4374 Lew 47 METROPOLITAN BOROUGH OF LEWISHAM THE PUBLIC HEALTH OF LEWISHAM Report of the Medical Officer of Health for the Year 1959 E. H. R. Smithard, MBE, MD, DPH London s e. g. Berhyman & Sons, Ltd., Blackheath Road, s.e.10 METROPOLITAN BOROUGH OF LEWISHAM Report of the Medical Officer of Health for the Year 1959 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 36 Housing 44 Inspection and Supervision of Food 49 Infectious Diseases58 Appendix A — Statutory Instruments 69 ,. B — Legal Proceedings 71 „ C — Special Reports to Health Committee 72 " 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 31/12/59 Medical Officer of Health E. H. R. Smithard, mbe, md, bs, mrcs, lrcp, dph Senior Public Health Inspector Deputy Senior Public Health Inspector E. Walker (a) (6) A. J. Phillips (a) (6) Group Public Health Inspectors A. G. Thomas (a) (b) (Food) *R. Mahoney (a) (6) (District) J. R. Craven (a) (b) (Housing) Smoke Inspector Assistant Group Housing Inspector J. W. Bevan (a) (b) (c) R. C. Brittain (a) (6) District Inspectors Divisional Food Inspectors *G. L. Belshaw (a) (b) H. W. Ellery (a) (b) *K. G. C. Burt (a) (b) (c) H. Tolson (a) (b) L. J. Cleverly (a) *C. L. Connor (a) (b) *R. L. Davis (a)(b) *G. E. Fallows (a) (b) *L. Gardiner (a) (b) *E. A. Howard (a) (b) *D. G. Oliver (a) (b) (c) *K. R. Wagener (a) (b) *T. E. R. Ware (a) (b) One vacancy (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. Carina, srn, rfn Mrs. L. Champness, srn, rfn Mrs. M. M. Coulson, srn Principal Clerk E. W. Cheesman Clerical Staff Student public health inspectors S. Burridge, (senior clerk) A. R. Burchmore C. R. Coleman A. J. Thrussell Mrs. D. J. Handford D. B. Smith Miss D. Cashman A. Lakeland Miss M. E. Hinchcliff J. T. Smith Mrs. M. G. James 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 Foreman Disinfector operative 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. H. Tomlinson, mb, BChir, of the Public Health Laboratory Service, 3 To the Mayor, Aldermen and Councillors of the Metropolitan Borough o) Lewisham Mr. Mayor, Ladies and Gentlemen, I submit my report for the health department for the year 1959. Vital statistics The Registrar General's estimate of the population in midyear 1959 at 22)1,000 was exactly the same as his estimate for the previous year. This latter figure was only 100 less than in the year before and so it seems that the downward trend in population which had occurred continuously since 1950 (when the population reached 228,300) may now have ceased. The crude birth rate for the year at 15.7 shows an increase from the 14.8 of the previous year. The adjusted birth rate, however, (allowing for age and sex distribution of population) brings it down to 14.9. The crude death rate at 111.8 compares with 11 in the previous year, the adjusted death rate is the same and therefore there is a real increase over the past year. The infant mortality rate at 18 indicates a return to the better figures we had in previous years, that is excepting 1958 when it was 24. The infant mortality rate can be divided into three parts, the early neonatal rate (under one week of age), the rest of the neonatal rate (up to one month of age) and the rest of the first year rate (that is from one month to twelve months). Theses rates were rerepectively 10.4, 2.8 and 4.7. The stillbirth rate came down one from 18 to 17. The various comparative figures of general statistics since the beginning of the century are shown in table 12. Infectious disease other than tuberculosis The total number of notifications received (including 143 for tuberculosis) was 3767, which is double the number of the previous year and is almost the sami' as 1957. The increase was almost entirely due to measles—from 835 to 2613. Food poisoning cases increased from 27 to 49 but the 27 of the previous year was an abnormally low figure; details are in section F of the report. Pneumonia increased from 61 to 108 cases due to a moderate influenza wave at the beginning of the year. Both scarlet fever and whooping cough showed some increase. Poliomyelitis at 6 cases was again low in comparison with earlier years. It is hoped and thought that vaccination has been a considerable factor here. It is also hoped that vaccination will become increasingly popular, but there is unfortunately not a great deal of support for this hope as so far vaccination acceptances have been disappointingly low bearing in mind the issues at stake. Tuberculosis The number of new notifications showed a major drop. Last year I reported that there had not in fact been much alteration in the annual number of new cases found in the past five years, these varying between 12 and 2711. It is therefore of some significance that the 1959 figures 4 are only 61 per cent of those of the previous year. The death rate from pulmonary tuberculosis, which had shown a steep drop in 1958 continued this trend in 1959 and fell to 5 per 100,000 population, which again is the lowest on record—perhaps abnormally so as it was only half the County of London figure, whereas in previous years the County of London figure had been more nearly matched. Clean air The paragraphs on atmospheric pollution in section B give details of the work done during the year aind can at present be taken to indicate the proposed plan for conversion of the whole borough into a smoke control area. This work, which is great in magnitude but which can have corresponding beneficent results, has been carried out by the normal staff of public health inspectors and, with a little augmentation, the normal staff of clerical assistants. All manner of problems both large and small have cropped up and have (it is hoped) been overcome with help and cooperation of the staff. I think it is true to say that this borough is as advanced as any metropolitan borough, and indeed almost as advanced as any other area in the country, in its work of conversion to smoke control. Old people No additional clubs applied for grant aid and altogether 14 clubs or organisations were in receipt of grants 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 existing facilities and by the institution of new facilities) that the club is increasing its activities or comfort for its members. The iniumber of old people on the club registers of the grant-aided clubs showed a slight increase during the year (thereby reversing the trend of the previous two years). A poster competition to aid recruitment was arranged by the Council through the agency of the Central old people's organisation and attracted a fair number of entries some of which, particularly the first prize-winning entry, was regarded as having out of the ordinary merit. Arrangements are now in hand for reproducing the prize-winning entry (with certain modifications) as a general poster for local use. A committee has been formed under the auspices of the King Edward's Hospital Fund to examine the facilities for old people's welfare in the borough and to make recommendations. Some eight organisations are represented on the committee, of which I am a member, anid one of the earlier decisions was that a house-to-house survey of a large part of the borough was essential. Arrangements are being made for this, but carrying it out will involve some considerable delay in the findings of the committee. 5 Home Safety After considering the matter on two or three occasions the Public Health committee came to the conclusion that there would be no advantage in the setting up of an ad hoc local safety committe, but that the best approach would be for the Public Health committee to have regular reports on home safety matters; this is being carried out. It was also decided to publish a quarterly home safety bulletin and the first issue was made in January 1960. Staff The shortage of one in the establishment of public health inspectors remained during the year. The scheme for training student inspectors is working well apart from some difficulties in recruitment. The type of candidate we want regularly year by year is the school leaver who has passed his GCE in the requisite subjects, but we do not get many applicants from schools when we advertise in June of each year, and when the appointment is made—as it has to be for academic purposes in. July—it is not known whether the boy has passed his GCE satisfactorily. There appears to be no solution to this problem at present, but in spite of the difficulties we have at present a full complement of students. In ending the introduction to this report I wish to express my thanks to the Public Health Department staff for their work during the year, and more particularly, as I have indicated above under the paragraph on clean air, for the additional work they have got through and difficulties they have surmounted in this new but extremely important subject. 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). Alderman J. A. Cox, J.P. (The Mayor). Alderman C. S. E. Fox. Councillors Mrs. R. K. Bartlett, J. V. Braund, Mrs. N. L. Bunce, Mrs. D. I. Cox, J. Donovan, P. E. J. Forward, F. S. Gander, B.Sc. (Hons.) Eng., F. W. T. Hibbert, Mrs. D. Hurren, Mrs. G. M. M. Land, Mrs. J. Marsh, Mra D. E. New and A. J. Pinnegar. 6 SECTION A —VITAL STATISTICS Area The urea 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 1959 was 221,000. (This includes members of the armed forces stationed in the area). Rateable value Rateable value of the borough at April 1, 1959 £3,124,896 Estimated net product of a penny rate 1959/60 £12,450 Estimated number of separately assessed dwellings at April 1, 1959 63,933 Births (adjusted for inward and outward transfers) Livebirths 3,475 Males Females Total Legitimate 1,643 1,626 3,269 Illegitimate 112 94 206 Totals 1,755 1,720 3,475 Crude birth rate per 1,000 of the estimated population 15.7 Adjusted birth rate for comparative purposes (Area comparability factor = 0.95) 14.9 Birth rate for England and Wales 16.5 Adjusted birth rate for London Administrative County 15.6 Stillbirths The stillbirths allocated to the borough during the year were 63, (31 males and 32 females) which represents a stillbirth rate per thousand live and still births of 17.4 in the case of males, 18.3 in the case of females, and 17.8 for all stillbirths. Deaths The deaths belonging to the borough registered during the year were 2,617, consisting of 1,375 males and 1,242 females, giving a crude death rate per thousand of the estimated population of 11.8. The area comparability factor for deaths is 1.0 therefore the adjusted rate is the same at 11.8 which compares with rates of 11.6 for England and Wales and 11.7 for the Administrative County of London. Infant mortality Infant deaths (all deaths of live-born children under one year) 64 Males Females Total Legitimate 31 27 58 Illegitimate 2 4 6 Total 33 31 64 7 Rates : 1. All infants per thousand livebirths 18.4 2. Legitimate infants per thousand legitimate livebirths 17.7 3. Illegitimate infants per thousand illegitimate livebirths 29.1 4. Male infants per thousand male livebirths 18.8 5. Female infants per thousand female livebirths 18.0 Neonatal deaths (under 4 weeks of age) 46 Neonatal death rates:— Males, per 1,000 male livebirths 13.7 Females, per 1,000 female livebirths 12.8 All infants, per 1,000 livebirths 13.2 Early neonatal deaths (under 1 week of age) 36 Males, per thousand male livebirths 12.0 Females, per thousand female livebirths 8.7 All infants per thousand livebirths 10.4 Reproductive wastage—(Stillbirths plus all infant deaths) 127 Males, per 1,000 live and still male births 35.8 Females, per 1,000 live and still female births 36.0 All infants, per 1,000 live and still births 35.9 Perinatal mortality (Deaths under 1 week plus stillbirths) 99 Males, per thousand live and still male births 29-1 Females, per thousand live and still female births 26-8 All infants, per thousand live and stillbirths 28-0 Maternal deaths Maternal deaths 3 Maternal mortality rate per thousand live and stillbirths 0-8 Other special causes of death Measles — Whooping-cough — Gastroenteritis (infants) 1 Tuberculosis (all forms) 12 Motor Vehicle Accidents 21 Suicide 27 Respiratory Diseases (other than Tuberculosis) (Code Nos. 22-25) 413 Cancer (Code Nos. 10-15) 532 Heart and circulation diseases (Code Nos. 17-21) 1,276 Comparative statistics for the year 1959 Table 1 Birth rate Death rate (per 1,000 population) (adjusted) Infant mortality rate (per 1,000 livebirths) Live births (adjusted) Still births Lewisham 14.9 17.8 11.8 18.4 England and Wales 16.5 20.7 11.6 22.0 London Administrative County 15.6 19.3 11.7 22.3 8 Causes of death at different periods The following table shows the causes of and Table Code No. Causes of death Nett deaths at the subjoined ages of "residents" whether occurring within or without the borough MALES Total persons (i.e., incl table opp.) All ages Under 1 yr. 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and under 75 75 and over Totals, all causes 1375 33 5 2 12 54 347 369 553 2617 1 Tuberculosis, respiratory 10 - - - - - 3 5 2 11 2 Tuberculosis, other forms 1 — — — — 1 — — — 1 3 Syphilitic diseases 1 - - - - - - 1 - 2 4 Diphtheria - - - - - - - - - - 5 Whooping cough - - — - - - - - - - 6 Meningococcal infections - - - - - - - - - - 7 Acute poliomyelitis 1 - - - - 1 - - - 1 8 Measles - - - - - - - - - - 9 Other infective and parasitic diseases - - - - - - - - - 2 10 Malignant neoplasm, stomach 36 - - - - 1 16 11 8 60 11 Malignant neoplasm, lung and bronchus 118 - - - - 6 62 32 18 140 12 Malignant neoplasm, breast 1 - - - - - 1 - - 45 13 Malignant neoplasm, uterus - - - - - - - - - 13 14 Other malignant and lymphatic neoplasms 132 - 2 1 1 5 36 40 47 259 15 Leukaemia, aleukaemia 10 - - 1 - 3 3 1 2 15 16 Diabetes 6 - - - - - 2 3 1 16 17 Vascular lesions of nervous system 134 - - - - 3 23 28 80 328 18 Coronary disease, angina 287 - — — — 8 82 98 99 470 19 Hypertension with heart disease 23 - - - - - 1 9 13 55 20 Other heart disease 133 - - - - 1 15 25 92 305 21 Other circulatory disease 54 - - - - 4 12 13 25 118 22 Influenza 18 - - - - 1 3 8 6 33 23 Pneumonia 90 5 — — — 4 18 24 39 181 24 Bronchitis 117 1 — — — 2 25 39 50 175 25 Other diseases of respira- , tory system 20 - - - - - 10 4 6 24 26 Ulcers of stomach and duodenum 15 - - - - - 4 3 8 29 27 Gastritis, enteritis and diarrhœa 8 1 1 - - - 1 1 4 19 28 Nephritis and nephrosis 6 — — — — 1 2 — 3 19 29 Hyperplasia of prostate 17 - - - - - 1 2 14 17 30 Pregnancy, childbirth, abortion - - - - - - - - - 3 31 Congenital malformations 9 8 — — 1 - — — — 13 32 Other defined and illdefined diseases 85 18 2 - 3 3 16 17 26 180 33 Motor vehicle accidents 14 - — — 4 5 4 1 — 21 34 All other accidents 15 - - - 2 - 2 2 9 33 35 Suicide 14 — - — 1 5 5 2 1 27 36 Homicide and operations of war - - - - - - - - - 2 9 of life during the year 1959 ages at death during the calendar year 1959:— 2 Code No. Causes of death Nett deaths at the subjoined ages of "residents" whether occurring within or without the borough FEMALES Total persons (i.e., incl. table opp.) All ages Under 1 yr. 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 one under 65 65 and under 75 75 and over Totals all causes 1242 31 3 5 6 38 199 284 676 2617 1 Tuberculosis, respiratory 1 - - - - - - - 1 11 2 Tuberculosis, other forms - - - - - - - - - 1 3 Syphilitic diseases 1 - - - - - - - 1 2 4 Diphtheria - - - - - - - - - - 5 Whooping cough - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - 1 8 Measles - - - - - - - - - - 9 Other infective and parasitic diseases 2 1 - - - 1 - - - 2 10 Malignant neoplasm, stomach 24 - - - - 2 4 9 9 60 11 Malignant neoplasm, lung and bronchus 22 - - - - 1 10 6 5 140 12 Malignant neoplasm, breast 44 - - - - 2 23 13 6 45 13 Malignant neoplasm, uterus 13 - - - - 2 5 5 1 13 14 Other malignant and lymphatic neoplasms 127 1 - 1 1 10 32 36 46 259 15 Leukaemia, aleukaemia 5 - - - 1 - 1 2 1 15 16 Diabetes 10 - - - - - - 5 5 16 17 Vascular lesions of nervous system 194 - - - - 1 28 45 120 328 18 Coronary disease, angina 183 - - - - - 28 56 99 470 19 Hypertension with heart disease 32 - - - - - 4 6 25 55 20 Other heart disease 172 1 - - - 1 18 23 129 305 21 Other circulafory diseases 64 - - - 1 1 4 15 43 118 22 Influenza 15 - - - - - 3 3 9 33 23 Pneumonia 91 4 1 - - 3 2 15 66 181 24 Bronchitis 58 3 - - - - 9 12 34 175 25 Other diseases of respiratory system 4 1 - - - - 1 - 2 24 26 Ulcer of stomach and duodenum 14 - - - - 1 2 6 5 29 27 Gastritis, enteritis and diarrhœa 11 - 1 - - - 4 1 5 19 28 Nephritis and nephrosis 13 - - 1 - - 2 4 6 19 29 Hyperplasia of prostate - - - - - - - - - 17 30 Pregnancy, childbirth, abortion 3 - - - - 3 - - - 3 31 Congenital malformations 4 3 - - - - 1 - - 13 32 Other defined and illdefined diseases 95 17 1 1 - 4 13 16 43 180 33 Motor vehicle accidents 7 - - - 2 1 1 1 2 21 34 All other accidents 18 - - - 1 1 2 2 12 33 35 Suicide 13 - - - - 4 5 3 1 27 36 Homicide and operations of war 2 — — 2 — - - - - 2 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 4wks. 1-2 mths. 3-5 mths. 6-8 mths. 9-11 mths. Total 1-11 mths. Total under 1 yr. Other infective and parasitic diseases M - - - - - - - - - - - - F - - - - 1 1 - - - - - 1 Inflammatory diseases of central nervous system M - - - - 1 1 - - - - - 1 F - - - - - - - - - - - - Pneumonia M - 1 1 - - 2 1 1 1 - 3 5 F - - - 1 2 3 - 1 - - 1 4 Bronchitis M - - - - - - - 1 - - 1 1 F - - - - - - 2 1 - - 3 3 Other respiratory diseases M - - - - - - - - - - - - F - 1 - - - 1 - - - - - 1 Gastroenteritis M - - - - - - - 1 - - 1 1 F - - - - - - - - - - - - Spina-bifida and meningocele M - - - - - - - - - - - - F - - - - - - 1 - 1 - 2 2 Congenital malformations of heart M - 2 - - - 2 1 1 - - 2 4 F - - - - - - - - - - - - Other congenital malformations M 2 1 - - - 3 - 1 - - 1 4 F — - — - 1 1 - - - - - 1 Injury at birth M 4 1 - - - 5 - - - - - 5 F 1 1 - 1 - 3 - - - - - 3 Postnatal asphyxia and atelectasis M 1 2 - - - 3 - - - - - - F 1 - - - - 1 - - - - - - Pemphigus and sepsis of newborn M - - - - - - - - - - - - F - - 1 - - 1 - - - - - 1 Haemolytic disease of newborn M - - - - - - - - - - - - F 1 - - - - 1 - - - - - 1 Immaturity M 4 2 1 - - 7 - - - - - 7 F 5 2 - - - 7 - - - - - 7 All other causes M 1 - - - - 1 1 - - - 1 2 F 1 2 - - - 3 1 1 - 1 3 6 TOTALS M 12 9 2 - 1 24 3 5 1 - 9 33 F 9 6 1 2 4 22 4 3 1 1 9 31 GRAND TOTAL 21 15 3 2 5 46 7 8 2 1 18 64 There were no deaths in the following groups: tuberculosis (all forms), syphilis, diphtheria, whooping cough, meningococcal infections, acute poliomyelitis, measles, haemorrhagic conditions, pink disease, diseases of ear and mastoid process, influenza, gastritis and duodenitis, diseases of skin and subcutaneous tissue, congenital hydrocephalus, congenital malformations of genito-urinary system, convulsions, accidents, and lack of care of newborn. 11 18 infants (9 male and 9 female) thus died between the age of one month and one year compared with 19 in the previous year and IS the year before that. 8 of the 18 were from pneumonia and bronchitis, 6 were spread over 4 other causes, and 4 were undefined. There was a decrease of IS in the number of deaths under 4 weeks of age, the biggest decrease being in immaturity which showed a drop of 13 (from 27 to 14 deaths. 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 27 757 178 February 24 1208 346 March 24 805 186 April 21 433 109 May 19 393 87 June 16 370 90 July 14 364 90 August 11 322 75 September 8 343 73 October 6 443 99 November 3 536 123 December 1 662 143 December 29 452 109 Average for period 7 April to 1 December 1959 434 100 Weekly average for the year 1959 545 131 „ „ 1958 497 117 „ „ 1957 602 150 „ „ 1956 469 124 „ „ 1955 480 129 „ „ 1954 424 115 „ „ 1953 471 133 The February figure was high, due to the second wave of influenza that winter, and this increased incidence lasted into March. The average for the year was slightly up. Social class in relation to cause of death Of the 2,617 deaths analysed by us the social categories were as follow:— Table 5 Social class I II III IV v Total No information Males 51 238 750 206 112 1357 18 Females 35 231 651 194 83 1194 48 Total 96 469 1401 400 195 2551 66 Percentage 4 18 55 16 7 100 - 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 1 2 6 - — 9 - 1 — — - 1 2 Tuberculosis, other forms - 1 - - - 1 - - - - - - 3 Syphilitic disease - - - - - - - - - - - — 4 Diphtheria - - - - - - - - - - - - 5 Whooping cough - - - — - - - - - - - - 6 Meningococcal infections - - - - - - - - - - - - 7 Acute poliomyelitis - - 1 - - 1 - - - - - - 8 Measles - - - - - - - - - - - — 9 Other infective and parasitic diseases - 1 1 - - 2 - - 1 - - 1 10 Malignant neoplasm, stomach 1 3 26 4 2 36 - 3 17 3 1 24 11 Malignant neoplasm, lung, bronchus - 16 65 14 21 116 - 5 11 4 - 20 12 Malignant neoplasm, breast - — 1 — — 1 3 8 23 4 2 40 13 Malignant neoplasm, uterus - - - - - - - 1 7 - 2 10 14 Other malignant and lymphatic neoplasms 4 29 73 18 8 132 5 23 65 23 8 124 15 Leukaemia, aleukaemia 1 3 7 2 1 14 1 — 4 — 2 7 16 Diabetes 2 2 1 — 1 6 - 3 5 2 — 10 17 Vascular lesions of nervous system 4 21 72 22 13 132 7 52 90 34 10 193 18 Coronary disease, angina 9 55 144 38 15 261 4 27 94 21 6 152 19 Hypertension with heart disease 1 4 25 6 7 43 1 12 32 10 4 59 20 Other heart disease 7 28 69 27 11 142 3 31 82 25 13 154 21 Other circulatory disease 5 8 21 6 5 45 2 11 38 12 3 66 22 Influenza - 1 6 5 4 16 - 2 4 6 1 13 23 Pneumonia 2 10 69 16 3 100 - 14 49 19 10 92 24 Bronchitis 5 13 60 22 10 110 - 8 32 9 8 57 25 Other diseases of respiratory system - 6 8 5 1 20 - 1 5 - - 6 26 Ulcer of stomach and duodenum - 4 8 2 1 15 1 3 6 1 1 12 27 Gastritis, enteritis and diarrhœa - — 3 - — 3 - 1 - 1 - 2 28 Nephritis and nephrosis 1 2 12 2 — 17 - 9 15 2 — 26 29 Hyperplasia of prostate 1 8 6 4 - 19 - - - — — — 30 Pregnancy, childbirth, abortion - — — - - — - — 3 — - 3 31 Congenital malformations 1 2 5 — — 8 2 2 3 2 1 10 32 Other defined and illdefined diseases 5 15 33 8 7 68 4 9 42 12 8 75 33 Motor vehicle accidents - 1 12 - 1 14 1 — 4 - 2 7 34 All other accidents 1 1 9 1 — 12 - 3 9 3 — 15 35 Suicid - 2 7 4 1 14 1 2 8 1 1 13 36 Homicide and operations of war — - - - — - - - 2 - - 2 No social class assessed - — - — — 18 - — - — - 48 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 vear by year. Table 7 Grouped deaths in social class Code Nos. Group Male Female 1 II III IV V Total 1 II III IV V Total 1, 2 TB No. 1 3 6 - - 10 - 1 — — - 1 % 10 30 60 — — 100 — 100 — — — 100 10-15 Cancers No. 6 51 172 38 32 299 9 40 127 34 15 225 % 2 17 57 13 11 100 4 18 56 15 7 100 17-21 Heart and circulation No. 26 116 341 99 51 633 17 133 336 102 36 624 % 4 18 54 16 8 100 3 21 54 16 6 100 12-25 Lung, not TB or cancer No. 7 30 143 48 18 246 - 25 90 34 19 168 % 3 12 50 20 15 100 — 15 54 20 11 100 33,34 Accidents No. 1 2 21 1 — 25 1 3 13 3 2 22 % 4 8 84 4 — 100 5 14 58 14 9 100 35 Suicides No. - 2 7 4 1 14 1 2 8 1 1 13 % - 14 50 29 7 100 8 15 61 8 8 100 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 II III IV V Registered births No. 101 627 2047 403 219 3397 78 % 3 18 61 12 6 100 Registered stillbirths No. — 7 29 8 8 52 11 % — 13 57 15 15 100 Registered infant deaths No. 4 9 36 10 3 62 2 % 6 15 58 16 15 100 Notified premature births No. 6 24 153 24 26 233 28 % 3 10 56 10 11 100 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 is still true to say that results have not yet reached the stage when dogmatic advice can be given with regard to specific articles of dietary. Nevertheless, for those adults who are prepared to alter their dietary legime 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. For cooking and frying purposes there are now excellent vegetable oils on the market. The following table brings the Lewisham figures of mortality from heart disease up to date. Table 9 Heart and circulation mortality Year Deaths from Total heart and circulation (all ages) Age group 45-65 Total deaths in borough Percentage Coronary diseases Other heart diseases* Other circulatory diseases† Total Coronary diseases (e)of (h) (f)of (h) (g)of (h) (a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) 1928 357 97 454 115 - 1993 23 5.8 ? 1933 516 117 633 162 - 2271 28 7.1 ? 1938 659 139 798 178 - 2403 33 7.4 ? 1943 583 64 647 129 - . 2359 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 9 470 360 118 948 161 110 2617 36 6.2 4.2 ? means figure not available. *R.G. Code Nos. 19 and 20. †R.G.Code No. 21 15 Lung cancer I have to report a further increase in lung cancer deaths during 1959. The male deaths increased from 1.14 to 118 and the female deaths from 21 to 22, giving a total of 140 cases as against 135 in the previous year. At the same time the total deaths from all forms of cancer also increased—from 472 to 532 and this slightly lowers the proportion of cancer deaths due to lung cancer, as is shown in the following table which gives similar figures for the past eight years. Table 10 Year MALE FEMALE All cancer deaths Lung cancer deaths (c)as % of(b) All cancer deaths Lung cancer deaths (f)as % of(e) (a) (b) (c) (d) (e) (f) (g) 1952 246 77 31 238 9 4 1953 237 83 35 215 13 6 1954 238 76 32 192 13 7 1955 303 102 34 226 19 8 1956 259 96 37 226 12 5 1957 267 101 38 229 21 9 1958 271 114 42 201 21 10 1959 297 118 40 235 22 9 In the 1957 report I gave a taible, based on figures supplied by the Tobacco Manufacturers, of the consumption of cigarettes in the U.K. in representative years since 1920. The table is reproduced below, brought up to date. Table 11 Consumption of cigarettes in the UK in representative years (based on figures published by the the Tobacco Manufacturers) Year Adult males (lbs. per head) Adult females (lbs. per head) Ratio M:F (F = 1) 1920 5.1 Negligible ? 1924 4.6 0.2 23.0 1928 5.6 0.3 18.7 1932 6.0 0.5 12.0 1936 7.1 0.8 8.9 1940 7.9 1.3 6.1 1944 9.0 2.5 3.6 1948 7.6 2.0 3.8 1952 7.7 2.5 3.1 1956 8. 3.1 2.6 1957 8.2 3.3 2.5 1958 8.3 3.3 2.5 16 General statistics from 1901 Table 12 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 25.9 - 3.9 - - - 128 - - 93 - 1902 132,432 13.7 — 74 26.3 - 4.3 - — - 122 - - 106 - 1903 136,405 11.1 — 72 26.1 - 2.5 - - - 92 - - 78 - 1904 140,401 12.0 — 70 25.6 - 3.6 - — - 122 - - 84 - 1905 144,420 11.7 — 67 25.2 - 2.8 - 30 63 93 - - 87 - 1906 148,463 12.0 — 72 23.2 - 2.0 - 30 83 113 - - 80 - 1907 152,532 11.5 — 67 23.7 - 2.5 - 34 56 90 - - 90 - 1908 156,627 11.0 — 68 22.8 - 1.4 - 30 57 87 - - 85 - 1909 160,749 10.4 — 63 21.9 - 2.0 - 35 40 75 - - 78 - 1910 164,899 9.7 — 65 20.7 - 2.6 - 29 50 79 - - 55 - 1911 161,677 11.4 46 68 21.2 - 2.3 - 31 73 104 - - 64 - 1912 165,249 10.5 39 63 20.3 - 2.8 - 30 39 69 - 208 68 11 1913 168,822 10.7 43 65 20.3 - 2.6 - 28 48 76 - 188 73 25 1914 169,211 10.9 40 62 19.5 - 3.3 - 27 46 73 - 138 77 18 1915 164,438 12.9 36 61 19.3 - 4.0 - 30 49 79 - 154 90 26 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 35 59 16.6 - 3.1 - 28 32 60 - 179 86 22 1920 174,698 10.8 38 59 22.8 - 3.8 - 32 30 62 - 160 73 22 1921 175,800 10.5 34 58 19.5 - 2.6 - 23 31 54 - 135 81 18 1922 176,600 11.1 31 57 18.1 - 2.5 - 26 28 54 - 154 74 16 1923 182,400 10.1 31 56 18.0 - 3.6 - 20 23 43 - 154 76 17 1924 184,900 10.5 29 56 16.4 - 3.6 - 23 24 47 - 149 68 22 1925 185,600 10.3 30 56 15.6 - 1.6 - 23 32 55 - 142 63 15 1926 187,800 10.0 29 54 15.4 - 2.1 - 18 22 40 - 158 71 17 1927 188,600 11.0 28 53 15.1 - 2.1 - 35 21 46 - 157 92 12 1928 199,300 10.0 29 54 15.2 - 2.3 - 22 30 52 - 168 77 15 1929 207,900 11.5 27 52 15.7 - 5.3 - — — 44 - 142 74 13 1930 207,900 9.7 28 53 15.1 - 0.9 37 - — 42 79 154 76 12 17 Table 12-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) Pulm tuber jnary ulosis 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 26 52 14.1 - 4.9 31 25 24 49 80 132 69 14 1932 221,500 10.2 26 49 12.7 - 3.4 32 31 23 54 86 123 59 11 1933 221,100 10.2 22 50 12.2 - 2.6 31 21 18 39 70 125 68 9 1934 222,180 10.1 23 50 12.2 - 1.5 36 21 22 43 79 129 58 14 1935 223,000 10.0 23 47 12.5 - 4.3 35 24 19 43 78 126 58 13 1936 224,000 10.9 23 48 13.0 - 2.0 37 23 32 55 92 131 62 12 1937 226,000 10.9 20 47 13.4 - 1.3 39 18 29 47 86 156 59 12 1938 229,000 10.5 23 49 13.9 - 2.1 26 - - 47 73 116 61 12 1939 220,300 10.8 - - 13.6 - 2.9 34 - - 42 76 111 64 12 1940 192,540 15.8 22 50 14.7 - 1.0 24 - - 45 69 111 67 11 1941 148,150 14.3 22 48 13.9 - 1.9 29 - - 34 63 176 93 10 1942 161,800 12.0 18 44 16.8 - 3.2 37 - - 37 74 175 73 15 1943 168,530 13.9 20 45 18.7 - 3.1 25 - - 42 67 194 76 14 1944 163,320 14.8 21 49 18.6 - 1.0 22 - - 40 62 196 79 11 1945 171,280 12.1 20 43 17.7 - 1.9 18 - - 34 52 179 71 13 1946 207,410 10.6 17 43 21 .7 - 1.1 21 - - 33 54 193 53 15 1947 221,170 11.9 17 42 21 .9 - 1.0 21 - - 33 54 166 55 12 1948 226,100 9.9 16 41 18.9 - 0.5 15 15 13 28 43 198 48 16 1949 227,700 10.2 11 35 16.8 - 0.3 16 13 6 19 35 146 40 12 1950 228,300 10.6 11 35 15.3 - 0.6 15 19 7 26 40 158 29 13 1951 227,200 11.2 10 34 15.3 67 0.3 16 17 8 25 41 117 26 15 1952 227,100 11.4 9 32 13.9 86 0.3 18 16 6 22 40 117 15 8 1953 225,800 11.1 9 29 14.4 75 0.3 23 16 6 22 45 136 19 14 1954 224,200 10.0 8 31 14.2 60 0.0 14 13 8 21 35 102 16 10 1955 223,400 10.8 7 28 14.0 69 0.9 18 11 6 17 35 114 10 5 1956 222,100 11.3 6 27 14.5 59 0.0 19 16 3 19 38 88 13 11 1957 220,900 11.0 8 32 14.8 65 0.6 18 12 4 16 33 100 14 10 1958 221,000 11.0 8 29 14.8 78 0.0 18 19 5 24 42 98 8 11 1959 221,000 11.8 | 7 28 15.7 75 0.8 18 13 5 18 36 52 5 8 *per 1,000 population. ‡per 1,000 notified livebirths. **per 1,000 registered livebirths. †per 1,000 registered live and stillbirths. ††per 100,000 population. — equals figure not available. 18 SECTION II — GENERAL PROVISION OF HEALTH SERVICES Disinfection and personal cleansing Details of the work carried out during the year are as follows:— Disinfecting Station Table 13 West North South Total Disinfection Premises visited 114 76 113 303 Rooms disinfected 259 162 235 654 Articles disinfected 3196 945 1289 5430 Dlsinfestation Premises visited 58 55 25 138 Rooms disinfested 129 170 108 407 Articles disinfested 132 71 21 224 Articles treated Beds 37 28 23 88 Mattresses 157 89 138 384 Bolsters 37 24 14 75 Pillows 357 135 200 692 Cushions 50 35 22 107 Quilts 70 44 86 200 Blankets 536 147 305 988 Sheets 114 68 118 300 Household articles 636 231 234 1101 Wearing apparel 1334 215 170 1719 Total articles 3328 1016 1310 5654 Articles received from the cleansing station - 1415 - 1415 Articles received from the Coroner's court - 1017 - 1017 Public library books treated after infection 227 306 264 797 Private library books treated after infection 17 14 40 71 Articles treated under the Public Health (London) Act s.122 14424 16397 15775 46596 Treatments for verminous conditions and for scabies were as follow:- Verminous conditions Table 14 1st Cleansing 2nd Cleansing 3rd Cleansing Children under 5 8 - - Adults 164 15 - School children 66 — — TOTALS 238 15 - 19 Scabies Table 14—continued Cases Contacts Treatments Children under 5 6 - 11 School children 17 — 23 Adults 19 3 32 TOTALS 42 3 66 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 was held from May 4 to October 2 and Mr. Phillips, the deputy senior public health inspector who is in charge of anti-pest work reports :— " 352 sites, grass verges and rear garage ways were visited on 5 occasions each and necessary treatment carried out by spraying or the use of powder. The material collected or destroyed on the sites consisted of 85 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. 4 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 18 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. 10 visits were also paid to both 20 this Council's and the London County Council's blocks of flats where dustchutes are used. 263 dustchutes with 921 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, 16 gallons insecticide and 120 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 28 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 40 gallons being used, as an anti-mosquito precaution on 3 occasions. Health Education During the year the food inspectors during the course of their routine inspections of food shops took the opportunities offered to put over items of health education to the occupiers, and on occasion to the food handlers. A large number of posters were obtained from central agencies in connection with health education generally and more particularly perhaps with environmental hygiene and home safety; and a new leaflet, on burns and scalds, was got out by the Department. At the end of the year preparations were made for the issue of a quarterly Bulletin on home safety to be distributed to some 300 organisations iini the borough. In the course of the year seven lectures or talks were delivered by Health Department staff, three of these to Boy Scout groups, three to older schoolgirls, and one to a women's co-operative guild. 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 630, of which 271 were received from institutions, 630 postmortem examinations were made and inquests were held in 85 cases. 21 Table 15 Month Bodies received from Institutions Others Post-mortem examinations Inquests Lewisham residents Others January 32 48 57 23 12 February 26 64 60 30 5 March 25 35 39 21 5 April 19 31 27 23 4 May 15 23 28 10 6 June 22 13 20 15 10 July 15 19 31 3 6 August 18 20 25 13 6 September 19 23 31 11 6 October 20 32 29 23 7 November 31 22 37 16 7 December 29 29 37 21 11 TOTALS 271 359 421 209 85 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. In his report on rodent control work during 1959, Mr. Walker, the senior public health inspector, states " All the infestations were of a minor character and were mainly dealt with by the laying of poison bait. Infestations were again in evidence on the banks of the various rivers aind ditches in the borough and there has been an increase in the number dealt with, particularly in the Ravensbourne. In this connection there should be an improvement when the scheme for the Couinty Council taking responsibility for cleansing and clearing the Ravensbourne and its tributaries comes into force. Our work in the past has been made increasingly difficult owing to the amount of rubbish deposited, and to the growth of weeds and scrub which has favoured conditions for the shelter and growth of the rat population." The undermentioned table gives a summary of the work on the rivers and ditches, prebait being laid on 3/4 days:— Table 16 Location Base points Poison bait taken (ozs.) (Estimated) River Ravensbourne 651 2277 River Quaggy 580 458 River Pool 112 — Ditches 47 146 22 Special liaison is made with the Borough Engineer's department for the treatment of sewers. In 1959 treatments were carried out in April and October. The method employed in carrying out the work was to deposit 8 ozs. poison bait on the first day and if a take was shown, 16 ozs. of bait was used on the second day. In any case at least 8 ozs. of poison bait was deposited. The following is a summary of the results obtained:— Spring treatment Manholes baited 2,971 Manholes showing takes 536 Manholes showing takes (on one or both days) 606 Autumn treatment Manholes baited 2,615 Manholes showing takes 740 Manholes showing takes (on one or both days) 933 In consultation with the Ministry of Agriculture and Fisheries and the Borough Engineer a scheme has been worked out (to commence in April, 1960) for continuous baiting of the sewer manholes, in place of the usual twice yearly treatment. The poison to be used will be sodium fluoracetate (1080). This highly toxic substance and its use is mainly confined at present to the baiting of sewers. The Ministry of Agriculture and Fisheries have undertaken to train a number of Council's sewermen in the technique of sewer baiting and the correct handling and use of this particular poison. Prevention of Damage by Pests Act, 1949 A copy of the report covering the nine months ended 31st December, 1959, submitted to the Minister of Agriculture, Fisheries and Food, as required by the provisions of the above Act, is appended:— 23 Table 17 Type of property Local authority Dwelling houses (including council houses) All other (including business premises) Total Agricultural Properties in borough 137 64,566 10,825 75,528 — Properties inspected as a result of:— (a) notification 14 1,231 100 1,345 — (b) survey 1 1,311 28 1,340 — (c) otherwise — 47 2 49 — Total inspections (including reinspections 15 2,666 130 2,811 - Properties inspected which were found to be infested by:— (a) Rats — major — — — — — — minor 4 870 75 949 — (b) mice—major — — — — — — minor 4 214 19 237 — Infested properties treated 8 1,077 86 1,171 - Total treatments (including retreatments) 13 1,522 248 1,783 — 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 1959:— Table 18 Specimens Number Remarks Faeces 1,129 Negative 259 Shigella sonnei 20 Salmonella typhimurium 14 Salmonella paratyphi B 2 Bact coli Urine 72 Routine Swabs, from nose, throat etc. 110 C. diphtheriae not isolated Sputum 36 Routine Foodstuffs 2 Water 3 Total specimens 1,647 24 Swimming baths There are 4 public swimming baths in the borough, in addition to a few club and school swimming baths. The public swimming baths are shown in the table, together with the laboratory tests taken during the year. Table 19 Bath Tests Variation of chlorine (p.p.m.) Chlorine Boct. Ladywell (1 & 2) 9 2 0.30—0.75 Forest Hill North 5 — 0.80—1.50 Forest Hill South 4 - 0.45—1.75 Downham 8 - 1.00—1.75 Bellingham (openair) 5 — 0.15—4.50 The water used for these baths is supplied by the Metropolitan Water Board anid is sterilised by the breakpoint chlorination method, sodium carbonate and sodium metaphosphate being used to control acidity and to keep the pH above 7.2. Colorimetric tests for free chlorine and pH value are also made at the baths at 9 a.m., 1 p.m. and 6 p.m. on weekdays and at 9 a.m. andil p.m. on Sundays, the results being recorded on log sheets kept for the purpose. The aim is to achieve a circulation of water every four hours, although it is rather more prolonged than this at the openair baths. National Assistance Act, 1948 — section 50 During the year the Council accepted responsibility for the burial of 6 persons, at a net cost to the Council of ,£27. National Assistance Act, 1948—section 47 Several possible cases were investigated during the year and in two cases it was necessary to apply to the court for ani 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 150 plans were submitted to the public health inspectors for examination and approval. 25 Water supply I am indebted to the Director of Water Examination of the Metropolitan Water Board for the information on which the following report on Lewisham's water supply is based. The water supply is mostly Thames-derived filtered water but there is also admixture from the Board's wells at Bexley, Darenth, Deptford 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 20 and 21 show the average results of the chemical and bacteriological analyses of the various supplies as forwarded by the Metropolitan Water Board:— 26 Average results of the chemical and bacteriological examination of the water supply to the Borough of Lewisham for 1959 milligrams per litre (unless otherwise stated) (a) CHEMICAL Table 20 Description of the sample Ammonia nitrogen Albuminoid nitrogen Oxidised nitrogen (nitrate) Chlorides as C1. Oxygen abs. from permanganate (4 hrs. at 27°C) Hardness (total) Hardness (noncarbonate) pH value Electrical Conductivity (gemmhos) Thames-derived filtered water .022 .075 3.8 28 1.08 250 56 7.7 525 Deptford .010 .033 8.3 37 0.18 374 142 7.0 750 Bexley .008 .031 5.4 18 0.10 298 60 7.2 575 Darenth .010 .024 5.6 17 0.08 266 36 7.2 500 Wilmington .012 .026 8.5 22 0.08 288 58 7.1 550 (b) BACTERIOLOGICAL Table 21 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. 37ºC. (20-24 hrs.) 22º C. (3 days) Coliform E. Coli 37ºC. (20-24 hrs.) 22º C. (3 days) Coliform E. Coli Thames derived filtered water - - - - 6.7 - 100.00 100.0 Deptford 18.7 217 97.07 99.51 0.2 5 99.53 100.0 Bexley 1.0 4 99.20 100.00 0.3 2 99.32 100.0 Darenth 0.2 3 96.58 100.00 0.1 8 100.00 100.0 Darenth Borehole 0.1 56 86.76 99.09 Wilmington No. 1 Well 0.7 44 75.91 95.62 0.1 2 99.61 99.6 Wilmington No 2. Well 2.0 95 86.18 96.06 27 Atmospheric pollution Clean Air Act During 1959 three more areas were made the subject of Smoke Control Orders and particulars with regard to these are as follows: — Name No. 3 No. 4 No. 5 (Brookdale (Penerley) (Glenbow) Acreage 80 280 150 Open space Nil 40 30 No. of industrial premises Nil 9 2 No. of commercial premises 120 213 37 No. of dwellings 1,172 3,367 2,059 No. of other premises 9 8 5 Present annual tonnage of bituminous coal etc., to be replaced 1,500 4,500 1,612 Likely assitional fuel required annually (o) Electricity (KWH) 160,000 450,000 180,000 (b) Gas (therms) 32,000 85,000 34,000 (c) Oil, etc, Nil Ni. Nil (d) Solid smokeless fuel (tons) 1,000 3,000 1,100 Existing appliances requiring replacement or adaptation (o) Open fires 1,820 5,006 2,195 (b) Open fires with boilers 37 209 23 (c) Combination grates without boilers 50 64 3 (d) Combination grates with boilers 18 6 6 (e) Washboilers 5 4 36 (f) Domestic boilers 12 294 22 (g) Other appliances (freestanding stoves etc.) 16 92 6 Total estimated cost of works £16,763 £54,680 £13,746 Date : Order made 30.9.59 28.10.59 30.9.59 Order Confirmed 11.12.59 26.1.60 11.12.59 Order operative 1.9.60 1.10.60 1.9.60 The progressive total (when these Orders are operative) will be 1,450 acres covering 10,805 dwellings. No. 1 (Ladywell) Order became operative on 1.9.59. and No. 2 (Southend) on 1.11.59. In spite of extensive local advertisement many required adaptations had not been done by the operative dates. Since these were the first two Orders in the borough and since there had been, at the beginning, a slight bottleneck in getting tradesmen for the work, the Council decided to consider late applications up to six months from the operative dates. The Council's intention is to cover the whole borough by smoke control orders as quickly as practicable. The time this takes will depend mainly on staff and on finance. Good progress has been made so far and the committee have adopted a tentative programme under which a middle strip of the borough, consisting of 9 areas, will be completed by 1961, a western strip of 6 areas by 1964, a north and eastern strip of 5 areas by 1967 and a southern group of 3 areas around the gasworks by about 1968. It is possible that some acceleration of this programme could occur in favourable circumstances. Measurement of Atmospheric Pollution Table 22 shows the results obtained from the three permanent deposit gauges and three smoke recording stations. A fourth deposit gauge is on a small allotment site in Brockman Rise. The graphs show the lowest and highest pollutions from water-insoluble matter in the years 1953-58 and also the pollution in 1959. 28 Table 22 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 Atmospheric Condition Table January February March April May Temperature— Mean maximum1 ºF 41.3 45.1 52.5 57.2 64.5. Mean minimum1 °F 33.0 35.9 40.9 44.5 47.5 Mean1 °F 37.1 40.5 46.7 50.9 56.0 Diff. from average1 °F -4.2 -0.6 +2.8 +3.2 +1.5 Highest maximum2 °F 53 60 61 70 84 Lowest minimum1 °F 24 30 36 38 39 Rainfall— Total2 in. 1.69 0.06 1.19 1.33 0.97 Percent of average1 100 6 107 113 29 Sunshine1 Daily mean hrs. 2.58 2.09 3.51 4.65 7.43 Percent of average 190 98 97 93 118 Wind1 NE/E/SE % 20 42 31 17 56 S/SW/W % 55 45 57 62 19 NW/N/Calm % 25 13 12 21 25 Atmospheric pollution— West Division3 : Water insol. matter tpm 8.45 5.87 8.68 7.03 8.05 Water sol. matter tpm 7.03 4.38 5.20 5.20 5.37 Sulphur † 3.83 2.84 1.69 1.71 0.76 Smoke, daily average * 33.3 22.1 12.5 5.6 3.9 „ maximum * 78.6 57.4 19.8 9.3 5.7 (date) (28-30) (18-20) (1-2) (22-24) (6-8) „ minimum * 3.0 9.7 5.3 2.9 2.1 (date) (3-6) (25-27) (3-6) (25-27) (16-19) North Division4: Water insol. matter tpm 8.76 10.97 11.14 10.27 9.73 Water sol. matter tpm 8.28 6.28 6.28 6.11 5.77 Sulphur † 5.81 5.17 3.31 2.81 1.96 Smoke, daily average* 28.3 19.7 11.0 5.8 3.6 ,, maximum * 75.6 50.1 16.5 10.1 5.9 (date) (28-30) (18-20) (11-13) (22-24) (6-8) ,, minimum * 8.1 14.2 4.7 2.5 1.6 (date) (21-26) (7.10) (3-6) (25-27) (16-19) South Divisions : Water insol. matter tpm 8.66 6.42 10.47 11.07 9.52 Water sol. matter tpm 7.15 7.15 6.65 5.50 5.17 Sulphur † 2.72 1.84 ? 1.12 0.34 Smoke, daily average * 18.5 18.9 10.4 5.7 3.6 „ maximum * 72.3 45.5 15.8 10.0 5.1 (date) (18-20) (18-20) (14-17) (1-3) (6-8) minimum * 1.4 9.4 4.9 2.4 2.1 (date) (21-23) (35-27) (3-6) (25-27) (16-19) Weather summary Cold but Sunny Very dry mild later Mostly mild Mild, rather moist Dry mianly sunny Notes : 1Kew ; 1Lewisham ; 3Valentine Court for smoke, Pool allotments for other tpm : tons per square mile per month ; † as trioxide in mg per 10 sq. cms. per 29 k indication of the sunshine, rainfall, etc., during the year. Some of these latter data teal office, and relate to the nearest station which records the particular item concerned. 1959 June July August September October November December Average or actual (as applic.) 70.4 75.5 74.3 71.3 63.2 50.6 48.2 59.5 53.5 57.0 58.0 52.7 49.1 41.1 41.3 46.2 61.9 66.3 66.1 62.0 56.1 45.9 44.7 52.9 -2.0 +1-8 +3.4 +3.5 +4.5 +1.6 +3.3 +1.9 88 93 86 82 77 60 53 93 (Jul. 6) 48 54 50 45 37 32 34 24 (Jan. 26) 0.83 1.06 1.16 0.04 1.71 2.39 2.60 15.03 35 64 50 5 83 95 152 70 7.99 9.37 7.74 7.07 5.15 1.94 1.16 5.05 114 146 128 151 166 113 90 125 23 9 32 64 40 13 18 31 49 55 41 15 48 68 76 49 28 26 27 21 12 19 6 20 9.21 7.66 7.99 10.81 5.30 7.32 5.93 7.69 3.55 3.88 5.70 4.38 5.04 6.69 6.36 5.23 0.85 0.81 0.70 1.11 1.22 2.03 2.29 1.65 2.5 1.5 1.2 1.5 3.0 21.0 13.0 10.1 4.8 2.8 20 20 7.0 49.0 51.0 78.6 (24-26) (8-10) (5-7) (9-11) (31-2) (11-13) (30-2) (Jan. 28-30) 0.9 0.8 0.4 1.0 1.0 9.0 6.0 0.4 (6-9) (25-28) (12-14) (16-18) (20-22) (21-24) (19-21) (Aug. 12-14) 9.00 8.02 7.35 8.73 5.34 6.31 4.23 8..32 4.26 4.09 4.93 4.43 5.60 7.45 5.94 5.78 1.26 1.16 1.47 2.01 1.59 3.15 2.69 2-70 2.8 2.2 2.9 4.0 6.0 17.0 12.0 9.6 4.8 3.3 4.5 6.0 12.0 37.0 47.0 75.6 (24-26) (29-3/) (19-21) (9-11) (31-2) (11-13) (30-2) (Jan. 28-30) 1.0 1.4 1.1 2.0 3.0 8.0 6.0 1.1 (6-9) (11-14) (12-14) (16-18) (20-22) (18-20) (5-8) (Aug. 19-21) 9.88 11.16 7.87 7.57 (-) 5-71 4.68 8.46 4.45 4.18 5.84 5.50 (-) 6.16 6.32 5.82 0.64 0.50 0.59 0.89 0.69 0.98 0.91 1.07 2.3 1.9 2.5 3.25 6.0 15.0 11.0 8.25 4.0 3.0 3.7 5.0 14.0 33.0 41.0 72.3 (24.26) (8-10) (5-7) (9-11) (31.2) (11-13) (30-2) (Jan. 18-20) 0.7 1.3 0.8 2.0 4.0 14.0 6.0 0.7 (6.9) (25-28) (12-14) (16-18) (20-22) (18-20) (19-21) (Jun. 6-9) Warm, dry, sunny Warm, very sunny Warm, dry and sunny Warm, very dry and sunny Warm and sunny Changeable, rather mild Mild, warm, wet. Place for smoke Wearside Road for others; Downham Depot for smoke, Verdant Lane for others g 100 cub. metres. 30 31 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 borough 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. 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 shown 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; health department leaflets have been printed and displayed; 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. During the year it was decided to issue a quarterly bulletin to local clubs, organisations, doctors and dentists, so that it could be available to club members, those attending surgeries, and so on. The first issue was in January 1960 and some 500 copies were distributed. The collection of home accident statistics is to some extent a longterm 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 the four quarters of 1959. No particular concentration in street, block of flats, or locality has so far shown up. I was unable to obtain returns direct from Lewisham Hospital but the LCC was collecting some statistics—at least for part of the year. 32 Accidents to Children — Sydenham Children's Hospital 1959 Table 23 Falls Cuts and bruises Poison Burns and scalds Foreign bodies Miscellaneous Total 1st quarter Boys - 5 19 8 1 4 7 — 39 -15 9 24 - 1 3 — 37 Girls - 5 8 6 - 2 5 — 21 -15 2 5 - 4 2 - 13 Total 1st quater 38 43 1 11 17 — 110 2nd quarter Boys - 5 24 12 6 3 5 — 50 -15 15 25 — 3 3 — 46 Girls - 5 15 8 3 1 6 - 33 -15 12 11 — 1 1 — 25 Total 2nd quarter 66 56 9 8 15 — 154 3 rd quarter Boys - 5 16 15 7 7 9 1 55 -15 6 17 1 3 1 1 29 Girls - 5 10 7 - 1 4 - 22 -15 5 9 — 2 — — 16 Total 3rd quarter 37 48 8 13 14 2 122 4th quarter Boys - 5 15 5 4 1 2 — 27 -15 6 11 2 1 1 - 21 Girls - 5 18 6 2 1 - - 27 -15 5 7 — — — — 12 Total 4th quarter 44 29 8 3 3 — 87 Total for year 185 176 26 35 49 2 473 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 33 work for old people, whether by recreational facilities or by the provision of meals. A sum of £5,100 was eventually included in the annual estimates for the year 1959-60 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 3,900 Lewisham Darby and Joan Club 470 St. Mark's Old Folks' Club 75 Bellingham Branch of the National Federation of Old Age Pensions Associations 60 Hither Green Branch of the National Federation of Old Age Pensions Associations 65 St. Philip's Darby and Joan Club 26 The Over 60 s Friendly Club 40 The Bellingham Community Association Darby and Joan Club 36 Lee Branch of the National Federation of Old Age Pensions Associations 36 Good Companions Club 18 St. Hilda's Seniors' Club 54 Blackheath Branch of the National Federation of Old Age Pensions Associations 20 September Club 24 Happy Old Folks' Club (St. Barnabas) 18 This left a sum of money available for new clubs which might qualify for grant, and one such club, the St. John's Club at Southiend, was given a grant in March 1960. 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 34 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. 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, and during the year ended 31 March 1960, 22,836 meals were delivered. In addition the WVS delivered 4,133 in one area of the borough. 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 24 W N S Total Visits 48 96 69 213 Futile visits 50 194 28 272 Revisits 324 1326 157 1807 Total 422 1616 254 2292 The chronic sick There is unfortunately little to report on progress towards a geriatric unit or an increased number of beds for the chronic sick in the borough. It can only be said that all hope of these being brought about is not yet dead, and representations are still being made. Facilities for the aged, generally During the year the King Edward Hospital Fund set up a committee to review the services for old people in this borough with a view to ascertaining whether any of such services should be strengthened or whether additional services were required. Lewisham was chosen for two main reasons: first, because although the services were in some respects (for example, the geriatric unit) less than in many other boroughs it was maintained by the hospital and other authorities that 35 the old people were not prejudiced thereby; and secondly that Lewisham could be regarded as a fairly typical suburban area and that if anything was required here it might well be required elsewhere. Beside representatives of the Fund, the committee includes representatives of the hospital management committee, the London County Council, local practitioners and LOPWA, and I represent the borough council. The committee has decided to carry out a partial house-tohouse survey of the borough through an official agency. This will no doubt be valuable but it will be a considerable time before the results ire available. 36 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 25 Reason for inspection West North South Total On complaint 854 767 285 1906 House to house 16 2 — 18 Improvement grants 111 171 66 348 Houses let in lodgings — 2 — 2 Rent Acts 93 46 37 176 Other Housing Act visits 367 492 193 1052 Notice from builder 339 209 110 658 Infectious diseases 11 15 22 48 Infestation 78 122 61 261 Factories, mechanical 53 23 108 184 Factories, non-mechanical 5 7 1 13 Outworkers 119 40 60 219 National Assistance Act, S47 14 5 1 20 Smoke observations 23 9 41 73 Clean air inspections — 705 9159 9864 Keeping of Animals 18 37 12 67 Water certificates 130 90 — 220 Fireguards 17 3 1 21 Crash helmets — 2 1 3 Hairdressers 35 12 1 48 Pharmacy and poisons 67 71 7 145 Milkshops 27 20 32 79 Icecream premises 155 84 87 326 Restaurants and eating houses 139 109 288 536 Bakehouses 3 40 9 52 Other food shops 306 199 643 1148 Other shops 87 51 27 165 Food inspections 108 450 190 748 Sampling 162 258 181 601 Markets and stalls 2 495 22 519 Slaughterhouses — 72 — 72 Futile visits 980 1569 6592 9141 All other matters 1358 1104 535 2997 Revisits 5438 9828 2925 18191 Total — all inspectors 11115 17109 21697 49921 Smoke abatement Observations 73 Intimations served — Complaints received 14 Statutory notices served — Legal proceedings Convictions — 37 Summary of notices served Table 26 West North South Total Intimation notices:— 73 Public Health (London) Act, 1936 179 170 422 Factories Act, 1937 1 5 — 6 Informal intimations under Housing Act, 1936 5 5 4 14 Total intimations 185 180 77 442 Statutory notices:— Public Health (London) Act, 1936 89 98 37 224 Factories Act, 1937 1 — — 1 Housing Act, 1936 9 4 1 14 Byelaws 23 9 32 64 Food and Drugs Act, 1955 — — — — Prevention of Damage by Pests Act 1949 — — — — Total statutory notices 122 111 70 303 Nuisances remedied Table 27 Nuisance West North South Total Wall and ceiling plaster repaired 122 132 71 325 Roofs repaired 66 61 40 167 Dampness remedied 256 207 109 572 Brickwork repaired 5 25 6 36 Chimneys repaired 3 — — 3 Drains cleared 18 15 18 51 Drains repaired 11 15 18 44 Drinking water cisterns repaired 1 — — 1 Dustbins supplied 10 6 3 19 Doors and doorframes repaired or renewed 17 16 12 45 Flushing cisterns repaired, renewed or cleansed 18 7 13 38 Flush pipes repaired or renewed 6 4 1 11 Firegrates, etc., repaired or renewed 13 17 10 40 Flooring repaired or renewed 55 50 24 129 Dry rot remedied 11 14 4 29 Gullies renewed, repaired or cleansed 4 5 1 10 Gutters repaired 28 44 19 91 Refuse cleared — — — — Rainwater pipes repaired 20 12 3 35 Soil pipes repaired, ventilated or renewed 6 7 5 18 Sinks provided 5 5 5 15 Sashcords renewed 35 24 27 86 Water closets repaired or renewed 15 15 11 41 Walls and ceilings cleansed — — - — Windows and frames repaired or renewed 12 15 11 38 Water service pipes repaired or renewed, water supply restored 5 10 1 16 Yards and areas paved 2 4 5 11 Other nuisances remedied 25 33 19 68 TOTALS 769 743 427 1939 38 Heating Appliances (Fireguards) Act, 1952 The public health inspectors are authorised for the purposes of inspection and testing of heating appliances under the Act. 21 inspections were made during the year. Registration of hairdressers 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 142 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 20 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 veterinary surgeon was obtained in one case after complaints had been received, and the public health committee decided to obtain such reports regularly for the time being. 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 207 premises and 10 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 39 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 28 Premises Number on register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which sections 1, 2, 3, 4 and 6 are to be enforced by local authorities 64 13 — — (ii) Factories not included in (i) in which section 7 is enforced by the local authority 489 184 7 — (iii) Other premises in which section 7 is enforced by the local authority (excluding outworkers' premises) 37 37 — — TOTAL 590 234 7 — 40 Cases in which defects were found Table 29 Defects No. of defects Prosecutions instituted Found Remedied Referred To HM Inspector By HM Inspector Want of cleanliness (S 1) — 3 - 3 - Overcrowding (S 2) — — — — - Unreasonable temperature (S 3) - - - - - Inadequate ventilation (S 4) — — — — - Ineffective drainage of floors (S 6) - - - - - Sanitary conveniences (S 7): (a) insufficient — 1 — 1 - (b) unsuitable or defective — 11 — 11 - (c) not separate for sexes — 2 — 2 - Other offences against the Act (not including offences relating to outwork) 3 3 3 - - TOTAL 3 20 3 17 — 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. 41 The following is a list of trades concerned, extracted from the August, 1959 lists received :— Trade Outworkers employed Clothing 162 Lampshades 11 Box making 10 Carding 2 Paper bags 2 Surgical appliances 1 Firework cases 8 Brushmaklng 2 198 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, onions and shrimps bsing temporary exceptions. The inspectors made 219 visits during the year which included some to places in which no work was being done at the time of the visit, although the outworkers were prepared to restart work when required. Reports were submitted to the Council setting out the position with regard to outworkers in the borough. No adverse comments were made. Rag Flock and Other Filling Materials Act, 1951 This Act came into force on November 1, 1951, and repealed the Rag Flock Acts, 1911 and 1928 and section 136 of the Public Health (London) Act, 1936. The Act is designed to secure the use of clean filling materials in upholstered articles and other articles which are stuffed or lined. It is an offence, subject to certain provisos, to use filling materials to which the Act applies for upholstery purposes except on premises registered by a local authority, and rag flock for filling can only be manufactured and stored on licensed premises. The local authority is required to maintain a register of premises used for upholstery and of premises used for the manufacture and storage of rag flock and to maintain a list of licences in respect of premises used for the storage of rag flock. Various penalties are prescribed for noncompliance with the provisions of the Act. Standards of cleanliness are laid down in the Rag Flock and Other Filling Materials Regulations, 1951 in relation to each kind of filling material described in the regulations, and tests are prescribed which have to be carried out by approved analysts. Four premises are registered for the use of filling materials for upholstery purposes. Samples of these materials proved satisfactory on examination. 42 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 public health inspector to be in attendance at an exhumation^ but no such attendance was made in 1959. Sanitary work generally Mr. Walker, the senior public health inspector, reports : " There was a decrease in the number of complaints received during the year, and in keeping with this trend the number of notices served under the Public Health (London) Act was considerably less. Also there was a noticeable decrease in the number of inspections under the Rent Act. It is possible that these decreases were due, to a large extent, to housing repair work being carried out in the previous year under the Rent Act. Inspections under the Clean Air Act have been considerable, and the figures include visits for the purpose of survey and again for approval of work carried out and for payment of grant. The work of the public health inspectors in connection with the smoke control orders has been proceeding smoothly, and the reaction of the householders has been reasonably cooperative. "As this is the last complete year in which I shall participate in the annual report of the medical officer of health, perhaps I may reflect briefly on matters of particular concern to the public health inspector. I have now completed nearly forty years in Lewisham, and although this borough has never had a serious " slum " problem, I have nevertheless seen a great change in public health standards generally. It is now exceptional, apart from the occasional problem family, to find a house in a dirty and unkempt condition, and even in older houses people live in conditions of comfort and cleanliness, some with all the labour-saving gadgets of modern life. Other things occur to me, such as the more efficient method of dealing with insect pests, e.g. bugs and fleas, with the coming into use of DDT and other preparations. This 43 has resulted in a great drop in the prevalence of these pests. We have revised our ideas in dealing with rats and mice, aind instead of employing a rat catcher with dog and ferrets a technique of poison baiting is used. Improvement grants are helping considerably to bring older houses up to modern standards, and there is still much scope in this direction. More recently clean food laws have been tightened up, and standards in the preparation and handling of food made stricter. Lastly, there has been the Clean Air Act and its application to London in the making of smoke control orders, which I hope will be completed in the next ten years or so. There is of course more to be done in the future, and indeed, for the public health inspector, there must be maintenance of these improved standards already attained." 44 SECTION D —HOUSING Building The following 244 new dwellings were completed by the Council during the year:— Adelaide Avenue 20 Boone Street 18 Church Vale 24 Dacre Park 12 Exbury Road 21 Fludyer Street 8 Hurstbourne Road 8 Ivy Road 34 Lawrie Park Gardens 20 Lee Church Street 35 Paragon Place 24 Porthcawe Road 8 Southbrook Road 1,2 Families rehoused for first time During the year the following families were rehoused:— 1. By the Lewisham Borough Council:— (a) in permanent properties 92 (b) in temporary bungalows 8 (c) in requisitioned properties — 100 2. By the London County Council (figures supplied by district offices) 62 162 N.B. — Number of families where points had been awarded for bedroom deficiency, rehoused by the Lewisham Borough Council or the London County Council during the year 110 Housing Act, 1957 Repair of houses (sections 9 and 10) During the year 14 informal and 13 formal notices were served. 14 properties were repaired by the owners after service of notices; in four 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 1959, together with the present position of cases originating in previous years which had not been complied with at the end of 1958 :— 45 Table 30 Properties Dwellings involved Present position 24 Lethbridge Road 1 Closing Order operative on whole house. 12 Rennell Street 1 Demolition Order made. 2 Rennell Street 1 Notices served 27/29 Molesworth Street 2 Demolition Orders made 69 St. Germans Road 1 Notices served 30 Limes Grove 1 Offer of works accepted 169 Sandhurst Road 1 Works completed 8 Dallas Road 1 L.C.C. purchasing with a view to demolition. 10 Dallas Road 1 L.C.C. purchasing with a view to demolition Closing Orders in respect of part of house Table 31 Properties Part of house Present position 107 Kirkdale Boxroom, bathroom, first floor and two rooms and scullery ground floor. Works carried out without service of notices 20 Blackheath Grove Two rooms in basement. Closing Order operative 10 2Wiverton Road Two rooms and kitchen semi-basement Offer of works accepted 41 Molesworth Street Two rooms and scullery lower ground floor Closing Order operative 2Handen Road First and second floor flats Orders determined 39 Gilmore Road Two rooms and scullery semi-basement Order determined 13 Silverdale Two rooms, scullery, bathroom in basement Order varied to permit use for storing furniture 8 Holbeach Road Two rooms first floor, rear room and scullery ground floor. Closing Order operative 24 Elthruda Road Three rooms scullery, W.C. ground floor Closing Order operative. Later determined on completion of works 15 Eastdown Park Two rooms, scullery W.C. in basement. Closing Order operative 46 Table 32 HOUSES IN CLEARANCE AREAS AND UNFIT HOUSES ELSEWHERE A —HOUSES DEMOLISHED Houses Displaced Clearance areas (Housing Act, 1957) Persons Families Houses unfit for human habitation 31 37 16 Houses included by reason of bad arrangement — — — Houses or land acquired under s.43 — 31 9 Not in clearance areas Formal or informal procedure under s. 17 (1) 2 6 1 Local authority houses certified unfit by medical officer of health 10 — — B —UNFIT HOUSES CLOSED (Housing Act, 1957) ss 16, 17 and 35 1 - - ss 17(3) and 26 — - — Parts of buildings closed under s.18 5 6 3 C —UNFIT HOUSES MADE FIT AND HOUSES IN WHICH DEFECTS WERE REMEDIED By owner By Local Authority After informal action by local authority 8 - After formal notice under Public Health Acts - - After formal notice under Housing Act, 1957 6 4 Under s.24 Housing Act, 1957 - - D — UNFIT HOUSES IN TEMPORARY USE (Housing Act, 1957) Houses Separate dwellings Retained for temporary accommodation under ss. 17, 46 and 48 - - Licensed for temporary occupation under ss. 34 or 53 - - E —PURCHASE OF HOUSES BY AGREEMENT Houses Occupants Houses in Clearance Areas other than those included in confirmed Clearance Orders or Compulsory Purchase Orders 6 46 47 Rent Act 1957 The Rent Act 1957 came into force on 6 July, 1957, and the following table shows the applications for certificates of disrepair dealt with during the year 1959:— Table 33 Applications for certificates 85 Decisions not to issue certificates — Decisions to issue certificates (a) in respect of some but not all the defects 64 (b) in respect of all defects 34 Undertakings given by landlords to repair 53 Undertakings refused for special reasons — Certificates of disrepair issued 50 Applications by landlords for cancellation of certificates 97 Objections by tenants to cancellation 44 Decisions to cancel in spite of tenants' objection 12 Certificates cancelled 62 House Purchase Loans Approximately 600 properties, a record number, were surveyed and reported on by the inspectors during the year for house purchase loans made by the Council. In many of these cases schedules of work were agreed and the repairs supervised and approved in order to make the premises "in all respects fit for habitation" as required by s.43 of the Housing (Financial Piovisions) Act 1958 under which loans are made. Discretionary Grants and Standard Grants Standard grants—given for the establishment of certain facilities otherwise lacking—are equivalent to 50 percent of the cost, with maxima of £25 for a bath or shower, £5 for a wash-hand basin, £75 for a hot water supply, £40 for a w.c. and £10 for a food store. The largest possible grant is therefore £155. These grants are made under the House Purchase and Housing Act, 1959, and during the year 21 applications were investigated and reported on. Discretionary grants are available for a wide range of improvements, including conversions to self-contained dwellings, to enable houses to 'be modernised and brought up to a "twelve point" standard. They are paid solely at the discretion of the Council, have a maximum of £400 for each dwelling, and are made under the Housing (Financial Provisions) Act, 1958. During the year 92 applications were investigated and reported on. On housing work generally, Mr. Craven, the group housing inspector states: 48 "The sharp rise in the number of applications and enquiries for improvement grants, noted towards the end of 1958, continued and increased throughout 1959. As a result the housing activities of the department were largely concentrated on the modernisation and improvementof those existing properties which fall short of present day standards. In this borough there are very many structurally sound and otherwise satisfactory properties which either lack certain amenities, particularly bathrooms, internal wc.s and hot water supplies, or are too large for single family occupation and are suitable for conversion to self-contained flats. No doubt the increased interest in improvement grants was partly due to the publicity given to the new standard grants which operated from the middle of 1959 and to the modifications made to the original discretionary grant scheme. As this Council operates both schemes there is now a wide scope and more encouragement for owners to improve their properties. The total number of applications djealt with under the two schemes in 1959 almost equalled the combined total of cases dealt with in the previous four years. The figures given in the body of the report refer to the number of applications, but as some of these are for more than one property, one being for as many as 32 houses, the total number of properties dealt with was considerably higher. Some encouraging features noted during the year were an increase ini applications in relation to tenanted properties and a renewal of interest by landlords in conversion of larger properties into selfcontained flats. "With regard to underground rooms, it was only necessary to initiate action in four cases. iCertain closing orders made in previous years in relation to this type of accommodation were determined on the rooms concerned being made fit for habitation, and these were eventually reoocupied. The Underground Rooms Act, which came into operation during the year, removed the confusion created by the wording of s.18 of the Housing Act 1957 and also restored the force of regulations made in relation to such rooms. Unfortunately the new Model Regulations issued by the Ministry as a basis for adoption by local authorities are considered to be retrograde and unsatisfactory in several respects. "It is pleasing to report that no appeals were entered by owners against the service of formal s.9 repair notices." 49 SECTION E — INSPECTION AND SUPERVISION OF FOOD 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; (/) 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; (i) 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. 50 At the end of the year there were 129 persons registered for the distribution of milk from premises within the borough. There are no premises in the borough used as dairies. Milk (Special Designations) Licences Licences, which remain in operation from January 1 to December 31, were issued during the year as follows:— Table 34 Dealer's Supplementary Total Licences issued for:— sale of pasteurised milk 94 20 114 sale of tuberculin tested milk 86 20 106 sale of sterilised milk 109 23 132 TOTALS 289 63 352 Examination of heat-treated milk 130 samples of pasteurised milk and 1 sample 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, 82 samples of milk were submitted for examination to the public analyst by the Council's inspectors; all of which were found to be genuine. The average composition of the samples is set out in the following table:— Table 35 Period Samples Average composition of samples examined Percentage of Milk fat Solids not fat Water First quarter 24 3.42 8.66 87.92 Second quarter 20 3.34 8.66 88.00 Third quarter 13 3.37 8.65 87.98 Fourth quarter 25 3.40 8.81 87.78 TOTALS 82 3.39 8.70 87.91 The legal standard is 3.0 percent milk fat and 8.5 percent solids not fat. 51 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 7½ 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. (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. The 50 samples submitted to the public analyst were found to have the:omposition shown in the appended table:- 52 Table 36 Period Samples Average percentage composition Fat Milk solidsnot fat Sucrose Water First quarter 19 11. 7 11.6 15.7 61.0 Second quarter 17 11.0 11.1 15.9 62.0 Third quarter 4 11.8 10.8 14.7 62.7 Fourth quarter 10 11.3 11.7 15.9 61.1 TOTALS 50 11.4 11.4 15.5 61.7 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 189 samples of icecream were submitted for bacteriological examination with the following results;— Table 37 Grading Samples submitted % Grade 1 136 72.0 Grade II 35 18.5 Grade III 7 3.7 Grade IV 11 5.8 TOTAL 189 100.0 In general, grades I and II are satisfactory, while grades III and IV may indicate some defect in manufacture, handling or storage. Such cases are followed up and advice is given. Adulteration of food The number of samples taken during the year under the Food and Drugs Act was 845; of these, 87 were formal and 758 informal. After examination the public analyst reported that 11 of the formal samples and 18 of the informal samples were adulterated or below standard; the percentage of adulteration amounted to 12.6 in the formal samples, 2.4 in the informal samples, and to 3.4 of all the samples submitted, compared with 4.4 in the previous year. 53 Samples analysed Table 38 Articles Examined Adulterated Formal Informal Total Formal Informal Total Baking powder, cereals and flour 7 52 59 2 2 4 Biscuits - 1 1 - 1 1 Bread and butter 10 1 11 2 — 2 Butter — 13 13 — — — Cheese - 10 10 - 1 1 Coffee, cocoa, chocolate 1 18 19 - — - Confectionery, sugar 4 28 32 1 2 3 Cream 1 12 13 — — — Drinks, soft 5 25 30 1 1 2 Dripping, lard and suet 3 11 14 — 2 2 Drugs 2 102 104 1 1 2 Fish — 13 13 — 1 1 Fish cakes, etc. 2 1 3 - - - Flavourers and condiments 5 152 157 1 2 3 Fruit, dried and canned 4 11 15 - — - Icecream 1 49 50 - - - Jellies and custards 1 23 24 - — - Jams, marmalades and preserves 1 21 22 - - - Margarine 1 9 10 — — — Meat products 6 13 19 — — — Milk 15 67 82 — — — Milk, Channel Islands - 4 4 - - - Milk, condensed 2 10 12 - — — Milk, hot 7 — 7 3 — 3 Paste, fish and meat — 22 22 - 1 1 Pie filling, pudding mixtures etcs. - 8 8 - - - Pies, meat - 3 3 - — - Sausages 5 31 36 — 2 2 Soups 1 14 15 — 2 2 Vegetables — 10 10 — — — Spirits 1 19 20 — — — Sugar — 5 5 — — — Wine 2 - 2 - — — TOTALS 87 758 845 11 18 29 Non-genuine samples Table 39 Article Formal or informal Adulteration or Irregularity Action taken or result of proceedings Sild Informal Contained only salted fish with no edible oil Remaining stock weighed. Weight of each tin corresponded to stated weight. 54 Table 39— continued Article Formal or informal Adulteration or irregularity Action taken or result of proceedings Sild Informal Contained only salted fish with no edible oil. Remaining stock weighed. Weight of each tin corresponded to stated weight. Oil of Wintergreen Informal Diluted with arachis oil. Formal sample taken. Shredded beef suet Informal Deficient in beef fat Formal sample to be taken Oil of Wintergreen Formal Diluted with arachis oil Warning letter sent. Pork chipolatas Informal Deficient in meat content. Warning letter sent Pork sausages Informal Deficient in meat content. Warning letter sent Flaked rice Informal Sample contained maggots. Formal sample genuine Processed gorgonzola cheese Informal Deficient in butterfat Manufacturer withdrew stocks from sale. Hot milk Formal Deficient in milk fats and MSNF. Referred for consideration of legal ings. Cream doughnuts Formal Contained imitation cream Referred for consideration of legal ings. Pearl barley Informal Contained 130 ppm sulphur dioxide and an excess amount of talc Formal sample taken. Pickling spice Informal Contained a whole date stone and several coarse particles of grit and dried earth. Formal sample to be taken Pearl barley Formal Contained 212 ppm sulphur dioxide and an excess amount of talc. Imported from West Germany — Ministry informed. Preserved banana flavouring Informal Contained 280 ppm benzoic acid and was devoid of banana flavour. Stock withdrawn from sale and returned to manufacturer. Soup powder Informal Contained a non-permitted red dye. Appeared to be old stock. Any other such stock to be withdrawn Fish paste Informal Contained a non-permitted red dye. from sale Warning letter sent. Cream of champignon soup Informal Insufficient fat to warrant the description of cream soup. Imported from West Germany. Ministry informed. Vinegar Formal A non-brewed product containing only 3.8% acetic acid. Manufacturer's comments invited. Marzipan Informal Mouldy Formal sample taken and found to be uine. Shredded beef suet Informal Slightly deficient in beef fat. Warning letter sent to manufacturers. Instant icing Informal Contained a non-permitted coal-tar dye. Remaining stock destroyed by manufacturer and production has ceased. 55 Table 39— continued Article Formal or informal Adulteration or irregularity Action taken or result of proceedings Iced Gem biscuits Informal Contained a non-permitted coal-tar dye. Manufacturers (a Belgian firm) stated they are now using a permitted vegetable dye. Formal sample to be taken. Grapefruit juice Informal Contained 25% added water. Formal sample taken. Hot milk Formal Deficient in milk fat. Legal proceedings to be instituted. Hot milk Formal Deficient in milk fat and MSNF. Legal proceedings to be instituted. Buttered rolls Formal Contained margarine in addition to butter. Legal proceedings to be instituted. Buttered rolls Formal Contained only margarine. Legal proceedings to be instituted. Grapefruit juice Formal Contained 23% added water. Legal proceedings to be instituted. Marzipan Formal Slightly deficient in ground almonds. Manufacturer's comments invited. 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:— Iced fancy cakes Strained egg custard with rice Iced sponge cake Milk Bottle (4) Loaf (3) Bread rolls (2) Toffee apples Shredded suet Bun Tinned mandarin oranges Bottle of lemonade Pork sausages (3) Water from cistern (2) Steamed prawns Mussels Cream buns (3) Dinner-meal Tap water Registration of food premises During the year the following were registered, the total (including previous registrations) being shown in the last column. Type 1959 Total Sale and storage of icecream 34 312 Manufacture of icecream 3 5 Fish frying 8 29 Fish curing 4 17 Preparation or manufacture of sausages 11 71 Preparation or manufacture of potted, pressed, pickled or preserved food 27 128 56 Unsound food Approximately 54 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 3 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. (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 deal 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). No further certificates were issued during the year. Food Hygiene Regulations, 1955 Regulations 15 and 16 require the provision of a water supply and wash hand basin on all food premises. No certificates of exemption were issued during the year. Pharmacy and Poisons The names of 18 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 185 persons previously registered were retained on the register. 145 visits were paid by the food inspectors in connection with the granting and renewal of these licences. 57 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. 145 pigs were slaughtered and the carcases inspected during the year. 1 of these carcases with a total weight of 164 lbs. was condemned as tuberculous, and 80½ lbs. of heads and offals from 10 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, states: "During the year we had, as in previous years, a number of complaints of foreign bodies in articles of food and although these are sometimes of a trivial nature they represent a lack of care on the part of someone employed in the food industry and may indicate a generally unsatisfactory state of affairs. It is pleasing to note a sharp decline in the number of complaints in connection with school milk. "There appeared to be a decline in the attention paid to food hygiene on the part of the Press and there was a welcome cessation of the popular comparison between the standards of food hygiene in Britain and those of other countries. The conditions under which food is prepared and marketed in this country are, generally speaking, as good or better than those of any other. This is reflected by the very small number of complaints received from the public and the fallingoff since the war years of the amount of food condemned by the inspectors. In all matters relating to food handling and food hygiene the personal factor is of major importance. Facilities provided will be used infrequently by the unsatisfactory type of person whereas the person of clean habits will maintain a good standard without the necessity of constant supervision. "It will be seen from the report that the standard of the icecream samples taken for analysis was well above the legal minimum and, of the general samples, there was a fall in the number found to be adulterated. It may be said that throughout the year the. food work of the department was maintained and the results were satisfactory." 58 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 1959 with comparative figures for the previous six years. Table 40 Diseases Cases notified 1959 1958 1957 1956 1955 1954 1953 Diphtheria - - - - 1 - 1 Dysentery 233 214 129 579 92 394 84 Encephalitis (acute) — 1 2 2 — — 3 Enteric or typhoid fever 6 4 2 3 1 1 2 Erysipelas 16 13 15 20 26 24 18 Food poisoning 49 27 42 46 48 110 32 Malaria — — — — 1 3 2 Measles 2613 835 2728 206 3905 521 2082 Meningococcal infection 3 3 4 9 4 6 10 Ophthalmia neonatorum 1 1 2 2 4 2 3 Pneumonia 108 61 96 89 121 77 189 Poliomyelitis (acute) 6 2 15 26 63 16 52 Puerperal pyrexia 48 59 93 57 92 59 57 Scabies 9 9 18 29 18 14 5 Scarlet fever 303 210 143 188 158 331 283 Tuberculosis 143 236 247 212 271 256 341 Whooping cough 229 154 225 241 412 449 574 TOTALS 3767 1829 3761 1709 5217 2263 3738 59 Notifications of infectious diseases in 1959 showing sex and age groups Table 41 Diseases Under 1 1- 3- 5- 10- 15- 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 3 3 27 10 10 15 41 30 9 18 4 3 16 23 8 12 - 1 118 115 Enteric or typhoid fever - - - - 1 - - - 1 - - 1 - - 1 2 - - 3 3 Erysipelas — - - — — — — — 1 — — 2 2 - 6 5 — — 9 7 Food poisoning 1 2 1 6 2 1 4 2 1 3 2 4 5 / 3 3 — 2 19 30 Measles 4/ 49 318 285 334 328 610 595 13 15 4 6 6 2 — - — 1 1332 1281 Meningococcal infection - - 1 - 1 — - - - 1 - - - - - - - - 2 1 Ophthalmia neonatorum - 1 — - - - - - - - - - - - - - - - - 1 Pneumonia — 1 — 1 - 1 2 1 1 3 7 4 15 6 18 13 20 15 63 45 Poliomyelitis (paralytic) - 1 - 1 - - 1 - - - - - 1 - - - - - 2 2 Poliomyelitis (nonparalytic) - - - - - - 1 1 - - - - - - - - - - 1 1 Puerperal pyrexia — — — — - — — — — - - 24 - 24 — — — — — 48 Scabies 1 — 1 — - — — — 2 1 1 1 2 - - - - - 7 2 Scarlet fever — — 8 9 25 39 69 101 19 23 3 4 1 2 — — — — 125 178 Tuberculosis (respiratory) - - - - 1 - - - - - 8 14 17 25 29 11 18 1 73 51 Tuberculosis (non-respiratory) - - - - - - 1 - - - 2 2 1 5 3 2 - 3 7 12 Whooping cough 14 16 26 30 26 22 41 42 2 5 1 2 1 1 - - - - 111 118 Totals 66 73 382 342 400 406 770 772 49 69 32 67 67 95 68 48 38 23 1872 1895 60 Analysis of certain diseases in table 41 into divisional areas— Table 42 Disease Div. areas Under 1 1- 3- 5- 10- 15- 25- 45- 65+ Total Dysentery W 2 19 13 23 11 1 14 4 1 88 N 3 11 8 29 7 4 11 5 - 78 S 1 7 4 19 9 2 14 11 - 67 Total 6 37 25 71 27 7 39 20 1 233 Measles W 37 238 250 388 7 5 4 - - 929 N 30 185 188 338 9 3 3 - 1 757 S 29 180 224 479 12 2 1 - - 927 Total 96 603 662 1205 28 10 8 - 1 2613 Pneumonia W - - 1 1 - 1 5 4 10 22 N 1 1 - 1 2 4 7 4 9 29 S - - - 1 2 6 9 23 16 57 Total 1 1 1 3 4 11 21 31 35 108 Poliomyelitis W - - - - - - - - - - N - - - 1 - - 1 - - 2 S 1 1 - 2 - - - - - 4 Total 1 1 - 3 - - 1 - - 6 Scarlet fever W - 8 23 54 13 2 1 - - 101 N - 1 13 47 15 1 1 - - 78 S - 8 28 69 14 4 1 - - 124 Total - 17 64 170 42 7 3 - - 303 Tuberculosis (respiratory) W - - 1 - - 8 15 15 8 47 N - - - - _ 11 15 14 6 46 S - - - - - 3 12 11 5 31 Total - - 1 - - 22 42 40 19 124 Whooping cough W 9 24 26 32 1 3 1 - - 96 N 12 10 8 14 2 - - - - 46 S 9 22 14 37 4 - 1 - - 87 Total 30 56 48 83 7 3 2 - - 229 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. 61 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 25— Table 43 W N S Total Visits 380 338 535 1253 Futile visits 505 343 320 1168 Revisits 196 245 170 611 Total 1081 926 1025 3032 Poliomyelitis In 1959 6 cases of poliomyelitis were confirmed, 2 of them in the North and 4 in the South divisions. 1 was aged under one year, another between one and three years of age and two between five and ten. 4 were paralytic and 2 non-paralytic. In order to keep the incidence of poliomyelitis at a low figure vaccination by injection is essential, though work is now being carried out on the possibility of using a vaccine by mouth, which of course would save a great deal of administrative difficulty. Recent work tends to indicate that in many children the duration of a satisfactory resistance to the infection after vaccination by three injections lasts only about two years, and if this is confirmed it indicates that a fourth injection (which has been advocated for some time in the United States) should be the rule here. Nevertheless even with three injections a modified resistance continues for probably a much longer period. Dysentery The total number of cases remained very much the same. The focus for local outbreaks is often the schools and the mildness of the type of dysentery conduces to this spread as the child may go on attending school for the first day or two when likely to be most infective. The only real bar to the quick spread of the disease appears to be an extremely high hygienic standard from the very start in connection with all the apparatus of the water closet and with hand washing; and with immediate exclusion from school. Measles 1959 was the epidemic half of the usual two-year cycle, but in spite of the 2613 cases there were no deaths. 62 Pneumonia The number of cases increased considerably, from 61 to 108, and this was associated with the influenzal wave of moderate intensity at the beginning of the year. Over half the notifications occurred in the South division, but with this disease again it is probable that notifications are incomplete. Scarlet fever The cases again increased, this time from 210 to 303. They were scattered throughout the borough and apart from one school in which some 36 cases were associated either in the schoolchildren or their home contacts, no special cause of spread came to light. Whooping cough The cases increased a little from the very low figure of the previous year but were still much below the figures for the earlier post-war years —reflecting probably the higher number of children being inoculated against the disease. Tuberculosis After the rather disappointing plateau of notifications of the past years the figure for 1959 came down quite dramatically. In the case of males it was reduced from 137 to 73—almost half, and in the case of females from 79 to 51. The number of deaths again showed a considerable drop*— from 13 to 11 for males and from 6 to 1 for females. These were both the lowest figures on record, and perhaps it is right to pause for a moment at the figure of one death for females in a year from pulmonary tuberculosis in a population of 220,000 and compare it with a mere ten years ago when in an almost similar population there were 42 deaths in females, and with 30 years ago when, although the population was a little smaller, there were 82 such deaths. Table 44 Age periods New cases notified Deaths Respiratory NonRespiratory Totals Respiratory NonRespiratory Totals M F M F M F M F M F M F 0- - - - - - - - - - - - - 1- - - - - - - - - - - - - 2- 1 - - - 1 - - - - - - - 5- - - 1 - 1 - - - - - - - 10- - - - - - - - - - - - - 15- 1 7 1 1 2 8 - - - - - - 20- 7 7 1 1 8 8 - - - - - - 25- 9 19 1 2 10 21 - - 1 - 1 - 35- 8 6 - 3 8 9 - - 45- 9 3 3 1 12 4 3 - - - 3 - 55- 20 8 - 1 20 9 65- 10 - - 2 10 2 5 - - - 1 - 75+ 8 1 - 1 8 2 2 1 - - 2 1 73 51 7 12 80 63 10 1 1 - 11 1 63 Analysis of new cases of tuberculosis into divisional areas:— Table 45 Division Sex 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total West Respiratory M - - 1 - - - 4 4 4 3 8 4 4 32 F - - - - - 2 2 6 1 2 2 - - 15 Non-respiratory M - - - - - 1 - - - - - - - 1 F - - - - - 1 1 - 1 1 - 1 1 6 North Respiratory M - - - - - 1 3 - 3 2 6 3 2 20 F - - - - - 3 4 9 3 1 5 - 1 26 Non-respiratory M - - - - - - 1 1 - 1 - - - 3 F - - - - - - - - 1 - - 1 - 2 South Respiratory M - - - - - - - 5 1 4 6 3 2 21 F - - - - - 2 1 4 2 - 1 - - 10 Non-respiratory M - - - 1 - - - - - 2 - - - 3 F - - - - - - - 2 1 - 1 - - 4 Summary of statistics as to tuberculosis for the last ten years Table 46 Year Population New cases notified (all forms) (excluding inward transfers) Notif. rate per 100,000 pop. Deaths Death rate from resp. tuberculosis per 100,000 pop. All forms Respiratory Lewisham County of London 1949 227,700 371 163 107 92 40 47 1950 228,300 406 178 72 66 29 36 1951 227,200 299 132 68 60 26 34 1952 227,100 307 135 42 35 15 28 1953 225,800 341 151 48 44 19 21 1954 224,200 256 114 38 36 16 18 1955 223,400 271 121 26 22 10 16 1956 222,100 212 95 29 29 13 13 1957 220,900 247 112 33 31 14 12 1958 221,000 236 107 19 18 8 12 1959 221,000 143 65 12 11 5 10 64 TUBERCULOSIS NOTIFICATIONS Rates per 100,000 M •-• F o-------o Inter-censal Popula- Ordinary Scale tions Estimated 65 Tuberculosis — environmental conditions Case papers showing the environmental condition of patients attending the Lewisham Chest Clinic in 1959 have been analysed in 195 cases with the following results:— Table 47 Cases %* Males 107 55 Females 88 45 Social classification:— Class I 3 2 Class II 21 13 Class III 113 68 Class IV 18 11 Class V 11 6 Not classifiable 31 — Rooms occupied:— 2 or more rooms per person 28 15 1— 2 rooms per person 118 62 Less than 1 room per person 43 23 No information 6 — Accommodation:— Separate bed 68 35 Separate bedroom 52 27 Condition of premises occupied:— Good 161 85 Fair 24 12 Poor 5 3 No information 5 — *Excluding cases not classified Food poisoning The cases last year formally notified increased to 49, which was the highest figure (by 1) since 1954. Again I must point out that the number notified is probably incomplete as many cases are sufficiently mild as not to require the attendance of a doctor. 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 Symptomless excreters Fatal cases 1st quarter 3 - - - 2nd quarter 7 6 — 1 3rd quarter 36 — 3 — 4th quarter 21 1 - - Year 67 7 3 1 66 (2) Particulars of outbreaks Table 49 Outbreaks Cases Total cases Family outbreaks Other outbreaks Notified Otherwise ascertained Agent identified :— Salmonella St. Paul 1 - 4 - 4 Salmonella typhimurium 2 1 4 3 7 Agent not identified 4 — 10 — 10 (3) Single cases Table 50 Notified Otherwise ascertained Total cases Agent identified:— Salmonella typhimurium 14 - 14 „ Bredeney 1 — 1 „ Kiambur 1 — 1 „ Newport 1 — 1 „ group D 1 — 1 Agent not identified 13 4 17 (4) Salmonella infections, not food-borne Nil NOTE: 18 cases notified by Hither Green Hospital which were returned to the Registrar General have their home addresses in the following authorities' areas: Deptford 6, Lambeth 4, Camberwell 2, Southwark 2, Beckenham 1, Wandsworth 1, Bermondsey 1, and Greenwich 1. The cases were referred to the authorities 'concerned for investigation. 1 "other outbreak" with 3 cases, including the fatal case was investigated by Woolwich as part of the outbreak at the British Hospital for Mothers and Babies, Woolwich. Mass radiography unit I am indebted to the Director of the Unit for information of work done in the borough during 1959 on which the following table is based. The Unit during the course of the year was stationed at 9 different locations in the borough, the time spent at each varying from 1 day to 2 weeks. 67 Table 51 Patients Men Women Total General analysis X-rayed 2,025 130 2,155 Previously x-rayed 1,833 64 1,897 Recalled for large film 81 3 84 Normal on large film 33 - 33 Abnormal on large film 48 3 51 Not yet re-attended 3 — 3 Analysis of abnormal large films:— Cases considered tuberculous:— (a) no further action required 1 — 1 (b) occasional supervision only 4 — 4 (c) requiring treatment 4 — 4 (d) still under investigation — — — (e) refused further investigation — — — Previously known tuberculous cases 3 — 3 Non-tuberculous cases:— (a) investigated 9 - 9 (b) still under investigation — — — Cardio-vascular lesions 2 1 3 No action required 25 2 27 68 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 52 Age at December 31, 1959 Under 1 1 2 3 4 5-9 10-14 Total under 15 Born in year 1959 1958 1957 1956 1955 1950-54 1945-49 (1) Diphtheria (including combined and triple):— Immunised during year Immunised at end of year 2,069 439 102 59 48 99 10 2,826 2,069 2,305 2,357 2,440 2,422 13,786 13,718 39,097 Estimated mid-year population 12,590 32,400 48,300 (ii) Whooping cough (including combined and triple):— Immunised during year 2,116 397 103 58 38 29 5 2,746 (iii) Vaccination. Vaccinated during the year (age at date of vaccination) Under 1 1-4 5-14 15 and over Total Primary 2,115 166 62 88 2,431 Revaccination - 18 33 179 230 (iv) Poliomyelitis Inoculated against poliomyelitis (at clinics and schools in Lewisham) 1st injection 2nd Injection 3rd Injection 12,233 12,113 16,671 Council Offices, E. H. R. SMITHARD Canadian Avenue, Medical Officer of Health S.E.6. August, 1959 69 APPENDIX A Acts of Parliament, Statutory Instruments and Circulars issued by Government Departments with regard to the public health services, during the year 1959: — Statutes Housing (Underground Rooms) Act House Purchase and Housing Act Factories Act London County Council (General Powers) Act Statutory Instruments The Poisons (No. 2 ) Rules 1958 The Poisons List (No. 2) Order, 1958 The Meat (Staining and Sterilisation) Regulations 1959 The Slaughterhouse Reports (Appointed Day) Order 1959 Milk and Dairies (General) Regulations 1959 The Meat (Staining and Sterilisation) (Revocation) Regulations 1959 The Labelling of Food (Amendment) Regulations 1959 The Food Standards (Icecream) Regulations 1959 The Icecream (Heat Treatment, etc.) Regulations 1959 Arsenic in Food Regulations, 1959 Condensed Milk Regulations 1959 The Smoke Control Areas (Exempted Fireplaces) Order 1959 The Slaughterhouses (Hygiene) (Amendment) Regulations 1959 The Slaughter of Animals (Prevention of Cruelty) (Amendment) Regulations 1959 The Slaughterhouse Licences (Forms and Records) Regulations 1959 The First-aid Boxes in Factories Order 1959 The Factories, 1959 (Commencement No. 1) Order 1959 Fluorine in Food Regulations 1959 The Public Health Officers Regulations 1959 Ministry of Health Circulars No. 4 Homeless families 7 Prevention of tuberculosis—(1) BCG Vaccination; (2) Expiry date of BCG Vaccine; (3) Tuberculosis registers 8 The Icecream (Heat Treatment, etc.) Regulations 1959 17 Revision and consolidation of present statutory regulations relating to appointment, qualifications and duties of Medical Officers of Health and Public Health Inspectors 70 Ministry of Health (continued) Circulars No. 29 Food Hygiene Codes of Practise. The Hygienic Transport and Handling of Meat. Hygiene in the Retail Meat Trade Ministry of Housing and Local Government Circulars No. 5 Clean Air Act 1956—Smoke Control Areas 13 Clean Air Act 1956—(i) leaflets for householders in proposed smoke control areas; (ii) Smoke Control Areas and British Railways; (iii) Model notice about making of Smoke Control Orders 16 Consultations with Executive Councils 17 Homeless families 29 Safety in the home 31 Litter 33 Contributions to Voluntary Bodies 37 House Purchase and Housing Act 1959 38 Housing (Underground Rooms) Act 1959 41 Slum clearance 44 (i) Smoke Control Areas (Exempted Fireplaces) Order, 1959 (ii) Mechanically fired furnaces installed before 31 December, 1956 (iii) Furnaces fired by pulverised fuel, wood waste, and large hand fired furnaces 48 Town and Country Planning Act 1959 53 Landlord and Tenant (Furniture and Fittings) Act, 1959 57 Radioactivity 65 Drought 1959—Short term measures Ministry of Agriculture, Fisheries and Food Circulars No. FSH 1 The Meat (Staining and Sterilisation) Regulations 1959 2 The Slaughter of Animals Act 1958 3 Milk and Dairies (General) Regulations 1959 4 The Slaughterhouse Reports (Appointed Day) Order 1959 The Slaughterhouse (Reports) Direction 1959 5 The Food Standards (Icecream) Regulations 1959 The Labelling of Food (Amendment) Regulations 1959 6 The Meat (Staining and Sterilisation) (Revocation) Regulations 1959 7 Arsenic in Food Regulations, 1959 8 Milk and Dairies (General) Regulations 1959 Approved chemical agents 9 The Slaughterhouses (Meat Inspection Grant) Regulations 1958 10 Milk and Dairies (General) Regulations 1959 Approved chemical agents 11 Condensed Milk Regulations 1959 12 Milk and Dairies (General) Regulations 1959 Approved chemical agents 71 Ministry of Agriculture, Fisheries and Food (continued) No. FSH 14 (1) The Slaughterhouse Licences (Forms and Records) Regulations 1959 (2) Slaughterhouse Reports 15 Fluorine in Food Regulations 1959 16 Milk and Dairies (General) Regulations 1959 Approved chemical agents PDP 1 Prevention of Damage by Pests Act 1949 Reports by Local Authorities 12 months ended 31.3.59 andWithdrawal of grants 4 Prevention of Damage by Pests Act 1949—Distribution of ship rat in United Kingdom General Register Office Circulars No. No. 1 Infections and other notifiable diseases—weekly return 2 Annual Reports of Medical Officers of Health 1958 Vital Statistics 3 Infections and other notifiable diseases—Quarterly Return APPENDIX B Legal Proceedings, 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 4 — 1 1 0 In one case an abatement order was made: in one case the summons was not proceeded with, and in two cases the summonses were withdrawn. London County Council drainage byelaws 1 - - Withdrawn Food and Drugs Act, 1955 Section 2 3 15 0 0 3 3 0 Food Hygiene Regulations, 1955 Regulation 23 3 20 0 0 5 5 0 Not guilty Regulation 24 1 Regulation 14 1 3 0 0 Regulation 17 1 2 0 0 72 APPENDIX C List of special reports submitted to the Health Committee by the medical officer of health during 1959:— January 6 Old People — Club recruiting February 3 Conference on "The Elderly in the Community." March 3 Comprehensive centre for old people 3 Home safety April 7 Comprehensive centre for old people 7 Lewisham Old People's Welfare Association— Constitution 7 Smoke control areas June 2 Conference on the welfare of old people's clubs 2 Royal Society of Health Congress 2 Competition for publicising old people 30 Geriatric unit 30 Clean Air Act — applications for additional grant September 8 Questionnaire on home safety 8 Clean Air Act No.3 (Brookdale) Smoke Control Area No.5 (Glenbow) Smoke Control Area 8 Fluoridation of public water supplies October 6 Clean Air Act No.4 (Penerley) Smoke Control Area November 3 Clean Air Conference 73 TABLES table SUBJECT page table SUBJECT page no. Section A no. Section D 1 Comparative statistics 7 30 Demolition orders 45 2 Causes of death by age 31 Closing orders 45 groups 8 32 Clearance areas 46 3 Deaths under one year 10 33 Rem Act 1957 47 4 Local sickness 11 5 Deaths by social class 11 6 Causes of death by social class 12 7 Grouped causes of death Section E by social class 13 34 Milk licenses 50 8 Births, infant deaths, etc., 35 Analysis of milk 50 by social, clan 13 36 Icecream composition 52 9 Heart and circulation 14 37 Icecream grading 52 ,.. T .,.38 Samples analysed 53 10 Lung cancer 15, ,r 39 Adulterated samples 53 11 Cigarette consumption ... 15 12 General Statistics from 1901 16 Section B 13 Disinfecting station 18 14 Verminous conditions, etc. 18 Section F 15 Public mortuary 21 40 Notified cases of infectious 16 Rodent control—treatment diseases 58 of rivers 21 41 Notifications of infectious diseases by age and sex 59 17 Prevention of Damage by Pests Act 23 42 Analysis of certain diseases , into divisional areas ... 60 18 Laboratory facilities 23 19 Swimming Baths 24 43 Infectious disease visiting 61 44 Tuberculosis notifications 20 Water, chemical samples 24 and deaths 62 21 Water, Bacteriological 45 Analsis, of new cases of samples 26 tuberculosis into divi- 22 Atmospheric conditions 28 sional areas 63 23 Accidents to children 32 46 Tuberculosis statistics 63 24 Old People's visits 34 47 Tuberculosis — mental conditions 65 Section C 48 Food poisoning cases 65 25 Sanitary inspection 36 49 Food poisoning outbreaks 66 26 Summary of notices 37 50 Food poisoning agents 66 27 Nuisances remedied 37 S1 Mass Radiography ... 67 28 Factory inspections 39 52 Immunisation against 29 Factory defects 40 infectious disease 68 CHARTS Atmospheric pollution 30 Tuberculosis notifications 64 74 INDEX SUBJECT PAGE SUBJECT PAGE Acts, regulations and orders 69 LCC (General Powers) Act, Area of borough 6 1953, section 43 19 Atmospheric conditions 27 Mass miniature radiography 66 Births and birth rate 6 Maternal deaths 7 Cancer 15 Measles 61 Clean Air Act 27 Milk, analysis of 50 Clearance areas 46 Milk and Dairies Regulations 49 Coronary disease 14 Mortuary and Coroner's Court 20 Deaths and death rate 6 National Assistance Act, 1948 Deaths, cause of 8 s. 50 24 s 47 24 Discretionary grants and standard grants 47 Nuisances remedied 37 Disinfection and personal Offensive trades 57 cleansing 18 Old people 32 Dog nuisances 24 Outworkers 40 Drainage work 24 Pet Animals Act, 1951 38 Dysentery 61 Pharmacy and Poisons Act, 1953 56 Exhumations 42 Pigeons 42 Factories 38 Pneumonia 62 Flies and mosquitos 19 Poliomyelitis 61 Food, adulteration of 52 Population 6 Food inspection and supervision 49 Prevention of Damage by Pests Food poisoning 65 Act, 1949 22 Food Hygiene Regulations, 1955 56 Rag Flock and Other Filling Materials Act, 1951 41 Food Standards Regulations 51 Rateable value 6 General statistics from 1901 16 Rent Act, 1957 47 Hairdressers 38 Health education 20 Rodent control 21 Health Services, general Sampling 53 provision of 18 Sanitary circumstances of the Heating appliances 38 area 36 Heattreated milk 50 Scarlet fever 62 Home Safety 31 Shops Act, 1950 56 House purchase loans 47 Sickness, local 11 Housing:— Slaughterhouses 57 Building 44 Smoke nuisances 36 Families rehoused 44 Social medicine statistics 11 Housing Act, 1957 44 Staff 2 Icecream composition 52 Stillbirths 6 Icecream grading 52 Swimming baths 24 Immunisation 68 Tuberculosis 62 Infant mortality 6 Unsound food 56 Infant mortality statistics 10 Vaccination 68 Infectious diseases 58 Vital statistics 6 Infectious disease visiting 61 Winter certificates 38 Laboratory facilities 23 Water supply 25 Legal proceedings 71 Whooping cough 62