down until a maximum number is reached. One implication is that reduction of such a population by about half (a common result of attempted control) merely brings it to the level at which it increases most rapidly. When, in Baltimore, half a rat population was caught by trapping, the survivors rapidly gained in weight, and within two months the pregnancy-rate had doubled. For such reasons as these it has been suggested that poisoning and trapping and such methods may not be profitable and, instead, action " to increase competition" among the rats themselves has been suggested. A worker in Baltimore has claimed that by reducing access to food and clearing away harbourage the rat population of Baltimore was reduced from 400,000 in 1944 to about 65,000 in 1949. 25 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 or four consecutive days followed by poison bait on the fourth or fifth day. The poison bait used is zinc phosphide mixed with sausage rusk and water. The following table gives a summary of work carried out in respect of the rivers during 1951 :— 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 82 3 12 29 41 164 82½ 206 Ravensbourne Silk Mills Path to Loampit Vale 21 3 3 14 4 68 31½ 79 Loampit Vale to Ladywell Recreation Ground 119 3 - 86 33 344 138½ 346 Flower House Estate to Ravensmead Road 16 4 - 9 7 36 18 45 Aitken Road to Flower House Estate 12 4 - 7 5 28 14 35 Fordmill Road to Aitken Road 20 3 - 18 2 72 17 ½ 44 Catford Bridge to Fordmill Road 20 4 11 9 44 22 55 Pool South Eastern Gas Board Works to Catford Bridge 31 3 14 2 15 64 60 150 Southend Lane to South Eastern Gas Board Works 30 3 18 — 12 72 72 180 Prevention of Damage by Pests Act, 1949 A copy of the annual report submitted to the Minister of Agriculture and Fisheries as required by the provisions of the above Act is appended. 26 Prevalence of rats and mice Table 16 Type of property (1) (ii) (iii) (iv) (v) Total in borough Properties inspected as a result of (a) notification or (b) otherwise Properties (under ii) found to be rat infested Properties found to be seriously mouse infested infested properties (under iii and ir) treated  (a) (b) Major Minor Local authorities' property 128 11 - - 6 1 7 Dwelling houses 61,800 1,084 1,130 9 955 205 1,169 Agricultural property 48 — 5 — 5 — 5 All other property (including business and industrial) 3,635 98 19 1 95 5 89 TOTAL 65,611 1,193 1,154 10 1,061 211 1,270 Number of " block " control schemes carried out 3 It has not been found necessary to serve notices under section 4 of the Prevention of Damage by Pests Act, 1949 for either treatment or structural works (i.e., proofing), and consequently no default action has been necessary and no legal proceedings have been taken. 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 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 Thamesderived 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 27 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 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 forwarded by the Metropolitan Water Board. 28 Average results of the examination of the water supply to the Borough of Lewisham for 1951 parts per million (unless otherwise stated) (a) 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 (non. carbonate) pH value Conductivity  Deptford well 6 0.014 0.038 7.2 33.2 0.14 363 124 7.1 600 Wilmington well 6 0.015 0.033 7.9 19.8 0.12 291 54 7.2 475 Darenth well 3 0.007 0.023 5.2 15.8 0.12 264 32 7.4 400 Bexley well 6 0.009 0.053 5.8 17.3 0.16 295 61 7.3 450 Shortlands well 6 0.005 0.022 5.1 16 3 005 295 77 7.3 450 River Thames derived filtered water 1749 0.022 0.085 40 22.5 1.34 264 63 7.8 450 (b) BACTERIOLOGICAL Table 18 No. of samples Agar colony count (average per millilitre) Percentage of samples negative to Bad. coli in 100 ml. Bact. coli per 100 ml.  22°C 3 days 37 °C (20-24 hrs.) Deptford well 244 11.2 1.2 99.6 0.008 Wilmington well 268 32.3 1.4 99.6 0.005 Darenth well 241 1.6 0.3 100.0 nil Bexley well 247 2.0 0.5 99.6 0.004 Shortlands well 256 7.8 0.1 100.0 nil River Thames derived filtered water 3321 - 20.0 99.9 0.002 29 Swimming baths The following is a summary of samples taken by the health department staff for submission to the public analyst for examination of chlorine content and to the Southern Group Laboratory for bacteriological examination :— Chlorine Bacteriological content examination Bellingham 2 2 Downham 3 2 Ladywell — first class 1 - — second class 2 - Forest Hill — first class 1 1 — second class 2 1 Private baths 1 2 A detailed report on the use of' breakpoint chlorination, which is the method employed at the baths, was included in my annual report of last year. Old people The latest Life Table (abridged) issued by the Registrar-General early in 1952, relates to the home population of England and Wales in 1950. From this is appears that men, on attaining pensionable age at 65, can look forward to an average of 12 more years of life, subject to the death probabilities indicated by the 1950 death records remaining the same. Women, on reaching the age of 60 (which in the case of women is regarded as the qualifying age for most old people's facilities), have an average further expectation of life of just over 18 years, subject to the same probabilities. These figures underline the fact that with the increasing number of old people in the population there is large scope for long-term work. It is interesting to note that the English Life Table based on the 1921 census showed that for women aged 60 the expectation of life was just over 16 years (compared with just over 18 years now), whereas for men of 60 the expectation of life was a little over 14 years compared with slightly over 15 years now. (In passing, since these figures are often confused in the public mind, I would point out that it is the expectation of life at birth which has increased so greatly in the last two or three decades, and not so much the expectation of life at relatively advanced ages). The expectation of life at birth, which for males was 49 in 1901, 52 in 1911 and 56 in 1921, has now risen to 66, and the corresponding figures for females are 52, 55, 60 and 71. These spectacular improvements have been due to the great success of the efforts made in the saving of infant and child life — see also the diagrams on page 10. 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 £1,750 30 was included in the annual estimates for the year 1951-52 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 1,200 Lewisham Darby and Joan Club 300 Over 60's Club 30 St. Mark's Old Folks' Club 65 Talbot Settlement Old People's Club 10 Good Companions Personal Service 15 St. Swithun's OAP Association 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. Besides the luncheon clubs at the Lewisham Darby and Joan club and at the Old Folks' club, St. Mark's Church Hall, Lee, two other luncheon clubs were started during the year or at the beginning of 1952, namely the Over 60's club held at St. Mark's Church Hall, Downham, and the St. Swithun's OAP Association, held at St. Swithun's Church Hall, Hither Green Lane. The health department during the year continued to take a detailed interest in the work for old people generally and remained in the closest touch with the Lewisham Old People's Welfare Association (LOPWA), which Association has offices in the department. LOPWA is, so far as the borough council's work for old people's welfare is concerned, the main body in the area and has affiliated to it the various other bodies to which the borough council makes grant. In May, 1951, LOPWA adopted a new constitution. The main object of the change was to provide a constitution which would enable the Association to obtain charitable status. Application to the Inland Revenue authorities has since successfully been made for recognition as a Charity for income tax purposes. As a result of recommendations put forward by a small subcommittee of LOPWA in March, 1951, a separate and independent 31 Association was formed in May, 1951, called the Lewisham Old People's Housing Association (LOPHA). The Welfare Association made a grant of £100 to the new Housing Association to cover preliminary expenses, and the latter has since bought and converted a house into flatlets for able-bodied elderly people. Plans for buying a second house are now under consideration. Although LOPHA and LOPWA are independent they are in fact closely connected in that Miss Ellis acts as secretary for both and the personnel of the two executive committees have several members in common. The other new development during the past year in which LOPWA was concerned was the opening of lunch clubs by two of the Old People's clubs. The dinners are collected from the kitchen and taken to the clubs each day by the Meals on Wheels van. The Committee is also examining the position as regards chiropody services for old people. On information to date it appears that the present service is by no means sufficient to meet the needs of old people, and the Welfare sub-committee have been discussing ways and means of increasing the service. It seems likely that the cost of any expansion would have to be met by the voluntary organisation. During the past year it was found necessary because of the greatly increased work to appoint an additional secretary. The laundry service carried out by the borough council for the small number of old people living at home whose infirmity is such as to make them incontinent of urine or faeces was continued and expanded during the year, over 5,000 articles being cleansed. The service was highly appreciated and it is likely that with the better equipment now being installed in the disinfecting station the demand on the service will continue to increase. It can only be used, however, where section 122 of the Public Health (London) Act applies. I reported last year that I had been in touch with the Regional Hospital Board and the Local Group Hospital Management Committee to find out if it were possible to help early cases of incontinence by admission to hospital for rehabilitation. For this purpose it would be desirable to set up a geriatric unit in a local hospital, but during the year no move was made in this direction. Early in 1952 I raised the matter again and it is still under active consideration. Measurement of atmospheric pollution A sum of money was included in the estimates to set up three stations in the borough to measure the amount of atmospheric pollution occurring in selected areas. Three sites were chosen as follows :— (1) In the recreation ground belonging to the London County Council and situated at the end of Winsford Road. (2) Wearside Road depot. (3) Allotments situated in Verdant Lane. 32 These three stations are well spaced throughout the borough am form the angles of a triangle, the sides of which are nearly two miles ii length. No part of the borough is more than two miles from any o these stations and no station is less than half a mile from the borougl boundary. Station (1) particularly picks up the extent of the pollutioi from an industrial area in the South.East. The station at Wearside Roai indicates conditions in a rather congested part of the borough. Station (3 shows conditions in a residential area, such as the Downham am Bellingham estates; in a month when an easterly wind prevails however, it would register pollution from the shunting yards at Hithe Green. The results are analysed once a month and the observations ar correlated with the wind directions as obtained from central source and they are also compared, on a national level, with the many othe stations in London and the provinces which carry out similar analyses The apparatus for the estimation of sulphur in the area was erectei in time for observations to be made at two of the three stations fo the month of December. The results of these observations show tha at the Wearside Road station the weight of sulphur, reckoned as sulphu trioxide in milligrams per hundred square centimetres per day, wa 1.94 while that at the Verdant Lane Ration was 1.54. Meteorology Table 19 gives some indication of the sunshine, rainfall, etc during the year, but these data are not specific to the borough, havin been obtained from the Meteorological Office through periodica reports from the Registrar.General, and they relate to south.east England Also included are some figures on temperature which were obtained a the Town Hall by the Borough Engineer's department in connection wit! plans for concreting ; the thermometer is in an alleyway 5ft. from th ground, but the recording conditions are not altogether satisfactory. Weather conditions in 1951 Table 19 Month Air temperature Rainfall Sunshine. percentage of average 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 Daily mean temperature °F Total rainfall mm. No. of days Daily sunshine hrs. Highest Lowest  January 54 18 + 0.8 153 + 2 96 Unsettled and and wet. 39.4 56 16 1.68 49 25 February 53 23 —0.2 271 +4.7 95 Unsettled and wet. 40.1 52 15 2.64 48 31 March 58 20 —1.0 162 + 5 83 Dull, cold, very wet. 42.1 52 15 3.94 56 32 April 79 26 —0.8 143 + 1 129 Cool, unsettled sunny. 46.7 43 13 5.65 77 37 39 May 74 30 —26 120 + 3 82 Cool and wet. 52.2 45 13 6.90 78 June 78 34 —0.2 57 —4 125 Sunny and dry. 57.7 48 11 7.20 78 47 July 85 39 + M 70 —5 112 Warm, sunny and dry. 61.1 55 13 6.96 85 52 August 80 37 —1.1 171 +4 97 Unsettled, wet cool. 60.9 59 14 6.48 84 53 September 78 37 + 1.6 171 0 72 Wa r m, dull, wet. 57.3 54 13 5.43 79 47 October 68 21 -0.2 40 —9 120 Very dry, sunny. 50.8 88 17 3.44 63 38 November 62 27 +4 211 + 6 105 Very wet, very mild. 44.9 78 17 2.15 59 35 December 56 17 + 2.4 76 —4 125 Dryish, rather mild. 41.3 79 18 1.44 53 27 33 34 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 2395 1713 842 4950 Dwelling-houses — Housing Act 115 72 44 231 Houses let in lodgings — — 2 2 Applications for rehousing 255 394 234 883 Rent Acts and Landlord and Tenant Acts 8 10 9 27 Notice from builder 654 192 161 1007 Building licences and certificates for materials 60 79 45 184 Infectious diseases 62 74 122 258 Infestation 86 63 68 217 Factories, mechanical 90 98 50 238 Factories, non-mechanical 17 10 11 38 Outworkers 197 120 146 463 Smoke observations 17 2 — 19 Keeping of animals in such a state as to be a nuisance 25 18 15 58 Water certificates 18 12 85 115 Futile visits 1054 1953 666 3673 All other matters 1143 646 383 2172 Reinspections 5179 8822 3678 17679 Totals 11375 14278 6561 32214 Visits of food inspectors : Notice from builder 44 10 15 69 Building licences and certificates for materials 1 31 1 33 Infectious diseases 11 18 6 35 Factories, mechanical 34 59 139 232 Factories, non-mechanical 11 4 14 29 Smoke observations 5 — — 5 Food shops — registered 161 112 260 533 Food shops — not registered 124 95 208 427 Milkshops and dairies 99 80 79 258 Icecream premises 215 203 136 554 Restaurants and eating houses 268 109 211 588 Bakehouses 136 78 29 243 Other shops 21 72 53 146 Food inspections 360 329 254 943 Markets and stalls 8 1317 341 1666 Pharmacy and poisons 91 78 38 207 Slaughterhouses 5 1 — 6 Sampling 201 87 69 357 Futile visits 67 36 23 126 All other matters 369 329 225 923 Reinspections 409 279 247 935 Totals 2640 3327 2348 8315 35 Reason for inspection West North South Total  Visits of housing inspectors : Dwelling-houses — PH Act 58 5 - 63 Dwelling-houses — Housing Act 246 539 9 794 Applications for rehousing 276 195 181 652 Notice from builder 2 — 1 3 Building licences and certificates for materials 2 3 5 Infestation 1 1 Futile visits 193 124 36 353 All other matters 97 103 10 210 Reinspections 989 755 103 1847 Totals 1863 1725 340 3928 Grand total — all inspectors 15878 19330 9249 44457 Smoke nuisances Number of observations 24 Number of intimations served — Number of complaints received 4 Number of statutory notices served — Number of legal proceedings — Number of convictions — Summary of notices served in 1951 Table 21 West North South Total  Intimation notices :— Public Health (London) Act, 1936 904 849 253 2006 Informal intimations under Factories Act, 1937 8 10 2 20 Informal intimations under Housing Act, 1936 31 10 4 45 Total intimations 943 869 259 2071 Statutory notices :— Public Health (London) Act, 1936 411 505 122 1038 Housing Act, 1936 9 1 2 12 Factories Act, 1937 3 — 3 Byelaws under the Housing Ac 4 5 1 10 Byelaws (other than Housing Byelaws) 14 2 2 18 Total statutory notices 438 516 127 1081 36 Nuisances remedied Table 22 Nuisance West North South Total  Drains cleared 17 17 5 39 Drains reconstructed or repaired 34 25 33 92 Soil pipes ventilated, repaired or renewed 21 16 5 42 Gullies renewed, repaired or cleansed 6 24 — 30 Water closets repaired or renewed 35 54 15 104 Flushing cisterns repaired or renewed 14 29 6 49 Flush pipes repaired or renewed 15 6 7 28 Sinks provided 3 4 1 8 Lavatory basins repaired or renewed 4 3 — 7 Waste pipes repaired or renewed 42 49 24 115 Roofs repaired or renewed 431 460 138 1029 Eaves gutters repaired or renewed 125 178 80 383 Rainwater pipes repaired or renewed 49 79 17 145 Drinking water cisterns repaired, cleansed or covered 3 4 - 7 Dampness abated 1229 696 205 2130 Wall and ceiling plaster repaired 799 1276 388 2463 Walls and ceilings cleansed 173 41 211 425 Brickwork repaired 46 184 51 281 Chimneys repaired or renewed 8 25 10 43 Firegrates repaired or renewed 62 126 34 222 Floors repaired or renewed 118 180 29 327 Window frames and reveals repaired or renewed 219 343 81 643 Sashcords repaired or renewed 79 92 26 197 Dry rot remedied 2 13 3 18 Yards and areas paved or paving repaired 8 25 17 50 Dustbins provided 52 18 26 96 Other nuisances remedied 298 517 135 950 TOTALS 3892 4484 1547 9923 Rent and Mortgage Interest (Restrictions) Acts In 14 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 8 cases the necessary statements were issued as the premises concerned had been made fit. Water certificates Certificates were issued in respect of 164 premises certifying that under the provisions of the Public Health (London) Act, 1936 a proper and sufficient supply of water had been provided. 37 Factories and Workshops The following tables give more detailed information of work done under the Factories Acts :— Inspections Table 23 Premises Number of Inspections Written notices Occupiers prosecuted  (1) Factories in which ss. 1, 2, 3, 4 and 6 are enforceable 47 2 — (ii) Factories not included in above in which s. 7 is enforceable 293 1 — (iii) Any other premises in which s. 7 is enforceable (excl. outworkers) — — — Cases in which defects were found Table 24 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 3 2 - 3 - Overcrowding — — — — — Unreasonable temperature 1 1 — — — Inadequate ventilation 5 1 — 1 — Ineffective drainage of floors — — — — — Sanitary conveniences— (o) insufficient 3 — — 3 — (b) unsuitable or defective 21 10 — 13 — (c) not separate for sexes 2 2 — — — Other offences against the Act (not including offences relating to outwork) 9 3 3 8 — TOTAL 44 19 3 28 — 38 Outworkers Outworkers are visited periodically by the woman sanitary inspector. The following is a list of trades concerned, extracted from the August, 1951 lists received :— No. of Trade outworkers employed Wearing apparel 225 Curtains and furniture hangings 1 Umbrellas 1 Artificial flowers 1 Paper bags 1 Boxmaking 17 Brush making 1 Carding, etc. of buttons, etc. 1 Stuffed toys 1 Cosaques, Christmas crackers, Christmas stockings, etc. 6 255 The inspector made 463 visits and revisits during the year, which included some to places in which no work was being done at the time of the visit, although the outworker was prepared to restart work when required. Uncleanliness and untidiness was noted in a few of the cases, but in no instance was it found necessary to serve a statutory notice. If the uncleanliness was of a moderately severe degree a revisit was paid at an early date. The impression obtained by the inspector was that, on the whole, only people with fairly good accommodation were doing outwork, probably because there was so much other work for married women if they want to earn money. Nearly all outworkers are seasonally employed. Dog Nuisances The Council operates a byelaw to prevent the fouling of the public footpath 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 from the reluctance of witnesses to appear in court to give evidence. 39 Four complaints were received during the year. Warning letters were sent in two cases, and legal proceedings were taken with respect to the other two. Rag Flock and Other Filling Materials Act, 1951 This Act came into force on November 1, 1951 and repealed the Rag Flock Acts, 1911 and 1928 and section 136 of the Public Health (London) Act, 1936. The Act is designed to secure the use of clean filling materials in upholstered articles and other articles which are stuffed or lined. It is an offence, subject to certain provisos, to use filling materials to which the Act applies for upholstery purposes except on premises registered by a local authority, and rag flock for filling can only be manufactured and stored on licensed premises. The local authority is required to maintain a register of premises used for upholstery and of premises used for the manufacture and storage of rag flock and to maintain a list of licences in respect of premises used for the storage of rag flock. Various penalties are prescribed for noncompliance with the provisions of the Act. Standards of cleanliness are laid down in the Rag Flock and Other Filling Materials Regulations, 1951 in relation to each kind of filling material described in the regulations, and tests are prescribed which have to be carried out by approved analysts. Three premises were registered for the use of filling materials for upholstery purposes, but to the end of the year no samples had been submitted for analysis. 40 SECTION "D" —HOUSING Building The following new houses or flats were completed by the Council during the year: Addington Grove 17 Balder Rise 8 Burghill Road 7 Drake Court 32 Falkland House 30 Farren Road 3 George Lane 3 Glenfarg Road 7 Merritt Road 3 Newlands Park 8 Sunnydene Street 12 Vestris Road 5 Wydeville Manor 28 Total 163 Families rehoused During the year the following families were rehoused:— 1. By the Lewisham borough council:— (a) Permanent properties 82 (b) Temporary bungalows 11 (c) Emergency hutments 4 (d) Requisitioned properties 161 258 2. By the London county council (figures supplied by district offices) 445 Total 703 3. *(a) Number of families previously living in overcrowded conditions rehoused by the Council during the 9 months ending 30 September, 1951 39 *(b) Number of families where points had been awarded for bedroom deficiency, rehoused in 3 months ending 31 December, 1951 45 Applications for rehousing The number of cases dealt with by the public health department during the year was as follows:— *See note at bottom of table on next page. 41 Table 25 West North South Total (a) Lewisham borough council housing applications:— Number visited 410 372 294 1076 Number found overcrowded* 45 24 44 113 Insanitary conditions found 17 10 4 31 (b) London county council housing applications:— Number visited 73 190 89 352 Number found overcrowded 21 35 34 90 (c) Housing applications referred from other authorities:— Number visited 47 27 16 90 Number found overcrowded 3 - 3 6 (d) Inspected on request of occupier:— Number visited 1 1 15 17 Number found overcrowded - - 7 7 Total visited 531 590 414 1535 Total overcrowded* 69 59 88 216 *Note—As from October 1, 1951 an amended points scheme was put into operation and a bedroom deficiency standard adopted from that date in substitution for the former overcrowding standard. 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. During the year 45 informal and 12 formal notices were served. 38 properties were repaired by the owners after service of notices and 7 properties were repaired by the Council under section 10 in default of the owners. 42 Demolition orders (section 11) The following is a list of cases involving demolition order procedure which originated in or were complied with during 1951, together with the present position of cases originating in previous years which had not been complied with at the end of 1950:— Table 26 Properties Number of dwellings involved Present position 6, 7, 8, 9, 10, 11, 12, 13, 14, 19, Ardmere Road 10 Demolished. 1, 2, 3, 4, Avenue Cottages, Romer Avenue. 4 Tenants rehoused. Properties to be demolished. 62, Lee Church Street 1 Undertaking not to relet accepted. 48 and 50, Beacon Road 2 Offer of works accepted. Repairs executed. 95, 97 and 99, Hither Green Lane 3 Offer of works accepted. Repairs executed. 33, Brandram Road 1 Offer of works to be accepted subject to statutory undertaking being given. 22, Lee Church Street 1 Offer of works accepted. Repairs executed. 323, Baring Road 1 Tenants rehoused. Property to be demolished. 40, Lee Church Street 1 Offer of works to be agreed. 42, Lee Church Street 1 Offer of works to be agreed. 78 and 80, Kirkdale 2 Consideration adjourned sine die. Sites to be acquired by the London County Council. 20, Lee Church Street 1 Offer of works accepted. Repairs executed. 96 and 98, Hither Green Lane 2 Properties to be purchased by borough council and demolished. 19, 21, 23, 25, 27-37 (odds) and 43-47 (odds), Lee Church Street. 13 Date for hearing of offers adjourned in view of proposal to include in a clearance area. 1-4, Suncroft Place 4 Demolished. 11, Springfield Rise 1 Offer of works accepted. Repairs executed. 67, Fludyer Street 1 Statutory undertaking given not to relet. 120, Wells Park Road 1 Offer of works accepted. Repairs executed. 11, 13, 15, 17, Lee Church Street 4 Tenants of 13 rehoused and undertaking not to relet accepted. No further action taken in respect of 11, 15 and 17 in view of proposal to include in a clearance area. 180 and 182, Marvels Lane 2 Tenants of 180 rehoused. Tenants of 182 to be rehoused. 58, Dacre Park 1 Statutory undertaking given to carry out repairs. 43 Properties Number of dwellings involved Present position 20 and 22, Boones Road 2 Statutory undertaking given to carry out repairs. 2 and 3, Stifford Cottages 2 Orders operative. Tenants rehoused. 60, Lee Church Street 1 Tenants rehoused. Statutory undertaking given not to relet. 40, Stanton Square 1 Order operative 11-1-52. 8 and 10, Sydenham Cottages, Marvels Lane 2 Demolished. 15, Hindsley Place 1 Works completed. 240, Burnt Ash Hill 1 Statutory undertaking given to carry out repairs. 37, Beacon Road 1 Order operative. 9, Springfield Rise 1 Adjourned for further approach to agents. 6, Myrtle Grove 1 Demolition order made, against which the owner has appealed. 7, Myrtle Grove 1 Order operative. 4-11 (inc.) (consec.), Clyde Place 8 Orders operative. 85, 87 and 91, Ewart Road 3 Notices to be served. 91, Mill Road 1 Notice to be served. 34, Clyde Vale 1 Notice to be served. 33, Wells Park Road 1 Notice to be served. Closing orders (section 12) The following is a list of closing orders which were originated, determined, became operative, or were varied during 1951:— Table 27 Properties Part of house Present position 2a, Sydenham Hill Three rooms, kitchen and bathroom in basement. Order determined. 37, Blessington Road Back room, kitchen, annexe, flank addition room and front room basement. Works carried out as required by statutory undertaking. 21, Devonshire Road Two rooms and water closet in basement. Statutory undertaking not to relet for human habitation accepted. 1. Dartmouth Hill One room and scullery in basement. Rooms vacant. Owners asked to submit informal undertaking not to relet for human habitation. 5, Peak Hill Avenue Front room basement. Amended undertaking accepted that front basement room only shall not be used for human habitation. Original undertaking included rooms on ground floor. 104, Foxberry Road Kitchen/living room on ground floor and three rooms on first floor. Statutory undertaking to carry out works accepted. 44 Properties Part of House Present position 119, Dacre Park 34, Lee Park Two rooms basement. Rear bedroom, rear hall, kitchen, passage, water closet basement. Order operative. Statutory undertaking not to relet for human habitation accepted. 39, Peak Hill Gardens Lower flat comprising front room, back room, kitchenette and passage in basement. Order operative. 96, Burnt Ash Road Front and back rooms and scullery in basement. Rooms vacant. Owners asked to submit informal undertaking not to relet for human habitation. 28a, Manor Park Three rooms and scullery in semi-basement. Statutory undertaking not to relet for human habitation accepted. 92, Dacre Park Two rooms with offices in basement. Notices to be served. House-to-house inspections Detailed inspections have been made of 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 during a part of the year; during this time 180 houses were inspected, and 111 intimation notices and 12 statutory notices served. Clearance areas and individual unfit houses The following is a copy of a return made to the Ministry of Local Government and Housing relating to action taken under the Housing Acts, 1936 to 1949 during the period April 1, 1945 to March 31, 1951 and showing the position at the end of the period:— Table 28 PART A —CLEARANCE AREAS Number of dwelling-houses demolished Number of persons displaced Unfit houses Other houses Land coloured "pink" None - None Land coloured "grey" - None 45 PART b —unfit houses not included in clearance areas Number of houses Number of persons displaced 1. Housing Act, 1936— (a) Houses demolished as a result of formal procedure under section 11 25 72 (b) Houses demolished as a result of informal notices preliminary to formal procedure under section 11 None None (c) Houses closed in pursuance of an undertaking given by the owners under section 11 3 8 (d) Parts of buildings closed (Section 12) 15 52 (e) Houses made fit— (i) As a result of formal notices under sections 9 to 12 S. 9 - 42 52 — S.11 - 4 S.12 - 6 (ii) As a result of informal notices preliminary to formal procedure under Sections 9 to 12 S. 9 - 1 1 — S.11 -Nil S.12 - Nil 2. Housing Act, 1949— (f) Closing Orders made under Section 3 (1) None None (g) Demolition Orders determined and Closing Orders substituted under Section 3 (2) None None (h) Demolition Orders quashed under Section 2 None 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 6,292 5,814 5,396 17,502 February 4,315 4,065 929 9,309 March 10,871 9,763 3,409 24,043 April 2,169 9,280 363 11,812 May 7,078 4,377 1,069 12,524 June 4,677 5,072 3,074 12,823 July 3,356 5,023 682 9,061 August 4,275 3,748 443 8,466 September 3,873 5,846 — 9,719 October 1,184 5,543 1,219 7,946 November 2,739 3,995 1,768 8,502 December 2,090 3,375 331 5,796 TOTALS 52,919 65,901 18,683 137,503 46 The following is a tabulated statement of various statistics, as submitted to the London county council:— Table 30 Item Total Total number of houses in the borough (separately assessed dwellings) 61,800 Public Health Act Number of houses inspected on account of complaints or illness 3,402 Number of statutory notices served 1,056 Number of houses repaired or nuisances remedied 9,923 Housing Act, 1936 Number of houses inspected — house to house (Housing Consolidated Regulations, 1925) 180 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 38 (b) by local authority in default of owners 7 Number of houses demolished— (a) in pursuance of orders unders. 1l 16 (b) voluntarily — Number of rooms on which closing orders were made. 5 Number of closing orders determined (i.e., houses made fit) 1 Overcrowding (Housing Act, 1936) Number of families found to be living in overcrowded conditions 158 *Number of overcrowded families who have obtained alternative accommodation:— (a) by L.B.C. 39 (b) by L.C.C. 63 Number of dwellings erected by the borough council during the year 163 Underground rooms (the Council has no regulations for underground rooms) Number occupied but unfit — Number closed or modified occupation approved — Houses let in lodgings Number in borough Not known Number of inspections under the byelaws 2 Number of prosecutions Nil Number of complaints remedied under the byelaws (not included under any other heading) Nil *Number of families rehoused by the L.B.C. to September 30, 1951. From October 1, 1951, bedroom deficiency was substituted for overcrowding standard. 47 SECTION "E" — INSPECTION AND SUPERVISION OF FOOD Milk and Dairies Regulations, 1949 At the end of the year there were 127 persons registered for the distribution of milk from premises within the borough and 21 persons registered for the distribution of milk within the borough from premises in the area of another authority. Thirty-eight premises in the borough were registered as dairies. Milk (Special Designations) Licences Table 31 Dealer's Supplementary Total Licences issued for:— sale of pasteurised milk 51 20 71 sale of tuberculin tested milk 52 17 69 sale of sterilised milk 75 21 96 sale of accredited milk 3 3 TOTALS 181 58 239 Analysis of milk During the year under review, 80 samples of milk were submitted for examination to the Public Analyst by the Council's inspectors. 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 32 Period Number of samples Average composition of samples examined Percentage of Milk fat Solids not fat Water First quarter 52 3.61 8.78 87.61 Second quarter 18 3.37 8.74 87.89 Third quarter 6 3.35 8.80 87.85 Fourth quarter 4 3.79 8.94 87.27 TOTALS 80 3.54 8.78 87.69 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. 48 In addition, the following samples of heat-treated milk were submitted to the laboratory for bacteriological examination:— Table 33 Milk Total Result Pasteurised 10 All satisfactory. Sterilised 2 All satisfactory. Icecream — grading During the year 34 samples of icecream were submitted to the laboratory for bacteriological examination with the following results Table 34 Grading Parliamentary division Total West North South Grade I 4 13 5 22 Grade II 4 3 3 10 Grade III 1 — - 1 Grade IV - 1 - 1 TOTAL 9 17 8 34 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 — composition Under the Food Standards (Icecream) Order, 1951, the standards laid down for icecream are not less than 5 percent fat, 10 percent sugar* and 1½ percent milk solids other than fat. There are provisos in respect of icecream containing fruit, fruit pulp or fruit puree and kosher ice. The 39 samples submitted for analysis from the borough were found to have the composition shown in the appended table:— Table 35 Number of samples Average percentage composition Fat Milk solidsnot fat Sucrose Water First quarter 5 9.2 7.9 13.3 69.6 Second quarter 15 9.8 8.0 13.5 68.7 Third quarter 13 10.5 9.8 11.0 68.7 Fourth quarter 6 12.3 8.8 13.7 65 2 TOTALS 39 10.3 8.7 12.9 68.3 *Sugar includes sucrose, invert sugar or solids of any sweetening material derived from starch. 49 Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 952, of which 2 were formal samples and 950 informal. After examination the public analyst reported that 1 of the formal samples and 8 of the informal samples were adulterated or below standard; the percentage of adulteration amounted to 50 in the case of the formal samples and 0.84 in the informal samples, whilst it was 0.94 of all the samples submitted compared with 0.91 in the previous year. The following table gives the groupings and the results of the samples analysed:— Table 36 Articles Number examined Number adulterated Informal Formal Total Informal Formal Total W N S W N S W N S W N S Beverages 15 5 30 - - - 50 - - - - - - - Cakes, tarts, etc. 21 6 4 — — — 31 — 1 — — — — 1 Cereals, etc. 9 14 2 - - - 25 - - - - - - - Condiments and flavourers 81 86 78 - 1 - 246 - 1 - - 1 - 2 Drugs and medicaments 23 42 8 — — — 73 — — — — — — — Fats 27 79 54 — — — 160 - - - - - - - Fish 6 - 4 - — — 10 — — — — — — — Fruit and vegetables 7 — 4 — — — 11 1 — — — — — 1 Icecream 13 16 10 — — — 39 — — — — — — — Jams, paste, spreads 25 21 19 - — — 65 — — — — — — — Bellies ... 13 4 1 — — — 18 — — — — — — — Preserved meats, sausages, etc. 46 3 5 - - - 54 3 - - - - - 3 Suger and confectionery 5 2 12 — — — 19 — — — — — — — Milk(fresh) 37 11 32 - - - 80 — — — — — — — Milk(other) 4 1 4 - - - 9 - - — — — - — Other foods and drinks 29 26 6 - 1 — 62 1 1 — - — — 2 totals 361 316 273 — 2 — 952 5 3 — — 1 — 9 50 Adulterated samples Table 37 Parliamentary division Article Formal or informal Adulteration or irregularity Action taken West Beef sausages Informal 235 parts sulphur dioxide per million. Notice subsequently displayed in shop to legal requirement. North Curry powder Informal Spices 67%. Stock withdrawn from sale. North Curry powder Formal Spices 67%. West Gin Informal Proof spirit 62.5%. Formal sample to be taken. West Beef sausage Informal Boric acid 0.11%. Formal sample to be taken. West Beef sausage Informal Boric acid 0.09%. Formal sample to be taken. North Soya flour Informal Wheat starch. Soya flour no longer sold. Apparently a technical mistake was made by the shop assistant. North Baking powder Informal Available carbon dioxide deficient 29%. Formal sample taken and found to be genuine. West Vegetable, tinned Informal Blown and slightly fermenting. Remainder of stock withdrawn from sale. Other samples In addition to samples submitted to the public analyst from 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:— Vegetable, tinned Rat Pus (2 samples) Mice excreta Meat extract Herring roes (tinned) Cheese Ham (tinned) River water (2 samples) Chocolate Easter egg Chocolate (wrapped) Meat (tinned). Crab meat, tinned (2 samples) Sausages Beef Pork Bread Whalemeat, canned, (2 samples) Strawberry flavouring for icecream Liquid flavouring Red cherries in syrup Tap water (6 samples) Swimming bath water (20 samples) 51 Unsound food A considerable amount of food was surrendered as unfit for human consumption. In all, approximately 13 tons were dealt with by the Council's food inspectors, this consisting of meat, fruit pulp, fish, vegetables, etc. In order to prevent waste where possible, much of this unsound food was forwarded to the appropriate authorities for reconditioning or animal feeding. 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 Registrar- General:— First quarter 6 Second quarter 3 Third quarter 11 Fourth quarter 7 27 (2) Outbreaks due to identified agents:— Total outbreaks Nil Total cases Nil Outbreaks due to:— (a) chemical poisons - (b) salmonella organisms - (c) staphylococci (including toxin) - (d) Cl. botulinum - (e) Other bacteria - (3) Outbreaks of undiscovered cause:— Total outbreaks 4 Total cases 7 (4) Single cases:— Agent identified 14; Unknown 6; Total 20 Registration of food premises The following premises are registered in accordance with the requirements of section 14 (1) of the Food and Drugs Act, 1938:— Icecream 340 Fish fryers 44 Sausages 105 Preserved meats 156 Preserved fish 26 Other preserved foods 1 52 Shops Act, 1950—Section 38 Subsection (2) of section 38 of the Shops Act, 1950 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. Slaughter of Animals (Amendment) Act, 1951 Circular MF 18/51 (dated August 15, 1951) was received from the Ministry of Food and called attention to the abovementioned Act which came into operation on October 1, 1951. It implements certain recommendations of the departmental committee on the export and slaughter of horses. The Act makes provisions regarding the supply of water and food to animals in slaughterhouses and knackers' yards and while in lairages awaiting slaughter, and amends paragraph 3 of the second schedule to the Act of 1933 which deals with the fastening of the heads of certain animals before stunning. Pharmacy and Poisons Act, 1933 and Pharmacy and Medicines Act, 1941 The names of 18 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 173 persons previously registered were retained on the register. 207 visits were paid by the food inspectors in connection with the granting and renewal of these licences. 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. 4 slaughtermen's licences were granted during the year under the Slaughter of Animals Act, 1933. 53 Meat inspection A report on meat inspection in the following form is included to comply with the provisions of Ministry of Health Circular 42/51:— Table 38 Cattle excl. cows Cows Calves Sheep and lambs Pigs Goats Number killed - - - - 6 - Number inspected - - - - 6 - All diseases (except tuberculosis)— Whole carcases condemned - - - - - - Carcases of which some part or organ was condemned - - - - - - Percentage of number inspected, affected with disease other than T.B. - - - - - - Tuberculosis only— Whole carcases condemned - - - - - - Carcases of which some part or organ was condemned - - - - - - Percentage of number inspected, affected - - - - - - 54 SECTION " F" — PREVALENCE OF and CONTROL OVER INFECTIOUS AND OTHER DISEASES INFECTIOUS DISEASES The undermentioned diseases are notifiable by Medical Practitioners to the Medical Officer of Health:— Anthrax Cholera Continued fever Diphtheria Dysentery (bacillary or amoebic) Encephalitis, acute Enteric fever Erysipelas Food poisoning Glanders Hydrophobia Malaria Measles Membranous croup Meningococcal infection Ophthalmia neonatorum Plague Pneumonia, acute influenzal Pneumonia, acute primary Poliomyelitis, acute Puerperal pyrexia Relapsing fever Scabies Scarlet fever Smallpox Tuberculosis, all forms Typhoid fever, including paratyphoid Typhus fever Whooping cough PRINCIPAL NOTIFIABLE DISEASES Number of Notified Cases (corrected for revised diagnosis) during the year 1951 with comparative figures for the previous six vears. Table 39 Diseases Number of cases notified 1951 1950 1949 1948 1947 1946 1945 Anthrax - - 1 - - - - Continued and relapsing fever - - — - - - 1 Diphtheria - - 3 5 9 8 24 Dysentery 365 63 9 24 26 57 31 Encephalitis (acute) 5 1 - - - 1 - Enteric or typhoid fever 4 1 3 2 4 2 — Erysipelas 24 41 35 33 45 34 50 Food poisoning 26 38 50 12 3 1 — Hydrophobia — - - - - 1 — Malaria 1 2 1 2 4 15 — Measles 3546 2,084 1,940 2,642 810 1,307 462 Meningococcal infection 6 7 3 5 19 11 3 Ophthalmia neonatorum 3 3 6 9 9 4 1 Pneumonia 173 108 84 67 104 108 71 Poliomyelitis (acute) and polioencephalitis 11 38 35 9 72 - 5 Puerperal pyrexia 63 29 27 50 43 32 25 Scabies 21 22 29 54 122 348 566 Scarlet fever 215 358 521 332 254 155 197 Smallpox - - - - 1 — — Tuberculosis 299 406 371 502 426 437 371 Whooping cough 819 813 363 789 362 291 238 TOTALS 5,581 3,608 3,109 4,035 1,887 2,375 1,674 For comments on the incidence of certain of these diseases, see the paragraph on infectious diseases in the introduction of the report (page 4). 55 Notifications of infectious diseases in 1951 showing sex and age groups:— Table 40 Diseases 0-1 1-5 5-15 15-45 45-65 65 up Total M F M F M F M F M F M F M F Diphtheria - - - - - - - - - - - - - - Dysentery 15 10 92 58 40 34 35 63 2 12 1 3 185 180 Encephalitis (acute) — 1 — 1 1 — 2 — — — — — 3 2 Enteric and paratyphoid 1 - - - 2 - - 1 - - - - 3 1 Erysipelas — — — — 1 — 2 4 3 6 4 4 10 14 Food poisoning 1 — 3 — 1 2 6 6 3 1 1 2 15 11 Malaria - - - — - - 1 — — — — — 1 - Measles 56 61 1043 1097 619 609 21 39 — — — 1 1739 1807 Meningococcal infection - 1 1 2 - 2 - - - - - - 1 5 Ophthalmia neonatorum 2 1 - - - - - - - - - - 2 1 Pneumonia 4 2 11 14 9 6 18 22 27 21 19 20 88 85 Poliomyelitis (acute) — — 5 — — 1 3 2 — — — — 8 3 Puerperal pyrexia - - - - - - - 63 - - - - - 63 Scabies - - 1 1 1 7 3 / — 1 — — 5 16 Scarlet fever 1 2 34 21 77 65 5 8 - 2 - - 117 98 Tuberculosis 1 - 10 7 11 15 98 102 36 9 7 3 163 136 Whooping cough 36 34 206 252 111 166 5 6 2 1 — — 360 459 Totals 117 112 1406 1453 873 907 199 323 73 53 32 33 2700 2881 Analyses of certain diseases in table 40 into divisional areas:— Table 41 Div. areas 0-1 1-5 5-15 15-45 45-65 65 up Total Measles W 49 860 415 23 - 1 1,348 N 29 539 387 16 - - 971 S 39 741 426 21 - - 1,227 Total 117 2,140 1,228 60 - 1 3,546 Pneumonia W 2 8 2 13 11 22 58 N 2 12 8 19 27 12 80 S 2 5 5 8 10 5 35 Total 6 25 15 40 48 39 173 Poliomyelitis W - - - 3 - - 3 N - 1 1 1 - - 3 S - 4 - 1 - - 5 Total - 5 1 5 - - 11 Scarlet fever W 1 27 64 4 2 - 98 N 1 7 28 3 - - 39 S 1 21 50 6 - - 78 Total 3 55 142 13 2 - 215 Whooping cough W 21 125 84 5 1 - 236 N 24 162 101 3 1 - 291 S 25 171 92 3 1 - 292 Total 70 458 277 11 3 - 819 For tuberculosis, see Table 45. 56 Infectious disease visiting The Council employs two infectious disease visitors whose duty it is to visit the homes of persons who are stated to be suffering from a notifiable infectious disease. Both infectious disease visitors are state registered nurses, and also registered fever nurses. 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 S Total Visits 797 668 846 2,311 Futile visits 284 367 436 1,087 Revisits 154 111 75 340 Total 1,235 1,146 1,357 3,738 Whooping cough With regard to the 823 cases notified during the year a follow-up was carried out which resulted as follows:— 1 had been confirmed as "not whooping cough" and so was not visited; 44 were not visited as they occurred in hospitals, residential nurseries or institutions; 1 had died before a visit could be made. In the rest the homes were visited by the infectious disease visitors. 178 of these visits were futile in that noone was in (59 cases at the first call, 49 cases at the second attempt, and in 7 cases at the third attempt). In the remainder details were taken of the patient, the possible cause of his infection, and of his method of isolation, and general advice was given with regard to contacts and to hygiene. 57 Revisits or follow-up visits were paid to 669 of the patients some time during the year or early in 1952 with the following results:— 11 had not been confirmed as whooping cough. In 196 there was no information at the revisit (168 were revisited once, 26 twice and 2 three times). In 12 cases the family had moved from the district. In 450 contact was made (after one, two or occasionally even more attempts) and from the cards the position found here was as follows:— In 406 the child had either fully and completely recovered, or, if the revisit were made fairly shortly after notification, the child was making a good recovery. In some of these it was specifically noted that a great improvement had been made after treatment in decompression apparatus. In 44 cases the visitor noted that recovery had not been complete the child might be losing weight, or be still debilitated, or be still suffering from a cough at night, or merely perhaps that its general health was only "fairly good." In these cases suitable advice was given which, in all but the fairly simple, was to take the child back to the private doctor or to hospital for further medical attention, if in fact this was not already being given. Revisits were not made in three cases. Influenza, pneumonia and bronchitis At the beginning of the year it seemed possible that a large-scale epidemic of influenza with its complications of pneumonia and bronchitis might be on the way, as in two or three weeks the death rate from such diseases in certain northern towns of the country exceeded all previous records. The position locally was therefore kept under close review, but the scare soon subsided. The percentage of deaths from influenza, pneumonia and bronchitis to all deaths did increase steadily from 25 to 44, in the first five weeks of the year, but after remaining at 36 for the next two weeks it rapidly dropped to almost normal. The worst week was that ending on February 3 when there were 36 deaths in the group (7 from influenza, 13 from pneumonia and 16 from bronchitis) out of the total of 82. Tuberculosis The position with regard to tuberculosis has undergone a considerable change in the last year or so compared with what it was only a few years previously. In this the long-term factor of increased personal and environmental hygiene must have played a part, but a better understanding of the disease and of its prevention, particularly by BCG vaccination, together with remarkable improvements in medical treatment, have been even more effective. Mass radiography too must be mentioned for its value in detecting unsuspected foci of infection in the population. Streptomycin, one of the mould derivatives, in the same general category as penicillin, has been used in treating certain cases of tuberculosis for a few years now and has got over most of its teething troubles, i.e., complications and side effects from the poisonous 58 properties of the drug preparation itself, but at the end of the year and the beginning of 1952 new drugs were reported on from America, which drugs appeared to produce in some cases of advanced tuberculosis almost miraculous effects. These drugs, one of which is isonicotinic acid hydrazide, are still being investigated and it is too early yet to say what their place will be, but there appears to be some reason to hope that as a result of the various methods of dealing with tuberculosis — hygiene, BCG, streptomycin, PAS and the newer drugs, together with better detection and earlier treatment — the disease, like diphtheria before it, may be on the way out. But just as diphtheria has been many years in dying, so we must expect trouble with tuberculosis for some time yet. It is essential, therefore, that all the effective weapons we have shall continue to be used, and in this connection some alarm was caused by the proposal (in new draft Regulations) to abolish the health department register of tuberculous cases. No decision had been reached by the end of the year. The mass radiography unit visited the borough in May, June and July and a report on it appears below. Recent review of the work of the units over the last few years indicates, according to Dr. Tattersall, a well known chest physician, that mass radiography should deal above all with household contacts of cases. All such contacts should be tuberculin tested and offered vaccination with BCG where necessary. Tuberculin testing is cheap and the testing of school entrants will disclose positive reactors whose earlier environment has been mainly within the home and family circle ; hence this approach gets at the unsuspected infectious case. With regard to BCG vaccination, Dr. Tattersall says, the clinical evidence in support is such that few clinicians favour withholding it until scientific trials have given more significant results. Since lung tuberculosis in teachers, besides affecting their own prospects, may have serious consequences among children, teachers should be offered vaccination. The era of the open-air sanatorium, he goes on to say, is over, and the notion that tuberculosis is most treatable in such surroundings is rapidly being disproved; treatment should increasingly be the responsibility of chest clinics supported by beds in local hospitals and by the relatively few major chest hospitals. The number of primary notifications of new cases of tuberculosis received during the year 1951, and deaths, together with comparative figures for the previous year, were as follows:— Table 43 Number of primary notifications of new cases Deaths 1950 1951 1950 1951 Pulmonary 361 266 66 60 Non-pulmonary 45 33 6 8 Totals 406 299 72 68 59 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 - - - 1 - - - 1 - 1 - 1- 2 2 - 1 2 3 - - - 1 - 1 2- 7 3 1 1 8 4 5- 5 7 3 2 8 9 - - - 1 - 1 10- 2 5 1 1 3 6 15- 10 21 2 4 12 25 - 1 - 1 - 2 20- 14 23 1 2 15 25 25- 35 31 4 6 39 37 l6 9 - 1 16 10 35- 32 14 — 1 32 15 45- 16 7 - - 16 7 l6 6 1 - 17 6 55- 19 1 1 1 20 2 65- 6 2 1 - 7 2 6 — 1 - 7 - 75- - 1 - - - 1 4 2 - 1 4 3 Totals 149 117 14 19 163 136 42 18 3 5 45 23 Analysis of new cases of tuberculosis into divisional areas:— Table 45 Division Sex 0- /- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total West Pulmonary M 1 1 1 1 1 2 5 13 13 4 11 2 - 55 F - 1 1 3 1 7 8 7 3 2 - 1 1 35 Non-pulmonary M - - - - 1 - 1 - - - - - 2 F - - - - - 1 1 2 - - - - - 4 Total M 1 1 1 1 1 3 5 14 13 4 11 2 - 57 F - 1 1 3 1 8 9 9 3 2 - 1 1 39 North Pulmonary M - 1 3 3 - 5 4 11 11 5 2 1 - 46 F - 1 1 3 3 6 7 10 5 4 - - - 40 Non-pulmonary M - - 1 2 - - 1 1 - - - 1 - 6 F - - - 1 1 1 1 3 1 - 1 - - 9 Total M - 1 4 5 - 5 5 12 11 5 2 2 - 52 F - 1 1 4 4 7 8 15 6 4 1 - - 51 60 Table 45—continued Division Sex 0- /- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total South Pulmonary M - - 3 1 1 3 5 11 8 6 5 3 - 46 F - - 1 1 1 8 8 14 6 2 2 1 - 44 Non-pulmonary M - - - 1 1 1 - 1 - - 1 - - 5 F - 1 1 1 - 2 - 2 - - - - - 7 Total M - - 3 2 2 4 5 12 8 6 6 3 - 51 F - 1 2 2 1 10 8 16 6 2 2 1 - 51 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- - - - - - - 2- 3 1 - 1 3 2 5- 1 - 1 2 2 2 10- 2 1 - - 2 1 15- 3 3 3 1 6 4 20- 5 18 - 1 5 19 25- 17 20 2 - 19 20 35- 7 3 - - 7 3 45- 6 4 - - 6 4 55- 3 - - - 3 - 65- 5 - 1 - 6 - 75- 2 1 - 1 2 2 Total 54 51 7 6 61 57 The sources from which information of the cases in the last table was obtained were as follows:- Table 47 Source of information Pulmonary Non-pulmonary Death returns — from local registrars 10 2 Death returns — from Registrar General 8 - Posthumous notifications 1 - Transfers from other areas (other than transferable deaths) 86 11 Other sources - - Totals 105 13 61 Quarterly revision of tuberculosis register:— Table 48 Pulmonary Non-pulmonary M F M F Number of cases on register at December 31, 1950 1,502 1,138 233 317 Number of cases notified for first time 149 117 14 19 Number of cases restored to register 10 11 - - Number of cases added to register otherwise 40 46 6 5 Number of cases removed from register 401 323 42 81 Number of cases on register at December 31, 1951 1,300 989 211 260 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 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 1951 227,200 299 1.32 68 60 0.26 Note:—The 1951 death rate from pulmonary tuberculosis for the County of London was 0.34. 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 62 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. 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 sanitary inspectors and infectious disease visitors during 1951 is shown in the following table:- Table 50 W N S Total Visits 111 133 155 399 Futile visits 46 64 57 167 Revisits — — — — Total 157 197 212 566 63 TB cases visited in 1951—conditions found Table 51 (a) Primary case in house (b) Second case in house Non transfer (c) Second case in house Inward transfer Social condition : Poor 11 311 1 32 2 9 Moderate 247 30 6 Superior 53 1 1 No information available 15 — — Not visited 33 33 11 Total 359 65 20 Of those visited : % V /o % Isolated in (a) Separate room 137 44 12 37 2 22 (fa) Separate bed 173 56 24 75 5 55 (c) In bed 93 30 9 28 1 II Satisfactory window area 311 100 30 94 9 100 Satisfactory lighting and ventilation 309 99 32 100 9 100 Satisfactory food cupboard 238 77 23 72 9 100 Separate water supply 285 92 28 87 9 100 Separate water closet 258 83 25 78 9 100 Separate bath 226 73 21 66 9 100 No bath 35 II 2 6 Nil — Defects requiring attention 46 15 7 22 1 II Mass radiography unit The southeast London mass radiography unit visited the borough during May, June and July when it was stationed at two centres. 3,894 men and 5,458 women were examined. Of the 3,894 men 185 were asked to return so that larger X-rays could be taken, and of these 5 did not reattend. Of the 180 remaining 35 were found to have no abnormality and 73 were thought to have old trouble not requiring further treatment; 42 were referred to their doctors as probably new tuberculous cases and a further 14 for some other reason probably not tuberculous. Eight were known to be old cases of tuberculosis and seven had heart abnormalities. One case was still being investigated at the time of the report. Of the 3,894 men, therefore, 42 or 1.1 percent were thought to be possible new cases of tuberculosis. (On investigation it is usually found that only about half these are finally diagnosed as tuberculosis). Of the 5,458 women 194 were asked to return for larger X-rays, but 2 did not attend. Of the 192 remaining 40 showed no abnormality and 76 showed old trouble not requiring treatment. 45 were referred to their doctor as probably new tuberculous cases and 5 for other reasons non-tubercular. Eleven were known to be old cases of tuberculosis and 15 had heart abnormalities. Of the 5,458 women, therefore, 45 or 0.8 percent were thought to be possible new cases of tuberculosis, though here again probably only about half of them will be finally diagnosed as tuberculous. 64 The figures were also divided amongst the various firms and groups and in 2 cases amongst the men and in 5 cases amongst the women there was more than one probably tuberculous person present in a group. In addition, amongst the private residents there were 13 probable cases of tuberculosis in 1,747 males examined and 24 probable cases amongst 2,665 females examined. Some further enquiries were made with regard to the groups with more than one case, but no special action was thought necessary. 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 13 cases of probable tuberculosis amongst 1,747 men, giving a percentage of 0.7, and 24 cases amongst 2,665 women, giving a percentage of 0.9, but taking these out and also the school children, the remaining figures for the borough council or for firms show 12 cases of tuberculosis amongst 1,876 men, giving an incidence of 0.6 percent, and 19 cases amongst 2,239 women, giving an incidence of 0.8 percent. It will be seen, therefore, that the incidence of tuberculosis amongst private residents is just a little 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 among 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. The numbers are however not so significant as in the previous year. Immunisation against infectious disease In 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 Age at December 31, 1951 Under 1 / 2 3 4 5-9 10-14 Total under 15 Born in year 1951 1950 1949 1948 1947 1946-42 1941-37 (i) Diphtheria and combined diphtheria and whooping cough:— Immunised during year 214 1,964 303 86 67 153 32 2,819 Immunised at end of year 214 2,140 2,163 3,087 2,992 13,762 10,919 35,277 Estimated mid-year population 20,200 28,787 48,987 (ii) Whooping cough (including combined)— Immunised during year (age at date of immunisation) 56 488 107 32 29 18 — 730 65 (iii) Vaccination against smallpox Age at December 31, 1951 Under 1 1-4 5-14 15 and over Total Primary:— Clinics 914 132 120 62 1,228 Private doctors 592 235 111 114 1,052 Revaccination:— Clinics 5 7 31 147 190 Private doctors 7 23 67 368 465 Town Hall, S.E.6. July, 1952 E. H. R. SMITHARD, Medical Officer of Health 66 APPENDIX A Acts of Parliament, Statutory Instruments and Circular Letters issued by Government Departments, with regard to the public health services, during the year 1951:— Statutes The Slaughter of Animals (Amendment) Act, 1951. Pet Animals Act, 1951. Rag Flock and Other Filling Materials Act, 1951. London County Council (General Powers) Act, 1951. National Assistance (Amendment) Act, 1951. Statutory Instruments No. 13 The Food Standards (Ice Cream) Order, 1951. 67 Ice Cream (Heat Treatment) Regulations, 1947-51. 137 The Soft Drinks (Amendment) Order, 1951. 462 The Labelling of Food (Amendment) Order, 1951. 593 The Cream (Revocation) Order, 1951. 668 The Food Standards (Cream) Order, 1951. 721 The Poisons List (Amendment) Order, 1951. 722 The Poisons Rules, 1951. 928 Dried Egg (Control of Use) (Revocation) Order, 1951. 1021 The Sanitary Officers (London) Regulations — Medical Officers of Health and Sanitary Inspectors; procedure for filling vacancies in these offices. 1029 The Meat Products and Canned Meat (Amendment No. 2) Order, 1951. 1036 The Public Health (Leprosy) Regulations, 1951. 1081 The Puerperal Pyrexia Regulations, 1951. 1196 The Food Standards (Edible Gelatine) Order, 1951. 1358 The Milk (Special Designations) (Specified Areas) Order, 1951. 1400 The Imported Canned Fruit (Amendment) Order, 1951. 1456 The Food Standards (Fish Paste) Order, 1951. 1457 The Food Standards (Meat Paste) Order, 1951. 1458 The Sampling of Food (Revocation) Order, 1951. 1487 The Infestation (Amendment) Order, 1951. 1759 The Hydrogen Cyanide (Fumigation of Buildings) Regulations, 1951. 1846 The Rag Flock and Other Filling Materials Regulations, 1951. 2240 The Food Standards (Edible Gelatine) (Commencement) Order, 1951. 2241 The Food Standards (Fish Paste) (Amendment) Order, 1951. 2242 The Food Standards (Meat Paste) (Amendment) Order, 1951. 67 Ministry of Health Circulars. No. 4 Housing Act, 1949 — Part II — Improvement of Housing Accommodation. 26 The Sanitary Officers (London) Regulations, 1951. Medical Officers of Health and Sanitary Inspectors ; procedure for filling vacancies in these offices. 28 Notification of Puerperal Pyrexia. 33 Notification of infectious diseases and food poisoning. 37 National Assistance Act, 1948 — National Assistance (Amendment) Act, 1951 —Removal of persons in need of care and attention. 42 Annual Reports of Medical Officers of Health, 1951. 44 Public Health (Tuberculosis) Regulations, 1940. Ministry of Food Circulars No. 1 The Food Standards (Ice Cream) Order, 1951. 2 The Public Health (Preservatives, etc., in food) Regulations—Borax in bacon. 4 The Soft Drinks (Amendment) Order, 1951. 7 Meat Products and Canned Meat (Amendment) Order, 1951. 8 Ice Cream (Heat Treatment, etc.) Regulations, 1947-51. 9 The Cream (Revocation) Order, 1951. 10 The Food Standards (Cream) Order, 1951. 11 The Dried Egg (Control of Use) Revocation Order, 1951. 13 Meat Products. 14 Standards for Edible Gelatine. 17 Standards for Meat Paste and Meat Spread and Fish Paste and Fish Spread. 18 The Slaughter of Animals (Amendment) Act, 1951. 19 Milk and Dairies Regulations, 1949 — Approved oxidising and preservative agents. 20 Dogs in Food Shops, Restaurants, etc. 21 Use of the word "Butter" in the description of Confectionery. Ministry of Local Government and Planning Circulars No. 62 Rag Flock and Other Filling Materials Act, 1951. Memorandum Explanatory memorandum to the Rag Flock and Other Filling Materials Act, 1951. Ministry of Agriculture and Fisheries Circulars No. 8 Warfarin as a rat poison. 9 Prevention of Damage by Pests Act, 1949 — Hospitals. 68 APPENDIX B Legal Proceedings in 1951 The following is a list of legal proceedings instituted during the year:— Public Health (London) Act, 1936 Date of hearing Nature of offence Fine Costs Remarks £ £ s. d. 12 January Non-compliance with nuissance notice in respect of 41, Limes Grove. — — Adjourned sine die. Builder instructed to begin work. 9 Feb. Non-compliance with abatement order in respect of 39, Summerfield Street. 5 - - 9 Feb. Non-compliance with nuisance notice in respect of 11, Haseltine Road. - - Adjourned to 9 March, on an application of the defendant pending settlement of negotiations between herself, the WDC and her surveyor. Adjourned sine die at second hearing (work in progress). 9 Feb. Non-compliance with nuisance notice in respect of 13, Haseltine Road. — - 9 Feb. Non-compliance with nuisance notice in respect of 15, Haseltine Road. — — 9 Feb. Non-compliance with abatement order in respect of 48, Dallas Road. 5 - 27 April Non-compliance with abatement order in respect of 48, Dallas Road. - 1 1 0 Summons withdrawn. Work completed satisfactorily before hearing. 9 Feb. Non-compliance with nuisance notice in respect of 40, Algiers Road. - - Adjourned sine die. Work licensed and due to commence. 19 Feb. Non-compliance with nuisance notice in respect of 49, Barmeston Road - - Adjourned sine die. Work in hand. 9 March Non-compliance with nuisance notice in respect of 5, Neuchatel Road. - - Adjourned sine die. Work given to builder. 9 March Non-compliance with nuisance notice in respect of 53a, Peak Hill. - 1 1 0 Order made for abatement of nuisance within 42 days. 31 August Non-compliance with abatement order in respect of 53a, Peak Hill. - - Adjourned sine die. Work in progress. 9 March Non-compliance with nuisance notice in respect of 61, Coombe Road. - 1 1 0 Order made for abatement of nuisance within 14 days. 27 April Non-compliance with abatement order in respect of 61, Combe Road. 5 1 0 0 9 March Non-compliance with nuisance notice in respect of 11, Peak Hill Gardens. - 1 1 0 Order made for abatement of nuisance within 28 days. 69 Date of hearing Nature of offence Fine Costs Remarks £ £ s. d. 31 August Non-compliance with abatement order in respect of 11, Peak Hill Gardens. 10 3 3 0 - 9 March Non-compliance with nuisance notice in respect of Flat 1,113, Dartmouth Road. - 1 1 0 Order made for abatement of nuisance within 28 days. 9 March Non-compliance with nuisance notice in respect of 9, Kingswood Place. - - Adjourned sine die. Work in hands of builder. 9 March Non-compliance with nuisance notice in respect of 10, Kingswood Place. - - Adjourned sine die. Work in hands of builder. 9 April Non-compliance with nuisance notice in respect of 50, Marsala Road. - 1 0 0 Order made for abatement of nuisance within 42 days. 19 Oct. Non-compliance with abatement order in respect of 50, Marsala Road. 5 - 27 April Non-compliance with nuisance notice in respect of Woodcot, Mill Gardens. - - Adjourned sine die. Defendant pleaded by letter that he was not the owner of the property. 27 April Non-compliance with ashpit notice in respect of Woodcot, Mill Gardens. - - Adjourned sine die. Defendant pleaded by letter that he was not the owner of the property. 17 Sept. Non-compliance with nuisance notice and ashpit notice in respect of Woodcot, Mill Gardens. 10/- - Order made for abatement of nuisance within 28 days. Penalty of 10/- imposed in respect of the ashpit notice. 27 April Non-compliance with nuisance notice in respect of 42, Knowles Hill Crescent. - - Order made for abatement of nuisance within 14 days. 27 April Non-compliance with nuisance notice in respect of 40, Knowles Hill Crescent. - - 27 April Non-compliance with nuisance notice in respect of 38, Knowles Hill Crescent. - - 11 May Non-compliance with nuisance notice in respect of 21, Dallas Road. - - Adjourned sine die pending settlement of war damage claim. 8 June Non-compliance with ashpit notice in respect of 94, Laleham Road. - - Summons withdrawn, dustbin supplied. 9 July Non-compliance with nuisance notice in respect of 35, Prospect Road. - - Order made for abatement of nuisance within 28 days. 17 Sept. Non-compliance with abatement order in respect of 35, Prospect Road. 10 2 2 0 - 70 Date of hearing Nature of offence Fine Costs Remarks £ £ s. d. 9 July Non-compliance with nuisance notice in respect of 42, Rowland Grove. — — Adjourned sine die. Repairs completed. 20 July Non-compliance with nuisance notice in respect of 35a, Blessington Road. - - Adjourned sine die. Work to be put in hand immediately. 20 July Non-compliance with nuisance notice in respect of 27, Cressingham Road. - - Case withdrawn. Nuisance abated. 31 August Non-compliance with nuisance notice in respect of 126, Marvels Lane. - - Adjourned sine die. Work in progress. 31 August Non-compliance with nuisance notice in respect of 124, Marvels Lane. - - Adjourned sine die. Work in progress. 31 August Non-compliance with nuisance notice in respect of 128, Marvels Lane. - - Adjourned sine die. Work in progress. 31 August Non-compliance with nuisance notice in respect of 18, Lampmead Road. - - Summons withdrawn. Work in progress. Order made for abatement of nuisance within 7 days. 31 August Non-compliance with nuisance notice in respect of 20, Glenton Road. - - 17 Sept. Non-compliance with nuisance notice in respect of 112, Wells Park Road. - - Adjourned sine die. Work completed. 15 Oct. Non-compliance with nuisance notice in respect of 371 Stanstead Road. - - Summons withdrawn. Notice abated prior to hearing. 15 Oct. Non-compliance with nuisance notice in respect of 36, Venner Road. - - Adjourned sine die. Licence application to cover defects received. 15 Oct. Non-compliance with nuisance notice in respect of 4, Stanton Square. - 3 0 0 Adjourned sine die. Work in progress. 15 Oct. Non-compliance with nuisance notice in respect of 12, Stanton Square. 15 Oct. Non-compliance with nuisance notice in respect of 18, Stanton Square. 15 Oct. Non-compliance with nuisance notice in respect of 29, Stanton Square. 15 Oct. Non-compliance with nuisance notice in respect of 31, Stanton Square. 15 Oct. Non-compliance with nuisance notice in respect of 32, Stanton Square. 15 Oct. Non-compliance with nuisance notice in respect of 33, Stanton Square. 15 Oct. Non-compliance with nuisance notice in respect of 39, Stanton Square. 71 Date of hearing Nature of offence Fine Costs Remarks £ £ s. d. 19 Oct. Non-compliance with nuisance notice in respect of 103, Manor Park. - — Adjourned to Nov. 2. Summons then withdrawn as work was completed. 19 Oct. Non-compliance with nuisance notice in respect of 132, Blackheath Hill. - 1 1 0 Adjourned sine die Work commenced. 5 Nov. Non-compliance with nuisance notice in respect of 20, Ringstead Road. - - Adjourned sine die. Work in hand. 5 Nov. Non-compliance with ashpit notice in respect of 42, Springfield Rise. 1 - Adjourned to Dec. 10. Fine then imposed. 12 Nov. Non-compliance with nuisance notice in respect of 5, Kingswood Place. - - Order made for abatement of nuisance within 28 days. 12 Nov. Non-compliance with nuisance notice in respect of 6, Kingswood Place. - - Order made for abatement of nuisance within 28 days. 12 Nov. Non-compliance with nuisance notice in respect of 7, Kingswood Place. - - Order made for abatement of nuisance within 28 days. 14 Dec. Non-compliance with nuisance notice in respect of 15, Taunton Road. - - Summons withdrawn. Work carried out. 14 Dec. Non-compliance with nuisance notice in respect of 32, Lee Park. - - Adjourned sine die. Work to commence withing 28 days. 14 Dec. Non-compliance with nuisance notice in respect of 40, Boyne Road. - - Summons withdrawn. Work done. 14 Dec. Non-compliance with nuisance notice in respect of 41, Loampit Hill. - 10 6 Summons withdrawn on payment of costs. Written agreement accepted to complete work within 28 days. BYELAWS MADE BY THE LONDON COUNTY COUNCIL Date of hearing Nature of offence Fine Costs Remarks £ £ s. d. 15 January Exchange of goldfish for old clothing on 15 Nov., 1950 at Haseltine Road. 2 1 0 0 — 9 April Exchange of goldfish for rags on 22 January at junction of Elfrida Road and Overdown Road. 1 - first summons. 9 April Exchange of goldfish for rags on 7 March at Launcelot Road. 5 - second summons. 72 Date of hearing Nature of offence Fine Costs ks £ £ s. d. 4 June Exchange of toys for old clothing on 20 April near Athelney Street School. 3 — — 9 July Exchange of toys, watches, marbles and jigsaw puzzles for rags on 16 March at Ardmere Road. - - Summons withdrawn as defendant seriously ill. CASES HEARD BY APPEALS COMMITTEE OF THE LONDON COUNTY COUNCIL Date of hearing Nature of appeal Remarks 23 July Appeal by tenant against notice served under s. 105 of the Public Health (London) Act, 1936 requiring him to provide a dustbin. Appeal dismissed. 23 July Appeal by owners against notice served under s. 105 of the Public Health (London) Act, 1936 requiring them to provide a dustbin. Appeal dismissed. HOUSING ACT, 1936 Date of hearing Nature of offence Fine Costs Remarks £ s. d. £ s. d. 29 Jan. Appeal against notices served under s. 9 in respect of 10, 14, 16, Morena Street. - - Appeal withdrawn. 5 July Appeal against notice served under s. 9 in respect of 28, Leyland Road. - - Appeal withdrawn. 73 FOOD AND DRUGS LEGISLATION Food and Drugs Act, 1938 Date of hearing Nature of offence Fine Costs Remarks £ s. d. £ s. d. 15 January Caterpillar in meat pie - 5 5 0 Discharged. 15 January Broken pieces of glass in bottle of milk. 5 5 0 2 2 0 — 9 March Nail in pastry. - 2 2 0 Absolute discharge. 27 April Mouse excreta in bread. 5 0 0 2 2 0 — 27 April Nail in bun. 5 0 0 1 1 0 — 27 April Stone in bun. 2 0 0 - — 23 July Flour contaminated with dirt. 3 0 0 2 2 0 — 23 July Maggot in bread. 3 0 0 2 2 0 — Milk and Dairies Regulations, 1949 Date of hearing Nature of offence Fine Costs Remarks £ s. d. £ s. d. 6 Nov. Dirty milk. 5 0 0 2 2 0 Case taken by Lambeth Borough Council under the Milk and Dairies Regulations. 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:— Maggot in cake mixture. Metal in bread. Metal staple in mince pie. Foreign matter in bread. Fly in a wrapped and sliced loaf of bread. Fly in bread. Dirty milk bottle (2 cases). 74 APPENDIX C List of special reports submitted to the Health Committee by the Medical Officer of Health during 1951:— February 6 Tuberculosis regulations. March 6 February 6 Influenza. March 6 Food and Drugs (Milk and Dairies and Artificial Cream) Act, 1950 — specification of the London area. March 6 Outworkers. March 6 Lewisham Old People's Welfare Association — Constitution. May 29 Measurement of atmospheric pollution. November 27 Pet Animals Act, 1951. 75 APPENDIX D Statistics based on 1% sample, 1951 Census Population distribution by age and marital condition, Lewisham Males Females Total 106,100 121,500 Marital Condition : Single 44,900 47,600 Married 58,100 60,300 Widowed and Divorced 3,100 13,600 Age (last birthday) : 0-4 10,700 9,300 5-14 14,300 14,100 15-24 13,900 15,400 25-34 16,300 16,500 35-44 16,200 19,000 45-54 14,800 18,100 55-64 10,000 12,600 65 and over 9,900 16,500 Occupation and social class (males, occupied and retired) Social class Lewisham London Administrative County Greater London England and Wales Nos. % % % % 1 3,000 4 4 5 3 II 11,900 15 13 17 15 III 47,700 61 53 55 53 IV 7,800 10 12 11 16 V 8,400 11 17 13 13 Housing In Lewisham there were 71,400 households, 25,400 of which were in shared dwellings. 300 were in the high density of between 2 and 3 persons per room, 3,100 between 1½ and 2 persons per room, 8,000 between 1 and 1½ persons per room and 60,000 at a density of one person or less per room. 12,500 households were without the exclusive 76 use of a water closet, 27,200 were without the exclusive use of a fixed bath and 4,700 were without the exclusive use of both a stove and a sink. 291,200 rooms were occupied by the households, the total population being 222,100. The following table compares Lewisham with other areas of which it is part:— Lewisham London Administrative County Greater London England and Wales Households (%) in shared dwellings 36 52 36 15 Persons per room (%) : Over 3 - 0.2 0.1 0.2 3 and over 2 0.4 1 1 1 2 and over 1½ 4 6 5 4 1½ and over 1 11 13 12 11 1 or less 84 80 82 84 Households (%) without exclusive use of: Water closet 18 35 24 21 Fixed bath 38 62 46 45 Both stove and sink 7 17 13 14 Persons per household : 1951 3.11 2.81 3.01 3.19 1931 3.65 3.46 3.57 3.72 Persons per room : 1951 0.76 0.83 0.77 0.73 1931 0.81 0.98 0.89 0.83 Percentage of persons living more than 2 per room : 1951 1.17 2.20 1.71 2.16 1931 4.09 13.13 9.46 6.94 77 TABLES TABLE NO. SUBJECT PAGE 1 Comparative statistics 7 2 General summary of vital statistics in last ten years 7 3 Causes of death by age groups 8 4 Deaths under one year of age 9 5 Local sickness 12 6 Total deaths by social class 12 7 Causes of death by social class 13 8 Grouped causes of death by social class 14 9 Births, infant deaths, etc. by social class 15 10 General statistics from 1901 17 11 Disinfecting station 18 12 Treatments for verminous conditions and scabies 19 13 Public mortuary 23 14 Rodent control 23 15 Rodent control — treatment of rivers ... ... ... ... 25 16 Prevalence of rats and mice 26 17 Water supply samples — chemical 28 18 Water supply samples — bacteriological 28 19 Weather conditions in 1951 33 20 Sanitary inspection 34 21 Summary of notices 35 22 Nuisances remedied 36 23 Factories and workshops — inspections 37 24 Factories and workshops — defects 37 25 Applications for rehousing 41 26 Demolition orders 42 27 Closing orders 43 28 Clearance areas and unfit houses 44 29 Civil building licences 45 30 Various housing statistics 46 31 Milk (special designations) licences 47 32 Analysis of milk 47 33 Heat-treated milk 48 34 Icecream — grading 48 35 Icecream — composition 48 36 Food and Drugs Act—samples analysed 49 37 Food and Drugs Act — adulterated samples 50 38 Meat inspection 53 39 Principal notifiable diseases 54 40 Notifications of infectious diseases by age and sex 55 41 Analysis of certain diseases into divisional areas 55 42 Infectious disease visiting 56 43 Tuberculosis notifications and deaths 58 44 Age distribution of tuberculosis cases 59 45 Analysis of new cases of tuberculosis into divisional areas 59 46 Cases of tuberculosis not formally notified 60 47 Sources of information in table 46 60 48 Revision of tuberculosis register 61 49 Summary of statistics as to tuberculosis for the last ten years 61 50 Tuberculosis — environmental investigations 62 51 Tuberculosis cases visited in 1951 63 52 Immunisation against infectious disease 64 CHARTS Ages at death 10 Special causes of death at 10 year intervals 11 Tuberculosis — environmental investigations 62 78 INDEX SUBJECT PAGE SUBJECT PAGE Acts, regulations and orders 66 National Assistance Act, 1948:— Area of borough 6 Section 47 22 Atmospheric pollution 31 Section 50 22 Nuisances remedied 36 Birth rate 6 Offensive trades 52 Census 1951 — 1% sample 75 Outworkers 38 Civil building licences 45 Deaths, ages at 10 Pharmacy and Poisons Act, 1933 52 Death rates 6 PoPulation 6 Deaths, causes of 8 Premature births 15 Disinfection and personal Prevention of Damage by Pests cleansing 18 Act, 1949 25 Dog nuisances 38 Rag Flock and other Filling Factories and workshops 37 Materials Act, 1951 39 Flies and mosquitoes 20 Rateable value 6 Food — adulteration of 49 Registration of food premises 51 Food — inspection and superRent and Mortgage Interest vision 47 (Restrictions) Acts 30 Food poisoning 51 Rodent control 23 Health services — general proSampling 49 vision of 18 Sanitary circumstances of the Housing:— area 34 New building 40 Shops Act, 1950 52 Families rehoused 40 Sickness, local 12 Applications for rehousing 40 Slaughterhouses 52 Housing Act, 1936 41 Smoke nuisances 35 Staff 2 Stillbirths 6 Icecream — composition 48 Swimming baths 29 Icecream — grading 48 Immunisation against infectious disease 64 Tables, list of 77 Infant mortality 6 Tuberculosis:— Infant mortality table 9 Age and sex distribution 59 Infectious diseases 54 Analysis in divisional areas 59 Infectious disease visiting 56 Cases other than by formal Influenza, pneumonia, etc 57 notification 60 Introduction 3 Environmental investigations 61 Mass miniature radiography 63 Quarterly revision of register 61 Laboratory facilities 20 Legal proceedings 68 Unsound food 51 Maternal deaths 7 Meat inspection 53 Vital statistics 6 Meteorology 33 Milk — analysis of 47 Milk and Dairies Regulations, Water certificates 36 1949 47 Water supply 26 Mortuary and Coroner's Court 22 Whooping cough 56