AC 4347 LEW 45 METROPOLITAN BOROUGH OF LEWISHAM THE PUBLIC HEALTH OF LEWISHAM Report of the Medical Officer of Health for the Year 1957 E. H. R. Smithhard, 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 1957 E. H. R. Smithhard, MBE, MD, DPH CONTENTS Page Staff 3 Introduction 4 Vital Statistics 8 General Provision of Health Services 23 Sanitary Circumstances of the Area 40 Housing 47 Inspection and Supervision of Food 55 Infectious Diseases 60 Appendix A — Statutory Instruments 70 „ B — Legal Proceedings 71 „ C — Special Reports to Health Committee 73 "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 3 STAFF as at 31/12/57 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) Smoke Inspector Assistant Group Housing Inspector J. W. Bevan (a) (b) (c) R. C. Brittain (a) (b) District Inspectors Divisional Food Inspectors *G. L. Belshaw (a) (b) H. W. Ellery (a) (b) *C. L. Connor (a) (b ) H. Tolson (a) (b) *R. L. Davis (a) (b) *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) Meat and Other Foods certificate. (c) Smoke Inspector's certificate. *With responsibility for certain food work. Women Health Officers Mrs. A. Carins, srn, rfn Mrs. L. Champness, srn, rfn Mrs. M. M. Coulson, srn Principal Clerk E. W. Cheesman Clerical Staff S. Burridge, (senior clerk) A. R. Burchmore (trainee public L. J. Cleverly health inspector) C. R. Coleman A. J. Thrussell (trainee public Mrs. I. L. Fry health inspector) Mrs. D. J. Handford D. B. Smith (trainee public health One vacancy inspector) 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 D. J. Allen, b.Sc., fric (Appointed as from 4/12/57.) Bacteriologists E. H. Bailey, mrcs, lrcp, and A. J. H. Tomlinson, mb, BChir, of the Public Health Laboratory Service. 4 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisham. Mr. Mayor, Ladies and Gentlemen, I submit my report for the health department for the year 1957. Vital statistics The Registrar General's estimate of the population in midyear 1957 at 220,900 was 1,200 less than his estimate for midyear 1956. The decrease from the 1951 census figure of 227,576 therefore continues steadily. The crude birth rate for the year at 14.8 again shows a slight increase on the previous year and the adjusted birth rate (allowing for age and sex distribution of the population) is also again higher at 14.1. The crude death rate at 11.0 shows a small decrease on the previous year. The infant mortality rate at 16 was 3 down on the previous year and is the lowest on record. This rate is divisible into two parts, the neonatal rate (i.e. one month of age) and the rest of the first year rate. The neonatal rate came down from 16 to 12; but the rest of the first year rate increased from 3 to 4. The stillbirth rate at 18 was almost the same as the previous year, and the combined stillbirth and infant death rate (reproductive wastage) at 33 was again the lowest on record. 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 247 for tuberculosis) was 3,761, which is over double the number in the previous year. This was more than accounted for by the large increase in measles cases, which were 2,728 last year as against 206 in the previous year. Dysentery cases showed a welcome drop (129 compared with the high figure of the previous year—579). The type of dysentery now prevalent, which tends to show itself particularly in schools, is one over which our control measures are not very effective. Poliomyelitis had a low incidence, there being only 15 cases as against 26 the previous year and 63 the year before. Although many children have been vaccinated against poliomyelitis I do not think that the drop in cases was in the main due to this as insufficient vaccinations had been performed. It is hoped that with more vaccine becoming available (whether from British or overseas sources) a high proportion of children will be protected and that it will be possible to extend this protection to other special groups, such as expectant mothers. Tuberculosis The number of new notifications showed a slight increase on the previous year, though well down on the years before that. The number of cases (and the rate) appears therefore to be coming down irregularly in a series of steps and there is considerably more work required—medically, 5 socially, and in particular by actively digging out cases and by the followup of contacts, mass x-ray and so on—before this disease can be regarded with relative complacency. Clean air Considerable progress was made in the preliminary work for the declaration of an area of the borough as a smoke control area under the Clean Air Act, and details of this, toether with the present position with regard to atmospheric pollution, will be found in the body of the report. 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 £3,750 was eventually included in the annual estimates for the year 1957-58 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 2,750 Lewisham Darby and Joan Club 350 St. Mark's Old Folks' Club 75 Bellingham Branch of the National Federation of Old Age Pensions Associations (formerly Bellingham Old People's Club) 60 Talbot Settlement Old People's Club 30 Hither Green Branch of the National Federation of Old Age Pensions Associations 60 St. Philip's "Darby and Joan" Club 24 The Friendly Club for the Over-Sixties 35 The Bellingham Community Association "Darby and Joan" Club 30 Lee Branch of the National Federation of Old Age Pensions Associations 35 Good Companions Club 18 St. Hilda's Seniors' Club 35 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 6 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. It is also hoped that some of the old people's organisations will be able to initiate and develop handicraft classes for members as a possible alternative to paid employment, such as is being done in some cases quite successfully in a few of the inner London boroughs. These latter boroughs have advantages of proximity of work, ease of transport and so on, which a borough such as this would not have, and the alternative of handicraft classes might have the same advantages locally without some of the disadvantages. At these handicraft classes, where there is sewing, basketwork, simple carpentry and so on, articles can be made either for home use, or for sale on behalf of the club, or for general sale if good enough. The Lewisham Darby and Joan Club has such handicraft classes and one or two attempts at sewing classes or make-do-and-mend affairs have been made by one or other of the grant-aided clubs, but I would very much like to see this side of club activities developed. The committee would willingly consider increasing the grant to any particular club which could show that through developing a handicraft class its expenses had been increased. 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-onwheels service to housebound old people. Visiting of old people—from 1 April, 1957 A woman health officer (a trained nurse with special experience) was appointed in the early part of the year for work on behalf of old people and also in connection with infectious disease. At the same time the two existing infectious disease visitors devoted part of their time to visiting old people. In fact, therefore, three nurses (now called Women Health Officers) are concerned with old people and with infectious disease. Their work is tabulated as follows:— W N S Total Visits 37 100 25 162 Futile visits 43 139 13 195 Revisits 139 654 65 858 Total 219 893 103 1215 7 The laundry service carried out by the borough council in cases of incontinence is dealt with in detail in section B, p 31. In last year's report I dealt at some length with the admission of old people not acutely ill to hospital or Home, and with the provision of a geriatric unit. The report was to the effect that there are often difficulties in securing quick admission, and that the general care of old people could be helped by a geriatric unit. During the past year discussions have continued and a sub-committee of the Management committee is still considering the problem. Staff There are still vacancies on the establishment for inspectors, but the scheme for training student inspectors is working quite well, though we were unfortunate last year in not obtaining a suitable candidate. At present four members of the staff are in training and two of these will be qualified to sit for their final examination next year. At the end of the year Mr. A. J. Lickorish, FIC, who had been public analyst to the borough since 1928, died. He had given very good service to the borough at a time when there was considerable development in food legislation and considerable alterations in the type of analysis usually required. At the end of the year, with the approval of the Ministry of Agriculture, Fisheries and Food, Mr. D. G. Allen, BSc, FRIC commenced duties as part-time public analyst for the borough. He is also part-time analyst to two other Metropolitan areas. 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:— Alderman A. A. Hawkins (Chairman) Councillor E. F. Inch (Vice-Chairman) Councillor T. A. Burch, J.P. (The Mayor) Councillor Mrs. C. Hayes (The Deputy Mayor) Aldermen C. S. E. Fox and Mrs. M. Smith Councillors Mrs. S. H. Armstrong, Mrs. Z. E. Bell, Mrs. N. L. Bunce, Mrs. D. I. Cox, J. Donovan, D. M. Eager, P. E. J. Forward, Mrs. G. M. M. Land, Mrs. D. E. New and Mrs. A. M. Skeggs. 8 SECTION A —VITAL STATISTICS Area The area of the borough is 7,015 acres. Public open space comprises 652 acres. Population Census 1951 227,576 The Registrar-General's estimate of the home population at midyear 1957 was 220,900. (This includes members of the armed forces stationed in the area). Rateable value Rateable value of the borough at April 1, 1957 £2,971,436 Estimated net product of a penny rate 1957/58 £11,800 Estimated number of separately assessed dwellings at April 1, 1957 63,000 Births (adjusted for inward and outward transfers) Livebirths 3,276 Males Females Total Legitimate 1,606 1,518 3,124 Illegitimate 73 79 152 Totals 1,679 1,597 3,276 Crude birth rate per 1,000 of the estimated population 14.8 Adjusted birth rate for comparative purposes 14.1 Birth rate for England and Wales 16.1 Adjusted birth rate for London Administrative County 14.5 Stillbirths The stillbirths allocated to the borough during the year were 59, (34 males and 25 females) which represents a stillbirth rate per thousand live and still births of 19.8 in the case of males, 15.4 in the case of females, and 17.7 for all stillbirths. Deaths The deaths belonging to the borough registered during the year were 2,433, consisting of 1,296 males and 1,137 females, giving a crude death rate per thousand of the estimated population of 11.0. The area comparability factor for deaths is 1.0 therefore the adjusted rate is the same at 11.0 which compares with rates of 11.5 for England and Wales and 11.3 for the Administrative County of London. 9 Infant mortality Infant deaths 53 Males Females Total Legitimate 28 24 52 Illegitimate — 1 1 Total 28 25 53 Rates: 1. All infants per thousand livebirths 16.2 2. Legitimate infants per thousand legitimate livebirths 16.6 3. Illegitimate infants per thousand illegitimate livebirths 6.6 4. Male infants per thousand male livebirths 16.7 5. Female infants per thousand female livebirths 15.7 Neonatal deaths (under 4 weeks of age) 38 Neonatal death rates:— Males, per 1,000 male livebirths 11.9 Females, per 1,000 female livebirths 11.3 All infants, per 1,000 livebirths 11.6 Reproductive wastage:— Stillbirths plus infant deaths 112 Rates:— Males, per 1,000 live and still male births 36.2 Females, per 1,000 live and still female births 30.8 All infants, per 1,000 live and still births 33.3 Maternal deaths Maternal deaths 2 Maternal mortality rate per thousand live and stillbirths 0.6 Other special causes of death Measles — Whooping-cough — Gastroenteritis (infants) — Suicide 24 Motor Vehicle Accidents 25 Tuberculosis (all forms) 33 Other Respiratory (Code Nos. 22-25) 329 Cancer (Code Nos. 10-15) 496 Heart and circulation diseases (Code Nos. 17-21) 1,168 Comparative statistics for the year 1957 Table 1 Birth rate Death rate (per 1,000 population) (adjusted) Infant mortality rate (per 1,000 livebirths) Live births (adjusted) Still births Lewisham 14.1 17.7 11.0 16.2 England and Wales 16.1 22.4 11.5 23.0 London Administrative County 14.5 20.0 11.3 21.9 Causes of death at different peric; of life during the year 1957 The following table shows the causes of ages at death during the calendar year 1957 :— Code No. Causes of death Nett deaths at the subjoined ages of "residents" whether occurring within or without the borough l Causes of death Nett deaths at the subjoined ages of " residents " whether occurring within or without the borough MALES ■ FEMALES Total persons (i.e., incl. table o pp.) 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 All ages Under 1 yr. 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 ana under 65 65 ana under 75 75 and over Totals, all causes 1296 28 3 5 17 53 370 362 458 1.Totals all causes 1137 25 4 4 9 42 211 276 566 2443 1 Tuberculosis, respiratory 19 — — — — 1 9 6 3 2. Tuberculosis, respiratory 12 _ 1 — — 3 6 1 1 31 2 Tuberculosis, other 1 — — — — — 1 — 3. Tuberculosis, other 1 — — — — — — 1 2 3 Syphilitic diseases 4 — — — 1 — 1 2 4 Syphilitic diseases 3 — 3 7 4 Diphtheria — — — — — 5 Diphtheria — — — 5 Whooping cough — — — — _ — — — — 5. Whooping cough — — — — 6 Meningococcal infections — — — — — — — — — 6 Meningococcal infections — — — — — — — — — — 7 Acute poliomyelitis 3 — — — 3 — — — 7 Acute poliomyelitis — — — — — — — — 3 8 Measles — — — — — — — — 8. Measles — — — — — — — — 9 Other infective and parasitic diseases 1 — — — 1 — — _ 9. Other infective and parasitic diseases ... 2 — — — 1 1 — — 3 10 Malignant neoplasm, stomach 50 — — — — 3 24 14 9 10 Malignant neoplasm, stomach 21 — — — — 1 6 7 7 71 11 Malignant neoplasm, lung and bronchus 101 — — — 1 2 56 32 10 11 Malignant neoplasm, lung and bronchus ... 21 — — — — 1 11 4 5 122 12 Malignant neoplasm, breast — — — — — — — — ' 12 Malignant neoplasm, breast 42 — — — — 6 18 10 8 42 13 Malignant neoplasm, uterus — — — — — — — 13. Malignant neoplasm, uterus 19 — — 2 8 6 3 19 14 Other malignant and lymphatic neoplasms 111 — — 1 1 5 34 34 36 14. Other malignant and lymphatic neoplasms 121 — 2 1 6 40 41 31 232 15 Leukaemia, aleukaemia 5 — — — 1 1 2 — 1 15. Leukaemia, aleukaemia ... 5 — — — — — 4 1 — 10 16 Diabetes 4 — — — — — — 2 2 16. Diabetes 15 — — — — .— 3 7 5 19 17 Vascular lesions of nervous system 137 — — —— — _ 32 39 66 17. Vascular lesions of nervous system 176 — 6 18 45 107 313 18 Coronary disease, angina 257 — — — — 10 78 89 80 18. Coronary disease, angina 122 —— — — — 1 22 43 56 379 19 Hypertension with heart disease 32 — — — — — 5 13 14 19. Hypertension with heart disease 49 _ — — — 4 9 36 81 20 Other heart disease 112 — — — 1 5 18 18 70 20. Other heart disease 176 —— — — — 3 12 26 135 288 21 Other circulatory disease 44 — — — — — 13 11 20 21. Other circulatory disease 63 — — 3 8 13 39 107 22 Influenza 9 — — — — 1 2 6 _ 22.Influenza 10 — — 1 1 — 1 4 3 19 23 Pneumonia 58 1 — — — — 10 12 35 23.Pneumonia 57 1 2 — — 1 4 13 36 115 24 Bronchitis 129 1 2 — 2 35 43 46 24. Bronchitis 56 1 — — — , 10 14 31 185 25 Other diseases of respiratory system 7 1 1 1 1 3 25. Other diseases of respiratory system 3 _ 1 _ _ 2 10 26 Ulcers of stomach and duodenum 24 9 7 8 26. Ulcer of stomach and duodenum 7 — 2 5 31 27 Gastritis, enteritis and diarrhoea 2 1 1 _ 27.Gastritis, enteritis and I diarrhoea... 10 — — — — — 1 4 5 12 28 Nephritis and nephrosis 16 2 1 4 4 5 28. Nephritis and nephrosis 6 — — — 1 3 1 1 22 29 Hyperplasia of prostate 28 — — — 1 7 20 29. Hyperplasia of prostate — — — — — 28 30 Pregnancy, childbirth, abortion — — — — — — — _ 30 Pregnancy, childbirth, abortion 2 — — — 1 1 — — — 2 31 Congenital malformations 12 8 — — 1 2 1 — 31. Congenital malformations 13 10 — — 2 — — — 1 25 32 Other defined and illdefined diseases 77 17 — 1 3 1 18 16 21 32. Other defined and illdefined diseases 94 13 1 1 1 2 21 19 36 171 33 Motor vehicle accidents 15 — — — 3 4 4 1 3 33. Motor vehicle accidents 10 — — — 2 1 2 3 2 25 34 All other accidents 21 1 — 1 4 6 5 2 2 34. All other accidents 13 — — — — 2 3 1 7 34 35 Suicide 17 — — — — 4 8 3 2 35. Suicide 7 — — — — 1 4 1 1 24 36 Homicide and operations of war — — — — — — — I_ 36. Homicide and operations of war 1 — — — — — 1 — — 1 12 Deaths under 1 year of age Table 3 Cause of death Sex Under 1 day 1-6 days 1 week 2 weeks 3 weeks Total under 4 wks. 1-2 mths. 3-5 mths. 6-8 mths. 9-11 mths. Total 1-11 mths Total under 1 yr. Inflammatory diseases of central nervous system M — — — — — — — — — — — — F — — — — — — — — 1 — 1 1 Pneumonia M — 1 — — — 1 — — — — — 1 F — — 1 — — 1 — — — — — 1 Bronchitis M — — — — — — — — — 1 1 1 F — — — — — — — — 1 — 1 1 Spina bifida and meningocele M 1 — — — — 1 — — — — — 1 F — 1 — 1 — 2 1 — — — 1 3 Congenital malformations of heart M — — 1 — — 1 3 1 — — 4 5 F — — — — — — 1 — — — 1 1 Congenital malforformations of genito-urinary system M 1 — — — — 1 — — — — — 1 F — — — — — — — — — — — — Other congenital malformations M — — — — — — — 1 — — 1 1 F — 2 1 1 — 4 1 1 — — 2 6 Injury at birth M 2 1 — — — 3 — — — — — 3 F 1 — — 1 — 2 — — — — — 2 Post-natal asphyxia and atelectasis M 1 2 — — — 3 — — — — — 3 F 3 — — — — 3 — — — — —- 3 Haemolytic disease of newborn M 1 1 — — — 2 — — — — — 2 F 1 — — — — 1 — — — — — 1 Immaturity M 2 4 — — — 6 — — — — — 6 F 2 2 — — — 4 — — — — — 4 Accident fall M — — — — — — — — — 1 1 1 F — — — — — — — — — — — — All other causes M 1 — — — 1 2 — — 1 — 1 3 F — 1 — — — 1 1 — — — 1 2 TOTALS M 9 9 1 — 1 20 3 2 1 2 8 28 F 7 6 2 3 — 18 4 1 2 — 7 25 GRAND TOTAL 16 15 3 3 1 38 7 3 3 2 15 53 There were no deaths in the following groups: tuberculosis (all forms), syphilis, diphtheria, whooping-cough, meningococcal infections, acute poliomyelitis, measles, diseases of ear and mastoid process, influenza, gastritis and duodenitis, gastro-enteritis, pemphigus and sepsis of newborn, convulsions, and lack of care of newborn. 13 Fifteen infants (8 males and 7 females) thus died between the ages of one month and one year compared with nine in the previous year and nineteen the year before that. Eight of the fifteen were from congenital malformations, two from bronchitis, one each from three other causes and two were undefined. On the other hand there was a decrease of fourteen in the number of deaths under 4 weeks of age, spread over many groups. 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 29 570 146 February 26 538 130 March 26 606 145 April 23 384 101 May 21 417 108 June 18 355 82 July 16 310 92 August 13 302 70 September 10 350 95 October 8 987 257 November 5 1528 375 December 3 702 165 December 31 779 190 Average for period 4 April to 4 December 1957 405 106 Weekly average for the year 1957 602 150 „ „ 1956 469 124 „ „ 1955 480 129 „ „ 1954 424 115 „ „ 1953 471 133 The chart on the next page shows the weekly applications for sickness benefit in 1957 for the "Lewisham" and "Downham" areas, and compares these with the maximum and the minimum for any week during the seven year period 1951-7. It will be seen that 1957 was a year well above the average for sickness. This was in the main due to the epidemic of heavy colds and/or Asian influenza in the autumn. 14 FIRST APPLICATIONS FOR SICKNESS BENEFIT 1951-7 Top Line - Maximum in the seven years Bottom Line - Minimum in the seven years Blocks - 1957 only Social class in relation to cause of death Of the 2,433 deaths analysed by us the social categories were as follows:— Table 5 Social class I II III IV V Total No information Males 34 253 731 162 101 1281 15 Females 45 217 587 154 82 1085 52 Total 79 470 1318 316 183 2366 67 Percentage 3 20 56 13 8 100 — 15 In detail, the social class, related to cause of death, was as follows:— Table 6 Code No. Cause of death Male Female 1 II Ill IV V Total 1 II Ill IV V Total 1 Tuberculosis, respiratory — 3 14 1 1 19 — 2 8 — — 10 2 Tuberculosis, other — — — — — — 1 — — — — 1 3 Syphilitic disease — — 2 1 — 3 — — — 1 — 1 4 Diphtheria — — — — — — — — — — — — 5 Whooping cough — — — — — — — — — — — — 6 Meningococcal infections — — — — — — — — — — — — 7 Acute poliomyelitis — — 2 — — 2 — — — — — — 8 Measles — 1 — — — 1 — — — — — — 9 Other infective and parasitic diseases — — — — — — — — 2 — — 2 10 Malignant neoplasm, stomach 1 11 32 3 4 51 — 4 10 4 2 20 11 Malignant neoplasm, lung, bronchus 5 15 65 7 9 101 — 7 10 2 1 20 12 Malignant neoplasm, breast — — — — — — — 3 33 8 1 45 13 Malignant neoplasm, uterus — — — — — — — 1 16 2 — 19 14 Other malignant and lymphatic neoplasms 6 31 57 13 7 114 2 26 65 15 7 115 15 Leukaemia, aleukaemia — — 9 — — 9 — — 5 2 1 8 16 Diabetes — 1 3 — — 4 — 2 9 1 — 12 17 Vascular lesions of nervous system 4 32 71 15 13 135 9 29 98 25 13 174 18 Coronary disease, angina 3 53 116 29 16 217 3 15 52 10 9 89 19 Hypertension with heart disease 2 16 45 8 4 75 1 27 40 15 5 88 20 Other heart disease 3 17 66 17 9 112 13 43 72 27 18 173 21 Other circulatory disease 1 4 23 3 3 34 3 10 22 10 4 49 22 Influenza — 1 6 1 1 9 — 1 7 2 1 11 23 Pneumonia 1 11 34 14 2 62 6 16 24 8 6 60 24 Bronchitis 2 22 71 22 14 131 2 6 33 8 3 52 25 Other diseases of respiratory system 1 2 9 — — 12 — 1 2 — 2 5 26 Ulcer of stomach and duodenum — 4 15 3 2 24 — — 5 1 — 6 27 Gastritis, enteritis and diarrhœa — — — — — — — — 1 — — 1 28 Nephritis and nephrosis 2 7 11 5 1 26 — 3 12 2 3 20 29 Hyperplasia of prostate — 6 11 5 1 23 — — — — — — 30 Pregnancy, childbirth, abortion — — — — — — — — 2 — — 2 31 Congenital malformations 2 1 8 1 1 13 — 3 11 3 1 18 32 Other defined and illdefined diseases 1 9 26 7 6 49 3 11 36 9 4 63 33 Motor vehicle accidents — 3 12 2 1 18 1 2 4 1 — 8 34 All other accidents — — 11 3 4 18 — 2 5 1 1 9 35 Suicide — 3 10 2 2 17 1 3 2 — — 6 36 Homicide and operations of war — — — — — — — — 1 — — 1 No social class assessed — — — — — 17 — — — — — 52 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. 16 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 V Total I II III IV V Total 1, 2 TB No. — 3 14 1 1 19 1 2 8 — — 11 % — 16 74 5 5 100 9 18 73 — — 100 10-15 Cancers No. 12 57 165 23 20 277 2 41 139 33 12 227 % 4 21 60 8 7 100 1 18 61 15 5 100 17-21 Heart and circulation No. 13 122 321 72 45 573 29 124 284 87 49 573 % 2 21 56 13 8 100 5 22 49 15 9 100 22-25 Lung, non-TB No. 4 36 120 37 17 214 8 24 66 18 12 128 % 2 17 56 17 8 100 6 19 52 14 9 100 33, 34 Accidents No. — 3 23 5 5 36 1 4 9 2 1 17 % — 8 64 14 14 100 6 23 53 12 6 100 35 Suicide No. — 3 10 2 2 17 1 3 2 — — 6 % — 18 58 12 12 100 17 50 33 — — 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. 100 577 1938 376 232 3223 53 % 3 18 60 12 7 100 Registered stillbirths No. — 6 32 9 4 51 8 % — 12 62 18 8 100 Registered infant deaths No. 3 6 37 3 3 52 1 % 6 12 70 6 6 100 Notified premature births No. 8 30 121 18 31 208 13 % 4 14 58 9 15 100 17 Coronary disease I have referred at considerable length to this condition in previous reports. Active research is progressing and increasing, particularly with regard to the dietary factor (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 (a) Deaths from Total heart and circulation (all ages) (e) Age group 45-65 Total deaths in borough (h) Percentage Coronary diseases (b) Other heart diseases* (c) Other circulatory diseases† (d) Total (f) Coronary diseases (g) (e) of (h) (i) (f) of (h) (j) (g) of (h) (k) 1928 357 97 454 115 ... 1993 23 5.8 ? 1933 516 117 633 162 ... 2271 28 7.1 ? 1938 659 139 798 178 ... 2403 33 7.4 ? 1943 583 64 647 129 ... 2359 27 5.5 ? 1948 696 63 759 155 ... 2253 34 6.9 ? 1953 775 113 888 140 – 2502 35 5.6 – 1950 281 519 79 879 158 79 2413 36 6.5 3.3 1 288 528 78 894 154 87 2542 35 6.1 3.4 2 327 537 86 950 180 89 2580 37 7.0 3.5 3 331 444 113 888 140 84 2502 35 5.6 3.4 4 358 387 113 858 176 99 2231 38 7.9 4.4 5 329 464 115 908 148 94 2423 37 6.1 3.9 6 385 421 113 919 149 84 2513 37 5.9 3.3 7 379 369 107 855 160 100 2433 35 6.2 4.1 ? means figure not available. *R.G. Code Nos. 19 and 20. †R.G. Code No. 21. Sex incidence in pulmonary tuberculosis and lung cancer The large table on General Statistics from 1901 (p. 18) shows an almost stable rate of notifications of pulmonary tuberculosis (male and female combined) from the time the disease became first notifiable in 1912, to about 1930. There was then a very gradual decrease in the rate (with one or two exceptions) until 1941 when, possibly due to the difficulties associated with the war years, the rate increased to as high as it has ever been and remained up until 1950. It then decreased again, more particularly in the last two or three years, falling below 100 per 100,000 population for the first time in 1956 and again being fractionally below (99.6) in 1957. The death rate from pulmonary tuberculosis (male and female combined) has been recorded locally for a rather longer period—from 1901 onwards. During a great part of this time it ran roughly parallel to the notification rate, remaining fairly high until about 1930, dropping a little up to the war and increasing again then. In contradistinction however to the notification rate, which showed an increase until well after the war, the death rate began declining about 1945 (when it was 71 per 100,000 population) and this decline was very rapid until 1952 when it reached 15 and has remained at much that figure since then. In other Continued on p. 20 18 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 29.0 54.4 15.2 — 2.3 — 22 30 52 — 168 77 15.1 1929 207,900 11.5 26.7 52.5 15.7 — 5.3 — — — 44 — 142 74 13.3 1930 207,900 9.7 27.9 53.1 15.1 — 0.9 37 — — 42 79 151 76 12.3 19 Table 10—continued. Year Population Death rate * % dying under age 45 % dying under age 65 Birth rate * Premature birth rate ‡ Maternal death rate † Stillbirth rate † Neonatal death rate ** One month to one year death rate (12)-(10) ** Infant mortality rate ** Reproductive wastage rate (9)+(12) Pulmonary tuberculosis Tuberculosis (all forms) Notif. rate†† Death rate†† % notif. rate under 15 (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) 1931 220,800 10.2 25.6 51.7 14.1 — 4.9 31 25 24 49 80 132 69 13.6 1932 221,500 10.2 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 10.0 22.6 46.7 12.5 — 4.3 35 24 19 43 78 126 58 12.7 1936 224,000 10.9 23.1 48.1 13.0 — 2.0 37 23 32 55 92 131 62 11.6 1937 226,000 10.9 20.4 46.7 13.4 — 1.3 39 18 29 47 86 156 59 11.9 1938 229,000 10.5 23.3 48.7 13.9 — 2.1 26 — — 47 73 116 61 12.4 1939 220,300 10.8 — — 13.6 — 2.9 34 — — 42 76 111 64 11.6 1940 192,540 15.8 22.1 50.0 14.7 — 1.0 24 — — 45 69 111 67 11.1 1941 148,150 14.3 21.7 48.1 13.9 — 1.9 29 — — 34 63 176 93 10.2 1942 161,800 12.0 18.4 43.8 16.8 — 3.2 37 — — 37 74 175 73 15.3 1943 168,530 13.9 20.5 44.9 18.7 — 3.1 25 — — 42 67 194 76 13.6 1944 163,320 14.8 21.4 48.8 18.6 — 1.0 22 — — 40 62 196 79 10.8 1945 171,280 12.1 20.5 43.4 17.7 — 1.9 18 — — 34 52 179 71 13.2 1946 207,410 10.6 17.5 43.0 21.7 — 1.1 21 — — 33 54 193 53 15.4 1947 221,170 11.9 17.0 41.9 21.9 — 1.0 21 — — 33 54 166 55 12.4 1948 226,100 9.9 15.6 40.7 18.9 — 0.5 15 15 13 28 43 198 48 15.7 1949 227,700 10.2 10.7 34.9 16.8 — 0.3 16 13 6 19 35 146 40 12.4 1950 228,300 10.6 11.2 35.2 15.3 — 0.6 15 19 7 26 40 158 29 12.6 1951 227,200 11.2 10.1 33.6 15.3 67 0.3 16 17 8 25 41 117 26 14.7 1952 227,100 11.4 8.7 32.0 13.9 86 0.3 18 16 6 22 40 117 15 8.8 1953 225,800 11.1 8.9 29.5 14.4 75 0.3 23 16 6 22 45 136 19 13.8 1954 224,200 10.0 8.3 31.5 14.2 60 0.0 14 13 8 21 35 102 16 10.2 1955 223,400 10.8 7.1 27.9 14.0 69 0.9 18 11 6 17 35 114 10 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 1957 220,900 11.0 7.8 31.7 14.8 65 0.6 18 12 4 16 33 100 14 10.1 *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. 20 words, as has been pointed out in previous reports, the death rate began dropping away prior to and at an increased acceleration to that of the notification rate. It now seems from a further analysis of the figures that there is a large difference here between males and females, and this difference is shown up well in table 11, which, in order to smooth out minor variations from year to year, is compounded of, in the main, four-year groups. Sex differences and ratios in Lewisham in 4-year groups Table 11 NOTIFICATIONS DEATHS M (annual average) F (annual average) M : F (F= 1) M (annual average) F (annual average) M : F (F- 1) 1913-15* – — — 74 60 1.2 1927-30 163 149 1.1 90 71 1.3 1931-34 154 128 1.2 73 64 1.1 1935-38 161 136 1.2 75 65 1.2 1947-50 204 173 1.2 59 37 1.6 1951-54 148 118 1.2 30 13 2.2 1955-57* 122 102 1.2 19 8 2.4 *3 years — not available This table shows that, both for notifications and for deaths, the ratio of male to female has always been over unity. The ratio for notifications has remained remarkably constant from the time (1927) when it was first recorded in the annual reports and this has continued right up to and including 1957. With regard to deaths however the story has been very different over the last hundred years and particularly over the last few years. Our own records of the differences between the sexes are (as with notifications) complete from 1927 onwards with the exception of the years 1939-1946, but with the deaths we also have three earlier years, 1913-15. In all the groupings of the years the male to female mortality has been over unity and until the beginning of the last war the ratio was much the same as with notifications. Since 1947 however the ratio of male to female deaths has much increased; in other words females are dying much less frequently than males from respiratory tuberculosis. Compared with a ratio before the war of about 1.2, the ratio for the four years after the war (1947-50) was 1.6, for the next four years 2.2. and for the last three years 2.4. This remarkable difference between the sexes is not of course confined to Lewisham, and national figures and the figures of the big towns also show it, though not always to the same extent. 21 The national figures show a gradual alteration in the ratio from 1851 onwards, but more particularly in the last few years—see table 12. Ratio of male to female (f = 1) in Lewisham and in England & Wales Table 12 Notifications Deaths Lewisham England and Wales Lewisham England and Wales 1851-60 — — — 0.9 61-70 — — — 0.9 71-80 — — — 1.0 81-90 — — — 1.1 91-00 — — — 1.2 1901-10 — — — 1.3 11-20 — — — 1.3 21-30 — 1.1 — 1.2 1931-34 1.2 1.2 1.1 1.3 35-38 1.2 1.2 1.2 1.4 39-42 — 1.3 — 1.4 43-46 — 1.3 — 1.5 47-50 1.2 1.2 1.6 1.6 51-54 1.2 1.2 2.2 2.1 * 55-57 1.2 1.5 2.4 2.7 — not available * 3 years It is a little difficult to be certain of the cause of the sex differences. The differing proportions of men to women in the population would not be sufficient to account for them. If women develop tuberculosis—as they apparently do—only slightly less often than men, why do the women now die at a very much lesser rate than the men? This could be because men cooperate less in treatment, or delay seeking treatment, or are in a hurry to get back to work and so do not complete treatment, or they may develop more illnesses of another nature, for example bronchitis, which may aggravate their existing tuberculosis, or they may develop tuberculosis later in life, when their natural expectation of life is less. On the other hand it was the belief at one time that women, although naturally rather tough, did themselves no good by either the slimming fashion or the tendency to wear light and thin clothing, particularly on the chest. Furthermore, women since the beginning of the last war have been working at routine jobs in increasing numbers, and their responsibilities to the home and so on cannot be so much smaller than the male responsibilities than they were before the war. It therefore seems that in spite of what would appear to be factors working in one direction the female incidence of respiratory tuberculosis mortality has been going in the opposite direction. It may be that statistically this difference is to some 22 extent accentuated by the actual rate of change of the figures, both of incidence and mortality; in other words, when the figures ceased to be stable and began dropping away then the difference in rate became more marked, and will close up again when the figures are again stabilised. In lung cancer there has always been a very marked sex difference, the mortality usually being 6 to 10 times in males what it is in females. This has been ascribed to the lesser amount of cigarette-tobacco smoked by females (see table 13), the known large increase in smoking in the last ten or fifteen years not yet having fully shown itself in lung cancer incidence due to the very long latent period before lung cancer develops. Consumption of cigarettes in the UK in representative years (based on figures published by the the Tobacco Manufacturers) Table 13 Year Adult males (lbs. per head) Adult females (lbs. per head) Ratio M : F (F = 1) 1920 5.1 Negligible ? 1924 4.6 0.2 23 1928 5.6 0.3 19 1932 6.0 0.5 12 1936 7.1 0.8 9 1940 7.9 1.3 6 1944 9.0 2.5 3.6 1948 7.6 2.0 3.8 1952 7.7 2.5 3.1 1956 8.0 3.1 2.6 Even so it has been rather surprising that the large increase in cigarette-tobacco consumption by women in the last twenty years has not made the female rate close in more on the male rate. A complicating factor here is that, although cigarette tobacco is looked upon as the main precipitating cause in the vast majority of cases of lung cancer, it is also thought that smoke in the atmosphere is an additional cause, and of course males by and large are more exposed to smoke in the atmosphere through working in the central parts of towns, or in smoky occupations, than females. These suggestions do not seem to account fully for the statistics and it may be that there is some intrinsic difference in the way the lung in females reacts to outside factors compared with the lung in males. For lung cancer, 1957 showed a further increase in deaths—five (to 101) in men, and nine (to 21) in women. The male to female ratio last year was therefore about five to one. 23 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 14 West North South Total Disinfection Premises visited 112 77 83 272 Rooms disinfected 258 198 168 624 Articles disinfected 1348 1134 1284 3766 Disinfestation Premises visited 25 18 3 46 Rooms disinfested 100 49 12 161 Articles disinfested 35 1 13 49 Articles treated Beds 39 25 35 99 Mattresses 143 121 113 377 Bolsters 25 29 37 91 Pillows 237 214 200 651 Cushions 24 38 24 86 Quilts 64 54 55 173 Blankets 326 209 220 755 Sheets 97 96 74 267 Household articles 229 178 186 593 Wearing apparel 199 171 353 723 Total articles 1383 1135 1297 3815 Articles received from the cleansing station — 1759 — 1759 Articles received from the Coroner's court — 762 — 762 Public library books treated after infection 210 157 233 600 Private library books treated after infection 13 3 15 31 Articles treated under the Public Health (London) Act s.122 12229 14498 14105 40902 A more detailed analysis of treatments for verminous conditions and for scabies is shown:— Verminous conditions Table 15 Number attended Number cleansed Number of individual families Number of persistent cases Children under 5 25 29 — — School children 168 246 96 7 Adults 39 40 — — TOTALS 232 315 96 7 24 Scabies Table 15—continued Cases Contacts Treatments Children under 5 7 – 12 School children 15 2 27 Adults 22 3 43 TOTALS 44 5 82 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 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. One person 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 29 to September 27 and Mr. Phillips, the deputy senior sanitary inspector who is in charge of antipest work, reports:— "412 bombed sites, grass verges and rear garage ways were visited on 7 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 160 mattresses and approximately 10 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 per cent gamma benzene hexachloride was used. 7 stables or piggeries, and one plot of land known to be particularly bad as a rubbish tip were treated as special sites and visited on 20 occasions each, particular attention being paid to the manure recepacles at the stables and piggeries and the compost heaps on the allotments. Throughout the campaign regular visits were paid to Lewisham Hospital to spray the refuse container there and also the site of the 25 kitchen waste bins. 5 visits were also paid to both this Council's and the London County Council's blocks of flats where dustchutes are used. 251 dustchutes with 881 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, insecticide and powder, for use in connection with the containers at the base of the dustchutes, particularly after these had been cleaned out, and for the sites of the bins used for the storage of kitchen waste. In addition treatment by spraying was carried out in 15 houses by staff from the disinfecting station following complaints from the householders concerned. In a number of cases a supply of insecticide containing 5 per cent DDT was also left with the householders for use in their own sprayers. Static water tanks and sections of the rivers where the water tends to become stagnant were sprayed with 5 percent DDT in kerosene base, a total of 80 gallons being used, as an anti.mosquito precaution on 5 occasions. 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 578, of which 256 were received from institutions, 578 postmortem examinations were made and inquests were held in 149 cases. Table 16 Month Bodies received from Institutions Others Post.mortem examinations Inquests Lewisham residents Others January 21 22 25 18 14 February 20 24 30 14 7 March 24 19 31 12 8 April 20 32 30 22 11 May 17 28 32 13 9 June 16 22 23 15 3 July 18 17 14 21 9 August 18 27 27 18 9 September 17 18 18 17 13 October 27 21 29 19 11 November 24 26 25 25 9 December 34 66 48 52 46 TOTALS 256 322 332 246 149 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. 26 In his report on rodent control work during 1957, Mr. Walker, the senior public health inspector, states:. "Notifications of infestation received were much the same as in the previous year and were spread fairly evenly over the whole borough. No infestation of a major character was discovered. The sewer treatments were carried out during April and September instead of June and December. Extended baiting was carried out in September i.e. days 1, 3, 5 and 2, 4, 6 instead of consecutive days, and this seems to have had the desired effect in that an increased number of pre.bait takes were recorded. The poisons used in these treatments were zinc phosphide and arsenious oxide, used alternately. It has been recommended by the Ministry of Agriculture that an experimental treatment with warfarin be carried out and it is hoped that this can be done in the near future. Warfarin could not be used previously as it has to be mixed with an oatmeal base which deteriorates quickly in the humid atmosphere of the sewers, but a mould inhibitor (paranitrophenol) can now be mixed with the bait which keeps it in a palatable condition for a reasonable time. In using this bait it will be essential for a still further extended baiting period to be planned." The undermentioned table gives a summary of the work on the rivers and ditches, prebait being laid on 3/4 days:. Table 17 Location Base points Poison bait taken (ozs.) (Est.) River Ravensbourne 414 639 River Quaggy 338 134 River Pool 68 24 Ditches 57 13 Special liaison is made twice yearly with the Borough Engineer's department for the treatment of sewers. In 1957 treatments were carried out in April and September. The method employed in carrying out this work was to deposit 8 oz. prebait on the first day and if a complete take was shown, 16 ozs. of prebait were used on the second day. Where complete takes were shown on the second day, the poison bait deposited was equal to the prebait. In any case at least 8 ozs. of poison bait was deposited. Poison takes were not inspected. 27 The following is a summary of the results obtained :— Spring treatment Manholes baited 1,781 Manholes showing prebait take 756 Manholes showing complete prebait take (on one or both days) 548 Autumn treatment Manholes baited 2,943 Manholes showing prebait take 710 Manholes showing complete prebait take 660 Prevention of Damage by Pests Act, 1949 A copy of the annual report covering the twelve months ended 31 March, 1958, submitted to the Minister of Agriculture, Fisheries and Food, as required by the provisions of the above Act, is appended. Table 18 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 15 1,248 179 1,442 . (b) survey . 4,407 11 4,418 . (c) otherwise 1 10 1 12 . Total inspections (including reinspections) 16 5,785 193 5,994 . Number of properties inspected which were found to be infested by: (a) Rats — major . . . . . — minor 6 882 122 1,010 . (b) Mice—major . . . . . — minor 5 298 43 346 . Number of infested properties treated 11 1,144 160 1,315 . Total treatments (including retreatments) 22 2,715 450 3,187 - Number of "block" control schemes carried out Nil 28 Laboratory facilities The following summary relates to the work carried out by the public health laboratory on behalf of the Council during 1957:— Table 19 Specimens Number Remarks Faeces 518 Negative 134 Positive . Shigella sonnei 3 „ Shigella flexneri 21 „ Salmonella typhimurium 6 „ Salmonella enteritidis 4 „ Salmonella cholerasuis 3 „ Salmonella paratyphi B 12 „ Salmonella heidelberg 2 „ Bact. coli, type 0 26 Urine 51 Negative Nose swabs, throat swabs, etc. 105 C. diphtheriae was not isolated from any of these specimens. Sputum, for organisms 33 for tubercle bacilli 13 Negative 3 Positive for malignant cells 1 Negative Foods (including 1 school meal) 7 Icecream 1 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 content Bacteriological examination Bellingham 5 . Downham 5 . Forest Hill 5 . Ladywell 1 . Private baths 3 4 A detailed report on the use of breakpoint chlorination, which is the method employed at the baths, was included in my annual report for 1950. National Assistance Act, 1948 — section 50 During the year the Council accepted responsibility for the burial of 3 persons, but at no net cost to the Council. 29 National Assistance Act, 1948—section 47 Several possible cases were investigated during the year, and in one instance it was necessary to apply to the court for an order for compulsory removal. Dog nuisances No proceedings were taken during the year, although complaints were received of the condition of certain roads. Drainage work During the year 147 plans were submitted to the public health inspectors for examination and approval. 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. All the well water is chlorinated and contact tanks are provided. Finally, any residual chlorine is completely removed or reduced to a level that would not be noticeable to consumers before the water leaves the works. Bacteriological analyses are made at least five times a week and in the case of the river.derived supplies, the water is analysed at all stages of purification. All new and repaired mains are chlorinated before being restored to use and samples are collected for analysis to establish that the quality of the water is up to the standard normally supplied. None of the supplies is plumbo.solvent. Tables 20 and 21 show the average results of the chemical and bacteriological analyses of the various supplies as forwarded by the Metropolitan Water Board:. 30 Average results of the chemical and bacteriological examination of the water supply to the Borough of Lewisham for 1957 parts per million (unless otherwise stated) (a) CHEMICAL Table 20 Description of the sample No. of samples Ammoniacal nitrogen Albuminoid nitrogen Oxidised nitrogen (nitrate) Chlorides as Cl. Oxygen abs. from permanganate (4 hrs. at 27X) Hardness (total) Hardness (noncarbonate) pH value Conductivity Bexley Well 3 0.007 0.018 6.5 17 0.06 304 66 7.1 575 Darenth Well 4 0.001 0.020 4.6 16 0.06 255 22 7.2 500 Darenth Bore Hole 4 0.006 0.020 5.0 17 0.11 272 36 7.2 525 Shortlands No. 1 3 0.005 0.026 4.3 17 0.03 275 54 7.2 525 Shortlands No. 2 2 0.002 0.010 4.5 18 0.02 278 57 7.3 525 Wilmington No. 1 4 0.002 0.025 6 .2 22 0.14 278 44 7.2 525 Wilmington No. 2 4 0 .001 0.030 7.4 22 0.10 286 49 7.2 550 Deptford Well 3 0.005 0.021 6.1 32 0.14 358 121 7.3 725 Thames-derived filtered water 1882 0.027 0.074 3.9 29 1.16 260 56 7.9 550 (b) BACTERIOLOGICAL Table 21 BEFORE CHLORINATION (RAW WATER) AFTER CHLORINATION (WATER PASSING INTO SUPPLY) No. of samples Plate counts (average per ml.) Colonies counted Coliform test No. of samples Plate counts (average per ml.) Colonies Counted Coliform test 37° c. (20.24 hrs.) 22° c. (3 days) Percentage samples neg. 100 ml. 37° c. (20.24 hrs.) 22° C. (3 days) Percentage samples neg. 100 ml. Coliform e. Coli Coliform E. Coli Bexley Well 321 0.2 4.3 99.10 100.0 252 0.02 4.3 100.0 100.0 Darenth Well 239 0.2 7.5 94.98 100.0 255 0.4 5.4 100.0 100.0 Darenth Bore Hole. 209 1.6 14.8 95.69 99.04 Shortlands No. 1 161 0.04 4.9 100.0 100.0 Shortlands No. 2 92 0.1 2.2 100.0 100.0 256 0.2 Wilmington No. 2 236 0.8 57 4 88.98 99.58 Wilmington No. 2 225 0.1 14 5 88 80 99 56 255 0.1 2.8 98.82 1000 Deptford Well i 244 0.1 217 o 99 59 100.0 248 0.1 4.6 98 39 1000 Thames derived filtered water - - - - - 3438 6.4 - 99.33 99.91 31 Laundering of soiled articles Under s.122 of the Public Health (London) Act 1936, the sanitary authority, in cases where it appears that the cleansing of a filthy article is necessary through health being endangered, may arrange for the article to be cleansed. This covers articles of bedding or clothing of incontinent persons, and nearly all incontinence, whether of urine or fasces, is through physical deterioration such as occurs in old age. It is very difficult to get laundries to accept such articles and it is even more difficult (particularly in the winter months) for the articles to be washed at home by relatives, or home helps, or other persons. It was because of the great need for such help to be given that the Council decided in the latter part of 1950 to arrange for such articles as fell within s.122 of the Public Health Act to be dealt with at the Council's Disinfecting Station. This service grew rapidly and has now been in operation for seven years. It is almost unique in that it from time to time attracts letters of thanks, thereby proving beyond doubt that the comfort it gives both to the deteriorating patient and to the patient's relatives is immense. Since the demand for the facility now appears to be stabilised, it may be desirable to review the position as it has developed over the seven.year period. The number of new cases in each calendar year is set out in table 22 which shows that in the first year 33 new cases were taken on. This figure rapidly increased until 1955 when it was 126, while in the last two years it has dropped somewhat to 96 and 94 respectively. The proportion of women to men over the seven years has been a little less than 2 to 1, and this proportion has remained fairly constant in each of the years under review, the widest difference being last year, 1957, when the proportion was almost 3 to 1. There is nothing very abnormal about these ratios since in table 23 it will be seen that nearly all cases are over 65 years of age (and most cases are over 75 years of age) and from the Census figures of 1951 there were then in the borough some 14,000 women and 9,000 men over 65 (of whom some 5,000 women and 3,000 men were over 75, 750 of these women and 330 of the men being over 85). Thus the older the age group the greater the proportion of women. Nevertheless the proportion of women helped is slightly greater than would be expected after allowing for these figures. 32 Table 22 1957 1956 1955 1954 1953 1952 1951 All Cases % New Cases M{no % 25 32 42 45 29 17 11 201 27 33 33 40 39 40 33 35 f{no % 69 64 84 68 45 26 22 378 73 67 67 60 61 60 67 65 TOTAL 94 96 126 113 74 43 33 579 Collections 3,466 3,595 3,367 3,427 2,693 1,477 607 18,632 . Articles cleansed 40,902 41,367 37,432 36,311 26,912 17,029 5,334 205,287 . Referred by 17 Private doctor 19 23 21 17 14 3 2 99 Hospital 4 3 5 7 1 4 — 24 4 Ranyard Nurse 56 54 80 62 41 17 16 326 56 LOPWA or 19 Home Help 9 14 16 23 15 17 14 108 Others 6 2 4 4 3 2 1 22 4 Reasons for referral Debility or senility 42 33 46 35 28 16 10 210 36 Stroke 23 25 36 39 25 10 14 172 30 Cancer 17 17 22 20 11 8 6 101 11 Others (mainly 96 heart cases) 12 21 22 19 10 9 3 11 Incontinence 243 41 Urine 43 37 50 53 26 18 16 Faeces 4 7 10 14 14 14 8 71 11 ) 47 52 66 46 34 11 9 265 4t The total articles cleansed in the course of each year rose from 5,000 odd in the first year to over 41,000 in 1956. As stated above the women patients far exceeded the men (table 22). 10% of the total cases were under the age of 65 (14% of the men and 8% of the women); 21% were between the ages of 65 and 75 (23% men and 20% women); while 69% were over the age of 75 (63% men and 72% women). In other words over two-thirds of the total cases were over the age of 75, and about one-fifth were between 65 and 75. Table 23 Ages Under 65 65.75 75+ Total % Total % Total % Male 28 14 47 23 126 63 Female 32 8 75 20 271 72 TOTAL 60 10 122 21 397 69 33 Table 23—(continued) Address West North South Total % Total % Total % Male 60 30 52 26 89 44 Female 102 28 119 31 157 41 TOTAL 162 29 171 29 246 42 With regard to geographical situation, 29% of the cases came from the West division, 29% from the North division and 42% from the South division. It is not apparent as to why there has been this higher number of cases in the South. The mode of referral is also shown in table 22, and lumping the years together it will be seen that 56% of all cases came to our attention through being referred by one of the district nurses; 19% were referred by the Old People's Welfare Association or by the home help service; 17% by the private doctor and only 4% by hospital. These percentages are much what might be expected, the district nurse being the person on the spot who knows what help is required, but it does rather indicate that the cases were being referred only at a late stage of deterioration. It is pleasing therefore to see that an analysis of the figures shows that the proportion referred by private doctor is tending to increase—thus, whereas in the first year this was only some 6%, last year it was 20% (and was in fact 24% the year before). There may also be another reason for this: in the early days there were some doubts about one or two legal points involved and we did not specifically call the attention of the district nurses or the doctors to the service. It therefore spread by word of mouth and so it is rather more natural that it would spread more rapidly through the few district nurses concerned than through the very much greater number of doctors who practise in the borough. Table 22 also shows the reasons for referral, and from the total figures for the period it will be seen that the most common reason was debility or senility—in other words the slow deterioration of old age. This accounted for over a third of the total number of cases. Rather under a third were cases of stroke, and about one.sixth were cases of cancer. Other figures in table 22 indicate whether the cases were due to urinary or faecal incontinence. Here however the figures require explanation. Some 46% are put down as "?," but the vast majority of these were cases which were taken on for only one or two collections while being removed to hospital. The exact type of incontinence is not recorded in these cases, but it is safe to assume that nearly all of them were cases of faecal incontinence. In certain other cases the fouled articles were due to discharges from other parts of the body. Collection of soiled laundry is made once, or more usually twice, a week, depending on the severity of the case, and the articles are taken back the next day, or on some occasions the same day. Table 22 shows that 34 the number of collections rose from 607 in 1951 to 3,427 in 1954 and has remained at about that figure since. Deliveries of course double the visits paid as they are made at different times to the collections. No issue of replacement articles is made and if the patient has not sufficient material, such as bed linen, it is found that the National Assistance Board will sometimes help in this matter, or additional help may be obtained from the Red Cross or the WVS. The soiled articles, before being collected from the house, are put into open mesh bags, which are numbered. At the time of collection the person is asked if the bag contains woollen or highly coloured articles and if so these are taken out at the disinfecting station and washed separately by a special process. People are asked to avoid the use of this type of article as much as possible. The bag on arrival at the disinfecting station is put into the foul washing machine which is capable of dealing with 40 lbs. dry weight. The average weight of the bags as received is 12 lbs. Although normally washed in the bag in which it is collected, if the case is known to be a particularly bad one the contents of the bag are emptied out and washed loose. In the washing machine the articles are first flushed in cold water, to which soda ash has been added, for ten minutes to remove the worst of the foul matter. The machine is then drained through the foul attachment which is connected direct to the drain in the same way as is a water closet. The articles are then washed for 15 minutes in warm water at a temperature of 110°—120°F., to which soap flakes and soda ash have been added. The machine is then drained off over a gully in the usual way. The articles are then washed for 15 minutes in hot water at a temperature of 180° — 200°F, to which soap flakes and sodium metasilicate have been added. This is then drained off and the articles rinsed firstly in hot water for five minutes, then in warm water for five minutes and finally in cold water, to which blue has been added, for a final five minutes. The articles then pass from the infected side of the station to the clean side where they are placed in the hydro.extractor for ten minutes. Each bag is then checked; this is not done before this stage in order to avoid too much handling of the foul articles by the staff. The articles are now nearly dry, the final drying and sterilization taking place when the articles are ironed on the calendar where they are subjected to a temp. perature of approximately 300°F. They are then placed on the airers which are steam heated to a temperature of some 100°F. for thirty minutes. The articles are then removed, again checked, folded and placed in clean linen bags and returned. Atmospheric pollution Clean Air Act Part of the Act was in force during 1957 and the rest of the Act comes into force in the middle of 1958. A smoke inspector was appointed in October 1957 and the successful applicant, Mr. Bevan, was already on the staff of public health inspectors and had taken a course for the special smoke certificate qualification. He was subsequently successful in the examination. 35 In a borough such as this, with relatively little industry, the main application of the Act is in relation to smoke control areas. In the middle of the year I reported to the committee that there were three areas in the borough any one of which might serve as the first smoke control area to be instituted, and eventually it was decided that an area of 320 acres in the Ladywell district should be the first to be dealt with. Of the 320 acres about 200 were of open space and the area itself included Ladywell Lodge and Ladywell Nursery and several roads of private dwellings of intermediate age. Altogether there were about 1,450 premises, of which some 1,380 were structurally separate dwellings. The area also included a laundry, baths, mortuary, police station, library and Lewisham Hospital; it was therefore one of moderately mixed development. A preliminary report, as required by the Ministry, was put up to the Ministry of Fuel and Power in July, and the Minister's approval to going ahead with a detailed inspection of the area for the purposes of a Smoke Control Order was received in September. In anticipation of the Minister's approval it was decided to stage an exhibition in the area in the early autumn. This was to be on a fairly large scale, as it was in the first proposed smoke control area of the borough, and it was open for about a week in the middle of October. Although primarily addressed to the inhabitants of the proposed smoke control area (who were specifically invited to an opening meeting for general explanation and questions), the exhibition was advertised in the borough generally and attracted many visitors, including quite a number from outside the borough. The main exhibitors were the Coal Utilisation Council (who work in close cooperation with the Solid Smokeless Fuels Federation), the Electricity Board and the Gas Board. It was a well. arranged exhibition and one of considerable interest to any person who desired to be informed on the question of smoke control. Immediately the exhibition was over the detailed examination and inspection of individual houses in the proposed area was started, the necessary information being recorded on a specially designed card. At the same time a descriptive eight.page pamphlet was got out, copies being given to each householder and, where necessary, sent to each house owner. The inspection of the area was not due for completion until February or March, 1958, and it is hoped that the requisite approvals will be obtained and the Order become operative in May 1959. So far we appear to have had very considerable cooperation both from householders and tenants of commercial and industrial premises in the area, and no large.scale difficulty is anticipated; they of course will be the first to benefit. Measurement of atmospheric pollution The three deposit stations have now been working for over five years, a period which is thought to even out discrepancies due to differences in wind direction and other atmospheric variables which must occur over the course of time. I have therefore got out a chart showing the monthly recordings at the three deposit.gauge stations which have been in existence for these five years, and the composite chart is shown 36 on the next page. The part of it which is the most interesting is the top graph, which shows the water.insoluble deposit. An inspection of the chart will indicate that the dotted line (which is that for the station at Pool Allotments) was, in the earlier part of the five.year period, well above that of the other two lines (for the other two stations), but from 1955 onwards the three lines come together much more and in fact in 1957 the dotted line was as often as not below either of the other two lines. There has in fact been not only a relative but an absolute improvement in the amount of water.insoluble matter (which is mainly dust and grit) deposited at the Pool Allotments gauge as compared with that deposited at the Wearside Road gauge or the Verdant Lane gauge, and since the Pool Allotments gauge is 300 yards in the prevailing wind direction from the retort houses at the Sydenham gasworks, it must be assumed that the improvement shown is due to a marked decrease in the grit and other insoluble matter thrown out from the gasworks. After I myself and my predecessors have recorded, on countless occasions over the last hundred years, complaints with regard to the gasworks, it is only right now to record that the improvements that have been carried out there (no doubt influenced to some extent by our complaints) appear in fact to have been highly effective. The improved position can be seen perhaps even more readily from the figures in table. Table 24 W (Pool Allotments) N (Wearside Road) S (Verdant Lane) W. in relation to others 1953 16.0 10.1 7.6 Highest 1954 13.9 9.4 6.2 Highest 1955 12.5* 10.4 8.6† Highest 1956 9.5 10.2 9.3 Middle 1957 8.5 8.8 8.8 Lowest *average of 8 months †average of 11 months 37 ATMOSPHERIC POLLUTION — DEPOSIT GAUGE RESULTS 1953-7 1953 1954 1955 1956 1957 38 39 Table 25 gives a record of the principal results from six stations and also give some indication of the sunshine, rainfall, etc., during the year. Some of these latter data are not specific to the borough, having been obtained from a publication of the metrological office, and relate to the nearest station which records the particular item concerned. Atmospheric Condition in 1957 ??? 25 January February March April May June July August September October November December Average or actual (as applic.) Temperature— Mean maximum1 °F 46.3 47.8 56.7 56.3 59.4 72.3 71 .7 68.9 62.7 59.3 47.7 45.1 57.9 Mean minimum1 °F 38.6 38.2 43.2 41.4 43.5 51.2 56.9 54.3 50.5 46.8 40.9 36.0 45.1 Mean1 °F 42.5 43.0 49.9 48.9 51.5 61.7 64.3 61 .6 56.6 53.1 44.3 40.5 51 .5 Diff. from average1 °F + 2.4 + 2.6 + 6.2 + 0.7 -2.2 + 2.2 + 1.3 -0.9 -1.9 + 1.5 -0.4 -0.2 + 0.9 Highest maximum2 °F 560 570 67.0 680 70.0 94.0 93.0 82.0 72.0 65.0 58.0 54.0 94 (June 30) Lowest minimum1 °F 32.0 31.0 33.0 340 38.0 45.0 55.0 50.0 38.0 38.0 30.0 25.0 25 (Dec. 17) Rainfall— Total2 in. 1.10 2.05 0.59 0.12 0.99 0.47 2.85 1.54 1.81 1.46 1 .89 1.53 1.37 Percent of average1 ... 71 155 38 13 73 40 130 122 124 52 107 79 84 Sunshine1 Daily mean hrs. 1.51 2.44 3.73 5.38 6.19 9.36 5.39 5.59 3.58 3.04 2.23 1.55 4.17 Percent of average ... 101 108 99 108 91 130 81 90 75 92 128 119 102 Wind1 NE/E/SE % 17 14 31 28 31 33 14 20 11 13 28 27 22 S/SW/W 0/ /o 68 64 54 18 36 32 64 60 65 59 39 52 51 NW/N/Calm 0/ /o IS 22 15 54 33 35 22 20 24 28 33 21 27 Atmospheric pollution— West Division3 : Water insol. matter tpm 9.35 7.09 6.73 13.42 11.13 9.91 6.99 6.26 6.46 6.99 10.54 7.95 8.57 Water sol. matter tpm 5.17 5.83 4.11 3.71 4.61 5.93 5.57 4.37 4.84 4.97 4.37 5.30 4.90 Sulphur † 3.58 2.58 1.76 2.63 1.50 1.07 0.92 0.89 1.33 1.98 2.49 2.4 1 .93 Smoke, daily average * 15.20 19.90 19.20 18.50 13.90 10.20 5.20 4.40 2.51 10.91 10.50 36.50 13.91 ,, maximum * 20.50 35.30 25.70 39-80 21.80 20.00 8.30 7.60 4.42 21.2 20.60 90.90 90.90 (date) ... (9-11) (20-22) (6-8) (2.3) (1-3) (12.14) (1-5) (1-2) (24-30) (9-11) (23-26) (4-3) (Dec. 4-6) „ minimum * 11.5 9.4 6.8 12.4 6.7 5.30 2.70 2.50 1.14 4.0 3.3 19.4 1.14 (date) ... (5-8) (5-8) (16-19) (24-26) (11-14) (19-21) (27-29) (3-6) (11-13) (26-29) (1-5) (21-24) (Sept. 11-13) North Division4 : Water insol. matter tpm 7.65 5.61 11.88 11.71 10.27 10.97 8.22 5.94 7.15 8.49 10.97 6.28 8.76 Water sol. matter tpm 4.73 6.24 6.81 3.99 4.05 4.43 6.44 4.20 4.13 6.1 4.87 5.10 5.13 Sulphur † 4.68 3.71 2.51 3.56 2.61 1.99 1.63 1 37 1.70 2.93 4.81 4.1 2.97 Smoke, daily average * 15.20 22.20 19.90 17.50 15.80 11.10 5.80 3.60 2.93 10.42 8.30 30.9 13.64 ,, maximum * 17.30 36.50 28.90 36.10 22.11 19.60 8.10 7.60 5.16 15.60 15.30 72.90 72.90 (date) ... (1-4) (20-22) (27-29) (2-3) (1-3) (1-4) (1-5) (28-29) (1-3) (9-11) (23-26) (4-6) (Dec. 4-6) „ minimum * 12.20 12.50 9.50 9.50 9.40 6.40 3.00 2.00 1 .32 5.40 3.50 17.70 1.32 (date) ... (5-8) (5-8) (16-19) (24-26) (15-17 12-25) (27-29) (10-13) (11-13) (26-29) (1-5) (21-24) (Sept. 11-13) South Division5 : Water insol. matter tpm 8.53 7.01 8.93 11.69 10.44 8.56 8.96 7.94 8.10 8.40 9.81 6.72 8.76 Water sol. matter tpm 4.84 7.11 5.89 4.02 4.05 8.10 6.75 6.62 5.86 6.78 5.27 6.82 6.01 Sulphur † 1.57 1.57 1.01 1.33 0.82 0.92 0.65 1.37 0.73 1.15 2.13 1.60 1.24 Smoke, daily average * 14.50 18.40 16.00 14.30 12.40 8.10 4.50 3.10 2.36 9.60 8.60 30.60 11.87 „ maximum * 20.30 32.80 20.20 26.20 14.40 15.10 6.20 4.90 5.18 16.00 16.90 88.80 88.80 (date) ... (9-11) (20-22) (13-15) (2-3) (8-10) (12-14) (20-23) (28-30) (28-30) (9-11) (23-26) (4-6) (Dec. 4-6) „ minimum * 11.10 9.30 7.50 9.80 7.30 5.00 2.50 1.50 1.01 5.40 2.60 16.60 101 (date) ... (5-8) (5-8) (16-19) (24-26) (11-14) (29-1) (27-29) (10-13) (7-10) (26-29) (1-5) (21-24) (Sept. 7-10) Weather summary ... Mild ; fairly dry Mild and moist Dry and very mild Very dry much N. wind ??? Warm, dry, very sunny Wet and dull Cool, dull, and moist Cool, cloudy & rather wet Warmish, dry and dull Fairly sunny and fogfree Changeable dryish Notes : 1Croydon ; 2Lewisham ; 3Valentine Court for smoke, Pool allotments for others; ??? Place for smoke, Wearside Road for others ; 5Downham Depot for smoke, Verdant Lane for others ; tpm : tons per square mile per month ; †as trioxide in mg per 100 sq. cms. Per ???100 cub. metres. 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 26 Reason for inspection West North South Total On complaint 833 896 348 2077 House to house 57 - - 57 Improvement grants 47 81 26 154 Houses let in lodgings 6 2 - 8 Rent Acts 235 188 86 509 Other Housing Act visits 358 335 211 904 Notice from builder 139 184 80 403 Infectious diseases 14 17 16 47 Infestation 277 160 104 541 Factories, mechanical 72 55 46 173 Factories, non-mechanical 17 4 8 29 Outworkers 63 64 105 232 National Assistance Act, S47 18 15 1 34 Smoke observations 2 3 4 9 Clean air inspections 217 1201 - 1418 Keeping of Animals 8 9 16 33 Water certificates 29 26 22 77 Fireguards - - - - Hairdressers 4 9 18 31 Pharmacy and poisons 78 77 2 157 Milkshops 17 25 28 70 Icecream premises 199 119 38 356 Restaurants and eating houses 81 108 187 376 Bakehouses 13 40 3 56 Other food shops 219 344 362 925 Other shops 23 54 7 84 Food inspections 137 426 145 708 Sampling 111 147 229 487 Markets and stalls - 1088 31 1119 Slaughterhouses - 108 - 108 Futile visits 977 2098 322 3397 All other matters 1459 1635 548 3642 Revisits 6053 8322 3078 17453 Total — all inspectors 11763 17840 6071 35674 Smoke abatement Observations ... ... 9 Intimations served ... ... - Complaints received ... ... 7 Statutory notices served ... ... - Legal proceedings ... ... ... - Convictions ... ... ... - 41 Summary of notices served Table 27 West North South Total Intimation notices:- Public Health (London) Act, 1936 274 235 78 587 Factories Act, 1937 2 5 1 8 Informal intimations under Housing Act, 1936 8 15 5 28 Total intimations 284 255 84 623 Statutory notices:- Public Health (London) Act, 1936 177 127 76 380 Factories Act, 1937 4 2 - 6 Housing Act, 1936 6 2 1 9 Byelaws 48 28 13 89 Food and Drugs Act, 1955 - - - - Total statutory notices 235 159 90 484 Nuisances remedied Table 28 Nuisance West North South Total Wall and ceiling plaster repaired 189 169 30 388 Roofs repaired 79 76 31 186 Dampness remedied. 365 153 72 590 Brickwork repaired 20 34 6 60 Chimneys repaired 13 9 4 26 Drains cleared 40 28 56 124 Drains repaired 26 26 23 75 Dustbins supplied 20 16 14 50 Doors and doorframes repaired or renewed 11 7 7 25 Flushing cisterns repaired, renewed or cleansed 10 26 4 40 Flush pipes repaired or renewed 6 2 2 10 Firegrates, etc., repaired or renewed 3 14 7 24 Flooring repaired or renewed 58 40 14 112 Dry rot remedied 3 3 3 14 Gullies renewed, repaired or cleansed 12 11 1 24 Gutters repaired 52 34 24 110 Refuse cleared 3 3 6 Rainwater pipes repaired 17 12 4 33 Soil pipes repaired, ventilated or renewed 19 3 1 23 Sinks provided 1 - 2 3 Sashcords renewed 72 25 18 115 Water closets repaired or renewed 19 20 13 52 Walls and ceilings cleansed 1 1 - 2 Windows and frames repaired or renewed 47 28 10 85 Water service pipes repaired or renewed, water supply restored 12 4 1 17 Yards and areas paved 8 4 1 13 Windows glazed 14 11 2 27 Other nuisances remedied 26 25 13 64 TOTALS 1146 789 363 2298 42 Heating Appliances (Fireguards) Act, 1952 The sanitary inspectors are authorised for the purposes of inspection and testing of heating appliances under the Act. No inspections were made during the year. Registration of hairdressers From October 1, 1955, under s.18 of the London County Council (General Powers) Act, 1954, no person may carry on the business of a hairdresser or barber on any premises in a borough unless he and those premises are registered by the borough council. Exceptions are for premises which are visited only by appointment with a customer, and for a person who in effect is doing hairdressing on his own premises parttime and who does not employ any other person to assist him. Registration in the first place is automatic on application, and a register is kept for the purpose. By the end of the year 121 persons had been registered. Byelaws governing the conduct of these establishments, designed to ensure cleanliness of the person, equipment and premises, came into force on December 1, 1955. The standard of hygiene in those visited up to the end of the year was good. Pet Animals Act, 1951 During the year 24 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 sufficiently supply of water. Certificates were issued in respect of 134 premises and 6 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 43 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 public health 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 bv the local authority. Details follow :— Inspections Table 29 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 67 29 - - (ii) Factories not included in (i) In which section 7 is enforced by the local authority 454 170 8 - (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 24 24 - - TOTAL 545 223 8 - 44 Cases in which defects were found Table 30 Defects No.of defects Prosecutions instituted Found Remedied Referred To HM Inspector By HM Inspector Want of cleanliness (S 1) - 2 - 2 - Overcrowding (S 2) - - - - - Unreasonable temperature (S 3) - - - - - Inadequate ventilation (S 4) - - - - - Ineffective drainage of floors (S 6) - - - - - Sanitary conveniences (S 7): (a) insufficient - - _ - - (b) unsuitable or defective 6 16 - 10 - (c) not separate for sexes - - - - - Other offences against the Act (not including offences relating to outwork) - - 2 - - TOTAL 6 18 2 12 - 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 textiles, the making of paper bags, boxes, brushes, baskets, artificial flowers, metal fittings, etc. Outworkers were visited periodically by the district public health inspectors. 45 The following is a list of trades concerned, extracted from the August, 1957 lists received:— Trade Outworkers employed Clothing 80 Dressmaking 8 Machining 7 Box and bag making 5 Toys 5 Miscellaneous 15 120 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 226 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. The total number of outworkers has decreased considerably since last year. 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. 46 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. Early in 1958 the Council managed to secure the services of an outside pigeon.catcher. Exhumations It is the practice for a sanitary inspector to be in attendance at an exhumation, and one such attendance was made in 1957. Sanitary work generally Mr. Walker, the senior public health inspector, reports: "As before, the total number of inspections made by the public health inspectors is much the same as in the preceding year. The number of complaints received, however, was much lower and this I think can be accounted for by the coming into force of the Rent Act 1957. It was noticed that many landlords were reaching agreement with tenants as to repairs and this, combined with the number of applications for disrepair certificates, has had the effect of cutting down complaints made for the remedying of nuisances under the Public Health Act. The use of oil heaters for occasional and, in some cases, permanent use seems to be increasing. While this form of heating has much to offer in efficiency and convenience, it does not seem generally known that a great amount of water vapour is given off in the combustion of paraffin. Where a heater of this type is in constant use in an unventilated or poorly ventilated room, the walls and the contents of the room, especially textiles, can become very damp or even wet. This trouble is being increasingly met by the inspectors when investigating complaints of dampness, and householders in these cases are given appropriate advice. I think it would be helpful if makers of the appliances could include a note of advice with the printed instructions usually given with every appliance sold." 47 SECTION D —HOUSING Building The following 102 new houses or flats were completed by the Council during the year :— Boone Street 9 Fludyer Street 8 Hither Green Lane 11 Lawrie Park Gardens 22 Lewisham Hill 20 Pond Road 12 Princes Rise 6 Ryculff Square 2 Sydenham Park Road 12 Families rehoused During the year the following families were rehoused :— 1. By the Lewisham Borough Council:— (a) in permanent properties 74 (b) in temporary bungalows 9 (c) in requisitioned properties - 83 2. By the London County Council (figures supplied by district offices) 36 119 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 79 Housing Act, 1957 Repair of houses (sections 9 and 10) During the year 28 informal and 9 formal notices were served. 22 properties were repaired by the owners after service of notices ; in three cases properties were repaired by the Council under section 10 in default of the owners. Demolition Orders and Closing Orders (whole house) 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 1957, together with the present position of cases originating in previous years which had not been complied with at the end of 1956 48 Table 31 Properties Dwellings involved Present position 58, Knowles Hill Crescent 1 Part of work required to comply with statutory undertaking completed. Undertaking to be cancelled. Closing order to be substituted in respect of two rooms on ground floor. 97, Mount Pleasant Road 1 Works completed. Demolition order revoked. 2, Fordel Road 1 Works completed. Demolition order revoked. 2, Cranston Road 1 Conversion still in progress. 2, Dallas Road 1 Demolished. 12, Dalmain Road 1 Works completed. Demolition order revoked. 95, Gilmore Road 1 Demolished 6 Jan '58. 169 Sandhurst Road 1 Demolition order procedure still deferred to enable freeholder to submit statutory undertaking to carry out works. 10, Dalmain Road 1 Works completed. Demolition order revoked. 67/69 Ewart Road 2 Purchased by Council for redevelopment and demolished. 30, Ravensbourne Road 1 Demolition order operative. 50, Eltham Road 1 Demolished. 182, Devonshire Road 1 Demolished. 43, Ronver Road 1 Works to comply with statutory undertaking completed. 28, Porson Street 1 Closing order operative on whole house. 62 Shipman Road 1 Works to comply with statutory undertaking completed. 28, Ravensbourne Road 1 Demolition order operative. 22 Wisteria Road 1 Works to comply with statutory undertaking completed. 61/63 Bell Green 2 Demolition orders operative. 398 Bromley Road 1 Undertaking accepted under s.11 Housing Act, 1936. 2 Nightingale Grove 1 Closing order operative on whole house. 25 Handen Road 1 Closing order operative on whole house. 2, Garlies Road 1 Demolition order operative. 37, Morena Street 1 Closing order operative on whole house. 4, Rojack Place 1 Closing order operative on whole house. 1, Brewster Cottages, Courthill 1 Closing order operative on whole Road house 9, Railway Terrace 1 Closing order operative on whole house Cottage rear of 42 Manor Park 1 Demolition order operative 7, Creeland Grove 1 Demolition order operative 23, Clyde Terrace 1 Demolition order operative 22 Clyde Terrace 1 Demolition order operative 49 Closing Orders in respect of part of house Table 32 Properties Part of house Present position 39, Gilmore Road Two rooms and scullery in semi-basement. Closing order operative. 42, Manor Park Three rooms, scullery and WC in semi-base. ment. Closing order operative. 13, Recreation Road Two rooms, scullery, bathroom and WC in semi.basement. Closing order operative. 53, Manor Park Two rooms and scullery in semi.basement. Closing order operative. 13. Davids Road Two basement rooms. Closing order operative. 4, Somerset Gardens Living room, scullery and WC in basement. Closing order operative. 13, Silverdale Two rooms, scullery and bathroom in basement. Closing order operative. 235, Lee High Road Two rooms and scullery in basement. Notices served. 58, Knowles Hill Crescent Front and middle rooms ground floor Notices served. In his report upon work under the Housing Acts, Mr. Craven, the group housing inspector, states:- "The most notable event in the year was the coming into operation of the new Rent Act, with consequent effects on certain aspects of housing work. In some instances the provisions of this Act showed undoubted benefits, but in one respect it would appear to be somewhat retrogressive. "Because of the new rent limits, it was found that the ' reasonable' cost of carrying out repairs to individual unfit properties was more likely and therefore the latter half of the year saw a decline in the proportion of cases where it was necessary to recommend action for possible demolition or closure. Again, because of the new rent limits, owners were encouraged to submit offers to make fit for habitation houses which had been previously subject to preliminary action leading to demolition or which had been closed. Thus many properties which, although in disrepair, had a reasonably long life were brought up to a good standard and in several instances houses which had been vacated were eventually re.occupied. "The unfortunate feature of the new Rent Act has been a reduction in the number of enquiries and applications for improvement grants for conversions of larger properties into self.contained flats. This is thought to be due to the discouraging effect of the new rent limits specifically applied to these cases by the Act. Conversions carried out under this scheme prior to the 1957 Rent Act, when the rents were fixed by the Council, attained a very good standard because owners made improvements beyond the minimum required, thus adding to the comfort and convenience of the tenants. The rent limits now allowed by the Act, namely twice the gross assessment, are much below the figures previously fixed by the Council for accommodation of a comparable size. It is thus thought that because of the relatively high cost of conversion, together with in many cases extensive maintenance work, owners will find it uneconomic to carry out work to the standard so far attained. The result may be that expenditure will be cut to a minimum, with a consequent lowering of standards, or worse still, owners may not be in a position to carry out conversions at all." 50 Table 33 HOUSES IN CLEARANCE AREAS AND UNFIT HOUSES ELSEWHERE A —HOUSES DEMOLISHED Clearance areas (Housing Act, 1936 and Housing Repairs and Rents Act, 1954). Houses demolished Displaced Persons Families Houses unfit for human habitation 44 62 23 Houses included by reason of bad arrangement 7 12 3 Houses or land acquired under section 27, Housing Act, 1936 5 2 1 Not in clearance areas Formal or informal procedure under section 11, Housing Act, 1936 7 24 9 B —UNFIT HOUSES CLOSED Number Section 11, Housing Act, 1936 and section 10(1) and 11(2) Local Govt. (Misc. Prov.) Act, 1953 8 33 8 Sections 3(1) and 3(2) Housing Act, 1949 - - - Parts of buildings closed under section 12, Housing Act, 1936 8 16 5 C —UNFIT HOUSES MADE FIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED By owner By Local Authority After informal action by local authority 18 - After formal notice under Public Health Acts - - After formal notice under Housing Act, 1936 11 1 Under section 5, Housing Repairs and Rents Act, 1954 4 - 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 Omission of Natural Lighting and Ventilation to Water Closets The Byelaws covering this matter, which have been in existence for many years, allow an internal water closet or bathroom provided that it has suitable means of artificial lighting and a suitable system of mechanical ventilation. It is generally thought that this byelaw was designed primarily to deal with hotels, large office blocks etc. where natural lighting and ventilation would be extremely difficult and where, because of the user of such premises, no nuisance or aesthetic objection would be likely. From time to time however, in other boroughs in the last 20 or so years, the County Council has put up blocks of flats involving residential accommodation only, where the water closets and bathrooms have not been naturally lighted or ventilated; and by and large the boroughs concerned have not objected to this, although it is known that in some cases objection was taken and was persisted in. A year or so back information was received from the County Council to the effect that it was proposed to erect two blocks of flats in Lewisham, these blocks having internal bathrooms and WCs with mechanical ventilation only. The Health committee had previously taken objection to the principle involved and accordingly in this case correspondence occurred between the Health department and the appropriate department of the County Council. As far as the Health department is concerned the points against having only artificial lighting and ventilation to water closets and WCs can be summarised as follows:- 1. Sunlight and even diffuse daylight are known to have a marked bactericidal effect on many kinds of organism capable of causing, and frequently causing, human disease. This bactericidal effect does not occur with artificial light. 2. Pathogenic bacteria grow much more rapidly in a warmer, moister atmosphere and therefore they will grow more rapidly in a WC which is enclosed than in one exposed-even if only by airbricks and an occasional opening of the window-to cool fresh air. 3. Mechanical ventilation depends on machinery and machinery can break down. Although the machinery for extraction of air is duplicated, there is nothing to show that the electric supply for this will be duplicated-in other words, that there will be an emergency supply from a source other than the mains. 4. The aerial change of 750 cubic feet per hour is probably insufficient in certain circumstances, which may well occur particularly in poorer class property. In such property crowding or overcrowding is more likely, and intestinal diseases or upsets are at least as likely and probably slightly more so, than in better.class property. As a result the sanitary convenience is likely to be used more, and there is consequently a greater likelihood of unpleasant intestinal smells escaping into the ordinary living rooms. These besides being aesthetically unpleasant may have a more definite psychological effect. 5. It is of importance from the public health aspect that lighting and ventilation in housing accommodation should be as simple and direct as possible. While the working of electrical and mechanical apparatus is no doubt within the competence of many people it is not within the competence of all, and the lower the intelligence (and usually the hygiene) the less likely is technical apparatus to be well maintained. 52 6. Considerable difficulty is found from time to time even now in maintaining a reasonable standard of cleanliness of water closets in the poorer type of block dwellings. Maintenance of cleanliness is greatly aided by good natural lighting and ventilation and will be made much more difficult in future if daylight is entirely excluded. 7. The standard of hygiene of social class V people, some of whom will no doubt tenant the flats, is probably on average less than that of the social class of people inhabiting hotels, or similar places which the exception to the byelaw (it is thought) was primarily designed to help. The chances of bacterial infection are thereby increased. 8. Hotel and office block users are either not resident or are only resident for very short periods. They are therefore able to put up with theoretically objectionable practices in a way which permanent residents cannot. In any event they are less likely to be chronically ill and even if they became acutely ill they would not remain there for more than a few hours. 9. When natural lighting is omitted in large office blocks, hotels, etc. the usual thing is that the WCs are in suites and the total size of the whole WC compartment, including the individual cubicles, is relatively large and therefore mechanical ventilation produces no draught and it also produces less feeling of oppression. Furthermore excellent maintenance can be relied upon. 10. It must be accepted that a proportion of adults have feelings akin to claustrophobia. Such feelings are more likely to be exacerbated in having to use the type of WC and bathroom proposed. 11. Even assuming that everything works perfectly now, or has been working perfectly for a few years at some estates, there is no guarantee that individual flats will not be sold within the next 60 or 70 years to individual tenants. This is more likely with one political party in power than another and it is more likely in the small blocks of flats than in the taller blocks. If this is so steps would have to be taken to ensure that the extraction mechanism would be within the control of each individual flat owner. 12. If this method of construction is used by one authority it would be difficult to stop " slum " landlords (whose existence we must accept) from also adopting windowless water closets. Here proper maintenance is much less likely to be satisfactory, and many hygienic and other evils may thus result. 13. If any of the tenants happen to be poor or to become poor (and this is a matter which cannot be ruled out) it is likely that the electric current, if based on a pre.payment meter, will not be maintained, or that an electric bulb which may normally light the WC may wear out and not be replaced for a matter of hours or days. During this time there would be likely to be increased fouling of the WC compartment and thereby increased risk to anybody using it. There must of course be reasons for a contrary view and so I have endeavoured to ascertain why things which are natural (such as light and ventilation) should be avoided. The point which immediately springs to mind is whether by so doing money could be saved. It appears that this may be possible, though not so in every case, and where it is possible the amount saved is only a small percentage of the total building cost. It is also said that there would be less danger from frost but this can be no real objection, because with present methods of construction the pipes can be properly protected and in fact can be all within the framework of the house-thereby also cutting out the aesthetic objection that the facade of the house or block of flats may look unpleasant because of multiplicity of pipes. In fact there need be none. As it seemed that the 53 only other reasonable explanation of the desire to push this principle of no natural ventilation was because of some failure on the architectural side to produce a suitable design, I tried to ascertain what in fact were the accepted reasons for the proposal. In this connection I have been informed as follows :- From the Architect's point of view, the planning of bathrooms and water closets internally in certain types of point and slab blocks permits reductions in dwelling area by more compact planning which reduces the amount of external wall and window and, on balance, shows saving in cost. The reduced bulk of building, particularly the considerably reduced frontage in slab blocks, facilitates a more open planning of the site. Incidental advantages are that condensation is reduced to a minimum, chilly draughts are avoided and the risk of frozen pipes is eliminated. The byelaws which control the method of lighting and ventilation of water closets provide for an amount of air change which is, by the nature of the system, quite independent of atmospheric conditions or the whim of tenants. The requirements of three air changes and a minimum extract rate of 750 cubic feet per hour is a good one. Mechanical ventilation has the advantage over natural means in that a water closet compartment is ventilated at a regular rate through the twenty.four hours of each day, quite regardless of outside atmospheric conditions. In cold or wet weather it is general to find windows in water closets closed, with the result that the compartment is without effective ventilation. It is also a feature of mechanical ventilation that there is a flow of air from the living rooms, bedrooms, etc., towards the water closet compartment. This is to be preferred to the reverse which can occur when winds blow on to the face of the building containing an open window to a water closet. Much can be said against the points raised here and I have already dealt with some of them in the objections to the system set out above, but the principle of the proposal is one which can only be approved or rejected over the years by the opinion of the members of the public who have to live in such flats. I hope that my fear that these flats, at present so outwardly and in most respects inwardly nice, will approach the unpleasant sub.standard conditions before their proper time, will be found to be incorrect. Rent Act 1957 The Rent Act 1957 came into force on 6 July 1957 and the following table shows the applications for certificates of disrepair dealt with during the period ended 31 December, 1957:. 54 Table 34 Applications for certificates 468 Decisions not to issue certificates 4 Decisions to issue certificates (a) in respect of some but not all the defects 276 (b) in respect of all defects 120 Undertakings given by landlords to repair 189* Undertakings refused for special reasons Certificates of disrepair issued 159 Applications by landlords for cancellation of certificates 10 Objections by tenants to cancellation 1 Decisions to cancel in spite of tenants' objection . Certificates cancelled 6 *14 not accepted. Housing Repairs and Rents Act, 1954 and Rent and Mortgage Interest (Restrictions) Act - certificates of disrepair The following table shows the position for the period 1 January to 5 July 1957:- Table 35 Applications for certificates of disrepair 9 Certificates issued 10 Applications for certificates withdrawn or certificates not granted . Applications outstanding at end of period . Certificates issued in 1957 in respect of applications received in 1956 1 Applications for revocation of certificates previously issued 5 Applications granted 5 Applications outstanding at end of period . Applications for revocation of certificates previously issued, received during 1956 and issued during 1957 . N.B. Applications for cancellation of these certificates made subsequent to 5 July 1957 merge into procedure under the Rent Act 1957 and are dealt with under that heading. 55 SECTION E -INSPECTION AND SUPERVISION OF FOOD Milk and Dairies Regulations, 1949 At the end of the year there were 112 persons registered for the distribution of milk from premises within the borough and 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 year as follows:. Table 36 Dealer's Supplementary Total Licences issued for:. sale of pasteurised milk 70 20 90 sale of tuberculin tested milk 66 20 86 sale of sterilised milk 102 21 123 TOTALS 238 61 299 Examination of heat.treated milk 136 samples of pasteurised milk and 4 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, 66 samples of milk were submitted for examination to the public analyst by the Council's inspectors ; all the samples were found to be genuine. The average composition of the samples is set out in the following table:. Table 37 Period Samples Average composition of samples examined Percentage of Milk fat Solids not fat Water First quarter 26 3.57 8.76 87.67 Second quarter 13 3.64 8.91 87.45 Third quarter 17 3.55 8.88 87.57 Fourth quarter 10 3.64 8.87 87.32 TOTALS 66 3.59 8.84 87.57 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. 56 Icecream - composition Under the Food Standards (Icecream) Order, 1953, icecream must contain not less than 5 percent fat, 10 percent sugar and 7| 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 70 samples submitted to the public analyst were found to have the composition shown in the appended table:. Table 38 Period Samples Average percentage composition Fat Milk solidsnot fat Sucrose Water First quarter 18 10.2 12.3 14.9 62.6 Second quarter 17 10.8 11.1 15.0 63.1 Third quarter 21 10.8 10.3 15.4 63 5 Fourth quarter 14 11.3 11.6 13.5 63.6 TOTALS 70 10.7 11.3 14.8 63.2 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 per cent 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 161 samples of icecream were submitted for bacteriological examination with the following results:- Table 39 Grading Samples submitted % Grade I 107 66.5 Grade II 42 26.1 Grade III 7 4.3 Grade IV 5 3 1 TOTAL 161 100.0 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. 57 Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 440, all of which were informal. After examination the public analyst reported that all the samples were genuine, the percentage of adulteration therefore amounting to 0 as compared with 2.69 for the previous year. The following table gives the groupings and the results of the samples analysed:- Table 40 ARTICLES Informal ARTICLES Informal Butter 13 Fruit and Vegetables 7 Cereals and Baking Powder 23 Icecream 70 Lard and Suet 6 Cheese 5 Margarine 8 Cocoa, coffee, tea 17 Meat, canned and pies 5 Confectionery (sweets) 4 Milk and Cream 68 Condiments and flavourers 77 Milk, condensed 8 Paste, fish and meat 23 Drugs 47 Sausages 4 Flour 9 Spirits 4 Other foods 42 TOTAL 440 Other samples In addition to samples submitted to the public analyst or bacteriologist for routine sampling, the following were submitted for various reasons, but mainly because of complaints received, or as a result of enquiries made into cases of food poisoning:- Sausages (9) Crab meat Ball gum Cauliflower-cheese Peas Mussels Cooked Beef Registration of food premises Reregistration of food premises was continued consequent to 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 Food and Drugs Act, 1938 which required merely registration of the premises. During the year the following were registered, the total (including the previous year) being shown in the last column. Type 1957 Total Sale and storage of ice-cream 120 245 Manufacture of icecream - - Fish frying 10 16 Fish curing 5 11 Preparation or manufacture of sausages 29 56 Preparation or manufacture of potted, pressed, pickled or preserved food 39 84 58 Unsound food Approximately 4 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 Twelve certificates of exemption in respect of sanitary conveniences were issued during the year. Food Hygiene Regulations, 1955 Regulations 15 and 16 require the provision of a water supply and wash hand basin on all food premises. Two premises were inspected during the year where it was not possible to provide these services and exemption certificates were accordingly issued. Pharmacy and Poisons The names of 11 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 199 persons previously registered were retained on the register. 157 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. 186 pigs were slaughtered and the carcases inspected during the year. 3 of these carcases with a total weight of 523 lbs. were condemned as tuberculous, and 18 lbs. of heads and offals from 2 carcases were also destroyed. 4 slaughtermen's licences were granted during the year. Offensive trades There are no offensive trades carried on in the borough. 59 Food work generally Mr. Thomas, the group food inspector, in commenting on the year's work, states :- "The work of re-registration of food premises coming within the provisions of Section 16 of the Food and Drugs Act 1955 was continued during the year. With regard to ice cream it is gratifying to note that the results of the bacteriological examination of samples show an improvement over those of the previous year. Of the samples taken during 1956 52.5 were Grade I whereas during 1957 the figure rose to 66.5. The analyses of the samples of ice.cream taken during the year show that the composition is being maintained at a figure well above the legal minimum standards. In connection with the sampling of food generally it will be seen from the results of the analyses that there was no adulteration, so that in no case was it necessary for a follow.up formal sample to be taken. The amount of food condemned as unfit for human consumption fell during the year. This can be accounted for, to a large extent, by the growing practice of wholesalers exchanging defective tins, etc. by arrangement between the shopkeepers and their travellers without the production of a condemnation certificate. Summing up one can say that the year shows a continued interest in the importance of cleanliness in connection with the storage and sale of food both on the part of the public and the trader, and this interest shows every indication of being well maintained. 60 SECTION F - PREVALENCE OF and CONTROL OVER INFECTIOUS AND OTHER DISEASES PRINCIPAL NOTIFIABLE DISEASES The undermentioned diseases are notifiable by medical practitioners to the Medical Officer of Health :- Anthrax Ophthalmia neonatorum Cholera Plague Diphtheria Pneumonia, acute influenzal Dysentery (bacillary or amoebic) Pneumonia, acute primary Encephalitis, acute Poliomyelitis, acute Enteric fever Puerperal pyrexia Erysipelas Relapsing fever Food poisoning Scabies Glanders Scarlet fever Hydrophobia Smallpox Malaria Tuberculosis, all forms Measles Typhoid fever, including paratyphoid Membranous croup Typhus fever Meningococcal infection Whooping cough INFECTIOUS DISEASES Number of notified cases (corrected for revised diagnosis) during the year 1957 with comparative figures for the previous six years. Table 41 Diseases Cases notified 1957 1956 1955 1954 1953 1952 1951 Diphtheria - - 1 - 1 - - Dysentery 129 579 92 394 84 169 365 Encephalitis (acute) 2 2 - - 3 5 Enteric or typhoid fever 2 3 1 1 2 - 4 Erysipelas 15 20 26 24 18 19 24 Food poisoning 42 46 48 110 32 33 26 Malaria - - 1 3 2 1 1 Measles 2728 206 3905 521 2082 2183 2546 Meningococcal infection 4 9 4 6 10 5 6 Ophthalmia neonatorum 2 2 4 2 3 4 3 Pneumonia 96 89 121 77 189 89 173 Poliomyelitis (acute) 15 26 63 16 52 15 11 Puerperal pyrexia 93 57 92 59 57 88 63 Scabies 18 29 18 14 5 18 21 Scarlet fever 143 188 158 331 283 379 215 Tuberculosis 247 212 271 256 341 307 299 Whooping cough 225 241 412 449 574 512 819 TOTALS 3761 1709 5217 2263 3738 3822 5581 61 Notifications of infectious diseases in 1957 showing sex and age groups Table 42 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 2 2 15 12 6 5 17 12 5 4 3 9 10 14 4 5 1 3 63 66 Encephalitis (acute) - - 1 - - - 1 - - - - - - - - - - - 2 - Enteric or typhoid fever - - - - - - - - - 1 - - - 1 - - - - - 2 Erysipelas - - - - - - - - - - 1 - 3 2 4 3 1 9 6 Food poisoning - - 2 1 4 2 5 3 2 3 3 1 3 5 3 4 - 1 22 20 Measles 38 31 295 286 340 291 667 719 21 15 7 9 3 6 - - - - 1371 1357 Meningococcal infection 1 - - 1 1 - 1 - - - - - - - - - - - 3 1 Ophthalmia neonatorum 2 - - - - - - - - - - - - - - - - - 2 - Pneumonia - 1 4 2 - 1 2 4 2 2 3 2 13 10 22 1/ 8 3 54 42 Poliomyelitis (paralytic) - - - - - - - 1 - - 1 - 3 - - - - - 4 1 Poliomyelitis (nonparalytic) - - 1 - 2 - 3 - - - - 1 1 2 - - - - 7 3 Puerperal pyrexia - - - - - - - - - - - 43 - 50 - - - - - 93 Scabies 1 - - 1 1 - 2 4 3 - - 2 1 1 1 - I - 10 8 Scarlet fever - 7 3 13 13 43 44 7 8 2 2 - 1 - - - - 72 71 Tuberculosis (respiratory) - - 2 - 3 1 4 4 4 3 24 20 35 43 40 18 16 3 128 92 Tuberculosis (non-respiratory) - - - - 1 - 2 1 - - 1 3 5 10 2 2 - - 11 16 Whooping cough 10 17 20 30 22 26 40 49 3 3 - 2 - 2 - 1 - - 9 130 Totals 54 51 347 336 393 339 787 841 47 39 45 94 77 147 76 50 27 11 1853 1908 62 Analysis of certain diseases in table 62 into divisional areas- Table 43 Disease Divareas Under 1 /- 3- 5- 10- 15- 25- 45- 65+ Total Dysentery W 1 7 2 6 1 1 4 1 - 23 N 2 15 6 4 3 6 6 1 1 44 S 1 5 3 19 5 5 14 7 3 62 Total 4 27 11 29 9 12 24 9 4 129 Measles W 26 242 272 662 16 6 2 - - 1226 N 24 194 189 314 8 3 4 - - 736 S 19 145 170 410 12 7 3 - - 766 Total 69 581 631 1386 36 16 9 . . 2728 Pneumonia W - 3 1 1 - 3 5 5 2 20 N 1 2 - - 1 - 11 9 2 26 S - 1 - 5 3 2 7 25 7 50 Total 1 6 1 6 4 5 23 39 11 96 Poliomyelitis W - 1 1 2 - 2 3 - - 9 N - - 1 2 - - 2 - - 5 S - - . . . . 1 - - 1 Total . 1 2 4 . 2 6 . . 15 Scarlet fever W _ 4 10 31 4 3 - - - 52 N . 2 2 18 4 _ . - - 26 S . A 14 38 7 1 1 - - 65 Total . 10 26 87 15 4 1 . . 143 Tuberculosis (respiratory) W - - 1 3 5 12 30 21 5 77 N - 1 1 3 2 16 23 16 9 71 S - 1 2 2 . 16 25 21 5 72 Total - 2 4 8 7 44 78 58 19 220 Whooping cough W 10 13 16 37 4 1 1 1 - 83 N 8 18 15 20 1 - - - - 62 S 9 19 17 32 1 1 1 - . 80 Total 27 50 48 89 6 2 2 1 . 225 Infectious disease visiting The Council employs three infectious disease visitors whose duty it is to visit the homes of persons who are stated to be suffering from a notifiable infectious disease. All the infectious disease visitors are state registered nurses, and two are 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. 63 The work of the infectious disease visitors as agents of the medical officer of health includes the investigation of home conditions, the giving of advice to patients and contacts, particularly where the patient is left at home, and in general the taking of such measures as may be necessary to combat the spread of infection. The following is a summary of the work in visiting infectious diseases carried out during the year which is in addition to the visits paid by the public health inspectors referred to in table 26:- Table 44 W N S Total Visits 436 382 687 1505 Futile visits 352 202 295 849 Revisits 107 140 256 503 Total 895 724 1238 2857 Poliomyelitis In 1957 15 cases of poliomyelitis were confirmed and of these 5 were paralytic and 10 non.paralytic. The distribution over the borough was 9 in the west, 5 in the north and 1 in the south divisions. 11 were males and 4 females. The following table gives figures for this borough over the last 11 years, the time during which the incidence has been hich. Table 45 Year (a) Intimated to Dept. (b) Removed to hospital (c) Confirmed (d) (d) as %age of(b) (e) 1947 176 172 76 43 8 26 25 9 35 9 83 79 41 49 1950 93 90 38 41 1 33 33 11 33 2 30 30 15 50 3 83 79 52 63 4 33 32 16 48 5 103 100 63 61 6 46 43 26 57 7 46 46 15 33 TOTAL 752 729 362 48 1957 proved to be a year of small incidence of this disease and in fact there has been no lower annual figure of cases occurring in the borough to borough residents since 1951. Vaccination against poliomyelitis was carried out through the County Council, and the local response was stated to be satisfactory. It is hoped however that a much larger number of children will be protected during the early part of 1958. 64 Dysentery After the high number of cases in 1956 (579), dysentery notifications fell to 129. The disease continued to be very mild, being more of a nuisance than anything else. When it occurs in a school however it does interfere considerably with education, both of patients and to a lesser extent of their home contacts. In certain areas where statistics have been kept it has been found that non.exclusion from school of symptomless children who have the organism in their stools appears to have no significant effect on the incidence of the disease. However in the London area if these positive cases are found they are excluded-normally until negative. Occasionally a child will go on excreting the causal organisms indefinitely, or at least for many months, and clearly it would be unreasonable to exclude the child from school for all that time if satisfactory precautions against spreading the infection were taken and maintained. In such cases, if the school authority is willing to have the child back and if the hygienic conditions in the school are good and the child itself is of a cooperative age or can be individually supervised, it is allowed to return. Food poisoning The number of cases last year formally notified was much the same as in the previous two years. Formal notification however is not a very exact indication of the amount of food poisoning in the area and, either because outbreaks are sometimes so mild as to show only transient symptoms in the patients, or because of failure of notification, the number of cases shown in the report is many less than the number of cases actually coming to the knowledge of the department. Thus we heard of a group of cases which, on investigation, appeared to have been associated with the consumption of tinned peas, but these are not included in the numbers shown in the report as they were not formally notified. Measles Measles tends to become epidemic at approximately two.year periods. If the beginning of the epidemic is in the autumn, then the number of cases each calendar year tends to even out. If however it does not really get going until the new year, nearly all the cases occur in that particular year with correspondingly few in the previous year. This 2.yearly cycle has been the position in Lewisham for about four years past and, whereas before that time there were usaully some 2,000 cases each year, since 1953 the numbers have been 500, 3,900, 200 and, last year, 2,700. Measles remains a very mild disease and in the 2,700 cases there was no death. Pneumonia The number of cases remained about average, which in itself indicates that there was no great influenzal epidemic during the year. (Influenza itself is not notifiable). There was much talk and publicity given to so.called Asian flu during the summer of 1957 and the disease 65 reached this country in the late summer. There was a high general sickness rate in the borough in the autumn, but it was difficult to say how much of this was due to the ordinary autumnal cold perhaps rather more severe because of the previous mild winter. At the very end of the year there appeared to be a second influenzal wave occurring and this one was in fact much more associated with cases of pneumonia and deaths from bronchitis. The wave continued into the early part of 1958, but the total number of cases was not large. Tuberculosis The number of cases notified increased a little over the previous year, but remained considerably less than in 1955 and the years before that. The number of deaths was 33 (31 respiratory and 2 of other forms). The mass x.ray unit is useful in digging out cases, and it is always hoped that such cases will be discovered, and treated, at a stage when they will be least potentially infectious to other people. 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 46 Age period s New cases notified Deaths Respiratory NonRespiratory Totals Respiratory NonRespiratory Totals M F M F M F M F M F M ] 0- - - - - - - - - - - - - 1- - - - - - - - 1 - - - 1 2- 5 1 1 6 1 _ 5- 4 4 2 1 6 5 10- 4 3 - - 4 3 - - - - - - 15- 11 11 - 2 11 13 - - - - - - 20- 13 9 1 1 14 10 - - - - - - 25- 19 29 4 7 23 36 1 3 - - 1 3 35- 16 14 1 3 17 17 45- 71 8 1 71 9 9 6 1 - 10 6 55- 19 10 2 1 21 11 65- 14 7 - - 14 2 6 1 - 1 6 2 75 + 2 1 - - 2 1 3 1 - - 3 1 128 92 11 16 139 108 19 12 1 1 20 13 66 Analysis of new cases of tuberculosis into divisional areas:- Table 47 Division Sex 0- /- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total West Respirator M - - 1 2 4 1 3 9 6 10 6 4 1 47 F - - - 1 1 4 4 11 4 2 3 - - 30 Non-respiratory M - - 1 1 - - - - - - 2 - - 4 F - - - - - 1 - 4 2 - - - - 7 North Respiratory M - - 2 2 - 4 6 4 6 7 4 7 - 42 F - - - 1 2 4 2 7 6 2 3 1 1 29 Non-respiratory M - - - 1 - - 1 2 1 - - - - 5 F - - - - - - 1 1 1 - - - - 3 South Respiratory M - - 2 - - 6 4 6 4 4 9 3 1 39 F - - 1 2 - 3 3 11 4 4 4 1 - 33 Non-respiratory M - - - - - - - 2 - - - - - 2 F - - - 1 - 1 - 2 - 1 1 - - 6 Summary of statistics as to tuberculosis for the last ten years Table 48 Year Population New coses 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 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 1957 220,900 247 1.12 33 31 0.14 0.12 For comments on sex differences in tuberculosis and in lung cancer, see p. 17 67 Mass radiography unit I am indebted to the Director of the Unit for information of work done in the borough during 1957 on which the following table is based. The Unit during the course of the year was stationed at 7 different locations in the borough, the time spent at each varying from 1 day to 1 week. Table 49 Patients Men Women Total General analysis X-rayed 5,940 2,974 8,914 Previously x-rayed 4,236 2,000 6,236 Recalled for large film 230 84 314 Normal on large film 92 48 140 Abnormal on large film 136 36 172 Not yet re-attended 2 - 2 Analysis of abnormal large films:- Cases considered tuberculous:- (a) no further action required 2 6 8 (b) occasional supervision only 14 - 14 (c) requiring treatment 6 - 6 (d) still under investigation 2 2 Non-tuberculous cases:- (a) investigated 16 10 26 (b) still under investigation 4 - 4 Cardio.vascular lesions 4 - 4 Previously known tuberculous cases 14 4 18 No action required 76 14 90 Tuberculosis - environmental conditions Case papers of patients attending the Lewisham Chest Clinic in 1957 have been analysed in 238 cases with the following results:- Cases %* Males 122 51 Females 116 49 Social classification:- Class I 2 1 Class II 20 10 Class III 133 64 Class IV 29 14 Class V 23 11 Not classifiable 31 - Rooms occupied:- 2 or more rooms per person 34 14 1-2 rooms per person 130 55 Less than 1 room per person 73 31 No information 1 - Accommodation:- Separate bed 85 36 Separate bedroom 61 26 Condition of premises occupied:- Good 192 82 Fair 34 15 Poor 7 3 No information 5 - *Excluding cases not classified 68 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 Registrar. General:- First quarter 9 Second quarter 8 Third quarter 22 Fourth quarter 3 42 (2) Outbreaks due to identified agents:- Total outbreaks 1 Total cases 8 Outbreaks due to:- (a) chemical poisons - (b) salmonella organisms 1 (c) staphylococci (including toxin) - (d) CI. botulinum - (e) other bacteria - (3) Outbreaks of undiscovered cause 1 Total cases 6 (4) Single cases:- Agent identified 11; Unknown 17 ; Total 28 Whooping cough Cases continued to decrease and this decrease has for some years been pretty consistent; thus in 1950 and again in 1951 there were over 800 cases, in 1952 and 1953 there were over 500 cases, in 1954 and 1955 there were over 400 cases and both in 1956 and 1957 the number came down to just over 200. It is uncertain as to how much of this decrease has been due to immunisation, which is certainly becoming more popular, and how much has been due to a "natural" decrease in the virulence or infectivity of the causal organism. 69 I am indebted to the Divisional Medical Officer of the London County Council for the information on which the folowing table is based:- Immunisation against diphtheria; whooping cough; smallpox Table 50 Age of December 31, 1957 Under 1 / 2 3 4 5-9 10-14 Total under 15 Born in year 1957 1956 1955 1954 1953 1952-48 1947-43 (i) Diphtheria (including combined and triple):— immunised during year 474 1,894 124 65 56 161 46 2,820 immunised at end of year 474 2,285 2,330 2,392 2,773 13,980 13,498 37,732 Estimated mid-year population 15,600 33,200 48,800 (ii) Whooping cough (including combined and triple):— Immunised during year (age at date of immunisation) 1,818 496 113 59 30 43 4 2,563 Vaccination. Vaccinated during the year (age of date of vaccination) Under 1 1-4 5-14 15 and over Total Primary 1,924 333 201 179 2,637 Revaccination 1 21 69 286 377 Town Hall, S.E.6. E. H. R. SMITHARD July, 1958. Medical Officer of Health 70 APPENDIX A Acts of Parliament, Statutory Instruments and Circular Letters issued by Government Departments with regard to the public health services, during the year 1957:- Statutes Public Health Officers (Deputies) Act, 1957. Rent Act, 1957. Housing Act, 1957. London County Council (General Powers) Act, 1957. Statutory Instruments No. 273 Public Analysts Regulations, 1957. 304 The Local Authorities (Charges for Dustbins) Order, 1957. 541 The Smoke Control Areas (Exempted Fireplaces) Order, 1957. 981 The Rent Restrictions Regulations, 1957. 1066 The Colouring Matter in Food Regulations, 1957. 1842 The Housing (Prescribed Forms) Regulations, 1957. 2157 The Food Hygiene (Amendment) Regulations, 1957. Ministry of Health Circulars. No. 5 Public Health Officers (Deputies) Act, 1957. 11 Manual of International Statistical Classification of Diseases, Injuries and Causes of Death. 14 Local Authority Services for the Chronic Sick and Infirm. 20 The Food Hygiene (Amendment) Regulations, 1957. Ministry of Housing and Local Government Circulars. No. 15 Charges for dustbins. 18 Housing of old people. 27 I. Smoke Control Areas (Exempted Fireplaces) Order, 1957. II. Model building byelaw. 32 Rent Act, 1957. 45 Improvement Grants. 46 Housing Act, 1957. 51 Housing Act, 1957. 54 Restriction of capital investment. 55 Housing Accommodation for Old People. 71 Ministry of Agriculture, Fisheries and Food Circulars. No. FSH 1 Public Analysts' Regulations, 1957. 2 Exchequer grants towards the cost of meat inspection. 3 Amendments to Memo. 3 (Meat). 4 Milk and Dairies Regulations, 1949 to 1954-Approved Oxidising or Preservative Agents. 5 The Colouring Matter in Food Regulations, 1957. 6 Slaughterhouses-Recommended minimum standards of struction, layout and equipment. 7 & 8 Milk and Dairies Regulations, 1949-1954-Approved Oxidising or Preservative Agents. 10 Milk and Dairies Regulations, 1949-1954-Approved Oxidising or Preservative Agents. PDP 1 Prevention of Damage by Pests Act, 1949-antimoulding substances for rat baits. 2 Prevention of Damage by Pests Act, 1949-Reports by Local Authorities for the 12 months ended 31 March, 1957. Home Office Circulars No. 100 The Heating Appliances (Fireguards) Regulations 1953British Standard 194S : 1953 incorporating amendments and supplement No. 1 (1956). General Register Office Circulars. No. 2 Annual Reports of Medical Officers of Health, 1956-vital statistics. 3 Infectious and other Notifiable Diseases-quarterly return. 4 Annual Reports of Medical Officers of Health, 1956-vital statistics. APPENDIX B Legal Proceedings in 1957 The following are details of legal proceedings instituted during the year:— Nature of Summons No. of summonses Total fines Total costs Remarks Public Health (London) Act, 1936 £ s. d. £ s. d. Failure to comply with requirements of nuisance notices 14 5 5 0 4 4 0 In seven cases, abatement orders were made; in six cases the summonses were withdrawn, the work having been completed. 72 Nature of Summons No. of summonses Total fines Total costs Remarks Public Health (London) Act, 1936-cont. £ s. d. £ s. d. Failure to comply with requirements of notice requiring provision of dustbin. 1 - Summons withdrawn. Dustbin supplied. Contravention of LCC drainage byelaws. 5 10 0 0 2 2 0 Contravention of LCC byelaws relating to removal of offensive matter. 1 - 1 1 0 Conditional discharge. London County Council (General Powers) Act, 1952 Section 26 (1) - exchange of toys for rags. 3 6 6 0 1 1 0 Food and Drugs Act, 1955. Section 2-food not of the nature, substance nor quality demanded 11 14 4 0 9 9 0 In two cases conditional discharges and in two cases absolute discharges were granted. One summons was withdrawn and one dismissed. Section 8-sale of food unfit for human consumption. 1 2 2 0 2 2 0 Food Hygiene Regulations, 1955 Regulation 8-food to be protected from risk of contamination. 11 26 0 0 10 10 0 In two cases an absolute discharge was granted. Three summonses were dismissed and one withdrawn Regulation 26 (1)-general requirements as to stalls. 1 3 3 0 1 1 0 Regulation 32 (3) driver of vehicle not wearing head covering 2 3 3 0 2 2 0 LCC byelaws for pro. teciton of food Bye. law 5 (d) - protection of food against contamination. 8 2 2 0 1 1 0 Three summonses dismissed. Four summonses withdrawn. Milk and Dairies Regulations, 1949, Section 31-cleanliness of vehicles used for conveyance of milk. 8 10 10 0 3 3 0 In one case an absolute discharge was granted. Two summonses were dismissed. 73 APPENDIX C List of special reports submitted to the Health Committee by the Medical Officer of Health during 1957:- January 8 Omission of natural lighting and ventilation to water closets. March 5 Public education on cancer. April 2 Smoke control areas. July 2 Proposed smoke control area at Ladywell. September 10 Smoke control area-proposed meeting and exhibition. December 3 Canteens at old people's clubs. 74 TABLES TABLE NO. SUBJECT PAGE TABLE NO. SUBJECT PACE Section A Section C 1 Comparative statistics 9 26 Sanitary inspection 40 2 Causes of death by age groups 10 27 Summary of notices 41 28 Nuisances remedied 41 3 Deaths under one year 12 29 Factory inspections 43 4 Local sickness 13 30 Factory defects 44 5 Deaths by social class 14 6 Causes of death by social class 15 Section D 31 Demolition orders 48 7 Grouped causes of death by social class 16 32 Closing orders 49 33 Clearance areas 50 8 Births, infant deaths, etc., by social class 16 34 Rent Act, 1957 54 35 Housing Repairs and Rents Act, 1954 54 9 Heart and circulation mortality 17 10 General statistics from 1901 18 Section F. 11 Sex differences in pulmonary tuberculosis 20 36 Milk licences 55 37 Analysis of milk 55 12 T.B. male to female ratio 21 38 Icecream composition 56 13 Consumption of cigarettes in U.K 22 39 Icecream grading 56 40 Samples analysed 57 Section B 14 Disinfecting station 23 Section F 15 Verminous conditions, etc. 23 41 Notified cases of infectious diseases 60 16 Public mortuary 25 42 Notifications of infectious diseases by age and sex 61 17 Rodent control—treatment of rivers 26 18 Prevention of Damage by Pests Act 27 43 Analysis of certain diseases into divisional areas 62 19 Laboratory facilities 28 44 Infectious disease visiting 63 20 Water, chemical samples 30 45 Poliomyelitis 63 21 Water, bacteriological samples 30 46 Tuberculosis notifications and deaths 65 22 Laundering of soiled articles 32 47 Analysis of new cases of tuberculosis into divisional areas 66 23 Laundry work by age and domicile 32 48 Tuberculosis statistics 66 24 Atmospheric pollution— water—insoluble matter 36 49 Mass radiography 67 50 Immunisation against infectious disease 69 25 Atmospheric conditions 38 CHARTS First applications for sickness benefit 1951-7 14 Atmospheric pollution—deposit gauge results 1953-57 37 75 INDEX SUBJECT PAGE Acts, regulations and orders 70 Area of borough 8 Atmospheric conditions 34 Births and birth rate 8 Clearance areas 50 Coronary disease 17 Deaths and death rate 8 Deaths, causes of 10 Disinfection and personal cleansing 23 Dog nuisances 29 Drainage work 29 Dysentery 64 Exhumations 46 Factories 42 Flies and mosquitoes 24 Food, adulteration of 57 Food inspection and supervision 55 Food poisoning 64 Food Hygiene Regulations, 1955 58 General statistics from 1901 18 Hairdressers 42 Health Services, general provision of 23 Heating appliances 42 Heattreated milk 55 Housing:- Building 47 Families rehoused 47 Housing Act, 1957 47 Housing Repairs and Rents Act, 1954 54 Icecream composition 56 Icecream grading 56 Immunisation 69 Infant moitality 9 Infant mortality statistics 12 Infectious diseases 60 Infectious disease visiting 62 Laboratory facilities 28 Laundering of soiled articles 31 Legal proceedings 71 LCC (General Powers) Act, 1953, Section 43 24 SUBJECT PAGE Mass miniature radiography 67 Maternal deaths 9 Measles 64 Milk, analysis of 55 Milk and Dairies Regulations, 1949 55 Mortuary and Coroner's Court 25 National Assistance Act, 1948, s.50 28 s.47 29 Nuisances remedied 41 Offensive trades 58 Old People 5 Omission of natural lighting to water closets 51 Outworkers 44 Pet Animals Act, 1951 42 Pharmacy and Poisons Act, 1953 58 Pigeons 46 Pneumonia 64 Poliomyelitis 63 Population 8 Prevention of Damage by Pests Act, 1949 27 Rag Flock and Other Filling Materials Act, 1951 45 Rateable value 8 Rent Act, 1957 53 Rodent control 25 Sampling 57 Sanitary circumstances of the area 40 Sex incidence in pulmonary tuberculosis 17 Shops Act, 1950 58 Sickness, local 13 Slaughterhouses 58 Smoke nuisances 40 Social medicine statistics 14 Staff 3 Stillbirths 8 Swimming baths 28 Tuberculosis 65 Unsound food 58 Vaccination 69 Vital statistics 8 Water certificates 42 Water supply 29 Whooping cough 68