AC 4374 LEW 43 METROPOLITAN BOROUGH OF LEWISHAM THE PUBLIC HEALTH OF LEWISHAM Report of the Medical Officer of Health for the Year 1955 E. H. R. Smithard, MBE, MD, DPH London : e. g. Berryman & Sons, Ltd., Blackheath Road, s.e.10 METROPOLITAN BOROUGH OF LEWISHAM Report OF THE Medical Officer of Health for the Year 1955 E. H. R. Smithard, MBE, MD, DPH CONTENTS Page Staff 2 Introduction 3 Vital Statistics 8 General Provision of Health Services 20 Sanitary Circumstances of the Area 32 Housing 41 Inspection and Supervision of Food 47 Infectious Diseases 54 Appendix A — Statutory Instruments 64 „ B — Legal Proceedings 65 „ C — Special Reports to Health Committee 67 „ D — Houses in Multiple Occupation 68 "The chief function of the Medical Officer of Health is to safeguard the health of the area for which he acts by such means as are at his disposal "He should endeavour to acquire an accurate knowledge of the influences, social, environmental, and industrial, which may operate prejudicially to health in the area "While he has special duties for the prevention of infectious diseases, all morbid conditions contributing to a high sickness rate or mortality in the area from these or other causes should be studied with a view to their prevention or control." —from the Ministry of Health Memorandum on the duties of MOHs 2 STAFF as at 31/12/55 Medical Officer of Health E. H. R. Smithard, mbe, md, bs, mrcs, lrcp, dph Senior Sanitary Inspector Deputy Senior Sanitary Inspector E. Walker (a) (b) A. J. Phillips (a) (b) Group Sanitary Inspectors A. G. Thomas (a) (b) (Food) R. Mahoney (a) (b) (District) J. R. Craven («) (6) (Housing) Assistant Group Housing Inspector R. C. Brittain (a) (b) District Inspectors Food Inspectors and Sampling Officers J. W. Bevan (a) (b) H. W. Ellery (a) (b) C. L. Connor (a) (b) G. E. Fallows (a) (b) R. L. Davis (a) T. R. A. Fitzherbert (a) (6) S. Kelly (a) H. Tolson (a) (b) H. J. Rogers (a) K. R. Wagener (a) (b) Four vacancies • (a) Sanitary inspector's certificate. (b) Food inspector's certificate. Infectious Disease Visitors Mrs. A. Carins, srn, rfn Mrs. L. Champness, srn, rfn Principal Clerk E. W. Cheesman Clerical Staff S. Burring senior clerk L. Gardiner C. R. Coleman Mrs. D. J. Handford L. J. Cleverly A. J. Burchmore (trainee sanitary Mrs. I. L. Fry inspector) Two vacancies Coroner's Court and Mortuary W. Richardson, officer-in-charge Disinfecting Station, Pest Control, etc. J. G. Beale, superintendent R. A. Sharman, foreman rodent Foreman Disinfector operative Disinfectors 9 Rodent operatives 3 Bathing attendants 2 Rodent/fly operatives 4 Drain testers 2 Public Analyst A. J. Lickorish, fic Bacteriologists E. H. Bailey, mrcs, lrcp, and A. J. H. Tomlinson, mb, bchir, of the Public Health Laboratory Service. 3 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisham. Mr. Mayor, Ladies and Gentlemen, I submit herewith my report for the health department for the year 1955. Vital statistics The Registrar General's estimate of the population in midyear 1955 at 223,400 was 800 less than his estimate for midyear 1954 (which in itself was 1,600 less than in the previous year). The decrease from the 1951 census figure of 227,576 therefore continues. The crude birth rate for the year at 14.0 shows another small decrease of 0.2 from the previous year and the adjusted birth rate (allowing for age and sex distribution of the population) is also slightly lower at 13.0. The crude death rate at 10.8 is an increase from the 9.95 of the previous year and compares with 11.5 for the administrative county. The infant mortality rate at 17 was 4 down on the previous year and is the lowest recorded, beating the low rate of 19 in 1949. This rate is divisible into two parts, the neonatal rate (i.e. under one month of age) and the rest of the first year rate. The neonatal rate also achieved a record low of 11, though the rest of the first year rate at 6 has been equalled though not passed on several occasions before. The stillbirth rate went up to 18 from the very low figure of 14 the previous year, but the combined stillbirth and infant death rate (reproductive wastage) of 35, is equivalent to the low record which was reached in two previous years, 1954 and 1949. Girl children, as is almost universally the case, had better rates than boy children and the infant mortality rate for females (per thousand female live births) was only 13.1 (9.2 neonatal and 3.9 rest of first year). That figure of 3.9 perhaps merits a short but non.complacent pause for " counting our blessings." In 1906 the corresponding rate, for all children, was 83 ; in other words the chance of a child who had reached the age of one month surviving to its first birthday was a mere 12 to 1 in its favour ; last year, for girl babies, the odds on the first birthday being reached were over 250 to 1. It would be difficult to exaggerate the saving in pain, anxiety and distress which this improvement entails. The premature birth rate, i.e. the number of children weighing 5½lbs. or less at birth per thousand live births was 69, which is an increase on the 60 of the previous year. There were unfortunately three maternal deaths during the year (after nil the previous year) and this gave a rate of 0.9 per thousand registered live and stillbirths. The various comparative figures of general statistics since the beginning of the century are shown in table 10. On the whole those for 1955 are reasonably satisfactory. Infectious disease other than tuberculosis The' total number of notifications received (including 271 for tuberculosis) reached the high figure of 5,217. This is not a record, as the figure was 5,581 in 1951, but it is considerably more than double the 2,263 notifications received in 1954 and this can be accounted for 4 entirely by the measles notifications which reached what was as far as we know a record figure of 3,905 cases. Measles tends to have a periodicity showing maxima in alternate years. Movements of population, such as occurred in the war, tend to iron out the peaks, and of course if the major peak period is at the end of one year and at the beginning of the next then there is also a likelihood that the total for each calendar year will approximate, although in fact the great majority of cases might have occurred within a short period of two or three months in the twenty-four. This phenomenon showed itself in the period under present review as the epidemic did not really begin until the commencement of 1955. There had in fact been only 521 cases in 1954, which was a record low number for some years past, and then there was this sudden period of very high incidence during the first part of 1955. The highest weekly notifications reached 371, for the week ending March 5. In spite of there being almost 4,000 cases of measles there was no death, which probably indicates both the decline in virulence of the organism compared with some years ago and, perhaps more important, the greater control we now have over the complications of measles through the newer drugs. Dysentery cases declined considerably, but the beginning of 1956 showed a nationwide increase. Poliomyelitis was again prevalent, the number of cases notified being 63—the highest since the record year of 1947. There seems no doubt about the efficacy of the new vaccines in the prevention of poliomyelitis, though the varying types of vaccine in use in different countries no doubt have varying degrees of prevention. The relatively small number of children for whom the British vaccine will be available prior to the summer of 1956 will certainly benefit and it is hoped and thought that there will be sufficient vaccine available in the winter of 1956 onwards for the children of all those parents who are wise enough to avail themselves of it. There was one death from whooping cough in spite of there being a slightly lesser number of cases (412 as against 449). It is desirable therefore to repeat that a considerable measure of protection can be given to a child by immunisation against whooping cough, and although this protection may not be absolute, i.e. may not prevent the child having the disease, it almost invariably makes the disease less serious and less prolonged. The injections can be given at the same time as the injections against diphtheria, and are best started about six months of age, or earlier if for whooping cough alone. Tuberculosis The number of new notifications, which had decreased considerably in the previous year, showed a small increase of 15 to 271 in 1955. This is equivalent to a rate of 114 per 100,000 population for pulmonary and 7 for other forms. The number of deaths from pulmonary tuberculosis at 22, was equivalent to a rate of 10 per 100,000 population. While the death rate therefore (as can be more easily seen in table 10) continues to fall steeply, the notfication rate keeps much the same and in fact it is 5 very similar to what it was in 1938. There is nothing particularly sinister about this because it may mean, and in fact it is thought that it does mean, that it is due to the active ascertainment of cases through mass x-ray and through the public becoming more aware of the desirability of early diagnosis. The prevention of tuberculosis by BCG vaccination which I have mentioned in several of my previous reports appears at long last to be becoming more popular. There has been rather excessive caution shown by the authorities in this country towards this factor in prevention, but a large control trial has recently been reported on and this (now more than thirty years since BCG vaccination was first used in man) provides clear evidence of the efficacy for some years at least of BCG vaccination in the prevention of tuberculosis in the group of adolescents who formed the material of the trial. Other countries have shown that a substantial degree of protection can be sustained for at least ten years. One has the impression however that there is too much timidity in preventing what, when it does occur, is still a very serious and prolonged disease which can upset for long periods at a time the normal life of the sufferer. It would seem that the efficacy of BCG vaccination is scientifically provable to a degree considerably in excess of what was scientifically provable of the efficacy of immunisation against diphtheria when the latter was first being pushed and popularised. Diphtheria happened to be an acute disease which in the substantial percentage of fatal cases quickly killed off its victims. It therefore interested the public (just as poliomyelitis does now) much more so than does a chronic disease like tuberculosis, and it is possibly this lack of public pressure which has slowed down the official support for BCG vaccination. Although this may be put forward as a reason it cannot be an excuse. Food hygiene The number of notified cases of food poisoning at 48 was much the same as in previous years, though considerably less than in 1954, which year was abnormal in that one incident produced some 80 cases. Throughout the year the food inspectors continued to give advice to occupiers of food shops with regard to general hygiene and pest control and they completed the propaganda campaign started the previous year, in which priority had been given to dairies, distributors of milk, icecream sellers, pastrycooks (and bakers), butchers, and greengrocers. At the very end of the year—actually January 1, 1956—new food legislation became operative. This was the Food and Drugs Act, 1955 and Regulations made under it. The 1955 Act consolidated and considerably amended previous food legislation, giving various new powers, particularly in relation to labelling and hygiene. The Food Hygiene Regulations, 1955 set out in very much more detail certain requirements which had been included under a section of the old Food and Drugs Act, and also various matters which had been dealt with by byelaws. Although most of the Regulations came into force on January 1, some 6 of them—those particularly involving structural alterations—do not come into force until July 1. The new legislation will increase considerably the work and supervision required of the food inspectors, and is clearly a considerable step forward in the proper hygienic control of food. Nevertheless it remains true that the greatest power is an the hands of the customer, and if customers who are in any way dissatisfied with the hygienic practices in food shops refuse to trade at those shops, this would be the quickest way of inducing a better regard for hygiene in the shopkeeper. Old people Two additional clubs applied for and received grant aid, and altogether eleven clubs or organisations were in receipt of a grant from the borough council. Details are shown in the body of the report. The grant made is reviewed each year and perhaps the chief factor in any upward revision is the indication (by the atmosphere of the club and particularly by the expansion of existing facilities and the institution of new facilities) that the club is increasing its activities or comfort for the old people. The health committee are especially pleased to see the institution or extension of lunch club facilities as they are aware that defective nutrition is one of the major factors leading to physical and even mental deterioration in old people. As appetite declines and facilities for cooking and buying also decrease the tendency is for old people, particularly those living alone, to have too little food, and although the mere lack of calories may not be of much importance the fact that the total quantity of food is small often means that certain essential chemical constituents of foodstuffs are missing or are not taken in sufficient amount. A good balanced meal such as is obtainable from the lunch clubs, or from the meals-on-wheels service for housebound old people, can do a lot towards supplying deficiencies, and the distribution of marmite, which has become very popular in the clubs, is also a considerable help in this connection. The Lewisham Old People's Welfare Association remained active during the year, and in many ways expanded its services. 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 four vacancies on the establishment. A scheme for the training of student sanitary inspectors has begun whereby 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. The first trainee began work in September. In ending the introduction to this report I wish to express my thanks to the health department staff for their work during the year. 7 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 G. T. Harman, j.p. (The Mayor) Aldermen Carter, Hawkins and Mrs. Smith Councillors Braund, Bridger, Miss Butler, Cook, Donovan, Mrs. Drapper, J.P., Greenhow, Hawes, Helps, Henry, Inch, Mrs. Land and New. 8 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 1955 was 223,400. (This includes members of the armed forces stationed in the area). Rateable value County of London rateable value of the borough at April 1, 1955 £1,911,537 Estimated net product of a penny rate, 1955/56 ... £7,680 Estimated number of separately assessed dwellings at April 1, 1955 61,878 Births (adjusted for inward and outward transfers) Livebirths 3,123 Males Females Total Legitimate 1,529 1,478 3,007 Illegitimate 67 49 116 Totals 1,596 1,527 3,123 Crude birth rate per 1,000 of the estimated population 14.0 Adjusted birth rate for comparative purposes 13.0 (Area comparability factor for births is 0.93). Birth rate for England and Wales 15.0 Crude birth rate for London Administrative County 15.1 Stillbirths The stillbirths allocated to the borough during the year were 56, (24 males and 32 females) which represents a stillbirth rate per thousand live and stillbirths of 14.8 in the case of males, 20.5 in the case of females, and 17.6 for all stillbirths. Deaths The deaths belonging to the borough registered during the year were 2,423, consisting of 1,252 males and 1,171 females, giving a crude death rate per thousand of the estimated population of 10.8. The area comparability factor for deaths is 1*0, therefore the adjusted rate remains at 10.8 per thousand of the estimated population, which compares with rates of 11.7 for England and Wales and 11.4 for the Administrative County of London, 9 Infant mortality Infant deaths 53 Male Female Total Legitimate 28 19 47 Illegitimate 5 1 6 Total 33 20 53 Rates : 1. All infants per thousand livebirths 16.97 2. Legitimate infants per thousand legitimate livebirths 15.6 3. Illegitimate infants per thousand illegitimate livebirths 51.7 4. Male infants per thousand male livebirths 20.7 5. Female infants per thousand female livebirths 13.1 Neonatal deaths (under 4 weeks of age) 34 Neonatal death rates :— Males, per 1,000 male livebirths 12.5 Females, per 1,000 female livebirths 9.2 All infants, per 1,000 livebirths 10.9 Reproductive wastage :— Stillbirths plus infant deaths 10.9 Rates :— Males per 1,000 live and still male births 35.2 Females per 1,000 live and still female births 33.3 All infants per 1,000 live and stillbirths 34.3 Maternal deaths Maternal deaths 3 Maternal mortality rate per thousand live and stillbirths 0.9 Other special causes of death Measles Whooping cough 1 Gastroenteritis (infants) Motor vehicle accidents 19 Suicide 20 Tuberculosis (all forms) 26 Other respiratory (Code Nos. 22-25) 316 Cancer (Code Nos. 10-15) 529 Heart and circulation diseases (Code Nos. 17-21) 1,205 Comparative statistics for the year 1955 Table 1 Birth rate Death rate (per 1,000 population) (adjusted) Infant mortality rate (per 1,000 livebirths) Live births (adjusted) Still births Lewisham 13.0 17.6 10.8 17.0 England and Wales 15.0 23.1 11.7 24.9 London Administrative County 13.1 20.2 11.4 23.3 10 11 Causes of death at different periods of life during the year 1955 The following table shows the causes of and ages at death during the calendar year 1955:- Table Code No. Causes of death Nett deaths at the subjoined age of "residents" whether occurring within or without the borough Code No. Causes of death Nett deaths at the subjoined ages of "residents" whether occurring within or without the borough MALES Total persons, (i.e., incl. table opp.) FEMALES Total Persons (i.e., incl. table opp.) All ages Under 1 yr. 1 and under 5 5 and under 15 5 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and over All ages Under 1 yr. 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and over Totals, all causes 1252 33 7 4 13 46 298 375 476 2423 Totals, all causes 1171 20 5 6 4 34 206 269 627 2423 1 Tuberculosis, respiratory 15 - - - - 1 5 6 3 22 1 Tuberculosis, respiratory 7 — — — — 2 1 1 3 22 2 Tuberculosis, other 1 - — — - - - 1 - 4 2 Tuberculosis, other 3 — — — — 1 2 — — 4 3 Syphilitic diseases 3 — — - - - 1 2 4 3 Syphilitic diseases 1 — — — — — — — 1 4 4 Diphtheria — — — - - — — — - 4 Diphtheria — — — — — — — — — — 5 Whooping cough 1 1 — — - - — — 1 5 Whooping cough — — — — — — — — — 1 6 Meningococcal infections — — — - - - — — 2 6 Meningococcal infections 2 1 1 - - - - - - 2 7 Acute poliomyelitis 1 - 1 - - - - - — 2 7 Acute poliomyelitis 1 — — — 1 - — — — 2 8 Measles - - - - - - - - - - 8 Measles — — — — — — — — — — 9 Other infective and parasitic diseases 3 - - - - - 1 2 - 5 9 Other infective and parasitic diseases 2 - - - 1 - 1 - - 5 10 Malignant neoplasm, stomach 38 - - - - - 12 16 10 59 10 Malignant neoplasm, stomach 21 - - - - - 8 6 7 59 11 Malignant neoplasm, lung and bronchus 102 - - - - 4 44 42 12 121 11 Malignant neoplasm, lung and bronchus 19 - - - - 1 9 6 3 121 12 Malignant neoplasm, breast 1 - - - - - 1 — — 56 12 Malignant neoplasm, breast 55 — — — — 2 24 17 12 56 13 Malignant neoplasm, uterus - - - - - - - - — 11 13 Malignant neoplasm, uterus 11 - - - - - 7 4 — 11 14 Other malignant and lymphatic neoplasms 157 - - - 2 7 37 56 55 272 14 Other malignant and lymphatic neoplasms 115 - - 2 1 4 36 29 43 272 15 Leukaemia, aleukaemia 5 — - - 2 - 3 — 10 15 Leukaemia, aleukaemia 5 — 1 — 1 - 2 1 10 16 Diabetes 3 — — — — 1 1 1 9 16 Diabetes 6 - - - - - 1 2 3 9 17 Vascular lesions of nervous system 107 - - - 1 3 20 31 52 297 17 Vascular lesions of nervous system 190 - - - - - 24 47 119 297 18 Coronary disease, angina 210 — — — 5 71 69 65 329 18 Coronary disease, angina 119 - - - - - 23 40 56 329 19 Hypertension with heart disease 40 - - - - 1 6 14 19 84 19 Hypertension with heart disease 44 - - - - - 3 10 31 84 20 Other heart disease 141 - - - 1 4 11 24 101 382 20 Other heart disease 239 — — — 3 18 38 180 380 21 Other circulatory diseases 52 - - - - 4 9 14 25 115 21 Other circulatory disease 63 - - - - 2 7 20 34 115 22 Influenza 2 - - - - - - 1 1 6 22 Influenza 4 - - - - - - 1 3 6 23 Pneumonia 51 2 1 1 1 1 8 10 27 106 23 Pneumonia 55 1 1 1 — — 6 11 35 106 24 Bronchitis 129 8 2 — - 1 21 48 49 182 24 Bronchitis 53 1 — — — 1 7 9 35 182 25 Other diseases of respiratory system 14 - - - - 1 9 3 1 24 25 Other diseases of respiratory system 10 - - - - - 2 2 6 24 26 Ulcers of stomach and duodenum 22 - - - - 1 5 7 9 29 26 Ulcer of stomach and duodenum 7 - - - - 1 - 2 4 29 27 Gastritis, enteritis and diarrhœa 2 - - - - - 1 - 1 9 27 Gastritis, enteritis and diarrhœa 7 - - - - 1 1 2 3 9 28 Nephritis and nephrosis 11 — 1 — 1 1 5 1 2 21 28 Nephritis and nephrosis 10 — — 1 2 2 4 1 21 29 Hyperplasia of prostate 22 - - - - - 2 6 14 22 29 Hyperplasia of prostate - - - - - - - - - 22 30 Pregnancy, childbirth, abortion - - - - - - - - — 3 30 Pregnancy, childbirth, abortion 3 - - - - 3 - - - 3 31 Congenital malformations 9 5 1 - - 2 1 — — 15 31 Congenital malformations 6 3 1 1 - - 1 - — 15 32 Other defined and illdefined diseases 67 17 - 1 1 1 16 12 19 152 32 Other defined and illdefined diseases 85 13 1 1 - 7 15 14 34 152 33 Motor vehicle accidents 17 — — 1 6 3 4 1 2 19 33 Motor vehicle accidents 2 — 1 — — — 1 — — 19 34 All other accidents 16 1 - 1 - 3 3 4 4 32 34 All other accidents 16 1 - — — 1 3 — 11 32 35 Suicide 10 — - — — 1 5 2 2 20 35 Suicide 10 - - — — 2 4 2 2 20 36 Homicide and operations of war - - - - - - - - - - 36 Homicide and operations of war - - - - - - - - - - - ./ 12 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. Meningococcal infection M - - - - - - - - - - - - F - - - - - - - 1 - - 1 1 Pneumonia M - - - - - - 1 1 - - 2 2 F - - - - - - 1 - - - 1 1 Bronchitis M - - - - 1 1 2 4 - 1 7 8 F - - - - - - - 1 - - 1 1 Intestinal obstruction M 1 - - - - 1 - - - - - 1 F - - - - - - - - - - - - Congenital malformation M 1 3 - - - 4 1 - - - 1 5 F - 1 1 1 - 3 - - - - - 3 Injury at birth M 1 - - - - 1 - - - - - 1 F 1 - - - - 1 - - - - - 1 Postnatal asphyxia and atelectasis M 3 1 - - - 4 - - - - - 4 F 2 2 - - - 4 - - - - - 4 Congenital debility M - - - - - - - - - - - - F - 1 - - - 1 - - - - - 1 Prematurity immaturity M 6 2 - - - 8 - - - - - 8 F 1 1 - - - 2 - - - - - 2 Other diseases of early infancy M - 1 - - - 1 - - - - - 1 F - 3 - - - 3 - - - - - 3 All other causes M - - - - - - 1 2 - - 3 3 F - - - - - - - - 1 2 3 3 TOTALS M 12 7 - - 1 20 5 7 - 1 13 33 F 4 8 1 1 - 14 1 2 1 2 6 20 GRAND TOTAL 16 15 1 1 1 34 6 9 1 3 19 53 There were no deaths in the following groups : tuberculosis (respiratory and other forms), syphilis, typhoid and paratyphoid fevers, diphtheria, whooping-cough, measles, diseases of ear and mastoid antrum, influenza, gastritis and duodenitis, gastro-enteritis and diarrhoea, convulsions and lack of care of the newborn. Nineteen infants (13 males and 6 females) thus died between the ages of one month and one year compared with 24 in the previous year. Eleven of the nineteen deaths (9 males and 2 females) were from pneumonia or bronchitis and therefore it seems that some of these might be regarded as being preventable, though sometimes pneumonia or bronchitis are merely the terminal illness of a weakly baby. 13 Local sickness Through the courtesy of the Regional Medical Officer of the Ministry of National Insurance, I am sent weekly a return indicating for the various areas of London the first certificates of sickness benefit received in the local offices. The areas served by these local offices are in the main coterminous with postal districts of London and do not coincide with borough boundaries. Lewisham is served by four offices, "Lewisham," "Downham," "Eltham," and "Norwood," but as only a very small portion of the borough comes within the purview of the 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 period ending "Lewisham" "Downham" January 25 870 242 February 22 786 201 March 22 621 177 April 19 472 115 May 17 372 94 June 14 340 96 July 12 295 74 August 9 273 69 September 6 311 85 October 4 410 109 November 1 512 145 November 29 519 138 January 3 465 126 Corresponding figure for November, 1954 474 131 Weekly average for the year 1955 480 129 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 2,423 deaths analysed by us the social categories were as follow Table 5 Social class I II III IV V Total No information Males 38 185 747 147 123 1245 7 Females 29 209 599 179 95 1111 60 Total 67 394 1346 326 223 2356 67 Percentage 3 17 57 14 9 100 — 14 In detail, the social class, related to cause of death, was as follows:— Table 6 Code No. Cause of death Male Female I II Ill IV V Total I II Ill IV V Total 1 Tuberculosis, respiratory - 1 7 2 4 14 1 2 1 — — 4 2 Tuberculosis, other - — — — — — - 1 1 — — 2 3 Syphilitic disease - — 1 — 1 2 - — — — — — 4 Diphtheria - - - - - - - - - - - - 5 Whooping cough - - 1 - - 1 - - - - - - 6 Meningococcal infections - - - - - - - 1 1 — — 2 7 Acute poliomyelitis - - - - - - - - 1 1 — 2 8 Measles - - - - - - - - - - - — 9 Other infective and parasitic diseases - - - 1 - 1 - - 2 - - 2 10 Malignant neoplasm, stomach 1 4 23 3 4 35 - 2 13 3 3 21 11 Malignant neoplasm, lung, bronchus 2 18 55 17 9 101 1 4 10 2 - 17 12 Malignant neoplasm, breast - — 1 — — 1 1 9 32 5 2 49 13 Malignant neoplasm, uterus - - - - - - - 4 3 2 1 10 14 Other malignant and lymphatic neoplasms 5 20 98 19 10 152 3 20 60 11 17 111 15 Leukaemia, aleukaemia - 3 6 2 — 11 - 1 3 1 — 5 16 Diabetes - - 1 - - 1 - - 6 1 — 7 17 Vascular lesions of nervous system 4 22 66 13 8 113 8 41 99 29 15 192 18 Coronary disease, angina 9 28 102 15 11 165 3 15 49 11 3 81 19 Hypertension with heart disease 1 12 40 6 12 71 4 13 33 7 9 66 20 Other heart disease 4 19 73 21 18 135 3 36 105 41 20 205 21 Other circulatory disease 2 9 44 7 11 73 2 16 45 13 6 82 22 Influenza 1 1 1 — - 3 - 1 1 2 — 4 23 Pneumonia 3 1 36 7 6 53 - 12 28 10 6 56 24 Bronchitis 2 19 84 18 19 142 1 11 28 13 4 57 25 Other diseases of respiratory system - 4 11 2 1 18 - - 5 1 2 8 26 Ulcer of stomach and duodenum 2 4 10 3 2 21 - 1 1 2 2 — 5 27 Gastritis, enteritis and diarrhœa - — - - — — - - 1 — — 1 28 Nephritis and nephrosis - 3 5 2 1 11 - 1 8 8 — 17 29 Hyperplasia of prostate - 2 13 1 — 16 - __ — — — - 30 Pregnancy, childbirth, abortion - — — — — — - 2 1 — — 3 31 Congenital malformations - 4 3 1 — 8 - 2 6 — - 8 32 Other defined and illdefined diseases 2 8 42 3 5 60 2 7 42 11 6 68 33 Motor vehicle accidents - 1 10 3 — 14 - — 3 - — 3 34 All other accidents - 1 7 1 4 13 - 3 7 3 1 14 35 Suicide - 1 7 - 2 10 - 4 3 2 — 9 36 Homicide and operations of war - - - - - - - - - - - - No social class assessed - — — — — 7 - — - — — 60 There are various 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. 15 Certain statistics have therefore been extracted from the last table and grouped in this way. They are shown in the following table which also includes the percentage of each social class for each disease or group of diseases. The percentages should be compared with those in table 5 for all deaths, but for certain groups it will be realised that the numbers are too small for comparison year by year. Table 7 Grouped deaths in social class Male Female I II III IV V Total I II III IV V Total 1, 2 TB No. — 1 7 2 4 14 1 3 2 - - 6 % — 7 50 14 29 100 17 50 33 — — 100 10-15 Cancers No. 8 45 183 41 23 300 5 40 121 24 23 213 % 3 15 60 14 8 100 2 19 57 II II 100 17-21 Heart and circulation No. 20 90 325 62 60 557 20 121 331 101 53 626 % 4 16 58 11 11 100 3 19 54 16 8 100 22-25 Lung, non-TB No. 6 25 132 27 26 216 1 24 62 26 12 125 % 3 12 61 12 12 100 1 20 49 20 10 100 33,34 Accidents No. - 2 17 4 4 27 - 3 10 3 1 17 % — 7 63 15 15 100 — 18 58 18 6 100 35 Suicide No. - 1 7 - 2 10 - 4 3 2 - 9 % — 10 70 — 20 100 — 45 33 22 — 100 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. Table 8 Social classification Total Not classifiable I II III IV V Registered births No. 91 568 1808 395 231 3093 28 % 3 18 59 13 7 100 Registered stillbirths No. - 10 31 7 2 50 5 % — 20 62 14 4 100 Registered infant deaths No. — 10 39 3 2 54 - % — 19 71 6 4 100 Notified premature births No. 6 31 126 22 14 199 12 % 3 16 63 11 7 100 16 Coronary disease In recent annual reports I have called attention to the likely association of coronary disease and other degenerative heart diseases with diet. Overweight in itself, and more particularly perhaps excess of fat in the diet, have been associated with these conditions. A great deal of research work has been going on during the past year, and although it seems even clearer that an association between diet and heart disease exists it is also obvious that there must be a multiplicity of factors concerned, many of which have yet to be unravelled. The chemical substance cholesterol keeps cropping up in this connection, but it is not yet apparent whether heart and artery disease may be caused by excess cholesterol in the diet or whether the deposition of cholesterolcontaining material in the arteries may be due to a more complex chemical change in the body which in fact produces cholesterol even when it is lacking in the diet. Nevertheless as I indicated last year the association of the two conditions of coronary artery disease and a high level of blood cholesterol makes one suspicious of foods containing a large amount of cholesterol. These foods particularly include dairy products, such as butter and eggs. There is some evidence that the level of cholesterol in the blood varies more with the amount and type of fat (as such) in the diet rather than with the amount of cholesterol. Recently a wellknown research worker in nutrition has suggested that most of the trouble is due to a deficiency of what are called the unsaturated or "essential" fatty acids. These fatty acids occur naturally in certain foods, more particularly fish oil and vegetable oil, and it is pointed out that the whole tendency in the manufacture of foods which contain fat or fatty acids is to turn the unsaturated fatty acids into saturated fatty acids, as thereby keeping qualities are improved and taste is also said to be improved. Nevertheless, comparing margarine with butter, it is believed that margarine may have (according to how it is prepared) up to five times the amount of essential fatty acids that butter has, and it is also known to have considerably less cholesterol. In a controlled experiment carried out in South Africa it was shown that eating beef dripping, butter, hydrogenated ground-nut oil, and eggs in large numbers was followed by rises in the level of a fat-protein combination in the blood which is thought to be directly associated with coronary disease; on the other hand if olive oil, ground-nut oil, seal oil or pilchard oil were eaten there was a fall in the amount of this substance in the blood. The Lancet in commenting on this states that if the results are substantiated, coronary-artery disease becomes in part a preventable disorder, and adds that "the hydrogenation plants of our modern food industry may turn out to have contributed to the causation of a major disease." 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:— 17 Table 9 Heart and circulation mortality Year Deaths from Total heart and circulation (all ages) Age group 45-65 Total deaths in borough Percentage Coronary diseases Other heart diseases* Other circulatory diseases† Total Coronary diseases (e) of (h) (f) of (h) (g) of (h) (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) 1928 357 97 454 115 ... 1993 23 5.8 ? 1933 516 117 633 162 ... 2271 28 7.1 ? 1938 659 139 798 178 ... 2403 33 7.4 ? 1943 583 64 647 129 ... 2359 27 5.5 ? 1948 696 63 759 155 ... 2253 34 6.9 ? 1953 775 113 888 140 - 2502 35 5.6 - 1950 281 519 79 879 158 79 2413 36 6.5 3.3 1 288 528 78 894 154 87 2542 35 6.1 3.4 2 327 537 86 950 180 89 2580 37 7.0 3.5 3 331 444 113 888 140 84 2502 35 5.6 3.4 4 358 387 113 858 176 99 2231 38 7.9 4.4 5 329 464 115 908 148 94 2423 37 6.1 3.9 ? means figure not available. *R.G. Code Nos. 19 and 20. †R.G. Code No. 21. Lung cancer The number of cases increased fairly considerably last year, to 121 (102 males, 19 females), from 89 the year before (76 males, 13 females). The peak does not appear to be in sight. In spite of the now fully accepted association between cigarette smoking and lung cancer (though of course there are other factors, which probably include atmospheric pollution in towns) the national habit of tobacco smoking seems to have been unaffected and, as is well known, the total national revenue obtained from duties on tobacco is in the neighbourhood of £700 million per annum. There have been one or two seemingly half-hearted warnings from the Ministry of Health, but it is likely that nothing far short of an all-out campaign, directed especially to the school-leaver and the adolescent, is likely to be effective. Chronic middle-aged smokers of 20 or more cigarettes a day can take a crumb of comfort from otherwise depressing statistics in that, if they give up cigarette-smoking now, for each year that passes their chances at that time of developing lung cancer seem to be slightly but progressively reduced. It is always possible that the carcinogenic agent in cigarette-smoking will be identified and eliminated; meanwhile the danger continues, and the individual smoker should review his habit afresh. Deaths under age 65 Deaths under the age of 65 are of additional importance in relation to the loss of productive manpower, this loss becoming all the more serious as the population ages. During 1955 the proportion of those dying under the age of 45 still further decreased, and reached a record low of 7.1 percent. The comparison with the corresponding proportion in 1911, the first year for which these records are available, namely 46.2 percent., is quite striking. In the last report, with regard to deaths under the age of 65, I had to show a slight increase in the proportion compared with the year before, but in 1955 this proportion again decreased to a low record, namely 27.9 percent. This compares with 74.1 percent. at the beginning of the century. 00 General statistics from 1901 Table 10 Year Population Death rate * % dying under age 45 % dying under age 65 Birth rate * Premature birth rate Maternal death rate † Stillbirth rate † Neonatal death rate ** One month to one year death rate (12- (10) ** Infant mortality rate ** Reproductive wastage rate (9)+(12) Pulmonary tuberculosis Tuberculosis (all forms) Notif. rate†† Death rate†† % notif. rate under 15 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 1901 127,495 13.0 - 74.1 25.9 - 3.9 - - - 128 - - 93 - 1902 132,432 13.7 — 74.1 26.3 4.3 — — 122 — 106 — 1903 136,405 11.1 — 71.7 26.1 2.5 — — 92 — 78 - 1904 140,401 120 — 69.9 25.6 3.6 - - 122 - 84 - 1905 144,420 11.7 — 67.2 25.2 2.8 30 63 93 — 87 - 1906 148,463 12.0 — 71.6 23.2 2.0 30 83 113 — 80 - 1907 152,532 11.5 — 67.1 23.7 2.5 - 34 56 90 — 90 — 1908 156,627 11.0 — 68.1 22.8 1.4 30 57 87 — 85 - 1909 160,749 10.4 — 62.8 21.9 2.0 35 40 75 — 78 - 1910 164,899 9.7 — 64.9 20.7 — 2.6 — 29 50 79 — — 55 — 1911 161,677 11.4 46.2 68.0 21.2 - 2.3 - 31 73 104 - - 64 - 1912 165,249 10.5 39.5 63.1 20.3 2.8 30 39 69 208 68 11.0 1913 168,822 10.7 42.6 65.3 20.3 2.6 28 48 76 188 73 25.2 1914 169,211 10.9 39.6 61.7 19.5 3.3 27 46 73 138 77 17.8 1915 164,438 12.9 36.3 60.8 19.3 4.0 30 49 79 154 90 26.4 1916 — 11.9 - — 18.4 — - - 75 — 102 - 1917 — 11.8 — — 14.9 — — - 87 — 112 — 1918 — 13.2 — — 13.8 — - - 66 — 106 - 1919 174,750 11.4 34.9 59.1 16.6 3.1 28 32 60 179 86 22.2 1920 174,698 10.8 38.2 59.5 22.8 — 3.8 — 32 30 62 — 160 73 21.8 1921 175,800 10.5 33.8 57.6 19.5 - 2.6 - 23 31 54 - 135 81 18.4 1922 176,600 11.1 30.9 56.8 18.1 2.5 26 28 54 154 74 15.7 1923 182,400 10.1 31.2 56.3 18.0 3.6 20 23 43 154 76 16.9 1924 184,900 10.5 29.5 55.6 16.4 3.6 23 24 47 149 68 21.6 1925 185,600 10.3 29.6 55.6 15.6 1.6 23 32 55 142 63 15.4 1926 187,800 10.0 29.0 54.2 15.4 2.1 18 22 40 158 71 16.9 1927 188,600 11.0 27.6 53.3 15.1 — 2.1 35 21 46 157 92 12.3 1928 199,300 10.0 29.0 54.4 15.2 2.3 22 30 52 168 77 15.1 1929 207,900 11.5 26.7 52.5 15.7 5.3 — — 44 - 142 74 13.3 1930 207,900 9.7 27.9 53.1 15.1 - 0.9 37 - — 42 79 154 76 12.3 19 Table 10—Continued. Year Population Death rate ♦ % dying under age 45 % dying under age 65 Birth rate * Premature birth rate ‡ Maternal death rate † Stillbirth rate † Neonatal death rate ** One month to one year death rate (12- (10) ** Infant mortality rate ** Reproductive wastage rate (9)+ (12) Pulmonary tuberculosis Tuberculosis (all forms) Notif. rate† † Death rate† † % notif. rate under 15 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 1931 220,800 10.2 25.6 51.7 14.1 4.9 31 25 24 49 80 132 69 13.6 1932 221,500 10.2 260 49.4 12.7 - 3.4 32 31 23 54 86 123 59 10.7 1933 221,100 10.2 21.9 49.8 12.2 - 2.6 31 21 18 39 70 125 68 9.2 1934 222,180 10.1 23.5 50.5 12.2 - 1.5 36 21 22 43 79 129 58 14.4 1935 223,000 10.0 22.6 46.7 12.5 - 4.3 35 24 19 43 78 126 58 12.7 1936 224,000 10.9 23.1 48.1 13.0 - 2.0 37 23 32 55 92 131 62 11.6 1937 226,000 10.9 20.4 46.7 13.4 - 1.3 39 18 29 47 86 156 59 11.9 1938 229,000 10.5 23.3 48.7 13.9 - 2.1 26 - - 47 73 116 61 12.4 1939 220,300 10.8 — — 13.6 - 2.9 34 — - 42 76 111 64 11.6 1940 192,540 15.8 22.1 50.0 14.7 — 1.0 24 — — 45 69 111 67 11.1 1941 148,150 14.3 21.7 48.1 13.9 - 1.9 29 - - 34 63 176 93 10.2 1942 161,800 12.0 18.4 43.8 16.8 - 3.2 37 — — 37 74 175 73 15.3 1943 168,530 13.9 20.5 44.9 18.7 - 3.1 25 - - 42 67 194 76 13.6 1944 163,320 14.8 21.4 48.8 18.6 - 1.0 22 - - 40 62 196 79 10.8 1945 171,280 12.1 20.5 43.4 17.7 - 1.9 18 — - 34 52 179 71 13.2 1946 207,410 10.6 17.5 43.0 21.7 - 1.1 21 - - 33 54 193 53 15.4 1947 221,170 11.9 17.0 41.9 21.9 - 1.0 21 - — 33 54 166 55 12.4 1948 226,100 9.9 15.6 40.7 18.9 - 0-5 15 15 13 28 43 198 48 15.7 1949 227,700 10.2 10.7 34.9 16.8 - 0.3 16 13 6 19 35 146 40 12.4 1950 228,300 10.6 11.2 35.2 15.3 — 0.6 15 19 7 26 40 158 29 12.6 1951 227,200 11.2 10.1 33.6 15.3 67 0.3 16 17 8 25 41 117 26 14.7 1952 227,100 11.4 8.7 32.0 13.9 86 0.3 18 16 6 22 40 117 15 8.8 1953 225,800 11.1 8.9 29.5 14.4 75 0.3 23 16 6 22 45 136 19 13.8 1954 224,200 10.0 8.3 31.5 14.2 60 0.0 14 13 8 21 35 102 16 10.2 1955 223,400 10.8 7.1 27.9 14.0 69 0.9 18 11 6 17 35 114 10 5.1 *per 1,000 population, fper 1,000 notified livebirths. **per 1,000 registered livebirths. † † per 1,000 registered live and stillbirths. † † per 100,000 population. equals figure not available. 20 SECTION B — GENERAL PROVISION OF HEALTH SERVICES Disinfection and personal cleansing Details of the work carried out during the year are as follows Disinfecting Station Table 11 West North South Total Disinfections Premises visited 169 148 143 460 Rooms disinfected 355 417 283 1055 Articles treated 2160 1710 1488 5358 Disinfestation Premises visited 48 45 12 105 Rooms disinfested 197 166 30 393 Articles disinfested 328 50 15 393 Analysis of articles treated Beds 53 37 56 146 Mattresses 210 155 164 529 Bolsters 42 42 43 127 Pillows 362 262 266 890 Cushions 46 54 24 124 Quilts 88 76 97 261 Blankets 466 278 326 1070 Sheets 131 97 95 323 Household articles 494 307 240 1041 Wearing apparel 596 452 192 1240 Total articles 2488 17-60 1503 5751 Articles received from cleansing station - 1728 - 1728 Articles received from Coroner's court — 564 — 564 Public library books treated after infection 256 367 230 853 Private library books treated after infection 28 22 33 83 Articles treated under the Public Health (London) Act s.122 10113 9808 17511 37432 A more detailed analysis of treatments for verminous conditions and for scabies is shown:— Verminous conditions Table 12 First cleansing Second cleansing Children under 5 17 - School children 226 20 Adults 34 1 TOTALS 277 21 21 Scabies Table 12—continued Cases Contacts Treatments Children under 5 7 14 School children 15 _ 31 Adults 14 2 26 TOTALS 36 2 71 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. No persons received 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 May 2 to September 29 and Mr. Phillips, the deputy senior sanitary inspector who is in charge of anti-pest work, reports:—" 433 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 material collected or destroyed on the sites consisted of 115 mattresses and approximately five tons of miscellaneous articles such as carpets, linoleum, furniture, clothing, cushions and even perambulators. 30 gallons of paraffin were used in the destruction of this material on the sites. As in previous years, 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. 7 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 22 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 regular visits were paid to Lewisham Hospital to spray the refuse container there and also the site of the kitchen waste bins. 20 visits were also paid to both this Council's and the London County Council's blocks of flats where dustchutes are used. 235 dustchutes with 826 openings were sprayed. One private block containing 9 chutes was also included in this treatment. The 22 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 8 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 5 occasions. Laboratory facilities The following summary relates to the work carried out by the laboratory on behalf of the Council during 1955:— Table 13 Specimen No. Faeces 564 Throat and Nose swabs 115 Urine 44 Sputa 15 Total 738 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 747, of which 417 were received from institutions. 747 postmortem examinations were made and inquests were held in 131 cases. Details are shown in the following table:— Table 14 Table 14 Month Bodies received from Institutions Others Post-mortem examinations Lewisham residents Others Inquests January 40 55 49 46 8 February 35 29 35 29 6 March 31 32 39 24 12 April 41 24 34 31 13 May 41 28 41 28 16 June 30 18 26 22 7 July 31 18 29 20 6 August 37 16 28 25 5 September 31 23 29 25 11 October 29 26 30 25 15 November 24 22 28 18 9 December 47 39 55 31 23 TOTALS 417 330 423 324 131 23 In June, 1955 the London county council intimated that they proposed to reduce from the end of the year the number of Coroners' districts from four to three, and the number of Courts to two in each district. As far as this borough was concerned it would, under the scheme, come into the "southern" district, together with nine other boroughs in south and east London, and the two Courts would be at Poplar (the other side of the Thames) and Southwark. This seemed unreasonable because of the following considerations amongst others:— (1) The proposed southern district, although one of three districts in which the London County area would be divided, would contain well over one-third of the population and almost one-half of the acreage. In fact the population is 38 percent of the total for the County and the acreage is 48 percent. (2) The abandonment of the Coroner's Courts at Greenwich and Lewisham would mean that the whole of the work of this vast southern area would be concentrated at Southwark and Poplar. Since Poplar is north of the river with poor communications this would mean in fact that nearly all the work for the eight boroughs south of the river would be concentrated at Southwark. (3) The Coroner's Court at Southwark is, as the crow flies, some seven miles from the southern part of Lewisham and some eight and a half miles from the eastern part of Woolwich. This means that by ordinary communications it is considerably further from these areas. If, therefore, people have to travel by train and by bus the cost may be considerable, the time consumed would be large, and the general difficulty of approach would be much greater than at present. (4) Although the ordinary person who attends a Coroner's Court may be unlikely to do so more than once or twice in his life nevertheless that person is usually in a state of high emotional stress. For example it may be a mother whose young child has died. Therefore everything should be done to relax the stress as far as practicable; travelling inconvenient distances to strange areas is not likely to do this. (5) In view of the above, it was thought that should the Courts at Poplar and Southwark be retained there should be a third Court further to the south-east. Although the Lewisham Court has advantages with regard to structure, layout, convenience of situation on lines of transport and so on, this does not necessarily mean that the Lewisham Court should be the third one in the area; it might be that the Court at Greenwich would have advantages over the one at Lewisham. It was, however, certain that a third Court somewhere in this area was desirable. (6) Mortuary accommodation together with postmortem facilities has usually gone with the Coroner's Courts. The mortuary facilities here are reasonably good and in fact Lewisham takes in a considerable proportion of the mortuary and postmortem work of the boroughs of Greenwich and Woolwich. It would therefore appear to be a suitable centre for continuing that work, more particularly while the Coroner's Court is there. 24 Protests were therefore made by the Public Health committee and eventually after further consideration by the County Council various modifications were made in their scheme, and as far as this area was concerned it was agreed that the Lewisham Court should be retained for a period of twelve months from the commencement of the proposed scheme and that the matter be further considered then, in the light of the experience of the working of the new scheme, before a final decision is made. 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. In his report on rodent control work during 1955, Mr. Walker, the senior sanitary inspector, states:— "The higher number of complaints received regarding rat infestation reported in the previous year continued well into 1955, the peak being reached in April, thereafter dropping, though still remaining high compared with previous years. As no reason for this rise was apparent locally, enquiries were made of neighbouring districts. It appears that the trend was evident to a greater or less extent in other areas, particularly those on the outer fringe of south east London, notably Penge, Beckenham, Bromley, and Sidcup and Chislehurst, and parts of Woolwich. This was discussed at some length at the No. 2 Workable Area Committee for rodent control, which covers the areas of Bermondsey, Deptford, Greenwich, Lewisham and Woolwich. I also attended a meeting in October of the No. 9 London Workable Area Committee which covers the area of Beckenham, Bromley, Chislehurst and Sidcup, Crayford, Erith, and Orpington, for a special discussion on this matter. No definite reason for the increase came to light during the discussions, although it was suggested that extensive advertising by private pest control firms may have increased the sensitivity of the public, and that the satisfactory service given by local authorities may have encouraged people to notify the existence of infestation. It will also be noticed that in both the sewer treatments carried out in the year there was an increase in prebait takes over the previous year, which would suggest a rise in the rat population in the sewers." The undermentioned table gives a summary of the work on the rivers and ditches:— Table 15 Location Base points Days on which prebait laid Poison bait taken (ozs.) (Est.) River Ravensbourne 269 3/4 165 River Quaggy 249 3/4 135 River Pool 123 3/4 52 Ditches 140 3/4 67 25 Special liaison is made twice yearly with the Borough Engineer's department for the treatment of sewers. In 1955 treatments were carried out in June and December. The method employed in carrying out this work was to deposit 8 oz. prebait on the first day and if a complete take was shown, 16 ozs. of prebait were used on the second day. Where complete takes were shown on the second day, the poison bait deposited was equal to the prebait. In any case at least 8 ozs. of poison bait was deposited. Poison takes were not inspected. The following is a summary of the results obtained:— Summer treatment Manholes baited 2,926 Manholes showing prebait take 506 Manholes showing complete prebait take (on one or both days) 448 Winter treatment Manholes baited 2,941 Manholes showing prebait take 470 Manholes showing complete prebait take 557 Prevention of Damage by Pests Act, 1949 A copy of the annual report covering the twelve months ended 31 March, 1956, submitted to the Minister of Agriculture, Fisheries and Food, as required by the provisions of the above Act, is appended. Table 16 Type of property Local authority Dwelling houses (including council houses) All other (including business premises) Total Agricultural Number of properties in borough 138 63,015 9,613 72,766 Number of properties inspected as a result of:— (a) notification 7 1,512 149 1,668 — (b) survey — 3,375 4 3,379 — (c) otherwise — 9 7 16 — Number of properties inspected which were found to be infested by: (a) Rats — major — — — — — — minor 3 1,356 97 1,456 — (b) Mice— major — — — — — — minor 3 342 51 396 — Number of infested properties treated 6 1,601 141 1,748 — Total treatments (including retreatments) 9 4,558 355 4,922 — Number of "block" control schemes carried out 38 26 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. 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 - Forest Hill 12 2 Ladywell 2 3 Private baths 4 3 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 8 persons, at a net cost of £48 18s. 6d. Dog nuisances No proceedings were taken during the year. Drainage work During the year 149 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 £2,750 was included in the annual estimates for the year 1955-56 for such organisations as accepted the Council's conditions and to assist any other such voluntary organisations as might be established during that year. Reports were made to the Public Health committee giving details of the work undertaken by the voluntary organisations and as a result grants were made as follows:— £ Lewisham Old People's Welfare Association 2,000 Lewisham Darby and Joan Club 350 St. Mark's Old Folks' Club 70 Talbot Settlement Old People's Club 30 The Good Companions Personal Service 35 St. Swithun's OAP Association 60 Bellingham Old People's Club 55 St. Philip's Darby and Joan Club 20 The Friendly Club (for the Over-sixties) 25 The Bellingham Community Association "Darby and Joan" Club 30 27 This left a sum of money available for new clubs which might qualify for grant. At the end of the calendar year one further application was under consideration. 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 reponsible for the Meals-on-Wheels service to housebound old people. The laundry service carried out by the borough council for the small number of old people living at home whose infirmity is such as to make them incontinent of urine or faeces was continued and expanded during the year, over 37,000 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 and the three smoke measurement stations continued in use throughout the year, though in the next table a gap of four months is shown for the west division deposit station and a gap of one month in the south division deposit station, because of results which were found to be unreliable due to local contamination. FOREST HILL , „ ha. 1955 Feb. March April Nay June July August Sept. Oct. Nov. Dec. U IB 15 1 g 15 22 1 8 15 22 29 5 12 1 9 26 3 10 17 24 31 7 14 21 28 5 12 19 26 2 9 16 23 30 6 13 20 2 7 4 11 18 25 1 8 15 22 29 6 13 20 21 The chart shows for the Forest Hill station the amount of smoke (continuous line) throughout the year and (dotted line) the minimum temperature. It will be obvious that, in general terms, one is almost the reciprocal of the other. 28 29 Table 17 gives a record of the principal results from the six stations and also given one indication of the sunshine, rainfall, etc., during the year. Some of these latter data are not specific to the borough, having been obtained from a publication of the metoer-logical office, and relate to the nearest station which records the particular item concerned. Atmospheric Condition 1955 Table 7 January February March April May June July August September October November December Average (if applic.) Temperature— 56.1 50.6 481 5.8 Mean maximum1 °F 41.2 40.3 45.0 58.2 59.0 67.2 74.1 74.4 67.2 42.2 41.2 39.9 43.3 Mean minimum1 33.8 31.4 31.9 40.8 43.7 59.3 55.0 56.6 51.3 49.1 45.9 44.0 50.0 Mean1°F 37.5 35.9 38.5 49.5 51.3 59.3 64.5C 65.5 59.3 -2.5 + 1.2 + 3.3 0.5 Diff. from average1 °F -2.6 -4.5 -5.2 + 1.3 -2.4 -0.2 +1.5 3.0 +0.7 68.0 61 .0 57.0 87 (July) 18 Highest maximum2 °F 54.0 54.0 63.0 72.0 69.0 78.0 87.0 87.0 80.0 30.0 29.0 27.0 24 (Feb. 28) Lowest minimum2 °F 25.0 24.0 25.0 34.0 37.0 42.0 51.0 51.0 45.0 Rainfall— 6 2.88 0.8 1.58 17.04 Total5 in. 1.89 1.02 0.75 0.16 3.86 1.73 0.01 0.71 2.17 109.0 33.0 80.0 - Percent of average1 121.0 82.0 54.0 14.0 206.0 80.0 42.0 68.0 92.0 Sunshine1 Daily mean hrs. 1.08 2.57 4.47 5.97 7.05 5.32 6.92 5.93 5.20 3.46 1.37 1.39 4.22 99.0 Percent of average 72.0 114.0 118.0 120.0 110.0 74.0 103.0 96.0 109.0 104.0 107.0 Wind1 7.0 31.0 22.0 29.0 NE/E/SE % 35.0 36.0 47.0 27.0 26.0 35.0 46.0 28.0 6.0 57.0 29.0 56.0 46.0 S/SW/W % 49.0 42.0 22.0 55.0 61.0 48.0 16.0 28.0 73.0 36.0 40. 22.0 25.0 NW/N/Calm % Atmospheric pollution— 16.0 22.0 31.0 18.0 130.1 17.0 38.0 4.4 21.0 West Division3 : 12.79 13.16 11.13 11.96 10.4 9.15 12.49(8mos). Water insol. matter tpm 18.03 12.76 — — - - 3.38 10.87 6.00 5.30 3.4 3.58 6.12(8mos.) Water sol. matter tpm 8.31 7.75 — — - - 1.08 0.97 0.88 1.68 3.0 2.17 1.96 Sulphur † 2.71 2.99 2.74 1.54 1.94 1.23 3.2 3.0 7.2 12.1 33. 21.4 15.3 Smoke, daily average 26.7 22.7 28.3 13.7 6.5 4.7 4.2 4.4 10.6 19.9 51. 57.8 289 „ maximum* 49.4 32.1 47.4 23.7 10.0 6.0 (6-8) - (28-30) (29-31) (16-18) (1-2) (2hrson30/11) (date) (12-4) (16-18) (1-4) (2-5) (21-24) (1-3) 2.6 (24-26) 3.6 5.4 9.3 11.6 2.1 „ minimum 10.8 9.6 15..7 6.4 4.2 3.2 (27-29) 2.1 (3.6) (5-7) (9-11) (24-28) (Aug. 17.19) (date) (29-31) (1-4) (26-29) (27-29) (30-10) (22-24) (17-19) North Division4 : 10.44 10.44 14.56 9.25 13.49 10.3 6.21 10.39 Water insol. matter tpm 8.53 7.84 14.59 8.82 10.44 6.75 3.89 7.21 3.56 13.89 5.0 3.35 6.14 Water sol. matter tpm 7.38 4.93 7.31 3. 59 6.88 2.15 2.65 2.15 1.31 4.06 4.6 3.77 3.36 Sulphur 4.60 5.11 5.28 2.33 2.05 4.4 3.4 2.8 8.3 11.5 30. 23.6 14.2 Smoke, daily average* 24.5 22.2 22.0 11.9 5.9 5.5 4.4 3.8 11 .8 17.9 44.9 69.1 253 „ maximum * 41.3 29.7 32.8 20.1 9.0 (8-10) 7 (13-15) (24-26) (28-30) (12-14) (16-18) (1-2) (3hrson30/11) (date) (12-14) (16-18) (1-4) (2-5) (21-24) 3.5 2-4 2.2 5.2 6.0 10.6 12.0 2.2 „ minimum * 14.7 12.1 13.4 7.0 4.2 (22-24) (27-29) (17-19) (3-6) (5-7) (9-11) (10-13) (Aug. 17-19) (date) (1-4) (1-4) (23-25) (17-19) (4-6) \ South Division5: - .8.79 10.18 8.73 8.6 3.98 8.59(11mos.) Water insol. matter tpm 6.78 6.42 7.64 9.98 9.09 - 3.52 14.52 5.96 0 6.15 4.5 2.90 5.28(11mos.) Water sol. matter tpm 8.50 3.92 4.61 3.59 7.31 1.13 1.21 7.48 0.96 2.14 2.86 210 1.92 Sulphur † 2.49 3.22 2.98 1.79 1.22 3.8 2.8 1.06 6.0 11.4 26. 18.9 13.1 Smoke, daily average 22.4 22.7 22.3 12.2 10.3 4.6 3.7i 2..5 8.4 18.4 42.0 46.9 46.9 ,, maximum 44.0 29.7 30.1 20.6 (21-24) (1-3) (13-15) 3.4 (28-30) (29-31) (16-18) (1 -2) (Dec 1-2) (date) (12-14) (16-18) (30-1) (2-5) 3.4 1.2 2.2 (24-26) ( 3.8 7.0 7.3 10.3 1.2 „ minimum * 8.9 11.1 13.1 5.5 (4-6) (22-24) (9-12) I1.6 (3-6) (5-7) (9-11) (24-28) (June 22.24) (date) (29.31) (1-4) (23-25) (27-29) v / \7 1 (17-19) Weather summary Cold; snowy; dull Very cold; snowy Dry; very cold; sunny Very dry; sunny cold; very wet; changeab;le Dryish ; normaal temp Sunny; dry and warm Warm; dry; calm and bright Changeable and sunny Cold; damp; fairly calm Mild; dry; dull; and calm Changeable and mild Notes : 1Croydon; 2Lewisham; 3Valentine Court for smoke, Pool allotments for other; 4person place for smoke, Wearside Road for others; 5Downham Depot for smoke, Verdant Lane for others; tpm: tons per square mile per month; fas trioxide in mg per 100 sq. cms. per day'18 per 100 cub. metres. 30 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 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. 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. None of the supplies is plumbo-solvent. Tables 18 and 19 show the average results of the chemical and bacteriological analyses of the various supplies as forwarded by the Metropolitan Water Board:— 31 Average results of the chemical and bacteriological examination of the water supply to the Borough of Lewisham for 1955 parts per million (unless otherwise stated) (a) CHEMICAL Table 18 Description of the sample No. of samples Ammoniacal nitrogen Albuminoid nitrogen Oxidised nitrogen (nitrate) Chlorides as Cl. Oxygen abs. from permanganate (4 hrs.at 27° C) Hardness (total) Hardness (noncarbonate) PH value Conductivity Bexley Well 4 0.005 0.017 5.5 16 0.12 286 56 7.1 458 Darenth Well . 8 Nil 0.018 5.5 16 0.06 270 40 7.2 440 Shortlands Well 10 0.002 0.020 4.5 17 0.08 272 70 7.1 450 Wilmington Well 7 0.006 0.024 7.1 21 0.12 286 56 7.2 450 Deptford Well 4 0.002 0.017 7.0 35 0.20 359 126 7.1 550 River Thames - derived filtered water 1663 0.014 0.085 3.8 26 1.04 258 65 7.8 450 (b) BACTERIOLOGICAL Table 19 BEFORE CHLORINATION AFTER CHLORINATION (WATER PASSING INTO SUPPLY) No. of samples Plate count (average per ml.) Colonies counted on agar 37°C. (20-24 hrs.) 8act. coli test No. of samples Plate count (average per ml.) Colonies counted on agar 37°C. (20-24 hrs.) Bact. coli test Percentage samples neg. 100 ml. Average number per 100 ml. Percentage samples neg. 100 ml. Average number per 100 ml. Bexley Well 420 0.1 100.0 — 256 — 100.0 - Darenth Well 398 0.2 99.3 0.01 251 — 100.0 — Shortlands Well 499 0.04 100.0 — 256 — 100.0 — Wilmington Well 470 3.0 99.4 0.01 255 — 100.0 — Deptford Well 221 2.2 99.6 0.01 225 — 100.0 — River Thames - derived filtered water 7040 — 60.4 3.73 3561 7.8 99.9 0.002 32 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 daring the year:— Table 20 Reason for inspection West North South Total District sanitary inspectors: Dwelling-houses— PH Act 1231 951 521 2667 Dwelling-houses — Housing Act 850 1703 679 3232 Houses let in lodgings — — — — Applications for rehousing 110 145 38 293 Certificates of disrepair, etc. 63 38 46 147 Notice from builder 101 122 25 248 Infectious diseases 34 28 24 86 Infestation 61 90 57 208 Factories, mechanical 64 34 17 115 Factories, non-mechanical 12 6 1 19 S47 National Assistance Act 20 11 9 40 Outworkers 65 72 116 253 Smoke observations — 1 - 1 Offensive trades — —. - - Keeping of animals in such a state as to be a nuisance 3 8 1 12 Water certificates 47 43 95 185 Futile visits 902 1125 448 2475 All other matters 671 666 314 1651 Reinspections 4228 3844 3355 11427 Totals 8462 8851 5746 23059 Food inspectors: Notice from builder 137 44 18 199 Heating Appliances (Fireguards) Act 8 2 — 10 Infectious diseases 7 13 9 29 Infestation 22 45 6 73 Factories, mechanical 26 39 80 145 Factories, non-mechanical 1 3 - 4 Smoke observations 1 9 2 12 Food shops — registered. . 124 196 236 556 Food shops — not registered 104 135 165 404 Milkshops and dairies 42 98 74 214 Icecream premises 140 160 114 414 Restaurants and eating houses 130 262 223 615 Bakehouses 60 40 10 110 Other shops 17 253 12 282 Food inspections 282 498 102 882 Sampling 444 281 246 971 Markets and stalls 8 840 507 1355 Pharmacy and poisons 91 98 18 207 Slaughterhouses — 91 — 91 Futile visits 86 76 30 192 All other matters 567 369 144 1080 Reinspections 538 946 393 1877 Totals 2835 4498 2389 9722 33 Table 20—continued Reason for inspection West North South Total Housing inspectors: Improvement grants 10 13 4 27 Dwelling-houses — PH Act — — - — Dwelling-houses — Housing Act 73 64 34 171 Houses let in lodgings - — — — Applications for rehousing - — — — Notice from builder - — - - Futile visits 207 131 44 382 All other visits 204 198 73 475 Rein spections 1801 1256 344 3401 Totals 2295 1662 499 4456 Grand total — all inspectors 13592 15011 8634 37237 Smoke abatement Observations 13 Intimations served Complaints received 8 Statutory notices served Legal proceedings Convictions Summary of notices served in 1955 Table 21 West North South Total Intimation notices:— Public Health (London) Act, 1936 475 344 223 1042 Factories Act, 1937 1 3 — 4 Informal intimations under Housing Act, 1936 19 26 11 56 Total intimations 495 373 234 1102 Statutory notices:— Public Health (London) Act, 1936 279 106 88 473 Factories Act, 1937 -— 1 — 1 Housing Act, 1936 4 2 1 7 Byelaws 51 8 6 65 Food and Drugs Act, 1938 — — — — Total statutory notices 334 117 95 546 34 Nuisances remedied — Public Health Act Table 22 Nuisance West North South Total Wall and ceiling plaster repaired 224 91 68 383 Roofs repaired 100 109 45 254 Dampness remedied 522 269 243 1034 Brickwork repaired 16 38 5 59 Chimneys repaired 8 7 2 17 Drains cleared 8 6 8 22 Drains repaired 40 38 21 99 Drinking water cisterns repaired 1 5 — 6 Dustbins supplied 45 17 17 79 Doors and doorframes repaired or renewed 9 6 2 17 Flushing cisterns repaired, renewed or cleansed 25 24 9 58 Flush pipes repaired or renewed 3 4 5 12 Firegrates, etc., repaired or renewed 32 24 11 67 Flooring repaired or renewed 92 46 16 154 Dry rot remedied 10 7 — 17 Gullies renewed, repaired or cleansed 3 3 1 7 Gutters repaired 52 38 29 119 Refuse cleared 6 3 — 9 Rainwater pipes repaired 18 11 3 32 Soil pipes repaired, ventilated or renewed 8 12 4 24 Sinks provided 2 9 2 13 Sashcords renewed 51 24 28 103 Water closets repaired or renewed 22 20 4 46 Walls and ceilings cleansed — 3 7 10 Windows and frames repaired or renewed 35 26 16 77 Water service pipes repaired or renewed, water supply restored 3 1 1 5 Yards and areas paved 2 7 5 14 Windows glazed 10 6 7 23 Other nuisances remedied 63 29 13 105 TOTALS 1410 883 572 2865 Nuisances remedied — Housing Act Table 23 Nuisance West North South Total Wall and ceiling plaster repaired 158 243 57 458 Roofs repaired 23 38 15 76 Dampness remedied 23 59 18 100 Brickwork repaired 24 31 10 65 Chimneys repaired 4 6 1 11 Drains cleared — 2 — 2 Drains repaired 8 19 1 28 Drinking water cisterns repaired — — — — Dustbins supplied 1 — — 1 Doors and door frames repaired 30 57 14 101 35 Table 24—continued Nuisance West North South Total Flushing cisterns repaired, renewed or cleansed 5 5 Flush pipes repaired or renewed — 1 1 2 Firegrates repaired 17 24 5 46 Flooring repaired or renewed 50 55 22 127 Dry rot remedied 3 6 2 11 Gullies renewed, repaired or cleansed 4 7 — 11 Gutters repaired 9 21 7 37 Refuse cleared — — 1 1 Rainwater pipes repaired 7 16 4 27 Soil pipes repaired, ventilated or renewed — — 2 2 Sinks provided 1 1 — 2 Sashcords renewed 16 19 14 49 Water closets repaired or renewed 5 11 3 19 Walls and ceilings cleansed 17 2 — 19 Windows and frames renewed or repaired 64 81 24 169 Water service pipes repaired or renewed, water supply restored 2 1 3 Yards and areas paved 3 5 1 9 Windows glazed 5 9 5 19 Woodwork painted 5 3 6 14 Other nuisances remedied 89 75 51 215 TOTALS 566 798 265 1629 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 200 premises and 8 blocks of flats certifying that under the provisions of the Public Health (London) Act, 1936, a proper and sufficient supply of water had been provided. Factories Section 7 of the Factories Act, 1937, requiring the provision of sufficient and suitable sanitary conveniences is enforced by the council in all factories, whether mechanical power is used in the factory or not. The provisions of sections 1, 2, 3, 4 and 6 relating to cleanliness, overcrowding, the maintenance of a reasonable temperature, the securing of adequate ventilation of workrooms and the furnishing of adequate means for draining floors where wet processes are carried on, 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. 36 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. Details follow:— Inspections Table 24 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 68 23 - - (ii) Factories not included in (i) in which section 7 is enforced by the local authority 459 260 1 - (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 26 26 - - TOTAL 553 309 1 - 37 Cases in which defects were found Table 25 Defects No. of cases in which defects were found Found Remedied Referred No. of cases in which prosecutions were instituted To HM Inspector By HM Inspector Want of cleanliness (S 1) - _- - - - Overcrowding (S 2) - - - - - Unreasonable temperature (S 3) - - - - - Inadequate ventilation (S 4) - 1 - 1 _ Ineffective drainage of floors (S 6) - - - - - Sanitary conveniences (S7): (a) insufficient - 1 - 1 - (b) unsuitable or defective 4 16 - 12 - (c) not separate for sexes 2 2 - - - Other offences against the Act (not including offences relating to outwork) - - - - - TOTAL 6 20 - 14 -- Sanitary work generally Mr. Walker, the senior sanitary inspector, reports: "The year's inspection figures show very little change from the previous year except for those of the district sanitary inspectors where a decrease is shown. This is no doubt due to the fact that a further district inspector left and no replacement was made, owing to there being no satisfactory response to advertisements issued. The work, as far as possible, had to be spread among other district and food inspectors. The increase in housing inspections was in the main due to the housing survey which was partly carried out during the year. "The number of applications for certificates of disrepair under the Housing Repairs and Rents Act, 1954, steadily diminished as the year progressed. The total of 147 for the year is a smaller figure than was expected. "The conditions under which outworkers are employed continues to be satisfactory, as will be seen from the fact that no adverse comments were made by the sanitary inspectors during their visits. The amount of work in many cases fluctuates, or is only seasonal, while in others it is done for the purpose of filling in spare time. Very few seem to take outwork as a full-time occupation." Registration of hairdressers From October 1, 1955, under s.18 of the London County Council (General Powers) Act, 1954, no person may carry on the business of a 38 hairdresser or barber on any premises in a borough unless he and those premises are registered by the borough council. Exceptions are for premises which are visited only by appointment with a customer, and for a person who in effect is doing hair dressing on his own premises part time and who does not employ any other person to assist him. Registration in the first place is automatic on application, and a register is kept for the purpose. By the end of the year 111 persons had been registered. Byelaws governing the conduct of these establishments, designed to ensure cleanliness of the person, equipment and premises, came into force on December 1. The standard of hygiene in those visited up to the end of the year was good. 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, 1955 lists received:— Trade outworkers employed Wearing apparel 147 Curtains 9 Christmas crackers 1 Boxmaking 9 Carding, etc., of buttons 1 Stuffed toys 1 Paper bags 1 Lampshades 12 Textile weaving 2 183 39 It will be noted that none of the outworkers are employed in food. Outworking in food will cease to be legal in July, 1956 as a result of the Food Hygiene Regulations, 1955. The inspectors made 253 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 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. 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 22 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, 40 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 value can be added to last year's report, although 60 young birds and 56 eggs were destroyed from colonies found under railway bridges and on the Town Hall roof. Exhumations It is the practice for a sanitary inspector to be in attendance at an exhumation but no such attendances were made during 1955. 41 SECTION D—HOUSING Building The following 464 new houses or flats were completed by the Council during the year:— Baizdon Road 61 Harvard Road 1 Brasted Close 27 Kilmorie Road 4 Brockley Road 16 Kirkdale 6 Brookbank Road 18 Lawn Terrace 8 Burnt Ash Road 6 Lewisham Park 44 Comerford Road 2 Littlewood 3 Crofton Park Road 6 Marsala Road 7 Davenport Road 8 Mount Pleasant Road 18 Ellerdale Street 6 Paynell Court 41 Ermine Road 6 Ronver Road 7 Ewhurst Road 6 St. Mildred's Road 12 Farley Road 5 Salehurst Road 3 Fordyce Road 7 Somertrees Avenue 6 George Lane 11 Thornford Road 3 Granville Park 16 Viney Road 58 Grierson Road 6 Walerand Road 16 Guyscliffe Road 20 Families rehoused During the year the following families were rehoused:— 1. By the Lewisham Borough Council:— (a) in permanent properties 255 (b) in temporary bungalows 10 (c) in requisitioned properties 31 296 2. By the London county council (figures supplied by district offices) 118 Total 414 3. Number of families where points had been awarded for bedroom deficiency, rehoused by the Council during the year 247 Housing Act, 1936 Repair of houses (sections 9 and 10) During the year 56 informal and 7 formal notices were served. 64 properties were repaired by the owners after service of notices and 8 properties were repaired by the Council under section 10 in default of the owners. 42 Demolition orders (section 11) Housing Act, 1936, and Closing orders under section 10, Local Government (Miscellaneous Provisions) Act, 1953 The following is a list of cases involving procedure for demolition orders or for complete closure of houses which originated in or were complied with during 1955, together with the present position of cases originating in previous years which had not been complied with at the end of 1954:— Table 26 Properties Dwellings involved Present position 58, Knowles Hill Crescent 1 Statutory undertaking given to carry out works. 7, Sunnyside, Blythe Hill 1 Works completed. 177, Hither Green Lane 1 Closing Order operative on whole house. 77, Malham Road 1 Statutory undertaking given to carry out works. 97, Mount Pleasant Road 1 Order operative. 18, Knowles Hill Crescent 1 Closing Order operative on whole house. 2, Dallas Road 1 Order operative. 95, Gilmore Road 1 Order operative. 78, Taunton Road 1 Order operative. 24, Wisteria Road 1 Closing order operative on whole house. 3, Myron Place 1 Closing order operative on whole house. 2, Cranston Road 1 Closing order (2.1.54) on whole house revoked and demolition order substituted. Order operative. 7, Balloch Road 1 Closing order operative on whole house. 95, Loampit Vale 1 Notices served. 2, Fordel Road 1 Notices served. 2, Agnew Road 1 Notices served. 23, Lethbridge Road 1 Notices to be served. 12, Dalmain Road 1 Notices served. 169, Sandhurst Road 1 Notices served. Closing orders in respect of part of house (section 12) Table 27 Properties Part of house Present position 52, Lee Road Four rooms and kitchen in basement. Works to comply with undertaking completed. 94, Loampit Vale Living room and scullery, ground floor; two first floor rooms and attic room. Works to comply with undertaking completed. 43 Table 27—continued Properties Part of house Present position 50, Lee Park Four rooms in basement. Order operative. 28, Ravensbourne Road. Two rooms, scullery and water closet in basement. Works in progress. 12, Manor Park Three rooms and scullery in basement. Order operative. 35, Burnt Ash Road Two rooms and scullery in basement. Notices served. Crown property. No further action possible. 35, Devonshire Road Two rooms, scullery, watercloset and passage in semibasement. Order operative. 45, Lee Park Two rooms and scullery in basement. Order operative. 46, Gilmore Road Two rooms and scullery in basement. Works to comply with undertaking completed. 18, Sydenham Park Two rooms, scullery and passage in basement. Works to comply with undertaking completed. 55, Belmont Park Three rooms and scullery in basement. Order operative. 59, Belmont Park Two rooms and scullery in basement. Order operative. 68, Malham Road Two rooms, kitchen and scullery on ground floor. Notices served. 2, Handen Road Two rooms and scullery on second floor and two rooms on first floor. Orders operative. 32, Manor Park Three rooms, scullery and watercloset in semibasement. Notices served. 265, Lee High Road Two rooms, kitchen and watercloset in basement. Order operative. 193c, Perry Vale 38, Eltham Road Top floor flat Two rooms, scullery and watercloset in basement. Notices to be served. Notices served. In his report upon work under the Housing Acts, Mr. Craven, the group housing inspector, states:— "The survey of older properties in the borough, started during 1954, was completed early in the year. In cases where action was found to be necessary, a classification was made under the Housing Act, 1936 indicating that 667 properties required repair and 159 properties closure or demolition. From this survey, together with previous knowledge and records in the department, the programme required by the Ministry of Housing and Local Government under 44 the Housing Repairs and Rents Act, 1954 was compiled and recommended for action in the five years 1956-60. Under this 12 properties were regarded as fit for demolition as individual units, and 147 properties as fit for demolition in 10 clearance areas. "During the year all the remaining properties in the 4951-55 programme were inspected. This resulted in the representation under section 25 of 15 properties in two areas (which were dealt with by the borough council) and a larger area of 38 houses, which had been included in the outstanding programme and previously inspected and reported to the Council as suitable for action under section 25, and which it was arranged, should be dealt with by the London county council. "Action under section 9 of the Housing Act, 1936 was taken in respect of 63 properties and the Council approved the carrying out of work in default in eight cases. "An increasing amount of interest in the improvement grant scheme was noted during the year. Many enquiries were received and dealt with and, following formal applications in respect of 31 properties, inspections were made, specifications for improvements and repairs approved, and estimates checked prior to submission to the Finance and Rating Committee. Out of this total, 14 applications were in respect of the improvement of single family houses, mainly for the provision of bathroom and internal water closet, while the remaining 17 were for the conversion of larger properties, which will result in the provision of a total of 45 self-contained flats or maisonettes, a net gain of 28 units of accommodation." Table 28 PART A—CLEARANCE AREAS AND INDIVIDUAL UNFIT HOUSES (Housing Act, 1936 and Housing Repairs and Rents Act, 1954) Dwelling-houses demolished Persons displaced Unfit houses ' Other houses Land coloured "pink" 2 — 2 Land coloured "grey" — None None PART B —HOUSES NOT INCLUDED IN CLEARANCE AREAS DEMOLITION AND CLOSING ORDERS 1. Housing Act, 1936:— Houses Persons displaced None None (a) Houses demolished as a result of formal or informal procedure under section 11 (b) Houses closed in pursuance of an undertaking given by the owners under section 11, and still in force 2 5 (c) Parts of buildings closed (section12) 10 25 45 PART B—HOUSES NOT INCLUDED IN CLEARANCE AREAS—continued DEMOLITION AND CLOSING ORDERS —continued 2. Housing Act, 1949:— Houses Persons displaced None None Closing Orders made under section 3 (1) and 3 (2) 3. Local Government (Miscellaneous Provisions) Act, 19S3:— Closing Orders made under sections 10 (1) and 11 (2) 5 20 REPAIRS Informal Action:— Number of houses* 50 4. Number of unfit or defective houses rendered fit during the period as a result of informal action by the local authority under the Housing Acts Action under statutory powers:— 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 1 6. Housing Act, 1936:— Number of houses made fit after service of formal notices (sections 9, 10, 11 and 16):— (a) by owners 14 (b) by local authority in default of owners 4 7. Housing Repairs and Rents Act, 1954:— Houses reconstructed, enlarged or improved and Demolition Orders revoked (section 5) None PART C —UNFIT HOUSES IN TEMPORARY USE (Housing Repairs and Rents Act, 1954) Number of houses* Position at end of period 8. (a) Houses retained for temporary accommodation and approved for grant under section 7 None (b) Separate dwellings contained in (a) above None (c) Houses licensed for temporary occupation (section 6) None PART D—PURCHASE OF HOUSES BY AGREEMENT 9. Houses in Clearance Areas, other than those included in confirmed Clearance Orders or Compulsory Purchase Orders, purchased in the period None *A defective house remedied more than once during the period is included once only. 46 Housing Repairs and Rents Act, 1954 and Rent and Mortgage Interest (Restrictions) Act—certificates of disrepair Applications for certificates of disrepair 140 Certificates issued 84 Applications for certificates withdrawn or certificates not granted 50 Applications outstanding at end of year 6 Certificates issued in 1955 in respect of applications received during 1954 27 Applications for revocation of certificates previously issued 87 Applications granted 79 Applications outstanding at end of year 8 Applications for revocation of certificates previously issued, received during 1954 and issued during 1955 6 for standards under ss. 11 ana 12 see appendix D. General statistics The following is a tabulated statement of various statistics extracted from a return to the London County Council covering the year 1955:— Item Total No. of new dwellings completed by the Borough Council 464 No. of new dwellings completed by other persons 137 Total houses in the borough (separately assessed dwellings) at 1 April, 1955 61,878 No. of dwelling-houses inspected on complaint 1,585 No. of dwelling-houses inspected house-to-house 3,403 No. of dwelling-houses inspected for any other reason 2,102 No. of dwelling-houses repaired, as a result of action under the Public Health and Housing Acts 1,029 Housing Act, 1936 Houses demolished as a result of formal or informal procedure under s.1l — Houses closed in pursuance of an undertaking given under s.11, and still in force 2 Parts of buildings closed by closing orders (s. 12):— Underground rooms — Other rooms 38 Local Government (Miscellaneous Provisions) Act, 1953 Closing orders made under s.10(l) 5 47 SECTION E—INSPECTION AND SUPERVISION OF FOOD Milk and Dairies Regulations, 1949 At the end of the year there were 112 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 29 Dealer's Supplementary Total Licences issued for:— sale of pasteurised milk 65 17 82 sale of tuberculin tested milk 62 17 79 sale of sterilised milk 75 17 92 TOTALS 202 51 253 Analysis of milk During the year under review, 199 samples of milk were submitted for examination to the Public Analyst by the Council's inspectors. 6 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 30 Period Samples Average composition of samples examined Percentage of Milk fat Solids not fat Water First quarter 79 3.89 8.78 87.33 Second quarter 26 3.36 8.78 87.86 Third quarter 22 3.64 8.67 87.69 Fourth quarter 66 4.00 8.86 87.14 TOTALS 193 3.83 8.79 87.38 48 Examination of heat-treated milk 215 samples of pasteurised milk and 9 samples of sterilised milk were submitted for examination during the year and all were found to be satisfactory. 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 7½ 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 67 samples submitted to the Public Analyst for analysis were found to have the composition shown in the appended table:— Table 31 Samples Average percentage composition Fat Milk solidsnot fat Sucrose Water First quarter 9 12.5 12.0 14.1 61.4 Second quarter 24 11.1 11.8 13.5 63.6 Third quarter 15 11.8 11.4 13.7 63.1 Fourth quarter 19 11.8 11.9 13.8 62.5 TOTALS 67 11.6 11.8 13.7 62.9 Icecream—grading Icecream is submitted to the Public Health Laboratory for bacteriological examination. The icecream is graded according to the time taken to decolorise a dye, methylene blue. The test is a provisional one and because of the many factors which govern the hygienic quality of icecream it is recommended officially that judgment should be based on a series of samples and that too much attention should not be paid to the result of an individual sample. It is suggested that over a six-monthly period, at least 50 percent of a vendor's samples should fall into grade 1,80 percent into grades 1 or 2, not more than 20 percent into grade 3 and none into grade 4. 49 During the year 175 samples of icecream were submitted for bacteriological examination with the following results:— Table 32 Grading Samples submitted % Grade 1 138 78.9 Grade II 16 9.1 Grade III 15 8.5 Grade IV 6 3.5 TOTAL 175 100.0 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. Unsound food Approximately 6½ 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. Food poisoning The following is the annual return of food poisoning notifications (corrected) furnished to the Ministry of Health:— (1) Food poisoning notifications (corrected) returned to RegistrarGeneral:— First quarter 2 Second quarter 6 Third quarter 33 Fourth quarter 12 53 (2) Outbreaks due to identified agents:— Total outbreaks Total cases — Outbreaks due to:— (a) chemical poisons — (b) salmonella organisms — (c) staphylococci (including toxin) — (d) Cl. botulinum — (e) Other bacteria — (3) Outbreaks of undiscovered cause:— Total outbreaks 2 Total cases 21 (4) Single cases:— Agent identified 13; Unknown 19; Total 32 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 395 Fish fryers 41 Sausages 108 Preserved meats 154 Preserved fish 27 Other preserved foods 3 Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 827, of which 123 were formal samples and 704 informal. After examination the public analyst reported that 8 of the formal samples and 7 of the informal samples were adulterated or below standard; the percentage of adulteration amounted to 6.50 in the formal samples, 0.99 in the informal samples and 1.81 of all the samples submitted, compared with 3.07 in the previous year. The following table gives the groupings and the results of the samples analysed:— Table 33 ARTICLES Examined Adulterated Informal Formal Total Informal Formal Total Bread and butter 1 8 9 — 1 1 Butter 9 — 9 — — — Cereals, bread, baking powder 11 2 13 — — — Cheese 5 — 5 — — — Cocoa, coffee, tea 17 — 17 — — — Confectionery (sweets) 26 — 26 — — — Condiments and flavourers 127 1 128 — — — Cream 7 7 — — — Drugs 68 1 69 — — — Fish, tinned 10 — 10 — — — Flour 15 — 15 — — — Fruit and vegetables 34 1 35 — — — Icecream 68 1 69 1 1 2 Lard and suet 17 — 17 — — — Margarine 22 — 22 — — — Meat, canned and pies 24 — 24 — — — Milk 91 108 199 — 6 6 Milk, condensed 8 — 8 1 — 1 Paste, fish and meat 27 — 27 — — — Sausages 85 — 85 5 — 5 Soft drinks 9 — 9 — — — Spirits 5 — 5 — — — Preserves 9 — 9 — — — Other foods 9 1 10 — — — TOTALS 704 123 827 7 8 15 51 Adulterated samples Table 34 Article Formal or Informal Adulteration or irregularity Action taken Sausages Informal 370 parts of sulphur dioxide per million. Notice displayed at subsequent visit. Milk Formal Fat deficient 16% Warning letter sent. Bread and butter Formal Bread and margarine Summons not served, owing to disappearance of defendant, who, it appears, gave a false address. Business changed hands. Hot milk Formal Extraneous water 14.2% £3 3s. fine; £1 1s. costs. Milk Formal Extraneous water 13.5% £3 3s. fine. Hot milk Formal Extraneous water 10.5% £1 1s. fine; £1 1s. costs. Hot milk Formal Extraneous water 10.8% £1 1s. fine. Hot milk Formal Extraneous water 8.3% £1 1s. fine; £1 1s. costs. Condensed milk Informal Acidity 0.75% Stock withdrawn from sale. Sausages Informal 240 parts of sulphur dioxide per million. Sausages were correctly labelled. Icecream Informal Fat deficient 34% £5 0s. 0d. fine. Icecream Formal Fat deficient 16% Sausages Informal 345 parts of sulphur dioxide per million. Notices displayed at subsequent visit. Sausages Informal 365 parts of sulphur dioxide per million. Sausages Informal 90 parts of sulphur dioxide per million. 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 (2) Water (7) River water (5) Corned beef Meat (4) Paste Lollies (19) Sand Bread (3) Icing sugar Dirt from van (2) Ice cubes Dried milk Rice Cakes Frozen egg (2) Egg albumen 52 Shops Act, 1950—section 38 Three certificates of exemption in respect of sanitary conveniences were issued during the year. Pharmacy and Poisons The names of 17 persons were entered on the Council's list of persons entitled to sell poisons in Part II of the poisons list and the names of 193 persons previously registered were retained on the register. 207 visits were paid by the food inspectors in connection with the granting and renewal of these licences. Slaughterhouses and slaughtermen There is one private slaughterhouse in the borough in respect of which the licence was renewed during the year, with the proviso that only pigs could be slaughtered. The premises were visited periodically by the food inspector. 342 pigs were slaughtered and the carcases inspected during the year. 8 of these carcases with a total weight of l,260 1bs. were condemned as tuberculous, and 3951bs. of heads and offals from 25 carcases were also destroyed. 3 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. 10 inspections were made during the year, and no adverse comments were made. Offensive trades There are no offensive trades carried on in the borough. Food work generally Mr. Thomas, the group food inspector, in commenting on the fact that the amount of food condemned during the year fell by 4½ tons as compared with 1954 states that this is almost entirely because butchers have no longer to accept meat allocated to them but can themselves buy what they require and can see, at the same time, the quality and condition of the carcases. Another factor has been the return to the practice of the wholesalers giving credit notes for blown tinned goods which are returned to them. Amongst the samples taken during the year were a number of hot milks purchased in restaurants, and some of these were found to be adulterated with water. This adulteration is usually caused by the addition of hot steam to cold milk in order to produce a so-called "hot milk." The result is of course a mixture of milk and water which cannot legally be sold as "milk." 53 On the quality of sausages there is at the moment no legal standard for meat content, and any action taken is on the certificate of the Public Analyst which is itself based on the now repealed minimum standard of 65 percent for pork and 50 percent for beef sausages. It is obvious that a sausage containing 60 percent of prime quality pork is superior to one containing 65 percent of inferior pork—probably derived from an old boar or sow—and it would seem that price cannot be divorced from quality. The composition of the icecream samples was well above the legal standard and the matter of the bacteriological examination of the samples can be regarded as satisfactory. A number of complaints were received from the public of foreign bodies in food and this is almost invariably due to carelessness. Difficulties with staff are usually put forward as an excuse but the fact remains that with normal care these complaints need never arise. In addition to the complaints which are brought to our notice there must be quite a number where the customer does not take any further action. In conclusion, the group food inspector thinks it would be fair to say that progress has been made in the hygienic condition of food premises generally and that the food sold in the borough has been of a good standard. 54 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 Cholera Continued fever Diphtheria Dysentery (bacillary or amoebic) Encephalitis, acute Enteric fever Erysipelas Food poisoning Glanders Hydrophobia Malaria Measles Membranous croup Meningococcal infection Ophthalmia neonatorum Plague Pneumonia, acute influenzal Pneumonia, acute primary Poliomyelitis, acute Puerperal pyrexia Relapsing fever Scabies Scarlet fever Smallpox Tuberculosis, all forms Typhoid fever, including paratyphoid Typhus fever Whooping cough INFECTIOUS DISEASES Number of notified cases (corrected for revised diagnosis) during the year 1955 with comparative figures for the previous six years. Table 35 Diseases Cases notified 1955 1954 1953 1952 1951 1950 1949 Anthrax — — — — — — 1 Diphtheria 1 — 1 — — — 3 Dysentery 92 394 84 169 365 63 9 Encephalitis (acute) — — 3 — 5 1 — Enteric or typhoid fever 1 1 2 — 4 1 3 Erysipelas 26 24 18 19 24 41 35 Food poisoning 48 110 32 33 26 38 50 Malaria 1 3 2 1 1 2 1 Measles 3905 521 2082 2183 2546 2084 1940 Meningococcal infection 4 6 10 5 6 7 3 Ophthalmia neonatorum 4 2 3 4 3 3 6 Pneumonia 121 77 189 89 173 108 84 Poliomyelitis (acute) 63 16 52 15 11 38 35 Puerperal pyrexia 92 59 57 88 63 29 27 Scabies 18 14 5 18 21 22 29 Scarlet fever 158 331 283 379 215 358 521 Tuberculosis 271 256 341 307 299 406 371 Whooping cough 412 449 574 512 819 813 363 TOTALS 5217 2263 3738 3822 5581 3608 3109 55 Notifications of infectious diseases in 1955 showing sex and age groups Table 36 Diseases Under 1 /- 3- 5- 10- 15- 25- 45- 65 plus Total M F M F M F M F M F M F M F M F M F M F Diphtheria — — — — — — — — — — — — — 1 — — — — — 1 Dysentery — 4 10 11 7 6 11 12 1 4 1 2 3 12 — 7 — 1 33 59 Enteric and Paratyphoid fever — — — — — — — — — — — — — — — 1 — — — 1 Erysipelas — — — — — — — 1 1 — — — 1 2 4 8 5 4 11 15 Food poisoning 1 1 1 1 — — 2 2 — 1 — 16 2 10 3 7 — 1 9 39 Malaria — — — — — — — — — — 1 — — — — — — 1 Measles 56 44 422 366 500 474 952 1026 17 17 10 4 5 11 — 1 — 1962 1943 Meningococcal infection 1 1 1 1 — — — — — — — — — — — — — — 2 2 Ophthalmia neonatorum 2 2 — — — — — — — — — — — — — — — — 2 2 Pneumonia 3 1 2 1 3 2 8 7 — 3 6 5 13 12 20 11 10 14 65 56 Poliomyelitis (paralytic) 1 1 3 1 2 1 11 8 1 1 2 3 4 3 1 — — — 25 18 Poliomyelitis (nonparalytic) 3 1 1 — 2 1 3 4 1 1 1 2 — — — — — 16 4 Puerperal pyrexia — — — — — — — — — — — 36 — 55 — 1 — — — 92 Scabies — 1 1 2 1 — 4 1 1 2 1 1 — 2 1 1 — — 8 10 Scarlet fever — — 8 7 18 16 46 49 4 7 1 — — 1 — 1 — — 77 81 Tuberculosis (respiratory) — — 2 — 3 — — 3 1 3 24 52 44 48 39 15 20 1 133 122 Tuberculosis (nonrespiratory) — — — — — — 1 — — 1 3 1 5 3 2 — — 5 11 Whooping cough 23 17 38 42 38 66 71 87 6 13 — 1 1 7 — 2 — — 177 235 Totals 90 73 489 432 574 566 1108 1197 36 52 48 124 76 169 70 57 35 21 2526 2691 56 Analysis of certain diseases in table 36 into divisional areas— Table 37 Disease Div. areas Under 1 /- 3- 5- 10- 15- 25- 45- 65+ Total Dysentery W 2 5 2 5 2 1 2 2 — 21 N 1 9 4 3 2 1 1 — 1 22 S 1 7 7 15 1 1 12 5 — 49 Total 4 21 13 23 5 3 15 7 1 92 Measles W 27 290 365 639 12 3 8 _ — 1,344 N 30 222 256 598 10 5 2 1 — 1,124 S 43 276 353 741 12 6 6 — — 1,437 Total 100 788 974 1,978 34 14 16 1 — 3,905 Pneumonia W 1 — 2 1 — 5 9 4 5 27 N 2 2 2 8 — 1 8 9 11 43 S 1 1 1 6 3 5 8 18 8 51 Total 4 3 5 15 3 11 25 31 24 121 Poliomyelitis W 2 _ 2 10 3 3 3 1 _ 24 N 2 2 4 10 1 2 3 — — 24 S 2 3 — 2 3 2 3 — — 15 Total 6 5 6 22 7 7 9 1 — 63 Scarlet fever W _ 7 18 27 3 — 1 1 — 57 N _ 1 6 17 3 _ — — — 27 S — 7 10 51 5 1 — — — 74 Total — 15 34 95 11 1 1 1 — 158 Tuberculosis (respiratory) W — 4 _ — — 25 35 13 6 83 N _ — 1 1 1 21 31 21 9 85 S — — — 2 3 30 26 20 6 87 Total — 4 1 3 4 76 92 54 21 255 Whooping cough W 9 28 27 46 5 — _ _ _ 115 N 5 21 31 31 5 — 1 _ — 94 S 26 31 46 81 9 1 7 2 — 203 Total 40 80 104 158 19 1 8 2 — 412 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. 57 The work of the infectious disease visitors as agents of the medical officer of health includes the investigation of home conditions, the giving of advice to patients and contacts, particularly where the patient is left at home, and in general the taking of such measures as may be necessary to combat the spread of infection. The following is a summary of the work in visiting infectious diseases carried out during the year which is in addition to the visits paid by the sanitary inspectors referred to in table 20:— Table 38 W N S Total Visits 462 355 641 1458 Futile visits 380 379 568 1327 Revisits 256 210 265 731 Total 1098 944 1474 3516 Poliomyelitis 1955 had the highest incidence of poliomyelitis since the epidemic of 1947. 63 cases were confirmed and of these 43 were paralytic and 20 non-paralytic. They were fairly well distributed over the borough, 24 being in the west, 24 in the north, and 15 in the south divisions. 41 were males and 22 females. Table 39 gives figures for this borough over the last 9 years, the time during which the incidence has been high. Table 39 Year (a) Intimated to Dept. (b) Removed to hospital (c) Confirmed (d) (d) as % age 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 5 103 100 63 61 TOTAL 660 640 321 49 58 Altogether it will be seen that there have been over 300 confirmed cases of poliomyelitis in the borough beginning with the year 1947. The next table gives various comparisons between each of these last nine years. Table 40 Year Confirmed coses Division No. of weeks with 3 or more cases Type Sex Age groups Result* W N S Paralytic N-P M F 0- /- 5- 15- 25- 45- 65+ Died Compl. recov. Paralysed Unknown Severe Mild 1947 % 76 26 24 26 10 47 29 43 33 2 23 27 11 12 1 — 7 22 20 19 8 34 32 34 62 38 57 43 3 30 35 15 16 1 0 10 32 29 28 — 1948 % 9 3 4 2 1 5 4 4 5 — 2 3 2 2 — _ — 5 1 2 1 33 45 22 56 44 44 56 0 22 34 22 22 0 0 0 63 12 25 — 1949 % 41 13 13 15 5 29 12 25 16 5 14 13 5 4 — — 3 14 10 10 4 32 32 36 71 29 61 39 12 34 32 12 10 0 0 8 38 27 27 — 1950 % 38 13 10 15 6 26 12 19 19 1 11 11 9 6 — _ _ 14 12 9 3 34 26 40 68 32 50 50 3 29 29 23 16 0 0 0 40 34 26 — 1951 % 11 3 3 5 Nil 2 9 8 3 — 5 1 1 4 — 8 — 1 2 27 27 46 18 82 73 27 0 46 9 9 36 0 0 0 89 0 11 — 1952 % 15 3 4 8 Nil 8 7 8 7 _ 4 8 1 2 _ — _ 8 4 3 _ 20 27 53 53 47 53 47 0 27 53 7 13 0 0 0 53 27 20 — 1953 % 52 75 14 13 10 35 17 22 30 3 13 21 10 5 — 2 22 13 13 2 48 27 25 67 33 42 58 6 25 40 19 10 0 0 4 44 26 26 — 1954 % 16 3 8 5 Nil 4 12 8 8 1 6 6 2 1 — _ _ 15 — 1 — 19 50 31 25 75 50 50 6 38 38 12 6 0 0 0 93 0 7 — 1955 % 63 24 24 15 10 43 20 38 25 5 12 28 8 9 1 _ 2 32 8 19 2 38 38 24 68 32 60 40 8 19 44 13 14 2 0 3 53 13 31 — Total % 321 113 104 104 — 199 122 173 146 17 90 118 49 45 2 _ 14 140 68 77 22 36 32 32 62 38 55 45 5 28 37 15 14 1 0 5 46 23 26 — *The percentages in these columns relate to the traced cases. 59 The following points of interest may be noted : the rough similarity of the three divisions of the borough in the number of cases ; the fairly constant ratio of paralytic to non-paralytic cases (except to some extent in non-epidemic years) ; the variations from year to year in the sexes (but giving a small preponderance of boys over the total period) ; the fact that only two persons over 45 years of age were affected in the whole nine years, while approximately one-third were under 5 and one-third were of school age ; and the total result that about one in twenty dies, five in twenty have severe paralysis, five in twenty have a mild paralysis and nine in twenty recover completely. These figures are from statistics collected to some extent this year ; some of the cases could not be traced, as indicated in the table. Measles, dysentery, whooping cough Notes on the incidence of these diseases are included in the introduction to this report. 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 41 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- 2- 2 3 - - - 2 3 - - - - - - - 510- 1 3 3 - 1 1 4 3 - - - - - - 1520- 11 13 32 20 1 2 1 11 14 34 21 - - - - - - 2535- 28 16 28 70 1 1 4 29 16 29 74 1 2 - 1 1 3 4555- 19 20 12 3 2 1 2 21 21 14 3 5 1 - 2 5 3 65- 19 1 _ _ 19 1 6 1 1 7 1 75 + 1 - - 1 - 3 3 - 3 3 133 122 5 11 138 133 15 7 1 3 16 10 60 Analysis of new cases of tuberculosis into divisional areas :— Table 42 Division Sex 0- /- 2- 5- 10- 15- 20- 45- 55- 65- 75- Total West Respiratory M - 2 2 - - 4 6 6 S 5 - 46 F - - - - - 10 5 2 - 1 - 37 Nori-respiratory M - - - - - - 1 - - - - 2 F - - - - - - - 1 - - - 2 Total M - 2 2 - - 4 7 6 5 5 - 48 F - - - - - 10 5 3 - 1 - 39 North Respiratory M - - 1 - 1 2 3 10 6 8 1 49 F - - - 1 - 6 10 4 1 - - 36 Non-respiratory M - - - - - - - - - - - — F - - - - - - 1 - - - - 4 Total M - - 1 - 1 2 3 10 6 8 1 49 F - - - 1 - 6 11 4 1 - - 40 South Respiratory M - - - - - 5 4 3 9 6 _ 38 F - - - 2 3 16 5 6 2 - - 49 Non-respiratory M - - - - - - - 2 1 - - 3 F - - - 1 - 2 - 1 - - - 5 T otal M - - - - - 5 4 5 10 6 - 41 F - - - 3 3 18 5 7 2 - - 54 Points to be noted in the above table are : (1) the relatively high number of cases in the age group 15-20, where there were 43 cases of respiratory tuberculosis of which 32 were female ; and (2) the total female to male preponderance in respiratory tuberculosis in the South division. Since 1952 the proportion of female to male cases there has been 88 percent, 78 percent, 80 percent, and, last year, 129 percent. This difference may be due to chance, or to selective mass x-ray, or to some other cause. 61 Summary of statistics as to tuberculosis for the last ten years Table 43 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 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 2.22 119 109 048 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 1955 223,400 271 1.21 26 22 0.10 0.16 General comments on tuberculosis are made in the introduction of this report (page 4). Tuberculosis — environmental conditions Case papers of patients attending the Lewisham Chest Clinic in 1955 have been analysed in 349 cases with the following results :— Cases 0/ * /o Males 181 52 Females 168 48 Social classification :— Class I 1 1 Class II 29 9 Class III 227 69 Class IV 34 11 Class V 32 10 Not classifiable 26 — Rooms occupied :— 2 or more rooms per person 43 12 1-2 rooms per person 212 61 Less than 1 room per person 92 27 No information ... 2 — Accommodation :— Separate bed 143 41 Separate bedroom 108 31 Condition of premises occupied :— Good 246 72 Fair 80 23 Poor 16 5 No information 7 - *Excluding cases not classified 62 Mass radiography unit I am indebted to the Director of the Unit for information of work done in the borough during 1955 on which the following table is based. The Unit during the course of the year was stationed at nine different locations in the borough, the time spent varying from two days to six weeks. Table 44 Patients Men Women Total General analysis X-rayed 6,153 6,176 12,329 Previously x-rayed 4,056 3,310 7,366 Recalled for large film 220 200 420 Normal on large film 80 91 171 Abnormal on large film 140 108 248 Not yet re-attended — 1 1 Analysis of abnormal large films :— Cases considered tuberculous :— (a) no further action required — 1 1 (b) occasional supervision only 12 7 19 (c) requiring treatment 21 18 39 (d) still under investigation 1 1 2 Non-tuberculous cases :—• (a) investigated 16 11 27 (b) still under investigation 1 — 1 Cardio-vascular lesions 9 12 21 Previously known tuberculous cases 5 9 14 No action required 75 49 124 All 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 is shown that since 1945 notifications had fallen from over 18,000 in that year to a new low figure of 161 (provisional) for 1955. The Minister expresses the hope that authorities will continue the campaign with renewed vigour during 1956 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, 1955, was 11,685,523. During the first half of 1955, 278,875 children were immunised, of whom 125,673 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 1956 being 486,000 children under one year. In 1951, only 28 percent of the number of babies reaching the age of one year were immunised ; in 1952 the 63 figure rose to 31 percent, slightly declining to 30.4 percent in 1953, and rising to 36 percent in 1954. In the first half of 1955 it rose to 38.4 percent. The Minister points out that elimination of diphtheria is conditional upon the maintenance of an adequate level of immunisation and that if parents leave their children unprotected there may be a return of diphtheria outbreaks, particularly among the 0-4 age group where the fatality ratio is still high in comparison with other age groups. 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 45 Age at December 31, 1955 Under 1 1 2 3 4 5-9 10-14 Total under 15 Horn in year 1955 1954 1953 1952 1951 1950-46 1945-41 (i) Diphtheria and combined diphtheria and whooping cough :— immunised during year immunised at end of year 329 329 1,883 2,201 160 2,660 74 2,155 66 2,812 208 14,578 7 14,947 2,727 39,682 Estimated mid-year population 16,000 32,200 48,200 (ii) Whooping cough (including combined)— Immunised during year (age at date of immunisation) 1,537 574 158 86 56 62 3 2,476 (iii) Vaccination. Vaccinated during the year (age at date of vaccination) Under 1 1-4 5-14 15 and over Total Primary :— at clinics 897 67 17 20 1,001 by General Practitioners 718 132 54 97 1,001 Revaccination :— at clinics and day nurseries — 10 20 103 133 by General Practitioners 1 6 23 259 289 64 APPENDIX A Acts of Parliament, Statutory Instruments and Circular Letters issued by Government Departments with regard to the public health services, during the year 1955 :— Statutes The Food and Drugs Act, 1955. Statutory Instruments No. 554 The Transfer of Functions (Ministry of Food) Order, 1955. 828 The Food Standards (Table Jellies) (Amendment) Order, 1955. 917 Slaughter of Animals (Prevention of Cruelty) (Amendment) Regulations, 1955. 959 The Transfer of Functions (Food and Drugs) Order, 1955. 1134 The Poisons List Order, 1955. 1135 The Poisons Rules, 1955. 1898 The Food and Drugs Act, 1954 (Appointed Day) Order, 1955. 1899 The Food Standards (Butter and Margarine) Regulations, 1955. 1900 The Labelling of Food (Amendment)Regulations, 1955. 1901 Mineral Oil in Food (Amendment) Regulations, 1955. 1906 The Food Hygiene Regulations, 1955. Ministry of Health Circulars. No. 5 Diphtheria prophylaxis — publicity campaign. 17 Annual Reports of Medical Officers of Health for 1955. Ministry of Agriculture, Fisheries and Food Circulars. No. 1 Myxomatosis in rabbits and hares. 4 Standard for table jellies. 5 Slaughter of Animals (Prevention of Cruelty) (Amendment) Regulations, 1955. 6 The Transfer of Functions (Food and Drugs) Order, 1955. 8 Milk and Dairies Regulations — approved oxidising and preservative agents. 10 Approved Oxidising and Preservative Agents Milk and Dairies Regulations, 1949-1954. 11 Labelling of Food (Amendment) Regulations, 1955: Food Standards (Butter and Margarine) Regulations, 1955. 13 Food and Drugs Act, 1955. 14 Food and Drugs Act, 1955. Ministry of Housing and Local Government Circulars. No. 59 Housing Repairs and Rents Act, 1954, Part II Return of certificates of disrepair. 73 Slum clearance compensation. General Register Office Circulars. No. 2 Infectious and other notifiable diseases — quarterly return. 3 Annual reports of Medical Officers of Health, 1954 — vital statistics. 65 APPENDIX B Legal Proceedings in 1955 The following are details of legal proceedings instituted during the year:— PUBLIC HEALTH (LONDON) ACT, 1936 Nature of summons No. of summonses Total fines Total costs Remarks Failure to comply with requirements of nuisance notices. 55 £ s. - d. £ 31 s. 7 d. 6 In 31 cases abatement orders were made. In the remaining cases the summonses were adjourned, withdrawn or not served. Failure to comply with requirements of an abatement order in connection with nuisance notices. 2 5 0 0 2 0 0 Authority to exercise powers to enter premises under section 274. 1 Warrant granted. Failure to comply with requirements of notice served under section 122 (cleansing or destruction of filthy or verminous articles). 1 - - Abatement order made. Failure to comply with requirements of an abatement order in connection with section 122. 1 2 2 0 - Failure to comply with notices requiring the provision of dustbins. 2 Withdrawn. Dustbins provided. Contraventions of byelaws 6(4)(a) and 12 of the drainage byelaws made by LCC. 2 5 0 0 2 0 0 - Continuing offence against byelaw 12. 1 — — Withdrawn.Work completed. Contravention of byelaw (1) made by the LCC (bones and meat in state of putrefaction removed by road during prohibited hours.) 1 2 2 0 1 1 0 - Contravention of byelaw (1) made by the LCC (failing to remove offensive matter in suitable carriage). 1 2 2 0 - LONDON COUNTY COUNCIL (GENERAL POWERS) ACTS Nature of summons No. of summonses Total fines Total costs Remarks Delivery of toys to children by rag and bone dealer contrary to section 26 of the Act of 1952. 1 £ s. d. £ s. d. Absolute discharge. 66 PUBLIC HEALTH (MEAT) REGULATIONS, 1924 and 1948 Nature of summons No. of summonses Total fines Total costs Remarks Failing to cause inside of meat van to be kept clean. Ditto ditto Failing to cause meat to be adequately covered when conveyed in vehicle. 1 2 1 £ s. d. £ s. d. 5 5 0 Absolute discharge. Summonses dismissed. Summons dismissed. FOOD AND DRUGS ACT, 1938 Nature of summons No. of summonses Total fines Total costs Remarks £ s. d. £ s. d. Contraventions of section 3 Sale of pork pie containing hair. 1 5 0 0 — — Milk containing glass 1 8 0 0 1 1 0 — Banbury cake containing piece of glass. 1 5 0 0 1 1 0 Bread containing fragments of insect. 1 10 0 0 5 5 0 - Sausages containing glass 1 5 0 0 1 1 0 - Bread containing tooth 1 — — Withdrawn. Hot milk containing extraneous water. 5 9 9 0 3 3 0 — Cake containing nail 1 3 3 0 1 1 0 — Mince pie containing piece of metal. 1 10 10 0 1 1 0 — Bread containing piece of string. 2 8 8 0 2 2 0 — Icecream deficient in fat 1 5 0 0 — — Contravention of section 14(6) Failure to notify Local Authority that as new occupier of premises, defendant wished to continue sale of icecream. 1 — 7 6 Summons withdrawn. Registration effected. Contraventions of section 13 Subs. 1 (c) (d) (h) 2 — — Summonses not served owing to disappearance of defendant. Subs. 1 1 — 1 1 0 Absolute discharge. Contravention of section 9 Sale of bread and butter said to be bread and margarine. 1 — — Summons not served owing to disappearance of defendant. APPEALS Nature of Appeal Result By owner against notice served requiring him to provide dustbin for use of tenant. Appeal upheld. Tenant ordered to provide dustbin. By applicant against refusal by Council to register premises for sale and storage of icecream under section 14 of the Food and Drugs Act, 1938. Appeal allowed. By owner against notice served requiring him to provide dustbin for use of tenant. Appeal dismissed. Against conviction for failing to cause inside of van used for conveyance of meat to be kept clean. Appeal dismissed. £15 15s. Od. costs awarded. APPENDIX C List of special reports submitted to the Health Committee by the Medical Officer of Health during 1955 :— January 11 Work generally under ss. 9 and 10 of the Housing Act, 1936. January 11 Report of the committee on air pollution. March 8 Workrooms for the elderly. March 8 Student sanitary inspectors. April 19 Workrooms for the elderly. July 5 Omission of natural lighting and ventilation to waterclosets. July 5 Housing: repairs and clearance. October 4 Houses in multiple occupation (See appendix D). 67 68 APPENDIX D HOUSES IN MULTIPLE OCCUPATION Sections 11 and 12 of the Housing Repairs and Rents Act, 1954 allow the Borough Council to serve notices (a) requiring adequate provision of various amenities and facilities in houses let in lodgings or occupied by members of more than one family and (b) specifying in relation to any room on the premises the maximum number of persons by whom it is suitable to be occupied for sleeping purposes. The person in control of the house must, on receipt of a notice, and if he is unable to carry out the works required, take such steps as are reasonably open to him (including if necessary the taking of legal proceedings) for securing a reduction in the number of persons or households accommodated. To help owners and agents the Committee adopted certain standards which can be used as guides, though it is stressed that each house coming into review is treated entirely on its individual merits. Nevertheless it was thought that these guides might be of great use to agents and owners. They are as under. STANDARDS (1) Natural lighting (a) Provision and maintenance in every habitable room of a window or windows opening directly to the external air and having a glass area equal to one-tenth of the floor area and an openable area equal to one-twentieth of the floor area. (b) Provision and maintenance, wherever practicable, of adequate means of natural light to a common staircase. (2) Ventilation Provision and maintenance of adequate means of ventilation for every passage, room, water closet apartment and staircase. (3) Water supply (a) Provision of one tap per floor and if more than one letting one tap per letting, from the rising main if practicable. In addition, provision of a sink of suitable size and pattern and efficient means for the carrying off of any waste water from the tap. (b) Provision in every hostel, boarding house, guest house, and boarding school of a water supply reasonably accessible to the occupants of each sleeping room. 69 (4) Sanitary conveniences (a) Provision and maintenance of one readily accessible water closet for every four habitable rooms, or one readily accessible water closet for every eight persons irrespective of age, whichever standard is higher. (b) Provision for single room lettings of one water closet for every four lettings, such water closet to be not more than one floor distant. (5) Facilities for storage, preparation and cooking of food Provision of separate kitchen facilities for every family. Such facilities to comprise a sink with piped water supply over, a proper waste pipe, and a food cupboard ventilated to the external air of dimensions of not less than :— for a one room letting 3 cu. ft. for a two room letting 4 cu. ft. for a three room letting 6 cu. ft. for a dwelling comprising more than three rooms 8 cu. ft. Note (a) Kitchen facilities can be provided in a living room providing the room is of adequate size, or alternatively they can be provided on a landing so long as the landing is sufficiently large, ventilated and separate for the use of one family. Note (b) Where a room is let to one person and no meals are provided, a kitchenette is to be available for each individual room, or one equipped kitchen provided on every floor. (6) Sleeping accommodation (a) A bedroom under 70 square feet is to be regarded as suitable for one person. A bedroom 70-90 square feet is to be regarded as suitable for a maximum of two persons. A bedroom 90-110 square feet is to be regarded as suitable for a maximum of three persons. A bedroom over 110 square feet is to be assessed by the committee. Underground rooms are not permitted to be used for sleeping purposes. Note :—A person is an individual over one year of age. (b) The provision in hostels and boarding schools of a minimum floor space of 60 square feet for each individual. 70 table subject page no. Section A 1 Comparative statistics 9 2 Causes of death by age groups 10 3 Deaths under one year 12 4 Local sickness 13 5 Deaths by social class 13 6 Causes of death by social class 14 7 Grouped causes of death by social class 15 8 Births, infant deaths, etc., by social class 15 9 Heart and circulation tality 17 10 General statistics from 1901 18 Section B 11 Disinfecting station 20 12 Verminous conditions, etc. 20 13 Laboratory facilities 22 14 Public mortuary 22 15 Rodent control—treatment of rivers 24 16 Prevention of damage by pests 25 17 Atmospheric conditions ... 28 18 Water, chemical samples... 31 19 Water, bacteriological samplesn 31 Section C 20 Sanitary inspection 32 21 Summary of notices 33 22 Nuisances remedied —Public Health Act 34 table subject page no. Section C—continued 23 Nuisances remedied —Housing Act 36 24 Factory inspections 36 25 Factory defects 37 Section D 26 Demolition orders 42 27 Closing orders (s. 12) 42 28 Clearance areas 44 Section 29 Milk licences 47 30 Analysis of milk 47 31 Icecream composition 48 32 Icecream grading. 49 33 Samples analysed 50 34 Adulterated samples 51 Section F 35 Notified cases of infectious diseases fectious diseases by age and sex 55 37 Analysis of certain diseases into divisional areas 56 38 Infectious disease visiting 57 39 Poliomyelitis 57 40 Comparison of polio cases over nine years ... 58 41 Tuberculosis notifications and deaths 59 42 Analysis of new cases of tuberculosis into divisional areas 60 43 Tuberculosis statistics 61 44 Mass radiography 62 45 Immunisation against fectious disease 63 CHART Measurement of atmospheric pollution 27 TABLES 71 INDEX subject page Acts, regulations and orders 64 Area of borough 8 Atmospheric conditions 27 Births and birth rate . 8 Clearance areas 44 Coronary disease 16 Deaths and death rate 8 Deaths, causes of 10 Deaths under age 65 17 Disinfection and personal cleansing 20 Dog nuisances 26 Drainage work 26 Dysentery 59 Exhumations 40 Factories. 35 Flies and mosquitoes 21 Food, adulteration of 50 Food inspection and supervision 47 Food poisoning 49 General statistics from 1901 18 Hairdressers, registration of 37 Health Services, general provision of 20 Heating appliances 52 Heattreated milk 48 Housing :— Building 41 Families rehoused 41 Housing Act, 1936 41 Housing Repairs and Rents Act, 1954 46 Icecream composition 48 Icecream grading 48 Immunisation 62 Infant mortality 9 Infant mortality statistics 12 Infectious diseases 52 Infectious disease visiting 56 Laboratory facilities 22 Legal proceedings 65 Lung cancer 17 subject page Mass miniature radiography 62 Maternal deaths 9 Milk, analysis of 47 Milk and Dairies Regulations, 1949 47 Mortuary and Coroner's Court 22 National Assistance Act, 1948, s.50 26 Nuisances remedied 34 Offensive trades 52 Old people 26 Outworkers 38 Pet Animals Act, 1951 39 Pharmacy and Poisons Act, 1953 52 Pigeons 39 Poliomyelitis 57 Population 8 Prevention of Damage by Pests Act, 1949 25 Rag Flock and Other Filling Materials Act, 1951 39 Rateable value 8 Rent and Mortgage Interest (Restrictions) Acts 46 Rodent control 24 Sampling 50 Sanitary circumstances of the area 32 Shops Act, 1950 52 Sickness, local 13 Slaughterhouses 52 Smoke nuisances 33 Social medicine statistics 13 Staff 2 Stillbirths 8 Swimming baths 26 Tuberculosis 59 Unsound food 49 Vital statistics 8 Water certificates 35 Water supply 30 Whooping cough 59 JR2/68