AC 4374 LEW 40 METROPOLITAN BOROUGH OF LEWISHAM THE PUBLIC HEALTH OF LEWISHAM REPORT OF THE Medical Officer of Health for the Year 1952 E. H. R. Smithard, MBE, MD, DPH London: e. G. Berryman & Sons, Ltd., Blackheath Road, S.E.10 METROPOLITAN BOROUGH OF LEWISHAM Report OF THE Medical Officer of Health for the Year 1952 E. H. R. Smithard, MBE, MD, DPH CONTENTS page Staff 2 Introduction 3 Vital Statistics 7 General Provision of Health Services 23 Sanitary Circumstances of the Area 45 Housing 54 Inspection and Supervision of Food 64 Infectious Diseases 74 Appendix A — Statutory Instruments 86 „ B — Legal Proceedings 88 „ C — Special Reports to Health Committee 93 List of Tables 94 Index 95 2 STAFF as at 31/12/52 Medical Officer of Health E. H. R. Smithard, mbe, md, bs, mrcs, lrcp, dph Senior Sanitary Inspector Deputy Senior Sanitary Inspector E. Walker (a) (b) A. J. Phillips (a) (6) Group Sanitary Inspectors A. G. Thomas (a) (b) (Food) R. Mahoney (a) (b) (District) J. R. Craven (a) (6) (Housing) District Inspectors Food Inspectors and Sampling Officers J. W. Bevan (a) (b) H. W. Ellery (a) (b) C. L. Connor (a) T. R. A. Fitzherbert (a) (b) G. E. Fallows (a) (b) H. Tolson (a) (b) A. Gartside, dpa (a) (6) E. A. Howard (a) Housing Inspectors H. J. Rogers (a) R. C. Brittain (a) (b) K. R. Wagener (a) (6) One vacancy Three vacancies 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, rfn, scm Miss M. B. Mitchell, srn, rfn, scm 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, Pest Control, 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 Lewis ham. Mr. Mayor, Ladies and Gentlemen, I submit herewith my report for the health department for the year 1952. The Registrar General's estimate of the population in midyear 1952 at 227,100 was 100 less than his estimate for midyear 1951. The prewar estimated total population in June 1939 was 231,000. The crude birth rate for the year at 13.9 shows a considerable drop from the figure of 15.3 for the previous year and the adjusted birth rate (allowing for age and sex distribution of the population) is even less, at 13.1. The crude death rate at 11.4 shows a small increase from the 11.2 of last year and the adjusted death rate is 11.6, which compares with 12.6 for the administrative county. The infant mortality rate at 22 was a drop of 3 from the previous year, the neonatal rate (i.e., under one month of age) showing a fractional decrease to 16 and the one month to one year rate a decrease from 8 to 6. The stillbirth rate again increased slightly, from 16.1 to 17.7, and this is disappointing. The combined stillbirth and infant death rate (reproductive wastage) remains almost the same, being 40 as against 41. One maternal death is ascribed to the year although this was a case where the interval between the maternal condition and death was over 12 months ; the maternal mortality rate per thousand live and stillbirths remains at 0.3. The premature birth rate, i.e., the number of children weighing 5½1bs. or less at birth per thousand livebirths is not so exact a figure, as a few babies who were for one reason or other not weighed at birth have been regarded as premature (this is probably true, but not necessarily so). Nevertheless the rate for 1952 at 86 is high enough to be specially noted. The various comparative figures of general statistics since 1901 are shown on page 22 (table 11). Tuberculosis The number of new notifications increased very slightly from 299 to 307, the notification rate rising fractionally from 1.32 to 1.35. The number of deaths from tuberculosis showed a marked reduction, from 68 to 42. The fall in the death rate from tuberculosis in this borough has been more or less paralleled by the remarkable fall in the tuberculosis death rate which has taken place in many parts of the world since 1939. According to figures published by the World Health Organisation combined statistics from 21 countries (including this country) with a total population of 404 millions show that the death rate has been roughly halved in the past 15 years. The chief causes are thought to be the energetic mass action directed towards the early detection of the disease by radiography and its prevention by BCG vaccination, and better hygiene more particularly in the control of milk; improved conditions and methods of treatment have also contributed. The decline in mortality has been greatest in children and adolescents. The male mortality rate has always been higher than the female and the difference between the two is becoming greater because, 4 it is suggested, recent social progress and improvements in hygiene have had more effect on women's living conditions. In 1952 in Lewisham there were 28 male deaths and 14 female; the corresponding figures for the previous year were 45 and 23, while for the two years 1937/8 the combined figures were 169 males and 153 females. Maternity and child welfare There was very little variation in the principal rates, and the slightness of the reduction in the neonatal rate with at the same time a slight increase in the stillbirth rate, are both somewhat vexatious factors. An analysis of the neonatal deaths indicates that 9 of the 52 were due to congenital deformities, 5 to injury at birth, 12 to asphyxia or lack of expansion of the lungs at birth, and 17 (against 21 last year) to prematurity or immaturity. Food hygiene The notified cases of food poisoning during the year amounted to 33, a slight increase from the 26 of the previous year, but this figure is not exact since many cases no doubt do not come to our notice. Throughout the year the food inspectors continued to give advice to occupiers of food shops with regard to general hygiene and pest control. Infectious disease other than tuberculosis With regard to the more acute infections the year again showed a high number of measles cases, but the 2183 cases fell far below the record figure of 3546 in the previous year. Only one death resulted. Dysentery cases, which had troubled us considerably in 1951, dropped from 365 in that year to 169 in 1952, but this figure is still much higher than in the years previous to 1951. There were 15 cases of poliomyelitis, which with the endemic prevalence in this country of recent years can be regarded as being on the low side. The increase which occurred in the number of cases of puerperal pyrexia notified can be explained by the more comprehensive definition of the term now in force. Scabies again touched a new low record from its wartime high, and whooping cough was rather less prevalent than in the previous two years. For the third year in succession there was no case of diphtheria notified and subsequently confirmed in the borough, but I would once more call attention to the fact that this emphasises rather than minimises the necessity for the protection of young children against the disease by immunisation. Unless the child population remains well immunised there is considerable danger of virulent diphtheria again becoming prevalent. Old people There is relatively little to report on extensions of aid and service given to old people in the borough and this rather indicates that the committee's effort to help clubs get going and to help maintain them in existence has not been fully successful. Nevertheless the Lewisham Old People's Welfare Association did during the year develop its 5 housing branch, which although a function to which the borough council cannot contribute directly is one which has the health committee's full support. Social medicine statistics ; the fog In section A, vital statistics, will be found some further 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. It is hoped to keep this analysis for a further year, making three years in all, and then to publish more comprehensive details of it. It shows promise of revealing some interesting factors. In section A will also be found a report of the increasing deaths from lung cancer (page 19) and in section B details of the great fog (pages 38 to 44). Establishment of Sanitary Inspectors The establishment, which was agreed to in 1947 after considerable thought and discussion, is 21 made up of the following : the Senior Sanitary Inspector, the Deputy Senior Sanitary Inspector, a group food inspector, a group housing inspector, a group district inspector, 3 food inspectors, 10 district inspectors, and 3 housing and special purpose inspectors. The senior and deputy senior inspectors also act as group district inspectors, there being 13 districts in all. There has been an increasing number of vacancies in the above establishment, amounting to four at the end of 1952. Recent advertisements for filling vacant positions have met with decreasing success ; thus although there were 17 applicants for an advertisement issued in September, 1950, to four advertisement in 1951 there were 8, 5 (none suitable), 5 and 6 applications, and for six advertisements in 1952 there were 1 (not suitable) 4, nil, 5 (none suitable), 3 (none suitable) and 2 applications. This matter was reported in detail to the Establishment Committee, and the Public Health Committee was also made aware of it, as I take the view that the long-term results may be more serious than the immediate results. Perhaps the main objective of the duties of sanitary inspectors is to improve or at least to preserve the standard of living accommodation and environmental conditions in the borough. A lowering of this standard may not be obvious at first, but once it occurs it is much more difficult to overcome. It is therefore in my view highly desirable that the establishment of sanitary inspectors shall be maintained. One of the reasons for the dearth of candidates is no doubt financial, and in this connection the London District Council was giving consideration to the matter at the end of the year. A further point is that the differential in the rate of pay between sanitary inspectors in the metropolis and those in the provinces has very considerably lessened since before the war, and therefore with the higher cost of living in London metropolitan work becomes less attractive. There is also however a general fall in the number of inspectors available, owing to 6 the decreasing number of candidates presenting themselves for examination. In the few years before the war there was an annual average of some 300 newly qualified inspectors. During the war years this dropped, for five of them to below 70, but under the postwar scheme it increased to over 400 in 1948 and 1949. The number however in 1951 dropped to 153 and in 1952 to 150, and the Examining Board for sanitary inspectors anticipates a drastic fall in the examination entrants during the next few years owing to the introduction in 1953 of an extended period of training. Without therefore a strong inducement to inspectors to come to the metropolis from the provinces the outlook for obtaining a complete establishment must remain poor. This bodes ill for the future of housing standards and other hygienic work in the borough. 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 Stoffel (P. E.) (Vice-Chairman); The Mayor (Alderman G. T. Harman, j.p.); Aldermen Carter, Mrs. Huggett and Street; Councillors Mrs. Armstrong, Mrs. Beardwell, Braund, Mrs. Bunce, Mrs. Drapper, j.p., Duhan, M.c., Fisher, Fisk, Hasling, Hawes, Mrs. Land, Mrs. Smith and Stoffel (W. J.). 7 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 1952 was 227,100. (This includes members of the armed forces stationed in the area). Rateable value County of London rateable value of the borough at April 1, 1952 £1,847,626 Estimated net product of a penny rate, 1952/53 £7,450 Number of separately assessed dwellings at April 1, 1952 60,420* Births (adjusted for inward and outward transfers) Livebirths 3,161 Males Females Total Legitimate 1,521 1,502 3,023 Illegitimate 73 65 138 Totals 1,594 1,567 3,161 Crude birth rate per 1,000 of the estimated population 13.9 Adjusted birth rate for comparative purposes 13.1† Birth rate for England and Wales 15.3 Adjusted birth rate for London Administrative County 17.6 Stillbirths The stillbirths allocated to the borough during the year were 57. This represents a stillbirth rate per thousand live and stillbirths of 17.7, Deaths The deaths belonging to the borough registered during the year were 2,580 consisting of 1,364 males and 1,216 females, giving a crude death rate per thousand of the estimated population of 11.4. The adjusted† rate works out at 11.6 per thousand of the estimated population which compares with a rate of 11.3 for England and Wales and an adjusted rate of 12.6 for the Administrative County of London. * The figure given in previous years for the number of separately assessed dwellings in the borough has been estimated. † The Registrar-General supplies an area comparability factor (0.94 for birth and 1.02 for death rates) by which the crude rate is to be multiplied to make allowance for the way in which sex and age distribution of the local population differs from that for England and Wales as a whole. When the rate has been so adjusted it can be more accurately compared with the crude rate for England and Wales or the adjusted rate for any other district. 8 Infant mortality Infant deaths 71 Legitimate 66 Illegitimate 5 Rates : 1. All infants per thousand livebirths 22.4 2. Legitimate infants per thousand legitimate livebirths 22.0 3. Illegitimate infants per thousand illegitimate livebirths ... ... ... ... ... 36.2 Neonatal deaths (under one month of age) 52 Neonatal death rate (per 1,000 livebirths) 16.5 Reproductive wastage:— Stillbirths plus infant deaths 128 Rate per thousand live and stillbirths 39.8 Maternal deaths Maternal deaths 1 Maternal mortality rate per thousand live and stillbirths 0.3 Other special causes of death Measles 1 Diarrhoea (under 2 years) 1 Suicide 15 Motor Vehicle Accidents 23 Tuberculosis (all forms) 42 Cancer (Code Nos. 10-15) 484 Heart and Circulation Diseases (Code Nos. 17-21) 1,249 Comparative statistics for the year 1952 Table 1 Birth rate (per 1,000 population) (adjusted) Death rate (per 1,000 population) (adjusted) Infant mortality rate (per 1,000 livebirths) Live births Still births Lewisham 13.1 17.7 11.6 22.4 England and Wales 15.3 22.6 11.3 27.6 London Administrative County 17.6 19.2 12.6 23.8 9 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 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 1952 227,100 3161 13.9 2580 11.4 71 22 35 0.15 The 1951 Census In the last annual report it was just possible to include (in appendix D) a short note on the Lewisham statistics as indicated by a 1 percent sample of the 1951 census. An additional matter which is of interest deals with the population distribution and marital condition. Of the males 44,900 were single, 58,100 married and 3,100 widowed or divorced. Of the females 47,600 were single, 60,300 were married and 13,600 were widowed or divorced. (The age distribution was set out in tabular form in appendix D of my last report— page 75). The proportion of total males to total females is 87 percent and this compares with 87 percent for London Administrative County, 88 percent for Greater London and 92 percent for England and Wales. 10 Causes of death at different periods The following table shows the causes of and Tibk Causes of death Nett deaths at the subjoined age of "residents" whether occurring within or without the borough MALES Total Persone (i.e., incl. table opp. All ages Under 1 yr. 1 and under 5 5 and under 15 IS and under 25 25 and under 45 45 and under 65 65 and under 75 75 and over Totals, all causes 1364 40 9 5 14 70 353 371 502 2580 1 Tuberculosis, respiratory 22 - - - - 6 11 3 2 35 2 Tuberculosis, other 6 - 1 1 2 2 — — — 7 3 Syphilitic diseases 6 - — — — — 1 2 3 9 4 Diphtheria — - — — — — — — — - 5 Whooping cough — - — — — — — — — - 6 Meningococcal infections — - — — — — — — — - 7 Acute poliomyelitis - - - - - - - — — - 8 Measles 1 - 1 — — — — — — 1 9 Other infective and parasitic diseases 2 - - - - 1 - 1 — 4 10 Malignant neoplasm, stomach 45 - - - - 1 14 19 11 75 11 Malignant neoplasm, lung and bronchus 77 - - - - 4 39 25 9 86 12 Malignant neoplasm, breast 2 - - - - - 1 — 1 66 13 Malignant neoplasm, uterus - - - - - - - — — 21 14 Other malignant and lymphatic neoplasms 117 - - - 2 9 39 29 38 226 15 Leukaemia, aleukaemia 5 - 1 — — — — 3 1 10 16 Diabetes 1 - - - - - - — 1 21 17 Vascular lesions of nervous system 132 - - - 1 2 24 39 66 299 18 Coronary disease, angina 212 - — — — 7 72 68 65 327 19 Hypertension with heart disease 28 - - - - 1 4 12 11 55 20 Other heart disease 214 1 — — 1 6 35 41 130 482 21 Other circulatory disease 43 - - - - - 14 13 16 86 22 Influenza 5 - - - - - 1 3 1 10 23 Pneumonia 56 2 2 — — — 7 15 30 103 24 Bronchitis 137 — 2 — — — 34 50 51 203 25 Other diseases of respiratory system 19 - - - - - 7 5 7 42 26 Ulcers of stomach and duodenum 24 - - - - - 16 6 2 30 27 Gastritis, enteritis and diarrhoea 3 1 - - - - 1 — 1 8 28 Nephritis and nephrosis 10 — — — 1 5 3 1 - 19 29 Hyperplasia of prostate 19 — — — — — 2 3 14 19 30 Pregnancy, childbirth, abortion - - - - - - - - - 1 28 31 Congenital malformations 13 10 — — 1 1 — 1 - 28 32 Other defined and illdefined diseases 114 26 2 3 1 10 18 21 33 227 33 Motor vehicle accidents 18 — — 1 4 7 — 5 6 39 34 All other accidents 21 — — — — 6 4 5 2 15 35 Suicide 10 — — — — 2 5 1 - 3 36 Homicide and operations of war 2 — — — 1 - 1 - - 3 * The maternal death, code 30, was of a case where the interval 11 of life during the year 1952 ages at death during the calendar year 1952:— deaths at the subjoined ages of " residents " whether occurring within or without the borough Causes of death FEMALES Total persons (i.e.. incl. table opp.) All ages Under 1 yr. 1 and under 5 5 and under 15 IS and under 25 25 and under 45 45 and under 65 65 and under 75 75 and over Totals, all causes 1216 31 3 5 9 57 230 294 587 2580 t Tuberculosis, respiratory 13 - -_ - - 9 2 1 1 35 2 Tuberculosis, other 1 - - - - - - - 1 7 3 Syphilitic diseases 3 - - - - - 2 - 1 9 4 Diphtheria - - - - - - - - - - 5 Whooping cough - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - 8 Measles - - - - - - - - - 1 9 Other infective and parasitic diseases 2 - - - - - - 1 1 4 10 Malignant neoplasm, stomach 30 - - - - - 4 7 19 75 11 Malignant neoplasm, lung and bronchus 9 - - - - - 3 2 4 86 12 Malignant neoplasm, breast 64 - - - - 9 25 10 20 66 Malignant neoplasm, uterus 21 - - - - 2 12 4 3 21 14 Other malignant and lymphatic neoplasms 109 - - 1 - 4 38 36 30 226 15 Leukaemia, aleukaemia- 5 - - - - 1 3 1 - 10 16 Diabetes 20 - - - - - 4 5 11 21 1/ Vascular lesions of nervous system 167 - - - - 3 36 46 82 299 1! Coronary disease, angina 115 - - - - - 17 42 56 327 19 Hypertension with heart disease 27 - - - - 1 4 5 17 55 20 Other heart disease 268 - - - - 8 28 49 183 482 21 other circulatory disease 43 - - - 1 - 6 11 25 86 22 Influenza 5 - - - - 1 1 - 3 10 23 Pneumonia 47 7 - - - - 4 9 27 103 24 1c Bronchitis 66 - - - - 4 4 24 34 203 15 Other diseases of respiratory system 23 - - 1 - 1 3 9 9 42 26 Ulcer of stomach and duodenum 6 - - - - - - 2 3 30 27 Gastritis, enteritis and diarrhoea 5 - - - - - 1 2 2 8 28 Nephritis and nephrosis 9 - - - - 1 3 3 2 19 29 hyperplasia of prostate - - - - - - - - - 19 30 Pegnancy, childbirth, abortion 1* - - - 1 - - - - 1 31 Congenital malformations 15 3 2 1 1 1 5 1 1 28 32 Uther defined and illdefined diseases . 113 19 1 1 3 9 19 18 43 227 33 Motor vehicle accidents 5 - - 1 - 2 1 1 - 23 34 All other accidents 18 2 - - 2 1 1 3 9 39 35 Suicide 5 - - - - - 3 2 - 15 36 Homicide and operations of war 1 — — — — — 1 - — 3 between maternal condition and death was stated to exceed 12 months. 12 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 l yr. Hernia, intestinal obstruction M - - - - - - - - 1 - 1 1 F - 1 - - - 1 - - - - - 1 Gastroenteritis, diarrhoea M - - — — - - - 1 - - 1 1 F - - - - - - - - - - - - Congenital malformation M 3 1 1 1 1 7 1 1 1 - 3 10 F 2 - - - - 2 1 - - - 1 3 Injury at birth M 3 1 - - - 4 - - - - - 4 F - 1 - - - 1 - - - - - 1 Postnatal asphyxia and atelectasis M S 1 - - - 6 - - - - - 6 F 3 3 - - - 6 - - - - - 6 Congenital debility and other ill-defined diseases of early infancy. M - - - - - - - - - - - - F - - — - - — 1 — - - 1 1 Prematurity, immaturity M 7 4 - - - 11 - - - - - 11 F 5 1 - - - 6 1 - - - 1 7 Other diseases of early infancy M 1 - - 2 - 3 1 - - - 1 2 F 2 - - - - 2 - - 1 - 1 3 Pneumonia M - - - - 1 1 - 1 - - 1 2 F - 1 - - - 1 2 3 1 - 6 1 Lack of care of newborn M - - - - - - - - - - - - F 1 - - - - 1 - - - - - 1 All other causes M - - - - - - - 1 - - 1 1 - - - - - - - - - - - 1 1 TOTALS M 19 7 1 3 2 32 2 4 2 - 8 40 F 13 7 - - - 20 5 4 2 - 11 31 GRAND TOTAL 32 14 1 3 2 52 7 8 4 - 19 71 There were no deaths in the following groups: respiratory tuberculosis, other tuberculosis, syphilis, typhoid and paratyphoid fevers, diphtheria, whooping cough, meningoccal infection, measles, diseases of ear and mastoid antrum, influenza, bronchitis, gastritis and duodenitis and convulsions. 13 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) The areas for Ministry of National Insurance statistics are in the main coterminous with postal areas of London and not with borough boundaries. (2) The Kidbrooke office was closed after the week ended October 21 and the area covered by that office incorporated in the Eltham office. It would be pointless to give figures for Eltham for the remainder of the year as there would be no comparison with the figures already given. "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 "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 Norwood January 29 660 183 315 337 February 26 614 174 293 316 March 25 518 148 269 290 April 22 487 124 249 230 May 20 425 110 198 216 June 17 323 83 148 162 July 15 317 86 147 143 August 12 273 64 131 142 September 9 292 80 139 142 October 7 460 124 209 223 November 4 483 127 256 243 December 2 486 134 255 December 30 467 120 — 240 Corresponding figure for November, 1951 470 120 230 240 Social class in relation to cause of death Of the 2,577 deaths analysed by us the social categories were as follow :— Table 6 Social class 1 II III IV V Total No information Males 34 223 743 215 126 1341 17 Females 25 266 648 154 74 1167 52 Total 59 489 1491 369 200 2508 69 Percentage 2 19 56 15 8 100 - 14 The social class, related to cause of death, was as follows:— Table 7 Code No. Cause of death Male Female 1 II Ill (V V Total 1 II Ill IV V Total 1 Tuberculosis, respiratory 2 12 5 5 24 - 1 11 1 - 13 2 Tuberculosis, other - 1 - 2 1 4 - - - - - - 3 Syphilitic disease - 1 2 - - 3 - - 1 - - 1 4 Diphtheria - - - - - - - - - - - - 5 Whooping cough - - - - — - - - - - - - 6 Meningococcal infections — - - - - - - - - - - - 7 Acute poliomyelitis - — - - - - - - - - - - 8 Measles - 1 - 1 - - - - - - 9 Other infective and parasitic diseases - - 3 - - 3 - 2 4 1 1 3 10 Malignant neoplasm, stomach 1 3 23 10 6 43 - 6 14 3 5 28 11 Malignant neoplasm, lung, bronchus 2 12 45 15 1 75 6 2 2 10 12 Malignant neoplasm, breast - - 1 - 1 2 1 18 32 9 5 65 13 Malignant neoplasm, uterus - - - - - - - 8 8 3 2 21 14 Other malignant and lymphatic neoplasms 1 16 76 20 6 119 3 28 59 9 3 102 15 Leukaemia, aleukaemia 1 2 5 1 2 11 - 2 7 3 _ 12 16 Diabetes 1 1 1 - - 3 - 2 4 3 2 11 17 Vascular lesions of nervous system 5 29 65 14 17 130 4 34 94 15 11 158 18 Coronary disease, angina 5 32 101 27 13 178 1 19 51 15 8 94 19 Hypertension with heart disease 2 10 32 7 3 54 3 10 32 3 1 49 20 Other heart disease 4 38 129 28 19 218 5 61 140 35 15 256 21 Other circulatory disease 2 7 26 10 8 53 1 14 32 5 6 58 22 Influenza 1 1 3 2 7 - 1 2 - 1 4 23 Pneumonia 3 8 30 11 11 63 1 9 32 11 3 56 24 Bronchitis 1 19 80 23 14 137 2 17 32 9 5 65 25 Other diseases of respiratory system - 1 2 1 1 5 - - 4 1 - 5 26 Ulcer of stomach and duodenum - 4 11 5 1 21 - 2 4 1 — 7 27 Gastritis, enteritis and diarrhoea - - - - - - - - - - — — 28 Nephritis and nephrosis - 3 13 4 - 20 - 5 5 2 1 13 29 Hyperplasia of prostate 2 3 12 3 - 20 - - - - — — 30 Pregnancy, childbirth, abortion - - - - - - - 1 - - — 1 31 Congenital malformations - 1 7 1 1 10 _ 1 3 2 1 7 32 Other defined and illdefined diseases - 23 42 12 11 88 - 22 58 12 1 93 33 Motor vehicle accidents - 2 9 5 2 18 - - 2 1 — 3 34 All other accidents 3 2 8 7 2 22 4 2 8 6 1 21 35 Suicide - 1 5 2 1 9 - 1 3 1 — 5 36 Homicide and operations of war - - - - - - - - - 1 - 1 No social class assessed - — — — — 17 - — — — - 52 15 There are discrepancies between the above table and table 3, for various reasons as given on page 16 of my annual report for 1950. 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 percentage 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 II III IV V Total 1 II III IV V Total 1,2 TB No. — 3 12 7 6 28 — 1 11 1 — 13 % — II 43 25 21 100 — 8 84 8 — 100 10-15 Cancers No. 5 33 150 46 16 250 4 62 126 29 17 238 % 2 13 60 18 7 100 2 26 53 12 7 100 17-21 Heart and circulation No. 18 116 353 86 60 633 14 138 349 73 41 615 % 3 18 56 14 9 100 2 22 57 12 7 100 22-25 Lung, non-TB No. 5 29 115 37 26 212 3 27 70 21 9 130 % 2 14 55 17 12 100 2 21 54 16 7 100 33-34 Accidents No. 3 4 17 12 4 40 4 2 10 7 1 24 % 7 10 43 30 10 100 17 8 42 29 4 100 35 Suicide No. — 1 5 2 1 9 — 1 3 1 — 5 % — II 56 22 II 100 — 20 60 20 — 100 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. 16 Table 9 Social classification Total Not classifiable 1 II III IV V Registered births No. 119 525 1824 463 206 3137 24 % 4 17 57 15 7 100 Registered infant deaths No. — 10 47 8 3 68 3 % — 15 69 12 4 100 Registered stillbirths No. 2 9 23 7 6 47 % 4 19 50 15 12 100 Notified premature births No. 9 29 108 32 19 197 34 % 5 15 54 16 10 100 Comparative occupational class statistics As stated in the 1950 report an arrangement was sought with other large towns in the UK to keep and compare some social-class vital statistics. The arrangement was originally for the year 1951, but as these statistics showed some interesting details it was decided, in order to be more accurate, that they should be kept for three years, namely 1951, 1952 and 1953. There are 14 towns with populations between 200,000 and 300,000, but three of these, Harrow, Hull and Stoke, were unable to take part. The other 11 towns, namely, Bradford, Cardiff, Coventry, Croydon, Islington, Lambeth, Leicester, Lewisham, Newcastle, Plymouth, and Portsmouth, all provided comparable statistics for 1951 which were summarised briefly in my annual report of last year. For 1952 two of them were unable to supply comparable information under certain headings, although they supplied this information under other headings. In the 10 towns (excluding Portsmouth) which supplied information there were 37,250 births, giving a rate of 14-7 per thousand population, of which 11 percent were in social classes I and II, 68 percent in class III and 21 percent in classes IV and V. Of the notified premature births, class III was virtually the same at 66 percent, but classes I and II dropped to 8 percent whereas in classes IV and V there were 26 percent. For the registered stillbirths, class III rose to 76 percent, classes I and II were 11 and classes IV and V were 13 percent. With regard to infant deaths, class III remained at 66 percent, classes I and II fell to 8 percent and classes IV and V rose to 26 percent. Thus, comparing infant deaths with total births it is seen that while the social class III percentage is approximately the same in the two categories the social class I and II percentage has dropped from 11 to 8 and the social class IV and V percentage has risen from 21 to 26 percent. This follows the pattern shown in the analysis of the figures for 1951 and again 17 underlines the fact that 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. For the 9 towns (excluding Plymouth and Portsmouth) giving pulmonary tuberculosis notifications, the rate was 135 per 100,000 population (Lewisham 117) and the deaths from respiratory tuberculosis gave a rate of 26 (Lewisham 16). Deaths from heart disease were 346 per 100,000 population, deaths from pneumonia 48, and from bronchitis 70 per 100,000 (Lewisham 380, 55 and 90 respectively). The pulmonary tuberculosis notifications show that only 7 percent were in classes I and II, 70 percent in class III and 23 percent in classes IV and V. On the other hand deaths from heart and circulatory diseases show that 17 percent were in classes I and II, 57 percent in class III and 26 percent in classes IV and V. Deaths from pneumonia and bronchitis occupied a rather intermediate position in the social classification. In pneumonia, 14 percent were in classes I and II and 30 percent in classes IV and V, whilst in bronchitis 11 percent were in classes I and II and 30 percent in classes IV and V, leaving 56 percent in the case of pneumonia and 59 percent in the case of bronchitis in class III. Reverting to the child welfare statistics, the social class divisions are more apparent. The notified premature birth rate for the towns was 71-9 per thousand births, the rate of social class I being 45-9, II 48-2, III 68*4, IV 84-6 and V 82-1. The registered stillbirth rate for the towns was 18-4 and here the social class I rate was 16-4 with classes II to V 17-8, 19-5, 24-0 and 24-9 respectively. The infant death rate for the towns was 28 • 3 per thousand livebirths, and here again there was a fairly wide divergence between the social classes, class I being 17-6, II 21 -4, III 26-8, IV 33-3 and V 37-1. These variations, though considerable, are rather less than in the previous year. Comparison with other areas A mere drop in the number of deaths from a certain cause may be satisfactory ; a drop in the rate, i.e. the number of deaths per thousand ol the population, is more satisfactory, especially when considered over a period of time during which the population may have changed considerably. Even here there may be invalidating factors, such as the age distribution of the population. Furthermore, a drop in numbers or rates, although apparently satisfactory, may, in comparison with larger areas, be seen to be not so good, perhaps because the rates for those larger areas have dropped even more. In other words although Lewisham, for example, may have improved, other areas may have improved more, or more rapidly. The diagrams herewith illustrate certain Lewisham statistics in relation to:— (1) the whole administrative County of London, and (2) the whole of England and Wales. 18 Four graphs are given, (i) the death rates from pulmonary tuberculosis, (ii) the infant mortality rates (deaths of infants under one year of age per thousand livebirths), (iii) the neonatal death rates (deaths of infants under one month of age), and (iv) the stillbirth rates per thousand live and stillbirths). The horizontal reading of the graphs covers the years 1939 to 1952; the vertical reading is in percentages. If the rates for Lewisham were the same as for London and for England and Wales the graphs would indicate a straight line along the hundred mark, i.e. Lewisham would be 100 percent of the London rate and of the England and Wales rate. The amount the actual line falls below the hundred mark in the graph is therefore in favour of Lewisham ; for example, if the England and Wales line is at 60 this would mean that the Lewisham rate is only 60 percent or three-fifths of the England and Wales rate ; if, on the other hand, the line is above the hundred mark it indicates that Lewisham is relatively badly placed to England and Wales, or London as the case may be. It will be seen from graph (i) that a remarkable change has taken place over the last 14 years in the death rate from pulmonary tuberculosis 19 in Lewisham compared with either London or England and Wales. With regard to London, although it is true that the Lewisham rate has always (apart from 1944/45) been somewhat below the London rate, the difference is tending to increase, and last year the Lewisham rate dropped away precipitously to little over 50 percent of the London rate. With regard to England and Wales the Lewisham rate was always considerably higher than the England and Wales rate, in 1941 reaching over 160 percent of the latter rate, but from 1945 the Lewisham rate began approximating to the England and Wales rate and in 1949 for the first time it fell below it. Last year, 1952, it was only just over 70 percent of the England and Wales rate. Graph (ii), the infant mortality rate, does not show so healthy a picture. In fact, compared with London and with England and Wales, both of which it used always to be well below, the general trend has been to approximate more and more to these rates, and in 1950 and again in 1951 it was exactly equal to the London rate while still remaining a little below the England and Wales rate. Graph (iii), the neonatal rate. Unfortunately we have no figures for Lewisham between 1938 and 1948 and so the graph is incomplete. If it shows anything it indicates that the Lewisham rate is not really significantly better than the London rate, though it is still somewhat better than the England and Wales rate. The last graph (graph (iv)) deals with the stillbirth rate. This indicates that apart from 1939 and 1942 the Lewisham rate has never been above the London rate, although on two other occasions it equalled it. On the whole it has kept fairly well below the London rate. With regard to England and Wales, on only one occasion has the Lewisham rate exceeded the England and Wales rate, namely in 1942 ; it has in fact been considerably below the England and Wales rate although it may be that in recent years there has been a tendency for it to approach that rate. Lung cancer It is necessary to remark on the incidence of cancerous growths in the lung and bronchial tubes. The number of deaths ascribed to this condition has grown in recent years at a startling rate, and it will be known that latterly the association of the disease with tobacco smoking has been brought to the fore. There seems no doubt from the investigations which have taken place that this association is a real one though it is also possible, if not indeed probable, that there are other factors which have to be present to, so-to-speak, precipitate the disease. Certain investigations have indicated that the rate of the disease is greater in industrial towns, and more particularly large towns like London, where there is an increase in the general coal and other smoke in the air and where there is also a relatively smaller amount of sunshine than there is in the country. There are of course many factors and interests involved, but it is only right to say that on present information, the advice which should be given to anyone, particularly a younger person, is to eliminate or considerably cut down tobacco smoking, 20 especially cigarette smoking. The risk of the disease seems to be almost proportional to the amount of tobacco smoked and it must be remembered that there may be a time lag of ten to even twenty years before the results of excessive smoking are seen. Nevertheless the risk of lung cancer, which on the whole affects a younger age group than is normally affected by cancer, though perhaps not great, is sufficient for thinking people to bear in mind when deciding on their personal habits. In 1952, 86 Lewisham residents (77 males and 9 females) died of lung cancer. This compares with a total of 78 persons in 1951 and the same number in 1950. In each of those three years the age group most affected was between 45 and 65. For the three years 57 percent of the deaths from this cause were below 65 years of age, whereas for other cancerous conditions only 43 percent were in that group. In other words, lung cancer is not only killing an increasing number of persons, but is doing this at a somewhat younger age. An analysis has been made of the 551 deaths from lung cancer recorded in this borough in the seven years 1946 to 1952 and these have been divided into wards. Results are shown in the following table and also on the accompanying map. This map can be compared with the map on page 44, which deals with deaths from respiratory causes as a result of the 1952 fog. This comparison shows points of interest, but if the comparison is in fact made one important point should be remembered : the maps are designed particularly to show the wards with the highest figures and those with the lowest. The scale therefore is very different in the one from what it is in the other. In the fog map the black areas have a death rate more than four times that of the white area, whereas in the lung cancer map the worst ward is only just over 25 percent more than the average for the whole borough and the best ward is only just over 25 percent less than the average for the whole borough ; the worst ward being just twice the best ward. It will be noted also that the lung cancer map covers seven years whereas the fog map merely portrays that one incident. Lung Cancer — Ward Statistics, 1946-52 Table 10 Ward Doubtful Others Total Electors Incidence* Excluding doubtfuls Including doubtfuls WEST Sydenham East 8 46 54 11,999 3.83 4.50 Sydenham West - 24 24 8,394 2.86 2.86 Honor Oak Park 3 32 35 11,442 2.80 3.07 Forest Hill 6 38 44 12,454 3.05 3.53 Brockley 3 42 45 11,823 3.55 3.81 Total WEST 20 182 202 56,112 3.24 3.60 *Per 10,000 electors registered in 1949. 21 NORTH Ladywell 7 30 37 10,262 2.92 3.61 Lewisham Village 1 15 16 6,523 2.30 2.45 Blackheath and Church Lee 1 16 17 7,112 2.25 2.39 Manor Lee 2 29 31 7,611 3.81 4.07 South Lee 3 41 44 12,948 3.17 3.40 Lewisham Park 2 26 28 9,343 2.78 3.00 Total NORTH 16 157 173 53,799 2.92 3.21 SOUTH Rushey Green 3 21 24 6,829 3.07 3.51 Culverley 2 19 21 6,543 2.91 3.21 St. Andrews 4 35 39 9,938 3.52 3.92 Whitefoot 1 13 14 6,830 1.90 2.05 Grove Park 1 18 19 7,773 2.32 2.44 Southend 6 30 36 10,423 2.88 3.45 Bellingham 1 22 23 8,249 2.67 2.79 Total SOUTH 18 158 176 56,585 2.79 3.11 BOROUGH 54 497 551 166,496 2.98 3.31 22 General Statistics from 1901 Table 11 Year Population Death rate » Birth rate * Premature birth rate t Maternal death rate t Still. birth rate t Neonatal death rate ** One month to one year death rate (10). (8) ** Infant mortality rate ** Reproductive wastage rate (7)+ (10) Pulmonary tuberculosis Tubercuodis (allforms) Notif. rate* Death rate* %notif. rate (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) 1901 127,495 13.0 25.9 - 3.9 - - - 128 - - 0.93 - 1902 132,432 13.7 26.3 - 4.3 - - - 122 — — 1.06 — 1903 136,405 11.1 26.1 - 2.5 - - - 92 — — 0.78 — 1904 140,401 12.0 25.6 - 3 6 - - - 122 - - 0.84 _ 1905 144,420 11.7 25.2 - 2.8 - 30 63 93 - - 0.87 _ 1906 148,463 12.0 23.2 - 2.0 - 30 83 113 — — 0.80 - 1907 152,532 11.5 23.7 - 2.5 - 34 56 90 — — 0.90 — 1908 156,627 11.0 22.8 - 1.4 - 30 57 87 — — 0.85 - 1909 160,749 10.4 21.9 - 20 - 35 40 75 — — 0.78 — 1910 164,899 9.7 20.7 - 2.6 — 29 50 79 — — 0.55 — 1911 161,677 11.4 21.2 - 2.3 - 31 73 104 - - 0.64 - 1912 165,249 10.5 20.3 - 2.8 - 30 39 69 — 2.1 0.68 11.0 1913 168,822 10.7 20.3 - 2.6 - 28 48 76 — 1.8 0.73 22.2 1914 169,211 10.9 19.5 - 3.3 - 27 46 73 - 1.4 0.77 17.8 1915 164,438 12.9 19.3 - 4.0 - 30 9 79 - 1.5 0.90 26.4 1916 - 11.9 18.4 - - - - - 75 - - 1.02 - 1917 - 11.8 14.9 - - - - - 87 - - 1.12 - 1918 - 13.2 13.8 - - - - 66 - - 1.06 - 1919 174,750 11.4 16.6 - 3.1 - 28 32 60 - 1.8 0.86 22.2 1920 174,698 10.8 22.8 - 3 8 - 32 30 62 - 1.6 0.73 21.8 1921 175,800 10.5 19.5 - 2.6 - 23 31 54 - 1.3 0.81 18.4 1922 176,600 11.1 18.1 - 2.5 - 26 28 54 — 1.5 0.74 15.7 1923 182,400 10.1 18.0 - 3.6 - 20 23 43 — 1.5 0.76 16.9 1924 184,900 10.5 16.4 - 3.6 - 23 24 47 — 1.5 0.68 21.6 1925 185,600 10.3 15.6 - 1.6 - 23 32 55 - 1.3 0.63 15.4 1926 187,800 10.0 15.4 - 2.1 - 18 22 40 - 1.6 0.71 16.9 1927 188,600 11.0 15.1 - 2.1 - 25 21 46 - 1.6 0.92 12.3 1928 199,300 10.0 15.2 - 2.3 - 22 30 52 — 1.7 0.77 15.1 1929 207,900 11.5 15.7 - 5.3 - — — 44 — 1.4 0.74 13.3 1930 207,900 9.7 15.1 - 0.9 37 — — 42 79 1.5 0.76 12.3 1931 220,800 10.2 14.1 - 4.9 31 25 24 49 80 1.3 0.69 13.6 1932 221,500 10.2 12.7 - 3.4 32 31 23 54 86 1.2 0.59 10.7 1933 221,100 10.2 12.2 - 2.6 31 21 18 39 70 1.2 0.68 9.2 1934 222,180 10.1 12.2 - 1.5 36 21 22 43 79 1.3 0.58 14.4 41.7 1935 223,000 10.0 12.5 - 4.3 35 24 19 43 78 1.2 0.58 12.7 1936 224,000 10.9 13.0 - 2.0 37 23 32 55 92 1.3 0.62 11.6 1937 226,000 10.9 13.4 - 1.3 39 18 29 47 86 1.5 0.59 11.9 1938 229,000 10.5 13.9 - 2.1 26 - - 47 73 1.1 0.61 12.4 11.6 1939 220,300 10.8 13.6 - 2.9 34 - - 42 76 1.1 0.64 11.1 1940 192,540 15.8 14.7 — 1.0 24 — - 45 69 1.1 0.67 11..2 1941 148,150 14.3 13.9 - 1.9 29 - - 34 63 1.8 0.93 10.2 1942 161,800 120 16.8 - 3.2 37 - - 37 74 1.8 0.73 15.3 1943 168,530 13.9 18.7 - 3.1 25 - - 42 67 1.9 0.76 13.6 1944 163,320 14.8 18.6 - 1.0 22 - - 40 62 1.9 0.79 10.8 1945 171,280 12.1 17.7 - 1.9 18 - 34 52 1.8 0.71 13.2 1946 207,410 10.6 21 .7 - 1.1 21 - - 33 54 1.9 0. 53 15.4 1947 221,170 11.9 21 .9 - 1.0 21 - - 33 54 1.6 0.55 12.4 1948 226,100 9.9 18 9 - 0.5 15 15 13 28 43 20 0.48 15.7 1949 227,700 10.2 16.8 - 0.3 16 13 6 19 35 1.5 0.40 19.6 1950 228,300 10.6 15.3 - 0.6 15 19 7 26 40 1.6 0.29 12.6 1951 227,200 11.2 15.3 67 0.3 16 17 8 25 41 1.2 0.26 14.7 8.8 1952 227,100 11.4 13.9 86 0.3 18 16 6 22 40 1.2 0.15 *per 1,000 population. ‡ 1,000 notified livebirths. ** 1,000 registered livebirths. †per 1,000 registered live and stillbiths. -equals figure not available. 23 SECTION "B" — GENERAL PROVISION OF HEALTH SERVICES Disinfection and personal cleansing The disinfecting station and the cleansing station are situated at Wearside Road Depot. During the year alterations were carried out at the disinfecting station, the superintendent's office and staff mess room being converted into an ironing and despatch room. An extension was built to the main building to provide new accommodation for the superintendent and to provide a messroom for the staff. An additional washing machine with a capacity of 11 cubic feet was installed in the part of the disinfecting station where bedding and clothing are received for disinfection, and a calender provided in the new ironing room. There has been a tendency in the past for people to indicate some doubt as to the desirability of disinfection of clothing and bedding after cases of infectious disease because they have been afraid that the articles would not be returned in a good condition. With the introduction of this new and additional plant it is possible to return articles in a condition approaching that in which they would be returned if sent to a laundry. It is also possible for the department to assist certain elderly people who are incontinent and who are incapable of dealing with their own washing, by collecting articles from their homes, and returning the articles after they have been washed and ironed. This service, which is only applicable to those cases coming under s. 122 of the Public Health (London) Act, has been particularly useful where hospitalisation is not available or where there is likely to be some delay before admission can be arranged, and it has also helped to ease the burden of life for chronic cases after discharge from hospital. It has been highly appreciated. Details of the work carried out during the year are as follows:— Disinfecting Station Table 12 West North South Total Disinfections Premises visited 222 170 186 578 Rooms disinfected 455 435 475 1365 Articles disinfected 3306 1984 2590 7880 Disinfestation Premises visited 63 57 24 144 Rooms disinfested 164 144 90 398 Articles disinfested 64 97 175 336 Articles treated Beds 76 54 90 220 Mattresses 202 151 211 564 Bolsters 39 50 59 148 Pillows 503 275 429 1207 Cushions 47 32 49 128 Quilts 137 103 152 392 Blankets 707 426 691 1824 Sheets 292 126 202 620 Household articles 693 462 474 1629 Wearing apparel 674 402 408 1484 Total articles 3370 2081 2765 8216 24  West North South Total Articles received from cleansing station - 4650 - 4650 Articles received from Coroner's court — 401 — 401 Public library books treated after infection 231 390 464 1085 Private library books treated after infection 56 100 37 193 Articles treated under the Public Health (London) Act s.122 6476 1110 9443 17029 Cleansing station Children treated for verminous condition 309 258 289 856 Adults treated for verminous condition 19 22 18 59 Scabies baths, children 20 6 18 44 Scabies baths, adults 7 11 8 26 A more detailed analysis of treatments for verminous conditions and for scabies is shown:— Table 13 First cleansing Second cleansing Third cleansing Fourth cleansing Children under 5 46 2 - - School children 738 68 2 - Adults 56 1 1 1 TOTALS 840 71 3 1 Scabies Cases Treatments Children under 5 3 8 School children 14 36 Adults 12 26 TOTALS 29 70 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 l0lbs. per square inch. Premises treated for bed-bugs are revisited and if necessary retreated the following summer. 25 Antifly and antimosquito campaign The campaign held last year lasted from May 5 to September 25, and as in previous years four men were employed working as two pairs, using motor cycles with sidecars as transport at the commencement of the campaign and during the later stages a light van and one motor cycle with sidecar. 1,254 sites and spraying points were visited, showing a slight decrease from the previous year's figure of 1,274 occasioned mainly by the redevelopment of some of the bombed sites. Regular visits were paid to these sites and treatment carried out as necessary. Grass verges, etc., were visited on 9 occasions and special sites (i.e. stables, allotments, dust chutes) were each visited on 22 occasions. Altogether 21,053 visits and treatments were made and in addition treatment by spraying was carried out in 12 houses by staff from the disinfecting station following complaints from the householders concerned. In a number of cases a supply of insecticide containing 5 percent DDT was also left with the householders for use in their own sprays, a total of 7 gallons of insecticide being dispensed in this way. In his report, Mr. Phillips, the deputy senior sanitary inspector, who is in charge of anti-pest work, says : " Measures were also taken to deal with offensive deposits such as old mattresses or dead animals, found mainly on bombed sites, either by destruction on the site by burning, or by collection and destruction centrally. 50 gallons of paraffin were used for destruction of such items on site and 90 mattresses and sundry other items of discarded clothing and useless furniture were dealt with in this manner. " The cooperation of the Borough Engineer's department was once again available for the treatment of dustbins with a powder supplied by the health department. This powder contained gammexane and was applied to dustbins at the time of refuse collection. Altogether 4 tons of powder containing 0.5 percent gamma benzene hexachloride was used. "Caretakers of blocks of flats belonging to the council were provided with sprayers, insecticide and powder, for use in connection with dust chute containers, particularly after these had been cleaned out, and for the sites of bins used for the storage of kitchen waste. cwts. gammexane powder and 80 gallons of 5 percent DDT were used. "Materials used in the main campaign were as follows General spraying — 1,040 gallons tip dressing (approximately 4i percent DDT in aqueous suspension). Static tanks and stagnant water on river edges — 80 gallons of 5 percent DDT in kerosene. Accumulations of rubbish, dog excreta, etc. — 561bs. of 10 percent DDT powder and 81 lbs. of gammexane powder." 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 is directed by the Medical Research Council, and apart from examinations 26 of nose and throat swabs, sputum, fasces, 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 milkborne disease ; for tubercle bacilli in certain cases and for grading under the Milk (Special Designations) Regulations. Samples of icecream are submitted for evidence of bacterial contamination and for grading, whilst samples of 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 1952:— Nose, Throat and Eye swabs 197 Food, generally 13 Icecream 21 Water 10 Faeces 520 Urine 7 Sputum 31 Blood 96 895 No diphtheria-causing organisms were isolated during the year. The figures for sputa include microscopic and cultural examinations for tubercle bacilli. Two Lowenstein-Jensen cultures made during the year were positive, both of them being from the same patient. Of the faeces examined, there was one case of threadworms in a child, and there were 150 positives, the majority being Shigella sonnei, the remainder Salmonella typhi-murium. 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 to themselves and not receiving from other persons proper care and attention, may be removed compulsorily. For this the medical officer of health must be satisfied, after thorough inquiry and consideration, that in the interests of any such person or for preventing injury to the health of, or serious nuisance to, other persons it is necessary to remove that person. The Local Authority may then apply to a court of summary jurisdisction 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 27 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, and in one instance it was necessary to apply to the court for an order for compulsory removal. This was granted. 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 10 persons, at a net cost of £40 6s. 6d. Public Mortuary and Coroner's Court The premises are situated in Ladywell Road and comprise a court room, witness room, coroner's office, caretaker's apartments and mortuary. The number of bodies taken to the mortuary during the year was 742, of which 398 were received from hospitals. 742 postmortem examinations were made and inquests were held in 109 cases. Details are shewn in the following table:— Table 14 Month Bodies received from hospitals Others Post-mortem examinations Inquests Lewisham residents Others January 25 32 33 24 7 February 24 33 28 29 3 March 35 39 44 30 13 April 32 28 37 23 10 May 38 26 31 33 9 June 23 9 19 13 9 July 30 18 23 25 9 August 23 17 21 19 2 September 31 23 30 24 14 October 42 33 42 33 11 November 40 24 35 29 10 December 55 62 66 51 12 TOTALS 398 344 409 333 109 28 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 in private or business premises during the year is appended:— Table 15 Parliamentary Division Total West North South Properties inspected on complaint 440 383 290 1113 Properties otherwise initially inspected 1207 1069 673 2949 Premises baited:— Initial treatments 797 809 581 2187 Retreatments (infestation found) 789 790 694 2273 No infestation found (initially or at reinspection) 1184 1525 968 3677 Total visits 6769 7098 5511 19378 An estimate of the kill in this connection is no longer made. This used to be based on the amount of poison bait taken. During the year, as indicated in my last report, the newer type of bait, warfarin, was used increasingly, but this bait is laid down in largish quantities for rather long periods as it is a relatively slow-working cumulative poison, and so it is not possible to calculate the kill from the amount taken. Special liaison is made twice yearly with the Borough Engineer's department for the treatment of sewers. In 1952, treatments were carried out from May 26 to June 23 and from November 23 to December 20. The method employed in carrying out this work was to deposit 8 oz. prebait on the first day and if a complete take was shown, 16 ozs. of prebait were used on the second day. Where complete takes were shown on the second day, the poison bait deposited was double the prebait. Where complete takes were not shown, the quantity of poison bait used was equivalent to the quantity of prebait used on the second day. Poison takes were recorded on the fourth dav. The following is a summary of the results obtained:— Summer treatment Manholes baited 2,868 Manholes showing prebait take 1,382 Manholes showing complete prebait take (on one or both days) 580 Winter treatment Manholes baited 2,913 Manholes showing prebait take 761 Manholes showing complete prebait take 347 The bait used for both treatments was sausage rusk, whilst zinc phosphide and arsenious oxide were the poisons used respectively. 29 Rodent control — treatment of rivers and ditches 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 and certain of the ditches in the borough. Treatment is carried out mainly between October and April by four men, and in addition to the actual destruction of rats it includes the clearance of such objects as water cisterns from river beds and the lopping of undergrowth along the banks, in order to remove likely sources of harbourage for rats. The normal practice followed in treating rivers and ditches 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. During 1952, treatments were carried out on all sections of the rivers in the borough together with certain ditches. Where heavy infestations were found, retreatments followed. The undermentioned table gives a summary of work carried out during the year:— Table 16 River No. of base points Prebaitin g Poison bait Estimated rats killed No. of days on which prebait laid Results Amount laid (lbs.) Amount taken (lbs.) Takes Partial takes No takes Pool 121 12 92 6 23 20 10 350 Quaggy 207 32 128 3 76 26 19 714 Ravensbourne 483 79 331 2 150 70 43 1517 Ditches. Ladywell Road to Chudleigh Road 42 7 16 0 26 3 2 63 Reigate Road to Verdant Lane 35 3 25 0 10 2 2 81 30 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. Table 17 Type of property (i) (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 iv) treated (a) (b) Major Minor Local authorities' property 142 - 16 - 11 5 16 Dwelling houses 60,420 1,042 2,823 - 1,189 179 1,368 Agricultural property 43 — 27 — 27 — 27 All other property (including business and industrial) 3,763 71 83 — 102 8 110 TOTAL 64,368 1,113 2,949 — 1,329 192 1,521 Number of "block" control schemes carried out 10 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. Rodent control — "block" control Where rats or mice are present in substantial numbers in a group of separately occupied premises, it is sometimes considered advisable to deal with these premises as a block rather than as a number of individual properties. Nine such block control treatments were carried out in respect of rats and one in respect of mice during the year. Details of the block control treatments carried out in respect of rats are as follows:— 31 Table 18 Location No. of properties* No. of base points Prebaiting Poison bait Estimated rats killed No. of days on which prebait laid Results Amount laid (ozs.) Amount token (ozs.) Takes Partial takes No evidence Heather Road 29 26 4 5 7 17 46 23 54 Heather Road (retreatments) 5 10 4 1 3 1 20 10 15 Baring Road 9 9 4 4 - 5 16 10 25 Baring Road (retreatments) 3 6 3 1 2 - 12 6 13 Burnt Ash Hill 13 4 4 - 1 12 4 3 7 Ashwater Road 22 6 4 3 - 19 6 5 12 Ashwater Road (retreatments) 1 1 3 1 2 1 2 Woodyates Road 17 52 4 7 5 5 98 64 125 Kellerton Road 8 26 4 3 2 3 44 21 52 Chinbrook Road 8 31 4 2 5 1 62 15 15 Pearfield Road 6 11 4 2 1 3 9 3 7 Hillcrest Road 8 19 4 2 4 2 34 8 20 "Included in Table 17. In his report on rodent control work during 1952, Mr. Walker, the senior sanitary inspector, states:— "This section continues to deal with a steady flow of complaints and requests for assistance. It will be seen that, in the aggregate, the figures do not show a great difference from those of last year. The work generally was in connection with minor infestations, no infestation of a major character being discovered. "Hen runs are often the focal point of many infestations, and the choice and use of poison in these cases has to be carefully considered. This is where the new poison Warfarin is particularly useful, as it is unlikely that a domestic animal would consume a fatal dose. The principal poison in use is still zinc phosphide, with Warfarin now a close second. "The increase in the number of infestations dealt with in rivers and ditches in the borough was in some measure due to the operatives spending more time on this particular work during the winter months. The work in this respect becomes increasingly difficult owing to the increase of vegetation and other obstacles in the rivers." 32 Water supply I am indebted to the Director of Water Examination and the Clerk of the Metropolitan Water Board for the information on which the following report on Lewisham's water supply is based. The water supply to Lewisham is divided into three zones ; the low zone is supplied from Deptford well and by Thames-derived filtered water ; the Eltham zone is supplied from Wilmington, Darenth and Bexley wells and, should the occasion arise, with a small proportion from the low zone ; the Bromley zone to the south of the Borough is supplied from Shortlands well and again on occasions with additional Thames-derived filtered water. River Thames water is abstracted at the Board's intakes at Walton and Laleham and is stored in the Queen Mary, Island Barn and Walton and Laleham reservoirs. The water is filtered at Hampton, Surbiton and Walton works and is chlorinated after filtration. In the case of Hampton, a contact tank has been built where the chlorine has time to exert its full effect before the water is pumped into supply ; consequently the water in the distribution system is for the greater part of the year free or almost free from residual chlorine. A similar contact tank is in an advanced stage of construction at Walton works and plans are being prepared for a contact tank at Surbiton works. All the well water is chlorinated and, in addition, contact tanks are provided at Deptford, Wilmington, Shortlands 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 analyses 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 stand pipes. Appended are the average results of the chemical and bacteriological analyses of the various supplies as forwarded by the Metropolitan Water Board:— u> Average results of the examination of the water supply to the Borough of Lewisham for 1952 parts per million (unless otherwise stated) (a) CHEMICAL v. ii-i ii Table 19 Description of the sample No. of samples Ammoniacal nitrogen Albuminoid nitrogen Oxidised nitrogen (nitrate) Chlorides as CI. Oxygen abs. from permanganate (3 hrs. at 2TC) Hardness (total) Hardness (noncarbonate) pH value Conductivity Wilmington well 8 0.013 0.026 7.3 19.5 0.12 291 54 7.2 475 Darenth well 2 0.013 0.025 5.3 14.8 0.08 254 29 7.3 425 Bexley well 5 0.011 0.037 6.2 16.1 0.07 282 50 7.3 475 Shortlands well 4 0.007 0025 5.4 18.6 0.19 282 61 7.4 450 Deptford well 4 0.021 0.033 7.7 34.4 0.15 343 107 7.2 650 River Thames filtered water 1714 0027 0093 3.1 24.6 1.05 256 62 7.8 475 (b) BACTERIOLOGICAL Table 20 No. of samples Agar colony count (average per millilitre) Percentage of samples negative to Bact. coli in 100 ml. Bact. coli per 100 ml. 22°C 3 days 37°C (20-24 hrs.) Wilmington well 255 33.3 1.2 100.0 nil Darenth well ... 251 1.2 0.1 99.6 0.004 Bexley well ... 261 10.9 0.6 100.0 nil Shortlands well 273 5.7 0.5 100.0 nil Deptford well 269 136.0 16.0 99.3 0.011 River Thames filtered water 3430 — 17.5 99.8 0.005 34 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 - Downham 5 - Ladywell —first class 1 - — second class 2 - Forest Hill — first class 2 1 — second class 3 1 Private baths 1 4 A detailed report on the use of breakpoint chlorination, which is the method employed at the baths, was included in my annual report for 1950. Old people The Council continued to make grants to organisations in the borough which are carrying out work for old people, whether by recreational facilities or by the provision of meals. A sum of £1,750 was included in the annual estimates for the year 1952-53 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 20 St. Mark's Old Folks' Club 60 Talbot Settlement Old People's Club 10 Good Companions Personal Service 20 St. Swithun's OAP Association 40 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. 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 Council makes grant. 35 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 17,000 articles being cleansed. The service was highly appreciated ; it can only be used, however, where section 122 of the Public Health (London) Act applies. I reported last year that I was still 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 progress was made in this direction. With regard to general care, the old person runs additional hazards which he does not always appreciate; thus his nutrition often suffers, resulting in decreased resistance to infection and increased illhealth. The defective nutrition is in part due to decreasing appetite in old age and more especially due to living alone and as a result not bothering, or not being able, to cook himself a proper meal. Consequently he tends to live on snacks or something out of a tin, and over the years his nutrition deteriorates. The Meals on Wheels service is a help in this connection although from the statistics available it would seem to touch only a small proportion of those old people who would benefit from it. Lunch clubs too are most useful and the establishment of such clubs is actively encouraged by the committee. It is disappointing that so little progress in their establishment or expansion was made during the year under review. A matter which might be explored further is the possibility of providing old people with certain nutrients which they frequently lack and, concomitantly, educating them to use such nutrients. What I have in mind especially are nutrients of the bemax, marmite, etc., type containing particularly the vitamin B complex, as it is probable that this vitamin is the most frequently lacking in the old person's dietary. Failing sight is another matter which the old person is frequently unaware of, as it is so gradual in onset; or if he is aware of it he finds it too much bother to get it corrected, or helped, by new spectacles. As a result accidents are much more frequent, both home accidents where the old person may stumble over obstacles or even fall downstairs, and also road accidents. Some figures recently published show that in the metropolitan area in 1951, 379 deaths from road accidents occurred, 6 percent of these being under the age of five, 9 percent between 5 and 15,9 percent between 15 and 45, 8 percent between 45 and 55, 14 percent between 55 and 65, and 54 percent age 65 and over. In other words, well over half the number of fatal accidents occurred in people aged 65 or over. Since the proportion of such people in the Lewisham population is only 12 percent this means that the number of fatal accidents in old people is likely to be of the order of 4 times the average. In fact, in 1952, the number of persons over 65 in Lewisham dying from accidents, of any cause, was 30 out of a total number of 62 fatal accidents. It must be remembered too that if not fatal, the accident may cause serious injury and prolonged illness. 36 Atmospheric Condition Table Temperature Rainfall Sunshine* Wind' Mean max.* Mean min* Mean* Diff. from av.* Highest max 4 Lowest min 4 Totalf % av.* Daily mean % av. NE/E/ SE s/sw/w NW| Call °F °F °F °F °F °F in. hr. % % % Jan. 42.3 34.3 38.3 — 2.7 54 21 201* 99 2.23 144 9 68 23 Feb. 43.2 33.2 38.2 — 2.3 53 27 0.93* 48 2.27 103 9 51 40 March 50.0 39.7 44.9 +1.4 60 30 2.45* 121 2.86 73 41 43 14 April 59.5 42.1 508 + 3.7 77 30 1.22* 74 619 140 24 55 21 May 67.1 48.6 57.9 + 4.4 83 41 1.59* 86 7.60 123 35 42 23 June 69.9 51.9 60.9 + 20 89 47 1.30 81 8.75 124 10 67 23 . July 72.8 56.2 64.5 + 1.2 90 51 0.55 29 6.74 95 23 54 23 August 70.5 55.7 63.1 + 10 84 52 3.39 116 6.22 100 17 59 24 Sept. 60.8 46.2 53.5 — 4.6 76 37 2.75 153 4.57 91 22 43 35 Oct. 54.9 43.6 49.3 — 1.8 61 33 1.93 96 3.42 102 26 56 18 Nov. 44.7 35.6 40.1 — 4.2 57 26 3.86 122 1.70 98 34 29 37 Dec. 41.5 33.4 37.5 — 3.4 52 26 201 76 1 43 115 14 59 27 Average — — — — — — 23.99 (total) — — — 22 52 26 "Croydon ; †Lewisham, ‡Lewisham,Wearside Road, except Jan. . May = Greenwich ; ¶as in Bellingham playpark, 37 11952 Atmospheric Pollutionf Pooll Allotments§ Verdant Lane Wearside Road Weather summary Wot tr ml. intttr Water sol. matter Sulphur Water insol. matter Water sol. matter Sulphur Water insol. matter Water sol. matter Sulphur TPA TPA ¶ TPA TPA ¶ TPA TPA ¶ - - 2.53 — — 2.05 — — 2.52 Sunny and cold ; snow .- - 2.35 — — 2.52 — — 2.67 Dry and fair ; cold first half - - 2.37 — — 1.62 — — 2.32 Mainly mild ; dull - - 1.76 — — 1.15 — — 1.61 Warm and sunny - - 1.18 — — 0.81 — — 0.93 Warm ; sunny in second half - 0.78 8.29 248 0.52 6.85 3.32 0.61 Dull ; warm in last week 1449 4 57 1.45 7.80 5.66 0.60 8.40 3.90 0.75 Dry ; rather warm 13.55 7.03 0.87 6.52 13.83 0.80 9.32 15.38 0.97 Wet ; heavy rainstorms 14.10 5 64 1 26 888 6.28 1.12 11.00 7.14 1.66 Unusually cold 11.96 10.47 1.53 5.30 9.22 1.27 7.94 8.76 2.14 Cold at first ; unsettled 15.64 10.17 1.99 13.90 11.72 2.02 10.21 11.26 2.98 Cold ; snow at end 17.33 762 2.40 6.25 5.92 2.63 9.84 6.14 3 71 Mainly cold 1451 6 mos.) , 7.58 (6 mos.) 1.71 (year) 8.13 (7ms.) 7.87 (7 mos.) 1.43 (year) 9.08 (7 mos.) 7.99 (7 mos.) 1.91 (year) — mg. Per 100 sq. cm. per day ; TPA, tons per acre per month ; §Prior to July 1, the station was 270 yards to the SW ;-no record. 38 Measurement of atmospheric pollution The situation of the three measurement stations in the borough was described in my annual report for 1951 (page 31). Owing to vandalism, the apparatus which had been set up in the recreation ground belonging to the London county council and situated at the end of Winsford Road had to be moved a little distance away, to a site in the Pool allotments, 270 yards to the north-east. Table 21 gives a record of the principal results from these three stations and also gives some indication of the sunshine, rainfall, etc., during the year. Some of these latter data are not specific to the borough, having been obtained from a publication of the meteorological office and thus relating to the nearest station which records the particular item concerned. This, for the first few months of the year, was the Observatory at Greenwich, but unfortunately when the Observatory was moved to Sussex even the simple observations of temperature, etc., ceased, and the nearest station subsequently was Croydon. The fog The fog of early December, 1952 has been described as a disaster, both for its material effects and for having caused the deaths of some 4,000 persons in the greater London area. There are qualifications which should be made to this latter statement since the death rate was increasing for a week or so before the fog, due to some influenzal, viral, or other infection, probably made worse by the colder weather which had set in suddenly about the middle of November. Further, it appears clear that the excess deaths, in Lewisham at any rate, were almost entirely of persons with severe pre-existing heart or lung disease, the fog being the final straw. To this extent the fog can be considered to have antedated "normal" death, but whether this antedating was by hours, days, weeks or even a few months does not get away from the fact that fog is a menace to human life. Figures for sickness are not so easy to assess, but from weekly returns we obtain from the Ministry of National Insurance it appears that there was an increase in sickness which began in the second half of November, and increased, but to a moderate extent only, in the first week of December, becoming almost double the normal in the week ending December 16, but returning suddenly to below normal in the week ending December 23. This seems to indicate that there was on the whole a quick recovery from the fog effects, though conversation with individuals gives the impression that there was some less serious but annoying sickness, such as a slight cough, or a feeling of being below par, which lasted the rest of the winter. Meteorologically the position was that between December 5 and 8 a high pressure system of relatively cool air was established over London, with an unusually prolonged period of calm. A temperature inversion some three or four hundred feet up occurred, the temperature above being greater than that below; thus the cold air immediately above the ground was overlaid by warmer air, with a sharply defined ceiling between them. Fog, smoke and other atmospheric pollution will collect below such a ceiling. 39 Although the main effect was in the London area the fog was more or less countrywide, as evidenced by the stations which keep observation on the amount of smoke in the atmosphere. There are 87 of these stations in England, Scotland and Wales, but only 62 of these also have records for December, 1951 which could be used for comparative purposes, and these stations are spread rather unevenly over the whole area; for example there are six in London, two each in Middlesex and Essex and one each in Surrey and Kent, making 12 for greater London, whereas there are 24 in Yorkshire, 6 in Lancashire, 5 in Scotland, with the others even more scattered. Assuming that double the 1951 smoke pollution can be regarded as a measure of fog, it can be said that this fog started on December 2 when 6 stations in Yorkshire, 5 in Lancashire, 1 in Middlesex and 8 elsewhere gave such figures; one of the Lancashire stations being over four times the normal. On December 3 and December 4 the number of stations showing abnormality remained much the same except that one of the Lancashire stations showed 5 times the normal, and one Glasgow station showed 6 times the normal. There was a sudden increase on December 5, when 19 Yorkshire stations were involved, all 6 of the London stations, 5 of the 6 Lancashire stations and 17 stations scattered elsewhere. One of the Lancashire stations showed 7 times the normal, one of the London stations showed 6 times and two 5 times the normal. On December 6 rather similar conditions prevailed over the country, but London and greater London were more affected in degree and the rest of the country slightly less affected. In London one station showed 9 times the normal, one 8 times, one 7 times and one 5. On December 7, 8 and 9 the fog gradually disappeared from the rest of the country, but only on the lastnamed day did it begin to clear in London. On December 7 and 8 one London station recorded over 10 times the normal amount of smoke, and even on December 9 one London station had 8 times the normal. On December 10 only one station in the whole country had an abnormal amount and that was in the Yorkshire area. Smoke pollution has been detailed here as it is the most likely cause of fog. Smoke by itself however is not likely to cause sudden death, or even quick death, the much more likely cause of this being the irritant, choking effect of oxides of sulphur. These accompany smoke pollution and run a parallel course, the graph of one being very similar to that of the other. As far as London is concerned therefore the figures given above for smoke pollution can be taken to indicate also the more deadly oxides of sulphur in the atmosphere at the time. There were some unexplained paradoxes in connection with the fog. Thus the effect on animals varied greatly. Many cattle died at the Smithfield show during a previous great fog in 1873 and something similar happened this time ; five cattle dying and nine others being slaughtered because of illness, and over 100 requiring treatment; yet it appears that the sheep and pigs escaped ill effects. It is suggested that this might be due to them being penned on the first floor, and because 40 their heads are nearer the floor there might have been some filtering action by the straw. A postmortem examination of the dead cattle showed commencing pneumonia, slight inflammation of the intestines and considerable fatty degeneration of certain organs, including the liver, kidneys and heart. This lastnamed finding is, to say the least of it, peculiar in that fatty degeneration usually takes a long time to occur; it is therefore possible that show cattle, being specially bred and specially fed, may be regarded as altogether abnormal and unable to withstand such things as fog for those reasons. Some confirmation of this arises from the fact that at the zoo in Regent's Park there was little noticeable effect on the animals. It may therefore be that the altogether abnormal conditions involved in transport and showing in an environment to which these special cattle were unused were the main factors in the Smithfield affair. With regard to plant life most gardeners saw the effects both at the time and shortly after and these effects will probably be even more obvious during the present summer, but here again different plants vary enormously in their reaction. The plain fact remains however that from the known effects on human, animal and plant life, conditions of fog are a dangerous menace to town populations. Effects in the borough The position in Lewisham was that there was a large increase in the number of deaths of Lewisham residents in the borough. In the week ending December 13 there were 134 such deaths registered, and in the week ending December 20 there were 94, making 228 for the two weeks. This compares with 37 and 39 (76 for the two weeks) for the corresponding period of 1951 and 45 and 50 (95 in all) for the corresponding period of 1950. The 228 deaths were analysed as follows:— Day of death Eight persons (a normal number) died on December 5, but 16 on December 6, 32 on December 7, 28 on December 8, 25 on December 9, 12 on December 10 and 16 on December 11. The daily number dying thereafter gradually dropped until on December 17 there were only 6. During the worst period, namely December 6 to 11 inclusive, 129 persons died, of whom 79 were males and 50 females. Sex There were 130 males and 98 females, giving a ratio of 133 males to 100 females, which is considerably higher than the usual yearly ratio. Thus in 1951 the ratio for the whole year was 106 to 100 and in 1950 108 to 100. For the two corresponding weeks of 1951 and 1950 together the ratio was 104 males to 100 females. During the days (December 6 to 11 inclusive) when most deaths occurred there were, as mentioned in the previous paragraph, 79 male deaths and 50 female deaths, giving a ratio of 158 males to 100 females. This rather indicates that the males were knocked out more quickly than the females. 41 Age at death The age distribution is shown in the following table:— Table 22 0-1 1-5 5-/5 15-45 45-65 65-75 75 plus Males - 1 - 2 39 35 53 Females 2 - 1 2 15 27 51 Total 2 1 1 4 54 62 104 In other words 24 percent were between 45 and 65, 27 percent between 65 and 75, and 46 percent over 75. For the whole of 1951 the corresponding percentages were 23, 26 and 41 respectively, thus indicating that in the recent trouble it was the old person who was most affected, relatively as well as absolutely. Social class Social classes were I, 6 ; II, 45 ; III, 122 ; IV, 31 ; V, 21 ; and 3 unknowns. This does not appear to be abnormal compared with the social class death registrations for a whole year. Causes of death Although deaths are divided for record purposes into the RegistrarGeneral's short list of 36 causes they are better for this occasion grouped into (a) circulatory (including cerebral hemorrhage, heart diseases, etc.); (b) respiratory (including influenza, pneumonia and bronchitis); and (c) others. The deaths were divided amongst these groups as follows (a) Circulatory 95 (b) Respiratory 93 (c) Others 40 Expressed in percentages, 42 percent died of circulatory conditions, 41 percent of respiratory conditions, and 17 percent of other conditions. The corresponding percentages for the whole of 1951 were 46, 15 and 39 respectively, thus indicating the relatively very high percentage of respiratory causes in the recent number of deaths. A number of the cases died suddenly and were thus reported to the coroner. In such cases a postmortem was held. On discussing the matter with the pathologist it appeared that the cause of death in almost all the cases was an aggravation of already existing heart or lung trouble. Location There are three registration districts in the borough, namely Lee, which is the north and east part; Lewisham Park, which is entirely for Lewisham hospital; and Sydenham, which is the south and west part of the borough. In corresponding quarters of the year 1950/1 and 1951/2 (November - January) the Lee and the Sydenham death registrations were approximately equal, being a weekly average of 16.1 in Lee and 16.5 in Sydenham, but for the two weeks in 1952 now under examination there were 80 registrations in Lee and 113 in Sydenham, giving instead of the ratio of 100 to 102 a ratio of 100 in Lee to 141 in 42 Sydenham. Redistributing the Lewisham Park deaths, i.e., the deaths at Lewisham hospital, as between Lee and Sydenham even accentuates the result, the exact ratio for the two weeks in question being 100 Lee to 145 Sydenham whereas for the two previous years it was 100 :94 and 100 : 85 respectively. In other words, compared with Lee, the Sydenham deaths from the fog were nearly 50 percent more than should have occurred. It is desirable therefore to consider why Sydenham should be more affected. Factors might be:— (1) An older population in the Sydenham area; (2) A denser fog owing to geographical configuration; or (3) A more poisonous fog due to greater atmospheric pollution in one part of the borough than in the other. With regard to (1), the age constitution of the population, it is not known how the two districts differ, but since Sydenham also includes Downham and Bellingham it is not likely to have a substantially older population, and even if it had it would probably have shown itself in the death returns in previous years, which, however, as stated above, were on the contrary almost exactly equal for the two areas. There is also the fact that Ladywell Institution is included in the Sydenham area and there were 16 deaths there, but again this would have shown itself in previous years. One factor does require adjustment and that is that all Ladywell deaths in 1952 have been counted as Lewisham residents even though their previous homes might have been outside the borough. This was not the case in 1951 and 1950, therefore it would be more correct to exclude these. There were 10 of them, but the exclusion still leaves the Lee/Sydenham ratio as 100 to 134. With regard to (2), intensity of the fog due to geographical configuration, the hills in the Sydenham area might possibly have had an effect. A contour map of this part of London shows Lewisham to be in a valley, which is relatively deep at the south end and shallows off in the north. The valley is bounded on the south and on the east by hills in the Sundridge Park, Elmstead, Chislehurst and Eltham areas, and on the west by a range in the Crystal Palace, Upper Sydenham and Dulwich areas, a ridge of which runs along towards Brockley. Atmospheric pollution would tend to linger in the southern part of the borough and if there were any movement of air from the east it might build up against the Sydenham Hills and affect particularly the Lower Sydenham district. I have been informed that although at and near ground level there was almost complete calm during the four days, it was noticeable that at a height (e.g. at the top of tall chimneys of a power station in another borough of London) there was a mild air current from the north-east. With regard to (3), poisoning from atmospheric pollution, one immediately thinks of the gas works at Bell Green, but when the deaths were spotted on a map there appeared to be no abnormal concentration of them in the immediate neighbourhood. This however does not fully rule out the possibility of the gas works being concerned (see Ward figures below). The domestic grate is another source of potential atmospheric 43 pollution and certain factors may have contributed to this, particularly at this time. Thus the colder weather would have led to more fires, there was more household coal available in the early winter than for some years past, and there had been a large increase in the new.type continuous burning fire — a fire which though having many advantages does tend, when banked up at night, to throw more smoke into the atmosphere. To return again to the Lee/Sydenham comparisons, a further analysis of the deaths into the circulatory group (Nos. 17 to 21 of the Registrar.General's short list) plus the respiratory group (Nos. 22 to 25) shows that 81 cases occurred in Lee and 107 in Sydenham, a ratio of 100 : 132, but separating the two groups there were 36 respiratory cases in Lee to 57 in Sydenham, a ratio of 100 : 158 (the circulatory cases, namely 45 in Lee to 50 in Sydenham give a ratio of only 100 : 111). This certainly seems to point to an increased factor in Sydenham affecting the lungs. Ward statistics The number of electors in the various wards are known, but not the total population. Since children however did not figure in the mortality statistics to a significant degree, the number of electors can be taken as a measure of the number of persons at risk. It must be assumed that the wards vary in age distribution, but no information is available as to the degree of this variation. As however the older people were most affected this has to be borne in mind when considering ward statistics. Some of these statistics have been condensed, and are shown in table 23. Respiratory death rate in wards :— Table 23 Ward Electors (nearest 100) Respiratory deathsf Rate per 10,000 West division : Sydenham West 8,600 3 3.5 Honor Oak Park 11,500 6 5.2 Brockley 11,800 7 5.9 Forest Hill 12,500 10 8.0 Sydenham East 12,100 10 8.3 North division : Ladywell 9,400* 5 5.3 Lewisham Village 6,700 3 4.5 Blackheath and Church Lee 7,100 2 2.8 Manor Lee 7,600 6 7.9 South Lee 13,300 6 4.5 Lewisham Park 9,700 7 7.2 South Division : Rushey Green 6,800 1 1.5 Culverley 6,600 3 4.5 St. Andrew's 9,800 4 4.1 Whitefoot 7,200 3 4.2 Grove Park 7,800 3 3.9 Southend 11,000 3 2.7 Bellingham 8,200 4 4.9 BOROUGH 167,700 86 5.1 "The electors at Ladywell Lodge have been excluded as have also the 7 respiratory deaths which occurred there, † Registrar.General's code numbers 22.25 for the 2 weeks ending December 20, 1952. 44 It will be seen that three wards, namely Forest Hill, Sydenham East and Manor Lee, had rates more than 50 percent over the average, while Sydenham West had a rate less than half that of these badly affected wards, and was in fact the only ward in the West division to have a rate below the average. Sydenham West is, in its entirety, over the 150 feet contour while most of it is over the 200 feet contour. The ward results are also shown in the map. 45 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:— Reason for Inspection West North South Total District sanitary inspectors : Dwelling-houses — PH Act 1737 1486 935 4158 Dwelling-houses — Housing Act 152 280 125 557 Houses let in lodgings — - - - Applications for rehousing 163 226 88 477 Rent Acts and Landlord and Tenant Acts 2 6 6 14 Notice from builder 223 111 138 472 Building licences and certificates for materials 36 52 14 102 Infectious diseases 147 109 96 352 Infestation 98 79 65 242 Factories, mechanical 107 117 30 254 Factories, non-mechanical 27 22 6 55 S47 National Assistance Act 15 11 6 32 Outworkers 208 161 190 559 Smoke observations 7 9 6 22 Offensive trades - - - - Keeping of animals in such a state as to be a nuisance 43 13 56 Water certificates 4 18 13 35 Futile visits 1200 2222 784 4206 All other matters 971 732 339 2042 Reinspections 6199 8595 3099 17893 Totals 11339 14249 5940 31528 Food inspectors : Notice from builder 26 24 19 69 Building licences and certificates for materials - - - - Infectious diseases 30 20 3 53 Infestation 74 122 19 215 Factories, mechanical 22 50 94 166 Factories, non-mechanical 2 4 23 29 Smoke observations 2 15 3 20 Food shops — registered 169 85 297 551 Food shops — not registered 156 108 262 526 Milkshops and dairies 84 74 95 253 Icecream premises 139 254 171 564 Restaurants and eating houses 275 140 241 656 Bakehouses 76 78 32 186 Other shops 5 127 20 152 Food inspections 316 368 233 917 Sampling 205 119 61 385 Markets and stalls 16 1325 281 1622 Pharmacy and poisons 97 87 21 205 Slaughterhouses - 8 — 8 Futile visits 72 36 7 115 All other matters 342 300 98 740 Reinspections 362 551 581 1494 Totals 2470 3895 2561 8926 46 Reason for inspection West North South Total Housing inspectors : Dwelling-houses — PH Act 14 114 42 170 Dwelling-houses—Housing Act 320 174 9 503 Houses let in lodgings — — — — Applications for rehousing 4 1 2 7 Notice from builder — — — - Building licences and certificates for materials 6 5 2 13 Infestation - - - - Futile visits 125 97 81 303 All other matters 53 39 18 110 Reinspections 1169 1251 145 2565 Totals 1691 1681 299 3671 Grand total — all inspectors 15500 19825 8800 44125 Smoke nuisances Observations 22 Intimations served — Complaints received 5 Statutory notices served — Legal proceedings — Convictions — Summary of notices served in 1952 Table 25 West North South Total Intimation notices:— Public Health (London) Act, 1936 517 551 211 1279 Informal intimations under Factories Act, 1937 3 5 1 9 Informal intimations under Housing Act, 1936 30 9 3 42 Total intimations 550 565 215 1330 Statutory notices:— Public Health (London) Act, 1936 248 319 105 672 Housing Act, 1936 12 4 1 17 Factories Act, 1937 — 3 — 3 Byelaws under the Housing Act — — — — Byelaws (other than Housing Byelaws) 15 8 5 28 Total statutory notices 275 334 111 720 47 Nuisances remedied Table 26 Nuisance West North South Total Drains cleared 26 15 4 45 Drains reconstructed or repaired 41 69 33 143 Soil pipes ventilated, repaired or renewed 9 13 4 26 Gullies renewed, repaired or cleansed 2 17 1 20 Water closets repaired or renewed 54 41 12 107 Flushing cisterns repaired, renewed or cleansed 31 42 11 84 Sinks provided 1 5 — 6 Roofs repaired or renewed 291 289 76 656 Gutters repaired or renewed 102 129 28 259 Rainwater pipes repaired or renewed 50 63 13 126 Drinking water cisterns repaired, cleansed or covered 2 3 4 9 Dampness abated 883 635 100 1618 Wall and ceiling plaster repaired 615 654 79 1348 Walls and ceilings cleansed 167 15 27 209 Brickwork repaired 45 157 12 214 Chimneys repaired or renewed 12 30 4 46 Firegrates or fireplaces repaired or renewed 88 68 5 161 Floors repaired or renewed 148 102 28 278 Window frames and reveals renewed or repaired 119 197 13 329 Doors and doorframes renewed or repaired 54 50 13 117 Sashcords repaired or renewed 78 76 14 168 Dry rot remedied 11 27 1 39 Yards and areas paved 9 21 1 31 Dustbins provided 56 20 16 92 Accumulations of refuse cleared — 2 1 3 Other nuisances remedied 156 240 46 442 TOTALS 3050 2980 546 6576 Rent and Mortgage Interest (Restrictions) Acts In 9 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 15 cases the necessary statements were issued as the premises concerned had been made fit. Water certificates Certificates were issued in respect of 49 premises certifying that under the provisions of the Public Health (London) Act, 1936, a proper and sufficient supply of water had been provided. Factories Section 7 of the Factories Act, 1937, requiring the provision of sufficient and suitable sanitary conveniences is enforced by the council in all factories, whether mechanical power is used in the factory or not. The provisions of sections 1, 2, 3, 4 and 6 relating to cleanliness, 48 overcrowding, the maintenance of a reasonable temperature, the securing of adequate ventilation of workrooms and the furnishing of adequate means for draining floors where wet processes are carried on, are enforced by the council in factories in which mechanical power is not used. The provisions of section 7 are also applied to certain building operations and works of engineering construction, etc. A local authority is required to keep a register of factories with respect to which it is responsible for the enforcement of any of the provisions mentioned above. Close cooperation is maintained with HM Inspectors of Factories in that any defaults found by HM Inspectors during the course of their visits to factories and for which it is the duty of the local authority to secure that remedial measures are taken, are notified to the health department. Similarly the sanitary inspectors notify HM Inspectors of any contraventions of the provisions of the Act which come within the jurisdiction of the lastnamed officers. HM Inspectors also forward to the health department details relating to the establishment of new factories, the introduction of mechanical power and other information which may come to their notice and which appears to affect factories subject to the control of the local authority. Special attention is paid to factories which provide canteens. These factories are visited by the council's food inspectors and the opportunity is taken to discuss with the canteen staff the various requirements needed to maintain a good standard in food hygiene. The medical officer of health is required in his annual report to the local authority to report specifically on the administration of, and furnish prescribed particulars with respect to, the matters under part I (factories) and part VIII (outworkers) which are administered by the local authority, and to send a copy of his annual report to the Minister of Labour and National Service. For convenience in furnishing this information a form is supplied by the Minister and the following is a copy of the return relating to 1952:— Inspections Table 27 Premises Number Number of on register Inspections Written notices Occupiers prosecuted (i) Factories in which sections 1, 2, 3, 4 and 6 are to be enforced by local authorities 87 84 - - (ii) Factories not included in (i) in which section 7 is enforced by the local authority 445 420 3 _ (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises)* 44 - - - TOTAL 576 504 3 - *Sites of building operations and works of engineering construction. 49 Cases in which defects were found Table 28 Defects No. of cases in which defects were found No. of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S 1) 5 3 - 4 - Overcrowding (S 2) - - - - — Unreasonable temperature (S3) - - - - - Inadequate ventilation (S 4) 1 - - 1 - Ineffective drainage of floors (S 6) - - - - - Sanitary conveniences (S7): (a) insufficient 5 5 - 5 - (b) unsuitable or defective 10 1 - 7 - (c) not separate for sexes 3 - - 3 - Other offences against the Act (not including offences relating to outwork) 3 3 3 2 - TOTAL 27 12 3 22 - In his report upon the work of the sanitary inspectors during the year under review, Mr. Walker, the senior sanitary inspector, states:— "Although the year brought some decrease in the amount of work done to dwelling-houses in the borough, the number of complaints was only slightly fewer than in 1951. This decrease, and the correspondingly smaller value of civil building licences issued by the department, was due almost entirely to the decreasing amount of war damage work to be done. Many properties have been reconditioned, and as more become so it is likely that there will be some fall in the number of complaints received. "Apart from reconditioning after war damage, there is often reluctance on the part of owners of older properties to carry out even the minimum of work required to keep houses in habitable repair, and this is reflected in the increased number of cases where legal proceedings have had to be taken. It is well known, of course, that this is due to the great increase in the cost of building work, and the operation of the Rent Restriction Acts. "The more dilapidated properties are as far as possible dealt with under section 9 of the Housing Act, 1936. In many cases it is found difficult to keep the cost of the work 'reasonable' and this is only done in fact by very careful inspection and preparation of specifications. The aim is to avoid demolition under section 11 as far as possible so as to keep the greatest number of houses habitable and in occupation." 50 Outworkers Under section 110 of the Factories Act, 1937 the occupier of every factory and every contractor employed by him must keep lists showing the names and addresses of all outworkers directly employed by him and of the places where they are employed, and must send to the district council in February and in August of each year, copies of those lists showing all outworkers so employed by him during the preceding six months. Section 111 of the same Act empowers the district council by notice in writing to the occupier of a factory or to any contractor employed by him to prohibit the employment of any persons as home workers in premises which the council regard as injurious or dangerous to health. The Home Work Order, 1911, specified the kinds of work to which these two sections apply. The types of work consist mainly of wearing apparel and various textiles, the making of paper bags, boxes, brushes, baskets, artificial flowers, metal fittings, etc. Outworkers are visited periodically by the woman sanitary inspector. The following is a list of trades concerned, extracted from the August, 1952 lists received:— Trade Outworkers employed Wearing apparel 185 Umbrellas 1 Artificial flowers 2 Boxmaking 14 Carding, etc., of buttons 2 Stuffed toys 1 Cosaques, Christmas crackers, Christmas stockings, etc. 5 210 The inspector made 559 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 outworkers were prepared to restart work when required. Reports were submitted to the Council at the end of the first six months and again at the end of the year setting out the position with regard to outworkers in the borough. At the end of June three premises in the West division were noted to be untidy, while lack of cleanliness or untidiness noted in respect of two premises at previous visits had been much improved. In one case cleanliness was noted as only being very fair. In the North division cleanliness was reported as being only very fair in two instances, whilst in three others it had improved. In one case the condition of the sanitary accommodation had improved. At four premises in the South division cleanliness had improved (although one could still be tidier), and in one case cleanliness was reported as being only very fair. 51 At the end of the year seven premises in the West division were noted as not being fully satisfactory with regard to cleanliness and in another three the sanitary accommodation was also not fully satisfactory. Untidiness previously noted in two cases had much improved. Three premises were noted in the North division where cleanliness was not fully satisfactory and two where sanitary accommodation required improvement. Untidiness or poor sanitary accommodation previously noted had been improved in five cases. In the South division one premises was noted for cleanliness and one for sanitary accommodation as not being fully satisfactory. In seven other cases untidiness or poor sanitary accommodation had improved. In the opinion of the sanitary inspector, the general standard of cleanliness and the accommodation used has much improved over the years. The impression is that only women with fairly good and comfortable home conditions are attempting to get outwork and that only the better class of work is being given out; the cheaper goods are being massproduced in factories. 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. Two complaints were received during the year. A warning letter was sent in one case, and legal proceedings were taken with respect to the other, a fine of ten shillings being imposed. 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. 52 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. Samples were taken of cotton felt, coir fibre, and hair, all three of which were satisfactory. One sample was taken of millpuff which was satisfactory as regards cleanliness requirements, but there was evidence of dye material present in a quantity suggestive of intentional rather than accidental inclusion. Pet Animals Act, 1951 This Act, which came into force on April 1, 1952, makes it an offence to keep a pet shop except under licence granted by a local authority in accordance with the provisions of the Act. Licences are issued on application, provided a fee of 10s. 0d. is paid and that the premises are approved by the council's inspectors and subject to conditions specified in the licence to secure that:— (i) animals will at all times be kept in accommodation suitable as respects size, temperature, lighting, ventilation and cleanliness; (ii) animals will be adequately supplied with suitable food and drink and (so far as necessary) visited at suitable intervals; (iii) animals, being mammals, will not be sold at too early an age; (iv) all reasonable precautions will be taken to prevent the spread among animals of infectious diseases; (v) appropriate steps will be taken in case of fire or other emergency Conditions to be specified in the licences have been approved by the Metropolitan Boroughs' Standing Joint Committee in order to ensure uniformity in the metropolitan area, and have been adopted by this Council. It is an offence to sell animals as pets in any part of a street or public place (except at a stall or barrow in a market) and to sell such animals to a person where there is reasonable cause to believe that such person is under the age of twelve years. Premises at which a business is conducted for the purpose of selling animals as pets includes a private dwelling. A licence is not required where a person keeps or sells only pedigree animals bred by him or the offspring of an animal kept by him as a pet, and where a person sells animals as pets in conjunction with a business of breeding pedigree animals and where the animals so sold were acquired for breeding or show purposes and have subsequently been found not to be suitable or required for such use the local authority may direct that the person concerned shall not be deemed to keep a pet shop by reason only of his carrying on the firstmentioned business. The expression "animal" has a wide definition under the Act and includes any description of vertebrate. 53 During the year 21 premises were licensed as pet shops. In the main, the sale of pets at these premises consists of cage birds and tropical and coldwater fish. In general it has been found that pets are kept for sale under conditions which do not call for any particular comment and in no case has it been found necessary to attach any special conditions (i.e., conditions other than the general conditions already mentioned and specified in every licence) to any licence which has been issued. Rivers (Prevention of Pollution) Act, 1951 This Act, which came into force on 1 October, 1951, is designed to prevent the pollution of all streams in England and Wales. The expression "stream" includes all inland waters (except lakes or ponds which do not discharge to streams) and tidal waters or parts of the sea already declared to be streams under the Rivers Pollution Prevention Act, 1876. The Council is responsible for the prevention of pollution of streams, for the control of obstructions therein due to the cutting of vegetation, etc., for making byelaws for prescribing standards as to what is to be considered poisonous or noxious, and for regulating the cleansing of articles or throwing litter into streams. It will also be necessary to impose conditions upon new or altered outlets into streams for the discharge of trade or sewage effluent. In order to ascertain possible sources of present pollution a preliminary survey of the rivers in the borough has been carried out by the district sanitary inspectors and a permanent record indicating the particular type of pollution is in the course of preparation. Since the Port of London Authority has parallel jurisdiction over a part of the river Ravensbourne and the northern part of the Quaggy in the borough as regards the prevention of pollution, a conference will be arranged at a later date with officers of that authority in order to avoid duplication of work by the two authorities concerned in dealing with this particular river. 54 SECTION "D" — HOUSING Building The following new houses or flats were completed by the Council during the year:— Balder Rise 2 Valentine Court 112 Thriffwood 22 Springbank Road 6 Silverdale 9 Somertrees Avenue 34 Panmure Road 16 Wisteria Road 4 Taunton Road 8 Grove Park Road 10 Belmont Park 6 Forster House 20 Paragon Place 13 Total 262 Families rehoused During the year the following families were rehoused:— 1. By the Lewisham borough council:— (а) Permanent properties 127 (b) Temporary bungalows 14 (c) Emergency hutments 6 (d) Requisitioned properties 137 284 2. By the London county council (figures supplied by district offices) 339 Total 623 3. Number of families where points had been awarded for bedroom deficiency, rehoused by the Council during the year 222 Applications for rehousing The number of cases dealt with by the public health department during the year was as follows:— 55 Table 29 West North South Total (a) Lewisham borough council housing applications:— Visited 85 81 28 194* Insanitary conditions found 13 6 4 23 (b) London county council housing applications:— Visited 49 128 43 220 Found overcrowded 7 14 14 35 (c) Housing applications referred from other authorities:— Visited 29 16 17 62 Found overcrowded 2 — — 2 (d) Inspected on request of occupier:— Visited 4 3 1 8 Found overcrowded 1 — — 1 Total visited 167 228 89 484 Total overcrowded 10 14 14 38 "The numbers visited show a considerable reduction from the previous year (1,076), mainly due to the fact that whereas, previously, overcrowding was assessed by us, the standard which has taken its place, namely bedroom deficiency, is assessed by the Housing department. 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 42 informal and 17 formal notices were served. 42 properties were repaired by the owners after service of notices and 3 properties were repaired by the Council under section 10 in default of the owners. 56 Demolition orders (section 11) The following is a list of cases involving demolition order procedure which originated in or were complied with during 1952, together with the present position of cases originating in previous years which had not been complied with at the end of 1951:— Table 30 Properties Dwellings involved Present position 1, 2, 3, 4, Avenue Cottages, Romer Avenue 4 Demolished. 33, Brandram Road 1 Committee prepared to consider an offer to carry out work if property not to be included in Lee Church Street Clearance Area. 323, Baring Road 1 Demolition and rebuilding completed. 40, 42, Lee Church Street 2 Included in Lee Church Street Clearance Area. 96, 98, Hither Green Lane 2 Demolished. 19, 21, 23, 25, 27-37 (odds), 43-47 (odds), Lee Church Street 13 Included in Lee Church Street Clearance Area. 11, 15, 17, Lee Church Street 3 Undertakings not to relet when vacant to be accepted. 180, 182, Marvels Lane 2 Demolished. 58, Dacre Park 1 Undertaking to carry out works accepted. 20, 22, Boones Road 2 Repairs required to comply with statutory undertakings completed. 2, 3, Stifford Cottages, Dartmouth Road 2 Demolished. 40, Stanton Square 1 Demolished. 240, Burnt Ash Hill 1 Statutory undertaking given to carry out work. 37, Beacon Road 1 Tenants rehoused. Owners applied for licence to demolish and rebuild. 9, Springfield Rise 1 Repairs required to comply with statutory undertaking completed. 6, Myrtle Grove 1 Demolished. 7, Myrtle Grove 1 Demolished. 4-11, Clyde Place 8 Order operative. Properties to be demolished when tenants are rehoused. 91, Mill Road 1 Demolished. 34, Clyde Vale 1 Offer of works accepted. 34a, Montpelier Vale 1 Tenants rehoused. Undertaking not to relet accepted. 1, 3, Winterbourne Road 2 Orders operative. Properties to be demolished. 39, 41, Boone Street 2 Orders operative. Properties to be demolished when vacated. 236, Baring Road 1 Notices served. 131, Sunderland Road 1 Notices to be served. 57 Closing orders (section 12) The following is a list of closing orders which were originated, determined, became operative, or were varied during 1952:- Table 31 Properties Part of house Present position 104, Foxberry Road Kitchen/living room on ground floor and three rooms on first floor. Works to comply with statutory undertaking completed. 119, Dacre Park Two rooms basement. Works carried out to make basement fit for habitation. Order determined. 39, Peak Hill Garden Lower flat comprising front room, back room, kitchenette and passage in basement. Order operative. Tenants to be rehoused. 92, Dacre Park Two rooms with offices in basement. Closing order operative. 21a, Mount Pleasant Road. Two rooms and scullery in semi basement. Tenants rehoused. Undertaking not to relet accepted. 43, Beadnell Road Two rooms and scullery in basement. Works required to comply with statutory undertaking completed 107a, Hither Green Lane. Upstairs room Tenants rehoused. Undertaking not to relet accepted. 5, Aberdeen Terrace Three rooms and scullery in basement. Order operative. 18, Belmont Hill Three rooms in basement. Order operative. 22, Belmont Park Three rooms and scullery in basement. Statutory undertaking to carry out works accepted. 33, Blessington Road Basement rooms Closing order dated 3 June, 1952 amended to allow use of basement rooms as builders' office and stores. 12, Blythe Hill Two rooms and scullery in basement. Order operative. 1, Station Approach Basement front room. Order operative. 5, The Glebe, Flat 6 Two rooms and scullery first floor above old stables. To be considered in conjunction with flats 2, 3, 4. 2, Handen Road Two roomsand scullery. Notices served. 9, Blythe Vale Two basement rooms. Closing order varied to permit use of rooms for occasional entertainments and storage. 14, Dermody Road Basement back and front rooms. Notices served. 80, Burnt Ash Hill Basement front, middle and back rooms, hall and bathroom. Notices served. 33, Wells Park Road Living room and scullery in basement. Order operative. In his report upon work under the Housing Acts during 1952, Mr. Craven, the group housing inspector, states:— "There was an appreciable increase over 1951 in the number of properties referred to the department following a decision to derequisition on the grounds of disrepair. Many of these cases were found to justify action under the Housing Act to secure repairs, or closure of part of the premises. 58 "The policy of notifying property owners, informally, of defects in cases which would justify action under section 9, was continued and in general the results have proved encouraging. Although the total of informal and formal section 9 notices served was approximately the same as in the previous year, more properties were repaired by the owner, with a corresponding decrease in the number of cases where the Council carried out the work in default. "Clearance Area activity was revived, for the first time since 1939, and much detailed work was done during the year on inspections of properties in and around Lee Church Street, the compilation of schedules for each property, and the preparation of maps and data prior to the official representations made in relation to the Lee Church Street Clearance Areas. Preliminary inspections were also made with a view to representing an area in Willow Way, Sydenham. "Work in connection with an improvement grant, the first to be approved by the Council under section 20 of the Housing Act, 1949, was started in November and it was necessary to make regular inspections while the work was in progress to ensure a satisfactory standard of work and to enable certificates to be given authorising interim payments of the grant as the work proceeded. "Towards the end of the year a number of older properties in selected roads off Lewisham High Street were inspected with a view to preparing evidence which might be required at a public enquiry into the Lewisham Clock Tower Development Scheme and the County of London Plan." Overcrowding (section 61) Under section 61 of the Housing Act, 1936, the Council is empowered to issue a licence to an occupier to enable him to remain in possession of overcrowded premises without committing an offence. Section 59(3) of the Act covers the case of the family whose house becomes overcrowded in course of time owing to increases in the number or ages of children. An occupier whose house becomes overcrowded in such circumstances is not guilty of an offence if he applies to the local authority for suitable alternative accommodation unless either suitable alternative accommodation is offered to him and he refuses it or he fails, in a particular case in which it would be reasonable and practicable to do so, to ameliorate the overcrowding by the displacement of some lodger or subtenant who is not a member of his family. Where, therefore, the overcrowding occurs by natural increase and the occupier has not deliberately aggravated it by subsequently taking in additional persons an application by him for his name to be put on the local authority's waiting list will in general be sufficient to give him protection. During the year three licences were issued under section 61 on the application of tenants of overcrowded premises, each licence remaining in force for a period not exceeding 12 months. 59 Clearance areas and individual unfit houses The following is a copy of a return made to the Ministry of Housing and Local Government relating to action taken under the Housing Acts, 1936 to 1949 during the year ended March 31, 1952 and showing the position at the end of the period:— Table 32 PART A —CLEARANCE AREAS Dwelling-houses demolished Persons displaced Unfit houses Other houses Land coloured "pink" None - None Land coloured "grey" None PART B —UNFIT HOUSES NOT INCLUDED IN CLEARANCE AREAS Houses Persons displaced 1. Housing Act. 1936 (a) Houses demolished as a result of formal procedure under section 11 4 9 (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 15 (d) Parts of buildings closed (Section 12) 12 20 (e) Houses made fit— (i) As a result of formal notices under sections 9 to 12 26 — (ii) As a result of informal notices preliminary to formal procedure under Sections 9 to 12 27 - 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 - Housing Act, 1936 — slum clearance programme, 1951-55 In 1950, the Council agreed upon a list of properties with which it was proposed to deal, either by way of demolition order procedure or, if more appropriate, by inclusion in clearance areas, as soon as the Minister of Health should allow again the exercise of such powers (suspended during the war) by local authorities. This list was forwarded to the London county council for consideration, as that 60 authority was engaged in discussing with the Minister the resumption of slum clearance. At the request of the Minister, the county council formulated a slum clearance programme for the whole of the LCC area for the five year period 1951-55, involving some 3,000 dwellings per annum. The county council reached agreement with the various metropolitan borough councils with respect to the number of houses unfit for human habitation to be dealt with by clearance area procedure each year in each borough and as to which of these houses should be dealt with by the county council and the borough councils respectively. The programme for Lewisham was as follows:— Year Locality Approximate No. of dwellings Responsible authority 1951 Southend Lane 12 Lewisham Borough Council 1952 Willow Way, Sydenham 16 Lewisham Borough Council Wells Park Road, Sydenham 55 London County Council Lee Church Street 120 Lewisham Borough Council 1953 Davids Road, Forest Hill 10 Lewisham Borough Council Dartmouth Road, Forest Hill 9 Lewisham Borough Council 1954 Hither Green Lane 7 Lewisham Borough Council 1955 - — - 229 The twelve properties in Southend Lane have already been dealt with by the Lewisham borough council as individual unfit houses. With regard to the programme for 1952, a detailed report on the Lee Church Street area will be found below. The Willow Way area is zoned for light industry and the area will be dealt with by a clearance order or orders which will leave the owners responsible for the necessary demolition. The properties have been inspected and a preliminary report submitted to the committee. The Wells Park Road area is being dealt with by the county council, and the requisite rehousing will be carried out by that authority. Clearance areas Lee Church Street clearance area The Council, in pursuance of section 33 of the Housing Act, 1936, gave notice to the London County Council that it was intended to consider a proposal that seven areas in the neighbourhood of Lee Church Street should be declared clearance areas. The County Council replied that it did not itself propose to deal with these areas and that an application for assistance in rehousing displaced families would be considered on its merits. All the properties affected are within an area designated for residential purposes on the Development Plan for the Administrative County of London with the exception of 19-33, Lee Church Street, which are within an area designated for educational purposes. 61 The Council referred the question of the redevelopment of such of the said clearance areas and adjoining land as are capable of redevelopment for housing purposes to the Housing (Building) Committee. The provision of suitable accommodation for the persons to be displaced was referred at the same time to the Housing (Management) Committee. Official representations under sections 25 and 154 of the Housing Act were considered by the Health Committee to the effect that each of the seven areas concerned should be declared a clearance area. These areas consist mainly of substandard houses in disrepair, with sanitary defects and bad arrangement of staircases, passages or waterclosets, rendering them unfit for human habitation or injurious to health, and for which the most satisfactory method of treatment is by the demolition of all the buildings. It was therefore proposed that the land should be acquired together with such adjoining lands (in addition to land already owned by the Council and at present occupied by temporary houses) as are reasonably necessary for the satisfactory development of the cleared areas and which the Housing (Building) Committee recommended should be acquired by compulsory purchase orders if necessary. The clearance areas are 3.861 acres in extent, the added lands 2.721 acres and the Council's land 1.811 acres, making a total area of 8.393 acres. The clearance areas comprise 125 dwellings (including 9 small shops) occupied by 131 families (378 persons). The added lands contain two halls, 1 small shop, 8 other business premises, 10 lockup garages, 6 ruined sheds and 10 dwellings occupied by 15 families (42 persons). The temporary bungalow sites contain 25 bungalows. The area designated for educational purposes comprises 1.606 acres. It was considered by the Housing (Building) Committee that the greater part of the clearance areas and added land (excluding the land to be used for educational purposes) could be redeveloped by erecting approximately 108 flats and 8 shops. When the temporary bungalow sites become available, they, together with certain small remaining portions of the other lands, would accommodate approximately a further 75 flats. The seven areas are as follows:— No. 1 2, 4, 6, 8, 18, 20, 22, 24, 26, St. Margaret's Passage. No. 2 1, 3, 3a, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 29, 31, 33, 35, 37, 39, 41, 43, 45, 47, 49, 51, 53, 55, 57, 59, 61, 63, 65, 67, 69, Fludyer Street. 2, 4, 6, 8, 16, 18, 20, 22, 24, 26, 28, 36, 38, 40, 54, 56, 58, 60, 62, Fludyer Street. 3, 5, 7, 9, 19, 21, 23, 25, 27, 29, 31, 33, 35, Lee Church Street. 8, 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38, 40, 42, Lee Church Street. No. 3 41, 43, 45, 47, Lee Church Street. 44, 46, 48, 50, 52, 54, 56, Lee Church Street. No. 4 49, 51, Lee Church Street. 60, 62, 64, Lee Church Street. 62 No. 5 27, 29, 31, 33, 35, 37, Boone Street. 46, 48, Boone Street. No. 6 6, 8, 10, 12, Boone Street. No. 7 6, 7, Frant Place. In addition the following properties are to be dealt with as individual unfit houses:— 39, Boone Street. 41, Boone Street. 11, Lee Church Street. 13, Lee Church Street. 15, Lee Church Street. 17, Lee Church Street. The Lewisham (Lee Church Street Clearance Areas) Compulsory Purchase Order, 1952 has been made by the Council and a notice in the prescribed form published in the local press. The Order has also been submitted to the Minister of Housing and Local Government for confirmation. 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 33 Month West North South Total £ £ £ £ January 3,299 2,805 285 6,389 February 2,038 2,297 1,813 6,148 March 4,586 2,765 246 7,597 April 2,529 1,543 — 4,072 May 453 120 — 573 June 749 1,047 838 2,634 July 710 739 679 2,128 August 1,050 658 — 1,708 September 870 750 — 1,620 October 1,794 1,698 — 3,492 November 3,278 1,294 — 4,572 December 1,069 — — 1,069 TOTALS £22,425 15,716 3,861 42,002 The large drop in the monthly values, compared with the previous year, was due to two main factors: the diminution in the amount ot war damage repairs still outstanding, and the increase (from £100 £200) which took effect in July, 1952 in the amount of repair work to a house which could be done without licence. 63 The following is a tabulated statement of various statistics, as submitted to the London county council:— Item Total Total houses in the borough (separately assessed dwellings) 60,420* Public Health Act Houses inspected on account of complaints or illness 2,580 Statutory notices served 700 Houses repaired or nuisances remedied 6,576 Housing Act, 1936 Houses inspected — house to house (Housing Consolidated Regulations, 1925) Nil Houses included by representations by the M.O.H. under s.25 125 Houses demolished following representation by the M.O.H. under s.25 - Houses repaired under ss. 9 and 10- (a) by owners 42 (b) by local authority in default of owners 3 Houses demolished— (a) inpursuanceofordersunders. 1l 15 (b) voluntarily — Rooms on which closing orders were made 18 Closing orders determined (i.e., houses made fit) 1 Overcrowding (Housing Act, 1936) Families found to be living in overcrowded conditions 38 Overcrowded families who have obtained alternative accommodation:— (a) by L.B.C 12 (b) by L.C.C 45 Dwellings erected by the borough council during the year 262 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 Inspections under the byelaws — Prosecutions — Complaints remedied under the byelaws (not included under any other heading) — * See note at bottom o page 7. 64 SECTION "E" — INSPECTION AND SUPERVISION OF FOOD Milk and Dairies Regulations, 1949 At the end of the year there were 128 persons registered for the distribution of milk from premises within the borough and 23 persons registered for the distribution of milk within the borough from premises in the area of another authority. Thirty-seven premises in the borough were registered as dairies. Milk (Special Designations) Licences Table 34 Dealer's Supplementary Total Licences issued for:— sale of pasteurised milk 52 20 72 sale of tuberculin tested milk 50 19 69 sale of sterilised milk 74 21 95 sale of accredited milk 3 - 3 TOTALS 179 60 239 Analysis of milk During the year under review, 46 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 35 Period Samples Average composition of samples examined Percentage of Milk fat Solids not fat Water First quarter 11 3.51 8.79 87.70 Second quarter 12 3.55 8.88 87.57 Third quarter 16 3.61 8.77 87.62 Fourth quarter 7 3.64 8.87 87.49 TOTALS 46 3.57 8.82 87.61 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. 65 Icecream — grading During the year 21 samples of icecream were submitted to the laboratory for bacteriological examination with the following results:— Table 36 Grading Parliamentary division Total West North South Grade 1 - 9 2 11 Grade II - 4 2 6 Grade III - 3 1 4 Grade IV - - - - TOTAL - 16 5 21 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) (Amendment) Order, 1952, the standards laid down for icecream are not less than 4 percent fat, 10 percent sugar* and 5 percent milk solids other than fat. There are provisos in respect of icecream containing fruit, fruit pulp or fruit puree, and kosher ice. The 33 samples submitted for analysis from the borough were found to have the composition shown in the appended table:— Table 37 Samples Average percentage composition Fat Milk solidsnot fat Sucrose Water First quarter - - - - - Second quarter 16 9.8 10.2 11.9 68.1 Third quarter 9 9.4 10.9 11.7 68.0 Fourth quarter 8 9.0 13.6 11.9 65.5 TOTALS 33 9.5 11.2 11.8 67.4 * Sugar includes sucrose, invert sugar or solids of any sweetening material derived from starch. 66 Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 826, of which 1 was a formal sample and 825 informal. After examination the public analyst reported that 3 of the informal samples were adulterated or below standard; the percentage of adulteration amounted to 0.364 in the informal samples, whilst it was 0.363 of all the samples submitted, compared with 0.94 in the previous year. The following table gives the groupings and the results of the samples analysed:— Table 38 ARTICLES Examined Adulterated Informal Formal Total Informal Formal Total W N S W N S W N S W N S Beverages 11 19 19 - - - 49 - - - - - - - Cakes, cake and pudding mixtures, flour 16 20 10 - - - 46 - 1 - - - - 1 Cereals, etc 2 13 1 — — — 16 — — — — — — — Condiments and flavourers 83 98 62 - - - 243 - - - - - - - Drugs and medicaments 15 52 6 — — - 73 — — — — — - — Fats 44 47 39 — - - 130 - — — — — — Fish 5 4 6 - - - 15 - - - - — — Fruit and vegetables 9 10 4 - — - 23 - - - - — — Icecream 13 18 2 - - - 33 - - - - - — Jams, spreads, pastes 24 20 17 — — — 61 — — — — — — — Jellies 3 6 3 — — — 12 — — — — — - — Preserved meats, sausages, etc 31 2 6 1 - - 40 1 - - - - - 1 Sugar and confectionery 9 10 8 — — — 27 — 1 — — — — 1 Milk (fresh) 10 2 34 — — — 46 — — — — — — Milk (other) 1 — 3 — — — 4 — — — — — — Other foods 1 1 - - — - 2 - - - - — — Wines, spirits etc 2 4 — — - - 6 — — - - - - — TOTALS 279 326 220 1 — — 826 1 2 — — — — 3 67 Adulterated samples Table 39 Parliamentary division Article Formal or informal Adulteration or irregularity Action taken North Butterscotch Informal Fatty matter 0.4%. (In accordance with code of practice agreed between Ministry of Food and representatives of the Chocolate and Sugar Confectionery Trade, Butter Scotch should contain butter fat to the extent of not less than 4%. Sample deficient in this ingredient to extent of at least 90%). Labels altered to conform with requirements of code of practice by addition ofterm "flavoured." West Sausage (preserved) Informal Sulphite preservative equivalent to 980 parts of sulphur dioxide per million. (Contravention of Public Health (Preservatives, etc., in Food Regulations). Formal sample taken and found to be genuine. North Pancake mixture. Informal Sample found to be maize starch (cornflour). Sample taken from bulk supply at request of vendor. Containers labelled "pancake." No sales made. Other samples In addition to samples submitted to the public analyst from routine sampling, the following 69 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:— Chocolate Gammexane (2) Spaghetti Sausages Bun, buttered Sausages (cooked) (2) Paste (2) Chocolate mousse Swimming bath water (15) Ham (cooked) Water (4) Prunes Icecream (21) Rag flock Flour Stewed steak Faeces Hair dye (2) Foreign matter in oats (2) Lollies (5) Drinking water Chicken livers (2) 68 Unsound food A considerable amount of food was surrendered as unfit for human consumption. In all, approximately 15 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 RegistrarGeneral:— First quarter 2 Second quarter 4 Third quarter 13 Fourth quarter 14 33 (2) Outbreaks due to identified agents:— Total outbreaks 3 Total cases 13 Outbreaks due to:— (a) chemical poisons - (b) salmonella organisms - (c) staphylococci (including toxin) 3 (d) CI. botulinum - (e) Other bacteria - (3) Outbreaks of undiscovered cause:— Total outbreaks 2 Total cases 2 (4) Single cases:— Agent identified 16; Unknown 2; Total 18 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 352 Fish fryers 41 Sausages 107 Preserved meats 153 Preserved fish 24 Other preserved foods 1 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. 69 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. Pharmacy and Poisons Act, 1933 and Pharmacy and Medicines Act, 1941 The names of 34 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 191 persons previously registered were retained on the register. 205 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. Synthetic cream Fillings in cakes, pastries, etc., are a frequent source of food poisoning symptoms. These fillings are usually synthetic creams, which if manufactured with due precautions taken to prevent bacterial contamination, and if properly pasteurised, should be free from pathogenic organisms on despatch from the factory. The journal of the Food Trade Review has however recently called attention to the potential danger which may follow at a later stage. It says:- "Once, however, the original package, such as a can or churn, is opened, a danger of contamination arises and this danger may be increased either by improper conditions of storage or by unhygienic handling. Further danger may arise in the processing of such creams in a bakehouse prior to their being sold to the consumer, especially as sugar or marshmallow or both are commonly added to synthetic creams and these products may act as nutrients for bacterial growth in the event of any contamination occurring at this stage." 70 The two main types of synthetic creams are the "cellulose ether creams" consisting of hardened palm kernel oil emulsified with a watery chemical solution, and "egg creams" consisting of hardened palm kernel oil emulsified with egg yolk and a solution of sodium alginate. Experimental work showed that at ordinary temperatures practically no growth of salmonella organisms (the usual food poisoning organisms) took place in the cellulose ether creams, but rapid growth to many millions of organisms per gram occurred in the egg cream within three days. The results of the work showed that ideally synthetic creams should be stored at low temperatures (1° to 8°C.). Even under these conditions, however it is not considered desirable that they should be kept for more than one week owing to the possibility of heavy infection preceding low temperature storage. If synthetic creams are held at 18° - 20°C. they have a very restricted life. This indicates two main points in practice:— (1) That increased and very special attention to hygiene must be paid by all handlers of synthetic creams, and (2) that the use of creams such as cellulose ether creams, which are not good nutrients for pathogenic bacteria, is preferable to and should be recommended instead of such creams as the egg creams. Meat inspection A report on meat inspection in the following form is included to comply with the provisions of Ministry of Health Circulars 42/51 and 2/53:- Table 40 Cattle excl. cows Cows Calves Sheep and lambs Pigs Goats Killed - - - - 6 - 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 - - - - - - 71 Byelaws for the protection of food Byelaws have been made by the London County Council under section 15 of the Food and Drugs Act, 1938, for securing the observance of sanitary and cleanly conditions and practices in connection with the handling, wrapping and delivery of food sold or intended for sale for human consumption, and in connection with the sale or exposure for sale in the open air of food intended for human consumption. These byelaws, which are based on the model byelaws published by the Ministry of Food, came into force on 3 November 1952 and repealed the byelaws made by the London County Council under section 6 of the London County Council (General Powers) Act, 1932. The model byelaws were prepared by a working party of officers of the Ministries of Food and Health and comments were invited from other government departments and associations representing local authorities and food handling trades. The new byelaws require that every person engaging in the handling, wrapping and delivery of food shall observe cleanliness in regard to his person and clothing and shall take steps to prevent food being contaminated by dust and dirt, etc., animals, rodents, flies and insects and other sources, including contamination by other persons. It is an offence for any person who is suffering from or is a carrier of any disease, to handle, wrap or deliver food so that there may be a risk of the disease being spread. In order to prevent contamination, food, where necessary, has to be kept covered during delivery, and all surfaces, fittings, apparatus, etc., including the interiors of vehicles and containers used during delivery with which food may come into contact, must be constructed of nonabsorbent material and be kept clean. Where refuse is incidental to a particular trade it has to be kept away from food and be stored in suitable receptacles which must be emptied at least once a day. It is forbidden to use any wrapping material or container which is not clean or which is likely to contaminate food, and newsprint, if used for wrapping, can not be allowed to come into direct contact with food except in the case of uncooked vegetables. Containers used in certain trades have to be returned after use in a clean condition. A legible notice is required to be affixed in a prominent position near every sanitary convenience requesting employees to wash their hands after using the convenience. Similar conditions apply where food is sold or exposed for sale in the open air, and in addition the name and address of the proprietor must be displayed on the stall or container used. In order to ensure compliance with the byelaws, suitable and sufficient lighting, either natural or artificial, needs to be available, both in rooms used for the handling of food and for stalls from which food is sold in the open air. In the main, the new byelaws follow on the lines of the byelaws which have been repealed, and have the effect of bringing requirements into line with the changes in law effected by the Food and Drugs Act, 1938, rather than establish a new code of practice. 72 Food work generally In commenting on the work generally, Mr. Thomas, the group food inspector states:—"The year was marked by a continuance of the growing interest on the part of the public in clean food, no doubt stimulated by the prominence given by the Press to this matter and to the reports on cases of food poisoning which occurred during the year. In this respect Lewisham fortunately had only 33 cases reported and these were of a minor character. Investigation of such cases would be helped considerably by an early visit to the doctor on the part of the patient, and prompt notification to this department. " Food samples taken during the year showed that the degree of adulteration was very low. Out of 826 taken only 3 were found to be adulterated. As is well known, the adulteration of food was rampant at the beginning of the century and it is likely that not enough credit for the improvement has been given to the hard work and zeal shown by food and drugs inspectors in the past. The fact that it is known that samples are still taken no doubt helps maintain this situation. "The standard of icecream sold in the borough was generally satisfactory. Chemical analysis showed that the constituents were well above the legal standard. The tests for bacterial purity were uniformly good in the case of the wellknown brands; the smaller manufacturers need rather more attention as they have not the same equipment and facilities. It was found that these manufacturers were very ready to cooperate and adopt recommendations made to them. "During the year lectures were given to adult schools, schools, and similar organisations. These were well received and considerable interest was shown by the audiences. "Attention should be drawn to a fundamental factor in the work of food inspectors — the ability to deal with a perishable commodity without delay. No difficulty of this nature was experienced during the year." Dogs in food shops In circular MF 20/51 issued by the Ministry of Food, it was stated that the Minister in answer to a question in the House of Commons had stated:—"I agree that dogs should not be allowed in food shops. It is a most unhygienic practice. But I cannot feel that I would have any great success if I tried to stop it by prohibitive regulation. Here is a problem more likely to be solved by voluntary action and I appeal to the public and the food trade to cooperate in keeping dogs out of their shops." It was further stated in the circular that in the opinion of the Minister, the encouragement of food traders to display notices issued by local authorities and signed by medical officers of health requesting customers not to bring dogs into their premises would be a practical step to a higher standard of food hygiene. The Minister's recommendation was supported by representative bodies of the retail food trades and local authority associations. 73 This question was considered by the Health Committee and authority was given to prepare and obtain suitable notices for exhibition in butchers, grocers, greengrocers and bakers and confectioners shops, where the occupiers of such shops agreed to display notices. The views of the various Chambers of Commerce and allied organisations were obtained and it was generally felt that the notices should be made of a strong and permanent material. The notices, which are in the following form, were distributed in the early part of 1953:— metropolitan borough of lewisham DOGS Please, for good hygiene, keep your dog out of food shops. E. H. R. Smithard, Town Hall, S.E.6 Medical Officer of Health At the same time as the notices were issued to shops, a poster was prepared for public exhibition urging the general public to keep dogs out of food shops, and the opportunity was also taken to stress the need to prevent dogs from fouling the footpath, and for keeping dogs under close control while in the street to lessen the likelihood of accidents. Publicity was also sought from the local press. 74 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 Ophthalmia neonatorum Cholera Plague Continued fever Pneumonia, acute influenzal Diphtheria Pneumonia, acute primary Dysentery (bacillary or amcebic) Poliomyelitis, acute Encephalitis, acute Puerperal pyrexia Enteric fever Relapsing fever Erysipelas Scabies Food poisoning Scarlet fever Glanders Smallpox Hydrophobia Tuberculosis, all forms Malaria Typhoid fever, Including paratyphoid Measles Typhus fever Membranous croup Whooping cough Meningococcal infection PRINCIPAL NOTIFIABLE DISEASES Number of Notified Cases (corrected for revised diagnosis) during the year 1952 with comparative figures for the previous six years. Table 41 Diseases 1952 1951 Cases notified 1947 1946 1950 1949 1948 Anthrax - - - 1 - - - Diphtheria - — - 3 5 9 8 Dysentery 169 365 63 9 24 26 57 Encephalitis (acute) — 5 1 - - - 1 Enteric or typhoid fever — 4 1 3 2 4 2 Erysipelas 19 24 41 35 33 45 34 Food poisoning 33 26 38 50 12 3 1 Hydrophobia — - - - - - 1 Malaria 1 1 2 1 2 4 15 Measles 2183 3546 2084 1940 2642 810 1307 Meningococcal infection 5 6 7 3 5 19 11 Ophthalmia neonatorum 4 3 3 6 9 9 4 Pneumonia 89 173 108 84 67 104 108 Poliomyelitis (acute) and polioencephalitis 15 11 38 35 9 72 - Puerperal pyrexia 88 63 29 27 50 43 32 Scabies 18 21 22 29 54 122 348 Scarlet fever 379 215 358 521 332 254 155 Smallpox — — — - - 1 — Tuberculosis 307 299 406 371 502 426 437 Whooping cough 512 819 813 363 789 362 291 TOTALS 3822 5581 3608 3109 4035 1887 2375 75 Notifications of infectious diseases in 1952 showing sex and age groups:— Table 42 Diseases Under 1 /- 3- 5- 10- 15- 25- 45- 65 plus Total M F M F M F M F M F M F M F M F M F M F Diphtheria - - - - - - - - - - - - - - - - - - - - Dysentery 5 10 17 14 9 5 10 10 3 - 1 6 7 17 9 7 36 3 97 72 Erysipelas — — — — — — — — — - — 2 2 4 - 3 6 8 8 11 hood poisoning 1 — 3 1 1 2 1 2 5 2 3 — 3 5 1 2 - 1 18 15 Malaria — — — — — — — — — — — 1 - - - - - - - 1 Measles 28 36 229 215 267 244 558 551 12 17 4 9 3 7 1 2 - - 1102 1081 Meningococcal infection - 2 - - - - 2 - - - - - - - - 1 - - 2 3 Ophthalmia neonatorum - 4 - - - - - - - - - - - - - - - - - 4 Pneumonia - 2 1 3 3 2 3 5 2 — 4 4 11 7 10 8 12 12 46 43 Poliomyelitis (paralytic) - - 2 1 - 1 1 2 - - - - - - - - - - 4 4 Poliomyelitis (nonparalytic) - - - - - - 2 1 1 1 1 1 - - - - - - 4 1 Puerperal pyrexia - — — — — — — - - - - 36 - 52 - - - - - 88 Scabies - — — 1 1 — 2 2 3 - - 3 2 3 1 - - - 9 9 Scarlet fever 1 — 11 5 39 25 133 120 16 15 3 5 2 4 - - - - 205 174 Tuberculosis - — — 2 5 3 3 6 5 3 44 42 67 56 37 71 7 6 168 139 Whooping cough 26 26 60 53 61 63 93 119 3 2 — 1 1 1 - 3 - - 244 268 Totals 61 80 323 295 386 345 808 818 50 40 60 110 99 156 59 47 61 24 1907 1915 76 Analyses of certain diseases in table 42 into divisional areas:— Table 43 Disease Div. areas Under 1 1- 3- 5- 10- 15- 25- 45- 65+ Total Dysentery W 2 5 6 13 2 3 16 6 - 53 N 13 24 6 6 1 3 6 7 38 104 S — 2 2 1 - 1 2 3 1 12 Total 15 31 14 20 3 7 24 16 39 169 Measles W 18 165 169 349 6 5 4 1 - 717 N 30 131 173 393 11 3 3 2 - 746 S 16 148 169 367 12 5 3 - - 720 Total 64 444 511 1109 29 13 10 3 - 2183 Pneumonia vv - 1 2 4 1 3 4 6 9 30 N 1 2 2 1 1 2 8 7 10 34 S 1 1 1 3 - 3 6 5 5 25 Total 2 4 5 8 2 8 18 18 24 89 Poliomyelitis W - 1 1 - - - - - - 2 N - 1 - 2 - 2 - - - 5 S - 1 - 4 2 - 1 - - 8 Total - 3 1 6 2 2 1 - - 15 Scarlet fever W - 5 22 70 12 2 2 - - 113 N 1 5 18 54 6 1 7 - - 87 S - 6 24 129 13 5 2 - - 179 Total 1 16 64 253 31 8 6 - - 379 Whooping cough W 17 34 38 75 3 1 - 1 - 169 N 11 26 32 72 - - 1 2 - 144 S 24 53 54 65 2 - 1 - - 199 Total 52 113 124 212 5 1 2 3 - 512 For tuberculosis, see Table 47 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. 77 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 24.:— Table 44 W N S Total Visits 690 636 791 2,117 Futile visits 268 325 516 1,109 Revisits 295 206 258 759 Total 1,253 1,167 1,565 3,985 Infantile paralysis The Infantile Paralysis Fellowship carries out much helpful work amongst patients who have suffered from paralytic poliomyelitis. A letter was received from the secretary of its Pilot Youth Club Committee stating that the IPF was forming an experimental youth club in London to cater for the teenage poliomyelitis cases, the maximum age being 25 years. The membership of the IPF has increased greatly in children up to 14 years of age, but it has been found difficult to persuade patients between the ages of 14 and 25 years to become members, and the secretary of the youth club asked whether the Fellowship could be supplied with a list of such patients in this area, or whether the Fellowship could be helped in any other way by publicity being given to their work. The club envisaged will be run by the young people themselves with guidance from headquarters and will be, as far as possible, run on the lines of an ordinary youth club. Approach to persons who are physically incapacitated has to be undertaken very tactfully. It was felt however that the IPF could do a great deal to help such persons to lead a normal life and that it would be desirable to encourage them to join the projected club. With the approval of the health committee, a letter was sent to possible members (some 24 being known to the health department) enclosing a leaflet describing the aims of the IPF and the proposed club, so that any patient who cared to join could approach the organisation direct. Dysentery This disease continued its erratic progress, the number of cases reported, though large by comparison with years prior to 1951, being only about half those of 1951. It remained a mild condition. Investigation was made in most cases of family contacts and this was instrumental in bringing several other cases to light. During the year a special investigation was started by the London boroughs in cooperation with the county council (who are interested especially because of their children's homes) and it remains to be seen whether this investigation will be able to suggest more effective methods of control. 78 Tuberculosis The Public Health (Tuberculosis) Regulations, 1952, provide for the notification of tuberculosis and revoke and replace the Public Health (Tuberculosis) Regulations, 1930. The new regulations were made because of the changes which had taken place in the operation of the tuberculosis services consequent upon the coming into force of the National Health Service Act, 1946, which placed the responsibility for the prevention of tuberculosis and for the care and aftercare of tuberculous persons as a statutory duty on the county councils and the county borough councils, although at the same time the metropolitan borough councils as sanitary authorities under the Public Health Act have an important part to play in preventing the spread of tuberculous infection. Copies of all notifications received are sent to the county medical officer and to the local chest physician. There is now no longer any requirement for a medical officer of health to keep a register of notifications, nor do the regulations provide for the supply of information relating to patients entering or leaving a sanatorium. Hospital boards and committees have however been asked by the Minister to continue to notify to the medical officer of health the movements of such patients and the Minister urges medical officers of health to continue to keep a tuberculosis register. This is being done but the reliance on goodwill in maintaining an efficient register seems a queer way of dealing with what is, and will be for a few years yet, a very dangerous disease. The number of primary notifications of new cases of tuberculosis received during the year 1952, and deaths, together with comparative figures for the previous year, were as follows:— Table 45 Primary notifications of new cases Deaths 1951 1952 1951 1952 Pulmonary 266 265 60 35 Nonpulmonary 33 42 8 7 Totals 299 307 68 42 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 tabl:— 79 Table 46 Age periods New cases notified Deaths Pulmonary NonPulmonary Totals Pulmonary NonPulmonary Totals M F M F M F M F M F M F 0- - - - - - - - - - - - - 1- - 2 - - - 2 - - 1 - 1 - 2- 2 3 3 - 5 3 - - 5- 2 3 1 3 3 6 - - 1 - 1 - 10- 5 2 - 1 5 3 - - 15- 16 16 2 1 18 17 - - 2 - 2 - 20- 24 21 2 4 26 25 - — 25- 31 31 5 4 36 35 6 9 2 - 8 9 35- 29 16 2 5 31 21 45- 18 13 - 3 18 16 11 2 - - 11 2 55- 19 2 - 3 19 5 65- 4 2 - 1 4 3 3 1 - - 3 1 75- 3 1 - 2 3 3 2 1 - 1 2 2 Totals 153 112 15 27 168 139 22 13 6 1 28 14 Analysis of new cases of tuberculosis into divisional areas:— Table 47 Division Sex 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total West Pulmonary M - - 2 - 2 8 11 13 15 7 1 2 1 62 F - - 2 1 1 5 6 10 6 6 1 - 1 39 Non-pulmonary M - - 1 1 - 1 - 3 1 - - - - 7 F - - - 1 - 1 1 2 3 - 2 1 1 12 Total M - - 3 1 2 9 11 16 16 7 1 2 1 69 F - - 2 2 1 6 7 12 9 6 3 1 2 51 North Pulmonary M - - - 1 1 4 7 13 8 5 8 2 - 49 F - 1 - 1 - 5 6 11 4 6 1 1 - 36 Non-pulmonary M - - - - - - 1 - - - - - - 1 F - - - 2 - - - 1 1 - - - - 4 Total M - - 1 1 4 8 13 8 5 8 2 - 50 F - 1 - 3 - 5 6 12 5 6 1 1 - 40 80 Table 47—continued Division Sex 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total South Pulmonary M - - - 1 2 4 6 5 6 6 10 - 2 42 F - 1 1 1 1 6 9 10 6 1 - 1 - 37 Non-pulmonary M - - 2 - - 1 1 2 1 - - - - 7 F - - - - 1 - 3 1 1 3 1 - 1 11 Total M - - 2 1 2 5 7 7 7 6 10 - 2 49 F - 1 1 1 2 6 12 11 7 4 1 1 1 48 Cases of tuberculosis coming to the notice of the department other than by formal notification:— Table 48 Age period Pulmonary Non-pulmonary Total M F M F M F 0- - - - - - - 1- 1 - - - 1 - 2- 2 - - - 2 - 5- 2 2 - 2 2 4 10- - 2 1 — 1 2 15- 5 4 - 1 5 5 20- 14 15 1 2 15 17 25- 28 25 1 1 29 26 35- 12 7 - 2 12 9 45- 5 — - - 5 - 55- 3 - - - 3 - 65- 2 - 1 - 3 - 75- 1 1 - 1 1 2 Total 75 56 4 9 79 65 The sources from which information of the cases in the last table was obtained were as follows:— Table 49 Source of information Pulmonary Non-pulmonary Death returns — from local registrars 4 1 Death returns — from Registrar General 1 1 Posthumous notifications 2 1 Transfers from other areas (other than transferable deaths) 124 10 Other sources — - Totals 131 13 81 Quarterly revision of tuberculosis register:— Table 5O Pulmonary Nonpulmonary M F M F On register at December 31, 1951 1,300 989 211 260 Notified for first time 153 112 15 27 Restored to register 10 16 2 2 Added to register otherwise 68 56 2 8 Removed from register 197 159 21 24 On register at December 31, 1952 1,334 1,014 209 273 Summary of Statistics as to Tuberculosis for the last ten years Table 51 Year Population New cases notified (all forms) (excluding inward transfers) Notif. rate per thousand pop. Deaths Death rate from resp. tuberculosis per thousand pop. All forms Respiratory Lewisham County of London 1943 168,530 403 2.40 150 128 0.76 0.79 1944 163,320 390 2.39 146 129 0.79 0.75 1945 171,280 371 2.17 138 122 0.71 0.70 1946 207,410 437 2.11 126 110 0.53 0.59 1947 221,170 426 1.93 134 121 0.55 0.60 1948 226,100 502 2.22 119 109 0.48 0.56 1949 227,700 371 1.63 107 92 0.40 0.47 1950 228,300 406 1.78 72 66 0.29 0.36 1951 227,200 299 1.32 68 60 0.26 0.34 1952 227,100 307 1.35 42 35 0.15 0.28 Environmental investigations Investigations were made under the 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. 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. 82 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 visits paid by the sanitary inspectors and infectious disease visitors during 1952 is shown in the following table:— Table 52 W N S Total Visits 130 90 100 320 Futile visits 54 66 44 164 Revisits — — — — Total 184 156 144 484 TB cases visited in 1952—conditions found Table 53 (o) Primary case in house (b) Second case in house Non transfer (e) Second case in house Inward transfer Social conditions: Poor 251 275 3 30 - 15 Moderate 208 24 13 Superior 42 3 2 No information available 18 1 1 Not visited 49 7 4 Total 342 38 20 Of those visited: % % % Isolated in (a) Separate room 117 43 13 43 8 53 (fa) Separate bed 139 51 18 60 9 60 (c) In bed 84 31 14 47 1 7 Satisfactory window area 272 99 29 97 15 100 Satisfactory lighting and ventilation 269 98 28 93 14 93 Satisfactory food cupboard 180 65 21 70 10 67 Separate water supply 239 87 29 97 13 87 Separate water closet 223 81 29 97 12 80 Separate bath 177 64 26 87 9 60 No bath 38 14 2 7 3 20 Defects requiring attention 36 13 7 23 3 20 With regard to overcrowding in households where a case of tuberculosis was reported only 6 cases were discovered during the year (2 to the extent of half an equivalent person, 2 by one person, 1 by two persons and 1 by four persons). In a further 12 cases the equivalent number of persons equalled the permitted number, in 10 it was a half-person below and in 35 it was one person below the permitted number. The total number of cases assessed was 293. 83 Mass radiography unit A twoday exhibition on the personal health services was arranged by the divisional office of the LCC at the Central Lewisham Welfare Centre, 410, Lewisham High Street in July. This exhibition was attended by the mass Xray unit — an innovation as the unit usually spends six weeks to two months in an area. The unit proved an attraction and examined some 750 persons. In a report received from the director of the unit, it is stated that for the first time men and women were admitted at the same hours and that children also were examined. In the past children under 15 have been excluded. 246 males were examined and of these 11 appeared possibly unsatisfactory on the miniature film and were recalled for reexamination on a large film. 8 of the 11 were found to have abnormalities, of which 3 were probably new cases of tuberculosis requiring further investigation, one had another chest condition requiring investigation, 2 had abnormalities requiring no action and in 2 the examination was not completed at the time of the report. 511 females were examined and of these 26 appeared possibly unsatisfactory on the miniature film and were recalled for reexamination on a large film. 23 of the 26 were found to have abnormalities, of which 9 were probably new cases of tuberculosis requiring further investigation, one was a previously known case of tuberculosis, 6 had abnormalities of the heart or blood vessels, 6 had abnormalities requiring no action, and in one the examination had not been completed at the time of the report. In all, therefore, there were 12 persons who were probably new cases of pulmonary tuberculosis for further investigation, and one of these was a child of 5. Tuberculosis control As indicated in last year's report the position with regard to tuberculosis has recently undergone a considerable change for the better and the disease now appears well on the downgrade. Better ascertainment, better methods of treatment, and better prevention (in which nutrition, BCG vaccination, and improved hygiene have played their parts) have helped bring about this more optimistic picture, though it is to be regretted that this country is still woefully lagging behind in prevention by BCG vaccine. (The small amount required has to be imported). The fundamental necessity of ascertainment in tuberculosis is illustrated by a report in the British Medical Journal last autumn of a survey of tuberculosis in a mining valley, a quotation being as follows:—"This survey also shows the hidden danger of unknown sources of infection. Of 68 women with positive sputum, 22 were previously unknown; and of 54 men with positive sputum, 15 were previously unknown. Thus for both sexes combined no fewer than 30 percent of those with positive sputum were not previously known to be suffering from tuberculosis. Of all the patients with active disease 40 percent were previously unknown. It would seem not unreasonable to suppose from this that in Britain as a whole a large proportion — 84 perhaps 25 percent — of those with infectious disease are not known and are not under any form of supervision or treatment. The need for highly efficient case-finding services is thus obvious, especially in the light of the increasingly effective forms of treatment that can now be offered." Immunisation against infectious disease The Ministry of Health issued a circular (15/52) with regard to a further publicity campaign in connection with diphtheria prophylaxis. The circular stresses the importance of cooperation between the borough council and the county council as local health authority. Cases of diphtheria (corrected for diagnosis) show a continuing decrease, from 23,000 for England and Wales in 1944 to 699 last year and deaths during the same period have decreased from 934 to 34. However, in spite of these good figures, it is considered essential to secure that not less than 75 percent of babies are immunised before their first birthday. Over 140,000 fewer children in the 0 to 5 age group were immunised in 1950 than in 1949, indicating that even after allowing for the lower birthrate there is a great deal of ground to be recovered. The circular therefore urges the need for an intensive effort to achieve the level of immunisation necessary to secure full benefit of the campaign. If parents leave their children unprotected there may be a return of diphtheria outbreaks. It is consequently considered that sustained publicity is necessary to make parents realise that diphtheria is still a dangerous disease and that their children should be given protection against it, through immunisation. Although the provision of an immunisation service is the responsibility of the London county council, the Lewisham borough council is always willing to assist the county council in the dissemination of propaganda and in any other way which will secure the immunisation of the maximum number of children. I am indebted to the Divisional Medical Officer of the London county council for the information on which the following table is based:— Immunisation against diphtheria; whooping cough; smallpox Table 54 , Age at December 31, 1952 Under 1 2 3 4 5-9 10-14 Total under Born in year 1952 1951 1950 1949 1948 1947-43 1942-38 15 (i) Diphtheria and combined diphtheria and whooping cough:— Immunised during year 222 2,252 297 158 93 245 12 3,279 Immunised at end of year 222 2,466 2,437 2,321 3,180 13,141 13,199 36,966 Estimated mid-year population 18,500 30,600 49,100 (ii) Whooping cough (including combined)— Immunised during year (age at date of immunisation) 406 898 173 75 45 35 3 1,635 85 (iii) Vaccination against smallpox Age at December 31, 1952 Under 1 1-4 5-14 IS and over Total Primary:— Clinics 1,021 154 29 25 1,229 Private doctors 561 200 66 119 946 Revaccination:— Clinics - 7 11 70 88 Private doctors 5 16 63 422 506 Town Hall, S.E.6. July, 1953 E. H. R. SMITHARD, Medical Officer of Health 86 APPENDIX A Acts of Parliament, Statutory Instruments and Circular Letters, issued by government departments with regard to the public health services during the year 1952:— Statutes Rivers (Prevention of Pollution) Act, 1951. Heating Appliances (Fireguards) Act, 1952. Statutory Instruments No. 549 The Labelling of Food (Amendment) Order, 1952. 704 The Public Health (Tuberculosis) Regulations, 1952. 815 The Icecream (Heat Treatment, etc.) Amendment Regulations, 1952. 1124 Meat Products No. 2 Order, 1952. 1283 The Food Standards (Icecream) (Amendment) Order, 1952. 1410 The Public Health (Aircraft) Regulations, 1952. 1481 The Public Health (Meat) (Amendment) Regulations, 1952. 1619 The Meat Products (Amendment) Order, 1952. 1697 The Food Standards (Coffee Mixture) Order, 1952. 1822 Mineral Oil in Food (Amendment) Order, 1952. 2033 Transfer of Functions (Slaughterhouses and Knackers' Yards) Order, 1952. 2203 The Food Standards (Suet) Order, 1952. 2257 The Meat Products (No. 3) Order, 1952. Ministry of Health Circulars. No. 1 National Health Service — cooperation between hospital, local authority and general practitioner services. 6 T uberculosis. 11 National Health Service — cooperation between hospital, local authority and general practitioner services. 14 Icecream (heat treatment) amendment Regulations, 1952. 15 Diphtheria prophylaxis — publicity campaign. 20 International certificates of vaccination against cholera and smallpox. 24 Public health (aircraft) Regulations, 1952. 28 Infectious disease in aircraft — tracing of contacts. 35 Civil defence — radiological defence course for medical officers of health. 87 Ministry of Food Circulars. No. 2 Liqueur chocolates. 3 Condemnation of imported canned meat. 4 The Meat Products No. 2 Order, 1952. 5 Milk and Dairies Regulations, 1949 — approved oxidising and preservative agents. 6 Icecream standard. 8 The Public health (meat) (amendment) Regulations, 1952. 9 Meat products (amendment) Order, 1952. 10 Standards for coffee mixtures. 12 Milk and Dairies Regulations, 1949 — approved oxidising and preservative agents. 13 Mineral oil in food (amendment) Order, 1952. 14 Methods and criteria of meat inspection — Memorandum 3/Meat. 15 Sulphur dioxide in imported dehydrated vegetables. 16 Labelling of food Order, 1950 — coronation souvenir boxes. 17 Standards for suet. Ministry of Housing and Local Government Circulars. No. 58 Rivers (Prevention of Pollution) Act, 1951. 92 Transfer of functions (slaughterhouses and knackers' yards) Order, 1952. 95 Building licensing — Defence regulation 56a. Financial limits for unlicensed work. Ministry of Agriculture and Fisheries Circulars. No. 3 Manufacturers of warfarin — revised prices. 4 The treatment of sewers — use and maintenance of baiting trap and ropes. 5 Manufacturers of warfarin — revised prices. 7 Prevention of Damage by Pests Act, 1949. Home Office Circulars. No. 102 Pharmacy and Poisons Act, 1933. 88 APPENDIX B Legal Proceedings in 1952 The following is a list of legal proceedings instituted during the year:— Public Health (London) Act, 1936 Date of hearing Offence Fine Costs Remarks £ £ s. d. 1 Feb. Non-compliance with nuisance notice in respect of 40, Longhurst Road. — — Summons withdrawn. Work completed. 1 Feb. Non-compliance with nuisance notice in respect of 44, Longhurst Road. - - Adjou rned sine die. Work in progress. 22 Feb. Non-compliance with abatement order in respect of Woodcot, Mill Gardens. 2 - - 22 Feb. Non-compliance with nuisance notice in respect of 27, Whatman Road. - 1 1 0 Order made for abatement of nuisance within 2 months. 22 Feb. Non-compliance with nuisance notice in respect of 29, Whatman Road. 1 1 0 Order made for abatement of nuisance within 4 months. 3 March Non-compliance with nuisance notice in respect of 48, Kirkdale. - 1 0 0 Order made for abatement.of nuisance within 14 days. 3 March Non-compliance with nuisance notice in respect of 29, Prospect Road. - 1 0 0 Order made for abatement of nuisance within 28 days. 3 March Non-compliance with nuisance notice in respect of 39, Willow Way. 1 - Adjourned sine die. Work completed. 3 March Non-compliance with abatement order in respect of 5, Kingswood Place. 3 - - 3 March Non-compliance with abatement order in respect of 6, Kingswood Place. 3 - - 3 March Non-compliance with abatement order in respect of 7, Kingswood Place. 3 - - 3 March Non-compliance with nuisance notice in respect of 7, Church Grove. Adjourned sine die to allow District Surveyor to enforce dangerous structure notice. Major part of work completed. 3 March Non-compliance with nuisance notice in respect of 41, Loampit Hill. 1 0 0 Order made for abatement of nuisance within 28 days. 3 March Non-compliance with abatement order in respect of 35, Prospect Road. 5 5 5 0 - 10 March Non-compliance with nuisance notice in respect of 108, Brockley Grove. - - Summons withdrawn. Work completed. 10 March Non-compliance with nuisance notice in respect of 11, Vian Street. - - Adjourned sine die. Work almost completed. 89 Date of hearing Offence Fine Costs Remarks £ £ s. d. 13 March Keeping of pigs in contravention of section 119, sub-sections 1 and 4. 6 5 5 0 — 31 March Non-compliance with nuisance notice in respect of 79, Willow Way. - - Order made for abatement of nuisance within 28 days. 31 March Non-compliance with nuisance notice in respect of 81, Willow Way. - - Order made for abatement of nuisance within 28 days. 31 March Non-compliance with nuisance notice in respect of 124, Perry Rise. - - Summons withdrawn. Work completed. 7 April Non-compliance with nuisance notice in respect of 1, Eliot Cottages. - - Summons withdrawn. Undertaking given to complete work within one month. 25 April Non-compliance with nuisance notice in respect of 37, Effingham Road. - - Order made for abatement of nuisance within 42 days. 28 April Non-compliance with nuisance notice in respect of 23, Fairlawn Park. - 1 1 0 Order made for abatement of nuisance within 28 days. 28 April Non-compliance with nuisance notice in respect of 17, 17a, Silverdale. - - Adjourned sine die. Defendant promised to complete work within 28 April Non-compliance with nuisance notice in respect of 101, Gilmore Road. — 1 1 0 28 days. Order made for abatement of nuisance within 56 days. 12 May Non-compliance with nuisance notice in respect of 81a, Adelaide Avenue. - - Adjourned sine die. 12 May Non-compliance with nuisance notice in respect of 7, Loampit Hill. - 10 6 Adjourned sine die. Work commenced. 12 May Non-compliance with abatement order in respect of 41, Loampit Hill. - - Adjourned sine die. 12 May Non-compliance with nuisance notice in respect of 109, Loampit Vale. - - Adjourned sine die. Work commenced. 16 May Non-compliance with nuisance notice in respect of 98, Wiverton Road (Basement flat). - - Adjourned sine die. New tenants have carried out most of required repairs. 16 May Non-compliance with nuisance notice in respect of 98, Wiverton Road (Upstairs flat(. - 1 1 0 Order made for abatement of nuisance within 28 days. 16 May Non-compliance with nuisance notice in respect of 13, Westdown Road. - - Summons withdrawn. Nuisance abated. 16 May Non-compliance with nuisance notice in respect of 76, Burnt Ash Road. - - Order made for abatement of nuisance within 14 days. 26 May Non-compliance with abatement order in respect of 5, Kingswood Place. 10 - - 90 Date of hearing Offence Fine Costs Remarks £ £ s. d. 26 May Non-compliance with abatement order in respect of 6, Kingswood Place. 10 — 26 May Non-compliance with abatement order in respect of 7, Kingswood Place. 10 — — 30 May Failing to pay costs of defendants' unsuccessful appeal to Quarter Sessions on 21 Feb., 1952 against Magistrate's conviction and fine for non-compliance with dustbin notice in respect of 42, Springfield Rise. - - Summons withdrawn on payment of £15 15s. Od costs. 5 June Recovery of cost of drainage repairs carried out by Council at 64, Eltham Road. - 2 14 0 Judgment given for £15 9s. 7d., the total cost of repairs. 13 June Non-compliance with nuisance notice in respect of 77, Algernon Road. - - Summons withdrawn. Work completed. 16 June Non-compliance with nuisance notice in respect of 34, Cressingham Road. - - Adjou rned sine die. Arrangements being made to carry out work. 16 June Non-compliance with nuisance notice in respect of 32, Cressingham Road. - - Adjourned sine die. Arrangements being made to carry outwork. 23 June Non-compliance with nuisance notice in respect of 58, Marsala Road. - - Summons withdrawn. Work commenced. 14 July Non-compliance with abatement order in respect of 79, Willow Way. 5 - - 14 July Non-compliance with abatement order in respect of 81, Willow Way. 5 - - 14 July Non-compliance with nuisance notice in respect of 58, Dalmain Road. - - Case withdrawn. Agents no longer manage this property. 22 August Non-compliance with nuisance notice in respect of 41, Kinver Road. - 1 1 0 Order made for abatement of nuisance within 28 days. 22 August Non-compliance with nuisance notice in respect of 85, Marsala Road. - - Order made for abatement of nuisance within 28 days. 29 August Non-compliance with abatement order in respect of 98, Wiverton Road. - 1 1 0 Withdrawn on payment of costs. 29 August Non-compliance with abatement order in respect of 23, Fairlawn Park. 5 2 2 0 - 29 August Non-compliance with dustbin notice in respect of 42, Springfield Rise. - - Adjourned sine die. Dustbin supplied. 15 Sept. Non-compliance with nuisance notice in respect of 83, Algernon Road. - - Order made for abatement of nuisance within 28 days. 91 Date of hearing Offence Fine Costs Remarks £ £ s. d. 26 Sept. Non-compliance with nuisance notice in respect of 43, Coombe Road. — — Adjourned sine die. Work commenced. 26 Sept. Non-compliance with nuisance notice in respect of 8, Church Grove. - - Adjourned sine die. Work in hand. 13 Oct. Non-compliance with nuisance notice in respect of 16, Burford Road. - - Adjourned sine die. Work in hand. 27 Oct. Non-compliance with nuisance notice in respect of 107 Kirkdale (Bottom flat). - - Adjourned sinedie. Work carried out. APPEALS Date of hearing Nature of appeal Remarks 21 Feb. Appeal by owner against conviction and fine imposed by magistrate for non-compliance with dustbin notice at 42, Springfield Rise. Appeal dismissed. £15 15s. costs. 21 April Appeal against notice served under s. 105 of the Public Health (London) Act, 1936 requiring the tenant to provide a dustbin. Appeal allowed. BYELAWS MADE BY THE LONDON COUNTY COUNCIL Date of hearing Offence Fine Costs Remarks £ £ s. d. 22 Dec. Exchange of goldfish in bowl for old clothing on 16 July, 1952 in Bromley Road. — 10 0 Absolute discharge. HOUSING ACT, 1936 Date of hearing Offence Fine Costs Remarks £ £ s. d. 9 June Non-compliance with request for information as to ownership of property (s. 168), 11, Peak Hill Gardens. 5 — — 92 FOOD AND DRUGS ACT, 1938 Date of hearing Offence Fine Costs Remarks £ £ s. d. 22 Feb. Mouse in fish and chips — contravention of section 3. 5 3 3 0 — 13 June Nail in iced cake — contravention of section 3. 5 3 3 0 — 20 Oct. Sale of unfit horse flesh for human consumption—contravention of section 9. 10 3 3 0 — Warnings In addition to legal proceedings authorised for contravention of statutory law, warning letters were sent in respect of the following matters, where the evidence or the circumstances were not sufficient to warrant legal proceedings being instituted:— Mouse excreta in spaghetti. (Food and Drugs). Wire in sugar confectionery. (Food and Drugs). Wire staple in bread. (Food and Drugs). Mouse excreta in flour. (Food and Drugs). String in bread. (Food and Drugs). Sack label in loaf. (Food and Drugs). Rabbit pieces unfit for food. (Food and Drugs). Mouse-eaten loaf. (Food and Drugs). Exchange of goldfish for rags. (L.C.C. byelaw). Sale of puppy to children. (Pet Animals Act). 93 APPENDIX C List of special reports submitted to the Health Committee by the Medical Officer of Health during 1952:— February 5 Lee Church Street and surrounding area — proposed slum clearance. February 5 Report on mass X-ray campaign, 1951. March 4 Pet Animals Act, 1951 — conditions for licences. April 8 Potential areas for clearance or demolition. May 27 Outworkers. May 27 Old people's voluntary affiliated organisations — grants. May 27 Utilisation by the London County Council of the services of Borough medical officers of health. July 1 Lee Church Street area — representation. July 1 Diphtheria publicity campaign — Ministry of Health cular 15/52. September 2 Dogs in foodshops. September 2 Outworkers. September 2 Preliminary report on 1951 census. September 30 Central Lewisham Welfare Centre — attendance of mass X-ray unit. October 28 Infantile Paralysis Fellowship. November 25 Dogs in food shops. November 25 Establishment of sanitary inspectors. 94 TABLES TABLE NO. SUBJECT PAGE TABLE SUBJECT PAGE Section A NO. Section D 1 Comparative statistics 8 29 Applications for rehousing 55 2 Summary of vital statistics in last ten years 9 30 Demolition orders 56 31 Closing orders 57 3 Causes of death by age groups 10 32 Clearance areas 59 33 Civil building licences 62 4 Deaths under one year 12 5 Local sickness 13 Section E 6 Deaths by social class 13 34 Milk licences 64 7 Causes of death by social class 14 35 Analysis of milk 64 8 Grouped causes of death by social class 15 36 Icecream grading 65 37 Icecream composition 65 9 Births, infant deaths, etc. by social class 16 38 Samples analysed 66 39 Adulterated samples 67 10 Lung cancer 20 40 Meat inspection ... 70 11 General statistics from 1901 22 Section F Section B 41 Principal notifiable diseases 74 12 Disinfecting station 23 42 Notifications of infectious diseases by age and sex 75 13 Verminous conditions, etc. 24 14 Public mortuary 27 43 Analysis of certain diseases into divisional areas 76 15 Rodent control 28 44 Infectious disease visiting 77 16 Rodent control—treatment of rivers 29 45 Tuberculosis notifications and deaths 78 17 Prevention of damage by pests 30 46 Age distribution of tuberculosis cases 79 18 Block control 31 47 Analysis of new cases of tuberculosis into divisional areas 79 19 Water, chemical samples 33 20 Water, bacteriological samples 33 48 Cases of tuberculosis not formally notified 80 21 Atmospheric conditions 36 22 Fog — ages at death 41 49 Source of information in table 48 80 23 Fog — death rate in wards 43 50 Tuberculosis register 81 Section C 51 Tuberculosis statistics 81 24 Sanitary inspection 45 52 Tuberculosis visits 82 25 Summary of notices 46 53 Tuberculosis environmental investigations 82 26 Nuisances remedied 47 27 Factory inspections 48 54 Immunisation against infectious disease 84 28 Factory defects 49 CHARTS PAGE Comparison with other areas 18 Lung cancer 21 Fog — ward mortality 44 95 INDEX SUBJECT PAGE SUBJECT PAGE Acts, regulations and orders 86 National Assistance Act, 1948:— Area of borough 7 Section 47 26 Atmospheric conditions 36 Section 50 27 Atmospheric pollution 38 Nuisances remedied 47 Births and birth rate 7 Offensive trades 69 Census, 1951 9 Old people 34 Outworkers 50 Civil building licences 62 Clearance areas 60 Pet Animals Act, 1951 52 Comparative occupational class statistics 16 Pharmacy and Poisons Act, 1933 69 Population 7 Comparison with other areas 17 Prevention of Damage by Pests Act, 1949 30 Deaths and death rate 7 Deaths, causes of 10 Rag Flock and other Filling Materials Act, 1951 51 Disinfection and personal cleansing 23 Dog nuisances 51 Rateable value 7 Dogs in food shops 71 Rent and Mortgage Interest (Restrictions) Acts 47 Factories and workshops 47 Rivers (Prevention of Pollution) Act, 1951 53 Flies and mosquitoes 25 Fog, the 38 Rodent control 28 Food, adulteration of 66 Food, byelaws for protection of 71 Sampling 66 Food hygiene 4 Sanitary circumstances of the area 45 Food, inspection and supervision 64 Food poisoning 68 Sanitary inspectors, establishment 5 Food work generally 72 Shops Act, 1950 68 Health services, general provision of 23 Sickness, local 13 Slaughterhouses 69 Housing:- Social class enquiry 13 New building 54 Social medicine statistics 5 Families rehoused 54 Staff 2 Applications for rehousing 54 Stillbirths 7 Housing Act, 1936 55 Swimming baths 34 Synthetic cream 69 Icecream, composition 65 Icecream, grading 65 Tuberculosis 3 Immunisation against infectious disease 84 Tuberculosis notifications 78 Tuberculosis, environmental investigations 81 Infant mortality 8 Infant mortality table 12 Infectious diseases 74 Unsound food 68 Infectious disease visiting 76 Introduction 3 Vital statistics 7 Laboratory facilities 25 Water certificates 47 Legal proceedings 88 Water supply 32 Lung cancer 19 Mass miniature radiography 83 Maternal deaths 8 Maternity and child welfare 4 Meat inspection 70 Milk, analysis of 64 Milk and Dairies Regulations, 1949 64 Mortuary and Coroner's Court 27