AC 4374 LEW 44 METROPOLITAN BOROUGH OF LEWISHAM THE PUBLIC HEALTH OF LEWISHAM Report of the Medical Officer of Health for the Year 1956 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 1956 E. H. R. Smithard, MBE, MD, DPH CONTENTS Page Staff 2 Introduction 3 Vital Statistics 10 General Provision of Health Services 22 Sanitary Circumstances of the Area 40 Housing 46 Inspection and Supervision of Food 52 Infectious Diseases 59 Appendix A - Statutory Instruments 68 „ B — Legal Proceedings 69 „ C — Special Reports to Health Committee 71 "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 68 2 STAFF as at 31/12/56 Medical Officer of Health E. H. R. Smithard, mbe, md, bs, mrcs, lrcp, dph Senior Public Health Inspector Deputy Senior Public Health Inspector E. Walker (a) (b) A. J. Phillips (a) (b) Group Public Health Inspectors A. G. Thomas (a) (b) (Food) *R. Mahoney (a) (b) (District) J. R. Craven (a) (b) (Housing) Assistant Group Housing Inspector R. C. Brittain (a) (b) District Inspectors Divisional Food Inspectors *J. W. Bevan (a) (b) H. W. Ellery (a) (b) *C. L. Connor (a) (b) H. Tolson (a) (b) R. L. Davis (a) *G. E. Fallows (a) (b) L. Gardiner (a) * E. A. Howard (a) (b) S. Kelly (a) H. J. Rogers (a) *K. R. Wagener (a) (b) Three vacancies (a) Public Health Inspector's certificate. (b) Food Inspector's certificate. *With responsibility for certain food work. Infectious Disease Visitors Mrs. A. Carins, srn, rfn Mrs. L. Champness, srn, rfn Principal Clerk E. W. Cheesman Clerical Staff S. Burridge, senior clerk A. R. Burchmore (trainee publichealth inspector) L. J. Cleverly C. R. Coleman A. J. Thrussell (trainee public health inspector) Mrs. I. L. Fry Mrs. D. J. Handford D. B. Smith (trainee public health 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 1956. Vital statistics The Registrar General's estimate of the population in midyear 1956 at 222,100 was 1,300 less than his estimate for midyear 1955. The decrease from the 1951 census figure of 227,576 therefore continues steadily. The crude birth rate for the year at 14.5 shows a slight increase on the previous year and the adjusted birth rate (allowing for age and sex distribution of the population) is also rather higher at 13.8. The crude death rate at 11.3 is again an increase on the previous year, but it remains less than the rate for the administrative county. The infant mortality rate at 19 was 2 up on the previous year, which was the lowest on record. 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 went up from 11 to 16, but the rest of the first year rate dropped from 6 to 3, which is a low record. The stillbirth rate at 19 was almost the same as the previous year and the combined stillbirth and infant death rate (reproductive wastage) of 38 therefore showed a slight increase. The various comparative figures of general statistics since the beginning of the century are shown in table 10. Infectious disease other than tuberculosis The total number of notifications received (including 212 for tuberculosis) was 1,709, which is the lowest number for many years past. The decrease was mainly due to the lack of measles cases, of which almost 4,000 had been notified in 1955, whereas only 206 were notified last year. Almost one-third of the total notifications of all infectious disease were due to dysentery, of which 579 cases were notified-a high number. Schools again seemed to be the centre of the spread and with our present knowledge it appears to be very difficult to control the disease once it appears in a school. However it remains a very mild infection, being more of a nuisance than anything else, but it does interfere considerably with education, both of patients and to a lesser extent of their home contacts. Poliomyelitis had only a moderate incidence, there being 26 cases as against 63 in the previous year. The Ministry of Health vaccine was used for the first time, but it arrived too late and in insufficient quantity for as many cases to be done as were willing to have it. It is hoped that more will be available in 1957 and that parents will appreciate the advantage of helping their children to avoid poliomyelitis in this way. The vaccine is not claimed to create an absolute protection, and perhaps the British vaccine is slightly less effective (and slightly safer) than vaccine used in some other countries, but all the statistics so far seem to indicate that it has a definite effect in reducing the likelihood of poliomyelitis infection. 4 Tuberculosis The number of new notifications, which had increased slightly last year compared with the previous year, dropped in 1956 to 212, the lowest on record. This is equivalent to a rate of 88 per 100,000 population for pulmonary tuberculosis and 8 for other forms. The number of deaths from pulmonary tuberculosis at 29 was equivalent to a rate of 13 per 100,000 population. This is slightly more than last year but there also seems to be a definite falling off in the number of new cases. When it is borne in mind that increasing efforts are made to ascertain new cases (by followup of contacts, mass X-ray and so on) this fall in the incidence is gratifying. Food hygiene The number of notified cases of food poisoning was 46 and this was much the same as in previous years. Throughout the year the food inspectors continued to give advice to occupiers of food shops with regard to general hygiene and pest control. The Food and Drugs Act, 1955 and the Regulations made under it came into force on January 1, 1956-although a few of the Regulations did not become fully operative until July 1. As a rather different method of registration of certain food premises is laid down under the new Act, the opportunity was taken to revise completely the food register. All registered premises were therefore noted for revisiting and detailed inspection, and applications for the registration of the necessary parts of the premises were put to the committee for approval. The opportunity was taken of giving further advice to the shopkeepers, both verbal and written, and as a result many premises which could be regarded as substandard were brought up to a reasonably hygienic level. The work of reregistration was not completed by the end of the year Old people One additional club applied for and received grant aid, and altogether twelve clubs or organisations were in receipt of grant from the Council. Details are shown in the body of the report. The grant 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 its members. 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. Similarly the committee give considerable encouragement to the running of the meals-on-wheels service for housebound old people a service which is administered by the Lewisham Old People's Welfare Association. The admission of old people who are not acutely ill to a hospital or a Home remains a difficult problem and a fuller report on this is made in the main section (p. 29). 5 Clean air The Clean Air Act came into force during the year and at the very end of the year various guiding memoranda were issued by the central Ministry. The avowed objective of the legislation is to do away, within the next fifteen years, with all visible smoke except from a few industrial processes. It is thought that if this can be achieved there might over the country as a whole be a saving of up to £200 million on material matters alone, quite apart from the increased health and the saving of hospital costs which might ensue. The problem is a large one and will require resolute tackling, but the objective appears to be attainable. Further details of the clean-air legislation and proposed procedure will be found in the body of the report. Staff There are still vacancies on the establishment for inspectors, but the scheme for training student inspectors is working well and this is likely to turn out to be the long-term solution of the problem. During the year the title of sanitary inspector was changed by legislation to that of Public Health Inspector. This is the third legislative alteration, reflecting perhaps not only the changing shades of meaning attached to words but also alterations in the duties required of the officers concerned. The first official title, which is referred to in the next section of this introduction (1856—1956) was inspector of nuisances. 1856 -1956 The prototype of the borough council, namely the Lewisham Board of Works, first met in 1856 and therefore it is opportune to include in the present report for 1956 some indication of the conditions one hundred years previously. Fortunately the first reports are still available. The Lewisham Board of Works was constituted under the Metropolis Local Management Act—"An Act for the Better Local Management of the Metropolis." Lewisham and Penge were connected and members of the Lewisham Board of Works were nominated by the Vestry of Lewisham, which consisted of 36 elected members, and that of Penge, which consisted of 18 elected members. The Lewisham district comprised the parish of Lewisham (including the district parishes of Sydenham and Forest Hill) and the hamlet of Penge. The Board of Works consisted of 27 members of whom 24 were appointed by the Vestry of Lewisham and 3 by the Vestry of Penge. The jurisdiction of the Board could be comprised under three heads: 1. the repair and general management of the public highways in the district, 2. the drainage of the district (both land drainage and drainage for sewerage purposes), and 3. the sanitary condition of the district, the Board being the local authority for the execution of the duties and powers of "the Nuisances Removal Act for England, 1855." 6 The Board at first decided that they must meet at least once a week, and did so on Thursdays at 6 p.m. This however after some time was found to be insufficient and for five months an additional weekly meeting was held on Monday mornings. If insufficient members were present to constitute a quorum, then, provided there were not less than three of them, they formed a committee "for the consideration and despatch of matters of business requiring immediate attention." During 1856 there were 74 meetings of the various kinds and a Dr. Henry Greenwood heads the list of attendances with 68. The first step taken by the Board was to determine what officers were required, and to allot their duties. At an early meeting a treasurer, a clerk, a medical officer of health, a surveyor, two inspectors of nuisances (also acting as assistant surveyors) and a scavenger or dustman were appointed. The clerk and surveyor were both fulltime with salaries of £200 a year. The duties of the medical officer of health were to inspect and ascertain the sanitary conditions of the district, to point out such causes as were likely to affect injuriously the health of the inhabitants, and to indicate the most efficacious mode of preventing or checking the spread of epidemics. He was required to make a report to the Board on this once a month, or oftener if required, and his remuneration was a fee of five guineas for each report. The duties of the inspectors of nuisances were to include enforcing the execution of the duties of the scavenger; to provide and keep a book for entry of all complaints of nuisances (into the truth of which the inspector had to enquire forthwith and report to the Board); to make, subject to the direction of the Board, complaints before justices and take legal proceedings; and to carry out certain duties as assistant surveyors. One of them had to be resident in the village of Lewisham and the other in the village of Sydenham and their salary was £80 a year each. The treasurer was apparently an honorary treasurer, as an Alderman was appointed who was required to invest £1,000 in Consols as security for the due performance of the duties of the office. After advertisement, Dr. F. E. Wilkinson was appointed medical officer of health and Messrs. John Duncan and Luke Skeet as inspectors of nuisances and assistant surveyors. A lot of work appeared to be done that first year, much of it on the drainage side, at the particular instance of the medical officer and the inspectors of nuisances. However the report says that the complaints of nuisances fey the inhabitants "are comparatively rare; the Board therefore relying on their medical officer and inspectors of nuisances for the efficient performance of this branch of their duties; the zeal of the former is fully manifested in his reports." The inspectors during that time laid before the Board about 150 reports of nuisances and the Board had "every reason to be satisfied with the readiness shown by the inhabitants to comply with their requirements." The first report of the medical officer of health dated January, 1856 is very long and 7 hensive, for which a fee of five guineas would appear to have been a gross underpayment! However in succeeding months the reports were much shorter. In the January report the medical officer dealt with various removable causes of disease, which he classified under eight heads, seven of which (dealing with light, ventilation, water supply, adulterated food, unfit food, defective drainage and the state of dwelling houses) remain the same today. The eighth head, namely "marsh miasm" is the only one which is now obsolete. "Marsh miasm" apparently included "the exhalations thrown out from decomposing vegetable matter, only partially covered with water and exposed to the sun's rays." The precise nature of these emanations was undecided, but the fact was "well known" that they were capable of producing a peculiar disease termed intermittent fever or ague. [It is probable that this meant that there were malarial-producing mosquitoes breeding in marshy districts.] The report deals in further detail with the districts of the borough and it appears that although the Lewisham Board of Works included also the village of Penge this latter place was regarded as "a hamlet of Battersea." The word Lewisham came from laesew, a meadow, and ham, a village. For the whole area of the Lewisham Board of Works, that is including Lee, Sydenham, etc., the population in 1841 was some 15,000 and by 1851 it had risen to 19,000. The first classified list of nuisances reported is for the period January to June 1856 and included drainage into the old canal at Forest Hill, complaint being made of the marshy state of the banks; thirteen houses at Lady-well entirely without water supply, the Lady-well being cut off; 22 houses at Lewis Grove discharging "all conceivable nuisances into the river"; choking up of a drain at Mr. Arnold's silk mill in Lewisham "to great annoyance of factory people"; and a great deal of offensive drainage, particularly in the Sydenham, Willow Road and Wells Road areas. It is interesting to note that in the summary of nuisances for the second half of 1856 the Sydenham Gasworks occurs. Very detailed tables of mortality for the year 1856 are given separately for the Blackheath, Sydenham, Lewisham and Penge wards. "Hooping cough" killed no less than 18 children and phthisis (tuberculosis) was the cause of death in 32 persons. Unfortunately no less than 119 out of a total of 353 deaths were not classified specifically but merely as "other diseases, chiefly chronic." A rather more accurate comparison of causes of death can be obtained over the last 50 years, and the chart shows these for certain diseases, or groups of diseases. The first thing to be noted, however, is the part of the chart labelled "all other" deaths. These are mainly the vague or not fully ascertained causes, and it will be seen that, compared with 1956, there were many more 25 years ago and still more 50 years ago. These excess numbers are nearly all in fact distributed to other parts of the chart and would account for some of the length of the 1956 lines. Alternatively the 1906 and 1931 lines can be assumed to be rather longer than they are shown. 8 9 In ending the introduction to this report I wish to express my thanks to the health department staff for their work during the year. My thanks are also due to the Public Health Committee for their support and guidance in the work done. The Public Health Committee during the year was constituted as follows:— Councillor Hawes (Chairman) Councillor Inch (Vice-Chairman) Alderman A. A. Hawkins, j.p. (The Mayor) Alderman Mrs. Smith Councillors Mrs. Armstrong, Mrs. Bell, Braithwaite, Mrs. Bunce, Mrs. Cox, Donovan, Forward, Mrs. Hayes, Mrs. Land, Mrs. New, Mrs. Skeggs and Vickers. 10 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 1956 was 222,100. (This includes members of the armed forces stationed in the area.) Rateable value Rateable value of the borough at April 1, 1956 £3,092,894 Estimated net product of a penny rate 1956/57 £12,100 Estimated number of separately assessed dwellings at April 1, 1956 63,000 Births (adjusted for inward and outward transfers) Livebirths 3,219 Males Females T otal Legitimate 1,573 1,508 3,081 Illegitimate 72 66 138 Totals 1,645 1,574 3,219 Crude birth rate per 1,000 of the estimated population 14.5 Adjusted birth rate for comparative purposes 13.8 Birth rate for England and Wales 15.7 Adjusted birth rate for London Administrative County 14.0 Stillbirths The stillbirths allocated to the borough during the year were 62, (42 males and 20 females) which represents a stillbirth rate per thousand live and still births of 24.9 in the case of males, 12.6 in the case of females, and 18.9 for all stillbirths. Deaths The deaths belonging to the borough registered during the year were 2,513, consisting of 1,364 males and 1,149 females, giving a crude death rate per thousand of the estimated population of 11.3; The area comparability factor for deaths is 0.96, therefore the adjusted rate is 10.8 which compares with rates of 11.7 for England and Wales and 11.7 for the Administrative County of London. 11 Infant mortality Infant deaths 61 Male Female T otal Legitimate 31 27 58 Illegitimate 3 - 3 Total 34 27 61 Rates: 1. All infants per thousand livebirths 18.9 2. Legitimate infants per thousand legitimate livebirths 18.8 3. Illegitimate infants per thousand illegitimate livebirths 21.7 4. Male infants per thousand male livebirths 20.7 5. Female infants per thousand female livebirths 17.2 Neonatal deaths (under 4 weeks of age) 52 Neonatal death rates:— Males, per 1,000 male livebirths 17.0 Females, per 1,000 female livebirths 15.2 All infants, per 1,000 livebirths 16.2 Reproductive wastage:— Stillbirths plus infant deaths 123 Rates:— Males, per 1,000 live and still male births 45.0 Females, per 1,000 live and still female births 29.5 All infants, per 1,000 live and still births 37.5 Maternal deaths Maternal deaths Other special causes of death Measles Whooping-cough Gastroenteritis (infants) Motor vehicle accidents 16 Suicide 27 Tuberculosis (all forms) 29 Other respiratory (Code Nos. 22-25) 352 Cancer (Code Nos. 10-15) 485 Heart and circulation diseases (Code Nos. 17-21) 1,219 Comparative statistics for the year 1956 Table 1 Birth rate Death rate (per 1,000 population) (adjusted) Infant mortality rate (per l,C00 livebirths) Live births (adjusted) Still births Lewisham 13.8 18.9 10.8 18.9 England and Wales 15.7 23.0 11.7 23.8 London Administrative Count 13.97 20.2 11.7 21.3 12 Causes of death at different periods The following table shows the causes of and Table Code No. Causes of death Nett deaths at the subjoined age of " residents " whether occurring within or without the borough MALES Total persons (i.e., incl. table opp.) All ages Under 1 yr. 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and over Totals, all causes 1364 34 6 5 5 46 337 383 548 2513 1 Tuberculosis, respiratory 24 5 8 8 3 29 2 Tuberculosis, other — — — — — — — — — — 3 Syphilitic diseases 6 — — — — — 1 4 1 8 4 Diphtheria — — — — — — — — — — 5 Whooping cough — — — — — — — — — — 6 Meningococcal infections — — — — — — — — — — 7 Acute poliomyelitis — — — — — — — — — — 8 Measles — — — — — — — — — — 9 Other infective and parasitic diseases 3 — 1 — — — 1 1 — 4 10 Malignant neoplasm, stomach 40 — — — — — 19 13 8 67 11 Malignant neoplasm, lung and bronchus 96 — — — — 4 49 30 13 108 12 Malignant neoplasm, breast — — — — — — — — — 41 13 Malignant neoplasm, uterus — — — — — — — — — 21 14 Other malignant and lymphatic neoplasms 118 — — 1 — 2 37 41 37 231 15 Leukaemia, aleukaemia 5 — 1 — — — 3 — 1 17 16 Diabetes 8 — — — — 1 — 3 4 22 17 Vascular lesions of nervous system 123 — — — — 2 22 36 63 300 18 Coronary disease, angina 254 — — — — 3 68 84 99 385 19 Hypertension with heart disease 35 — — — — — 6 9 20 81 20 Other heart disease 139 — — — — 4 18 21 96 340 21 Other circulatory disease 50 — — — — 1 12 13 24 113 22 Influenza 1 — — — — 1 — — 3 23 Pneumonia 70 4 1 — — — 6 21 38 113 24 Bronchitis 147 2 — — 2 35 47 61 208 25 Other diseases of respiratory system 20 — — — — — 3 9 8 28 26 Ulcers of stomach and duodenum 32 — — — — 1 7 9 15 38 27 Gastritis, enteritis and diarrhoea 2 — — — — — 1 1 — 11 28 Nephritis and nephrosis 11 — — — — 3 1 5 2 20 29 Hyperplasia of prostate 26 — — — — — — 7 19 26 30 Pregnancy, childbirth, abortion — — — — — — — — — — 31 Congenital malformations 7 3 1 — 1 — 1 — 1 17 32 Other defined and illdefined diseases 96 25 2 2 — 6 23 16 22 182 33 Motor vehicle accidents 12 — — 1 4 4 1 2 — 16 34 All other accidents 23 — — 1 — 4 6 1 11 36 35 Suicide 15 — — — - 4 7 2 2 27 36 Homicide and operations of war 1 — — — — — 1 — — 1 13 laf life during the year 1956 1 iges at death during the calendar year 1956:— 2 code No. Causes of death Nett deaths at the subjoined ages of "residents" whether occurring within or without the borough FEMALES Total persons (i.e., Incl. table opp.) All ages Under 1 yr. 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and over Totals, all causes 1149 27 2 8 2 33 187 258 632 2513 1 Tuberculosis, respiratory 5 — — — — 3 1 1 — 29 2 Tuberculosis, other — — — — — — — — — — 3 Syphilitic diseases 2 — — — — — — 1 1 8 4 Diphtheria — — — — — — — — — — 5 Whooping cough — — — — — — — — — — 6 Meningococcal infections — — — — — — — — — — 7 Acute poliomyelitis — — — — — — — — — — 8 Measles — — — — — — — — — — 9 Other infective and parasitic diseases 1 — — — — 1 — — — 4 10 Malignant neoplasm, stomach 27 — — — — — 8 11 8 67 11 Malignant neoplasm, lung and bronchus 12 — — 1 — — 6 — 5 108 12 Malignant neoplasm, breast 41 — — — — 3 19 7 12 41 13 Malignant neoplasm, uterus 21 — — — — 2 5 10 4 21 14 Other malignant and lymphatic neoplasms 113 — _ — 2 6 37 27 41 231 15 Leukaemia, aleukaemia 12 1 — 3 5 3 17 16 Diabetes 14 — — — — — 4 5 5 22 17 Vascular lesions of nervous system 177 — — — — 2 15 39 121 300 18 Coronary disease, angina 131 — — — — — 16 47 68 385 19 Hypertension with heart disease 46 — — — — — 3 7 36 81 20 Other heart disease 201 10 18 33 140 340 21 Other circulatory disease 63 — 1 8 13 41 113 22 Influenza 2 — — — — — 1 — 1 3 23 Pneumonia 63 4 - - - - 7 7 45 113 24 Bronchitis 61 2 - - - - 7 13 39 208 25 26 Other diseases of respiratory system 8 — — — — — 1 2 5 28 Ulcer of stomach and duodenum 6 — — — — — 1 1 4 38 27 28 Gastritis, enteritis and diarrhoea 9 — 1 — — — 1 3 4 11 Nephritis and nephrosis 9 — — — — 1 4 1 3 20 29 Hyperplasia of prostate — — — — — — — — — 26 30 Pregnancy, childbirth, abortion — — — — — — — — — — 31 Congenital malformations 10 8 — 1 — — 1 — — 17 32 33 Other defined and illdefined diseases 86 13 — 5 — 3 16 18 31 182 Motor vehicle accidents 4 — — — — — 2 2 16 34 All other accidents 13 — — — — — — 2 11 36 35 Suicide 12 - - 1 - 1 3 5 2 27 36 Homicide and operations of war — — — — — — — - — 1 14 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_ Inflammatory diseases of central nervous system M — — — — — — — — — 1 1 1 F — — — — — — — — — — — — Pneumonia M — — — 1 1 2 1 — — 1 2 4 F — 1 2 — — 3 — 1 — — 1 4 Bronchitis M _ — — — — — — 1 — 1 2 2 F — — — 1 — 1 1 — — — 1 2 Spina bifida and meningocele M — — — — — — — — — — — — F 1 1 1 1 — 4 1 — — — 1 5 Other congenital malformations M 1 — 1 — — 2 1 — — — 1 3 F 1 2 — — — 3 — — — — — 3 Injury at birth M 3 3 — — — 6 — — — — — 6 F 1 2 — — — 3 _ _ _ _ _ 3 Postnatal asphyxia and atelectasis M 2 9 _ _ _ 11 _ _ _ _ 11 F _ 1 _ _ _ 1 _ _ _ _ _ 1 Pemphigus and sepsis of newborn M _ _ _ _ _ _ _ _ _ _ _ _ F _ _ _ 1 _ 1 _ _ _ _ _ 1 Haemolytic disease of newborn M _ _ _ _ _ _ _ _ _ _ _ _ F 1 1 — _ _ 2 _ _ _ _ _ 2 Immaturity M 7 _ _ _ _ 7 _ _ _ _ _ 7 F 3 1 _ _ 2 6 _ _ _ _ _ 6 TOTALS M 13 12 1 1 1 28 2 1 _ 3 6 34 F 7 9 3 3 2 24 2 1 _ _ 3 27 GRAND TOTAL 20 21 4 4 3 52 4 2 _ 3 9 61 There were no deaths in the following groups: tuberculosis (all forms), syphilis, diphtheria, whooping-cough, meningococcal infection, acute poliomyelitis, measles, diseases of ear and mastoid process, influenza, gastritis and duodenitis, gastro-enteritis, convulsions, accidents and lack of care of the newborn. Nine infants (6 males and 3 females) thus died between the ages of one month and one year compared with 19 in the previous year and 24 in the year before that. Six of the nine were from pneumonia or bronchitis, and two were due to congenital malformations. On the other hand there was an increase of 18 in the number of deaths under 4 weeks of age, spread over many groups. 15 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 31 761 194 February 28 803 225 March 27 576 148 April 24 418 105 May 22 407 94 June 19 357 92 July 17 320 85 August 14 270 77 September 11 314 90 October 9 445 125 November 6 450 140 December 4 549 137 January 1 425 102 Average for period 6 April to 6 December 1956 383 101 Weekly average for the year 1956 469 124 Weekly average for the year 1955 480 129 Weekly average for the year 1954 424 115 Weekly average for the year 1953 471 133 The chart on the next page shows the weekly applications for sickness benefit in 1956 for the "Lewisham" and "Downham" areas, and compares these with the maximum and the minimum for any week during the six year period 1951-6. It will be seen that 1956 was an average year. 16 FIRST APPLICATIONS FOR SICKNESS BENEFIT 1951-6 Top Line — Maximum in the six years. Bottom Line — Minimum in the six years. Blocks — 1956 only. Social class in relation to cause of death Of the 2,513 deaths analysed by us the social categories were as follow:— Table 5 Social class I II III IV V Total No information Males 41 211 755 174 168 1349 15 Females 32 203 590 189 76 1090 59 Total 73 414 1345 363 244 2439 74 Percentage 3 7 55 15 10 100 — 17 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. 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 1 II III IV V Total 1 Tuberculosis, respiratory 1 5 9 2 2 19 - - 2 2 - 4 2 Tuberculosis, other - - - - - - - - - - - - 3 Syphilitic disease - 2 1 1 4 - - 2 - - 2 4 Diphtheria - - - - - - - - - - - - 5 Whooping cough — - - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - - - 8 Measles — - - - - - - - - - - - 9 Other infective and parasitic diseases - - 6 - - 6 - 2 - 1 - 3 10 Malignant neoplasm, stomach 1 2 25 3 7 38 2 4 14 4 3 27 11 Malignant neoplasm, lung, bronchus 1 18 62 12 10 103 - 1 9 2 - 12 12 Malignant neoplasm, breast - - - — — - 1 14 15 7 1 38 13 Malignant neoplasm, uterus - - - - - - 1 3 9 3 2 18 14 Other malignant and lymphatic neoplasms 1 26 73 13 13 126 6 18 57 20 6 107 15 Leukaemia, aleukaemia - 1 5 — 1 7 2 2 6 1 1 12 16 Diabetes - 1 2 — 2 5 - 4 6 1 2 13 l7 Vascular lesions of nervous system 4 31 71 13 13 132 5 39 97 26 13 180 18 Coronary disease, angina 8 26 113 31 22 200 5 16 48 15 7 91 19 Hypertension with heart disease 4 12 36 10 13 75 3 15 45 16 6 85 20 Other heart disease 6 25 85 26 12 154 4 35 101 34 18 192 21 Other circulatory disease 1 4 27 4 3 39 - 12 26 5 4 47 22 Influenza - - — - 1 1 - - — 2 — 2 23 Pneumonia 3 9 36 12 16 76 1 8 28 16 2 55 24 Bronchitis 7 24 84 20 25 160 - 10 31 18 6 65 25 Other diseases of respiratory system - - 12 7 6 25 - - 12 - - 12 26 Ulcer of stomach and duodenum 2 1 15 3 4 25 - - 2 2 — 4 27 Gastritis, enteritis and diarrhoea - - 1 - - 1 - 1 2 — — 3 28 Nephritis and nephrosis - 2 13 1 3 19 - 4 7 1 — 12 29 Hyperplasia of prostate 1 6 9 2 1 19 - - - - - - 30 Pregnancy, childbirth, abortion - - -. - - - - - - - - - 31 Congenital malformations - 2 9 - - 11 - - 11 - - 11 32 Other defined and illdefined diseases - 9 39 8 4 60 - 9 45 8 3 65 33 Motor vehicle accidents 1 - 6 2 1 10 - 1 2 1 1 5 34 All other accidents - 4 7 2 6 19 2 3 6 3 1 15 35 Suicide - 3 8 2 2 15 - 2 7 1 - 10 36 Homicide and operations of war - - - - - - - - - - - - No social class assessed - - - - - 15 - - - - - 59 18 Certain statistics have thus 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 Total 1 II III IV V Totol 1, 2 TB No. 1 5 9 2 2 19 - - 2 2 - 4 % 5 26 49 10 10 100 — — 50 50 — 100 10-15 Cancers No. 3 47 165 28 31 274 12 42 110 37 13 214 % 1 17 61 10 11 100 6 20 51 17 6 100 17-21 Heart and circulation No. 23 98 332 84 63 600 17 117 317 96 48 595 % 4 16 55 14 11 100 3 20 53 16 8 100 22-25 Lung, non-TB No. 10 33 132 39 48 262 1 18 71 36 8 134 % 4 13 50 15 18 100 1 13 53 27 6 100 33, 34 Accidents No. 1 4 13 4 7 29 2 4 8 4 2 20 % 3 14 45 14 24 100 10 20 40 20 10 100 35 Suicide No. - 3 8 2 2 15 - 2 7 1 - 10 % — 20 54 13 13 100 — 20 70 10 - 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. 129 538 1928 394 212 3201 18 % 4 17 60 12 7 100 Registered stillbirths No. - 8 37 8 4 57 3 % - 14 65 14 7 100 Registered infant deaths No. - 2 47 8 2 59 1 % - 3 80 14 3 100 Notified premature births No. 4 22 120 23 11 180 9 % 2 12 67 13 6 100 19 Coronary disease I have referred at considerable length to this condition in previous reports. Active research is progressing and increasing, and the dietary factor seems to be emerging as highly important (see p.16 of the 1955 annual report). The following table brings the Lewisham figures up to date. 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 21 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 6 385 421 113 919 149 84 2513 37 5.9 3.3 4 means figure not available. *R.G. Code Nos. 19 and 20. †R.G. Code No. 21. Lung cancer The number of deaths decreased slightly last year, to 108 (96 males, 12 females) from 121 the year before. I have for some years now called attention to the association of cigarette smoking with this form of cancer, and have pointed out that here, at least, was one way in which the number of cancer cases could be diminished. So far the rather half-hearted national warnings on the subject have had little or no effect on the total number of cigarettes smoked and it seems that for some years yet the number of lung cancer cases will increase. An all-out campaign against cigarette-smoking, directed especially to the schoolleaver and the adolescent, would appear to be necessary. 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 12.0 — 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 10.0 290 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 20 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 rote†† % 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 26.0 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 223,000 100 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 - 10 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 10.7 349 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 4.8 1956 222,100 11.3 5 9 26.7 14.5 59 0.0 19 16 3 19 38 88 13 11.3 21 *per 1,000 population. ‡ per 1,000 notified livebirths. **per 1,000 registered livebirths. †per 1,000 registered live and stillbirths. ††Per 100,000 population. — equals figure not available. 22 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 Disinfection Premises visited 112 103 148 363 Rooms disinfected 227 237 307 771 Articles disinfected 2146 1975 1576 5697 Disinfestation Premises visited 27 18 3 48 Rooms disinfested 97 45 5 147 Articles disinfested 60 24 3 87 Articles treated Beds 53 40 48 141 Mattresses 138 122 158 418 Bolsters 38 28 25 91 Pillows 329 166 267 762 Cushions 24 21 25 70 Quilts 69 65 93 227 Blankets 383 163 320 866 Sheets 92 67 100 259 Household articles 457 410 251 1118 Wearing apparel 623 917 292 1832 Total articles 2206 1999 1579 5784 Articles received from the cleansing station - 2126 - 2126 Articles received from the Coroner's court — 656 — 656 Public library books treated after infection 173 306 269 748 Private library books treated after infection 47 2 44 93 Articles treated under the Public Health (London) Act s.122 9301 13889 18177 41367 A more detailed analysis of treatments for verminous conditions and for scabies is shown :— Verminous conditions Table 12 First cleansing Second cleansing Third cleansing Children under 5 28 1 - School children 251 30 2 Adults 43 — — TOTALS 322 31 2 23 Scabies Table 12—continued  Cases Contacts Treatments Children under 5 3 _ 6 School children 7 2 15 Adults 11 2 24 TOTALS 21 4 45 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 April 30 to September 28 and Mr. Phillips, the deputy senior sanitary inspector who is in charge of antipest work, reports:—"416 bombed sites, grass verges and rear garage ways were visited on 4 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 107 mattresses and approximately 8 tons of miscellaneous articles such as carpets, linoleum, furniture, clothing, and cushions. 60 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 some 4 tons of powder containing 0.5 percent gamma benzene hexachloride was used. 7 stables or piggeries, 11 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 24 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. 244 dustchutes with 864 openings were sprayed. One private block containing 9 chutes was also included in this treatment. The caretakers of this Council's flats were also provided with sprayers, 17 gallons insecticide and 108 lbs 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 6 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 housholders for use in their own sprayers. Static water tanks and sections of the rivers where the water tends to become stagnant were sprayed with 5 percent DDT in kerosene base as an anti-mosquito precaution on 4 occasions. Gooseberry or clover mite, (bryobia praetiosa) 14 complaints were received during the year of clusters of tiny red insects over the windows and sills and the surrounding brickwork of certain of the Council's new houses or flats. The insects were subsequently identified as the gooseberry or clover mites which feed on plant juices and have been reported as a serious pest of many shrubs, trees and grasses. They migrate from their natural habitat into dwelling houses at certain times of the year, namely April—June, and October— November. Large numbers are found on new lawns and recently disturbed ground and this no doubt accounts for the fact that the complaints came from the tenants of recently erected Council property. The mites are harmless to humans and will not damage furniture or fabrics. It was found that the use of DDT either as a spray or as a powder was of little value and that a large scale treatment of the adjoining ground would have to be carried out. A strip of the grass surround ten feet wide, and the walls themselves to the height of the ground floor sill, were treated with a heavy spraying of a Geigy preparation known as Akar 338. This is a 25 percent emulsifiable solution of chlorobenzilate, an acaricide which is effective against the fruit tree red spider, and this solution was used after dilution with water to 0.1 percent. This proved most effective and in most cases one thorough treatment was sufficient; in two cases, where a slight reinfestation occurred, a second treatment was found necessary. 25 Laboratory facilities The following summary relates to the work carried out by the laboratory on behalf of the Council during 1956 :— Table 13 Specimens Number Remarks Faeces 1,416 Negative 629 Positive - Shigella sonnei 34 ,. - Salmonella typhimurium 9 „ - Salmonella enteritidis 5 ,, - Salmonella cholerasuis 4 „ - Salmonella paratyphi B 4 „ - Salmonella heidelberg 3 „ - Bact. coli, type 0 26 Urine 5 Nose swabs, throat swabs, etc. 122 C. diphtheriae was not isolated from any of these specimens. Figure includes 1 positive Vincent's angina Sputum, for organisms 16 for tubercle bacilli 15 Negative 1 Positive for malignant cells 2 Negative Slides of urethral discharge for gonococci 1 Negative Icecream 3 Water (Lad/well Lodge) 1 Sundry foods 7 The large number of faecal specimens reflects the high incidence of Sonne dysentery infection during the year. 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 634, of which 317 were received from institutions, 634 postmortem examinations were made and inquests were held in 112 cases. 26 Details are shown in the following table: — Table 14 Month Bodies received from Institutions Others Post-mortem examinations Inquests Lewisham residents Others January 37 38 45 30 9 February 56 49 78 27 11 March 44 24 45 23 9 April 14 23 27 10 4 May 20 28 33 15 15 June 18 24 25 17 9 July 18 20 18 20 11 August 24 16 30 10 8 September 12 17 13 16 4 October 30 22 26 26 8 November 20 28 32 16 11 December 24 28 36 16 13 TOTALS 317 317 408 226 112 I called attention in last year's report to the possibility that the Court might be closed after the twelve months' extension agreed by the county council. Early in 1957 however the county council informed the borough council that the Court would be retained. 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 public health inspector. In his report on rodent control work during 1956, Mr. Walker, the senior public health inspector, states: — " The number of premises found to be rat infested shows a considerable reduction on the previous year when the number was unusually high and was commented upon at that time. The amount of poison bait taken during treatment of the rivers was also less and would suggest a reduction in the above-ground rat population. The infestations dealt with were all of a minor character and spread fairly evenly over the whole of the borough. "The results of the sewer treatments carried out during the year do not coincide with the above ground treatment and actually show an increase in pre-bait taken in the summer treatment over the previous year. The Ministry of Agriculture, Fisheries and Food have decided, with the cooperation of all local authorities to, in future carry out these treatments during the months of April and October. It is thought that among other advantages to be gained, there will be less chance of the sewers being surcharged at these times, as the month of December particularly has been troublesome in this respect. It has also been decided to carry out an extended system of prebaiting i.e. on days 1, 3, 5 instead of the usual 1, 2, 3 and the result of this will be reviewed at a later date." 27 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 468 3/4 197 River Quaggy 215 3/4 77 River Pool 85 3/4 34½ Ditches - - - Special liaison is made twice yearly with the Borough Engineer's department for the treatment of sewers. In 1956 treatments were carried out in June and December. The method employed in carrying out this work was to deposit 8 ozs. 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 2,900 Manholes showing prebait take 650 Manholes showing complete prebait take (on one or both days) 662 Winter treatment Manholes baited 2,929 Manholes showing prebait take 491 Manholes showing complete prebait take 545 28 Prevention of Damage by Pests Act, 1949 A copy of the annual report covering the twelve months ended 31 March, 1957, 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 1,290 153 1,450 — (b)survey — 8,819 14 8,833 — (c) otherwise — 5 1 6 — Total inspections (including reinspections) 7 10,221 168 10,396 - Number of properties inspected which were found to be infested by : (a)Rats — major — — — — - — minor 2 893 96 991 - (b)Mice—major — — — — - — minor 1 356 40 397 - Number of infested properties treated 3 1,177 128 1,308 - Total treatments (including retreatments) 4 3,659 332 3,995 — Number of "block" control schemes carried out 64 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 4 - Downham 11 - Forest Hill 9 - Ladywell - - Private baths 3 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. 29 National Assistance Act, 1948 — section 50 During the year the Council accepted responsibility for the burial of 6 persons, at a net cost of £24 10s. Od. Dog nuisances No proceedings were taken during the year, although complaints were received of the condition of certain roads. Drainage work During the year 157 plans were submitted to the public health 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 £2,950 was eventually included in the annual estimates for the year 1956-57 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 2,150 Lewisham Darby and Joan Club 350 St. Mark's Old Folks' Club 70 Bellingham Old People's Club 55 Talbot Settlement Old People's Club 30 The Good Companions' Personal Service 35 Hither Green Branch of the National Federation of Old Age Pensions Associations 60 St. Philip's "Darby and Joan" Club 20 The Friendly Club for the Over-Sixties 35 The Bellingham Community Association " Darby and Joan" Club 40 Lee Branch of the National Federation of Old , Age Pensions Association 30 Good Companions Club 10 This left a sum of money available for new clubs which might qualify for grant. 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. 30 The health department during the year continued to take a detailed interest in the work for old people generally and remained in the closest touch with the Lewisham Old People's Welfare Association (LOPWA), which Association has offices in the department. LOPWA is, so far as the borough council's work for old people's welfare is concerned, the main body in the area and has affiliated to it the various other bodies to which the Council makes grant. LOPWA is responsible for the meals-on-wheels service to housebound old people. The laundry service carried out by the borough council for the small number of old people living at home whose infirmity is such as to make them incontinent of urine or faeces was continued and expanded during the year, over 41,000 articles being cleansed. The service was highly appreciated; it can only be used, however, where section 122 of the Public Health (London) Act applies. Admission of old people not acutely ill to hospital or home Prior to 1948 there was not much difficulty about the admission of old people who were found to be in need of medical care to hospital or Home, as even if it were difficult to obtain immediate admission to a hospital the relieving officer in collaboration with the district medical officer could arrange for the patient's admission. The offices of relieving officer and district medical officer ceased to exist in 1948 and since then it has, in many parts of the country, become more and more difficult to obtain admission of old people requiring institutional care. Under the National Health Service there has been a greater demand on hospital accommodation and at the same time there has been a continuation of the difficulty, through lack of personnel, of staffing hospital wards. For one reason or another, more particularly perhaps because of the increasing number of old people in the community, there has also been a greater difficulty in getting suitable old people into Homes, and this in spite of the fact that in London, at least, quite a number of smalltype residential Homes have come into being. The tendency for some years — and this perhaps has been accelerated since the advent of the national health service — is for local geriatric units to be formed in Hospital Management Committee areas. The advantage of a geriatric unit is that it enables specialist help and consideration to be given to the problems of old people, and one of the better developments is that a greater number of old people can be taken into hospital for short stay and then allowed to return home after they themselves and perhaps their home conditions have been improved. This part of the work is sometimes called rehabilitation. Apart from this there are what are called " half-way houses," which are usually administered by a voluntary organisation or a local welfare authority and sometimes by the hospital authority direct, but even where the administration is not with the hospital authority that authority pays towards the maintenance of old people therein. These half-way houses are primarily for old people who are not really ill enough to be admitted to hospital, but are too ill or frail to be regarded as suitable for 31 admission to a residential Home. There is often quite a considerable going and coming as between the half-way house and the hospital on the one hand and the half-way house and the Home on the other. The hospital geriatric unit also includes such adjuncts as physiotherapy, massage and various other kinds of special treatment so as to shorten the patient's stay in the hospital and to rehabilitate him more firmly. When we set up our laundry scheme to help incontinent aged persons we hoped that this scheme might be paralleled by the formation of a geriatric unit in this area, so that, for example, some old people who had recently become incontinent could be admitted to the unit, rehabilitated (and thereby relieved of their incontinence) and then returned home. If rehabilitation efforts are not made the tendency is for these incontinent cases to carry on indefinitely and to deteriorate. Of course it is true that even in the cases which are rehabilitated in hospital deterioration is likely to continue — though probably more slowly — or after being checked to recur, but by and large it has been thought that the geriatric unit can serve a very useful purpose in easing the life of many old people. Nevertheless there appears over the years to have been virtually no progress made for such a unit in this borough, the hospital management committee and the regional hospital board, one or other of them or both together, finding reasons why a geriatric unit could not be set up, although it must be said that the Board appear to be more in favour of it than the Management committee. In the middle of 1956 it was stated in Parliament that in all the areas of England and Wales only seven did not have posts of geriatric physician. As there appeared to be a considerable discrepancy in the number of cases which should in the view of the local doctor be in hospital and the number of such cases on the waiting list of the local hospital, I sent a questionnaire to representative doctors in the borough to find out the position. In summary the result was that in practices which covered only a part of the borough, there were no less than 77 sick old patients for whom inpatient hospital facilities were desirable in the summer of 1956, and there had been at one time a maximum of 200 such patients during the previous year. I reported the facts in detail to the Public Health committee who authorised me to send copies of the report to both the hospital management committee and the regional hospital board, and at the end of the year discussions were still continuing with these authorities. Atmospheric pollution The Clean Air Act The Clean Air Act 1956 received the Royal Assent in July, but it was not until the very end of the year that central administrative action appeared in the form of various memoranda. Some brief notes on the application of the Act follow: 32 Under section 1, which prohibits the emission of dark smoke from the chimney of any building (except emissions lasting for not longer than periods specified by the Minister by regulations), ordinarily action under this section would be initiated by the public health inspector, either as the result of a complaint, or as the result of his own observation of his district. Under section 3, new furnaces (with some specified exceptions) must be, so far as practicable, smokeless and must not be installed unless notice has been given to the Council. The Council is authorised to approve plans. Such notice will be referred to the medical officer of health as the chief officer of the department and the plans will be recommended for approval or otherwise after being considered by the specialist smoke inspector, or in the more difficult cases after advice has been obtained from a central organisation or panel of consultants. Under section 6, it is required that new furnaces burning certain fuels shall be fitted with plant to arrest grit and dust and this plant must be approved by the Council. Under section 7, the Minister may make regulations as to the measurement and recording of grit and dust emitted from such furnaces and as to the making of such measurements available to the Council. The Council may by notice apply the regulations to any furnace or oven. Administration of the duties and work under this section and under section 8 (which may require the submission of information by the occupier on furnaces and fuel consumed) and other administrative pojnts in other sections of Act, will be dealt with by the public health department. Smoke control areas Under section 11 of the Clean Air Act the Council has power to make an Order, which has to be confirmed by the Minister, declaring the whole of the borough or any part of it a smoke control area. Under this order, and subject to possible exemptions and limitations under the section, if smoke is emitted from the chimney of any building within the area the occupier is guilty of an offence, unless it can be shown that the smoke was not caused by using other than an authorised fuel. There are many provisos and limitations included in the section. Under section 12, the Council must repay to an occupier or owner 7/10ths of the expenditure incurred by him on adaptations to avoid contravening section 11 and they may also repay to him the whole or any part of the remainder of the expenditure. To qualify for this payment the work must be done to the Council's satisfaction. Various other provisions apply where the expenditure is incurred in cases where the occupier of a private dwelling is not the owner. The Council may, by notice in writing, require the occupier or owner of a private dwelling in a smoke control area to carry out adaptations to avoid contraventions of section 11 and, in certain circumstances, the Council may do the work themselves and recover not more than 3/10ths of the cost. Under section 15, grants can be made for certain premises, such as church halls etc., where necessary adaptations to fireplaces are required. 33 Under section 16, smoke (other than that dealt with above) becomes a statutory nuisance under the Public Health (London) Act 1936 " if it is a nuisance to the inhabitants of the neighbourhood." In a prosecution the defendant can claim that the best practicable means had been employed to prevent the nuisance, and it will be seen therefore that technical evidence may be important. There are various other major and minor procedural matters in subsequent sections and in the schedules of the Act. I made a detailed report to the committee in the autumn of 1956 and the committee recommended the Council to appoint a specialist smoke inspecctor as soon as practicable. The inspector was appointed early in 1957. Atmospheric pollution from diesel engines Some concern has been expressed from time to time with regard to the ill effects which the exhaust from diesel engines might have on the public through atmospheric pollution. It has even been suggested that this atmospheric pollution from diesel engines might be a contributory cause of the increasing incidence of lung cancer. The matter has been considered in detail by the metropolitan boroughs Standing Joint committee during the year and there has recently been a considerable amount of research work done on it. The general position appears to be that the poisonous substances such as carbon monoxide, the oxides of nitrogen and the hydrocarbons coming from diesel exhaust are only about one-quarter of the amount which is discharged from a comparable petrol engine, but the diesel engine does discharge a small quantity of oxide of sulphur (which petrol engines do not) and if the engine is not well maintained it discharges far more soot or carbon than a petrol engine. An interim report by the Medical Research Council's atmospheric pollution research group showed that there was virtually no difference between the amounts of benzpyrene (a hydrocarbon which is known to be able to produce cancer) present in the air of a London bus garage where many bus engines were running, and in the open street. The Transport Executive states that medical advice indicates that the diesel engine when well-maintained does not emit any harmful amount of substances liable to be injurious to health and that the exhaust emission of London buses contains little, if any, carcinogenic hydrocarbons. I submitted a comprehensive report on the subject to the Health committee early in the year. Measurement of atmospheric pollution The three deposit stations and the three smoke measurement stations continued in use throughout the year, but in November, as a result of continued complaints with regard to grit and smoke in the neighbourhood of the gasworks, a further deposit station was set up in the grounds of the Sydenham Children's hospital and at the end of the 34 year a further site in the neighbourhood was being sought for the establishment of a fourth smoke measurement station. Correct locations for the two different types of station involve differing conditions and the deposit station at the Children's hospital is by no means ideally situated. However if the readings are taken in conjunction with those at existing stations some further statistics in relation to local pollution can no doubt be obtained. Details from the main stations are shown in the accompanying table. Sydenham Gasworks During the year the number or the intensity of complaints with regard to smoke and grit in the neighbourhood of Sydenham gasworks increased and local concern was expressed at the possible effect on health in the neighbourhood. In my annual report for 1952 I dealt in detail with the effects of the smog which had occurred in December of that year, and pointed out that on a ward basis it appeared that, with regard to deaths from respiratory troubles during the smog, two wards in the immediate neighbourhood of the gasworks were the worst in the borough. At the same time a compilation of lung cancer deaths in the seven years 1946/52 had been made in ward areas and it again appeared that one of the wards in immediate conjunction with the gasworks, and a ward in another part of the borough which might be affected particularly by railway smoke, were the two wards with the highest incidence in those seven years. It is always a little hazardous to issue statistics based on relatively small numbers unless full explanations and reservations can be given and appreciated. Since 1952 the ward statistics for lung cancer have changed fairly considerably and those based on the total period, i.e. before 1952 and after 1952, do not indicate any significant increase in lung cancer mortality in the ward in which the gasworks is situated, bearing in mind the increase in lung cancer over the whole country. As far as the measurement of atmospheric pollution is concerned, all the evidence which has been accumulated over the last few years has been to the effect that pollution in the neighbourhood of the gasworks has decreased both absolutely and even more so relatively to the pollution in certain other parts of the borough. This objective evidence bears out the knowledge that the gasworks' authorities have done a considerable amount of work over the past years in reducing nuisance as far as practicable. Nuisance is to some extent unavoidable from any large-scale industrial process of this sort and it is quite inevitable when horizontal retorts are used for gas-making. As a result of various enquiries and investigations made it appeared towards the end of the year that the only major step (apart of course from the ideal ones of either ceasing to make gas in Sydenham or using the Works there as only a holding station) would be to ensure that only the better quality gas-making coal were made available for the Works. The coal supplied to the Works is variable and 35 some deliveries of it consist of either too fine a coal or a coal which contains too much moisture. In these conditions a greater amount of smoke and grit is produced. At the end of the year therefore it was decided to send a deputation to the Ministry of Fuel and Power, or alternatively (if the Ministry thought this desirable) to the National Coal Board, to see what could be done with regard to obtaining better quality coal. This deputation took place early in 1957 when, besides representatives of the Council and the Coal Board, representatives of the gasworks were present, and it is hoped that, as a result of what was said at the meeting, action will be taken this year to improve the quality of coal supplied and that this will produce a further diminution in the nuisance from the gasworks. 36 Table 17 gives a record of the principal results from the six stations and also are not specific to the borough, having been obtained from a publication of the me Atmospheric Condit 17 January February March April May Temperature— Mean maximum1 °F 44.3 35.8 51.0 52.8 65.8 Mean minimum1 °F 35.5 25.9 37.3 35.5 444 Mean1 °F 39.9 30.9 44.1 44.1 55.2 Diff. from average1 °F .0.2 .9.5 +0.4 .4.1 +1.5 Highest maximum2 °F 53.0 57.0 65.0 68.0 79.0 Lowest minimum2 °F 29.0 17.0 27.0 33.0 39.0 Rainfall— Total2 in. 2.92 0.12 0.75 0.94 0.3 Percent of average 194 14 40 78 17 Sunshine' Daily mean hrs. 1.63 1.72 4.78 4.48 7.8 Percent of average 109 76 126 90 120 Wind1 ne/e/se % 13 34 50 32 11 s/sw/w % 59 18 30 27 52 NW/N/Calm % 28 48 20 41 37 Atmospheric pollution— West Division : Water insol. matter tpm 8.95 11.33 7.42 12.23 10.70 Water sol. matter tpm 4.11 10.61 4.51 5.93 3.35 Sulphur † 3.02 3.09 1.86 2.08 1.13 Smoke, daily average 38.0 31.6 16.0 17.7 44 „ maximum * 202.0 52.2 25.4 26.7 9.5 (date) (4.6) (4.7) (14.16) (18.20) (30.3) „ minimum * 18.0 19.3 7.8 12.7 2.4 (date) (14.17) (25.29) (21.23) (11.13) (9.1) (21.24) North Division4 : Water insol. matter tpm 17.45 10.94 10.81 15.60 7.8 Water sol. matter tpm 8.49 4.30 5.30 7.02 3.15 Sulphur † 4.35 5.63 3.20 3.61 1.90 Smoke, daily average 34.0 29.8 15.1 16.5 4.7 „ maximum * 176.0 48.1 202 21 8 113 (date) (4.6) (4.7) (17.20) (18.20) (30.3) „ minimum * 16.0 22.0 7.9 12.1 3.2 (date) (21.24) (11.14) (21.23) (11.13) (5.8) South Division5 : Water insol. matter tpm 7.57 9.55 10.73 10.74 8.73 Water sol. matter tpm 4.88 6.82 5.76 5 53 4.11 Sulphur 2.71 3.39 1.92 1.93 1.11 Smoke, daily average * 24.0 27.7 13.0 12.9 4.0 „ maximum ... * 61 0 44.7 16.5 19.7 5.4 (date) (4.6) (4.7) (17.20) (18.20) (1.4) „ minimum * 15.0 15.7 4.8 7.2 2.4 (date) (21.24) (25.29) (21.23) (25.27) (5.8) Weather summary Wet and changeable Dry ; dull ; very cold Dry ; mild ; sunny cold ; dryish ; Warm very dry sunny Notes : 'Croydon ; 2Lewisham ; 3Valentine Court for smoke, Pool allotments for others ; tpm : tons per square mile per month ; †as trioxide in mg per 100 sq. cms. per day 37 me indication of the sunshine, rainfall, etc., during the year. Some of these latter data Heal office, and relate to the nearest station which records.the particular item concerned. 1956 7 June July August September October November December Average or act. ual (as applic.) 64.0 69.0 65.7 65.9 56.2 47.4 46.5 55.4 49.9 55.1 51.8 53.3 43.9 38.5 40.4 42.6 56.9 62 1 58.7 59 6 50.1 42.9 43.5 49.0 .2.6 .0.9 .3.8 + 1.0 .1.5 .1.8 + 2.8 .1.6 78.0 84.0 76.0 76.0 67.0 58.0 56.0 84 (July 9) 44.0 51.0 49.0 49.0 36.0 27.0 30.0 17 (Feb. 2) 2.16 3.03 3.11 1.87 1.14 0.39 2.17 1.58 105 196 108 116 34 24 110 — 4.19 5.44 5.14 3.76 3.18 1.66 0.21 3.66 58 81 83 79 96 95 16 86 6 16 10 32 6 18 15 20 48 53 64 44 50 33 61 45 46 31 26 24 44 49 24 35 8.55 10.31 10.60 9.08 7.06 8.58 9.78 9.55 5.34 7.22 6.36 5.10 3.54 3.78 6.46 5.53 2.06 0.85 0.93 0.89 1.49 2.48 3.12 1 92 5.4 3.1 2.5 3.2 9.7 23.8 24.1 15.0 6.9 4.2 4.2 4.6 19.8 46.5 67.4 202.0 (20.22) (11.13) (29.31) (22.25) (10.12) (21.23) (21) (Jan. 4.6) 3.1 1.2 1.5 2.3 3.7 17.3 9.2 1.2 (30.31) (4.6) (18.21) (5.7) (1.2) (24.27) (15.18) (July 4.6) 7.15 9.63 8.63 6.61 7.85 10.77 8.56 10.16 4.90 6.44 5.47 5.44 6.28 4.77 6.68 5.69 0.97 1.69 1.16 1.38 3.30 5 18 4.12 3.04 5.0 3.9 2.7 2.9 10.6 27.3 24.6 14.8 8.6 5.1 4.7 4.3 17.3 41.1 53.8 176.0 (27.29) (11.13) (29.31) (19.21) (10.12) (21.23) (22.24) (Jan. 4.6) 4.0 2.6 1.6 2.4 2.8 20.1 12.4 1.6 (30.31) (28.31) (25.28) (5.7) (1.2) (24.27) (15.18) (Aug.25.28) 9.22 12.64 10.14 8.46 8.40 8.50 7.28 9.33 5.40 8.17 6.65 8.99 9.32 7.34 7.28 6.69 0.97 0.57 0.53 0.59 1.29 2.86 1 .85 1.64 4.8 3.1 2.2 2.1 10.2 23.2 21.0 12.3 6.5 3.9 3.6 2.8 16.2 42.0 47.0 61.0 (9.12) (11.13) (29.31) (19.21) (10.12) (21.23) (22.24) (Jan. 4.6) (18.20) 1.9 1.2 1.1 1.6 2.8 16.8 7.4 1.1 (30.31) (4.6) (25.28) (5.7) (1.2) (24.27) (15.18) (Aug.25.28) Cold; moist; dull Cool ; dull ; wet Cold ; dull ; wet Mild ; dull ; moist Cool ; dry Cool ; Very dry Mild very dull Place for smoke, Wearside Road for others; 5ownham Depot for smoke, Verdant Lar per 100 cub. metres. e for others 38 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. The dose of chlorine at these stations is now controlled automatically in regard to the changes in quality of the filtered water as well as to changes in rate of flow. All the well water is chlorinated and here also contact tanks are provided. Finally, any residual chlorine is completely removed or reduced to a level that would not be noticeable to consumers before the water leaves the works. Bacteriological analyses are made at least five times a week and in the case of the river.derived supplies, the water is analysed at all stages of purification. None of the supplies is plumbo.solvent. All new and repaired mains are chlorinated before being restored to use and samples are collected for analysis to establish that the quality of the water is up to the standard normally supplied. 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: — Average results of the chemical and bacteriological examination of the water supply to the Borough of Lewisham for 1956 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 CI. Oxygen abs. from permanganate (4 hrs. at 27°C) Hardness (total) Hardness (non. carbonate) PH value Sulphates as SO, Conductivity Bexley Well 5 0.006 0.022 5.6 17 0.06 282 54 7.2 28 475 Darenth Well 3 0 005 0.027 5.0 16 0.06 262 38 7.1 14 425 Darenth Bore Hole 3 0.007 0.030 5.5 16 0.12 280 54 7.2 22 450 Shortlands No. 1 4 0.001 0.024 4.8 16 0.08 282 74 7.2 40 475 Shortlands No. 2 4 0.005 0.025 5.1 16 0.06 282 72 7.2 40 500 Wilmington No. 1 4 0.012 0.027 6.6 22 0.18 284 56 7.1 22 400 Wilmington No. 2 4 0.004 0.026 8.4 21 0.18 292 62 7.2 22 425 Deptford Well 3 0.003 0.025 7.3 34 0.12 362 134 7.1 100 600 River Thames . derived filtered water 1598 0.036 0.086 4.3 30 1.16 258 72 7.7 58 500 u> sO (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.) Bact. 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 467 0.2 100.0 . 257 . 100.0 . Darenth Wells 421 0.02 99.5 0.01 255 . 100.0 . Shortlands Wells 499 0.01 1000 . 255 . 100.0 . Wilmington Wells 366 0.3 96.5 0.09 244 . 100.0 . Deptford Well 199 0.1 99.5 0.03 201 . 100.0 .. River Thames . derived filtered water 7066 — 61.2 4.43 3736 5.0 99.9 0.002 40 SECTION C —SANITARY CIRCUMSTANCES OF THE AREA The following table gives a summary of the inspections, etc., carried out by the public health inspectors during the year :— Table 20 Reason for inspection West North South Total On complaint 1319 1046 629 2994 House to house 186 68 — 254 Improvement grants 8 8 8 24 Houses let in lodgings — — — . Rent Acts 18 4 11 33 Other Housing Act visits 444 420 284 1148 Notice from builder 203 186 72 461 Infectious diseases 30 38 21 89 Infestations 54 182 109 345 Factories, mechanical 66 79 73 218 Factories, non.mechanical 8 8 12 28 Outworkers 105 76 108 289 National Assistance Act, S47 5 9 3 17 Smoke observations 18 20 2 40 Offensive trades . . . . Keeping of Animals 2 3 4 9 Water certificates 16 39 33 88 Fireguards 1 3 3 7 Hairdressers 10 3 10 23 Pharmacy and poisons 64 84 3 151 Milkshops 33 75 42 150 Icecream premises 104 285 72 461 Restaurants and eating houses 62 146 97 305 Bakehouses 49 66 3 118 Other food shops 128 424 228 780 Other shops 10 159 7 176 Food inspections 196 316 73 585 Sampling 306 245 260 811 Markets and stalls 6 841 270 1117 Slaughterhouses — 73 — 73 Futile visits 952 1208 399 2559 All other matters 1623 1171 699 3493 Revisits 6445 6421 3245 16111 Total — all inspectors 12471 13706 6780 32957 Smoke abatement Observations 40 Intimations served . Complaints received 6 Statutory notices served . Legal proceedings . Convictions . 41 Summary of notices served Table 21 West North South Total Intimation notices :— Public Health (London) Act, 1936 396 325 137 858 Factories Act, 1937 1 2 3 6 Informal intimations under Housing Act, 1936 15 32 12 59 Total intimations 412 369 152 923 Statutory notices :— Public Health (London) Act, 1936 202 156 72 430 Factories Act, 1937 1 — — 1 Housing Act, 1936 3 1 1 5 Byelaws 33 16 15 64 Food and Drugs Act, 19S5 — — — — Total statutory notices 239 183 88 500 Nuisances remedied Table 22 Nuisance West North South Total Wall and ceiling plaster repaired 250 290 86 626 Roofs repaired 95 101 67 263 Dampness remedied 448 213 87 748 Brickwork repaired 35 53 9 97 Chimneys repaired 8 17 4 29 Drains cleared 24 18 25 67 Drains repaired 30 30 27 87 Drinking water cisterns repaired 3 — — 3 Dustbins supplied 28 18 12 58 Doors and door frames repaired or renewed 15 41 23 79 Flushing cisterns repaired, renewed or cleansed 15 25 11 51 Flush pipes repaired or renewed 9 8 4 21 Firegrates, etc., repaired or renewed 19 33 25 77 Flooring repaired or renewed 28 75 28 131 Dry rot remedied 2 6 — 8 Gullies renewed, repaired or cleansed 14 18 7 39 Gutters repaired 44 58 47 149 Refuse cleared — 3 — 3 Rainwater pipes repaired 18 16 11 45 Soil pipes repaired, ventilated or renewed 4 6 6 16 Sinks provided 1 3 2 6 Sashcords renewed 68 47 34 149 Water closets repaired or renewed 26 38 19 83 Walls and ceilings cleansed 3 8 2 13 Windows and frames repaired or renewed 46 83 32 161 Water service pipes repaired or renewed, water supply restored 43 19 5 67 Yards and areas paved 2 5 1 8 Windows glazed 10 25 9 44 Other nuisances remedied 39 53 32 124 TOTALS 1327 1310 615 3252 42 Pet Animals Act, 1951 During the year 18 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 special conditions to any licence which has been issued. 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 97 premises and 3 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. 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: — 43 Inspections Table 23 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 64 28 . . (II) Factories not included in (i) In which section 7 is enforced by the local authority 446 218 1 . (ill) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 23 23 . " TOTAL 533 269 1 . Cases in which defects were found Table 24 Defects No. of defects Prosecutions instituted Found Remedied Referred To HM Inspector By HM Inspector Want of cleanliness (S1) . 1 . 1 . Overcrowding (S2) . . . . . Unreasonable temperature (S3) . . . . . Inadequate ventilation (S4) 1 1 1 . . Ineffective drainage of floors (S6) . . . . . Sanitary conveniences (S 7) : (o) insufficient . 1 . 2 . (b) unsuitable or defective . 1 . 3 . (c) not separate for sexes . 2 . 3 . Other offences against the Act (not including offences relating to outwork) 2 2 2 . . TOTAL 3 8 3 9 . 44 Sanitary work generally Mr. Walker, the senior public health inspector, reports: "The number of inspections made is very little different from last year. It is interesting to note that of 858 intimation notices served under the Public Health (London) Act, half were complied with before the service of a statutory notice. Of the 430 statutory notices served only 32 were not complied with, and legal proceedings were instituted in these cases. A noticeable feature is the great reduction in applications for certificates of disrepair under the Housing Repair and Rents Act, 1954. The supervision of drainage work continues to be an important part of the inspector's work. Particular attention is paid to the sealing of old drains where demolition is carried out as this can be a troublesome source of rat infestation. Samples of water from the rivers in the Borough are regularly taken, and where pollution is suspected the inspectors' make inspections to ascertain the source. The housing inspectors' time has been increasingly occupied on the work of improvement grants, while continuing their work under Section 9 and 11 of the Housing Act, 1936, as far as possible. The work required under Section 9, seems to be increasing." 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 public health inspectors. The following is a list of trades concerned, extracted from the August, 1956 lists received: — Trade Outworkers employed Wearing apparel 141 Christmas crackers 1 Boxmaking 12 Stuffed toys 1 Paper bags 1 Lampshades 17 Lacemaking 2 175 45 It will be noted that none of the outworkers are employed in food. Outworking in food ceased to be legal in July, 1956 as a result of the Food Hygiene Regulations, 1955. The inspectors made 289 visits 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 of these materials proved satisfactory on examination. Destruction of pigeons Section 121 of the Public Health (London) Act, 1936, enables a local authority to take steps for the purpose of abating or mitigating any nuisance, annoyance or damage caused or which might be caused by the congregation of pigeons which are as far as can be ascertained without an owner. The local authority is enabled to seize and destroy, or sell or otherwise dispose of any such pigeons in excess of such number as may be considered reasonable. The difficulties of dealing with the problem remain and little of value can be added to previous reports although several young birds and 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 attendance was made in 1956. 46 SECTION D —HOUSING Building The following 154 new houses or flats were completed by the Council during the year :— Brasted Close 10 Duncombe Hill 3 Hither Green Lane 66 Leahurst Road 24 Lingards Road 12 London Road 8 Pascoe Road 3 Peak Hill 28 Families rehoused During the year the following families were rehoused :— 1. By the Lewisham Borough Council:— (a) in permanent properties 103 (b) in temporary bungalows 12 (c) in requisitioned properties 2 117 2. By the London County Council (figures supplied by district offices) 71 188 N.B. — Number of families where points had been awarded for bedroom deficiency, rehoused by the Lewisham Borough Council or the London County Council during the year 140 Housing Act, 1936 Repair of houses (sections 9 and 10) During the year 50 informal and 8 formal notices were served. 50 properties were repaired by the owners after service of notices ; in one case property was repaired by the Council under section 10 in default of the owner. 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 1956, together with the present position of cases originating in previous years which had not been complied with at the end of 1955 :— 47 Table 25 Properties Dwellings involved Present position 58, Knowles Hill Crescent 1 Statutory undertaking to carry out outstanding works given by new mortgagee. 77, Malham Road 1 Works to comply with statutory undertaking completed. 78, Taunton Road 1 Demolished. 95, Loampit Vale 1 Closing Order operative on whole house. 97, Mount Pleasant Road 1 Demolition postponed. Extension of time granted under section 5 Housing Repairs and Rents Act, 1954. 2, Fordel Road 1 Demolition Order operative. 3, Myron Place 1 Use for storage of paper approved, provided that paper is clean and premises are rat proofed. 2, Agnew Road 1 Works to comply with statutory undertaking completed. 2, Cranston Road 1 Work in progress to convert property into two self contained maisonettes. 23, Lethbridge Road 1 Works to comply with statutory undertaking completed. 2, Dallas Road 1 Demolition Order operative. House empty. 12, Dalmain Road 1 Demolition Order operative. Demolition deferred under section 5 Housing Repairs and Rents Act, 1954. 95,Gilmore Road 1 Demolition Order operative, premises empty. 169,Sandhurst Road 1 Demolition Order procedure deferred pending outcome of service by freeholder of schedule of dilapidations. 10, Dalmain Road 1 Demolition Order operative. Demolition deferred under section 5 Housing Repairs and Rents Act, 1954. 67/69, Ewart Road 2 Demolition Orders operative in respect of both houses. 42,Wells Park Road 1 Closing Order operative on whole house. 22/22a, Elthruda Road 2 Closing Order operative on whole house. 30, Ravensbourne Road 1 Demolition Order to be made. 1, Railway Terrace 1 Closing Order operative on whole house. 19, Railway Terrace 1 Closing Order operative on whole house. 4,Champion Crescent 1 Closing Order operative on whole house. 50,Eltham Road 1 Demolition Order operative. 48 Table 25—continued Properties Dwellings involved Present position 182, Devonshire Road 1 Demolition Order operative. 43, Ronver Road 1 Statutory undertaking given to carry out work. 28, Porson Street 1 Notices served. 62, Shipman Road 1 Notices served. 28, Ravensbourne Road 1 Notices served. 22, Wisteria Road 1 Notices served. 18, Knowles Hill Crescent 1 Order determined. 61/63, Bell Green 2 Notices served. 18/20, Willow Way 2 Notices not served. Included in LCC clearance area. Closing Orders in respect of part of house (section 12) Table 26 Properties Part of house Present position 28,Ravensbourne Road. Two rooms, scullery and water closet in basement. Converted to Demolition Order procedure. 68,Malham Road Two rooms, kitchen and scullery on ground floor. Notices served. Works carried out to render fit for habitation. Official representation withdrawn. 32, Manor Park Three rooms, scullery and water closet in semi.basement. Closing Order operative. 193c, Perry Vale Top floor flat Closing Order operative. Subsequently determined. 38, Eltham Road Two rooms, scullery and water closet in basement. Closing Order operative. 49, Belmont Park Two rooms and scullery in basement. Closing Order operative. 25,Devonshire Road Two rooms, scullery, passage and outside WC in semi.basement. Closing Order operative. 27,Devonshire Road Two rooms, scullery, passage and outside WC in semi.basement. Closing Order operative. 1, Kingswood Place Two rooms in basement. Closing Order operative. 37, Devonshire Road Two rooms, scullery, passage and WC in semi.basement. Closing Order operative. 25, Tyrwhitt Road Two rooms, kitchen, hall and larder in basement. Closing Order operative. 49 Table 26—continued Properties Part of house Present position 39, Gilmore Road Two rooms and scullery in semi.basement. Notices served. 42, Manor Park Three rooms, scullery and WC in semi.basement. Notices served. Further action postponed pending consideration of application for improvement grant. 35,Burnt Ash Road Two rooms and scullery in basement. Found to be Crown Property — no further action possible. 13, Recreation Road Two rooms, scullery, bathroom and WC in semi.basement. Notices served. 53, Manor Park Two rooms and scullery in semi.basement. Notices to be served. 24,St. Germans Road Three rooms and scullery in basement. Order determined. 7,Wynell Road Three rooms and scullery in basement. Order determined. 61,Westwood Hill Four rooms, kitchen and scullery in basement. Use of basement as private workshop approved. 50,Lee Park Four rooms in basement. Order determined. 45,Lee Park Two rooms and scullery in basement. Order determined. In his report upon work under the Housing Acts, Mr. Craven, the group housing inspector, states :— " It was again necessary to recommend action under Section 11 of the Act, 1936 (for demolition), in respect of a rather higher percentage of the total cases of individual unfit properties dealt with during the year. Although some of these cases were recommended for demolition by reason of irremediable inherent and other defects, many came into this category merely because the value of the property, when compared with the cost of necessary repairs, was considered to be low and the property therefore was not repairable at reasonable expense. For all practical purposes the latter cases were potentially suitable for action under section 9, and when fully repaired they would provide reasonably satisfactory housing accommodation. Fortunately it was possible in certain instances for the inspector concerned to persuade owners to use the facilities now available under section 5 of the 1954 Act and under the grant scheme for improvements and conversions, thus saving some of these properties from demolition. " Inspections of houses included in the clearance area programme for the years 1956/60 were begun. The selection of areas to be dealt with and the order of priority was based on knowledge available in the department in relation to degree of unfitness. As a result preliminary work was completed prior to representation under section 25 of two areas, with a total of 35 houses." 50 Table 27 HOUSES IN CLEARANCE AREAS AND UNFIT HOUSES ELSEWHERE A—HOUSES DEMOLISHED Houses demolished Displaced Clearance areas (Housing Act, 1936 and Housing Repairs and Rents Act, 1954). Persons Families Houses unfit for human habitation 68 239 82 Houses included by reason of bad arrangement — — — Houses or land acquired under section 27, Housing Act, 1936 . . . Not in clearance areas Formal or informal procedure under section 11, Housing Act, 1936 3 19 6 B —UNFIT HOUSES CLOSED Number Section 11, Housing Act, 1936 and section 10(1) and 11(2) Local Govt. (Misc. Prov.) Act, 1953 6 4 2 Sections 3(1) and 3(2) Housing Act, 1949 — — — Parts of buildings closed under section 12, Housing Act, 1936 9 27 8 C —UNFIT HOUSES MADE FIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED By owner By Local Authority After informal action by local authority 39 . After formal notice under Public Health Acts . . After formal notice under Housing Act, 1936 9 . Under section 5, Housing Repairs and Rents Act, 1954 — — D — UNFIT HOUSES IN TEMPORARY USE (Housing Repairs and Rents Act, 1954) Number of houses Separate dwellings Retained for temporary accommodation under sections 2, 3 and 4 Licensed for temporary occupation under section 6 . . E —PURCHASE OF HOUSES BY AGREEMENT Number of houses Occupants Houses in Clearance Areas other than those included in confirmed Clearance Orders or Compulsory Purchase Orders — — 51 Housing Repairs and Rents Act, 1954 and Rent and Mortgage Interest (Restrictions) Act — certificates of disrepair Applications for certificates of disrepair 23 Certificates issued 19 Applications for certificates withdrawn or certificates hot granted 7 Applications outstanding at end of year 1 Certificates issued in 1956 in respect of applications received in 1955 4 Applications for revocation of certificates previously issued 26 Applications granted 21 Applications outstanding at end of year 5 Applications for revocation of certificates previously issued, received during 1955 and issued during 1956 4 52 SECTION E — INSPECTION AND SUPERVISION OF FOOD Milk and Dairies Regulations, 1949 At the end of the year there were 111 persons registered for the distribution of milk from premises within the borough and 21 registrations for the distribution of milk within the borough from premises in the area of another authority. There are no premises in the borough used as dairies. Milk (Special Designations) Licences Licences, which remain in operation from January 1 to December 31, were issued during the vear as follows :— Table 28 Dealer's Supplementary Total Licences issued for :— sale of pasteurised milk 68 21 89 sale of tuberculin tested milk 63 21 84 sale of sterilised milk 103 21 124 TOTALS 234 63 297 Examination of heat.treated milk 176 samples of pasteurised milk and 9 samples of sterilised milk were submitted for examination during the year and all were found to be satisfactory. Analysis of milk During the year under review, 156 samples of milk were submitted for examination to the public analyst by the Council's inspectors. 7 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 29 Period Samples Average composition of samples examined Percentage of Milk fat Solids not fat Water First quarter 71 3.52 8.80 87.68 Second quarter 16 3.43 8.80 87.77 Third quarter 23 3.56 8.81 87.63 Fourth quarter 39 3.76 8.92 87.32 TOTALS 149 3.58 8.83 87.59 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. 53 Icecream — composition Under the Food Standards (Icecream) Order, 1953, icecream must 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 55 samples submitted to the public analyst for analysis were found to have the composition shown in the appended table :— Table 30 Samples Average percentage composition Fat Milk solids. not fat Sucrose Water First quarter 6 12.2 11.3 13.7 62.8 Second quarter 13 11.5 11.2 13.6 63.7 Third quarter 24 11.5 11.1 13.4 64.0 Fourth quarter 12 11.6 12.4 13.3 62.7 TOTALS 55 11.6 11.4 13.5 63.5 Icecream — grading Icecream is submitted to the Public Health Laboratory for bacteriological examination. The icecream is graded according to the time taken to decolorise a dye, methylene blue. The test is a provisional one and because of the many factors which govern the hygienic quality of icecream it is recommended officially that judgment should be based on a series of samples and that too much attention should not be paid to the result of an individual sample. It is suggested that over a six-monthly period, at least 50 percent of a vendor's samples should fall into grade 1, 80 percent into grades 1 or 2, not more than 20 percent into grade 3 and none into grade 4. During the year 166 samples of icecream were submitted for bacteriological examination with the following results :— Table 31 Grading Samples submitted % Grade I 87 52.5 Grade II 48 28.9 Grade III 22 13.2 Grade IV 9 5.4 TOTAL 166 100.0 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. 54 Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 778, of which 109 were formal samples and 669 informal. After examination the public analyst reported that 13 of the formal samples and 8 of the informal samples were adulterated or below standard; the percentage of adulteration amounted to 11.93 in the formal samples, 1.19 in the informal samples, and to 2.69 of all the samples submitted compared with 1.81 in the previous year. The following table gives the groupings and the results of the samples analysed :— Table 32 ARTICLES Examined Adulterated Informal Formal Total Informal Formal Total Bread.and.butter - 22 22 - 4 4 Butter 18 - 18 - - - Cereals, bread, baking - powder 29 — 29 — — — Cheese 5 — 5 - — — Cocoa, coffee, tea 18 - 18 - - - Confectionery (sweets) 15 — 15 — — — Condiments and flavourers 127 6 133 - - — Cream 5 — 5 - - - Drugs 58 3 61 — — — Fish, tinned 9 — 9 - — Flour 17 17 - — Fruit and vegetables 5 1 6 1 1 2 Icecream 55 — 55 — — — Lard and suet 17 4 21 2 1 3 Margarine 18 — 18 — — — Meat, canned and pies 15 1 16 — — — Milk 112 44 156 - 7 7 Milk, condensed 5 - 5 - - - Paste, fish and meat 36 1 37 1 — 1 Sausages 50 3 53 2 — 2 Soft drinks 12 — 12 — - — Spirits 11 12 23 — - — Other foods 32 12 44 2 2 TOTALS 669 109 778 8 13 21 55 Adulterated samples Table 33 Article Formal or Informal Adulteration or irregularity Action taken or result of proceeding Shredded beef suet Informal Fat 74% See report of formal sample.* Buttered cheese rolls. Formal Rolls, cheese and margarine. Dismissed. Hot milk Formal Added water 5.1% £1 fine. Hot milk Formal Added water 8.8% £2 fine. £1 1s. 0d. costs Hot milk Formal Added water 8.0% £2 fine Shredded beef suet. Informal Fat 73% Formal sample taken and found to be genuine. Paste Informal 100 parts S02 per million. Formal sample taken and found to be genuine. Shredded beef suet. Formal Fat 79.6% *£10 10s. 0d. fine. £5 5s. 0d. costs. Bread and butter Formal Bread and margarine Notice with regard to sale of bread and butter temporarily removed owing to redecoration. Displayed at subsequent visit. Dried apricots Informal 2650 parts S02 per million. Withdrawn. Apricots boxed in South Africa. Dried apricots Formal 2475 parts S02 per million. Hot milk Formal Added water 28.4% Conditional discharge for 12 months. Hot milk Formal Added water 28.8% Conditional discharge for 12 months. Bread and butter Formal Bread and margarine Legal proceedings authorised. Cream doughnuts Formal Imitation cream Warning letter sent. Cream doughnuts Formal Imitation cream Hot milk Formal Fat deficient 35% Conditional discharge 12 months. Bread and butter Formal Bread and margarine Absolute discharge. Hot milk Formal Fat deficient 25.7% Legal proceedings authorised. Pork sausages Informal 375 parts SO2 per million. At subsequent visit notice displayed in shop and on cellophane wrapper around sausages. Pork sausages Informal 270 parts S02 per million. Notice as required by regulations displayed at subsequent visit. Other samples In addition to samples submitted to the public analyst from routine sampling, the following were also submitted either to the public analyst or for bacteriological examination. They were submitted for various reasons, but mainly because of complaints received, or as a result of enquiries made into cases of food poisoning:— 56 Sausages (7) Water (7) Corned beef (4) Meat (7) "Lollies" (12) Sliced bread Mince pie South Devon milk Semolina Dust Baked beans in tomato sauce (3) Hen egg albumen Dried egg albumen Baby cereal oats (2) Cheese roll Cakes (4) Vinegar Wheat flour Milk bottles (2) Tinned fish Food poisoning The following is the annual return of food poisoning notifications (corrected) as furnished to the Ministry of Health:— (1) Food poisoning notifications (corrected) returned to RegistrarGeneral:— First quarter 7 Second quarter 16 Third quarter 16 Fourth quarter 11 50 (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 1 Total cases 3 (4) Single cases:— Agent identified 28; Unknown 19; Total 47 Registration of food premises Food premises are in the course of re-registration in consequence of the coming into force of the Food and Drugs Act, 1955, which requires the specific registration of any rooms or accommodation used for the purpose for which registration is required, as distinct from the requirements of the Food and Drugs Act, 1938 which required merely registration of the premises. At the end of the year, the following had been registered:— Sale and storage of icecream 125 Manufacture of icecream — Fish frying 6 Fish curing 6 Preparation or manufacture of sausages 27 Preparation or manufacture of potted, pressed, picked or preserved food 45 57 Unsound food Approximately 11 tons of food was surrendered as unfit for human consumption. This was dealt with by the Council's food inspectors and consisted of meat, fruit pulp, fish, vegetables, etc. Shops Act, 1950 — section 38 Two certificates of exemption in respect of sanitary conveniences were issued during the year. Pharmacy and Poisons The names of 14 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 203 persons previously registered were retained on the register. 151 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. 299 pigs were slaughtered and the carcases inspected during the year. 16 of these carcases with a total weight of 2,853lbs. were condemned as tuberculous, and 262lbs., mainly offals, was destroyed for other reasons. 3 slaughtermen's licences were granted during the year. Heating Appliances (Fireguards) Act, 1952 The public health inspectors are authorised for the purposes of inspection and testing of heating appliances under the Act. 7 inspections took place 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 year's work, states: "On 1 January the Food and Drugs Act, 1955 together with the Food Hygiene Regulations, 1955, came into force. The regulations contain a number of new requirements for food premises and are in addition to the byelaws for the protection of food which came into force in November, 1952. The requirements of section 16 of the Act have necessitated the re-registration of all food premises coming within the scope of that section, and while this work is in progress the opportunity is taken to explain and discuss the requirements of the regulations with food shopkeepers in the borough. 58 "Samples taken of icecream during the year show a high standard of bacterial purity and the chemical analyses show a standard well above the legal requirements. This satisfactory state of affairs is a tribute to the manufacturers and the storage facilities in the shops within the borough. The general sampling of food showed a gratifying absence of adulteration and although one can readily acknowledge the successful efforts made by reputable firms to put on the market products of a high standard this can only be confirmed by regular sampling. "Complaints of foreign bodies in articles of food were fewer during 1956 and it would appear that these incidents, which are almost entirely due to carelessness, are being affected by the higher standards in food hygiene and the general trend towards cleaner food during recent years." 59 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 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 1956 with comparative figures for the previous six years. Table 34 Diseases Cases notified 1956 1955 1954 1953 1952 1951 1950 Anthrax — — — — — — — Diphtheria — 1 — 1 — — — Dysentery 579 92 394 84 169 365 63 Encephalitis (acute) 2 — — 3 — 5 1 Enteric or typhoid fever 3 1 1 2 — 4 1 Erysipelas 20 26 24 18 19 24 41 Food poisoning 46 48 110 32 33 26 38 Malaria — 1 3 2 1 1 2 Measles 206 3905 521 2082 2183 2546 2084 Meningococcal infection 9 4 6 10 5 6 7 Ophthalmia neonatorum 2 4 2 3 4 3 3 Pneumonia 89 121 77 189 89 173 108 Poliomyelitis (acute) 26 63 16 52 15 11 38 Puerperal pyrexia 57 92 59 57 88 63 29 Scabies 29 18 14 5 18 21 22 Scarlet fever 188 158 331 283 379 215 358 Tuberculosis 212 271 256 341 307 299 406 Whooping cough 241 412 449 574 512 819 813 TOTALS 1709 5217 2263 3738 3822 5581 3608 60 Notifications of infectious diseases in 1956 showing sex and age groups Table 35 Diseases Under 1 1- 3- 5- 10- 15- 25- 45- 65 plus Total M F M F M F M F M F M F M F M F M F M F Dysentery 10 7 40 33 44 31 75 86 40 22 6 33 35 70 13 24 1 9 264 315 Encephalitis (acute) — — — 1 — — 1 — — — — — — — — — — — 1 1 Enteric or typhoid fever 1 — — — — — — 1 — — — 1 — — — — — — 1 2 Erysipelas — 2 — — — — — — — — — 1 4 1 6 4 — 2 10 10 Food poising 4 1 1 1 6 — 4 2 2 — 1 1 7 5 6 4 1 — 32 14 Measles 6 7 28 25 24 31 41 35 1 3 — 2 — 2 — 1 — — 100 106 Meningococcal infection 3 — 1 1 — 1 1 — — — — 2 — — — — — — 5 4 Ophthalmia neonatorum 2 — — — — — — — — — — — — — — — — — 2 — Pneumonia 2 — 4 4 — 3 4 5 1 — 4 — 8 7 20 10 8 9 51 38 Poliomyelitis (paralytic) — — — — 1 1 2 2 1 — 2 2 2 — — 1 — — 8 6 Poliomyelitis (nonparalytic) — — — — 1 — 2 4 1 — — 2 — 2 — — — — 4 8 Puerperal pyrexia — — — — — — — — — — — 24 — 33 — — — — — 57 Scabies 1 — 3 1 3 2 2 5 2 1 1 4 — 3 — 1 — — 12 17 Scarlet fever — — 14 3 18 15 48 49 12 16 8 3 1 1 — — — — 101 87 Tuberculosis (respiratory) — — — 2 — 1 6 4 3 5 16 21 37 42 27 12 15 4 104 91 Tuberculosis (nonrespiratory) — — — — 1 — 1 1 — — 1 2 7 3 — — — 1 10 7 Whooping cough 9 19 17 27 22 29 43 65 4 4 — — 1 1 — — — — 96 145 Totals 38 36 108 98 120 114 230 259 67 51 39 98 102 170 72 57 25 25 801 908 61 Analysis of certain diseases in table 35 into divisional areas— Table 36 Disease Div. areas Under 1 1- 3- 5- 10- 15- 25- 45- 65+ Total Dysentery W 1 9 9 24 15 2 11 2 4 77 N 8 38 41 52 12 18 28 7 2 206 S 8 26 25 85 35 19 66 28 4 296 Total 17 73 75 161 62 39 105 37 10 579 Measles W 1 20 18 14 1 - 1 - - 55 N 6 22 24 51 2 2 1 - - 108 S 6 11 13 11 1 - - 1 - 43 Total 13 53 55 76 4 2 2 1 - 206 Pneumonia W - - 1 3 - 2 7 5 2 20 N 2 4 1 2 - - 4 10 7 30 S - 4 1 4 1 2 4 15 8 39 Total 2 8 3 9 1 4 15 30 17 89 Poliomyelitis W - - 1 2 - 1 1 - - 5 N - - - 3 1 5 3 - - 12 S - - 2 5 1 - - 1 - 9 Total - - 3 10 2 6 4 1 - 26 Scarlet fever W - 7 7 23 12 3 - - - 52 N - 4 7 15 5 4 1 - - 36 S - 6 19 59 11 4 1 - - 100 Total - 17 33 97 28 11 2 - 188 Tuberculosis (respiratory) W - - - 3 2 10 23 13 7 58 N - 1 1 6 3 16 20 10 6 63 S - 1 - 1 3 11 36 16 6 74 Total - 2 1 10 8 37 79 39 19 195 Whooping cough W 9 16 22 42 3 - - - - 92 N 10 18 11 28 2 - 2 - - 71 S 9 10 18 38 3 - - - - 78 Total 28 44 51 108 8 - 2 - - 241 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 public health inspectors on certain other occasions. 62 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 bv the public health inspectors referred to in table 20:— Table 37 W N s Total Visits 257 301 412 970 Futile visits 288 322 335 945 Revisits 125 275 574 974 Total 670 898 1321 2889 Poliomyelitis In 1956 26 cases of poliomyelitis were confirmed and of these 14 were paralytic and 12 non-paralytic. The distribution over the borough was 5 in the west, 12 in the north and 9 in the south divisions. 12 were males and 14 females. The following table gives figures for this borough over the last 10 years, the time during which the incidence has been high. Table 38 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 S 103 100 63 61 6 46 43 26 57 TOTAL 706 683 347 49 63 Measles, dysentery 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 39 Age periods New cases notified Deaths Respiratory NonRespiratory Totals Respiratory NonRespiratory Totals M F M F M F M F M F M F 0- — — — — — — — — — — — — 1- - 1 — — — 1 — — — — — — 2- - 2 1 — 1 2 — — — — — — 5- 6 4 1 1 7 5 — — — — — — 10- 3 5 — — 3 5 — — — — — — 15- 7 6 — 2 7 8 — — — — — — 20- 9 15 1 — 10 15 — — — — — — 25- 21 27 4 2 25 29 5 3 — — 5 3 35- 16 15 3 1 19 16 45- 16 9 — — 16 9 8 1 — — 8 1 55- 10 3 — — 10 3 65- 14 1 — — 14 1 8 1 — — 8 1 75+ 2 3 — 1 2 4 3 — — — 3 — 104 91 10 7 114 98 24 5 - - 24 5 64 Analysis of new cases of tuberculosis into divisional areas:— Table 40 Division Sex 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Tolal. West Respiratory M - - - 2 - 5 1 7 5 5 3 5 1 34 F - - - 1 2 2 2 7 4 4 - - 2 24 Non-respiratory M - - - 1 - - - 2 - - - - - 3 F - - - - - 1 - - - - - - - 1 Total M - - - 3 - 5 1 9 5 5 3 5 1 37 F - - - 1 2 3 2 7 4 4 - - 2 25 North Respiratory M - - - 4 1 1 6 7 2 3 3 4 1 32 F - - 2 2 2 1 8 8 3 2 2 - 1 31 Non-respiratory M - - - - - - 1 - 1 - - - - 2 F - - - 1 - 1 - 1 1 - - - 1 5 Total M - - - 4 1 1 7 7 3 3 3 4 1 34 F - - 2 3 2 2 8 9 4 2 2 - 2 36 South Respiratory M - - - - 2 1 2 7 9 8 4 5 - 38 F - 1 - 1 1 3 5 12 8 3 1 1 - 36 Non-respiratory M - - 1 - - - - 2 2 - - - - 5 F - - - - - - - 1 - - - - - 1 Total M - - 1 - 2 1 2 9 11 8 4 5 - 43 F - 1 - 1 1 3 5 13 8 3 1 1 - 37 Last year with regard to the above table I remarked on (1) the relatively high number of cases in the age group 15-20, 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 had been 88 percent, 78 percent, 80 percent, and 129 percent. This year the figures are remarkably different. Only 13 cases of respiratory tuberculosis occurred in the age group 15-20 (against 43); and the female to male ratio in the South reverted to "normal," this time being 95 percent. With regard to the 1956 figures generally, there were 58 cases of respiratory tuberculosis in the West, 63 in the North, and 74 in the South (compared with 83, 85, and 87 respectively in the previous year — a comparison which may or may not be significant). 65 Summary of statistics as to tuberculosis for the last ten years Table 41 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 1947 221,170 426 1.93 134 121 0.55 0.60 1948 226,100 502 2.22 119 109 0.48 0.56 1949 227,700 371 1.63 107 92 0.40 0.47 1950 228,300 406 1.78 72 66 0.29 0.36 1951 227,200 299 1.32 68 60 0.26 0.34 1952 227,100 307 1.35 42 35 0.15 0.28 1953 225,800 341 1.51 48 44 0.19 0.21 1954 224,200 256 1.14 38 36 0.16 0.18 1955 223,400 271 1.21 26 22 0.10 0.16 1956 222,100 212 0.95 29 29 0.13 0.13 General comments on tuberculosis are made in the introduction of this report. Tuberculosis — environmental conditions Case papers of patients attending the Lewisham Chest Clinic in 1956 have been analysed in 250 cases with the following results:— Cases %* Males 129 52 Females 121 48 Social classification:— Class I 3 1 Class II 15 7 Class III 154 68 Class IV 32 14 Class V 22 10 Not classifiable 24 — Rooms occupied:— 2 or more rooms per person 40 16 1—2 rooms per person 134 54 Less than 1 room per person 73 30 No information 3 — Accommodation:— Separate bed 113 45 Separate bedroom 78 31 Condition of premises occupied: Good 165 67 Fair 75 31 Poor 4 2 No information 6 — *Excluding cases not classified 66 Mass radiography unit I am indebted to the Director of the Unit for information of work done in the borough during 1956 on which the following table is based. The Unit during the course of the year was stationed at 11 different locations in the borough, the time spent at each varying from 2 days to 4 weeks. Table 42 Patients Men Women Total General analysis X-rayed 4,423 5,361 9,784 Previously x-rayed 1,966 2,065 4,031 Recalled for large film 214 206 420 Normal on large film 105 101 206 Abnormal on large film 108 104 212 Not yet re-attended 1 1 2 Analysis of abnormal large films:— Cases considered tuberculous:— (a) no further action required — 1 1 (b) occasional supervision only 10 15 25 (c) requiring treatment 17 8 25 (d) still under investigation 1 1 2 Non-tuberculous cases:— (a) investigated 16 9 25 (b) still under investigation — — — Cardio-vascular lesions 6 9 15 Previously known tuberculous cases 6 13 19 No action required 52 48 100 67 Immunisation against infectious disease 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 43 Age at December 31, 1956 Under 1 1 2 3 4 5-9 10-14 Total under 15 Born in year 1956 1955 1954 1953 1952 1951-45 1944-40 (i) Diphtheria (including combined:— immunised during year 391 1,877 126 57 54 121 5 2,631 immunised at end of year 391 2,206 2,327 2,717 2,209 14,894 14,038 38,782 Estimated mid-year population 15,600 33,200 48,800 (ii) Whooping cough (including combined)— Immunised during year (age at date of munisation) 1,545 646 121 59 51 49 3 2,474 (iii) Vaccination. Vaccinated during the year (age at date of vaccination) Under 1 1-4 5-14 15 and over Total Primary:– at clinics 962 69 19 13 1,063 by General Practitioners 832 132 46 72 1,082 Revaccination:— at clinics and day nurseries — 8 12 53 73 by General Practitioners — 9 34 310 353 Town Hall, S.E.6 June, 1957 E. H. R. SMITHARD Medical Officer of Health 68 APPENDIX A Acts of Parliament, Statutory Instruments and Circular Letters issued by Government Departments with regard to the public health services, during the year 1956:— Statutes Clean Air Act, 1956. Sanitary Inspectors (Change of Designation) Act, 1956. Slum Clearance (Compensation) Act, 1956. London County Council (General Powers) Act, 1956. Statutory Instruments No. 919 The Milk and Dairies (Channel Islands and South Devon Milk) Regulations, 1956. 938 The Food Hygiene (Amendment) (No. 1) Regulations, 1956. 1166 The Food Standards (Curry Powder) (Amendment) Regulations, 1956. 1167 The Food Standards (Tomato Ketchup) (Amendment) Regulations, 1956. 1183 The Flour (Composition) Regulations, 1956. 1710 The Housing (Payments for well maintained Houses) Order, 1956. 1984 Food Hygiene (Amendment) (No. 2) Regulations, 1956. 2022 The Clean Air Act, 1956 (Appointed Day) Order, 1956. 2023 The Smoke Control Areas (Authorised Fuels) Regulations, 1956. Ministry of Health Circulars. No. 4 Diphtheria prophylaxis — publicity campaign. 11 The Food Hygiene (Amendment) (No. 1) Regulations, 1956. 18 Poliomyelitis Vaccine. 19 Annual Reports of Medical Officers of Health for 1956. 23 Food Hygiene (Amendment) (No. 2) Regulations, 1956. Memorandum. Closure of schools and exclusion of pupils. Ministry of Agriculture, Fisheries and Food Circulars. No. FSH 2 Model byelaws for private and public slaughterhouses. 3 Milk and Dairies Regulations, 1949 - 1954 — approved oxidising and preservative agents. FSH 4 Food and Drugs Act, 1955. Milk and Dairies (Channel Islands and South Devon Milk) Regulations, 1956. PDP 8 Rodent Control treatment in sewers. FSH 5 The Flour (Composition) Regulations, 1956. The Food Standards (Curry Powder) (Amendment) Regulations, 1956. The Food Standards (Tomato ketchup) (Amendment) Regulations, 1956. 8 Milk and Dairies Regulations, 1949 to 1954 — approved oxidising or preservative agents. Memorandum. Slaughterhouses — provision in England and Wales. Model By elans. Series III Sanitary conditions and management of private slaughterhouses (Issued by the Ministry of Agriculture, Fisheries and Food). Series IIIa Sanitary conditions and management of public slaughterhouses (Issued by the Ministry of Agriculture, Fisheries and Food). 69 Ministry of Housing and Local Government Circulars. No. 32 The Housing of Old People. 34 Town and Country Planning Act, 1954. Land transactions. 44 Slum Clearance : Simplification and Acceleration of Administrative Procedure. 57 Frozen pipes. 61 Petrol rationing. 62 Moving from slums. 64 Clean Air Act, 1956. Memoranda. Clean Air Act — Smoke control areas. Clean Air Act — Miscellaneous provisions. Amendment to Model Byelaws series IV. Buildings (1953 Edition). Issued by the Ministry of Housing and Local Government). General Register Office Circulars. No. 2 Infectious and other notifiable diseases — quarterly return. 3 Annual reports of Medical Officers of Health, 1955 — vital statistics. APPENDIX B Legal Proceedings in 1956 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 £ s. d. £ s. d. Failure to comply with requirements of nuisance notices. 32 8 8 0 15 15 0 In 13 cases abatement orders were made; in 12 cases the summonses were withdrawn as the work was in progress or had been completed; in 3 cases the summonses were adjourned sine die; in 3 cases fines were imposed and in 1 case the summons was re-served. Failure to comply with requirements of notices requiring the provision of dustbins. 5 — — In 4 cases the summonses were withdrawn as the dustbins had been supplied. In 1 case the summons could not be served. Contraventions of LCC drainage byelaws. 4 4 0 0 1 1 0 — Contraventions of LCC water closet byelaws. 4 38 3 0 5 5 0 — 70 FOOD AND DRUGS ACTS Nature of Summons No. of summonses Total fines Total costs Remarks £ s. d. £ s. d. Food and Drugs Act, 1938 Section 3. Jam containing beetle. 1 — — Withdrawn — warning letter sent. Section 9. Raisins containing insects. 1 — — Withdrawn. Food and Drugs Act, 1955 Section 8— Dirty bread 1 — — Dismissed. Cereal containing insects 1 5 0 0 1 1 0 — Section 2— Margarine sold as butter 1 — — Dismissed. Milk containing extraneous water 1 2 0 0 — — Ditto 1 2 0 0 1 1 0 — Ditto 1 1 0 0 — — Margarine sold as butter 1 — — Not served. Bread containing metal bolt 1 5 0 0 2 2 0 — Bread containing dirt and fibre 1 10 10 0 2 2 0 — Suet deficient in fat 1 — — Withdrawn. Re-served on manufacturers. Ditto 1 10 10 0 5 5 0 — Milk containing foreign body 1 5 0 0 3 3 0 — BYELAWS MADE BY THE LONDON COUNTY COUNCIL IN CONNECTION WITH THE HANDLING OF FOOD Nature of summons No. of summonses Total fines Total costs Remarks £ s. d. £ s. d. 5(a) Meat in course of delivery not protected from contamination 1 1 0 0 — — 5(b) Dirty meat van 1 — — Dismissed. Dirty vehicle delivering bacon 1 3 0 0 1 1 0 — Dirty milk vans 4 — — Adjourned. 71 FOOD HYGIENE REGULATIONS, 1955 Nature of summons No. of summonses Total fines Total costs Remarks Various Regulations £ s. d. £ s. d. Unsuitable premises used for the manufacture of sweets. 17 21 0 0 7 7 0 Plea of not guilty accepted in respect of 6 of the summonses. 23(i) Dirty rooms used for preparing food 5 8 0 0 3 3 0 8 Dirty bread van 5 – – 4 summonses withdrawn: 1 adjourned. 23(1) Dirty rooms used 2 2 2 0 – — 8 for preparing food 1 1 1 0 – — 8 Dirty van delivering meat products 1 – – Withdrawn. 8 Dirty van delivering cakes 2 – – Adjourned. 8 Bacon dirty in course of delivery 1 – – Adjourned. 26(i) Dirty stall 1 – — Adjourned. PUBLIC HEALTH (Preservatives, etc. in Food) REGULATIONS, 1925-1948 Nature of summons No. of summonses Total fines Total costs Remarks £ s. d. £ s. d. Dried apricots containing excess S02 1 — — Withdrawn. APPENDIX C List of special reports submitted to the Health Committee by the Medical Officer of Health during 1956:— February 7 Atmospheric pollution from diesel engines. April 10 Establishment of Sanitary Inspectors. May 29 Employment and grading of Sanitary Inspectors. September 11 Rat repression — charge for treatment of business premises. September 11 Sydenham gasworks — complaint by Bellingham and District Welfare Community Association. September 11 Old people — admission to hospital or home. October 9 Application of the Clean Air Act, 1956. November 6 Old people — further report. 72 TABLES TABLE NO. SUBJECT PAGE TABLE NO. SUBJECT PAGE Section A Section C— continued 1 Comparative statistics 11 23 Factory inspections 43 2 Causes of death by age groups 12 24 Factory defects 43 3 Deaths under one year 14 Section D 4 Local sickness 15 25 Demolition orders 47 5 Deaths by social class 16 26 Closing orders (s.12) 48 6 Causes of death by social class 17 27 Clearance areas 50 7 Grouped causes of death by social class 18 Section E 8 Births, infant deaths, etc., by social class 18 28 Milk licences 52 9 Heart and circulation mortality 19 29 Analysis of milk 52 30 Icecream composition 53 10 General statistics from 1901 20 31 Icecream grading 53 32 Samples analysed 54 33 Adulterated samples 55 Section B 11 Disinfecting station 22 12 Verminous conditions, etc. 22 Section F 13 Laboratory facilities 25 34 Notified cases of infectious diseases 59 14 Public mortuary 26 35 Notifications of infectious diseases by age and sex 60 15 Rodent control—treatment of rivers 27 16 Prevention of damage by of rivers 28 36 Analysis of certain diseases into divisional areas 61 37 Infectious disease visiting 62 17 Atmospheric conditions 36 38 Poliomyelitis 62 18 Water, chemical samples 39 39 Tuberculosis notifications and deaths 63 19 Water, bacteriological samples 39 40 Analysis of new cases of tuberculosis into divisional areas 64 Section C 41 Tuberculosis statistics 65 20 Sanitary inspection 40 42 Mass radiography 66 21 Summary of notices 41 43 Immunisation against infectious disease 67 22 Nuisances remedied 41 CHARTS Comparison of certain mortalities in 1906, 1931 and 1956 8 First applications for sickness benefit 1951-6 16 73 INDEX SUBJECT PAGE Acts, regulations and orders 68 Area of borough 10 Atmospheric conditions 31 Births and birth rate 10 Clearance areas 50 Coronary disease 19 Deaths and death rate 10 Deaths, causes of 12 Disinfection and personal cleansing 22 Dog nuisances 29 Drainage work 29 Dysentery 63 Exhumations 45 Factories 42 Flies and mosquitoes 23 Food, adulteration of 54 Food inspection and supervision 52 Food poisoning 56 General statistics from 1901 20 Gooseberry or clover mite 24 Health Services, general provision of 22 Heating appliances 57 Heattreated milk 52 Housing:— Building 46 Families rehoused 41 Housing Act, 1936 46 Housing Repairs and Rents Act, 1954 51 Icecream composition 53 Icecream grading 53 Immunisation 67 Infant mortality 11 Infant mortality statistics 14 Infectious diseases 59 Infectious disease visiting 61 Laboratory facilities 25 Legal proceedings 69 Lung cancer 19 SUBJECT PAGE Mass miniature radiography 66 Maternal deaths 11 Milk, analysis of 52 Milk and Daries Regulations, 1949 52 Mortuary and Coroner's Court 25 National Assistance Act, 1948, s.50 39 Nuisances remedied 41 Offensive trades 57 Old people 29 Outworkers 44 Pet Animals Act, 1951 42 Pharmacy and Poisons Act, 1953 57 Pigeons 45 Poliomyelitis 62 Population 10 Prevention of Damage by Pests Act, 1949 28 Rag Flock and Other Filling Materials Act, 1951 45 Rateable value 10 Rodent control 26 Sampling 54 Sanitary circumstances of the area 40 Shops Act, 1950 57 Sickness, local 15 Slaughterhouses 57 Smoke nuisances 40 Social medicine statistics 16 Staff 2 Stillbirths 10 Swimming baths 28 Tuberculosis 63 Unsound food 57 Vital statistics 10 Water certificates 42 Water supply 38