AC 4374 LEW 46 METROPOLITAN BOROUG|H OF LEWISHAM THE PUBLIC HEALTH OF LEWISHAM Report of the Medical Officer of Health for the Year 1958 E. H. R. Smithard, MBE, MD, DPH London : E. G. Berryman & Sons, Ltd., Blackheath Road, S.E.10 METROPOLITAN BOROUGH OF LEWISHAM Report OF THE Medical Officer of Health for the Year 1958 E. H. R. Smithard, MBE, MD, DPH CONTENTS Page Staff 2 Introduction 3 Vital Statistics 6 General Provision of Health Services 18 Sanitary Circumstances of the Area 34 Housing 41 Inspection and Supervision of Food 46 Infectious Diseases 55 Appendix A — Statutory Instruments 65 „ B — Legal Proceedings 67 „ C — Special Reports to Health Committee 68 "The chief function of the Medical Officer of Health is to safeguard the health of the area for which he acts by such means as are at his disposal . . " He should endeavour to acquire an accurate knowledge of the influences, social, environmental and industrial, which may operate prejudicially to health in the area..." " While he has special duties for the prevention of infectious diseases, all morbid conditions contributing to a high sickness rate or mortality in the area from these or other causes should be studied with a view to their prevention or control." —from the Ministry of Health Memorandum on the duties of MOHs 2 STAFF as at 31/12/58 Medical Officer of Health E. H. R. Smithard, mbe, md, bs, mrcs, lrcp, dph Senior Public Health Inspector E. Walker (a) (b) Group Public Health Inspectors A. G. Thomas (a) (b) (Food) J. R. Craven (a) (6) (Housing) Smoke Inspector J. W. Bevan (a) (b) (c) District Inspectors *G. L. Belshaw (a) (b) *C. L. Connor (a) (b) *R. L. Davis (a) (b) *G. E. Fallows (a) (b) *L. Gardiner (a) *E. A. Howard (a) {b) S. Kelly (a) *K. R. Wagener (a) (b) *T. E. R. Ware (a) (b) Deputy Senior Public Health Inspector A. J. Phillips (a) (b) *R. Mahoney (a) (b) (District) Assistant Group Housing Inspector R. C. Brittain (a) (b) Divisional Food Inspectors H. W. Ellery (a) (b) H. Tolson (a) (b) i nree 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) L. J. Cleverly C. R. Coleman Miss D. Cashman Mrs. D. J. Handford One vacancy Trainee public health inspectors A. R. Burchmore A. J. Thrussell D. B. Smith D. W. Card Coroner's Court and Mortuary W. C. Spear, officer-in-charge Disinfecting Station, Pest Control, etc. J. G. Beale, superintendent R. A. Sharman, foreman rodent operative Foreman Disinfector Disinfectors 9 Rodent operatives 3 Bathing attendants 1 Rodent/fly operatives 2 Drain testers 2 Public Analyst D. J. Allen, B.sc., fric Bacteriologists E. H. Bailey, mrcs, lrcp, and A. J. IT. Tomlinson, mb, BChir, of the Public Health Laboratory Service. 3 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Lewisham Mr. Mayor, Ladies and Gentlemen, I submit my report for the health department for the year 1958. Vital statistics The Registrar General's estimate of the population in midyear 1958 at 221,000 was 100 more than his estimate for midyear 1957. This is the first time since the 1951 census that the estimated population has increased. The crude birth rate for the year at 14.8 is exactly the same as the previous year and the adjusted birth rate (allowing for age and sex distribution of the population) is also the same at 14.1. The crude death rate at 11.0 is the same as in the previous year and so is the adjusted rate. The infant mortality rate at 24 was disappointingly high being 8 up on the previous year (which however was the lowest on record). The infant mortality rate is divisible into two parts, the neonatal rate (i.e., up to one month of age) and the rest of the first year rate. The neonatal rate went up from 12 to nearly 19 and this therefore accounted for almost all the increase in the infant mortality rate. The rest of the first year rate showed a small increase from a little over 4 to almost 6. The stillbirth rate remained at 18 and over recent years it has shown a surprising uniformity, but the combined stillbirth and infant death rate (reproductive wastage) at 41 showed the effect of the increased infant mortality rate. One point of statistical interest in the figures for 1958 was the number of births of boys compared with that of girls ; there were 1,633 boys and 1,642 girls, and looking through past reports it seems that this is the only occasion which can be traced where the births of girls have exceeded those of boys. 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 236 for tuberculosis) was 1,829, which is less than half the number in the previous year but compares with 1,709 in 1956. The decrease was almost entirely due to the drop in measles—from 2,728 in 1957 to 835 last year. Dysentery cases increased moderately, (from 129 to 214) but showed no special problems. There were only two cases of poliomyelitis, this being by far the smallest number since the disease became common in 1947. It is too early to say what part of this diminution was due to vaccination, but it has been abundantly proved by now that vaccination is effective, and therefore it is hoped that it will become more popular. Two particular points have come to light in connection with polio vaccination: (1) that even if it does not prevent in all cases the occurrence of the disease it reduces very considerably the proportion of cases which are likely to become paralysed, and (2) it is probable that the protection acquired from the usual three doses of the vaccine may last a considerable number of years. The number of cases of whooping cough at 154 was 4 smaller than for many years past. Here again the increase in popularity of vaccination against whooping cough, which in the absence of poliomyelitis risk is usually done in combination with immunisation against diphtheria, may be having the desired effect. Tuberculosis The number of new notifications showed a slight, but only slight, decrease on the previous year, and there has not in fact been much alteration in the annual number of new cases found for the past five years, these being 256, 271, 212, 247 and 236 respectively. It is pleasing to report, however, that the death rate from pulmonary tuberculosis, which on the other hand has been falling steeply for a number of years, was in 1958, at 8 per 100,000 pcpulation, little more than half the previous year and was the lowest on record. Clean air The Council's proposal to make its first smoke control area in the Ladywell part of the borough was formally objected to by one householder. As a result the Minister held a Public Inquiry in August but nevertheless confirmed the Order, the only modification being that the date it became operative was postponed from May 30, 1959 to September 1, 1959. The Order covers some 1,400 premises and 320 acres of which 200 are open space. During the year detailed inspections were made of the second area in the borough to be proposed as a smoke control area and this was in the Southend neighbourhood. The Order was made by the Council on January 1, 1959 and has subsequently been confirmed by the Minister who has decided that it shall become operative on November 1, 1959 ; there were no formal objections. The Southend Smoke Control Order covers some 2,800 dwellings and 620 acres of which 360 are open space. It is hoped that it will be possible to make the whole borough a smoke control area before the end of the 1960s. Old people Three additional clubs applied for and received grant aid and altogether 15 clubs or organisations were in receipt of grant from the Council. Details are shown in the body of the report. The grant is reviewed each year and perhaps the chief factor in an upward revision is an indication (by the atmosphere of the club and particularly by the expansion of numbers and of existing facilities and by the institution of new facilities) that the club is increasing its activities or comfort for its members. It was disappointing therefore to find that at the review in the spring of 1958 the numbers of old people on the registers of the grant aided clubs had shown a substantial reduction from the previous year and the number of members in average attendance had also shown a reduction. One factor for this could have been the bad winter and the influenza outbreak which had then occurred, with the consequent death of an abnormal number of club members. However, 5 it has been even more disappointing to find that at the review in the spring of 1959 the numbers, both on the registers and of those attending, had still further decreased. When it is borne in mind that the total number of old people in the borough is certainly increasing year by year these facts are even more disturbing. It is necessary therefore to consider whether the clubs are doing all they can both to attract members and to retain them, or whether some new approach of this sort is necessary to help the comfort and living conditions of old people. Staff By the end of the year there was still a shortage of three in the establishment of public health inspectors but early in 1959 this was reduced to one. The scheme for training student inspectors is working well and altogether there are four formally appointed students in training and additionally there is one of the health department clerks who started training before the scheme came into being. Two of these five will be sitting for their final examination in July 1959. It would seem therefore that unless something unexpected occurs we should in the future be able to maintain our establishment of public health inspectors. 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 F. A. Fisk, J.P. (The Mayor). Aldermen C. S. E. Fox, Mrs. D. Hurren and Mrs. M. Smith. Councillors Mrs. S. H. Armstrong, Mrs. N. L. Bunce, Mrs. D. I. Cox, J. Donovan, D. M. Eager, P. E. J. Forward, Mrs. C. Hayes, Mrs. G. M. M. Land, Mrs. D. E. New and Mrs. A. M. Skeggs. 6 SECTION A —VITAL STATISTICS Area The area of the borough is 7,015 acres. Public open space comprises 652 acres. Population Census 1951 227,576 The Registrar-General's estimate of the home population at midyear 1958 was 221,000. (This includes members of the armed forces stationed in the area). Rateable value Rateable value of the borough at April 1, 1958 ,£2,962,610 Estimated net product of a penny rate 1958/59 £12,130 Estimated number of separately assessed dwellings at April 1, 1958 63,370 Births (adjusted for inward and outward transfers) Livebirths 3,275 Males Females Total Legitimate 1,542 1,553 3,095 Illegitimate 91 89 180 Totals 1,633 1,642 3,275 Crude birth rate per 1,000 of the estimated population 14.8 Adjusted birth rate for comparative purposes (Area comparability factor = 0.95) 14.1 Birth rate for England and Wales 16.4 Adjusted birth rate for London Administrative County 16.7 Stillbirths The stillbirths allocated to the borough during the year were 60, (31 males and 29 females) which represents a stillbirth rate per thousand live and still births of 18.6 in the case of males, 17.4 in the case of females, and 18.0 for all stillbirths. Deaths The deaths belonging to the borough registered during the year were 2,433, consisting of 1,329 males and 1,104 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 11.7 for England and Wales and 11.8 for the Administrative County of London. 7 Infant mortality Infant deaths 80 Males Females Total Legitimate 49 25 74 Illegitimate 6 — 6 Total 55 25 80 Rates: 1. All infants per thousand livebirths 24.4 2. Legitimate infants per thousand legitimate livebirths 23.9 3. Illegitimate infants per thousand illegitimate livebirths 30.3 4. Male infants per thousand male livebirths 33.7 5. Female infants per thousand female livebirths 15.2 Neonatal deaths (under 4 weeks of age) 61 Neonatal death rates:— Males, per 1,000 male livebirths 25.1 Females, per 1,000 female livebirths 12.2 All infants, per 1,000 livebirths 18.6 Reproductive wastage:— Stillbirths plus infant deaths 140 Rates:— Males, per 1,000 live and still male births 51.7 Females, per 1,000 live and still female births 32.3 All infants, per 1,000 live and still births 40.8 Maternal deaths Maternal deaths Nil Maternal mortality rate per thousand live and stillbirths — Other special causes of death Measles Whooping-cough Gastroenteritis (infants)1 Tuberculosis (all forms) 19 Motor Vehicle Accidents 21 Suicide 31 Respiratory Diseases (other than Tuberculosis) (Code Nos. 22-25) 395 Cancer (Code Nos. 10-15) 472 Heart and circulation diseases (Code Nos. 17-21) 1,152 Comparative statistics for the year 1958 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 18.0 11.0 24.4 England and Wales 16.4 21.6 11.7 22.6 London Administrative County 16.7 20.2 11.8 22.6 8 9 Causes of death at different periods of life during the year 1958 The following table shows the causes of and ages at death during the calendar year 1958:- Table 2 Code No. Causes of death Nett deaths at the subjoined ages of "residents" whether occurring within or without the borough Code No. Causes of death Nett deaths at the subjoined ages of " residents " whether occurring within or without the borough MALES Total persons (i.e., incl table opp.) FEMALES Total - persons (i.e., incl. table opp.) All ages Under 1 yr. 1 and under 5 5 and under 15 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 and under 65 65 and under 75 75 and over Totals, all causes 1329 55 7 5 6 49 316 380 511 2433 Totals all causes 1104 25 4 1 7 40 183 257 587 2433 1 Tuberculosis, respiratory 12 - - - - 3 3 4 2 18 1 Tuberculosis, respiratory 6 — — — - 2 - - 4 18 2 Tuberculosis, other 1 - - 1 — — — — — 1 2 Tuberculosis, other - - - - - - - - - 1 3 Syphilitic diseases 3 - - - - - 1 2 - 5 3 Syphilitic diseases 2 - - - - - 1 - 1 5 4 Diphtheria - - - - - - - - - - 4 Diphtheria - - - - - - - - - - 5 Whooping cough - - - - - - - - - - 5 Whooping cough - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - 8 Measles - - - - - - - - — - 8 Measles — - - - - - - - - - 9 Other infective and parasitic diseases 2 - 1 - - 1 - - - 8 9 Other infective and parasitic diseases 6 _ _ - - - 4 2 - 8 10 Malignant neoplasm, stomach 31 _ - - - 1 11 15 4 50 10 Malignant neoplasm, stomach 19 - — — - 1 5 11 2 50 11 Malignant neoplasm, lung and bronchus 114 - - - - 2 57 33 22 135 11 Malignant neoplasm, lung and bronchus 21 - - - - - 11 4 6 135 12 Malignant neoplasm, breast - - - - - - - - - 36 12 Malignant neoplasm, breast 36 - — — — 2 17 9 8 36 13 Malignant neoplasm, uterus - - - - - - - - - 10 13 Malignant neoplasm, uterus 10 - — — — 1 5 2 2 10 14 Other malignant and lymphatic neoplasms 120 - 1 1 — 5 31 47 35 231 14 Other malignant and phatic neoplasms 111 - — — 2 2 35 33 39 231 15 Leukaemia, aleukaemia 6 - - — — 1 2 2 1 10 15 Leukaemia, aleukaemia 4 - — — - 1 2 1 — 10 16 Diabetes 6 - - — — — 1 1 4 13 16 Diabetes 7 - — — — — 1 1 5 13 17 Vascular lesions of nervous system 108 - - - - 2 13 27 66 273 17 Vascular lesions of nervous system 165 - — — — 2 19 45 99 273 18 Coronary disease, angina 260 — - — — 8 83 93 76 407 18 Coronary disease, angina 147 - - — — — 16 47 84 407 19 Hypertension with heart disease 32 - - - - - 3 8 21 72 19 Hypertension with heart disease 40 - - - - _ 5 13 22 72 20 Other heart disease 118 — — — — 2 11 18 87 291 20 Other heart disease 173 - — — — 4 17 15 137 291 21 Other circulatory disease 59 1 - — — — 12 19 27 109 21 Other circulatory disease 50 - - — — 1 3 15 31 109 22 Influenza 5 — - — 1 — 1 2 1 14 22 Influenza 9 - - - - 1 — 3 5 14 23 Pneumonia 79 5 1 1 - - 7 19 46 141 23 Pneumonia 62 3 1 - - 3 2 13 40 141 24 Bronchitis 152 4 - - - 1 40 44 63 213 24 Bronchitis 61 2 1 — — - 7 11 40 213 25 Other diseases of respiratory system 17 1 - 1 - - 4 5 6 27 25 Other diseases of respiratory system 10 - - - - 2 1 4 3 27 26 Ulcers of stomach and denum 22 - - - - - 2 11 9 28 26 Ulcer of stomach and duodenum 6 - - - - 1 1 1 3 28 27 Gastritis, enteritis and dirrhœa 4 1 1 - - - - - 2 9 27 Gastritis, enteritis and diarrhœa 5 - - - - 1 2 1 1 9 28 Nephritis and nephrosis 7 — - — — 2 2 2 1 16 28 Nephritis and nephrosis 9 - - - - 1 3 3 2 16 29 Hyperplasia of prostate 13 - - - - - - 3 10 13 29 Hyperplasia of prostate - - - - - - - - - 13 30 Pregnancy, childbirth, tion - - - - - - - - — - 30 Pregnancy, childbirth, abortion - - - - - - - - - - 31 Congenital malformations 10 8 - — 1 — 1 — — 20 31 Congenital malformations 10 6 2 1 — — 1 — - 20 32 Other defined and illdefined diseases 86 33 1 - - 3 16 15 18 179 32 Other defined and illdefined diseases 93 14 - — - 7 11 17 44 179 33 Motor vehicle accidents 17 - - 1 3 4 7 1 1 21 33 Motor vehicle accidents 4 — - — — 1 2 1 — 21 34 All other accidents 29 2 2 - 1 9 4 3 8 52 34 other accidents 23 — - — 4 5 3 2 9 52 35 Suicide 16 - - - - 5 4 6 1 31 35 Suicide 15 — - — 1 2 9 3 - 31 36 Homicide and operations of war - - - - - - - - - - 36 Homicide and operations of war — — - — — — — - — — 10 Deaths under 1 year of age Table 3 Cause of death Sex Under 1 day 1-6 days 1 week 2 weeks 3 weeks Total under 4 wks. 1-2 mths. 3-5 mths. 6-8 mths. 9-11 mths. Total 1-11 mths Total under 1 yr. Haemorrhagic conditions M - 1 - - - 1 - - - - - 1 F - - - - - - - - - - - - Pneumonia M - 2 - 1 - 3 2 - - - 2 5 F - 1 1 - - 2 1 - - - 1 3 Bronchitis M - - - - - - 3 1 - - 4 4 F - - - - - - 1 - - 1 2 2 Other respiratory diseases M - - - 1 - 1 - - - - - 1 F - - - - - - - - - - - - Gastroenteritis M - - - - - - 1 - - - 1 1 F - - - - - - - - - - - - Spina bifida and meningocele M - - - - - - - - - - - - F - - - - - - 1 - - - 1 1 Congenital hydrocephalus M - - - - - - 1 - - - 1 1 F - - - - - - - - 1 - 1 1 Congenital malformations of heart M 1 1 - - 1 3 1 - - - 1 4 F - 2 - - - 2 - - - - - 2 Congenital malforformations of genito-urinary system M 1 - - - - 1 - - - - - 1 F - - - - - - - - - - - - Other congenital malformations M - 1 - 1 - 2 - - - - - 2 F 1 1 - - - 2 - - - - - 2 Injury at birth M 4 2 - - - 6 - - - - - 6 F - 1 - - - 1 - - - - - 1 Post-natal asphyxia and atelectasis M 2 1 - - - 3 - - - - - 3 F 3 2 - - - 5 - - - - - 5 Haemolytic disease of newborn M 1 - - - - 1 - - - - - 1 F - - - - - - - - - - - - Immaturity M 12 7 1 - - 20 - - - - - 20 F 3 4 - - - 7 - - - - - 7 Accidental falls M - - - - - - 1 - - - 1 1 F - - - - - - - - - - - - Other accidents M - - - - - - - 1 _ - 1 1 F - - - - - - - - - - - - All other causes M - - - - - - - - 3 - 3 3 F - - - 1 - 1 - - - - - 1 TOTALS M 21 15 1 3 1 41 9 2 3 - 14 55 F 7 11 1 1 - 20 3 - 1 1 5 25 GRAND TOTAL 28 26 2 4 1 61 12 2 4 1 19 80 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, pemphigus and sepsis of newborn, convulsions, and lack of care of newborn. 11 19 infants (14 males and 5 females) thus died between the ages of one month and one year compared with 15 in the previous year and 9 the year before that. 9 of the 19 were from pneumonia and bronchitis, 3 from congenital causes, 2 from accidents, and one each from two other causes, while 3 were undefined. There was an increase of 23 in the number of deaths under 4 weeks of age, spread over several groups, but the biggest group was inmaturity where there were 27 deaths (compared with 10 the previous year). 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 28 916 239 February 25 622 152 March 25 575 138 April 22 585 120 May 20 440 92 June 17 338 79 July 15 319 72 August 12 292 68 September 9 333 76 October 7 422 103 November 4 564 128 December 2 573 141 December 30 484 119 Average for period 2 April to 2 December 1958 414 97 Weekly average for the year 1958 497 117 „ „ 1957 602 150 „ „ 1956 469 124 „ „ 1955 480 129 „ „ 1954 424 115 „ „ 1953 471 133 In spite therefore of a high figure in January (due to the influenza wave) the average figure for the year was normal. Social class in relation to cause of death Of the 2,433 deaths analysed by us the social categories were as follow Table 5 Social class I II III IV V Total No information Males 22 237 731 195 129 1314 15 Females 32 242 550 149 80 1053 51 Total 54 479 1281 344 209 2367 66 Percentage 2 20 54 15 9 100 - 12 In detail, the social class, related to cause of death, was as follows :— Table 6 Code No. Cause of death Male Female 1 II III IV V Total 1 II Ill IV V Total 1 Tuberculosis, respiratory - - 9 — 2 11 - — 4 — 1 5 2 Tuberculosis, other - - 1 1 - 2 - - - - - - 3 Syphilitic disease - - 2 - - 2 - - - - - - 4 Diphtheria - - - - - - - - - - - - 5 Whooping cough - — - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - - - 8 Measles - - - - - - - - - - - - 9 Other infective and parasitic diseases - - 1 - - 1 - - 2 - - 2 10 Malignant neoplasm, stomach - 4 17 3 7 31 - 4 8 5 1 18 11 Malignant neoplasm, lung, bronchus 4 17 60 17 10 108 2 2 15 2 - 21 12 Malignant neoplasm, breast - — — — — — 2 9 16 7 2 36 13 Malignant neoplasm, uterus - - - - - - 1 4 3 1 - 9 14 Other malignant and lymphatic neoplasms 2 23 79 14 9 127 2 21 54 19 10 106 15 Leukaemia, aleukaemia - - 8 2 2 12 - 4 2 1 1 8 16 Diabetes - 3 1 - - 4 - 3 3 1 — 7 17 Vascular lesions of nervous system. 2 20 73 16 11 122 5 35 89 13 10 152 18 Coronary disease, angina 7 50 120 31 19 227 5 34 51 15 8 113 19 Hypertension with heart disease 2 10 28 6 7 53 2 12 29 12 3 58 20 Other heart disease - 25 64 17 9 115 5 35 86 27 16 169 21 Other circulatory disease - 11 25 13 6 55 2 11 25 11 6 55 22 Influenza - - 3 1 - 4 - 3 3 - 2 8 23 Pneumonia - 12 46 10 11 79 2 20 27 9 3 61 24 Bronchitis - 26 84 28 20 158 2 10 34 6 7 59 25 Other diseases of respiratory system 1 3 6 3 4 17 - 1 5 - - 6 26 Ulcer of stomach and duodenum - 1 11 7 2 21 - 1 8 - — 9 27 Gastritis, enteritis and diarrhœa - - 1 - - 1 - - - - — - 28 Nephritis and nephrosis - 1 6 2 - 9 - 3 6 2 — 11 29 Hyperplasia of prostate - 1 10 2 1 14 - — - — — - 30 Pregnancy, childbirth, abortion -- — — — — - — — — 31 Congenital malformations - 1 9 — 10 - 1 7 2 1 11 32 Other defined and illdefined diseases 1 13 43 15 5 77 1 18 50 12 9 90 33 Motor vehicle accidents 1 4 5 2 1 13 - 2 3 1 — 6 34 All other accidents 1 6 13 1 3 24 - 5 12 3 — 20 35 Suicide 1 6 6 4 — 17 1 4 8 — — 13 36 Homicide and operations of war _ - - - - - - - - - - - No social class assessed - - - - - 15 - — — - - 51 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. 13 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 Code No s. Group Male Female 1 II III IV V Total 1 II III IV V Total 1, 2 TB No. - - 10 1 2 13 - - 4 - 1 5 % — — 77 8 15 100 — — 80 — 20 100 10-15 Cancers No. 6 44 164 36 28 278 7 44 98 35 14 198 % 2 16 59 13 10 100 3 22 51 17 7 100 17-21 Heart and circulation No. 11 116 310 83 52 572 19 127 280 78 43 547 % 2 22 52 15 9 100 3 22 53 14 8 100 22-25 Lung, non-TB No. 1 41 139 42 35 258 4 34 69 15 12 134 % 0 15 55 16 14 100 3 25 52 11 9 100 33,34 Accidents No. 2 10 18 3 4 37 - 7 15 4 - 26 % 5 27 49 8 11 100 - 27 58 15 — 100 35 Suicides No. 1 6 6 4 - 17 1 4 8 - - 13 % 6 35 35 24 — 100 8 31 61 — — 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. 97 583 1964 372 211 3227 48 % 3 18 60 12 7 100 Registered stillbirths No. - 8 29 6 7 50 10 % - 16 58 12 14 100 Registered infant deaths No. - 8 52 7 11 78 3 % — 10 67 9 14 100 Notified premature births No. 6 26 160 21 23 236 17 % 3 11 67 9 10 100 14 Coronary disease I have from time to time in previous reports referred at considerable length to this condition. Active research is progressing and increasing, particularly with regard to the dietary factor, although it would perhaps be true to say that results have not yet reached the stage when any dogmatic advice can be given with regard to specific articles of dietary. Nevertheless, for those adults who are prepared to alter their dietary regime on a likely possibility rather than a scientific probability, advice which could be given at this stage would amount to this: eat sparingly, cut down fats particularly, look askance at foodstuffs with a high cholesterol content—brains, egg yolk, kidneys, butter—prefer vegetable and fish oil to animal fat, and take regular exercise. This is simple advice, easy to follow, and unlikely to do any harm; and it is advice which quite possibly might do a lot of good. There are, almost inevitably, " savings " and " provisos " even to these simple rules but the only one of note here is in relation to vegetable fat: coconut oil is under some suspicion, while peanut oil is probably advantageous. The following table brings the Lewisham figures of mortality from heart disease 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 - 1958 770 109 879 150 - 2433 36 6.2 - 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 8 407 363 109 879 150 99 2433 36 6.2 4.1 † means figure not available. *R.G. Code Nos. 19 and 20. †R.G. Code No. 21. 15 Cancer I reported last year (p22) on the ratio between lung cancer in males and in females on the one hand and its relationship to the amount of cigarette-tobacco they smoke. I have stated for some years now that the evidence of the close association between lung cancer and cigarettetobacco is overwhelming, but in spite of propaganda both locally and on a national scale there is no indication that the consumption of cigarettetobacco in the country is diminishing. This cigarette habit is a particularly unfortunate one when it starts in young adolescents because they cannot appreciate the realities of lung cancer at some vague date, possibly twenty or thirty years, in the future, and therefore it is essential that everything possible should be done by those who can guide them to prevent their starting the cigarette habit, or if this is impossible, to ensure that the number of cigarettes smoked is as low as possible. Meanwhile I have to report a further increase in lung cancer deaths during 1958. The male deaths increased from 101 to 114 and the female deaths remained at 21, giving a total of 135 cases as against 122 in the previous year. At the same time the total deaths from all forms of cancer underwent a slight decrease— from 492 to 472, and this puts up the proportion of cancer deaths due to lung cancer from 25 to 29 percent, as is shown in the following table which gives similar figures for the past eight years. Table 10 Year (a) All cancer deaths (b) Lung cancer deaths (c) (c) as % of (b) (d) 1951 470 78 17 1952 484 86 18 1953 452 96 21 1954 430 89 21 1955 529 121 23 1956 485 108 22 1957 496 122 25 1958 472 135 29 16 General statistics from 1901 Table 11 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 79 154 76 1 2.3 17 Table 11—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 43 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 1958 221,000 11.0 8.2 28.7 14.8 78 0.0 18 19 5 24 42 98 8 10.6 *per 1,000 population. fper 1,000 notified livebirths. **per 1,000 registered livebirths. fper 1,000 registered live and stillbirths. ttPer 100,000 population. — equals figure not available. 18 SECTION B — GENERAL PROVISION OF HEALTH SERVICES Disinfection and personal cleansing Details of the work carried out during the year are as follows:— Disinfecting Station Table 12 West North South Total Disinfection Premises visited 108 83 102 295 Rooms disinfected . 247 207 202 656 Articles disinfected 1833 1530 1134 4497 Disinfestation Premises visited 55 44 18 117 Rooms disinfested 177 170 68 415 Articles disinfested 27 15 29 71 Articles treated Beds 37 39 34 110 Mattresses 136 101 123 360 Bolsters 35 31 31 97 Pillows 268 159 226 653 Cushions 26 31 17 74 Quilts 65 54 71 190 Blankets 325 151 220 696 Sheets 90 92 89 271 Household articles 429 435 237 1101 Wearing apparel 449 452 115 1016 Total articles 1860 1545 1163 4568 Articles received from the cleansing station - 1223 - 1223 Articles received from the Coroner's court - 723 — 723 Public library books treated after infection. 146 206 173 525 Private library books treated after infection. 13 6 6 25 Articles treated under the Public Health (London) Act s.122 18796 13575 14678 47049 A more detailed analysis of treatments for verminous conditions and for scabies is shown:— Verminous conditions Table 13 1st Cleansing 2nd Cleansing 3rd Cleansing Children under 5 14 - - Adults 26 - — School children 139 28 2 TOTALS 179 28 2 19 Scabies Table 13—continued Cases Contacts Treatments Children under 5 1 - 2 School children 8 - 13 Adults 7 1 11 TOTALS 16 1 26 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. No person received treatment during the year. Anti-fly and anti-mosquito campaign The campaign started with four men working in pairs but it was found that, when two of the men resigned, two men, each working with his own van, were able to carry out the necessary work, which has been reduced by the development of many of the sites over the years. The campaign was held from April 28 to September 25 and Mr. Phillips, the deputy senior public health inspector who is in charge of anti-pest work reports:— "366 sites, grass verges and rear garage ways were visited on 6 occasions each and necessary treatment carried out by spraying or the use of powder. The material collected or destroyed on the sites consisted of 110 mattresses and a large quantity of miscellaneous articles such as carpets, linoleum, furniture and clothing. Most of this rubbish was taken direct to the wharf at Greenwich because of the difficulty of destroying it on the site when wet. On a few occasions, however, when the material was reasonably dry it was destroyed by burning." The co-operation 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. 5 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 20 occasions each, particular attention being paid to the manure receptacles at the stables and piggeries. Throughout the campaign regular visits were paid to Lewisham Hospital to spray the refuse container there and also the site of the kitchen waste bins. 18 visits were also paid to both this Council's and the London County Council's blocks of flats where dustchutes are used. 249 dustchutes with 889 openings were sprayed. One private block containing 9 chutes was also included in this treatment. The caretakers of the Council's flats were also provided with sprayers, 17 gallons insecticide and 108 lbs powder, for use in connection with the containers at the base of the dustchutes, particularly after these had been cleaned out, and for the sites of the bins used for the storage of kitchen waste. In addition treatment by spraying was carried out in 21 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. Sections of the rivers where the water tends to be stagnant were sprayed with 5 per cent. DDT in a 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 556, of which 235 were received from institutions, 556 postmortem examinations were made and inquests were held in 72 cases. Table 14 Month Bodies received from Institutions Others Post-mortem examinations Inquests Lewisham residents Others January 26 41 42 25 9 February 28 24 38 14 5 March 26 34 39 21 7 April 22 34 40 16 8 May 18 24 25 17 7 June 20 16 18 18 8 July 19 18 18 19 6 August 22 28 34 16 3 September 9 25 21 13 2 October 8 26 23 11 2 November 21 22 29 14 9 December 16 29 25 20 6 TOTALS 235 321 352 204 72 Rodent control A section, consisting from May to September of a foreman and three operatives and from October to April of the foreman and five operatives, is maintained for the purpose of repressing rat infestation, and this section is supervised by the senior public health inspector. 21 In his report on rodent control work during 1958, Mr. Walker, the senior public health inspector, states:— "The total notifications of infestation were much the same as in the previous year, and again no infestation of a major character was discovered. The rivers in the borough continue to be a source of infestation and these are inspectedand treated at regular intervals, it being noticed that very few complaints in this connection are received. No new developments in technique have come to light and we continue to use the pre-baiting method with zinc phosphide and arsenious oxide and direct baiting with warfarin." The undermentioned table gives a summary of the work on the rivers and ditches, prebait being laid on 3/4 days:— Table 15 Location Base points Poison bait taken (ozs.) (Estimated) River Ravensbourne 198 66 River Quaggy 500 143 River Pool 120 40 Ditches 8 3 Special liaison is made with the Borough Engineer's department for the treatment of sewers. In 1958 treatment was only carried out during the spring, instead of the usual two occasions, the autumn treatment not being possible as overhaul of the sewers had to be made following the severe flooding which occurred in September due to an unprecedented rainstorm. The method employed in carrying out the spring treatment was to deposit 8 oz. prebait on the first day and if a complete take was shown, 16 ozs. of prebait was used on the second day. Where complete takes were shown on the second day, the poison bait deposited was equal to the prebait. In any case at least 8 ozs. of poison bait was deposited. Poison takes were not inspected. The following is a summary of the results obtained :— Spring treatment Manholes baited ... ... ... ... 2,400 Manholes showing prebait take ... ... 710 Manholes showing complete prebait take (on one or both days) ... ... ... 585 Prevention of Damage by Pests Act, 1949 A copy of the annual report covering the twelve months ended 31 March, 1959, submitted to the Minister of Agriculture, Fisheries and Food, as required by the provisions of the above Act, is appended. 22 Table 16 Type of property Local authority Dwelling houses (including council houses) All other (including business premises) Total Agricultural Number of properties in borough 138 63,015 9,613 72,766 - Number of properties inspected as a result of:— - (a) notification 10 1,265 152 1,427 - (b) survey 2 1,433 19 1,454 — (c) otherwise . — 48 1 49 — Total inspections (including reinspections) 12 2,928 172 3,112 - Number of properties inspected which were found to be infested by : (a) Rats — major — — — -- - — minor 6 934 108 1,048 - (b) Mice—major — — — - - — minor 4 225 26 255 - Number of infested properties treated 9 1,152 129 1,290 - Total treatments (including retreatments) 31 2,179 279 2,489 - Number of "block" control schemes carried out Nil Laboratory facilities The following summary relates to the work carried out by the public health laboratory on behalf of the Council during 1958 :— Table 17 Specimens Number Remarks Faeces 747 Negative 138 Shigella sonnei 18 Salmonella typhimurium 19 Salmonella paratyphi B 1 Staphylococcus aureus 1 Bact. coli. type 0 26 1 „ 0 126 19 „ „ „ 0 127 1 „ „ 0119 1 Esch. coli. type 0 78 Urine 53 Routine Swabs, from nose, throat etc. 142 C. diphtheriae was not isolated from any of these specimens. membrane from tonsil 1 Sputum, for organisms 31 for tubercle bacilli Negative „ „ 1 Positive for malignant cells 1 Negative Foodstuffs 11 Water 2 Blood films, for malarial parasites 1 23 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 examinations:— Chlorine Bacteriological content examination Bellingham 3 Forest Hill 7 Ladywell 4 Private baths 3 3 A detailed report on the use of breakpoint chlorination, which is the method employed at the baths, was included in my annual report for 1950. National Assistance Act, 1948 — section 50 During the year the Council accepted responsibility for the burial of 5 persons, at a net cost to the Council of £25 5s. National Assistance Act, 1948—section 47 Several possible cases were investigated during the year, but in no case was it 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 and paths. Drainage work During the year 131 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 Baord for the information on which the following report on Lewisham's water supply is based. The water supply is mostly Thames-derived filtered water but there is also admixture from the Board's wells at Bexley, Darenth, Deptford, Shortlands and Wilmington. 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 put 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 18 and 19 show the average results of the chemical and bacteriological analyses of the various supplies as forwarded by the Metropolitan Water Board:— 24 Average results of the chemical and bacteriological examination of the water supply to the Borough of Lewisham for 1958 milligr ams per litre (unless otherwise stated) (a) CHEMICAL Table 18 Description of the sample Ammonia nitrogen Albuminoid nitrogen Oxidised nitrogen (nitrate) Chlorides as CI. Oxygen abs. from permanganate (4 hrs. at 27°C) Hardness (total) Hardness (noncarbonate) pH value Electrical Conductivity (gem mhos) Thames-derived filtered water 0027 0077 4.2 26 1.26 270 66 7.9 550 Bexley Well 0005 0020 5.6 17 0.15 302 64 7.2 550 Darenth Well Nil 0019 5.4 16 0.06 260 30 7.2 475 Darenth Bore Hole 0002 0023 5.9 17 0.08 274 38 7.2 525 Deptford Well 0005 0021 6.5 36 0.18 368 128 7.2 725 Shortlands No. 1 Nil 0017 5.1 17 0.03 278 60 7.2 525 Shortlands No. 2 Nil 0025 5.0 16 0.03 278 58 7.3 525 Shortlands No. 3 Nil 0020 5.2 18 0.05 284 72 7.3 550 Wilmington No. 1 0011 0 026 5.6 21 0.14 280 48 7.3 525 Wilmington No. 2 0009 0024 7.3 22 0.13 294 60 7.3 550 (b) BACTERIOLOGICAL Table 19 BEFORE CHLORINATION (RAW WATER) AFTER CHLORINATION (WATER PASSING INTO SUPPLY) Plate counts (average per ml.) Colonies counted on agar Coliform count Plate counts (average per ml.) Colonies counted on agar Coliform count Percentage samples neg. 100 ml. Percentage samples neg. 100 ml. 370 C. (20-24 hrs.) 22° C. (3 days) 370 C. (20-24 hrs.) 22° C. (3 days) Coliform E. Coli Coliform E. Coli Thames derived filtered water 9.7 99.07 99.88 Bexley Well 0.1 7.5 94.80 99.26 0.1 5.7 97.28 100.0 Darenth Well 0.3 7.8 87.95 99.20 Darenth Bore Hole 0.1 92.0 88.79 96.73 0.1 193.5 100.0 100.0 Deptford Well 0.1 2.1 .1 92.69 95.89 0.2 28.5 98.67 100.0 Shortlands No. 1 0.1 1.9 97.39 99.13 0.1 5.5 100.0 100.0 Shortlands No. 2 0.1 13.0 96.60 97.96 Shortlands No. 3 0.1 4.0 97.91 99.16 Wilmington No. 1 0.7 71.1 86.96 0.1 2.7 99.59 100.0 Wilmington No. 2 0.5 39.8 72.12 87.61 25 Atmospheric pollution Clean Air Act General comments on smoke control areas under the Clean Air Act are dealt with in the introduction to the report but details with regard to the first two areas to be made the subject of Orders are as follows:— Name No. 1 No. 2 (Ladywell) (Southend) Acreage 320 620 Open space 200 360 No. of industrial premises 7 3 No. of commercial premises ... 49 58 No. of dwellings 1,380 2,827 No. of other premises 15 33 Present annual tonnage of bituminous coal, etc. to be replaced 2,145 2,100 Likely additional fuel required annually (a) Electricity 183,000 KWH 226,800 KWH (b) Gas 35,600 therms 44,100 therms (c) Oil, etc — — (d) Solid smokeless fuel 1,445 tons 1,344 tons Existing appliances requiring replacement or adaptation : (a) Open fires 1,674 2,666 (b) Open fires with boilers 226 112 (c) Combination grates without boilers 48 1 (d) Combination grates with boilers 3 Nil («) Washboilers Nil 20 (/) Domestic boilers * 406 Total estimated cost of works £14,338 £14,531 * Included in the figure for open fires with boilers Measurement of Atmospheric Pollution The results obtained for the three deposit gauges and three smoke recording stations are shown in table 20. The fourth deposit-gauge remained at the South Eastern children's hospital until the end of July and it was then transferred to a small allotment site in Brockman Rise which is within the proposed Southend smoke control area. 26 Table 20 gives a record of the principal results from six stations and also are not specific to the borough, having been obtained from a publication of the m Atmospheric Condition January February March April Temperature— Mean maximum1 °F 43.4 46.8 45.3 52.9 62.3 Mean minimum1 °F 35.5 38.3 34.0 38.8 46.5 Mean1 °F 39.5 42.5 39.7 45.9 54.5 Diff. from average1 °F -0.6 + 2.1 -4.0 -2.3 +0.7 Highest maximum2 °F 55 60 60 72 78 Lowest minimum1 °F 25 29 26 29 41 Rainfall— Total2 in. 1.3 1.8 1.1 1.4 1.7 Percent of average1 ... 81 14l 94 87 120 Sunshine1 Daily mean hrs. 1.2 1.4 3.4 4.7 6.9 Percent of average ... 79 61 89 96 108 Wind1 NE/E/SE % 16 8 51 30 13 S/SW/W % 65 77 27 42 15 NW/N/Calm % 19 15 22 28 12 Atmospheric pollution— West Division3: Water insol. matter tpm 5.2 7.8 7.7 9.4 7.5 Water sol. matter tpm 3.9 7.5 6.5 5.3 4.9 Sulphur + 2.4 2.6 3.3 1.7 1.4 Smoke, daily average * 21 5 12.6 16.5 10 7 2.7 „ maximum * 49.3 20.8 27.7 16.0 6.3 (date) ... (15.17) (1.4) (1.4) (9.11) (1.2) „ minimum * 9.6 7.5 7.8 3.6 1.0 (date) ... (8./0) (8.11) (5.7) (26.30) (10.13) North Division Water insol. matter tpm 6.1 9.1 9.8 11.2 5.3 Water sol. matter tpm 5.1 5.4 8.6 5.8 4.6 Sulphur t 3.9 3.4 3.3 3.2 1.5 Smoke, daily average * 21 .2 14.3 14.9 10.1 3.3 „ maximum * 44.3 23.0 30.7 13 8 6.5 (date) ... (15.17) (1.4) (1.4) (16.18) (1.2) „ minimum * 11.9 9.2 9.7 5.1 1.6 (date) ... (1.3) (8.11) (15.18) (26.30) (10.13) South Division5 : Water insol. matter tpm 6.5 9.6 10.6 11.2 6.8 Water sol. matter tpm 5.7 6.6 7.6 5.3 4.3 Sulphur ... t 1.7 1.4 2.0 1.2 0.4 Smoke, daily average * 19.1 14.2 14 5 10.6 2.6 „ maximum * 40.8 18.2 24 1 18.2 5..3 (date) ... (15.17) (5.7) (1.4) (4.8) (1.2) „ minimum * 9.8 7.9 9.5 3.7 1.2 (date) ... (1.3) (8.11) (15.18) (23.25) (10.25) Weather summary Changeable ; rather dull Changeable: wet, dull Very cold Cold at first, then warm Notes : 'Croydon; 2Lewisham ; :,Valentine Court for smoke, Pool allotments for others tpm : tons per square mile per month ; +as trioxide in mg per 100 sq. cms. per 27 me indication of the sunshine, rainfall, etc., daring the year. Some of these latter data office, and relate to the nearest station which records the particular item concerned. 1958 June July August September October November December Average or actual (as applic.) 66.0 70.5 68.9 67.7 588 48.6 45.6 56.4 50.9 55.1 55.8 54.5 47.5 40.6 38.1 44.6 58.5 62.8 62.3 61 .1 53.1 44.6 41 .9 50.5 -1.0 .0.2 .0.2 + 2.5 + 1.5 .0.1 + 1.2 +0 83 84 84 82 66 58 55 84 (July 9) 47 49 50 44 42 34 33 25 (Jan. 23) 4.9 1.6 4.1 3.6 2.1 1.6 25 28 263 94 183 236 112 72 156 136 5.6 6.5 4.1 5 2 3.5 1.5 0.9 3.7 78 98 66 108 105 83 73 87 23 10 12 45 18 29 20 23 59 60 73 43 56 24 43 54 18 30 15 12 26 47 37 23 5.3 9.9} 8.2 7.1 9.2 90 7.7 7.8 5.9 5.4 5.0 50 49 5.2 6.4 5.5 0.7 0.8 0.7 0.7 0.6 20 2.6 1.6 2.2 25 20 3.4 7.9 29.7 28.4 11.7 2.9 4.3 3.8 5.3 14.5 52.5 56 1 21.6 (14-17) (5.8) (30.31) (13.16) (28.30) (15.18) (4.5) — 1.2 0.7 0.7 1.2 2.6 150 10.9 5.1 (25-27) (26.31) (1.5) (20.23) (1.3) (8.11) (20.22) — 4.7 4.0 7.6 7.1 4.5 10.9 10.6 7.6 8.8 4.4 5.8 6.9 4.4 5.9 6 8 6.1 1.3 1.2 10 1.4 2.2 4.4 4.5 2.6 2.7 2.9 2.6 3.5 7.4 23 5 24.0 10.9 4.1 ,4.9 4.5 5.2 15.4 39.3 61.6 21.1 (28-30) (9.11) (23.26) (13.16) (22.24) (15.18) (4.5) — 1.7 10 1.2 1.9 3.6 12.6 8.3 5.6 (25-27) (26.29) (1.5) (6.9) (1.3) (8.11) (20.22) — 8.3 6.6 6.6 7.1 4 7.3 9.0 8.2 (/1 months) 8.3 4.7 5.2 6.5 9.0 5.4 6.3 6.2 0.5 0.5 0.3 0.7 0.8 1.7 1.8 1.1 1.9 2.8 1.9 2.6 6.8 22.6 15.0 9.5 2.4 3.3 3.4 3.9 13.3 36.5 33.5 16.9 (1-3) (5.8) (23.26) (13.16) (29.31) (25) (4.5) — 1.2 0.5 0.9 1.1 2.1 14.0 7.0 4.9 25-27 (30.31) (1.5) (6.9) (1.3) (8.11) (20.22) — hangaool, dull, and every wet Changeable Dull, very wet Warm and very wet Wet at first, dry later Dry, dull and quiet Dull & wet, Foggy periods A dull, wet year Place for smoke, Wearside others; Downham Depot for smoke, Verdant Lane for others per 100 cub. metres; +included small insects to account in large part for an excess. 28 Home safety As a result of pressure by the Metropolitan Boroughs' Standing Joint Committee a clause was included in the LCC (General Powers) Bill of 1957 (which subsequently became an Act) under which metropolitan boroughs were given powers to deal to some extent with home safety. S.82 of the 1957 Act allows a brough council " for the purpose of promoting safety in the home and of encouraging the taking of proper precautions in preventing the occurrence of accidents therein " to make arrangements for the dissemination in the borough of information and advice relating to such matters. This power has been followed in certain of the metropolitan boroughs by the establishment of a Home Safety committee, whereas in others of the metropolitan boroughs it has been thought that any work of this nature can best be supervised by the Public Health committee direct. Before and after the passing of the Act, the Health department had arranged or carried out certain propaganda or educational efforts in connection with home safety. For example, home safety films have been shewn to old peoples' clubs; various posters, leaflets and pamphlets have been displayed or made available to the public; the Council subscribes to the Royal Society for the Prevention of Accidents, home safety section; a health department leaflet, headed "Burns and Fireguards" has been printed and displayed; another leaflet entitled "Burns and Scalds" is also being produced; various suggestions have been made for home safety in the provision of housing; statistics on accidents in the home are collected or sought from hospitals. There are considerable difficulties administratively in creating a home safety committee. In general it is accepted that the functions of a home safety committee include the following :— (a) To carry on a continual propaganda campaign locally, and inform the public of the extent and gravity of the home accident problem. (b) To enlist the support of all interested municipal and social organisations for this campaign. (c) To investigate local home accident cases and their causes. (d) To investigate possible remedies. In short, local home safety committees would be responsible for all activities within their area for education and propaganda in this field. A full ad hoc home safety committee should have on it representatives of 1.—local authorities (covering health, welfare, housing, education), 2.—fire services, 3.—hospital authorities, 4.—local medical committees, 5.—area gas board, 6.—area electricity board, 7.—voluntary organisations. It will be seen therefore that such a committee would be rather large and possibly unwieldy, as it would have—quite apart from members of the Health committee—at least eight representatives of outside bodies, and in addition representatives of voluntary organisations and of hospital authorities if more than one Management committee is 29 involved. Also it must be realised that the London county council is itself a local authority as far as accidents in the home are concerned and in fact the power given to metropolitan boroughs under the 1957 LCC (General Powers) Act, namely to be able to disseminate information and advice, could be interpreted as a very limited power. Further, if a home safety committee were set up it would, as far as the borough council is concerned, be merely advisory and would normally make reports to the Public Health committee for such action as the latter committee could take. Because of these difficulties it was decided, early in 1959, that the Public Health committee would continue to supervise local home safety work directly. The parallel powers of the county council and the borough council are to some extent an embarrassment and this has particularly shown itself in the collection of information—a basic necessity. Although certain things can be done in the way of propaganda, educational leaflets and so on to exhort the public, it is likely that no major remedial step can be taken until more knowledge is obtained of the fundamental reasons for accidents, and of their local pattern. The best approach from this angle at present is to collect as much statistical information as possible and with this in mind I approached the hospitals following the receipt of the Ministry's circular last year, and I asked them for some simple information on accident cases. In view of the possible reaction of the hospital authorities that they were not entitled to disclose the name and address of the accident case without the case's formal consent, I asked that at this stage I should be informed merely of the road in which the case lived and preferably the initials of the patient so that if necessary identification could be made at a later date if further investigation were then required. Owing perhaps in part to some duplication of requests for information, I have not yet had a reply from the Lewisham Group Hospital Management Committee as to whether they can furnish me with the simple information requested, but I have had complete cooperation from the Sydenham Children's Hospital (which is in the area of another management committee) and the information obtained from that hospital is being analysed and is already forming a useful background for possible extension of our work here in the future. The hospital takes in children from many districts and details of those accidents which belong to boroughs other than Lewisham are sent on by me to the medical officer of health concerned. The collection of home accident statistics is to some extent a long. term process and it is only by obtaining the knowledge and studying it and analysing it that one has a chance of showing different groups of accidents which may be more preventable than other groups, or certain localities which appear to be more accident.prone than others. It would of course be on those that any work of the department would be particularly brought to bear. The accompanying table indicates in detail the figures for Lewisham cases reported from the Sydenham Children's Hospital for 30 the second, third and fourth quarters of 1958. No particular concentration in street, block of flats, or locality has so far shown up. Accidents to Children — Sydenham Children's Hospital 1958 Table 21 Category 2nd Quarter 3rd Quarter 4th Quarter Total Accidents Grand Total Boys Girls Roys Girls Boys Girls Boys Girls -5 -15 -5 -15 -5 -15 -5 -15 -5 -15 -5 -15 -5 -15 -5 -15 Falls 20 6 4 7 21 13 15 9 20 11 8 4 61 30 27 20 138 Cuts and bruises 9 12 5 9 8 24 3 7 7 13 6 2 24 49 14 18 105 Poison 4 - 3 - 3 1 3 1 2 - - - 9 1 6 1 17 Burns and scalds 2 3 4 1 4 3 2 1 6 8 4 3 12 14 10 5 41 Foreign bodies 3 2 4 2 5 3 3 2 5 2 1 1 13 7 8 5 33 Miscellaneous - - - - - - - - - - - - - - - - 9 Total 38 23 20 19 41 44 26 20 40 34 19 10 119 101 65 49 343 Old people General comments on the problems connected with the care of old people are made in the introduction of this report. 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 £3,850 was eventually included in the annual estimates for the year 1958-59 for such organisations as accepted the Council's conditions and to assist any other such 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 follwos :— Lewisham Old People's Welfare Association ... 2,750 Lewisham Darby and Joan Club 380 St. Mark's Old Folks' Club 75 Bellingham Branch of the National Federation of Old Age Pensions Associations 60 Talbot Settlement Old People's Club* 4 Hither Green Branch of the National Federation of Old Age Pensions Associations 65 St. Philip's Darby and Joan Club 24 The Over 60's Friendly Club 40 *Ceased as a club early in the financial year 31 £ The Belling ham Community Association Darby and Joan Club 36 Lee Branch of the National Federation of Old Age Pensions Associations 35 Good Companions Club 18 St. Hilda's Seniors' Club 50 Blackheath Branch of the National Federation of Old Age Pensions Associations 15 September Club 12 Happy Old Folks' Club (St. Barnabas) 20 This left a sum of money available for new clubs which might qualify for grant. It is hoped that such old people's organisations as can will not only provide the usual afternoon's recreation with a little tea, but will also make arrangements to provide lunch either on the day the club meets or another day. To this end the Lewisham Old People's Welfare Association is prepared to co-operate by conveying the meals in bulk from the central kitchen, where they are obtained, to the luncheon club. It has also been suggested to the clubs which do not already do it, that they might consider setting up handicraft classes for their members, this being thought to be a preferable alternative to the so-called " workshops for the elderly " which have been set up in a few inner London boroughs. There are many difficulties with regard to starting such workshops in an outer London dormitory borough such as this, but these difficulties would not apply to handicraft classes and if the work turned out at such classes were good enough it would have a saleable value of its own. Unfortunately most of the clubs found it impracticable to get sufficient of their members interested in the scheme to allow a qualified teacher to be obtained for them, but one or two clubs are still making efforts in this direction. With regard to nutrients, a wellknown preparation which contains many of the factors of the vitamin B complex, and which is held to be particularly useful in the dietary of old people, has for some years been sold at the clubs and in this way some reduction in price can be obtained. A little time ago the makers felt they had to increase the retail price further and even this small increase had the effect of reducing quite significantly the amount of the nutrient sold. Consequently a scheme was devised, and authorised by the committee, under which if a return were made every six months by the club giving the number of jars of the nutrient sold and also stating that not more than one 4-oz. jar had been sold to any one club member during a four-weekly period, then an additional grant would be paid to that club equivalent to 3d. per jar. This seems to have had the effect of stimulating sales to some degree although it is too early yet to say how successful the scheme will be. 32 The health department during the year continued to take a detailed interest in the work for old people generally and remained in the closest touch with the Lewisham Old People's Welfare Association (LOPWA), which Association has offices in the department. LOPWA is, so far as the borough council's work for old people's welfare is concerned, the main body in the area and has affiliated to it the various other bodies to which the Council makes grant. LOPWA is responsible for the meals-on-wheels service to housebound old people. Visiting of old people Three nurses (officially called Women Health officers) are concerned with old people and with infectious disease. Their work for old people is tabulated as follows :— Table 22 W N S Total Visits 37 81 101 219 Futile visits 60 148 51 259 Revisits 265 1388 140 1793 Total 362 1617 292 2271 The chronic sick In the report for 1956 I dealt at some length with the admission of old people not acutely ill to hospital or a Home and with the provision of a geriatric unit. The report was to the effect that there were often difficulties in securing quick admission and that the general care of old people could be helped by a geriatric unit. Ultimately a medical committee was set up by the Lewisham Group Hospital Management Committee to consider this matter, and I was appointed a member of it. Unfortunately I found myself in disagreement in certain matters with the majority of the committee and had to put in a minority report. The majority report was to the effect that apart from those chronic sick already in the care of the hospitals in the group there were about ninety under care in the sick bay in Ladywell Lodge who could be regarded as of the type needing hospital care. These included patients from all parts of London and sick patients from other homes, so that only about one-third to one-half had actually originated in Lewisham. However, once admitted to the Lodge, it became impracticable to regard them as other than Lewisham residents. The procedure, however, for dealing with normal applications for the admission to Lewisham hospital of alleged chronic sick patients provided, so the majority report said, for a speedy assessment of need, which if found to exist, was followed by early admission. On the whole, it was felt that, apart from the problem of those patients in Ladywell Lodge to which reference had been made, there was little need at the moment to make greater provision for the care of the chronic sick than already existed. What was needed, however, it was suggested, was a 33 rehabilitation service for the elderly sick, under the control of the hospital authority, designed to return as many as possible to a reasonably normal and independent way of life. In the minority report both I myself and the divisional medical officer of the LCC expressed doubt as to the majority report's opinion on the likely demand for beds for the chronic sick. In my view there would need to be an increase in the beds provided for these patients to a figure of about 260, this figure being based on a survey undertaken by the Ministry of Health and on the experience of surrounding areas. I further suggested that it was highly desirable that all the hospital services for old people should be under the unified control of a geriatrician of consultant status and that this should be brought about and consolidated by the creation of a geriatric unit for the group. I understand that the Lewisham Group Hospital Management Committee accepted the majority report and agreed that the possibility of setting up a rehabilitation service should be explored. 34 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 23 Reason for inspection West North South Total On complaint 1064 954 424 2442 House to house — — — — Improvement grants 31 44 22 97 Houses let in lodgings — 1 — 1 Rent Acts 330 184 113 627 Other Housing Act visits 387 398 249 1034 Notice from builder 297 228 85 610 Infectious diseases 9 31 6 46 Infestation 121 166 46 333 Factories, mechanical 52 36 70 158 Factories, non-mechanical 8 8 6 22 Outworkers 101 41 60 202 National Assistance Act, S47 — 6 7 13 Smoke observations 8 2 3 13 Clean air inspections 1 996 2335 3332 Keeping of Animals 3 13 10 26 Water certificates 130 34 11 175 Fireguards 17 14 9 40 Crash helmets 14 19 13 46 Hairdressers 35 6 12 53 Pharmacy and poisons 66 73 2 141 Milkshops 20 27 34 81 Icecream premises 128 51 40 219 Restaurants and eating houses 70 124 169 363 Bakehouses 17 41 11 69 Other food shops 252 345 489 1086 Other shops 17 75 10 102 Food inspections 91 325 128 544 Sampling 105 235 152 492 Markets and stalls — 704 24 728 Slaughterhouses — 65 — 65 Futile visits 816 2436 2269 5521 All other matters 1236 1204 397 2837 Revisits 5941 8106 2839 16886 Total — all inspectors 11367 16992 10045 38404 Smoke abatement Observations 13 Intimations served — Complaints received 6 Statutory notices served — Legal proceedings — Convictions — 35 Summary of notices served Table 24 West North South Total Intimation notices :— Public Health (London) Act, 1936 280 277 145 702 Factories Act, 1937 — 2 — 2 Informal intimations under Housing Act, 1936 14 17 5 36 Total intimations 294 296 150 740 Statutory notices :— Public Health (London) Act, 1936 154 131 90 375 Factories Act, 1937 — — — — Housing Act, 1936 11 3 1 15 Byelaws 41 14 55 110 Food and Drugs Act, 1955 — — — — Prevention of Damage by Pests Act 1949 — 2 — 2 Total statutory notices 206 150 146 502 Nuisances remedied Table 25 Nuisance West North South Total Wall and ceiling plaster repaired 145 189 69 403 Roofs repaired 72 88 55 215 Dampness remedied 313 190 130 633 Brickwork repaired 18 33 8 59 Chimneys repaired 10 2 9 21 Drains cleared 19 27 18 64 Drains repaired 23 16 17 56 Drinking water cisterns repaired — — — — Dustbins supplied 8 16 9 33 Doors and doorframes repaired or renewed 17 32 14 63 Flushing cisterns repaired, renewed or cleansed 17 19 16 52 Flush pipes repaired or renewed 4 3 1 8 Firegrates, etc., repaired or renewed 19 21 15 55 Flooring repaired or renewed 50 72 22 144 Dry rot remedied 7 8 — 15 Gullies renewed, repaired or cleansed 8 5 1 14 Gutters repaired 31 50 26 107 Refuse cleared — 3 1 4 Rainwater pipes repaired 18 14 16 48 Soil pipes repaired, ventilated or renewed 7 3 2 12 Sinks provided — 5 1 6 Sashcords renewed 32 46 42 120 Water closets repaired or renewed 18 26 13 57 Walls and ceilings cleansed — — — — Windows and frames repaired or renewed 35 46 25 106 Water service pipes repaired or renewed, water supply restored 3 10 3 16 Yards and areas paved 6 4 6 16 Windows glazed 8 26 7 41 Other nuisances remedied 21 28 19 68 TOTALS 909 982 545 2436 36 Heating Appliances (Fireguards) Act, 1952 The public health inspectors are authorised for the purposes of inspection and testing of heating appliances under the Act. 40 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 part-time and who does not employ any other person to assist him. Registration in the first place is automatic on application, and a register is kept for the purpose. By the end of the year 131 persons were 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 21 premises were licensed as pet shops. In the main, the sale of pets at these premises consists of cage birds and tropical and coldwater fish. In general it has been found that pets are kept for sale under conditions which do not call for any particular comment and in no case has it been found necessary to attach special conditions to any licence which has been issued. A report by a consultant veterinary surgeon was obtained in one case after complaints had been received. 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 dwellinghouse, subject to certain provisos, until the sanitary authority has certified that it has a proper and sufficient supply of water. Certificates were issued in respect of 190 premises and 11 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 37 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 by the local authority. Details follow :— Inspections Table 26 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 66 22 — — (ii) Factories not included in (i) in which section 7 is enforced by the local authority 469 158 2 — (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 26 26 — — TOTAL 561 206 2 — 38 Cases in which defects were found Table 27 Defects No.of defects Prosecutions instituted Found Remedied Referred To HM By HM Inspector Inspector Want of cleanliness (S 1) — 1 — 1 — Overcrowding (S 2) — — — — — Unreasonable temperature (S 3) — — — — — nadequate ventilation (S 4) — — — — — neffective drainage of floors (S6) — — — — — Sanitary conveniences (S 7): (a) insufficient 3 3 — (b) unsuitable or defective — 1 — 1 — (c) not separate for sexes — — — — — Other offences against the Act (not including offences relating to outwork) 3 3 3 — — TOTAL 3 8 3 5 — 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. 39 The following is a list of trades concerned, extracted from the August, 1958 lists received :— Trade Outworkers employed Clothing 71 Lampshades 2 Box making 1 Carding 1 75 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 202 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 again decreased considerably from the previous year, and is less than one-third of what it was in 1954. 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 ot 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. 40 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 other likely places. Early in 1958 the Council managed to secure the help of an outside pigeon-catcher, who serves various other boroughs also, and he has reported that he has been able to kill many birds in the course of the year. Exhumations It is the practice for a sanitary inspector to be in attendance at an exhumation, and one such attendance was made in 1958. Sanitary work generally Mr. Walker, the senior public health inspector, reports : " The number of inspections made in response to complaints during the year was somewhat higher than in the preceding year, as also were those in connection with applications under the Rent Act. "The number of clean air inspections has greatly increased due to house-to-house visitation in connection with smoke control areas, and the higher figure for "futile visits" is mostly in connection with this part of the work. The reaction of the public to smoke control areas is varied. Many people welcome the innovation and are already using smokeless fuels, even in old-fashioned fireplaces; a general complaint in this connection is the difficulty of obtaining ready supplies of "premium" fuels. There is however a minority which is definitely hostile to using any kind of smokeless fuel, and a greater number of people who have a prejudice against the use of coke. There appears to have been a further increase in the use of oil-burning appliances, but I have observed signs that the popularity of these heaters is on the wane, and indeed I have met several people who have given them up for various reasons. "The number of outworkers seems to diminish steadily, but those visited have been found to be working under very satisfactory conditions." 41 SECTION D —HOUSING Building The following 223 new houses or flats were completed by the Council during the year :— Boone Street 48 Boones Road 12 Campshill Road 12 Fernbrook Road 7 Hindsley Place 10 Hither Green Lane 11 Hither Green Lane/Wellmeadow Road 20 Lawrie Park Gardens 22 Pond Road 7 Ronver Road 20 Southbrook Road 12 Springbank Road 4 Summerfield Street 10 Whitbread Road 28 Families rehoused for first time During the year the following families were rehoused :— 1. By the Lewisham Borough Council:— (a) in permanent properties 47 (b) in temporary bungalows 2 (c) in requisitioned properties — 49 2. By the London County Council (figures supplied by district offices) 57 106 N.B. — Number of families where points had been awarded for bedroom deficiency, rehoused by the Lewi sham Borough Council or the London County Council during the year 72 Housing Act, 1957 Repair of houses (sections 9 and 10) During the year 36 informal and 15 formal notices were served. 29 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 1958, together with the present position of cases originating in previous years which had not been complied with at the end of 1957 42 Table 28 Properties Dwellings involved Present position 24 Wisteria Road 1 Closing order on whole house determined 2 Cranston Road 1 Demolition order revoked 22, 22a Elthruda Road 2 Closing order on whole house determined 30 Ravensbourne Road 1 Demolished 28 Ravensbourne Road 1 Demolished 2 Nightingale Grove 1 Closing order on whole house determined 37 Morena Street 1 Closing order on whole house determined 1 Brewster Cottages, Courthill Road 1 Closing order on whole house determined 12 Sundermead Road 1 Closing order operative on whole house 8 Dallas Road 1 Represented 10 Dallas Road 1 Represented 169 Sandhurst Road 1 Undertaking to carry out works given to Bromley County Court 4 Champion Crescent 1 Closing order on whole house determined Closing Orders in respect of part of house Table 29 Properties Part of house Present position 58 Knowles Hill Crescent Front and middle rooms ground floor Closing order operative 25 Trywhitt Road Two living rooms, kitchen, hall and larder in basement Closing order determined 53 Manor Park Two rooms and scullery in semi-basement Closing order varied to permit rooms to be used for storage purposes 235 Lee High Road Two rooms and scullery in basement Closing order made, 31 Jan 58, determined 8 July 58. 43 Morley Road Two rooms and kitchen in basement Closing order operative 150 Blackheath Hill Two rooms and scullery in rear basement Closing order operative 8 Hoi beach Road Two rooms first floor and rear room and scullery ground floor Notices served 24 Elthruda Road Three rooms, scullery, and w.c., ground floor Notices served 15 Eastdown Park Two rooms, scullery and w.c. in basement Notices served 96a Wiverton Road Two rooms and kitchen in semi-basement Closing order operative 43 Table 30 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 4 125 29 Houses included by reason of bad arrangement — 3 1 Houses or land acquired under section 27, Housing Act, 1936 Not in clearance areas Formal or informal procedure under section 11, Housing Act, 1936 4 7 2 Local authority houses certified unfit by medical officer of health — 40 10 B—UNFIT HOUSES CLOSED Number Section 11, Housing Act, 1936 and section 10(1) and 11(2) Local Govt. (Misc. Prov.) Act, 1953 1 16 5 Sections 3(1) and 3(2) Housing Act, 1949 — — Parts of buildings closed under section 12, Housing Act, 1936 5 14 2 C —UNFIT HOUSES MADE FIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED By owner By Local Authority After informal action by local authority 26 After formal notice under Public Health Acts — — After formal notice under Housing Act, 1936 6 2 Under section 5, Housing Repairs and Rents Act, 1954 1 — 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 3 17 44 Rent Act 1957 The Rent Act 1957 cams into force on 6 July, 1957, and the following table shows the applications for certificates of disrepair dealt with during the year 1958:— Table 31 Applications for certificates 420 Decisions not to issue certificates 8 Decisions to issue certificates (а) in respect of some but not all the defects 279 (б) in respect of all defects 97 Undertakings given by, landlords to repair 223 Undertakings refused for special reasons — Certificates of disrepair issued 266 Applications by landlords for cancellation of certificates 160 Objections by tenants to cancellation 49 Decisions to cancel in spite of tenants' objection 7 Certificates cancelled 117 In his report on work under the Housing Acts, Mr. Craven, the group housing inspector, states :— "A noticeable feature of the year under review was the impact of owner-occupation on the work of the housing section. From observations and information reaching the Department in various ways it is clear that there has been in the last 4 to 5 years a rapid and significant increase in the number of houses in this class of ownership. This is obviously very desirable from the point of view of maintenance of property in good condition, but it has had the effect of switching the emphasis from certain Housing Act duties to others. To some extent this trend was discovered during a survey of older properties, carried out in the middle of the year, in connection with the clearance programme for the years 1961-1965. Included in this survey were certain groups of houses, previously noted as borderline cases, where it was found that the general condition of several of the properties had been greatly improved following purchase by sitting tenants, or which otherwise had become owner-occupied. Instances of increased activity, again because of this factor, were in connection with mortgage applications to the Council, where some of the properties concerned were subject to other Housing Act procedures, and also in the number of improvement grant applications from owner-occupiers. Many of the latter related to smaller single family dwellings, between 50-60 years of age in reasonably good condition but merely lacking modern amenities. "Referring to the comment in the 1957 report regarding the reduction in the number of improvement grant enquiries and applications for conversion of larger properties, which was thought to 45 be due to the discouraging effect of the rent limits applied to these cases by the Rent Act 1957, it is pleasing to note that the House Purchase and Housing Bill introduced in Parliament at the end of the year contained provisions for reverting to the previous practice of rent fixing by the local authority. "With regard to the improvement grant scheme generally there was a sharp rise in the number of enquiries and applications towards the end of the year. This was partly due to the publicity given in the press to the Bill already mentioned with its new scheme of "standard grants" and to some extent by the Council's pamphlet, "About the Rates" distributed to each household, which referred to the grant scheme." 46 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. The Milk and Dairies (General) Regulations, 1959 These Regulations re-enact with amendments the Milk and Dairies Regulations, 1949 to 1954. The principal changes are :— (a) the registration of distributors is now required to be effected only with the local authority in whose area the premises from which the milk is distributed are situated ; (b) suitable and properly trapped internal drains are permitted in a milking house which is not used for the housing of cattle where no other means of drainage is reasonably practicable ; (c) provision is made for the local authority to pay compensation to a person who sustains damage or loss through being debarred from certain employment connected with cows or with milk because he is suffering, or has been in contact with a 'person suffering, from a disease liable to cause infection of milk ; (d) where milk is infected, or suspected of being infected, with disease :— (i) the appropriate notice may be served by a medical officer of health on the occupier of registered premises outside (as well as inside) his district and, in the case of tuberculosis, it shall operate until it is withdrawn ; (ii) the conditions as to compensation have been considerably modified ; (e) an electric or gas boiler may be used in a milking house or milk room and bottles which have contained certain foods other than milk may by cleansed in a milk room ; (f) there are new provisions as to personal cleanliness, precautions against contamination or infection of milk and the provision of first aid equipment ; (g) the Minister may permit milk to be cooled in a closed container in a milking house not used for the housing of cattle where the cows are milked by mechanical means direct to such container ; (h) there are new provisions relating to the misuse of milk churns, the cleansing of vessels and appliances, the storage of cartons and non-returnable containers and the use of bottle-washing machines for cleansing glass bottles ; 47 («) the collection of milk by milk tanker from a tank on a farm is permitted ; (j) a person selling milk as, or as part of, a meal or refreshments is exempted from the prohibition against opening any receptacle containing milk or transferring milk from one receptacle to another elsewhere than on registered premises. Milk (Special Designations) Licences Licences, which remain in operation from January 1 to December 31, were issued during the year as follows :— Table 32 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 103 21 124 TOTALS 239 61 300 Examination of heat-treated milk 94 samples of pasteurised milk and 5 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, 39 samples of milk were submitted for examination to the public analyst by the Council's inspectors ; 2 of the samples were found to be not genuine. The average composition of the genuine samples is set out in the following table :— Table 33 Period Samples Average composition of samples examined Percentage of Milk fat Solids not fat Water First quarter 12 3.55 8.78 87.67 Second quarter 9 3.33 8.77 87.90 Third quarter 10 3.50 8.65 87.85 Fourth quarter 6 3.65 8.84 87.51 TOTALS 37 3.50 8.75 87.75 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. 48 Icecream — composition Under the Food Standards (Icecream) Order, 1953, icecream must contain not less than 5 percent fat, 10 percent sugar and 1\ percent milk solids other than fat. There are provisos in respect of icecream containing any fruit, fruit pulp or fruit puree, and kosher ice. The 61 samples submitted to the public analyst were found to have the composition shown in the appended table :— Table 34 Period Samples Average percentage composition Fat Milk solidsnot fat Sucrose Water First quarter 10 11.4 10.8 15.8 62.0 Second quarter 15 11.2 10 3 14.5 64.0 Third quarter 28 11.0 11.3 14.9 62.8 Fourth quarter 8 II.7 11.4 14.8 62./ TOTALS 61 11.2 11.4 14.9 62.9 Food Standards (Icecream) Regulations 1959, Labelling of Food (Amendment) Regulations 1959 The composition and labelling of icecream is now altered as, on April 27 1959, new regulations under the above headings came into operation. The main changes (quoting the British Food Journal) are :— (a) standards are fixed for dairy icecream and for milk ice—which are required to contain milk fat and must not contain any other fat; (b) saccharin and other artificial sweeteners may not be used in any icecream or in milk ice, and no minimum sugar content is laid down; (c) icecream made with non-milk fat may not be labelled or advertised in a way which is suggestive of butter, cream or milk ; but such icecream may continue to be sold as 'icecream' and may bear a statement that it contains skimmed milk solids ; (d) after November 30, 1959, all pre-packed icecream which is made with non-milk fat must be labelled that it contains vegetable or non-milk fat if it is sold as 'icecream.' A summary of the standards specified is as follows :— (i) Icecream or ice must contain not less than 5 percent fat, and 7£ percent milk-solids-not-fat. (M.S.N.F.). (ii) Icecream or ice containing fruit, fruit pulp or fruit puree must either conform to the above standard or must have a total fat and M.S.N.F. content of not less than 12½ percent. which must include not less than 7½ percent fat and 2 percent M.S.N.F. 49 (iii) Dairy icecream, dairy cream ice or cream ice must conform to whichever of the above standards is appropriate and must not contain any fat other than milk fat (except fat introduced by the use as ingredients of egg, flavouring substances or emulsifying or stabilising agents). (iv) Milk ice (including milk ice containing fruit, fruit pulp or fruit puree) must contain not less than 2½ percent milk fat and no other fat (except fat introduced by the use as ingredients of egg, flavouring substances, or emulsifying or stabilising agents), and not less than 7 percent M.S.N.F. (v) 'Parev' (kosher) ice must contain not less than 10 percent fat and no milk fat or other derivative of milk. (vi) The use of any artificial sweetener is forbidden in all these products. Icecream — grading Icecream is submitted to the Public Health Laboratory for bacteriological examination. The icecream is graded according to the time taken to decolorise a dye, methylene blue. The test is a provisional one and because of the many factors which govern the hygienic quality of icecream it is recommended officially that judgment should be based on a series of samples and that too much attention should not be paid to the result of an individual sample. It is suggested that over a six-monthly period, at least 50 percent of a vendor's samples should fall into grade 1, 80 percent into grades 1 or 2, not more than 20 percent into grade 3 and none into grade 4. During the year 150 samples of icecream were submitted for bacteriological examination with the following results:— Grading Table 35 Samples submitted % Grade 1 111 74.0 Grade II 34 22.7 Grade III 4 2.7 Grade IV 1 0.6 TOTAL 150 1000 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. Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 587; of these, 61 were formal and 526 informal. After examination the public analyst reported that 8 of the formal samples and 18 of the informal samples were adulterated or below standard; the percentage of adulteration amounted to 13.1 in the formal samples, 3.4 in the informal samples, and to 4.4 of all the samples submitted, compared with nil in the previous year. 50 Samples analysed Table 36 Articles Examined Adulterated Formal Informal Total Formal Informal Total Baking powder, cereals and flour 4 59 63 — 2 2 Butter 7 14 21 — — — Confectionery, sugar 1 7 8 — — — Coffee, cocoa, and chocolate 2 10 12 — 2 2 Cream 1 5 6 — — — Drinks, soft 4 5 9 — — — Dripping, lard, suet — 12 12 — — — Drugs 2 57 59 — 1 1 Fish, canned — 6 6 — — — Flavourers and condiments 4 95 99 2 9 11 Fruit, dried 1 7 8 1 — 1 Icecream 2 59 61 — — — Jellies and custards — 22 22 — — — Jams, marmalade and serves 1 17 18 — — — Lager, canned 1 — 1 — — — Margarine — 7 7 — — — Meat products — 12 12 — 3 3 Milk 11 28 39 2 — 2 Milk, Channel Islands — 6 6 — — — Milk, condensed — 10 10 — — — Milk drink 1 — 1 — — — Milk, hot 8 — 8 3 — 3 Mussels, cooked 1 1 — — — Paste, fish and meat — 19 19 — — — Pies, meat — 3 3 — — — Sausages 3 42 45 — 1 1 Soups — 12 12 — — — Vegetables, canned 1 6 7 — — — Spirits 4 6 10 — — — Sugar, brown 2 2 TOTALS 61 526 587 8 18 26 Non-genuine samples Table 37 Article Formal or informal Adulteration or irregularity Action taken or result of proceedings Glucose tablets Informal Incorrect statement of ingredients on label Manufacturer agreed to amend label Gravy powder Informal Incorrect statement of ingredients on label Warning letter sent Cocoa Informal Incorrect statement of ingredients on label Referred to manufacturer Cocoa Informal Incorrect statement of ingredients on label Referred to manufacturer Pork luncheon meat Informal Sample contained only 74% meat There is no standard for meat content Pork sausages Informal Sample contained only 45% meat Formal sample taken which proved genuine Table 37—continued Article Formal or informal Adulteration or irregularity Action taken or result of proceedings Dried parsley Informal Contained grit and earth Manufacturer withdrew stocks from sale Cold milk Formal 2.6% deficient in milk fat Letter of advice sent Hot milk Formal 27.3% deficient in milk fat and 13.8% deficient in milk solids other than milk fat Warning letter sent Pickling spice Informal Sample contained dried earth Formal sample taken Pickling spice Formal Sample contained stone and dried earth Referred to local authority where supplier's premises situated Milk Formal 4.1% deficient in milk solids other than milk fat Warning letter sent Luncheon meat Informal Sample contained only 68% meat There is no standard for meat content Hot milk Formal 13.1% deficient in milk solids other than milk fat Warning letter sent Horseradish sauce Informal Contained a dyestuff not mentioned on label Further sample to be taken Horseradish sauce Informal Contained colouring matter not mentioned on label Referred to manufacturer for observation Horseradish sauce Informal All ingredients not specified on label Manufacturer stated labels were approved by Ministry of Food Non-brewed condiment Informal Contained only 3.8% acetic acid Formal sample to be taken Non-brewed condiment Formal Contained only 3.8% acetic acid Warning letter sent Hot milk Formal Contained only 2.7% milk fat Letter of advice sent Pork luncheon meat Informal Contained only 74% meat No standard, but supplier asked for comments Plain flour Informal Sample deficient in creta praeparata and iron A mixture of two flours supplied by different millers. Both asked for Gravy powder Informal All ingredients not specified on label explanation Labels prepared after advice from Ministry of Food Lemon juice Informal Sample showed stock had deteriorated Remaining stock destroyed Stoned raisins Plain flour Formal 14% of raisins had not had stones removed Imported from Australia. Ministry informed Informal Sample contained excess of creta praeparata Manufacturer's comments invited 52 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:— Sliced loaf (2) Demerara sugar Frozen fish sticks Cooked minced meat Sponge fingers Orange drink Filled milk bottle (3) Minced beef Medicine Bread rolls (2) Canned apricots (2) Canned peaches Canned cream Garden mint in vinegar Biscuits Bread (3) Flour Egg albumen Smoked sausage (3) Egg whites Minced turkey Egg yolk Water Jellied veal Cold roast mutton Tap water Tank water Chinese egg white Registration of food premises During the year the following were registered, the total (including previous registrations) being shown in the last column. Type 1958 Total Sale and storage of icecream 34 279 Manufacture of icecream 2 2 Fish frying 5 21 Fish curing 2 13 Preparation or manufacture of sausages 5 61 Preparation or manufacture of potted, pressed, pickled or preserved food 18 102 Unsound food Approximately 14 tons of food were 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 No certificates of exemption in respect of sanitary conveniences were issued during the year. Under s.38 of the Shops Act, 1950, we already had powers and duties with regard to ventilation, temperature and sanitary conveniences in shops. Under s.18 of the L.C.C. (General Powers) Act, 1958, additional powers and duties under s.38 came to us on 1 January 1959, and these were to do with lighting, with washing facilities and with facilities for the taking of meals. The relevant subsections of s.38 are (3), (4) and (5), which are as follows:— (3) In every part of a shop in which persons are employed about the business of the shop, suitable and sufficient means of lighting shall be provided, and every such part of a shop shall be kept suitably and sufficiently lighted. 53 (4) In every shop, not being a shop exempted from the provisions of this subsection, there shall be provided and maintained suitable and sufficient washing facilities available for the use of persons employed in or about the shop. (5) Where persons employed about the business of a shop take any meals in the shop, there shall be provided and maintained suitable and sufficient facilities for the taking of those meals. The law governing exemption certificates under subsection (4) is the same as that governing exemption certificates under subsection (2) which we already dealt with, and the definitions of "shop" and "suitable and sufficient" are also the same for the whole section. Twelve premises had already been granted certificates of exemption under s.38(6) relating to the provisions of s.38(4). Food Hygiene Regulations, 1955 Regulations 15 and 16 require the provision of a water supply and wash hand basin on all food premises. No certificates of exemption were issued during the year. Pharmacy and Poisons The names of 13 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 206 persons previously registered were retained on the register. 141 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. 111 pigs were slaughtered and the carcases inspected during the year. 5 of these carcases with a total weight of 346 lbs. were condemned as tuberculous, and 75 lbs. of heads and offals from 6 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. Food work generally Mr. Thomas, the group food inspector, in commenting on the year's work, reports as follows:— "During the year I am afraid no progress was made to solve the problem of" What is a sausage?" The old standards of 65% meat content for pork and 50% for beef were revoked and any action now taken is based on the opinion of the public analyst who is guided by the old standards. Samples taken in this borough showed reasonably good results. 54 "It would be very pleasant to be able to report that at least one restaurant in the borough was displaying a notice inviting customers to inspect the kitchen. If such a notice exists, I have yet to see it. This would appear to be a point in favour of the snack bar where all operations are carried out in full view of the customer, who can, and no doubt, does, express his opinion on what he sees. "The day of the supermarket is with us and although the small trader and "personal service" have their champions there can be no denying that from the public health point of view the large food stores selling food under hygienic conditions with the provision of adequate facilities for the staff, and with proper supervision, have much to recommend them. It will be seen from the report that there has again been an increase in the number of samples of icecream coming within the Grade 1 category—out of 150 samples taken only 5 were unsatisfactory. This is extremely gratifying and supports the point in connection with the large provision stores, as the manufacture of icecream is now almost wholly in the hands of a few wellknown companies with the equipment and financial resources to provide and maintain a high standard. The analyses of the 61 samples taken for composition were also very satisfactory—no sample being below the legal standard. "During the year we received the usual crop of complaints of foreign bodies in articles of food and on investigation almost all of these were found to be due to carelessness on the part of a food handler and did not reflect on the hygienic conditions under which the article was produced. This is the human element and it is difficult to see how this can ever be entirely eradicated. "Generally, one can say that the progress made in former years has been maintained during 1958 and that a continuation of a high standard in the handling and preparation and distribution of all forms of food is appreciated both by those employed in the trade and the public." 55 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 1958 with comparative figures for the previous six years. Table 38 Diseases Coses notified 1958 1957 1956 1955 1954 1953 1952 Diphtheria 1 1 Dysentery 214 129 579 92 394 84 169 Encephalitis (acute) 1 2 2 — — 3 Enteric or typhoid fever 4 2 3 1 1 2 Erysipelas 13 15 20 26 24 18 19 Food poisoning 27 42 46 48 110 32 33 Malaria — 1 3 2 1 Measles 835 2728 206 3905 521 2082 2183 Meningococcal infection 3 4 9 4 6 10 5 Ophthalmia neonatorum 1 2 2 4 2 3 4 Pneumonia 61 96 89 121 77 189 89 Poliomyelitis (acute) 2 15 26 63 16 52 15 Puerperal pyrexia 59 93 57 92 59 57 88 Scabies 9 18 29 18 14 5 18 Scarlet fever 210 143 188 158 331 283 379 Tuberculosis 236 247 212 271 256 341 307 Whooping cough 154 225 241 412 449 574 512 TOTALS 1829 3761 1709 5217 2263 3738 3822 Notifications of infectious diseases in 1958 showing sex and age groups Table 39 Diseases Under 1 1- 3- 5- 10- /J- 25- 45- 65 + Total M F M F M F M F M F M F M F M F M F M F Dysentery 4 9 27 17 11 10 21 22 10 8 6 12 11 23 11 9 3 101 113 Encephalitis (acute) — — — — — 1 — — — — — — — — Enteric or typhoid . fever - - — — — 1 — 1 1 ~ — — 1 — 1 3 Erysipelas Food poisoning Measles 1 9 — i! 1 88 — - 88 1 101 1 80 3 231 1 201 5 2 7 3 1 1 5 2 1 4 5 2 4 ? 2 3 1 16 437 7 11 398 Meningococcal infection 1 2 Ophthalmia neonatorum 1 1 Pneumonia ... 1 — 1 3 1 1 2 1 1 1 2 1 i 5 14 * 8 8 35 26 Poliomyelitis (paralytic) Poliomyelitis (nonparalytic) 1 Puerperal pyrexia... — - — — — — — — 11 — 34 — 3 — — 59 Scabies — — — 1 — — I — 1 1 I i — — 1 — — 4 0 Scarlet fever 1 4 4 23 14 65 72 6 12 4 1 1 3 — — — 104 106 Tuberculosis ■ (respiratory) — — 1 1 1 2 6 5 4 4 21 22 39 32 41 13 24 — 137 79 Tuberculosis (non-respiratory) — — — — — — 1 — 2 — 1 2 7 — 3 1 3 3 17 Whooping cough ... 7 5 8 13 12 15 46 36 i 5 1 1 1 1 77 Totals ... 24 28 130 128 150 123 376 340 31 43 40 69 66 110 74 44 35 18 926 903 57 Analysis of certain diseases in table 39 into divisional areas— Table 40 Disease Div. areas Under 1 1- 3- 5- 10- 15- 25- 45- 65+ Total Dysentery W 1 10 3 13 8 3 5 1 1 45 N 3 27 8 3 _ 5 10 2 - 58 S 9 7 10 27 10 10 19 17 2 111 Total 13 44 21 43 18 18 34 20 3 214 Measles W 2 31 35 69 2 1 1 - 141 N 15 102 91 214 5 3 4 1 _ 435 S 4 43 55 149 5 2 1 - - 259 Total 21 176 181 432 12 6 6 1 - 835 Pneumonia W _ 3 1 1 _ - 2 1 1 9 N 1 - 1 1 1 1 1 7 8 21 S - 1 - 1 1 2 7 12 7 31 Total 1 4 2 3 2 3 10 20 16 61 Poliomyelitis W - - - - - - - - - - N - - - - - 1 1 _ _ 2 S - - - - - - - - - - Total - - - - - 1 1 - - 2 Scarlet fever W _ 4 10 42 8 1 2 _ - 67 N 1 1 5 39 5 1 1 - _ 53 S - 3 22 56 5 3 1 - - 90 Total 1 8 37 137 18 5 4 - - 210 Tuberculosis (respiratory) W _ 1 2 4 3 9 25 14 5 63 N - - - 3 3 19 21 17 10 73 S - 1 1 4 2 15 25 23 9 80 Total - 2 3 11 8 43 71 54 24 216 Whooping cough W 2 7 12 28 _ _ _ 49 N 4 8 3 13 _ - _ - _ 28 S 6 6 12 41 8 1 2 1 - 77 Total 12 21 27 82 8 1 2 1 - 154 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. 58 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 23— Table 41 W N S Total Visits 248 297 474 1019 Futile visits 311 213 270 794 Revisits 104 121 159 384 Total 663 631 903 2197 Poliomyelitis In 1958 2 cases of poliomyelitis were confirmed, one paralytic and the other non-paralytic. Both cases occurred in the North and were males. The following table gives figures for this borough over the last 12 years, the time during which the incidence has been high. Table 42 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 8 23 22 2 9 TOTAL 775 751 364 47 Dysentery The number of cases almost doubled (from 129 to 214) though even this higher figure was considerably less than the 579 cases in 1956. The disease continued to be very mild, but when it appears in schools it has a high nuisance value and may interfere considerably with education. 59 Food poisoning The number of cases last year formally notified showed a further drop; however it is unlikely that all, or indeed nearly all, such cases are notified. As is usual there was a much greater proportion in the third or fourth quarters of the year (the warmer months) than in the first two. Each case is investigated as far as possible but in so many instances all the suspected food has been eaten or perhaps thrown away and it is relatively rarely that we are able to say with any degree of confidence how the food itself became infected. Measles 1958 was an "off peak" year although even so over 800 cases were notified. They were almost invariably of a very mild degree. Pneumonia In spite of the second wave of so-called "Asian Flu" which occurred at the beginning of the year, the number of cases of pneumonia dropped from 96 in the previous year to 61 in 1958. Here again it seems notification is by no means complete, and the number of deaths from respiratory causes in January and February 1958 indicated that pneumonia was still a relatively common fatal condition amongst the elderly. Scarlet fever The number of cases of scarlet fever increased from 143 in the previous year to 210 in 1958. As is usual, school children were the most affected, particularly those between the ages of 5 and 10 (137 cases). 37 cases were between 3 and 5, and only 18 in the older school children. Two or three schools were particularly affected, but the disease nowhere reached epidemic proportions; it was on the whole a mild infection. Whooping cough The number of cases at 154 was the lowest for many years past. Tuberculosis The number of cases notified decreased a little, but remained disappointingly high. In fact cases in males increased—from 128 to 137 for pulmonary disease, but this was more than counterbalanced by a drop in females from 92 to 79. The number of deaths showed a large drop—from 19 to 12 for males (pulmonary) and from 12 to 6 for females. These were the lowest figures on record. 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:— 60 Table 43 Age periods New cases notified Deaths Respiratory NonRespiratory Totals Respiratory NonRespiratory Totals M F M F M F M F M F M F 0- - - - - - - - -- - - - - 1- 1 - _ - 1 - - - - - - - 2- 1 3 - - 1 3 - - - - - - 5- 6 5 — 1 6 6 - - 1 - 1 - 10- 4 4 - 2 4 6 - - 15- 12 6 — 1 12 7 - - - - - - 20- 9 16 — - 9 16 - - - - -- - 25- 17 10 - 3 17 13 3 2 - - 3 2 35- 22 22 2 4 24 26 45- 13 5 - 1 13 6 - - - 3 - 55- 28 8 - 2 28 10 65- 20 _ 1 3 21 3 4 - - - 4 - 75 + 4 - - - 4 - 2 4 - - 2 4 137 79 3 17 140 96 12 6 1 - 13 6 An interesting feature is the great preponderance of notifications of non-respiratory tuberculosis in females compared with males—the reverse of what occurs with respiratory tuberculosis. There has for many years been the same tendency, but never before so marked. Analysis of new cases of tuberculosis into divisional areas:— Table 44 Division Sex 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total West Respiratory M - - 1 2 2 2 2 7 8 2 8 4 1 39 F - - 2 2 1 1 5 2 7 2 2 - - 24 Non-respiratory M - - - - - - - - 2 - - - - 2 F - - - 1 1 - - 2 1 - 1 1 - 7 North Respiratory M - - - 1 1 8 5 5 4 5 9 7 3 48 F - - - 2 2 2 4 4 8 3 - - - 25 Non-respiratory M - - - - - - - - - - - 1 - 1 F - - - - 1 - - 1 1 - - 2 - 5 South Respiratory M - 1 - 3 1 2 2 5 10 6 11 9 - 50 F - - 1 1 1 3 7 4 7 - 6 - - 30 Non-respiratory M - - - - - - - - - - - - - - F - - - - - 1 - - 2 1 1 - - 5 61 Summary of statistics as to tuberculosis for the last ten years Table 45 Year Population New cases notified (all forms) (excluding inward transfers) Notif. rate per thousand pop. Deaths Death rate from resp. tuberculosis per thousand pop. All forms Respiratory Lewisham County of London 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 29 013 0.13 1957 220,900 247 1.12 33 31 0.14 012 1958 221,000 236 1.07 19 18 00.8 0.12 The accompanying chart shows, on the log scale, the rates per 100,000 for notifications and deaths (all forms) for England and Wales and for Lewisham, and respiratory tuberculosis for London and for Lewisham, since 1942. TUBERCULOSIS - log scales 62 Mass radiography unit I am indebted to the Director of the Unit for information of work done in the borough during 1958 on which the following table is based. The Unit during the course of the year was stationed at 15 different locations in the borough, the time spent at each varying from 1 day to 2 weeks. Table 46 Patients Men Women Total General analysis X-rayed 9,537 12,051 21,588 Previously x-rayed 4,827 5,696 10,523 Recalled for large film 413 420 833 Normal on large film 178 200 378 Abnormal on large film 234 219 453 Not yet re-attended 1 1 2 Analysis of abnormal large films:— Cases considered tuberculous:— (a) no further action required 2 — 2 (b) occasional supervision only 29 15 44 (c) requiring treatment 36 24 60 (d) still under investigation 2 1 3 (e) refused further investigation 1 1 2 Previously known tuberculous cases 15 10 25 Non-tuberculous cases:— (a) investigated 50 30 80 (b) still under investigation — — — Cardio-vascular lesions 10 27 37 No action required 89 111 200 Tuberculosis — environmental conditions Case papers showing the environmental condition of patients attending the Lewisham Chest Clinic in 1958 have been analysed in 337 cases with the following results:— Table 47 Cases %* Males 191 57 Females 146 43 Social classification Class I 3 1 Class II 27 9 Class III 219 74 Class IV 30 10 Class V 16 6 Not classifiable 42 — Rooms occupied:— 17 2 or more rooms per person 55 1—2 rooms per person 177 53 Less than 1 room per person 99 30 No information 6 — Accommodation:— Separate bed 121 36 Separate bedroom 86 26 Condition of premises occupied:— 79 Good 262 Fair 51 15 Poor 21 6 No information 3 — *Excluding cases not classified 63 Food poisoning The following is the annual return of food poisoning notifications (corrected) as furnished to the Ministry of Health:— (1) Food poisoning cases Table 48 Notifications (corrected) Cases otherwise ascertained Fatal cases 1st quarter 2 — 2nd quarter 6 2 — 3rd quarter 14 4 — 4th quarter 13 1 - Year 35 7 — (2) Particulars of outbreaks Table 49 Outbreaks Cases Family outbreaks Other outbreaks Notified Otherwise ascertained Total cases Agent identified:— Salmonella typhimurium 2 - 5 - 5 CI. welchii 1 — 3 — 3 Agent not identified 1 — 2 — 2 (3) Single cases Table 50 Notified Otherwise ascertained Total cases Agent identified:— Salmonella typhimurium 5 5 10 „ Newport 2 — 2 „ Heidelburg 1 — 1 ,, St. Paul 1 - 1 „ Aberdeen — 1 1 „ enteritis 1 — 1 Agent not identified 7 1 8 (4) Salmonella infections, not food-borne Nil NOTE: 8 cases notified by Hither Green Hospital which were returned to the Registrar-General have their home addresses in the following authorities areas : Southwark 4, Deptford 3, and Bermondsey 1. The cases were referred to the authorities concerned for investigation. 64 I am indebted to the Divisional Medical Officer of the London County Council for the information on which the following table is based:— Immunisation against diphtheria; whooping cough; smallpox; poliomyelitis Table 51 Age at December 31, 1958 born in year Under / 2 3 4 5-9 10-14 Total under 15 1958 1957 1956 1955 1954 1953-49 1948-44 (i) Diphtheria (including combined and triple):— immunised during year immunised at end of year 1,866 526 96 44 45 105 25 2,707 1,866 1,000 2,381 2,374 2,437 14,062 13,620 37,740 Estimated mid-year population 15,700 32,800 48,500 (ii) Whooping cough (including combined and triple):— Immunised during year 1,953 457 92 35 34 32 2,603 (iii) Vaccination. Vaccinated during the year (age at date of vaccination) Under 1 1-4 5-14 15 and over Total Primary 1,245 91 17 12 1,365 Revaccination 1 17 55 73 (iv) Poliomyelitis Inoculated against poliomyelitis (at clinics and schools in Lewisham 1st injection 2nd injection 3rd injection 14,030 13,708 42 Council Offices, E. H. R. SMITHARD Canadian Avenue, Medical Officer of Health S.E.6. August, 1959 65 APPENDIX A Acts of Parliament, Statutory Instruments and Circulars issued by Government Departments with regard to the public health services, during ithe year 1958:— Statutes Litter Act Slaughter of Animals Act Slaughterhouses Act London County Council (General Powers) Act Local Government Act Housing (Financial Provisions) Act Statutory Instruments Clean Air Act, 1956 (Appointed Day) Order Clean Air—The Alkali etc. Works Order The Dark Smoke (Permitted Periods) Regulations Labelling of Food (Amendment) Regulations Clean Air—The Dark Smoke (Permitted Periods) (Vessels) Regulations The Public Health (Preservatives etc. in Food) (Amendment) Regulations The Factories (Cleanliness of Walls and Ceilings) Order The Antioxidant in Food Regulations The Slaughterhouses (Meat Inspection Grant) Regulations The Slaughter of Pigs (Anaesthesia) Regulations The Public Health (Preservatives etc. in Food) (Amendment No. 2) Regulations The Slaughterhouses (Hygiene) Regulations The Slaughter of Animals (Prevention of Cruelty) Regulations The Poisons (No. 2) Rules The Poisons List Order The Poisons List (No. 2) Order The Poisons Rules Ministry of Health Circulars No. 1 Annual Reports of Medical Officers of Health for 1957 5 Investigation of Food Poisoning (Revised Memorandum) 6 Accidents in the home; burns and scalds 22 Annual Reports of Medical Officers of Health for 1958 66 Ministry of Housing and Local Government Circulars No. 6 Clean Air Act, 1956—date of operation of remaining provisions ; byelaws under S24; miners' concessionary coal ; approval of new furnaces 9 Report of the Committee on Administrative Tribunals and Enquiries 24 Clean Air Act, 1956—Alkali etc. Works Regulation Act, 1906 30 Flatlets for old people 33 Clean Air Act, 1956—Memoramdum on provisions coming into force on 1 June 1958 44 The Litter Act, 1958 51 Report of the Committee on Administrative Tribunals and Enquiries— Development plan procedure 61 Flats and Houses 1958—design and economy Ministry of Agriculture, Fisheries and Food Circulars No. FSH 1 2 7 Milk and Dairies Regulations 1949—1954, Approved Oxidising or Preservative Agents 20 3 Slaughter of Animals Acts, electric stunning 5 Labelling of Food (Amendment) Regulations, 1958 6 Chemical compounds used in agriculture and food storage 8 Meat Content and Price of Sausages 11 Slaughterhouses Act, 1958 12 The Public Health (Preservatives etc. in Food) (Amendment) Regulations, 1958 13 Copper in foods 14 The Antioxidant in Food Regulations, 1958 15 The Slaughterhouses (Meat Inspection Grant) Regulations 1958 16 Tea sampling on importation 17 The Slaughter of Pigs (Anaesthesia) Regulations, 1958 18 The Slaughterhouses (Hygiene) Regulations, 1958. The Slaughter of Animals (Prevention of Cruelty) Regulations, 1958 19 The Public Health (Preservatives etc. in Food) (Amendment No. 2) Regulations, 1958 PDP 1 Prevention of Damage by Pests Act, 1949 (1) Handbooks for Rodent Operatives (2) Use of Sodium Fluoracetate for sewer treatments 4 Prevention of Damage by Pests Act, 1949—state rat and mouse destruction service 5 Prevention of Damage by Pests Act, 1949—Ministry's pests functions 67 General Register Office Circulars No. 1 Infectious and other notifiable diseases—weekly return 2 Transfer of Births, Deaths and Stillbirths 3 Annual Reports of Medical Officers of Health, 19S7—Vital Statistics 4 Infectious and other notifiable diseases—quarterly return Miscellaneous Memorandum 188 MED Food poisoning Memorandum Clean Air Act, 1956—Memorandum on industrial provisions Model Byelaws Series II for preventing the occurrence of nuisances from snow, filth, dust, ashes and rubbish APPENDIX B Legal Proceedings in 1958 The following are details of legal proceedings issued during the year:— Nature of summons No. of summonses Total fines Total costs Remarks £ s. d. £ s. d. Public Health (London) Act, 1936 Non-compliance with nuisance notices 28 — 15 5 0 In thirteen cases, abatement orders were made; in three cases the summonses were adjourned sine die, and in twelve cases the summonses were withdrawn. Non-compliance with an abatement order 4 22 10 0 4 4 0 One summons was withdrawn Non-compliance with Court Order made for failing to comply with abatement order - - - Conditional discharge London County Council (General Powers) Act, 1954 Section 12 1 2 0 0 1 1 0 Food and Drugs Act, 1955 Section 2 3 15 0 0 4 4 0 One summons was dismissed Section 8(1 )(a) Food Hygiene Regulations, 1955 2 - 1 1 0 One summons was withdrawn. A conditional discharge was granted on the other. Regulation 23 1 5 5 0 1 1 0 Regulation 10 1 10 0 0 1 1 0 68 APPENDIX C List of special reports submitted to the Health Committee by the medical officer of health during 1958:— January 14 Estimates of expenditure and income. March 5 Ladywell smoke control area. 11 Proposed Ladywell smoke control area. June 3 General report on Old People's clubs. July 1 Proposed smoke control area at Southend. September 9 Basement bakehouses. October 7 Extension of facilities at Old People's clubs. December 2 Extension of services to Old People. 2 Clean Air Act—Smoke Control Areas. 69 TABLES TABLE SUBJECT PAGE TABLE SUBJECT PAGE NO. 1 Section A Comparative statistics 7 NO. 28 Section D Demolition orders 42 2 Causes of death by age groups 8 29 Closing orders 42 30 Clearance areas 43 3 Deaths under one year 10 31 Rent Act 1957 44 4 Local sickness 11 S Deaths by social class 11 6 Causes of death by social class 12 Section E 32 Milk licenses 47 7 Grouped causes of death by social class 13 33 Analysis of milk 47 8 Births, infant deaths, etc., by social class 13 34 Icecream composition 48 35 Icecream grading 49 9 Heart and circulation mortality 14 36 Samples analysed 50 10 Lung cancer 15 37 Adulterated smples 51 11 General statistics from 1901 16 Section B Section F 12 Disinfecting station 18 38 Notified cases of infectious diseases 55 13 Verminous conditions, etc. 18 14 Public mortuary 20 39 Notifications of infectious diseases by age and sex 56 15 Rodent control—treatment of rivers 21 40 Analysis of certain diseases into divisional areas 57 16 Prevention of Damage by Pests Act 22 41 Infectious disease visiting 58 17 Laboratory facilities 22 42 Poliomyelitis 58 18 Water, chemical samples 24 43 Tuberculosis notifications and deaths 60 19 Water, Bacteriological samples 24 44 Analysis of new cases of tuberculosis into divisional areas 60 20 Atmospheric conditions 26 21 Accidents to children 30 45 Tuberculosis statistics 61 22 Old People's visits 32 46 Mass Radiography 62 Section C 47 Tuberculosis — environmental conditions 62 23 Sanitary inspection 34 48 Food poisoning cases 63 24 Summary of notices 35 49 Food poisoning outbreaks 63 25 Nuisances remedied 35 50 Food poisoning agents 63 26 Factory inspections 37 51 Immunisation against infectious disease 64 27 Factory defects 38 CHART Tuberculosis rates for notification and deaths 61 70 INDEX SUBJECT PAGE Acts, regulations and orders 65 Area of borough 6 Atmospheric conditions 25 Births and birth rate 6 Cancer 15 Clean Air Act 25 Clearance areas 43 Coronary disease 14 Deaths and death rate 6 Deaths, cause of 8 Disinfection and personal cleansing 18 Dog nuisances 23 Drainage work 23 Dysentery 58 Exhumations 40 Factories 36 Flies and mosquitos 19 Food, adulteration of 48 Food inspection and supervision 46 Food poisoning 59 Food Hygiene Regulations, 1955 53 Food Standards Regulations 48 General statistics from 1901 16 Hairdressers 36 Health Services, general provision of 18 Heating appliances 36 Heattreated milk 47 Home Safety 28 Housing: — Building 41 Families rehoused 41 Housing Act, 1957 41 Icecream composition 48 Icecream grading 49 Immunisation 64 Infant mortality 7 Infant mortality statistics 10 Infectious diseases 55 Infectious disease visiting 57 Laboratory facilities 22 Legal proceedings 67 LCC (General Powers) Act, 1953, section 43 19 SUBJECT PAGE Mass miniature radiography 62 Maternal deaths 7 Measles 59 Milk, analysis of 47 Milk and Dairies Regulations 46 Mortuary and Coroner's Court 20 National Assistance Act, 1948 s. 50 23 s. 47 23 Nuisances remedied 25 Offensive trades 53 Old people 30 Outworkers 38 Pet Animals Act, 1951 36 Pharmacy and Poisons Act, 1953 53 Pigeons 40 Pneumonia 59 Poliomyelitis 58 Population 6 Prevention of Damage by Pests Act, 1949 21 Rag Flock and Other Filling Materials Act, 1951 39 Rateable value 6 Rent Act, 1957 44 Rodent control 20 Sampling 50 Sanitary circumstances of the area 34 Scarlet fever 59 Shops Act, 1950 52 Sickness, local 11 Slaughterhouses 53 Smoke nuisances 34 Social medicine statistics 11 Staff 2 Stillbirths 6 Swimming baths 23 Tuberculosis 59 Unsound food 52 Vaccination 64 Vital statistics 6 Water certificates 36 Water supply 23 Whooping cough 59