TrsT. f-f C^ ^ i <-f- ;? .^/vy ££W ^2. fe; I lll65fPS5. / i < •' ^ ''*• '■-.. METROPOLITAN BOROUGH OF LEWISHAM THE PUBLIC HEALTH OF LEWISHAM Report of the Medical Officer of Health for the Year 1954 E. H. R. SMITHARD, MBE, MD, DPH London : E. G. Berryman & Sons, Ltd., Blackhenth Road, S.E.10 METROPOLITAN BOROUGH OF LEWISHAM Report OF THE Medical Officer of Health for the Year 1954 E. H. R. Smithard, MBE, MD, DPH CONTENTS Page Staff 2 Introduction 3 Vital Statistics 6 General Provision of Health Services 18 Sanitary Circumstances of the Area ... 30 Housing 38 Inspection and Supervision of Food ... 45 Infectious Diseases 52 Appendix A — Statutory Instruments 61 „ B — Legal Proceedings ... 64 C — Special Reports to Health Committee 69 2 STAFF as at 31/12/54 Medical Officer of Health E. H. R. Smithard, mbe, md, bs, mrcs, lrcp, dph Senior Sanitary Inspector E. Walker (a) (6) Group Sanitary Inspectors A. G. Thomas (a) (6) (Food) J. R. Craven (a) (b) (Housing) Assistant Group Housing Inspector R. C. Brittain (a) (b) District Inspectors J. W. Be van (a) (b) C. L. Connor (a) R. L. Davis (a) E. A. Howard (a) S. Kelly (a) H. J. Rogers (a) Three vacancies Principal Clerk E. W. Cheesman Clerical Staff S. Burridge, senior clerk Mrs. I. D. Ward Miss I. L. Hatton C. R. Coleman Coroner's Court and Mortuary W. Richardson, officer-iti-charge Disinfecting Station, Pest Control, etc. J. G. Beale, superintendent Foreman disinfector Disinfectors ... ... 9 Bathing attendants ... 2 Drain testers... Deputy Senior Sanitary Inspector A. J. Phillips (a) (b) R. Mahoney (a) (b) (District) Food Inspectors and Sampling Officers H. W. Ellery (a) (b) G. E. Fallows (a) (b) T. R. A. Fitzherbert (a) (A) H. Tolson (a) (b) K. R. Wagener (a) (b) (b) Food inspector's certificate. L. J. Cleverly L. Gardiner Miss D. J. Miles Two vacancies R. A. Sharman, foreman rodent operative Rodent operatives ... ... 3 Rodent/fly operatives ... 4 ... 2 (a) Sanitary inspector's certificate. Infectious Disease Visitors Miss M. E. K. Johnston, srn, rfn, scm Mrs. A. Carins, srn, rfn 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 1954. Vital statistics The Registrar General's estimate of the population in midyear 1954 at 224,200 was 1,600 less than his estimate for midyear 1953. Since the census the rate of decrease of the population appears to have accelerated. The prewar estimated population, in June, 1939, was 231,000. The crude birthrate for the year at 14-2 shows a small decrease of 0-2 from the figure of 14-4 the previous year, and the adjusted birthrate (allowing for age and sex distribution of the population) is 0-1 lower at 13-3. The crude death rate at 9-95 shows a fairly substantial decrease from the 11-1 of the previous year and the " adjusted" death rate, also 9-95, compares with 10-68 for the administrative county. The infant mortality rate at 21 was 1 down on the previous year, the neonatal rate (i.e. under one month of age) being 3 down, and the one month to one year rate being 2 up. The stillbirth rate showed a welcome drop to no less than 14, compared with 23, and after the increasing stillbirth rates of recent years this is doubly pleasing ; it is in fact the lowest on record. The combined stillbirth and infant death rate (reproductive wastage) therefore goes down considerably — from 45 to 35 — and equals the low record of 1949. No maternal deaths occurred during the year and this would appear to be the first year in the history of the borough council where there has been no such death (there were three years in the First War where no records are available). The premature birth rate, i.e. the number of children weighing 5Jlbs. or less at birth per thousand live births, is not a very exact figure as a few babies who for one reason or other were not weighed at birth have been regarded as premature (this is probably true but not necessarily so). The rate for 1954 at 60 is however considerably down on the previous year, which again was down on the year before that, and so this too is a matter for appreciation. The various comparative figures of general statistics since the beginning of the century are shown in table 10. It is a matter of interest, though not one for complacency, that all except two of the 1954 figures there shown are improvements. The two exceptions are, first, the one month to one year infant death rate which has been mentioned above, and secondly, the percentage of inhabitants dying under the age of 65, which has gone up from 29-5 to 31-5. Comment on this is made later in the report. Tuberculosis The number of new notifications decreased considerably (after two successive years' increase) and at 256, producing a rate of 1-02 for pulmonary and 0-12 for other forms, they reached a record low. The number of deaths from tuberculosis at 38 also showed a considerable 4 decrease from the 48 of the previous year and the death rate at 0-17 is the lowest on record. The position with regard to tuberculosis over the country as a whole seems to be that the death rate is going down rapidly while the notification rate, certainly as far as respiratory tuberculosis is concerned, has remained fairly stationary. This has been thought to be due in the main to increased activity in finding out cases — by mass x-ray, examination of near contacts of patients and so on. These efforts still continue, and therefore the diminution in notifications in this area in 1954 is a hopeful sign that the actual sources of infection are also decreasing, and if this is so we can look forward to even more rapid decreases in the future. However it is too early yet to be certain. Food hygiene The notified cases of food poisoning during the year amounted to 110, against only 32 in the previous year. Some 80 of these however were connected with one incident which occurred at an institution in the area. Throughout the year food inspectors continued to give advice to occupiers of food shops with regard to general hygiene and pest control and towards the end of the year a more specific propaganda campaign was started by the food inspectors, and priority in this campaign was given to dairies, distributors of milk, icecream sellers, pastrycooks (and bakers), butchers, and greengrocers, in that order. It was proposed to follow up this campaign, which was directed to owners and employees of food premises, by a further campaign in the spring of this year directed primarily to the public. Infectious disease other than tuberculosis With regard to the more acute infections the year showed an unexpected decline in the number of measles cases, 521 only, this number being the first year since 1947 in which less than about 2,000 cases have been notified. I am sure the low figure was due to chance and the fact that the expected winter epidemic started rather later than usual (as a matter of interest the first three months of 1955 produced about 3,000 cases). Dysentery cases reached a peak of 394, which is the highest figure on record, the next being 365 in 1951. We were relatively fortunate in poliomyelitis in that the number of cases dropped from 52 in 1953 to 16 last year. Of these 16 cases 12 were non-paralytic. Whooping cough was slightly down on the year before, but even so there were 449 cases which must have caused a considerable amount of distress and also probably some unpleasant complications. It is only right to remind the public that immunisation against whooping cough is much more effective than it used to be. Whooping cough is more dangerous the younger the child is and is particularly dangerous under one year of age. It is as well therefore to get the child protected as early as possible and meanwhile to do everything to keep it away from likely sources of infection. 5 Old people There is again relatively little to report. Two additional clubs received grant aid during the year, but one of them happens to be just outside the borough boundary, though half or more of its members live in Lewisham. The Lewisham Old People's Welfare Association remained active during the year and the closely allied Lewisham Old People's Housing Association now has three houses divided into flatlets for old people. Housing The Housing Repairs and Rents Act came into force during the year. It affected the work of the department mainly in two ways, although it will affect the work in other ways at a later period. These two ways were first, the necessity of carrying out a survey of the housing accommodation in the borough in order to submit details of certain of the unfit houses to the Minister, and secondly, through the issue of certificates in connection with disrepair. It was thought that applications for these certificates (which are applied for if the landlord seeks to put up the rent and the tenant thinks that the house is not in a good state of repair) would be very large. In fact, after the Act came into force a mere trickle of applications began and although it increased somewhat a month or two later it did not reach a high number. All these applications required inspection of the house by the sanitary inspectors, and on report to the committee nearly all the applicants were granted certificates. A little later applications began coming in for revocation of the certificates issued when the houses had been put in repair. Staff The department was handicapped in its work during the year, not only in housing but in many other public health matters, through the shortage of Sanitary Inspectors. At the end of the year there were three vacancies on the establishment. It is hoped to start a scheme for the training of student sanitary inspectors in 1955 as a result of which one student will be appointed each year for the four-year course. This is a long-term attempt to improve the establishment, but meanwhile the short-term problem remains acute. 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 Mrs. Armstrong (Chairman) Councillor Mrs. Bunce (Vice-Chairman) Councillor C. T. Braithwaite, J.P. (The Mayor) Aldermen Carter, Hawkins and Mrs. Smith Councillors Boon, Braithwaite (C. P.), Braund, Bridger, Brough, B.sc., Miss Butler, Donovan, Mrs. Drapper, J.P., Greenhow, Hawes, Helps, Henry and Mrs. Land. 6 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 1954 was 224,200. (This includes members of the armed forces stationed in the area). Rateable value County of London rateable value of the borough at April 1, 1954 £1,866,679 Estimated net product of a penny rate, 1954/55 ... £7,520 Estimated number of separately assessed dwellings at April 1, 1954 61,120 Births (adjusted for inward and outward transfers) Livebirths ... ... ... ... ... ... ... 3,193 Males Females Total Legitimate ... 1,560 1,508 3,068 Illegitimate ... 63 62 125 Totals 1,623 1,570 3,193 Crude birth rate per 1,000 of the estimated population 14-2 Adjusted birth rate for comparative purposes ... ... 13-3 (Area comparability factor for births is 0-93). Birth rate for England and Wales ... ... ... 15-2 Birth rate for London Administrative County 15-2 Stillbirths The stillbirths allocated to the borough during the year were 45, which represents a stillbirth rate per thousand live and stillbirths of 13-9. Deaths The deaths belonging to the borough registered during the year were 2,231, consisting of 1,200 males and 1,031 females, giving a crude death rate per thousand of the estimated population of 9-95. The area comparability factor for deaths is 1-0 therefore the adjusted death rate remains at 9-95 per thousand of the estimated population, which compares with rates of 11-3 for England and Wales and 10-7 for the Administrative County of London. 7 Infant mortality Infant deaths ... ... ... ... 66 Legitimate ... ... ... ... ... ... 58 Illegitimate ... ... ... ... ... ... 8 Rates : 1. All infants per thousand livebirths ... ... 20-7 2. Legitimate infants per thousand legitimate livebirths ... ... ... ... ... 18-9 3. Illegitimate infants per thousand illegitimate livebirths ... ... ... ... ... 64-0 Neonatal deaths (under 4 weeks of age) ... ... 42 Neonatal death rate (per 1,000 livebirths) ... ... 13-2 Reproductive wastage :— Stillbirths plus infant deaths ... ... ... Ill Rate per thousand live and stillbirths ... ... 34-3 Maternal deaths Maternal deaths ... ... ... ... Nil Other special causes of death Whooping cough Gastroenteritis (infants) 4 Motor vehicle accidents 17 Suicide 19 Tuberculosis (all forms) 38 Cancer (Code Nos. 10-15) 430 Heart and circulation diseases (Code Nos. 17-21) ... 1,155 Comparative statistics for the year 1954 Table 1 Birth rate Death rate (per 1,000 population) (adjusted) Infant mortality rate (per 1,000 livebirths) Live births (adjusted) Still births Lewisham 13.3 13.9 10.0 20.7 England and Wales 15.2 24.0 11.3 25.5 London Administrative County 15.2 19.8 10.7 20.7 Causes of death at different perio The following table shows the causes of ai Ti Nett deaths at the subjoined age of " residents" whether occurring within or without the borough Code No. Causes of death MALES Ti pei 1 and 5 and 15 and 25 and 45 and 65 one 75 (i All Under under under under under under under an </ in ages I yr. 5 15 25 45 65 75 over ul op Totals, all causes 1200 44 4 9 13 49 320 363 398 |223 1 Tuberculosis, respiratory 25 2 12 9 2 > 2 Tuberculosis, other 1 — — 1 i 3 Syphilitic diseases 8 6 2 1 4 Diphtheria — — — 5 Whooping cough ... — — — — — — — — 6 Meningococcal infections... 1 — — 1 — — — — 7 Acute poliomyelitis — — — — — — — 8 Measles — — — 9 Other infective and parasitic diseases 2 — — 2 — — — 10 Malignant neoplasm, stomach ... 41 2 14 13 12 11 Malignant neoplasm, lung 10 and bronchus ... 76 — 4 39 23 12 Malignant neoplasm, breast — 13 Malignant neoplasm, uterus — I 14 Other malignant and 30 phatic neoplasms 111 — — 2 3 40 36 15 Leukaemia, aleukaemia ... 10 1 1 1 1 3 2 1 16 Diabetes 2 — 1 1 17 Vascular lesions of nervous 53 system 117 — — 2 4 19 39 18 Coronary disease, angina... 232 — — 4 82 87 59 19 Hypertension with heart 12 l disease ... 34 7 15 20 Other heart disease 133 1 2 19 31 80 21 21 Other circulatory disease 50 — — 1 15 13 22 Influenza 4 1 2 1 — 23 Pneumonia 63 9 1 1 9 18 25 24 Bronchitis 89 1 1 1 19 31 36 25 Other diseases of 1 3 tory system 6 — — — 1 1 26 Ulcers of stomach and duodenum 19 4 7 8 27 Gastritis, enteritis and diarrhoea 7 2 1 — — 2 2 "7 28 Nephritis and nephrosis ... 8 — — 1 1 2 2 1 1 9 29 Hyperplasia of prostate ... 17 8 30 Pregnancy, childbirth, abortion - 31 Congenital malformations 10 8 — — 1 — 1 ■""" 32 Other defined and illdefined 15 24 2 A diseases ... 92 22 1 4 6 20 33 Motor vehicle accidents ... 14 — 1 3 4 4 — 34 All other accidents 13 1 1 2 1 3 1 n 2 35 Suicide 14 — — — 6 4 2 36 Homicide and operations of war . 1 1 — 9 lof life during the /ear 1954 s at death during the calendar year 1954 :— Causes of death Totals, all causes I' Tuberculosis, respiratory |2 Tuberculosis, other 13 1 Syphilitic diseases |l Diphtheria I: Whooping cough ... ■ 6 i Meningococcal infections... 11 Acute poliomyelitis ■ 8 Measles I' Other infective and parasitic diseases Malignant neoplasm, stomach Malignant neoplasm, lung and bronchus ... Malignant neoplasm, breast V Malignant neoplasm, uterus H Other malignant and lym- ■ Phatic neoplasms I; Leukaemia, aleukaemia ... I Diabetes Vascular lesions of nervous system Coronary disease, angina... Hypertension with heart disease ... Other heart disease Other circulatory disease I Influenza ] Pneumonia 1 Bronchitis Other diseases of respiratory system Wcer of stomach and duodenum Gastritis, enteritis and diarrhoea Nephritis and nephrosis ... yperplasia of prostate ... rcgnancy, childbirth, aborI tion r>!k8enjita' malformations utherdefined and illdefined diseases Motor vehicle accidents ?! other accidents Suicide Homicide and operations of war 1031 11 1 3 1 21 13 32 13 107 6 12 180 126 23 197 63 1 28 58 82 3 13 5 Nett deaths at the subjoined ages of " residents " whether occurring within or without the borough FEMALES All Under ages I yr. 22 I and under 5 J and under 15 15 and under 25 25 and under 45 45 and under 65 32 197 65 and under 75 256 8 18 6 32 2 34 17 11 1 5 1 2 12 1 2 2 4 11 2 38 2 3 53 36 75 and over 511 1 : 12 24 29 17 5 13 2 1 14 2 1 2 2 27 3 6 92 73 10 136 33 1 19 37 4 5 1 3 38 10 10 Deaths under 1 year of age Table 3 Cause of death Sex • Under 1 day 1-6 days 1 week 2 weeks 3 weeks Total under 4 wks. 1-2 mths. 3-5 mths. 6-8 mths. 9-11 mths. Total 1-11 mths. Total under 1 yr. Tuberculosis, respiratory M - - - - - - - - - - - - F - - - - - - - - - 1 1 1 Pneumonia M 1 2 1 _ _ 4 2 2 — 1 5 9 h - 1 - 1 - 2 - - - •- - 2 Bronchitis M _ _ _ _ _ _ _ 1 _ _ 1 1 F - - - - - - 1 1 - 1 3 3 Gastro-enteritis diarrhoea M _ _ _ - - 7 - - - 2 2 F - - - - - - 1 1 - - 2 2 Congenital malformation M 2 4 _ _ 1 7 1 _ _ _ 1 F - 2 - - - 2 - 1 - - 1 3 Injury at birth M 1 1 _ — _ 2 _ _ _ _ - 2 F - - - - - - - - - - - - Postnatal asphyxia and atelectasis M 1 1 _ _ 2 _ _ _ 2 F 2 2 - - - 4 - - - - - 4 Prematurity immaturity M 10 2 - - - 12 - - - - - 12 F 2 1 " - - 3 - " - - - 3 Other diseases of early infancy M _ 1 1 _ 2 _ _ 2 F - - - - - - - - - - - - All other causes M 1 _ _ 1 3 1 1 _ 2 6 F - - - - 1 1 - 3 - - 3 4 TOTALS M 15 12 2 1 30 8 4 1 1 14 44 F 4 6 - 1 1 12 2 6 2 10 22 GRAND TOTAL 19 18 2 1 2 42 10 10 1 3 24 66 There were no deaths in the following groups : tuberculosis (other forms), syphilis, typhoid and paratyphoid fevers, diphtheria, whoopingcough, meningococcal infection, measles, diseases of ear and mastoid antrum, influenza, gastritis and duodenitis, hernia, intestinal obstruction, congenital debility and other ill defined diseases of early infancy, convulsions and lack of care of newborn. Twenty-four infants thus died between the ages of one month and one year compared with 20 in the previous year. Nine of the 24 deaths were from pneumonia or bronchitis, 4 from gastro-enteritis or diarrhoea (none in the previous year), two from congenital malformations, one from respiratory tuberculosis and 8 from a variety of other and relatively rare causes. On the face of it therefore it seems that some of these might be regarded as being in preventable categories. 11 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 last 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 4 Morbidity shown in insurance certificates Average for four weeks ending Lewisham Downham January 26 694 183 February 23 635 171 March 23 505 128 April 20 359 98 May 18 394 111 June 15 355 89 July 13 281 77 August 10 276 77 September 7 318 82 October 5 380 119 November 2 453 122 November 30 474 131 December 28 385 107 Corresponding figure for November, 1953 448 134 Weekly average for the year 1954 424 115 Weekly average for the year 1953 471 133 Social class in relation to cause of death Of the 2,231 deaths analysed by us the social categories were as follow' Table 5 Social class 1 II III IV V Total No information Males 39 218 658 169 96 1180 15 Females 25 199 537 152 66 979 57 Total 64 417 1196 321 162 2159 72 Percentage 3 19 55 IS 8 100 — 12 In detail the social class, related to cause of death, was as follows :— Table 6 Code No. Cause of death Male Female 1 II Ill IV V Total 1 a Ill IV V Tot 1 Tuberculosis, respiratory - 1 13 5 5 24 - 1 6 1 — 2 Tuberculosis, other - — — 1 j 1 - — — 1 — 3 Syphilitic disease - 1 6 — 1 8 - — 3 — — 4 Diphtheria - - - - - - - - - - - - 5 Whooping cough - - - - - - - - - - - - 6 Meningococcal infections - — 1 — — 1 - — — — — 7 Acute poliomyelitis - - - - - - - - - - - - 8 Measles - - - - - - - - - - - - 9 Other infective and parasitic diseases - 1 11 - - 12 - 1 2 - _ - 10 Malignant neoplasm, stomach ... - 5 23 8 4 40 - 6 13 3 1 2 11 Malignant neoplasm, lung, bronchus 2 17 44 10 3 76 1 1 7 4 1 12 Malignant neoplasm, breast ... - — — — — 1 9 14 4 1 H 13 Malignant neoplasm, uterus - - - - - - - 2 8 2 2 14 14 Other malignant and lymphatic neoplasms 4 22 66 15 3 110 1 19 61 17 7 105 15 Leukaemia, aleukaemia _ 4 9 3 — 16 - 2 5 — — 16 Diabetes - 1 2 — — 3 - 4 2 1 — 17 Vascular lesions of nervous system 8 31 61 19 12 131 4 43 99 20 10 171 TI 18 Coronary disease, angina 7 44 92 25 11 179 3 16 37 14 7 19 Hypertension with heart disease 3 18 50 7 7 85 4 14 38 13 12 81 16! 20 Other heart disease 2 17 57 14 7 97 7 25 93 30 7 21 Other circulatory disease 4 7 40 7 9 67 3 20 34 8 2 i 22 Influenza - 1 1 — 2 - — _ 23 Pneumonia 3 7 28 10 6 54 _ 3 15 5 4 27 24 Bronchitis 1 12 53 16 11 93 - 10 34 9 3 56 25 Other diseases of respiratory system 1 1 5 1 2 10 2 2 __ 26 Ulcer of stomach and duodenum - 2 13 3 2 20 - — 5 — 27 Gastritis, enteritis and diarrhoea - — 3 3 1 1 — — ; 28 Nephritis and nephrosis - 8 19 1 1 29 - 2 12 2 1 i/ 29 Hyperplasia of prostate 1 3 8 3 1 16 - — — — — -* 30 Pregnancy, childbirth, abortion - - - -- - - - - - - -— - 31 Congenital malformations - — 1 — — 1 - — — — - ■-* 32 Other defined and illdefined diseases 3 11 30 12 7 63 16 38 12 6 n 33 Motor vehicle accidents _ 2 7 3 2 14 _ 1 1 1 1 34 All other accidents - 1 6 3 1 11 _ 1 9 — 1 ii 35 Suicide _ 2 I 9 2 1 14 1 3 — 1 36 Homicide and operations of war I- - No social class assessed — — — 15 — I ~~~ "" 0 13 There are small discrepancies between the above table and table 2, owing to different methods of assessment, and 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 6, and grouped in this way. They are shown in table 7, 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 5 for all deaths. Grouped deaths in social class Table 7 Male Female 1 II III IV V Total 1 II III IV V Total 1,2 TB No. — 1 13 6 5 25 — 1 6 2 — 9 % 4 52 24 20 100 — II 67 22 — 100 10-15 Cancers No. 6 48 142 36 10 242 3 39 108 30 11 191 °/ 10 . 2 20 59 15 4 100 2 20 56 16 6 100 17-21 Heart and circulation No. 24 117 300 72 46 55) 21 118 301 85 38 563 0/ /o 4 21 54 13 8 100 4 21 53 15 7 100 22-25 Lung, non-TB No. 5 20 87 28 19 159 — 15 51 14 7 87 0/ /o 3 13 54 18 12 100 — 17 59 16 8 100 33,34 Accidents No. — 3 13 6 3 25 — 2 10 1 2 15 °/ /o — '2 52 24 12 100 — 13 67 ; 13 100 35 Suicide No. — 2 9 2 1 14 — 1 3 — 1 5 •/ /o — 14 65 14 7 100 — 20 60 — 20 /00 Social class in relation to infant statistics 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 percentage. 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 5. 14 Table 8 Social classification Total Not classifiable / II III IV V Registered births No. 117 518 2027 323 162 3197 24 °/ /O 4 16 65 10 5 100 Registered infant deaths No. 2 6 45 7 1 61 5 0/ /o 3 10 74 II 2 100 Registered stillbirths No. 2 10 24 6 1 43 - 0/ /o 5 24 55 14 2 100 Notified premature births No. 3 17 124 26 15 185 8 % 2 9 67 14 8 100 Lung cancer The increase in cases was temporarily checked last year when there were 76 male deaths and 13 female deaths from this disease compared with 83 and 13 respectively in the previous year. Coronary disease Another cause of death which like lung cancer has increased rapidly in recent years is a disease of the main blood vessels of the heart itself — the coronary arteries. The following table shows deaths from various heart and circulation causes in the borough in representative years from 1928, the last columns showing various percentages:— Table 9 Heart and circulation mortality Year (°) Deaths from Total heart and circulation (all ages) (e) Age group 45-65 Total deaths in borough (h) Percentage Other Coronary \ heart diseases i diseases (b) | (c) Other circulatory diseases (d) Total (f) Coronary diseases (?) (e) of (h) (0 (fK 00 (J) (t)f w # 1928 357 97 454 115 ? 1993 23 5-8 ; 1933 516 117 633 162 ■> 2271 28 7-1 1938 659 139 798 178 1 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 i 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 70 3-5 3 331 444 113 888 140 84 2502 35 5-6 3-4 4 358 ' 387 113 858 176 99 2231 38 7-9 7 means figure not available 15 Apart from socalled " nervous strain " and " pressure of living it has been suggested with more and more evidence (none of it howev( conclusive) that dietary factors may be of considerable importance bot in coronary disease and also in other degenerative diseases of the hea and blood vessels. Overweight in itself has been known for man years to be associated with degeneration of the heart and blood vessel Last year I stated that it would be interesting to see if the derationin of butter and the increased availability of eggs had any effect on tl incidence of coronary heart disease. It is unwise to rely much o the figures for any one year, even in a borough of this size, but the tab above does indicate some figures of interest insofar as 1954 w; concerned. Thus the total deaths from coronary disease increased by 2 while the deaths from all other heart and circulatory diseases decrease by 57, giving a net diminution in the total deaths from heart an circulation causes of 30. Nevertheless in spite of this, taking the aj group 45 to 65, the total of heart and circulation deaths went up froi 140 to 176 compared with the previous year, and those from coronai disease from 84 to 99. The percentage of persons in this age grou dying of heart and circulation diseases increased from 5.6 to 7.9 an that of coronary disease from 3.4 to 4.4. Deaths under age 65 Deaths under the age of 65 of course have particular importanc in relation to loss of productive manpower, and with an ageir population the problem of manpower and earning capacity becomi increasingly serious. Although during 1954 the proportion of thos who died under the age of 45 still further decreased, namely froi 8.9 to 8.3 percent, those dying under the age of 65 increased — froi 29.5 to 31.5 percent. It is a simple arithmetical calculation therefoi that those dying between the age of 45 and the age of 65 were last ye: 23.2 percent of the total deaths as compared with only 20.6 the previoi year, an increase of 2.6, or over 12 percent. It is desirable therefore 1 examine the deaths in this age grouping rather carefully. There wei 320 males and 197 females (these figures are almost exactly the san as in the previous year when they were 322 and 192 respectively, tl difference in percentage being due to the decrease in the total numbi of deaths from all ages in the year — from 2,502 to 2,231). Of tl males the main increases in the 45.65 age group deaths last year wei 5 in cancer of the lung, 12 in other cancers, 12 in coronary disease, an 13 in other heart diseases. On the other hand there were decreases i vascular lesions of the nervous system (8), in pneumonia and bronchit (16) and in digestive ulcers (7). In females of the same age group thei were 20 more deaths from vascular lesions of the nervous systen while there were 10 less deaths from pneumonia or bronchitis. It seen therefore that in spite of the year being good for " chests," it was, as f; as this age group was concerned, particularly bad for diseases of tl heart and circulation. General Statistics from 1901 Table 10 Year Population Death rate * % dying under age 45 % dying under age 65 Birth rate * Premature birth rate t Maternal death rate t Stillbirth rate t 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) (1S) (16) 1901 127,495 130 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 0.85 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 11.4 34.9 59.1 16.6 3.1 28 32 60 1.8 0.86 111 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 0.74 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 1.6 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 16 0.92 12 3 1928 199,300 10.0 29.0 54.4 15.2 2.3 22 30 52 17 0 77 15.1 1929 I 207,900 11.5 26.7 52.5 1 5.7 5.3 44 1 .4 0.74 13.3 1930 107.900 9 7 17.9 53 1 15.1 0.9 37 41 79 1.5 0.76 12.3 Table 10 continued. Year Population I | Death rate ♦ ! % dying under age 45 % dying under age 65 Birth rate * Premature birth rate t Maternal death rate t f Stillbirth rate t 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) 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 — 2.6 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 22.6 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 — 2.0 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 11 0.61 12.4 1939 220,300 10.8 — — 13.6 — 29 34 42 76 1.1 0.64 11.6 1940 192,540 15.8 22.1 50.0 14.7 — 10 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 44.9 187 — 3.1 25 — 42 67 1.9 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 11.9 17.0 41.9 21 .9 — 1.0 21 — 33 54 1.6 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 227,200 112 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 1.2 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 1954 224,200 100 8.3 31.5 14 2 60 0.0 14 13 | 8 21 35 1.0 0.16 8.8 *per 1,000 population, tper 1,000 notified livebirths. **per 1,000 registered livebirths. fper 1,000 registered live and stillbirths. — equals figure not available. 18 SECTION "B" —GENERAL PROVISION OF HEALTH SERVICES Disinfection and personal cleansing Details of the work carried out during the year are as follows :— A more detailed analysis of treatments for verminous conditions and for scabies is shown :— Verminous conditions Table 12 First cleansing Second cleansing Third cleansing Fourth cleansing Children under 5 38 3 — _ School children 406 36 1 1 Adults 65 3 - — TOTALS 509 42 1 1 Disinfecting Station Table 11 West North South Total Disinfections Premises visited 202 147 186 535 Rooms disinfected 4S4 346 375 1175 Articles disinfected 2S31 2914 1888 7333 Disinfestation Premises visited 45 31 18 94 Rooms disinfested 123 102 56 281 Articles disinfested 134 13 10 157 Articles treated Beds 62 39 80 181 Mattresses 225 216 195 636 Bolsters 56 40 64 160 Pillows 395 339 380 1114 Cushions 25 45 37 107 Quilts 135 87 133 355 Blankets 557 305 495 1357 Sheets 88 68 71 227 Household articles 405 325 211 941 Wearing apparel 717 1463 232 2412 Total articles 2665 2927 1898 7490 Articles received from cleansing station 2793 2793 Articles received from Coroner's court — 524 — 524 Public library books treated after infection 215 342 219 776 Private library books treated after infection 15 14 21 50 Articles treated under the Public Health (London) Act s.122 9951 5760 20600 36311 19 Scabies Table 12—continued Cases Contacts Treatments Children under 5 3 _ 7 School children 10 3 24 Adults 4 4 13 TOTALS 17 7 44 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 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. Two persons received such treatment during the year. Anti-fly and anti-mosquito campaign As in previous years four men were employed, working in pairs. The campaign was held from April 30 to September 30 and Mr. Phillips, the deputy senior sanitary inspector who is in charge of anti-pest work, reports :—" 417 bombed sites, grass verges and rear garage ways were visited on 5 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 material collected or destroyed on the sites consisted of 138 mattresses and approximately four tons of miscellaneous articles such as carpets, linoleum, furniture, clothing, cushions and even perambulators. 12 gallons of paraffin were used in the destruction of this material on the sites. A remarkably large quantity of bread was also found, a positive encouragement to 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 4 tons of powder containing 0-5 percent gamma benzene hexachloride was used. 20 8 stables or piggeries, 10 allotment sites, and one plot of land known to be particularly bad as a rubbish tip were treated as special sites and visited on 21 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. 22 visits were also paid to both this Council's and the London County Council's blocks of flats where dustchutes are used. 226 dustchutes with 807 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. In addition treatment by spraying was carried out in 10 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. Static water tanks and sections of the rivers where the water tends to become stagnant were sprayed with 5 percent DDT in kerosene base as an anti-mosquito precaution on 4 occasions. Laboratory facilities The following summary relates to the work carried out by the laboratory on behalf of the Council during 1954 :— Table 13 Specimen Number Remarks Faeces 1169 Negative 694 Positive — Shigella sonnei 21 „ —Salmonella typhi-murium 3 „ — Salmonella newport 1 „ — Bact. coli type 0 26 1 „ — Bact. coli type 0 55 2 „ — Bact. coli type 0 86 Urine 6 Nose swabs ... 66 f C. diphtheriae was not isolated from \ any of these specimens Throat swabs 146 Sputum 9 Negative 1 Positive for TB Pus 1 Cherry cake 1 Liver sausage 1 21 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 735, of which 409 were received from institutions. 735 postmortem examinations were made and inquests were held in 123 cases. Details are shown in the following table :— Table 14 Month Bodies received from Institutions Others Post-mortem examinations Inquests Lewisham residents Others January 47 36 55 28 10 February 35 35 38 32 7 March 37 33 42 28 9 April 32 22 31 23 10 May 35 35 39 31 11 June 31 22 21 32 14 July 24 20 21 23 6 August 28 22 33 17 10 September 34 24 31 27 10 October 40 20 32 28 17 November 30 20 29 21 10 December 36 37 42 31 9 TOTALS 409 326 414 321 123 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, and this section is supervised by the senior sanitary inspector. A summary of the work carried out in private or business premises during the year is appended :— Table 15 Parliamentary Division Total West North South Properties inspected on complaint 468 447 388 1303 Premises baited :— Initial treatments 711 796 770 2277 Retreatments (infestation found) 729 812 696 2237 No infestation found (initially or at re- inspection) 1126 1682 1806 4614 Total visits 6636 7207 6592 20435 Rivers and ditches, base points 98 373 218 689 Other premises, base points 168 200 193 561 22 In his report on rodent control work during 1954, Mr. Walker, the senior sanitary inspector, states:— " The number of complaints and actual infestations dealt with during the year is appreciably higher than the previous year. This cannot be accounted for, and it appears that the increase is evenly spread over the whole borough. " The No. 2 Workable Area Committee for rodent control met twice during the year. This Committee covers the areas of Bermondsey, Deptford, Greenwich, Lewisham and Woolwich, and affords a very useful opportunity for the exchange of views and experience met with in those districts. " Sewer treatments were carried out in June and December and again there appears no evidence that these treatments affected the incidence of aboveground infestations. The subject was discussed at a meeting of the area committee during the year, and on the advice of the Ministry it was decided to continue the experimental baiting of sewers. Defective drains are still the source of many rat infestations, and these are dealt with by the sanitary inspectors as they arise." The undermentioned table gives a summary of the work on the rivers and ditches :— Table 16 Location 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 River Pool 98 4 35 42 21 102 53i 137 River Quaggy 201 3/4 44 86 71 260 147 367 River Ravensbourne 372 3/4 51 212 109 526 265 662 Ditches— Rear of Hazelbank Road* — Ladywell Lodge to Chudleigh Road* - - -- - - - - - -Reigate Road to cemetery, Verdant Lane 18 3/4 10 — 8 26 13 29 "Inspected but no evidence of infestation found. Special liaison is made twice yearly with the Borough Engineer's department for the treatment of sewers. In 1954, treatments were carried out from Juno 10 to July 3 and from December 2 to 22. 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. 23 The following is a summary of the results obtained: — Summer treatment Manholes baited 2,927 Manholes showing prebait take 421* Manholes showing complete prebait take (on one or both days) 387 Winter treatment Manholes baited 2,927 Manholes showing prebait take 877* Manholes showing complete prebait take 454 *(The reason for the large disparity between the number of manholes showing prebait take in the summer and winter treatments was that the sewers became surcharged between baitings.) Prevention of Damage by Pests Act, 1949 A copy of the annual report covering the twelve months ended 31 March, 1955. submitted to the Minister of Agriculture and Fisheries, as required by the provisions of the above Act, is appended. Table 17 Type of property Local authority Dwelling houses (including council houses) All other (including business premises) Total Agricultural Number of properties in ' borough 170 61,120 3,990 65,280 44 Number of properties inspected as a resu It of :— (o)'notification 8 1,510 112 1,630 — (b) survey — 3,960 125 4,085 8 Number of properties inspected which were found to be infested by : (o) Rats — major - 1 — 1 — — minor 5 1,618 122 1,745 5 (b) Mice — major - — — — — — minor 2 300 90 392 3 Number of infested properties treated 7 1,919 212 2,138 8 Total treatments... — — — 2,024 — Total retreatments 4,534 — Number of " block " control schemes carried out 19 It has not been found necessary to serve notices under section 4 of the Act for either treatment or structural works (i.e., proofing) and consequently no default action has been necessary and no legal proceedings have been taken. 24 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 Public Health Laboratory Service for bacteriological examination Chlorine Bacteriological content examination Bellingham 3 Downham 10 - Ladywell — east pool 4 1 — west pool 2 - Forest Hill north pool 4 - —south pool 3 1 Private baths 3 4 A detailed report on the use of breakpoint chlorination, which is the method employed at the baths, was included in my annual report for 1950. National Assistance Act, 1948 — section 50 During the year the Council accepted responsibility for the burial of 5 persons, at a net cost of £21 7s. Od. Dog nuisances No proceedings were taken during the year. Drainage work During the year 192 plans were submitted to the sanitary inspectors for examination and approval. 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 ,£2,500 was included in the annual estimates for the year 1954—55 for such organisations as accepted the Council's conditions and to assist an) other such voluntary organisations as might be established during thai year. Reports were made to the Public Health committee giving details of the work undertaken by the voluntary organisations and as a resuli grants were made as follows :— £ Lewisham Old People's Welfare Association 1,800 Lewisham Darby and Joan Club 300 St. Mark's Old Folks' Club 65 Talbot Settlement Old People's Club 22 The Good Companions Personal Service 30 St. Swithun's OAP Association 50 Bellingham Old People's Club 50 St. Philip's Darby and Joan Club 20 The Friendly Club (for the Over-sixties) 37 10s. This left a sum of money available for new clubs which mighl qualify for grant. At the end of the calendar year one further applicatior was under consideration. 25 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 Mealson-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, over 36,000 articles being cleansed. The service was highly appreciated ; it can only be used, however, where section 122 of the Public Health (London) Act applies. Measurement of atmospheric pollution The three deposit stations continued in use throughout the year. In the second half of the year smoke measurements were begun. The apparatus for this consists of an electric motor which draws outside air through a filter paper, the smoke producing a stain on the paper. The amount of smoke is calculated by comparison with standard shades and the amount of air drawn through is measured by a modified gas meter. The outside air is sampled 10 to 20 feet above ground level and about 3 feet from a wall. The smoke measurement stations were set up in consultation with the Fuel Research Station at Greenwich (acting under the Department of Scientific and Industrial Research) and are sited at Valentine Court, Paragon Place, and Downham Depot. Towards the end of the year arrangements were made in certain areas of greater London to make more frequent measurements of smoke and other impurities in the atmosphere should there be a prolonged smog. Lewisham was one of the areas concerned and as far as smoke measurement was involved volunteers at or near the sites at Valentine Court and Paragon Place were shown how to take recordings, and they arranged themselves into rotas for 24-hour work. One such warning of smog was given on the evening of November 15 and three-hourly recordings were made from the smoke apparatus at both Valentine Court and Paragon Place. At Valentine Court between 9 p.m. on November 15 and noon on November 16 the average amount of smoke was 184 milligrammes per hundred cubic metres, while at Paragon Place between 10 p.m. on November 15 and 7 a.m. on November 16 the average was 235 milligrammes per hundred cubic metres. The smog however was not prolonged as it began to disappear in the early hours of the morning. 26 Table 18 gives a record of the principal results from the six stations and also gii are not specific to the borough, having been obtained from a publication of the mete Atmospheric Conditii 1 January February March April ] Temperature— Mean maximum1 °F 40-9 41-9 49-6 54-1 iH Mean minimum1 °F 33-9 33 9 38-3 36-7 45) Mean1 °F 37-4 37-9 43 9 45-4 537 Diff. from average' °F -2-7 -2-5 + 0-2 -2-8 M Highest maximum °F 570 52-0 62-0 61 -0 860 Lowest minimum5 °F 220 20-0 28-0 35-0 ■ 41 Rainfall— Total2 in. 0-99 1 -73 1-50 0-20 1-65 Percent of average' 530 101-0 84-0 18-0 1# Sunshine' Daily mean hrs. 1-83 1 82 3-26 5-84 51! Percent of average 1230 81 -0 86-0 118-0 8241 Wind' NE/E/SE ... % 390 29-0 32-0 37-0 IH S/SW/W % 41 0 52-0 53-0 28-0 4+1 NW/N/Calm ... % 200 19-0 15 0 35-0 mi Atmospheric pollution— West Division3 : Water insol. matter tpm 809 12-06 13-92 13-32 197 Water sol. matter tpm 4-57 5-97 7-29 5-14 T1 < i Sulphur t 2-51 2-51 2-25 1 92 l'ii Smoke, daily average * — — — — „ maximum * — — — — (date) — — — — „ minimum ♦ — — — — (date) — — — — North Division4 : Water insol. matter tpm 11-20 10-93 13-70 12 35 11'H Water sol. matter tpm 8-13 6-23 7-57 5-40 ■ Sulphur t 3 91 3 71 3-25 2-65 Smoke, daily average * — — — — „ maximum * — — — — (date) — — — — „ minimum ♦ — — — — (date) — — — — South Divisionk : Water insol. matter tpm 5-63 6-95 5-80 7-44 Water sol. matter tpm 5-43 5-30 7-57 5-53 Sulphur t 2-71 2-43 1 87 1-73 Smoke, daily average * — — — — „ maximum * — — — — (date) — — — — „ minimum * — — — — (date) — — — Weather summary Changeable very cold at end Cold early; mainly dull Unsettled Changeable very cold at first Dry ; sunny ; cool Dull* w ■co Notes : 'Croydon ; :Lewisham ; 3Valentine Court for smoke, Pool allotments for other tpm : tons per square mile per month ; fas trioxide in mg per 100 sq. c Bpc 27 eindication of the sunshine, rainfall, etc., during the year. Some of these latter data icaloffice, and relate to the nearest station which records the particular item concerned. 954 June July August September October November December Average[/$$$] 650 66.2 67.5 64.3 60.3 51.6 49.1 56.0 50.9 53 .2 53 .0 50.0 50.1 41.3 41.0 44.0 57.9 59.7 60.3 57. 1 55.2 46.5 45.1 50.0 46 -3.3 -2.2 -1.5 + 3.6 + 1.8 + 4.4 -0.5 78.0 78.0 81.0 84.0 70.0 61 .0 57.0 69.0 48.0 47.0 48.0 42.0 34.0 32.0 31. 0 36.0 236 2.40 3 .15 1.81 1.46 2.86 1.06 1 .76 390 106.0 102.0 109.0 59.0 174.0 70.0 97.0 5.43 4.34 4.78 5.44 3.21 1.46 1.56 3 68 750 65.0 77.0 114.0 97.0 84.0 120.0 93.0 14.0 0.0 4.0 4.0 2.0 12.0 8.0 16.0 590 85.0 72.0 82.0 88.0 67.0 17.0 62.0 27.0 15.0 24.0 14.0 10.0 21.0 18.0 22.0 14.98 16.00 14.98 14.65 17.36 11.33 10.14 13.88 10.37 4.38 7.42 6.83 5. 87 8.75 9.15 6.96 1.47 1 36 1.17 1.89 2.82 2.60 2.81 2.05 — 4.9 6.8 6.5 10.4 31.0 21.0 13 .4 7.6 10.5 9.4 18.7 184 .4 39.7 45.0 — (6.12) (18.24) (22.30) (6.12) @ (15.17) — 3.7 3 .9 3 .9 5.2 13 .9 9.5 6.7 (20.27) (4.10) (8.14) (13.19) (27.30) (1.3) — 998 5.27 8.20 6.62 5.47 11.66 5.47 9.40 609. 4.68 10.14 4.78 5.60 9.61 7.87 7.18 1.80 0.97 1.43 1 57 2 35 4.10 3.76 2.64 — 8.3 9.5 12.1 28.8 22.9 16.3 — 11.3 13.4 18.7 235.3 42.4 64.2 — (18.24) (22.30) (6.12) t (15.17) — ~~ — 6.6 6.7 6.3 13.9 13 .6 9.4 — (4.10) (8.14) (1.5) (27.30) (22.24) 18 83 ■ in 5 .30 5.66 3. 33 3.56 7.44 3.82 6.23 ■ '6/ n 7Q 4.58 5.01 3.26 3.13 9.39 6.92 5.81 ■ v /7 0.70 0.86 0.86 1.11 2.04 2.28 1.56 1 . 5.4 8.1 5.7 7.4 5.8 101 9.4 14 .7 22.0 42.4 21 .0 34.3 11.5 19.5 (6.12) (18.24) (22.30) (6.12) (17.19) (15.17) 3.1 2.6 2.9 4.2 13.0 9.8 5.9 (20.27) (31.3) (8.14) (13.19) (27.30) (1.3) ■ Dull, ■ tool, Mwet Notably cool and dull Cool and dull ; rather wet Cool and unsettled ; wet, sunny Unsettled and mild Wet ; very unsettled last part Mild, dry and bright EV°r sm°ke, Wearside Road for others ; 'Downham Depot for smoke, Verdant Lane for others ; ■ 'rWcub. metres. @ 15 hrs. on 15/16 ; $ 9 hrs. on 15/16 28 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 from Deptford Well and by Thames-derived filtered water ; the Eltham zone is supplied from Wilmington, Darenth and Bexley Wells and should the occasion arise, with a small proportion from the low zone ; the Bromley zone to the south of the borough is supplied from Shortlands Well and again on occasions with additional Thames-derived filtered water. River Thames water is abstracted at the Board's intakes at Walton, Laleham and Wraysbury and is stored in the Board's reservoirs at Walton, Littleton and Staines. The water is filtered at Hampton, Surbiton and Walton works. Contact tanks have been built at Hampton and Walton where there is opportunity for chlorine to exert its full effect before the water is pumped into supply and thereby chlorinous and other tastes are to a great extent avoided. The dose of chlorine at these stations is now controlled automatically in regard to changes in quality of the filtered water as well as to changes in rate of flow. All the well water is chlorinated and here also contact tanks are provided. Finally, any residual chlorine is completely removed or reduced to a level that would not be noticeable to consumers before the water leaves the works. Bacteriological analyses are made at least five times a week and in the case of the river-derived supplies, the water is analysed at all stages of purification. All new and repaired mains are chlorinated before being restored to use and samples are collected for analyses to establish that the quality of the water is up to the standard normally supplied. None of the supplies is plumbo-solvent. Appended are the average results of the chemical and bacteriological analyses of the various supplies as forwarded by the Metropolitan Water Board :— 29 Average results of the examination of the chemical and bacteriological water supply to the Borough of Lewisham parts per million (unless otherwise stated) (o) CHEMICAL Table 19 for 1954 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 3. 0 .007 0.025 4.8 16.0 0.13 282 53 7.2 425 Darenth Well 4 0.003 0.018 5.3 15.4 0.07 265 40 7.1 425 Shortlands Well 4 0.004 0.024 5.4 18.5 0.14 287 74 7.2 425 Wilmington Well 8 0.006 0.025 7.2 16.6 0.11 290 62 7.2 450 Deptford Well 3 0.007 0.027 6.2 320 0.18 357 125 7.1 600 River Thames.derived filtered water 1585 0.021 0.092 3.9 26.7 1.20 269 70 7.9 450 .(b) BACTERIOLOGICAL Table 20 No. of samples Agar colony count (average per millilitre) Percentage of samples negative to Bact. coli in 100 ml. Bact. coli per 100 ml. 22 °C 3 days 37 °C (20.24 hrs.) Bexley Well 306 5.6 0.1 100.0 Nil Darenth Well 236 29.8 0.8 99.6 0.008 Shortlands Well 257 2.1 0.2 100.0 Nil Wilmington Well 252 51 2 0.3 99.6 0.008 Deptford Well 254 2.2 0.1 100.0 Nil River Thames.derived filtered water 3604 8.8 99.8 0.004 30 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 21 Reason for inspection West North South Total District sanitary inspectors : Dwelling-houses — PH Act 1358 1251 646 3255 Dwelling-houses — Housing Act 712 832 379 1923 Houses let in lodgings — — — — Applications for rehousing 119 151 33 303 Rent Acts and Landlord and Tenant Acts 23 17 26 66 Notice from builder 136 100 95 331 Building licences and certificates for materials — — — — Infectious diseases 17 12 9 38 Infestation 44 115 60 219 Factories, mechanical 72 78 32 182 Factories, non-mechanical 11 16 25 52 S47 National Assistance Act 11 6 5 22 Outworkers 154 116 169 439 Smoke observations 2 — 6 8 Offensive trades — — — — Keeping of animals in such a state as to be a nuisance 7 2 1 10 Water certificates 22 46 141 209 Futile visits 892 1407 587 2886 All other matters 650 892 262 1804 Reinspections 5110 6467 3289 14866 Totals 9340 11508 5765 26613 Food inspectors : Notice from builder 58 104 12 174 Heating Appliances (Fireguards) Act. 7 — 1 8 Infectious diseases 14 24 15 53 Infestation 27 39 4 70 Factories, mechanical 55 55 103 213 Factories, non-mechanical 1 2 9 12 Smoke observations — — 10 10 Food shops—registered... 105 186 274 565 Food shops — not registered 138 132 276 546 Milkshops and dairies 109 133 60 302 Icecream premises 202 190 176 568 Restaurants and eating houses 250 152 262 664 Bakehouses 98 49 23 170 Other shops 7 175 16 198 Food inspections 323 346 150 819 Sampling 422 285 264 971 Markets and stalls 3 1222 514 1739 Pharmacy and poisons 87 78 17 182 Slaughterhouses 2 33 — 35 Futile visits 80 23 6 109 All other matters 451 349 145 945 Reinspections 819 729 368 1916 Totals 3258 4306 2705 10269 31 Table 21—continued Reason for inspection West North South Total Housing inspectors : Dwelling-houses — PH Act — — — — Dwelling-houses — Housing Act 120 106 21 247 Houses let in lodgings — — — — Applications for rehousing — — — — Notice from builder — Building licences and certificates for materials Infestation Futile visits 100 143 19 262 All other matters 150 162 21 333 Reinspections 1523 1146 262 2931 Totals 1893 1557 323 3773 Grand total — all inspections 14491 17371 8793 40655 Smoke nuisances Observations 18 Intimations served — Complaints received 2 Statutory notices served — Legal proceedings — Convictions — Summary of notices served in 1954 Table 22 West North South Total Intimation notices :— Public Health (London) Act, 1936 529 357 167 1053 Informal intimations under Factories Act. 1937 3 5 1 9 Informal intimations under Housing Act, 1936 26 29 12 67 Total intimations 558 391 180 1129 Statutory notices Public Health (London) Act, 1936 196 263 116 575 Factories Act, 1937 1 4 — 5 Housing Act, 1936 3 4 2 9 Byelaws (other than Housing Byelaws).. 43 16 6 65 Food and Drugs Act, 1938 — 13 — 13 Total statutory notices 243 300 124 667 32 Nuisances remedied — Public Health Act Table 23 Nuisance West North South Total Wall and ceiling plaster repaired 128 178 63 369 Roofs repaired 102 166 56 324 Dampness remedied. 448 334 183 965 Brickwork repaired 15 78 12 105 Chimneys repaired 3 12 4 19 Drains cleared 16 23 6 45 Drains repaired 28 63 47 138 Drinking water cisterns repaired — 2 — 2 Dustbins provided 45 30 16 91 Doors and door frames repaired or renewed 9 7 11 27 Flushing cisterns repaired, renewed or cleansed 16 22 11 49 Flushing pipes repaired or renewed 2 1 1 4 Firegrates, etc., repaired or renewed 39 51 18 108 Flooring repaired or renewed and dry rot remedied 83 69 30 182 Gullies renewed, repaired or cleansed 3 9 1 13 Gutters repaired 32 65 27 124 Accumulations of refuse cleared — — 3 3 Rainwater pipes repaired 11 25 6 42 Soilpipes ventilated, repaired or renewed 2 1 6 9 Sinks provided 3 1 — 4 Sashcords renewed 50 34 23 107 Water closets repaired or renewed 22 26 12 60 Walls and ceilings cleansed 4 5 63 72 Windows and window frames renewed or repaired 31 47 16 94 Water service pipes repaired or renewed 2 6 8 16 Yards and areas paved 2 5 3 10 Other nuisances remedied 60 84 29 173 TOTALS 1156 1334 655 3145 Nuisances remedied — Housing Act Table 24 Nuisance West North South Total Wall and ceiling plaster repaired 304 252 24 580 Roofs repaired 39 28 4 71 Dampness remedied 60 37 8 105 Brickwork repaired 43 42 3 88 Chimneys repaired 12 4 16 Drains cleared 2 2 Drains repaired 11 7 1 19 Drinking water cisterns repaired — 1 — 1 Dustbins provided 1 1 — 2 Doors and doorframes repaired or renewed 53 58 12 123 33 Table 24—continued Nuisance West North South Total Flushing cisterns repaired, renewed or cleansed 5 3 — 8 Flushing pipes repaired or renewed 1 — — 1 Firegrates, etc., repaired or renewed 21 29 5 55 Flooring repaired or renewed and dry rot remedied 48 42 3 93 Gullies repaired, renewed or cleansed 11 3 1 15 Gutters repaired 26 21 2 49 Accumulations of refuse cleared — 2 — 2 Rainwater pipes repaired 17 9 — 26 Soilpipes ventilated, repaired or renewed — — 1 1 Sinks provided 1 — — 1 Sashcords renewed 28 22 4 54 Water closets repaired or renewed 12 7 — 19 Walls and ceilings cleansed — — — — Windows and window frames renewed or repaired 64 55 6 125 Water service pipes repaired or renewed 2 1 — 3 Yards and areas paved 6 6 1 13 Other nuisances remedied 206 153 14 373 TOTALS 971 785 89 1845 Rent and Mortgage Interest (Restrictions) Acts In 4 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 3 cases the necessary statements were issued as the premises 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 308 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, 34 overcrowding, the maintenance of a reasonable temperature, the securing of adequate ventilation of workrooms and the furnishing of adequate means for draining floors where wet processes are carried on, are enforced by the council in factories in which mechanical power is not used. The provisions of section 7 are also applied to certain building operations and works of engineering construction, etc. A local authority is required to keep a register of factories with respect to which it is responsible for the enforcement of any of the provisions mentioned above. Close cooperation is maintained with HM Inspectors of Factories in that any defaults found by them during the course of their visits 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 their jurisdiction. 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 1954:— Inspections Table 25 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 73 64 _ (ii) Factories not included in (i) in which section 7 is enforced by the local authority 424 395 3 1 (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 35 2 2 TOTAL 532 461 5 1 35 Cases in which defects were found Table 26 Defects No. of cases in which defects were found No. of cases in which prosecutions were instituted Found Remedied Referred To HM Inspector By HM Inspector Want of cleanliness (S 1) ... 3 3 Overcrowding (S 2) - - - - - Unreasonable temperature (S 3) - - - - - Inadequate ventilation (S 4) - 1 - 1 - Ineffective drainage of floors (S 6) - - - - - Sanitary conveniences (S 7) : (a) insufficient 2 3 - 1 - (b) unsuitable or defective 1 7 - 6 1 (c) not separate for sexes - 4 - 4 - Other offences against the Act (not including offences relating to outwork) - 1 1 1 - TOTAL 3 19 1 16 1 Sanitary work generally Mr. Walker, the senior sanitary inspector, reports : " The total number of inspections and visits differ very little from that of the previous year. The increase in housing inspections is accounted for by the commencement of the housing survey and, to a lesser extent, visits in connection with certificates of disrepair. " There have been increasing requests by outside bodies for talks by individual sanitary inspectors on various aspects of public health work, and these have been acceded to gladly. This is in addition to the educational work of the food inspectors, who have been engaged in a special clean food campaign with shopkeepers and their staffs. Parties of school children have also been given talks and demonstrations on the work of the department. " An increasing interest in improvement grants under the Housing Act 1949, is now being shown by property owners, due no doubt to recent publicity on the subject. This interest is being encouraged and advice is readily given by the sanitary inspectors when requested. In practice it is found helpful if prospective applicants discuss the matter with one of the housing inspectors before making the actual application, as this often saves subsequent alterations to plans and specifications." 36 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 district sanitary inspectors. The following is a list of trades concerned, extracted from the August, 1954 lists received :— Trade Outworkers employed Wearing apparel 217 Umbrellas 1 Artificial flowers 1 Boxmaking 14 Carding, etc., of buttons 1 Stuffed toys 2 Paper bags 1 Lampshades 2 Textile weaving 1 240 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. No adverse comments were made. 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. 37 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. 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 During the year 19 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 to any licence which has been issued. 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. The difficulties of dealing with the problem remain and little of any value can be added to last year's report. Exhumations It is the practice for a sanitary inspector to be in attendance at an exhumation and two such attendances were made during 1954 in respect of licences issued by the Secretary of State. 38 SECTION "D" —HOUSING Building The following new houses or flats were completed by the Council during the year :— Abernethy Road ... 5 Aislibie Road 8 Baizdon Road 93 Baring Road 4 Beadnell Road 14 Border Road 8 Bromley Hill 24 Bromley Road 14 Buckthorne Road 10 Comerford Road 12 Dacre Park 6 Dalmain Road 6 Denwood, Inglemere Road 16 Devonshire Road 6 Eddystone Road 7 Elwyn Gardens, Corona Road 24 Ermine Road 3 Eton Grove 6 Fermor Road 3 The Glebe 4 Guibal Road 6 Hither Green Lane 12 Honor Oak Park 16 Houston Road 6 Hurstbourne Road 4 Kent House RoaD 5 Kirkdale 12 Ladywell Park 6 Langthorne Court, Bromley Road 45 Lawn Terrace 20 Linchmere Road ... 8 Manor Lane Terrace 4 Neuchatel Road 7 Paynell Court 16 Prendergast Road 60 Sangley Road 6 Sheenewood, Westwood Hill 52 Somertrees Avenue 4 Tyrwhitt Road 9 Westwood Hill 9 Whitbread Road 2 Winn Road 9 Total 591 39 Families rehoused During the year the following families were rehoused :— 1. By the Lewisham Borough Council:— (a) Permanent properties 380 (b) Temporary bungalows 20 (c) Emergency hutments (d) Requisitioned properties 260 660 2. By the London county council (figures supplied by district offices) 219 Total 879 3. Number of families where points had been awarded for bedroom deficiency, rehoused by the Council during the year 294 Housing Act, 1936 Repair of houses (sections 9 and 10) During the year 67 informal and 9 formal notices were served. 44 properties were repaired by the owners after service of notices and 3 properties were repaired by the Council under section 10 in default of the owners. Demolition orders (section 11) The following is a list of cases involving demolition order procedure which originated in or were complied with during 1954, together with the present position of cases originating in previous years which had not been complied with at the end of 1953 :— Table 27 Properties Dwellings involved Present position 33, Brandram Road 1 Repairs required to comply with statutory undertaking completed. 37, Beacon Road 1 Demolished. 131, Sunderland Road 1 Repairs completed. 53, Ladywell Road 1 Repairs required to comply with statutory undertaking completed. 1, 2, 3, 4, Willow Close 4 Demolished. 30, Beacon Road 1 Repairs required to comply with statutory undertaking completed. 72, Brightfield Road 1 Demolished. 58, Knowles Hill Crescent 1 Notices served (1955). 7, Sunnyside, Blythe Hill 1 Work in progress. 40 Table 27—continued Properties Dwellings involved Present position 177, Hither Green Lane 1 Notices served (1955). 77, Malham Road 1 Statutory undertaking given to carry out work. 41 and 43, Brightfield Road 2 Undertakings to be accepted that houses, when vacant, shall not be used for human habitation until such time as the Council, on being satisfied that they have been rendered fit for that purpose, cancels the undertakings. 97, Mount Pleasant Road ... 1 Notices served. Closing orders for whole house (section 11, amended) Closing orders in respect of whole houses originated in 1954 under section 11, Housing Act, 1936 and section 10, Local Government (Miscellaneous Provisions) Act, 1953 :— Table 28 Properties Dwellings involved Present position 156, Courthill Road 1 Order made on breach of undertaking to carry out repairs. 2, Milford Road 1 Order made (except for purposes of storage). 14, Knowles Hill Crescent 1 Order made. Closing orders in respect of part of house (section 12) Table 29 Properties Part of house Present position 5, Aberdeen Terrace Three rooms and scullery in basement. Order determined. 18, Belmont Hill Three rooms in basement. Order determined. 5, The Glebe Flats 2, 3, 4 Orders determined. 5, The Glebe Flat 6 Demolished. 79, Burnt Ash Road Two rooms and scullery in basement. Works to comply with statutory undertaking completed. 20, Belmont Hill Three rooms in basement. Order determined. 38, Eltham Road Two rooms in basement. To be acquired by Council under Compulsory Purchase Order. 25, Montem Road Two rooms and scullery in basement. Works to comply with statutory undertaking completed. 172, Lewisham Road Bedroom and kitchen/ living room in basement. Works to comply with statutory undertaking completed. 52, Lee Road Four rooms and kitchen in basement. Works in progress. 41 Table 29—continued Properties Part of house - Present position 47, Loampit Hill One room in basement Order operative. 61, Westwood Hil Four rooms, kitchen and scullery in basement. Order operative (1955). 104, Wiverton Road Living room, bedroom, kitchen and scullery in basement. Statutory undertaking accepted in 1937 that rooms would not be used for human habitation. Works carried out and undertaking cancelled. 83a, Perry Hill Two main rooms and scullery in basement. Order operative. 2, Dartmouth Row... Two rooms in basement. Works to comply with statutory undertaking completed. Flat 1, South Vale Mansions. Three rooms, kitchen and bathroom in basement. Order operative. 363, Stanstead Road Two main rooms and back addition scullery in basement. Works to comply with statutory undertaking completed. 26, Manor Park Three rooms, scullery, bathroom and watercloset in basement. Works completed. 23a, Silverdale Three main rooms, box room and scullery in basement. Order operative. 290, Brockley Road Two main rooms and kitchen in basement. Works to comply with statutory undertaking completed. 1, Junction Approach Front room in basement. Order operative. 94, Loampit Vale Living room and scullery, ground floor ; two first floor rooms and attic room. Work in progress. 32, Lee Park Four rooms and scullery in basement. Order operative. 20, Lawrie Park Avenue. Flat 4, five rooms, kitchen and bathroom in annexe. Order operative. 8, Wisteria Road Two rooms and bathroom in semibasement. Order operative. 50, Lee Park Three rooms in basement. Notices served. 53a, Honor Oak Road Two rooms, kitchen, bathroom and watercloset in basement. Order operative. 28, Ravensbourne Road. Two rooms, scullery and watercloset in basement. Undertaking to carry out repairs received. 12, Manor Park Three rooms and scullery in basement. Notices served. 35, Burnt Ash Road Two rooms and scullery in basement. Notices served. 35, Devonshire Road Two rooms, scullery, watercloset and Notices served. 45, Lee Park 9, Mount Pleasant Road. sage in semibasement. Two rooms and scullery in basement. Notices served. Two rooms and scullery in basement. Works to comply with statutory undertaking completed. 42 In his report upon repair work under the Housing Acts during 1954, Mr. Craven, the group housing inspector, states :— " The outstanding feature of the year was the coming into operation of the Housing Repairs and Rents Act and its consequent effect on procedure and action under the Acts of 1936 and 1949. The principal changes which the new Act brought about in connection with the department's work were (a) the new standard to be applied when considering unfitness of dwellings ; (b) the permitted rent increase for fit properties and its effect on valuations made in determining ' reasonable cost' ; (c) the necessity for preparing a programme of action for dealing with unfit houses ; (d) the modification of the Housing Act, 1949 in relation to improvement grants. " The new standard of fitness was adopted in connection with the compiling of schedules of repairs under ss. 9, 11 and 12 of the 1936 Act and was also borne in mind when the survey of the older properties, to enable the programme to be prepared, was started towards the end of the year. " There was a notable increase in the number of applications for improvement grants, and in the last four months of the year applications in respect of 16 properties were reported on and approved by the Finance and Rating Committee. In addition to the grants approved, many tentative applications were received, which for various reasons proved to be ineligible. Valuable experience has been gained in the operation of the grants and in the procedure involved and it is now possible to give property owners general advice and guidance and to deal expeditiously with the majority of the points raised. " From the standpoint of the health department, it is felt that a valuable contribution is thus being made by the Council in assisting owners of older properties who are willing to provide facilities similar to those which are now regarded as necessary to a healthy life and in some cases to carry out full conversion of larger houses in multiple occupation. One of the conditions laid down in the standard of fitness to be applied to houses subject to grant is that the property shall be in good repair, and as a result it has been found that owners are willing to carry out, at their own expense, all the essential repairs required at the same time as the improvement work. In certain cases this repair work has been quite a considerable item. It has thus been possible to bring many properties up to a standard of good repair without the necessity for formal action by the department." Overcrowding (section 61) No applications were received from tenants under this section during the year. 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 year ended 31 December, 1954 :— 43 PART A —CLEARANCE AREAS (Housing Act, 1936) Table 30 Dwelling-house s 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 DEMOLITION AND CLOSING ORDERS 1. Housing Act, 1936 :— Houses Persons displaced (a) Houses demolished as a result of formal or informal procedure under section 11 6 19 (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 (section12) 9 25 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 Provisions) Act, 1953 :— Closing Orders made under section 10 (1) 5 22 REPAIRS Informal Action :— Number of houses* 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 37 Action under statutory powers :— 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 7 (b) by local authority in default of owners 3 *A defective house remedied more than once during the period is included once only. 44 General statistics The following is a tabulated statement of various statistics, extracted from a return to the London County Council covering the year 1954 :— Item Total No. of new dwellings completed by the Borough Council ... ... ... ... ... ... 591 No. of new dwellings completed by other persons 128 Total houses in the borough (separately assessed dwellings) at 1 April, 1954 61,120 No. of dwelling-houses inspected on complaint 3,255 No. of dwelling-houses inspected house-to-house 247 No. of dwelling-houses inspected for any other reason 2,314 No. of dwelling-houses repaired, as a result of action under the Public Health and Housing Acts 1,037 Housing Act, 1936 Houses demolished as a result of formal or informal procedure under s. 6 Houses closed in pursuance of an undertaking given under s.ll, and still in force None Parts of buildings closed by closing orders (s. 12) :— Underground rooms 1 Other rooms 33 Local Government (Miscellaneous Provisions) Act, 1953 Closing orders made under s. 10(1) 8 Housing Repairs and Rents Act, 1954 The above Act came into operation on 1 September, 1954, and from that date to the end of the year, 67 certificates under section 26 were issued on the application of tenants who had received notice of increase in rent from the landlords. 9 of these certificates were subsequently revoked before the end of the year on the application of the landlords, the sanitary inspectors being satisfied that the necessary works had been carried out. 45 SECTION "E" —INSPECTION AND SUPERVISION OF FOOD Milk and Dairies Regulations, 1949 At the end of the year there were 93 persons registered for the distribution of milk from premises within the borough and 22 registrations for the distribution of milk within the borough from premises in the area of another authority. 5 premises in the borough were registered as dairies. Milk (Special Designations) Licences Licences, which remain in operation from January 1 to December 31, were issued during the year as follows :— Table 31 Dealer's Supplementary Total Licences issued for :— sale of pasteurised milk 62 17 79 sale of tuberculin tested milk 58 17 75 sale of sterilised milk 92 17 109 sale of accredited milk 2 2 TOTALS 214 51 265 Analysis of milk During the year under review, 170 samples of milk were submitted for examination to the Public Analyst by the Council's inspectors. 8 of these samples were certified as adulterated or below standard. The average composition of the genuine samples is set out in the following table :— Table 32 Period Samples Average composition of samples examined Percentage of Milk fat Solids not fat Water First quarter 36 3.47 8.79 87.74 Second quarter ... 24 3.38 8.85 87.77 Third quarter 58 3.69 8.92 87.39 Fourth quarter 44 3.90 8.92 87.18 TOTALS 162 3.65 8.88 87.47 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. 46 Examination of heattreated milk 148 samples of pasteurised milk were submitted for examination. One of these samples failed to satisfy the methylene blue test. 7 samples of sterilised milk were examined during the course of the year and all 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 sixmonthly 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 132 samples of icecream were submitted for bacteriological examination with the following results :— Table 33 Grading Parliamentary division Total % West North South Grade 1 23 31 16 70 53 Grade II 10 13 10 33 25 Grade III 15 — 2 17 13 Grade IV 3 1 8 12 9 TOTAL 51 45 36 132 100 In general grades I and II are satisfactory, while grades III and IV may indicate some defect in manufacture, handling or storage. Such cases are followed up and advice is given. Icecream — composition The Food Standards (Icecream) Order, 1953 restored the standard for icecream which was in force before 7 July, 1952. Icecream must, therefore, 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 55 samples submitted to the Public Analyst for analysis were found to have the composition shown in the appended table :— 47 Table 34 Samples Average percentage composition Fat Milk solids. not fat Sucrose Water First quarter 13 9.7 11 .6 13.7 65.0 Second quarter 14 11.1 11.1 13.2 64.6 Third quarter 16 10.5 11.6 12. 3 65 .6 Fourth quarter 12 10.1 11.2 12.1 66 .6 TOTALS 55 10.4 11.4 12. 8 65.4 Sugar means sucrose, invert sugar or the solids of any sweetening material derived from starch. Unsound food Approximately 11 tons of food was surrendered as unfit for human consumption. This was dealt with by the Council's food inspectors and consisted of meat, fruit pulp, fish, vegetables, etc. In order to prevent waste, much of this unsound food was forwarded to the appropriate authorities for reconditioning or animal feeding. Food poisoning The following is the annual return of food poisoning notifications (corrected) furnished to the Ministry of Health :— (1) Food poisoning notifications (corrected) returned to Registrar. General:— First quarter 14 Second quarter 84 Third quarter 7 Fourth quarter 5 110 (2) Outbreaks due to identified agents Total outbreaks 6 Total cases 88 Outbreaks due to:— (a) chemical poisons . (b) salmonella organisms 1 (c) staphylococci (including toxin) 3 (d) CI. botulinum (e) Other bacteria 2 48 (3) Outbreaks of undiscovered cause:— Total outbreaks 1 Total cases 2 (4) Single cases:— Agent identified 9 ; Unknown 11 ; Total 20 The high figure of notifications in the second quarter was due to one outbreak at a residential institution in the area. Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 847, of which 105 were formal samples and 742 informal. After examination the public analyst reported that 13 of the formal and 13 of the informal samples were adulterated or below standard ; the percentage adulteration amounted to 12-38 in the formal samples, 1-75 in the informal samples and 3-07 of all the samples submitted, compared with 0-57 in the previous year. The following table gives the groupings and the results of the samples analysed :— Table 35 ARTICLES Examined Adulterated Informal Formal Total Informal Formal Total Bread and butter 19 19 4 4 Butter 39 2 41 — — Cereals, bread, baking powder 29 1 30 Cheese 8 — 8 — — — Cocoa, coffee, tea 21 2 23 — Confectionery (sweets) 8 3 11 — — — Condiments and flavourers 122 3 125 Cream 5 1 6 — — — Drugs 52 1 53 — — — Fish, tinned 6 — 6 — — — Flour 21 — 21 — — — Fruit and vegetables 36 — 36 8 — 8 Icecream 54 1 55 — — — Ice lollies 19 — 19 — — — Lard and suet 13 2 15 — — — Margarine 11 1 12 — — — Meat, canned and pies 17 1 18 — — — Milk 130 40 170 8 8 Milk, condensed 10 — 10 — — — Paste, fish and meat 25 — 25 — — Sausages 69 12 81 5 1 6 Soft drinks 17 2 19 — — — Spirits 1 11 12 — — Other foods 29 3 32 — TOTALS 742 105 847 13 13 26 49 Adulterated samples Table 36 Article Formal or Informal Adulteration or irregularity Action taken Sausages Informal 130 parts of sulphur dioxide per million. Formal sample taken and found to be genuine. Tangerines (4) Informal 15, 13, 11 and 10 parts of thiourea per million. Unable to trace country of origin or importers. Report sent to Ministry of Food. Oranges (4) Informal 14, 11, 12 and 26 parts of thiourea per million. Further samples to be taken. All samples imported from Spain. Report sent to Ministry of Food, who will deal with the matter. Sausages Formal 330 parts of sulphur dioxide per million. Warning letter sent. Hot milk Formal Added water 21.6% Fat deficient 43.5% Summons withdrawn. Incorrectly served. Hot milk Formal Fat deficient 14% Bread and butter Formal Bread and margarine Fined 10s. £2 costs. Hot milk Formal Added water 5.4% Fined £2. £1 1s. 0d. costs. Bread and butter Formal Bread and margarine Fined £2. Milk Formal Fat deficient 26% Fined £3. £1 1s. 0d. costs. Milk Formal Added water 11.5% Summons dismissed. Owner. ship not proved. Bread and butter Formal Bread and margarine Hot milk Formal Fat deficient 20% Fined £3. £1 1s. 0d. costs. Sausages Informal 155 parts of sulphur dioxide per million. Notices displayed at subsets quent visit. Sausages Informal 220 parts of sulphur dioxide per million. Milk Formal Added water 20.9% Fat deficient 21.5% Fined £3. £2 2s. 0d. costs. Hot milk Formal Added water 14.7% Fat deficient 25% Fined £3. £1 1s. Od. costs. Buttered toast Formal Margarine on toast. Fined £3. £2 2s. Od. costs. Sausages Informal 295 parts of sulphur dioxide per million. Sausages were correctly labelled. Sausages Informal 275 parts of sulphur dioxide per million. Notice displayed at subsequent visit. 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:— Sausages (4) Tap water (2) Olive oil River water Meat (2) Mud deposit Cake (2) Liquor hamamelidis Cemetery water Bread Cellar water (3) Desiccated coconut 50 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 389 Fish fryers 40 Sausages 108 Preserved meats 154 Preserved fish 27 Other preserved foods 2 Shops Act, 1950 — section 38 No certificates of exemption in respect of sanitary conveniences were issued during the year. Pharmacy and Poisons The names of 15 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 208 persons previously registered were retained on the register. 182 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 and slaughtermen There are two private slaughterhouses in the borough in respect of which licences were renewed during the year, with the proviso in one case that only pigs could be slaughtered. Both premises were visited periodically by the food inspectors. 5 slaughtermen's licences were granted during the year. Heating Appliances (Fireguards) Act, 1952 The sanitary inspectors are authorised for the purposes of inspection and testing of heating appliances under the Act. 8 inspections were made during the year, and no adverse comments were made. Food work generally In commenting on the work generally, Mr. Thomas, the group food inspector states:— The year saw the ending of food rationing and this has been reflected in the general tendency to return to the prewar relationship between customer and shopkeeper. No longer has the housewife to buy at a particular shop, and the result has been an allround improvement in the way foodstuffs are displayed and a general endeavour on the part of shopkeepers to attract customers. Noone is attracted to a dirty shop and it is pleasing to note the increase in the number of fittings 51 to improve hygiene, such as perspex covers and refrigerated counters. The nationwide Clean Food campaign has had good results which are not always at first sight apparent. There has been a big improvement in the general concept of fitting out foodshops—such things as tiled walls and floors, easily cleaned surfaces, coving at floor and ceiling levels, and so on, are being regarded as standard practice. "In the autumn an intensive local Clean Food campaign was begun in which various leaflets and posters were sent out to the foodshops and were followed by a visit from the food inspector. The food shopkeeper whose premises are clean and wellkept welcomes inspection and is always ready to cooperate and it is pleasing to be able to report that the campaign was well received. Generally the year can be regarded as one in which allround progress has been maintained together with a marked improvement in the appreciation of the general public of food hygiene." 52 SECTION "F" — PREVALENCE OF and CONTROL OVER INFECTIOUS AND OTHER DISEASES PRINCIPAL NOTIFIABLE 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 INFECTIOUS DISEASES Number of notified cases (corrected for revised diagnosis) during the year 1954 with comparative figures for the previous six years. Table 37 Diseases Cases notified 1954 1953 1952 1951 1950 1949 1948 Anthrax - - - - - 1 - Diphtheria - 1 — - - 3 5 Dysentery 394 84 169 365 63 9 24 Encephalitis (acute) - 3 - 5 1 - - Enteric or typhoid fever 1 2 - 4 1 3 2 Erysipelas 24 18 19 24 41 35 33 Food poisoning 110 32 33 26 38 50 12 Malaria 3 2 1 1 2 1 2 Measles 521 2082 2183 2546 2084 1940 2642 Meningococcal infection 6 10 5 6 7 3 5 Ophthalmia neonatorum 2 3 4 3 3 6 9 Pneumonia 77 189 89 173 108 84 67 Poliomyelitis (acute) 16 52 15 11 38 35 9 Puerperal pyrexia 59 57 88 63 29 27 50 Scabies 14 5 18 21 22 29 54 Scarlet fever 331 283 379 215 358 521 332 Smallpox - - - - - - - Tuberculosis 256 341 307 299 406 371 502 Whooping cough 449 574 512 819 813 363 789 TOTALS 2263 3738 3822 5581 3608 3109 4035 Notifications of infectious diseases in 1954 showing sex and age groups Table 38 Diseases Under I 1- 3- 5- 10- 15- 25- 45- 65 plus Total M F M F M F M F M F M F M F M F M F M F Diphtheria — — — — — — — — — — — — — — — — — — — — Dysentery 7 3 26 32 31 39 70 69 12 15 4 15 20 34 4 7 2 4 176 218 Encephalitis (acute) — — — — — — — — — — — — — — — — — — — — Enteric and Paratyphoid fever — — — — — — — — — — — 1 — — — — — — — 1 Erysipelas — — — — — — — — — — — — 3 3 4 6 3 5 10 14 Food poisoning 1 — 1 3 2 3 1 1 3 — 1 44 9 25 4 11 — 1 22 88 Malaria — — — — — — — — — — 2 — — 1 — — — — 2 1 Measles 8 11 41 54 46 44 162 147 2 2 1 2 — 1 -— — — — 260 261 Meningococcal infection 2 1 — 1 1 — — — — 1 — — — — — — — — 3 3 Ophthalmia neonatorum 1 1 — — — — — — — — — — — — — — — — 1 1 Pneumonia — — 1 — — 3 8 5 2 2 5 7 8 11 7 10 3 5 34 43 Poliomyelitis (paralytic) — 1 — — — 2 — 1 — — — — — — — — — — — 4 Poliomyelitis (nonparalytic) — — 2 — 2 — — 3 2 — 2 — — 1 — — — — 8 4 Puerperal pyrexia — — — — — — — — — — — 21 — 38 — — — — — 59 Scabies — — — — — — 1 1 3 1 2 2 2 1 1 — — — 9 5 Scarlet fever — — 10 1 31 23 112 113 16 19 4 1 — 1 — — — — 173 158 Tuberculosis (respiratory) — — 1 1 1 3 3 4 2 5 19 34 37 40 39 17 16 6 118 110 Tuberculosis (nonrespiratory) — — 1 — — — 2 2 — 1 1 3 5 5 4 3 — 1 13 15 Whooping cough 20 14 48 44 58 71 77 94 2 3 2 2 8 1 3 1 1 209 240 Totals 39 31 131 136 172 188 436 440 44 49 41 132 86 169 64 57 25 23 1038 1225 53 54 Analysis of certain diseases in table 43 into divisional areas— Table 39 Disease Div. areas Under 1 1- 3- 5- 10- 15- 25- 45- 65+ Total Dysentery W 4 19 34 70 19 5 27 3 1 182 N 4 26 21 26 1 3 8 1 1 91 S 2 13 15 43 7 11 19 7 4 121 Total 10 58 70 139 27 19 54 11 6 394 Measles W 8 50 54 220 2 3 1 — — 338 N 1 12 9 12 1 — — — — 35 S 10 33 27 77 1 — — — — 148 Total 19 95 90 309 4 3 1 — — 521 Pneumonia W — — — 5 3 5 9 6 2 30 N — 1 3 3 — 5 4 4 5 25 S —- — — 5 1 2 6 7 1 22 Total — 1 3 13 4 12 19 17 8 77 Poliomyelitis W _ — — 1 1 _ 1 — — 3 N — 2 4 1 — 1 — — — 8 S 1 — — 2 1 1 — — — 5 Total 1 2 4 4 2 2 1 — — 16 Scarlet fever W — 4 19 105 14 1 1 — — 144 N — 5 13 40 8 — — — — 66 S — 2 22 80 13 4 — — — 121 Total — 11 54 225 35 5 1 — — 331 Whooping cough W 8 24 41 40 3 1 4 — 1 122 N 15 52 43 57 1 — 2 — — 170 S 11 16 45 74 1 1 4 4 1 157 Total 34 92 129 171 5 2 10 4 2 449 For tuberculosis, see Table 42 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. 55 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 21:— Table 40 W N S Total Visits 602 397 637 1,636 Futile visits 391 213 375 979 Revisits 320 278 381 979 Total 1,313 888 1,393 3,594 Poliomyelitis 1954 was a mild year as far as the incidence of poliomyelitis was concerned. Sixteen cases were confirmed and of these 4 were paralytic and 12 non-paralytic. They were fairly well distributed over the borough, 3 being in the west, 8 in the north, and 5 in the south divisions. Eight were males and 8 females. Table 41 gives figures for this borough over the last 8 years, the time during which the incidence has been high. Table 41 Year (a) Intimated to Dept. (b) Removed to hospital (c) Confirmed (d) (d) as %oge of (b) (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 4 33 32 16 48 TOTAL 557 540 258 46 Dysentery, food poisoning, whooping cough Notes on the incidence of these diseases are included in the introduction to this report (page 4). 56 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 42 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 3 1 — 3 3 5- 3 4 2 2 5 6 — — — — — — 10- 2 5 — 1 2 6 15- 11 12 — — 11 12 — 2 — — — 2 20- 8 22 1 3 9 25 25- 23 28 3 4 26 32 2 3 — — 2 3 35- 14 12 2 1 16 13 45- 21 10 3 2 24 12 l2 3 — — 12 3 55- 18 7 1 1 19 8 65- 11 4 — 1 11 5 9 1 — 1 9 2 75 + 5 2 — — 5 2 2 1 1 — 3 1 118 110 13 15 131 125 25 11 1 1 26 12 57 Analysis of new cases of tuberculosis into divisional areas:— Table 43 Division Sex 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75— Total West Respiratory M — — 1 1 — 5 6 8 2 9 6 4 2 44 F — — — 2 3 6 7 9 7 5 2 3 — 44 Non—respiratory M — — 1 — — — — 1 — — 1 — — 3 F — — — 2 — — 1 — — — — 1 — 4 Total M — — 2 1 — 5 6 9 2 9 7 4 2 47 F — — — 4 3 6 8 9 7 5 2 4 — 48 North Respiratory M — — — 1 1 1 9 3 6 2 4 3 30 F — — 1 — — — 8 13 3 2 2 1 1 31 Non—respiratory M — — — 1 — — — — 1 2 — — — 4 F — — — — — — — 3 1 1 — — — 5 T otal M — — — 1 1 1 1 9 4 8 2 4 3 34 F — — 1 — — — 8 16 4 3 2 1 1 36 South Respiratory M — — 1 2 1 5 1 6 9 6 10 3 44 F — 1 2 2 2 6 7 6 2 3 3 — — 35 Non—respiratory M — — — 1 — — 1 1 1 1 — — — 5 F — — — — 1 — 2 2 — 1 1 — — 7 Total M — — 1 3 1 5 2 7 10 7 10 3 — 49 F — 1 2 2 3 6 9 8 2 4 4 — 1 42 58 Summary of statistics as to tuberculosis for the last ten years Table 44 Year Population New cases notified (all forms) (excluding inward transfers) Notif. rate per thousand pop. Deaths Death rate from resp. tuberculosis per thousand pop. All forms Respiratory Lewisham County of London 1945 171,280 371 2.17 138 122 0.71 0.70 1946 207,410 437 2.11 126 110 0.53 0.59 1947 221,170 426 1.93 134 121 0.55 0.60 1948 226,100 502 2.22 119 109 0.48 0.56 1949 227,700 371 1.63 107 92 0.40 0.47 1950 228,300 406 1.78 72 66 0.29 0.36 1951 227,200 299 1.32 68 60 0.26 0.34 1952 227,100 307 1.35 42 35 0.15 0.28 1953 225,800 341 1.51 48 44 0.19 0.21 1954 224,200 256 1.14 38 36 0.16 0.18 General comments on tuberculosis are made in the introduction of this report (page 3). Tuberculosis — environmental conditions Case papers of patients notified in 1954 and attending the Lewisham Chest Clinic have been analysed in 356 cases with the following results:— Cases %* Males 186 52 Females 170 48 Social classification:— Class I 5 2 Class II 44 14 Class III 212 67 Class IV 33 10 Class V 24 7 Not classifiable 38 Rooms occupied:— 2 or more rooms per person 55 16 1.2 rooms per person 187 53 Less than 1 room per person 1ll 31 No information 3 Accommodation:— Separate bed 157 44 Separate bedroom 115 33 Condition of premises occupied:— Good 259 75 Fair 71 20 Poor 17 5 No information 9 *Excluding cases not classified. 59 Mass radiography unit In am indebted to Dr. J. M. Morgan, director of the unit, for information of work done in the borough in 1954 on which the following table is based:— Table 45 Patients Men Women Total General analysis X-rayed 6,028 7,544 13,572 (Previously x-rayed) 2,554 2,522 5,076 Recalled for large film 283 315 598 Normal on large film 97 120 217 Abnormal on large film 184 194 378 Not yet re-attended 6 4 10 Analysis of abnormal large films:— Cases considered tuberculous, for investigation: 56 38 94 (a) proved active 23 19 42 (b) proved quiescent 23 17 40 (c) still under investigation 10 2 12 Non-tuberculous cases for investigation 14 9 23 Still under investigation 1 2 3 Cardio-vascular lesions 12 24 36 Previously known TB cases 6 5 11 No action required 95 116 211 All the surveys included in the above summary were open to the general public. 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 1945 notifications had fallen from over 18,000 in that year to a new low figure of 182 (provisional) for 1954. The Minister expresses the hope that authorities will continue the campaign with renewed vigour during 1955 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, 1954, was 11,126,651. During the first half of 1954, 305,552 children were immunised, of whom 118,693 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 1955 being 490,500 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, slightly declining to 30.4 percent in 1953. In the first half of 1954 it rose to 35.75 percent. The Minister points 60 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 38 cases there were 3 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 46 Age at December 31, 1954 Under 1 1 2 3 4 5-9 10-14 Total under 15. Horn in year 1954 1953 1952 1951 1950 1949-45 1944-40 (i) Diphtheria and combined diphtheria and whooping cough:— immunised during year immunised at end of year 318 2,420 202 107 82 325 6 3,460 318 2,500 2,081 2,746 2,610 14,162 15,082 39,499 Estimated mid-year population 16,400 32,500 48,9001 (ii) Whooping cough (including combined)— Immunised during year (age at date of immunisation) 1,394 1,006 187 122 73 48 3 2,833 (iii) Vaccination. Vaccinated during the year (age at date of vaccination) Under 1 1-4 5-14 15 and over Total Primary:— at clinics 909 57 13 13 992 by General Practitioners 602 202 60 119 983 Revacci nation:— at clinics and day nurseries 1 9 14 56 80 by General Practitioners 2 17 22 295 336 61 APPENDIX A Acts of Parliament, Statutory Instruments and Circular Letters issued by Government Departments with regard to the public health services, during the year 1954:— Statutes The Housing Repairs and Rents Act, 1954. The Slaughterhouses Act, 1954. Slaughter of Animals (Amendment) Act, 1954. Food and Drugs (Amendment) Act, 1954. London County Council (General Powers) Act, 1954. Statutory Instruments No. 141 Transfer of Functions (Markets) Order, 1954. 478 The Housing (Improvement Grants) (Expenses) Regulations, 1954. 613 The Food Standards (Margarine) Order, 1954. 674 Visiting Forces Act, 1952 — Public Health (Aircraft) (Amendment) Regulations, 1954. 266 The Poisons List Order, 1954. 267 The Poisons Rules, 1954. 1035 The Rent Restriction Regulations, 1954. 1036 The Housing Repairs (Increase of Rent) Regulations, 1954. 1044 The Mineral Oil in Food (Amendment) Order, 1954. 985 The Rag Flock and other Filling Materials Regulations, 1954. 1089 The Food Standards (Soft Drinks) (Amendment) Order, 1954. 1268 The Milk and Dairies (Amendment) Regulations, 1954. 1267 The Milk (Special Designations) (Raw Milk) (Amendment) Regulations, 1954. 1280 The Slaughter of Animals (Prevention of Cruelty) Regulations, 1954. 1095 The Poisons List (No. 2) Order, 1954. 1096 The Poisons (No. 2) Rules, 1954. 1584 The Slaughter of Animals (Prevention of Cruelty) (No. 2) Regulations, 1954. 1691 The Puerperal Pyrexia (Amendment) Regulations, 1954. Ministry of Health Circulars. No. 1 Annual Reports of Medical Officers of Health for 1953. 5 Diphtheria Prophylaxis — publicity campaign. 8 Prevention of tuberculosis. 14 Visiting Forces Act, 1952 — Public Health (Aircraft) (Amendment) Regulations, 1954. 18 Poliomyelitis. 28 Annual Reports of Medical Officers of Health for 1954. 29 Notification of Puerperal pyrexia. 62 Ministry of Food Circulars. No. 1 Milk and Dairies Regulations, 1949 and 1953 — Approved oxidising and preservative agents. 2 The Public Health (Preservatives in Food) Regulations, 1925-1948 — Thiourea. 3 Cream soups. 4 Slaughtering facilities. 5 The Licensing and Provision of Slaughterhouses. 7 The Food Standards (Margarine) Order, 1954. 8 The Slaughter of Animals (Pigs) Act, 1953. 10 The Public Health (Meat) Regulations, 1924-1952 — Slaughtering and meat inspection. 12 The Slaughterhouses Act, 1954. 13 Meat content and price of sausages. 14 Standards for soft drinks. 15 The Slaughter of Animals (Amendment) Act, 1954. 17 The Milk and Dairies (Amendment) Regulations, 1954, and the Milk (Special Designations) (Raw Milk) (Amendment) Regulations, 1954. 18 The Slaughter of Animals (Prevention of Cruelty) Regulations, 1954. 16 Model Byelaws for Knackers' Yards. 19 The Milk (Special Designations) (Raw Milk) Regulations, 1949 and 1950, and the Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949 to 1953. 22 The Food and Drugs (Amendment) Act, 1954. 21 The Slaughter of Animals (Prevention of Cruelty) (No. 2) Regulations, 1954. Ministry of Housing and Local Government Circulars. No. 8 Rivers (Prevention of Pollution) Act, 1951. 20 Transfer of Functions (Markets) Order, 1954. 30 Housing — slum clearance. 42 Small Dwellings Acquisition Acts, 1899-1923, Housing Act, 1949 (s. 4 and 5):— (1) The building or purchase of private houses and flats. (2) The repair, improvement and conversion of houses and flats. 36 Housing Act, 1949 — Part II. Grants for the improvement or conversion of housing accommodation. 53 Housing Repairs and Rents Act, Pt. II — Powers and duties ol local authorities. 52 Rag Flock and Other Filling Materials Act, 1951. 55 Housing Repairs and Rents Act, 1954. 75 Slum clearance procedure. 63 Ministry of Agriculture and Fisheries Circulars. No. 1 Prevention of Damage by Pests Act. 2 Bait bases. Registrar General Circulars. No. 2 Transfers of births, deaths and stillbirths. 4 Annual Reports of Medical Officers of Health, 1953 — Vital statistics. 64 APPENDIX B Legal Proceedings in 1954 The following is a list of legal proceedings instituted during the year:— PUBLIC HEALTH (LONDON) ACT, 1936 Date of hearing Offence Fine Costs Remarks £ £ s. d. 23 Feb. Noncompliance with nuisance notice in respect of 10, Belmont Hall Court. — - Summons withdrawn Nuisance abated. 23 Feb. Noncompliance with nuisance notice in respect of 166, Adelaide Avenue. — - Adjourned sine die. 23 Feb. Noncompliance with nuisance notice in respect of 85, Marsala Road. — 1 1 0 Order made for abatement of nuisance within 28 days. 23 Mar. Noncompliance with nuisance notice in respect of 145, Perry Rise. — 1 1 0 Order made for abatement of nuisance within 28 days. 23 Mar. Noncompliance with nuisance notice in respect of 329, Southend Lane. — - Summons withdrawn. Work completed. 23 Mar. Noncompliance with nuisance notice in respect of 26, Garlies Road. — 1 1 0 Order made for abatement of nuisance within 14 days. 23 Mar. Noncompliance with nuisance notice in respect of 70, Effingham Road. — 1 1 0 Order made for abatement of nuisance within 14 days. 23 Mar. Noncompliance with nuisance notice in respect of 74, Effingham Road. 5 1 1 0 23 Mar. Noncompliance with nuisance notice in respect of 2, Rembrandt Road. — 1 1 0 Order made for abatement of nuisance within 2 months. 27 Apr. Noncompliance with nuisance notice in respect of 18, Burford Road. 5 1 1 0 27 Apr. Noncompliance with nuisance notice in respect of 33, Rhyme Road. — 1 1 0 Order made for abatement of nuisance within 28 days. 27 Apr. Noncompliance with abatement order in respect of 35, Vancouver Road. 10 1 1 0 27 Apr. Noncompliance with nuisance notice in respect of 7, Balloch Road. — 1 1 0 Order made for abatement of nuisance within 6 weeks. 27 Apr. Noncompliance with nuisance notice in respect of 19, Scrooby Street. 5 1 1 0 25 May Noncompliance with nuisance notice in respect of 23, Devonshire Road. — - Summons withdrawn. Work completed. 25 May Noncompliance with nuisance notice in respect of 33, Devonshire Road. — - Summons withdrawn. Work completed. 65 Date of hearing Offence Fine Costs Remarks £ £ s. d. 25 May Noncompliance with nuisance notice in respect of 132a, Adelaide Avenue. — - Summons withdrawn. Work completed. 25 May Noncompliance with nuisance notice in respect of 11, Winchfield Road. — 2 2 0 Order made for abatement of nuisance within 14 days. 25 May Noncompliance with nuisance notice in respect of 29, Stanton Square. — - Summons withdrawn. Work completed. 25 May Noncompliance with nuisance notice in respect of 77, Burnt Ash Road. — - Adjourned sine die Work in hand. 22 June Noncompliance with nuisance notice in respect of 51, Halesworth Road. — 1 1 0 Order made for abatement of nuisance within 14 days. 27 July Noncompliance with nuisance notice in respect of 79, Marsala Road. — - Adjourned. Work in hand. 27 July Noncompliance with nuisance notice in respect of 24, Ivy Road. — - Summons withdrawn. Work completed. 28 Sept. Noncompliance with nuisance notice in respect of 45, Halesworth Road. — - Summons withdrawn. Work completed. 28 Sept. Noncompliance with nuisance notice in respect of 89, Mill Road. — - Summons withdrawn. Work completed. 28 Sept. Noncompliance with nuisance notice in respect of 95, Gilmore Road. — 1 1 0 Order made for abatement of nuisance within 14 days. 28 Sept. Noncompliance with nuisance notice in respect of 48, Brightfield Road. — - Summons not served. Defendants moved. 28 Sept. Noncompliance with nuisance notice in respect of 79, Marsala Road. — - Summons withdrawn. Work completed. 26 Oct. Noncompliance with nuisance notice in respect of 1, Courthill Road. — - Order made for abatement of nuisance within 28 days. 26 Oct. Contravention section 37 Public Health (London) Act, 1936 in respect of 60, Lee Park. — - Case dismissed. 26 Oct. Contravention of sections 95 and 37 of the Public Health (London) Act, 1936 in respect of 56, Lee Park. — - Case dismissed. 23 Nov. Noncompliance with nuisance notice in respect of 167, Hither Green Lane (first floor flat). — - Summons withdrawn. Work completed. 23 Nov. Noncompliance with nuisance notice in respect of 167, Hither Green Lane (second floor flat). — - Summons withdrawn. Work completed. 66 Date of hearing Offence Fine Costs Remarks £ s. d. 26 Oct. Contravention of sections 95 and 37 of the Public Health (London) Act, 1936 in respect of 58, Lee Park. — - Case dismissed. 26 Oct. Noncompliance with nuisance notice in respect of 48, Brightfleld Road. — - Adjourned for on month. 23 Nov. Noncompliance with nuisance notice in respect of 27, Cambridge Drive. — - Case withdrawn. Wor completed. 23 Nov. Noncompliance with abatement order in respect of 95, Gilmore Road. 5/5/- 2 2 0 — FOOD AND DRUGS LEGISLATION Date of offence Offence Fine Costs Remarks £ £ s. d. 10 Feb. Nail in loaf of bread. Contravention of s. 3. 10 - — 5 Apr. Scone containing a piece of metal. Contravention of s. 3. 1 1 1 0 — 21 May Bottle of milk containing piece of cardboard. Contravention of s. 3. 5 - 12 July Mineral oil and dirt in sliced loaf of bread. Contravention of s. 3. 5 - 12 July Metal staple in hot cross bun. Contravention of s. 3. — - Case dismissed. 27 Aug. Sale of hot milk containing extraneous water. 2 1 1 o — Sale of bread and margarine said to be bread and butter. Contraventions of s. 3. 2 - Sale of milk deficient in milk fat. — - Summonses withdrawn, incorrectly served. Sale of hot milk deficient in milk fat and containing extraneous water. — - — 17 Sept. Contraventions of s. 3. Sale of bread and margarine said to be bread and butter. Contravention of s. 3. 10/- 2 0 0 — 4 Oct. Metal in bread. Contravention of s. 3. 5 2 2 0 — 67 Date of offence Offence Fine Costs Remarks £ £ s. d. 18 Oct. Sale of hot milk containing extraneous water. 3 1 1 0 — Sale of hot milk deficient in milk fat. 3 1 1 0 — Contraventions s. 3 Food and Drugs Act, 1938 and s. 9 Food and Drugs (Milk Dairies and Artificial Cream) Act, 1950. — 18 Oct. Sale of bread and margarine said to be bread and butter. Contravention of s. 3. 3 2 2 0 — 18 Oct. Sale of bread and margarine said to be bread and butter. Sale of milk containing — - Case dismissed. Ownership of premises not proved. extraneous water. Contraventions of s. 3 Food and Drugs Act, 1938 and s. 9 Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950. — 18 Oct. Sale of hot milk deficient in milk fat. Contravention of s. 3. 3 1 1 0 — 18 Oct. Sale of milk deficient in milk fat. Contravention of s. 3. 3 1 1 0 — 19 Nov. Sale of bottle of milk containing piece of wood. Contravention of s. 3. 10 - — 19 Nov. Contravention of s. 13 Food and Drugs Act, 1938. Failing to keep bakery clean. 10 - —— FACTORIES ACT, 1937 Dote of offence Offence Fine Costs Remarks £ £ s. d. 19 Nov. Failing to maintain and keep clean the sanitary conveniences at a bakery. Contravention of s. 7. 10 - — 68 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:— Mould in steak and kidney pie. Pencil in loaf of bread. Glass in cake. Mouse excreta in bread. Dirty milk bottle. HOUSING ACT, 1936 Date of offence Offence Fine Costs Remarks £ £ s. d. 4 Jan. Appeal against notices served under s. 9. Appellant maintained that notices should have been served under s. 11. — — Appeal dismissed. 4 Jan. Ditto ditto — — Appeal dismissed. 1 Apr. Appeal against notices served under s. 9. — — Appeal allowed. BYELAWS MADE BY THE LONDON COUNTY COUNCIL Date of hearing Offence Fine Costs Remarks £ £ s. d. 28 Sept. Using lorry for collection of offensive matter during prohibited hours and use of unsuitable type of lorry. Contravention of byelaws made under s. 16(2) of the Public Health (London) Act, 1891. 3/3/- 1 1 0 — 23 Nov. Failing to keep and maintain drainage work connected to waterclosets in respect of 144, Lewisham Road. 1 1 1 0 — 69 APPENDIX C List of special reports submitted to the Health Committee by the Medical Officer of Health during 1954:— January 5 Atmospheric pollution and Smokeless zones. March 30 Sydenham gasworks. March 30 Atmospheric pollution — apparatus for measuring smoke. June 1 Housing: Repair and slum clearance. July 6 Additional help for Old People. October 5 Air pollution. November 2 Food hygiene campaign. 70 TABLES TABLE SUBJECT PAGE TABLE SUBJECT PAGE NO. Section A NO. Section C—continued 1 Comparative statistics 7 24 Nuisances remedied —Housing Act 32 2 Causes of death by age groups 8 25 Factory inspections 34 3 Deaths under one year 10 26 Factory defects 35 4 Local sickness 11 5 Deaths by social class 11 Section D 6 Causes of death by social class 12 27 Demolition orders 39 28 Closing orders (s.ll) 40 7 Grouped causes of death by social class 13 29 Closing orders (s.12) 40 8 Births, infant deaths, etc., by social class 14 30 Clearance areas 43 9 Heart and circulation mortality 14 31 Section E Milk licences 45 10 General statistics from 1901 16 32 Analysis of milk 45 33 Icecream grading 46 Section B 34 Icecream composition 47 35 Samples analysed 48 11 Disinfecting station 18 36 Adulterated samples 49 12 Verminous conditions, etc. 18 13 Laboratory facilities 20 Section F 14 Public mortuary 21 37 Notified cases of infectious diseases 52 15 Rodent control 21 16 Rodent control—treatment of rivers 22 38 Notifications of infectious diseases by age and sex 53 17 Prevention of damage by pests 23 39 Analysis of certain diseases into divisional areas 54 18 Atmospheric conditions 26 40 Infectious disease visiting 55 19 Water, chemical samples 29 41 Poliomyelitis 55 20 Water, bacteriological samples 29 42 Tuberculosis notifications and deaths 56 Section C 43 Analysis of new cases of tuberculosis into divisional areas 57 21 Sanitary inspection 30 44 Tuberculosis statistics 58 22 Summary of notices 31 45 Mass radiography 59 23 Nuisances remedied —Public Health Act 32 46 Immunisation against infectious disease 60 GRAPH Pulmonary tuberculosis death rates, 1931-54 56 71 INDEX SUBJECT PAGE SUBJECT PAGE Acts, regulations and orders 61 Mass miniature radiography 59 Area of borough 6 Maternal deaths 7 Atmospheric conditions 25 Milk, analysis of 45 Milk and Dairies Regulations, 1949 45 Births and birth rate 6 Mortuary and Coroner's Court 21 Clearance areas 42 National Assistance Act, 1948, Coronary disease 14 s.50 24 Nuisances remedied 32 Deaths and death rate 6 Deaths, causes of 8 Offensive trades 50 Deaths under age 65 15 Old people 24 Disinfection and personal Outworkers 36 cleansing 18 Dog nuisances 24 pet Animals Act, 1951 37 rainage wor Pharmacy and Poisons Act, 1953 50 Dysentery 55 Pigeons 37 Poliomyelitis 55 Exhumations 37 Population 6 Prevention of Damage by Pests Act. 1949 23 Factories 33 Flies and mosquitoes 19 Food, adulteration of 48 Rag Flock and Other Filling Food inspection and supervision 45 Materials Act, 1951 36 Food poisoning 47 Rateable value 6 Rent and Mortgage Interest General statistics from 1901 16 (Restrictions) Acts 33 Rivers 22 Rodent control 21 Health services, general vision of 18 Sampling 48 Heating appliances 50 Sanitary circumstances of the Heattreated milk 46 area 30 Housing:— Shops Act, 1950 50 Building 38 Sickness, local 11 Families rehoused 39 Slaughterhouses 50 Housing Act, 1936 39 Smoke nuisances 31 Housing Repairs and Rents Act, Social medicine statistics 11 1954 44 staff 2 Stillbirths 6 Icecream composition 46 Swimming baths 24 Icecream grading 46 Immunisation 59 Tuberculosis 56 Infant mortality 7 Infant mortality statistics 10 Unsound food 47 Infectious diseases 52 Infectious disease visiting 54 Vital statistics 6 Laboratory facilities 20 Water certificates 33 Legal proceedings 64 Water supply 28 Lung cancer 14 Whooping cough 55