AC4374 2 Man know to who hab 3 Litary . LEW 41 METROPOLITAN BOROUGH OF LEWISHAM THE PUBLIC HEALTH OF LEWISHAM Report of the Medical Officer of Health for the Year 1953 E. H. R. SMITHARD, MBE, MD, DPH London : E. G. Berryman & Sons, Ltd., Blackheoth Road, S.E.10 METROPOLITAN BOROUGH OF LEWISHAM Report of the Medical Officer of Health for the Year 1953 E. H. R. Smithard, MBE, MD, DPH CONTENTS page Staff 2 Introduction 3 Vital Statistics 7 General Provision of Health Services 22 Sanitary Circumstances of the Area 44 Housing 57 Inspection and Supervision of Food 68 Infectious Diseases 82 Appendix A — Statutory Instruments 96 „ B — Legal Proceedings 98 „ C — Special Reports to Health Committee 101 „ D — Census of Distribution and other Services 102 „ E — Further details from the 1951 Census of Population 105 List of Tables 110 Index 111 2 STAFF as at 31/12/53 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) (b) Group Sanitary Inspectors A. G. Thomas (a) (b) (Food) R. Mahoney (a) (b) (District) J. R. Craven (a) (b) (Housing) Assistant Group Housing Inspector R. C. Brittain (a) (b) District Inspectors Food Inspectors and Sampling Officers J. W. Bevan (a) (b) H. W. Ellery (a) (b) C. L. Connor (a) G. E. Fallows (a) (b) R. L. Davis (a) T. R. A. Fitzherbert (a) (b) E. A. Howard (a) H. Tolson (a) (b) H. J. Rogers (a) K. R. Wagener (a) (b) Four vacancies (a) Sanitary inspector's certificate. (b) Food inspector's certificate. Infectious Disease Visitors Miss M. E. K. Johnston, srn, rfn, scm Mrs. A. Carins, srn, rfn Principal Clerk E. W. Cheesman Clerical Staff S. Burridge, senior clerk L. J. Cleverly Miss I. D. Coppin L. Gardiner Miss I. L. Hatton Miss D. J. Miles C. R. Coleman Two vacancies 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 Rodentfly operatives 4 Drain testers 2 Public Analyst A. J. Lickorish, fic Bacteriologists E. H. Bailey, mrcs, lrcp, and A. J. H. Tomlinson, mb, BChir, of the Public Health Laboratory Service. 3 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisham. Mr. Mayor, Ladies and Gentlemen, I submit herewith my report for the health department for the year 1953. The Registrar General's estimate of the population in midyear 1953 at 225,800 was 1,300 less than his estimate for midyear 1952. The prewar estimated total population in June, 1939 was 231,000. The crude birthrate for the year at 14.4 shows an increase of 0.5 from the figure of 13.9 for the previous year, but the adjusted birthrate (allowing for age and sex distribution of the population) is only 0.3 higher, at 13.4. The crude death rate at 11.1 shows a small decrease from the 11.4 of last year, and the adjusted death rate, also 11.4, compares with 12.5 for the administrative county. The infant mortality rate at 22 was the same as in the previous year, the neonatal rate (i.e., under one month of age) and the one month to one year rate both remaining constant. The stillbirth rate again increased, this time fairly steeply, from 17.7 to 23.5, and this is disquieting ; it is the highest rate since 1943. The combined stillbirth and infant death rate (reproductive wastage) therefore goes up, from 40 to 45. One maternal death again occurred and so the maternal mortality rate per thousand live and stillbirths remains at 0.3. The premature birth rate, i.e., the number of children weighing 5½lbs. 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). The rate for 1953 at 75 is a little down on the previous year. The various comparative figures of general statistics since 1901 are shown in table 12. Tuberculosis The number of new notifications again increased, from 307 to 341, the notification rate rising from 1.35 to 1.51. The number of deaths from tuberculosis showed a slight rise, from 42 to 48. In 1953 in Lewisham there were 34 male deaths and 14 female ; the corresponding figures for the previous year were 28 and 14, while for the two years 1937-8 the combined figures were 169 males and 153 females. The increasing male preponderance therefore continues. Maternity and child welfare There was very little variation in the principal rates other than the stillbirth rate. The immovability of the neonatal rate with at the same time the increase in the stillbirth rate are both somewhat vexatious factors, allied as they may be to nutrition. An analysis of the neonatal deaths indicates that 8 of the 53 were due to congenital deformities, 7 to injury at birth, 11 to asphyxia or lack of expansion of the lungs at birth, and 20 (against 17 last year) to prematurity or immaturity. 4 Food hygiene The notified cases of food poisoning during the year amounted to 32, almost the same figure as 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. The contemplated Food and Drugs Act will revise the provisions for protecting the public against the sale of food containing injurious ingredients and against the misdescription of food and drugs in labels and advertisements. The Act also aims to provide fuller powers by way of regulations to secure that food is not contaminated in the course of preparation, distribution and sale. During the year the Council revised the establishment of sanitary inspectors, as a result of which two more food inspectors were appointed from among the district inspectors. The total establishment was cut from 21 to 20, there being now no woman inspector. The new establishment of six food inspectors will enable more time to be devoted to food hygiene, supervision of shops, and food education of the public. Infectious disease other than tuberculosis With regard to the more acute infections the year again showed a high number of measles cases, but the 2,082 cases fell far below the record figure of 3,546 in 1951. Only one death resulted. Dysentery cases, which had troubled us considerably in 1951 and had dropped from 365 in that year to 169 in 1952 declined still further to 84 last year. There were 52 cases of poliomyelitis, the highest since the record number of 72 in 1947. This disease is dealt with in some detail in the body of the report. The continued high 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 (5 cases only) from its wartime high, and whooping cough had a prevalence about the same as in the previous year. One case of diphtheria was confirmed, the first since 1949, and I would call attention to the fact that this rarity 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 again 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 efforts 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 during the year further developed its housing branch, which although a function to which the borough council cannot contribute directly is one which has the health committee's full support. 5 Social medicine statistics As indicated in previous reports, various vital statistics in relation particularly to occupational class have been obtained from 11 of the 14 towns in the United Kingdom which have a population between 200,000 and 300,000. These now cover the projected period of three years. An analysis will be carried out and fuller details will be published in the next annual report. New fronts In section A, the statistical section, I have included three paragraphs (lung cancer, coronary disease, and deaths under age 65) which call attention to the main causes of death in relation to loss of productive manpower. With an ageing population this problem is increasingly serious, but it must be remembered that, apart from the fatal diseases, there are many crippling and relatively non-fatal conditions which also contribute to loss of production. There are signs that certain of these causes are coming within the practical range of preventive medicine. Housing The proposed Housing Repairs and Rents Act will confer additional powers on local authorities in relation to unfit houses under the Housing Act, 1936. Local authorities will be required to submit to the Minister within one year of the passing of the Act, proposals for dealing with unfit houses in their area, these proposals being submitted in London jointly by the London county council and the Metropolitan borough councils. In order to make the fullest use of existing housing accommodation, the demolition of properties included in clearance areas (including those under orders already confirmed), can be postponed where the properties are of an adequate standard or can be made adequate for the time being, and local authorities can acquire unfit houses which can be made adequate for the time being as an alternative to making a demolition order. Houses in existing demolition or clearance areas which are in an adequate state of repair can be occupied temporarily under licence from the local authority. Contributions from the Exchequer will be provided towards the cost of repair, improvement and maintenance of such houses. It is hoped that the Act will provide a clearer statutory definition of the phrase "unfit for human habitation." Local authorities may require the carrying out of works where houses are occupied by more than one family and are unsuitable for such occupation as they stand. In order to encourage greater use of the provisions in the Housing Act, 1949, whereby grants can be made to property owners for the improvement of houses which they own, it is intended to provide a certain relaxation of the conditions under which such grants are made. The Bill is also concerned with increases in rent. A preliminary survey of all properties in their districts is being undertaken by the sanitary inspectors in connection with the proposals for dealing with unfit houses which have to be submitted to the Minister. 6 It is impossible at present to foresee the total amount of additional work required from health department staff as a result of the proposed Act, but it is likely to be very considerable. 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 Mrs. Bunce (Vice-Chairman) Councillor D. A. J. Draper, DFC., JP. (The Mayor) Aldermen Carter, Hawkins and Mrs. Smith Councillors Mrs. Armstrong, Boon, Braund, Bridger, Brough, B.Sc., Burch, Donovan, Mrs. Drapper, JP., Greenhow, Hawes, Helps, Henry, Mrs. Land. 7 SECTION "A" —VITAL STATISTICS Area The area of the borough is 7,015 acres. Public open space comprises 652 acres. Population Census 1951 227,576 The Registrar-General's estimate of the home population at midyear 1953 was 225,800. (This includes members of the armed forces stationed in the area). Rateable value County of London rateable value of the borough at April 1, 1953 £1,861,174 Estimated net product of a penny rate, 1953/54 £7,560 Estimated number of separately assessed dwellings at April 1, 1953 60,770 Births (adjusted for inward and outward transfers) Livebirths 3,247 Males Females Total Legitimate 1,619 1,491 3,110 Illegitimate 72 65 137 Totals 1,691 1,556 3,247 Crude birth rate per 1,000 of the estimated population 14.4 Adjusted birth rate for comparative purposes 13.4 (Area comparability factor for births is 0.93) Birth rate for England and Wales 15. Birth rate for London Administrative County17.5 Stillbirths The stillbirths allocated to the borough during the year were 78, which represents a stillbirth rate per thousand live and stillbirths of 23.5 Deaths The deaths belonging to the borough registered during the year were 2,502, consisting of 1,313 males and 1,189 females, giving a crude death rate per thousand of the estimated population of 11.1 The area comparability factor for deaths is 1.0 therefore the adjusted death rate remains at 11.1per thousand of the estimated population, which compares with rates of 11.4for England and Wales and 12.5for the Administrative County of London. 8 Infant mortality Infant deaths 73 Legitimate 70 Illegitimate 3 Rates : 1.All infants per thousand livebirths 22.5 2. Legitimate infants per thousand legitimate livebirths 22.5 3. Illegitimate infants per thousand illegitimate livebirths 21.9 Neonatal deaths (under 4 weeks of age) 53 Neonatal death rate (per 1,000 livebirths) 16.3 Reproductive wastage :— Stillbirths plus infant deaths 151 Rate per thousand live and stillbirths 45.4 Maternal deaths Maternal deaths 1 Maternal mortality rate per thousand live and stillbirths 0.3 Other special causes of death Diarrhoea Measles 1 Acute poliomyelitis 2 Motor vehicle accidents 15 Suicide 27 Tuberculosis (all forms) 48 Cancer (Code Nos. 10-15) 452 Heart and circulation diseases (Code Nos. 17-21) 1,170 9 Comparative statistics for the year 1953 Table 1 Birth rate Death rate (per 1,000 population) (adjusted) Infant mortality rate (per 1,000 livebirths) Live births (adjusted) Still births Lewisham 13.4 23.5 11.1 22.5 England and Wales 15.5 22.4 11.4 26.8 London Administrative County 17.5 21.0 12.5 24.8 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 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 1953 225,800 3247 14.4 2502 11.1 73 22 44 0.19 10 Causes of death at different periods The following table shows the causes of and Table Nett deaths at the subjoined age of "residents" whether occurring within or without the borough Code No. Causes of death MALES Total persons (i.e., incl. table opp.) All ages Under 1 yr. 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and over Totals, all causes 1313 44 7 9 10 65 3 22 371 485 2502 1 Tuberculosis, respiratory 32 - - - - 8 15 7 2 44 2 Tuberculosis, other 2 - - - - 1 1 - - 4 3 Syphilitic diseases 12 - - - - - 7 3 2 14 4 Diphtheria - - - - - - - - - - 5 Whooping cough - - - - - - - - - - 6 Meningococcal infections 1 1 - - - - - - - 1 7 Acute poliomyelitis 1 - 1 - - - - - - 2 8 Measles 1 - 1 - - - - - - 1 9 Other infective and parasitic diseases 3 - - 1 - - 1 - 1 5 10 Malignant neoplasm, stomach 34 - - - - 2 13 13 6 54 11 Malignant neoplasm, lung and bronchus 83 - - - - 5 34 34 10 96 12 Malignant neoplasm, breast - - - - - - - - - 51 13 Malignant neoplasm, uterus - - - - - - - - - 16 14 Other malignant and lymphatic neoplasms 115 - - 1 4 5 32 31 42 222 15 Leukaemia, aleukaemia 5 - - 2 - 1 - 1 1 13 16 Diabetes 6 - - - 1 - 3 1 1 20 17 Vascular lesions of nervous 128 - - 1 - - 27 42 58 282 18 system Coronary disease, angina 219 - - - - 3 70 70 76 331 19 Hypertension with heart disease 24 - - - - - 1 9 14 61 20 Other heart disease 156 - - - - 7 12 44 93 383 21 Other circulatory disease 49 - - - - 5 10 10 24 113 22 Influenza 24 - - - - 2 5 3 14 59 23 Pneumonia 68 8 1 1 - - 12 15 31 119 24 Bronchitis 128 1 - - - 2 32 43 50 204 25 Other diseases of respiratory system 7 - - - - - 3 1 3 11 26 Ulcers of stomach and duodenum 24 - - - - 2 11 7 4 35 27 Gastritis, enteritis and diarrhoea 4 - - - - 1 1 1 1 11 28 Nephritis and nephrosis 6 - - - - 1 1 3 1 16 29 Hyperplasia of prostate 26 - - - - - 2 9 15 26 30 Pregnancy, childbirth, abortion - - - - - - - - - 1 31 Congenital malformations 11 8 - - - 2 - 1 - 18 32 Other defined and illdefined diseases 96 26 3 2 - 5 16 17 27 214 33 Motor vehicle accidents 12 - 1 - 2 4 - 2 3 15 34 All other accidents 20 - - - 3 4 6 3 4 31 35 Suicide 15 - - - - 5 7 1 2 27 36 Homicide and operations of war 1 - - 1 - - - - - 2 11 of life during the year 1953 ages at death during the calendar year 1953 :— Nett deaths at the subjoined ages of "residents" whether occurring within or without the borough Code No. Causes of death FEMALES Total persons (i.e., incl. table opp.) All ages Under 1 yr. 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and over Totals, all causes 1189 29 2 1 7 50 192 277 631 2502 1 Tuberculosis, respiratory 12 - 1 - - 5 4 - 2 44 2 Tuberculosis, other 2 1 - - - - - - 1 4 3 Syphilitic diseases 2 - - - - 1 - 1 - 14 4 Diphtheria - - - - - - - - - - 5 Whooping cough - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - 1 7 Acute poliomyelitis 1 - - - 1 - - - - 2 8 Measles - - - - - - - - - 1 9 Other infective and parasitic diseases 2 - - - - - - 1 1 5 10 Malignant neoplasm, stomach 20 - - - - - 4 7 9 54 11 Malignant neoplasm, lung and bronchus 13 - - - - 1 6 3 3 96 12 Malignant neoplasm, breast 51 - - - - 5 19 17 10 51 13 Malignant neoplasm, uterus 16 - - - - - 9 4 3 16 14 Other malignant and lymphatic neoplasms 107 - 1 - 1 6 29 31 39 222 15 Leukaemia, aleukaemia 8 - - - - - 4 2 2 13 16 Diabetes 14 - - - - 1 1 8 4 20 17 Vascular lesions of nervous system 154 - - - 1 3 14 36 100 282 18 Coronary disease, angina 112 - - - - - 14 38 60 331 19 Hypertension with heart disease 37 - - - - 1 4 9 23 61 20 Other heart disease 227 - - - - 5 20 36 166 383 21 Other circulatory disease 64 - - - 1 1 9 19 34 113 22 Influenza 35 - - - - 1 6 2 26 59 23 Pneumonia 51 5 - - - 2 6 9 29 119 24 Bronchitis 76 - - - - - 10 20 46 204 25 Other diseases of respiratory system 4 - - - - 1 - 1 2 11 26 Ulcer of stomach and duodenum 11 - - - - - 2 2 7 35 27 Gastritis, enteritis and diarrhoea 7 - - - - 2 2 2 1 11 28 Nephritis and nephrosis 10 - - - - - 4 3 3 16 29 Hyperplasia of prostate - - - - - - - - - 26 30 pregnancy, childbirth, abortion 1 - - - - 1 - - - 1 31 Congenital malformations 7 4 - - - 2 1 - - 18 32 Other defined and illdefined diseases 118 19 - 1 2 6 20 21 49 214 33 motor vehicle accidents 3 - - - - - - - 2 1 15 34 All other accidents 11 - - - 1 1 1 - 8 31 35 Suicide 12 - - - - 4 3 3 2 27 36 Homicide and operations of war 1 - - - - 1 - - - 2 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 1-11 mths. Total under lyr. Tuberculosis, other M - - - - - - - - - - - - F - - - - - - 1 - - - 1 1 Meningococcal infection M - - - - - - - - 1 - 1 1 F - - - - - - - - - - - - Diseases of ear and mastoid antrum M - - - - - - - - - - F - - - - - - - - 1 1 1 Pneumonia M - - 1 - 1 2 4 1 1 - 6 8 F - - 2 - - 2 - 2 - 1 3 5 Bronchitis M - - - - - - 1 - - - 1 1 F - - - - - - - - - - - - Congenital malformations M - 2 2 2 1 7 1 - - - 1 8 F - 1 - - - 1 1 - 1 1 3 4 Injury at birth M 2 1 - - - 3 - - - - - 3 F 2 2 - - - 4 - - - - - 4 Postnatal asphyxia and atelectasis M 5 2 - - - 7 - - - - - 7 F 1 3 - - - 4 - - - - - 4 Congenital debility M - 1 - - - 1 - - - - - 1 F - - - - - - - - - - - - Prematurity M 7 7 - - - 14 - - - - - 14 F 5 1 - - - 6 - - - - - 6 All other causes M - - - - - - - - 1 - 1 1 F 1 1 - - 2 2 - - - 2 4 TOTALS M 14 13 3 7 7 34 6 1 3 - 10 44 F 9 8 2 - - 19 4 2 1 3 10 29 GRAND TOTAL 23 21 5 2 2 53 10 3 4 3 20 73 There were no deaths in the following groups: respiratory tuberculosis, syphilis, typhoid and paratyphoid fevers, diphtheria, whooping cough, measles, influenza, gastritis and duodenitis, hernia and intestinal obstruction, gastroenteritis and diarrhoea, other diseases of early infancy, convulsions, and lack of care of the newborn. 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 in the local offices. The areas served by these local offices are in the main coterminous with postal districts of London and do not coincide with borough boundaries. Lewisham is served by four offices, "Lewisham," "Downham," "Eltham" and "Norwood," but as only a very small portion of the borough comes within the purview of the latter two, it is felt that a better representation of the trend of sickness within the borough is given by quoting only the figures for "Lewisham" and "Downham." Table 5 Average of four weeks ending Lewisham Downham January 27 761 265 February 24 ... 1189 302 March 24 578 165 April 21 407 104 May 19 363 98 June 16 290 75 July 14 300 84 August 11 272 87 September 8 309 81 October 6 372 104 November 3 501 142 December 1 448 134 December 29 339 90 Corresponding figure for November, 1952 486 134 Social class in relation to cause of death Of the 2,513 deaths analysed by us the social categories were as follow Table 6 Social class I II III IV V Total No information Males 41 216 716 218 107 1298 17 Females 29 234 622 190 66 1141 57 Total 70 450 1338 408 173 2439 74 Percentage 3 18 55 17 7 100 - 14 The social class, related to cause of death, was as follows :— Table 7 Code No. Cause of death Male Female 1 II Ill IV V Total I a Ill IV V Total 1 Tuberculosis, respiratory 1 3 19 6 3 32 1 - 7 1 1 10 2 Tuberculosis, other - - 1 - - 1 - - 1 - - 1 3 Syphilitic disease 4 3 1 - - 8 - - - - - - 4 Diphtheria - - - - - - - - - - - - 5 Whooping cough - - - - - - - - - - - - 6 Meningococcal infections - - 1 - - 1 - - - - - - 7 Acute poliomyelitis - - - - - - - - 1 - - 1 8 Measles - - 1 - - 1 - - - - - - 9 Other infective and parasitic diseases - 1 5 - 2 8 - 3 5 1 - 9 10 Malignant neoplasm, stomach 1 7 13 8 3 32 - 1 11 5 1 18 11 Malignant neoplasm, lung, bronchus 3 16 44 14 8 85 - 2 7 1 - 10 12 Malignant neoplasm, breast - - - - - - - 11 33 7 1 52 13 Malignant neoplasm, uterus - - - - - - - 2 12 1 - 15 14 Other malignant and lymphatic neoplasms 4 18 70 21 9 122 5 28 55 10 8 116 15 Leukaemia, aleukaemia - 1 8 1 - 10 - 4 9 2 1 16 16 Diabetes - - 3 1 1 5 - 1 1 1 1 4 17 Vascular lesions of nervous system 3 27 69 21 16 136 5 25 91 29 6 156 18 Coronary disease, angina 5 39 101 20 7 172 4 24 38 11 4 81 19 Hypertension with heart disease - 8 23 6 2 39 - 17 22 4 5 48 20 Other heart disease 4 16 67 26 9 122 7 36 96 34 12 185 21 Other circulatory disease 4 24 40 17 9 94 2 28 55 23 2 110 22 Influenza - 2 10 2 1 15 - 2 7 4 1 14 23 Pneumonia 5 8 41 12 8 74 - 16 35 15 6 72 24 Bronchitis 3 17 75 26 12 133 2 12 36 14 8 72 25 Other diseases of respiratory system - 1 10 - 1 12 1 4 4 2 - 11 26 Ulcer of stomach and duodenum - 2 13 4 4 23 - 2 5 1 1 9 27 Gastritis, enteritis and diarrhoea - - - - - - - - - - - - 28 Nephritis and nephrosis - 1 7 - 1 9 - 1 9 1 - 11 29 Hyperplasia of prostate - 4 12 7 - 24 - - - - - - 30 Pregnancy, childbirth, abortion - - - - - - - - - - - - 31 Congenital malformations 1 1 7 2 - 11 - 1 3 2 1 7 32 Other defined and illdefined diseases 2 6 56 12 7 83 1 11 61 14 6 93 33 Motor vehicle accidents - 2 5 3 - 10 - - 1 1 - 2 34 All other accidents - 4 8 6 1 19 1 2 8 3 - 14 35 Suicide - 5 6 3 3 17 - 1 7 3 - 11 36 Homicide and operations of war - - - - - - - - 2 - - 2 No social class assessed - - - - - 17 - - - - - 57 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. 1 3 20 6 3 33 1 - 8 1 1 11 °/ /o 3 9 61 18 9 100 9 - 73 9 9 100 10-15 Cancers No. 8 42 135 44 20 249 5 46 127 26 11 227 % 3 17 54 18 8 100 2 20 62 11 5 100 17-21 Heart and circulation No. 16 114 300 90 43 563 18 130 302 101 29 580 % 3 20 53 16 8 100 3 23 52 17 5 100 12-25 Lung, non-TB No. 8 28 136 40 22 234 3 34 82 35 15 169 % 3 12 58 18 9 100 2 20 48 21 9 100 33,34 Accidents No. - 6 13 9 1 29 1 2 9 4 - 16 % - 21 45 31 3 100 6 12 57 25 - 100 35 Suicide No - 5 6 3 3 17 1 7 3 - 11 % - 29 35 18 18 100 - 9 64 27 - 100 16 The following table shows the social classification in relation to registered births, registered infant deaths, notified stillbirths and 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; the percentages in the category of registered births can be compared with those for the registered deaths shown in table 6. Table 9 Social classification Total Not classifiable 1 II III IV V Registered births No. 113 564 2001 363 202 3243 18 % 3 17 63 11 6 100 Registered infant deaths No. 2 8 51 8 5 74 - % 3 11 68 11 7 100 Registered stillbirths No. 1 5 44 9 4 63 - % 2 8 70 14 6 100 Notified premature births No. 9 38 125 27 13 212 1 % 4 18 59 13 6 100 Lung cancer In the last report I gave details of recent statistics for the borough, particularly in relation to wards. The increase in cases still continues and last year there were 83 male deaths and 13 female deaths from this disease compared with 77 and 9 respectively in the previous year. I mentioned the association with tobacco smoking, particularly cigarette smoking, in the report and this association has subsequently received considerable publicity on a national scale, including a statement by the Minister of Health and by the offer of a large sum of money by tobacco companies for investigation of the disease. Perhaps the exact nature of the association will become apparent shortly, or perhaps it may turn out to be one of the mysterious problems which take a long time to unravel. In the meanwhile, therefore, it is only right that public attention should again be called to the fact that this form of cancer is one which is to a large extent preventable through action by the individual, namely by giving up or considerably curtailing the amount of tobacco, particularly cigarette tobacco, used. This is of more importance the younger the person is, as lung cancer may take 20-30 years to develop. Coronary disease Another cause of death, which, like lung cancer, has increased rapidly in recent years, is disease of the main blood vessels of the muscles of the heart itself — the coronary arteries. This disease, which has ■ 17 always been considerably more prevalent in the higher than in the lower social groups and which has been thought to be associated particularly with the so.called "nervous strain of living," appears to be undergoing a decrease in gradient as far as social groups are concerned. This social class difference may, however, not be so real as it appears to be, probably from the fact that coronary death certification is not fully differentiated from death certification from other heart diseases. Allied diseases which may get mixed up with coronary disease are those shown in the Registrar General's short list numbers 19, 20 and 21, namely hypertension with heart disease, other heart disease, and other circulatory disease respectively. The following table shows deaths from these causes in the borough in representative years since 1928, the last columns showing the percentages which the total deaths in different subdivisions of the group bear to the total deaths from all causes :— Table 10 Heart and circulation mortality Year Deaths from Total heart and circulation (all ages) Age group 45.65 Total deaths in borough Percentage Coronary diseases Other heart diseases Other circulatory diseases Total Coronary diseases (e) of (h) (f)of (h) (g) of (h) (a) (b) (c) (d) (e) (f) (g) (h) (i) (J) (k) 1928 357 97 454 115 ? 1993 23 5.8 ? 1933 516 117 633 162 ? 2271 28 7.1 ? 1938 659 139 798 178 ? 2403 33 7.4 ? 1943 583 64 647 129 ? 2359 27 5.5 ? 1948 696 63 759 155 ? 2253 34 6.9 ? 1953 775 113 888 140 . 2502 35 5.6 . 1950 281 519 79 879 158 79 2413 36 6.5 3.3 1 288 528 78 894 154 87 2542 35 6.1 3.4 2 327 537 86 950 180 89 2580 37 7.0 3.5 3 331 444 113 888 140 84 2502 35 5.6 3.4 ? means figure not available Apart from the socalled "nervous strain" and "pressure of living," it has been suggested, with more and more evidence (none of it however conclusive), that dietary factors may be of considerable importance both in coronary disease and also in other degenerative diseases of the heart and blood vessels. Statistics from certain occupied countries, particularly Norway, during the war, when diet was considerably different to what it was in prewar and postwar times, indicate that excess fat food and more particularly perhaps excess dairy produce may have an effect on these circulatory conditions. It is known that the state of blood vessels has some connection with the amount of a substance called cholesterol 18 in them and in the body, and cholesterol is present in high degree in most fat foods and in dairy produce, particularly the yolks of eggs. Nevertheless, it is true to say that the effect of dietary cholesterol on the condition of the arteries is still highly obscure, and much more research work requires to be done on the subject. At present it is perhaps desirable only to point out that there may well be an association between a high dietary cholesterol and a high incidence of heart disease and individuals may feel that they should be sparing in the amount of eggs (particularly the yolks), butter, and fat food generally, which they consume. Overweight in itself has been known for many years to be associated with degeneration of the heart and blood vessels. It will be interesting to see if the derationing of butter and the increased availability of eggs has any effect on the incidence of coronary heart disease, though perhaps owing to economic considerations the derationing—of butter anyhow—may not have much effect on consumption. Margarine contains a relatively negligible quantity of cholesterol — about one-seventh that of butter. Deaths under age 65 The last two paragraphs, lung cancer and coronary disease, deal with two conditions which affect relatively younger persons. A reference to column 5 of table 12 on pages 20 and 21, will show how great has been the decrease in the deaths of youngish people over the years, but much scope for improvement remains. Death under the age of 65 is, apart from personal and family distress, economically serious to the nation as it represents so many man-years of productive labour wasted. Clearly, therefore, the diseases which kill below that age should be in the forefront of any concerted attack designed to improve the public health. The following table indicates the main enemies; they are formidable, but even now some of them would appear to be giving ground, or to be revealing different ways by which they may be attacked. Table 11 England and Wales, 1952. Years lost per 10,000 population* Short list No. Disease Aged 15-64 Remarks M F 1 TB, respiratory 37 26 10-15 All cancers 113 98 Lungs (M) 34; breast (F) 22 17 Vascular lesions of nervous system 30 32 18-20 Cardio-vascular diseases 106 56 Coronary: M 66 ; F 16 23,24 Pneumonia, bronchitis 93 53 33,34 Accidents 97 27 1-36 All causes of death 834 549 *Modified from a table by Dr. Logan of the General Register Office (Med. Off., 1954, 1, 252). 19 Census of distribution and other services The Census of Distribution Committee of the Board of Trade, in a report published in 1946, recommended the taking of a census and indicated the trades to be covered and the type of information to be collected. The first "Census of Distribution and Other Services" was taken by the Board of Trade in 1951, being conducted by post, and traders were required to make returns for the calendar or business year 1950. The report, published by the Board of Trade in 1953, shows that in Lewisham there were 2,248 establishments whose major activity came within the category of either retail or service trade. These establishments employed 4,880 males and 3,944 females fulltime and 2,515 persons parttime. There were 10 establishments classed as "central offices and warehouses" belonging to the larger multiple organisations employing 233 persons. Details are given in appendix D. General Statistics from 1901 Table 12 Year Population Death rate * % dying under age 45 % dying under age 65 Birth rate * Premature birth rate ‡ Maternal death rate † Stillbirth rate † Neonatal death rate ** One month to one year death rate (12.(10) ** Infant mortality rate ** Reproductive wastage rate (9)+(12) Pulmonary tuberculosis Tuberculosis (all forms) Notif. rate* Death rate* % notif. rate under 15 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 1901 127,495 13.0 - 74.1 25.9 - 3.9 - - - 128 - - 0.93 - 1902 132,432 13.7 - 74.1 26.3 - 4.3 - - - 122 - - 1.06 - 1903 136,405 11.1 - 71.7 26.1 - 2.5 - - - 92 - - 0.78 - 1904 140,401 120 - 69.9 25.6 - 3.6 - 122 - - 0.84 - 1905 144,420 11.7 - 67.2 25.2 - 2.8 - 30 63 93 - - 0.87 - 1906 148,463 120 - 71.6 23.2 - 2.0 - 30 83 113 - - 0.80 - 1907 152,532 11.5 - 67.1 23.7 - 2.5 - 34 56 90 - - 0.90 - 1908 156,627 110 - 68.1 22.8 - 1.4 - 30 57 87 - - 085 - 1909 160,749 10.4 - 62.8 21 .9 - 2.0 - 35 40 75 - - 0.78 - 1910 164,899 9.7 - 64.9 20.7 - 2.6 - 29 50 79 - - 0.55 - 1911 161,677 11.4 46.2 68.0 21.2 - 2.3 - 31 73 104 - - 0.64 - 1912 165,249 10.5 39.5 63.1 20.3 - 2.8 - 30 39 69 - 2.1 0.68 110 1913 168,822 10 7 42.6 65.3 20.3 - 2.6 - 28 48 76 - 1.8 0.73 25.2 1914 169,211 10.9 39 6 61 .7 19.5 - 3.3 - 27 46 73 - 1.4 0.77 17.8 1915 164,438 12.9 36.3 60.8 19.3 - 4.0 - 30 49 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 174,750 114 34.9 59.1 16.6 - 3.1 - 28 32 60 - 1.8 0.86 22.2 1920 174,698 10.8 38.2 59.5 22.8 - 3.8 - 32 30 62 - 1.6 0.73 21.8 1921 175,800 10.5 33 8 57.6 19.5 - 2.6 - 23 31 54 - 1.3 0.81 18.4 1922 176,600 11.1 30.9 56.8 18.1 - 2.5 - 26 28 54 - 1.5 074 15 7 1923 182,400 10.1 31 .2 56.3 18.0 - 3.6 - 20 23 43 - 1.5 0.76 16.9 1924 184,900 10.5 29.5 55.6 16.4 - 3.6 - 23 24 47 - 1.5 0.68 21.6 1925 185,600 10.3 29.6 55.6 15.6 - 16 - 23 32 55 - 1.3 0.63 15.4 1926 187,800 10.0 29.0 54.2 15.4 - 2.1 - 18 22 40 - 1.6 0.71 16.9 1927 188,600 11.0 27.6 53.3 15.1 - 2.1 - 35 21 46 - 1.6 0.92 12.3 1928 199,300 100 29.0 54 4 15.2 - 2.3 - 22 30 52 - 1.7 0.77 15.1 1929 207,900 11.5 26 7 52.5 15.7 - 5.3 - - 44 - 1.4 0.74 13.3 1930 207,900 9.7 27.9 53.1 15.1 - 0.9 37 - — 42 79 1.5 0.76 12.3 20 Table 1 2 continued. Year Population Death rate * % dying under age 45 % dying under age 65 Birth rate * Pre. mature birth rate Maternal death rate † Stillbirth rate † Neonatal death rate ** One month to one year death rate (12.(10) ** Infant mortality rate ** Reproductive wastage rate (9) +(12) Pulmonary tuberculosis Tuberculosis (all forms) % notif. rat under15 Notif. rate* Death rate* (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 1931 220,800 10.2 25.6 51.7 14.1 - 4.9 31 25 24 49 80 1.3 0.69 13.6 1932 221,500 10.2 26.0 49.4 12.7 - 3.4 32 31 23 54 86 1.2 0.59 10.7 1933 221,100 10.2 21 9 49.8 12 2 - 26 31 21 18 39 70 1.2 0.68 9.2 1934 222,180 10.1 23.5 50.5 12.2 - 1.5 36 21 22 43 79 1.3 0.58 14.4 1935 223,000 100 226 46.7 12.5 - 4.3 35 24 19 43 78 1.2 0.58 12.7 1936 224,000 10.9 23.1 48.1 13.0 - 20 37 23 32 55 92 1.3 0.62 11.6 1937 226,000 10.9 20.4 46.7 13 4 - 1.3 39 18 29 47 86 1.5 0.59 11.9 1938 229,000 10.5 23.3 48.7 13.9 - 2.1 26 - - 47 73 1.1 0 61 12.4 1939 220,300 10.8 - - 13.6 - 2.9 34 - - 42 76 1.1 0.64 11.6 1940 192,540 15.8 22.1 50.0 14.7 - 1.0 24 - - 45 69 1.1 0.67 11.1 1941 148,150 14.3 21.7 48.1 13.9 - 1.9 29 - - 34 63 1.8 0.93 10.2 1942 161,800 12.0 18.4 43.8 16.8 - 3.2 37 - - 37 74 1.8 0.73 15.3 1943 168,530 13.9 20.5 44.9 18.7 - 3.1 25 - - 42 67 19 0.76 13.6 1944 163,320 14.8 21 4 48.8 18.6 - 1.0 22 - - 40 62 1.9 0.79 10.8 1945 171,280 12.1 20.5 43 4 17 7 - 1.9 18 - - 34 52 1.8 0.71 13.2 1946 207,410 10.6 17.5 43.0 21.7 - 1.1 21 - - 33 54 1.9 0.53 15.4 1947 221,170 119 17.0 41 .9 21.9 - 1.0 21 - - 33 54 16 0.55 12.4 1948 226,100 9 9 15 6 40.7 18 9 - 0.5 15 15 13 28 43 2.0 0.48 15.7 1949 227,700 10.2 10 7 34.9 16 8 - 0.3 16 13 6 19 35 1.5 0.40 12.4 1950 228,300 10.6 11.2 35.2 15 3 - 0.6 15 19 7 26 40 1.6 0.29 12.6 1951 227,200 11.2 10.1 33 6 15.3 67 0.3 16 17 8 25 41 1.2 0.26 14.7 1952 227,100 11.4 8.7 320 13 9 86 0.3 18 16 6 22 40 12 0.15 8.8 1953 225,800 11.1 8.9 29.5 14.4 75 0.3 23 16 6 22 45 1.4 0.19 11.4 *per 1,000 population, fper 1,000 notified livebirths. **per 1,000 registered livebirths. † per 1,000 registered live and stillbirths. — equals figure not ovailable. 21 22 SECTION "B" —GENERAL PROVISION OF HEALTH SERVICES Disinfection and personal cleansing The disinfecting station and the cleansing station are situated at Wearside Road Depot. An extension to the main building provides accommodation for the superintendent and a messroom for the staff. A washing machine with a capacity of 11 cubic feet is installed in the part of the disinfecting station where bedding and clothing are received for disinfection and there is a calender in the 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 this 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 13 West North South Total Disinfections Premises visited 214 141 214 569 Rooms disinfected 465 321 461 1247 Articles disinfected 3164 3856 2292 9312 Disinfestation Premises visited 53 60 9 122 Rooms disinfested 191 173 33 397 Articles disinfested 45 273 28 346 Articles treated Beds 77 51 70 198 Mattresses 216 242 261 719 Bolsters 52 43 55 150 Pillows 427 402 420 1249 Cushions 67 45 32 144 Quilts 120 82 137 339 Blankets 543 1047 583 2173 Sheets 145 226 144 515 Household articles 500 853 364 1717 Wearing apparel 1062 1138 255 2455 Total articles 3209 4129 2321 9658 23 Table 13—continued West North South Total Articles received from cleansing station - 3700 - 3700 Articles received from Coroner's court - 491 - 491 Public library books treated after infection 195 352 260 807 Private library books treated after infection 26 14 18 58 Articles treated under the Public Health (London) Act s.122 6519 2675 17718 26912 A more detailed analysis of treatments for verminous conditions and for scabies is shown :— Verminous conditions Table 14 First cleansing Second cleansing Third cleansing Fourth cleansing Children under 5 44 1 - - School children 654 77 8 - Adults 51 5 2 1 TOTALS 749 83 10 1 Scabies Cases Treatments Children under 5 6 12 School children 19 42 Adults 10 24 TOTALS 35 78 Treatment by disinfection Rooms and furniture are sprayed with a solution of Dettol and Pine. Bedding is steam treated with a pressure from 10-201bs. per square inch. Articles are either steam treated with a pressure from 5-l0lbs. 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. London County Council (General Powers) Act, 1953 Section 43 of the above Act states that, on receipt of a report from the medical officer of health or a sanitary inspector that any aged person within their district is verminous or is for any other reason in 24 need of cleansing in order to prevent injury or the danger of injury and is so enfeebled that he is unable to avail himself of any facilities for cleansing himself provided by the authority or to cleanse himself properly, the sanitary authority may on the application or with the consent of that person (but not otherwise) cause him to be cleansed free of charge at the place where he resides or at any other suitable place. The authority is enabled to make such arrangements and provide any apparatus required to exercise these powers. It has not been necessary to arrange for the cleansing of any person under this section. Anti-fly and anti-mosquito campaign In his report on the campaign for 1953, which was held from May 4 to October 1, Mr. Phillips, the deputy senior sanitary inspector who is in charge of anti-pest work, says:—"As in previous years four men were employed working as pairs. In 1953, however, a second light van was available and so both pairs were equipped with light vans in place of the motor cycles and sidecars which had been used previously. This was found a big advantage as mattresses and other material in a very wet condition could be placed in the van and taken direct to the wharf for disposal instead of other transport having to be arranged for or the material having to be disposed of on the site, resulting in the use of much paraffin and the production of much smoke." 527 bombed sites, grass verges and rear garage ways were visited on 6 occasions each and necessary treatment was carried out by spraying or the use of powder. The bombed sites showed a marked decline in number from the previous year due to re-development, but of those remaining some were in a much worse condition than previously, due possibly to the fact that dealers are loth to collect materials which have little or no salvage value. There is no doubt that some of the materials emanate from disreputable dealers who sort their vans near a bombed site and discard what is of no value. The following were collected from bombed sites or destroyed on the site :— 145 mattresses; 7 pillows; 6 cushions; 12 carpets; 10 feather beds; 22 articles of furniture; and a quantity of flock, rags, clothing and linoleum. 24 gallons of paraffin were used in the destruction of this material on the sites. A remarkably large quantity of bread was found on sites, no doubt an encouragement for rats. 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. The powder contained gammexane and was applied to dustbins at the time of refuse collection. Altogether 3½ tons of powder containing 0.5 percent gamma benzene hexachloride was used. 8 stables or piggeries, 9 allotment sites, and one plot of land known to be particularly bad as a rubbish tip were treated as special sites and visited on 20 occasions each, particular attention being paid to the manure receptacles at the stables and piggeries and the compost heaps on the allotments. Throughout the campaign daily visits were paid to Lewisham Hospital to spray the refuse container there and also the site of the kitchen waste bins. 25 20 visits were also paid to both this Council's and the London County Council's blocks of flats where dustchutes are used. 189 dustchutes with 628 openings were sprayed. One private block containing 9 chutes with 27 openings was also included in this treatment. The caretakers of this Council's flats were also provided with sprayers, insecticide and powder, for use in connection with the containers at the base of the dustchutes, particularly after these had been cleaned out, and for the sites of the bins used for the storage of kitchen waste. Three-quarters of a hundredweight gammexane powder and 35 gallons of 5 percent DDT were used. In addition treatment by spraying was carried out in 19 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 sprayers, a total of 9 gallons of insecticide being dispensed in this way. The assistance of the department was also requested in the autumn in one case where a large number of flies were interfering with the work in a factory. These flies were identified as coelopa frigida (seaweed fly) and spraying was carried out by the disinfectors. 12 static water tanks and sections of the rivers where the water had become stagnant were sprayed with 5 percent DDT in kerosene base as an anti-mosquito precaution on 6 occasions. Materials used in the main campaign were as follows :— General spraying 840 gallons tip dressing (approximately 4i percent DDT in aqueous suspension). Static tanks, etc.:—65 gallons of 5 percent DDT in kerosene. Accumulations of rubbish, dog excreta, etc.:—401bs. of 10 percent DDT powder and 771bs. 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, or to the laboratory at County Hall. This service is provided by the Public Health Laboratory Service which is directed by the Medical Research Council, and apart from examinations of nose and throat swabs, sputum, faeces, urine, blood, cerebrospinal fluid, exudates, swabs from situations other than the nose and throat, washings of infected cavities, hair and scales for ringworm, biopsy material for trichina larvae and so on, provision is also made for the examination of water, shellfish, sewage, milk, icecream, retail food and certain other materials. Specimens from general practitioners 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, 26 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 1953 :— Table 15 Specimen Number Remarks Faeces 282 Negative 72 Positive — Shigella sonnei 5 ,, —Salmonella typhi-murium 5 ,, —Salmonella enteritidis Urine 6 Nose swabs 39 C. diphtheriae not isolated in any case. Throat swabs 109 Sputum 21 Negative 1 Positive for TB. Blood 1 Serological, for syphilis — negative. Milk 57 Dried Milk 1 Icecream 64 Water 17 Synthetic cream 1 Dried egg 1 Meat 4 Negative 1 Positive — TB present. Custard 2 Stewed apple 1 Gravy 1 Swab from mincer 1 Potato and greens 1 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 jurisdiction for an order for the removal of the person to a suitable hospital or other place in, or within convenient distance of, the area of the local authority and for his detention and maintenance therein. In order to enable local authorities to deal expeditiously with certain types of cases, the procedure required under section 47 of the National Assistance Act, 1948 has been simplified by the National Assistance (Amendment) Act, 1951, which enables the medical officer of health to make direct application to the court, provided there is supporting medical evidence. 27 Several possible cases were investigated during the year, but in no instance was it necessary to apply to the court for an order for compulsory removal. National Assistance Act, 1948 — section 50 Under section 50 of the above Act, it is the duty of the local authority to arrange for the burial or cremation of the body of any person who has died or been found dead in their area if it appears that no suitable arrangements for the disposal of the body have or are being made. The local authority can recover expenses incurred from the estate of the deceased person or from any person liable to maintain the deceased person immediately before his death. The recovery of expenses is subject to any payment received by the authority from the Ministry of National Insurance under the National Insurance Act, 1946. During the year the Council accepted responsibility for the burial of 7 persons, at a net cost of £20 14s. 0d. 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 801, of which 459 were received from institutions. 801 postmortem examinations were made and inquests were held in 120 cases. Details are shown in the following table :— Table 16 Month Bodies received from Institutions Others Post-mortem examinations Inquests Lewisham residents Others January 41 57 69 29 11 February 60 42 65 37 16 March 32 41 47 26 9 April 33 22 30 25 9 May 35 18 31 22 7 June 34 20 31 23 6 July 40 24 34 30 12 August 36 19 27 28 12 September 16 16 18 14 3 October 56 26 56 26 16 November 40 24 33 31 8 December 36 33 38 31 11 TOTALS 459 342 479 322 120 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 17 Parliamentary Division Total West North South Properties inspected on complaint 578 481 351 1410 Properties otherwise initially inspected 1299 1134 685 3118 Premises baited :— Initial treatments 622 602 547 1771 Retreatments (infestation found) 656 633 576 1865 No infestation found (initially or at reinspection) 892 1178 1083 3153 Total visits 6045 4167 4820 15032 Rivers and ditches, base points 72 493 219 784 Other premises, base points 178 163 148 439 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 1953, treatments were carried out from June 15 to July 4 and from November 30 to December 19. 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 equal to the prebait. In any case at least 8 ozs. of poison bait was deposited. Poison takes were not inspected. The following is a summary of the results obtained :— Summer treatment Manholes baited 2,935 Manholes showing prebait take 888 Manholes showing complete prebait take (on one or both days) 403 29 Winter treatment Manholes baited 2,934 Manholes showing prebait take 900 Manholes showing complete prebait take 516 The bait used for both treatments was sausage rusk, whilst zinc phosphide was the poison used. 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 1953, 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 18 Location Base points Prebaiting Poison bait Estimated rats killed Days on which prebait laid Takes Results Partial takes No takes Amount laid (ozs.) Amount taken (ozs.) (Est.) River Pool 54 3/4 34 - 20 77 39 80 River Quaggy 50 3 29 - 21 80 40 90 River Ravensbourne 350 3/4 212 5 133 535 273 600 Ditches— Pattenden Road* - - - - - - - - Reigate Road to cemetery, Verdant Lane 18 3 10 - 8 30 15 35 Allotments, Verdant Lane to cemetery, Verdant Lane 18 3 11 - 7 30 15 35 Wydeville Manor Road* - - - - - - - - Fernbrook Road to Milborough Crescent 18 3 14 - 4 30 15 35 Chinbrook Meadows to Grove Park Hospital 18 2 10 - 8 24 12 30 *Inspected but no evidence of infestation found. Prevention of Damage by Pests Act, 1949 A copy of the annual report covering the period 1 January, 1953 to 31 March, 1954, submitted to the Minister of Agriculture and Fisheries, as required by the provisions of the above Act, is appended. 30 Table 19 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 (") (b) Major Minor Local authorities' property 116 8 23 - 5 3 8 Dwelling houses 61,120 1,307 2,975 - 1,825 201 2,026 Agricultural property 44 6 19 - 6 - 6 All other property (including business and industrial) 3,990 89 101 - 87 9 96 TOTAL 65,270 1,410 3,118 - 1,923 213 2,136 Number of "block" control schemes carried out 12 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. Four such block control treatments were carried out in respect of rats during the year. Details are as follows :— Table 20 Location Properties* Base points Prebaiting Poison bait Estimated rats killed Days on which prebait laid Results Amount laid (ozs.) Amount taken (ozs.) (Est.) Takes Partial takes No takes Chelford Road/ 7 14 4 4 1 2 18 11 20 Ansford Road 4 7 4 1 - 3 4 3 7 Honor Oak Road/ 8 - - - - 8 - - - Canonbie Road 15 5 4 - 4 11 10 3 7 Pearfield Road/ 10 13 4 2 4 4 26 7 15 Wynell Road 5 9 4 1 2 2 18 4 10 Upwood Road 49 22 4 11 - 38 37 13 20 *Included in Table 19 31 In his report on rodent control work during 1953, Mr. Walker, the senior sanitary inspector, states :— "The rodent control staff dealt with about the same number of infestations as last year, and again no rat infestations of a major character were encountered. An increasing number of requests for assistance in exterminating mice have been received. The method used for heavy infestations is poison bait, and, in less serious cases, traps are also used or lent, and advice given as to their use. "The methods and poisons used in baiting both for rats and mice are those advised by the Ministry of Agriculture and Fisheries. In the use of Warfarin the Ministry have suggested an increase in the proportion of master mix to the oatmeal or other base used and the results have been most encouraging. In the case of rats, the infestations have been cleared up in a much shorter period, and for mice far greater success than before has been achieved. "The usual inspections and treatment of the rivers in the borough were carried out, and fewer infestations were discovered than in the previous year. Sewer treatments were carried out on two occasions. As yet there seems to be no definite evidence that this work affects the incidence of above-ground infestations." 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 6 - Ladywell — first class 5 - — second class 9 - Forest Hill — first class 1 - — second class 1 - Private baths 1 2 A detailed report on the use of breakpoint chlorination, which is the method employed at the baths, was included in my annual report 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 £2,100 was included in the annual estimates for the year 1953-54 for such 32 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 :— £ s. d. Lewisham Old People's Welfare Association 1,500 0 0 Lewisham Darby and Joan Club 300 0 0 Over 60's Club 18 0 0 St. Mark's Old Folks' Club 65 0 0 Talbot Settlement Old People's Club 37 10 0 The Good Companions Personal Service 24 0 0 St. Swithun's OAP Association 50 0 0 Bellingham Old People's Club 62 10 0 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. LOPWA is responsible for the Meals-on-Wheels service to housebound old people. 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, nearly 27,000 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 have reported in each of the last two years that I have been in touch with the regional hospital board and the local group hospital management committee to find out if it were possible to help early cases of incontinence by admission to hospital for rehabilitation. For this purpose it would be desirable to set up a geriatric unit in a local hospital, but I regret to say that no progress has been made in this direction. 33 Measurement of atmospheric pollution Table 21 gives a record of the principal results from the 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 relate to the nearest station which records the particular item concerned. See Tables overleaf. 34 Atmospheric Condition Table Temperature Rainfall Sunshine* Wind* Mean max.* Mean min* Mean* Difr. from av* Highest max.† Lowest min. † Total† % av.* Daily mean % av. NE/E/ SE s/sw/w N W| calm Jan. ºF °F °F °F °F °F in. hr. % % % 40.9 34.7 37.8 — 2.3 56 29 0.43 53 0.78 52 9 62 29 Feb. 44.4 35.3 39.9 — 0.5 57 26 1.26 63 1 .89 84 15 53 32 March 50.6 34.1 42.3 — 1.4 67 30 0.35 18 3.50 93 50 28 22 April 53.9 40.4 47.1 — 1.1 65 34 1.89 150 5.43 109 37 52 11 May 64.4 48 0 56.2 + 2.5 88 40 1.46 79 7.82 122 37 37 26 June 66.6 51 .2 58.9 — 0.6 83 45 106 72 5.41 75 22 36 42 July 69.3 54.2 61 .7 — 1.3 82 52 2.96 129 6.47 97 10 80 10 August 72.2 54.7 63.5 + 1.0 93 49 1.26 53 7.76 125 6 75 19 Sept. 66.3 50.2 58 3 — 0.3 75 47 2.44 142 6.27 131 16 65 19 Oct. 57.7 46.4 52.1 + 0.5 70 38 2.96 123 2.67 80 23 35 42 Nov. 52.3 44.4 48.3 + 3.6 59 33 1.73 44 1.84 106 6 84 10 Dec. 49.3 42.4 45.9 + 5.2 60 31 0.51 21 1 .08 83 31 43 26 Average - - - - - - 18.31 (total) - - - 22 54 24 *Croydon ; †Lewisham ; TPMI2, tons per square mile per month; q as trioxide in mg per 100 35 1953 21 Atmospheric Pollution† Weather summary Pool Allotments Verdant Lane Wearside Road later insol. matter Water sol. matter Sulphur Water insol. matter Water sol. matter Sulphur Water insol. matter Water sol. matter Sulphur PMI2 TPMI2 q TPMI2 TPMI2 q TPMI2 TPMI9 q Dry; severe gale at end 4.61 5.54 2.52 9.22 4.31 3.04 7.84 4.74 3.54 4.09 5.36 2.33 8.23 5.27 2.38 12.88 8.10 3.37 Mainly dry; cold at first, then mild 16.07 10.01 2.82 11.33 12.78 2.73 13.83 11.23 3.52 Dry; fairly sunny; quiet with fog 15.54 7.46 1.38 7.05 7.93 1.13 10.60 7.94 1.80 Sunny; wet; rather cool 14.05 3.25 1.29 7.57 3.49 0.97 13.01 4.74 0.97 Warm; sunny; dryish 14.05 7.32 1.21 8.48 6.36 1.12 11.02 6.60 1.77 Dull; cold at first; dryish 17.80 6.82 0.59 5.17 3.95 048 7.11 3.82 0.82 Unsettled and wet; rather cool 17.70 4.74 1 05 8.07 5.76 0.51 6.72 402 1.02 Mainly fair; then changeable 17.96 12.23 1.14 8.17 876 0.73 5.53 7.97 1 .42 Fine at first; then heavy rain 15.54 8.98 0.77 6.98 8.17 1.40 14.39 8.63 2.47 Dull and quiet 1.37 7 88 2.41 4.87 6.65 1.81 7.11 8.50 2.80 Mild; low rainfall 16.14 7.49 2.35 7.31 7.58 2.62 10.93 8.73 3.39 Unusually mild; very dry but dull 5.99 7.26 1.65 7.62 6.75 1.58 10.08 7.08 2.24 cm Per day. 36 South Eastern Gas Board — Gasworks at Bell Green Over a period of many years complaints have been received of nuisance from the emission of smoke, grit and fumes from the gasworks at Bell Green. Complaints continued to be received in the early part of 1953 and it was decided that observations on the quantity and quality of the emissions should be made by the council's sanitary inspectors. As a result of these observations it was not possible to prove that there was any contravention of the byelaws (which only permit of action where black smoke is emitted in the aggregate of two minutes in a halfhourly period). The South Eastern Gas Board and its predecessors the South Suburban Gas Co. have been aware of the complaints, and over a period of years various alterations to the plant and the general management of the gasworks have been carried out with a view to minimising nuisances which may be caused. In order to secure a full discussion on this matter, the South Eastern Gas Board received a deputation consisting of the MP for the West Division of Lewisham and representatives of the Council and its officers. The nature of the complaints, together with other factors attributed to the nuisance experienced from the gasworks, were discussed with the Board's representatives; a detailed inspection of the works was made and the Board's representatives gave information as to the measures carried out and under consideration to secure amelioration of any nuisance. As a result of the inspection the deputation were impressed with the efforts which had been made, particularly by the installation of grit arrestors and the gravelling of a large area of the Works, but considered that the horizontal retort houses were responsible for the majority of the complaints. The Board's representatives admitted that a considerable amount of smoke and dust was caused every time one of the horizontal retorts was charged, but said that a new form of charging machine had been ordered, which if successful, would be installed to replace all the present charging machines. In view of the extremely high cost, which could result in an increase in the price of gas to consumers, no guarantee could be given to replace all the horizontal retorts by vertical retorts, before the former were worn out. At the meeting I submitted a statement which (omitting the history) can be precised as follows General data The works have been in existence about a hundred years. They are the third largest works south of the Thames. They handle approximately 1,000 tons of coal a day and about 500 tons of coke are despatched from them each day. The River Pool runs through the gasworks and a large amount of water is abstracted from it daily. This is used for various processes. Water is also abstracted from wells and all the water after use is returned to the river through some half dozen effluents. The Works are in the Sydenham East ward and have a large concentration of population to their south and west. There is the large Bellingham estate on the east and northeast, but as far as the 37 northeast is concerned it is separated from the Works by a small open space (Bellingham Playpark) and a recreation ground. Bordering the Works on the north is Selworthy Road and behind that Winsford Road and other property. Effects The following must be considered :— (1) Effects on the air. (2) Effects on the river. (3) Effects on riverside allotments and gardens. (4) Effects on illhealth and deaths associated with fog. (5) Effects on the incidence of lung cancer. (6) Psychological effects on local residents and material effects on their property, including the SE Children's hospital. (1) Effects on the air Points to note are (a) the high degree of pollution at the Pool Allotments station (which is between a quarter and half mile from the gasworks), (b) the preponderant amount of total water-insoluble deposit, (c) the relatively small amount of sulphur (this is in line with the fact that some sulphur is removed in gas production), (d) the increasing amount of total pollution at Pool Allotments in the summer and autumn of 1953. A comparison with other pollution measuring stations in London shows that the Pool Allotments pollution had been getting rapidy worse both relatively and absolutely. Thus in May, 1953, of 28 stations in London, Pool Allotments was the ninth highest but it did not show more than double the pollution of any other station. In June, of the 30 stations then in London, Pool Allotments was the eleventh highest and had more than double that of two of the London stations. In July, when there were 29 stations, Pool Allotments was the sixth highest and had more than double eleven of the other stations, while in August, 1953, of 38 stations then established in London, Pool Allotments was the fifth highest of all these and had more than double the pollution of 22 of them. A comparison has also been made with other stations in Kent and Surrey (since Pool Allotments is virtually on the London border of Kent and near the London border of Surrey). In August, 1953 (the last month for which figures were then available) there were 36 stations in Kent and Surrey measuring atmospheric pollution. The average water insoluble deposit for these 36 stations was 6.93 tons per square mile while the Pool Allotments deposit was 17.70 tons per square mile. Only two of the 36 stations were higher than Pool Allotments, and Pool Allotments in fact had more than twice the amount of pollution of 29 of these 36 stations. (2) Effects on the river A recent set of analyses of river water indicated that during its passage through the gasworks the suspended matter in the water is increased from 6 to 16 parts per million and the biological oxygen 38 demand (BOD) is raised from 3.1 to 23.9 parts per million. A Royal Commission took the view that a river water taking up more than 4 parts per million oxygen will almost certainly show signs of pollution, except possibly in very cold weather. The river therefore before entering the gasworks is in a fairly clean condition, but is more than " bad " according to the Royal Commission standard when it leaves the gasworks. In point of fact the Royal Commission's recommendation for a standard for sewage effluent was that it should not contain more than 30 parts per million suspended matter nor have a BOD of more than 20 parts per million. It will be seen therefore that after passage through the gasworks the river Pool fails even to reach the standard of sewage effluent. Soon after leaving the gasworks the Pool undergoes two or three almost right-angle bends and at these bends naturally a deposit of mud accumulates. This deposit when stirred produces an oily film on the river, and the water has a phenolic smell. Recent analysis of a sample of the mud scooped up from near the surface showed that it contained 0.8 percent tar, 36.8 percent mineral matter, 40 percent other organic matter and 22.6 percent water (this being the equivalent if the mud were dried to 1 percent tar, 47 percent mineral matter and 52 percent other organic matter). A large proportion of the organic matter is coal. The river water some 30 feet downstream from where the mud was lightly stirred, was found to contain 0.8 parts per million of phenols. (3) Effects on riverside allotments and gardens The analyses set out in (2) above confirm complaints we have had from time to time, particularly from Pool Allotments holders, but also from other riparian occupiers much further downstream, that the water is harmful to plant life. There is a widespread local belief that in times of flood the gasworks "wash out their tanks into the river." The gasworks deny this and the explanation is probably that in times of flood the increased rapidity of the stream stirs up this tarry and phenolic mud, some of which settles out on the banks and the gardens lower down the stream. It is possible however that after heavy rain the surface water from the gasworks contains various matters derived from coal. (4) Effects on illhealth and deaths associated with fog In my annual report for 1952 I have dealt at length with the fog that December and although the evidence for incrimination of the gasworks was not complete the fact that the Sydenham East ward had the highest mortality (and Forest Hill ward, which adjoins it, the next highest) was in itself suspicious of gasworks' influence. (5) Effects on the incidence of lung cancer Lung cancer is nowadays accepted as being associated with both smoking of tobacco and with atmospheric smoke in industrial areas. It is unwise to go too deeply into these matters, which are still not fully explained, but it seems likely that it is not entirely a coincidence that the East Sydenham ward had the highest number of deaths from lung cancer in the period 1946 to 1952. 39 (6) Psychological effects on local residents and material effects on their property including the SE children's hospital The baneful effect of the gasworks may be considerably more widespread than covering an area a mile in diameter. The complaints we have had illustrate the irritation and frustration of the average housewife in trying to keep her premises clean and her washing done properly, and also no doubt cover the annoyance of the householder or house-owner in having his fabric affected and his paint damaged. A recent report has been received from the South-eastern Children's hospital, which is across the road from the gasworks but due west of it, extracts from which are as follows :—"I would like to refer to the excessive grime with which we have to contend. At certain times of the day when the wind is blowing from the direction of the Works clouds of fine sparkling dust can be seen falling on the hospital, and children who are put out on the balcony for fresh air and sunshine return to their wards quite dirty. Windows and paintwork need cleaning at least twice as frequently as at any other hospital in our Group, which adds considerably to our annual costs for keeping the premises clean and obviously one of the first essentials in a hospital is that the wards and departments should be as clean and hygienic as possible." A detailed statistical table was also submitted on atmospheric pollution in the Borough in the previous twelve months. It was suggested by the Board that one of their technical officers should consider the data contained in the statement, in order to obtain possible agreement on the likely degree of pollution form the gasworks, and this was accepted by the Council's representatives. The matter was still under consideration at the end of the year. Hither Green railway sidings A deputation consisting of the Member of Parliament for North Lewisham, six members of the Council and the appropriate officers was received by representatives of the Railway Executive for the Southern Region of British Railways on February 6, when complaints received from residents in the neighbourhood of these sidings relating to noise, -smoke and grit, were thoroughly discussed. The representatives of the Railway Executive explained the reasons for the inability to find an alternative site for the railway line prefabrication depot and expressed the opinion that as nightwork at the depot had now ceased and improved facilities for the loading and unloading of materials had been provided, the noise arising from the work being undertaken at this depot was not now a serious cause for complaint. Most of the dust and dirt complained of was thought to emanate from the locomotive sheds and an assurance was given that efforts would be made to secure an improvement in this respect. No further complaints have in fact been received since the date of the meeting. 40 Smokeless zones In accordance with the instructions of the health committee, a detailed report on smokeless zones was submitted for consideration at the November meeting. After setting out the position both nationally and in regard to areas which already possessed smokeless zone powers, the following considerations would appear to apply to Lewisham in particular :— (1) It would probably be impracticable, or anyhow inexpedient, to promote a borough council Bill to enable a smokeless zone to be established and therefore if the Council were convinced of the desirability of such a zone they should try and get the LCC to include the necessary clauses in their next General Powers Bill. (2) It was thought that a smokeless zone in a residential area such as Lewisham was more difficult to bring about as it was not possible to burn bituminous coal smokelessly in an open grate and supplies of smokeless solid fuel were at present insufficient to meet a very great increase in the demand. It was understood that in order to help public opposition on the ground of financial burden Salford was prepared to pay compensation up to a maximum of £2 a house to assist in the alteration or suitable adaptation of existing fuel burning appliances or in the introduction of more modern equipment. This might also be necessary in London. At present in this country 35 million tons of coal were being used yearly for domestic purposes. Thirty-seven million tons of solid smokeless fuel were being produced annually, but much of this was for special industrial purposes; only 5 million tons were available for homes. (3) The LCC were considering the whole matter in conjunction with the Metropolitan Boroughs' Standing Joint Committee, and it might be desirable to await the result of this conference. (4) Everything must have a beginning and there seemed no reason why individual boroughs should not do what they could to reduce smoke in the atmosphere without waiting for further legislation. Thus, (a) any new blocks of flats put up by the Council might be designed to be free of smoke emission. In this connection smokeless estates had already been established by other authorities. The Council's block of flats known as Passfields had no open fires but the central heating was by bituminous coal. (b) It should be remembered also that there was in Pimlico a district heating scheme in which residual heat was used from the Battersea Power Station; district heating was always a possible development elsewhere, and had been used in Continental countries for many years. (c) Under the Housing Act, 1949 if the Council made a grant for the improvement of a house, conditions could be stipulated whereby any scheme for alteration to fuel burning appliances should assist the burning of solid smokeless fuels— i.e., bringing in the "prior approval" requirement. 41 (5) If and when staff were available and their duties allowed, a preliminary survey might be made of an area of Lewisham, to ascertain the likely problems in establishing an initial smokeless zone. (6) Meanwhile any opportunity of putting over propaganda in favour of burning smokeless fuels should be seized, but it would be desirable first to see that none of the Council's own offices or depots were offenders. The matter was under active consideration at the end of the year. Atmospheric pollution incidents In October and the beginning of November, three or four complaints were received of smells, described usually as sulphurous smells, which had been noticed in the early hours of two Sunday mornings previously, namely October 11 and September 27. The complaints originated in different parts of the borough, including Lee and Forest Hill and at a later date other persons recalled a similar occurrence, but could not be certain of the date. A complaint was also received that two houses which had been painted at the same time during the summer had had the paint blackened and made greasy from "offensive fumes which had polluted the air during the early hours of the morning on more than one occasion." This was stated to have occurred about a fortnight before the beginning of November, during the early hours of a Saturday morning. The paintwork (which was of a high gloss type) was certainly covered by greasy dirt, which, where it had not weathered away, could be scraped off with a penknife. On the two dates mentioned in the first sentence, there was, atmospherically, an anticyclone giving bright weather during the course of the day, but rather misty conditions with almost no wind during the night. This would have tended to keep any atmospheric pollution near the ground. The area from which the complaints came however, was so large as to make it rather difficult to believe that the only cause was local to this borough. Enquiries locally and observation on the part of the sanitary inspectors failed to elicit any explanation which appeared to be acceptable in connection with these complaints, but other information was to the effect that pollution of the River Thames was causal, even although the nearest point of the river was some 3 miles away. Water supply I am indebted to the Director of Water Examination 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 with 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 Thames-derived filtered water in addition. 42 The river water is abstracted at the Board's intakes on the River Thames at Walton and Laleham and is stored in the Staines, Littleton and Walton reservoirs. The water is filtered at Hampton, Surbiton and Walton works and is chlorinated after filtration. At Hampton and Walton contact tanks have been built where the chlorine has time to exert its full effect before the water is pumped into supply. All the well water is chlorinated and then dechlorinated before being pumped into supply; contact tanks are now installed at Bexley, Shortlands and Wilmington stations. 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 supply and samples are collected for analysis to establish that the quality of the water is up to the standard normally supplied. None of the supplies is plumbo-solvent. All houses in Lewisham are supplied directly and not by means of stand-pipes. Appended are the average results of the chemical and bacteriological analyses of the various supplies as forwarded by the Metropolitan Water Board :— Average results of the examination of the water supply to the Borough of Lewisham for 1953 parts per million (unless otherwise stated) (a) CHEMICAL Table 22 Description of the sample No. of samples Ammoniacal nitrogen Albuminoid nitrogen Oxidised nitrogen (nitrate) Chlorides as CI. Oxygen abs. from permanganate (4 hrs. at 27°C) Hardness (total) Hardness (non. carbonate) pH value Conductivity Bexley Well 4 0.005 0.021 4.8 16.1 0.06 284 54 7.3 450 Darenth Well 4 Nil 0.018 4.9 15.1 0.10 264 34 7.2 450 Shortlands Well 8 0.003 0.022 4.7 15.5 0.12 283 68 7.2 500 Wilmington Well 8 0.007 0.023 6.8 19.7 0.12 293 59 7.2 500 River Thames.derived filtered water 1766 0.012 0.081 3.3 26.8 1.02 259 64 7.9 500 (b) BACTERIOLOGICAL Table 23 No. of samples Agar colony count (average per millilitre) Percentage of samples negative to Bact. coIi in 100 ml. Bact. coli per 100 ml. 22° C 3 days 37°C (20.24 hrs.) Bexley Well 309 0.7 0.2 100.0 Nil Darenth Well 253 1.8 0.6 100.0 Nil Shortlands Well 253 - - 1000 Nil Wilmington Well 251 38.0 0.8 100.0 Nil River Thames.derived filtered water 3488 - 13.5 99.9 0.001 43 44 SECTION "C" — SANITARY CIRCUMSTANCES OF THE AREA The following table gives a summary of the inspections, etc., carried out by the district sanitary inspectors, food inspectors and housing inspectors during the year :— Table 24 Reason for inspection West North South Total District sanitary inspectors : Dwelling-houses — PH Act 1426 1366 742 3534 Dwelling-houses — Housing Act 149 203 93 445 Houses let in lodgings - - - - Applications for rehousing 100 175 29 304 Rent Acts and Landlord and Tenant Acts 3 - - 3 Notice from builder 153 124 197 474 Building licences and certificates for materials 20 23 - 43 Infectious diseases 262 52 95 409 Infestation 44 78 26 148 Factories, mechanical 79 58 16 153 Factories, non-mechanical 9 54 6 69 S47 National Assistance Act 8 11 2 21 Outworkers 166 119 184 469 Smoke observations 64 3 2 69 Offensive trades - - - - Keeping of animals in such a state as to be a nuisance 26 8 4 38 Water certificates 11 33 2 46 Futile visits 938 1642 542 3122 All other matters 780 774 307 1861 Reinspections 4180 6385 2426 12991 Totals 8418 11108 4673 24199 Food inspectors : Notice from builder 38 67 5 110 Building licences and certificates for materials 1 - 1 2 Infectious diseases 4 1 10 15 Infestation 28 71 2 101 Factories, mechanical 41 66 70 177 Factories, non-mechanical 5 - 2 7 Smoke observations 2 9 6 17 Food shops—registered 114 144 360 618 Food shops — not registered 134 109 222 465 Milkshops and dairies 92 124 97 313 Icecream premises 179 223 177 579 Restaurants and eating houses 204 182 247 633 Bakehouses 87 74 22 183 Other shops 16 117 34 167 Food inspections 327 306 219 852 Sampling 328 187 118 633 Markets and stalls 21 1809 499 2329 Pharmacy and poisons 86 82 10 178 Slaughterhouses - 1 - 1 Futile visits 80 53 1 134 All other matters 369 363 87 819 Reinspections 766 775 345 1886 Totals 2922 4763 2534 10219 45 Reason for inspection West North South Total Housing inspectors : Dwelling-houses — PH Act 8 2 - 10 Dwelling-houses — Housing Act 115 107 15 237 Houses let in lodgings - - - - Applications for rehousing 1 - - 1 Notice from builder - - - - Building licences and certificates for materials - - - - Infestation - - - - Futile visits 91 86 16 193 All other matters 66 132 6 204 Reinspections 1170 945 62 2177 Totals 1451 1272 99 2822 Grand total — all inspections 12791 17143 7306 37240 The decreased total of inspections by the district sanitary inspectors reflects the number of staff vacancies. The same remark applies to tht decreased total of inspections by the housing inspectors ; it was noi possible to do any house-to-house inspections during the year. Smoke nuisances Observations 86 Intimations served Complaints received 9 Statutory notices served — Legal proceedings — Convictions — Summary of notices served in 1953 Table 25 West North South Total Intimation notices :— Public Health (London) Act, 1936 470 484 187 1141 Informal intimations under Factories Act, 1937 1 4 - 5 Informal intimations under Housing Act, Act, 1936 23 19 2 44 Total intimations 494 507 189 1190 Statutory notices :— Public Health (London) Act, 1936 213 289 100 602 Housing Act, 1936 8 5 2 15 Byelaws (other than Housing Byelaws) 30 22 6 58 Total statutory notices 251 316 108 675 46 Nuisances remedied — Public Health Act Table 26 Nuisance West North South Total Drains cleared 35 18 14 67 Drains reconstructed or repaired 22 50 23 95 Soilpipes ventilated, repaired or renewed 7 5 1 13 Gullies renewed, repaired or cleansed 6 8 - 14 Water closets repaired or renewed 18 26 11 55 Flusing cisterns repaired, renewed or cleansed 12 33 8 53 Flush pipes repaired or renewed 5 5 - 10 Sinks provided - - 1 1 Roofs repaired 142 240 52 434 Gutters repaired 44 92 14 150 Rainwater pipes repaired 16 24 4 44 Drinking water cisterns repaired 5 3 - 8 Dampness remedied 447 378 96 921 Wall and ceiling plaster repaired 112 272 55 439 Walls and ceilings cleansed 5 13 6 24 Brickwork repaired 9 54 6 69 Chimneys repaired 1 16 4 21 Firegrates repaired or renewed 27 43 14 84 Floors repaired or renewed 57 66 11 134 Window frames and reveals renewed or repaired 15 37 13 65 Sashcords renewed 26 31 2 59 Dry rot remedied 1 20 2 23 Yards and areas paved 2 9 3 14 Dustbins provided 26 30 5 61 Accumulations of refuse cleared - 1 2 3 Doors and doorframes repaired or renewed 13 11 4 28 Other nuisances remedied 53 78 28 159 TOTALS 1106 1563 379 3048 Nuisances remedied — Housing Act Table 27 Nuisance West North South Total Drains cleared 4 - - 4 Drains reconstructed or repaired 9 5 1 15 Soil pipes ventilated, repaired or renewed - - - - Gullies renewed, repaired or cleansed 2 - - 2 Water closets repaired or renewed 6 4 3 13 Flushing cisterns repaired, renewed, or cleansed 5 2 1 8 Flush pipes repaired or renewed - - - - Sinks provided - - - - Roofs repaired 46 18 8 72 Gutters repaired 25 10 5 40 Rainwater pipes repaired 15 6 4 25 Drinking water cisterns repaired - - - - 47 Nuisance West North South Total Dampness remedied 48 27 7 82 Wall and ceiling plaster repaired 246 105 38 389 Walls and ceilings cleansed - - - - Brickwork repaired 19 9 4 32 Chimneys repaired 6 3 1 10 Firegrates repaired or renewed 24 6 6 36 Floors repaired or renewed 43 21 5 69 Window frames and reveals renewed or repaired 36 4 4 44 Sashcords renewed 18 8 3 29 Dry rot remedied 1 1 - 2 Yards and areas paved 13 2 1 16 Dustbins provided 5 1 - 6 Accumulations of refuse cleared - - - - Doors and doorframes repaired or renewed 36 9 4 49 Other nuisances remedied 122 42 26 190 TOTALS 729 283 121 1133 Rent and Mortgage Interest (Restrictions) Acts In 5 instances certificates were issued to tenants under the above Acts in respect of premises which were not in a reasonable state of repair. Applications were also received from owners for the rescission of certificates previously issued and in 8 cases the necessary statements were issued as the premises concerned had been made fit. Water certificates Under the provisions of section 95 of the Public Health (London) Act, 1936 an occupied house without a proper and sufficient water supply is a nuisance and if a dwelling-house, is unfit for human habitation. Further, it is not lawful to occupy a house as a dwelling-house, subject to certain provisos, until the sanitary authority has certified that it has a proper and sufficient supply of water. Certificates were issued in respect of 102 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, 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, 48 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 1953 :— Inspections Table 28 Premises Number on register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which sections 1, 2, 3, 4 and 6 are to be enforced by local authorities 82 76 - - (ii) Factories not included in (i) in which section 7 is enforced by the local authority 431 330 5 - (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 26 - - - TOTAL 539 406 5 - 49 Sanitary work generally Mr. Walker, the senior sanitary inspector, reports: "This year has brought about a further decrease in the number of inspections carried out and in the nuisances abated. This is in most part accounted for by a decrease in staff of six inspectors in 1952-1953 and only two replacements. In addition very little war damage work was done, especially of complete reconditioning of premises. The sanitary inspectors were increasingly occupied with the supervision of drain construction and sanitary fittings in new buildings. Materials were mostly in good supply except perhaps for cast iron goods, particularly soil pipes, which had to be ordered well in advance of requirements. "The more dilapidated properties are passed to the housing inspectors for treatment under section 9 of the Housing Act, 1936, and there continued to be a steady flow under this heading. Factory inspections are carried out by both district inspectors and food inspectors, the latter visiting only factories where food is prepared or where a canteen is provided. The district inspectors confine their attention to non-food factories only. All outworkers were visited at least on two occasions during the year. In my opinion the standard of cleanliness, and the conditions under which the work is done, is very high. Most of the persons on the register are women, usually living in a very good home environment. In no case was a person or premises considered unsuitable, Cases in which defects were found Table 29 Defects No. of coses in which defects were found No. of coses in which prosecutions were instituted Found Remedied Refe To HM Inspector rred By HM Inspector Want of cleanliness (S 1) - 2 - 3 - Overcrowding (S 2) - - - - - Unreasonable temperature (S 3) - - - - - Inadequate ventilation (S 4) - - - - - Ineffective drainage of floors (S 6) - - - - - Sanitary conveniences (S 7) : (a) insufficient - - - - - (b) unsuitable or defective 3 5 - 3 - (c) not separate for sexes 2 3 - 1 - Other offences against the Act (not including offences relating to outwork) - - - - - TOTAL 5 10 - 7 - 50 "During the year, the report of the working party on the Recruitment, Training and Qualification of Sanitary Inspectors was published, and implementation of this is now awaited." 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 were visited periodically by the woman sanitary inspector. The following is a list of trades concerned, extracted from the August, 1953 lists received :— Trade Ou tworkers employed Wearing apparel 207 Umbrellas 1 Artificial flowers 1 Boxmaking 13 Carding, etc., of buttons 1 Stuffed toys 2 Paper bags 1 Lampshades 2 Textile weaving 1 229 The inspectors made 469 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 one premises in the West division had been noted in which cleanliness was only very fair and sanitary accommodation fair. In no case was adverse comment called for in the North division but in one case where previously cleanliness had been reported as only 51 very fair, it was reported as having improved. In the South division cleanliness was reported as only very fair in one case. In general it appeared that much less work was being done than in the previous six months. This may have been due to the seasonal variation as between the months preceding Christmas and the months in the earlier part of the year. At the end of the year in one case in the West division adverse comment was made, cleanliness being reported as only fairly good and the sanitary accommodation as satisfactory but in poor repair. In the North division four cases were found where cleanliness was only fair and in one of these the sanitary accommodation was only fair. No comment was called for in respect of the South division. 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. Several complaints were received during the year. Legal proceedings were taken with respect to 5 cases, fines ranging from 2s. 6d. to 10s. Od. being imposed, and a warning letter sent to the remainder. Rag Flock and Other Filling Materials Act, 1951 This Act came into force on November 1, 1951, and repealed the Rag Flock Acts, 1911 and 1928 and section 136 of the Public Health (London) Act, 1936. The Act is designed to secure the use of clean filling materials in upholstered articles and other articles which are stuffed or lined. It is an offence, subject to certain provisos, to use filling materials to which the Act applies for upholstery purposes except on premises registered by a local authority, and rag flock for filling can only be manufactured and stored on licensed premises. The local authority is required to maintain a register of premises used for upholstery and of premises used for the manufacture and storage of rag flock and to maintain a list of licences in respect of premises used for the storage of rag flock. Various penalties are prescribed for noncompliance with the provisions of the Act. Standards of cleanliness are laid down in the Rag Flock and Other Filling Materials Regulations, 1951 in relation to each kind of filling material described in the regulations, and tests are prescribed which have to be carried out by approved analysts. 52 Four premises are registered for the use of filling materials for upholstery purposes. Samples were taken of coir fibre and washed flock, both of which were satisfactory. 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. Od. 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 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. 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. 53 Rivers (Prevention of Pollution) Act, 1951 Under this Act the Council is responsible for the prevention of pollution of streams and also for the control of obstructions therein due to the cutting of vegetation, etc. It can make byelaws for prescribing standards as to what is to be considered poisonous or noxious and for regulating the cleansing of articles or throwing of litter into streams. It can impose conditions on new or altered outlets into streams for the discharge of trade or sewage effluent. The Port of London authority has concurrent powers as to prevention of pollution up to three miles from the tidal limit of the Thames. The PLA's jurisdiction is considered by that authority as extending to the point on the Ravensbourne where it is joined by the Pool River (just upstream of Catford Bridge) and extending over the Quaggy throughout its northern appearance in the borough, but not to the part of the Quaggy going through the Grove Park area. In order to avoid duplication of work where there are concurrent powers with the PLA a conference was held with representatives of that authority, as a result of which information was obtained as to the methods the PLA employ to discover pollution, and the standards adopted. Copies of analyses of samples taken by the PLA at Deptford Creek (where the Ravensbourne enters the Thames) and of any special samples taken within the borough, are forwarded for our information and we in turn have undertaken to notify the PLA of any pollution, not of a trivial nature, found in the borough where there is parallel jurisdiction, and to send them copies of analyses of samples taken at these points. There are three rivers in the borough, the Ravensbourne, the Pool and the Quaggy. The Ravensbourne is thought to rise at a spring known as Caesar's Well at Keston Common and after forming three lakes it goes through Bromley and Beckenham to enter the borough adjoining Ravensmead Road about 200 yards east of Ravensbourne Station. It runs roughly parallel to the Catford loop line, crossing Brangbourne Road to Southend Lane, and then runs between the railway line and the Bromley Road until it goes under the railway at the south end of the Private Banks ground where it is joined by the River Pool. It then goes on under Catford Road through Ladywell recreation ground, under Ladywell Road past the borough council depot in Wearside Road and then the borough council depot in Molesworth Street, to be joined by the Quaggy between Loampit Vale and the railway. It leaves the borough at Elverson Road. The River Pool, which enters the borough at the borough boundary in Meadowview Road, meanders considerably towards the Gas Works, goes through the Gas Works ground and through the Pool allotment gardens, joining the Ravensbourne as indicated above. Traced backwards from the borough boundary it runs through New Beckenham and at Cator Park divides into two. The easterly half is called the River Beck and this can be traced through Beckenham to a large lake in Kelsey Park and then through West Wickham into the Surrey Hills. The westerly half, known as the Chaffinch Brook comes from Elmers End where it is joined by the effluent from the Croydon Sewage Works 54 at the South Norwood Sewage Farm. Prior to that it runs through Beckenham golf course, originating in the Shirley area. The River Quaggy comes in through Sundridge Park to the borough boundary about a quarter of a mile south east of Grove Park Station. It flows through the Chinbrook Meadows recreation ground, passes under Marvels Lane and goes out of the borough at Grove Park hospital. It then goes through Mottingham and part of Eltham, re-entering the borough boundary at Lee Green just north of Lee High Road, in Lee Road. It then flows through the Manor House gardens, then between Leahurst Road and Manor Park and then between Gilmore Road and Lee High Road, joining the Ravensbourne as indicated above near Lewisham Junction Station. The streams in the borough were surveyed by the district sanitary inspectors, particularly with regard to points of pollution, and also to map other entries to the streams, such as clean surface water drains or sewers, or drainage of adjoining land. Samples of water have been taken from the rivers and submitted for analysis. Since the cleanliness or otherwise of the rivers in the borough also depends to a great extent on the cleanliness or pollution of the water as it enters the borough, specimens were also obtained from certain points in the rivers before they reached the borough boundary. In the annual report of the medical officer of health for 1903 it was reported that because of suspected pollution, samples had been collected for examination at various points outside the borough, several of these samples being taken in the Borough of Beckenham. No information was available with regard to the weather conditions which prevailed when these samples were taken and heavy rain or drought would have had a marked effect on the results. With the cooperation of the Beckenham health department, samples were taken during April, 1953 from approximately the same places. There proved to be a remarkable similarity between the results obtained from the samples taken in 1953 and those taken 50 years previously. Apart from that the River Quaggy at Lee Road was found to have a high chlorine content and the River Ravensbourne at its exit from the borough to have a high nitrous nitrogen content. Local pollution is probably indicated in these two cases and further investigation will be required both there and at other known points of local pollution. The River Pool at the Southend boundary, both now and 50 years ago, shows evidence of much contamination. It appears that the bad effect of the Croydon sewage effluent is still very marked when the Pool enter the borough boundary, and some further action will no doubt be required. Drainage work In accordance with the requirements of the Public Health (London) Act and the byelaws made by the London County Council, every person about to construct, reconstruct, or alter any drainage work, has to deposit in duplicate with the sanitary authority such plans, sections 55 and block plan and such detailed description and particulars of the work to be carried out as may be necessary for the purpose of enabling the authority to ascertain whether such work will be in accordance with the statutory provisions relative thereto. During the year 136 plans were submitted to the sanitary inspectors for examination and approval. Destruction of pigeons Section 121 of the Public Health (London) Act, 1936, enables a local authority to take steps for the purpose of abating or mitigating any nuisance, annoyance or damage caused or which might be caused by the congregation of pigeons which are as far as can be ascertained, without an owner. The local authority is enabled to seize and destroy, or sell or otherwise dispose of any such pigeons in excess of such number as may be considered reasonable. Complaints have been received from time to time of nuisance caused by pigeons and it has been the practice to refer these complaints to a bird catcher who has wherever possible, and without payment from the Council, removed the offending birds by means of trapping. In the early part of the year the official bird catcher stated that with the improvement in the food situation he, and other professional bird catchers, were finding that there was practically no market for the birds when caught and that therefore there was little remuneration to be obtained from this work. The suggestion that a fee should be paid by the Council was not considered a sufficient inducement by the bird catcher to continue his efforts and the Health Committee accordingly decided that the staff of the health department should experiment with various methods for catching pigeons. The advice of the infestation branch of the Ministry of Agriculture and Fisheries was sought on the matter generally and also specifically with regard to equipment required, the training available and whether many other local authorities undertook such work. It subsequently transpired that only a few local authorities had had any communication with the Ministry on this subject and we were advised that the only three methods of dealing with pigeons which offered any hope of success were shooting, trapping and the use of bird scaring machines. The use of poison is illegal. Details of a cage trap to be baited with a suitable bait were also given. The shooting of pigeons presents many difficulties in towns and in any case Lewisham, in conjunction with other metropolitan boroughs gave an undertaking some years ago not to resort to this method. A cage trap was therefore made and baited and a live decoy was also used, but this method has not proved successful. Eggs have been removed from nests and various other methods have been tried to cope with the problem, but so far no marked success has been achieved. We shall continue with our experiments in order to try and find a satisfactory solution to this problem. - 56 Exhumations An exhumation or disinterment is only lawful when authorised by an order from a coroner, a licence of one of her Majesty's principal secretaries of State or a faculty of the Ordinary (a judge of the Consistory Court in whom jurisdiction over all things necessary for the decent and respectful treatment of the dead in consecrated ground is vested). It is an offence, both at common law and under section 25 of the Burial Act, 1857, to disinter any human remains from any place of burial without lawful authority. Generally, exhumations for the purpose of holding an inquest are made by order of the coroner; exhumations from unconsecrated ground for public or private reasons are authorised by the Secretary of State whilst the transfer of remains from one consecrated place of burial to another is authorised by a faculty of the Ordinary. Under certain circumstances, e.g. the exhumation of remains from consecrated ground for reasons other than their transfer to other consecrated ground, it is necessary to obtain both a faculty and a licence of the Secretary of State. The Secretary of State may prescribe such precautions as he considers desirable as a condition of any licence and it is the practice to forward to the medical officer of health a copy of any licences issued for the removal of human remains interred in his district, in order that he may be in a position to take any action under his general powers which appears necessary in the interests of the public health. It is the practice for a sanitary inspector to be in attendance at an exhumation of this nature and one such attendance was made during 1953 in respect of a licence issued by the Secretary of State. 57 SECTION "D" —HOUSING Building The following new houses or flats were completed by the Council during the year :— Paragon Place 9 Ryculff Square 60 Pond Road 6 Forster House 34 Whitefoot Lane 32 Hillmore Grove 17 Bryden Close 28 Broseley Grove 6 Kent House Road 28 Stanyhurst, Stanstead Road 20 Ermine Road 20 Bargrove Crescent 15 Creeland Grove 12 Dartmouth Road 21 Shorndean Street 2 Sportsbank Street 6 Engleheart Road 7 Elthruda Road 4 Greatfield Close 41 Eastern Road 9 Lawrie Park Avenue 8 Lawrie Park Gardens 3 Sheenewood, Westwood Hill 27 Total 415 Families rehoused During the year the following families were rehoused :— 1. By the Lewisham Borough Council :— (a) Permanent properties 224 (b) Temporary bungalows 6 (c) Emergency hutment 1 (d) Requisitioned properties 104 335 2. By the London county council (figures supplied by district offices) 239 Total 574 3. Number of families where points had been awarded for bedroom deficiency, rehoused by the Council during the year 294 58 Applications for rehousing The number of cases dealt with by the public health department during the year was as follows :— Table 30 West North South Total (a) Lewisham borough council housing applications :— Visited 47 49 3 99 Insanitary conditions found 2 4 — 6 (b) London county council housing applications :— Visited 45 117 21 183 Found overcrowded 2 4 11 17 (c) Housing applications referred from other authorities :— Visited 11 7 5 23 Found overcrowded — — — — (d) Inspected on request of occupier :— Visited – – – – Found overcrowded — — — — Total visited 103 173 29 305 Total overcrowded 2 4 11 17 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 44 informal and 15 formal notices were served. 38 properties were repaired by the owners after service of notices and 6 properties were repaired by the Council under section 10 in default of the owners. 59 Demolition orders (section 11) The following is a list of cases involving demolition order procedure which originated in or were complied with during 1953, together with the present position of cases originating in previous years which had not been complied with at the end of 1952 :— Table 31 Properties Dwellings involved Present position 33, Brand ram Road 1 Statutory undertaking given to carry out work. 58, Dacre Park 1 Repairs required to comply with statutory undertaking completed. 240, Burnt Ash Hill 1 Repairs required to comply with statutory undertaking completed. 4-11, Clyde Place 8 Demolished. 34, Clyde Vale 1 Repairs required to comply with statutory undertaking completed. 1, 3, Winterbourne Road 2 Demolished. 39, 41, Boone Street 2 Orders operative. Properties to be demolished when vacated. 236, Baring Road 1 Demolished 131, Sunderland Road 1 Work in progress. 16, Rutland Walk 1 Repairs required to comply with statutory undertaking completed. 53, Ladywell Road 1 Offer of works to be submitted. 156, Courthill Road 1 Offer of works to be submitted. 1, 2, 3, 4, Willow Close 4 Notices served. 30, Beacon Road 1 Notices served. Closing orders for whole house (section 11, amended) Closing orders in respect of whole houses originated in 1953 under section 11, Housing Act, 1936 and section 10, Local Government (Miscellaneous Provisions) Act, 1953 :— Table 32 Properties Dwellings involved Present position 99,101, Gilmore Road 2 Orders made 2/1/54. 2, Cranston Road 1 Order made 2/1/54. 33, Wells Park Road 1 Order made 11/1/54. 13, Dalmain Road 1 Order made 2/1/54. 60 Closing orders in respect of part of house (section 12) Table 33 Properties Part of house Present position 22, Belmont Park Three rooms and scullery in basement. Works to comply with statutory undertaking completed. 5, The Glebe, Flats 2, 3, 4, 6, Flat 2. One room ground floor, six rooms first floor and one room second floor. Flat 3. Six rooms ground floor. Flat 4. Five rooms first floor. Flat 6. Two rooms and scullery first floor above old stables. Orders operative. 2, Handen Road Two rooms and scullery. Order operative. 14, Dermody Road Basement back and front rooms. Order operative. 80, Burnt Ash Hill Basement front, middle and back rooms, hall and bathroom. Order operative 30/1/53. Works subsequently carried out to make basement fit for habitation. Order determined. 51, Belmont Park Three rooms in basement. Statutory undertaking received that flat will not be used for human habitation. 7, Peak Hill Avenue Front room, back room, hall, scullery and water closet in basement. Order operative. 6, Dartmouth Row Front and back rooms, basement. Order operative. 59, Clarendon Rise Main room at rear, scullery, bathroom and cellars. Order operative. 79, Burnt Ash Road. Two rooms and scullery in basement. Statutory undertaking to carry out works accepted. 93, Brockley Rise Two rooms and scullery in basement. Works to comply with statutory undertaking completed. 9, Mount Pleasant Road. Two rooms and scullery in basement. Offer of works to be submitted. 17, Lee Park Two rooms, hall, passage and scullery in basement. Order operative. 7, Wynell Road Front and back rooms, small approach room and scullery in basement. Order operative. 20, Belmont Hill Three rooms in basement. Order operative. 51, Gilmore Road Two rooms and scullery in basement. Order operative. 5, Newstead Road Two rooms, kitchen and bathroom in basement. Order made. 61 Properties Part of house Present position 38, Eltham Road Two rooms in basement. Included in area covered by Compulsory Purchase Order. 25, Montem Road Two rooms and scullery in basement. Statutory undertaking to carry out works accepted. 108, Westwood Hill Three rooms and cellar in basement. Order operative. 4, St. Germains Villas, Silk Mills Path. Two basement rooms. Closing order on two basement rooms dated 18/3/37. Permission now granted for use of front room for storage of furniture and back room for preparation of meals. 192, Kirkdale Basement flat Statutory undertaking accepted 7/2/49 that flat would not be used for human habitation. Works carried out to render flat fit and undertaking cancelled. 172, Lewisham Road Basement bedroom and kitchen/living room. Notices served. 52, Lee Road Four rooms and kitchen in basement. Notices served. 47, Loampit Hill One room basement. Notices served. 61, Westwood Hill Four rooms, kitchen and scullery in basement. Notices to be served. 29, Devonshire Road. Basement flat... Closing order dated 26/7/50. Works carried out to make flat fit for human habitation. Order determined. 21, Devonshire Road. Basement flat, two rooms and water closet. Undertaking accepted in 1951 that basement flat would not be relet for human habitation until rendered fit. Works carried out. Undertaking cancelled. 92, Dacre Park Two rooms with store room, scullery, bathroom and water closet in basement. Closing order dated 12/9/52. Works carried out to make flat fit for human habitation. Order determined. 12, Blythe Hill Two rooms and scullery in basement. Closing order dated 29/5/52. Works carried out to make flat fit for human habitation. Order determined. 1, Station Approach. Basement front room. Closing order dated 12/9/52. Use of basement front room as storeroom now permitted. In his report upon repair work under the Housing Acts during 1953, Mr. Craven, the group housing inspector, states :— "Following the trend reported last year there was again an increase in the number of properties referred to the department subsequent to the Housing (Management) committee's decisions to derequisition on grounds of disrepair. The majority of these cases justified action under the Housing Act, 1936. It has been found that a small proportion of these properties remain unoccupied and in a 62 state of disrepair for some considerable time after the service of a section 9 notice. This appears to be due, generally, to protracted negotiations in connection with the various claims the owner is entitled to make. These cases are periodically reviewed and the owner pressed to have repairs carried out, and to allow reoccupation of the property as soon as it has been made suitable. This procedure has been successful in most cases. "There was an increase over the previous year in the number of properties where it was necessary for the Council to carry out work in default under section 10. In two properties special difficulties were encountered in that, during the course of the work, hidden defects of a major character were disclosed, in both cases arising from dry rot infestation, and it was necessary to consult the District Surveyor. This resulted in substantial additions to the specification and cost of the work. Details of these cases were reported to the Public Health committee at the time, but it would appear that, in the absence of a complete knowledge of the previous history of the premises, and owing to the fact that it is extremely difficult to assess the extent of dry rot infestation without carrying out a comprehensive structural investigation prior to serving the notice, it is inevitable that occasional difficult cases will arise. "The only appeal heard at the County Court against section 9 notices was in the case of two properties owned by the same person in Upper Sydenham. The appeal was dismissed and the work is almost completed." 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 one licence was issued under section 61 on the application of a tenant of overcrowded premises, the licence remaining in force for a period not exceeding 12 months. 63 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 and Public Health Acts during the period 1 April, 1952 to 31 December, 1952 Table 34 PART A —CLEARANCE AREAS (Housing Act, 1936) Dwelling-houses demolished Persons displaced Unfit houses Other houses Land coloured "pink " None – None Land coloured "grey" – None None PART B —UNFIT HOUSES NOT INCLUDED IN CLEARANCE AREAS Houses Persons displaced DEMOLITION AND CLOSING ORDERS 1. Housing Act, 1936 :— (a) Houses demolished as a result of formal or informal procedure under section 11 13 32 over 10 years 12 under 10 years (b) Houses closed in pursuance of an undertaking given by the owners under section 11, and still in force 3 6 over 10 years (c) Parts of buildings closed (section12) 8 10 over 10 years 6 under 10 years 2. Housing Act, 1949 :— (a) Closing Orders made under section 3 (1) None None (b) Demolition orders determined and Closing Orders substituted under section 3 (2) None None REPAIRS Number of houses* 3. Informal action :— Number of unfit or defective houses rendered fit as a result of informal action by the local authority under the Housing Acts 9 4. Public Health Acts :— Number of houses in which defects were remedied after service of formal notices— (a) by owners None (b) by local authority in default of owners None 5. Housing Act, 1936 :— Number of houses made fit after service of formal notices (sections 9, 10 and 16)— (a) by owners None (b) by local authority in default of owners 4 *A defective house remedied more than once during the period is included once only. 64 The following is a copy of a return made to the Ministry of Housing and Local Government relating to action taken under the Housing and Public Health Acts during the year ended 31 December, 1953 :— part a —clearance areas (Housing Act, 1936) Table 35 Dwelling-houses demolished Persons displaced Unfit houses Other houses Land coloured " pink " None — None Land coloured "grey" – None None PART B —HOUSES NOT INCLUDED IN CLEARANCE AREAS Houses Persons displaced DEMOLITION AND CLOSING ORDERS 1. Housing Act, 1936 :— (a) Houses demolished as a result of formal or informal procedure under section 11 12 54 adults 16 children (b) Houses closed in pursuance of an undertaking given by the owners under section 11, and still in force None None (c) Parts of buildings closed (section 12) 17 18 adults 5 children 2. Housing Act, 1949 :— (a) Closing Orders made under section 3 (1) None None (b) Demolition orders determined and Closing Orders substituted under section 3 (2) None None 3. Local Government (Miscellaneous Provision) Act, 1953 :— Closing Orders made under section 10 (1) 3 7 adults 2 children REPAIRS Number of houses" Informal action :— 4. Number of unfit or defective houses rendered fit during the period as a result of informal action by the local authority under the Housing Acts Action under statutory powers 30 5. Public Health Acts :— Number of houses in which defects were remedied after service of formal notices (a) by owners None (b) by local authority in default of owners None 6. Housing Act, 1936 :— Number of houses made fit after service of formal notices (sections 9, 10, 11 and 16)— (a) by owners 8 (b) by local authority in default of owners 6 *A defective house remedied more than once during the period is included once only. 65 Lee Church Street Clearance Area The public inquiry into the Compulsory Purchase Order in respect of these areas was held at the Town Hall on June 16. The Council's case was stated and the arguments of four objectors were put before the Ministry of Housing and Local Government's Inspector, who later visited the areas concerned. The Order has been confirmed by the Minister with slight modifications in that the compensation for the acquisition of two houses (1, Fludyer Street and 33, Boone Street) and a house, shop and yard (49, Lee Church Street) will be assessed upon existing use value instead of site value only. The Minister has further directed that payments under section 42 of the Housing Act, 1936 be made by the Council in respect of certain houses which, although unfit, had been well maintained. A scheme is now being prepared for the redevelopment of the whole area for housing purposes, and steps are being taken to acquire the lands included in the Order, to cause the buildings thereon to be vacated, to carry out such rehousing as is necessary and to build on the lands so acquired. Slum clearance programme, 1956-60 By agreement between the London county council and this Council the responsibility for carrying out the first five-year programme of slum clearance so far as it affects this borough is being shared between the two authorities. The programme is well in hand and an enquiry has been received from the Clerk of the county council as to whether the borough council is prepared to continue its cooperation in slum clearance for a second five-year period. With the approval of the health committee a provisional list of properties suitable for inclusion in the proposed slum clearance programme for 1956/60 has been prepared and forwarded to the County Council for consideration. Local Government (Miscellaneous Provisions) Act, 1953 Two sections of this Act affect the work of a health department. Under section 10 a local authority can make a Closing Order in respect of a whole house where the making of a Demolition Order would be to the detriment of the adjoining property. Such a closing order can be revoked at any time and a demolition order substituted in place thereof. Section 11 extends until 14 July, 1954 the time within which an owner of a house in respect of which a demolition order became operative before 1 January, 1946 may apply to have such Order quashed on the ground that as a the result of subsequent works the house is now fit for human habitation. The local authority is empowered in cases where a demolition order has been made before 14 July, 1953 and where it is considered inexpedient to enforce compliance with the Order owing to the effect of demolition upon adjoining property, to revoke the demolition order and make a closing order in place thereof, 66 The provisions are useful in that they enable a local authority to overcome the difficulty often experienced in the past in enforcing a demolition order under the Housing Act, 1936, in respect of a house situated within a terrace, because of the necessity to protect and support adjoining houses when demolition was carried out. Housing Act, 1949 — section 3 and Town and Country Planning Act, 1947— section 30 A list of buildings of special architectural or historic interest is being compiled by the Ministry of Housing and Local Government in accordance with certain provisions of the above Acts. When completed a certified copy will be deposited with the Council and notices will be served on the owners and occupiers of the buildings concerned. A provisional list has in the meantime been received which covers a rather wider range of properties than will be included in the statutory list. Buildings in the provisional list are placed in grades I, II or III and the statutory list will in general cover grades I and II only. Buildings placed in grade III are considered worthy of retention if this can be done without unduly affecting other and wider interests. The listing of a building is not meant to operate as a bar to demolition, but each case will be considered on its merits. Buildings classified as grade I or II are of sufficient interest to render it inexpedient for them to be demolished pending a decision as to whether they should be made the subject of a building preservation order or included in the statutory list. General statistics 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) 60,770 Public Health (London) Act, 1936 Houses inspected on account of complaints 2,172 Houses inspected on notification of illness 424 Number of written intimations served 1,141 Number of statutory notices served 602 Number of prosecutions 34 Number of nuisances abated 3,048 Housing Act, 1936 Houses inspected — house to house (Housing Consolidated Regulations, 1925) Nil Notices served under section 9 :— (a) Informal 44 (b) Formal I5 67 Item Total Houses made fit for habitation :— (a) By owners :— (i) Section 9 38 (ii) Section 11 4 (b) By local authority in default of owners (s.10) 6 Orders made under section 11 1 Houses demolished — (a) As a result of such orders 11 (b) Voluntarily — Houses closed (Local Government (Miscellaneous Provisions) Act, 1953) Nil Number of such orders determined Nil Rooms in respect of which Closing Orders were made under s.12 56 Number of such orders determined 4 Number of underground rooms found to be unfit ... The Council has no regulations for underground rooms. Number of underground rooms closed or modified occupation approved Number of closing orders determined in respect of underground rooms Families found to be living in overcrowded conditions Overcrowded families who have obtained alternative accommodation. Not now possible to assess. Houses let in lodgings— Number in borough Not known Number of inspections made — Number of notices served — Number of prosecutions — Number of complaints remedied – 68 SECTION "E" —INSPECTION AND SUPERVISION OF FOOD Milk and Dairies Regulations, 1949 A local authority is required to keep a register of all persons carrying on the trade of a distributor of milk in their district and of all premises within their district which are used as dairies, not being dairy farms. The definition of a "distributor" contained in the regulations referred to has been amended by The Milk and Dairies (Amendment) Regulations, 1953 (SI 1876) and now means a person trading as a dairyman elsewhere than at or from premises in relation to which he is registered as a dairy farmer under these regulations but does not include a purveyor of cream in the hermetically sealed containers in which it is delivered to his premises provided that such a purveyor is not otherwise a purveyor of milk. The term dairy includes any milk store, milk shop or other premises from which milk is supplied on or for sale or in which milk is kept or used for the purpose of sale or of manufacture into butter, cheese, dried milk or condensed milk for sale or in which vessels used for the sale of milk are kept, but does not include a shop from which milk is supplied only in the properly closed and unopened vessels in which it is delivered to the shop, or a shop or other place in which milk is sold for consumption on the premises only. At the end of the year there were 80 persons registered for the distribution of milk from premises within the borough and 16 persons registered for the distribution of milk within the borough from premises in the area of another authority. Five premises in the borough were registered as dairies. Milk (Special Designations) Licences Under the Milk (Special Designations) (Specified Areas) Order, 1951 the use of special designations for retail sales of milk is compulsory in the County of London. The designations referred to are "pasteurised," " sterilised," " tuberculin tested " and " accredited " and are authorised by the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations and the Milk (Special Designation) (Raw Milk) Regulations of 1949. A dealer's licence (except in the case of milk sold by wholesale) authorises the use of a special designation in relation only to milk sold within the licensing area of the licensing authority. Where the holder of a licence authorising him to use a special designation in relation to milk sold by him at or from premises in one licensing area proposes to sell milk by retail in another licensing area, the licensing authority of the second licensing area may grant him a supplementary licence authorising him during the period of operation of the first mentioned licence to use the special designation in relation to milk so sold in their licensing area. Licences, which remain in operation from January 1 to December 31 were issued during the year as follows:— 69 Table 36 Dealer's Supplementary Total Licences issued for :— sale of pasteurised milk 55 18 73 sale of tuberculin tested milk 52 18 70 sale of sterilised milk 85 20 105 sale of accredited milk 4 4 TOTALS 196 S6 252 Analysis of milk During the year under review, 100 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 37 Period Samples Average composition of samples examined Percentage of Milk fat Solids not fat Water[/##3] First quarter 34 3.44 8.78 87.78 Second quarter 18 3.34 8.77 87.89 Third quarter 27 3.60 8.92 87.48 Fourth quarter 21 3.76 8.94 87.30 TOTALS 100 3.53 885 87.62 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. Examination of heattreated milk—pasteurised It is a requirement of the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949, that a sample of milk taken in accordance with Part I of the third schedule after pasteurisation and before delivery to the consumer shall satisfy the prescribed phosphatase test. After pasteurisation and on the day of, but before delivery to, the consumer pasteurised milk must satisfy the requirements of the methylene blue test. The phosphatase test is a colorimetric test. The enzyme phosphatase is not destroyed if milk is heated only to lower temperatures or for shorter periods than those prescribed but is completely destroyed where pasteurisation to the required legal standard has been carried 70 out. The test is considered to be satisfied by milk which gives a reading of 2.3 Lovibond blue units or less. The methylene blue test is a test based on the time taken by milk to decolorise a dye, methylene blue. This test is deemed to be satisfied by milk which fails to decolorise methylene blue in thirty minutes. 52 samples of pasteurised milk were submitted for examination, all of which satisfied both the phosphatase and methylene blue tests. Examination of heattreated milk — sterilised Sterilised milk is required to satisfy the requirements of the turbidity test. This test consists of mixing the sample of milk with a reagent, and the mixture after filtration is required to be free from turbidity in order to satisfy the requirements of this test. Five samples of sterilised milk were examined during the course of the year and all the samples were of the required standard. Icecream — grading Icecream is submitted to the Public Health Laboratory for bacteriological examination. The icecream is graded according to the time taken to decolorise a dye, methylene blue. The test is a provisional one and because of the many factors which govern the hygienic quality of icecream it is recommended officially that judgment should be based on a series of samples and that too much attention should not be paid to the result of an individual sample. It is suggested that over a six monthly period, at least 50 percent of a vendor's samples should fall into grade 1, 80 percent into grades 1 or 2, not more than 20 percent into grade 3 and none into grade 4. During the year 64 samples of icecream were submitted for bacteriological examination with the following results :— Table 38 Grading Parliamentary division Total West North South Grade 1 6 18 7 31 Grade II 4 7 6 17 Grade III 4 4 2 10 Grade IV 2 2 2 6 TOTAL 16 31 17 64 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. 71 Icecream — composition The Food Standards (Icecream) Order, 1953 which came into operation on June 1, restored the standard for icecream which was in force before 7 July, 1952. Icecream must, therefore, once again contain not less than 5 percent fat, 10 percent sugar* and 1\ percent milk solids other than fat. There are provisos in respect of icecream containing any fruit, fruit pulp or fruit puree, and kosher ice. The 71 samples submitted to the Public Analyst for analysis were found to have the composition shown in the appended table :— Table 39 Samples Average percentage composition Fat Milk solids. not fat Sucrose Water[/##] First quarter 20 8.4 13.7 12 2 65.7 Second quarter 22 10.4 10.4 12 6 66.6 Third quarter 12 10.4 9.9 12 9 66.8 Fourth quarter 17 10.3 11.1 12.9 65.7 TOTALS 71 9.8 114 12.6 66.2 *Sugar means sucrose, invert sugar or the solids of any sweetening material derived from starch. Of the 71 samples, 69 were informal and 2 were formal. One of the informal samples noted in the table was reported as being adulterated or below standard, in that there was a fat deficiency of 42.5 percent. The two formal samples were taken in respect of this adulterated sample and were found to be genuine. Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 866, of which 5 were formal samples and 861 informal. After examination the public analyst reported that 4 of the informal and 1 of the formal samples were adulterated or below standard ; the percentage adulteration amounted to 0.46 in the informal samples, 2(H) in the formal samples, and 0.57 of all the samples submitted, compared with 0.363 in the previous year. 72 The following table gives the groupings and the results of the samples analysed :— Table 40 ARTICLES Examined Adulterated Informal Formal Total Informal Formal Total Beverages, liquid 20 – 20 – – – Butter 16 — 16 — – — Cereals, bread, baking powder 82 – 82 – – – Cheese 15 — 15 — – — Cocoa, coffee, tea 16 — 16 – — Condiments and flavourers 192 1 193 1 1 2 Confectionery (sweets) 12 — 12 – – — Cream 5 — 5 – – — Drugs 61 1 62 1 – 1 Fish, tinned 11 — 11 – — Fruit, dried 12 — 12 . – — Icecream 69 2 71 1 – 1 Ice lollies 25 — 25 – – — Lard 15 — 15 – – — Margarine 16 — 16 – – — Milk 100 — 100 – – — Milk, condensed 7 — 7 – – — Paste, fish and meat 50 — 50 – – Sausages and preserved meats 62 1 63 1 – 1 Soup 19 — 19 – – — Spirits 6 — 6 – – — Other foods 50 — 50 – – — TOTALS 861 5 866 4 1 5 Adulterated samples Table 41 Article Formal or Informal Adulteration or irregularity Action taken Sal Volatile Informal Ammonia deficient 30.3% Seven bottles of consignment withdrawn from sale. Formal sample taken on delivery from wholesalers. Found to be genuine. Dried parsley Informal Siliceous matter 6.9% Report to Health Com. mittee. Warning letter sent to retailer. Dried parsley Formal Siliceous matter 8.2% Icecream Informal Fat deficient 42.5% Two formal samples taken. Both found to be genuine. Pork sausages Informal 1130 parts of sulphur dioxide per million. Formal sample taken and found to be genuine. 73 Other samples In addition to samples submitted to the public analyst from routine sampling, the following were also submitted either to the public analyst or for bacteriological examination. They were submitted for various reasons, but mainly because of complaints received, or as a result of enquiries made into cases of food poisoning:— Dried egg powder Custard powder (2) Tap water (4) Stewed apple Synthetic cream Gravy Meat (4) Swab from mixer Bread (1) Washingup water Lolly mould Potato and greens Dried milk Unsound food A considerable amount of food was surrendered as unfit for human consumption. In all, approxiately 13½ 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 3 Third quarter 5 Fourth quarter 22 32 (2) Outbreaks due to identified agents :— Total outbreaks 3 Total cases 23 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— Total cases— (4) Single cases :— Agent identified 6; Unknown 3; Total 9 74 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 373 Fish fryers 41 Sausages 107 Preserved meats 153 Preserved fish 27 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. 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 one shop during the year. Pharmacy and Poisons Act, 1933 and Pharmacy and Medicines Act, 1941 The poisons law was amended by the Poisons List Order, 1952 and the Poison Rules, 1952 which came into operation on 1 January, 1953. The Poisons List Order added certain substances to the Poisons List and the Third Schedule thereto sets out a complete list of poisons to which the Pharmacy and Poisons Act, 1933 applies. The Poisons Rules consolidated with amendments, the Poison Rules, 1949, 1950 and 1951, which were revoked. The principal amendments of substance applied to the First, Third, Fourth, Fifth, Seventh, Eighth and Ninth Schedules and made appropriate provisions for the substances newly added to the Poisons List by the Poisons List Order, 1952, and the names of certain substances already on the list were revised to accord with current usage. The Poisons (No. 2) Rules, 1952, which also came into operation on 1 January made good the omission of certain substances from the First Schedule to the Poisons Rules, 1952. The Poisons List Order, 1953 (SI 1953 No. 1300) adds certain substances to the Poisons List and in the Third Schedule sets out the complete list as from the date of operation of the Order. The Poisons Rules, 1953 (SI 1953 No. 1301) impose appropriate requirements and restrictions on the sale of substances now added to 75 the Poisons List by the Poisons List Order, 1953. Certain of these substances are, when in specified forms, exempted from restrictions under the Pharmacy and Poisons Act, 1933 and the Poisons Rules, 1952. Sodium nitrite is now included in Part II of the Poisons List. A local authority maintains a list of persons entitled to sell poisons listed in Part II of the Poisons List, in accordance with the requirements of section 21 of the Pharmacy and Poisons Act, 1933. Part II poisons include certain preparations used in agriculture and horticulture together with various poisons which have a domestic use. The food inspectors are responsible for ensuring that all premises from which Part II poisons are sold are entered in the Council's list, that any deputy who may have been appointed is a responsible person, and that substances which are included in the first schedule are being sold by the listed seller or by one of the "responsible deputies." The poisons register has to be inspected; the storage arrangements have to be satisfactory and requirements as to labelling and containers complied with. The names of 17 persons were entered on the Council's list of persons entitled to sell poisons in Part II of the poisons list and the names of 207 persons previously registered were retained on the register. 178 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 Under section 144 of the Public Health (London) Act, 1936, any person carrying on the business of slaughtering and using any premises as a slaughterhouse is required to obtain a licence from the Council. There are two private slaughterhouses in the borough, but very little killing is done. The premises are visited periodically by the food inspectors. Applications for the renewal of licences in respect of these slaughterhouses were received during the year and both licences were renewed. In the case of one licence there is a proviso that only pigs can be slaughtered at the premises. Slaughter of Animals Act, 1933— licences to slaughtermen The above Act provides that no animal shall be slaughtered or stunned in a slaughterhouse or knacker's yard by any person who is not the holder of a licence granted by the local authority. A person so licensed must be of the age of eighteen years or upwards and must, in the opinion of the local authority, be a fit and proper person to hold such a licence. A licence is in force in the district of the local authority granting the licence and also in the district of any other local authority. Four slaughtermen's licences were granted during the year. 76 Disposal of meat and offal unfit for human consumption Circular 21/53 of the Ministry of Food gives details of the revised conditions under which condemned meat and offal belonging to the Ministry are sold by public auction at monthly intervals. The buyer can only dispose of, or sell condemned meat, etc., if it has been processed, boiled in accordance with stated requirements, or sterilised, and may only sell to a processor, to a retailer for sale by him for animal feeding, or to owners of zoos, menageries, fur farms and fisheries and maggot breeders for use in such businesses and not for resale. Before delivery the seller is required to notify the medical officer of health of the names and addresses of any consignees in his district and such meat and material has to be stained green before delivery to the buyer. Slaughterhouse managers have been instructed by the Minister to notify local authorities of the names and addresses of buyers of meat and offal which are unfit for human consumption. Keeping of pigs Complaints were received with regard to smells arising from the keeping of pigs in the yard attached to a butcher's shop in Sydenham. It was found that there was a contravention of section 119, subsection 4 of the Public Health (London) Act, 1936 in that the pigs were kept within 40 yards of a street or public place. The owner was asked to dispose of the pigs within a reasonable time and thereafter not to replace them. The pigs were removed and the styes demolished. A further contravention of the Public Health (London) Act, 1936 was discovered at Elstree Hill, where four pigs were being kept within the proscribed distance from a street. A report was submitted to the health committee in November, when it was decided that the requirements of section 119 must be enforced but that in view of the fact that there was no immediate likelihood of a nuisance being caused to nearby residents, the owner of the pigs should be allowed six months in which to dispose of them or to move them to a position which would be more than 40 yards from a street. Basement bakehouses Under the Factories Act, 1937, section 54, a basement bakehouse means a bakehouse any baking room of which is so situated that the surface of the floor is more than three feet below the surface of the footway of the adjoining street, or of the ground nearest to the room. A basement bakehouse must not be used as a bakehouse unless (a) it was so used at the date of the passing of the Factories Act (30 July, 1937) and (b) certificates of suitability have been issued by the Council. Any basement bakehouse which is not used as a bakehouse for a period exceeding 12 months must not be so used again. District councils were required in the year beginning at the date of the commencement of the Factories Act of 1937 (namely 1938) and in every fifth successive year, to carry out an examination of basement bakehouses in respect of which certificates of suitability had been 77 issued. If as a result of this examination the Council is not satisfied that the bakehouse is suitable for use as such as regards construction, height, light, ventilation, or any other hygienic respect, it must give notice in writing that the certificate shall cease to have effect after the expiration of such period, being not less than one month, as may be specified in the notice. The occupier may appeal against the notice to a court of summary jurisdiction. If the Council is satisfied that the bakehouse is suitable as regards the matters aforesaid, it must give notice in writing that the certificate shall continue to operate so long as the bakehouse may otherwise lawfully be used, but without prejudice to the power of the Council to revoke the certificate as the result of a subsequent periodic examination. At the initial inspection prior to the war, ten basement bakehouses were noted. One of these was destroyed during the war and one became disused. A preliminary inspection was made in February, 1948 prior to the quinquennial inspection required to be made after July of that year. At the time of the preliminary inspection, of the eight basement bakehouses in the borough, two were satisfactory; two were unsatisfactory and only fit to be closed and four required works to be carried out to put them in a satisfactory condition. Schedules of works were served on this last group of four bakehouses. At the quinquennial inspection later in the year six of the eight bakehouses were regarded as satisfactory and certificates of suitability were issued. The remaining two were regarded as unsatisfactory and were closed in accordance with recommendations made. (One of these was replaced by a newly constructed bakehouse above ground level). At the quinquennial inspection made in the year beginning 1 July, 1953, it was found that one of the six remaining basement bakehouses had been closed for over 12 months. Four of the bakehouses were found to be in a satisfactory condition and certificates of suitability were continued. In the case of the fifth bakehouse, it was recommended that the certificate of suitability should be continued subject to certain works being executed. Notices were accordingly served in respect of the required works, which, however, had not been completed by the end of the calendar year. The Foods Standards (Icecream) Order, 1953 The above Order reenacted the Food Standards (Icecream) Order, 1951 as from 1 June and restored the higher standard for icecream in relation to the minimum quantity of fat and milk solids other than fat which was in operation before the reduction made in July, 1952. Icecream, with certain exceptions, must therefore once again contain not less than 5 percent fat, 10 percent sugar and 7 A percent milk solids other than fat. Methods and criteria of meat inspection Memo. 3/Meat was issued by the Minister of Food during the year in substitution for Memo. 62/Foods as amended by Memo. 62b/Foods. Part I contains general guidance for authorised officers, 78 occupiers of slaughterhouses and slaughtermen in connection with dangers associated with the consumption of meat derived from or which has been in contact with diseased carcases or offal. Part II deals with ante-mortem inspection and stresses the importance of early inspection of each animal by an authorised officer, as soon as possible after arrival in the lairage, in order that animals showing signs of disease may be segregated, slaughtered apart from other animals and subjected to post-mortem examination. Instructions on post-mortem examinations are contained in part III, and the use of simple laboratory methods at the slaughterhouses and of other established laboratories such as the Public Health Laboratory Service is recommended where a more detailed report is required. Part IV details the action to be taken when evidence of disease is found and lists the diseases which justify the rejection of the entire carcase. It also gives instructions for dealing with carcases affected with tuberculosis and those affected by diseases which do not justify the condemnation of the entire carcase. Sulphur-dioxide in imported dehydrated vegetables By circular MF 15/52 the importation and sale of certain dehydrated vegetables was authorised so that each variety of vegetable may contain a specified quantity of sulphur dioxide. Standards for suet The Food Standards (Suet) Order, 1952 (SI 1952 No. 2203) prescribed a standard for block suet and revised the standard for shredded suet previously contained in the Food Standards (Shredded Suet) Order, 1944 which was revoked. Offals in Meat Products Order, 1953 This Order retained the minimum meat content requirements for uncooked pork sausages, beef sausages and sausage meat at 65 percent for pork and 50 percent for beef, prescribed in the Meat Products (No. 2) Order. The requirements for a number of other meat products were not renewed. The Home-Canned Fruit and Vegetables Order, 1950 This Order was revoked by the Canning of Food and Feeding Stuffs and Home Canned Fruit and Vegetables (Revocation) Order, 1953. A Food Standards Order was not made for the continuation of the standards of composition for canned fruit and vegetables prescribed by the Order of 1950. Canned Corned Meat (Prices) Order, 1953 The Meat Products (No. 3) Order was replaced by the Canned Corned Meat (Prices) Order, 1953. The provisions prescribing maximum prices and minimum meat contents for sausages and sausage 79 meat were not retained. The use of certain offals was prohibited in the composition or preparation of uncooked open meat products for sale for human consumption. The Labelling of Food Order, 1953 The Order reenacted in a consolidated and revised form the Labelling of Food Order, 1950, and its amending Order. New provisions included a definition of biscuits and flour confectionery; a declaration under certain circumstances of ingredients on labels for prepacked foods consisting of two or more ingredients; the type of label to be used for intoxicating liquors; requirements as to the labelling of certain types of coffee; emulsifying salts and edible starch can be designated as such when forming an ingredient of some other food ; exemption from requirements to disclose ingredients for preparations specified in the BP and BPC. The Cream and Use of Milk (Revocation) Order, 1953 The Cream Order, 1951 was revoked, thereby removing restrictions on the manufacture and sale of cream. The prohibition on the use of milk in the manufacture of breads, cakes, sweetmeats and synthetic cream was also removed. Manufacturers may obtain milk without authorisation from the Minister and, until a specified date, imports of cream from a number of countries is licensed. The Food Standards (Preserves) Order, 1953 Prescribed revised standards for jam and marmalade. The Food Standards (Preserves) (Amendment) Order, 1953 Prescribed revised standards for fig and lemon jam and for rhubarb and ginger jam. Revised standards prescribed in the original order for certain other jams became effective as from the operative date of the amending Order. The Artificial Sweeteners in Food Order, 1953 Prohibited the use of artificial sweeteners, other than saccharin in the composition or preparation of any food sold or intended for sale for human consumption. The Food Standards (Saccharin Tablets) Order, 1953 This Order revised the standard for saccharin tablets and applied the standard to all sweetening tablets containing saccharin. Slaughter of Animals (Pigs) Act, 1953 This Act provided for the humane slaughter of pigs in places other than slaughterhouses or knackers' yards to which the Slaughter of Animals Act, 1933, applies. 80 Merchandise Marks Act, 1953 Amends the provisions of the Merchandise Marks Acts, 1887 to 1938 relating to false trade descriptions and to imported goods bearing the trade mark of a manufacturer, dealer or trader in the United Kingdom and amended the Merchandise Marks Act, 1887 in relation to offences. Heating Appliances (Fireguards) Act, 1952 The above Act which came into force on March 23, 1953 makes it an offence for any person, except in certain specified circumstances, in the course of business to sell, or let under a hirepurchase agreement or on hire, or to offer or expose for sale or for letting under a hirepurchase agreement or on hire, any appliance required by Regulations under the Act to be fitted with a guard, and either the appliance is not fitted with a guard or the guard does not comply with standards prescribed by the Regulations. Regulations have been made by the Secretary of State (SI 1953 No. 526) requiring fireguards to be fitted to gas fires, electric fires and oil heaters of types so designed that they are suitable for domestic use and so constructed that, without a guard, there is likelihood of injury by burning or of ignition of clothing by reason of contact with or proximity to the heating element or flame. The Regulations prescribe the standard with which the guards must comply and the tests to be employed in ascertaining whether guards comply with those standards. The Regulations came into force on October 1 and, with certain exceptions, including provision for the disposal of appliances manufactured before the date from which the regulations operate, an offence is committed as outlined in the first paragraph if the guard does not conform to the prescribed standard. The sanitary inspectors were authorised for the purposes of inspection and testing of heating appliances under the Act. Food work generally In commenting on the work generally, Mr. Thomas, the group food inspector states :—"Generally speaking the year can be regarded as a satisfactory one. The standard of cleanliness, the freedom from any serious outbreak of food poisoning, the almost complete absence of adulteration of food sold in the borough as shown by the Analyst's reports, and the continued interest shown by the public in food hygiene can all be regarded as satisfactory. "In May a request was made by the London County Council for a series of lectures to be given by the food inspectors to schools in the borough. The object of the lectures was to increase the interest of the school child in milk and milk production, and with the cooperation of the head teachers 26 lectures were given. Considerable interest was shown by the children and the film strips showing milk production and distribution were much appreciated. 81 "All condemned food was collected as in previous years by the Borough Engineer's department and, where suitable, used for animal feeding. The arrangement with the Sheppey Glue and Chemical Works was continued throughout the year— this firm taking condemned meat, etc. The remainder was used for animal feeding or treated as refuse. "The question of the cleanliness of places where meals are prepared, i.e., restaurants, cafes, and so on, received a good deal of attention and publicity during the year and I feel that the essence of the matter is the type of person engaged in this work. There can be no doubt that there are some who should never be allowed to handle food intended for human consumption. They are naturally slovenly and careless and no regulations or Acts of Parliament will change them. It may well be that the time has come when the person and not the premises should have primary consideration, as in the case of public houses where the suitability of the licensee is the governing factor." 82 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 amoebic) Poliomyelitis, acute Encephalitis, acute Puerperal pyrexia Enteric fever Relapsing fever Erysipelas Scabies Food poisoning Scarlet fever Glanders Smallpox Hydrophobia Tuberculosis, all forms Malaria Typhoid fever, including paratyphoid Measles Typhus fever Membranous croup Whooping cough Meningococcal infection PRINCIPAL NOTIFIABLE DISEASES Number of notified cases (corrected for revised diagnosis) during the year 1953 with comparative figures for the previous six years. Table 42 Diseases Cases notified 1953 1952 1951 1950 1949 1948 1947 Anthrax – – – – 1 – – Diphtheria 1 — — — 3 5 9 Dysentery 84 169 365 63 9 24 26 Encephalitis (acute) 3 — 5 1 — — — Enteric or typhoid fever 2 — 4 1 3 2 4 Erysipelas 18 19 24 41 35 33 45 Food poisoning 32 33 26 38 50 12 3 Malaria 2 1 1 2 1 2 4 Measles 2082 2183 3546 2084 1940 2642 810 Meningococcal infection 10 5 6 7 3 5 19 Ophthalmia neonatorum 3 4 3 3 6 9 9 Pneumonia 189 89 173 108 84 67 104 Poliomyelitis (acute) 52 15 11 38 35 9 72 Puerperal pyrexia 57 88 63 29 27 50 43 Scabies 5 18 21 22 29 54 122 Scarlet fever 283 379 215 358 521 332 254 Smallpox – – – – – – 1 Tuberculosis 341 307 299 406 371 502 426 Whooping cough 574 512 819 813 363 789 362 TOTALS 3738 3822 5581 3608 3109 4035 1887 83 Notifications of infectious diseases in 1953 showing sex and age groups :— Table 43 Diseases Under 1 1- 3- 5- 10- 15- 25- 45- 65 plus Total M F M F M F M F M F M F F F M F M F Diphtheria – – – – – 1 – – – – – – – – – – – – – 1 Dysentery — 1 11 13 11 7 8 9 3 2 3 3 4 6 2 — 1 — 43 41 Encephalitis (acute) – – – – – – 1 – 1 – – – 1 – – – – 3 — Enteric and Paratyphoid fever – – – – – – – – – – 1 – – – – – 1 – 2 – Erysipelas — — — — — — — 1 — — — — 3 2 2 9 — 1 5 13 Food poisoning 2 — 11 2 7 2 1 1 — — — 1 1 1 1 1 — 1 23 9 Malaria — — — 2 — 2 — Measles 40 35 267 253 300 256 461 429 4 11 8 8 5 3 1 1 1085 997 Meningococcal infection 1 2 1 3 1 – 1 – – – – – – – – – 1 – 5 5 Ophthalmia neonatorum 1 2 – – – – – – – – – – – – – – – – 1 2 Pneumonia 2 2 5 8 7 4 5 8 2 2 9 2 15 20 27 15 24 32 96 93 Poliomyelitis (paralytic) 2 7 3 1 1 6 3 1 2 – 7 – 2 – – – – 17 18 Poliomyelitis (nonparalytic) – – – – – 2 5 1 – 3 1 2 – 3 – – – – 6 11 Puerperal pyrexia — — — — — — — — — — — 20 — 37 – — – — — 57 Scabies – – – – 1 1 – 3 – – – – – – – – – – 1 4 Scarlet fever 1 — 9 8 35 20 77 94 10 20 4 1 3 1 – – – – 139 144 Tuberculosis (respiratory) – – 2 2 4 2 11 6 4 4 34 44 46 56 54 14 16 7 171 135 Tuberculosis (nonrespiratory) 1 – – – 2 1 – 6 2 4 3 3 7 1 1 1 3 14 21 Whooping cough 33 25 65 67 67 82 90 128 4 1 1 1 1 5 1 1 – 2 262 312 Totals 83 67 378 359 436 379 666 689 31 45 67 92 82 143 88 42 44 47 1875 1863 84 Analysis of certain diseases in table 42 into divisional areas :— Table 44 Disease Div. areas Under 1 1- 3- 5- 10- 15- 25- 45- 65+ Total Dysentery W _ 9 14 9 3 5 6 1 _ 47 N 1 12 1 2 - — 2 _ 1 19 S – 3 3 6 2 1 2 1 - 18 Total 1 24 18 17 5 6 10 2 1 84 Measles W 25 180 194 328 4 4 3 1 _ 739 N 27 161 179 255 3 5 3 – 1 634 S 23 179 183 307 8 7 2 – – 709 Total 75 520 556 890 15 16 8 1 1 2082 Pneumonia W 1 2 4 6 3 5 13 16 14 64 N 2 11 5 4 _ 2 9 7 33 73 S 1 – 2 3 1 4 13 19 9 52 Total 4 13 11 13 4 11 35 42 56 189 Poliomyelitis W 1 1 4 7 5 4 3 _ _ 25 N – 7 – 3 – 3 1 _ _ 14 s 1 2 – 5 1 3 1 – – 13 Total 2 10 4 15 6 10 5 – – 52 Scarlet fever W _ 6 20 58 5 – 1 _ _ 90 N _ 2 13 43 5 1 2 _ – 66 S 1 9 22 70 20 4 1 – – 127 Total 1 17 55 171 30 5 4 – – 283 Whooping cough W 18 40 55 77 2 1 1 1 1 196 N 13 35 28 61 1 – 2 – – 140 S 27 57 66 80 2 1 3 1 1 238 Total 58 132 149 218 5 2 6 2 2 574 For tuberculosis, see Table 50 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. 85 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 45 W N S Total. Visits 552 408 718 1,678 Futile visits 325 307 597 1,229 Revisits 253 143 222 618 Total 1,130 858 1,537 3,525 Poliomyelitis 1953 was a bad year as far as the incidence of poliomyelitis was concerned. 52 cases were confirmed, this being the highest number since the peak year of 1947 when there were 76 cases. Of the 52 cases, 35 were paralytic and 17 non-paralytic. 25 of them were in the west division, 14 in the north and 13 in the south. 22 were males and 30 females, of whom 3 were known to be pregnant, one of these aborting. Of the 52, 3 were under one year of age, 13 between one and five, 21 between 5 and 15, 10 between 15 and 25 and 5 between 25 and 45. As far as our own records go (these possibly being incomplete), 8 of the cases were of the bulbar type (paralysis of a nerve in the brain); there were 2 deaths, 22 cases made a complete recovery, 13 had severe paralysis and 13 had moderate or mild paralysis; 2 were untraced. There has been a tendency in recent years for poliomyelitis to show itself more and more in local outbreaks, such as in a family, a school, or a hospital, whereas some years ago this method of spread seemed to be the exception. It is likely that there are several strains of the various types of virus (three types are wellknown at present) and it is possible that the infecting strain now is different to that of some years back. Much has been said recently as to whether virulent paralytic infection is more likely to spread from case to case (the socalled " narrow stream ") or whether there is more usually a mild infection affecting large numbers of people with only a very small proportion of them showing definite signs of poliomyelitis or paralysis. Clearly, if one or other of these theories were proved to be correct, the administrative measures required in attempting to control the disease would be very different. Thus on the narrow-stream hypothesis, early diagnosis of a case with rigorous control or partial quarantine of contacts, should in theory prevent spread just as it seems to do in practice where smallpox is concerned; while with the other theory of widespread infection little if any benefit 86 could be produced administratively, except possibly by some quarantining in the early days of the season. It is quite likely that both hypotheses have the truth in them, and in fact different strains of the virus may act in different ways so that both methods of spread may be going on at the same time in the same place. Therefore it is proposed in future to take, where practicable, more intensive measures of surveillance or quarantine of close contacts of cases, provided that we get to know of the cases at an early enough date. In 1953 there were three well-defined groups of cases, the first early in the season at a local hospital, the second at a residential nursery, and the third in the late autumn at a school. Poliomyelitis has been endemic in London with a fairly high incidence for seven years now and a brief review of the experience in this borough during those seven years may be of interest. Table 45 shows the number of possible cases intimated to the department, the number of such cases removed to hospital, the number of such cases finally confirmed as suffering from poliomyelitis and the percentage of confirmed cases of the total intimated cases. Table 46 Year Intimated to Dept. Removed to hospital Confirmed (d) as %age of (b) (a) (b) (c) (d) (e) 1947 176 172 76 43 8 26 25 9 35 9 83 79 41 49 1950 93 90 38 41 1 33 33 11 33 2 30 30 15 50 3 83 79 52 63 TOTAL 524 508 242 46 It will be seen that over the seven-year period somewhat less than half of those intimated to the department had subsequently been confirmed, but this figure has tended to rise in recent years, presumably as a result of the disease being better diagnosed in the early stages, and in 1953 nearly two-thirds of the cases intimated were subsequently confirmed. Table 46 gives other information comparing the disease in the seven different years. 87 Table 47 Year Confirmed cases Division No. of weeks with 3 or more cases Type Sex Age groups Result* W N S Paralytic N-P M F 0- 1- 5- 15- 25- 45- 65+ Died Compl. recov. Paralysed Unknown Severe Mild 1947 % 76 26 24 26 10 47 29 43 33 2 23 27 11 12 1 _ 7 22 20 19 8 34 32 34 62 38 57 43 3 30 35 15 16 1 0 10 32 29 28 - 1948 % 9 3 4 2 1 5 4 4 5 _ 2 3 2 2 _ – _ 5 1 2 1 33 45 22 56 44 44 56 0 22 34 22 22 0 0 0 63 12 25 – 1949 % 41 13 13 15 5 29 12 25 16 5 14 13 5 4 _ – 3 14 10 10 4 32 32 36 71 29 61 39 12 34 32 10 0 0 8 38 27 27 – 1950 % 38 13 10 15 6 26 12 19 19 1 11 11 9 6 _ — _ 14 12 9 3 34 26 40 68 32 50 50 3 29 29 23 16 0 0 0 40 34 26 – 1951 °/ /O 11 3 3 5 2 9 8 3 5 1 1 4 – – – 8 – 1 2 27 27 46 18 82 73 27 0 46 9 9 36 0 0 0 89 0 11 – 1952 % 15 3 4 8 8 7 8 7 4 8 1 2 _ _ 8 4 3 _ 20 27 53 53 47 53 47 0 27 53 7 13 0 0 0 53 27 20 – 1953 % 52 25 14 13 10 35 17 22 30 3 13 21 10 5 _ _ 2 22 13 13 2 48 27 25 67 33 42 58 6 25 40 19 10 0 0 4 44 26 26 v Total % 242 86 72 84 _ 152 90 129 113 11 72 84 39 35 1 _ 12 93 60 57 20 35 30 35 63 37 53 47 5 30 35 16 /4 0 0 5 42 27 26 *The percentages in these columns relate to the traced cases. 88 The following points of interest may be noted : the rough similarity of the three divisions of the borough in the number of cases ; the fairly constant ratio of paralytic to non-paralytic cases (except to some extent in non-epidemic years); the variations from year to year in the sexes (but averaging out over the total period); the fact that only one person over 45 years of age was affected in the whole seven years, while approximately one-third were under 5 and one-third were of school age; and the total result that about one in twenty dies, six in twenty have severe paralysis, five in twenty have a mild paralysis and eight in twenty recover completely. These figures are from statistics collected to some extent this year; some of the cases could not be traced, as indicated in the table. Poliomyelitis remains a baffling disease, and one which is a particular anxiety to parents of young children because it seems to affect the community of young children indiscriminately, and there is so little of any value that can be done to safeguard the child. Nevertheless much research work has been going on and continues to go on, particularly in America, and much more is known about the disease than a few years ago. Experiments in immunisation of children are taking place in America this year and there is a mild belief that they may show some success. At present, however, in this country only general advice can be given, and of this general advice perhaps some five points stand out:— (1) Because it is likely that the virus is often transmitted from hand to mouth, efforts should be made to ensure that every child washes his hands before meals and adopts other hygienic practices, such for example, as not sucking fingers, pencils, and so on. (2) Because a child may carry the causal organism in his bowel without showing any signs of the disease, it is desirable, to some extent for his own good but particularly for the good of the community, that he should be made to wash his hands thoroughly after using the water closet. (3) Because injuries, excessive exercise, and other such factors alter what is technically known as the "blood-brain barrier" and thereby let virus through this barrier into the brain and spinal cord more easily, any child who, when there is poliomyelitis about the district, seems out-of-sorts should be encouraged or forced to stay in bed, or at the least to rest quietly at home until the nature of the illness has become manifest. (4) Similarly, because of the reason given in (3) above, even small traumata, like having injections, or removal of teeth (and 89 certainly removal of tonsils), should be avoided where practicable during the times when poliomyelitis is prevalent in an area. (5) Because of the increased chance of other children being in an infectious state, it is well, during times when the disease is prevalent, to avoid crowded places, gatherings of young children, and unnecessary travel; and to pay even more attention to general hygiene, such as protecting food from flies, washing crockery and cutlery in very hot water, and so on. Whooping cough Of the 574 cases notified during the year, 8 occurred in residential nurseries or institutions and were not, therefore, visited. In the remainder of the cases the homes were visited by the infectious disease visitors. 103 of these visits were futile in that noone was in (6 cases at the first call, 32 cases at the second attempt, and in 11 cases at the third attempt). In the remainder details were taken of the patient, the possible cause of his infection, and of his method of isolation, and general advice was given with regard to contacts and to hygiene. Revisits or follow-up visits were paid to 427 of the patients some time during the year or early in 1954 with the following results :— 2 had not been confirmed as whooping cough. In 91 there was no information at the revisit (68 were revisited once, 22 twice, and 1 three times). In 7 cases the family had moved from the district. In 283 the child had either fully and completely recovered, or, if the revisit were made fairly shortly after notification, the child was making a good recovery. In some of these it was specifically noted that a great improvement had been made after treatment in decompression apparatus. In 44 cases the visitor noted that recovery had not been complete —the child might be losing weight, or be still debilitated or be still suffering from a cough, or merely perhaps that its general health was only "fairly good." In 21 of these cases some more specific complaint, notably bronchitis, was associated with the whooping cough. In all cases suitable advice was given which, in all but the fairly simple, was to take the child back to the private doctor or to hospital for further medical attention, if in fact this was not already being given. 90 Tuberculosis The age distribution of the new cases of tuberculosis notified by formal notifications and the deaths from tuberculosis during the year are shown in the following table :— Table 48 Age periods New cases notified Deaths Respiratory NonRespiratory Totals Respiratory NonRespiratory Totals M F M F M F M F M F M F 0- – – 1 – 1 – – – – 1 – 1 1- 2 2 _ – 2 2 – – – – – 2- 4 2 2 1 6 3 – – 5- 11 6 _ 6 11 12 – – – _ – – 10- 4 4 7 – 6 4 _ _ __ _ _ _ 15- 16 19 1 2 17 21 _ _ — _ _ _ 20- 18 25 3 1 21 26 _ _ _ _ _ _ 25- 29 41 3 4 32 45 1 8 5 1 – 9 5 35- 17 15 – 3 17 18 – – – – – 45- 30 7 1 31 7 15 – – – – – 55- 74 7 1 24 ft 4 1 - 16 4 65- 12 6 1 1 13 7 7 – – – 7 – 75- 4 1 – 2 4 3 2 2 1 2 3 171 135 14 21 185 156 32 12 2 2 34 14 New cases of tuberculosis coming to the notice of the department other than by formal notification :— Table 49 Source of information Respiratory Non-respiratory Death returns — from local registrars 4 – Death returns — from Registrar General 1 – Posthumous notifications 2 1 Totals 7 1 91 Analysis of new cases of tuberculosis into divisional areas :— Table 50 Division Sex 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total West Respiratory M - 2 3 5 2 6 4 9 9 5 8 6 1 60 F - 2 1 3 - 5 9 11 8 4 2 3 1 49 Non-respiratory M 1 - 1 - - 1 1 – – – – – – 4 F - - - - - 1 - 1 – – – – 1 3 Total M 1 2 4 5 2 7 5 9 9 5 8 6 1 64 F - 2 1 3 - 6 9 12 8 4 2 3 2 52 North Respiratory M - - - 2 - 5 4 13 6 17 5 2 3 57 F - - 1 2 2 5 10 17 3 1 2 1 - 44 Non-respiratory M - - 1 - 1 - 1 2 – – – – – 5 F - - 1 3 - - - 2 2 - - 1 - 9 Total M - - 1 2 1 5 5 15 6 17 5 3 2 62 F - - 2 5 2 5 10 19 5 1 2 2 - 53 South Respiratory M – – 1 4 2 7 8 7 2 9 10 4 - 54 F - - - 1 2 9 6 13 4 2 3 2 - 42 Non-respiratory M - - - - 1 - 1 1 - - - 1 - 4 F – - 3 - 1 1 1 1 - 1 - 1 9 Total M - 1 4 3 7 9 8 2 9 10 5 - 58 F - - - 4 2 10 7 14 5 2 4 2 1 51 Quarterly revision of tuberculosis register:— Table 51 Respiratory Non-respiratory M F M F On register at December 31. 1952 1,334 1,014 209 273 Notified for first time 171 135 14 21 Restored to register 14 17 1 1 Added to register otherwise 48 56 3 3 Removed from register 170 157 16 19 On register at December 31, 1953 1,397 1,065 211 279 92 Summary of statistics as to tuberculosis for the last ten years Table 52 Year Population New coses notified (all forms) (excluding inward transfers) Not if. rate per thousand pop. Deaths Death rate from resp. tuberculosis per thousand pop. All forms Respiratory Lewisham County of London 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 207,410 437 211 126 110 0.53 0.59 1947 221,170 426 1.93 134 121 0.55 0.60 1948 226,100 502 111 119 109 0.48 056 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 1953 225,800 341 1.51 48 44 0.19 0.21 Although the deaths from tuberculosis have come down considerably in recent years there is still much room for improvement. In this borough last year two children died as a result of tuberculosis, a figure which is so small that to make comparisons with it would be statistically incorrect. But taking England and Wales as a whole it is true that though the child mortality from tuberculosis has been reduced to about a quarter of what it was seven years ago, it has recently been stated that it is still more than five times as high as it is in Sweden or Denmark (where BCG vaccine is very widely used) or in one or two states in America (where BCG vaccine is little used). The general opinion, which is forming with extreme slowness in this country, is that BCG vaccine can play an important part in fighting the tuberculosis problem. It has further been stated that while most of our energy and money should go towards the eradication of all active foci of tuberculous infection, until this has been achieved we must protect the widest possible circle of contacts of all forms of tuberculosis with BCG. During the year a small extension of the use of BCG was, at long last, allowed by the Ministry of Health by their authorisation of local education authorities to vaccinate school children just before their fourteenth birthday (Ministry of Health circular 22/53). The Public Health (Infectious Diseases) Regulations, 1953 Statutory Instrument 299 of 1953 which came into operation on April 1 superseded the Public Health (Infectious Diseases) Regulations of 1927 and the Infectious Diseases (London) Regulations of the same year. The new Regulations continue to require notification of malaria, dysentery, acute primary pneumonia and acute influenzal pneumonia and prescribe the action to be taken in relation to certain of these diseases in conformity with the present working of the health services. 93 The Regulations amplify the precautionary measures to be taken against food poisoning by relating them to typhoid fever, paratyphoid fever or other salmonella infections, dysentery and staphylococcal infection likely to cause food poisoning. The previous regulations dealt with enteric fever and dysentery only. The precautionary measures are applied to carriers of these diseases as well as to actual patients, and certain persons can be prevented from continuing in employment which involves the handling of food and also from entering such employment. A local authority can authorise the medical officer of health to issue notices in emergency in order to check the spread of these diseases, and the Council has given the authorisation in this borough. Mass radiography unit I am indebted to Dr. J. M. Morgan, director of the unit, for information of work done in the borough in 1953 on which the following table is based :— Table S3 Patients Town Hall October - November Factories, hospitals, schools during the year Men Women Total Men Women Total General analysis X-rayed 2,378 4,396 6,774 1,376 1,742 3,118 (Previously x-rayed) 1,815 2,780 4,595 — — — Recalled for large film 92 127 219 39 51 90 Normal on large film 29 40 69 17 14 31 Abnormal on large film 62 87 149 22 37 59 Not yet re-attended 1 — 1 — — — Analysis of abnormal large films :— Cases considered tuberculous, for investigation: 16 19 35 4 10 14 (a) proved active 10 9 19 1 6 7 (b) proved quiescent 3 8 11 2 3 5 (c) still under investigation 3 2 5 1 1 2 Non-tuberculous cases for investigation 6 11 17 1 1 2 Still under investigation — 2 2 — — — Cardio-vascular lesions 1 10 11 3 5 8 Previously known TB cases No action required 1 38 4 43 5 81 1 13 3 18 4 31 Dr. Morgan comments that the figures are as expected, being equal to the average figure for the particular type of survey in the country as a whole. Immunisation against infectious disease The publicity campaign sponsored by the Ministry of Health in connection with diphtheria prophylaxis was continued. In a circular issued by the Ministry it was stated that since 1944 (when records of 94 corrected notifications of diphtheria were first kept) notifications had fallen from over 23,000 in that year to a new low figure of 240 (provisional) for 1953. The Minister expresses the hope that authorities will plan and sustain the campaign with renewed vigour in their areas during 1954 and that particular efforts will be made in areas where there is a low percentage of immunised children under five. The number of children immunised throughout the country under local authority arrangements (including those immunised by family doctors) from the beginning of 1940 to 30 June, 1953 was 10,569,796. During the first half of 1953, 270,584 children were immunised, of whom 103,123 were under one year of age. The objective of the campaign is still to secure immunisation of not less than 75 percent of babies before their first birthday, the objective for 1954 being 498,000 children under one year. In 1951, only 28 percent of the number of babies reaching the age of one year were immunised; in 1952 the figure rose to 31 percent but in the first half of 1953 it improved only to 31.5 percent. The Minister points out that elimination of diphtheria is conditional upon the maintenance of an adequate level of immunisation and that if parents leave their children unprotected there may be a return of diphtheria outbreaks, as exemplified during a recent outbreak in the Midlands, where among 78 cases there were 6 deaths, all of them children who had not been immunised. Although the provision of an immunisation service for diphtheria, whooping cough, smallpox or other diseases, 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, 1953 Born in year Under 1 2 3 4 5-9 10-14 Total under 15 1953 1952 1951 1950 1949 1948-44 1943-39 (i) Diphtheria and combined diphtheria and whooping cough :— Immunised during year Immunised at end of year 80 1,657 173 91 59 260 20 2,340 80 1,879 2,639 2,528 2,380 13,862 14,275 37,643 Estimated mid-year population ... 17,300 31,500 48,800 (ii) Whooping cough (including combined)— Immunised during year (age at date of immunisation) 707 717 128 84 38 35 3 1,712 95 (lii) Vaccination against smallpox Age at December 31, 1952 Under 1 1-4 5-14 15 and over Total Primary :— Clinics 949 104 9 14 1,076 Private doctors 444 152 52 75 723 Revaccination :— Clinics – 2 9 72 83 Private doctors – 4 47 219 270 Town Hall, S.E.6. June, 1954 E. H. R. SMITHARD, Medical Officer of Health 96 APPENDIX A Acts of Parliament, Statutory Instruments and Circular Letters issued by Government Departments with regard to the public health services, during the year 1953 :— Statutes The Local Government (Miscellaneous Provisions) Act, 1953. Merchandise Marks Act, 1953. Slaughter of Animals (Pigs) Act, 1953. London County Council (General Powers) Act, 1953. Statutory Instruments No. 23 The Canning of Food and Feeding Stuffs and Home-Canned Fruit and Vegetables (Revocation) Order, 1953. 245 The Canned Corned Meat (Prices) Order, 1953. 246 The Offals in Meat Products Order, 1953. 299 Public Health (Infectious Diseases) Regulations, 1953. 416 The Heating Appliances (Fireguards) Act, 1952 (Commencement) (C.l) Order, 1953. 526 The Heating Appliances (Fireguards) Regulations, 1953. 536 The Labelling of Food Order, 1953. 552 The Cream and Use of Milk (Revocation) Order, 1953. 691 The Food Standards (Preserves) Order, 1953. 726 The Milk (Great Britain) Order, 1953. 731 The Egg Products (Revocation) Order, 1953. 828 The Food Standards (Ice Cream) Order, 1953. 1282 The Flour Order, 1953. 1283 The Bread Order, 1953 1300 The Poisons List Order, 1953. 1301 The Poisons Rules, 1953. 1307 The Food Standards (Preserves) (Amendment) Order, 1953. 1309 The Saccharin (Revocation) Order, 1953. 1310 The Food Standards (Saccharin Tablets) Order, 1953. 1311 Artificial Sweeteners in Food Order, 1953. 1407 The Salvaged Goods (Revocation) Order, 1953. 1609 The Public Health (Condensed Milk) (Amendment) Regulations, 1953. 1610 The Public Health (Preservatives, etc., in Food) (Amendment) Regulations, 1953. 1820 The Public Health (Preservatives, etc., in Food) (Amendment No. 2) Regulations, 1953. 1821 The Milk (Special Designation) (Pasteurised and Sterilised Milk) (Amendment) Regulations, 1953. 1828 The Food Standards (Soft Drinks) Order, 1953. 1876 The Milk and Dairies (Amendment) Regulations, 1953. 1889 The Labelling of Food (Amendment) Order, 1953, 97 Ministry of Health Circulars No. 2 Annual Report of Medical Officers of Health for 1952. 6 Public Health (Infectious Diseases) Regulations, 1953. 8 Diphtheria Prophylaxis — Publicity Campaign. Ministry of Food Circulars No. 1 Meat Products (No. 3) Order, 1952. 3 Milk and Dairies Regulations, 1949. Approved Oxidising and Preservative Agents. 4 The Home Canned Fruit and Vegetables Order, 1950— Revocation. 6 Offals in Meat Products Order, 1953. 9 The Cream and Use of Milk (Revocation) Order, 1953. 10 Ice Cream'Standard. 11 Milk and Dairies Regulations, 1949. Approved Oxidising and Preservative Agents. 12 The Prevention of Nuisance from Blowflies. 15 The Food and Drugs (Whalemeat) Regulations, 1949 and 1950— The Faroe Island — Veterinary Certificates. 16 Clean Catering. 17 The Food Standards (Saccharin Tablets) Order, 1953. Artificial Sweeteners in Food Order. 18 The Flour Order, 1953. The Bread Order, 1953. 19 The Salvaged Goods (Revocation) Order, 1953. 20 Public Health (Condensed Milk) (Amendment) Regulations, 1953. 21 Disposal of Meat and Offal unfit for human consumption. 22 Standards for Soft Drinks. 23 The Milk (Special Designations) (Pasteurised and Sterilised Milk) (Amendment) Regulations, 1953. 24 The Milk and Dairies (Amendment) Regulations, 1953. Ministry of Housing and Local Government Circulars No. 31 Defence Regulations No. 50 (Demolition of War Damaged Property). 39 Control of Building Operations (Repair, Maintenance, etc.). Licensing of Work on Existing Dwellings. Ministry of Agriculture and Fisheries Circulars No. 2 The Use of Rodenticidal Dusts containing Anticoagulants in the control of common rat and house mouse. Home Office Circulars No. 98 The Heating Appliances (Fireguards) Regulations, 1953. 98 APPENDIX B Legal Proceedings in 1953 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. c 19 Jan. Non-compliance with nuisance notice in respect of 40, Rowland Grove. — — Adjourned sine die. Repairs substantially completed. 16 Feb. Non-compliance with nuisance notice in respect of 58, Dal main Road. – – Order made for abatement of nuisance within 28 days. 16 Feb. Non-compliance with nuisance notice in respect of 43, Brightfield Road. – – Order made for abatement of nuisance within 14 days. 16 Feb. Non-compilance with nuisance notice in respect of 39, Limes Grove. – – Order made for abatement of nuisance within 14 days. 16 Feb. Non-compliance with nuisance notice in respect of 47a, Clarendon Rise. – – Summons withdrawn. Work completed. 9 Mar. Non-compliance with nuisance notice in respect of 48, Dallas Road. – – Adjourned sine die. Work in progress. 27 Mar. Non-compliance with nuisance notice in respect of 32, Honley Road. – – Order made for abatement of nuisance within 56 days. 10 April Non-compliance with abatement order in respect of 101, Gilmore Road. 10/- – 10 April Non-compliance with nuisance notice in respect of 37, Dalmain Road. – 1 1 0 Order made for abatement of nuisance within 28 days. 1 May Non-compliance with nuisance notice in respect of 11, Watlington Grove. – – Order made for abatement of nuisance within 28 days. 1 May Non-compliance with nuisance notice in respect of 26, Kinver Road. – 1 0 0 Order made for abatement of nuisance within 42 days. 8 May Non-compliance with nuisance notice in respect of 79, Marsala Road. – 1 0 0 Order made for abatement of nuisance within 42 days. 22 May Non-compliance with nuisance notice in respect of 46, Mount Ash Road. – – Adjourned sine die. Work nearly completed. 6 July Non-compliance with nuisance notice in respect of 7, Kent House Road. – – Order made for abatement of nuisance within 28 days. 6 July Non-compliance with nuisance notice in respect of 61, Miall Road. – – Order made for abatement of nuisance within 28 days. 6 July Non-compliance with nuisance notice in respect of 94, Catford Hill. – – Adjourned sinedie. Work completed. 6 July Non-compliance with abatement order in respect of 43, Brightfield Road. – – Adjourned to 24 July Summons not served. 99 Date of hearing Offence Fine £ Costs Remarks £ s. d. 27 July Non-compliance with nuisance notices in respect of 115, 117, 119 and 125, Amblecote Road. — — Summonses withdrawn. Owner gave undertaking to carry out the necessary works. 24 July Non-compliance with abatement order in respect of 43, Brightfield Road. 5 3 3 0 7 Sept. Non-compliance with nuisance notice in respect of 13, Taunton Road. – – Case cancelled. Repairs put in hand. 2 Oct. Non-compliance with nuisance notice in respect of 59, Eastdown Park. – – Adjourned sine die. Work in progress. 16 Oct. Non-compliance with nuisance notice in respect of 16, Bell Green. – – Adjourned sine die. Work in progress. 16 Oct. Non-compliance with nuisance notice in respect of 30, Honley Road. – – Order made for abatement of nuisance within 6 weeks. 16 Oct. Non-compliance with nuisance notice in respect of 28, Honley Road. – 1 0 0 Order made for abatement of nuisance within 6 weeks. 16 Oct. Non-compliance with nuisance notice in respect of 34, Cambridge Drive. – – Work in progress. Summons not proceeded with. 16 Oct. Non-compliance with nuisance notice in respect of 14, Taunton Road. – – Work completed. Summons withdrawn. 13 Nov. Non-compliance with nuisance notice in respect of 30, Hurstbourne Road. – – Adjourned sine die. Work in hand. 13 Nov. Non-compliance with nuisance notice in respect of 35, Vancouver Road. – – Order made for abatement of nuisance within 3 months. 13 Nov. Non-compliance with nuisance notice in respect of 17, Farren Road. – – Adjourned sine die. Work in hand. 13 Nov. Non-compliance with nuisance notice in respect of — — Adjourned sine die. Work in hand. 13 Nov. 141, Perry Rise. Non-compliance with nuisance notice in respect of 30, Rockbourne Road. — — Summons not properly served. For rehearing on 11 December. 13 Nov. Non-compliance with nuisance notice in respect of 30, Rockbourne Road. – – Summons withdrawn 9 December. Police unable to serve. To be dealt with under s.9, 13 Nov. Non-compliance with nuisance notice in respect of — — Housing Act, 1936. Adjourned sine die. Work in progress. 13 Nov. 74, Malham Road. Non-compliance with nuisance notice in respect of — 1 1 0 Order made for abatement of nuisance within 13 Nov. 100, Effingham Road. Non-compliance with nuisance notice in respect of 80, Brightfield Road. — — 14 days. Adjourned sine die. Work in progress. 100 Date of hearing Offence Fine £ Costs Remarks £ s. d. 13 Nov. Non-compliance with nuisance notice in respect of 76, Effingham Road. — 1 1 0 Order made for abatement of nuisance within 14 days. 13 Nov. Non-compliance with nuisance notice in respect of 12, Rennell Street. – – Adjourned sine die. Work completed. 13 Nov. Non-compliance with nuisance notice in respect of 2, Rhyme Road. – – Summons withdrawn. Work completed. 13 Nov. Non-compliance with nuisance notice in respect of 47, Wearside Road. – – Adjourned sine die. Work done. 13 Nov. Non-compliance with nuisance notice in respect of 45, Carholme Road. – – Adjourned sine die. Work in hand. 13 Nov. Non-compliance with nuisance notice in respect of 48, Dallas Road. – – Adjourned to 4 Dec. 4 Dec. Non-compliance with nuisance notice in respect of 48, Dallas Road. – – Adjourned sine die. Work in hand. 4 Dec. Non-compliance with nuisance notice in respect of 13, Hazel Grove. – – Adjourned sine die. Work carried out. 21 Dec. Non-compliance with nuisance notice in respect of 38, Longhurst Road. – – Adjourned sine die. Builder instructed. HOUSING ACT, 1936 Date of hearing Offence Fine £ Costs Remarks £ s. d. 9 Mar. Basement flat at 34, Lee Park relet in contravention of undertaking. (ss12and 14). – – Summons dismissed. No witness to owner's signature on undertaking. Adjourned until 10 July. 5 June Basement flat at 34, Lee Park relet in contravention of agreement (ss 12 & 14). – – 10 July Basement flat at 34, Lee Park relet in contravention of agreement (ss 12 & 14). 5 3 3 0 29 May Failure to pay instalments under Order made under s 10 where the council carried outwork in default. – – Order made for payment of instalments due amounting to £19 10s. –FOOD AND DRUGS LEGISLATION Date of hearing Offence Fine £ Costs Remarks £ s. d. 31 Aug. Caustic soda and broken bottle stopper in bottle of stout. Contravention of s. 3. 5 2 2 0 101 BYELAWS MADE BY THE LONDON COUNTY COUNCIL Date of hearing Offence Fine £ Costs Remarks £ s. d. 7 Sept. Unlawfully carrying on the business of rag dealer contrary to the byelaws. 3 1 0 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:— Foreign matter in sausages (cloth). (Food and Drugs). Sale of dried parsley containing 8.2 percent siliceous matter. (Food and Drugs). Mice excreta in bread. (Food and Drugs). Foreign body in bread. (Food and Drugs). APPENDIX C List of special reports submitted to the Health Committee by the Medical Officer of Health during 1953 :— january 6 Willow Way clearance area— preliminary report. January 6 Recent increase in deaths in the borough of borough residents. March 3 Willow Way and nearby area— proposed slum clearance. March 31 Slaughterhouses. June 9 Destruction of pigeons. June 9 South Eastern Gas Board, gas works, Bell Green. June 9 Rivers (Prevention of Pollution) Act, 1951. June 9 Emergency help at Coroner's Court and mortuary. June 9 Old People's voluntary affiliated organisations— grants. July 7 South Eastern Gas Board— gas works, Bell Green. September 8 Accidents in the home. September 8 Establishment and grading of sanitary inspectors. September 8 Basement bakehouses. September 8 Food hygiene. October 6 Slum clearance programme, 1956/60. October 6 Food hygiene propaganda. November 3 South Eastern Gas Board— alleged nuisances at Bell Green gas works. November 3 Smokeless zones. December 1 Two ? atmospheric pollution incidents. 102 APPENDIX D Distribution and other services Establishments in Lewisham by nature of business were shown in the 1951 Board of Trade census as follows :— Type of business Establishments Persons engaged full time part time Retail trade Total 1,713 6,880 2,018 Grocery group 277 1,179 269 Grocers 204 919 193 Grocers with offlicence 24 118 33 Grocers with meat 13 59 11 Grocers with bakery goods 22 58 20 Grocers with hardware 14 25 12 Other food retailers 464 1,789 347 Dairymen 43 415 37 Butchers 98 374 49 Fishmongers, poulterers 39 145 * Greengrocers, fruiterers 159 382 138 Bread and flour confectioners 63 362 36 Offlicences 52 89 46 Cooked meat and delicatessen * * ♦ Confectioners, tobacconists, newsagents 255 476 495 Chocolate, sugar confectioners 7 11 + Chocolate, sugar confectioner-tobacconists 129 214 ♦ Chocolate, sugar confectioner - tobacconist newsagents 44 94 147 Tobacconists 32 51 23 Tobacconist-newsagents Newsagents 43 106 208 Clothing group 263 1,080 316 Boots and shoes Boots and shoes with repairs 42 147 28 Men's wear 57 177 27 Women's outer wear 15 118 69 Women's underwear 8 18 * Women's outfitters 31 353 100 Milliners * * * Men's and women's wear 26 107 49 Wool, artneedlework 13 20 * Draper 31 93 19 Secondhand clothes dealers 13 10 * Hardware 147 360 124 Domestic hardware, ironmongery 76 158 49 Radio, electrical goods 41 122 27 Radio, electrical goods with repairs Electrical goods with contracting 12 26 * Booksellers, stationers 25 67 112 103 Type of business Establishments Persons engaged full time part time Chemists goods, photographic goods group 60 260 65 Dispensing chemists 51 227 * Furniture group 70 252 66 Domestic furniture 27 144 33 Soft furnishings, floor coverings 11 37 10 Antique dealers Secondhand furniture dealers 23 34 * Jewellery, leather and sports goods group 38 92 19 Jewellery, watches and clocks 9 43 * Leather goods Sports goods 24 * Toys * * * Fancy goods * * * General group 9 1,019 150 Coal, builder's materials, corn group 49 178 18 Coal 29 125 * Other nonfood retailers 56 128 37 Florists 27 52 20 Pawnbrokers 5 15 * Service trades Catering group 207 681 341 Restaurants, cafes, etc 126 438 259 Fried fish shops 21 39 27 Canteens 60 204 55 Hairdressers 106 271 47 Funeral furnishers 16 83 * Repairers group Boot and shoe repairers 67 119 17 Motor vehicles, cycles and accessories group 52 221 39 Motor vehicle repairers, garages group 55 506 i 33 To avoid disclosure of particulars relating to individual establishments or organisations, some entries in the tables are withheld, and the symbol * is used to show where this has been done. The number of establishments falls short of the total number proper to the census. It has been estimated that the number of establishments included in the report represents the following percentages of the total number of establishments:— 104 Percentage of total number of establishments Retail trade (total) 91 Service trades:— Catering group (excluding canteen) 87 Canteens 76 Hairdressers 91 Funeral furnishers 76 Portrait photographers 84 Repairers group :— Boot and shoe repairers 90 Watch and clock repairers 88 Other repairers Motor vehicles, cycles and accessories group Motor vehicle repairers, garages group It should be borne in mind when comparing figures in the above table with similar figures occurring elsewhere in the annual report that the figures here quoted refer to the major activity of any establishment. 105 APPENDIX E Further details from the 1951 Census A report on the County of London, compiled from the census which took place in April, 1951, was published by HM Stationery Office during the year. The following data, in the main relating to Lewisham, have been extracted from it. The total population in the City and County was 3,347,982, a decline of over a million persons since the 1931 census. This decrease was common to all boroughs except Hampstead, Lewisham and Woolwich, Lewisham showing the biggest increase of these three boroughs, of 7,623 persons, the total population at the census being 227,576. Ward populations varied from 8,339 (Culverley) to 17,607 (South Lee). The persons per acre in the wards varied from 22.3 (Blackheath and Church Lee) to 57.1 (Grove Park). The persons per room varied from 0.67 (St. Andrew's) to 1.06 (Grove Park) and the percentage of persons living more than two per room varied from 0.6 (Ladywell, Manor Lee and St. Andrew's) to 2.9 (Grove Park), the average for the whole borough being 1.4 percent. Dwellings, rooms and households In Lewisham there were 58,417 structurally separate dwellings occupied and 919 additional ones vacant (511 furnished, 408 others) making 59,336 structurally separate dwellings in all, including four caravans comprising four rooms and occupied by three households. In addition there were 121 miscellaneous habitations and institutions housing non-private households. The 59,336 structurally separate dwellings comprised the following in relation to the number of rooms and the number of private households therein. Private households Roomed dwellings Number of dwellings therein 1 room 212 197 2 rooms 1,798 1,725 3 rooms 8,011 7,923 4 rooms 12,491 12,867 5 rooms 18,487 19,899 6 rooms 9,717 13,746 7 rooms 4,524 7,192 8 or 9 rooms 3,167 6,182 10 or more rooms 929 2,369 All sizes 59,336 72,100 The total number of rooms was 296,618. 106 Private households in relation to size, rooms occupied and density of occupation Of the 72,100 total households which comprised 223,761 total persons with an average of 0.77 persons per room, 2,009 households (3,128 persons) occupied dwellings of one room only. The most frequent number of rooms occupied were 3, 4 and 5 (occupied by about 18,000 households in each case). At the other end of the scale 849 households occupied dwellings of 8 or 9 rooms and 193 households occupied dwellings of 10 or more rooms. With regard to households in shared dwellings (included in the previous paragraph) there were 25,606 such households in all comprising 65,213 persons and occupying 78,028 rooms, giving an average number of persons per room of 0.84. Of these households 1,812 (comprising 2,858 persons) shared one-room households. The most frequent setup (almost twice as frequent as any other) was the sharing of three-roomed households, and this was done by 10,623 households in all, comprising 26,967 persons. At the other end of the scale 49 households, comprising 211 persons, shared dwellings of 8 or 9 rooms, and 8 households, comprising 35 persons, shared dwellings of 10 or more rooms. Private households by density of occupation (persons per room) Of the 72,100 households, 82.6 percent had a density of one person per room or less, this comparing with a percentage of 79.2 for the whole County. 12.5 percent had between 1 and 1½ persons per room, 4.1 percent between 1½ and 2, 0.7 percent between 2 and 3 and 0.1 percent (82 households in all, comprising 404 persons) had over 3 persons per room. The percentage of persons living at more than 2 per room was 1.40 in Lewisham compared with 2.55 in the whole County (in the 1931 Census the percentage was 4.09 for Lewisham and 13.13 for the County). Private households according to possession of certain household arrangements Of the 72,100 households, 44 were entirely without a piped water supply and 15,265 shared a piped water supply with another household. 563 were entirely without a cooking stove and 4,451 shared a cooking stove with another household. 1,547 were entirely without a kitchen sink, and 5,676 shared a kitchen sink with another household. 52 were entirely without a water closet and 14,807 shared a water closet with another household. 13,245 were entirely without a fixed bath and 14,966 shared a fixed bath with another household. Grouping these 5 facilities together (piped water, cooking stove, kitchen sink, water closet and fixed bath), 40,635 households had exclusive possession of all 5 of these facilities, being equivalent to 56 percent of all households (compared with 33 percent for the whole County) ; 90 percent of all Lewisham households had exclusive use of a stove and a sink (compared with 83 percent for the whole County). Numerous subdivisions of these figures according to the number of persons in the household and the number of households sharing dwellings, are given in the census. 107 Miscellaneous information Three children's homes and hostels were in the borough, with a total population of 259, of which 216 were inmates only. There were five hospitals, etc., under the National Health Service with a total population of 1,270, of whom 845 were inmates only. There were six other hospitals and nursing homes with a total population of 90, 49 of whom were inmates only. There was one institution for the mentally ill with a population of 27, including 14 (all females) who were inmates only. There were 13 homes for the aged and infirm with a total population of 916, of whom 872 were inmates only. There were 4 police stations with a total population of 15, none of whom was apparently resident. Of the hotels and boarding houses with 10 or more rooms there were 35 in Lewisham, of which 23 had 10 to 14 rooms, 7 had 15 to 24 rooms, 4 had 25 to 49 rooms and one had between 50 and 100 rooms. These hotels and boarding houses contained 162 staff and their relatives, 248 resident guests and 56 visitor guests. Ages by marital condition These statistics are grouped into five-year periods and are best set out in full. Age last birthday Persons MALES FEMALES Total Single Married Wid. D'v'd Total Single Married Wid. D'v'd All ages 227,576 106,821 44,126 58,978 3,261 456 120,755 47,651 60,025 12,276 803 0—4 19,934 10,238 10,238 – – – 9,696 9,696 – – – 5-9 16,026 8,211 8,211 7,815 7,815 – – – 10-14 13,371 6,708 6,708 — – – 6,663 6,663 – – – 15-19 11,963 5,324 5,310 14 – – 6,639 6,377 262 – – 20-24 14,819 6,814 5,226 1,586 — 2 8,005 4,130 3,863 5 7 25-29 18,453 8,883 2,908 5,934 10 31 9,570 2,093 7,325 69 83 30-34 17,446 8,503 1,439 6,973 27 64 8,943 1,372 7,329 114 128 35-39 18,122 8,878 1,036 7,683 61 98 9,244 1,234 7,694 209 107 40-44 17,468 8,584 755 7,639 83 107 8,884 1,390 7,058 294 142 45-49 16,199 7,766 632 6,943 124 67 8,433 1,395 6,453 467 118 50-54 14,541 6,461 395 5,863 170 33 8,080 1,141 5,990 847 102 55-59 13,475 5,891 307 5,319 242 23 7,584 1,142 5,137 1,255 50 60-64 11,574 5,052 260 4,404 374 14 6,522 908 3,832 1,745 37 65-69 9,282 3,817 275 3,076 459 7 5,465 793 2,575 2,084 13 70-74 6,848 2,773 185 2,017 567 4 4,065 625 1,504 1.927 9 75-79 4,606 1,762 145 1,058 555 4 2,844 477 714 1,650 3 80-84 2,353 819 71 367 380 1 1,534 265 234 1,032 3 85-89 897 273 20 90 162 1 624 114 51 459 – 90-94 182 57 5 12 40 125 19 4 101 1 '5 and over 27 7 – – 7 — 20 2 – 18 – 108 It will be seen that the number of males exceeds the number of females as far as age 14, but from then onwards the number of females exceeds the number of males in an almost continually increasing ratio until in the age group 85 to 89 there are more than double the number of females to males (624 compared with 273). It will also be seen that there were 20 females over the age of 95 and 7 males of that age group. Ages of juveniles With regard to persons under the age of 21, there were 31,533 males and 32,288 females in Lewisham. The distribution in the various ages was as follows :— Age last birthday Males Females  0 1,734 1,655 1 1,855 1,749 2 2,022 1,805 3 2,197 2,162 4 2,430 2,325 5 1,761 1,700 6 1,839 1,682 7 1,595 1,581 8 1,689 1,565 9 1,327 1,287 10 1,244 1,307 11 1,371 1,364 12 1,316 1,317 13 1,451 1,328 14 1,326 1,347 15 1,339 1,311 16 1,294 1,295 17 1,207 1,223 18 836 1,363 19 648 1,447 20 1,052 1,475 From this table the preponderance of females is only obvious at ages 18 and 19 and to a lesser extent at age 20. This is presumably because of national service. Distribution by marital condition and age, and sex ratios In Lewisham 40.3 of the population were single (compared with 42.4 for the whole county), 52.3 were married (49 for the county) and 7.4 were widowed or divorced (8.6 for the county). 8.8 percent of the Lewisham population were aged 0.4 (as against 8.1 for the county), 12.9 were aged 5.14 (as against 11.5), 43.2 were aged 15.44 (as against 45.3), 24.5 were aged 45.64 (as against 24.0) and 10.6 were aged 65 and over (as against 11.1 for the county). It will be seen therefore that Lewisham has a rather larger than average number of children 109 in relation to its total population. The sex ratio, that is females per thousand males, was 1,130 in Lewisham, as compared with 1,138 for the whole county — almost exactly the same. Of the different boroughs the lowest ratio was 1,025 females to 1,000 males which occurred in Stepney and the highest was 1,402 females to 1,000 males which occurred in Chelsea. Persons in full time attendance at an educational establishment In Lewisham 31,622 persons were attending full time at educational establishments, of whom 329 were aged 0-4, 14,913 were 5-9, 13,005 were 10-14, 1,382 were aged 15, 734 were aged 16, 556 were aged 17-19, 457 were aged 20-24 and 246 were 25 and over. The sexes were approximately equal up to the age of 14, the females were then in moderate preponderance to the age of 19, but at ages 20 to 24 there were 316 males as against 141 females, and over 25 years of age there were 207 males against 39 females. Occupied population in relation to terminal education ages There were 70,227 occupied males of whom 48,716 had finished their education under the age of 15, 9,057 at age 15, 7,503 at age 16, 3,536 at ages 17 to 19, 1,415 at age 20 and over, and 2,240 unstated. With regard to the females there were 35,365 employed, of whom 25,527 finished their education under the age of 15, 5,954 at age 15, 5,119 at age 16, 2,763 between the ages of 17 and 19, 1,002 at 20 and over, and 1,501 not stated. Social class distribution of occupied and retired males over the age of 15 In Lewisham there were 79,009 such males and the social class, with the percentages, can be shown in the following table to which I have added for comparison purposes the percentages of what would appear to be the borough with the highest class I and II grouping, the borough with the highest class IV and V grouping, and the whole County:— No. of males Percentage Comparisons (percentages) Hampstead Bermondsey Whole County Social class 1 2,794 3.5 11.9 0.8 4.0 II 12,553 15.9 26.2 8.0 13.0 III 46,429 58.8 46.5 46.1 54.2 IV 7,681 9.7 8.0 13.2 11.9 V 9,552 12.1 7.4 31.9 16.9 The term "social class" is based on occupation and the occupational unit groups are graded to one of five groups, traditionally described as social classes. Very broadly speaking, class I are the professional, etc., occupations, class II are the intermediate occupations, class III are the skilled occupations, class IV are partly skilled occupations, class V are unskilled occupations. 110 TABLES table subject page no. Section A 1 Comparative statistics 9 2 Summary of vital statistics in last ten years 9 3 Causes of death by age groups 10 4 Deaths under one year 12 5 Local sickness 13 6 Deaths by social class 13 7 Causes of death by social class 14 8 Grouped causes of death by social class 15 9 Births, infant deaths, etc., by social class 16 10 Heart and circulation tality 17 11 Deaths under age 65 18 12 General statistics from 1901 20 Section B 13 Disinfecting station 22 14 Verminous conditions, etc. 23 15 Laboratory facilities 26 16 Public mortuary 27 17 Rodent control 28 18 Rodent control—treatment of rivers 29 19 Prevention of damage by pests 30 20 Block control 30 21 Atmospheric conditions 34 22 Water, chemical samples 43 23 Water, bacteriological samples 43 Section C 24 Sanitary inspection 44 25 Summary of notices 45 26 Nuisances remedied —Public Health Act 46 table subject page no. Section C 27 Nuisances remedied —Housing Act 46 28 Factory inspections 48 29 Factory defects 49 30 Applications for rehousing 58 31 Demolition orders 59 32 Closing orders (s.ll) 59 33 Closing orders (s.12) 60 34 Clearance areas, 1952 63 35 Clearance areas, 1953 64 Section D 36 Milk licences 69 37 Analysis of milk 69 38 Icecream grading 70 39 Icecream composition 71 40 Samples analysed 72 41 Adulterated samples 72 Section E 42 Principal notifiable diseases 82 43 Notifications of infectious diseases by age and sex 83 44 Analysis of certain diseases into divisional areas 84 45 Infectious disease visiting 85 46 Poliomyelitis 86 47 Comparison of polio cases over 7 years 87 48 Tuberculosis notifications and deaths 90 49 Cases of tuberculosis not formally notified 90 50 Analysis of new cases of tuberculosis into divisional areas 91 51 Tuberculosis register 91 52 Tuberculosis statistics 92 53 Mass radiography 93 54 Immunisation against fectious disease 94 Ill INDEX subject page Acts, regulations and orders 96 Area of borough 7 Atmospheric conditions 34 Atmospheric pollution incidents 41 Bakehouses 76 Births and birth rate 7 Census, 1951 106 Census of distribution 19 Clearance areas 63 Coronary disease 16 Deaths and death rate 7 Deaths, causes of 10 Deaths under age 65 18 Disinfection and personal cleansing 22 Dog nuisances 51 Drainage work 54 Exhumations 56 Factories 47 Flies and mosquitoes 24 Food, adulteration of 71 Food hygiene 4 Food, inspection and supervision 68 Food poisoning 73 General statistics from 1901 20 Health services, general provision of 22 Heating Appliances (Fireguards) Act, 1952 80 Hither Green railway sidings 39 Housing :— New building 57 Families rehoused 57 Applications for rehousing 58 Housing Act, 1936 58 Housing Act, 1949 66 Icecream, composition 71 Icecream, grading 70 Immunisation 93 Infant mortality 8 Infant mortality analysis 12 Infectious diseases 82 Infectious disease visiting 84 Laboratory facilities 25 Legal proceedings 98 Lung cancer 16 Mass miniature radiography 93 Maternal deaths 8 subject page Maternity and child welfare 3 Meat inspection 77 Milk, analysis of 69 Milk and Dairies Regulations, 1949 68 Mortuary and Coroner's Court 27 National Assistance Act, 1948:— Section 47 26 Section 50 27 Nuisances remedied 46 Offensive trades 75 Old people 31 Outworkers 50 Pet Animals Act, 1951 52 Pharmacy and Poisons Act, 1933 74 Pigeons, destruction of 55 Pigs, keeping of 76 Poliomyelitis 85 Population 7 Prevention of Damage by Pests Act, 1949 29 Rag Flock and other Filling Materials Act, 1951 51 Rateable value 7 Rent and Mortgage Interest (Restrictions) Acts 47 Rivers (Prevention of Pollution) Act, 1951 53 Rodent control 28 Sampling 72 Sanitary circumstances of the area 44 Shops Act, 1950 74 Sickness, local 13 Slaughterhouses 75 Smokeless zones 40 Social class 13 Social medicine statistics 5 South Eastern Gas Board 36 Staff 2 Stillbirths 7 Swimming baths 31 Tuberculosis 90 Unsound food 73 Vital statistics 7 Water certificates 47 Water supply 41 Whooping cough 89